Miss. Admin. Code Title 15 — Health

# Miss. Admin. Code Title 15 — Health

## **MISSISSIPPI DEPARTMENT OF HEALTH** MISSISSIPPI DEPARTMENT OF HEALTH

### **Part 2** Epidemiology

##### **15 Miss. Admin. Code Pt. 2, R. 1.1.2** Definitions {#sec-2-1.1.2 omnilex-key=us-ms-regs-official--title-15--2#1.1.2}

1. Class 1A: Diseases of major public health importance which shall be reported directly to the Department of Health by telephone within 24 hours of first knowledge or suspicion. Class 1A diseases and conditions are dictated by requiring an immediate public health response. Laboratory

directors have an obligation to report laboratory findings for selected diseases (Refer to Appendix B in the Rules and Regulations Governing Reportable Diseases and Conditions). 2. Class 1B: Diseases of major public health importance which shall be reported directly to the Department of Health by telephone on the next business day after first knowledge or suspicion. Class 1B diseases and conditions require individual case investigation, but not an immediate public health response. Laboratory directors have an obligation to report laboratory findings for selected diseases (Refer to Appendix B in the Rules and Regulations Governing Reportable Diseases and Conditions). 3. Class 2: Diseases or conditions of public health importance of which individual cases shall be reported by mail, telephone or electronically, within 1 week of diagnosis. In outbreaks or other unusual circumstances they shall be reported the same as Class 1. Class 2 diseases and conditions are those for which an immediate public health response is not needed for individual cases. Laboratory directors have an obligation to report laboratory findings for selected diseases (Refer to Appendix B to the Rules and Regulations Governing Reportable Diseases and Conditions). 4. Class 3: Laboratory based surveillance. Reported by laboratory only. Diseases or conditions of public health importance of which individual laboratory findings shall be reported by mail, telephone, or electronically within one week of completion of laboratory test (refer to Appendix B of the Rules and Regulations Governing Reportable Diseases and Conditions.). Types of results deemed reportable may be updated due to changes in technology by the State Epidemiologist upon advice of the Director of the Public Health Laboratory. 5. Class 4: Diseases of public health importance for which immediate reporting is not necessary for surveillance or control efforts. Diseases and conditions in this category shall be reported to the Mississippi Cancer Registry within 6 months of the date of first contact for the reportable condition. i. All Class 4 reports should be submitted to: Mississippi Cancer Registry Cancer Research and Registries University of Mississippi Medical Center 2500 North State Street Jackson, MS39216

**History**
- *Source: Miss.Code Ann. §41-91-7*

##### **15 Miss. Admin. Code Pt. 2, R. 1.1.3** Phone: 601-815-5482 Fax: 601-815-5483 {#sec-2-1.1.3 omnilex-key=us-ms-regs-official--title-15--2#1.1.3}

State Epidemiologist; with the concurrence of the State Health Officer, when the Board is not in session, may declare a disease or condition reportable for a specific length of time, not to exceed 12 months. The Board shall be informed of any action taken under this provision at its next regular meeting. The intent and purpose of this authority is to allow rapid investigation of and response to new or emerging threats to the health of the public.

Subchapter 2 CASE DEFINITIONS Rule 1.2.1 For surveillance and reporting purposes, the criteria for diagnosis of reportable conditions shall be those specified by the Council of State and Territorial Epidemiologists and the Centers for Disease Control and Prevention. Current criteria can be found at http://wwwn.cdc.gov/nndss/case-definitions.html for infectious diseases.

Subchapter 3 DUTY OF LABORATORY DIRECTORS TO REPORT Rule 1.3.1 It shall be the duty of the director or other person in charge of any clinical laboratory in the State of Mississippi or serving Mississippi clinicians or institutions to notify the Mississippi State Department of Health of any laboratory finding as provided for in Appendix A of the Rules and Regulations Governing Reportable Diseases and Conditions for all classes of diseases or conditions. The report shall in all cases include the name and location of the physician or other health care provider ordering the test in addition to the patient identifying information specified in Subchapter 1. Tests considered reportable shall be those listed in Appendix B to the Rules and Regulations Governing Reportable Diseases and Conditions.

Subchapter 4 DUTIES OF LOCAL HEALTH OFFICER Rule 1.4.1 The director of the local health department, as the local health officer, shall be responsible for the control of communicable diseases and other conditions within his or her jurisdiction considered prejudicial to the public health. It shall be his or her duty to collect and make reports as required to the Mississippi State Department of Health, to provide consultation services to physicians regarding

communicable diseases, to advise and consult with all others in matters relating to public health, and to investigate reports of known or suspected communicable diseases or of conditions which might be prejudicial to the public health. It shall be his or her duty to determine in individual cases or groups of cases whether to impose restrictions on the activities of patients or contacts of persons with a communicable disease and to fix the period of isolation for such diseases. For all the diseases listed in Appendix A, Class 1A and Class 1B, the local health officer shall, on first knowledge or suspicion, conduct an investigation into all the circumstances and prescribe such reasonable methods of control as may be calculated to minimize the danger of further dissemination of the disease process. The measures proposed in the most current edition of the Control of Communicable Diseases Manual, published by the American Public Health Association shall be considered as supplementary. In all matters where there is disagreement as to diagnosis, isolation or in any other situation where the responsibility rests with the health officer, the opinion of the health officer shall prevail. In the discharge of his or her duties, the health officer or designee shall not be denied the right of entry to any premises nor shall he or she be denied pertinent patient health information and patient identifiers.

Subchapter 5 REPORTING OF PATIENTS WHO ABANDON TREATMENT Rule 1.5.1 If any patient suffering from any of the diseases or conditions listed in Appendix A to the Rules and Regulations Governing Reportable Diseases and Conditions leaves the care of his/her physician or leaves any hospital, and the condition of the patient is considered harmful to the public health, it shall be the duty of the attending physician or superintendent or other person in charge of the hospital to report the circumstances to the Department of Health, whether the case has been previously reported or not.

Subchapter 6 SUSPECTS OR CONTACTS OF COMMUNICABLE DISEASES REQUIRED TO SUBMIT TO EXAMINATION Rule 1.6.1 The local health officer is authorized to examine, treat, and/or isolate at his or her discretion or under the direction of the State Health Officer any person who, on credible information, is suspected of suffering from any communicable disease, or who is a contact with a known case of such disease or may be a carrier or have the disease in the incubation or prodromal phase. Said suspect or contact shall be notified in writing to report to a reasonable place at a reasonable time for such examination. Should the suspect or contact refuse to submit to examination satisfactory to the health officer, said suspect or contact shall be prosecuted at law to compel compliance and/or be isolated in a manner prescribed by the health officer until the danger of transmitting the disease in question has passed. In the

event that the aforementioned suspect or contact is a minor, the parent or guardian shall be apprised of the facts and requested to deliver said minor for examination. In the event of refusal, the health officer shall maintain action at law to compel compliance of the parent or guardian and/or impose isolation as necessary.

Subchapter 8 FOOD HANDLING ESTABLISHMENTS Rule 1.8.1 The production, processing, storage, handling, distribution and sale of food for human consumption shall conform to the specifications of the current Mississippi Food Code. Local authorities may impose additional, specific requirements. It shall be the duty of the local health officer to investigate any potential or actual disease occurrence in connection with food handling and to impose any measures he/she deems necessary for its control.

Subchapter 9 NOTIFICATION OF OTHER HEALTH CARE PROVIDERS Rule 1.9.1 Any provider of health care services, including but not limited to physician, hospital, and emergency clinic who refers or transfers a patient to another provider of health care services and who has knowledge that the patient has one of the conditions listed in Subchapter 13 or carries the infectious agent thereof or any other disease or agent transmissible under the circumstances of the care to be provided, shall advise the health care service provider to whom the patient is referred or transferred of the presence of the condition together with pertinent details as indicated by accepted standards of medical practice.

Subchapter 10 NOTIFICATION OF THIRD PARTY INDIVIDUALS Rule 1.10.1 In certain circumstances where such notification has significant potential for interrupting the transmission of disease, the Department of Health, through its official representatives, may notify a third party of the presence of a reportable disease in another person. Such notification shall be subject to the prior approval of the State Health Officer or of the State Epidemiologist, and shall take place only under the following conditions: 1. Significant, medically recognized, and biologically plausible potential for the transmission of the disease involved must exist under the circumstances; 2. The party to be notified:

a. Must be at significant risk of acquiring the disease in question or of aggravation of the disease by additional exposure if such notification does not occur, and be potentially able to avoid such transmission by realistic means as a result of the notification; or, b. Must stand in loco parentis or otherwise be responsible for the activities of other persons whose activities could realistically be expected to produce the potential for transmission of the disease to other individuals, and such notification would enable that person to take action which could realistically result in prevention of transmission; or, c. Could, with such notification, aid in preventing further transmission of the disease by offering testimony in a judicial proceeding concerning the infected individual’s violation of an order of the Mississippi State Department of Health.

**History**
- *Source: Miss. Code Ann. §41-3-17*
- *Source: Miss.Code Ann. §41-3-17*
- *Source: Miss.Code Ann. §41-3-17*
- *Source: Miss.Code Ann. §41-3-17*
- *Source: Miss.Code Ann. §41-3-17*
- *Source: Miss.Code Ann. §41-3-17 Subchapter 7 PERSONS IN CHARGE OF CERTAIN BUSINESSES AND INSTITUTIONS REQUIRED TO EXCLUDE CERTAIN PERSONS Rule 1.7.1 When any superintendent or other person in charge of any school or other institution, whether public or private, or the person in charge of any establishment or business dealing with perishable foods or foodstuffs for public consumption knows or suspects that any person attending or employed in said school, institution, or business is afflicted with any disease transmissible under the conditions prevailing in that institution or establishment, said person in charge shall exclude the affected person from attending or working in said school, institution or business until he/she shall have been declared by the health officer, or by medical certification acceptable to the health officer, not to be a significant threat to the health of others as a result of the above mentioned disease.*
- *Source: Miss.Code Ann. §41-3-17*
- *Source: Miss.Code Ann. §41-3-17*
- *Source: Miss.Code Ann. §41-3-17*
- *Source: Miss.Code Ann. §41-3-17*

##### **15 Miss. Admin. Code Pt. 2, R. 1.10.2** Rule 1.10.2 {#sec-2-1.10.2 omnilex-key=us-ms-regs-official--title-15--2#1.10.2}

Such notification shall always be dependent on the presence of a disease that can be transmitted under the circumstances involved, and where there either is no other practical means of limiting transmission or where notification provides such a significant advantage over other means of attempting to reduce transmission that in the opinion of the State Health Officer or the State Epidemiologist, notification is warranted.

**History**
- *Source: Miss.Code Ann. §41-3-17*

##### **15 Miss. Admin. Code Pt. 2, R. 1.11.1** Subchapter 11 NOTIFICATION OF EMERGENCY MEDICAL SERVICE PROVIDERS -POSTEXPOSURE {#sec-2-1.11.1 omnilex-key=us-ms-regs-official--title-15--2#1.11.1}

When in the course of providing emergency services to an individual, an emergency medical technician, firefighter, peace officer, or other provider of emergency services comes into direct bare-skin contact with the patient's blood or other internal body fluids, and the patient is transported to a medical care facility, the emergency medical services provider shall notify the medical facility of the blood exposure. Notification shall be in writing and shall include the date and time of the exposure, a description of the nature of the exposure, and the circumstances under which it occurred. If the medical facility to whom the victim is delivered learns during that admission or episode of treatment that the patient has one of the conditions listed in Subchapter 13 or carries the causative agent thereof, the medical facility shall then advise the emergency medical service worker who was exposed as to the condition which was present, and the need for any protective measures to be taken. The hospital shall retain in the patient's medical record a copy of the written notification by the emergency medical services provider of the exposure. The emergency service provider and/or the agency to which he or she is employed shall not disclose any patient identifying information provided under this section to any other person or agency.

Subchapter 12 PREVENTION OF BLOODBORNE PATHOGENS DURING EXPOSURE-PRONE PROCEDURES Rule 1.12.1 The Guidelines for Prevention of Transmission of Human Immunodeficiency Virus and Hepatitis B Virus to Patients during Exposure-Prone Invasive Procedures published in the MMWR by the Centers for Disease Control and Prevention shall be the guidelines followed in all applicable circumstances in the State of Mississippi. (Copies of these guidelines may be obtained by contacting the Epidemiology Program at 601-576-7725.) This document may also be accessed at www.cdc.gov/mmwr/preview/mmwrhtml/00014845.htm.

Subchapter 13 BLOODBORNE AGENTS Rule 1.13.1 The State Board of Health declares the diseases listed in the following table and/or infectious agents, transmissible by blood or body fluids, to require the use of appropriate blood and body fluid precautions, including notification of other health care personnel, emergency medical personnel, and providers of post- mortem services as indicated by accepted standard of medical practice or required by law.

Transmissible by Blood or Body Fluids Creutzfeldt-Jakob Disease (CJD) Human Immunodeficiency Virus (HIV) infection Hepatitis B Syphilis Hepatitis C Viral Hemorrhagic Fever

**History**
- *Source: Miss.Code Ann. §41-3-17*
- *Source: Miss.Code Ann. §41-3-17*
- *Source: Miss. Code Ann. §41-3-17*

##### **15 Miss. Admin. Code Pt. 2, R. 1.14.1** Testing for infection with human immunodeficiency virus (HIV) shall be performed only under the following conditions: 1 {#sec-2-1.14.1 omnilex-key=us-ms-regs-official--title-15--2#1.14.1}

No individual or agency shall perform screening tests or collect specimens for the performance of such tests without either the ability to perform appropriate confirmatory tests, such as fluorescent antibody, Western blot, or other tests accepted as confirmatory by the State Department of Health, or arrangements to have such confirmatory tests performed. 2. Individuals tested for HIV infection shall be notified of the results of the testing only upon completion of appropriate confirmatory or second level test such as fluorescent antibody, Western blot, or other tests accepted as confirmatory by the State Department of Health. 3. No testing shall be performed without appropriate post-test counseling of individuals tested. 4. All conditions stated above pertain to any brand of rapid HIV test. Exceptions: 1) “negative” rapid HIV test results may be provided directly to the patient. 2) provision of “preliminary positive” rapid HIV test results to the patient pending receipt of required confirmatory test results is permitted. Providers offering rapid HIV testing should receive specific pre- and post-test counseling training. It is preferred that the confirmatory test specimen collection occur immediately, but if that is not possible,

every effort should be made to assure that the patient reports for confirmatory testing as soon as possible. 5. For all diagnosed cases of HIV infection, subsequent HIV-related serology results as defined shall be reported to the health department. Laboratories shall report each test result for the following required HIV-related serology: a. HIV viral load results, both detectable and undetectable b. CD4+ (T4) lymphocyte results of any value

Subchapter 15 IMPORTATION OF WILD ANIMALS Rule 1.15.1 Any wild animal (including but not limited to raccoons, skunks, foxes, prairie dogs and ferrets) known to be capable of harboring and transmitting any disease which may affect humans (such as rabies), or of harboring the vector which transmits the illness (such as plague), from an area or farm enzootic for that illness, shall not be imported into the state

**History**
- *Source: Miss.Code Ann. §41-3-17*
- *Source: Miss.Code Ann. §41-3-17*

##### **15 Miss. Admin. Code Pt. 2, R. 1.16.1** Subchapter 16 STORAGE OF BIOLOGICALS {#sec-2-1.16.1 omnilex-key=us-ms-regs-official--title-15--2#1.16.1}

All local health offices, pharmacies, drug stores, apothecary shops, wholesale drug houses and other entities or institutions located within the State of Mississippi and selling or offering to sell or furnish to the public certain biologicals to be used for the purpose of preventing or curing disease shall maintain refrigeration systems in which said biologicals shall be stored at all times. The temperature of the refrigeration system shall not be above 46º F at any time. In the compartment of the refrigeration system where biologicals are stored, a standard thermometer shall be so placed in a fixed position as to indicate the average temperature of the storage compartment. Except for oral polio vaccine, varicella vaccine and other biologicals which must remain frozen until time of use, products should not be placed against ice or stored and maintained at temperatures below 35º F

of the Control of Communicable Diseases Manual, published by the American Public Health Association shall be considered as supplementary.

**History**
- *Source: Miss.Code Ann. §41-3-17 Subchapter 17 SPECIFIC DISEASE CONTROL MEASURES Rule 1.17.1 The following measures shall be used to control or prevent the included diseases of public health importance. The measures proposed in the most current edition*
- *Source: Miss.Code Ann. §41-3-17*

##### **15 Miss. Admin. Code Pt. 2, R. 1.17.2** Anthrax 1 {#sec-2-1.17.2 omnilex-key=us-ms-regs-official--title-15--2#1.17.2}

Class 1A case report required. 2. Human infections: Any person infected with anthrax shall be isolated until all lesions are healed or the diagnosis disproved to the satisfaction of the health officer. All lesion discharges shall be subjected to concurrent disinfection in a manner acceptable to the health officer.

**History**
- *Source: Miss.Code Ann. §41-3-17*

##### **15 Miss. Admin. Code Pt. 2, R. 1.17.3** Brucellosis (Undulant Fever) 1 {#sec-2-1.17.3 omnilex-key=us-ms-regs-official--title-15--2#1.17.3}

Class1B case report required. 2. Whenever the local health officer shall have reason to suspect that any dairy herd may be infected with brucellosis he/she shall prohibit the movement, sale or giving of milk from the herd until the herd is proven free of brucellosis by veterinary certification acceptable to him/her. Milk shall be from dairy herds under a brucellosis eradication program complying with requirements set forth in the current Mississippi State Board of Health Regulations, and the Mississippi State Department of Health's Regulations Governing the Production and Sale of Milk and Milk Products.

**History**
- *Source: Miss.Code Ann. §41-3-17*

##### **15 Miss. Admin. Code Pt. 2, R. 1.17.4** Cancer 1 {#sec-2-1.17.4 omnilex-key=us-ms-regs-official--title-15--2#1.17.4}

Class 4 case report required. 2. Diseases and conditions in this category shall be reported within six months of the first date of contact for the reportable condition to the Mississippi Cancer Registry. The National Program of Cancer Registries at the Centers for Disease Control and Prevention requires the reporting of certain diseases and conditions. A comprehensive reportable list including ICD9CM/ICD10CM codes is available on the Mississippi Cancer Registry website, https://www.umc.edu/cancerinstitute/Cancer-Research/Cancer- Registries/Mississippi%20Cancer%20Registry/Resources1/Overview.html 3. Each record shall provide a minimum set of data items which meets the uniform standards required by the National Program of Cancer Registries and documented in the North American Association of Central Cancer Registries (NAACCR) Data Standards and Data Dictionary, Volume II.

[Refer to Section 41-91-7(2) (b), Mississippi Code 1972 as amended. See Preface.]

**History**
- *Source: Miss.Code Ann. §41-91-7*

##### **15 Miss. Admin. Code Pt. 2, R. 1.17.5** Diphtheria 1 {#sec-2-1.17.5 omnilex-key=us-ms-regs-official--title-15--2#1.17.5}

Class 1B case report required. a. Every case or suspected case of diphtheria shall be isolated until 2 cultures from the throat and 2 from the nose taken not less than 24 hours apart and not less than 24 hours after antibiotic therapy fail to show diphtheria bacilli. Where culturing is impractical, isolation may be ended after 14 days of appropriate antibiotic treatment. In suspected cases, isolation may be terminated if laboratory and clinical findings fail to confirm the diagnosis. b. All articles in contact with a patient and all articles soiled by discharges of a patient shall be disinfected or disposed of in a manner acceptable to the health officer. c. At termination of isolation, the quarters shall undergo terminal disinfection. d. All close contacts should have cultures taken and should be kept under surveillance for 7 days. Adult contacts whose occupation involves handling food or close association with children must be excluded from these occupations until shown by bacteriological examination not to be carriers.

**History**
- *Source: Miss.Code Ann. §41-3-17*

##### **15 Miss. Admin. Code Pt. 2, R. 1.17.6** Foodborne Illness 1 {#sec-2-1.17.6 omnilex-key=us-ms-regs-official--title-15--2#1.17.6}

Class 1A case report required for outbreaks. Some foodborne diseases require case reports for a single case see Appendix A to the Rules and Regulations Governing Reportable Diseases and Conditions. a. Whenever the local health officer shall know of or suspect the existence of an outbreak of illness due to food infection or food poisoning, he/she shall conduct an immediate investigation of all the circumstances. b. The local health officer shall prohibit infected or potentially infected persons from engaging in the preparation or handling of

foods or foodstuffs until said health officer is satisfied that said persons are free of pathogenic microorganisms. c. The local health officer shall, upon investigation, prohibit practices in preparation, processing, storing or handling of food or foodstuffs which are known or may be reasonably inferred to be conducive to food poisoning. d. The local health officer shall require compliance of all persons or firms with at least the minimum sanitary requirements of the Mississippi State Board of Health in regard to the physical plant in which or from which perishable foods or foodstuff are offered to the public.

**History**
- *Source: Miss.Code Ann. §41-3-17*

##### **15 Miss. Admin. Code Pt. 2, R. 1.17.7** Hepatitis 1 {#sec-2-1.17.7 omnilex-key=us-ms-regs-official--title-15--2#1.17.7}

Class 1A case report required for hepatitis A. a. Patients with hepatitis A should be questioned as to whether they work as a food-handler (including voluntary work) and whether they have children in the household who attend a daycare center. This information shall be a part of the case report. b. The local health officer shall prohibit persons infected or potentially infected with hepatitis A from engaging in the preparation or handling of foods or foodstuffs until said health officer is satisfied that said persons are free of hepatitis A virus. 2. Class 2 case report required for acute viral hepatitis other than hepatitis A.

**History**
- *Source: Miss.Code Ann. §41-3-17*

##### **15 Miss. Admin. Code Pt. 2, R. 1.17.8** Hansen Disease (Leprosy) 1 {#sec-2-1.17.8 omnilex-key=us-ms-regs-official--title-15--2#1.17.8}

Class 3 case report required. 2. Treatment should be in consultation with the Mississippi State Department of Health for local treatment.

**History**
- *Source: Miss.Code Ann. §41-3-17*

##### **15 Miss. Admin. Code Pt. 2, R. 1.17.9** Influenza-Associated Pediatric Mortality: Class 1B case report required {#sec-2-1.17.9 omnilex-key=us-ms-regs-official--title-15--2#1.17.9}

**History**
- *Source: Miss.Code Ann. §41-3-17*

##### **15 Miss. Admin. Code Pt. 2, R. 1.17.10** Measles: Class 1A case report required {#sec-2-1.17.10 omnilex-key=us-ms-regs-official--title-15--2#1.17.10}

Effective outbreak control is dependent on immediate telephone report of individual cases.

**History**
- *Source: Miss. Code Ann. §41-3-17*

##### **15 Miss. Admin. Code Pt. 2, R. 1.17.11** Rule 1.17.11 {#sec-2-1.17.11 omnilex-key=us-ms-regs-official--title-15--2#1.17.11}

Meningitis: Class 1A case report required for meningococcal and Haemophilus influenzae meningitis or other forms of invasive disease, since chemoprophylaxis for high risk contacts is provided by the Department of Health. (Usually presents as meningitis or septicemia, or less commonly as cellulites, epiglottitis, osteomyelitis, pericarditis, or septic arthritis.)

**History**
- *Source: Miss.Code Ann. §41-3-17*

##### **15 Miss. Admin. Code Pt. 2, R. 1.17.12** Rule 1.17.12 {#sec-2-1.17.12 omnilex-key=us-ms-regs-official--title-15--2#1.17.12}

Ophthalmia Neonatorum (Neonatal Gonococcal Ophthalmia): All physicians and healthcare providers attending births must install in the eyes of the newborn no more than 24 hours after delivery an appropriate dose of an antibiotic currently recommended and approved for neonatal ocular prophylaxis for ophthalmia neonatorum. When recommended antibiotics for neonatal ocular prophylaxis are unavailable or in limited supply, healthcare providers, hospitals and healthcare facilities attending births should adhere to the following recommendations: 1. When supply is limited or unavailable, consider screening for gonococcal infection at delivery for women who were not tested during pregnancy and/or are at risk for infection. a. If testing is done at delivery, ensure prompt follow up and treatment of both mother and infant if testing is positive. 2. When supply is limited, reserve prophylaxis with appropriate prophylactic ointment for infants at risk for gonococcal ophthalmia neonatorum, to include: a. Infants born to mothers with no prenatal care b. Infants born to mothers at risk for gonococcal infection (e.g., women aged <25 years and those aged ≥25 years who have a new sex partner, more than one sex partner, a sex partner with concurrent partners, a sex partner who has an STI, or live in a community with high rates of gonorrhea) 3.If an appropriate prophylactic ophthalmic antibiotic is unavailable, review and consider following the Centers for Disease Control and Prevention recommended alternative neonatal ocular prophylaxis regimen to prevent gonococcal ophthalmia neonatorum in those infants with risk factors noted above.

**History**
- *Source: Miss. Code Ann. §41-3-17*

##### **15 Miss. Admin. Code Pt. 2, R. 1.17.13** Poisoning {#sec-2-1.17.13 omnilex-key=us-ms-regs-official--title-15--2#1.17.13}

1. Class 2 case report required for individual cases. 2. For the purpose of reporting, poisoning includes, but is not limited to cases involving observable clinical symptomology or significant clinical laboratory changes as a result of over exposure to drugs, household products, pesticides, agricultural or industrial chemicals, plants, venomous animals or any other toxicant. Reports made to the Mississippi Poison Control Center at the University of Mississippi Medical Center in Jackson (1-800-222-1222) will satisfy this requirement

**History**
- *Source: Miss.Code Ann. §41-3-17*

##### **15 Miss. Admin. Code Pt. 2, R. 1.17.14** Rabies 1 {#sec-2-1.17.14 omnilex-key=us-ms-regs-official--title-15--2#1.17.14}

Class 1A case report required. 2. Control in Animals: The Mississippi State Department of Health subscribes to the most current edition of the Compendium of Animal Rabies Prevention and Control, parts I, II, and III, by the National Association of State Public Health Veterinarians. The provisions of this compendium have been endorsed by the CDC, U. S. Public Health Service, Department of Health and Human Services; the American Veterinary Medical Association; the Council of State and Territorial Epidemiologists; and other public and private agencies. The compendium can be found at www.nasphv.org/documentsCompedia.html .The following are state specific modifications to the Compendium. 3. Vaccine Administration: All animal rabies vaccines are restricted to use by or under the supervision of a veterinarian or person specifically licensed or designated by the State Board of Health to administer rabies vaccine. 4. Vaccine Selection: The current Compendium lists vaccines licensed for use in the United States. Only licensed vaccines shall be used. Vaccines selected for immunizing dogs and cats shall be licensed as providing 3-year immunity. 5. Wildlife Vaccination: Vaccination of wildlife is not recommended since no vaccine is licensed for use in wild animals. Offspring of wild animals bred with domestic dogs or cats are considered wild animals. 6. Pre-Exposure Vaccination (Dogs and Cats): All dogs and cats shall be vaccinated against rabies at three months of age, revaccinated one year later and every three years thereafter, using a rabies vaccine approved as providing a 3 year immunity.

7. Post-Exposure Management

a. Any animal bitten or scratched by a wild, carnivorous mammal or bat that is not available for testing should be regarded as having been exposed to rabies. b. Dogs, Cats, and Ferrets: Unvaccinated dogs, cats, and ferrets exposed to a rabid animal should be euthanized immediately. If the owner is unwilling to have this done, or if the animal is overdue for vaccinations, refer to the recommendations contained within the Postexposure Management section of the most current version of the Compendium of Animal Rabies Prevention and Control (www.nasphv.org/documentsCompedia.html). Dogs, cats, and ferrets that are currently vaccinated should be revaccinated immediately, kept under the owner’s control, and observed for 45 days. 8. Management of Animals that Bite Humans a. A healthy dog, cat, or ferret that bites a person shall be confined and observed for 10 days in a manner acceptable to the local health officer or his or her designee. Rabies vaccine shall not be administered during the observation period. Such animals shall be evaluated by a veterinarian at the first sign of illness during confinement. Any illness in the animal shall be reported immediately to the local health department. If signs suggestive of rabies develop, the animal shall be euthanized, its head removed, and the head shipped under refrigeration to the Department of Health Laboratory for examination. Any stray or unwanted dog, cat, or ferret that bites a person may be euthanized immediately, in lieu of 10 days of observation, and the head submitted as described above for rabies examination. Animals other than dogs, cats, or ferrets that might have exposed a person to rabies should be reported immediately to the health department. This is not to include low risk animals such as small rodents and lagomorphs (e.g., squirrels, rats, mice, gerbils, and rabbits). Prior vaccination of an animal does not preclude the necessity for euthanasia and testing if the period of virus shedding is unknown for that species. Management of animals other than dogs, cats, and ferrets depends on the species, the circumstances of the bite, the epidemiology of rabies in the area, and the biting animal’s history, current health status, and potential for exposure to rabies. The need for euthanizing and testing the animal shall be decided upon consultation with the Epidemiology Program. Post-exposure management of persons should follow the recommendations of the ACIP.

**History**
- *Source: Miss.Code Ann. §41-3-17*

##### **15 Miss. Admin. Code Pt. 2, R. 1.17.15** Respiratory Syncytial Virus (RSV)-Associated Pediatric Mortality: Class 1B case report required {#sec-2-1.17.15 omnilex-key=us-ms-regs-official--title-15--2#1.17.15}

**History**
- *Source: Miss.Code Ann. §41-3-17*

##### **15 Miss. Admin. Code Pt. 2, R. 1.17.16** Rule 1.17.16 {#sec-2-1.17.16 omnilex-key=us-ms-regs-official--title-15--2#1.17.16}

SARS-CoV-2 (COVID-19) For SARS-CoV-2, the virus that causes Coronavirus Disease 2019 (COVID-19), the following are explicitly reportable in Mississippi:

1. Pediatric COVID-19 associated deaths (<18 years of age) and COVID- 19 associated deaths in pregnant women. Class 1A-requires reporting by telephone to MSDH within 24 hours of first knowledge or suspicion. 2. Suspected or confirmed COVID-19 associated Multisystem Inflammatory Syndrome in Children (MIS-C) in individuals <21 years of age. Class 1B-reporting by telephone to MSDH Office of Epidemiology within one business day of first knowledge or suspicion.

3. Suspected and confirmed COVID-19 outbreaks. Class 1A- requires reporting by telephone to MSDH within 24 hours of first knowledge or suspicion.

**History**
- *Source: Miss.Code Ann. §41-3-17*

##### **15 Miss. Admin. Code Pt. 2, R. 1.17.17** Sexually Transmitted Diseases – General {#sec-2-1.17.17 omnilex-key=us-ms-regs-official--title-15--2#1.17.17}

1. Any person known or suspected of having syphilis, gonorrhea, Chlamydia, chancroid, human immunodeficiency virus (HIV) or other sexually transmissible disease (STD) or suspected of having been exposed to syphilis, gonorrhea, Chlamydia, chancroid, HIV or other STD shall submit to examination as provided in Section 105. Any person who, after due notification, fails or refuses to report for examination at the time and place designated by the health officer shall be subject to prosecution and the local health officer or the Mississippi State Department of Health or its representative may make an affidavit of such fact and cause the issuance of a warrant returnable before any court of competent jurisdiction. All records and reports herein required shall be kept in secret files and disclosed only as required before the court (Section 41-23-29, Mississippi Code of 1972 as amended.).

2. It shall be the duty of the local health officer or his or her representative to conduct effective epidemiological actions including initial and follow up interviews, rapid contact and suspect referral to medical examination, satisfactory determination of the source of patient infection and all subsequent infections, and appropriate administration of prophylactic treatment to all at risk critical period contacts.

3. Case reports of genital Chlamydia, gonorrhea, chancroid and syphilis shall include date, type of treatment and dose, or if no treatment has been initiated.

4. Syphilis

a. Class 1B (including congenital and infection in pregnancy) case report required.

b. General i. Any reactive serologic test for syphilis (STS) shall be reported to the State Department of Health by the laboratory performing the test. Report shall include test result, patient's name, age, race, sex, and address, and name of physician ordering the test.

ii. RPR or VDRL ≥ 1:8 - Class 1B case report required.

iii. Any reactive STS in persons 10 years of age or younger - Class 1B case report required.

iv. RPR or VDRL ≤ 1:4 - Class 1B case report required. MSDH "Laboratory Log Sheet" or a form providing all the same information may be used.

5. All Mississippi physicians and medical practitioners providing prenatal care to pregnant people shall be required to:

a. Perform syphilis testing for all pregnant people in their first trimester (or at the initial visit for prenatal care) and again in the third trimester (28-32 weeks).

b. Perform syphilis testing for all pregnant people at the time of delivery.

c. Ensure appropriate treatment for syphilis infections during pregnancy and for congenital syphilis, per the most current Centers for Disease Control and Prevention (CDC) treatment guidelines.

d. Ensure appropriate reporting of syphilis infection in pregnancy to the Department.

**History**
- *Source: Miss. Code Ann. §41-3-17*

##### **15 Miss. Admin. Code Pt. 2, R. 1.17.18** Tuberculosis {#sec-2-1.17.18 omnilex-key=us-ms-regs-official--title-15--2#1.17.18}

1. Class 1A case report required. 2. Human Infections: The local health officer shall determine and prescribe for individual cases and contacts the isolation, quarantine restrictions and/or treatment necessary for their protection and that of other people. Should any patient fail to observe the isolation methods prescribed by the local health officer, said health officer shall quarantine the patient in writing and prescribe therein the procedures to be carried out by said patient. Should the patient break his/her quarantine restrictions, the local health officer may apply by letter outlining the circumstances to the Executive Secretary of the Mississippi State Board of Health and request approval of proceedings to commit the patient to a hospital. Upon approval by the Executive Secretary of the Mississippi State Board of Health, the local health officer may initiate proceedings as provided by law for the forcible commitment of the patient. (Sections 41-33-5, 41-33-7, Mississippi Code of 1972 as amended.) 3. Control in Animals: Bovine tuberculosis may be transmitted to man by infected cattle through close contact or the consumption of raw milk. Milk shall be from dairy herds that comply with tuberculosis requirements set forth in the current Mississippi State Board of Health Regulations, and the Mississippi State Department of Health Regulations Governing the Production and Sale of Milk and Milk Products. 4. Tuberculosis Management in Correctional Institution: The following regulations govern all Mississippi state correctional facilities, city and county facilities housing state prisoners, and privately operated correctional facilities in the state. a. “Correctional Institutions” and/or “correctional facility” shall be construed to mean any of the state-operated penitentiaries, privately operated correctional facilities, community work centers, community pre-release centers, restitution centers, county or regional correctional facilities, and/or administrative offices as is applicable to each respective policy. b. All inmates shall be medically screened for communicable diseases (including Mycobacterium tuberculosis [TB], syphilis, and Human Immunodeficiency Virus [HIV]) to prevent the spread of these diseases within the correctional institutions and to the public. Employees (i.e. full and part-time employees, contract staff and volunteers) shall be screened for tuberculosis infection and disease. c. The correctional institution shall establish schedules, protocols, and responsibilities for the testing of inmates and employees to ensure compliance with all relevant Mississippi State Department of

Health (MSDH) guidelines. The correctional institution shall appoint a liaison to ensure that all necessary screening is provided to each inmate and employee under its jurisdiction regardless of the individual’s physical location. d. The director of the correctional institution, in consultation with the correctional institution’s medical director, shall issue procedures to ensure that inmates, prior to being transferred into the correctional institution from another correctional institution, a non-state facility, or out-of-state jurisdiction have been properly tested/screened for communicable disease within the previous thirty (30) days. If such testing and screening has not been accomplished, the director shall ensure that these procedures are completed prior to the transfer or upon the receipt of the inmate. e. Screening shall include a Rapid Plasma Reagin (RPR) for syphilis, HIV serology, and TB testing, including, TB signs and symptoms assessment, exposure history, two-step Mantoux tuberculin skin test or blood assay for mycobacterium tuberculosis (BAMT) and chest x-ray if indicated. All HIV-Positive inmates and employees shall have an x-ray as part of the medical screening. No inmate shall be placed in the general population until the medical assessment is completed. Any symptomatic inmate shall remain in respiratory isolation until TB test results are known and active tuberculosis disease has been ruled out. Documentation of these screening tests shall be maintained for all inmates in a correctional institution. Test results shall be reported to the MSDH. f. Screening, latent therapy, active treatment and treatment follow-up of inmates and employees for tuberculosis shall follow the policies and procedures included in the latest revision of the Tuberculosis Manual of the MSDH. All latent and active TB treatment of the inmates shall be directly observed by a health care provider. g. The correctional institution’s medical director, in order to contain communicable disease and/or enforce screening schedules, with the approval of the correctional institutional superintendent and/or classification director shall have the authority to: i. Place inmates in quarantine ii. Suspend employees iii. Move inmates between approved housing locations or to approved medical facilities

iv. Issue procedures for the care and treatment of inmates and employees with communicable diseases h. Each correctional institution or correctional facility shall provide a complete, legible and accurate Tuberculin Testing Summary (MSDH Form 181) summarizing the correctional facility’s tuberculin testing activity and containing a roster of all inmates and employees that were first identified as having a significant Mantoux tuberculin skin test reaction* or positive BAMT within the reporting period. This roster shall include comments and conclusions concerning the individual follow-up of each person listed. The Tuberculin Testing Summary, with appropriate notations, shall be logged in the Office of the State Tuberculosis Program on or before March 15th of each year for the twelve (12) months preceding January 31st of that year. 5. Summary of TB screening and procedures: a. All inmates shall have a two-step Mantoux tuberculin skin test or BAMT. Each Mantoux tuberculin skin test shall be administered using five tuberculin units (5 t.u.) of purified protein derivative (PPD) unless individually excluded by a licensed physician or nurse practitioner due to medical contraindications or exceptions noted herein. BAMT testing shall be collected and results interpreted by personnel trained and certified in the procedure BAMT results shall be given as EIA positive, Negative or Indeterminate. All Mantoux tuberculin skin test shall be administered and read by personnel trained and certified in the procedure and the results recorded in millimeters of induration. Exception to the tuberculin skin test requirements may be made if: i. The individual is currently receiving or can provide documentation of having successfully completed a course of therapy for latent tuberculosis approved by the State Tuberculosis Program. ii. The individual is currently receiving or can provide documentation of having successfully completed a course of multi-drug chemotherapy approved by the State Tuberculosis Program for active tuberculosis disease, or iii. The individual has a documented previous significant tuberculin skin test reaction* or positive BAMT.

b. The tuberculin skin test status of all employees shall be documented in the individual’s personnel record. The BAMT or the first step of

a two-step Mantoux tuberculin skin test shall be performed (i.e. administered and read) on all new employees (and rehires) within thirty (30) days prior to the first day of employment. The Mantoux tuberculin skin test or BAMT shall be administered and read by personnel trained and certified in the procedure. The results of the tuberculin skin test shall be recorded in millimeters of induration. The results of the BAMT shall be recorded as EIA positive, negative or indeterminate. An employee shall not have contact with inmates or be allowed to work in areas of the correctional institution to which inmates have routine access prior to the reading of the first-step of a two-step Mantoux tuberculin skin test or having a BAMT and completing an exposure history and symptom assessment. The results of both steps of the two-step Mantoux tuberculin skin test or BAMT shall be documented in the individual’s personnel record within fourteen (14) days of employment. Exception to the tuberculin skin test requirement may be if: i. The individual is currently receiving or can provide documentation of having successfully completed a course of therapy for latent tuberculosis infection approved by the State Tuberculosis Program, or ii. The individual is currently receiving or can provide documentation of having successfully completing a course of multi-drug chemotherapy approved by the State Tuberculosis Program for active tuberculosis disease, or iii. The individual has a documented previous significant tuberculin skin test reaction* or positive BAMT c. All inmates and employees with a previous significant Mantoux tuberculin skin test* or positive BAMT and/or symptoms suggesting TB (e.g. cough, sputum production, chest pain, anorexia, weight loss, fever, night sweats, especially if symptoms last three weeks or longer, regardless of the size of the skin test), shall receive a chest x-ray and be evaluated by a physician or nurse practitioner within 72 hours. Individuals found to have a significant Mantoux tuberculin skin test or positive BAMT, signs and symptoms of tuberculosis or a chest x-ray suggestive of active tuberculosis shall be placed in respiratory isolation according to MSDH policies, reported to MSDH and evaluated by physician or nurse practitioner for tuberculosis therapy. d. Individuals found to have a significant Mantoux tuberculin skin test or positive BAMT or with a history of a previous significant Mantoux tuberculin skin test or positive BAMT and a chest x-ray

not suggestive of active tuberculosis, shall be evaluated by a physician or nurse practitioner for latent tuberculosis therapy. Individuals with significant Mantoux tuberculin skin tests or positive BAMT and no evidence of active TB disease should be reminded periodically about the symptoms of tuberculosis and the need for prompt evaluation of any pulmonary symptoms of tuberculosis. A tuberculosis symptom assessment shall be documented as part of the annual health screening. No additional follow-up for these individuals is indicated unless symptoms suggestive of active tuberculosis develop; specifically, routine annual chest x-rays are not indicated.

e. Employees found to have a positive/significant reaction * to the skin test or a positive BAMT and no signs or symptoms of tuberculosis disease and have a negative chest x-ray shall, as a condition of employment, have thirty (30) days to report to the MSDH office in their county of residence to confirm appropriate follow-up testing has been completed and receive treatment, if indicated. The employees shall provide the director or designee with a written statement from the MSDH verifying compliance with the directives set forth by the correctional institution’s medical director and this regulation.

 Criteria for a significant tuberculin skin test Reaction >5 mm (greater than or equal to 5mm) High risk contact to an active tuberculosis case HIV-positive persons Fibrotic changes on chest radiograph consistent with prior TB Patients with organ transplants and other immunosuppressed patients (receiving the equivalent of >15 mg. of prednisone for 1 mo or more-risk of TB in patients treated with corticosteroids increases with higher doses and longer duration) Reaction >10 mm (greater than or equal to 10 mm) any other prisoner or employee of the prison

f. All inmates and employees who do not have a significant Mantoux tuberculin skin test or positive BAMT shall be retested annually within thirty (30) days of the anniversary of their last Mantoux tuberculin skin test. Inmates and employees exposed to an active infectious case of TB between annual tuberculin skin test shall be treated as contacts and be managed appropriately. All contacts to

an active tuberculosis case shall have HIV testing as part of the exposure management. Rule 1.17.19 Typhoid Fever 1. Class 1B report required. a. In case of typhoid fever, enteric precautions shall be maintained for not less than 4 weeks from date of onset, and urine and feces cultures for release from temporary carrier status shall not be taken earlier. A person diagnosed with typhoid fever or with growth of Salmonella typhi from feces, urine, blood, or other bodily source shall be considered a temporary typhoid carrier. Release from temporary carrier status and health department supervision shall be on the basis of not less than 3 consecutive negative cultures obtained from authenticated specimens of feces taken not less than 24 hours apart at least 48 hours after any antibiotic , and not earlier than one month after onset. If any one of this series is positive, the temporary carrier status shall be continued. b. During the first 6 months of the temporary carrier status, the patient may again be tested for release by securing not less than 3 consecutive negative cultures obtained from authenticated specimens at intervals of 1 month. If the patient is positive at the 6th month or if no test is made, the case is classed as a permanent carrier. Final release from permanent carrier status must be with the advice and consent of the State Epidemiologist, and cannot be considered unless 3 consecutive monthly cultures obtained from authenticated specimens collected at least 48 hours after any antibiotic, have been negative on examination by the Department of Health Laboratory or other laboratories approved by the Department of Health. c. Whenever the typhoid carrier status shall be declared by the local health officer and there is no patient history of typhoid during the preceding year, the patient shall be classed as a permanent carrier. d. No person classed as a carrier shall engage in handling of foods or foodstuffs for public consumption, nor shall such carrier offer to perform such services for any family (other than his or her own) or for any other group or institution, either private or public. No such carrier shall engage in providing domestic services for hire or provide direct client care in a nursing home or child day care center without the advice and written consent of the health officer. e. When any person is declared to be a carrier of typhoid, the local health officer shall collect pertinent information about the carrier.

The necessity for imposing restrictions on the patient's activities shall be explained to the patient and the patient shall signify in writing his or her willingness to observe the carrier agreement and restrictions. A copy of the carrier information shall be forwarded immediately to the Epidemiology Program, Mississippi State Department of Health, in Jackson. f. When any known carrier of typhoid moves from the county, a copy of the carrier's history and agreements, together with the prospective future address of the carrier, shall be forwarded to the Mississippi State Department of Health by the local health officer of the county from which the carrier is moving. The original copy of the history and agreement shall remain as a part of the files of the county health department of the county from which the carrier has moved. g. All family or other close contacts of a case of typhoid or other salmonella infection shall submit specimens of their feces as required by the health officer and submit to any reasonable examination as may aid in the search for unknown carriers and sub clinical cases. h. All family or other close contacts of a carrier of typhoid or other salmonella infection shall be prohibited from handling foods or foodstuffs for public consumption until contact is broken and repeated negative laboratory examinations are reported. For salmonelloses, except typhoid, a series of 2 negative feces cultures taken not less than 24 hours apart at any time after contact is broken will satisfy this provision. For typhoid fever a series of 2 negative stools taken not less than 24 hours apart and not less than 14 days after contact is broken will satisfy this provision. i. The owner or operator of a house, hotel, apartment or other institution in which a typhoid carrier resides shall provide a sanitary method of excreta disposal which will not subject other occupants of the house, apartment, hotel or other institution or the general public to typhoid or paratyphoid infection. If the owner or operator of the property on which a carrier resides fails for due cause to provide such sanitary methods of excreta disposal, the carrier shall

provide such facilities as meet approval of the Mississippi State Department of Health. j. Any typhoid carrier planning to change his/her place of residence or his/her occupation shall notify the local health officer in writing of such anticipated change. k. Whenever a case or carrier of typhoid is diagnosed it shall be the duty and responsibility of the local health officer to conduct a search for the source of the infection and for the food, water or person from whom it was acquired. Strict measures for assuring the safety of the water and milk supplies and of all foodstuffs should be instituted. l. Mandatory report and surveillance required.

Subchapter 18 PENALTY FOR VIOLATION OF RULES AND REGULATIONS REGARDING REPORTABLE DISEASES Rule 1.18.1 Any physician, dentist or other person who shall fail, neglect, or refuse to comply with, or shall falsify any report, or shall violate any of the Rules and Regulations of the Mississippi State Board of Health shall, upon conviction, be guilty of a misdemeanor and subject to the penalty provided by law.

1. By virtue of authority vested in it by the Mississippi Code Annotated Sections 41-63-4 or as otherwise amended, the Mississippi Department of Health does hereby adopt and promulgate the following regulations and standards for the Healthcare Data Registry System. 2. Purpose -The Mississippi State Department of Health (MSDH), acting as the state’s public health authority, is required to design and establish a registry program concerning the condition and treatment of persons seeking medical care in the state of Mississippi (“Healthcare Data Registry System”). MSDH must collect, analyze and disseminate these health care data in order to improve the quality and efficiency of medical care. 3. Reporting Responsibility-Each of the following licensed health care facilities in the state of Mississippi shall be required to report the

specified health care data described in these rules and regulations: A. Hospital Facilities – See Rule 1.19.2; B. Ambulatory Surgical Facilities – See Rule 1.19.3 [Reserved]; C. Outpatient Diagnostic Imaging Centers – See Rule 1.19.4 [Reserved]; 4. Reporting Contact-In order to facilitate communication and problem solving, each reporting facility must designate a person as contact and advise the Department from time to time of any changes to such contact information. Contact information shall include the office name, telephone number, job title and name of the person assigned this responsibility to the MSDH.

5. Penalties for Not Reporting- A. The MSDH is authorized to assess penalties as provided by statute pursuant to Mississippi Code Annotated § 41-63-4 Paragraph (12) which states, “A person or organization who fails to supply data required under this section is liable for a civil penalty of Five Cents (5¢) for each record for each day the submission is delinquent. A submission is delinquent if the department does not receive it within thirty (30) days after the date the submission was due. If the department receives the submission in incomplete form, the department shall notify the provider and allow fifteen (15) additional days to correct the error. The notice shall provide the provider an additional fifteen (15) days to submit the data before the imposition of any civil penalty. The maximum civil penalty for a delinquent submission is Ten Dollars ($10.00) for each record. The department shall issue an assessment of the civil penalty to the provider. The provider has a right to an informal conference with the department, if the provider requests the conference within thirty (30) days of receipt of the assessment. After the informal conference or, if no conference is requested, after the time for requesting the informal conference has expired, the department may proceed to collect the penalty. In its request for an informal conference, the provider may request the department to waive the penalty. The department may waive the penalty in cases of an act of God or other acts beyond the control of the provider. Waiver of the penalty is in the sole discretion of the department;” and B. Failure of any health care facility or other person or entity covered by the “Mississippi Health Care Certification of Need Law of 1979”, Mississippi Code Annotated § 41-7-171 through § 41-7-209, to report any requested information, data or otherwise failure to report under these provisions, shall be in violation of the “Mississippi Health Care Certification of Need

Law of 1979” and subject to violations provided in Mississippi Code Annotated § 41-7-209.

6. Confidentiality-Information maintained in the Mississippi Healthcare Data Registry System shall be confidential and shall not be distributed or released except with the permission of MSDH in accordance with its established policies and procedures. Violation of confidentiality requirements may be subject to severe civil and/or criminal penalties. A. The release of identifiable patient health information may be made by MSDH only to the facility that initially reported the identifiable information, upon the written request of such facility. Any request by any other party for the release of identifiable information shall be reviewed by the MSDH Data Use Council (described below), and the Data Use Council may approve such request only for the purpose of public health assessment or research under such guidelines and stipulations as may be necessary to maintain confidentiality requirements. B. Prior to the dissemination or release of any data analysis or statistical reports concerning registry information, including any release to MSDH divisions or programs, the Data Use Council may review the methods and procedures deemed necessary to maintain the privacy and confidentiality of patient records, including the system security requirements. C. The MSDH shall be required to regularly monitor the physical security of the registry, to train personnel concerning the system’s confidentiality standards, to limit access to the registry information solely to authorized personnel, and to implement password and encryption protections in the system. 7. Protected Health Information-The disclosure of protected health information by a reporting facility pursuant to these rules and regulations shall be recognized as a disclosure to a public health authority as required by law, pursuant to the Health Insurance Portability and Accountability Act and the Privacy Rules promulgated there under at 45 CFR Sections 164.512(a) and (b). 8. Data Use Council-The State Health Officer will create a Data Use Council consisting of not less than five individuals to recommend policies and procedures regarding the release of any registry data to MSDH divisions and programs, to the public, to researchers and to industry. Appointments to the Council shall be made at the sole discretion of the State Health Officer for such terms as may be established by the policies and procedures of the MSDH. MSDH divisions and programs may, with the consent of the Data Use

Council, use patient abstract data to assist in fulfilling its public health mission. These data will not be re-released in any form by the program without the prior authorization of the Data Use Council. Authorization for subsequent release shall be considered only if the proposed release does not identify a patient. 9. Temporary Waiver of Reporting Requirement-With respect to any licensed health care facility otherwise required to report data or other information to the MSDH pursuant to these rules and regulations, the MSDH shall be authorized to temporarily waive reporting requirements due to system requirements of MSDH or the reporting facility, or in the case of irregularities or errors involving data delivery. Any waiver of the reporting requirements must be made in writing by the MSDH and notice of the termination of any waiver shall be provided to the applicable reporting facility, at which time these Regulations shall become applicable to such facility. 10. Charges and Fees for Access to Data-Subject to the confidentiality requirements of these Regulations, the MSDH may develop reports and data analyses based upon registry data which may be released to the public. The reports may be published or disseminated for a reasonable charge, or without charge at the discretion of MSDH as outlined in the policies and procedures established by the Healthcare Data Registry System. At the time of the promulgation of these Regulations, the MSDH shall refrain from assessing any charges to reporting facilities for the collection of health care data. Nothing shall prohibit the State Board of Health from authorizing, at any future date in accordance with its statutory authority, the assessment of reasonable charges for the collection of such data, or the reporting of specified health care data to the MSDH for purposes of the registry. 11. Persons receiving encounter-level data must complete an application and submit the signed data use agreement according to policies and procedures of the Hospital Discharge Registry System. Encounter level datasets available include Inpatient, Outpatient, and Emergency Department The following provides the cost to purchase one or many datasets by calendar year: A. State Inpatient Database: $1,740 per year of data (students $300) B. State Emergency Department Database: $1,740 per year of data (students $300) C. Ad Hoc Data Request - Customized data requests are priced according to policies and procedures established by the Healthcare Data Registry System and are primarily on the

time required to analyze the request write the query; and the time required to access, merge, validate and prepare the information for delivery. D. Hospitals requesting data – The MSDH will not charge hospitals for data requests when the data they are requesting originated from their facility. All other hospital requests will follow the Ad Hoc Data Request or dataset file request fee schedule. E. Waiver Grants awarded to students – The MSDH may award grants to students actively involved in a school setting (High School, Undergraduate or Graduate). The grants will be in the form of a waiver for agreeing to allow the MSDH to publish their findings and methodology if the MSDH Data Use Council deems the information appropriate. Data restrictions will apply. Should the student request more than three datasets, the Ad Hoc Data Request will apply.

**History**
- *Source: Miss.Code Ann. §41-3-17*
- *Source: Miss.Code Ann. §41-3-17 Subchapter 19 Mississippi Healthcare Data Registry System Rule 1.19.1 Reporting Requirements and Procedures*
- *Source: Miss.Code Ann. §41-3-17*

##### **15 Miss. Admin. Code Pt. 2, R. 1.19.2** Hospital Reporting 1 {#sec-2-1.19.2 omnilex-key=us-ms-regs-official--title-15--2#1.19.2}

Definitions as used in this Subchapter: A. Hospital – means a place devoted primarily to the maintenance and operation of facilities for the diagnosis, treatment and care of individuals suffering from physical and mental infirmity, illness, disease, injury or deformity, or a place devoted primarily to providing obstetrical or other medical, surgical, or nursing care of individuals, whether or not any such place be organized or operated for profit and whether any such place be publicly or privately owned, and is licensed by the Department as a hospital. The term “hospital” does not include convalescent or boarding homes, children’s homes, homes for the aged or other like establishments where room and board only are provided, nor does it include offices or clinics where patients are not regularly kept as bed patients. B. Freestanding emergency room- a facility open twenty-four (24) hours a day for the treatment of urgent and emergent medical conditions which is not located on a hospital campus. C. Department – means the Mississippi State Department of Health. D. Student- an individual with a full-time undergraduate or graduate enrollment status at a college or university. 2. Hospital Discharge Data A. Purpose -A statewide Hospital Discharge Data System (HDDS) is one of the most important tools for addressing a broad range of health policy issues, including the improvement of the quality and efficiency of medical care. “Discharge data”

is defined as the consolidation of complete billing, medical, and personal information describing a patient or resident, the services received, and charges billed for a single hospital stay. The requirements for the collection and submission of data as described shall also apply to those non-federal acute care hospitals located in Alabama, Arkansas, Louisiana, and Tennessee. Data submitted by these non- Mississippi hospitals shall relate exclusively to those patients who are Mississippi residents. B. Reporting Required-Each reporting facility shall report discharge data using methods outlined in the policies and procedures established by the Healthcare Data Registry System. C. Data Elements -The Mississippi HDDS is based on the Health Care Finance Administration (HCFA) UB-04 or the most recent version and additional selected information routinely collected by health care facilities on each patient. Data elements are listed in the HDDS policy manual. D. Quality Assurance-MSDH Data Use Council will develop guidelines for quality assurance and accuracy that each reporting hospital will be required to follow. E. Time of Reporting and Methodology- Reporting facilities shall submit data for each calendar month based upon discharges occurring during such month. Collected data shall be submitted to the HDDS no later than 75 days after the end of the calendar quarter.

**History**
- *Source: Miss.Code Ann. §41-3-17*

##### **15 Miss. Admin. Code Pt. 2, R. 1.19.3** Ambulatory Surgical Facilities Reporting {#sec-2-1.19.3 omnilex-key=us-ms-regs-official--title-15--2#1.19.3}

RESERVED FOR FUTURE USE.

**History**
- *Source: Miss.Code Ann. §41-3-17*

##### **15 Miss. Admin. Code Pt. 2, R. 1.19.4** Outpatient Diagnostic Imaging Centers Reporting RESERVED FOR FUTURE USE {#sec-2-1.19.4 omnilex-key=us-ms-regs-official--title-15--2#1.19.4}

Subchapter 20 HOSPITAL REPORTING OF HEALTHCARE ASSOCIATED INFECTIONS AND HEALTHCARE DATA VIA THE NATIONAL HEALTHCARE SAFETY NETWORK (NHSN)

**History**
- *Source: Miss. Code Ann. §41-3-17*

##### **15 Miss. Admin. Code Pt. 2, R. 1.20.1** Rule 1.20.1 {#sec-2-1.20.1 omnilex-key=us-ms-regs-official--title-15--2#1.20.1}

Purpose – CMS currently requires that all acute care hospitals, long term acute care hospitals, inpatient rehabilitation facilities and outpatient dialysis centers participating in the Prospective Payment System (PPS) report specific measures related to HAI’s and infection prevention to CDC via NHSN. CMS currently publishes selected measures on the Hospital Compare website for the previous reporting year. As a mechanism of responding to specific HAI’s exceeding acceptable thresholds, MSDH Department of Epidemiology will use these data to respond to specific outbreaks or aberrant events in collaboration with facilities involved.

Facility-specific data obtained from NHSN by MSDH will be used for epidemiological purposes related to prevention and surveillance and will not be disclosed to third parties by MSDH. MSDH will also assist facilities to improve reporting where deficiencies are identified.

##### **15 Miss. Admin. Code Pt. 2, R. 1.20.2** Rule 1.20.2 {#sec-2-1.20.2 omnilex-key=us-ms-regs-official--title-15--2#1.20.2}

Reporting Required – Any facility, including acute care hospitals, long term acute care hospitals, inpatient rehabilitation facilities and outpatient dialysis centers, required to report to NHSN by CMS shall confer NHSN viewing rights to MSDH. MSDH will not require reporting of additional measures, beyond those required by CMS.

##### **15 Miss. Admin. Code Pt. 2, R. 1.20.3** Time of Reporting – Timeliness of reporting shall be as directed by existing CMS /NHSN reporting requirements {#sec-2-1.20.3 omnilex-key=us-ms-regs-official--title-15--2#1.20.3}

Appendices to the Rules and Regulations Governing Reportable Diseases and Conditions

Appendix A List of Reportable Diseases and Conditions

Appendix A. List of officially reportable diseases and conditions The following diseases or conditions are hereby declared to be reportable.

Class 1A: Diseases of major public health importance which shall be reported directly to the Department of Health by telephone within 24 hours of first knowledge or suspicion. Class 1A diseases and conditions are dictated by requiring an immediate public health response. Laboratory directors have an obligation to report laboratory findings for selected diseases (Refer to Appendix B).

Any Suspected Outbreak (including foodborne and waterborne outbreaks) (Possible biological weapon agents appear in bold italics) Anthrax Pertussis Botulism (includes foodborne, infant or wound) Plague Escherichia coli O157:H7 and any shiga Poliomyelitis toxin-producing E. coli (STEC) Rabies (human or animal) Glanders Ricin intoxication (castor beans) Haemophilus influenzae Invasive Disease †‡ Smallpox Hemolytic Uremic Syndrome- Tuberculosis post-diarrheal (HUS) Viral hemorrhagic fevers (filoviruses Hepatitis A [e.g., Ebola, Marburg] and arena Measles viruses [e.g., Lassa, Machupo]) Neisseria meningitidis Invasive Disease †‡

Any unusual disease or manifestation of illness, including but not limited to the appearance of a novel or previously controlled or eradicated infectious agent, or biological or chemical toxin. † Usually presents as meningitis or septicemia, or less commonly as cellulitis, epiglottitis, osteomyelitis, pericarditis or septic arthritis. ‡ Specimen obtained from a normally sterile site.

Class 1B: Diseases of major public health importance which shall be reported directly to the Department of Health by telephone on the next business day after first knowledge or suspicion. Class 1B diseases and conditions require individual case investigation, but not an immediate public health response. Laboratory directors have an obligation to report laboratory findings for selected diseases (Refer to Appendix B in the Rules and Regulations Governing Reportable Diseases and Conditions) Arboviral infections Respiratory Syncytial Virus (RSV)- Chikungunya virus, Associated Pediatric Mortality Eastern Equine Encephalitis virus, (<18 years of age) Zika virus (including Congenital Zika virus SARS-CoV-2 Associated Mortality in Infection and Congenital Zika Syndrome) Pregnancy

Class 2: Diseases or conditions of public health importance of which individual cases shall be reported by mail, telephone or electronically, within 1 week of diagnosis. In outbreaks or other unusual circumstances they shall be reported the same as Class 1A. Class 2 diseases and conditions are those for which an immediate public health response is not needed for individual cases.

Anaplasmosis Lyme disease Arboviral infection including but not limited to Malaria California group, Meningitis other than Meningococcal or Dengue, Haemophilus influenzae

LaCrosse virus, Mumps St. Louis encephalitis virus, M. tuberculosis Infection (positive TST West Nile virus or positive IGRA*) Western Equine Encephalitis virus Poisonings**(including elevated blood Chlamydia trachomatis, genital infection lead levels***) Creutzfeldt-Jakob Disease, including new variant Rocky Mountain spotted fever Ehrlichiosis Rubella (including congenital) Enterococcus, invasive infection ‡ , vancomycin Spinal Cord Injuries resistant Streptococcus pneumoniae, invasive Gonorrhea infection ‡

Hepatitis (acute, viral only) Tetanus Note-Hepatitis A requires Class 1A Report Trichinosis Hepatitis B infection in pregnancy Typhus Fever HIV Infection in pregnancy Viral Encephalitis in horses and Listeriosis ratities**** ‡ Specimen obtained from a normally sterile site. *TST-tuberculin skin test; IGRA-Interferon-Gamma Release Assay (to include size of TST in millimeters and numerical results of IGRA testing). Brucellosis SARS-CoV-2 Associated Multisystem Chancroid Inflammatory Syndrome in Children Cholera (MIS-C) <21 years of age Diphtheria SARS-CoV-2 Associated Pediatric Encephalitis (human) Mortality (<18 years of age) HIV infection-including AIDS Staphylococcus aureus, Influenza-Associated Pediatric Mortality vancomycin resistant (VRSA) or (<18 years of age) vancomycin intermediate (VISA) Legionellosis Syphilis (including congenital) Melioidosis Tularemia Non-cholera Vibrio disease Typhoid Fever Psittacosis Varicella infection, Primary, in patients Q Fever >15 years of age Yellow Fever

**Reports for poisonings shall be made to Mississippi Poison Control Center, UMMC 1-800- 222-1222 ***Elevated Blood Levels should be reported to the MSDH Lead Program at 601-576-7447. Blood lead levels (venous) ≥3.5μg/dL in patients less than or equal to 6 years of age. ****Except for rabies, and equine encephalitis, diseases occurring in animals are not required to be reported to the MSDH.

Class 3: Laboratory based surveillance. To be reported by laboratory only. Diseases or conditions of public health importance of which individual laboratory findings shall be reported by mail, telephone, or electronically within one week of completion of laboratory test (refer to Appendix B).

All blood lead test results in patients ≤6 years of CD4 count and HIV Viral Load* age Chagas Disease (American trypanosomiasis) Campylobacteriosis Cryptosporidiosis Candida auris Hansen Disease (Leprosy) Carbapenem-resistant Acinetobacter Hepatitis C infection baumannii (CRAB) Hepatitis C RNA results** Carbapenem-resistant Enterobacteriaceae (CRE) Nontuberculous Mycobacterial Disease Carbapenem-resistant Pseudomonas aeruginosa Salmonellosis (CRPA) Shigellosis

*HIV associated CD4 (T4) lymphocyte results of any value and HIV viral load results, both detectable and undetectable **All positive AND negative Hepatitis C RNA results

Class 4: Diseases of public health importance for which immediate reporting is not necessary for surveillance or control efforts. Diseases and conditions in this category shall be reported to the Mississippi Cancer Registry within six months of the date of first contact for the reportable condition.

The National Program of Cancer Registries at the Centers for Disease Control and Prevention requires the collection of certain diseases and conditions. A comprehensive reportable list including ICD9CM/ICD10CM codes is available on the Mississippi Cancer Registry website,

https://www.umc.edu/cancerinstitute/Cancer-Research/Cancer- Registries/Mississippi%20Cancer%20Registry/Resources1/Overview.html.

Each record shall provide a minimum set of data items which meets the uniform standards required by the National Program of Cancer Registries and documented in the North American Association of Central Cancer Registries (NAACCR)

Appendix B Laboratory Results That Must be Reported to the Mississippi State Department of Health

Laboratory Results That Must be Reported to the Mississippi State Department of Health Laboratories shall report these findings to the Mississippi State Department of Health at least WEEKLY. Diseases in bold type Are Class 1A disease and shall be reported immediately by telephone. Isolates of organisms marked with a dagger (†) shall be sent to the Mississippi State Department of Health Public Health Laboratory. All referring laboratories should call the Public Health Laboratory at (601) 576-7582 prior to shipping any isolate. Confirmatory tests for some of these results may be obtained by special arrangement through the Epidemiology Program at (601) 576-7725. Positive Bacterial Cultures or Direct Examinations

Result Reportable Disease Anaplasmosis phagocytophilum Anaplasmosis Any bacterial agent in CSF Bacterial meningitis Bacillus anthracis† Anthrax Bordetella pertussis Pertussis Borrelia burgdorferi† Lyme disease Brucella species† Brucellosis Burkholderia mallei† Glanders Burkholderia pseudomallei† Melioidosis Campylobacter species Campylobacteriosis Carbapenem-resistant Acinetobacter baumannii† Carbapenem-resistant Acinetobacter baumannii (CRAB) Carbapenem-resistant Enterobacteriaceae Carbapenem-resistant Enterobacteriaceae (CRE) Carbapenem-resistant Pseudomonas aeruginosa† Carbapenem-resistant Pseudomonas aeruginosa (CRPA) Chlamydia psittaci Psittacosis Chlamydia trachomatis Chlamydia trachomatis genital infection Clostridium botulinum†** Botulism Clostridium tetani Tetanus Corynebacterium diphtheriae† Diphtheria Coxiella burnetii† Q fever Ehrlichia species Ehrlichiosis Enterococcus species*, vancomycin resistant Enterococcus infection, invasive vancomycin resistant Escherichia coli O157:H7 and any shiga toxin-producing Escherichia coli O157:H7 and any shiga toxin- E. coli (STEC)† producing E. coli (STEC) Francisella tularensis† Tularemia Grimontia hollisae† Noncholera Vibrio disease Haemophilus ducreyi Chancroid Haemophilus influenza †*(not from throat, sputum) Haemophilus influenzae infection, invasive Legionella species Legionellosis Listeria monocytogenes† Listeriosis Mycobacterium species Nontuberculous mycobacterial disease Mycobacterium tuberculosis† Tuberculosis Neisseria gonorrheae Gonorrhea Neisseria meningitidis †* Neisseria meningitidis infection, invasive Photobacterium damselae† Noncholera Vibrio disease Rickettsia prowazekii Typhus fever Rickettsia rickettsia Rocky Mountain spotted fever Salmonella species, not S. typhi† Salmonellosis Salmonella typhi † Typhoid fever Shigella species† Shigellosis Staphylococcus aureus- vancomycin resistant or Staphylococcus aureus vancomycin resistant (VRSA) or vancomycin intermediate resistant vancomycin intermediate (VISA) Streptococcus pneumoniae*†† Streptococcus pneumoniae, invasive infection

Vibrio cholerae 01† Cholera Vibrio species† Noncholera Vibrio disease Yersinia pestis† Plague

† Isolates of organism should be sent to the Mississippi State Department of Health Public Health Laboratory. All referring laboratories should call the Public Health Laboratory at (601) 576-7582 prior to shipping any isolate. †† Isolates should be sent to the Mississippi State Department of Health Public Health Laboratory for specimens obtained from a normally sterile site in patients ≤12 years of age. *Specimen obtained from a normally sterile site (usually blood or cerebrospinal fluid, or, less commonly, joint, pleural, or pericardial fluid). Do not report throat or sputum isolates. **Contact the Mississippi State Department of Health, Epidemiology Program at (601) 576-7725 or the Public Health Laboratory (601) 576-7582 for appropriate tests when considering a diagnosis of botulism.

Positive Serologic Tests Anaplasmosis Arboviral agents including but not limited to those due to: California encephalitis virus (IgM) Chikungunya virus (IgM) Dengue (IgM) Eastern equine encephalitis virus (IgM) LaCrosse virus (IgM) St. Louis encephalitis virus (IgM) Western equine encephalitis virus (IgM) West Nile virus (IgM) Zika virus Brucellosis Chagas Disease (American trypanosomiasis) Cholera Chlamydia trachomatis genital infection Ehrlichiosis (IgM and IgG) Hepatitis A (anti-HAV IgM) Hepatitis B (anti-HBcIgM) Hepatitis B (HBsAg) in pregnancy Hepatitis C HIV infection Legionellosis § (including urine Ag) Lyme disease (IgM and IgG, including Western Blot) Malaria Measles (IgM) Mumps (IgM) M. tuberculosis infection (IGRA) Plague Poliomyelitis Psittacosis Rocky Mountain spotted fever (IgM and IgG) Rubella (IgM) Syphilis

Smallpox Trichinosis Varicella infection, primary in patients > 15 years of age Yellow fever (IgM) § Serologic confirmation of an acute case of legionellosis cannot be based on a single titer. There must be a four-fold rise in titer to >1:128 between acute and convalescent specimens.

Positive Parasitic Cultures or Direct Examinations (including PCR) Result Reportable Disease Condition Any parasite in CSF† Parasitic meningitis Cryptosporidium parvum Cryptosporidiosis Trypanosoma cruzi Chagas disease (American trypanosomiasis) Plasmodium species† Malaria Positive Fungal Cultures or Direct Examinations Result Reportable Disease Condition Any fungus in CSF Fungal meningitis Candida auris† Candida auris Positive Viral Cultures or Direct Examinations (including PCR) Result Reportable Disease Condition Any virus in CSF Viral meningitis Arboviral agents including but not limited to: California encephalitis virus California encephalitis virus Chikungunya virus Chikungunya virus Dengue virus, serotype 1, 2, 3, or 4 Dengue Eastern equine encephalomyelitis virus Eastern equine encephalitis (EEE) virus LaCrosse virus LaCrosse encephalitis virus St. Louis encephalitis virus St. Louis encephalitis (SLE) virus Western equine encephalitis virus Western equine encephalitis (WEE) virus West Nile virus West Nile encephalitis (WNV) virus Zika virus Zika virus Arena viruses Viral hemorrhagic fevers Filoviruses Viral hemorrhagic fevers Hepatitis C RNA (positive and negative Hepatitis C results) Poliovirus, type 1, 2, or 3 Poliomyelitis Varicella virus Varicella in patients > 15 years of age Variola virus Smallpox Yellow fever virus Yellow fever Positive Blood Chemistries ALL blood lead test results in patients less than or equal to 6 years of age are reportable to the MSDH Lead Program at (601) 576-7447. Positive Toxin Identification Ricin toxin from Ricinus communis (castor beans) Shiga toxin (Escherichia coli)

Surgical Pathology Results All parasites Creutzfeldt-Jakob Disease, including new variant Hansen disease (Mycobacterium leprae) Human rabies Malignant Neoplasms Mycobacterial disease including Tuberculosis Trichinosis Acid Fast Bacilli Smears Any smear positive for acid-fast bacillus (Tuberculosis)

**History**
- *Source: Miss.Code Ann. §41-3-17*

### **Part 3** Part 3: Bureau of Acute Care Systems

##### **15 Miss. Admin. Code Pt. 3, R. 5.4.9** Education {#sec-3-5.4.9 omnilex-key=us-ms-regs-official--title-15--3#5.4.9}

1. Level III Trauma Centers must have internal trauma education programs including training in trauma for physicians, mid-level providers, nurses, ancillary staff and pre-hospital providers.

2. Level III Trauma Centers must have a written trauma education plan.

19. Chapter 6 Level IV Trauma Centers Subchapter 1 Hospital Organization Rule 6.1.1. General

1. Level IV Trauma Centers are generally licensed, small, rural facilities with a commitment to the resuscitation of the trauma patient and written transfer protocols in place to assure those patients who require a higher level of care are appropriately transferred. These facilities may be staffed by a physician, or a licensed mid-level practitioner (i.e., physician assistant or nurse practitioner) or Registered Nurse. The major trauma patient will be resuscitated and transferred.

2. This designation does not contemplate that Level IV Trauma Centers will have resources available for emergency surgery for the trauma patient. Specialty coverage may or may not be available, but a well-organized resuscitation team is required.

3. Level IV Trauma Centers may meet the following standards in their own facility or through a formal affiliation with another trauma center.

Rule 6.1.2. Hospital Departments/Divisions/Sections – the Level IV Trauma Center must have the following departments, divisions, or sections: Emergency Medicine

Rule 6.1.3. Trauma Program/Service

1. There must be a written commitment letter from the Board of Directors and the medical staff on behalf of the entire facility which states the facility's commitment to compliance with the Mississippi Trauma System Rules and Regulations. The written commitment shall be in the form of a resolution passed by an appropriate quorum of the members of the governing authority. Should the business organization be other than a corporation, a letter explaining such together with a written commitment of the hospital’s chief executive officer to the establishment of a trauma care program may be sufficient. A trauma program must be established and recognized by the organization.

Compliance with the above will be evidenced by:

a. Board of Director's and medical staff letter of commitment;

b. Written policies, procedures and guidelines for care of the trauma patient;

c. A defined Trauma Team with written roles and responsibilities;

d. Appointed Trauma Medical Director with a written job description;

e. A written Trauma Performance Improvement Plan;

f. Appointed Trauma Program Manager with a written job description;

g. Documentation of Trauma Center representative's attendance at the Trauma Care Region meetings.

Rule 6.1.4. Trauma Medical Director (TMD)

1. The Level IV Trauma Center must have a physician director of the trauma program. In this instance, the physician is responsible for working with all members of the trauma team and overseeing the implementation of a trauma specific performance improvement process for the facility. Through this process, he/she should have overall responsibility for the quality of trauma care rendered at the facility. The director must be given administrative support to implement the requirements specified by the Mississippi Trauma System of Care Plan. The director should assist in the development of standards of care and assure appropriate policies and procedures are in place for the safe resuscitation and transfer of trauma patients. The physician director must have current verification in ATLS. ATLS requirements are waived for Board Certified Emergency Medicine and Board-Certified General Surgery Physicians.

The TMD must have the authority to manage all aspects of trauma care. The TMD authorizes trauma service privileges of the on-call panel, works in cooperation with the nursing administration to support the nursing needs of trauma patients, and develops treatment protocols along with the trauma team in collaboration with the peer review processes. The TMD must perform an annual assessment of the trauma panel providers.

2. Compliance with the above will be evidenced by:

a. Chairing and participating in the multidisciplinary trauma committee where trauma performance improvement is presented and attend a minimum of 50 percent of the committee meetings.

b. Administrative support can be documented in the organizational chart

which depicts the reporting relationship between the trauma program medical director and administration;

c. Trauma specific policies, procedures and guidelines approved by the TMD

Rule 6.1.5. Trauma Program Manager (TPM)

1. The Trauma Center must have a person to act as a liaison to the regional evaluation process to conduct many of the administrative functions required by the trauma program. It is not anticipated that this would be a full-time role. Specifically, this person is responsible, with the TMD, for coordinating optimal patient care for all injured victims. This position will ideally serve as liaison with local EMS personnel, the Trauma Care Region, and other Trauma Centers. The TPM must obtain/maintain TNCC and/or 4 hours of trauma related education per year.

2. Compliance with the above will be evidenced by:

a. Attendance at and participation in the committee where trauma performance improvement is presented;

b. A written job description of roles and responsibilities to the trauma program which include: management of the trauma program, monitoring of clinical activities on trauma patients, providing staff with trauma related education, implementation of trauma specific performance improvement and supervision of the trauma registry;

c. Documentation of collaboration with TMD in the development and implementation of trauma specific policies, procedures and guidelines.

Rule 6.1.6. Trauma Team

1. The team approach is optimal in the care of the multiple injured patients. The Trauma Center must have a written policy for notification and mobilization of an organized trauma team to the extent that one is available. The Trauma Team may vary in size and composition when responding to the trauma activation. The physician leader or mid-level provider on the trauma team is responsible for directing all phases of the resuscitation in compliance with ATLS protocol.

Suggested composition of the trauma team includes, if available:

a. Physicians and/or mid-level providers

b. Laboratory Technicians

c. Nursing

d. Ancillary Support Staff

2. Compliance with the above will be evidenced by:

a. A written resuscitation protocol which adheres to the principles of ATLS;

b. A written trauma team activation criteria policy which includes physiologic, anatomic and mechanism of injury criteria.

Rule 6.1.7. Multidisciplinary Trauma Committee

1. The purpose of the committee is to provide oversight and leadership to the entire trauma program. The exact format will be hospital specific and may be accomplished by collaboration with another designated trauma center in the system. The major focus will be on PI activities, policy development, communication among all team members, development of standards of care, education and outreach programs, and injury prevention. The committee oversees the implementation of the process which includes all program related services, meets regularly, takes attendance, maintains minutes and works to correct overall program deficiencies to optimize patient care.

Membership for the committee includes representatives (if available in the community) from:

a. Emergency Medicine

b. Respiratory Therapy

c. Radiology

d. Laboratory

e. Rehabilitation

f. Pre-hospital Care Providers

g. Administration

h. Nursing

i. Trauma Program Manager

j. Trauma Medical Director (Chairman; must be present ≥ 50%)

2. The clinical managers (or designees) of the departments involved with trauma care should play an active role with the committee.

3. The trauma center may wish to accomplish performance improvement activities in this committee or develop a separate peer review committee. This committee should handle peer review independent from department based review. The committee must meet regularly and maintain attendance and minutes. This committee must report findings to the overall hospital performance improvement program.

20. Subchapter 2 Clinical Components

Rule 6.2.1. Required Components

1. The Trauma Center must maintain published on-call schedules for physicians and/or mid-level providers on-call to the facility.

2. Emergency Medicine (In-house 24 hours/day). Emergency Physician and/or mid- level provider (Physician Assistant/Nurse Practitioner) must be in the specified trauma resuscitation area upon patient arrival.

21. Subchapter 3 Facility Standards

Rule 6.3.1. Emergency Department

1. The facility must have an emergency department staffed so trauma patients are assured immediate and appropriate initial care. There must be a designated physician director. It is not anticipated that a physician will be available on-call to an emergency department in a Level IV Trauma Center; however, it is a desirable characteristic of a Level IV. The on-call practitioner must respond to the emergency department based on local written criteria. A system must be developed to assure early notification of the on-call practitioner. Compliance with this criterion must be documented and monitored by the Trauma Performance Improvement process.

2. All physicians and mid-level providers (Physician Assistant/Nurse Practitioner) on the trauma team responsible for directing the initial resuscitation of the trauma patients must be currently certified in The American College of Surgeons Advanced Trauma Life Support (ATLS). ATLS requirements are waived for Board Certified Emergency Medicine and Board-Certified General Surgery Physicians. Rural Trauma Team Development Course (RTTDC) may be substituted for ATLS at Level IV Trauma Centers.

3. Emergency nurses staffing the trauma resuscitation area must be a current provider in TNCC, ATCN, or RTTDC within the last four years. Nurses must obtain trauma training within 18 months of assignment to the ER. Adequate numbers of nurses must be available in-house 24 hours/day, to meet the need of

the trauma patient. The nurse may perform other patient care activities within the hospital when not needed in the emergency department.

4. Compliance with the above will be evidenced by:

a. Published on-call list of practitioners to the Emergency Department;

b. Documentation of nursing staffing patterns to assure 24-hour coverage.

c. The list of required equipment necessary for the ED can be found online at the Department’s website.

22. Subchapter 4 Clinical Support Services

Rule 6.4.1. General

1. It is not anticipated that Level IV Trauma Centers have any of the following services available 24/7: a. Respiratory Therapy Services

b. Radiology Services

c. Clinical Laboratory Services

d. Hemodialysis: There must be a written protocol to transfer the patient to a facility that provides this service if this service is not available at the Level IV Trauma Center.

2. Should any of these services be available, the facility should make them available to the trauma patient as necessary and within the capabilities of the facility.

Rule 6.4.2. Burn Care: There must be a written protocol to transfer the patient to a Burn Center, if appropriate burn care is not available at the Level IV Trauma Center. Policies and procedures shall be in place to assure the appropriate care is rendered during the initial resuscitation and transfer of the patient.

Rule 6.4.3. Prevention/Public Outreach

1. The Level IV Trauma Center is responsible for working with other trauma centers and the Department to develop education and prevention programs for the public and professional staff.

2. Level IV Trauma Centers shall collaborate with Level I, II and III Trauma

Centers, Burn Centers and Tertiary/Secondary Pediatric Centers for the purpose of systemwide performance improvement.

Rule 6.4.4. Transfer Guidelines

1. All facilities will work together to develop transfer guidelines indicating which patients should be considered for transfer and procedures to ensure the most expedient, safe transfer of the patient. All designated facilities will agree to provide service to the trauma patient regardless of their ability to pay. 2. The following trauma patient treatment guidelines must be in place, at a minimum:

a. Pediatrics

b. Burns

c. Surgical

d. Orthopedics

e. Neurological

3. Once the decision for transfer has been made, it is the responsibility of the referring physician to initiate resuscitation measures within the capabilities of the local hospital. The referring provider shall select a mode of transport according to the patient’s needs so that the level of care is appropriate during transport.

Rule 6.4.5. Level IV Trauma Centers must have an internal trauma education program.

23. Chapter 7 Pediatric Trauma Centers

The hospital resources for adult trauma centers are described in Chapters 3, 4, 5 and 6. The traumatized pediatric patient has special requirements that go beyond the resources required for an adult Trauma Center.

All adult trauma centers in Mississippi are required to function at one of the three levels of pediatric trauma care. An adult Trauma Center does not have to function at the same or similar levels but must function at some level of pediatric trauma care. The three levels of pediatric trauma care include: tertiary, secondary, and primary.

24. Subchapter 1 Tertiary Pediatric Trauma Centers

Rule 7.1.1. General

1. Tertiary Pediatric Trauma Centers shall act as regional tertiary care facilities at the hub of the trauma care system for injured pediatric patients. The facility shall have the ability to provide leadership and total care for every aspect of injury from prevention to rehabilitation. The Tertiary Pediatric Trauma Center must have adequate depth of resources and personnel.

2. A standalone pediatric trauma center provides tertiary pediatric trauma care without sharing resources with another facility (i.e., CT scanner, radiology, surgeons, etc.). Only Level I Trauma Centers and standalone pediatric hospitals may qualify as a Tertiary Pediatric Trauma Center. 3. Tertiary Pediatric Trauma Centers have the responsibility of providing leadership in pediatric trauma education, trauma prevention, pediatric trauma research, system planning and performance improvement.

4. The list of required equipment for Tertiary Pediatric Trauma Centers can be found online at the Department’s website.

Rule 7.1.2. Hospital Departments/Divisions/Sections

1. The Tertiary Pediatric Trauma Center must have the following department, divisions, or sections:

a. Emergency medicine

b. General surgery (not required for stand-alone Pediatric Trauma Center)

c. Pediatric surgery

d. Orthopedic surgery

e. Neurological surgery

f. Anesthesia

Rule 7.1.3. Pediatric Trauma Program

1. There must be a written commitment on behalf of the entire facility to the organization of pediatric trauma care. The written commitment shall be in the form of a resolution passed by an appropriate quorum of the members of the governing authority. Should the business organization be other than a

corporation, a letter explaining such together with a written commitment of the hospital’s chief executive officer to the establishment of a pediatric trauma care program is sufficient. The pediatric trauma program must be established and recognized by the medical staff and hospital administration. The pediatric trauma program must come under the direction of a board-certified in General Surgery or Pediatric Surgery in Tertiary Center, current or previous board-certification in General or Pediatric Surgery in Primary and Secondary Centers with special interest in pediatric trauma care. An identified hospital administrative leader must work closely with the pediatric trauma medical director to establish and maintain the components of the pediatric trauma program including appropriate financial support. The pediatric trauma program location in the organizational structure of the hospital must be under the overall adult trauma program and must be such that it may interact effectively with at least equal authority with other departments providing pediatric patient care. The administrative structure must minimally include an administrator, pediatric medical director, trauma program manager, trauma registrar, and the appropriate support staff. These resources must be captured under the organization of the adult trauma program. The pediatric trauma program must be multidisciplinary in nature and the performance improvement evaluation of this care must be extended to all the involved departments.

2. Compliance with the above will be evidenced by but not confined to:

a. Governing authority and medical staff letter of commitment in the form of a resolution;

b. Written policies and procedures and guidelines for care of the pediatric trauma patient;

c. Defined pediatric trauma team and written roles and responsibilities;

d. Appointed pediatric trauma medical director with a written job description;

e. Appointed pediatric trauma program manager with a written job description;

f. A written pediatric trauma performance improvement plan;

g. Documentation of representative attendance at statewide performance improvement meetings.

Rule 7.1.4. Pediatric Trauma Service: The pediatric trauma service must be established and recognized by the medical staff and be responsible for the overall coordination and management of the system of care rendered to the injured pediatric patient. The pediatric trauma service will vary in each institution depending on the needs of the pediatric patient and the resources available. The pediatric trauma service

must come under the organization of the adult trauma program (not required for a standalone facility) and direction of a surgeon who is board certified (Tertiary Pediatric Trauma Center, current or previous board certified). All pediatric patients with multiple system trauma or serious injury must be evaluated and/or admitted by the pediatric trauma service. The surgeon responsible for the overall care of the pediatric patient must be identified.

Rule 7.1.5. Pediatric Trauma Medical Director (TMD): Tertiary pediatric Trauma Centers must have a physician director Board Certified in General Surgery or Pediatric Surgery of the pediatric trauma program. This role can be filled by the TMD of the adult Trauma Center. The pediatric TMD plays an important administrative role and may not direct more than one pediatric Trauma Center. The pediatric TMD will be responsible for developing a performance improvement process and will have overall accountability and administrative authority for the pediatric trauma program. The pediatric TMD must be given administrative support to implement the requirements specified by the State trauma plan. The pediatric TMD is responsible for working with the credentialing process of the hospital, and in consultation with the appropriate service chiefs, for recommending appointment and removal of physicians from the pediatric trauma team. He/she must cooperate with nursing administration to support the nursing needs of the pediatric trauma patient and develop treatment protocols for the pediatric trauma patient. The pediatric trauma medical director, in collaboration with the trauma program manager, must coordinate the budgetary process for the trauma program. The director must be currently certified in ATLS, maintain personal involvement in care of the injured pediatric patient, maintain education in pediatric trauma care, and maintain involvement in professional organizations. The pediatric TMD must be actively involved with the trauma system development at the community, regional, and state levels. The TMD must perform an annual assessment of the general surgeons, pediatric surgeons, and mid-level providers assigned to the pediatric trauma service using a formal documented process.

Rule 7.1.6. Pediatric Trauma Program Manager

1. Tertiary pediatric Trauma Centers must have a registered nurse working in the role of the TPM. The TPM of the adult Trauma Center may assume this additional role; however, if a pediatric TPM is utilized, the pediatric TPM is to report and be held accountable by the adult TPM. Working in conjunction with the pediatric trauma medical director, the pediatric TPM is responsible for organization of the pediatric trauma program and all systems necessary for the multidisciplinary approach throughout the continuum of trauma care. The pediatric TPM is responsible for working with the pediatric trauma team to assure optimal patient care. There are many requirements for data coordination, PI, education, and prevention activities incumbent upon this position. The TPM must obtain 16 hours of trauma related education per year.

2. The pediatric TPM/designee must offer or coordinate services for pediatric trauma education. The pediatric TPM must liaison with local EMS personnel, the Department and other trauma centers.

Rule 7.1.7. Pediatric Trauma Team: The team approach is optimal in the care of the multiple injured pediatric patient. There must be identified members of the pediatric trauma team. Policies must be in place describing the respective role of all personnel on the pediatric trauma team. The composition of the pediatric trauma

team will depend on the characteristics of the hospital and its staff. All physicians and/or mid-level providers (physician assistant/nurse practitioner) on the pediatric trauma team responsible for directing the initial resuscitation of the pediatric trauma patient must be certified in Advanced Trauma Life Support (ATLS). ATLS requirement is waived for Board Certified Emergency Medicine, Board Certified General Surgery and Board-Certified Pediatric Surgery physicians.

Composition of the trauma team for a severely injured patient includes:

1. ED physician and/or mid-level providers (Physician Assistant/Nurse Practitioner)

2. General/Pediatric surgeon

3. Nurses: ED

4. Laboratory Technicians

5. Radiology Services

6. Respiratory Therapist

Rule 7.1.8. Multidisciplinary Trauma Committee

1. The purpose of the committee is to provide oversight and leadership to the entire trauma program including the pediatric trauma program. The exact format will be hospital specific and may be accomplished by collaboration with another designated Trauma Center in the region. Each Trauma Center may choose to have one or more committees as needed to accomplish this task. One committee must be multidisciplinary and focus on pediatric trauma program oversight and leadership. The major focus will be on performance improvement (PI) activities, pediatric trauma policy development, communication among all pediatric trauma team members, and establishment of pediatric trauma standards of care, education, and outreach programs for pediatric injury prevention. The committee has administrative and systematic control and oversees implementation of all pediatric trauma program services, meets regularly, takes attendance, maintains minutes, and works to correct overall pediatric trauma program deficiencies to optimize pediatric patient care. Membership for the committee includes representatives from:

a. TMD (Chairman, must be present greater than 50% of the meetings)

b. Pediatric Emergency Medicine

c. Pediatric Surgery

d. Pediatric Orthopedics

e. Pediatric Neurosurgery

f. Anesthesia

g. Operating room

h. Intensive care

i. Respiratory Therapy

j. Radiology

k. Laboratory

l. Pediatric Rehabilitation

m. Pre-hospital care providers

n. Administration

o. Pediatrics

p. Nursing

q. Trauma Program Manager

2. Clinical managers (or designees) of the departments involved with pediatric trauma care must play an active role with the committee.

3. The pediatric trauma center may wish to accomplish PI activities in this committee or develop a separate peer review committee. This committee must handle peer review independent from departmental based review. This committee must meet regularly, maintain attendance, and maintain minutes. This committee must report findings to the overall multidisciplinary trauma committee and hospital performance improvement program.

Rule 7.1.9. Required Clinical Components

1. Tertiary pediatric Trauma Centers must maintain published call schedules and have the following physician coverage immediately available 24 hours/day:

2. Pediatric Emergency Medicine (in-house 24 hours/day). Emergency Physician and/or mid-level provider (physician assistant/nurse practitioner) must be in the specified trauma resuscitation area upon patient arrival.

3. Trauma/General/Pediatric Surgery (in-house 24 hours/day). The surgeon covering pediatric trauma call must be unencumbered and immediately available to respond to the pediatric trauma patient. The 24-hour-in-house availability of the attending surgeon is the most direct method for providing this involvement. A PGY 4 or 5 resident may be approved to begin the resuscitation while awaiting the arrival of the attending surgeon but cannot be considered a replacement for the attending surgeon in the ED. The surgeon is expected to be in the ED upon arrival of the seriously injured pediatric patient. The surgeon’s participation in major therapeutic decisions, presence in the ED for major resuscitation, and presence at operative procedures is mandatory. There must be a back-up surgeon schedule published. A system must be developed to assure early notification of the on-call surgeon and compliance with these criteria and their appropriateness must be documented and monitored by the PI process. Response time for Alpha Activations is 15 minutes and starts at patient arrival or EMS notification, whichever is shorter. Response time for Bravo Activations is 20 minutes from patient arrival.

4. Orthopedic Surgery. It is required to have the orthopedic surgeon dedicated to the pediatric Trauma Center solely while on-call, but if not dedicated, a published back-up call schedule must be available. Response time for all trauma activations is 60 minutes from the time notified to respond.

5. Neurological Surgery. The neurosurgeons on the pediatric trauma team must be board certified. The pediatric neurosurgeon liaison to the pediatric trauma team must attend a minimum of 50% of the peer review committees annually and participate in the multidisciplinary trauma committee. It is required to have the neurosurgeon dedicated to the pediatric trauma center solely while on-call, but if not dedicated, a published back-up call schedule must be available. Response time for all trauma activations is 30 minutes from the time notified to respond.

6. It is desirable the following specialists are promptly available 24 hours/day:

a. Cardiac Surgery

b. Cardiology

c. Critical Care Medicine

d. Hand Surgery

e. Infectious Disease

f. Microvascular Surgery

g. Nephrology

h. Nutritional support

i. Obstetrics/Gynecologic Surgery

j. Ophthalmic Surgery

k. Oral/Maxillofacial

l. Pediatrics

m. Pediatric Critical Care Medicine

n. Pediatric Rehabilitation

o. Plastic Surgery

p. Pulmonary Medicine

q. Radiology

r. Thoracic Surgery*

s. Child Life or Family Support Programs

* The trauma surgeon is presumed to be qualified and have privileges to provide emergency thoracic surgical care to pediatric patients with thoracic injuries. If this is not the case, the facility must have a board- certified thoracic surgeon available for the injured pediatric patient (within 30 minutes of the time notified to respond).

7. Policies and procedures must exist to notify the transferring hospital of the patient’s condition.

Rule 7.1.10. Qualifications of Surgeons on the Trauma Team

1. Basic qualifications for pediatric trauma care for any surgeon is Board Certification in a surgical specialty recognized by the American Board of Medical Specialties, the Advisory Board of Osteopathic Specialties, the Royal College of Physicians, the American Dental Association and Surgeons of Canada, or other appropriate foreign board. Many boards require a practice period. Such an individual may be included when recognition by major professional organizations has been received in their specialty. The board certification criteria apply to the general surgeons, orthopedic surgeons, and neurosurgeons.

2. Alternate criteria in lieu of board certification are as follows:

a. A non-board-certified general surgeon must have completed a surgical residency program.

b. He/she must be licensed to practice medicine.

c. He/she must be approved by the hospital’s credentialing committee for surgical privileges.

d. The surgeon must meet all criteria established by the pediatric trauma medical director to serve on the pediatric trauma team.

e. The surgeon’s experience in caring for the pediatric trauma patient must be tracked by the trauma PI program.

f. The pediatric trauma medical director must attest to the surgeon’s experience and quality as part of the recurring granting of pediatric trauma team privileges.

g. The pediatric trauma medical director using the trauma PI program is responsible for determining each general surgeon’s ability to participate on the pediatric trauma team.

3. The surgeon is expected to serve as the captain of the resuscitating team and is expected to be in the emergency department upon arrival of the seriously injured pediatric patient to make key decisions about the management of the pediatric trauma patient’s care. The surgeon will coordinate all aspects of treatment, including resuscitation, operation, critical care, recuperation, and rehabilitation (as appropriate in a tertiary pediatric trauma center), and determine if the patient needs transport to a higher level of care. If transport is required, he/she is accountable for coordination of the process with the receiving physician at the receiving facility. If the patient is to be admitted to the tertiary pediatric Trauma Center, the surgeon is the admitting physician and will coordinate the patient care while hospitalized. Guidelines must be written at the local level to determine which types of patient should be admitted to the tertiary pediatric Trauma Center or which patients should be considered for transfer to a higher level of care. General surgeons/pediatric surgeons taking trauma call must have eight (8) hours of trauma specific continuing medical education (CME) over three years. This can be met within the 40-hour requirements by licensure.

4. The pediatric surgeon liaison and general surgeon liaison (not required for stand- alone pediatric Trauma Center) must participate in a multidisciplinary trauma committee, the PI process; maintain committee attendance at least fifty percent (50%) over a year’s period of time.

Rule 7.1.11. Qualifications of Emergency Physicians

1. For those physicians providing emergency medicine coverage, board certification in Emergency Medicine or General/Pediatric Surgery is required or current certification in ATLS.

2. Alternate criteria for the non-boarded physician working in the Emergency Department are as follows:

a. He/she must be licensed to practice medicine.

b. He/she must be approved by the hospital’s credentialing committee for emergency medicine privileges.

c. The physicians meet all criteria established by the pediatric trauma and emergency medicine directors to serve on the pediatric trauma team.

d. The physician’s experience in caring for the pediatric trauma patient must be tracked by the trauma PI program.

e. The pediatric trauma and emergency medicine directors must attend to the physician’s experience and quality as part of the recurring granting of pediatric trauma team privileges.

f. ATLS must be obtained within 18 months of hire.

3. The emergency medicine liaison must participate in a multidisciplinary trauma committee, the PI process; maintain committee attendance at least fifty percent (50%) over a year’s period of time. General/Pediatric Surgery and Emergency physicians must be currently certified in ATLS (ATLS requirements are waived for Board Certified Emergency Medicine and Board Certified General / Pediatric Surgery physicians), and it is required they be involved in at least eight (8) hours of trauma related CME every 3 years.

Rule 7.1.12. Facility Standards: Emergency Medicine

1. The facility must have a dedicated pediatric emergency department so pediatric patients are assured immediate and appropriate initial care. The emergency physician must be in-house 24 hours/day and immediately available at all times. The emergency department medical director must meet the recommended requirements related to commitment, experience, continuing education, ongoing credentialing, and board certification in emergency medicine.

2. The director of the emergency department, along with the pediatric trauma medical director, will establish trauma-specific credentials that must exceed those that are required for general hospital privileges. Examples of credentialing requirements would include skill proficiency, training requirements, conference attendance, education requirements, ATLS verification, and specialty board certification.

3. The emergency medicine physician will be responsible for activating the pediatric trauma team based on predetermined response protocols. He will provide trauma leadership and care for the pediatric trauma patient until the arrival of the surgeon in the resuscitation area. The emergency department must have established

standards and procedures to ensure immediate and appropriate care for the pediatric trauma patient. The emergency department medical director, or his/her designee, must act as a liaison and participate with the multidisciplinary trauma committee and the trauma PI process.

4. There shall be an adequate number of RN’s staffing the trauma resuscitation area in-house 24 hours/day. Emergency nurses staffing the trauma resuscitation area must be a current provider of Trauma Nurse Core Curriculum (TNCC) or Advanced Trauma Care for Nurses (ATCN) and participate in the ongoing PI process of the trauma program. Nurses must obtain TNCC or ATCN within 18 months of assignment to the ER.

5. The list of required equipment necessary for the ED can be found online at the Department’s website.

Rule 7.1.13. Facility Standards: Surgical Suites/Anesthesia

1. The operating room (OR) must be staffed and available in-house 24 hours/day.

2. An operating room must be adequately staffed and available within 30 minutes of time of notification. Availability of the operating room personnel and timeliness of starting operations must be continuously evaluated by the trauma performance improvement process, and measures must be implemented to ensure optimal care.

3. The OR nurses must participate in the care of the pediatric trauma patient and be competent in the surgical stabilization of the major pediatric trauma patient. The Surgical nurses are an integral member of the trauma team and must participate in the ongoing PI process of the pediatric trauma program and be represented on the Multidisciplinary Trauma Committee.

4. The OR supervisor must be able to demonstrate a prioritization scheme to assure the availability of an operating room for the emergency pediatric patient during a busy operative schedule. There must be an on-call system for additional personnel for multiple patient admissions.

5. The anesthesia department in a tertiary pediatric Trauma Center must be organized and run by an anesthesiologist who has a special interest in the care of the injured pediatric patient. Anesthesiologist on the pediatric trauma team must have successfully completed an anesthesia residency program approved by the Accreditation Council of Graduate Medical Education or the American Board of Osteopathic Specialists and have board certification in anesthesia. One anesthesiologist must maintain commitment to education in trauma related anesthesia.

6. Anesthesia must be available in-house 24hours/day. Anesthesia Chief Residents or Certified Registered Nurse Anesthetist (CRNAs) who are capable of assessing

emergency situations in pediatric trauma patient and of providing indicated treatment, including initiation of surgical anesthesia may fill this requirement. When the CRNA or chief resident is used to meet this requirement, the staff Anesthesiologist on-call will be available within 30 minutes, and present for all operations.

7. Hospital policy must be established to determine when the anesthesiologist must be immediately available for airway control and assisting with resuscitation. The availability of the anesthesiologist and the absence of delays in airway control or operative anesthesia must be documented and monitored by the PI process. The maximum response time for all trauma patients is 30 minutes from the time notified to respond.

8. The list of required equipment necessary for Surgery and Anesthesia can be found online at the department’s website.

Rule 7.1.14. Facility Standards: PACU

1. Tertiary pediatric Trauma Centers must have a PACU staffed 24 hours/day and available to the postoperative pediatric trauma patient. Frequently it is advantageous to bypass the PACU and directly admit to the PICU. In this instance, the Pediatric ICU may meet these requirements.

2. PACU staffing must be in sufficient number to meet the critical needs of the pediatric trauma patient.

3. The list of required equipment necessary for PACU can be found online at the Department’s website.

Rule 7.1.15. Facility Standards: Pediatric ICU (PICU)

1. Tertiary pediatric Trauma Centers must have a PICU that meets the needs of the pediatric trauma patient.

2. The surgical director or co-director must be the TMD or general/pediatric surgeon taking trauma call. The director is responsible for the quality of care and administration of the PICU and will set policy and establish standards of care to meet the unique needs of the pediatric trauma patient.

3. The pediatric trauma surgeon assumes and maintains responsibility for the care of the serious or multiple injured pediatric patient. A surgically directed PICU physician team is essential. The team will provide in-house physician coverage for all PICU pediatric trauma patients at all times. This service can be staffed by appropriately trained physicians from different specialists, but must be led by a

qualified surgeon consistent with the medical staff privileging process of the institution. The pediatric trauma surgeon must maintain control over all aspects of care, including but not limited to respiratory care and management of the mechanical ventilation; placement and use of pulmonary catheters; management of fluid and electrolytes, antimicrobials, and enteral and parenteral nutrition.

4. There must be in-house physician coverage for the PICU at all times. A physician credentialed by the facility must be available to the pediatric trauma patient in the PICU 24 hours/day. This coverage is for emergencies only and is not intended to replace the primary surgeon but rather is intended to ensure that the patient’s immediate needs are met while the surgeon is contacted.

5. Tertiary Pediatric Trauma Centers must provide staffing in sufficient numbers to meet the critical needs of the pediatric trauma patient. Critical care nurses must be available 24 hours per day. PICU nurses are an integral part of the pediatric trauma team and as such, shall be represented on the multidisciplinary trauma committee and participate in the PI process of the trauma program at least 50% of the time.

6. The list of required equipment necessary for the PICU can be found online at the Department’s website.

Rule 7.1.16. Clinical Support Services: Respiratory Therapy

1. The service must be staffed with qualified personnel in-house 24 hours/day to provide the necessary treatment for the injured pediatric patient.

Rule 7.1.17. Clinical Support Services: Radiological Services

1. A radiological service must have a certified radiological technician in-house 24 hours/day and immediately available at all times for general radiological procedures. A technician must be in-house and immediately available for computerized tomography (CT) for both head and body.

2. Sonography, angiography and MRI must be available to the trauma team and may be covered with a technician on call.

3. The radiology liaison must attend at least 50% of the committee meetings and should educate and guide the entire trauma team in the appropriate use of radiologic services.

4. A staff radiologist must be promptly available, when requested, for the interpretation of radiographs, performance of complex imaging studies or interventional procedures. The radiologist must ensure the preliminary

interpretations are promptly reported to the pediatric trauma team and the trauma PI program must monitor all changes in interpretations.

5. Written policy must exist delineating the prioritization/availability of the CT scanner for pediatric trauma patients.

6. The Trauma Center must have policies designated to ensure the trauma patients who may require resuscitation and monitoring are accompanied by appropriate trauma providers during transportation to, and while in the radiology department.

Rule 7.1.18. Clinical Support Services: Laboratory Services

1. Clinical laboratory service must have the following services available in-house 24 hours/day:

a. Access to blood bank and adequate storage facilities. Sufficient quantities of blood and blood products must be maintained at all times. Blood typing and crossmatch capabilities must be readily available.

b. Standard analysis of blood, urine and other body fluids including micro- sampling when appropriate.

c. Blood gas and pH determinations (this function may be performed by services other than the clinical laboratory service, when applicable).

d. Alcohol and drug screening

e. Coagulation studies

f. Microbiology

2. Trauma Centers of all levels must have a massive blood transfusion protocol developed collaboratively between the trauma service and blood bank.

Rule 7.1.19. Clinical Support Services: Acute Hemodialysis

1. Tertiary pediatric Trauma Centers must have Acute Hemodialysis services.

Rule 7.1.20. Clinical Support Services: Burn Care

1. There must be a written protocol to transfer the patient to a Burn Center, if appropriate burn care is not available at the tertiary pediatric Trauma Center.

Policies and procedures shall be in place to assure the appropriate care is rendered during the initial resuscitation and transfer of the patient.

Rule 7.1.21. Clinical Support Services: Rehabilitation/Social Services

1. Recognizing that early rehabilitation is imperative for the trauma patient, a physical medicine and rehabilitation specialist must be available for the trauma program.

2. The rehabilitation of the pediatric trauma patient and the continued support of the family members are an important part of the trauma system. Each facility will be required to address a plan for integration of rehabilitation into the acute and primary care of the pediatric trauma patient, at the earliest stage possible after admission to the Tertiary Pediatric Trauma Center. Hospitals will be required to identify a mechanism to initiate rehabilitation services and/or consultation in a timely manner as well as policies regarding coordination of the multidisciplinary rehabilitation team. The rehabilitation services must minimally include:

a. Occupational Therapy b. Physical Therapy c. Speech Pathology d. Social Work, e. Psychological f. Nutritional support

Rule 7.1.22. Clinical Support Services: Prevention/Public Outreach

1. Tertiary pediatric Trauma Centers will be responsible for taking a lead role in coordination of appropriate agencies, professional groups, and hospitals in their region to develop a strategic plan for public awareness. This plan must take into consideration public awareness of the trauma system, access to the system, public support for the system, as well as specific prevention strategies. Prevention program must be specific to the needs of the region. A Tertiary Pediatric Trauma Center’s prevention program must include and track partnerships with other community organizations. At a minimum, trauma registry data must be utilized to identify injury trends and focus prevention needs.

2. Outreach is the act of providing resources to individuals and institutions that do not have the opportunities to maintain current knowledge and skills. Staff members at the Tertiary Pediatric Trauma Center must provide consultation to staff members of other level facilities. For example, ATLS, Pre-Hospital Trauma Life Support (PHTLS), TNCC, and Transport Nurse Advance Trauma Course (TNATC) courses can be coordinated by the tertiary pediatric Trauma Center.

Rule 7.1.23. Clinical Support Services: Transfer Guidelines

1. Tertiary pediatric Trauma Centers shall work in collaboration with the referral facilities in the system and develop inter-facility transfer guidelines. These guidelines must address criteria to identify high-risk pediatric trauma patients that could benefit from a higher level of trauma care. All designated facilities will agree to provide services to the pediatric trauma patient regardless of his/her ability to pay.

Rule 7.1.24. Clinical Support Services: Education

1. Tertiary Pediatric Trauma Centers must have a written trauma education plan.

2. Tertiary Pediatric Trauma Centers must have internal trauma education programs including educational training in pediatric trauma for physicians, nurses, and pre-hospital providers. The Tertiary Pediatric Trauma Center must take a leadership role in providing educational activities. Education can be accomplished via many mechanisms (i.e., classic CME, preceptorships, fellowships, clinical rotations, telecommunications or providing locum tenens, etc.).

3. The Tertiary Pediatric Trauma Center is expected to support a pediatric surgical residency program. Additionally, there should be a senior resident rotation in at least one of the following disciplines: emergency medicine, general surgery, orthopedic surgery, neurosurgery or support a trauma fellowship.

Rule 7.1.25. Clinical Support Services: Research

1. The trauma research program must be designated to produce new knowledge applicable to the care of the injured patients. The research may be conducted in a number of ways including traditional laboratory and clinical research, reviews of clinical series, and epidemiological or other studies. Publications of articles in peer-review journals as well as presentations of results in local, regional, and national meetings and ongoing studies approved by human and animal research review boards are expected from productive programs. The program should have an organized structure that fosters and monitors ongoing productivity.

2. The research program must be balanced to reflect the number of different interests. There must be a research committee, and identifiable Institutional Review Board process, active research protocols, surgeons involved in extramural educational presentations and adequate number of peer reviewed scientific

publications. Publications should appear in peer-reviewed journals. In a three- year cycle, the suggested minimum activity is ten publications (per review cycle) from the physicians representing the membership of the trauma team.

25. Subchapter 2 Secondary Pediatric Trauma Center

Rule 7.2.1. General

1. A Secondary Pediatric Trauma Center is an acute care facility with the commitment, medical staff, personnel and specialty training necessary to provide care of the pediatric trauma patient. The decision to transfer a pediatric patient rest with the physician attending the pediatric trauma patient. All Secondary Pediatric Trauma Centers will work collaboratively with other trauma facilities to develop transfer protocols and a well-defined transfer sequence.

2. As a minimum, only Level III or higher adult trauma centers may qualify as a Secondary Pediatric Trauma Center.

3. Surgeons and ED physicians must be credentialed by the hospital for pediatric trauma care.

4. The list of required equipment for Secondary Pediatric Trauma Centers can be found on-line at the Department’s website.

26. Subchapter 3 Primary Pediatric Trauma Center

Rule 7.3.1. General

1. Primary Pediatric Trauma Centers are facilities with a commitment to the initial resuscitation of the pediatric trauma patient and have written transfer protocols in place to assure those patients who require a higher level of care are appropriately transferred.

2. All designated trauma centers shall, as a minimum, be designated as a Primary Pediatric Trauma Center as a condition of designation in the Mississippi Trauma System.

3. The list of required equipment for Primary Pediatric Trauma Centers can be found online at the department’s website.

27. Chapter 8 Burn Centers Subchapter 1 Hospital Organization Rule 8.1.1. General

1. The burn center must be an acute care facility licensed in Mississippi or associated with a designated Level I Trauma Center in the MS Trauma System. The burn center must have a medical and an administrative commitment to the care of patients with burns. There must be a written commitment on behalf of the entire facility to the organization of burn care. The written commitment shall be in the form of a resolution passed by an appropriate quorum of the members of the governing authority. The burn center must have written guidelines for the triage, treatment, and transfer of burned patients from other facilities. The burn center must maintain an organizational chart relating personnel within the burn center and the hospital. The burn center must maintain current accreditation by the Joint Commission (TJC) or other recognized accrediting organization(s). The list of required equipment for burn centers can be found online at the Department’s website.

Rule 8.1.2. Burn Program

1. The burn center hospital must formally establish and maintain an organized burn program that is responsible for coordinating the care of burned patients. Compliance will be evidenced by, but not limited to:

a. Governing authority and medical staff letter of commitment in the form of a resolution;

b. Written policies and procedures and guidelines for care of the burn patient;

c. Defined burn team and written roles and responsibilities;

d. Appointed Burn Center Medical Director with a written job description;

e. Appointed Burn Center Program Manager with a written job description;

f. A written Burn Center Performance Improvement plan;

g. Documentation of representative attendance at statewide performance improvement meetings.

Rule 8.1.3. Burn Center Director

1. The burn center director must be a surgeon with board certification by the American Board of Surgery or American Board of Plastic Surgery; certification of special qualifications in surgical critical care is desirable. The burn center director must have completed a one-year fellowship in burn treatment or must have experience in the care of patients with acute burn injuries for two or more years during the previous five years. The burn center director must participate in continuing medical education in burn treatment (48 hours of burn/trauma related CME in a 3-year period) and must demonstrate ongoing involvement in burn- related research and community education in burn care and/or prevention.

2. Responsibilities of the burn center director must include, but not be limited to, the following:

a. Creation of policies and procedures within the burn center that specify the care of burned patients;

b. Creation of policies and protocols for use throughout the burn care system for referral care, triage, and transport of burn patients;

c. Communications on a regular basis with physicians and other authorities about patients who have been refused;

d. Direction of the burn center administrative functions, including approval of medical staff credentialing;

e. Direction and active participation in the burn center performance improvement program;

f. Liaison with adjacent and regional burn centers; and

g. Development and participation in internal and external continuing medical education programs in the care and prevention of burn injuries.

Rule 8.1.4. Burn Program Manager (BPM)

1. Burn Centers must have a registered nurse, with two (2) or more years of experience as a nurse in a burn center, working full time in the role of Burn Program Manager (BPM), who is administratively responsible for the burn center. The BPM must have at least two (2) years or more of experience in acute burn care and six (6) months or more managerial experience. Working in conjunction with the Burn Center Director, the BPM is responsible for organization of the program and all systems necessary for the multidisciplinary approach throughout the continuum of

burn care. The BPM is responsible for working with the burn team to assure optimal patient care. There are many requirements for data coordination and performance improvement, education and prevention activities incumbent upon this position.

2. The BPM or his/her designee should offer or coordinate services for burn education. The BPM should liaison with local EMS personnel, the Department, trauma centers and other burn centers.

3. The BPM must participate in 16 or more hours of burn-related education (can be met by attendance at the annual meetings of the American Association for the Surgery of Trauma, ABA, or any ABA-endorsed meetings or continuing education programs, such as ABLS or ABLS Now) each year or 48 hours in a three-year period.

4. There must be an organizational chart relating the nurse manager to the burn service and other members of the burn team.

Rule 8.1.5. Burn Team – the team approach is optimal in the care of the multiple injured patient. There must be identified members of the burn team. Policies should be in place describing the respective role of all personnel on the team. The composition of the team in any hospital will depend on the characteristics of the hospital and its staff. In some instances, a tiered response may be appropriate. If a tiered response is employed, written policy must be in place and the system monitored by the PI process. Composition of the burn team for an injured patient shall include:

1. Emergency Physicians and/or mid-level providers (physician assistant/nurse practitioner)

2. General/Trauma Surgeon

3. Physician Specialists

4. Anesthesiologist

5. Laboratory Technicians as dictated by clinical needs

6. Nursing: ED, OR, ICU, etc.

7. Auxiliary Support Staff

8. Respiratory Therapist

9. Security Officers

Rule 8.1.6. Multidisciplinary Burn Care Committee

1. The purpose of the committee is to provide oversight and leadership to the entire burn program. The exact format will be hospital specific and may be accomplished by collaboration with another designated burn center. Each burn center may choose to have one or more committees as needed to accomplish the task. One committee should be multidisciplinary and focus on program oversight and leadership. The major focus will be on PI activities, policy development, communication among all team members, and establishment of standards of care, and education and outreach programs for injury prevention. The committee has administrative and systematic control and oversees implementation of all program related services, meets regularly, takes attendance, maintains minutes and works to correct overall program deficiencies to optimize patient care. Attendance from the list below must be at least 50% or greater and reported at least quarterly. Membership for the committee should include representatives from:

a. Administration

b. Operating Room

c. Anesthesia

d. Burn and/or Plastic Surgery

e. Burn Emergency/Emergency Medicine

f. Pre-hospital providers

g. Intensive Care

h. Radiology

i. Laboratory

j. Rehabilitation

k. Respiratory Therapy

l. Nursing

m. Burn Program Manager/BPM

2. The clinical managers (or designees) of the departments involved with burn care should play an active role with the committee.

3. The burn center may wish to accomplish performance improvement activities in this committee or develop a separate peer review committee. This committee

should handle peer review independent from department based review. The committee must meet regularly and maintain attendance and minutes. This committee must report findings to the overall hospital performance improvement program.

Rule 8.1.7. Policies and Procedures – the burn center must maintain an appropriate policy and procedure manual that is reviewed annually by the burn center director and the Burn Program Manager. The policy and procedure manual must contain, at a minimum, the following policies addressing the following:

1. Administration of the burn center.

2. Staffing of the burn center.

3. Criteria for admission to the burn center by the burn service.

4. Use of burn center beds by other medical or surgical services.

5. Criteria for discharge and follow-up care.

6. Availability of beds and the transfer of burn patients to other medical or surgical units within the hospital.

7. Care of patients with burns in areas of the burn center hospital other than the burn center.

Rule 8.1.8. Personnel

1. The burn center must be granted the necessary authority to direct and coordinate all services for patients admitted to the burn service. The burn center director must make sure that medical care conforms to the burn center protocols. Privileges for physicians participating in the burn service must be determined by the medical staff credentialing process and approved by the burn center director. Qualifications for surgeons who are responsible for the care of burned patients must conform to criteria documenting appropriate training, patient care experience, continuing medical education, and commitment to teaching and research in the care of burned patients.

28. Subchapter 2 Clinical Components

Rule 8.2.1. Trauma Evaluation

1. Patients with burns and trauma must be evaluated and/or stabilized at a trauma center before transfer to a burn center. Physician judgment will be necessary in such situations and should be in concert with the regional medical control plan and triage protocols.

Rule 8.2.2. Burn Service Coverage

1. The burn service must maintain an on-call schedule for attending staff surgeons who are assigned to the burn service. The staff surgeons must be promptly available on a 24-hour basis. Patients with >20%TBSA 2 nd

or 3 rd degree burns and any patient with signs of airway injury must be seen by the attending on call for burn surgery or by the Burn ICU Physician within 2 hours of admission. All other inpatient admissions for burn injuries must be seen by the attending on call for burn surgery within 24 hours.

Rule 8.2.3. Qualifications of Attending Staff Surgeons

1. The Burn Center Director must appoint qualified attending staff surgeons to participate in the care of patients on the burn service. Attending staff surgeons must be board-certified or board eligible with current Advanced Burn Life Support (ABLS). Certification of special qualifications in critical care is desirable. The attending staff surgeon must have demonstrated expertise in burn treatment. Attending staff surgeons must participate in continuing medical education in burn treatment. Other attending surgeons must demonstrate participation in an internal education plan.

Rule 8.2.4. Nursing Staff

1. There must be a patient care system in effect that is used to determine nurse staffing for each patient in the burn center. This system must be used to determine daily staffing needs. There must be a burn center orientation program that documents nursing competencies specific to the care and treatment of burn patients, including critical care, wound care, and rehabilitation. Burn center nursing staff must be provided with a minimum of two (2) burn-related continuing education opportunities

annually.

Rule 8.2.5. Mid-Level Providers

1. Appropriate credentialed mid-level providers may be used as members of the burn team. These individuals may include, but are not limited to, physician assistants, surgical assistants, or nurse practitioners. They may augment but do not replace the physician member of the team.

Rule 8.2.6. Burn Center Referral Criteria

1. Burn injuries that should be referred to a burn center include, but are not limited to the following:

a. Partial-thickness burns of greater than 10% of the total body surface area;

b. Burns that involve the face, hands, feet, genitalia, perineum, or major joints;

c. Third-degree burns;

d. Electrical burns, including lightning injury;

e. Chemical burns;

f. Inhalation injury;

g. Burn injury in patients with pre-existing medical disorders that could complicate management, prolonged recovery, or affect mortality;

h. Burn injury in patients who will require special social, emotional, or rehabilitative intervention;

i. Burns and concomitant trauma (such as fractures) when the burn injury poses the greatest risk of morbidity or mortality. If the trauma poses the greater immediate risk, the patient’s condition may be stabilized initially in a Trauma Center before transfer to a burn center;

j. Burns in children; children with burns should be transferred to a burn center designated to treat children. In the absence of a regional designated pediatric burn center, an adult burn center

may serve as a second option for the management of pediatric burns.

Rule 8.2.7. Specialty Services – the following specialists must be available for consultation:

29. General surgery

30. Cardiothoracic surgery

31. Neurological surgery

32. Obstetrics/gynecology

33. Ophthalmology

34. Anesthesiology

35. Pediatrics (if applicable)

36. Orthopedic surgery

37. Plastic surgery

38. Urology

39. Pulmonary

40. Radiology

41. Nephrology

42. Psychiatry

43. Cardiology

44. Gastroenterology

45. Hematology and/or Pathology

46. Neurology

47. Pathology

48. Infectious disease

Subchapter 3 Facility Standards

Rule 8.3.1. Emergency Department – the emergency department must have written protocols mutually developed with the burn service for the care of acutely burned patients.

Rule 8.3.2. Surgical Suites – the burn center hospital must have operating rooms available 24 hours a day.

Rule 8.3.3. Allograft Use – the burn center hospital’s policies and procedures for the use of allograft tissues must be in compliance with all federal, state, and the Joint Commission/other recognized accrediting organizations’ requirements, and with standards of the American Association of Tissue Banks.

49. Subchapter 4 Clinical Support Services

Rule 8.4.1. Respiratory Therapy Service

1. Respiratory therapists must be available for the assessment and management of patients on the burn service on a 24-hour basis. Members must participate in an internal education plan.

Rule 8.4.2. Renal Dialysis, Radiological Services, and Clinical Laboratory

1. Renal dialysis, radiological services (including computed tomography scanning), and clinical laboratory services must be available 24 hours per day.

Rule 8.4.3. Rehabilitation/Social Services

1. There must be a rehabilitation program designed for burned patients that

identifies specific goals.

2. The primary burn care therapist must have annual participation in 16 hours or more of burn-related education (can be met by attendance at the annual meetings of the American Association for the Surgery of Trauma, American Burn Association (ABA), or any ABA-endorsed meetings or continuing education programs, such as ABLA or ABLS Now) each year or 48 hours over a three (3) year period.

3. Social service consultation must be available to the burn service. Members must participate in an internal education plan.

Rule 8.4.4. Nutritional Support

1. A dietician must be available on a daily basis for consultation.

2. Members must participate in an internal education plan.

Rule 8.4.5. Pharmacy

1. A pharmacist who has at least six (6) months of experience in critical care and the pharmacokinetics implications for patients with acute burn injuries must be available on a 24-hour basis. 2. Members must participate in an internal education plan.

Rule 8.4.6. Clinical Psychiatry

1. A psychiatrist or clinical psychologist should be available for consultation by the burn service on a 24-hour basis.

Rule 8.4.7. Continuity of Care Program

1. The burn center must provide the following services:

a. Patient and family education in rehabilitation programs;

b. Support for family members or other significant persons;

c. Coordinated discharge planning;

d. Follow-up after hospital discharge;

e. Access to community resources;

f. Evaluation of the patient’s physical, psychological, developmental, and vocational status;

g. Planning for future rehabilitative and reconstructive needs.

Rule 8.4.8. Weekly Patient Care Conferences

1. Patient care conferences must be held at least weekly to review and evaluate the status of each patient admitted to the burn center. Each clinical discipline should be represented to appropriately contribute to the treatment plan for each patient. Patient care conferences must be documented in the progress notes of each patient and/or in minutes of the conference.

Rule 8.4.9. Infection Control Program

1. The burn center must have effective means of isolation that are consistent with principles of universal precautions and barrier techniques to decrease the risk of cross-infection and cross-contamination. The burn center hospital must provide ongoing review and analysis of nosocomial infection data and risk factors that relate to infection prevention and control for burn patients. This data must be available to the burn team to assess infection risk factors that relate to infection prevention and control for burn patients.

Rule 8.4.10. Mass Casualty Plan

1. The burn center must have a written multiple-casualty plan for the triage and treatment of patients burned in a multiple casualty incident occurring within its service area. The multiple casualty plan must be reviewed and updated as needed, and on an annual basis by EMS representatives and the burn center director.

Rule 8.4.11. Burn Prevention

1. The burn center will be responsible for taking a lead role in coordination of appropriate agencies, professional groups and hospitals in their region to develop a strategic plan for public awareness. This plan must take into consideration public awareness of the burn system, access to the system, public support for the system, as well as specific prevention strategies. Prevention programs must be specific to the needs of the region. Trauma Registry data must be utilized to identify injury trends and focus prevention needs.

Rule 8.4.12. Trauma Registry

1. All facilities designated as burn centers in Mississippi must participate in the statewide Trauma Registry for the purpose of supporting peer review and performance improvement activities at the local, regional, and state levels. Since this data relates to specific trauma patients and are used to evaluate and improve the quality of health care services, this data is confidential and will be governed by the Miss. Code Ann. §41-59-77.

2. This database must include all patients who are admitted to the burn center hospital for acute burn care treatment. Compliance with the above will be evidenced by:

a. Documentation of utilization of the Trauma Registry data in the trauma/burn performance improvement process.

b. Timely submission of Trauma Registry Data to the Department and the appropriate Trauma Region.

Rule 8.4.13. Transfer Guidelines

1. All facilities will work together to develop transfer guidelines indicating which patients should be considered for transfer and procedures to ensure the most expedient, safe transfer of the patient. The transfer guidelines shall make certain that feedback is provided to the facilities and assure that this information becomes part of the trauma registry. All designated facilities will agree to accept and provide service to the trauma/burn patient regardless of their ability to pay.

Rule 8.4.14. Education

1. The burn center must be actively engaged in promoting Advanced Burn Life Support (ABLS) courses in its region. It is desirable for the director to be an ABLS instructor and essential that the director is current in ABLS. The unit should have one or more employees who are ABLS instructors.

2. The burn center must offer education on the current concepts in emergency and inpatient burn care treatment to pre-hospital and hospital care providers within its service area.

3. The burn center must have an internal burn education plan for the staff.

Rule 8.4.15. Research

1. The burn center must participate in basic, clinical, and health sciences research. The medical director must demonstrate ongoing involvement in burn-related research.

**History**
- *Source: Miss. Code Ann. § 41-59-5*
- *Source: Miss. Code Ann. § 41-59-5*
- *Source: Miss. Code Ann. § 41-59-5*
- *Source: Miss. Code Ann. § 41-59-5*
- *Source: Miss. Code Ann. § 41-59-5*
- *Source: Miss. Code Ann. § 41-59-5*
- *Source: Miss. Code Ann. § 41-59-5*
- *Source: Miss. Code Ann. § 41-59-5*
- *Source: Miss. Code Ann. § 41-59-5*
- *Source: Miss. Code Ann. § 41-59-5*
- *Source: Miss. Code Ann. § 41-59-5*
- *Source: Miss. Code Ann. § 41-59-5*
- *Source: Miss. Code Ann. § 41-59-5*
- *Source: Miss. Code Ann. § 41-59-5*
- *Source: Miss. Code Ann. § 41-59-5*
- *Source: Miss. Code Ann. § 41-59-5*
- *Source: Miss. Code Ann. § 41-59-5*
- *Source: Miss. Code Ann. § 41-59-5*
- *Source: Miss. Code Ann. § 41-59-5*
- *Source: Miss. Code Ann. § 41-59-5*
- *Source: Miss. Code Ann. § 41-59-5*
- *Source: Miss. Code Ann. § 41-59-5*
- *Source: Miss. Code Ann. § 41-59-5*
- *Source: Miss. Code Ann. § 41-59-5*
- *Source: Miss. Code Ann. § 41-59-5*
- *Source: Miss. Code Ann. § 41-59-5*
- *Source: Miss. Code Ann. § 41-59-5*
- *Source: Miss. Code Ann. § 41-59-5*
- *Source: Miss. Code Ann. § 41-59-5*
- *Source: Miss. Code Ann. § 41-59-5*
- *Source: Miss. Code Ann. § 41-59-5*
- *Source: Miss. Code Ann. § 41-59-5*
- *Source: Miss. Code Ann. § 41-59-5*
- *Source: Miss. Code Ann. § 41-59-5*
- *Source: Miss. Code Ann. § 41-59-5*
- *Source: Miss. Code Ann. § 41-59-5*
- *Source: Miss. Code Ann. § 41-59-5*
- *Source: Miss. Code Ann. § 41-59-5*
- *Source: Miss. Code Ann. § 41-59-5*
- *Source: Miss. Code Ann. § 41-59-5*
- *Source: Miss. Code Ann. § 41-59-5*
- *Source: Miss. Code Ann. § 41-59-5*
- *Source: Miss. Code Ann. § 41-59-5*
- *Source: Miss. Code Ann. § 41-59-5*
- *Source: Miss. Code Ann. § 41-59-5*
- *Source: Miss. Code Ann. § 41-59-5*
- *Source: Miss. Code Ann. § 41-59-5*
- *Source: Miss. Code Ann. § 41-59-5*
- *Source: Miss. Code Ann. § 41-59-5*
- *Source: Miss. Code Ann. § 41-59-5*
- *Source: Miss. Code Ann. § 41-59-5*
- *Source: Miss. Code Ann. § 41-59-5*
- *Source: Miss. Code Ann. § 41-59-5*
- *Source: Miss. Code Ann. § 41-59-5*
- *Source: Miss. Code Ann. § 41-59-5*
- *Source: Miss. Code Ann. § 41-59-5*
- *Source: Miss. Code Ann. § 41-59-5*
- *Source: Miss. Code Ann. § 41-59-5*
- *Source: Miss. Code Ann. § 41-59-5*
- *Source: Miss. Code Ann. § 41-59-5*
- *Source: Miss. Code Ann. § 41-59-5*
- *Source: Miss. Code Ann. § 41-59-5*
- *Source: Miss. Code Ann. § 41-59-5*
- *Source: Miss. Code Ann. § 41-59-5*
- *Source: Miss. Code Ann. § 41-59-5*
- *Source: Miss. Code Ann. § 41-59-5*
- *Source: Miss. Code Ann. § 41-59-5*
- *Source: Miss. Code Ann. § 41-59-5*
- *Source: Miss. Code Ann. § 41-59-5*
- *Source: Miss. Code Ann. § 41-59-5*
- *Source: Miss. Code Ann. § 41-59-5*
- *Source: Miss. Code Ann. § 41-59-5*
- *Source: Miss. Code Ann. § 41-59-5*
- *Source: Miss. Code Ann. § 41-59-5*

##### **15 Miss. Admin. Code Pt. 3, R. 1.1.5** Rule 1.1.5 {#sec-3-1.1.5 omnilex-key=us-ms-regs-official--title-15--3#1.1.5}

Definitions: For the purpose of clarity and usage in the Mississippi Stroke SOC, the following abbreviations, acronyms, and terms shall be defined as follows:

AHA/ASA – American Heart Association/American Stroke Association

ALS - Advanced life support, including techniques of resuscitation, such as, intravenous access, and cardiac monitoring

ASLS – Advanced stroke life support

BACS – Bureau of Acute Care Systems, Mississippi State Department of Health

BEMS – Bureau of Emergency Medical Services, Mississippi State Department of Health

BLS - Basic life support techniques of resuscitation, including simple airway maneuvers, administration of oxygen, and intravenous access

CAP – Corrective Action Plan

CCRN - Critical Care Registered Nurse

CEN - Certified Emergency Nurse

CPG – Clinical Practice Guidelines

Department - Mississippi State Department of Health

Designation - Formal recognition of hospitals by the Department as providers of specialized stroke services to meet the needs of patients suffering from an acute stroke

DNV – Det Norske Veritas Healthcare. CMS approved accreditation organization

Emergency Department (or Emergency Room) - The area of an acute care hospital that customarily receives patients in need of emergency medical evaluation and/or care

EMS - Emergency Medical Services

EMSAC – Emergency Medical Services Advisory Council

ENA - Emergency Nurses Association

Field Triage - Classification of patients according to medical need at the scene of an injury or onset of an illness

GWTG – Get with the Guidelines database

Inclusive Stroke System of Care - a Stroke care system that incorporates every health care facility willing to participate in the voluntary system in order to provide a continuum of services for all patients suffering from an acute Stroke; the patient's needs are matched to the appropriate hospital resources

Level 1 – Stroke Center defined in the Stroke System of Care Plan

Level 2 – Stroke Center defined in the Stroke System of Care Plan

Level 3 – Stroke Center defined in the Stroke System of Care Plan

Level 4 – Non-Stroke Hospital defined in the Stroke System of Care Plan

Medical Control - Physician direction over pre-hospital activities to ensure efficient field triage, transportation, and care of stroke patients

Mid-level Providers/Practitioners – Physician Assistant (PA) and/or Nurse Practitioners (NP)

Mississippi Stroke System of Care Plan - A formally organized plan developed by the Department, which sets out a comprehensive system for the prevention and management of Stroke patients

Non-Designated Hospital - A licensed acute care hospital that has applied for designation as a stroke center, but has not been designated by the Department

Non-Participating Hospital – A licensed acute care hospital that has informed the Department that they do not desire to participate in the Stroke SOC

Performance Improvement (PI or Quality Improvement) - A method of evaluating and improving processes of patient care which emphasizes a multi-disciplinary

approach to problem solving, and focuses not on individuals, but systems of patient care which might cause variations in patient outcome

Research - Clinical or laboratory studies designed to produce new knowledge applicable to the care of stroke patients

Service Area (or "catchment area") - Geographic area defined by the local EMS agency as the area served by a designated stroke Center

SHO – State Health Officer

Stroke Centers – Stroke Center defined in the Stroke System of Care Plan

Stroke Ready Hospitals – Stroke Center defined in the Stroke System of Care Plan

Stroke Registry – centralized, statewide database program managed by the Department and used by hospitals to track stroke patients and the care of stroke patients

TJC – The Joint Commission accreditation organization

Triage - the process of sorting patients on the basis of the actual or perceived injury or illness and assigning them to the most effective and efficient stroke care resources, in order to insure optimal care and the best chance of survival

**History**
- *Source: Miss. Code Ann. § 41-3-15*

##### **15 Miss. Admin. Code Pt. 3, R. 1.2.1** Application for Stroke Center Designation a {#sec-3-1.2.1 omnilex-key=us-ms-regs-official--title-15--3#1.2.1}

Hospitals may participate in the Stroke SOC on a voluntary basis, but must meet the standards defined in Appendix A of the Stroke SOC. Each hospital would determine whether they are available to receive patients or on critical care diversion b. The decision to participate in the Stroke SOC is made jointly by the hospital administration and the medical staff c. A written commitment in the form of a resolution passed by the appropriate quorum of the governing authority of the hospital, and co- signed by the director of the medical staff, signifies the facility’s desire to participate in the system d. Level 1 and Level 2 Stroke Centers must have a neurologist director responsible for oversight of the Stroke Program (developing and maintaining basic stroke care protocols and stroke component of hospital performance improvement)

e. Level 3 Stroke Ready Hospitals must have a physician director for oversight of the Stroke Program (developing and maintaining basic stroke care protocols) f. Stroke Centers and Stroke Ready Hospitals must participate in the approved national registry platform.

**History**
- *Source: Miss. Code Ann. § 41-3-15*

##### **15 Miss. Admin. Code Pt. 3, R. 1.2.2** Application Process for Initial Stroke Center Designation a {#sec-3-1.2.2 omnilex-key=us-ms-regs-official--title-15--3#1.2.2}

The participation of acute care facilities in the Stroke SOC is voluntary; however, participating hospitals must be appropriately designated according to ability to care for stroke patients – designation is a process of verifying that appropriate staff and resources are available b. To receive initial designation as a Stroke Center the applicant hospital shall submit a letter of application to the Department a. If currently designated as a Stroke Center by The Joint Commission or another nationally accrediting organization, and standards meet or exceed the regulations of this chapter, reciprocity shall be granted c. Within 60 days of receipt of the letter of application, the Department shall: a. acknowledges receipt of the letter application b. provides the status of the application (accepted or rejected) d. If the application is accepted, the Department shall: a. work with the hospital staff to schedule the date for the designation survey visit b. provides materials to hospital staff for preparing for the designation survey visit e. If the application is rejected, the Department shall: a. provides reasons for rejection b. requires documentation of corrective actions before accepting subsequent letters of application for designation from the applicant hospital f. The Department shall provide results of the designation survey and any proposed CAP to the Mississippi Stroke SOC Advisory Committee g. The Mississippi Stroke SOC Advisory Committee will make a recommendation for designation to the State Health Officer h. The Department shall inform the applicant hospital of the status of the application within 30 days of the Advisory Committee meeting

**History**
- *Source: Miss. Code Ann. § 41-3-15*

##### **15 Miss. Admin. Code Pt. 3, R. 1.2.3** Term of Stroke Center Designations: a {#sec-3-1.2.3 omnilex-key=us-ms-regs-official--title-15--3#1.2.3}

The Department shall designate Stroke Centers for a period not to exceed three (3) years. Designations shall remain active for three years provided no substantive changes or variances have occurred. The Department may

perform periodic Stroke Center audits/reviews. The State Health Officer may extend Stroke Center designations for one (1) year. In cases of reciprocity the term of designation expires concurrently with the designation granted by the organization through which reciprocity was granted

Rule 1.2.4. Continuing Designation: a. Any Designated Stroke Center that loses, either permanently or temporarily, patient care specialties required by this regulation, shall report that loss to the Department b. If the loss will result in the hospital’s inability to carry out the patient care activities associated with the current level of designation for a period longer than 30 days, the facility must submit a Corrective Action Plan that addresses how and when the facility will become compliant c. Subsequent designations for Stroke Centers designated based on reciprocity must be applied for through the same process followed for their initial designation and as prescribed in this document

**History**
- *Source: Miss. Code Ann. § 41-3-15*
- *Source: Miss. Code Ann. § 41-3-15*

##### **15 Miss. Admin. Code Pt. 3, R. 1.2.5** Rule 1.2.5 {#sec-3-1.2.5 omnilex-key=us-ms-regs-official--title-15--3#1.2.5}

Suspension of Stroke Center Designation: The State Health Officer may suspend the Stroke Center designation of any hospital for: a. Documented conditions of serious threat or jeopardy to patients’ health or welfare b. Failure to comply with laws or regulations c. Failure to satisfactorily complete the minimum requirements as a Stroke Center as defined by the regulations for the designation level d. Failure to complete a Corrective Action Plan within the timeframe specified by the Department e. Hospitals having their Designation status suspended may reapply for designation after resolution of all issues related to the suspension, and completion and new application and designation survey visit

Rule 1.2.6. Change of Stroke Center Designation: Stroke Centers will be permitted to change their designation if the following conditions are met in their entirety: a. The Stroke Center has been appropriately surveyed and designated by an accredited organization and/or the Department, the designation is current, and the Stroke Center is in full compliance with Department, regulations, policies, procedures, and protocols b. The request to change designation has been approved by Mississippi Stroke Advisory Council c. The State Health Officer or designee issues the new designation

**History**
- *Source: Miss. Code Ann. § 41-3-15*
- *Source: Miss. Code Ann. § 41-3-15*

##### **15 Miss. Admin. Code Pt. 3, R. 1.3.1** Subchapter 3 Financial Support for the Stroke SOC {#sec-3-1.3.1 omnilex-key=us-ms-regs-official--title-15--3#1.3.1}

The Mississippi State Department of Health is authorized to contract with the Mississippi Healthcare Alliance for services in the Stroke SOC. Services include but are not limited to stroke education and prevention initiatives, public awareness initiatives designed for the purpose of making the public aware of the public health concern associated with stroke training in use of the Stroke Registry, maintenance of the website providing lists and maps of currently designated Stroke Centers, education activities of stroke patient care providers, including EMS, ED and Stroke Center personnel, CPR training and the dissemination of literature for use by stroke providers. When funds are used in public awareness campaigns and stroke programs, it should be noted that the Mississippi State Department of Health is the state agency assigned the responsibility for developing, implementing and managing the Stroke System of Care.

Rule 1.3.2. Stroke Center Funding: There are no assigned annual fund distributions for Stroke Centers.

Subchapter 4 Mississippi State Stroke Registry

Rule 1.4.1. Stroke Data Collection and Use a. Participants in the statewide Stroke SOC will utilize a Department approved national registry platform to collect data on Stroke patients and identify system issues, such as over and under triage b. All designated Stroke Centers shall enter data on all stroke patients c. Data collection will begin with systems and field data and continue through patient discharge.

Subchapter 5 Stroke Center Standards

Rule 1.5.1. During the Initial Application for Designation Process – Level 1 Stroke Centers shall verify the following resources: a. Hospital Organization

i. Core team of personnel, infrastructure, and expertise to diagnose and treat stroke patients who require intensive medical, surgical, and interventional vascular care. The team consists of a neurologist, neurosurgeon, and endovascular specialists ii. Fully equipped Emergency Department (ED) for rapid diagnosis and treatment using standard CT imaging within 20 minutes and the ability to have results reported within 45 minutes of arrival iii. Departments/Sections 1. Emergency Department 2. Interventional/Vascular Suite 3. Laboratory 4. Radiology 5. Stroke Unit or Designated Beds 6. Operating Room iv. Stroke Treatment Protocols 1. Protocols and care plans are available in the Emergency Department, acute care areas and stroke units for the acute assessment and treatment of patients with ischemic or hemorrhagic stroke 2. Utilizes an evidenced based bedside dysphagia screen protocol approved by the organization 3. Protocol for IV thrombolytics 4. A single activation should alert the stroke team b. Clinical Capabilities i. Specialty availability (contact made with patient and care plan determined): 1. Door to Physician as defined in the AHA/ASA CPGs 2. At least one designated stroke team practitioner is able to respond to the bedside as defined in the AHA/ASA CPGs 3. NIHSS completed as defined in the AHA/ASA CPGs

4. Door to CT initiated as defined in the AHA/ASA CPGs 5. Door to CT interpreted as defined in the AHA/ASA CPGs 6. Door to Lab completed as defined in the AHA/ASA CPGs 7. Door to EKG completed as defined in the AHA/ASA CPGs 8. Door to CXR completed as defined in the AHA/ASA CPGs 9. Door to Needle as defined in the AHA/ASA CPGs 10. Door to Groin as defined in the AHA/ASA CPGs 11. Door to Revascularization as defined in the AHA/ASA CPGs c. Consultant availability (on-call in accordance with hospital Stroke Plan): i. Neurologist ii. Neurosurgeon iii. Endovascular Specialist iv. Pulmonary/Critical Care v. Internal Medicine/Hospital Care Services d. Facilities and Resources i. Emergency Department 1. Personnel a. Emergency Physicians privileged in the diagnosis and treatment of ischemic and hemorrhagic stroke b. Nursing personnel with expertise in Alteplase administration and care of the acute stroke patient until admission to a hospital unit or transfer 2. Equipment a. Airway control and ventilation equipment Oxygen/Pulse oximetry b. Suction devices

c. 12-lead ECG capability d. Intravenous fluid administration equipment e. Approved thrombolytic medications for stroke treatment f. Cardiac rhythm monitoring capability g. Intubation/emergency airway management equipment h. Two-way communication capability with EMS ii. Intensive Care Unit/Stroke Areas 1. Personnel a. Designated Stroke Medical Director 2. Equipment i. Appropriate cardiac monitoring and respiratory support equipment iii. Interventional/Vascular Suite 1. Personnel a. Radiologic staff with experience in interventional suite operations and all aspects of diagnostic and interventional stroke care b. Nursing staff experienced in interventional suite operations, conscious sedation, cardiac monitoring, and cardiac and neurological emergencies 2. Equipment a. A variety of guiding, diagnostic, intermediate, aspiration and microcatheters b. Cerebral guidewires and microwires c. Stents, balloons and clot retrieval devices d. Advanced hemodynamic and ECG monitoring e. Intravenous antihypertensives, vasoactive/vasopressor medications

f. Thrombolytic and antiplatelet medications g. Distal protection devices h. Intubation/emergency airway management equipment iv. Rehabilitation 1. Protocol for stroke patients 2. Complete rehabilitation services including OT, PT, and SLP available for all stroke patients within 24-48 hours v. Laboratory Services 1. Glucose 2. Blood cell count with platelet count 3. Coagulation studies 4. Blood chemistries 5. Troponin vi. Continuing Education: 1. Core Stroke Team – At least 8 hours of stroke education annually 2. Emergency Department Staff – Minimal of two educational activities per year or as defined by the nationally accrediting organization 3. EMS Personnel – Stroke program will provide educational activities to EMS personnel 4. Public Educational Activities – Stroke program will provide at least two public educational activities per year or as defined by the nationally accrediting organization

Rule 1.5.2. During the Initial Application for Designation Process – Level 2 Stroke Centers shall verify the following resources a. Hospital Organization

i. Core team of personnel, infrastructure, and expertise to diagnose and treat stroke patients who require intensive medical and surgical care. The team consists of a diagnostic radiologist, neurologist, and neurosurgeon ii. Fully equipped Emergency Department for rapid diagnosis and treatment using standard CT imaging as defined in the AHA/ASA CPGs iii. Departments/Sections 1. Emergency Department 2. Laboratory 3. Radiology 4. Stroke unit or designated beds 5. Operating Room iv. Stroke Treatment Protocols 1. Protocols and care plans are available in the Emergency Department, acute care areas and stroke units for the acute assessment and treatment of patients with ischemic or hemorrhagic stroke 2. Utilizes an evidenced based bedside dysphagia screen protocol approved by the organization. 3. Protocol for IV thrombolytics 4. A single activation should alert the stroke team 5. Evaluation protocol to assess for large vessel occlusion that may benefit from intervention 6. Transfer protocol to Level 1 Stroke Center for large vessel occlusion a. Consider rapid transfer to Level 1 Stroke Center for the following: i. Patients, who were previously functionally independent, with signs of large vessel occlusion (examples include aphasia, neglect, eye deviation, hemiplegia, intubated, NIHSS ˃6);

consider transfer at the discretion of the accepting physician ii. Patients with large strokes with cerebral edema for consideration of surgical decompression b. Clinical Capabilities i. Specialty availability (contact made with patient and care plan determined): 1. Door to Physician as defined in the AHA/ASA CPGs 2. At least one designated stroke team practitioner is able to respond to the bedside as defined in the AHA/ASA CPGs 3. NIHSS completed as defined in the AHA/ASA CPGs 4. Door to CT initiated as defined in the AHA/ASA CPGs 5. Door to CT interpreted as defined in the AHA/ASA CPGs 6. Door to Lab completed as defined in the AHA/ASA CPGs 7. Door to EKG completed as defined in the AHA/ASA CPGs 8. Door to CXR completed as defined in the AHA/ASA CPGs 9. Door to Needle as defined in the AHA/ASA CPGs c. Consultant availability (on-call in accordance with hospital Stroke Plan): i. Neurologist ii. Neurosurgeon iii. Pulmonary/Critical Care iv. Internal Medicine/Hospital Care Services d. Facilities and Resources i. Emergency Department 1. Personnel a. Emergency Physicians privileged in the diagnosis and treatment of ischemic and hemorrhagic stroke

b. Nursing personnel with expertise in Alteplase administration and care of the acute stroke patient until admission to a hospital unit or transfer 2. Equipment a. Airway control and ventilation equipment Oxygen/Pulse oximetry b. Suction devices c. 12-lead ECG capability d. Intravenous fluid administration equipment e. Thrombolytic medications f. Cardiac rhythm monitoring capability g. Intubation/emergency airway management equipment h. Two-way communication capability with EMS ii. Intensive Care Unit/Stroke Areas 1. Personnel a. Designated Stroke Medical Director 2. Equipment a. Appropriate cardiac monitoring and respiratory support equipment iii. Rehabilitation 1. Protocol for stroke patients 2. Complete rehabilitation services including OT, PT, and SLP available for all stroke patients within 24-48 hours iv. Laboratory Services 1. Glucose 2. Blood cell count with platelet count 3. Coagulation studies

4. Blood chemistries 5. Troponin v. Continuing Education: 1. Core Stroke Team – At least 8 hours of stroke education annually 2. Emergency Department Staff – Minimal of two educational activities per year or as defined by the nationally accrediting organization 3. EMS Personnel – Stroke program will provide educational activities to EMS personnel 4. Public Educational Activities – Stroke program will provide at least two public educational activities per year or as defined by the nationally accrediting organization Rule 1.5.3. During the Initial Application for Designation Process – Level 3 Stroke Ready Hospital shall verify the following resources a. Hospital Organization i. ED Physician, other qualified physician, or physician extender available 24/7 to diagnose and initiate appropriate treatment including patient transfer to a Level 1 or Level 2 facility ii. Rapid diagnosis and treatment using standard CT imaging as defined in the AHA/ASA CPGs iii. Departments/Sections 1. Emergency Department 2. Laboratory 3. Radiology iv. Stroke Treatment Protocols 1. Protocols and care plans are available in the Emergency Department for the acute assessment and treatment of patients with ischemic or hemorrhagic stroke 2. Utilizes an evidenced based bedside dysphagia screen protocol approved by the organization 3. Protocol for IV thrombolytics

4. A single activation should alert the stroke team 5. Evaluation protocol to assess for large vessel occlusion that may benefit from intervention 6. Transfer protocol to Level 1 Stroke Center for large vessel occlusion a. Consider rapid transfer to Level 1 Stroke Center for the following: i. Patients, who were previously functionally independent, with signs of large vessel occlusion (examples include aphasia, neglect, eye deviation, hemiplegia, intubated, NIHSS ˃6); consider transfer at the discretion of the accepting physician ii. Patients with large strokes with cerebral edema for consideration of surgical decompression b. Clinical Capabilities i. Specialty availability (contact made with patient and care plan determined): 1. Door to Physician as defined in the AHA/ASA CPGs 2. At least one designated stroke team practitioner is able to respond to the bedside as defined in the AHA/ASA CPGs 3. NIHSS completed as defined in the AHA/ASA CPGs 4. Door to CT initiated as defined in the AHA/ASA CPGs 5. Door to CT interpreted as defined in the AHA/ASA CPGs 6. Door to Lab completed as defined in the AHA/ASA CPGs 7. Door to EKG completed as defined in the AHA/ASA CPGs 8. Door to CXR completed as defined in the AHA/ASA CPGs 9. Door to Needle as defined in the AHA/ASA CPGs c. Consultant availability (on-call in accordance with hospital Stroke Plan):

i. Neurologist (on-call, tele-medicine, or transfer agreement to Level 1 or 2 Stroke Center) ii. Critical Care Specialist iii. Internal Medicine/Hospital Care Services d. Facilities and Resources i. Emergency Department 1. Personnel a. Emergency Physicians, other qualified physicians or physician extender privileged in the diagnosis and treatment of ischemic and hemorrhagic stroke b. Nursing personnel with expertise in Alteplase administration and care of the acute stroke patient until admission to a hospital unit or transfer 2. Equipment a. Airway control and ventilation equipment Oxygen/Pulse oximetry b. Suction devices c. 12-lead ECG capability d. Intravenous fluid administration equipment e. Thrombolytic medications f. Cardiac rhythm monitoring capability g. Intubation/emergency airway management equipment h. Two-way communication capability with EMS ii. Laboratory Services 1. Glucose 2. Blood cell count with platelet count 3. Coagulation studies 4. Blood chemistries

5. Troponin iii. Continuing Education: 1. Core Stroke Team – At least 8 hours of stroke education annually 2. Emergency Department Staff – Minimal of two educational activities per year or as defined by the nationally accrediting organization Rule 1.5.4. During the Initial Application for Designation Process – Level 4 Non Stroke Hospital shall verify the following resources a. Hospital Organization i. Facility is able to access and evaluate for possible stroke, but lacks essential components to treat patients with IV thrombolytics ii. Transition plans must be established to facilitate rapid evaluation and transfer of patients to Level 1 or Level 2 Stroke Centers. iii. May be bypassed in accordance with this plan or an EMS Medical Control Plan.

Subchapter 6 Pre-hospital Component and Field Triage

Rule 1.6.1. The Stroke triage and transfer guidelines are based on the concept of getting the right patient to the right hospital in the shortest period of time. In order to do this some hospitals may be completely bypassed, based on EMS guidelines or protocols, in favor of a more distant but more medically capable hospital.

Subchapter 7 Inter-facility Transfers of Stroke Patients

Rule 1.7.1. Drip and Ship Transfer Protocol 1. Patients may be transferred from Level 2, 3, or 4 center to a Level 1 or 2 center provided that any such transfer is medically prudent, after implementation of time sensitive therapy, as determined by the transferring Stroke Center physician of

record, and is conducted by the appropriate level of emergency medical service provider 2. Level 2, 3 and 4 centers shall develop written criteria for consultation and transfer of patients needing a higher/specialty level of care 3. Level 1 and 2 centers shall provide feedback as requested to the Level 2, 3 or 4 center and shall participate in the state performance improvement process

Subchapter 8 Performance Improvement and System Evaluation

Rule 1.8.1. Performance Improvement shall be an essential part of the Stroke SOC. It shall be used to analyze proper functioning of the system and implement improvements in system operation. The PI program will be system-wide. Every designated Stroke Center is required to participate in the system PI process and input the required statewide minimal dataset. The appropriateness and quantity of all activities of the Stroke system must be continuously evaluated. a. The Stroke PI committee shall be a subcommittee of the Stroke Advisory Committee responsible for the PI oversight of the Stroke System. Members of the Stroke PI committee shall include: i. Chairperson – Neurologist participating in the Stroke System ii. Each Level 1 and 2 Stroke Center will be authorized an administrative and/or clinical representative iii. Level 3 hospitals may participate. The number of representatives will be determined by the permanent members of the sub- committee iv. Three EMS organizations – one from a hospital-based EMS provider, a private EMS provider, and a public/government EMS provider

Rule 1.8.2. Specific audit filters will be established by the Stroke PI committee a. In general, the following performance improvement processes should be performed by each Stroke Center. The results of these reviews shall be reported to the Stroke PI committee. i. Each Stroke Center assigns a PI person to oversee the process

ii. Standards established iii. Determine audit filters iv. Collect data v. Evaluate data vi. Determine PI issues present vii. Develop corrective action plan viii. Re-evaluate to document results/effectiveness of CAP b. The following performance elements should be considered by each pre- hospital entity: i. Quality measure regarding response times (time to dispatch, EMS response, on-scene time, and transport time) will be collected and analyzed ii. Accuracy of patient assessment iii. Transport protocol adherence iv. Procedures initiated/completed v. Medical control interaction vi. Transport mode (air/ground) vii. Record/documentation viii. Inter-facility care/transport c. The following performance elements should be considered by each Stroke Center: i. Outcome review ii. Complications iii. Deaths iv. Achievement of time sensitive goals (CT completed/reporting times and Door to Alteplase administration times)

v. Core stroke quality measures established for hospital stroke care will be entered into the approved national registry platform for blinded comparison between hospitals

Rule 1.8.3. Data will be reviewed and analyzed at no less than two separate levels. Primary patient care data will be reviewed at each facility by its Multidisciplinary Committee. These committees will utilize nationally accepted patient review criteria and will also review the pre-hospital care of stroke patients. The final level of data review will take place at the state level. Statewide data will be used for the review of statewide criteria and epidemiological purposes. The Statewide Education/Prevention program will be based on this data. Stroke registry personnel should be included on the PI Committee.

**History**
- *Source: Miss. Code Ann. § 41-3-15*
- *Source: Miss. Code Ann. § 41-3-15*
- *Source: Miss. Code Ann. § 41-3-15*
- *Source: Miss. Code Ann. § 41-3-15*
- *Source: Miss. Code Ann. § 41-3-15*
- *Source: Miss. Code Ann. § 41-3-15*
- *Source: Miss. Code Ann. § 41-3-15*
- *Source: Miss. Code Ann. § 41-3-15*
- *Source: Miss. Code Ann. § 41-3-15*
- *Source: Miss. Code Ann. § 41-3-15*
- *Source: Miss. Code Ann. § 41-3-15*

##### **15 Miss. Admin. Code Pt. 3, R. 1.4.3** All designated OB and Neonatal facilities will actively engage in the process of data collection and retrieval {#sec-3-1.4.3 omnilex-key=us-ms-regs-official--title-15--3#1.4.3}

Chapter 2 Maternal Program Requirements Rule 2.1.1 Maternal Program Philosophy Designated facilities must have a family-centered philosophy. The facility environment for perinatal care must meet the physiologic and psychosocial needs of the mothers, infants, and families. Parents must have reasonable access to their infants at all times and be encouraged to participate in the care of their infants. The OB Center must ensure parent, sibling, and neonate visitation are supported and facilitated, following appropriate safety guidelines.

**History**
- *Source: Miss. Code Ann. § 41-3-15*

##### **15 Miss. Admin. Code Pt. 3, R. 2.1.2** Rule 2.1.2 {#sec-3-2.1.2 omnilex-key=us-ms-regs-official--title-15--3#2.1.2}

Maternal Program Plan The facility must develop a written maternal operational plan for the maternal program that includes a detailed description of the scope of services and clinical resources available for all maternal patients and families. The plan will define the maternal patient population evaluated, treated, transferred, or transported by the

facility consistent with clinical guidelines based on current standards of maternal practice ensuring the health and safety of patients. 1. The written Maternal Program Plan must be reviewed and approved by Perinatal Multidisciplinary Committee and be submitted to the facility's governing body for review and approval. The governing body must ensure that the requirements of this section are implemented and enforced.

2. The written Maternal Program Plan must include, at a minimum:

a. Clinical guidelines based on current standards of maternal practice, and policies and procedures that are adopted, implemented, and enforced by the maternal program;

b. A process to ensure and validate that these clinical guidelines based on current standards of maternal practice, policies, and procedures are reviewed and revised a minimum of every three years;

c. Written triage, stabilization, and transfer guidelines for pregnant and postpartum patients that include consultation and transport services;

d. Written guidelines or protocols for prevention, early identification, early diagnosis, and therapy for conditions that place the pregnant or postpartum patient at risk for morbidity or mortality;

e. The role and scope of telehealth/telemedicine practices if utilized, including:

i. Documented and approved written policies and procedures that outline the use of telehealth/telemedicine for inpatient hospital care, or for inpatient consultation, including appropriate situations, scope of care, and documentation that is monitored through the PI Plan and process; and

ii. Written and approved procedures to gain informed consent from the patient or designee for the use of telehealth/telemedicine, if utilized, that are monitored for compliance;

f. Written guidelines for discharge planning instructions and appropriate follow up appointments for all mothers and infants;

g. Written guidelines for the hospital disaster response, including a defined mother and infant evacuation plan and process to relocate mothers and infants to appropriate levels of care with identified resources, and this process must be evaluated annually to ensure maternal care can be sustained and adequate resources are available;

h. Requirements for minimal credentials for all staff participating in the care of maternal patients;

i. Provisions for providing continuing staff education, including annual competency and skills assessment that is appropriate for the patient population served;

j. A perinatal staff registered nurse as a representative on the nurse staffing committee; and k. The availability of all necessary equipment and services to provide the appropriate level of care and support of the patient population served.

Rule 2.1.3. Performance Improvement: The facility must have a documented PI Plan. The maternal program must measure, analyze, and track quality indicators and other aspects of performance that the facility adopts or develops that reflect processes of care and is outcome based. 1. The Chief Executive Officer, Chief Medical Officer (or Chief of Staff), and Chief Nursing Officer must implement a culture of safety for the facility and ensure adequate resources are allocated to support a concurrent, data-driven maternal PI Plan. 2. The facility must demonstrate that the Maternal PI Plan consistently assesses the provision of maternal care provided. The assessment will identify variances in care, the impact to the patient, and the appropriate levels of review. This process will identify opportunities for improvement and develop a plan of correction to address the variances in care or the system response. An action plan will track and analyze data through resolution or correction of the identified variance. 3. Maternal facilities must review their incidence and management of placenta accreta spectrum disorder through the PI Plan and report the incidence and outcomes through the Perinatal Multidisciplinary Committee. (see guideline)

4. The Maternal Medical Director (MMD) must have the authority to make referrals for peer review, receive feedback from the peer review process, and ensure maternal physician representation in the peer review process for maternal cases. 5. The MMD and the Maternal Program Manager (MPM) must participate in regional PI regional initiatives and submit requested data to assist with data analysis to evaluate regional outcomes as an element of their maternal PI Plan. 6. The facility must have documented evidence of maternal PI summary reports reviewed and reported by the Perinatal Multidisciplinary Committee that monitors and ensures the provision of services or procedures through telehealth and telemedicine, if utilized, is in accordance with the standard of care applicable to the provision of the same service or procedure in an in-person setting. 7. The facility must have documented evidence of maternal PI summary reports to support that aggregate maternal data are consistently reviewed to identify developing trends, opportunities for improvement, and necessary corrective actions. Summary reports must be provided through the Perinatal Multidisciplinary Committee, available for site surveyors, and submitted to the department as requested.

Rule 2.1.4. Medical Staff. The facility must have an organized maternal program that is recognized by the facility's medical staff and approved by the facility's governing body. 1. The credentialing of the maternal medical staff must include a process for the delineation of privileges for maternal care. 2. The maternal medical staff must participate in ongoing staff and team-based education and training in the care of the maternal patient.

**History**
- *Source: Miss. Code Ann. § 41-3-15*
- *Source: Miss. Code Ann. § 41-3-15*
- *Source: Miss. Code Ann. § 41-3-15*

##### **15 Miss. Admin. Code Pt. 3, R. 2.1.5** Medical Director {#sec-3-2.1.5 omnilex-key=us-ms-regs-official--title-15--3#2.1.5}

There must be an identified MMD. The MMD must be credentialed by the facility for treatment of maternal patients and have their responsibilities and authority defined in a job description. The MMD is responsible for the provision of maternal care services and: 1. Examining qualifications of medical staff requesting maternal privileges and making recommendations to the appropriate committee for such privileges;

2. Assuring maternal medical staff competency in managing obstetrical emergencies, complications and resuscitation techniques; 3. Monitoring maternal patient care from transport if applicable, to admission, stabilization, operative intervention(s) if applicable, through discharge, and inclusive of the PI Plan; 4. Participating in ongoing maternal staff and team-based education and training in the care of the maternal patient; 5. Overseeing the inter-facility maternal transport; 6. Collaborating with the MPM in areas to include developing or revising policies, procedures and guidelines, assuring medical staff and personnel competency, education and training; and the PI Plan; 7. Frequently leading the maternal PI meetings with the MPM and participating in Maternal Program Oversight and other maternal meetings as appropriate; 8. Ensuring that the PI Plan is specific to maternal and fetal care, is ongoing, data- driven and outcome-based; 9. Participating as a clinically active and practicing physician in maternal care at the facility where medical director services are provided; 10. Maintaining active staff privileges as defined in the facility's medical staff bylaws; and 11. Developing collaborative relationships with other MMD(s) of designated facilities within the applicable Perinatal Care Region.

Rule 2.1.6. Maternal Program Manager (MPM). The facility must identify an MPM who has the authority and oversight responsibilities written in his or her job description for the provision of maternal services through all phases of care, including discharge and identifying variances in care for inclusion in the PI Plan and: 1. Be a registered nurse with perinatal experience; 2. Be a clinically active and practicing registered nurse participating in maternal care at the facility where program manager services are provided; 3. Have the authority and responsibility to monitor the provision of maternal patient care services from admission, stabilization, operative intervention(s) if applicable, through discharge, and inclusive of the PI Plan;

4. Collaborate with the MMD in areas to include developing or revising policies, procedures and guidelines; assuring staff competency, education, and training and the PI Plan; 5. Frequently leads the maternal PI meetings and participates in the Perinatal Multidisciplinary Committee and other maternal meetings as appropriate; and 6. Ensure that the PI Plan is specific to maternal and fetal care, is ongoing, data- driven and outcome based, including telehealth/telemedicine utilization, when used.

Chapter 3 Maternal Designation Level I (Basic Care) Subchapter 1 Hospital Organization Rule 3.1.1. The Level I maternal designated facility shall provide care for low-to moderate risk pregnancies with the ability to detect, stabilize, and initiate management of unanticipated maternal-fetal or neonatal problems that occur during the antepartum, intrapartum, or postpartum period until the patient can be transferred to a facility at which specialty maternal care is available.

Rule 3.1.2. Maternal Program 1. There shall be a written commitment on behalf of the entire facility to the organization of neonatal and maternal care. The written commitment shall be in the form of a resolution at the time of application passed by appropriate quorum of the members of the governing authority. Should the business organization be other than a corporation, a letter explaining such, together with a written commitment of the hospital’s chief executive officer, to the establishment of a maternal care program may be sufficient. The maternal program must be established and recognized by the medical staff and hospital administration. The maternal program must come under the direction of a family medicine physician or an obstetrics and gynecology physician, with obstetrics training and experience, and with privileges in maternal care. The administrative structure must minimally include an administrator, Maternal Medical Director (MMD), Maternal Program Manager (MPM), and appropriate support staff. The Maternal Program must be multidisciplinary in nature, and the performance improvement evaluation of this care must be extended to all the departments involved.

2. Compliance with the above will be evidenced by but not limited to: a. Governing authority and medical staff letter of commitment in the form of a resolution; b. Written policies and procedures and guidelines for the care of the maternal patient; c. Defined maternal team and written roles and responsibilities; d. Appointed Maternal Medical Director with a written job description; e. Appointed Maternal Program Manager with a written job description; f. A written Maternal Performance Improvement plan.

Rule 3.1.3. Maternal Service: The maternal service shall be established and recognized by the medical staff and be responsible for the overall coordination and management of the system of care rendered to the perinatal patient. The maternal service will vary in each organization depending on the needs of the patient and the resources available. The service shall come under the organization and direction of the Maternal Medical Director.

Rule 3.1.4. Maternal Medical Director (MMD): The MMD must be a board-eligible or board- certified physician with obstetrics training and experience, and with privileges in maternal care that demonstrates administrative skills and oversight of the performance improvement (PI) plan and has completed annual continuing education specific to maternal care. The MMD must cooperate with nursing administration to support the nursing needs of the perinatal patient and develop treatment protocols for the perinatal patients. A qualified provider with obstetric privileges may be responsible for the management of the program’s obstetric services.

Rule 3.1.5. Maternal Program Manager (MPM): Level I OB Centers must have a registered nurse with documented perinatal nursing experience, working in the role of the MPM. Working in conjunction with the MMD, the MPM is responsible for organization of the program and all systems necessary for the multidisciplinary approach throughout the continuum of maternal care, as well as developing or revising policies, procedures and guidelines, assuring staff competency, education, and training.

Rule 3.1.6. Perinatal Multidisciplinary Committee 1. The purpose of the committee is to provide oversight and leadership to the entire maternal program. Each perinatal center may choose to have one or more committees as needed to accomplish the task. One committee must be multidisciplinary and focus on program oversight and leadership. The major focus will be on PI activities, policy development, communication among all team members, and establishment of standards of care, and education. The committee has administrative and systematic control and oversees implementation of all program related services, meets regularly, takes attendance, maintains minutes and works to correct overall program deficiencies to optimize patient care. Membership for the committee includes representatives from:

a. Maternal Medical Director (Chairman – must be present at greater than 75% of all meetings.)

b. Maternal Program Manager c. Obstetrics and Gynecology d. Certified Nurse Midwife (if applicable) e. Maternal Fetal Medicine f. Anesthesia g. Pediatrician/Family Physician/APPs h. Labor and Delivery i. Nursing j. Laboratory k. Radiology (Ultrasound) l. Respiratory Therapy m. Social Services/Pastoral Care n. Dietary o. Lactation Specialist (or equivalent)

2. The clinical managers (or designees) of the departments involved with maternal care must play an active role with the committee.

3. The OB Center may wish to accomplish performance improvement activities in this committee or develop a separate peer review committee. This committee must handle peer review independently from department-based review. The committee must meet regularly and maintain attendance and minutes. This committee must report findings to the overall hospital performance improvement (PI) program.

Subchapter 2 Obstetric Service Provision Rule 3.2.1. Patient-centered continuum of care shall be coordinated among all providers to ensure continuity, with prenatal assessments and care plans accessible at delivery sites and postpartum records shared with outpatient providers.

Rule 3.2.2. High-risk pregnancy management: Early identification of high-risk pregnancies and appropriate risk-management shall occur with the consultation of Level IV, if needed. The program shall manage high-risk patients within its capabilities or initiate transfer protocols for those requiring advanced care. (see guidelines)

Subchapter 3 Transfer Guidelines Rule 3.3.1 Identification and Management of Transfers: The program shall define criteria for maternal transfers to higher‐level facilities and maintain prearranged relationships for immediate consultation and patient relocation. All designated facilities will agree to provide service to the maternal patient regardless of their ability to pay. Written agreements should be in place for the transfer of perinatal patients.

Rule 3.3.2. Communication and Documentation Requirements: Effective bidirectional communication protocols shall be employed, ensuring complete documentation and timely exchange of clinical information between transferring and receiving entities. Mechanisms for timely exchange of medical records, orders, and status updates shall be established before and after patient transfer.

Rule 3.3.3. Stabilization and Transfer Protocols: Patients requiring transfer shall receive prompt assessment, stabilization, and initiation of the transfer process. Follow-up reporting on patient status post-transfer shall be ensured.

Subchapter 4 Clinical Components Rule 3.4.1. Interdisciplinary Team: The Level I OB Center has an interdisciplinary team that includes individuals with expertise in and/or knowledge about the specialized care, treatment and services required for perinatal care. The interdisciplinary team includes individuals and specialized services to support the care, treatment, and services provided by the program. The following individuals and services are represented on the team:

1. Obstetrics and Gynecology physician: The Obstetrics and Gynecology physician with obstetrics training and experience must be available for consultation, at all times. *

2. Qualified Physicians/Certified Nurse Midwife: Ensure that a qualified birthing professional with appropriate physician back-up is available to attend all deliveries or other obstetrical emergencies. *

a. must arrive at the patient’s bedside within 30 minutes of an urgent request; and b. must complete annual continuing education, specific to the care of pregnant and postpartum patients, including complicated conditions. * A physician with privileges to perform emergency cesarean deliveries must be readily available at all times.

3. Anesthesia: Anesthesia providers, such as anesthesiologists, nurse anesthetists, or anesthesiologist assistants working with an anesthesiologist for labor

analgesia and surgical anesthesia must be readily available at all times. Anesthesia personnel with training and experience must be available at all times and arrive at the patient’s bedside within thirty (30) minutes of an urgent request.

4. Nursing: Qualified labor, delivery, surgical, and recovery nursing personnel in adequate numbers to meet the needs of each patient are readily available at all times. Every birth must be attended by an appropriately trained and qualified RN with level-appropriate competencies as demonstrated by nursing competency documentation.

a. Nursing leadership must have level-appropriate formal training and experience in maternal care.

5. Laboratory and Blood Bank Services: Laboratory personnel must be immediately available to obtain and process appropriate samples and report urgent/emergent results. Blood bank services must be available at all times to determine blood type and Rh type, crossmatch blood and perform antibody testing. There must also be guidelines or protocols in place for:

a. initiation of massive blood component transfusion at all times with the process to obtain more blood and component therapy as needed; b. Emergency release of blood components; and c. Management of multiple blood component therapy.

6. Radiology and Ultrasound Support: Radiology and Ultrasound support services should be readily available at all times. Note: It is anticipated that the Level I center will have limited obstetric ultrasonography with interpretation capabilities readily available at all times. 7. Respiratory and Pharmacy: Respiratory care personnel and a registered pharmacist should be readily available at all times.

8. Support Staff: a. Lactation Specialists: Lactation Specialists or support staff with knowledge and skills in breastfeeding and lactation to meet the needs of maternal patients must be available at all times.

b. Social services, pastoral care, or bereavement services must be provided as appropriate to meet the needs of the patient population served.

c. A dietician or nutritionist should be available with the appropriate training and experience for the population served.

Rule 3.4.2. An on-call schedule of providers, back-up providers, and provision for patients without a physician must be readily available to facility and maternal staff and posted on the labor and delivery unit.

Rule 3.4.3. Physicians providing back-up coverage must arrive at the patient’s bedside within thirty (30) minutes of an urgent request.

Rule 3.4.4. Certified nurse midwives, physician assistants and nurse practitioners who provide care for maternal patients: 1. must operate under guidelines reviewed and approved by the MMD; and 2. must have a formal arrangement with a physician with obstetrics training or experience, and with maternal privileges who must: a. provide back-up and consultation; and b. arrive at the patient’s bedside within 30 minutes of an urgent request.

Rule 3.4.5. Level I Obstetrical Center requirements: 1. Surveillance and care of all patients admitted to the obstetric service, with an established triage system for identifying high-risk patients who should be transferred to a facility that provides specialty or sub-specialty care. 2. Capability to begin an emergency cesarean delivery within 30 minutes of the decision to do so. 3. Mothers that are stable and likely to deliver before 35 weeks’ gestation or have a fetus that is likely to require specialty services and mothers who themselves are likely to require specialty services should be transferred prior to delivery, when possible. 4. Proper detection and supportive care of known maternal conditions and unanticipated maternal-fetal problems that occur during labor and delivery.

5. Care of postpartum conditions. 6. Maintain a staff of providers certified to perform normal and operative vaginal deliveries and cesarean sections including obstetricians and family physicians with advanced training in obstetrics, providers certified to perform normal vaginal deliveries including certified nurse midwives, and registered nurses with training in labor and delivery, post-partum care or inpatient obstetrics. 7. Capability to implement patient safety bundles for common causes of preventable maternal morbidity, such as management of maternal venous thromboembolism, obstetric hemorrhage, and severe maternal hypertension in pregnancy.

Rule 3.4.6. Guideline/Protocol Development The facility must have written guidelines or protocols for various conditions that place the pregnant or postpartum patient at risk for morbidity or mortality, including promoting prevention, early identification, early diagnosis, therapy, stabilization, and transfer. The guidelines or protocols must address a minimum of:

1. massive hemorrhage and transfusion of the pregnant or postpartum patient in coordination of the blood bank, including management of unanticipated hemorrhage or coagulopathy;

2. obstetrical hemorrhage, including promoting the identification of patients at risk, early diagnosis, and therapy to reduce morbidity and mortality;

3. placenta accreta spectrum disorder, including team education, risk factor screening, evaluation, diagnosis, fostering telemedicine medical services and referral as appropriate, treatment and multidisciplinary management of unanticipated placenta accreta spectrum disorder cases, including postpartum care;

4. hypertensive disorders in pregnancy, including eclampsia and the postpartum patient to promote early diagnosis and treatment to reduce morbidity and mortality;

5. sepsis or systemic infection in the pregnant or postpartum patient;

6. venous thromboembolism in the pregnant and postpartum patient, including assessment of risk factors, prevention, early diagnosis and treatment;

7. shoulder dystocia, including assessment of risk factors, counseling of patient, and multidisciplinary management; and

8. behavioral health disorders, including depression, substance abuse and addiction that includes screening, education, consultation with appropriate personnel and referral.

Rule 3.4.7. Perinatal Education. 1. The Level I OB Center must have internal perinatal education programs including training for physicians, nurses, ancillary staff, and prehospital providers.

2. Level I OB Centers must have a written perinatal education plan.

Chapter 4 Maternal Designation Level II (Specialty Care) Subchapter 1 Hospital Organization Rule 4.1.1. The Level II maternal designated facility shall provide Level I facility level of care plus care of appropriate moderate- to high-risk antepartum, intrapartum, and postpartum conditions.

Rule 4.1.2. Maternal Program 1. There shall be a written commitment on behalf of the entire facility to the organization of neonatal and maternal care. The written commitment shall be in the form of a resolution at the time of application passed by appropriate quorum of the members of the governing authority. Should the business organization be other than a corporation, a letter explaining such, together with the written commitment of the hospital’s chief executive officer, to the establishment of a maternal care program may be sufficient. The maternal program must be established and recognized by the medical staff and hospital administration. The maternal program must come under the direction of a

family medicine physician with obstetrics training and experience and with privileges in maternal care or an obstetrics and gynecology physician. The administrative structure must minimally include an administrator, Maternal Medical Director (MMD), Maternal Program Manager (MPM), and appropriate support staff. The Maternal Program must be multidisciplinary in nature, and the performance improvement evaluation of this care must be extended to all the departments involved.

2. Compliance with the above will be evidenced by but not limited to:

a. Governing authority and medical staff letter of commitment in the form of a resolution;

b. Written policies and procedures and guidelines for the care of the maternal patient;

c. Defined maternal team and written roles and responsibilities;

d. Appointed Maternal Medical Director with a written job description;

e. Appointed Maternal Program Manager with a written job description;

f. Analysis and review of system perinatal outcome and quality data; and

g. A written Maternal Performance Improvement plan.

Rule 4.1.3. Maternal Service: The maternal service shall be established and recognized by the medical staff and be responsible for the overall coordination and management of the system of care rendered to the perinatal patient. The maternal service will vary in each organization depending on the needs of the patient and the resources available. The service shall come under the organization and direction of the Maternal Medical Director.

Rule 4.1.4. Maternal Medical Director (MMD): The MMD must be a board-eligible or board- certified physician with obstetrics training and experience, and with privileges in maternal care that demonstrates administrative skills and oversight of the performance improvement (PI) plan and has completed annual continuing

education specific to maternal care. Based upon available resources and facility determination of the most appropriate staffing, it may be acceptable for such leader to be board certified in another specialty with privileges and expertise in obstetric care including surgical skill and privileges to perform cesarean delivery. The MMD must cooperate with nursing administration to support the nursing needs of the perinatal patient and develop treatment protocols for the perinatal patients. A qualified provider with obstetric privileges may be responsible for the management of the program’s obstetric services.

Rule 4.1.5. Maternal Program Manager (MPM): Level II OB Centers must have a registered nurse with documented perinatal nursing experience, working in the role of the MPM. Working in conjunction with the MMD, the MPM is responsible for organization of the program and all systems necessary for the multidisciplinary approach throughout the continuum of maternal care, as well as developing or revising policies, procedures and guidelines, assuring staff competency, education, and training.

Rule 4.1.6. Perinatal Multidisciplinary Committee 1. The purpose of the committee is to provide oversight and leadership to the entire maternal program. Each perinatal center may choose to have one or more committees as needed to accomplish the task. One committee must be multidisciplinary and focus on program oversight and leadership. The major focus will be on PI activities, policy development, communication among all team members, and establishment of standards of care, and education. The committee has administrative and systematic control and oversees implementation of all program related services, meets regularly, takes attendance, maintains minutes and works to correct overall program deficiencies to optimize patient care. Membership for the committee includes representatives from:

a. Maternal Medical Director (Chairman – must be present at greater than 75% of all meetings.)

b. Maternal Program Manager c. Neonatal Medical Director (if different from the MMD) d. Neonatal Program Manager (if different from the MPM)

e. Pediatrician or Neonatologist f. Obstetrics and Gynecology g. Certified Nurse Midwife (if applicable) h. Maternal Fetal Medicine i. Anesthesia j. Labor and Delivery k. Nursing l. Laboratory m. Radiology (Ultrasound) n. Respiratory Therapy o. Social Services/Pastoral Care p. Dietary q. Lactation Specialist (or equivalent) r. General surgery s. Internal Medicine t. Family Medicine u. Advanced Practice Provider 2. The clinical managers (or designees) of the departments involved with maternal care must play an active role with the committee.

3. The OB Center may wish to accomplish performance improvement activities in this committee or develop a separate peer review committee. This committee must handle peer review independently from department-based review. The committee must meet regularly and maintain attendance and minutes. This committee must report findings to the overall hospital performance improvement (PI) program.

Subchapter 2 Obstetric Service Provision Rule 4.2.1. Patient-centered continuum of care shall be coordinated among all providers to ensure continuity, with prenatal assessments and care plans accessible at delivery sites and postpartum records shared with outpatient providers.

Rule 4.2.2. High-risk pregnancy management: Early identification of high-risk pregnancies and appropriate risk-management shall occur. The program shall manage high- risk patients within its capabilities or initiate transfer protocols for those requiring advanced care.

Rule 4.2.3. Transfer Agreements and Continuity of Information: Written transfer agreements shall be maintained with higher‐level referral centers. Mechanisms for timely exchange of medical records, orders, and status updates shall be established before and after patient transfer.

Rule 4.2.4. Patient Education and Quality Improvement: The program shall provide comprehensive education regarding available perinatal services and engage in ongoing quality improvement activities, including review of outcomes from prenatal through postpartum care.

Subchapter 3 Transfer Guidelines Rule 4.3.1 Identification and Management of Transfers: The program shall define criteria for maternal transfers to higher‐level facilities and maintain prearranged relationships for immediate consultation and patient relocation. All designated facilities will agree to provide service to the maternal patient regardless of their ability to pay. Written agreements should be in place for the transfer of perinatal patient.

Rule 4.3.2. Communication and Documentation Requirements: Effective bidirectional communication protocols shall be employed, ensuring complete documentation

and timely exchange of clinical information between transferring and receiving entities.

Rule 4.3.3. Stabilization and Transfer Protocols: Patients requiring transfer shall receive prompt assessment, stabilization, and initiation of the transfer process. Follow-up reporting on patient status post-transfer shall be ensured.

Subchapter 4 Clinical Components Rule 4.4.1. Interdisciplinary Team: The Level II OB Center has an interdisciplinary team that includes individuals with expertise in and/or knowledge about the specialized care, treatment and services required for perinatal care. The interdisciplinary team includes individuals and specialized services to support the care, treatment, and services provided by the program. The following individuals and services are represented on the team:

1. Obstetrics and Gynecology physician: The Obstetrics and Gynecology physician with obstetrics training and experience must be available for consultation, at all times. * a. Based on available resources and facility determination of the most appropriate staffing, it may be acceptable for a family physician with obstetric fellowship training or equivalent training and skills in obstetrics, and with surgical skill and privileges to perform cesarean delivery to meet the criteria for being readily available at all times.

2. Obstetrics: An obstetrics provider must be readily available at all times.

3. Qualified Physicians/Certified Nurse Midwife: Ensure that a qualified physician or certified nurse midwife with appropriate physician back-up is available to attend all deliveries or other obstetrical emergencies. * a. Must arrive at the patient’s bedside within thirty (30) minutes of an urgent request; and b. Must complete annual continuing education, specific to the care of pregnant and postpartum patients, including complicated conditions.

*A physician with privileges to perform emergency cesarean deliveries must be readily available at all times.

4. Maternal-Fetal Medicine (MFM): A MFM specialist must be readily available at all times for consultation on-site. Availability may be through phone or telemedicine, if necessary.

5. Anesthesia: Qualified personnel with anesthesia privileges must be readily available at all times. Anesthesia personnel with training and experience must be available at all times and arrive at the patient’s bedside within thirty (30) minutes of an urgent request.

6. Internal medicine providers, family medicine providers, and general surgeons must be readily available at all times for obstetric patients.

7. Nursing: Qualified labor, delivery, surgical, and recovery nursing personnel in adequate numbers to meet the needs of each patient are readily available at all times.

8. Laboratory and Blood Bank Services: Laboratory personnel must be immediately available to obtain and process appropriate samples and report urgent/emergent results. Blood bank services must be available at all times to determine blood type and Rh type, crossmatch blood and perform antibody testing. There must also be guidelines or protocols in place for:

a. Massive blood component transfusion;

b. Emergency release of blood components; and

c. Management of multiple blood component therapy.

9. Radiology Support: Radiologic services with interpretation must be readily available at all times and include:

a. Computed tomography scans;

b. Magnetic resonance imaging;

c. Non obstetric ultrasound imaging

d. Standard obstetric ultrasound imaging; and

e. Maternal echocardiography.

10. Respiratory and Pharmacy: Respiratory care personnel and a registered pharmacist should be readily available at all times.

11. Support Staff: a. Lactation Specialists: Lactation Specialists or support staff with knowledge and skills in breastfeeding and lactation to meet the needs of maternal patients must be available at all times.

b. Social services, pastoral care, or bereavement services must be provided as appropriate to meet the needs of the patient population served.

c. A dietician or nutritionist should be available with the appropriate training and experience for the population served.

Rule 4.4.2. An on-call schedule of providers, back-up providers, and provision for patients without a physician must be readily available to facility and maternal staff and posted on the labor and delivery unit.

Rule 4.4.3. Ensure that physicians providing back-up coverage must arrive at the patient’s bedside within 30 minutes of an urgent request.

Rule 4.4.4. Certified nurse midwives, physician assistants and nurse practitioners who provide care for maternal patients: 1. Must operate under guidelines reviewed and approved by the MMD; and 2. Must have a formal arrangement with a physician with obstetrics training or experience, and with maternal privileges who must:

a. provide back-up and consultation; and

b. arrive at the patient’s bedside within 30 minutes of an urgent request.

Rule 4.4.5. Level II Obstetrical Center requirements:

1. Surveillance and care of all patients admitted to the obstetric service, with an established triage system for identifying high-risk patients who should be transferred to a facility that provides specialty or sub-specialty care. 2. Capability to begin an emergency cesarean delivery within 30 minutes of the decision to do so. 3. Proper detection and supportive care of known maternal conditions and unanticipated maternal-fetal problems that occur during labor and delivery. 4. Care of postpartum conditions. 5. Maintain a staff of providers certified to perform normal and operative vaginal deliveries and cesarean sections including obstetricians and family physicians with advanced training in obstetrics, providers certified to perform normal vaginal deliveries including certified nurse midwives, and registered nurses with training in labor and delivery, post-partum care or inpatient obstetrics. 6. Mothers that are stable and likely to deliver before 32 weeks gestation or have a neonate that is likely to require sub-specialty services, or mothers who themselves are likely to require sub-specialty services should be transferred prior to delivery, when possible. 7. Access to maternal fetal medicine consultation and antenatal diagnosis technology including fetal ultrasound.

Rule 4.4.6. Guideline/Protocol Development The facility must have written guidelines or protocols for various conditions that place the pregnant or postpartum patient at risk for morbidity or mortality, including promoting prevention, early identification, early diagnosis, therapy, stabilization, and transfer. The guidelines or protocols must address a minimum of: 1. massive hemorrhage and transfusion of the pregnant or postpartum patient in coordination of the blood bank, including management of unanticipated hemorrhage or coagulopathy;

2. obstetrical hemorrhage, including promoting the identification of patients at risk, early diagnosis, and therapy to reduce morbidity and mortality;

3. placenta accreta spectrum disorder, including team education, risk factor screening, evaluation, diagnosis, fostering telemedicine medical services and referral as appropriate, treatment and multidisciplinary management of unanticipated placenta accreta spectrum disorder cases, including postpartum care;

4. hypertensive disorders in pregnancy, including eclampsia and the postpartum patient to promote early diagnosis and treatment to reduce morbidity and mortality;

5. sepsis or systemic infection in the pregnant or postpartum patient;

6. venous thromboembolism in the pregnant and postpartum patient, including assessment of risk factors, prevention, early diagnosis and treatment;

7. shoulder dystocia, including assessment of risk factors, counseling of patient, and multidisciplinary management; and

8. behavioral health disorders, including depression, substance abuse and addiction that includes screening, education, consultation with appropriate personnel and referral.

Rule 4.4.7. Perinatal Education. 1. The Level II OB Center must have internal perinatal education programs including training for physicians, nurses, ancillary staff, and prehospital providers.

2. Level II OB Centers must have a written perinatal education plan. Chapter 5 Maternal Designation Level III (Subspecialty Care) Subchapter 1 Hospital Organization Rule 5.1.1. The Level III maternal designated facility must provide Level II facility level of care plus provide care of more complex maternal medical conditions, obstetric complications, and fetal conditions.

Rule 5.1.2. Maternal Program 1. There shall be a written commitment on behalf of the entire facility to the organization of neonatal and maternal care. The written commitment shall be in the form of a resolution at the time of application passed by an appropriate quorum of the members of the governing authority. Should the business

organization be other than a corporation, a letter explaining such, together with the written commitment of the hospital’s chief executive officer, to the establishment of a maternal care program may be sufficient. The maternal program must be established and recognized by the medical staff and hospital administration. The maternal program must come under the direction of a family medicine physician or an obstetrics and gynecology physician, with obstetrics training and experience, and with privileges in maternal care. The administrative structure must minimally include an administrator, Maternal Medical Director (MMD), Maternal Program Manager (MPM), and appropriate support staff. The Maternal Program must be multidisciplinary in nature, and the performance improvement evaluation of this care must be extended to all the departments involved. The program must provide perinatal system leadership if acting as a regional center in areas where Level IV facilities are not available.

2. Compliance with the above will be evidenced by but not limited to:

a. Governing authority and medical staff letter of commitment in the form of a resolution;

b. Written policies and procedures and guidelines for the care of the maternal patient;

c. Defined maternal team and written roles and responsibilities;

d. Appointed Maternal Medical Director with a written job description;

e. Appointed Maternal Program Manager with a written job description; and

f. A written Maternal Performance Improvement plan.

Rule 5.1.3. Maternal Service: The maternal service shall be established and recognized by the medical staff and be responsible for the overall coordination and management of the system of care rendered to the perinatal patient. The maternal service will vary in each organization depending on the needs of the patient and the resources available. The service shall come under the organization and direction of the Maternal Medical Director.

Rule 5.1.4. Maternal Medical Director (MMD): The MMD must be a board-eligible or board- certified physician with obstetrics training and experience, and with privileges in maternal care or a board-certified maternal-fetal medicine (MFM) physician that demonstrates administrative skills and oversight of the performance improvement (PI) plan and has completed annual continuing education specific to maternal care. The MMD must cooperate with nursing administration to support the nursing needs of the perinatal patient and develop treatment protocols for the perinatal patients. A qualified provider with obstetric privileges may be responsible for the management of the program’s obstetric services.

Rule 5.1.5. Maternal Program Manager (MPM): Level III OB Centers must have a registered nurse with documented perinatal nursing experience, working in the role of the MPM. Working in conjunction with the MMD, the MPM is responsible for organization of the program and all systems necessary for the multidisciplinary approach throughout the continuum of maternal care, as well as developing or revising policies, procedures and guidelines, assuring staff competency, education, and training.

Rule 5.1.6. Perinatal Multidisciplinary Committee 1. The purpose of the committee is to provide oversight and leadership to the entire maternal program. Each perinatal center may choose to have one or more committees as needed to accomplish the task. One committee must be multidisciplinary and focus on program oversight and leadership. The major focus will be on PI activities, policy development, communication among all team members, and establishment of standards of care, and education. The committee has administrative and systematic control and oversees implementation of all program related services, meets regularly, takes attendance, maintains minutes and works to correct overall program deficiencies to optimize patient care. Membership for the committee includes representatives from:

a. Maternal Medical Director (Chairman – must be present at greater than 75% of all meetings.)

b. Maternal Program Manager

c. Neonatal Medical Director (if different from MMD)

d. Neonatal Program Manager (if different from MPM)

e. Pediatrician or Neonatologist

f. Obstetrics and Gynecology *

g. Certified Nurse Midwife (if applicable)

h. Maternal Fetal Medicine (MFM)**

i. Anesthesia***

j. Labor and Delivery

k. Nursing

l. Laboratory

m. Radiology (Ultrasound)

n. Respiratory Therapy

o. Social Services/Pastoral Care

p. Dietary

q. Lactation Specialist (or equivalent)

r. General surgery

s. Internal Medicine

t. Family Medicine

u. Advanced Practice Provider

v. Intensive Care Unit

2. The clinical managers (or designees) of the departments involved with maternal care must play an active role with the committee.

3. The OB Center may wish to accomplish performance improvement activities in this committee or develop a separate peer review committee. This committee must handle peer review independently from department-based review. The committee must meet regularly and maintain attendance and minutes. This committee must report findings to the overall hospital performance improvement (PI) program. * The director of obstetric service shall be a board-certified OB-GYN or MFM. ** The director of the MFM program shall be a board-eligible or board-certified MFM physician. *** The director of obstetric anesthesia services shall be a board-certified anesthesiologist with obstetric anesthesia fellowship training or experience in obstetric anesthesia.

Subchapter 2 Obstetric Service Provision Rule 5.2.1. Patient-centered continuum of care shall be coordinated among all providers to ensure continuity, with prenatal assessments and care plans accessible at delivery sites and postpartum records shared with outpatient providers.

Rule 5.2.2. High-risk pregnancy management: Early identification of high-risk pregnancies and appropriate risk-management shall occur. The program shall manage high- risk patients within its capabilities or initiate transfer protocols for those requiring advanced care.

Rule 5.2.3. Transfer agreements and continuity of information: Written transfer agreements shall be maintained with higher-level referral centers. Mechanisms for timely exchange of medical records, orders, and status updates shall be established before and after patient transfer.

Rule 5.2.4. Patient education and quality improvement: The program shall provide comprehensive education regarding available perinatal services and engage in ongoing quality improvement activities, including review of outcomes from prenatal through postpartum care.

Rule 5.2.5. Leadership and accountability: A designated perinatal services leader shall be appointed, who is responsible for aligning staffing, resources, policies, and procedures with the organization’s verified Maternal Level of Care and for continuous program oversight.

Subchapter 3 Transfer Guidelines Rule 5.3.1. The Level III OB Center must have the capability to accept maternal transports from lower levels of care for unanticipated high-risk pregnancies.

**History**
- *Source: Miss. Code Ann. § 41-3-15*
- *Source: Miss. Code Ann. § 41-3-15*
- *Source: Miss. Code Ann. § 41-3-15*
- *Source: Miss. Code Ann. § 41-3-15*
- *Source: Miss. Code Ann. § 41-3-15*
- *Source: Miss. Code Ann. § 41-3-15*
- *Source: Miss. Code Ann. § 41-3-15*
- *Source: Miss. Code Ann. § 41-3-15*
- *Source: Miss. Code Ann. § 41-3-15*
- *Source: Miss. Code Ann. § 41-3-15 Rule 3.2.4. Patient Education and Quality Improvement: The program shall provide comprehensive education regarding available perinatal services and engage in ongoing quality improvement activities, including review of outcomes from prenatal through postpartum care.*
- *Source: Miss. Code Ann. § 41-3-15*
- *Source: Miss. Code Ann. § 41-3-15*
- *Source: Miss. Code Ann. § 41-3-15*
- *Source: Miss. Code Ann. § 41-3-15*
- *Source: Miss. Code Ann. § 41-3-15*
- *Source: Miss. Code Ann. § 41-3-15*
- *Source: Miss. Code Ann. § 41-3-15*
- *Source: Miss. Code Ann. § 41-3-15*
- *Source: Miss. Code Ann. § 41-3-15*
- *Source: Miss. Code Ann. § 41-3-15*
- *Source: Miss. Code Ann. § 41-3-15*
- *Source: Miss. Code Ann. § 41-3-15*
- *Source: Miss. Code Ann. § 41-3-15*
- *Source: Miss. Code Ann. § 41-3-15*
- *Source: Miss. Code Ann. § 41-3-15*
- *Source: Miss. Code Ann. § 41-3-15*
- *Source: Miss. Code Ann. § 41-3-15*
- *Source: Miss. Code Ann. § 41-3-15*
- *Source: Miss. Code Ann. § 41-3-15*
- *Source: Miss. Code Ann. § 41-3-15*
- *Source: Miss. Code Ann. § 41-3-15*
- *Source: Miss. Code Ann. § 41-3-15*
- *Source: Miss. Code Ann. § 41-3-15*
- *Source: Miss. Code Ann. § 41-3-15*
- *Source: Miss. Code Ann. § 41-3-15*
- *Source: Miss. Code Ann. § 41-3-15*
- *Source: Miss. Code Ann. § 41-3-15*
- *Source: Miss. Code Ann. § 41-3-15*
- *Source: Miss. Code Ann. § 41-3-15*
- *Source: Miss. Code Ann. § 41-3-15*
- *Source: Miss. Code Ann. § 41-3-15*
- *Source: Miss. Code Ann. § 41-3-15*
- *Source: Miss. Code Ann. § 41-3-15*
- *Source: Miss. Code Ann. § 41-3-15*
- *Source: Miss. Code Ann. § 41-3-15*
- *Source: Miss. Code Ann. § 41-3-15*
- *Source: Miss. Code Ann. § 41-3-15*
- *Source: Miss. Code Ann. § 41-3-15*
- *Source: Miss. Code Ann. § 41-3-15*
- *Source: Miss. Code Ann. § 41-3-15*
- *Source: Miss. Code Ann. § 41-3-15*
- *Source: Miss. Code Ann. § 41-3-15*

##### **15 Miss. Admin. Code Pt. 3, R. 5.3.2** Rule 5.3.2 {#sec-3-5.3.2 omnilex-key=us-ms-regs-official--title-15--3#5.3.2}

Maternal transports from lower levels: The program shall maintain the capability to accept urgent maternal transports from lower-level facilities. Upon transfer request, the receiving team must confirm ETA, mobilize appropriate staff and resources, and prepare bed assignments to guarantee safe admission and continuity of care. Rule 5.3.3. Identification and Management of Transfers: The program shall define criteria for maternal transfers to higher‐level facilities and maintain prearranged relationships for immediate consultation and patient relocation. The program shall maintain documented mechanisms to facilitate and accept maternal transfers/transports. All designated facilities will agree to provide service to the maternal patient regardless of their ability to pay. Written agreements should be in place for the transfer of perinatal patients.

Rule 5.3.4. Communication and Documentation Requirements: Effective bidirectional communication protocols shall be employed, ensuring complete documentation

and timely exchange of clinical information between transferring and receiving entities to address maternal care quality issues.

Rule 5.3.5. Stabilization and Transfer Protocols: Patients requiring transfer shall receive prompt assessment, stabilization, and initiation of the transfer process. Follow-up reporting on patient status post-transfer shall be ensured.

Subchapter 4 Clinical Components Rule 5.4.1. Interdisciplinary Team: The Level III OB Center must have an interdisciplinary team that includes individuals with expertise in and/or knowledge about the specialized care, treatment and services required for perinatal care. The interdisciplinary team includes individuals and specialized services to support the care, treatment, and services provided by the program. The following individuals and services are represented on the team:

1. Obstetrics and Gynecology physician: The Obstetrics and Gynecology physician with obstetrics training and experience must be available for consultation at all times.

2. Obstetrics: A board-eligible or board-certified obstetrician must be physically present on site at all times.

3. Qualified Physicians/Certified Nurse Midwife: Ensure that a qualified physician or certified nurse midwife with appropriate physician back-up is available to attend to all deliveries or other obstetrical emergencies.

a. Must arrive at the patient’s bedside within thirty (30) minutes of an urgent request; and

b. Must complete annual continuing education, specific to the care of pregnant and postpartum patients, including complicated conditions.

4. Maternal-Fetal Medicine (MFM): A MFM specialist with inpatient privileges must be readily available at all times, either on site, by phone, or by telemedicine. Timing of the need to be on site is directed by the urgency of the clinical situation; however the provider must be able to be on site to provide

direct care within 24 hours. The MFM specialist shall also be available at all times for consult for all pregnant or postpartum patients in the ICU.

5. Anesthesia: Board-certified anesthesiologist must be on site 24 hours a day, 7 days a week.

6. Intensive Care Unit (ICU): There must be the availability of an adult medical and surgical ICU that accepts pregnant women and women in the postpartum period. The ICU must be staffed by adult critical care providers on site 24 hours a day, 7 days a week.

7. Internal medicine providers, family medicine providers, and general surgeons must be readily available at all times for obstetric patients.

8. Nursing: Nursing leaders and qualified labor, delivery, surgical, and recovery nursing personnel who have special training and experience in the management of women with complex and critical maternal illnesses and obstetric complications in adequate numbers to meet the needs of each patient are readily available at all times.

9. Laboratory and Blood Bank Services: Laboratory personnel must be immediately available to obtain and process appropriate samples and report urgent/emergent results. Blood bank services must be available at all times to determine blood type and Rh type, crossmatch blood and perform antibody testing. There must be in-house availability of all blood components. There must also be guidelines or protocols in place for:

a. Massive blood component transfusion;

b. Emergency release of blood components; and

c. Management of multiple blood component therapy.

10. Radiology Support: Radiologic services with interpretation must be readily available at all times and include:

a. Specialized obstetric ultrasound and fetal assessment (to include Doppler studies);

b. Computed tomography scans;

c. Magnetic resonance imaging;

d. Standard non-obstetric ultrasound imaging

e. Standard obstetric ultrasound imaging;

f. Maternal echocardiography; and

g. Basic interventional radiology (capable of performing uterine artery embolization).

11. Respiratory and Pharmacy: Respiratory care personnel and a registered pharmacist should be readily available at all times. a. Appropriate equipment and personnel physically present at all times onsite to ventilate and monitor women in labor and delivery until they can be safely transferred to the ICU.

12. Support Staff: a. Lactation Specialists: Lactation Specialists or support staff with knowledge and skills in breastfeeding and lactation to meet the needs of maternal patients must be available at all times.

b. Social services, pastoral care, or bereavement services must be provided as appropriate to meet the needs of the patient population served.

c. A dietician or nutritionist should be available with the appropriate training and experience for the population served.

13. Subspecialists shall be readily available, per the facility’s policy, for inpatient consultation, which include critical care, general surgery, infectious disease, hematology, cardiology, nephrology, neurology, gastroenterology, internal medicine, behavioral health, and neonatology.

Rule 5.4.2. An on-call schedule of providers, back-up providers, and provision for patients without a physician must be readily available to facility and maternal staff and posted on the labor and delivery unit.

Rule 5.4.3. Ensure that physicians providing back-up coverage must arrive at the patient’s bedside within 30 minutes of an urgent request.

Rule 5.4.4. Certified nurse midwives, physician assistants and nurse practitioners who provide care for maternal patients: 1. must operate under guidelines reviewed and approved by the MMD; and

2. must have a formal arrangement with a physician with obstetrics training or experience, and with maternal privileges who must:

a. provide back-up and consultation; and b. arrive at the patient’s bedside within 30 minutes of an urgent request.

Rule 5.4.5. Level III Obstetrical Center requirements: 1. Manage complex maternal and fetal illnesses before, during and after delivery. 2. Maintain access to consultation and referral to Maternal-Fetal Medicine specialists.

Rule 5.4.6. Guideline/Protocol Development The facility must have written guidelines or protocols for various conditions that place the pregnant or postpartum patient at risk for morbidity or mortality, including promoting prevention, early identification, early diagnosis, therapy, stabilization, and transfer. The guidelines or protocols must address a minimum of:

1. Massive hemorrhage and transfusion of the pregnant or postpartum patient in coordination of the blood bank, including management of unanticipated hemorrhage or coagulopathy; 2. Obstetrical hemorrhage, including promoting the identification of patients at risk, early diagnosis, and therapy to reduce morbidity and mortality;

3. Placenta accreta spectrum disorder, including team education, risk factor screening, evaluation, diagnosis, fostering telemedicine medical services and referral as appropriate, treatment and multidisciplinary management of unanticipated placenta accreta spectrum disorder cases, including postpartum care; 4. Hypertensive disorders in pregnancy, including eclampsia and the postpartum patient to promote early diagnosis and treatment to reduce morbidity and mortality; 5. Sepsis or systemic infection in the pregnant or postpartum patient; 6. Venous thromboembolism in the pregnant and postpartum patient, including assessment of risk factors, prevention, early diagnosis and treatment; 7. Shoulder dystocia, including assessment of risk factors, counseling of patient, and multidisciplinary management; and 8. Behavioral health disorders, including depression, substance abuse and addiction that includes screening, education, consultation with appropriate personnel and referral.

Rule 5.4.7. Perinatal Education. 1. The Level III OB Center must have internal perinatal education programs including training for physicians, nurses, ancillary staff, and prehospital providers.

2. Level III OB Centers must have a written perinatal education plan. Chapter 6 Maternal Designation Level IV (Regional Perinatal Health Care Centers) Subchapter 1 Hospital Organization Rule 6.1.1. The Level IV maternal designated facility must provide Level III facility level of care plus provide on-site medical and surgical care of the most complex maternal conditions and critically ill pregnant women and fetuses throughout antepartum, intrapartum, and postpartum care.

Rule 6.1.2. Maternal Program 1. There shall be a written commitment on behalf of the entire facility to the organization of neonatal and maternal care. The written commitment shall be in the form of a resolution at the time of application passed by an appropriate

quorum of the members of the governing authority. Should the business organization be other than a corporation, a letter explaining such, together with the written commitment of the hospital’s chief executive officer, to the establishment of a maternal care program may be sufficient. The maternal program must be established and recognized by the medical staff and hospital administration. The maternal program must come under the direction of a family medicine physician or an obstetrics and gynecology physician, with obstetrics training and experience, and with privileges in maternal care. The administrative structure must minimally include an administrator, Maternal Medical Director (MMD), Maternal Program Manager (MPM), and appropriate support staff. The Maternal Program must be multidisciplinary in nature and the performance improvement evaluation of this care must be extended to all the departments involved. The Level IV facility must provide perinatal system leadership, including facilitation of collaboration with facilities in the region, analysis and review of system perinatal outcome and quality data, provision of outreach education and assistance with quality improvement as needed.

2. Compliance with the above will be evidenced by but not limited to:

a. Governing authority and medical staff letter of commitment in the form of a resolution;

b. Written policies and procedures and guidelines for the care of the maternal patient;

c. Defined maternal team and written roles and responsibilities;

d. Appointed Maternal Medical Director with a written job description;

e. Appointed Maternal Program Manager with a written job description; and

f. A written Maternal Performance Improvement plan.

Rule 6.1.3. Maternal Service: The maternal service shall be established and recognized by the medical staff and be responsible for the overall coordination and management of the system of care rendered to the perinatal patient. The maternal service will vary in each organization depending on the needs of the patient and the resources

available. The service shall come under the organization and direction of the Maternal Medical Director.

Rule 6.1.4. Maternal Medical Director (MMD): The MMD must be a board-eligible or board- certified physician with obstetrics training and experience, and with privileges in maternal care or a board-eligible or board-certified maternal-fetal medicine physician that demonstrates administrative skills and oversight of the performance improvement (PI) plan and has completed annual continuing education specific to maternal care. The MMD must cooperate with nursing administration to support the nursing needs of the perinatal patient and develop treatment protocols for the perinatal patients. A qualified provider with obstetric privileges may be responsible for the management of the program’s obstetric services.

Rule 6.1.5. Maternal Program Manager (MPM): Level IV OB Centers must have a registered nurse with documented perinatal nursing experience, working in the role of the MPM. Working in conjunction with the MMD, the MPM is responsible for organization of the program and all systems necessary for the multidisciplinary approach throughout the continuum of maternal care, as well as developing or revising policies, procedures and guidelines, assuring staff competency, education, and training.

Rule 6.1.6. Perinatal Multidisciplinary Committee 1. The purpose of the committee is to provide oversight and leadership to the entire maternal program. Each perinatal center may choose to have one or more committees as needed to accomplish the task. One committee must be multidisciplinary and focus on program oversight and leadership. The major focus will be on PI activities, policy development, communication among all team members, and establishment of standards of care, and education. The committee has administrative and systematic control and oversees implementation of all program related services, meets regularly, takes attendance, maintains minutes and works to correct overall program deficiencies to optimize patient care. Membership for the committee includes representatives from:

a. Maternal Medical Director (Chairman – must be present at greater than 75% of all meetings.)

b. Maternal Program Manager

c. Neonatal Medical Director (if different from MMD)

d. Neonatal Program Manager (if different from MPM)

e. Pediatrician or Neonatologist

f. Obstetrics and Gynecology*

g. Certified Nurse Midwife (if applicable)

h. Maternal Fetal Medicine (MFM)**

i. Anesthesia***

j. Labor and Delivery

k. Nursing

l. Laboratory

m. Radiology (Ultrasound)

n. Respiratory Therapy

o. Social Services/Pastoral Care

p. Dietary

q. Lactation Specialist (or equivalent)

r. General surgery

s. Internal Medicine

t. Advanced Practice Provider

u. Family Medicine

v. Intensive Care Unit

2. The clinical managers (or designees) of the departments involved with maternal care must play an active role with the committee.

3. The OB Center may wish to accomplish performance improvement activities in this committee or develop a separate peer review committee. This committee must handle peer review independently from department-based review. The committee must meet regularly and maintain attendance and minutes. This committee must report findings to the overall hospital performance improvement (PI) program. * The director of obstetric service shall be a board-certified OB-GYN or MFM **The director of the MFM program shall be a board-eligible or board-certified MFM physician. *** The director of obstetric anesthesia services shall be a board-certified anesthesiologist with obstetric anesthesia fellowship training or experience in obstetric anesthesia.

Subchapter 2 Obstetric Service Provision Rule 6.2.1. Patient-centered continuum of care shall be coordinated among all providers to ensure continuity, with prenatal assessments and care plans accessible at delivery sites and postpartum records shared with outpatient providers.

Rule 6.2.2. High-risk pregnancy management: Early identification of high-risk pregnancies and appropriate risk-management shall occur. The program shall manage high- risk patients within its capabilities

Rule 6.2.4. Patient education and quality improvement: The program shall provide comprehensive education regarding available perinatal services and engage in

ongoing quality improvement activities, including review of outcomes from prenatal through postpartum care.

Rule 6.2.5. Leadership and accountability: A designated perinatal services leader shall be appointed, who is responsible for aligning staffing, resources, policies, and procedures with the organization’s verified Maternal Level of Care and for continuous program oversight.

Subchapter 3 Transfer Guidelines Rule 6.3.1. The Level IV OB Center must have the capability to accept maternal transports from lower levels of care for unanticipated high-risk pregnancies.

Rule 6.3.2. Maternal transports from lower levels: The program shall maintain the capability to accept urgent maternal transports from lower-level facilities. Upon transfer request, the receiving team must confirm ETA, mobilize appropriate staff and resources, and prepare bed assignments to guarantee safe admission and continuity of care. Rule 6.3.3 Identification and Management of Transfers: The program shall maintain prearranged relationships for immediate consultation and patient relocation. The program shall maintain documented mechanisms to facilitate and accept maternal transfers/transports. All designated facilities will agree to provide service to the maternal patient regardless of their ability to pay. Written agreements should be in place for the transfer of perinatal patient.

Rule 6.3.4. Communication and Documentation Requirements: Effective bidirectional communication protocols shall be employed, ensuring complete documentation and timely exchange of clinical information between transferring and receiving entities to address maternal care quality care issues. Follow-up reporting on patient status post-transfer shall be ensured.

Rule 6.4.1. Interdisciplinary Team: The Level IV OB Center must have an interdisciplinary team that includes individuals with expertise in and/or knowledge about the specialized care, treatment and services required for perinatal care. The interdisciplinary team includes individuals and specialized services to support the care, treatment, and services provided by the program. The following individuals and services are represented on the team:

1. Obstetrics and Gynecology physician: The Obstetrics and Gynecology physician with obstetrics training and experience must be available for consultation at all times.

2. Obstetrics: A board-eligible or board-certified obstetrician must be physically present on site at all times.

3. Qualified Physicians/Certified Nurse Midwife: Ensure that a qualified physician or certified nurse midwife with appropriate physician back-up is available to attend all deliveries or other obstetrical emergencies.

a. Must arrive at the patient’s bedside within thirty (30) minutes of an urgent request; and

b. Must complete annual continuing education, specific to the care of pregnant and postpartum patient, including complicated conditions.

4. Maternal-Fetal Medicine (MFM): A board-certified MFM attending with full inpatient privileges must be readily available at all times, either on site, by phone, or by telemedicine for consultation and management. The need to be on site is directed by the urgency of the clinical situation; however, the provider must be able to be on site to provide direct care within 24 hours. The MFM specialist shall also be available at all times for consultation for all pregnant or postpartum patients in the ICU.

5. MFM Critical Care Team: The facility must have a MFM critical care team in place whose members have the expertise to manage highly complex, critically ill, or unstable maternal patients. This includes co-management for all pregnant or postpartum patients in the ICU.

a. A MFM Critical Care Team member with full obstetrical privileges shall be available at all times for on-site consultation and management, and to

arrive at the patient’s bedside within thirty (30) minutes of an urgent request

b. A board-certified MFM physician with expertise in critical care obstetrics shall lead the team.

6. Anesthesia: Board-certified anesthesiologist with obstetric anesthesia fellowship training or experience must be physically present on site 24 hours a day, 7 days a week.

7. Medical/Surgical: On-site medical and surgical capabilities must be available for complex maternal conditions.

8. Intensive Care Unit: There must be the availability of an on-site adult medical and surgical ICU for obstetric patients who are primarily or co-managed by an MFM team. This includes the onsite provision of medical and surgical care for complex maternal and surgical care for complex maternal conditions, supported by the availability of critical care units or ICU beds. (Co- management includes at least daily rounds by an MFM specialist physician with interaction with the ICU team and other subspecialists with daily documentation.) The ICU must be staffed by adult critical care providers on site 24 hours a day, 7 days a week. In some settings, the ICU is in adjoining or connected building, which is acceptable as long as maternal-fetal medicine care is as noted above. If the woman must be transported by ambulance to the ICU, this is not considered onsite.

9. Internal medicine providers, family medicine providers, and general surgeons must be readily available at all times for obstetric patients.

10. At least one of the following adult subspecialties must be readily available for consultation and treatment as needed onsite: neurosurgery, cardiac surgery, or transplant. If the facility does not have all three subspecialties available, there should be a process in place to transfer women to a facility that can provide the needed services.

11. Nursing: The center shall have a continuous availability of adequate RNs who have experience in the care of women with complex medical illnesses and obstetric complications with close collaboration between critical care nurses and obstetric nurses with expertise in care for critically ill women.

i. The Nursing Service Line leadership must have an advanced degree and national certification.

12. Laboratory and Blood Bank Services: Laboratory personnel must be immediately available to obtain and process appropriate samples and report urgent/emergent results. Blood bank services must be available at all times to determine blood type and Rh type, crossmatch blood and perform antibody testing. There must be in-house availability of all blood components. There must also be guidelines or protocols in place for:

a. Massive blood component transfusion;

b. Emergency release of blood components; and

c. Management of multiple blood component therapy.

13. Radiology Support: Radiologic services with interpretation must be readily available at all times and include:

a. Specialized obstetric ultrasound and fetal assessment (to include Doppler studies);

b. Computed tomography scans;

c. Magnetic resonance imaging;

d. Standard obstetric ultrasound imaging;

e. Maternal echocardiography; and

f. Advanced interventional radiology (capable of performing uterine artery embolization).

11. Respiratory and Pharmacy: Respiratory care personnel and a registered pharmacist should be readily available at all times.

12. Support Staff: a. Lactation Specialists: Lactation Specialists or support staff with knowledge and skills in breastfeeding and lactation to meet the needs of maternal patients must be available at all times.

b. Social services, pastoral care, or bereavement services must be provided as appropriate to meet the needs of the patient population served.

c. A dietician or nutritionist should be available with the appropriate training and experience for the population served.

13. Subspecialists shall be readily available, per the facility’s policy, for inpatient consultation, which includes critical care, general surgery, infectious disease, hematology, cardiology, nephrology, neurology, gastroenterology, internal medicine, behavioral health, and neonatology.

a. At least one of the following adult subspecialties must be available at all times, per the facility’s policy, for consultation and treatment needed on site:

i. Neurosurgery

ii. Cardiac surgery

iii. Transplant surgery Note: If the organization does not have all three subspecialties available, there should be a process in place to transfer women to a facility that can provide the needed services.

Rule 6.4.2. An on-call schedule of providers, back-up providers, and provision for patients without a physician must be readily available to facility and maternal staff and posted on the labor and delivery unit.

Rule 6.4.3. Ensure that physicians providing back-up coverage must arrive at the patient’s bedside within 30 minutes of an urgent request.

Rule 6.4.4. Certified nurse midwives, physician assistants and nurse practitioners who provide care for maternal patients:

1. must operate under guidelines reviewed and approved by the MMD; and

2. must have a formal arrangement with a physician with obstetrics training or experience, and with maternal privileges who must:

a. provide back-up and consultation; and

b. arrive at the patient’s bedside within 30 minutes of an urgent request.

Rule 6.4.5. Level IV OB Obstetrical Center requirements: 1. Manage complex maternal and fetal illnesses before, during and after delivery. 2. Maintain access to consultation and referral to Maternal-Fetal Medicine specialists. 3. Maintain a full range of surgical and medical specialists including Maternal- Fetal Medicine specialists at the site. 4. Facilitate maternal transport and provide outreach education.

Rule 6.4.6. Guideline/Protocol Development The facility must have written guidelines or protocols for various conditions that place the pregnant or postpartum patient at risk for morbidity or mortality, including promoting prevention, early identification, early diagnosis, therapy, stabilization, and transfer. The guidelines or protocols must address a minimum of:

1. Massive hemorrhage and transfusion of the pregnant or postpartum patient in coordination of the blood bank, including management of unanticipated hemorrhage or coagulopathy;

2. Obstetrical hemorrhage, including promoting the identification of patients at risk, early diagnosis, and therapy to reduce morbidity and mortality;

3. Placenta accreta spectrum disorder, including team education, risk factor screening, evaluation, diagnosis, fostering telemedicine medical services and referral as appropriate, treatment and multidisciplinary management of both

anticipated and unanticipated placenta accreta spectrum disorder cases, including postpartum care;

4. Hypertensive disorders in pregnancy, including eclampsia and postpartum patients to promote early diagnosis and treatment to reduce morbidity and mortality;

5. Sepsis or systemic infection in the pregnant or postpartum patient;

6. Venous thromboembolism in the pregnant and postpartum patient, including assessment of risk factors, prevention, early diagnosis and treatment;

7. Shoulder dystocia, including assessment of risk factors, counseling of patient, and multidisciplinary management; and

8. Behavioral health disorders, including depression, substance abuse and addiction that include screening, education, consultation with appropriate personnel and referral.

Rule 6.4.7. Perinatal Education. 1. The Level IV OB Center must have internal perinatal education programs including training for physicians, nurses, ancillary staff, and prehospital providers.

2. Level IV OB Centers must have a written perinatal education plan.

Chapter 7 Neonatal Levels of Care Subchapter 1 Neonatal Program Requirements The neonatal levels of care establish a tiered framework—Level I through Level IV—to match facility resources, clinical expertise, and support services with the acuity of mothers and their newborns. Each ascending level builds on the previous one by defining progressively advanced requirements for infrastructure, staffing, specialized services, and quality‐improvement activities, ensuring that every infant receives risk-appropriate, evidence-based care at the right place and time.

Rule 7.1.1. Designated neonatal facilities must have a family-centered philosophy. Parents must have reasonable access to their infants at all times and be encouraged to participate in the care of their infants. The facility environment for perinatal care must meet the physiologic, developmental, and psychosocial needs of the mothers, infants, and families.

**History**
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- *Source: Miss. Code Ann. § 41-3-15 Subchapter 4 Clinical Components*
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##### **15 Miss. Admin. Code Pt. 3, R. 7.1.2** Rule 7.1.2 {#sec-3-7.1.2 omnilex-key=us-ms-regs-official--title-15--3#7.1.2}

Designated neonatal facilities organized medical staff and institutional governing body must demonstrate an institutional commitment to the neonatal program and will 1. Include allocation of sufficient personnel and resources to attain optimal neonatal care; 2. Reaffirm the neonatal program at least every three (3) years; and 3. Verify the neonatal program description is current at the time of neonatal verification Rule 7.1.3. Neonatal Program Plan. The facility must develop a written neonatal operational plan for the neonatal program that includes a detailed description of the scope of services and clinical resources available for all neonatal patients, mothers, and families. The plan must define the neonatal patient population evaluated, treated, transferred, or transported by the facility consistent with clinical guidelines based on current standards of neonatal practice ensuring the health and safety of patients. The plan must identify the resources used to develop the facility’s neonatal policies and procedures for the neonatal services it provides. 1. The written Neonatal Program Plan must be reviewed and approved by Perinatal Multidisciplinary Committee and be submitted to the facility's governing body for review and approval. The governing body must ensure the requirements of this section are implemented and enforced.

2. The written Neonatal Program Plan must include, at a minimum:

a. Clinical guidelines based on current standards of neonatal practice, and policies and procedures that are adopted, implemented, and enforced by the neonatal program;

b. A process to ensure and validate these clinical guidelines based on current standards of neonatal practice, policies, and procedures, are reviewed and revised a minimum of every three years;

c. Written triage, stabilization, and transfer guidelines for neonatal patients that include consultation and transport services;

d. The role and scope of telehealth/telemedicine practices, if utilized, including:

i. documented and approved written policies and procedures that outline the use of telehealth/telemedicine for inpatient hospital care or for consultation, including appropriate situations, scope of care, and

ii. documentation that is monitored through the neonatal Performance Improvement (PI) Plan and process; and

iii. written and approved procedures to gain informed consent from the patient or designee for the use of telehealth/telemedicine, if utilized, that are monitored for variances;

e. written guidelines for discharge planning instructions and appropriate follow-up appointments for all neonates/infants;

f. provisions to facilitate continuity of care for high-risk neonatal patients from delivery to discharge;

g. delineation of roles, responsibilities, and authority of the medical, nursing, and ancillary patient care directors;

h. physician, advanced practice nurse, and/or other medical care provider staffing plan for neonatal coverage;

i. plan for nurse staffing including provisions for flexibility and change in census and acuity;

j. written guidelines for the hospital disaster response, including a defined neonatal evacuation plan and process to relocate mothers and infants to appropriate levels of care with identified resources, and this process must be evaluated annually to ensure neonatal care can be sustained and adequate resources are available;

k. written minimal education and credentialing requirements for all staff participating in the care of neonatal patients, which are documented and monitored by the managers who have oversight of staff;

l. written requirements for providing continuing staff education, including annual educational needs assessment to evaluate the ongoing educational needs of all staff participating in the care of newborns, which are documented and monitored by the managers who have oversight of staff;

m. annual education plan for all staff participating in the care of newborns that includes didactic, education, simulation, competency, and skills validation;

n. measures to monitor the availability of all necessary equipment and services required to provide the appropriate level of care and support for the patient population served;

o. documented guidelines for consulting support personnel with knowledge and skills in breastfeeding and lactation, which includes expected response times, defined roles, responsibilities, and expectations;

p. Appropriate allocations for family-centered care including providing parents with reasonable access to their infants and encouraging advocacy, shared decision-making, and participation in their child’s care; and

q. Assurance of equitable care for all neonatal patients and families and provisions for promoting an environment of cultural humility.

1. The facility will have a system for identification and review of significant events that could indicate threats to patient safety, with a goal of learning from identified events and mitigating future risk of recurrence, including:

a. A list of specific triggers or safety indicators that warrant a record review, with the goal of identifying significant safety events such as errors, adverse events, near misses, complications, and mortalities;

b. A process for systematic multidisciplinary review of selected cases or safety events, using acceptable failure mode and effect analysis tools with a goal of identifying interventions to improve systems and reduce future safety risks; and c. A process for monitoring the implementation of identified interventions. 2. The facility will have a dashboard or equivalent that is used to summarize and track quality indicators relevant to newborn care, including: a. A list of selected quality measures relevant to the facility with a process for obtaining data needed for each selected neonatal quality measure; b. A platform to display performance on the selected quality measures, including a process for updating data with a frequency that allows for appropriate identification of performance concerns; c. Benchmarking of performance, when possible, with internal or external benchmarks; and d. A multidisciplinary forum for review of the dashboard or equivalent. 3. The facility will have a structured approach to quality improvement (QI) that seeks to improve care quality and outcomes. Quality outcomes include care that is safe, efficient, effective, timely, equitable, and patient centered. Approaches will include: a. A clear process for determining current QI initiatives, with a goal that the unit is engaged in at least 1 to 2 such initiatives at any given time; b. Identification of a multidisciplinary QI team for each initiative, with a designated team lead; c. Use of structured improvement methods or framework to guide improvement efforts; and d. A multidisciplinary quality committee that meets regularly to identify and review QI initiatives. 4. The facility will maximize efforts to standardize and improve care through the use of guidelines and policies that align with research-driven and evidence-based best practices, including: a. A process for identifying topics for guideline or policy development; b. A process for developing guidelines and policies that incorporate evidence- based recommendations;

c. A platform for making guidelines and policies readily available to clinical providers; and d. A process for periodic review of guidelines and policies to guarantee they remain updated, and evidence based. 5. The facility will have multidisciplinary involvement in quality and safety activities, including: a. Involvement of all disciplines represented in the neonatal quality and safety activities as appropriate and as described above; and b. For level IV facilities, involvement of subspecialty services with significant presence in the neonatal unit. 6. The neonatal-specific unit will coordinate with hospital quality and safety activities, including: a. Structured collaboration with the obstetrics and pediatric surgery departments, if applicable, to identify and implement opportunities for shared quality and safety efforts; b. Participation in hospital-level quality and safety activities to confirm alignment of neonatal quality goals with hospital priorities; c. Alignment with hospital activities and reporting of quality measures to national organizations; and d. Participation in efforts to guarantee everyday readiness for external assessments by regulatory organizations. 7. The facility will participate in larger communities of perinatal safety and quality, including: a. Collaboration between transferring and receiving hospitals to examine and improve population-level quality and safety through structured activities such as transport review and sharing of clinical protocols; and b. For level III and IV facilities, participation in regional, state, or national databases that allows benchmarking of performance. 1. The Neonatal Medical Director (NMD) must have the authority to make referrals for peer review, receive feedback from the peer review process, and ensure neonatal physician representation in the peer review process for neonatal cases.

2. The facility must have documented evidence of neonatal PI summary reports reviewed and reported by Perinatal Multidisciplinary Committee that monitor and ensure the provision of services or procedures through telehealth and telemedicine, if utilized, is in accordance with the standards of care applicable to the provision of the same service or procedure in an in-person setting.

3. The facility must have documented evidence of neonatal PI summary reports to support that aggregate neonatal data are consistently reviewed to identify developing trends, opportunities for improvement, and necessary corrective actions. Summary reports must be provided through the Perinatal Multidisciplinary Committee, available for site surveyors, and submitted to the Department as requested.

1. The credentialing of the neonatal medical staff must include a process for the delineation of privileges for neonatal care.

2. The neonatal medical staff must participate in ongoing staff and team-based education and training in the care of the neonatal patient.

2. Ensure neonatal medical staff and advanced practice provider competencies in managing neonatal emergencies, complications, and resuscitation techniques;

3. Monitor neonatal patient care from transport, to admission, stabilization, and operative intervention(s), as applicable, through discharge, and review variances in care through the neonatal Performance Improvement (PI) Plan;

4. Participate in ongoing neonatal staff and team-based education and training in the care of the neonatal patient;

5. Oversee the inter-facility neonatal transport as appropriate;

6. Collaborate with the Neonatal Program Manager (NPM), maternal teams, consulting physicians, and nursing leaders and units providing neonatal care to include developing, implementing, or revising:

a. written policies, procedures, and guidelines for neonatal care that are implemented and monitored for variances;

b. the Neonatal PI Plan, specific reviews, and data initiatives;

c. criteria for transfer, consultation, or higher-level of care; and

d. medical staff, advanced practice providers, and personnel competencies, education, and training;

7. Participate as a clinically active and practicing physician in neonatal care at the facility where medical director services are provided;

8. Ensure that the Neonatal PI Plan is specific to neonatal/infant care, is ongoing, data driven, and outcome based;

9. Frequently lead the neonatal PI meetings with the NPM and participate in the Perinatal Multidisciplinary Committee and other neonatal meetings, as appropriate;

10. Maintain active staff privileges as defined in the facility's medical staff bylaws; and

11. Develop and maintain collaborative relationships with other NMDs of designated neonatal facilities within the applicable region.

12. Collaborate with the transport team to develop, revise, and implement written policies, procedures, and guidelines, for neonatal care that are implemented and monitored for variances;

13. Participate in ongoing transport staff competencies, education, and training;

14. Review and evaluate transports from initial activation of the transport team through delivery of patient, resources, quality of patient care provided, and patient outcomes; and

15. Integrate review findings into the overall Neonatal PI Plan and process.

Rule 7.1.7. Neonatal Program Manager (NPM). The facility must identify an NPM who has the authority and oversight responsibilities written in his or her job description, for the provision of neonatal services through all phases of care, including discharge, and identifying variances in care for inclusion in the Neonatal PI Plan. The NPM must be a registered nurse with defined education, credentials, and experience for neonatal care applicable to the level of care being provided. The NPM must maintain a current status of successful completion of the Neonatal Resuscitation Program (NRP) or a department-approved equivalent course. The NPM must: 1. Ensure staff competency in resuscitation techniques;

2. Participate in ongoing staff and team-based education and training in the care of the neonatal patient;

3. Monitor utilization of telehealth/telemedicine, if used;

4. Collaborate with the NMD, maternal program, consulting physicians, and nursing leaders and units providing neonatal care to include developing, implementing, or revising:

a. written policies, procedures, and guidelines for neonatal care that are implemented and monitored for variances; b. the Neonatal PI Plan, specific reviews, and data initiatives; c. criteria for transfer, consultation, or higher-level of care; and d. staff competencies, education, and training;

5. Regularly and actively participate in neonatal care at the facility where program manager services are provided;

6. Consistently review the neonatal care provided and ensure the Neonatal PI Plan is specific to neonatal/infant care, data driven, and outcome-based;

7. Frequently lead the meetings and participate in Perinatal Multidisciplinary Committee and other neonatal meetings as appropriate; and

8. Develop and maintain collaborative relationships with other NPMs of designated neonatal facilities within the applicable PCR.

Rule 7.1.8. Transfer Guidelines The program shall define criteria for neonatal transfers to higher‐level facilities and maintain prearranged relationships for immediate consultation and patient relocation. All designated facilities will agree to provide service to the neonatal patient regardless of their ability to pay. Written agreements should be in place for the transfer of the neonatal patient. Rule 7.1.9 Stabilization and Transfer Protocols: Patients requiring transfer shall receive prompt assessment, stabilization, and initiation of the transfer process. Follow-up reporting on patient status post- transfer shall be ensured.

Rule 7.1.10. Communication and Documentation Requirements: Effective bidirectional communication protocols shall be employed, ensuring complete documentation and timely exchange of clinical information between transferring and receiving entities.

Subchapter 2 General Program Requirements Rule 7.2.1 Family Centered Care Core Components The facility will: 1. Allow all parents to have reasonable access to their infants at all times; 2. Have access to the services, personnel, and equipment needed to provide the appropriate level of care for all infants;

3. Support the physiologic, developmental, and psychosocial needs of infants and their families; 4. Have a process to screen every family for social determinants, depression, and cultural needs; and 5. Refer patients and families to appropriate resources as needed. Family centered care additional best practices 1. Implement the utilization of primary nursing. 2. Involve family in daily and multidisciplinary patient care rounds. 3. Implement and support a family advisory council. 4. Establish a process to evaluate potential health disparities of the patient population served. 5. Implement a coordinated process to assess and address the emotional needs of families. 6. Engage in shared decision-making by involving family in discharge planning, including transport discussions. 7. Provider and staff training on shared decision making and how to engage in difficult and inclusive conversations. 8. Explicit efforts to support lactation and the needs of breastfeeding individuals. Rule 7.2.2 Lactation and Neonatal Nutrition 1. The facility will: a. have personnel with the knowledge and skills to support lactation available at all times; b. have pumping equipment and secure human milk storage facilities available; c. have policies and procedures in place to support: i. the initiation and maintenance of lactation; ii. early initiation of milk expression; iii. safety, preparation, storage, and use of human milk and formula; iv. long-term pumping and transition to breastfeeding; and v. the utilization of donor human milk, if available. d. provide annual education to all direct care providers on the importance of, and support of lactation (i.e., pumping, mixing, safe storage, misappropriation, and proper identification); and i. all direct care providers have didactic education, skills verification, and competency on the proper mixing of human milk and formula;

e. establish a program for breastfeeding and lactation support, including data collection. Rule 7.2.3 Neonatal Resuscitation The facility must have written policies and procedures specific to the resuscitation and stabilization of newborns based on current standards of professional practice. 1. At least 1 person with the skills to perform a complete neonatal resuscitation including endotracheal intubation, establishment of vascular access, and administration of medications must be immediately available on-site 24/7 2. A full range of neonatal resuscitative equipment, supplies, and medications must be immediately available at all times. 3. If the facility provides obstetrical delivery services: a. Each birth will be attended by at least 1 AAP Neonatal Resuscitation Program (NRP) trained provider whose only responsibility is the management of the newborn and initiating resuscitation. b. In the event of identified antepartum and intrapartum risk factors, at least 2 NRP trained providers should be present at birth and be responsible solely for the management and resuscitation of the newborn. Additional qualified providers should be available depending on the anticipated risk, number of newborns, and the obstetrical setting. c. If advanced resuscitation measures are anticipated, a fully qualified neonatal resuscitation team should be present at the time of birth. Rule 7.2.4 Radiology When obtaining imaging in neonatal and obstetrical patients, radiology services will incorporate the “as low as reasonably achievable” principle. Rule 7.2.3 Policies and Procedures The facility will have written: 1. neonatal, medical, and ancillary care guidelines, policies, and procedures that are established on evidence-based literature, and best-practice standards, that are monitored and tracked for adherence, reviewed at least every 3 years, and revised as needed;

2. a policy that mandates the escalation of concern and the urgent presence of a privileged care provider at the bedside, including a method to track adherence; 3. policies and procedures that define the criteria for neonatal team presence at a delivery and identify a method to track adherence, if applicable; 4. policies and procedures for the triage, stabilization, and transfer of obstetrical patients to the appropriate level of care, if applicable; 5. policies and procedures for consultation by telehealth and telephone, if applicable; 6. policies and procedures for intrafacility and interfacility neonatal transport; 7. policies and procedures for transfer to a higher level of neonatal care or for services not available at the facility, if applicable; 8. policies and procedures for car seat safety observation before discharge; and 9. policies and procedures for disaster response, including evacuation of obstetrical and neonatal patients to the appropriate level(s) of care. Rule 7.2.4 Staff Privileges The facility will have specified requirements for all privileged care providers participating in the care of neonatal patients, and have a credentialing process for delineation of privileges; a process to verify that all ancillary care services, clinical staff, and support staff have relevant neonatal training and expertise and a mechanism in place for medical, nursing, and ancillary care leadership to review and approve these credentials and track adherence. Subchapter 3 Level I Neonatal Center (Well Care) Rule 7.3.1. This Subchapter establishes the rules and regulations governing the organization, staffing, and delivery of neonatal care within Level I – Well Care facilities. It is intended to ensure that mothers and their newborns receive safe, effective, and timely clinical services in accordance with current standards of professional practice. These requirements apply to all facilities designated as Level I – Well Care, which manage neonates of thirty-five (35) weeks gestational age or greater and may transiently retain infants of less than thirty-five (35) weeks gestational age. The Subchapter further mandates the implementation of a comprehensive

Performance Improvement (PI) Plan to monitor outcomes and drive continuous improvement in neonatal services. Rule 7.3.2. General Requirements The Level I neonatal designated facility shall: 1. provide neonatal resuscitation at every delivery;

2. evaluate and provide postnatal care to stable term newborn infants;

3. stabilize and provide care for infants born 35-37 weeks gestational age who remain physiologically stable;

4. stabilize newborn infants who are ill and those born at < 35 weeks gestational age until transfer to a higher level of care ;

5. maintain a staff of providers including pediatricians, family physicians, nurse practitioners with newborn training, registered nurses with newborn training including being current with Neonatal Resuscitation Program Certification and S.T.A.B.L.E.

Rule 7.3.2. Neonatal Program 1. There shall be a written commitment on behalf of the entire facility to the organization of neonatal care. The written commitment shall be in the form of a resolution at the time of application passed by appropriate quorum of the members of the governing authority. Should the business organization be other than a corporation, a letter explaining such, together with a written commitment of the hospital’s chief executive officer, to the establishment of a neonatal care program may be sufficient. The neonatal program must be established and recognized by the medical staff and hospital administration.

2. The neonatal program must come under the direction of a practicing pediatrician, family medicine physician or a physician specializing in obstetrics and gynecology with experience in the care of neonates/infants and with privileges in neonatal care;

3. Neonatal Medical Director (NMD), Neonatal Program Manager (NPM), and appropriate support staff. The Neonatal Program must be multidisciplinary in

nature and the performance improvement evaluation of this care must be extended to all the departments involved.

4. Compliance with the above will be evidenced by but not limited to:

a. Governing authority and medical staff letter of commitment in the form of a resolution; b. Written policies and procedures and guidelines for the care of the neonatal patient; c. Defined neonatal team and written roles and responsibilities; d. Appointed Neonatal Medical Director with a written job description; e. Appointed Neonatal Program Manager with a written job description; f. Analysis and review of system perinatal outcome and quality data; and g. A written Neonatal Performance Improvement (PI) plan.

Rule 7.3.4. Neonatal Medical Director (NMD). The NMD must be a physician who is a currently practicing pediatrician, family medicine physician, or physician specializing in obstetrics and gynecology with experience in the care of neonates/infants and with privileges in neonatal care. He/she must maintain a current status of successful completion of the Neonatal Resuscitation Program (NRP) or a department-approved equivalent course, while also completes annual continuing medical education specific to the care of neonates. The NMD must demonstrate effective administrative skills and oversight of the Neonatal PI Plan. The MMD may also serve as the NMD. Rule 7.3.5. Neonatal Program Manager (NPM): Level I Neonatal Centers must have a registered nurse with documented perinatal nursing experience, working in the role of the NPM. Working in conjunction with the NMD, the NPM is responsible for organization of the program and all systems necessary for the multidisciplinary approach throughout the continuum of maternal care, as well as

developing or revising policies, procedures and guidelines, assuring staff competency, education, and training. The MPM may also serve as the NPM.

Rule 7.3.6. Perinatal Multidisciplinary Committee 1. The purpose of the committee is to provide oversight and leadership to the entire maternal program. Each perinatal center may choose to have one or more committees as needed to accomplish the task. One committee must be multidisciplinary and focus on program oversight and leadership. The major focus will be on PI activities, policy development, communication among all team members, and establishment of standards of care, and education. The committee has administrative and systematic control and oversees implementation of all program related services, meets regularly, takes attendance, maintains minutes and works to correct overall program deficiencies to optimize patient care. Membership for the committee includes representatives from:

a. Maternal Medical Director (Chairman – must be present at greater than 75% of all meetings.) b. Maternal Program Manager c. Neonatal Medical Director (if different from the MPM) d. Neonatal Program Manager (if different from the MPM) e. Pediatrician or Neonatologist f. Family Physician/APPs g. Obstetrics and Gynecology h. Certified Nurse Midwife (if applicable) i. Maternal Fetal Medicine j. Anesthesia k. Labor and Delivery l. Nursing m. Laboratory n. Radiology (Ultrasound) o. Respiratory Therapy p. Social Services/Pastoral Care

q. Dietary r. Lactation Specialist (or equivalent) s. Pharmacist 2. The clinical managers (or designees) of the departments involved with maternal care must play an active role with the committee.

3. The Neonatal Center may wish to accomplish PI activities in this committee or develop a separate peer review committee. This committee must handle peer review independently from department-based review. The committee must meet regularly and maintain attendance and minutes. This committee must report findings to the overall hospital PI program.

Rule 7.3.7. Clinical Components The clinical components outlined below form the foundation for delivering integrated, high-quality maternal and neonatal care. They ensure seamless collaboration, timely availability of skilled providers, access to essential support services, and standardized stabilization and resuscitation protocols. 1. Maternal – Neonatal Collaboration

a. The neonatal program shall collaborate with the maternal program , consulting physicians, and nursing leadership to ensure that pregnant patients identified as high risk for requiring higher-level neonatal care are transferred to a higher-level facility prior to delivery, unless such transfer is deemed clinically unsafe.

b. The facility shall ensure the provision of appropriate, supportive, and emergency care by qualified personnel for unanticipated maternal-fetal or neonatal complications arising during labor and delivery, continuing through patient disposition.

2. On-Call Coverage The on-call physician, advanced practice nurse, or physician assistant shall:

a. Possess documented special competence in neonatal care, with privileges and credentials formally reviewed and approved by the NMD. b. Maintain current certification in the NRP or department-approved equivalent.

c. Complete annual continuing education specific to neonatal and infant care.

d. Respond to an urgent request by arriving at the patient’s bedside within thirty (30) minutes of notification. e. Ensure documented back-up coverage where the on-call provider is unavailable or covering multiple facilities, with back-up call providers likewise responding within thirty (30) minutes of an urgent request.

3. Ancillary Services:

a. The facility shall maintain written guidelines that define the twenty-four- hour availability of anesthesia, laboratory, radiology, respiratory therapy, ultrasonography, and blood bank services.

i. Where preliminary interpretation of imaging studies is conducted pending formal radiologist report, such preliminary findings shall be documented in the patient’s medical record.

ii. The facility shall monitor and compare preliminary impressions with final interpretations under the radiology PI Plan, with summary activity reports presented to the Neonatal Multidisciplinary Committee. b. Pharmacy services shall ensure a pharmacist is available at all times.

i. Where compounding of medications for neonates or infants is performed by a pharmacy technician, a pharmacist shall provide immediate and direct supervision of the compounding process.

ii. The pharmacist shall implement and adhere to compounding guidelines designed to ensure the accuracy and safety of the final product. Such processes shall be monitored through the pharmacy PI Plan, and summary reports shall be presented to the Neonatal Multidisciplinary Committee.

4. Stabilization and Resuscitation a. The facility shall develop, maintain, and enforce written policies, procedures, and guidelines for the stabilization and resuscitation of neonates, in accordance with current standards of professional practice.

b. The facility shall ensure the availability of trained personnel capable of stabilizing distressed neonates, including those of less than thirty-five (35) weeks gestation, until safe to transfer to a higher level of care.

c. Staffing requirements for neonatal resuscitation shall include:

i. Attendance by at least one individual, at the time of each birth, who holds current NRP certification (or Department-approved equivalent) and whose primary responsibility is neonatal management and resuscitation.

ii. On-site availability of at least one individual skilled in complete neonatal resuscitation, inclusive on endotracheal intubation, vascular access establishment, and administration of emergency medication.

iii. Immediate availability of additional NRP-certified personnel for:

1. Multiple birth deliveries; 2. Unanticipated maternal-fetal complications during labor and delivery; 3. Deliveries identified or suspected to be high-risk.

iv. Immediate on-site availability of all necessary resuscitative equipment, supplies, and medications.

v. Any deviations from these requirements must be monitored through the Neonatal PI Plan, with reporting of variances to the Perinatal Multidisciplinary Committee.

5. Support Services

a. The neonatal program shall ensure the availability of personnel with specialized knowledge and skills in breastfeeding and lactation, to provide assistance and counseling to mothers.

b. The facility shall provide social services, spiritual care, and counseling resources, as appropriate, to address the holistic needs of the patient population served.

6. Staff Education

a. The facility shall designate a registered nurse with neonatal or perinatal care experience to oversee and coordinate staff education and competency assessments.

Subchapter 4 Level II Neonatal Center (Special Care) Rule 7.4.1. This Subchapter establishes the rules and regulations governing the organization, staffing, and delivery of neonatal care within facilities designated as Level II – Special Care. It is intended to ensure that mothers and their newborns receive safe, effective, and timely clinical services in accordance with current standards of professional practice. These requirements apply to all facilities designated as Level II – Special Care, which manage neonates of thirty-two (32) weeks gestational age or greater and birth weight of at least fifteen hundred (1,500) grams, as well as those that may transiently retain more immature or lower–birth–weight infants. The Subchapter further mandates the implementation of a comprehensive Performance Improvement (PI) Plan to monitor outcomes and drive continuous improvement in neonatal services.

Rule 7.4.2. General Requirements The Level II neonatal designated facility shall maintain all Level I capabilities plus: 1. Provide comprehensive care for infants born ≥32 weeks of gestation and weighing ≥ 1500 grams who have physiologic immaturity or who are moderately ill with problems that are expected to resolve rapidly and are not anticipated to need subspecialty services on an urgent basis.

2. Provide care for infants convalescing after intensive care.

3. Provide mechanical ventilation for brief duration (less than 24 hours) and/or continuous positive airway pressure for a condition expected to resolve rapidly or until transfer to a higher-level facility is achieved.

4. Stabilize infants born before 32 weeks gestation and weighing less than 1500 grams until transfer to a Level III or Level IV neonatal intensive care facility.

5. Maintain a staff of providers including those listed in Basic Care plus pediatric hospitalists, neonatologists, and neonatal nurse practitioners.

6. Referral to a higher level of care for all infants when needed for pediatric surgical or medical subspecialty intervention.

7. Level II nurseries must have equipment (e.g., portable x-ray machine, blood gas analyzer) and personnel (e.g., physicians, specialized nurses, respiratory therapists, radiology technicians and laboratory technicians) to provide ongoing care of admitted infants as well as to address emergencies.

Rule 7.4.3. Neonatal Program 1. There shall be a written commitment on behalf of the entire facility to the organization of neonatal care. The written commitment shall be in the form of a resolution at the time of application, passed by appropriate quorum of the members of the governing authority. Should the business organization be other than a corporation, a letter explaining such, together with a written commitment of the hospital’s chief executive officer, to the establishment of a neonatal care program may be sufficient. The neonatal program must be established and recognized by the medical staff and hospital administration.

2. The neonatal program must come under the direction of a practicing pediatrician, family medicine physician or a physician specializing in obstetrics and gynecology with experience in the care of neonates/infants and with privileges in neonatal care;

3. Neonatal Medical Director (NMD), Neonatal Program Manager (NPM), and appropriate support staff. The Neonatal Program must be multidisciplinary in nature, and the performance improvement evaluation of this care must be extended to all the departments involved.

4. Compliance with the above will be evidenced by but not limited to:

a. Governing authority and medical staff letter of commitment in the form of a resolution;

b. Written policies and procedures and guidelines for the care of the neonatal patient;

c. Defined neonatal team and written roles and responsibilities;

d. Appointed Neonatal Medical Director with a written job description;

h. Appointed Neonatal Program Manager with a written job description;

i. Analysis and review of system perinatal outcome and quality data; and

j. A written Neonatal Performance Improvement (PI) Plan.

Rule 7.4.4. Neonatal Service: The neonatal service shall be established and recognized by the medical staff and be responsible for the overall coordination and management of the system of care rendered to the neonatal patient. The neonatal service will vary in each organization depending on the needs of the patient and the resources available. The service shall come under the organization and direction of the Neonatal Medical Director.

Rule 7.4.5. Neonatal Medical Director (NMD). The NMD must be a physician who is a is a board-eligible/certified neonatologist or board-certified pediatrician with sufficient training and expertise to assume responsibility of care for infants who require Level II care, including endotracheal intubation, assisted ventilation, and CPAP management, or equivalent. and maintains a current status of successful completion of the Neonatal Resuscitation Program (NRP) and completes annual continuing medical education specific to neonatology. If the neonatologist or pediatrician is certified by the American Board of Pediatrics, they will meet maintenance of certification requirement. The NMD must demonstrate effective administrative skills and oversight of the Neonatal PI Plan. If the NMD and/or on-site provider is not a neonatologist, the privileged care provider must maintain a consultative relationship with a board certified or eligible neonatologist at a higher-level neonatal facility; and the facility must have a written policy or guideline that defines the criteria for neonatologist consultation at a higher-level neonatal facility.

Privileged Care Providers with pediatric- or neonatal-specific training qualified to manage the care of infants with mild to moderate critical conditions, including emergencies, will be continuously available, on-site or on-call and available to arrive on-site within an appropriate time frame as defined by the facility’s policies and procedures. 1. If the on-site or on-call provider is not a physician, a written policy will be in place that defines the criteria for notification and time frame for on-site physician presence, and a tracking mechanism for compliance is required;

2. If an infant is maintained on a ventilator, a pediatric- or neonatal-specific privileged care provider who can manage respiratory emergencies will be immediately available on-site;

3. Continuously provided neonatal care for the last consecutive two years and has experience and training in the care of neonates/infants, including assisted endotracheal ventilation and NCPAP management;

4. Maintains a current status of successful completion of the NRP or a department-approved equivalent course; and

5. Must complete annual continuing medical education specific to the care of neonates. The facility will establish a written policy for backup privileged care provider coverage that establishes flexibility for variable census and acuity. This policy will document the criteria for notification and time frame for onsite presence, be based on allocating the appropriate number of competent medical providers to a care situation, attend to a safe and high-quality work environment, and be operationally reviewed annually for adequacy and adherence. The MMD may also serve as the NMD. Rule 7.4.6. Neonatal Program Manager (NPM): Level II Neonatal Centers must have a registered nurse with a Bachelor of Science in Nursing with documented perinatal nursing experience and nursing certification preferred, working in the role of the NPM. Working in conjunction with the NMD, the NPM is responsible for organization of the program and all systems necessary for the multidisciplinary approach throughout the continuum of maternal care The NPM will: 1. demonstrate a current status of NRP completion; 2. have sufficient experience and expertise to create, and/or support, a program that provides care to infants who require level II care;

3. be responsible for inpatient activities in the level II facility and, as appropriate, obstetrical, well newborn, and/or pediatric units; 4. coordinate with respective neonatal, pediatric, and obstetric care services, as appropriate; 5. provide oversight of annual neonatal-specific education, which includes low- volume, high-risk procedures consistent with the care provided in the level II; and 6. foster collaborative relationships with multidisciplinary team members, facility leadership, and higher-level facilities to create a diverse, equitable, and inclusive environment focused on the quality of care and patient care outcomes. Rule 7.4.7. Perinatal Multidisciplinary Committee 1. The purpose of the committee is to provide oversight and leadership to the entire maternal program. Each perinatal center may choose to have one or more committees as needed to accomplish the task. One committee must be multidisciplinary and focus on program oversight and leadership. The major focus will be on PI activities, policy development, communication among all team members, and establishment of standards of care, and education. The committee has administrative and systematic control and oversees implementation of all program related services, meets regularly, takes attendance, maintains minutes and works to correct overall program deficiencies to optimize patient care. Membership for the committee includes representatives from: a. Maternal Medical Director (Chairman – must be present at greater than 75% of all meetings.)

b. Maternal Program Manager

c. Neonatal Medical Director (if different from MMD)

d. Neonatal Program Manager (if different from MPM)

e. Pediatrics

f. Pediatric Hospitalist

g. Neonatology

h. Obstetrics and Gynecology

i. Certified Nurse Midwife (if applicable)

j. Maternal Fetal Medicine

k. Anesthesia

l. Labor and Delivery

m. Nursing

n. Laboratory

o. Radiology (Ultrasound)

p. Respiratory Therapy

q. Pharmacy

r. Social Services/Pastoral Care

s. Dietary

t. Family Medicine

u. APPs/Neonatal Nurse Practitioner

v. Lactation Specialist (or equivalent)

2. The clinical managers (or designees) of the departments involved with maternal care must play an active role with the committee.

3. The Neonatal Center may wish to accomplish PI activities in this committee or develop a separate peer review committee. This committee must handle peer review independently from department-based review. The committee must meet regularly and maintain attendance and minutes. This committee must report findings to the overall hospital PI program.

Rule 7.4.8. Clinical Components The clinical components outlined below form the foundation for delivering integrated, high-quality maternal and neonatal care. They ensure seamless

collaboration, timely availability of skilled providers, access to essential support services, and standardized stabilization and resuscitation protocols. 1. Maternal – Neonatal Collaboration a. The neonatal program shall collaborate with the maternal program, consulting physicians, and nursing leadership to ensure that pregnant patients identified as high risk for requiring higher-level neonatal care are transferred to a higher-level facility prior to delivery, unless such transfer is deemed clinically unsafe.

b. The facility shall ensure the provision of appropriate, supportive, and emergency care by qualified personnel for unanticipated maternal-fetal or neonatal complications arising during labor and delivery, continuing through patient disposition.

2. On-Call Coverage - The on-call physician, advanced practice nurse, or physician assistant shall:

a. Possess documented special competence in neonatal care, with privileges and credentials formally reviewed and approved by the NMD.

b. Maintain current certification in the NRP or department-approved equivalent.

c. Complete annual continuing education specific to neonatal and infant care.

d. Respond to an urgent request by arriving at the patient’s bedside within thirty (30) minutes of notification.

e. Ensure documented back-up coverage where the on-call provider is unavailable or covering multiple facilities, with back-up call providers likewise responding within thirty (30) minutes of an urgent request.

f. Where neonatal surgery is performed, a surgeon privileged and credentialed to operate on neonates/infants shall be on-call and shall arrive at the patient’s bedside in a timeframe consistent with current standards of professional practice. Surgeon response times shall be monitored and reviewed through the Neonatal PI Plan.

3. Ancillary Services: a. Anesthesia

i. Anesthesia services shall be provided by practitioners with demonstrated pediatric experience and competence.

b. Laboratory and Transfusion Services

i. Laboratory services shall ensure personnel are on-site at all times, as defined by written management guidelines, including when a neonate/infant is maintained on endotracheal ventilation. The ability to determine blood type, crossmatch, and perform antibody testing and the ability to perform analysis on small volume samples. ii. Low-volume specialty laboratory services may be provided by an outside laboratory, but the facility will have policies and procedures in place to verify timely and direct communication of all critical value results.

iii. The facility’s blood blank shall be capable of providing blood and blood component therapy and irradiated, leukoreduced or cytomegalovirus negative blood within the timelines established and approved transfusion guidelines.

c. Pharmacy – Pharmacy services must ensure a registered pharmacist experienced in neonatal/pediatric pharmacology is available at all times and completes continuing education requirements specific to pediatric and neonatal pharmacology.

i. If a pharmacy technician compounds medications for neonates/infants, a pharmacist must provide immediate, direct supervision of the process.

ii. The pharmacy will have policies and procedures in place to address drug shortages and to verify medications are appropriately allocated to the level II SCN; and must implement policies and procedures to verify the accuracy of each compounded product, monitor compounding activities through the pharmacy PI Plan, and present summary reports at Perinatal Multidisciplinary Committee meetings.

d. Radiology – must adhere to the “As Low as Reasonably Achievable” (ALARA) principle for neonatal imaging and provide the following:

i. Personnel trained in neonatal x-ray and ultrasound operation, including cranial ultrasonography, must be on-site and able to respond to urgent requests within 30 minutes.

Appropriately trained staff must remain continuously available to meet routine diagnostic imaging needs and to manage emergencies . ii. Interpretation of neonatal and perinatal studies must be available at all times; any preliminary reads pending final interpretation must be documented in the medical record.

iii. The radiology PI Plan must compare preliminary and final readings, with summary reports submitted to the Perinatal Multidisciplinary Committee.

e. Respiratory Therapy

i. The respiratory care leader will: 1. be a full-time respiratory care practitioner, with neonatal and pediatric respiratory care certification preferred; 2. have sufficient time allocated to oversee the respiratory therapists (RTs) who provide care in the level II facility; 3. provide oversight of annual simulation and skills verification, which includes neonatal respiratory care modalities and low- volume, high-risk neonatal respiratory procedures; 4. develop a written RT staffing plan that establishes flexibility for variable census and acuity. This plan and actual staffing will be based on allocating the appropriate number of competent RTs to a care situation, attend to a safe and high-quality work environment, and be operationally reviewed annually for adherence and to verify respiratory therapy staffing is adequate for patient care needs; and 5. maintain appropriate staffing ratios for infants receiving supplemental oxygen and positive pressure ventilation.

ii. Respiratory care practitioners assigned to the special care nursery will 1. be a respiratory care practitioner with documented experience and training in the respiratory support of newborns and infants, with neonatal or pediatric respiratory care certification preferred; 2. be on-site 24/7 and immediately available when an infant is supported by assisted ventilation or CPAP; 3. be able to attend deliveries and assist with resuscitation as requested;

4. demonstrate a current status of NRP completion; 5. participate in annual simulation and respiratory skills verification, which includes low-volume, high-risk procedures consistent with the types of respiratory care provided in the SCN; and 6. have their credentials reviewed by the respiratory care leader annually for adequacy and adherence. iii. The facility shall maintain neonatal/infant blood gas monitoring capabilities to support the management of respiratory function and acid–base status in acutely ill neonates.

f. Therapy services – A speech, occupational, or physical therapist with neonatal expertise must be engaged to meet the developmental and functional needs of the patient population.

i. Therapy services should be individualized based on gestational age, clinical status, and family goals. ii. At least one individual skilled in the evaluation and management of neonatal feeding and swallowing concerns, with neonatal therapy certification preferred.

iii. Therapists must document competencies in neonatal care and participate in the Neonatal PI Plan for therapeutic interventions.

g. Nutrition i. Nutrition services shall be provided by a registered dietitian or a nutritionist trained in neonatal nutrition who will 1. collaborate with the medical team to establish feeding protocols, develop patient-specific feeding plans, and help determine nutritional needs at discharge; 2. establish policies and procedures to verify proper preparation and storage of human milk and formula; and 3. have policies and procedures for dietary consultation for patients.

ii. The facility will: 1. provide a specialized area or room, with limited access and away from the bedside, to accommodate mixing of formula or additives to human milk; 2. develop standardized feeding protocols for the advancement of feedings based on the availability of, and family preference for

human milk, donor human milk, fortification of human milk and formula; and 3. have policies and procedures in place for accurate verification and administration of human milk and formula, and to avoid misappropriation.

4. Stabilization and Resuscitation a. The facility shall develop, maintain, and enforce written policies, procedures, and guidelines for the stabilization and resuscitation of neonates, in accordance with current standards of professional practice.

b. The facility shall ensure the availability of trained personnel capable of stabilizing distressed neonates, including those of less than thirty-five (35) weeks gestation, until safe to transfer to a higher-level of care.

c. Staffing requirements for neonatal resuscitation shall include: i. Attendance by at least one individual, at the time of each birth, who holds current NRP certification (or Department-approved equivalent) and whose primary responsibility is neonatal management and resuscitation.

ii. At least one additional provider with full neonatal resuscitation skills - including endotracheal intubation, vascular access establishment, and administration of emergency medication – must be immediately available on-site.

iii. Immediate availability of additional NRP-certified personnel for:

1. Multiple birth deliveries;

2. Unanticipated maternal-fetal complications during labor and delivery;

3. Deliveries identified or suspected to be high-risk.

iv. Immediate on-site availability of all necessary resuscitative equipment, supplies, and medications.

v. Any deviations from these standards must be monitored through the Neonatal PI Plan, with reporting of variances to the Perinatal Multidisciplinary Committee.

5. Neonatal Transport The facility will have policies and procedures in place to identify a local neonatal transport program to facilitate transport to a higher-level neonatal facility.

6. Pediatric Medical Subspecialists and Pediatric Surgical Specialists Policies and procedures will be in place for referral to a higher level of neonatal care when pediatric medical subspecialty or pediatric surgical specialty consultation and/or intervention is needed.

7. Support Services

a. The neonatal program shall ensure the availability of personnel with specialized knowledge and skills in breastfeeding and lactation, to provide assistance and counseling to mothers. Services shall include latch assessment, milk supply evaluation, and coordination with nutrition teams. Breastfeeding support activities are reviewed periodically through the Neonatal PI Plan.

b. The facility shall provide social services, spiritual care, and counseling resources, as appropriate, to address the holistic needs of the patient population served. Referrals to community resources and follow-up support are coordinated through the neonatal team.

i. The Level II social worker will be a Master’s prepared medical social worker with perinatal and/or pediatric experience. ii. The facility will: 1. Provide 1 social worker for every 30 beds providing Level II neonatal care and/or specialty and subspecialty perinatal care 2. Have a written description that clearly identifies the responsibilities and function of the social worker and 3. Have social services available for each family member with an infant in the special care nursery as needed.

8. Retinopathy of Prematurity If the facility back transfers infants for convalescent care, the facility must have a process in place to appropriately identify infants at risk for retinopathy of prematurity to guarantee timely examination and treatment by having documented policies and procedures for the monitoring, treatment, and follow-up of retinopathy of prematurity and the ability to perform on-site

retinal examinations, or off-site interpretation of digital photographic retinal images, by a pediatric ophthalmologist or retinal specialist with expertise in retinopathy of prematurity, if needed. 9. Discharge Planning and Follow-Through Care

a. The Neonatal Program must develop and implement discharge plans for infants at high risk of neurodevelopmental, medical, or psychosocial complications.

i. Plans include referrals to specialty care, early intervention programs, and community-based services. 1. The facility will have written medical, neurodevelopmental, and psychosocial criteria that automatically warrant high-risk neonatal follow-up with appropriate developmental follow-up services; and have a written referral agreement with a developmental follow-up clinic or practice, when possible, to provide neurodevelopmental services for the neonatal population served.

ii. Follow-up outcomes are monitored via the Neonatal PI Plan to ensure continuity of care.

10. Nurse Education and Orientation Level II Neonatal Centers nursing orientation will incorporate didactic education, simulation, skills verification, and competency and shall be tailored to the individual needs of the nurse based on clinical experience. The facility must document an annual educational needs assessment to determine the educational needs of the clinical nursing staff and ancillary team members. Annual nursing education will address the annual needs assessment and incorporate simulation and skills verification of low-volume, high-risk procedures consistent with the types of care provided in the level II centers and include education related to serious safety events.

11. Clinical Nurse Educator

a. be an RN, with nursing certification specific to the care environment preferred; b. have at least a Bachelor of Science in Nursing, Master’s preferred; c. demonstrate a current status of NRP completion; d. cultivate collaborative relationships with the neonatal nurse leader and facility leadership to improve the quality of care and patient care outcomes5; and

e. have experience and expertise to evaluate the educational needs of the clinical staff, develop didactic and skill-based educational tools, oversee education and skills verification, and evaluate retention of content, critical thinking skills, and competency relevant to level II neonatal care.9 f. The facility will have a dedicated individual with sufficient time allocated to perform the roles and responsibilities of the clinical nurse educator. The Source: Miss. Code Ann. § 41-3-15

Subchapter 5 Level III Neonatal Center (Intensive Care) This Subchapter establishes the rules governing the organization, staffing, and delivery of intensive neonatal care within facilities designated as Level III – Neonatal Intensive Care Centers. Its purpose is to ensure that mothers and their neonates—ranging from mild to critical illness or requiring sustained life support—receive safe, effective, and timely clinical services in accordance with current professional standards. Rule 7.5.1. General Requirements The Level III neonatal designated facility shall maintain all Level I and II capabilities as well as the following: 1. Level III NICUs are defined by having continuously available personnel (neonatologists, neonatal nurses, and respiratory therapists) and equipment to provide life support for as long as necessary.

2. Provide comprehensive care for infants born less than 32 weeks gestation and weighing less than1500 grams and infants born at all gestational ages and birth weights with critical illness.

3. Provide prompt and readily available access to a full range of pediatric medical subspecialists, pediatric surgical specialists, pediatric anesthesiologists or anesthesiologists with experience in neonatal surgical care and pediatric ophthalmologists, on site or by prearranged consultative agreements.

4. Provide a full range of respiratory support and physiologic monitoring that may include conventional and/or high-frequency ventilation, inhaled nitric oxide delivery, and/or therapeutic hypothermia or have policies and procedures in place to facilitate neonatal transfer to a higher level of care.

5. Perform advanced imaging with interpretation on an urgent basis, including computed tomography, MRI and echocardiography.

6. Social and family support including social services and pastoral care.

7. If geographic constraints for land transportation exist, the Level III facility should ensure availability of rotor and fixed-wing transport services to transfer infants requiring subspecialty intervention from other regions and facilities.

8. Consultation and transfer agreements with both lower-level referring hospitals and regional centers, including back-transport agreements.

9. Prompt diagnosis and appropriate referral of all conditions requiring surgical intervention. Major surgery should be performed by pediatric surgical specialists (including anesthesiologists with pediatric expertise) on–site within the hospital or at a closely related institution, ideally in close geographic proximity if possible. Level III facilities should be able to offer complete care, management, and evaluation for high-risk neonates 24 hours a day. A neonatologist should be available either in-house or on- call with the capacity to be in-house in a timely manner, 24 hours a day.

10. Level III facilities should maintain a sufficient volume of infants less than 1500 grams to meet professionally accepted guidelines to achieve adequate experience and expertise.

11. Enrollment in the Vermont Oxford Network to report and monitor data regarding outcomes of infants born less than 32 weeks and weighing less than 1500 grams.

12. Participation in and evaluation of quality improvement initiatives.

Rule 7.5.2. Neonatal Program 1. There shall be a written commitment on behalf of the entire facility to the organization of neonatal care. The written commitment shall be in the form of a resolution at the time of application passed by appropriate quorum of the members of the governing authority. Should the business organization be other than a corporation, a letter explaining such, together with a written commitment of the hospital’s chief executive officer, to the establishment of a

neonatal care program may be sufficient. The neonatal program must be established and recognized by the medical staff and hospital administration.

2. The neonatal program must come under the direction of a practicing pediatrician, family medicine physician or a physician specializing in obstetrics and gynecology with experience in the care of neonates/infants and with privileges in neonatal care;

3. Neonatal Medical Director (NMD), Neonatal Program Manager (NPM), and appropriate support staff. The Neonatal Program must be multidisciplinary in nature, and the performance improvement evaluation of this care must be extended to all the departments involved.

4. Compliance with the above will be evidenced by but not limited to: a. Governing authority and medical staff letter of commitment in the form of a resolution;

b. Written policies and procedures and guidelines for the care of the neonatal patient;

c. Defined neonatal team and written roles and responsibilities;

d. Appointed Neonatal Medical Director with a written job description;

e. Appointed Neonatal Program Manager with a written job description; and

f. A written Neonatal Performance Improvement (PI) plan.

Rule 7.5.3. Neonatal Service: The neonatal service shall be established and recognized by the medical staff and be responsible for the overall coordination and management of the system of care rendered to the neonatal patient. The neonatal service will vary in each organization depending on the needs of the patient and the resources available. The service shall come under the organization and direction of the Neonatal Medical Director.

Rule 7.5.4. Neonatal Medical Director (NMD). The NMD must be a physician who is a board-eligible or board-certified neonatologist with neonatal or infant care

experience and maintains a current status of successful completion of the Neonatal Resuscitation Program (NRP) or Department-approved equivalent. The NMD is responsible for the oversight of neonatal transport protocols, staff competencies, safety standards and performance review. The NMD must also complete annual continuing medical education specific to the care of neonates, as well as demonstrate effective administrative skills and oversight of the Neonatal PI Plan. Rule 7.5.5. Neonatal Program Manager (NPM): Level III Neonatal Centers must have a registered nurse with at least a Bachelor of Science in Nursing (Master’s preferred) with documented neonatal nursing experience and nursing certification preferred, working in the role of the NPM. The NPM must maintain a current NRP certification or equivalent. Working in conjunction with the NMD, the NPM is responsible for organization of the program and all systems necessary for the multidisciplinary approach throughout the continuum of maternal care, as well as developing or revising policies, procedures and guidelines, assuring staff competency, education, and training. The NPM must have sufficient experience and expertise to create, and/or support, a program that provides care to infants who require Level III NICU care, be responsible for inpatient activities in the NICU and, as appropriate, obstetric, well newborn, and/or pediatric units; and coordinate with respective neonatal, pediatric, and obstetric care services, as appropriate. The NMD must provide oversight of annual neonatal-specific education which includes low-volume, high-risk procedures consistent with the care provided in the level III NICU and foster collaborative relationships with multidisciplinary team members, facility leadership, and higher-level facilities to create a diverse, equitable, and inclusive environment to improve the quality of care and patient care outcomes Rule 7.5.6. Perinatal Multidisciplinary Committee 1. The purpose of the committee is to provide oversight and leadership to the entire maternal program. Each perinatal center may choose to have one or more committees as needed to accomplish the task. One committee must be multidisciplinary and focus on program oversight and leadership. The major focus will be on PI activities, policy development, communication among all team members, and establishment of standards of care, and education. The committee has administrative and systematic control and oversees implementation of all program related services, meets regularly, takes attendance, maintains minutes and works to correct overall program deficiencies to optimize patient care. Membership for the committee includes representatives from:

a. Maternal Medical Director (Chairman – must be present at greater than 75% of all meetings.) b. Maternal Program Manager c. Neonatal Medical Director d. Neonatal Program Manager e. Pediatrics f. Neonatology g. Obstetrics and Gynecology h. Certified Nurse Midwife (if applicable) i. Maternal Fetal Medicine j. Pediatric surgery / pediatric ophthalmology k. Anesthesia/pediatric anesthesia l. Labor and Delivery m. Nursing n. Laboratory o. Radiology (Ultrasound) p. Respiratory Therapy q. Social Services/Pastoral Care r. Dietary s. Family Medicine t. APPs/Neonatal Nurse Practitioner u. Lactation Specialist (or equivalent)

2. The clinical managers (or designees) of the departments involved with maternal care must play an active role with the committee.

3. The Neonatal Center may wish to accomplish PI activities in this committee or develop a separate peer review committee. This committee must handle peer review independently from department-based review. The committee must meet regularly and maintain attendance and minutes. This committee must report findings to the overall hospital PI program.

Rule 7.5.7. Clinical Components The clinical components outlined below form the foundation for delivering integrated, high-quality maternal and neonatal care. They ensure seamless collaboration, timely availability of skilled providers, access to essential support services, and standardized stabilization and resuscitation protocols. 1. Maternal – Neonatal Collaboration a. The neonatal program shall collaborate with the maternal program, consulting physicians, and nursing leadership to ensure that pregnant patients identified as high risk for requiring higher-level neonatal care are transferred to a higher-level facility prior to delivery, unless such transfer is deemed clinically unsafe.

b. The facility shall ensure the provision of appropriate, supportive, and emergency care by qualified personnel for unanticipated maternal-fetal or neonatal complications arising during labor and delivery, continuing through patient disposition.

2. On-Site Clinical Coverage - The on-call physician, advanced practice nurse, or physician assistant shall: a. At least one neonatal provider (pediatric hospitalist, neonatologist, neonatal nurse practitioner, or neonatal physician assistant) must be on- site at all times with documented competence and privileges reviewed by the NMD.

b. Neonatologists

1. The NICU neonatologists will: i. be a board eligible or certified neonatologist or equivalent ii. complete annual CME specific to neonatology iii. demonstrate a current status of NRP completion ii. Have credentials that are reviewed by the NMD at least every two (2) years; and

i. Preferably be on-site and immediately available 24/7, a written policy will be in place that defines the criteria for notification and timeframe, as defined by the facility’s policies and procedures.

3. If a neonatologist is not on-site 24/7, a written policy will be in place that defines the criteria for notification and timeframe for on-site presence, and a tracking mechanism for compliance is required.

c. Privileged Care Providers Privileged Care Providers with neonatal-specific training qualified to manage the care of infants with mild to complex critical conditions, including emergencies, will be on site 24/7 and: i. Maintain current NRP certification or equivalent.

ii. Complete annual continuing education in neonatal care; and review of credentials at least every two years by the NMD.

iii. If no neonatologist on-site, have a board-certified neonatologist available for consultation and on-site, arrival within thirty (30) minutes of urgent requests.

iv. Ensure back-up neonatologist coverage (documented on-call) if covering multiple facilities, with the same 30-minute response time. The facility will establish a written policy for backup privileged care provider coverage that establishes flexibility for variable census and acuity. This policy will document the criteria for notification and time frame for on-site presence, be based on allocating the appropriate number of competent medical providers to a care situation, attend to a safe and high-quality work environment, and be operationally reviewed annually for adequacy and adherence.

d. Pediatric Medical Subspecialists i. The facility must have on-site access to a broad range of pediatric medical subspecialties including, but not limited to: cardiology, pulmonology, infectious disease, neurology, ophthalmology, endocrinology, hematology, gastroenterology, nephrology, and genetics or metabolism. ii. The pediatric medical subspecialists must be readily accessible for on- site consultation, have credentials to consult at the facility, including documented training, certification, competencies, and CME specific to

their subspecialty and document consultations in the medical record within an appropriate time frame and as defined by the facility’s policies and procedures. e. Neonatal Surgical Program – Optional for Level III i. Pediatric surgeons and pediatric surgical specialists will be available on- site or at another closely related NICU facility. 1. If pediatric surgery is not offered on-site at the facility, policies and procedures will be in place with a facility that provides surgical care to facilitate transfer of an infant when needed. ii. Infants requiring cardiovascular surgery or extracorporeal membrane oxygenation (ECMO) will be transferred to a facility that provides these services. 1. If pediatric surgery is accessible on-site, the surgeons will: a. be available at the bedside within 1 hour of request or identified need; b. have credentials to provide care at the facility, including documented training, certification, competencies, and continuing education specific to their pediatric surgery specialty; c. establish a program for evaluating surgical performance by accurately tracking data, identifying trends, and implementing quality improvement initiatives to address surgical performance in a coordinated systematic approach within a culture of safety, equity, and prevention; and d. report neonatal surgical and anesthesia care back to the PI Committee.

3. Ancillary Services: a. Anesthesia i. If pediatric surgery is performed on-site, anesthesia providers with pediatric expertise must: 1. be on the medical staff and promptly available 24/7 to respond to the bedside within 1 hour of request or identified need; 2. serve as the primary responsible anesthesia provider for all infants <24 month of age and should serve as the primary anesthesiologist for children 5 year of age based on the American Society of Anesthesiologists (ASA) physical status classification; and 3. be physically present for all neonatal surgical procedures for which they serve as the primary responsible anesthesia provider.

b. Laboratory and Transfusion Services i. Laboratory services shall ensure personnel are on-site at all times. ii. Laboratory services will have the ability to determine blood type, crossmatch, and perform antibody testing.

iii. Pediatric pathology and intra-operative frozen section services must be available in the operative suite at the request of the operating surgeon.

iv. The facility’s blood blank shall be capable of providing blood and blood component therapy and irradiated, leukoreduced or CMV- negative blood within the timelines established and approved transfusion guidelines.

1. Policies and procedures will be in place to facilitate emergency access to blood and blood component therapy so that the NICU can provide hematologic interventions, if applicable.

v. The laboratory will have the ability to perform analysis on small volume sample and access to perinatal pathology services, if applicable.

1. Low-volume specialty laboratory services may be provide by an outside laboratory, but the facility will have policies and procedures in place to maintain timely and direct communication of all critical value results.

c. Pharmacy – Pharmacy services must ensure at least one registered pharmacist experienced in neonatal/pediatric pharmacology is available at all times, completes continuing education requirements specific to pediatric and neonatal pharmacology and participates in multidisciplinary care, including participation in patient care rounds. i. If a pharmacy technician compounds medications for neonates/infants, a pharmacist must provide immediate, direct supervision of the process. ii. The pharmacist must implement guidelines to address drug shortages, verify medications are appropriately allocated to the Level III NICU and verify the accuracy of each compounded product, monitor compounding activities through the pharmacy PI Plan, iii. Total parenteral nutrition (TPN) tailored for neonates/infants must be readily available upon request.

1. The facility will have a written policy and procedure for the proper preparation and delivery of TPN.

d. Radiology – must adhere to the “As Low as Reasonably Achievable” (ALARA) principle for neonatal imaging and include the following:

i. Personnel trained in neonatal x-ray equipment must be on-site and available at all times to address emergencies.

ii. Personnel appropriately trained in ultrasound, computed tomography, including cranial ultrasound, computed tomography (CT), and magnetic resonance imaging (MRI) equipment and available on-site within a time period consistent with current standards of professional practice.

iii. Fluoroscopy must be available at all times.

1. If fluoroscopy is not offered on-site at the facility, policies and procedures will be in place to facilitate transfer of an infant to a higher level of care.

iv. Neonatal diagnostic imaging studies and radiologists with pediatric expertise to interpret the neonatal diagnostic imaging studies, available at all times;

v. A radiologist with pediatric expertise to interpret images consistent with the patient condition and within a time period consistent with current standards of professional practice with monitoring of variances through the Neonatal PI Plan and process;

vi. Pediatric-trained radiologists must be available at all time for interpretation of neonatal and perinatal studies; any preliminary reads pending final interpretation must be documented in the medical record.

vii. Pediatric echocardiography with pediatric cariology interpretation and consultation within professional timeframes.

viii. The radiology PI Plan must compare preliminary and final readings, with summary reports submitted to Perinatal Multidisciplinary Committee.

e. Respiratory Therapy The respiratory care leader will: i. be a full-time respiratory care practitioner, with neonatal and pediatric respiratory care certification preferred; ii. have sufficient time allocated to oversee the RTs who provide care in the level III NICU; iii. provide oversight of annual simulation and skills verification which includes neonatal respiratory care modalities and low-volume, high-risk neonatal respiratory procedures; iv. develop a written RT staffing plan that establishes flexibility for variable census and acuity. This plan and actual staffing will be based on allocating the appropriate number of competent RTs to a care situation, attend to a safe and high-quality work environment, and be operationally reviewed annually for adherence and to verify respiratory therapy staffing is adequate for patient care needs; and v. maintain appropriate staffing ratios for infants receiving supplemental oxygen and positive pressure ventilation. Respiratory care practitioners assigned to the NICU will: i. be a respiratory care practitioner with documented experience and training in the respiratory support of newborns and infants, with neonatal and pediatric respiratory care certification preferred; ii. be on-site 24/7 and immediately available to supervise assisted ventilation, assist in resuscitation, and attend deliveries; iii. demonstrate a current status of NRP completion; iv. participate in annual simulation and respiratory skills verification, which includes low-volume, high-risk procedures consistent with the types of respiratory care provided in the NICU; and v. have their credentials reviewed by the respiratory care leader annually for adequacy and adherence. vi. provide neonatal/infant blood gas monitoring capabilities to support the management of respiratory and metabolic management. Therapy Services – The facility will provide on-site consultative services by qualified neonatal therapists to address the 6 core practice domains (environment, family and psychosocial support, sensory system, neurobehavioral system, neuromotor and musculoskeletal systems, and oral feeding and swallowing) and to provide the appropriate care for the neonatal population served. The facility will have on-site access to the

following neonatal therapists who have dedicated time allocated to serve the NICU: 1. an occupational and/or physical therapist with neonatal expertise, and neonatal therapy certification preferred; and 2. a speech language pathologist with neonatal expertise, skilled in the evaluation and management of neonatal feeding and swallowing concerns, and neonatal therapy certification preferred. i. If swallow studies are not offered on-site at the facility, policies and procedures will be in place to facilitate neonatal transfer to a higher level of care. ii. The facility will operationally review neonatal therapist personnel on an annual basis to maintain adequate multidisciplinary neonatal therapist coverage based on the specific need and volume of the neonatal population served.

f. Nutrition

i. At least one registered dietician or nutritionist who has specialized training in neonatal nutrition will have dedicated time allotted to serve the NICU and will: 1. collaborate with the medical team to establish feeding protocols, develop patient-specific feeding plans, and help determine nutritional needs at discharge; 2. establish policies and procedures to verify proper preparation and storage of human milk and formula; 3. participate in multidisciplinary care, including participation in patient care rounds; and 4. have policies and procedures for dietary consultation for infants in the NICU. Neonatal Nutrition ii. The facility will: 1. provide a specialized area or room, with limited access and away from the bedside, to accommodate mixing of formula or additives to human milk; 2. develop standardized feeding protocols for the advancement of feedings based on the availability of, and family preference for

human milk, donor human milk, fortification of human milk and formula; and 3. have policies and procedures in place for accurate verification and administration of human milk and formula, and to avoid misappropriation. g. Clinical Nurse Staffing i. A written nurse staffing plan is in place that establishes flexibility for variable census and acuity. This plan and actual staffing will be based on allocating the appropriate number of competent RNs to a care situation, attend to a safe and high-quality work environment, and be operationally reviewed annually for adequacy and adherence.

h. Clinical Nurse Staff i. Each clinical nurse will: 1. be an RN, with nursing certification specific to the care environment preferred; 2. demonstrate a current status of NRP completion; 3. participate in annual simulation and skills verification, which includes low-volume, high-risk procedures consistent with the types of care provided in the level III NICU; and 4. promote a family-centered approach to care, including but not limited to skin-to-skin care, appropriate developmental positioning based on gestational age, lactation and breastfeeding support, and engagement of families in their infant’s care. ii. If the facility utilizes LPNs or non-licensed direct care providers to support the clinical nursing staff, the facility must: 1. have written criteria that define the LPNs’ or non-licensed direct care providers’ scope of neonatal care; 2. provide annual education specific to the care of the neonatal population served; and 3. have a written staffing plan that establishes collaborative work assignments in accordance with the facility’s policies and procedures. i. Clinical Nurse Specialist The clinical nurse specialist will: a. be an RN, with neonatal nursing certification and clinical nurse specialist certification preferred; b.have at least a Bachelor of Science in Nursing, Master’s or Doctorate preferred;

c. demonstrate a current status of NRP completion; d.foster continuous quality improvement in nursing care; e. develop and educate staff to provide evidence-based nursing care; f. be responsible for mentoring new staff and developing team building skills; g.provide leadership to multidisciplinary teams; h.facilitate case management of high-risk neonatal patients; and; i. cultivate collaborative relationships with multidisciplinary team members and facility leadership to improve the quality of care and patient care outcomes; j. The roles and responsibilities of the NICU clinical nurse specialist can be allocated to multiple individuals to perform this role.

4. Stabilization and Resuscitation a. The facility shall develop, maintain, and enforce written policies, procedures, and guidelines for the stabilization and resuscitation of neonates, in accordance with current standards of professional practice.

b. The facility shall ensure the availability of trained personnel capable of stabilizing distressed neonates.

c. Staffing requirements for neonatal resuscitation shall include:

i. Attendance by at least one individual, at the time of each birth, who holds current NRP certification (or Department-approved equivalent) and whose primary responsibility is neonatal management and resuscitation.

ii. At least one additional provider with full neonatal resuscitation skills - including endotracheal intubation, vascular access establishment, and administration of emergency medication – must be immediately available on-site.

iii. Additional personnel who maintain a current status of successful completion of the NRP or a Department-approved equivalent must be on-site and immediately available upon request for the following:

1. Multiple birth deliveries;

2. Unanticipated maternal-fetal complications during labor and delivery;

3. Deliveries identified or suspected to be high-risk.

iv. Immediate on-site availability of all necessary resuscitative equipment, supplies, and medications.

v. Any deviations from these standards must be monitored through the Neonatal PI Plan, with reporting of variances to the Perinatal Multidisciplinary Committee.

5. Neonatal Transport If the facility has a neonatal critical care transport program, it will have an identified director of neonatal transport services. The director of neonatal transport services can be the NMD or another physician who is a pediatrician, board-eligible or certified neonatologist, pediatric hospitalist, or pediatric medical subspecialist with expertise and experience in neonatal and infant transport. If the facility does not have its own transport program, the facility must have policies and procedures in place to identify a local neonatal transport program to facilitate transport. Responsibilities of the director of neonatal transport services include the following: i. Train and supervise staff; ii. Provide appropriate review of all transport records; iii. develop and implement policies and procedures for patient care during transport; iv. develop guidelines for determining transport team composition and medical control and establish a mechanism to track adherence; v. establish policies and procedures to provide transport updates and outreach education; vi. establish a program for evaluating performance by tracking data, identifying trends, and implementing quality improvement initiatives to address transport performance in a coordinated systematic approach within a culture of safety, equity, and prevention; and vii. report neonatal transport data and neonatal-specific reviews back to the PI committee. viii. The director of neonatal transport services may delegate specific requirements to other person(s) or group(s) but retains the responsibility of certifying that these functions are addressed appropriately.

The facility will: i. establish minimum education, experience, and training requirements for all transport team members ii. select transport team members based on their experience and competence in the care of neonates and the transport team must collectively have the ability to provide a level of care that is similar to that of the admitting unit; and iii. provide annual transport education to all transport team members that incorporates equipment training, didactic education, simulation, and skills verification of low-volume, high-risk procedures consistent with the types of care provided during neonatal transport.

6. Support Services

The neonatal program shall ensure the availability of personnel with specialized knowledge and skills in breastfeeding and lactation, to provide assistance and counseling to mothers at all times. Services shall include latch assessment, milk supply evaluation, and coordination with nutrition teams. An IBCLC should be available for on-site consultation on weekdays and accessible by telehealth or telephone at all times. IBCLC personnel should be operationally reviewed on an annual basis to establish adequately trained lactation coverage based on the specific need and volume of the neonatal population served. a. Social Worker

i. The NICU social worker will: 1. be a Master’s prepared medical social worker with perinatal and/or pediatric experience. ii. The facility will: 1. provide 1 social worker for every 30 beds providing level III neonatal care and/or specialty and subspecialty perinatal care; 2. have a written description that clearly identifies the responsibilities and functions of the NICU social worker; and 3. have social services available for each family with an infant in the NICU as needed. b. Pastoral Care Personnel skilled in pastoral care will be available as needed and by family request, and will represent, or have the ability to consult, multiple religious affiliations representative of the population served. Rule 7.5.8 Retinopathy of Prematurity

The facility must have process in place to appropriately identify infants at risk for retinopathy of prematurity to guarantee timely examination and treatment by having documented policies and procedures for the monitoring, treatment, and follow-up of retinopathy of prematurity, and the ability to perform on-site retinal examinations, or off-site interpretation of digital photographic retinal images, by a pediatric ophthalmologist or retinal specialist with expertise in retinopathy of prematurity. Rule 7.5.9 Discharge Planning and Follow-Through Care 1. Systems will be in place to establish preparation for NICU discharge, including post-discharge follow-up by general and subspecialty pediatric care providers, home care arrangements and community service resources, and enrollment in a developmental follow-up program as needed.

The facility must have written medical, neurodevelopmental, and psychosocial criteria that automatically warrant high-risk neonatal follow- up with appropriate developmental follow-up services; as well as provide developmental follow-up services or have written referral agreement with a developmental follow-up clinical or practice, when possible, to provide neurodevelopmental services for the neonatal population served. a. Follow-up outcomes are monitored via the Neonatal PI Plan to ensure continuity of care.

**History**
- *Source: Miss. Code Ann. § 41-3-15 Rule 7.1.4. Patient Safety and Quality Improvement. The facility must have a documented and approved Neonatal PI Plan. The Chief Executive Officer, Chief Medical Officer (or Chief of Staff), and Chief Nursing Officer must implement a culture of safety for the facility and ensure adequate resources are allocated to support a concurrent, data-driven Neonatal PI Plan.*
- *Source: Miss. Code Ann. § 41-3-15 Rule 7.1.5. Medical Staff. The facility must have an organized, effective neonatal program that is recognized by the facility's medical staff and approved by the facility's governing body.*
- *Source: Miss. Code Ann. § 41-3-15 Rule 7.1.6. Medical Director. There must be an identified NMD. The NMD must be credentialed by the facility for treatment of neonatal patients and have their responsibilities and authority defined in a job description. The NMD must maintain a current status of successful completion of the Neonatal Resuscitation Program (NRP) or a department-approved equivalent course. The NMD is responsible for the provision of neonatal care services and must: 1. Examine qualifications of medical staff and advanced practice providers requesting privileges to participate in neonatal/infant care and make recommendations to the appropriate committee for such privileges.*
- *Source: Miss. Code Ann. § 41-3-15*
- *Source: Miss. Code Ann. § 41-3-15*
- *Source: Miss. Code Ann. § 41-3-15*
- *Source: Miss. Code Ann. § 41-3-15*
- *Source: Miss. Code Ann. § 41-3-15*
- *Source: Miss. Code Ann. § 41-3-15 Rule 7.3.3. Neonatal Service: The neonatal service shall be established and recognized by the medical staff and be responsible for the overall coordination and management of the system of care rendered to the neonatal patient. The neonatal service will vary in each organization depending on the needs of the patient and the resources available. The service shall come under the organization and direction of the Neonatal Medical Director.*
- *Source: Miss. Code Ann. § 41-3-15*
- *Source: Miss. Code Ann. § 41-3-15*
- *Source: Miss. Code Ann. § 41-3-15*
- *Source: Miss. Code Ann. § 41-3-15*
- *Source: Miss. Code Ann. § 41-3-15*
- *Source: Miss. Code Ann. § 41-3-15*
- *Source: Miss. Code Ann. § 41-3-15*
- *Source: Miss. Code Ann. § 41-3-15*
- *Source: Miss. Code Ann. § 41-3-15*
- *Source: Miss. Code Ann. § 41-3-15*
- *Source: Miss. Code Ann. § 41-3-15*
- *Source: Miss. Code Ann. § 41-3-15*
- *Source: Miss. Code Ann. § 41-3-15*
- *Source: Miss. Code Ann. § 41-3-15*

##### **15 Miss. Admin. Code Pt. 3, R. 7.5.10** Nursing Orientation and Education 1 {#sec-3-7.5.10 omnilex-key=us-ms-regs-official--title-15--3#7.5.10}

Level III NICU nursing orientation will incorporate didactic education, simulation, skills verification, and competency and will be tailored to the individual needs of the nurse based on clinical experience. 2. The facility will document an annual educational needs assessment to determine the educational needs of the clinical nursing staff and ancillary team members. 3. Annual nursing education will address the annual needs assessment and incorporate simulation and skill verification of low-volume, high-risk procedures consistent with the types of care provided in the level III NICU and include education related to serious safety events. 4. Clinical Nurse Educator a. The NICU clinical nurse educator will: i. Be an RN, with nursing certification specific to the care environment preferred;

ii. Have at least a Bachelor of Science in Nursing, Master’s preferred; iii. Demonstrate a current status of NRP completion; iv. Cultivate collaborative relationships with the NPM and facility leadership to improve the quality of care and patient care outcomes; and v. have experience and expertise to evaluate the educational needs of the clinical staff, develop didactic and skill-based educational tools, oversee education and skills verification, and evaluate retention of content, critical thinking skills, and competency relevant to level III neonatal care. b. The facility will have a dedicated individual with sufficient time allocated to perform the roles and responsibilities of the NICU clinical nurse educator.

**History**
- *Source: Miss. Code Ann. § 41-3-15*

##### **15 Miss. Admin. Code Pt. 3, R. 7.5.11** Rule 7.5.11 {#sec-3-7.5.11 omnilex-key=us-ms-regs-official--title-15--3#7.5.11}

Neonatal Outreach The Level III facility will provide multidisciplinary outreach education to referring facilities by assessing educational needs and evaluating clinical care and outcomes, including transport data, as part of collaboration with lower-level neonatal facilities, if applicable.

Subchapter 6 Level IV Neonatal Center (Advanced Neonatal Intensive Care) This Subchapter establishes the rules governing the organization, staffing, and delivery of the highest‐level neonatal care within facilities designated as Level IV – Advanced Neonatal Intensive Care Centers. Its purpose is to ensure that mothers and neonates with the most complex medical and surgical conditions benefit from multidisciplinary expertise, evidence-based practices, and continuous quality improvement aligned with current professional standards. Rule 7.6.1. General Requirements: The Level IV neonatal designated facility shall maintain all Level III capabilities and shall also: 1. Provide care for infants of all gestational ages and birth weights, with mild to complex critical conditions or medical problems requiring sustained life support, hemodynamic support, conventional and high frequency mechanical ventilation, iNO delivery, and/or therapeutic hypothermia.

2. Be located within an institution with the capability to provide surgical repair of complex congenital or acquired conditions. 3. Maintain a full range of pediatric medical subspecialists, pediatric surgical subspecialists and pediatric anesthesiologists at the site.

4. Have the ability to provide ECMO or policies and procedures in place to facilitate neonatal transfer to another unit or facility that provides ECMO. 5. Facilitate transport and provide outreach education including community taught NRP and S.T.A.B.L.E. classes. 6. Have sufficient experience based on patient volume and a systematic process to assess the quality of care provided, including a method to track specific quality indicators and clinical diagnoses, review aggregate data using accepted methodology, and develop action plans as needed to improve patient outcomes.

2. The neonatal program must come under the direction of neonatologist;

3. Neonatal Medical Director (NMD), Neonatal Program Manager (NPM), and appropriate support staff. The Neonatal Program must be multidisciplinary in nature and the performance improvement evaluation of this care must be extended to all the departments involved.

4. Compliance with the above will be evidenced by but not limited to: i. Governing authority and medical staff letter of commitment in the form of a resolution;

ii. Written policies and procedures and guidelines for the care of the neonatal patient;

iii. Defined neonatal team and written roles and responsibilities;

iv. Appointed Neonatal Medical Director with a written job description;

v. Appointed Neonatal Program Manager with a written job description;

vi. Analysis and review of system perinatal outcome and quality data

vii. A written Neonatal Performance Improvement (PI) plan.

Rule 7.6.3. Neonatal Service: The neonatal service shall be established and recognized by the medical staff and be responsible for the overall coordination and management of the system of care rendered to the neonatal patient. The neonatal service will vary in each organization depending on the needs of the patient and the resources available. The service shall come under the organization and direction of the Neonatal Medical Director.

Rule 7.6.4. Neonatal Medical Director (NMD). The NMD must be a physician who is a board-eligible or board-certified neonatologist with neonatal or infant care experience and maintains a current status of successful completion of the Neonatal Resuscitation Program (NRP) or Department-approved equivalent. The NMD is responsible for the validation of neonatal transport protocols, staff competencies, safety standards, and performance review. The NMD must also complete annual continuing medical education specific to the care of neonates, as well as demonstrate effective administrative skills and oversight of the Neonatal PI Plan.

Rule 7.6.5. Neonatal Program Manager (NPM): Level IV Neonatal Centers must have a registered nurse with at least a Bachelor of Science in Nursing (Master’s preferred) with documented perinatal nursing experience, working in the role of the NPM. The NPM must maintain a current NRP certification or equivalent. Working in conjunction with the NMD, the NPM is responsible for organization of the program and all systems necessary for the multidisciplinary approach throughout the continuum of maternal care, as well as developing or revising policies, procedures and guidelines, assuring staff competency, education, and training. The NPM must have sufficient experience and expertise to create, and/or support, a program that provides care to infants who require Level IV NICU care, be responsible for inpatient activities in the NICU and, as appropriate, obstetrical, well newborn, and/or pediatric units; and coordinate with respective neonatal, pediatric, and obstetric care services, as appropriate. The NMD must provide

oversight of annual neonatal-specific education which includes low-volume, high- risk procedures consistent with the care provided in the level IV NICU and foster collaborative relationships with multidisciplinary team members, facility leadership, and higher-level facilities to create a diverse, equitable, and inclusive environment to improve the quality of care and patient care outcomes. In conjunction with the NMD, he/she shall conduct monthly case reviews, analyze transport outcomes and report variances through the PI process.

Rule 7.6.6. Perinatal Multidisciplinary Committee 1. The purpose of the committee is to provide oversight and leadership to the entire maternal program. Each perinatal center may choose to have one or more committees as needed to accomplish the task. One committee must be multidisciplinary and focus on program oversight and leadership. The major focus will be on PI activities, policy development, communication among all team members, and establishment of standards of care, and education. The committee has administrative and systematic control and oversees implementation of all program related services, meets regularly, takes attendance, maintains minutes and works to correct overall program deficiencies to optimize patient care. Membership for the committee includes representatives from:

a. Maternal Medical Director (Chairman – must be present at greater than 75% of all meetings.)

b. Maternal Program Manager c. Neonatal Medical Director d. Neonatal Program Manager e. Pediatrics f. Pediatric Hospitalist g. Neonatology h. Obstetrics and Gynecology i. Certified Nurse Midwife (if applicable)

j. Maternal Fetal Medicine k. Pediatric surgery / pediatric ophthalmology l. Anesthesia/pediatric anesthesia m. Family Medicine n. APPs/Neonatal Nurse Practitioner o. Labor and Delivery p. Nursing q. Laboratory r. Radiology (Ultrasound) s. Respiratory Therapy t. Social Services/Pastoral Care u. Dietary v. Lactation Specialist (or equivalent) w. Pharmacist

2. The clinical managers (or designees) of the departments involved with maternal care must play an active role with the committee.

3. The Neonatal Center may wish to accomplish PI activities in this committee or develop a separate peer review committee. This committee must handle peer review independently from department-based review. The committee must meet regularly and maintain attendance and minutes. This committee must report findings to the overall hospital PI program.

Rule 7.6.7. Clinical Components The clinical components outlined below form the foundation for delivering integrated, high-quality maternal and neonatal care. They ensure seamless collaboration, timely availability of skilled providers, access to essential support services, and standardized stabilization and resuscitation protocols.

1. Maternal – Neonatal Collaboration a. The neonatal program must collaborate with the maternal program , consulting physicians, and nursing leadership to ensure that pregnant patients who are at high risk of delivering a neonate that requires specialized care are transferred to a facility with specialized care capabilities before delivery unless the transfer would be unsafe.

b. The facility shall ensure the provision of appropriate, supportive, and emergency care delivered by qualified personnel for unanticipated maternal-fetal or neonatal complications arising during labor and delivery, continuing through patient disposition.

2. On-Site Clinical Coverage a. Neonatologists The NICU neonatologists will: i. be a board eligible or certified neonatologist or equivalent; ii. Complete annual CME specific to neonatology; iii. Demonstrate a current status of NRP completion; 1. Have credentials that are reviewed by the NMD at least every two (2) years; and iv. Preferably be on-site and immediately available 24/7, a written policy will be in place that defines the criteria for notification and timeframe, as defined by the facility’s policies and procedures. 1. If a neonatologist is not on-site 24/7, a written policy will be in place that defines the criteria for notification and timeframe for on-site presence, and a tracking mechanism for compliance is required.

3. Privileged Care Providers Privileged Care Providers with neonatal-specific training qualified to manage the care of infants with mild to complex critical conditions, including emergencies, will be on site 24/7 and: i. Maintain current NRP certification or equivalent;

ii. Complete annual continuing education in neonatal care; and review of credentials at least every two years by the NMD.

iii. If no neonatologist on-site, have a board-certified neonatologist available for consultation and on-site, arrival within thirty (30) minutes of urgent requests.

iv. Ensure back-up neonatologist coverage (documented on-call) if covering multiple facilities, with the same 30-minute response time. The facility will establish a written policy for backup privileged care provider coverage that establishes flexibility for variable census and acuity. This policy will document the criteria for notification and time frame for on- site presence, be based on allocating the appropriate number of competent medical providers to a care situation, attend to a safe and high-quality work environment, and be operationally reviewed annually for adequacy and adherence.

4. Pediatric Medical Subspecialists The facility must have on-site access to a broad range of pediatric medical subspecialties including, but not limited to; i. cardiology, pulmonology, infectious disease, neurology, ophthalmology, endocrinology, hematology, gastroenterology, nephrology, and genetics or metabolism; and ii. the pediatric medical subspecialists must: 1. be readily accessible for in-person consultation; 2. have credentials to consult at the facility, including documented training, certification, competencies, and continuing education specific to their subspeciality; and 3. document consultations in the medical record within an appropriate time frame and as defined by the facility’s policies and procedures.

5. Neonatal Surgical Program – Required for Level IV Pediatric Surgeons Pediatric surgeons and pediatric surgical specialists will: a. Be available at the bedside within one hour of request or identified need and be capable of performing major pediatric surgery, including surgery for complex conditions; b. If transplant or cardiac surgery is not offered on-site at the facility, policies and procedures will be in place to facilitate neonatal transport to a facility that provides appropriate surgical care; c. provide consultation to a broad range of pediatric surgical specialists including, but not limited to: d. general pediatric surgery, neurosurgery, urology, ophthalmology, otolaryngology, orthopedics, and plastic surgery;

e. have credentials to provide care at the facility, including documented training, certification, competencies, and continuing education specific to their pediatric surgery specialty; f. establish a program for evaluating surgical performance by accurately tracking data, identifying trends, and implementing quality improvement initiatives to address surgical performance in a coordinated systematic approach within a culture of safety, equity, and prevention; and g. report neonatal surgical and anesthesia care back to the PI Committee. 6. Ancillary Services: a. Anesthesia 1. Pediatric anesthesiologists must be on the medical staff and promptly available 24/7 to respond to the bedside within 1 hour of request or identified need; 2. serve as the primary responsible anesthesia provider for all infants <24 mo. of age and should serve as the primary anesthesiologist for children ≤ 5 y of age or based on the ASA physical status classification; and 3. be physically present for all neonatal surgical procedures for which they serve as the primary responsible anesthesia provider.

b. Laboratory and Transfusion Services 1. Laboratory services shall have: 1. laboratory personnel on-site 24/7; 2. the ability to determine blood type, crossmatch, and perform antibody testing; 3. a blood bank capable of providing blood component therapy and irradiated, leukoreduced or CMV-negative blood; a. policies and procedures will be in place to facilitate emergent access to blood and blood component therapy so that the NICU can provide a full range of hematologic interventions; 4. the ability to perform neonatal blood gas monitoring; 5. the ability to perform analysis on small volume samples; 6. the capability to process biopsies and perform autopsies; and 7. access to perinatal pathology services, if applicable.

2. Low-volume specialty laboratory services may be provided by an outside laboratory, but the facility will have policies and procedures in place to maintain timely and direct communication of all critical value results.

c. Pharmacy – Pharmacy services must ensure at least one registered pharmacist experienced in neonatal/pediatric pharmacology is available at all times, completes continuing education requirements specific to pediatric and neonatal pharmacology and participates in multidisciplinary care, including participation in patient care rounds. i. If a pharmacy technician compounds medications for neonates/infants, a pharmacist must provide immediate, direct supervision of the process.

The pharmacist must implement guidelines to address drug shortages, verify medications are appropriately allocated to the Level III NICU and verify the accuracy of each compounded product, monitor compounding activities through the pharmacy PI Plan,

ii. Total parenteral nutrition (TPN) tailored for neonates/infants must be readily available upon request.

1. The facility will have a written policy and procedure for the proper preparation and delivery of TPN.

c. Radiology – must adhere to the “As Low as Reasonably Achievable” (ALARA) principle for neonatal imaging and include the following: 1. Appropriately trained radiology personnel continuously available on- site to meet routine diagnostic imaging needs and to address emergencies.

2. Fluoroscopy available on-call 24/7;

3. Personnel appropriately trained in the following techniques will be on- call and/or available on-stie to perform advanced imaging as requested: a. ultrasonography, including cranial ultrasonography, b. computed tomography (CT), and c. magnetic resonance imaging (MRI)

4. the ability to provide timely imaging interpretation by radiologists with pediatric expertise as requested;

5. The facility will provide pediatric echocardiography and have the ability to consult with a pediatric cardiologist for timely echocardiography interpretation as requested.

a. If fluoroscopy is not offered on-site at the facility, policies and procedures will be in place to facilitate transfer of an infant to a higher level of care.

6. Neonatal diagnostic imaging studies and radiologists with pediatric expertise to interpret the neonatal diagnostic imaging studies, available at all times;

7. A radiologist with pediatric expertise to interpret images consistent with the patient condition and within a time period consistent with current standards of professional practice with monitoring of variances through the Neonatal PI Plan and process;

8. Pediatric-trained radiologists must be available at all time for interpretation of neonatal and perinatal studies; any preliminary reads pending final interpretation must be documented in the medical record.

9. Pediatric echocardiography with pediatric cariology interpretation and consultation within professional timeframes.

10. The radiology PI Plan must compare preliminary and final readings, with summary reports submitted to Perinatal Multidisciplinary Committee.

11. Personnel trained in neonatal x-ray equipment must be on-site and available at all times.

12. Personnel appropriately trained in ultrasound, computed tomography, and cranial ultrasound equipment available on-site within a time period consistent with current standards of professional practice.

13. Fluoroscopy must be available at all times.

14. Neonatal diagnostic imaging studies and radiologists with pediatric expertise to interpret the neonatal diagnostic imaging studies, available at all times;

15. A radiologist with pediatric expertise to interpret images consistent with the patient condition and within a time period consistent with current standards of professional practice with monitoring of variances through the Neonatal PI Plan and process;

16. Pediatric-trained radiologists must be available at all times for interpretation of neonatal and perinatal studies; any preliminary reads pending final interpretation must be documented in the medical record.

17. Pediatric echocardiography with pediatric cariology interpretation and consultation within professional timeframes.

18. The radiology PI Plan must compare preliminary and final readings, with summary reports submitted to the Perinatal Multidisciplinary Committee.

d. Respiratory Therapy The respiratory care leader will: i. be a full-time respiratory care practitioner, with neonatal and pediatric respiratory care certification preferred; ii. have sufficient time allocated to oversee the RTs who provide care in the level III NICU; iii. provide oversight of annual simulation and skills verification which includes neonatal respiratory care modalities and low-volume, high-risk neonatal respiratory procedures; iv. develop a written RT staffing plan that establishes flexibility for variable census and acuity. This plan and actual staffing will be based on allocating the appropriate number of competent RTs to a care situation, attend to a safe and high-quality work environment, and be operationally reviewed annually for adherence and to verify respiratory therapy staffing is adequate for patient care needs; and v. maintain appropriate staffing ratios for infants receiving supplemental oxygen and positive pressure ventilation. Respiratory care practitioners assigned to the NICU will:

i. be a respiratory care practitioner with documented experience and training in the respiratory support of newborns and infants, with neonatal and pediatric respiratory care certification preferred; ii. be on-site 24/7 and immediately available to supervise assisted ventilation, assist in resuscitation, and attend deliveries; iii. demonstrate a current status of NRP completion; iv. participate in annual simulation and respiratory skills verification, which includes low-volume, high-risk procedures consistent with the types of respiratory care provided in the NICU; and v. have their credentials reviewed by the respiratory care leader annually for adequacy and adherence. vi. provide neonatal/infant blood gas monitoring capabilities to support the management of respiratory and metabolic management.

e. Therapy Services 1. The facility will provide on-site consultative services by qualified neonatal therapists to address the 6 core practice domains (environment, family or psychosocial support, sensory system, neurobehavioral system, neuromotor and musculoskeletal systems, and oral feeding and swallowing) and to provide the appropriate care for the neonatal population served. 2. The facility will have on-site access to the following neonatal therapists who have dedicated time allocated to serve the NICU: 1. an occupational and/or physical therapist with sufficient neonatal expertise, and neonatal therapy certification preferred; and 2. a speech language pathologist with neonatal expertise, skilled in the evaluation and management of neonatal feeding and swallowing concerns, and neonatal therapy certification preferred. 3. The facility will operationally review neonatal therapist personnel on an annual basis to maintain adequate multidisciplinary neonatal therapist coverage based on the specific need and volume of the neonatal population served.

f. Dietician The NICU will have at least 1 full-time NICU-dedicated registered dietitian or nutritionist available on-site who has specialized training in neonatal nutrition and will:

1. collaborate with the medical team to establish feeding protocols, develop patient-specific feeding plans, and help determine nutritional needs at discharge; 2. establish policies and procedures to verify proper preparation and storage of human milk and formula; 3. participate in multidisciplinary care, including participation in patient care rounds; and 4. have policies and procedures for dietary consultation for infants in the NICU. i. Neonatal Nutrition The facility will: 1. provide a specialized area or room, with limited access and away from the bedside, to accommodate mixing of formula or additives to human milk; 2. develop standardized feeding protocols for the advancement of feedings based on the availability of, and family preference for human milk, donor human milk, fortification of human milk and formula; and 3. have policies and procedures in place for accurate verification and administration of human milk and formula, and to avoid misappropriation.

ii. Lactation and Breastfeeding Support The facility will: 1. have personnel with the knowledge and skills to support lactation available at all times; 2. have an IBCLC available for on-site consultation on weekdays and accessible by telehealth or telephone 24/7; and 3. operationally review IBCLC personnel on an annual basis to establish adequately trained lactation coverage based on the specific need and volume of the neonatal population served.

iii. Clinical Nurse Staffing A written nurse staffing plan is in place that establishes flexibility for variable census and acuity. This plan and actual staffing will be based on allocating the appropriate number of competent RNs to a care situation, attend to a safe and high-quality work environment, and be operationally reviewed annually for adequacy and adherence.

iv. Clinical Nurse Staff Each clinical nurse will: 1. be an RN, with nursing certification specific to the care environment preferred; 2. demonstrate a current status of NRP completion; 3. participate in annual simulation and skills verification, which includes low-volume, high-risk procedures consistent with the types of care provided in the level III NICU; and

4. promote a family-centered approach to care, including but not limited to skin-to-skin care, appropriate developmental positioning based on gestational age, lactation and breastfeeding support, and engagement of families in their infant’s care. If the facility utilizes LPNs or non-licensed direct care providers to support the clinical nursing staff, the facility must: 1. have written criteria that define the LPNs’ or non-licensed direct care providers’ scope of neonatal care; 2. provide annual education specific to the care of the neonatal population served; and 3. have a written staffing plan that establishes collaborative work assignments in accordance with the facility’s policies and procedures.

v. Clinical Nurse Specialist The clinical nurse specialist will : 1. be an RN, with neonatal nursing certification and clinical nurse specialist certification preferred; 2. have at least a Master of Science in Nursing, Doctorate preferred; 3. demonstrate a current status of NRP completion; 4. foster continuous quality improvement in nursing care; 5. develop and educate staff to provide evidence-based nursing care; 6. be responsible for mentoring new staff and developing team building skills; 7. provide leadership to multidisciplinary teams; 8. facilitate case management of high-risk neonatal patients; and 9. cultivate collaborative relationships with multidisciplinary team members and facility leadership to improve the quality of care and patient care outcomes.

The facility will have a dedicated full-time equivalent (FTE) allocated to perform the roles and responsibilities of the NICU clinical nurse specialist.

7. Stabilization and Resuscitation

a. The facility shall develop, maintain, and enforce written policies, procedures, and guidelines for the stabilization and resuscitation of neonates, in accordance with current standards of professional practice.

b. The facility shall ensure the availability of trained personnel capable of stabilizing distressed neonates.

c. Staffing requirements for neonatal resuscitation shall include:

1. Attendance by at least one individual, at the time of each birth, who holds current NRP certification ( or Department-approved equivalent) and whose primary responsibility is neonatal management and resuscitation.

2. At least one additional provider with full neonatal resuscitation skills - including endotracheal intubation, vascular access establishment, and administration of emergency medication – must be immediately available on-site.

3.Additional personnel who maintain a current status of successful completion of the NRP or a Department-approved equivalent, must be on-site and immediately available upon request for the following: 4. Multiple birth deliveries; to care for each neonate;

5. Unanticipated maternal-fetal complications during labor and delivery;

6. Deliveries identified or suspected to be high-risk for the pregnant patient or the neonate.

4. Immediate on-site availability of all necessary resuscitative equipment, supplies, and medications.

5. Any deviations from these standards must be monitored through the Neonatal PI Plan, with reporting of variances to the Perinatal Multidisciplinary Committee 7. Neonatal Transport If the facility has a neonatal critical care transport program, it will have an identified director of neonatal transport services. The director of neonatal transport services can be the NMD or another physician who is a pediatrician, board-eligible or certified neonatologist, pediatric hospitalist, or pediatric medical subspecialist with expertise and experience in neonatal and infant transport. If the facility does not have its own transport program, the facility must have policies and procedures in place to identify a local neonatal transport program to facilitate transport. Responsibilities of the director of neonatal transport services include the following: i. Train and supervise staff; ii. Provide appropriate review of all transport records; iii. develop and implement policies and procedures for patient care during transport; iv. develop guidelines for determining transport team composition and medical control and establish a mechanism to track adherence; v. establish policies and procedures to provide transport updates and outreach education; vi. establish a program for evaluating performance by tracking data, identifying trends, and implementing quality improvement initiatives to address transport performance in a coordinated systematic approach within a culture of safety, equity, and prevention5; and vii. report neonatal transport data and neonatal-specific reviews back to the PI committee. viii. The director of neonatal transport services may delegate specific requirements to other person(s) or group(s) but retains the responsibility of certifying that these functions are addressed appropriately. The facility will: i. establish minimum education, experience, and training requirements for all transport team members; ii. select transport team members based on their experience and competence in the care of neonates and the transport team must collectively have the ability to provide a level of care that is similar to that of the admitting unit; and iii. provide annual transport education to all transport team members that incorporates equipment training, didactic education, simulation, and skills

verification of low-volume, high-risk procedures consistent with the types of care provided during neonatal transport. 8. Support Services a. The neonatal program shall ensure the availability of personnel with specialized knowledge and skills in breastfeeding and lactation, to provide assistance and counseling to mothers at all times. Services shall include latch assessment, milk supply evaluation, and coordination with nutrition teams. An IBCLC should be available for on-site consultation on weekdays and accessible by telehealth or telephone at all times. IBCLC personnel should be operationally reviewed on an annual basis to establish adequately trained lactation coverage based on the specific need and volume of the neonatal population served. b. Child Life Services Child life services, or the equivalent, will be available for on-site consultation to support patient-and family-centered care by establishing and maintaining therapeutic relationships between patients, family members, multidisciplinary team members, and community resources.

c. Social Worker The NICU social worker will: 1. be a Master’s prepared medical social worker with perinatal and/or pediatric experience. The facility will: 1. provide 1 social worker for every 30 beds providing level III neonatal care and/or specialty and subspecialty perinatal care; 2. have a written description that clearly identifies the responsibilities and functions of the NICU social worker; and 3. have social services available for each family with an infant in the NICU as needed.

d. Pastoral Care Personnel skilled in pastoral care will be available as needed and by family request, and will represent, or have the ability to consult, multiple religious affiliations representative of the population served. e. Retinopathy of Prematurity The facility must have process in place to appropriately identify infants at risk for retinopathy of prematurity to guarantee timely examination and treatment by having documented policies and procedures for the monitoring, treatment, and follow-up of

retinopathy of prematurity, and the ability to perform on-site retinal examinations, or off-site interpretation of digital photographic retinal images, by a pediatric ophthalmologist or retinal specialist with expertise in retinopathy of prematurity.

**History**
- *Source: Miss. Code Ann. § 41-3-15 Rule 7.6.2. Neonatal Program 1. There shall be a written commitment on behalf of the entire facility to the organization of neonatal care. The written commitment shall be in the form of a resolution at the time of application passed by appropriate quorum of the members of the governing authority. Should the business organization be other than a corporation, a letter explaining such, together with a written commitment of the hospital’s chief executive officer, to the establishment of a neonatal care program may be sufficient. The neonatal program must be established and recognized by the medical staff and hospital administration.*
- *Source: Miss. Code Ann. § 41-3-15*
- *Source: Miss. Code Ann. § 41-3-15*
- *Source: Miss. Code Ann. § 41-3-15*
- *Source: Miss. Code Ann. § 41-3-15*
- *Source: Miss. Code Ann. § 41-3-15*
- *Source: Miss. Code Ann. § 41-3-15*

##### **15 Miss. Admin. Code Pt. 3, R. 7.6.8** Discharge Planning and Follow-Through Care 1 {#sec-3-7.6.8 omnilex-key=us-ms-regs-official--title-15--3#7.6.8}

Systems will be in place to establish preparation for NICU discharge, including post-discharge follow-up by general and subspecialty pediatric care providers, home care arrangements and community service resources, and enrollment in a developmental follow-up program as needed.

The facility must have written medical, neurodevelopmental, and psychosocial criteria that automatically warrant high-risk neonatal follow-up with appropriate developmental follow-up services; as well as provide developmental follow-up services or have written referral agreement with a developmental follow-up clinical or practice, when possible, to provide neurodevelopmental services for the neonatal population served.

Follow-up outcomes are monitored via the Neonatal PI Plan to ensure continuity of care.

Rule 7.6.9. Nursing Orientation and Education 1. Level IV NICU nursing orientation will incorporate didactic education, simulation, skills verification, and competency and will be tailored to the individual needs of the nurse based on clinical experience. 2. The facility will document an annual educational needs assessment to determine the educational needs of the clinical nursing staff and ancillary team members. 3. Annual nursing education will address the annual needs assessment and incorporate simulation and skill verification of low-volume, high-risk procedures consistent with the types of care provided in the Level IV NICU and include education related to serious safety events. Clinical Nurse Educator a. The NICU clinical nurse educator will:

i. Be an RN, with nursing certification specific to the care environment preferred; ii. Have at least a Bachelor of Science in Nursing, Master’s preferred; iii. Demonstrate a current status of NRP completion; iv. Cultivate collaborative relationships with the NPM and facility leadership to improve the quality of care and patient care outcomes; and v. Have experience and expertise to evaluate the educational needs of the clinical staff, develop didactic and skill-based educational tools, oversee education and skills verification, and evaluate retention of content, critical thinking skills, and competency relevant to level III neonatal care. b. The facility will have at least one dedicated FTE allocated to perform the roles and responsibilities of the NICU clinical nurse educator.

Rule 7.6.10. Neonatal Outreach The Level IV Neonatal Center will provide multidisciplinary outreach education to referring facilities by assessing educational needs and evaluating clinical care and outcomes, including transport data, as part of collaboration with lower-level neonatal facilities.

**History**
- *Source: Miss. Code Ann. § 41-3-15*
- *Source: Miss. Code Ann. § 41-3-15*
- *Source: Miss. Code Ann. § 41-3-15*

##### **15 Miss. Admin. Code Pt. 3, R. 1.1.1** Definitions {#sec-3-1.1.1 omnilex-key=us-ms-regs-official--title-15--3#1.1.1}

1. “BACS” means the Bureau of Acute Care Systems, Mississippi State Department of Health.

2. “Beneficiary Agreement” means the instruments sent by the Department to Eligible Beneficiaries for certification of program requirements and binds the Eligible Beneficiary to all terms and conditions of the Program prior to release of funds.

3. “Coronavirus or COVID-19” means the Coronavirus Disease 2019.

4. “Critical Access Hospital” means a rural hospital designated by the Centers for Medicare and Medicaid Services (CMS) as a Critical Care Hospital and licensed as a Critical Care Hospital by HFLC.

5. “Department, the Department, or MSDH” means the Mississippi State Department of Health, as established by Miss. Code Ann. §43-3-1, et seq. (Rev. 2006).

6. “Eligible Beneficiary” means an entity defined in Section 1(iii) (a-f) of SB 2372 that has applied for funding by submitting a formal application through this Program and has demonstrated that it is in fact eligible to receive funds under SB 2372 based on the facts and data submitted with its application for funding. Entities eligible to apply include licensed hospitals in the State of Mississippi, including specialty hospitals recognized and licensed as such by HFLC. Hospitals owned and operated by the Department of Veterans Affairs and the State Department of Mental Health are NOT eligible to apply. No other entities except as expressly defined herein and in compliance with SB 2372 will be eligible to apply for funding under this Program.

7. “Emergency Department” means an organized hospital-based facility for the provision of unscheduled episodic services to patients who present for immediate medical attention that is available 24 hours per day seven days per week and approved by HFLC for such purpose.

8. “Frequently Asked Questions” means a listing of questions and answers related to the Program and potentially eligible expenses that can be found at https://msdh.ms.gov/sustainabilitygrant.

9. “HFLC” means the Bureau of Health Facilities Licensure and Certification, Mississippi State Department of Health.

10. “Licensed Bed” means the number of beds listed on the current hospital license issued by HFLC.

11. “Mississippi Hospital Sustainability Grant Program” means Senate Bill 2372, 2023 Regular Legislative Session.

12. “Operating Expenses” means an expense that a business incurs through its normal business operations.

13. “Program” means the “Mississippi Hospital Sustainability Grant Program” provided in Senate Bill 2372, 2023 Regular Legislative Session.

14. “Rural Hospital” means a licensed hospital in a Rural County Designation as determined by data from the U.S. Health Resources and Services Administration (HRSA) or a Metropolitan County Designation as listed under an exception for outlying counties that do not have any urbanized area population by HRSA and approved as such by HFLC.

15. “Specialty Services’ as used in these regulations refers to services provided at specialty licensed hospitals such as women’s health services, long-term acute care, rehabilitation or psychiatric services.

**History**
- *Source: Senate Bill 2372, 2023 Regular Legislative Session*

##### **15 Miss. Admin. Code Pt. 3, R. 1.1.2** Funding Formula for Eligible Beneficiaries {#sec-3-1.1.2 omnilex-key=us-ms-regs-official--title-15--3#1.1.2}

1. Eligible Beneficiaries may be eligible for funds up to a certain amount under this Program, following submission and evaluation of a formal application for funding, based upon the following initial funding criteria.

A. Each licensed hospital that has fewer than one hundred (100) licensed beds and that is not classified as a critical access hospital that operates an emergency department is eligible to receive up to Six Hundred Twenty-five Thousand Dollars ($625,000) to defray the costs of providing emergency department services, if such hospital submits an application for funding with proof of negative economic impact as required by the Program Rules and Regulations. A hospital is not eligible to receive funding unless it has submitted a formal application with all required information and supporting documentation, and that application has been reviewed and deemed eligible under Program guidelines.

B. Each rural hospital that has fewer than one hundred (100) licensed beds and that is classified as a critical access hospital that operates an emergency department is eligible to receive up to Five Hundred Thousand Dollars ($500,000) to defray the costs of providing emergency department services, if such hospital submits an application for funding with proof of negative economic impact as required by the Program Rules and Regulations. A hospital is not eligible to receive funding unless it has submitted a formal application with all required information and supporting documentation, and that application has been reviewed and deemed eligible under Program guidelines.

C. Each hospital that operates an emergency department and that has more than one hundred (100) licensed beds is eligible to receive up to One Million Dollars ($1,000,000), if

such hospital submits an application for funding with proof of negative economic impact as required by the Program Rules and Regulations. A hospital is not eligible to receive funding unless it has submitted a formal application with all required information and supporting documentation, and that application has been reviewed and deemed eligible under Program guidelines.

D. Each hospital with fewer than two hundred (200) licensed beds with the majority of such beds being dedicated to providing specialty services such as women’s health services, long-term acute care, rehabilitation, or psychiatric services is eligible to receive up to Five Hundred Thousand Dollars ($500,000), if such hospital submits an application for funding with proof of negative economic impact as required by the Program Rules and Regulations. A hospital is not eligible to receive funding unless it has submitted a formal application with all required information and supporting documentation, and that application has been reviewed and deemed eligible under Program guidelines.

E. Each rural hospital with fewer than one hundred (100) licensed beds with no emergency department is eligible to receive up to Three Hundred Thousand Dollars ($300,000) to defray the costs of providing access to hospital care in rural communities, if such hospital submits an application for funding with proof of negative economic impact as required by the Program Rules and Regulations. A hospital is not eligible to receive funding unless it has submitted a formal application with all required information and supporting documentation, and that application has been reviewed and deemed eligible under Program guidelines.

2. In addition to the funds listed above, each small rural hospital with fifty (50) beds or less which operated an emergency department is eligible to receive up to Two Hundred Fifty Thousand Dollars ($250,000) to defray the costs of providing access to hospital care in rural communities, if such hospital submits an application for funding with proof of negative economic impact as required by the Program Rules and Regulations.

3. A hospital is not eligible to receive funding unless it has submitted a formal application with all required information and supporting documentation, and that application has been reviewed and deemed eligible under Program guidelines.

4. In the event funds remain available after the close of the Program’s initial application period, and funding of all Eligible Beneficiaries, MSDH will work directly with the Mississippi Legislature to develop a plan for allocating any remaining program funds in compliance with federal regulations.

**History**
- *Source: Senate Bill 2372, 2023 Regular Legislative Session*

##### **15 Miss. Admin. Code Pt. 3, R. 1.1.3** Eligible Beneficiaries {#sec-3-1.1.3 omnilex-key=us-ms-regs-official--title-15--3#1.1.3}

Eligible Beneficiaries are those specifically outlined in SB 2372, Section 1 (iii) (a-f) as eligible to apply for funding under this program for an amount UP TO the amount outlined in the applicable portion of SB 2372, Section 1 (iii) (a-f).

In order to be considered for funding under this Program, an entity must (1) be defined as eligible to apply in SB 2372, Section 1 (iii) (a-f); (2) submit an application for funding with all required information and documentation within the initial application window; and (3) demonstrate through its application and supporting documentation that it experienced a financial harm as a result of the COVID-19 pandemic.

The Program will maintain Frequently Asked Questions on the Department website https://msdh.ms.gov/sustainabilitygrant.

**History**
- *Source: Senate Bill 2372, 2023 Regular Legislative Session*

##### **15 Miss. Admin. Code Pt. 3, R. 1.1.4** Required Application and Eligibility Documentation {#sec-3-1.1.4 omnilex-key=us-ms-regs-official--title-15--3#1.1.4}

1. The initial Program application window will open on June 1, 2023, and close at 11:59 pm CST on June 30, 2023.

2. As per the ARPA Final Rule, the use of ARPA funds must be reasonably proportional to the harm experienced. As such, applicants must submit revenue and operating expense data from the fiscal years 2017, 2018, and 2019 as compared to revenue and operating expenses for fiscal year 2022. Using the data from FYs 2017-2019, a pre-pandemic baseline will be determined. This will be compared to FY 2022 data to calculate the negative impact resulting from or exacerbated by the pandemic. FY 2021 data can be considered but only for periods beyond March 3, 2021, as required by ARPA guidelines. Data considered for FY 2021 must

be compared to the same time period from the pre-pandemic fiscal years (e.g., if the non-Federal entity operates on a calendar year basis, they may provide documentation showing data from April thru December 2021, but must show data for April thru December for FYs 2017-2019 in order to perform an accurate comparison). This data must demonstrate a clear negative impact resulting from or exacerbated by the pandemic.

3. Applicants must submit audited financial statements for FYs 2017- 2019, 2021 (if applicable), and 2022 to support the revenue and operating expenses used in calculating the award. If audited or reviewed financial statements are not available, internally prepared financials may be provided but there may be additional procedures to be performed to ensure the validity of the data. This will be evaluated on a case-by-case basis.

4. Applicants will not be reimbursed for increased operating expenses that occurred before March 3, 2021.

5. Applicants will not be reimbursed for increased operating expenses previously reimbursed by any other State or Federal funding and will be required to certify that no other funding has been received in relation to the costs covered under this program. If additional funding has been received, it will be factored into the award calculation, as appropriate.

6. None of the funds issued under this program shall be used to pay employee premium payments.

**History**
- *Source: House Bill 271, 2023 Regular Legislative Session*

##### **15 Miss. Admin. Code Pt. 3, R. 1.1.5** Beneficiary Agreements {#sec-3-1.1.5 omnilex-key=us-ms-regs-official--title-15--3#1.1.5}

Beneficiary agreements will be sent by the Program to the attention of the Administrator listed for the Eligible Beneficiary hospital utilizing the most current address on file at HFLC for the hospital. (Hospitals should maintain accurate contact information with HFLC)

1. Prior to release of any Program funds all Eligible Beneficiaries will be required to certify, through a Beneficiary Agreement, that it understands and agrees to certain required provisions, including but not limited to, the following statements:

a. That the Eligible Beneficiary understands and agrees to follow and comply with the guidelines, guidance, rules, regulations and/or other criteria, as may be amended from time to time, by the United

States Department of the Treasury regarding the use of monies from the American Rescue Plan established by the ARP Act;

b. That the Eligible Beneficiary understands and agrees to follow and comply with all provisions of the Program, including but not limited to, the Mississippi Hospital Sustainability Grant in Senate Bill 2372, 2023 Regular Legislative Session, and the Department Mississippi Hospital Sustainability Grant Program Rules and Regulations.

c. That, if the Eligible Beneficiary is found to be fully or partially noncompliant with any Program requirements, the Eligible Beneficiary agrees to return all or a portion any monies received from the Program to the Department, and the Eligible Beneficiary understands that it, or its legally responsible officials, may be subject to additional civil and criminal penalties.

d. That the Eligible Beneficiary certifies and acknowledges that by accepting reimbursement under this Program for negative economic impact as a result of the COVID-19 pandemic, it may be subject to additional monitoring, oversight, and/or auditing by the U.S. Department of Treasury’s Office of the Inspector General, the Mississippi Office of the State Auditor, the Mississippi State Department of Health, or such other federal or state agencies with authority to conduct such reviews;

e. That the Eligible Beneficiary certifies it has not received and will not receive reimbursement for the expense in question from any other source of funds, including insurance proceeds.

f. The Beneficiary Agreement must be signed under penalty of perjury certifying that all responses and statements are true and correct and are not false, fraudulent, or materially misleading.

2. All supporting information requested in the Beneficiary Agreement must be provided. The failure to enter into the Beneficiary Agreement and agree to the required certifications and representations will result in the Eligible Beneficiary being disqualified from the Program.

**History**
- *Source: Senate Bill 2372, 2023 Regular Legislative Session*

##### **15 Miss. Admin. Code Pt. 3, R. 1.1.6** Return of funds {#sec-3-1.1.6 omnilex-key=us-ms-regs-official--title-15--3#1.1.6}

Any funds provided by the Department to a hospital as a beneficiary that are found to be fully or partially noncompliant with the requirements of the guidelines, guidance, rules, regulations and/or other criteria, as may be amended

from time to time, by the United States Department of the Treasury regarding the use of monies from the American Rescue Plan Act (ARPA) of 2021, Public Laws 117-2, Mississippi Hospital Sustainability Grant Program, or these rules and regulations shall be returned to the state.

**History**
- *Source: Senate Bill 2372, 2023 Regular Legislative Session*

##### **15 Miss. Admin. Code Pt. 3, R. 1.1.7** Appeals Process {#sec-3-1.1.7 omnilex-key=us-ms-regs-official--title-15--3#1.1.7}

1. An Eligible Beneficiary may appeal any award or disqualification notice received from the Department by giving written notice within ten (10) calendar days of the date of the notice of award decision. The appeal must be received by the Program at the address below by 5:00 p.m. CST of the 7th day.

2. If an appeal is not made within the seven (7) calendar day timeframe, the Eligible Beneficiary will have waived its right to appeal the decision and the original decision shall be deemed final. Appeals must be written and state with specificity the basis for the Eligible Beneficiary’s disagreement with the decision. Appeals are determined solely on the written record. The appeal must attach copies of all documents, records, papers or other information to support the appeal. In addition, all appeals must be dated and contain the Eligible Beneficiary’s name and the name of any authorized representative.

3. To be considered, the written appeal must be delivered by one of two methods: By United States Mail to the following address: Mississippi State Department of Health Mississippi Hospital Sustainability Grant Program – Appeals Room O-434 P.O. Box 1700 Jackson, MS 39215-1700

Or by courier mail or hand delivery to the following: Mississippi State Department of Health Mississippi Hospital Sustainability Grant Program – Appeals Room O-434 570 East Woodrow Wilson Avenue Jackson, MS 39216

4. The Department will review the appeal and all supporting material to determine if the appeal can be resolved based upon the Eligible Beneficiary’s submission and Program requirements. If so, a final written determination of the appeal will be issued by the Department.

5. If the appeal cannot be resolved after the initial review, the Department will forward the appeal for review by an Independent Hearing Officer (“IHO”), to be designated by the Attorney General of Mississippi. The Department will provide to the IHO the Eligible Beneficiary’s file, the appeal and all supporting material provided by the Eligible Beneficiary on appeal, all program requirements and policies, a Department explanation of the case, and Department’s recommendation (if any). The IHO will review all the written materials and issue a written recommendation to the Department. The Department will review and make a final written determination which will be issued by the Department to the Eligible Beneficiary within ten (10) days of the receipt of the IHO’s decision.

6. All appeal determinations made by the Department are final with no further administrative review and are not subject to judicial review.

7. An Eligible Beneficiary may withdraw an appeal at any time by providing written notice to the Department. Such written notice must be delivered to the Department at the addresses set forth above.

8. Program requirements established by the Department as dictated by federal and state law may not be waived or abrogated.

**History**
- *Source: Senate Bill 2372, 2023 Regular Legislative Session*

##### **15 Miss. Admin. Code Pt. 3, R. 1.1.8** Fraud Referrals {#sec-3-1.1.8 omnilex-key=us-ms-regs-official--title-15--3#1.1.8}

In cases in which fraud is suspected or where false or materially misleading information or documentation has been provided by an Eligible Beneficiary, a written referral will be made to the Mississippi State Auditor’s Office, the Office of the United States Attorney, or other appropriate federal or state agencies. The Department will cooperate fully in such investigations and provide all information and documentation which it has received or gathered on the Eligible Beneficiary.

**History**
- *Source: Senate Bill 2372, 2023 Regular Legislative Session*

##### **15 Miss. Admin. Code Pt. 3, R. 1.1.9** Waiver {#sec-3-1.1.9 omnilex-key=us-ms-regs-official--title-15--3#1.1.9}

The Mississippi Hospital Sustainability Grant Program Rules and Regulations may be amended by the Department at any time and are further subject to amendment pursuant to any change in the federal law providing for the grant funds and the regulations and guidance implemented related thereto. The Department, in its sole discretion, may temporarily waive any requirement of the Rules to the extent that the result of such waiver promotes the public purpose of the Mississippi Hospital Sustainability Grant Program created

through S.B. 2372 of the 2023 Regular Legislative Session and is not prohibited by state or federal law.

**History**
- *Source: Senate Bill 2372, 2023 Regular Legislative Session*

##### **15 Miss. Admin. Code Pt. 3, R. 1.1.10** Availability of Funds {#sec-3-1.1.10 omnilex-key=us-ms-regs-official--title-15--3#1.1.10}

This Program is contingent upon the availability of funds as appropriated by the Legislature and provided by the Federal government.

**History**
- *Source: Senate Bill 2372, 2023 Regular Legislative Session*

### **Part 4** Office of Health Services

##### **15 Miss. Admin. Code Pt. 4** Office of Health Services {#sec-4 omnilex-key=us-ms-regs-official--title-15--4}

1

Title 15: Mississippi State Department of Health Part 4: Office of
Health Services Subpart 1: Bureau of Genetics
Chapter 1. NEWBORN SCREENING AND BIRTH DEFECTS REGISTRY
Subchapter 1. AUTHORITY
Rule 1.1.1. Statutory Authority
1. Sections 41-21-201 and 41-21-203 of the Mississippi Code of 1972,
Annotated, authorizes the State Department of Health to adopt rules and
regulations to carry out the Newborn Screening and Follow-up Program
for hypothyroidism, phenylketonuria (PKU), hemoglobinopathy,
congenital adrenal hyperplasia (CAH), galactosemia, and other such
conditions listed on the Recommended Uniform Screening Panel
(RUSP) and as specified by the State Board of Health as stated herein
below in Rule 1.1.2.
2. Section 41-24-1 of the Mississippi Code of 1972, Annotated, authorizes
the State Department of Health to adopt rules and regulations to
establish a program of testing to determine the presence of sickle cell trait
or sickle cell anemia.
SOURCE: Miss. Code Ann. § 41-21-201
Rule 1.1.2. Legal Requirements
1. Under the statutory authority, conditions listed on the RUSP will be
included in the comprehensive newborn screening program within three
(3) years after being added to the RUSP and adopt any rules and
regulations necessary to accomplish the program.
a. If any RUSP-listed conditions are not added to the
comprehensive newborn screening program within three (3)
years, a report on the status and reasons for the delay will be
submitted to the House and Senate Public Health Committees
once a year after the three-year period.
2. Under the statutory authority, a list of each of the conditions included in
the comprehensive newborn screening program and made available to
physicians and other health care providers who are required to provide
for newborn screening testing under Section 41-21-203.
3. Under the statutory authority, informational materials about newborn
screening tests will be available for use by physicians and other health
care providers to inform pregnant women and parents.

2

4. Under the statutory authority, ongoing epidemiologic surveillance of the
comprehensive newborn screening program will be used determine the
efficacy and cost effectiveness of screening newborn infants.
5. Under the statutory authority, the physician attending a newborn child,
or the persons attending a newborn child who was not attended by a
physician, is held responsible for ensuring that the child is tested for the
newborn screening tests as described in these rules and regulations. State
law exempts from these tests any child whose parents object thereto on
the grounds that such tests conflict with their religious practices or
tenets.
6. Under the statutory authority, screening for congenital hypothyroidism
(TSH), phenylketonuria (PKU), hemoglobinopathies (Hgb), congenital
adrenal hyperplasia (CAH), and galactosemia (GAL) will be conducted
statewide. Screening for the following conditions, as determined and
specified by the State Board of Health, will also be conducted:
a. 2-Methylbutyryl-CoA Dehydrogenase Deficiency
b. 3-Hydroxy-3-Methylglutaryl-CoA Lyase Deficiency (HMG)
c. 3-Methylcrotonyl-CoA Carboxylase Deficiency (3MCC Def)
d. 3-Methylglutaconyl-CoA Hydratase Deficiency
e. 5-Oxoprolinuria (Pyroglutamic aciduria)
f. Argininemia
g. Argininosuccinic Aciduria (ASA Lyase Deficiency)
h. Biotinidase Deficiency
i. Carbamoylphosphate Synthetase Deficiency (CPS Deficiency)
j. Carnitine Palmitoyltransferase I Deficiency (CPT I)
k. Carnitine Palmitoyltransferase II Deficiency (CPT II)
l. Carnitine/Acylcarnitine Translocase Deficiency (Translocase)
m. Citrullinemia (ASA Synthetase Deficiency)
n. Critical Congenital Heart Defects (CCHD) - Under the
statutory authority, all licensed hospitals and other state
licensed birthing facilities must test every newborn for CCHD
statewide. All CCHD screenings must be performed prior to
discharge and in accordance with current standards of care.

3

Screening results must be reported to the Mississippi State
Department of Health Newborn Screening Program. (Point of
care testing which does not require blood)
o. Cystic Fibrosis (CF)
p. Glutaric Aciduria Type I (GA I)
q. Homocystinuria
r. Hyperammoninemia, Hyperornithinemia,
Homocitrullinemia Syndrome (HHH)
s. Hypermethioninemia
t. Isobutyryl-CoA Dehydrogenase Deficiency
u. Isovaleric Acidemia (IVA)
v. Long-Chain 3-hydroxyacyl-CoA Dehydrogenase
Deficiency (LCHAD)
w. Malonic Aciduria
x. Maple Syrup Urine Disease (MSUD)
y. Medium-Chain Acyl-CoA Dehydrogenase Deficiency (MCAD)
z. Methylmalonic Acidemia (MMA)
aa. Mitochondrial Acetoacetyl-CoA Thiolase Deficiency
bb. Mucopolysaccharidosis I (MPS1)
cc. Multiple Acyl-CoA Dehydrogenase Deficiency (MADD or GA II)
dd. Multiple CoA Carboxylase Deficiency
ee. Pompe
ff. Propionic Acidemia (PPA)
gg. Severe Combined Immunodeficiency (SCID)
hh. Short-Chain Acyl-CoA Dehydrogenase Deficiency (SCAD)
ii. Short-Chain Hydroxy Acyl-CoA Dehydrogenase Deficiency
(SCHAD)

4

jj. Spinal Muscular Atrophy (SMA)
kk. Trifunctional Protein Deficiency (TFP Deficiency)
ll. Tyrosinemia Type I (TYR I)
mm. Tyrosinemia Type II (TYR II)
nn. Very Long-Chain Acyl-CoA Dehydrogenase Deficiency
(VLCAD)
oo. X-linked adrenoleukodystrophy (X-ALD) (starts July 1, 2023)
pp. Cystic Fibrosis (338)
qq. Guanidinoacetate Methyltransferase Deficiency (GAMT)
rr. Infantile Globoid Cell Leukodystrophy
ss. Mucopolysaccharidosis Type I + Fuller
tt. Mucopolysaccharidosis Type II+ Fuller.
SOURCE: Miss. Code Ann. § 41-21-201
Subchapter 2. SPECIMEN COLLECTION
Rule 1.2.1. Specimen Collection Requirements
1. The specimen must be dried blood spots for screening and whole blood
for confirmatory testing. Specimen should be collected according to the
instructions issued by the Newborn Screening Program and as specified
in the Child Health and Public Health Nursing Manuals.
2. Newborn screening should be performed prior to hospital discharge.
Any specimen collected prior to 24 hours of age will require repeat
specimen collection.
3. Newborn screening collection for Hgb is accepted for testing under the
assumption that the infant has not been transfused. This statement is
noted on Mississippi's newborn screening collection card. The most
recent transfusion date must be appropriately documented on the
collection card.
4. The performing laboratory must receive the specimen within five
working days of the date of collection. All specimens requiring repeat
testing will be monitored by the Newborn Screening Program as follows:

5

a. Specimen repeated due to lack of information will be
the responsibility of the originating hospital.
b. All other repeat specimen will be followed by the patient's
local county health department unless there is a special
circumstance.
5. A Mississippi State Department of Health newborn screening collection
card must be completed in full and accompany the specimen. It is critical
that the data on the collection card be accurate; the information entered
must be compatible with that recorded on the infant's birth certificate.
The collection card must be completed according to the instructions
issued by the Newborn Screening Program.
SOURCE: Miss. Code Ann. § 41-21-201
Subchapter 3. CCHD Reporting Rule
1.3.1 Reporting Requirements
1. All infants will receive a CCHD screening after 24 hours of age or
before discharge.
a. All infants should be on room-air for at least 24 hours and
asymptomatic, including those in the NICU.
b. Neonatal intensive care unit (NICU) infants who are stable and
preparing for discharge.
c. Infants with a prenatal diagnosis of a cardiac defect or infants
who have already had a complete postnatal echocardiogram
performed should be excluded.
d. CCHD results must be entered on the collection card for all
screens done.
i. If the CCHD screening results are not available and the
bloodspot is ready to be shipped. Ship the bloodspot
specimen once it is dried.
SOURCE: Miss. Code Ann. § 41-21-201
Rule 1.3.2. Fees
1. A charge will be assessed for every infant screened.
SOURCE: Miss. Code Ann. § 41-21-201

6

Subchapter 4. FOLLOW-UP
Rule 1.4.1. Documentation of Screening Outcomes
1. The Newborn Screening Program will be responsible for assuring that
all infants have a CCHD screening outcome documented.
a. Each healthcare facility is responsible for providing additional
information on all infants that failed the CCHD Screening or did
not have a “passed” result documented on the Newborn
Screening Collection Card.
i. Except in the case where the card is marked as expired.
Rule 1.4.2. Follow-up for Positive Results, Questionable Results, and Repeat Screening
1. The Newborn Screening Program will be responsible for assuring that
all infants with positive, questionable, and repeat screening tests are
appropriately followed. Follow-up on infants who have a primary care
provider will be coordinated with the provider. The local health
department will provide repeat follow-up on all specimens that have
been collected too early or improperly.
Rule 1.4.3. Repeat Screening Outside of the Health Department
1. Special cases where the infant may have a repeat completed outside of
the health department are: (1) Infant has not been discharged from the
birthing facility or (2) parent/guardian request to return to birthing
facility due to parent preference, location, or health department
scheduling conflict.
SOURCE: Miss. Code Ann. § 41-21-201
Rule 1.4.4. Repeat Screening Due to Incomplete Collection Card
1. If the newborn screening tests have to be repeated due to lack of
information on the collection card, the hospital will be charged
with finding the newborn and repeating the newborn screening
tests.
SOURCE: Miss. Code Ann. § 41-21-201
Subchapter 5. LABORATORY REQUIREMENTS
Rule 1.5.1. Compliance with Standards
1. Any laboratory which offers this testing must meet the
standards outlined in this section and, if requested, provide the

7

agency with a written statement that they will comply with
these standards. All specimens must be tested in an approved
laboratory located in the United States.
2. The results of hemoglobinopathies, galactosemia, and congenital
adrenal hyperplasia screening are not always clear cut and this type
of screening requires extensive input from a recognized reference
laboratory. Screening by tandem mass spectrometry requires
extensive expertise and experience in this testing methodology.
3. A single control laboratory is required for screening. The
laboratory should be proficient in all required testing
methodologies.
SOURCE: Miss. Code Ann. § 41-21-201
Rule 1.5.2. Specimen Requirements:
1. Specimen acceptable for analysis includes only dried blood spots
for newborn screening, and whole blood or serum for confirmatory
testing.
SOURCE: Miss. Code Ann. § 41-21-201
Rule 1.5.3. Method for Specimen Analysis
1. Argininemia: Method: fluorometric assay or by tandem mass
spectrometry analysis
2. Biotinidase Deficiency: Method: continuous flow enzyme assay
3. Congenital Hypothyroidism: Method: Enzyme Immunoassay (EIA)
4. Cystic Fibrosis (CF): Immunoreactive Trypsinogen (IRT) Method:
Immunoassay
5. Congenital Adrenal Hyperplasia (CAH): Method: Enzyme
Immunoassay (EIA)
6. Galactosemia: Method: continuous flow chemistry analysis for
Galactose- 1-Phospahte Uridyltransferase deficiency
7. Hemoglobinopathies: Method: isoelectric focusing
8. Phenylketonuria (PKU): Method: continuous flow chemistry analysis
or tandem mass spectrometry analysis
9. Other Disorders: Method: tandem mass spectrometry analysis,
or biochemical and other established technologies.

8

SOURCE: Miss. Code Ann. § 41-21-201
Rule 1.5.4. Quality Control
1. The laboratory must be successfully participating in an acceptable
proficiency testing program that will monitor the performance of all
testing methodologies. Acceptable testing programs include the
following:
a. College of American Pathologists (CAP)
b. American Association of Clinical Chemists (AACC)
c. Centers for Disease Control (CDC)
2. Test methods used by the laboratory must be FDA cleared/approved
and must be used according to the manufacturers’ directions.
Documentation must be provided upon request for any appropriate and
necessary test used by the laboratory that is not FDA cleared/approved.
3. The laboratorian must examine the quality and integrity of blood spots
and must have a written procedure for rejection of those specimen
judged to be unacceptable.
4. The laboratory must test a minimum of 40,000 specimens per year for
each disorder.
5. Standard curves must be done with each assay of TSH and CAH.
6. Since interpretation of 17-OHP levels for CAH is weight dependent, a
birth weight and current weight in grams must be documented for all
specimen submitted for CAH testing.
7. Laboratories must be Medicare approved.
8. Hemoglobinopathies
a. Control(s) containing AFSC must be included in each assay.
b. All samples that are not normal (not FA or AF) must be sent to
a recognized reference laboratory as liquid blood unless a
diagnosis has been determined by DNA analysis or other valid
means.
c. If transfused, a repeat blood spot specimen or a liquid blood
sample will be collected and tested between two and twelve
weeks post last transfusion.
SOURCE: Miss. Code Ann. § 41-21-201

9

Rule 1.5.5. Disorders being Screened by Biochemical and Other Technologies
1. Biotinidase Deficiency: Biotinidase Deficiency is caused by the
complete or partial lack of the enzyme biotinidase. This condition can
lead to seizures, developmental delay, eczema, and hearing loss.
2. Congenital Adrenal Hyperplasia: Congenital Adrenal Hyperplasia
(CAH) is a genetic endocrine disorder caused primarily by a deficiency
of enzymes needed for the adrenal glands to make the hormones cortisol
and aldosterone. It can result in masculinization of female genitalia as
well as adrenal crisis and early infant death.
3. Cystic Fibrosis: Cystic Fibrosis (CF) is an inherited condition that
affects the glands that produce mucus, tears, sweat, saliva, and digestive
juices. It causes severe lung damage and nutritional deficiencies.
Respiratory failure is the most dangerous consequence.
4. Congenital Hypothyroidism: Hypothyroidism is a disorder in which
there is a decrease in the production of thyroid hormone, possibly
resulting in brain damage and mental retardation in the absence of
prompt treatment.
5. Galactosemia: Galactosemia is an inborn error of metabolism, inherited
as an autosomal-recessive trait, in which the hepatic enzyme galactose-
1- phosphate uridyl transferase is absent, preventing the conversion of the
milk sugar galactose to glucose. If untreated death can occur in the first
month of life.
6. Hemoglobinopathies: Hemoglobinopathy, which includes sickle cell
diseases, thalassemia, and other variants are blood disorders resulting
from change in the structure of hemoglobin. Sickle Cell Disease, the
most common hemoglobinopathy in Mississippi, is an inherited disease
found primarily in African-Americans and people of Mediterranean
descent. Although there is no cure for sickle cell disease, early detection
is important for effective treatment and prevention of complications.
Infection due to Streptococcus pneumonia is a significant cause of death
during the first few years of life for patients with sickle cell disease.
SOURCE: Miss. Code Ann. § 41-21-201
Rule 1.5.6. Disorders Screened by Tandem Mass Spectrometry
1. A tandem mass spectrometer is an analytical instrument consisting of two
mass spectrometers in series connected by a reaction chamber or collision
cell. It can identify a compound by its mass and determine how much of
the compound is present. Through tandem mass spectrometry analysis,
many genetic disorders can be detected from one blood specimen.

10

2. Medium Chain Acyl-CoA Dehydrogenase Deficiency: Medium
Chain Acyl-CoA Dehydrogenase Deficiency (MCAD) is a hereditary
condition that is caused by a lack of an enzyme required to convert fat
to energy. For individuals with this condition, prolonged fasting can lead
to hypoglycemia, vomiting, lethargy, seizures, coma, apnea, cardiac
arrest, or sudden unexplained death.
3. Phenylketonuria: Phenylketonuria (PKU) is a genetic disorder inherited
as an autosomal-recessive trait caused by the absence of an enzyme that
is necessary for metabolism of the essential amino acid phenylalanine.
If untreated, neurologic deterioration, seizures, and severe mental
retardation will occur.
4. Other Disorders: Other less prevalent conditions are detectable by
tandem mass spectrometry. They are grouped into amino acid
disorders, organic acid disorders, and fatty acid disorders (See
Attachment A). Many of these conditions can be life threatening if
appropriate and timely interventions are not initiated.
SOURCE: Miss. Code Ann. § 41-21-201
Rule 1.5.7. Record Retention
1. Records of standardization, quality control, and patient values must be
kept for at least two years. It is advisable for laboratories to retain these
records until the statute of limitations regarding medical malpractice
actions expires as stipulated by Mississippi state law.
SOURCE: Miss. Code Ann. § 41-21-201
Rule 1.5.8. Specimen Retention
1. Specimen must be retained for at least 365 days. Under no
circumstances will the retained specimen be used for research or
purposes other than confirmation of previous test results.
SOURCE: Miss. Code Ann. § 41-21-201
Chapter 2. BIRTH DEFECTS REGISTRY
Subchapter 1. Authority
Rule 2.1.1. Statutory Authority
1. Section 41-21-205 of the Mississippi Code of 1972, Annotated,
authorizes the State Department of Health (the department) to adopt
rules and regulations to govern the operation of the Birth Defects
Registry.

11

SOURCE: Miss. Code Ann. § 41-21-201
Rule 2.1.2. Legal Requirements
Under the statutory authority, the Board of Health (the board) shall:
1. Establish in the department a birth defects surveillance program to:
a. identify and investigate birth defects, and
b. maintain a central registry of cases of birth defects
2. Design a birth defects data system that will:
a. provide information to identify risk factors and causes of
birth defects, provide information on other possible causes of
birth defects,
b. provide for the development of strategies to prevent birth defects,
c. provide for interview studies about the causes of birth defects, and
d. provide for the collection of birth defect information
3. Adopt rules, regulations and procedures to govern the operation of
the registry program and to carry out the intent of this action
4. Specify the types of information to be provided to the birth defects
registry and the persons and entities who are required to provide such
information to the birth defects registry
5. Prescribe the manner in which records and other information are
made available to the department
6. Obtain records and/or test results of individuals with birth defects
not previously reported or observed for inclusion in the central
registry.
7. Collect, analyze and place data in the central registry to
facilitate epidemiological studies/ reviews and to maintain
security
8. Use the registry to:
a. investigate the causes of birth defects and other health conditions
as authorized by statute,
b. design and evaluate measures to prevent the occurrence of
birth defects, and other conditions, and

12

c. refer and track children with special health care needs
d. conduct other investigations and activities necessary for the
board and the department to fulfill their obligation to protect
the public health
SOURCE: Miss. Code Ann. § 41-21-205
Rule 2.1.3. The Genetics Advisory Committee
1. The State Health Officer may appoint or delegate his authority for the
purposes of this section to an advisory committee, not to exceed (13)
persons, to assist in the design and implementation of this central
registry with representation from relevant groups including, but not
limited to, hospitals, two (2) pediatricians, board-certified clinical
geneticists, personnel of the department, personnel of other appropriate
state agencies, and one (1) consumer representative from a family that
has experience with a newborn infant with an abnormal screening test. .
If a central registry advisory committee is created by the State Health
Officer, the board shall consult and be advised by the committee on the
promulgation of rules, regulations and procedures for the purposes of
this section.
SOURCE: Miss. Code Ann. § 41-21-205
Chapter 3. Identifying Reportable Cases
Rule 3.1.1. Definition of Birth Defect
1. Birth Defect: A birth defect is an abnormality of structure, function or
metabolism, whether genetically determined or a result of environmental
influences during embryonic or fetal life. A birth defect may present from
the time of conception through one year after birth, or later in life.
a. From birth to one year of age certain principal birth defects shall
be reported.
b. Other birth defects found later in life may be reported at any time
up to age twenty-one.
2. Reportable Birth Defects: Live Births and Reportable Fetal Deaths
with birth defects (fetal death of 20 completed weeks of gestation or
more, or a weight of 350 grams or more) shall be reported. Birth Defects
of the following categories must be reported:
Craniofacial GI/GU

13

Neural Tube Teratogen
Cardiac Skeletal
Genetic Disorders Skin
Congenital Tumors Central Nervous System
3. Persons and Entities Required to Provide Information to the Registry
a. The physician must report every birth defect case the first time the
patient is seen, for individuals born on or after January 1, 2000. A
reporting form or its equivalent as determined by the Mississippi
State Department of Health is required when reporting a suspected
or diagnosed birth defect. If the patient is seen for another birth
defect on another occasion, that defect shall also be reported.
b. Appropriate birth certificate data will be reported.
c. Appropriate data from other department registries such as the
Cancer Registry, Newborn Hearing Registry will be reported.
d. The state (s) tertiary care center and other hospitals will report
data through newborn discharge summaries or by completing and
submitting individual reporting forms.
e. Appropriate data on specified disorders detected through newborn
screening will be reported.
4. Criteria for Inclusion as a Case
a. The infant/fetus must have a reportable structural defect,
newborn screening disorder, functional or metabolic disorder,
genetically determined or a defect resulting from an
environmental influence during embryonic or fetal life.
b. The defect optimally should be diagnosed or its signs and
symptoms recognized within the first year of life, but defects
can be recognized and included up to twenty-one years of age.
c. An infant must have been born alive or a fetus must have
gestational age of at least 20 weeks or a birth weight of at least
350 grams to be included in the Birth Defects Registry.
5. Process for Making Records and Other Information Available to
The Birth Defects Registry

14

a. Hospitals, physicians, and other health care professionals may
submit records and birth defect information electronically or
by completing and submitting individual reporting forms.
b. The following persons who act in compliance with this section
are not civilly or criminally liable for furnishing the
information required under this section:
i. A hospital, clinical laboratory, genetic treatment center
or other health care facility;
ii. An administrator, officer or employee of a hospital,
clinical laboratory, genetic treatment center or other
health care facility; and
iii. A physician or employee of a physician.
c. The department field staff will visit health care facilities to
gather medical and other required information of children
with birth defects. This information will be recorded on
registry data report forms. The department may obtain
records and/or test results of individuals with known or
potential birth defects not previously reported.
6. Confidentiality and Security
a. Information collected and analyzed by the department under
this section shall be placed in the central registry to facilitate
epidemiological studies/ reviews and to maintain security.
i. Data obtained under this section directly from the
medical records of a patient is for the confidential use
of the department and the persons or public or private
entities that the department determines are necessary
to carry out the intent of this section. The data is
privileged and may not be divulged or made public in
a manner that discloses the identity of an individual
whose medical records have been used for obtaining
data under this section.
ii. Information that may identify an individual whose
medical records have been used for obtaining data
under this section is not available for public inspection
under the Mississippi Public Records Act of 1993.
iii. Statistical information collected under this section is
public information.

15

b. Misuse of the Registry Data: Any person or entity who
misuses the information provided to the registry shall be
subject to a civil penalty of Five Hundred Dollars ($500.00)
for each such failure or misuse. Such penalty shall be assessed
and levied by the board after a hearing, and all such penalties
collected shall be deposited into the State General Fund.
7. Policies and Procedures
The department will maintain written policies and procedures to
guide the operations of the Birth Defects Registry.
SOURCE: Miss. Code Ann. §41-21-205

### **Part 5** Office of Health Informatics

##### **15 Miss. Admin. Code Pt. 5, R. 2.1.6** Applicants without legitimate and tangible interest are: {#sec-5-2.1.6 omnilex-key=us-ms-regs-official--title-15--5#2.1.6}

1. The natural parents of an adopted child if that parent does not have legal custody. Alleged natural parent of any child if the parent’s name is not on the certificate.

2. A parent whose parental rights has been legally terminated and notice of such has been provided to the State Registrar.

3. Commercial, political, for-profit, and not-for profit firms or entities requesting copies of records, specific information on an individual record or listings of names and addresses from a series of records.

Miss. Code Ann. §93-5-26

**History**
- *SOURCE: Miss. Code Ann. §41-57-1; Miss. Code Ann. §41-57-2; Miss. Code Ann. §41-57-7;*

##### **15 Miss. Admin. Code Pt. 5, R. 2.1.7** Rule 2.1.7 {#sec-5-2.1.7 omnilex-key=us-ms-regs-official--title-15--5#2.1.7}

Nothing in this rule shall be construed to permit disclosure of information contained in the Information for Medical and Health Use Only section of the birth certificate, unless specifically authorized by the State Registrar for statistical research or if authorized by statute or a court of competent jurisdiction within this state.

Subchapter 2. Free Copies Rule 2.2.1. A free certified copy or verification of birth or death records shall be provided in accordance with state statutes under the following conditions: 1. Volunteers in the armed services will be provided a free certification of birth upon the personal representation of the local recruiting officer for the selected armed service branch. 2. Copies of birth or death certificates necessary for establishing claims for dependency, disability or survivor benefits will be provided free of charge for veterans who reside in Mississippi, or their claimants upon written application by any recognized Veterans Service Officer. 3. Up to five (5) certified copies of a death certificate will be furnished, free of charge, for any deceased person who died in Mississippi and was an honorably discharged veteran of the Armed Forces of the United States or who was killed or died while serving on active duty in the Armed Forces of the United States upon written application by any recognized Veterans Service Officer.

Miss. Code Ann. §41-57-26; Miss. Code Ann. §35-3-9 Subchapter 3. Certification and Service Fees Rule 2.3.1. Certified copy and service fees: The State Registrar may, in his or her discretion and upon receipt of a request and fee established herein, furnish certified copies, verification of information, or non-certified copies of records and reports on file. The fee for each service requested shall be as delineated below. The fee for the certified birth certificate is inclusive of the one dollar ($1.00) fee required under §41-57-11(2) for the Mississippi Children’s Trust Fund.

1. Birth Record, Death Record, and Statistical Report of Marriage: Seventeen dollars ($17.00) for the first certified copy of a record on file. Six dollars ($6.00) for each additional certified copy of the same record ordered at the same time. 2. Statistical Report of Divorce and Certificate of Birth Resulting in Stillbirth: Seventeen dollars ($17.00) for one non-certified copy of a report on file. 3. Amendment (Correction or change to record or report): Twenty-eight dollars ($28.00) for court order or affidavit amendment to record or report on file. Fee includes one certified copy of the amended record. Additional certified copies of the amended record ordered at the time of amendment shall be six dollars ($6.00) for each copy. 4. Creation of Delayed Record for filing: Twenty-eight dollars ($28.00) for a creating, by court order or affidavit, a record one (1) year or more after the date of the event. A request for the record must be submitted and a finding of ‘Not on File’ must be made prior to a request to create a delayed record for filing. The fee includes the issuance of one certified copy of the record filed. The fee for additional copies of the record ordered at the time of filing shall be six dollars ($6.00) for each additional copy. If the creation of a delayed record is determined to be fraudulent, the entire fee will be retained and the record will not be filed, or if it has already been filed when it is determined to be fraudulent the record will be removed from the files. 5. Creation of an Adoption Record: Fifty-five dollars ($55.00) for creation of an adoption record for filing. Fee includes one certified copy of the birth record created from the adoption decree. Six dollars ($6.00) for each additional copy ordered at the same time as the filing. 6. Disclosure from Adoption Record: Twenty-five dollars ($25.00) for disclosure of identifying or non-identifying information from adoption files. Licensed adoption agencies shall be charged a fee of six dollars ($6.00) for verification of affidavit or contact status when State File Number and date of adoption can be provided, seventeen dollars ($17.00) will be charged when this information is unknown. Note: disclosure and verification shall be made only in accordance with Mississippi Code sections 93-17-203 through 93-17-223. 7. Extended Search of Records: Requests for a record search which cover multiple years, multiple counties or multiple names for the same record shall be charged at twenty-eight dollars ($28.00) per hour. 8. Research and Genealogy: The fee for research and genealogy plain paper copy records shall be the same as the fee for certified copies of the respective certificate, report or search. 9. The full first copy fee shall be retained on all requests that result in a finding of ‘not on file’.

10. Expedited Service: IN situations where faster service is warranted a fee may be applied as outlined in Office of Vital Records policies.

Subchapter 1. Registration of Births Rule 3.1.1. Fraudulent records and documents related to the birth record shall be turned over to the appropriate law enforcement agency for investigation and to the district attorney in the county of venue for prosecution. The penalty for filing a fraudulent birth record is detailed under Penalties (Rule1.6.1) of this subpart.

information required by the certificate and certify to the facts of birth within 72 hours after the birth. If that person does not certify to the facts of birth within the required 72 hours, the certificate may be signed by a medical staff member or the person in charge of the hospital. The completed certificate shall be filed with the Office of Vital Records of the Department of Health within five days after the date of birth.

1. The suggested method of preventing confusion with multiple births is to initially identify each member by its order of birth in the set. 2. For each member of a set of multiple births, a separate birth certificate, or spontaneous fetal death report shall be completed.

notarized Name of Child form, witnessed by a hospital representative, signed by both parents or the mother if no father is listed, and filed with the birth certificate shall be required, but the certificate shall not be considered nor marked as having been amended.

Code Ann. §93-9-28 Rule 3.3.2. Paternity shall be determined in the following manner: 1. Mother married. If the mother was married at the time of either conception or birth, or at any time between conception and birth, the name of the husband shall be entered on the certificate of birth as the father of the child, unless paternity has been determined and the natural father otherwise named by a court of competent jurisdiction. 2. Mother not married; no acknowledged father. If the mother was not married at the time of either conception or birth, or at any time between conception and birth, and there is no Acknowledgement of Paternity affidavit filed and no determination of paternity by a court of competent jurisdiction, the name of the father shall not be entered on the certificate of birth. 3. Mother not married; acknowledged father. If the mother was not married at the time of conception or birth, or at any time between conception and birth, and the natural father acknowledges such paternity, the name of the father shall be entered on the certificate. Such acknowledgement of paternity shall be made by affidavit of both mother and father on the form prescribed by the Department of Health and filed with the Office of Vital Records. (The Acknowledgement of Paternity affidavit may be rescinded under Rule 3.3.4 – Rescission of acknowledgement of paternity, or superseded by court order. Once a rescission has been filed the father’s information will be removed from the birth certificate and the surname of the child will be changed to the legal name of the mother at the time of birth.) 4. Court-determined paternity. A petition, bill of complaint, or other proceeding filed in a court of competent jurisdiction may result in a determination of paternity. The name of the father as determined by said court shall be entered on the birth certificate upon receipt of a certified copy of the court judgment. Court determined paternity shall take precedence over all other methods of assigning paternity.

Miss. Code Ann. §93-9-9; Miss. Code Ann. §93-9-28 Rule 3.3.3. The surname of the child shall be determined in the following manner: 1. Mother married. If the mother was married at the time of conception or birth, or at any time between conception and birth, the surname of the child shall be that

of the husband except that a notarized Name of Child form, signed by both the listed mother and husband, and witnessed by a health facility representative, filed at the same time as the birth certificate is filed may alter this rule. 2. Mother not married; no acknowledged father. If the mother was not married at the time of conception or birth, or at any time between conception and birth, the surname of the child shall be that of the legal surname of the mother, except that a statement, signed by the listed mother and witnessed by a health facility representative, filed at the same time the birth certificate is filed may alter this rule. 3. Mother not married; acknowledged father. If the mother was not married at the time of conception or birth, or at any time between conception and birth, and the natural father acknowledges such paternity, the surname of the child shall be that of the father except that a notarized Name of Child form signed by both the listed mother and the acknowledged father, witnessed by a health facility representative, and filed at the same time the birth certificate is filed may alter this rule. The Acknowledgement of Paternity affidavit may be rescinded under Rule 3.3.4 – Rescission of acknowledgement of paternity. Upon rescission the father’s information will be removed from the birth certificate and the surname of the child will be changed to the legal surname of the mother at the time of birth. 4. Court-determined paternity. In the event of court-determined paternity, the surname of the child shall be that of the father, unless the judgment specifies otherwise.

Miss. Code Ann. §93-9-9; Miss. Code Ann. §93-9-28 Rule 3.3.4. Rescission of acknowledgement of paternity: In those cases where the mother was not married at the time of either conception or birth, or at any time between conception and birth, and the mother and natural father acknowledge such paternity by affidavit, either the mother or the acknowledged father may rescind the acknowledgement within the earlier of one year of the date of the signature on the Acknowledgement of Paternity affidavit or the date of a judicial proceeding relating to the child, including a proceeding to establish a support order, in which the signatory is a party. This rescission rule also applies in cases where the mother and father married after the birth of the child and legitimized the child by affidavit. This rescission rule does not apply to a legitimation affidavit in cases where the mother and father were married prior to the birth of the child but the fact was not listed on the certificate of live birth.

Miss. Code Ann. §93-9-9; Miss. Code Ann. §93-9-28 Rule 3.3.5. When an affidavit for Acknowledgement of Paternity or Legitimation, in cases where the mother and father were married after the birth of the child, whether

filed at birth or thereafter, has been rescinded, the name of the father and all information pertaining to the father shall be removed from the birth certificate, and the surname of the child shall be changed to the legal surname of the mother at the time of birth. After a father’s name has been removed by rescission, a court order shall be required to put that or another father’s name on the certificate.

Miss. Code Ann. §93-9-9; Miss. Code Ann. §93-9-28 Subchapter 4. Infants of Unknown Parentage Rule 3.4.1. Foundling registration: Any emergency medical services provider, as defined in §43-15-207, who takes possession of certain abandoned infants under §43-15- 201, or whoever assumes custody of a live born infant of unknown parentage shall file a certificate of live birth within five days and such certificate shall contain the following: 1. Have “Foundling” plainly marked in the top margin of the certificate. 2. The required facts which may be determined by approximation. A list of the required facts may be obtained from the Bureau of Vital Records. 3. The signature of the custodian and the custodian’s title, if any. 4. The place where the child was found or taken into possession shall be entered as the place of birth.

Miss. Code Ann. §43-15-207 Subchapter 5. Birth Occurrence Reports Rule 3.5.1. On the first day of each month, each institution which accepts patients for delivery shall make a report to the Office of Vital Records, on forms prescribed by the Department of Health, giving a complete list of births occurring in or enroute to the institution during the preceding month. For those births which occurred enroute to the institution, a notation shall be made on the report. If there were no births at the institution during the month, a report shall be submitted showing that there were none.

not be filed and the record and all documents pertaining to the record shall be turned over to the appropriate law enforcement agency for investigation and the district attorney, in the county of the alleged birth, for prosecution.

Miss. Code Ann. §41-57-27 Rule 3.7.2. In cases where a licensed health care facility failed to file the certificate in a timely manner, the State Registrar may accept the standard birth form, if accompanied with a signed statement attesting to the existence of a hospital file and completed worksheets or a completed Certificate of Live Birth.

These individuals shall be selected from the following in order of priority: 1. The parents of the applicant child, or in the absence of one parent, 2. The custodial parent of the child and a member of the child’s family no more than one degree removed, who would have reason to know the facts of the birth, or in absence of such person, 3. The custodial parent of the child and any person who would have reason to know the facts of the birth, or in the absence of such person, 4. The legal guardian of the applicant child, or the legal guardian of any person who would have reason to know the facts of birth, or in absence of such persons, 5. Any two adults having personal knowledge of the facts of birth.

**History**
- *SOURCE: Miss. Code Ann. §41-57-1; Miss. Code Ann. §41-57-7*
- *SOURCE: Miss. Code Ann. §41-57-1; Miss. Code Ann. §41-57-7; Miss. Code Ann. §41-57-25;*
- *SOURCE: Miss. Code Ann. §41-57-1; Miss. Code Ann. §41-57-7; Miss. Code Ann. §41-57-13 Rule 2.3.2. Complaints of records not received will be honored one time within six (6) months of the original request. Certified copies returned to the State Registrar by the US Postal Service or expedite courier will be re-mailed if notification of correct address is provided within six (6) months of original request. If no notification is received returned mail will be destroyed six (6) months after the date returned, and any notification of failure to receive thereafter will not be honored.*
- *SOURCE: Miss. Code Ann. §41-57-1; Miss. Code Ann. §41-57-7 Rule 2.3.3. Certified copies of vital records may be made by mechanical, electronic, or other reproductive processes, except that the information contained in the Information for Medical and Health Use Only section of the birth certificate shall not be included.*
- *SOURCE: Miss. Code Ann. §41-57-1; Miss. Code Ann. §41-57-7 Rule 2.3.4. When a certified copy is issued, each copy shall be certified as a true copy by the State Registrar in whose custody the record is entrusted, and shall include the date issued, the signatures of the State Health Officer and State Registrar or an authorized facsimile thereof, and an embossed or raised seal of the Mississippi Board of Health. Certified copies shall be produced on paper which incorporates security features to assist in the determination of alterations made to certified copies and in the identification of fraudulent copies.*
- *SOURCE: Miss. Code Ann. §41-57-1; Miss. Code Ann. §41-57-7 Rule 2.3.5. When the State Registrar finds evidence that a certificate was registered through misrepresentation or fraud, the State Registrar shall have authority to withhold the issuance of a certified copy, to amend said certificate to conform with registration procedures of the Board of Health, or to remove the certificate from the files completely and report all related information to the appropriate law enforcement agency.*
- *SOURCE: Miss. Code Ann. §41-57-1; Miss. Code Ann. §41-57-7 Rule 2.3.6. The State Registrar may negotiate fees for statistical and administrative purposes with state and federal government agencies. Fees for unique statistical services shall be assessed on a time and materials cost bases for providing such services.*
- *SOURCE: Miss. Code Ann. §41-57-1; Miss. Code Ann. §41-57-7 Chapter 3. Registration of Live Births*
- *SOURCE: Miss. Code Ann. §41-57-1; Miss. Code Ann. §41-57-7 Rule 3.1.2. A certificate of live birth for each birth which occurs in this state shall be filed with the Office of Vital Records of the Department of Health within five days after such birth and shall be registered if it has been completed and filed in accordance with this rule. Births registered within one year after the date of occurrence shall be registered on the standard certificate of birth form. Births which occur in this state but outside a licensed healthcare facility with no licensed healthcare provider in attendance or available immediately after the birth shall meet the requirements specified in the Home Births section (Rule 3.6.1) of this subpart prior to being deemed as registered or filed. Births registered one or more years after the date of the event shall meet the requirements specified in the Delayed Registration of Birth section (Rule 3.7.1) of this subpart prior to being deemed as registered or filed.*
- *SOURCE: Miss. Code Ann. §41-57-1; Miss. Code Ann. §41-57-7 Subchapter 2. Responsibility for Filing of Birth Certificates Rule 3.2.1. The responsibility for filing birth certificates is determined by the circumstances of the birth. The certificate of birth must be filed within five days.*
- *SOURCE: Miss. Code Ann. §41-57-1; Miss. Code Ann. §41-57-7 Rule 3.2.2. Birth on a moving conveyance: When a birth occurs and the cord is cut on a moving conveyance within the United States and the child is first removed from the conveyance in this state, the birth shall be registered in this state, and the place where the child is first removed shall be considered the place of birth. When a birth occurs and the cord is cut on a moving conveyance while in international waters or airspace, or in a foreign country, and the child is first removed from the conveyance in this state, the birth shall be registered in this state but the certificate shall show the actual place of birth insofar as can be determined.*
- *SOURCE: Miss. Code Ann. §41-57-1; Miss. Code Ann. §41-57-7 Rule 3.2.3. Birth in hospital or enroute to hospital: When a birth occurs and the cord is cut in a hospital or enroute thereto, the hospital shall be recorded as the place of birth and the person in charge of the hospital or his designated representative shall obtain the personal data and prepare the certificate. The completed certificate shall be presented to the mother for her approval and signature before she leaves the hospital. The physician or nurse-midwife in attendance shall provide the medical*
- *SOURCE: Miss. Code Ann. §41-57-1; Miss. Code Ann. §41-57-7 Rule 3.2.4. Birth at place other than a hospital: When a birth occurs and the cord is cut outside a hospital, the place of birth shall be recorded as the address at which the cord was cut and the certificate shall be prepared and filed by one of the following, in the indicated order of priority: 1. The physician in attendance at or immediately after the birth, or in the absence of such a person, 2. Any verifiable midwife or other person in attendance at or immediately after the birth, or in the absence of such a person, 3. The father or the mother, or in the absence of the father and the inability of the mother, 4. The person in charge of the premises where the birth occurred, or in the absence of such a person, 5. A representative of the State Registrar.*
- *SOURCE: Miss. Code Ann. §41-57-1; Miss. Code Ann. §41-57-7 Rule 3.2.5. Multiple births.*
- *SOURCE: Miss. Code Ann. §41-57-1; Miss. Code Ann. §41-57-7 Subchapter 3. Paternity and Name of Child Rule 3.3.1. This section details the conditions under which the father’s name may be entered on the certificate, the specification of the child’s name under each condition, and conditions under which the surname of the child may be different from either the father’s surname or mother’s surname if no father is listed. Traditionally a child assumes the legal surname of his or her father as listed on the birth certificate, or of the mother if no father is listed. When the surname given a child is not traditional, a*
- *Source: Miss. Code Ann. §41-3-17; Miss. Code Ann. §41-57-23; Miss. Code Ann. §93-9-9; Miss.*
- *SOURCE: Miss. Code Ann. §41-57-1; Miss. Code Ann. §41-57-7; Miss. Code Ann. §41-57-23;*
- *SOURCE: Miss. Code Ann. §41-57-1; Miss. Code Ann. §41-57-7; Miss. Code Ann. §41-57-23;*
- *SOURCE: Miss. Code Ann. §41-57-1; Miss. Code Ann. §41-57-7; Miss. Code Ann. §41-57-23;*
- *SOURCE: Miss. Code Ann. §41-57-1; Miss. Code Ann. §41-57-7; Miss. Code Ann. §41-57-23;*
- *SOURCE: Miss. Code Ann. §41-57-1; Miss. Code Ann. §41-57-7; Miss. Code Ann. §43-15-201;*
- *SOURCE: Miss. Code Ann. §41-57-1; Miss. Code Ann. §41-57-7 Subchapter 6. Registration of Home Births Filed within One (1) Year of Birth Rule 3.6.1. When a birth occurs at a place other than a licensed healthcare facility the birth shall be classified as a home birth. The certificate for such a birth shall be prepared and filed in accordance with Rule 3.2.4 of this publication. A birth certificate for a home birth determined to be fraudulent, in whole or in part, shall*
- *SOURCE: Miss. Code Ann. §41-57-1; Miss. Code Ann. §41-57-7 Rule 3.6.2. In all cases where a birth occurred outside a licensed healthcare facility with no licensed healthcare provider or verifiable midwife in attendance or available immediately after the birth, a representative of the State Registrar shall make a home visit and obtain or review the following proofs for the filing of the certificate: 1. A state issued picture identification of parents, or in the absence of that other picture identification acceptable to the State Registrar, 2. Prenatal care or medical records confirming pregnancy, or two notarized affidavits of persons who were aware of the pregnancy and the estimated date of delivery, 3. Two affidavits from persons present at the birth or soon after who can verify date and place of birth. The place of birth must be in Mississippi to be filed as a Mississippi birth certificate. One affidavit must be from someone other than a listed or alleged parent, preferably a health care provider, 4. Proof of a live born child, 5. Other proof may be required, at the discretion of the State Registrar, when there is doubt about parentage, date of birth, or place of birth.*
- *Source: Miss. Code Ann. §41-3-17 Rule 3.6.3. Insufficient proof for filing a birth certificate: When the State Registrar has reasonable cause to question the adequacy or validity of the information provided or the supporting affidavits, the birth certificate shall not be filed. Once the State Registrar determines the proof is insufficient, a court order will be required prior to the birth being registered. Pursuant to Mississippi Code Annotated §41-57-19, the State Board of Health shall be summoned to appear at any such hearing.*
- *SOURCE: Miss. Code Ann. §41-57-1; Miss. Code Ann. §41-57-7; Miss. Code Ann. §41-57-19 Subchapter 7. Delayed Registration of Birth Rule 3.7.1. Any living person born in the state of Mississippi whose birth has not been registered with the Office of Vital Records of the Department of Health, may file a delayed registration of birth by affidavit, with proof, or by court order. A delayed birth certificate form must be used if the birth is not registered within one year of the date of birth. Delayed birth registrations determined to be fraudulent, in whole or in part, shall not be filed and the record and all documents pertaining to the record shall be turned over to the appropriate law enforcement agency for investigation and to the district attorney in the county of venue for prosecution.*
- *SOURCE: Miss. Code Ann. §41-57-1; Miss. Code Ann. §41-57-7; Miss. Code Ann. §41-57-19;*
- *SOURCE: Miss. Code Ann. §41-57-1; Miss. Code Ann. §41-57-7 Subchapter 8. Delayed Registration of Birth by Affidavit Rule 3.8.1 Delayed registration for a child less than six (6) years of age: The delayed certificate of birth shall be signed and sworn to before a notary public by two individuals competent to sign and swear to the accuracy of the facts stated therein.*
- *SOURCE: Miss. Code Ann. §41-57-1; Miss. Code Ann. §41-57-7 Rule 3.8.2. If the child is legitimate, a copy of the marriage license of the parents shall be furnished to the State Registrar before the delayed certificate of birth may be filed.*
- *SOURCE: Miss. Code Ann. §41-57-1; Miss. Code Ann. §41-57-7*

##### **15 Miss. Admin. Code Pt. 5, R. 3.8.3** Rule 3.8.3 {#sec-5-3.8.3 omnilex-key=us-ms-regs-official--title-15--5#3.8.3}

The applicant must either show proof that a birth certificate is not on file or pay the fee for a search to determine that the record is not on file.

**History**
- *SOURCE: Miss. Code Ann. §41-57-1; Miss. Code Ann. §41-57-7*

##### **15 Miss. Admin. Code Pt. 5, R. 3.8.4** Rule 3.8.4 {#sec-5-3.8.4 omnilex-key=us-ms-regs-official--title-15--5#3.8.4}

The proofs specified in this subpart under Rule 3.2.4 – Registration of birth at a place other than a health care facility shall be provided. An immunization or other health care record for the child may be substituted for the record or affidavit confirming the pregnancy.

1. The person whose birth is to be registered, if that person is eighteen (18) years of age or older, or 2. One or both of the parents of the applicant, or 3. The legal guardian of the applicant, or 4. The next of kin of the applicant, or 5. Any adult having personal knowledge of the facts of birth.

2. The date of birth and place of birth; 3. The full maiden name of the mother; 4. The full name of the father, compliance with Rule 3.3.2 in this subpart is required if the father’s name is to be listed. If the mother is married, a copy of the marriage license must also be furnished.

Subchapter 10. Adoption Rule 3.10.1. The laws of the state of Mississippi provide for the adoption of and for the issuance of new birth certificates to adopted individuals. The law, further, provides a method for the adoptee or the adoptive parents, in cases where the adoptee is a minor, to obtain non-identifying and identifying information concerning the birth parents, and for the birth parents to permit or prohibit contact by the adoptee or the adoptive parents.

Miss. Code Ann. §93-17-205; Miss. Code Ann. §9-17-207; Miss. Code Ann. §93- 17-213; Miss. Code Ann. §§93-17-215 thru 221 Subchapter 11. Adoption of Mississippi Born Children Rule 3.11.1 When a person with a Mississippi registered birth is adopted in this or any other state, a new birth certificate shall be prepared by the State Registrar and registered in accordance with Section 93-17-21 of the Mississippi Code of 1972, Annotated. The State Registrar shall honor orders of courts of other states having appropriate jurisdiction over Mississippi born persons in matters of adoption.

2. Report of Adoption, a form prescribed and furnished by the State Registrar. The report shall include such facts as are necessary to locate and identify the certificate of birth of the person adopted, provide information necessary to establish a new certificate of birth of the person adopted, identify the order of adoption and be certified by the clerk of the court. The Report of Adoption must be complete and meet the requirements of an acceptable record under Rule 1.9.3 of this subpart. 3. A report of the medical and social history of the birth parents, including information regarding genetically inheritable diseases or illnesses, and any similar information furnished by the birth parents about the adoptee’s grandparents, aunts, uncles, brothers and sisters. The court may waive this requirement when one or more of the petitioners for adoption is the natural mother or father of the adoptee, or the adoptee is an adult. 4. The names, current addresses and social security numbers of the adoptee’s birth parents, guardian and legal custodian and any other available information about the birth parent’s identity and location. The court may waive this

requirement when one or more of the petitioners for adoption is the natural mother or father of the adoptee, or the adoptee is an adult. 5. The required service fee.

Miss. Code Ann. §93-17-205 Rule 3.11.4. Disclosure of non-identifying information from the sealed file shall be made only under the following conditions: 1. The person making the request has sufficient proof of identity and is an adoptee eighteen (18) years of age or older; an adoptive parent; the guardian or legal custodian of an adoptee; or the offspring or blood sibling of an adoptee if the requester is eighteen (18) years of age or older. 2. Payment of the required service fee.

2. A licensed adoption agency has requested the information while acting on behalf of any person specified in Miss. Code Ann.§93-17-207 who requests non-identifying medical, social or genetic background information and the information is not on file and an affidavit prohibiting a search for the birth parent has not been filed or a notice of contact with the birth parent for that adoptee is not on file. In this case, only non-identifying information may be furnished by the licensed adoption agency to the person so identified in Miss. Code Ann. §93-17-207.

3. A licensed adoption agency providing post-adoption services has requested the information while acting on behalf of any person twenty-one (21) years of age or over who has been adopted in this state, providing however, that the birth parent has not executed an affidavit prohibiting the release of such information or that a notice is not on file that such birth parent has been contacted once and has refused to authorize the release of confidential information. 4. Payment of the required service fee.

Miss. Code Ann. §§93-17-215 thru 219 Subchapter 12. Adoption of Foreign Born Children Rule 3.12.1. The Mississippi Code provides for the issuance of a Mississippi birth certificate upon the adoption of, by Mississippi residents, foreign-born children. See Section 93-17-21, Mississippi Code of 1972, Annotated.

Miss. Code Ann. §93-17-21

Subchapter 15. Centralized Adoption Statistics Rule 3.15.1. With the assistance of the Administrative Office of Courts, the State Registrar shall compile and annually make available to the public for a reasonable fee, statistics about all adoptions finalized in the State. The statistics shall include the number of adoptions where the adopting parent is a blood relative and the number of adoptions where the adopting parent is not a blood relative to the adoptee. No individual identifying information shall be made available in these statistics.

Subchapter 16. Amendments to Birth Certificate Rule 3.16.1. Mississippi statutes authorize alteration of birth certificates only when the original birth facts are incorrectly recorded. An omission in this context is considered to be an error.

knowledge of the facts (in the order of priority specified in Rule 3.8.1 of this subpart). Proof of the facts must be at least one piece of documentary evidence, showing the type of document and a date five (5) years or more prior to the request, which supports the item to be corrected. The documentary evidence must also contain sufficient identifying information that is consistent with the same type of information on the birth certificate. From the date of birth up to but not including the date three (3) calendar months after the date of birth, corrections in the placement of given names, adding or dropping a given name but not both, or corrections in the spelling of a given name where it does not change the pronunciation of the name may be made by affidavit without the proof requirement.

Attempts to change a record though fraudulent means will result in no change to the record and all documents pertaining to the record will be turned over to the appropriate law enforcement agency for investigation.

Note: The witnessed statement giving a child a non-traditional surname, filed with the birth certificate by the facility of birth, is not considered an amendment to the name item.

2. Where the item was left blank on the existing certificate, amendments shall be made by completing the items, with a notation as to source, date of amendment and initials of the authorized agent placed on the certificate in such a way so as not to become part of any certification.

3. Excepting only adoptions, the change authority and the date of change shall be legible on any certified copy issued. The certificate shall contain an entry in the margin amended by authority of Section 41-57-23(1) or Section 93-17-1 of the Mississippi Code of 1972, Annotated. Where the change was based upon a rule, the Mississippi Board of Health authority to make rules and regulations, Section 41-3-17 will be referenced.

Subchapter 17. Legitimation by Marriage and Affidavit of Natural Parents Rule 3.17.1. 1. The affidavit of the natural parents of an illegitimate child, submitted with proof of marriage between the parties, shall result in the addition of the father’s name, race, age at time of birth or date of birth, and state of birth to the child’s birth certificate, and change the child’s surname to that of the father, provided that no father is listed on the certificate on file. If another man is named as father on the birth certificate, this name may only be changed pursuant to an order from a chancery court, or the Chancellor in vacation of the county of residence of the petitioner, or any chancery district of the state if the petitioner is a nonresident. When the natural parents were married prior to the birth of the child, but the father’s information was not contained on the filed certificate, the affidavit shall correct the omission of the father’s information. Signatories in this case cannot rescind the acknowledgement and any action to remove the father shall be by Chancery court order. 2. When the natural parents marry after the birth of the child, the affidavit amends the birth record by providing the father’s information and changing the surname of the child to that of the father. In this case a signatory can rescind the acknowledgement in accordance with Rule 3.18.2 of this subpart.

Acknowledgement of Paternity affidavit must be signed by both the mother and natural father, contain a notary seal for both signatures, indicate the date signed, and be filed with the office of vital records. When an Acknowledgement of Paternity affidavit is filed the father’s information shall be added to the birth certificate and the surname of the child shall be changed to that of the father.

Miss. Code Ann. §93-9-9; Miss. Code Ann. §93-9-28 Rule 3.18.2. Rescission of acknowledgement of paternity: A signatory may, in accordance with §41-57-23(3) and §93-9-9(4), rescind an Acknowledgement of Paternity affidavit by completing and filing with the office of vital records a Rescission of Acknowledgement of Paternity affidavit. The person signing a rescission affidavit must sign his or her name in the same manner as the signature on the Acknowledgement of Paternity affidavit. The signature must be notarized and the date signed must be within one year of the date of the signature on the Acknowledgement of Paternity filed with the office of vital records. After a rescission has been filed the father’s information will be removed and surname of the child will be changed to the legal name of the mother at the time of birth, in accordance with Rule 3.3.4 of this subpart.

Miss. Code Ann. §93-9-9; Miss. Code Ann. §93-9-28 Subchapter 19. Amendments by Court Order Rule 3.19.1. Proceedings brought under Mississippi Code Annotated §41-57-23 must be brought against the Board of Health. Any court action should be based upon the certificate on file with the Board of Health. The petition should set out the error to be corrected, and include any documentation or other evidence upon which the claim of an error is based. A certified copy of the subject certificate and any documentary support of the petition should be attached as exhibits. In the absence of any support for a claim, the Board of Health will base its answer on the prima facie facts on the birth certificate on file. Court proceedings brought under Mississippi Code Annotated §93-17-1 do not necessarily entitle a party to an amendment to a birth certificate, unless the Board of Health is a party to the proceedings.

Miss. Code Ann. §93-17-1 Subchapter 20. Amendment of a Delayed Registration Birth Certificate Rule 3.20.1. Amendments to delayed birth certificates shall be made only upon the receipt of an order of a court of competent jurisdiction.

The birth name shall not be eradicated and the name changed shall not be put in

the birth name place. The face of the certificate shall be stamped to indicate the legal authority under which the name was changed and the date of the change.

Chapter 4. Registration of Deaths Subchapter 1. Deaths Rule 4.1.1. Mississippi statutes applicable to the determination and registration of deaths are §41-36-3, §41-57-1, and §41-57-7. A determination of death must be made in accordance with accepted medical standards.

2. The medical examiner shall certify cause in deaths affecting the public interest. A death affecting the public interest is defined by Sections 41-61-53(e) and 41-61-59 of the Mississippi Code of 1972, Annotated. 3. Where an attending physician refuses to sign a certificate of death, or in case of any death affecting the public interest, the State Medical Examiner or properly qualified designee shall sign the death certificate 4. In any case where doubt exists as to who shall certify, the medical examiner shall certify the death.

Rule 4.4.3. If the death affects the public interest (See §41-61-59) the medical examiner shall complete his portion of the death certificate and forward the certificate to the funeral director within forty-eight (48) hours of assuming jurisdiction over a death. In the event that the cause of death determination is awaiting laboratory or autopsy results, the medical examiner shall indicate such in the cause of death section and sign the record. Once the determination of the cause of death is made, the record shall be amended by completing and submitting the form Statement to Amend Cause of Death. The medical examiner’s portion of the death certificate is: 1. Name of deceased 2. Hour and date of death 3. Place of death (hospital, institution, or physical location) 4. Certifier’s signature 5. Cause and details of death

2. In those cases where no funeral director is involved, the hospital or the medical examiner shall be responsible for completion and filing of the entire death certificate within five days of death.

conveyance while in international waters or airspace, or in a foreign country, and the body is first removed from the conveyance in this state, the death shall be registered in this state but the certificate shall show the actual place of death insofar as can be determined. If the death affects the public interest, the medical examiner of the county in which the conveyance stops and death is pronounced shall be notified promptly by any person having knowledge or suspicion of such a death. All other registration procedures as provided in these regulations shall apply.

2. The burial-transit permit shall accompany any dead body when it is moved out of state. If the dead body is shipped by common carrier, the burial-transit permit shall be enclosed in a durable envelope and attached to the shipping case.

Miss. Code Ann. §41-39-101, et seq. Subchapter 8. Disposition of Unclaimed Dead Bodies Rule 4.8.1 A dead human body which is not claimed for burial or cremation within forty- eight hours shall become the responsibility of the Board of Supervisors of the county in which the dead body is located. The Board of Supervisors shall make reasonable efforts to notify members of the decedent’s family or other known interested persons, and, if the dead body is not claimed for burial or cremation by any interested person within five days, the Board of Supervisors shall, as soon as

it may think appropriate, authorize and direct the burial or cremation and burial of the residue of such dead body.

Rule 4.10.3. In cases where the death registration is not court ordered, the State Registrar may require additional documentary evidence to prove the facts of death.

Rule 5.1.1. Spontaneous fetal deaths (stillbirths and miscarriages) are subject to statistical reporting requirements. A “Certificate of Birth Resulting in Stillbirth” may be

obtained, upon request, by a parent named on the fetal death report, to memorialize the delivery of a stillborn child. Such a certificate shall state clearly that the certificate is not proof of live birth.

2. Any other person in attendance at or immediately after the delivery, or in the absence of such a person, 3. The father or mother, or in the absence of the father and the inability of the mother, the person in charge of the premises where the delivery occurred.

Rule 5.2.5. The person responsible for completing the fetal death report shall advise the parent or parents: 1. That a parent may, but is not required to, request the preparation of a certificate of birth resulting in stillbirth; 2. That a parent may obtain a certificate of birth resulting in stillbirth by contacting the Bureau of Vital Statistics to request the certificate and paying the required fee; and 3. How a parent may contact the Bureau of Vital Statistics to request a certificate of birth resulting in stillbirth.

Rule 5.3.1. As with a live born child, when a reportable fetal death occurs, the surname of the fetus is traditionally the same as the father if the mother and father were married, at the time of conception or delivery or at any time between conception and delivery. If the mother and father were not married the name of the fetus and/or paternity may be established in accordance with Rules 5.3.2 and 5.3.3.

2. Mother not married; no acknowledged father. If the mother was not married at the time of either conception or delivery, or at any time between conception and delivery, and there is no Acknowledgement of Paternity affidavit filed and no determination of paternity by a court of competent jurisdiction, the name of the father shall not be entered on the fetal death report. 3. Mother not married; acknowledged father. If the mother was not married at the time of conception or delivery, or at any time between conception and delivery, and the natural father acknowledges such paternity, the name of the father shall be entered on the fetal death report. Such acknowledgement shall be made by affidavit of both mother and father on the form prescribed by the Department of Health and filed with the Office of Vital Records. 4. Court-determined paternity. Any petition, bill of complaint, or other proceeding filed in a court of competent jurisdiction may result in a determination of paternity. The name of the father as determined by said court shall be entered on the fetal death report upon receipt of a certified copy of the court judgment. Court determined paternity shall take precedence over all other methods of assigning paternity.

Miss. Code Ann. §93-9-9; Miss. Code Ann. §93-9-28 Rule 5.3.3. Surname of fetus The surname of the fetus shall be determined in the following manner: 1. Mother married. If the mother was married at the time of conception or delivery, or at any time between conception and delivery, the surname of the fetus shall be that of the husband except that a statement, signed by both the listed

mother and husband, and witnessed by a health facility representative, filed at the same time the fetal death report is filed may alter this rule. 2. Mother not married; no acknowledged father. If the mother was not married at the time of conception or delivery, or at any time between conception and delivery, the surname of the fetus shall be that of the legal surname of the mother, except that a statement, signed by the listed mother and witnessed by a health facility representative, filed at the same time the fetal death report is filed may alter this rule. 3. Mother not married; acknowledged father. If the mother was not married at the time of conception or delivery, or at any time between conception and delivery, and the natural father acknowledges such paternity, the surname of the fetus shall be that of the father except that a notarized Name of Child form signed by both the listed mother and the acknowledged father, witnessed by a health facility representative, and filed at the same time the fetal death report is filed may alter this rule. 4. Court-determined paternity. In the event of court-determined paternity, the surname of the fetus shall be that of the father, unless the judgment specifies otherwise.

Miss. Code Ann. §93-9-9; Miss. Code Ann. §93-9-28 Subchapter 4. Preparation and issuance of a certificate of birth resulting in stillbirth Rule 5.4.1. Within sixty (60) days of a request and payment of the required fee by a parent named on the fetal death report, a Certificate of Birth Resulting in Stillbirth shall be prepared and issued to the requesting parent. Such a certificate shall contain no less than the date of the stillbirth; the county in which the stillbirth occurred, the state file number corresponding to the fetal death report, and the statement “This certificate is not proof of live birth.”

Subchapter 2. Reporting Rule 6.2.1. Requirements Each induced termination of pregnancy which is performed in this state shall be reported to the State Registrar of Vital Statistics within fifteen (15) days of the procedure on a form prescribed or furnished by the Mississippi State Department of Health. Patients are to be listed by identification number only and not by name. The attending physician shall prepare, or cause to be prepared, sign and file the report.

7. The charges are to be coded with the current ICD medical coding classification system in such a way as to distinguish treatment following induced abortions from treatments following ectopic or molar pregnancies.

Rule 6.3.8. Disclosure of the reports or the contents of the reports in a manner or fashion which would permit the identification of the person who is the subject of the report is prohibited.

**History**
- *SOURCE: Miss. Code Ann. §41-57-1; Miss. Code Ann. §41-57-7 Rule 3.8.5. One or more pieces of documentary evidence shall be provided which corroborate the facts set forth on the delayed certificate. Each document must include information as to the type of document and the date it was originally created or filed. The document(s) must establish: 1. The full name of the child at the time of birth, 2. The date of birth and place of birth, 3. The full maiden name of the mother, 4. The full name of the father, if the father’s name is to be listed on the certificate. The father’s name may be listed on the certificate only in compliance with Rule 3.3.2 of this subpart.*
- *SOURCE: Miss. Code Ann. §41-57-1; Miss. Code Ann. §41-57-7 Rule 3.8.6. The State Registrar shall examine the sworn statement and the documentary evidence and shall determine the acceptability of such evidence in establishing the facts of birth. If the State Registrar rejects the provided evidence as unsatisfactory, written notification of the rejection and the reasons for the rejection shall be provided to the person making application on behalf of the child.*
- *SOURCE: Miss. Code Ann. §41-57-1; Miss. Code Ann. §41-57-7 Rule 3.8.7. Upon receipt of the service fee and the acceptance of the signed delayed certificate form, the State Registrar, or authorized representative, shall abstract onto the delayed certificate a description of each piece of documentary evidence submitted to support the facts shown on the certificate. This delayed certificate shall then be used to register the birth and the applicant shall be provided with one certified copy of the certificate.*
- *SOURCE: Miss. Code Ann. §41-57-1; Miss. Code Ann. §41-57-7 Rule 3.8.8. After the birth is registered, all documentary evidence provided on behalf of the child shall be returned to the person making application for the child.*
- *SOURCE: Miss. Code Ann. §41-57-1; Miss. Code Ann. §41-57-7 Rule 3.8.9. Delayed registration when the applicant is six (6) years of age or over For an individual six (6) years of age or over, the delayed certificate of birth shall be signed and sworn to before a notary public by two (2) individuals, selected in the following order of priority, who are competent to sign and swear to the accuracy of the facts stated therein:*
- *SOURCE: Miss. Code Ann. §41-57-1; Miss. Code Ann. §41-57-7 Rule 3.8.10. The applicant must either show proof that a birth certificate is not on file or pay the fee for a search to determine that the record is not on file.*
- *SOURCE: Miss. Code Ann. §41-57-1; Miss. Code Ann. §41-57-7 Rule 3.8.11. In addition, the applicant shall furnish the State Registrar at least two pieces of documentary evidence which corroborate the facts set forth on the delayed certificate. Each document must contain identification as to the type of document and a date of creation or filing which is five (5) years or more prior to the application. These documents must establish: 1. The full name of the applicant at the time of birth;*
- *SOURCE: Miss. Code Ann. §41-57-1; Miss. Code Ann. §41-57-7 Rule 3.8.12. The State Registrar shall examine the sworn statement and the documentary evidence and shall determine the acceptability of such evidence in establishing the facts of birth. If the State Registrar rejects the evidence offered as unsatisfactory, written notification of the rejection and the reasons for the rejection shall be provided to the applicant. Commensurate with the individual’s age, the State Registrar may waive some of the five (5) years required on the evidence. If the State Registrar accepts the evidence offered, upon receipt of the service fee, the State Registrar, or designated representative, shall abstract on the delayed certificate of birth, a description of each document submitted to support the facts shown on the delayed birth certificate. This delayed certificate shall then be used to register the birth and the applicant shall be provided with one certified copy of the certificate.*
- *SOURCE: Miss. Code Ann. §41-57-1; Miss. Code Ann. §41-57-7 Rule 3.8.13. After the birth is registered, all documentary evidence provided shall be returned to the applicant.*
- *SOURCE: Miss. Code Ann. §41-57-1; Miss. Code Ann. §41-57-7 Rule 3.8.14. Closure of delayed birth files: Any application for a delayed certificate not completed within one year from date of application may be dismissed at the discretion of the State Registrar. Upon dismissal, the State Registrar shall advise the applicant of his or her decision and all documents submitted in support of such registration shall be returned to the applicant. No refund of fees shall be made.*
- *SOURCE: Miss. Code Ann. §41-57-1; Miss. Code Ann. §41-57-7 Rule 3.8.15. An applicant wishing to reopen a case must comply with all the requirements of Rule 3.8.1 or 3.8.9 above.*
- *SOURCE: Miss. Code Ann. §41-57-1; Miss. Code Ann. §41-57-7 Rule 3.8.16. When an applicant does not submit the documentation required for delayed registration, or when the State Registrar has reasonable cause to question the validity or adequacy of the applicant’s sworn statement or the documentary evidence, and if the deficiencies are not corrected, the State Registrar shall not register the delayed certificate. However, the applicant may file a petition for a delayed certificate of birth under the provisions of Section 41-57-19 of the Mississippi Code of 1972, Annotated.*
- *SOURCE: Miss. Code Ann. §41-57-1; Miss. Code Ann. §41-57-7; Miss. Code Ann. §41-57-19 Rule 3.8.17. When a delayed birth certificate is determined to be filed fraudulently, the entire fee shall be retained by the State Registrar, and the record and all documents pertaining to the record shall be turned over to the appropriate law enforcement agency for investigation and to the district attorney in the county of venue for prosecution.*
- *SOURCE: Miss. Code Ann. §41-57-1; Miss. Code Ann. §41-57-7; Miss. Code Ann. §41-57-27 Subchapter 9. Delayed Registration of Birth by Court Order Rule 3.9.1. There are cases where an applicant cannot provide sufficient documentation to support his application. In these cases, the applicant has recourse to the chancery courts of Mississippi. Upon receipt of the service fee and a certified copy of the court decree that mandates a delayed certificate to be filed, the State Registrar shall register the birth and issue one certified copy of the certificate to the applicant.*
- *SOURCE: Miss. Code Ann. §41-57-1; Miss. Code Ann. §41-57-7; Miss. Code Ann. §41-57-19*
- *SOURCE: Miss. Code Ann. §41-57-1; Miss. Code Ann. §41-57-7; Miss. Code Ann. §93-17-21;*
- *SOURCE: Miss. Code Ann. §41-57-1; Miss. Code Ann. §41-57-7; Miss. Code Ann. §93-17-21 Rule 3.11.2. For a new certificate to be prepared and issued, the following shall be furnished to the State Registrar immediately after adoption: 1. Certified copy of final decree of adoption.*
- *SOURCE: Miss. Code Ann. §41-57-1; Miss. Code Ann. §41-57-7; Miss. Code Ann. §93-17-205 Rule 3.11.3. Upon receipt of these documents and the service fee, the State Registrar or designated representative, shall remove the original birth certificate from the active files and secure it with the documents required in Rule 3.11.2 (1-4) of this subpart in a sealed file, prepare a new certificate, register the new birth record into the active files, and provide the adoptive parents with one certified copy of the new birth certificate.*
- *SOURCE: Miss. Code Ann. §41-57-1; Miss. Code Ann. §41-57-7; Miss. Code Ann. §93-17-21;*
- *SOURCE: Miss. Code Ann. §41-57-1; Miss. Code Ann. §41-57-7; Miss. Code Ann. §93-17-207 Rule 3.11.5. Disclosure of identifying information from the sealed file shall be made available only under the following conditions: 1. An affidavit is not on file expressly prohibiting the release of any information about such birth parent’s identity and location, and prohibiting any licensed adoption agency from conducting a search for such birth parent under the terms of the Mississippi Adoption Confidentiality Act or a notice of contact with the birth parent for that adoptee is not on file.*
- *SOURCE: Miss. Code Ann. §41-57-1; Miss. Code Ann. §41-57-7; Miss. Code Ann §93-17-207;*
- *SOURCE: Miss. Code Ann. §41-57-1; Miss. Code Ann. §41-57-7; Miss. Code Ann. §93-17-21 Rule 3.12.2. The birth of any child born in a foreign country and adopted in the state of Mississippi by a person or a couple, one of whom is or was at the time of adoption a bonafide resident of this state, may be registered in the manner described in Rule 3.11.1, with the exception that the place of birth shall be shown as the actual town, district and county of said child’s birth.*
- *SOURCE: Miss. Code Ann. §41-57-1; Miss. Code Ann. §41-57-7; Miss. Code Ann. §93-17-21 Subchapter 13. Adoption of Persons Born in Another State Rule 3.13.1. The Board of Health cannot act on a birth certificate of another state, but any person adopting a child born in another state will be referred to the appropriate authority in that state as provided in Section 93-17-21, Mississippi Code of 1972, Annotated.*
- *SOURCE: Miss. Code Ann. §41-57-1; Miss. Code Ann. §41-57-7; Miss. Code Ann. §93-17-21 Subchapter 14. Adoption of Children with no Birth Certificate Rule 3.14.1. The State Registrar will prepare a birth certificate for an adopted individual who has no birth certificate on file or whose place of birth is unknown, upon receipt of a court order as provided for in Section 93-17-21, Mississippi Code of 1972, Annotated.*
- *SOURCE: Miss. Code Ann. §41-57-1; Miss. Code Ann. §41-57-7; Miss. Code Ann. §41-57-19;*
- *SOURCE: Miss. Code Ann. §41-57-1; Miss. Code Ann. §41-57-7; Miss. Code Ann. §93-17-205*
- *SOURCE: Miss. Code Ann. §41-57-1; Miss. Code Ann. §41-57-7 Rule 3.16.2. Amendment of obvious errors: In the process of registering a birth, the State Registrar is charged with responsibility of ensuring, insofar as is administratively possible, the completeness of the record. To this end, during the first year after the date of birth, the State Registrar or designated representative will examine each certificate for obvious errors and make any necessary corrections. Obvious errors, include the transposition of letters in words of common knowledge, the provision of misinformation, and/or omissions of information. Correction of these errors may be made based on either telephone or written query to the facility of birth and/or mother as shown on the birth certificate. When amendments to obvious errors are made by the State Registrar, a notation as to the source of the information, together with the date the change was made and the initials of the authorized agent making the change, shall be made on the certificate in such a way so as not to become a part of any certification issued. The certificate is not to be considered nor marked as having been amended. Correction of obvious errors does not include, the placement of given names, adding or dropping a given name, nor, generally, spelling of the names.*
- *SOURCE: Miss. Code Ann. §41-57-1; Miss. Code Ann. §41-57-7 Rule 3.16.3. Amendment by Affidavit Minor errors and omissions: Certificates which have missing information or the incorrect recording of the child’s first name, middle name(s), sex, or date of birth by one (1) day may be amended by affidavit with proof of the facts. Omissions or incorrect recording of both or either parent’s given name, place of birth, date of birth, or race may also be corrected by affidavit with proof of the facts. Affidavits must contain notarized signatures of two (2) reputable persons having personal*
- *SOURCE: Miss. Code Ann. §41-57-1; Miss. Code Ann. §41-57-7; Miss. Code Ann. §41-57-21 Rule 3.16.4. At the discretion of the State Registrar and commensurate with the age of the person named on the certificate, all or part of the requirements for documentary evidence may be waived. Conversely, should there be any question concerning the validity of the affidavit or documentary evidence, the State Registrar may require a Mississippi chancery court order prior to making the correction. Anyone giving false information in such affidavit shall be subjected to the penalties of perjury.*
- *SOURCE: Miss. Code Ann. §41-57-1; Miss. Code Ann. §41-57-7; Miss. Code Ann. §41-57-27 Rule 3.16.5. More than one amendment to an item: Once an amendment of an item is made on a birth certificate, that item shall not be amended again unless a court order is received from a court of competent jurisdiction within the state of Mississippi.*
- *SOURCE: Miss. Code Ann. §41-57-1; Miss. Code Ann. §41-57-7 Rule 3.16.6. Methods of amending certificates 1. Certificates shall be amended by eradication of the item to be amended and insertion of correct data, except as provided in Rule 3.21.1. Original information contained in the certificate shall be preserved for reference and placed on the certificate in such a way so as not to become part of any certification. When such amendments are made, a notation as to the source, date of amendment and initials of the authorized agent shall be included on the certificate.*
- *SOURCE: Miss. Code Ann. §41-57-1; Miss. Code Ann. §41-57-7; Miss. Code Ann. §41-3-17*
- *SOURCE: Miss. Code Ann. §41-57-1; Miss. Code Ann. §41-57-7; Miss. Code Ann. §93-17-1(2) Subchapter 18. Filiation or Paternity Rule 3.18.1. Acknowledgement of paternity by affidavit: Acknowledgments of paternity by the natural father may be done by affidavit provided no father is listed on the birth certificate of the child. If a father is listed or the mother was married at conception or birth, or any time between conception and birth, a court order shall be required.*
- *SOURCE: Miss. Code Ann. §41-57-1; Miss. Code Ann. §41-57-7; Miss. Code Ann. §41-57-23;*
- *SOURCE: Miss. Code Ann. §41-57-1; Miss. Code Ann. §41-57-7; Miss. Code Ann. §41-57-23;*
- *SOURCE: Miss. Code Ann. §41-57-1; Miss. Code Ann. §41-57-7; Miss. Code Ann. §41-57-23;*
- *SOURCE: Miss. Code Ann. §41-57-1; Miss. Code Ann. §41-57-7 Subchapter 21. Court Order Changes which are not Corrections to Birth Facts Rule 3.21.1. Change of name by court order: A name change, which is not a correction to the birth facts shall, upon receipt of a certified Mississippi chancery court order and required fee, be added to the birth certificate as a marginal notation of the fact.*
- *SOURCE: Miss. Code Ann. §41-57-1; Miss. Code Ann. §41-57-7; Miss. Code Ann. §93-17-1 Rule 3.21.2. Change of sex by court order: Sex reassignment shall be added to the birth certificate as a marginal notation, upon receipt of a certified Mississippi chancery court order, and the required fee.*
- *SOURCE: Miss. Code Ann. §41-57-1; Miss. Code Ann. §41-57-7*
- *SOURCE: Miss. Code Ann. §41-36-3; Miss. Code Ann. §41-57-1; Miss. Code Ann. §41-57-7 Rule 4.1.2. Registration of deaths: A certificate for every death which occurs in this state shall be filed with the Office of Vital Records of the Department of Health within five days after such death occurs and shall be registered if it has been completed and filed in accordance with this rule. If unknown, the place of death is assumed to be that where the body is found. If the date of death is unknown, it shall be determined by approximation.*
- *SOURCE: Miss. Code Ann. §41-57-1; Miss. Code Ann. §41-57-7 Rule 4.1.3. Removal of dead body: The hospital, nursing home, funeral director, other institution or individual who first assumes custody of a dead body shall immediately ascertain the identity of the person who will certify the death (See Rule 4.2.1). The body shall not be removed until such person has been notified and he has indicated he will certify the cause of death.*
- *SOURCE: Miss. Code Ann. §41-57-1; Miss. Code Ann. §41-57-7 Subchapter 2. Who Shall Certify Rule 4.2.1. Certification of death 1. The physician in charge of the decedent’s care shall certify to the cause of death if death does not affect the public interest.*
- *SOURCE: Miss. Code Ann. §41-57-1; Miss. Code Ann. §41-57-7; Miss. Code Ann. §41-61- 53(e); Miss. Code Ann. §41-61-59; Miss. Code Ann. §41-61-63 Subchapter 3. Deaths of Females Between Ages Ten (10) and Sixty (60) Rule 4.3.1. The certifier of cause of death of a female between the ages of ten (10) and sixty (60) will specify, by checking the appropriate box on the death certificate, whether or not the female was or had been pregnant within 90 days of the date of death.*
- *SOURCE: Miss. Code Ann. §41-57-1; Miss. Code Ann. §41-57-7; Miss. Code Ann. §41-57-13(4) Subchapter 4. Place of Death Rule 4.4.1. Death in an institution: When death occurs in a hospital or nursing home and is not a death that affects the public interest, the person in charge of that institution, or his designated representative, shall initiate the preparation of the death certificate by completing the following items: 1. Name of deceased 2. Hour and date of death 3. Place of death (hospital, institution, or physical location)*
- *SOURCE: Miss. Code Ann. §41-57-1; Miss. Code Ann. §41-57-7 Rule 4.4.2. The institution shall obtain the certification of cause of death and forward the certificate to the funeral director and medical certifier within 48 hours of death. In the event that the cause of death determination is awaiting laboratory or autopsy results, the certifier shall indicate such in the cause of death section and sign the record. Once the determination of the cause of death is made, the record shall be amended by completing and submitting the form Statement to Amend Cause of Death.*
- *SOURCE: Miss. Code Ann. §41-57-1; Miss. Code Ann. §41-57-7*
- *SOURCE: Miss. Code Ann. §41-57-1; Miss. Code Ann. §41-57-7; Miss. Code Ann. §41-61-59 Rule 4.4.4. In those cases where no funeral director is involved, the hospital or the medical examiner shall be responsible for completion and filing of the entire death certificate within five days of death.*
- *SOURCE: Miss. Code Ann. §41-57-1; Miss. Code Ann. §41-57-7 Rule 4.4.5. Death at place other than an institution 1. When death occurs at a place other than an institution and the death does not affect the public interest (See §41-61-59), the funeral director or person acting as such who first assumes custody of the body shall initiate preparation of the certificate and forward same to the medical certifier within forty-eight (48) hours of death. If the death affects the public interest the medical examiner shall initiate the death certificate and forward it to the funeral director within forty-eight (48) hours of death.*
- *SOURCE: Miss. Code Ann. §41-57-1; Miss. Code Ann. §41-57-7; Miss. Code Ann. §41-61-59 Rule 4.4.6. Death on a moving conveyance: When death occurs on a moving conveyance within the United States and the body is first removed from the conveyance in this state, the death shall be registered in the state, and the place where it is first removed shall be considered the place of death. When a death occurs on a moving*
- *SOURCE: Miss. Code Ann. §41-57-1; Miss. Code Ann. §41-57-7 Rule 4.4.7. Presumptive death: When a death is presumed to have occurred within this state but the body cannot be located, a death certificate may be prepared by the State Registrar upon receipt of an order of a court of competent jurisdiction within this state, which shall include the finding of facts required to complete the death certificate. Such a death certificate shall be marked Presumptive and shall show on its face the date of registration and shall identify the court and the date of decree.*
- *SOURCE: Miss. Code Ann. §41-57-1; Miss. Code Ann. §41-57-7 Subchapter 5. Who Shall File a Death Certificate Rule 4.5.1. Filing of death certificate 1. Unless the only services being rendered are transport services, the funeral director, or person acting as such, who first assumes custody of a dead body, shall review and correct any items, other than information in the PRONOUNCEMENT and CAUSE OF DEATH sections, completed by an institution or the medical examiner, complete the death certificate, and file it with the Office of Vital Records of the Department of Health within five days of the date of death.*
- *SOURCE: Miss. Code Ann. §41-57-1; Miss. Code Ann. §41-57-7 Subchapter 6. Interstate Transportation of Dead Bodies Rule 4.6.1. A burial-transit permit is required when a dead body is transported into or out of the State.*
- *SOURCE: Miss. Code Ann. §41-57-1; Miss. Code Ann. §41-57-7 Rule 4.6.2. Burial-transit permit 1. A burial-transit permit may be issued by the organization that originates the death certificate, or a certified copy of the death certificate may serve as a burial- transit permit.*
- *SOURCE: Miss. Code Ann. §41-57-1; Miss. Code Ann. §41-57-7 Rule 4.6.3. Transportation of dead bodies: A dead body or fetus shall be buried, cremated or otherwise disposed of within 48 hours of death unless the body has been embalmed by a licensed embalmer or unless the body is kept under refrigeration at a temperature of 4°C (39°F). If the dead body is transported within or out of the state and the destination cannot be reached within 24 hours after death, the body shall be embalmed by a licensed embalmer or kept under refrigeration at a temperature of 4°C (39°F). Any dead body shipped by common carrier shall be enclosed in an outside shipping case. The outside shipping case may be made of metal, wood or any other suitable material which is approved by the common carrier. The outside case may be omitted in all instances when the body is transported in a hearse or funeral director s conveyance.*
- *SOURCE: Miss. Code Ann. §41-57-1; Miss. Code Ann. §41-57-7 Subchapter 7. Disposition of Dead Bodies Rule 4.7.1. Mississippi statutes and regulations do not require the use of vaults, caskets or embalming, except as provided in Rule 4.6.3. The Board of Health does not license or otherwise regulate cemeteries or crematoriums.*
- *SOURCE: Miss. Code Ann. §41-57-1; Miss. Code Ann. §41-57-7 Rule 4.7.2. No person knowing or having reason to know that a death may be under the jurisdiction of the medical examiner shall bury the body without the permission of the medical examiner. No body shall be cremated unless the death certificate has first been completed and filed with the Office of Vital Records of the Department of Health. Dead bodies may be donated to medical schools as provided for in Sections §41-39-7 and 41-39-101, et seq. of the Mississippi Code of 1972, Annotated.*
- *SOURCE: Miss. Code Ann. §41-57-1; Miss. Code Ann. §41-57-7; Miss. Code Ann. §41-39-7;*
- *SOURCE: Miss. Code Ann. §41-57-1; Miss. Code Ann. §41-57-7; §41-39-5 Subchapter 9. Monthly Reports of Deaths Rule 4.9.1. Funeral homes: On the first day of every month, each person, firm, corporation, burial society or burial association engaged in the business of burying dead bodies shall make a report to the Office of Vital Records on forms prescribed and furnished by the Department of Health of deaths during the preceding month. If there were no funerals during the month, a report shall be filed to this effect.*
- *SOURCE: Miss. Code Ann. §41-57-1; Miss. Code Ann. §41-57-7 Rule 4.9.2. Hospitals and nursing homes: On the first day of every month, each institution shall make a report of all deaths occurring in or enroute to the institution during the preceding month, to the Office of Vital Records on forms prescribed and furnished by the Department of Health. If there were no deaths during the month, a report shall be filed to this effect.*
- *SOURCE: Miss. Code Ann. §41-57-1; Miss. Code Ann. §41-57-7 Rule 4.9.3. Medical examiner/Investigator: On the first day of every month, each county medical examiner or county medical examiner investigator responsible for certifying deaths in the public interest, shall make a report to the office of Vital Records on forms prescribed and furnished by the Department of Health of deaths during the preceding month. If there were no deaths certified in the public interest during the month, a report shall be filed to that effect.*
- *SOURCE: Miss. Code Ann. §41-57-1; Miss. Code Ann. §41-57-7 Subchapter 10. Delayed Registration of Death Rule 4.10.1. Deaths registered after one year of the date of death shall be registered on the standard certificate of death form, preferably the version in use at the time of death. The certificate must be signed by the attending physician or medical examiner, and the funeral director or person who acted as such.*
- *SOURCE: Miss. Code Ann. §41-57-1; Miss. Code Ann. §41-57-7 Rule 4.10.2. In the absence of the attending physician or medical examiner, and the funeral director or person who acted as such, the certificate may be filed by chancery court order.*
- *SOURCE: Miss. Code Ann. §41-57-1; Miss. Code Ann. §41-57-7*
- *SOURCE: Miss. Code Ann. §41-57-1; Miss. Code Ann. §41-57-7 Rule 4.10.4. Upon acceptance of the evidence offered and receipt of the service fee, the State Registrar, or his or her designated representative shall register the death and provide the applicant with one certified copy.*
- *SOURCE: Miss. Code Ann. §41-57-1; Miss. Code Ann. §41-57-7 Subchapter 11. Amendments to Death Certificate Rule 4.11.1. All items in the medical certification or of a medical nature may be amended only upon receipt of the specified amendment form from (1) the person certifying the information or, if deceased or incapacitated, from that person or persons responsible for the completion of such items or (2) the State Medical Examiner.*
- *SOURCE: Miss. Code Ann. §41-57-1; Miss. Code Ann. §41-57-7; §41-57-13 Rule 4.11.2. Any amendment that is or may be contested by any of the principals i.e., surviving spouse, informant, parents or relatives of the principals, may, at the discretion of the State Registrar, require adjudication in a Mississippi chancery court.*
- *SOURCE: Miss. Code Ann. §41-57-1; Miss. Code Ann. §41-57-7 Rule 4.11.3. Other items may be amended on affidavit of the informant and funeral director or person acting as such.*
- *SOURCE: Miss. Code Ann. §41-57-1; Miss. Code Ann. §41-57-7 Rule 4.11.4. Any item, once amended, shall be further amended only upon receipt of an order from a Mississippi chancery court.*
- *SOURCE: Miss. Code Ann. §41-57-1; Miss. Code Ann. §41-57-7 Rule 4.11.5. Notwithstanding any of the above, the State Registrar may in his or her discretion, require or not require documentation in support of the amendment to be made, or require a court order from a Mississippi chancery court.*
- *SOURCE: Miss. Code Ann. §41-57-1; Miss. Code Ann. §41-57-7 Chapter 5. Spontaneous Fetal Deaths Subchapter 1.*
- *SOURCE: Miss. Code Ann. §41-57-1; Miss. Code Ann. §41-57-7; Miss. Code Ann. §41-57-31 Subchapter 2. Reporting Rule 5.2.1. Reporting requirements Each spontaneous fetal death of 20 completed weeks of gestation or more, calculated from the date the last normal menstrual period began to the date of delivery, or a weight of 350 grams or more, which occurs in this state shall be reported within five days after delivery to the State Registrar. If either or both the completed weeks of gestation or the weight are unknown, the fetal death must be reported.*
- *SOURCE: Miss. Code Ann. §41-57-1; Miss. Code Ann. §41-57-7; Miss. Code Ann. §41-57-31 Rule 5.2.2. Responsibility for reporting spontaneous fetal deaths: If a dead fetus was delivered in an institution or enroute thereto, the person in charge of the institution, or his designated representative, shall prepare and submit the report to the State Registrar.*
- *SOURCE: Miss. Code Ann. §41-57-1; Miss. Code Ann. §41-57-7 Rule 5.2.3. If an investigation by a coroner or medical examiner is required, the coroner or medical examiner shall prepare and submit the report to the State Registrar.*
- *SOURCE: Miss. Code Ann. §41-57-1; Miss. Code Ann. §41-57-7 Rule 5.2.4. If a dead fetus was delivered outside an institution and is not subject to the jurisdiction of the coroner or medical examiner, the report shall be prepared and submitted to the State Registrar by one of the following in the indicated order of priority: 1. The physician in attendance at or immediately after the delivery, or in the absence of such a person.*
- *SOURCE: Miss. Code Ann. §41-57-1; Miss. Code Ann. §41-57-7*
- *SOURCE: Miss. Code Ann. §41-57-1; Miss. Code Ann. §41-57-7; Miss. Code Ann. §41-57-31 Rule 5.2.6. If the delivery of a dead fetus occurred on a moving conveyance within the United States and the fetus is first removed in this state, the delivery shall be registered in this state, and the place of delivery shall be the place where the fetus is first removed. When a delivery occurs on a moving conveyance while in international waters or airspace, or in a foreign country, and the fetus is first removed from the conveyance in this state the delivery shall be registered in this state but the fetal death report shall show the actual place of delivery insofar as can be determined.*
- *SOURCE: Miss. Code Ann. §41-57-1; Miss. Code Ann. §41-57-7 Rule 5.2.7. The name of the fetus shall be entered in accordance with Rule 5.3.2. The name of the father and other information about the father shall be entered in accordance with Rule 5.3.3. If a name is not provided, “baby boy” or “baby girl” and the last name of the parent shall be inserted.*
- *SOURCE: Miss. Code Ann. §41-57-1; Miss. Code Ann. §41-57-7 Rule 5.2.8. In the case of multiple fetuses, a separate report shall be submitted for each fetus.*
- *SOURCE: Miss. Code Ann. §41-57-1; Miss. Code Ann. §41-57-7 Rule 5.2.9. Institution reports On the first day of each month, each institution which accepts patients for delivery shall prepare a list of all spontaneous fetal deaths occurring in that institution during the preceding month. This list shall be on the form prescribed and furnished by the State Department of Health and shall be submitted to the State Registrar. If there were no spontaneous fetal deaths, a report shall be submitted showing that there were none.*
- *SOURCE: Miss. Code Ann. §41-57-1; Miss. Code Ann. §41-57-7 Subchapter 3. Paternity and Name of Fetus*
- *SOURCE: Miss. Code Ann. §41-57-1; Miss. Code Ann. §41-57-7 Rule 5.3.2. Paternity Paternity shall be determined in the following manner: 1. Mother married. If the mother was married at the time of either conception or delivery, or at any time between conception and delivery, the name of the husband shall be entered on the fetal death report as the father of the fetus, unless paternity has been determined otherwise by a court of competent jurisdiction.*
- *SOURCE: Miss. Code Ann. §41-57-1; Miss. Code Ann. §41-57-7; Miss. Code Ann. §41-57-23;*
- *SOURCE: Miss. Code Ann. §41-57-1; Miss. Code Ann. §41-57-7; Miss. Code Ann. §41-57-23;*
- *SOURCE: Miss. Code Ann. §41-57-1; Miss. Code Ann. §41-57-7; Miss. Code Ann. §41-57-31 Chapter 6. Induced Terminations Subchapter 1. Introduction Rule 6.1.1. Induced terminations are subject to statistical reporting requirements. No vital records are made or kept and therefore no certified copies of these records can be issued. Any records submitted are destroyed as soon as the statistical analyses have been completed. Any identifying information gathered under these statutes is strictly confidential and may not be released.*
- *SOURCE: Miss. Code Ann. §41-57-1; Miss. Code Ann. §41-57-7*
- *SOURCE: Miss. Code Ann. §41-57-1; Miss. Code Ann. §41-57-7; Miss. Code Ann. §41-41- 407(3) Rule 6.2.2. Institution reports On the first day of each month, each facility in which induced terminations of pregnancy are performed shall prepare a list of all induced terminations performed in that facility during the preceding month. The list shall be on forms prescribed and furnished by the State Department of Health and shall be submitted to the State Registrar. Patients are to be listed by identification number only and not by name. If there were no induced terminations of pregnancy at a facility during the month, a report shall be submitted showing that there were none.*
- *SOURCE: Miss. Code Ann. §41-57-1; Miss. Code Ann. §41-57-7 Subchapter 3. Complications Resulting from Induced Terminations Rule 6.3.1. Reporting requirements A physician shall file a written report with the Department of Health regarding each patient who comes under the physician’s professional care and requires medical treatment or suffers death that the attending physician has a reasonable basis to believe is a primary, secondary, or tertiary result of an induced abortion.*
- *SOURCE: Miss. Code Ann. §41-57-1; Miss. Code Ann. §41-57-7; Miss. Code Ann. §41-41-77 Rule 6.3.2. These reports shall be submitted within thirty (30) days of the discharge or death of the patient treated for the complication.*
- *SOURCE: Miss. Code Ann. §41-57-1; Miss. Code Ann. §41-57-7; Miss. Code Ann. §41-41-77 Rule 6.3.3. The report shall not contain the name of the woman, common identifiers such as her social security number or motor vehicle operator’s license number or other information or identifiers that would make it possible to identify in any manner or under any circumstances an individual who has obtained or seeks to obtain an abortion.*
- *SOURCE: Miss. Code Ann. §41-57-1; Miss. Code Ann. §41-57-7; Miss. Code Ann. §41-41-77 Rule 6.3.4. Standardized report forms shall be developed and distributed or made available online in a downloadable format to all medical professional organizations, licensed physicians, hospitals, emergency rooms, and abortion facilities, Department of Health clinics, and ambulatory surgical centers operating in the state.*
- *SOURCE: Miss. Code Ann. §41-57-1; Miss. Code Ann. §41-57-7; Miss. Code Ann. §41-41-77 Rule 6.3.5. Each report of medical treatment following abortion shall contain the following information: 1. The age and race of the patient 2. The characteristics of the patient, including residency status, county of residence, marital status, education, number of previous pregnancies, number of stillbirths, number of living children and number of previous abortions 3. The date the abortion was performed and the method used if known 4. The type of facility where the abortion was performed 5. The condition of the patient that led to treatment, including, but not limited to, pelvic infection, hemorrhage, damage to pelvic organs, renal failure, metabolic disorder, shock, embolism, coma or death 6. The amount billed to cover the treatment of the complication, including whether the treatment was billed to Medicaid, insurance, private pay or other method. This should include charges for physician, hospital, emergency room, prescription or other drugs, laboratory tests and any other costs for the treatment rendered.*
- *SOURCE: Miss. Code Ann. §41-57-1; Miss. Code Ann. §41-57-7; Miss. Code Ann. §41-41-78 Rule 6.3.6. Summarized aggregate data from the reports shall be included in the annual Vital Statistics Report*
- *SOURCE: Miss. Code Ann. §41-57-1; Miss. Code Ann. §41-57-7; Miss. Code Ann. §41-41-77 Rule 6.3.7. The reports shall be retained for five (5) years after the date the report is received, then each individual report shall be destroyed.*
- *SOURCE: Miss. Code Ann. §41-57-1; Miss. Code Ann. §41-57-7; Miss. Code Ann. §41-41-77*
- *SOURCE: Miss. Code Ann. §41-57-1; Miss. Code Ann. §41-57-7; Miss. Code Ann. §41-41-77 Rule 6.3.9. Disclosure of confidential identifying information shall constitute a felony which, upon conviction, shall be punished by imprisonment in the State Penitentiary for not more than three (3) years, or a fine of not more than five thousand dollars ($5,000.00) or both.*
- *SOURCE: Miss. Code Ann. §41-57-1; Miss. Code Ann. §41-57-7; Miss. Code Ann. §41-41-77*

### **Part 8** Office of Health Policy and Planning

##### **15 Miss. Admin. Code Pt. 8, R. 206.2** Rule 206.2 {#sec-8-206.2 omnilex-key=us-ms-regs-official--title-15--8#206.2}

Certificate of Need Criteria and Standards for Nursing Home Beds for Intellectually and Other Developmentally Disabled Individuals If the legislative moratorium were removed or partially lifted, MSDH would review applications for ID/DD nursing home care beds under the statutory requirements of Sections 41-7-173 (h) subparagraph (viii), 41-7-191, and 41-7-193, Mississippi Code 1972, as amended. MSDH will also review applications for Certificate of Need according to the applicable policy statements contained in this Plan; the general criteria as listed in the Mississippi Certificate of Need Review Manual; all adopted rules, procedures, and plans of MSDH; and the specific criteria and standards listed below. Certificate of Need review is required for the offering of ID/DD nursing home care services, as defined, if the capital expenditure exceeds $10,000,000.00; if the licensed bed capacity is increased through the conversion or addition of beds; or if ID/DD nursing home care services have not been provided on a regular basis by the proposed provider of such services within the period of twelve (12) months prior to the time such services would be offered. Certificate of Need review is required for the construction, development, or otherwise establishment of new ID/DD nursing home care beds regardless of capital expenditure. Need Criterion 1: ID/DD Nursing Home Care Bed Need The applicant shall document need for ID/DD nursing home care beds using the need methodology as presented below. The applicant shall document in the application the following: A. Using the ratio of one bed per 1,000 population under sixty-five (65) years of age, the state as a whole must show a need; and B. The ID/DD Long-Term Care Planning District (LTCPD) where the proposed facility/beds/services are to be located must show a need. Need Criterion 2: Number of Beds to Be Constructed, Converted, and/or Licensed The applicant shall document the number of beds that will be constructed, converted and/or licensed as offering ID/DD nursing home care services. Need Criterion 3: Facilities Proposing to Add Fifteen or Less ID/DD Beds MSDH shall give priority consideration to those CON applications proposing the offering of ID/DD nursing home care services in facilities which are fifteen (15) beds or less in size. Chapter 3 Mental Health This chapter addresses mental illness, alcoholism, drug abuse, and developmental disabilities. These conditions result in social problems of such magnitude that mental health ranks as one of the state’s priority health issues. The Mississippi Department of Mental Health (DMH), regional Community Mental Health Centers (CMHCs) and licensed private sector facilities provide most of the state's mental health services. Unless otherwise specified, information in this chapter is limited to the programs and services of private non-governmental entities.

##### **15 Miss. Admin. Code Pt. 8, R. 300** Rule 300 {#sec-8-300 omnilex-key=us-ms-regs-official--title-15--8#300}

Mississippi Department of Mental Health State law designates DMH as the agency to coordinate and administer the delivery of public mental health services, alcohol/drug abuse services, and services for persons with intellectual/developmental disabilities throughout the state, as well as community-based day programs for individuals with Alzheimer’s disease and other dementia. Responsibilities of DMH include: (a) state-level planning and expansion of all types of mental health, intellectual/developmental disabilities and substance abuse services, (b) standard-setting and support for community mental health and intellectual/developmental disabilities and alcohol/drug abuse programs, (c) state liaison with mental health training and educational institutions, (d) operation of the state's psychiatric facilities, and (e) operation of the state's facilities for individuals with intellectual/developmental disabilities. Regional community mental health centers provide a major component of the state's mental health services. Fourteen (14) centers currently operate in the state's mental health service areas, and most centers have satellite offices in other counties. Each center must meet federal and state program and performance standards. The major objectives of the regional community mental health centers include: (a) providing accessible services to all citizens with mental and emotional problems; (b) reducing the number of initial admissions to state hospitals; and (c) preventing re-admissions through supportive aftercare services. These centers are a vital element in the plan to provide an integrated system of mental health services to all residents of Mississippi. 301 Mental Health Needs in Mississippi The prevalence of mental illness, although difficult to assess, serves as a good indicator of the volume of need for mental health services in a given population. The negative social stigma associated with the term “mental illness” also obstructs efforts to measure the true incidence/ prevalence of most types of mental illness and behavior disorders and the need for mental health services. Using the methodology updated by the federal Center for Mental Health Services (CMHS) for estimated prevalence of serious mental illness among adults (Federal Register, June 24, 1999) and U.S. Bureau of the Census 2010 population estimates, DMH estimates the 2019 prevalence rate of serious mental illness among adults in Mississippi, ages eighteen (18) years and above, as 5.2 percent or 109,000 individuals. The same methodology estimates the national prevalence for the same age group also as 5.2 percent. In Fiscal Year 2020, a total of 3,697 people received services at state-operated behavioral health programs which include the Mississippi State Hospital, East Mississippi State Hospital, North Mississippi State Hospital, South Mississippi State Hospital, Specialized Treatment Facility, and Central Mississippi Residential Center. A total of 2,197 adults received acute psychiatric services at the four (4) state hospitals in Fiscal Year 2020; and a total of 110,200 people were served at the fourteen (14) CMHCs in 2018. 301.1 Mental Health Needs of Children/Adolescents Precise data concerning the size of the country’s population of children and adolescents with emotional or mental disorders remain difficult to obtain. The National Institute of Mental Health

estimates the prevalence of any mental disorder nationally among adolescents, aged thirteen (13) to eighteen (18), is 49.5 percent with an estimated 22.2 percent having a severe impairment. The methodology adjusts for socio-economic differences across states. In Fiscal Year 2018, the fourteen (14) CMHCs served 34,795 children and adolescents with serious emotional disturbance. (Note: Totals might include some duplication across community mental health centers and other nonprofit programs). 301.2 National Survey on Drug Use and Health for Mississippi According to the Substance Abuse and Mental Health Administration’s (SAMHSA) 2020 Behavioral Health Barometer for Mississippi (most available data), during 2017-2019, the annual average prevalence of past-year illicit drug use disorder among people aged twelve (12) years or older was 2.4% (or 58,000), similar to both the regional average (2.7%) and the national average (2.9%). Also, during 2017 – 2019, among people aged twelve (12) or older, the annual average prevalence of past-year marijuana use in Mississippi was 11.8% (or 290,000), lower than both the regional average (14.0%) and the national average (16.2%); and, the annual average prevalence of past-year alcohol use disorder was 4.4% (or 107,000), similar to both the regional average (4.5%) and the national average (5.3%). 301.3 Developmental Disabilities The nationally accepted prevalence rate estimate used by the Administration on Developmental Disabilities for estimating the state rate is 1.8 percent of the general population. By applying the 1.8 percent prevalence rate to Mississippi’s 2025 population projections, the results equal 56,072 individuals who may have a developmental disability. The intellectual and/or developmental disability bed need determinations can be found in Chapter 2 of this Plan. 302 Adult Psychiatric Services (State Operated and Private) Mississippi’s four (4) state-operated hospitals and thirteen (13) crisis stabilization units provide the majority of inpatient psychiatric care and services throughout the state. In FY 2018, the Mississippi State Hospital at Whitfield reported a total of 118 active psychiatric licensed beds; East Mississippi State Hospital at Meridian reported 108 active psychiatric licensed beds, North Mississippi State Hospital in Tupelo reported fifty (50) licensed beds, and South Mississippi State Hospital in Purvis reported fifty (50) licensed beds. The four (4) facilities reported 2,197 adults received acute psychiatric services at the hospitals in FY 2020, 849 at the Mississippi State Hospital at Whitfield, 407 at the East Mississippi State Hospital, 475 at the North Mississippi State Hospital, and 466 at the South Mississippi State Hospital. Additionally, a total of 3,525 adults were served through the thirteen (13) crisis centers in FY 2020. Because the medically indigent have difficulty accessing private psychiatric facilities in their respective communities, many private facilities have low occupancy rates. State institutions provide the majority of inpatient care for the medically indigent. To address this problem, the Legislature provided funding for seven (7) state Crisis Intervention Centers to function as satellites to existing facilities operated by DMH. These centers are operational in Brookhaven, Corinth, Newton, Laurel, Cleveland, Grenada, Gulfport, and Batesville. DMH contracted with Life Help (Region VI Community Mental Health Center) to operate the crisis center in Grenada beginning

September 1, 2009. This pilot program began with the purpose of studying the potential for increased efficiencies and improved access to services for individuals without them being involuntarily committed. The role of these centers in the regional system is to provide stabilization and treatment services to persons who are in a psychiatric crisis. Beginning July 1, 2010, DMH transitioned five (5) of the remaining state-operated crisis centers (now called Crisis Stabilization Units) to regional community mental health centers located in Batesville, Brookhaven, Cleveland, Corinth and Laurel. In 2017, DMH transitioned the remaining crisis center in Newton to Weems Community Mental Health Center. The Gulfport center is operated by Gulf Coast Mental Health (Region XIII CMHC) and is partially funded by a grant from DMH. Timber Hills operates a Crisis Stabilization Unit (CSU) in Batesville and Corinth. Region 8 Mental Health Services operates the Brookhaven CSU. Delta Community Mental Health (Region V CMHC) operates the Cleveland CSU. Pine Belt Mental Healthcare Resources operates the Laurel CSU. All CSUs accept voluntary and involuntary admissions twenty-four (24) hours a day, seven (7) days a week. In FY 2019, a shift in funds from the DMH’s inpatient programs to its service budget allowed for the opening of forty-eight (48) additional crisis stabilization beds. Previously, Mississippi had eight (8), 16-bed Crisis Stabilization Units across the state. Currently, there are thirteen (13) Crisis Stabilization Units with 176 beds. The new units include: LifeCore Health Group (Region 3) which opened eight (8) crisis beds in Tupelo; Community Counseling Services (Region 7) which opened eight (8) beds in West Point; Singing River (Region 14) which opened eight (8) beds in Gautier; Hinds Behavioral Health Services (Region 9) which opened sixteen (16) beds in Jackson; and Region 1 Community Mental Health Center which opened eight (8) beds in Marks. These beds offer time-limited residential treatment services to serve adults with severe mental health episodes that if not addressed would likely result in the need for inpatient treatment. In FY 2020, the CSUs had a 91% diversion rate from people having to enter the state hospitals for inpatient treatment. Mississippi has eighteen (18) adult psychiatric facilities, with a capacity of 677 licensed beds for adult psychiatric patients, including 231 beds held in abeyance by MSDH distributed throughout the state. The criteria and standards section of this chapter provides a full description of the services that private facilities must provide. Map 3-1 shows the location of inpatient facilities in Mississippi serving adult acute psychiatric patients; Table 3-1 shows utilization statistics. 303 Child Adolescent Psychiatric Services Nine facilities, with a total of 277 licensed beds, provide acute psychiatric inpatient services for children and adolescents. Map 3-2 shows the location of inpatient facilities that serve adolescent acute psychiatric patients; Table 3-2 gives utilization statistics. The criteria and standards section of this chapter provides a further description of the programs that inpatient facilities offering child/adolescent psychiatric services must provide. DMH operates a separately licensed twenty-two (22) bed facility (Oak Circle Center) at Mississippi State Hospital to provide short-term inpatient psychiatric treatment for children and adolescents between the ages of four (4) and seventeen (17).

##### **15 Miss. Admin. Code Pt. 8, R. 304** Rule 304 {#sec-8-304 omnilex-key=us-ms-regs-official--title-15--8#304}

Psychiatric Residential Treatment Facilities Psychiatric Residential Treatment Facilities (PRTF) serve emotionally disturbed children and adolescents who are not in an acute phase of illness that requires the services of a psychiatric hospital, but who need restorative residential treatment services. “Emotionally disturbed” in this context means a condition exhibiting certain characteristics over a long period of time and to a marked degree. The Criteria and Standards section of this chapter describes these facilities more fully. Table 3-3 shows facilities are in operation with a total of 314 PRTF beds. Map 3-3 presents the location of the private psychiatric residential treatment facilities throughout the state. Children and adolescents who need psychiatric residential treatment beyond the scope of these residential treatment centers are served in acute psychiatric facilities or sent out of the state to other residential treatment facilities. DMH operates a specialized thirty-two (32) bed treatment facility (ICF/IID) in Brookhaven for youth with an intellectual and/or developmental disability who are thirteen (13) years, but less than twenty- one (21) years of age. A similar facility, licensed as a psychiatric residential treatment facility, is located in Harrison County for youth who have also been diagnosed with a mental disorder. Adolescents appropriate for admission are thirteen (13) years, but less than twenty-one (21) years of age, who present with a diagnosis of a severe emotional disturbance and need psychiatric residential care. 305 Alcohol and Substance Abuse Disorder Services 305.1 Alcohol and Substance Abuse Disorders Alcohol and other drug problems cause pervasive effects: biological, psychological, and social consequences for the user; psychological and social effects on family members and others; increased risk of injury and death to self, family members, and others (especially by accidents, fires, or violence); and derivative social and economic consequences for society at large. The location of facilities with alcohol and substance use programs is shown on Maps 3-4 and 3-5. Each of the fourteen (14) regional community health centers provide a variety of alcohol and drug services, including residential and transitional treatment programs, along with recovery support services. Tables 3-4 and 3-5 show the utilization of these facilities for adult and adolescent chemical dependency services, respectively. The community mental health centers (CMHCs) with whom DMH contracts are the foundation and primary service providers of the public substance use disorders services delivery system. Each CMHC serves a designated number of Mississippi counties. There are sixty‐seven (67) community‐based satellite centers throughout the state which allow greater access to services by the area’s residents. The goal is for each CMHC to have a full range of treatment options available for citizens in its region. Other nonprofit service agencies/organizations, which make up a smaller part of the service system, also receive funding through the DMH to provide community‐based services. Many of these free‐standing nonprofit organizations receive additional funding from other sources such as grants from other state agencies, community service organizations, donations, etc. Substance use disorder services usually include: (1) alcohol, tobacco, and other drug prevention services; (2) general outpatient treatment including individual, group, and family counseling; (3)

recovery support (continuing care) planning and implementation services; (4) primary residential treatment services (including withdrawal management); (5) transitional residential treatment services; (6) vocational counseling and employment seeking assistance; (7) emergency services (including a 24‐ hour hotline); (8) educational programs targeting recovery from substance use disorders which include understanding the disease, the recovery process, relapse prevention, and anger management; (9) recreational and social activities presenting alternatives to continued substance use and emphasizing the positive aspects of recovery; (10) 10-15 week intensive outpatient treatment programs for individuals who are in need of treatment but are still able to maintain job or school responsibilities; (11) community‐based residential substance use disorders treatment for adolescents; (12) specialized women's services; (13) priority treatment for pregnant/parenting women; (14) services for individuals with a co‐occurring disorder of substance use disorder and serious mental illness; and, (15) employee assistance programs. 306 Certificate of Need Criteria and Standards for Acute Psychiatric, Chemical Dependency, and/or Psychiatric Residential Treatment Facility Beds/Services Should MSDH receive a CON application regarding the acquisition and/or otherwise control of major medical equipment or the provision of a service for which specific CON criteria and standards have not been adopted, the application shall be deferred until MSDH has developed and adopted CON criteria and standards. If MSDH has not developed CON criteria and standards within 180 days of receiving a CON application, the application will be reviewed using the general CON review criteria and standards presented in the Mississippi Certificate of Need Review Manual and all adopted rules, procedures, and plans of MSDH. 306.1 Policy Statement Regarding Certificate of Need Applications for Acute Psychiatric, Chemical Dependency, and Psychiatric Residential Treatment Facility Beds/Services 1. Indigent/Charity Care: An applicant must provide a “reasonable amount” of indigent/charity care as described in Chapter 1 of this Plan. 2. Mental Health Planning Areas: MSDH shall use the state as a whole to determine the need for acute psychiatric beds/services, chemical dependency beds/ services, and psychiatric residential treatment beds/services. Tables 3-6, 3-7, and 3-8 give the statistical need for each category of beds. 3. Public Sector Beds: Because DMH is a public entity and directly operates facilities providing acute psychiatric, chemical dependency, and psychiatric residential treatment facility beds, the number of licensed beds operated by DMH shall not be counted in the bed inventory used to determine statistical need for additional acute psychiatric, chemical dependency, and psychiatric residential treatment facility beds. 4. Comments from DMH: MSDH shall solicit and take into consideration comments received from DMH regarding any CON application for the establishment or expansion of inpatient acute psychiatric, chemical dependency, and/or psychiatric residential treatment facility beds. 5. Separation of Adults and Children/Adolescents: Child and adolescent patients under

eighteen (18) years of age must receive treatment in units that are programmatically and physically distinct from adult (18 plus years of age) patient units. A single facility may house adults as well as adolescents and children if both physical design and staffing ratios provide for separation. 6. Separation of Males and Females: Facilities must separate males and females age thirteen (13) and over for living purposes (e.g., separate rooms and rooms located at separate ends of the halls, etc.). 7. Patients with Co-Occurring Disorders: It is frequently impossible for a provider to totally predict or control short-term deviation in the number of patients with mixed psychiatric/ addictive etiology to their illnesses. Therefore, MSDH will allow deviations of up to twenty- five percent (25%) of the total licensed beds as "swing-beds" to accommodate patients having diagnoses of both psychiatric and substance abuse disorders. However, the provider must demonstrate to the Division of Licensure and Certification that the “swing- bed” program meets all applicable licensure and certification regulations for each service offered, i.e., acute psychiatric, chemical dependency, and psychiatric residential treatment facility services, before providing such "swing-bed" services. 8. Comprehensive Program of Treatment: Any new mental health beds approved must provide a comprehensive program of treatment that includes, but is not limited to, inpatient, outpatient, and follow-up services, and in the case of children and adolescents, includes an educational component. The facility may provide outpatient and appropriate follow-up services directly or through contractual arrangements with existing providers of these services. 9. Medicaid Participation: An applicant proposing to offer acute psychiatric, chemical dependency, and/or psychiatric residential treatment facility services or to establish, expand, and/or convert beds under any of the provisions set forth in this section or in the service specific criteria and standards shall affirm in the application that: a. The applicant shall seek Medicaid certification for the facility/program at such time as the facility/program becomes eligible for such certification; and b. The applicant shall serve a reasonable number of Medicaid patients when the facility/program becomes eligible for reimbursement under the Medicaid Program. The application shall affirm that the facility will provide MSDH with information regarding services to Medicaid patients. 10. Licensing and Certification: All acute psychiatric, chemical dependency treatment, co- occurring disorders beds/services, and psychiatric residential treatment facility beds/services must meet all applicable licensing and certification regulations of the Division of Health Facilities Licensure and Certification. If licensure and certification regulations do not exist at the time the application is approved, the program shall comply with such regulations following their effective date. 11. Psychiatric Residential Treatment Facility: A psychiatric residential treatment facility (PRTF) is a non-hospital establishment with permanent licensed facilities that provides a

twenty-four (24) hour program of care by qualified therapists including, but not limited to, duly licensed mental health professionals, psychiatrists, psychologists, psychotherapists, and licensed certified social workers, for emotionally disturbed children and adolescents referred to such facility by a court, local school district, or the Department of Human Services, who are not in an acute phase of illness requiring the services of a psychiatric hospital and who are in need of such restorative treatment services. For purposes of this paragraph, the term “emotionally disturbed” means a condition exhibiting one or more of the following characteristics over a long period of time and to a marked degree, which adversely affects educational performance: a. An inability to learn which cannot be explained by intellectual, sensory, or health factors; b. An inability to build or maintain satisfactory relationships with peers and teachers; c. Inappropriate types of behavior or feelings under normal circumstances; d. A general pervasive mood of unhappiness or depression; or e. A tendency to develop physical symptoms or fears associated with personal or school problems. An establishment furnishing primarily domiciliary care is not within this definition. 12. Certified Educational Programs: Educational programs certified by the Department of Education shall be available for all school age patients. Also, sufficient areas suitable to meet the recreational needs of the patients are required. 13. Preference in CON Decisions: Applications proposing the conversion of existing acute care hospital beds to acute psychiatric and chemical dependency beds shall receive preference in CON decisions provided the application meets all other criteria and standards under which it is reviewed. 14. Dedicated Beds for Children's Services: It has been determined that there is a need for specialized beds dedicated for the treatment of children less than fourteen (14) years of age. Therefore, of the beds determined to be needed for child/adolescent acute psychiatric services and psychiatric residential treatment facility services, twenty-five (25) beds under each category, for a total of fifty (50) beds statewide, shall be reserved exclusively for programs dedicated to children under the age of fourteen (14). 15. CON Authority: Effective April 12, 2002, no healthcare facility shall be authorized to add any beds or convert any beds to another category of beds without a CON under the authority of Section 41-7-191(1)(c). 16. Delicensed/Relicensed Beds: Effective March 4, 2003, if a healthcare facility has voluntarily delicensed some of its existing bed complement, it may later relicense some or all of its delicensed beds without the necessity of having to acquire a CON. MSDH shall maintain a record of the delicensing healthcare facility and its voluntarily delicensed beds

and continue counting those beds as part of the state’s total bed count for health care planning purposes. 17. Reopening a Facility: A healthcare facility has ceased to operate for a period of sixty (60) months or more shall require a CON prior to reopening. 18. Medicaid Participation (DeSoto County): Notwithstanding any prior Medicaid participation restrictions or conditions, and pursuant to House Bill 3 from the 2026 Legislative Session (effective February 4, 2026), there shall be no prohibition or restrictions on participation in the Medicaid program for the forty-bed (40) psychiatric residential treatment facility (PRTF) located in DeSoto County that would not otherwise apply to any other such facility in the state. 306.2 General Certificate of Need Criteria and Standards for Acute Psychiatric, Chemical Dependency, and Psychiatric Residential Treatment Facility Bed/Services The Mississippi State Department of Health will review applications for a Certificate of Need for the establishment, offering, or expansion of acute psychiatric, chemical dependency treatment, and/or psychiatric residential treatment beds/services under the applicable statutory requirements of Miss. Code Ann. §§ 41-7-173, 41-7-191, and 41-7-193. MSDH will also review applications for Certificate of Need according to the policies in this Plan; the general criteria listed in the Mississippi Certificate of Need Review Manual; all adopted rules, procedures, and plans of MSDH; and the general and service specific criteria and standards listed below. The offering of acute psychiatric, chemical dependency treatment, and/or psychiatric residential treatment facility services is reviewable if the proposed provider has not offered those services on a regular basis within the period of twelve (12) months prior to the time such services would be offered. The construction, development, or other establishment of a new healthcare facility to provide acute psychiatric, chemical dependency treatment, and/or psychiatric residential treatment services requires CON review regardless of capital expenditure. Need Criterion 1: Bed Need Requirements A. New/Existing Acute Psychiatric, Chemical Dependency, and/or Psychiatric Residential Treatment Facility Beds/Services: The applicant shall document a need for acute psychiatric, chemical dependency, and/or psychiatric residential treatment facility beds using the appropriate bed need methodology as presented in this section under the service specific criteria and standards. B. Projects that do not involve the Addition of Acute Psychiatric, Chemical Dependency, and/or Psychiatric Residential Treatment Facility Beds: The applicant shall document the need for the proposed project. Documentation may consist of, but is not limited to, citing of licensure or regulatory code deficiencies, institutional long-term plans duly adopted by the governing board, recommendations made by consultant firms, and deficiencies cited by accreditation agencies (JCAHO, CAP, etc.). C. Projects that Involve the Addition of Beds: The applicant shall document the need for

the proposed project. Exception: Notwithstanding the service specific statistical bed need requirements as stated in "a" above, MSDH may approve additional beds for facilities which have maintained an occupancy rate of at least eighty percent (80%) for the most recent twelve (12) month licensure reporting period or at least seventy percent (70%) for the most recent two (2) years. D. Child Psychiatry Fellowship Program: Notwithstanding the service specific statistical bed need requirements as stated in “A” above, MSDH may approve a fifteen (15) bed acute child psychiatric unit at the University of Mississippi Medical Center for children aged four (4) to twelve (12) to provide a training site for psychiatric residents. E. Establishment or Addition of Programs for the Exclusive Treatment of Adults for Primary Psychiatric Diagnosis of Post Traumatic Stress Disorder (PTSD): Notwithstanding the service specific statistical bed need requirements as stated in "a" above, MSDH may approve service and/or beds for the exclusive treatment of adults eighteen years of age and older with a primary psychiatric diagnosis of PTSD. The applicant shall document the need for the proposed project and justify the number of inpatient beds to be dedicated for such purpose. Need Criterion 2: Data Requirements The application shall affirm that the applicant will record and maintain, at a minimum, the following information regarding charity care and care to the medically indigent and make such information available to MSDH within fifteen (15) business days of request: A. Source of patient referral; B. Utilization data (e.g., number of indigent admissions, number of charity admissions, and inpatient days of care); C. Demographic/patient origin data; D. Cost/charges data; and E. Any other data pertaining directly or indirectly to the utilization of services by the medically indigent or charity patients that MSDH request. Need Criterion 3: Referral/Admission of Charity/Indigent Patients A CON applicant desiring to provide or to expand chemical dependency, psychiatric, and/or psychiatric residential treatment facility services shall provide copies of signed memoranda of understanding with Community Mental Health Centers and other appropriate facilities within their patient service area regarding the referral and admission of charity and medically indigent patients. Need Criterion 4: Letters of Commitment Applicants should also provide letters of comment from the Community Mental Health Centers, appropriate physicians, community and political leaders, and other interested groups that may be

affected by the provision of such care. Need Criterion 5: Non-Discrimination Provision The application shall document that within the scope of its available services, neither the facility nor its participating staff shall have policies or procedures which would exclude patients because of race, color, age, sex, ethnicity, or ability to pay. Need Criterion 6: Charity/Indigent Care The application shall document that the applicant will provide a reasonable amount of charity/indigent care as provided for in Chapter 1 of this Plan. 306.3 Service Specific Certificate of Need Criteria and Standards for Acute Psychiatric, Chemical Dependency and/or Residential Treatment Facility Beds/Services 306.3.1 Acute Psychiatric Beds for Adults Need Criterion 1: Statistical Need for Adult Psychiatric Beds MSDH shall base statistical need for adult acute psychiatric beds on a ratio of 0.21 beds per 1,000 population aged eighteen (18) and older for 2025 in the state as a whole as projected by the Division of Health Planning and Resource Development. Table 3-6 presents the statistical need for adult psychiatric beds. Need Criterion 2: Proposed Size of Facility/Unit The applicant shall provide information regarding the proposed size of the facility/unit. Acute psychiatric beds for adults may be located in either freestanding or hospital-based facilities. Freestanding facilities should not be larger than sixty (60) beds. Hospital units should not be larger than thirty (30) beds. Patients treated in adult facilities and units should be eighteen (18) years of age or older. Need Criterion 3: Staffing The applicant shall provide documentation regarding the staffing of the facility. Staff providing treatment should be specially trained for the provision of psychiatric and psychological services. The staff should include both psychiatrists and psychologists and should provide a multi-discipline psychosocial medical approach to treatment. Acute Psychiatric Beds for Children and Adolescents. 306.3.2 Acute Psychiatric Beds for Children & Adolescents Need Criterion 1: Statistical Need for Child/Adolescent Beds MSDH shall base statistical need for child/adolescent acute psychiatric beds on a ratio of 0.55 beds per 1,000 population aged five (5) to seventeen (17) for 2025 in the state as a whole as projected by the Division of Health Planning and Resource Development. Table 3-6 presents the statistical

need for child/adolescent psychiatric beds. Of the specified beds needed, twenty- five (25) beds are hereby set aside exclusively for the treatment of children less than fourteen (14) years of age. Need Criterion 2: Proposed Size of Facility/Unit The applicant shall provide information regarding the proposed size of the facility/unit. Acute psychiatric beds for children and adolescents may be located in freestanding or hospital-based units and facilities. A facility should not be larger than sixty (60) beds. All units, whether hospital- based or freestanding, should provide a homelike environment. Ideally, a facility should provide cottage-style living units housing eight (8) to ten (10) patients. Because of the special needs of children and adolescents, facilities or units which are not physically attached to a general hospital are preferred. For the purposes of this Plan, an adolescent is defined as a minor who is at least fourteen (14) years old but less than eighteen (18) years old, and a child is defined as a minor who is at least five (5) years old but less than fourteen (14) years old. Need Criterion 3: Staffing The applicant shall provide documentation regarding the staffing of the facility. Staff should be specially trained to meet the needs of adolescents and children. Staff should include both psychiatrists and psychologists and should provide a multi-discipline, psychosocial medical approach to treatment. The treatment program must involve parents and/or significant others. Aftercare services must also be provided. Need Criterion 4: Structural Design of Facility – Separation of Children and Adolescents The applicant shall describe the structural design of the facility in providing for the separation of children and adolescents. In facilities where both children and adolescents are housed, the facility should attempt to provide separate areas for each age grouping. 306.3.3 Chemical Dependency Beds for Adults Need Criterion 1: Statistical Need for Adult Chemical Dependency Beds MSDH shall base statistical need for adult chemical dependency beds on a ratio of 0.14 beds per 1,000 population aged eighteen (18) and older for 2025 in the state as a whole as projected by the Division of Health Planning and Resource Development. Table 3-7 presents the statistical need for adult chemical dependency beds. Need Criterion 2: Proposed Size of Facility/Unit The applicant shall provide information regarding the proposed size of the facility/unit. Chemical dependency treatment programs may be located in either freestanding or hospital- based facilities. Facilities should not be larger than seventy-five (75) beds, and individual units should not be larger than thirty (30) beds. The bed count also includes detoxification beds. Staff should have specialized training in the area of alcohol and substance abuse treatment, and a multi-discipline psychosocial medical treatment approach that involves family and significant others.

Need Criterion 3: Aftercare/Follow-Up Services Provided The applicant shall describe the aftercare or follow-up services proposed for individuals leaving the chemical dependency program. Chemical dependency treatment programs should include extensive aftercare and follow-up services. Need Criterion 4: Type of Clients to be Treated at Facility The applicant shall specify the type of clients to be treated at the proposed facility. Freestanding chemical dependency facilities and hospital-based units should provide services to substance abusers as well as alcohol abusers. 306.3.4 Chemical Dependency Beds for Children & Adolescents Need Criterion 1: Statistical Need for Child/Adolescent Chemical Dependency Beds MSDH shall base statistical need for child/adolescent chemical dependency beds on a ratio of 0.44 beds per 1,000 population aged five (5) to seventeen (17) for 2025 in the state as a whole as projected by the Division of Health Planning and Resource Development. Table 3-7 presents the statistical need for child/adolescent chemical dependency beds. Need Criterion 2: Proposed Size of Facility/Unit The applicant shall provide information regarding the proposed size of the facility/unit. Chemical dependency beds may be located in either freestanding or hospital-based facilities. Because of the unique needs of the child and adolescent population, facilities shall not be larger than sixty (60) beds. Units shall not be larger than twenty (20) beds. The bed count of a facility or unit shall include detoxification beds. Need Criterion 3: Provision of Home-Like Environment Facilities or units, whether hospital-based or freestanding, should provide a home-like environment. Ideally, facilities should provide cottage-style living units housing eight (8) to ten (10) patients. Because of the special needs of children and adolescents, facilities or units which are not physically attached to a general hospital are preferred. Need Criterion 4: Staffing The applicant shall provide documentation regarding the staffing of the facility. Staff should be specially trained to meet the needs of adolescents and children. Staff should include both psychiatrists and psychologists and should provide a multi-discipline, psychosocial medical approach to treatment. The treatment program must involve parents and significant others. Aftercare services must also be provided. Need Criterion 5: Structural Design of Facility – Separation of Children and Adolescents The applicant shall describe the structural design of the facility in providing for the separation of children and adolescents. Child and adolescent patients shall be separated from adult patients for

treatment and living purposes. Need Criterion 6: Aftercare/Follow-Up Services Provided The applicant shall describe the aftercare or follow-up services proposed for individuals leaving the chemical dependency program. Extensive aftercare and follow-up services involving the family and significant others should be provided to clients after discharge from the inpatient program. Chemical dependency facilities and units should provide services to substance abusers as well as alcohol abusers. 306.3.5 Psychiatric Residential Treatment Facility Beds/Services Need Criterion 1: Statistical Need for Psychiatric Residential Treatment Beds MSDH shall base statistical need for psychiatric residential treatment beds on a ratio of 0.5 beds per 1,000 population aged five (5) to nineteen (19) for 2023 in the state as a whole as projected by the Division of Health Planning and Resource Development. Table 3-8 presents the statistical need for psychiatric residential treatment facility beds. Need Criterion 2: Age Group to be Served The application shall state the age group that the applicant will serve in the psychiatric residential treatment facility and the number of beds dedicated to each age group (5 to 13, 14 to 17, and 18 to 21). Need Criterion 3: Structural Design of Facility The applicant shall describe the structural design of the facility for the provision of services to children less than fourteen (14) years of age. Of the beds needed for psychiatric residential treatment facility services, twenty-five (25) beds are hereby set aside exclusively for the treatment of children less than fourteen (14) years of age. An applicant proposing to provide psychiatric residential treatment facility services to children less than fourteen (14) years of age shall make provision for the treatment of these patients in units which are programmatically and physically distinct from the units occupied by patients older than thirteen (13) years of age. A facility may house both categories of patients if both the physical design and staffing ratios provide for separation. Need Criterion 4: Bed Count as Authorized by the Legislature This criterion does not preclude more than twenty-five (25) psychiatric residential treatment facility beds being authorized for the treatment of patients less than fourteen (14) years of age. However, MSDH shall not approve more psychiatric residential treatment facility beds statewide than specifically authorized by legislation (Miss. Code Ann. § 41-7-191 et. seq). This authorization is limited to 334 beds for the entire state. Pursuant to House Bill 3 (2026), the 334-bed cap is maintained; however, any facility-specific Medicaid participation restrictions previously established by the Department for the 40-bed facility in DeSoto County are hereby removed. (NOTE: the 314 licensed and CON approved beds indicated in Table 3-8 were the result of both CON approval and legislative actions).

Need Criterion 5: Proposed Size of Facility/Unit The applicant shall provide information regarding the proposed size of the facility/unit. A psychiatric residential treatment facility should provide services in a homelike environment. Ideally, a facility should provide cottage-style living units not exceeding fifteen (15) beds. A psychiatric residential treatment facility should not be larger than sixty (60) beds. Need Criterion 6: Staffing The applicant shall provide documentation regarding the staffing of the facility. Staff should be specially trained to meet the treatment needs of the age category of patients being served. Staff should include both psychiatrists and psychologists and should provide a multi-discipline, psychosocial medical approach to treatment. The treatment program must involve parents and/or significant others. Aftercare/follow-up services must also be provided. 307 Private Distinct-Part Geriatric Psychiatric Services During 2020, twenty-one (21) Mississippi hospitals operated certified distinct-part geriatric psychiatric units (Geropsych DPU) with a total of 331 beds. Geropsych units receive Medicare certification as a distinct-part psychiatric unit but are licensed as short-term acute hospital beds. These Geropsych units served a total of 53,962 inpatient days of psychiatric services to patients aged fifty-five (55) and older. The industry standard formula for determining Geropsych DPU bed need is 0.5 beds per 1,000 population aged fifty-five (55) and over. The State Data Center of Mississippi under the University of Mississippi Center for Population Studies, projects Mississippi will have 943,320 persons aged fifty- five (55) and older by 2025. This population will need a total of 472 Geropsych DPU beds. The optimum unit size of a Geropsych unit is twelve (12) to twenty-four (24) beds. Table 3-9 shows the state’s twenty-one (21) distinct-part geriatric psychiatric units. County population projections can be found in Chapter 1 of this Plan. The following facilities received approval through a Determination of Reviewability for the establishment of a Geriatric Psychiatric Distinct Part (Geriatric-Psychiatric DPU or Gero-psych) Unit/Service: • Garden Park Medical Center (Add 8 beds) - Approved on 12/15/2017; • Garden Park Medical Center (Amendment to add 1 bed) - Approved on 10/19/2018; • Merit Health Wesley (Add 2 beds) - Approved on 3/15/2019; • Tippah County Hospital (Add 10 beds) – Approved on 12/23/2019; and • Trace Regional Hospital (Add 8 beds) - Approved on 4/9/2020.

Chapter 4 Perinatal 400 Natality Statistics Mississippi experienced 36,634 live births in 2019. Of these live births, 49.8 percent (18,248) were white non-Hispanic, 42.9 percent (15,702) were black non-Hispanic, 2.7 percent (976) were other non-Hispanic and 4.7 percent (1708) were Hispanic. A physician attended 97.8 percent of all in- hospital live births delivered in 2019 (36,449). Nurse midwife deliveries accounted for 690 live births. More than 99 percent of the live births occurred to women 15 to 44 years of age. Births to unmarried women made up 54.9 percent (20,106) of all live births in 2019; 80.6 percent (12,656) of births to black non- Hispanic women were to unmarried women. The rate for other race/ethnicity groups were 33.3 percent (6,069) for white non-Hispanic women, 43.0 percent (420) for other non- Hispanic women and 56.3 percent (961) for Hispanic women. Women under the age of fifteen (15) gave birth to forty-two (42) children: twenty-seven (27) were black non-Hispanic and nine (9) were white non-Hispanic five (5) were Hispanic, and one (1) was other non-Hispanic. The birth rate in 2019 was 12.3 live births per 1,000 population; the general fertility rate was 62.6 live births per 1,000 women aged 15-44 years. Mississippi reported 349 fetal deaths in 2019. The black non-Hispanic fetal death ratio, which is the number of fetal deaths per 1000 live births to women in the specified age group, was more than two times that of non-Hispanic white women, with a ratio of 14.3 per 1,000 live births compared to 6.1 for non-Hispanic white women. Women aged 40 and older, had the highest fetal death ratio at 15.3 per 1,000 live births, followed by women aged 20-24 with a ratio of 10.2. MSDH requires the reporting of fetal deaths with gestation of twenty (20) or more weeks or fetal weight of 350 grams or more. MSDH does not report fetal death rates for an age group if there are less than 100 births within that age group. The number of maternal deaths between 2016-2018 which occurred while pregnant or within forty- two (42) days of the end of a pregnancy are twenty-one (21) or on average about seven (7) maternal deaths each year. Maternal Death is defined as a death of a woman while pregnant or within forty-two (42) days of termination of pregnancy, irrespective of the duration and site of the pregnancy, from any cause related to or aggravated by the pregnancy or its management but not from accidental or incidental causes. The Maternal Mortality Rate is calculated as the number of maternal deaths per 100,000 live births and it is used to measure trends and make national/international comparisons. Maternal death data for the last three (3) years is presented in Table 4-1 (this data was generated using information from the MMRIA system). 401 Infant Mortality Infant mortality remains a critical concern in Mississippi. There was an increase in the infant mortality rate to 8.8 in 2019 from 8.4 in 2018. Table 4-2 shows the infant, neonatal, and post- neonatal mortality rates for non-Hispanic black infants were all substantially above the rates for

non-Hispanic white and Hispanic infants. Table 4-3 displays Mississippi’s infant mortality rates from 2005 to 2019, along with the rates for the United States. Map 4-1 shows the five-year average infant mortality rate by county for the period 2015 to 2019. Many factors contribute to Mississippi’s high infant mortality rate including: a high incidence of preterm birth and low birthweight, young and advanced maternal age, lack of education, poverty, lack of access for planned delivery services, and lack of adequate perinatal and acute medical care. More than 97 percent of expectant mothers received some level of prenatal care in 2019. More than 75.9 percent (27,795) of mothers began prenatal care in the first trimester; 17.4 percent (6,371) began in the second trimester, and 3.9 percent (1,440) during the third trimester. Only 1.3 percent (486) of expectant mothers received no prenatal care prior to delivery. The Kessner Index measures prenatal care adequacy based on the month in which prenatal care began, the number of prenatal visits, and the length of gestation. In Mississippi, 8.1 percent of women have inadequate prenatal care (white women account for 6.5 percent, black women account for 10.1 percent, and women of other races account for 8.4 percent). In 2019, 12.3 percent of births were low birthweight (less than 5.5 pounds or 2,500 grams) and 14.6 percent were premature (gestational age less than 37 weeks). These indicators differ markedly by maternal race: 8.7 percent of non-Hispanic white births were low birthweight compared to 17.3 percent for non- Hispanic black births. The low birthweight rate for Hispanics was 7.8 percent. The premature birth rate was 10.4 percent for Hispanic women, 12.4 percent for non-Hispanic white women and 17.8 percent for non- Hispanic black women. A total of 2,911 Mississippi teenagers (under 20 years of age) gave birth in 2019 — 7.9 percent of the state's 36,634 live births. Teenage births increased each year from 2005 until 2007 but decreased steadily through 2018. There was a slight (2.6%) increase in the number of births to teenagers between 2018 and 2019. In 2019, 13.9 percent of teenage births were low birthweight and 13.7 percent were premature. There are several factors that could create a high-risk pregnancy condition. These factors include: • Existing health conditions (e.g., high blood pressure, heart or blood disorders, renal conditions, thyroid disease, diabetes, asthma, autoimmune diseases, epilepsy, obesity, sexually transmitted infections, stress, depression, anxiety, etc.); • Age (young age or over 35 years of age); • Lifestyle factors (e.g., substance use/substance use disorders including alcohol and tobacco); • Short interpregnancy intervals [Interpregnancy care. Obstetric Care Consensus No. 8. American College of Obstetricians and Gynecologists. Obstet. Gynecol. 2019;133:e51– 72.]; and

• Conditions of pregnancy (e.g., multiple gestation, preeclampsia and eclampsia, gestational diabetes, previous preterm birth, birth defects or genetic conditions of the fetus). 402 Physical Facilities for Perinatal Care In Fiscal Year 2019, fifty-nine (59) hospitals reported at least one live birth. Forty-three (43) of these hospitals handled deliveries on a regular basis while sixteen (16) hospitals performed deliveries in cases where the mother could not reach a hospital with obstetrical services in time. Three (3) of these hospitals reported more than 2,000 obstetrical deliveries in Fiscal Year 2019, accounting for 7,095 deliveries or 20.1 percent of the state's total hospital deliveries: Forest General Hospital with 2,516 deliveries, North Mississippi Medical Center with 2,322 deliveries, and the University of Mississippi Medical Center with 2,2,257 deliveries. These hospitals with a large number of deliveries are strategically located in north, central and south Mississippi. Map 4- 2 shows the Perinatal Planning Areas. 403 Certificate of Need Criteria and Standards for Obstetrical Services Should the Mississippi State Department of Health receive a Certificate of Need application regarding the acquisition and/or otherwise control of major medical equipment or the provision of a service for which specific CON criteria and standards have not been adopted, the application shall be deferred until the Department of Health has developed and adopted CON criteria and standards. If the Department has not developed CON criteria and standards within 180 days of receiving a CON application, the application will be reviewed using the general CON review criteria and standards presented in the Mississippi Certificate of Need Review Manual and all adopted rules, procedures, and plans of the Mississippi State Department of Health. 403.1 Policy Statement Regarding Certificate of Need Applications for the Offering of Obstetrical Services 1. Indigent/Charity Care: An applicant is required to provide a reasonable amount of indigent/charity care as described in Chapter 1 of this Plan. 2. Perinatal Planning Areas (PPA): MSDH shall determine the need for obstetrical services using the Perinatal Planning Areas as outlined on Map 4-2 at the end of this chapter. 3. Travel Time: Obstetrical services should be available within one (1) hour normal travel time of ninety-five percent (95%) of the population in rural areas and within thirty (30) minutes normal travel time in urban areas. 4. Preference in CON Decisions: The MSDH shall give preference in CON decisions to applications that propose to improve existing services and to reduce costs through consolidation of two basic obstetrical services into a larger, more efficient service over the addition of new services or the expansion of single service providers. 5. Patient Education: Obstetrical service providers shall offer an array of family planning and related maternal and child health education programs that are readily accessible to current and prospective patients.

6. Levels of Care: All hospitals providing obstetric and newborn services will be designated a perinatal level of care by MSDH, based upon its functional capabilities to provide risk- appropriate care for pregnant women and neonates. The levels of care will be divided into four levels defined in accordance with the 2012 policy statement by the American Academy of Pediatrics, (PEDIATRICS Vol. 130, No. 3, September 2012) and maternal standards set forth by the American College of Obstetricians and Gynecologists with modifications approved by MSDH. The levels are: • Level I- Basic Care, Well newborn nursery • Level II- Specialty Care, Special care nursery • Level III- Sub-specialty Care, Neonatal Intensive Care Unit • Level IV- Regional Care Details of the levels are outlined in section 405.03 of the State Health Plan. 7. An applicant proposing to offer obstetrical services shall be equipped to provide perinatal services in accordance with the guidelines contained in the Minimum Standards of Operation for Mississippi Hospitals § 130, Obstetrics and Newborn Nursery. All hospitals offering obstetric and newborn care shall conform to the practice guidelines of the American Academy of Pediatrics, Policy Statement, Levels of Care and professional standards established in the Guidelines for the Operations of Perinatal Units. 8. An applicant proposing to offer obstetrical services shall agree to provide an amount of care to Medicaid mothers/babies comparable to the average percentage of Medicaid care offered by other providers of the requested service within the same, or most proximate, geographic area. 403.2 Certificate of Need Criteria and Standards for Obstetrical Services The Mississippi State Department of Health will review applications for a Certificate of Need to establish obstetric services under the statutory requirements of Miss. Code Ann. §§ 41-7-173, 41- 7-191, and 41-7-193. MSDH will also review applications for Certificate of Need according to the general criteria listed in the Mississippi Certificate of Need Review Manual; all adopted rules, procedures, and plans of MSDH; and the specific criteria and standards listed below. The establishment or expansion of Level I-basic or Level II-specialty perinatal services shall require approval under the Certificate of Need statute if the $10,000,000.00 capital expenditure threshold is crossed. Any hospital proposing to establish or expand existing services to become a Level III-subspecialty or Level IV-regional perinatal center shall require approval under the Certificate of Need statute. Provision for individual units should be consistent with the regionalized perinatal care system involved. Those facilities desiring to provide obstetric services shall meet the Basic facility minimum standards as listed under Guidelines for the Operation of Perinatal Units found at the end of this Chapter.

Need Criterion 1: Minimum Procedures The application shall demonstrate how the applicant can reasonably expect to deliver a minimum of 150 babies the first full year of operation and 250 babies by the second full year. In this demonstration, the applicant shall document the number of deliveries performed in the proposed perinatal planning area (as described in Section 403.1, Policy Statement 2, by hospital). Need Criterion 2: Perinatal Services The application shall document that the facility will provide one of the three types of perinatal services: Basic, Specialty, or Subspecialty. Need Criterion 3: Staffing Requirements The facility shall provide full-time nursing staff in the labor and delivery area on all shifts. Nursing personnel assigned to nursery areas in Basic Perinatal Centers shall be under the direct supervision of a qualified registered nurse with extra training such as Neonatal Resuscitation Program (NRP) certification and the S.T.A.B.L.E program. Need Criterion 4: Policies Any facility proposing the offering of obstetrical services shall have written policies delineating responsibility for immediate newborn care, resuscitation, transfer to higher-level of care, selection and maintenance of necessary equipment, and training of personnel in proper techniques. Need Criterion 5: Staff Required for Medical Emergency The application shall document that the nurse, anesthesia, neonatal resuscitation, and obstetric personnel required for emergency cesarean delivery shall be in the hospital or readily available at all times. Need Criterion 6: Travel Time The application shall document that the proposed services will be available within one (1) hour normal driving time of 95 percent of the population in rural areas and within 30 minutes normal driving time in urban areas. Need Criterion 7: Transfer of Patients in Medical Emergency The applicant shall affirm that the hospital will have protocols for the transfer of medical care of the neonate in both routine and emergency circumstances. Need Criterion 8: Data Requirements The application shall affirm that the applicant will record and maintain, at a minimum, the following information regarding charity care and care to the medically indigent and make it available to the Mississippi State Department of Health within fifteen (15) business days of request:

A. Source of patient referral; B. Utilization data (e.g., number of indigent admissions, number of charity admissions, and inpatient days of care); C. Demographic/patient origin data; D. Cost/charges data; and E. Any other data pertaining directly or indirectly to the utilization of services by medically indigent or charity patients, which the Department may request. Need Criterion 9: Non-Discrimination Provision The applicant shall document that within the scope of its available services, neither the facility nor its participating staff shall have policies or procedures, which would exclude patients because of race, age, sex, ethnicity, or ability to pay. 404 Certificate of Need Criteria and Standards for Neonatal Special Care Services Should the Mississippi State Department of Health receive a Certificate of Need application regarding the acquisition and/or otherwise control of major medical equipment or the provision of a service for which specific CON criteria and standards have not been adopted, the application shall be deferred until the Department of Health has developed and adopted CON criteria and standards. If the Department has not developed CON criteria and standards within 180 days of receiving a CON application, the application will be reviewed using the general CON review criteria and standards presented in the Mississippi Certificate of Need Review Manual and all adopted rules, procedures, and plans of MSDH. 404.1 Policy Statement Regarding Certificate of Need Applications for the Offering of Neonatal Special Care Services 1. Indigent/Charity Care: An applicant is required to provide a reasonable amount of indigent/charity care as described in Chapter 1 of this Plan. 2. Perinatal Planning Areas (PPA): MSDH shall determine the need for neonatal special care services using the Perinatal Planning Areas as outlined on Map 4-2. 3. Bed Limit: The total number of neonatal special care beds is not to exceed eight (8) per 1,000 live births in a specified PPA as defined below: a. Two (2) intensive care beds per 1,000 live births; and b. Six (6) intermediate care beds per 1,000 live births. 4. Size of Facility: A single neonatal special care unit (Subspecialty) Level 3 or greater facility should contain a minimum of fifteen (15) beds. 5. Levels of Care: MSDH shall determine the perinatal level of care designation of the facility

based upon its functional capabilities to provide risk-appropriate care for pregnant women and neonates. Facilities shall be designated as one of four levels of care as outlined in Section 405.03 of the State Health Plan. • Level I- Basic Care, Well Newborn Nursery • Level II- Specialty Care, Special Care Nursery • Level III- Sub-Specialty Care, Neonatal Intensive Care Unit • Level IV- Regional Care 6. Medicaid Care: An applicant proposing to offer neonatal special care services shall agree to provide an amount of care to Medicaid babies comparable to the average percentage of Medicaid care offered by other providers of the requested services. 404.2 Certificate of Need Criteria and Standards for Neonatal Special Care Services The Mississippi State Department of Health will review applications for a Certificate of Need to establish neonatal special care services under the statutory requirements of Miss. Code Ann. §§ 41-7-173, 41-7-191, and 41-7-193. The MSDH will also review applications for Certificate of Need according to the general criteria listed in the Mississippi Certificate of Need Review Manual; all adopted rules, procedures, and plans of MSDH; and the specific criteria and standards listed below. All neonatal intensive care units providing subspecialty care are reviewable under the Certificate of Need law based upon the addition/conversion of hospital beds required to establish such units. Those facilities desiring to provide neonatal special care services shall meet the capacity and levels of neonatal care for the specified facility (Specialty, Subspecialty or Regional) as outlined by the American Academy of Pediatrics, Policy Statement, Levels of Neonatal Care (PEDIATRICS Vol. 130, No. 3, September 2012). Need Criterion 1: Minimum Procedures The application shall demonstrate that the Perinatal Planning Area (PPA) wherein the proposed services are to be offered had a minimum of 3,600 deliveries for the most recent 12-month reporting period. MSDH shall determine the need for neonatal special care services based upon the following: A. Two (2) neonatal intensive (subspecialty) care bed per 1,000 live births in a specified Perinatal Planning Area for the most recent 12-month reporting period; and B. Six (6) neonatal intermediate (specialty) care beds per 1,000 live births in a specified Perinatal Planning Area for the most recent 12-month reporting period. Neonatal intensive care beds can only be housed within a hospital designated as a Level III facility.

Neonatal intermediate or specialty care beds can be housed within either a Level II, Level III or Level IV facility. Applications submitted by existing providers of neonatal special care services, which seek to expand capacity by adding or converting neonatal special care beds must document the need for the proposed project. The applicant shall demonstrate that the facility in question has maintained an occupancy rate for neonatal special care services of at least seventy percent (70%) for the most recent two (2) years or maintained an eighty percent (80%) neonatal special care services occupancy rate for the most recent year, notwithstanding the neonatal special care bed need outlined in Table 4-5 below. The applicant may be approved for additional or conversion of neonatal special care beds to meet projected demand balanced with optimum utilization rate for the Perinatal Planning Area. Need Criterion 2: Minimum Bed Requirement for Single Neonatal Special Care Unit A single neonatal special care unit (Subspecialty or Regional) that is Level III or greater should contain a minimum of fifteen (15) beds (neonatal intensive care and/or neonatal intermediate care). An adjustment downward may be considered for a specialty unit when travel time to an alternate unit is a serious hardship due to geographic remoteness. Need Criterion 3: Travel Time The application shall document that the proposed services will be available within one (1) hour normal driving time of ninety-five percent (95%) of the population in rural areas and within thirty (30) minutes normal driving time in urban areas. Need Criterion 4: Referral Networks The application shall document that the applicant has established referral networks to transfer infants requiring more sophisticated care than is available in less specialized facilities. Need Criterion 5: Data Requirement The application shall affirm that the applicant will record and maintain, at a minimum, the following information regarding charity care and care to the medically indigent and make it available to the Mississippi State Department of Health within fifteen (15) business days of request: A. Source of patient referral; B. Utilization data (e.g., number of indigent admissions, number of charity admissions, and inpatient days of care); C. Demographic/patient origin data; D. Cost/charges data; and E. Any other data pertaining directly or indirectly to the utilization of services by medically

indigent or charity patients which the Department may request. Need Criterion 6: Non-Discrimination Provision The applicant shall document that within the scope of its available services, neither the facility nor its participating staff shall have policies or procedures which would exclude patients because of race, age, sex, ethnicity, or ability to pay. 404.3 Neonatal Special Care Services Bed Need Methodology The determination of need for neonatal special care beds/services in each Perinatal Planning Area will be based on eight (8) beds per 1,000 live births as defined below. 1. Two (2) neonatal intensive care beds per 1,000 live births in the most recent 12- month reporting period. 2. Six (6) neonatal intermediate care beds per 1,000 live births in the most recent 12- month reporting period. 405 Guidelines for the Operation of Perinatal Units (Obstetrics and Newborn Nursery) 405.1 Organization Obstetrics and newborn nursery services shall be under the direction of a member of the staff of physicians who has been duly appointed for this service and who has experience in maternity and newborn care. There shall be a qualified professional registered nurse responsible at all times for the nursing care of maternity patients and newborn infants. Provisions shall be made for pre-employment and annual health examinations for all personnel on this service. Physical facilities for perinatal care in hospitals shall be conducive to care that meets the normal physiologic and psychosocial needs of mothers, neonates and their families. The facilities provide for deviations from the norm consistent with professionally recognized standards/guidelines. The perinatal service should have facilities for the following components: 1. Antepartum care and testing 2. Fetal diagnostic services 3. Admission/observation/waiting 4. Labor 5. Delivery/cesarean birth

6. Newborn nursery 7. Newborn special care unit (Level II- Specialty) 8. Newborn Intensive Care Unit (Level III Subspecialty and Level IV –Regional care only 9. Recovery and postpartum care 10. Visitation. 405.2 Staffing The facility must be staffed to meet its patient care commitments based upon its designated level of care, consistent with the American Academy of Pediatrics, Policy Statement, Levels of Care and professional guidelines. Hospitals with Neonatal Intensive Care Units providing subspecialty care must include appropriately trained personnel (neonatologists, neonatal nurses, and respiratory therapists) and equipment to provide life support for as long as necessary. 405.3 Perinatal Levels of Care Level 1- Basic Care, Well Newborn Nursery Neonatal Guidelines 1. Provide neonatal resuscitation at every delivery. 2. Evaluate and provide postnatal care to stable term newborn infants. 3. Stabilize and provide care for infants born at 35-37 weeks gestation who remain physiologically stable. 4. Stabilize newborn infants who are ill and those born at less than 35 weeks gestation until transfer to a facility that can provide the appropriate level of care. 5. Maintain a staff of providers including pediatricians, family physicians, nurse practitioners with newborn training, registered nurses with newborn training, including being current with Neonatal Resuscitation Program Certification and S.T.A.B.L.E. Maternal Guidelines 1. Surveillance and care of all patients admitted to the obstetric service, with an established triage system for identifying high-risk patients who should be transferred to a facility that provides specialty or sub-specialty care. 2. Capability to begin an emergency cesarean delivery within 30 minutes of the decision to do so. 3. Mothers that are stable and likely to deliver before 35 weeks gestation or have a fetus that is likely to require specialty services and mothers who themselves are likely to require specialty services should be transferred prior to delivery, when possible.

4. Proper detection and supportive care of known maternal conditions and unanticipated maternal-fetal problems that occur during labor and delivery. 5. Care of postpartum conditions. 6. Maintain a staff of providers certified to perform normal and operative vaginal deliveries and cesarean sections including obstetricians and family physicians with advanced training in obstetrics, providers certified to perform normal vaginal deliveries including certified nurse midwives, and registered nurses with training in labor and delivery, post-partum care or inpatient obstetrics. Hospital Resources 1. Availability of anesthesia, radiology, ultrasound, blood bank and laboratory services available on a 24-hour basis. 2. Consultation and transfer agreement with specialty and/or subspecialty perinatal centers. 3. Parent-sibling-neonate visitation. 4. Data collection and retrieval. 5. Quality improvement programs, maximizing patient safety. Level II- Specialty Care, Special Care Nursery Neonatal Guidelines 1. Performance of all basic care services as described above. 2. Provide care for infants born at more than 32 weeks and weighing more than 1500g who have physiological immaturity or who are moderately ill with problems that are expected to resolve rapidly and are not anticipated to need subspecialty services on an urgent basis. 3. Provide for infants’ convalescent care after intensive care. 4. Provide mechanical ventilation for brief duration (less than 24 hours) and/or continuous positive airway pressure. 5. Stabilize infants born before 32 weeks gestation and weighing less than 1500 grams until transfer to a Level III or Level IV neonatal intensive care facility. 6. Maintain a staff of providers including those listed in Basic Care plus pediatric hospitalists, neonatologist, and neonatal nurse practitioners. 7. Referral to a higher level of care for all infants when needed for pediatric surgical or medical subspecialty intervention.

Level II nurseries must have equipment (e.g., portable x-ray machine, blood gas analyzer) and personal (e.g., physicians, specialized nurses, respiratory therapists, radiology technicians and laboratory technicians) to provide ongoing care of admitted infants as well as to address emergencies. Maternal Guidelines 1. Perform all basic maternal services listed above. 2. Mothers that are stable and likely to deliver before 32 weeks gestation or have a neonate that is likely to require sub-specialty services, or mothers who themselves are likely to require sub-specialty services should be transferred prior to delivery, when possible. 3. Access to maternal fetal medicine consultation and antenatal diagnosis technology including fetal ultrasound. Level III- Sub-Specialty Care/Neonatal Intensive Care Unit Neonatal Guidelines 1. Provision of all Level I and Level II services. 2. Level III NICUs are defined by having continuously available personnel (neonatologists, neonatal nurses, and respiratory therapists) and equipment to provide life support for as long as necessary. 3. Provide comprehensive care for infants born less than 32 weeks gestation and weighing less than1500 grams and infants born at all gestational ages and birth weights with critical illness. 4. Provide prompt and readily available access to a full range of pediatric medical subspecialists, pediatric surgical specialists, pediatric anesthesiologists or anesthesiologists with experience in neonatal surgical care and pediatric ophthalmologists, on site or by prearranged consultative agreements. 5. Provide a full range of respiratory support and physiologic monitoring that may include conventional and/or high-frequency ventilation and inhaled nitric oxide. 6. Perform advanced imaging with interpretation on an urgent basis, including computed tomography, MRI and echocardiography. 7. Social and family support including social services and pastoral care. 8. If geographic constraints for land transportation exist, the Level III facility should ensure availability of rotor and fixed-wing transport services to transfer infants requiring subspecialty intervention from other regions and facilities. 9. Consultation and transfer agreements with both lower-level referring hospitals and regional centers, including back-transport agreements.

10. Prompt diagnosis and appropriate referral of all conditions requiring surgical intervention. Major surgery should be performed by pediatric surgical specialists (including anesthesiologists with pediatric expertise) on site within the hospital or at a closely related institution, ideally in close geographic proximity if possible. Level III facilities should be able to offer complete care, management, and evaluation for high-risk neonates 24 hours a day. A neonatologist should be available either in-house or on call with the capacity to be in-house in a timely manner, 24 hours a day. 11. Level III facilities should maintain a sufficient volume of infants less than 1500 grams to meet professionally accepted guidelines to achieve adequate experience and expertise. 12. Enrollment in the Vermont Oxford Network to report and monitor data regarding outcomes of infants born less than 32 weeks and weighing less than 1500 grams. 13. Participation in and evaluation of quality improvement initiatives. Maternal Guidelines 1. Manage complex maternal and fetal illnesses before, during and after delivery. 2. Maintain access to consultation and referral to Maternal-Fetal Medicine specialists. Level IV- Regional Care Neonatal Guidelines 1. All level III capabilities listed above. 2. Located within an institution with the capability to provide surgical repair of complex congenital or acquired conditions. 3. Maintain a full range of pediatric medical subspecialists, pediatric surgical subspecialists and pediatric anesthesiologists at the site. 4. Facilitate transport and provide outreach education including community taught NRP and S.T.A.B.L.E. classes. Maternal Guidelines 1. All level III capabilities listed above. 2. Maintain a full range of surgical and medical specialists including Maternal-Fetal Medicine specialists at the site. 3. Facilitate maternal transport and provide outreach education. 405.4 Perinatal Care Services Antepartum Care There should be policies for the care of pregnant patients with obstetric, medical, or surgical

complications and for maternal transfer. Intra-Partum Services: Labor and Delivery Intra-partum care should be both personalized and comprehensive for the mother and fetus. There should be written policies and procedures regarding: 1. Assessment 2. Admission 3. Medical records (including complete prenatal history and physical) 4. Consent forms 5. Management of labor including assessment of fetal well-being: a. Term patient b. Preterm patients c. Premature rupture of membranes d. Preeclampsia/eclampsia e. Third trimester hemorrhage f. Pregnancy Induced Hypertension (PIH) 6. Patient receiving oxytocic or tocolytics 7. Patients with stillbirths and miscarriages 8. Pain control during labor and delivery 9. Management of delivery 10. Emergency cesarean delivery (capability within 30 minutes) 11. Assessment of fetal maturity prior to repeat cesarean delivery or induction of labor 12. Vaginal birth after cesarean delivery 13. Assessment and care of neonate in the delivery room 14. Infection control in the obstetric and newborn areas 15. A delivery room shall be kept that will indicate: a. The name of the patient

b. Date of delivery c. Sex of infant d. Apgar e. Weight f. Name of physician g. Name of person assisting h. What complications, if any, occurred i. Type of anesthesia used j. Name of person administering anesthesia k. Maternal transfer 16. Immediate postpartum/recovery care 17. Housekeeping Newborn Care There shall be policies and procedures for providing care of the neonate including: 1. Immediate stabilization period 2. Neonate identification and security 3. Assessment of neonatal risks 4. Cord blood, Coombs, and serology testing 5. Eye care 6. Subsequent care 7. Administration of Vitamin K 8. Neonatal screening 9. Circumcision 10. Parent education 11. Visitation

12. Admission of neonates born outside of facility 13. Housekeeping 14. Care of or stabilization and transfer of high-risk neonates Postpartum Care There shall be policies and procedures for postpartum care of mother: 1. Assessment 2. Subsequent care (bed rest, ambulation, diet, care of the vulva, care of the bowel and bladder functions, bathing, care of the breasts, temperature elevation) 3. Postpartum sterilization 4. Immunization: RHIG and Rubella 5. Discharge planning. 405.5 Hospital Evaluation & Level of Care Designation MSDH maintains the authority to evaluate hospitals offering obstetric and newborn services and designate a level of care based upon its clinical services and capacity. References • American Academy of Pediatrics, Committee on Fetus and Newborn and American College of Obstetricians and Gynecologists Committee on Obstetric Practice, Edited by Kilpatrick, S, Papile, L., Macones, G. Guidelines for Perinatal Care, 8 th Edition, Published 2017. • American Academy of Pediatrics, Committee on fetus and Newborn; Levels of Neonatal Care. Pediatrics 2012; 130;587 DOI:10.1542/peds.2012-1999. Chapter 5 Acute Care Mississippi had ninety-two (92) non-federal medical/surgical hospitals in FY 2020, with a total of 10,534 licensed acute care beds (plus 558 beds held in abeyance by MSDH). This total also excludes long-term acute care (LTAC), rehabilitation, psychiatric, chemical dependency, and other special purpose beds. In addition, numerous facilities provide specific health care services on an outpatient basis. Some of these facilities are freestanding, others are closely affiliated with hospitals. Such facilities offer an increasingly wider range of services, many of which were once available only in inpatient acute care settings. Examples include diagnostic imaging, therapeutic radiation, and ambulatory surgery.

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General Medical/Surgical Hospitals When calculating the occupancy rate using total licensed bed capacity, the overall occupancy rate drops to 36.26 percent. Table 5-1 shows the licensed Mississippi hospital beds by service areas. These statistics indicate an average daily census in Mississippi hospitals of 3,819.87. Seventy-four (74) of the state's hospitals reported occupancy rates of less than forty percent (40%) during FY2020. Mississippi requires Certificate of Need (CON) review for all projects that increase the bed complement of a healthcare facility or exceed a capital expenditure threshold of $10 million for clinical services or $20 million for non-clinical services. The law requires CON review regardless of capital expenditure for the construction, development, or other establishment of a new healthcare facility, including a replacement facility; the relocation of a healthcare facility or any portion of the facility which does not involve a capital expenditure and is more than 5,280 feet from the main entrance of the facility; and a change of ownership of an existing healthcare facility, unless the MSDH receives proper notification at least thirty (30) days in advance. A healthcare facility that has ceased to treat patients for a period of sixty (60) months or more must receive CON approval prior to reopening. A CON is required for major medical equipment purchase if the capital expenditure exceeds $3,000,000.00 and is not a replacement of existing medical equipment. A statewide glut of licensed acute care beds complicates planning for community hospital services. There are far more hospital beds than needed. The average use of licensed beds has been less than fifty percent (50% percent) in recent years. With few exceptions, the surplus is statewide. The continued presence of surplus hospital beds in all planning districts, and in nearly all counties with acute care hospitals, raises a number of basic planning questions: • Does the “carrying cost” of maintaining unused beds raise operating cost unnecessarily? • Do the surpluses, and any associated economic burdens, retard the introduction of new and more cost-effective practices and services? • Do existing services providers maintain unwarranted surpluses to shield themselves from competition, as argued by some potential competitors? • Should the space allocated to surplus beds be converted to other uses, particularly if doing so would avoid construction of new space, or facilities, to accommodate growing outpatient caseloads? • Do the large surpluses mask need for additional services and capacity in some regions and reduce the sensitivity and responsiveness of planners and regulators to these legitimate community needs? • Do the continuing surpluses, and the view of them by stakeholders and other interested parties, create an environment that invites policy intervention by legislators and other responsible parties?

These questions are unusually difficult to answer definitively. The fact they arise frequently suggests the importance of reducing excess capacity where it is possible to do so and is not likely to result in problematic consequences. MSDH urges each hospital to voluntarily reduce the licensed bed capacity to equal its average daily census plus a confidence factor that will assure an unused hospital bed will be available on any given day. 501 Hospital Outpatient Services Table 5-2 shows the number of visits to hospital emergency rooms and hospital outpatient clinics in FY 2020. These statistics represent an increase over 2016’s total of 5,629,572 visits to hospitals with emergency departments and hospital outpatient clinics. 502 Certificate of Need Criteria and Standards for General Acute Care Facilities Should MSDH receive a CON application regarding the acquisition and/or otherwise control of major medical equipment or the provision of a service for which specific CON criteria and standards have not been adopted, the application shall be deferred until MSDH has developed and adopted CON criteria and standards. If MSDH has not developed CON criteria and standards within 180 days of receiving a CON application, the application will be reviewed using the general CON review criteria and standards presented in the Mississippi Certificate of Need Review Manual and all adopted rules, procedures, and plans of MSDH. 502.1 Policy Statement Regarding Certificate of Need Applications for General Acute Care Hospitals & General Acute Care Beds 1. Need in Counties Without a Hospital: Ten counties in Mississippi do not have a hospital: Amite, Benton, Carroll, Humphreys, Issaquena, Itawamba, Prentiss Quitman, Smith and Tunica. Most of these counties do not have a sufficient population base to indicate a potential need for the establishment of a hospital, and all appear to receive sufficient inpatient acute care services from hospitals in adjoining counties. 2. Expedited Review: MSDH may consider an expedited review for CON applications that address only license code deficiencies, project cost overruns, and relocation of facilities or services. 3. Capital Expenditure: For the purposes of CON review, transactions which are separated in time but planned to be undertaken within twelve (12) months of each other and which are components of an overall long-range plan to meet patient care objectives shall be reviewed in their entirety without regard to their timing. For the purposes of this policy, the governing board of the facility must have duly adopted the long-range plan at least twelve (12) months prior to the submission of the CON application. 4. Addition or Conversion of Beds: No healthcare facility shall be authorized to add any beds or convert any beds to another category of beds without a CON. 5. Beds in Abeyance: If a healthcare facility has voluntarily delicensed some of its existing bed complement, it may later relicense some or all of its delicensed beds without the necessity of having to acquire a CON. MSDH shall maintain a record of the delicensing

healthcare facility and its voluntarily delicensed beds and continue counting those beds as part of the state’s total bed count for health care planning purposes. 6. Break in Services: A healthcare facility that has ceased to operate for a period of sixty (60) months or more shall require a CON prior to reopening. 502.2 Certificate of Need Criteria and Standards for the Establishment of a General Acute Care Hospital MSDH will review applications for a CON to construct, develop, or otherwise establish a new hospital under the applicable statutory requirements of Miss. Code Ann. §§ 41-7-173, 41-7-191, and 41-7-193. MSDH will also review applications for a Certificate of Need according to the general criteria listed in the Mississippi Certificate of Need Review Manual; all adopted rules, procedures, and plans of MSDH; and the specific criteria and standards listed below. Need Criterion 1: Acute Care Hospital Need Methodology With the exception of psychiatric, chemical dependency, and rehabilitation hospitals, MSDH will use the following methodologies to project the need for general acute care hospitals: A. Counties Without a Hospital MSDH shall determine hospital need by multiplying the state’s average annual occupied beds per 1,000 population (1.41 in FY 2013) by the estimated 2023 county population to determine the number of beds the population could utilize. A hospital with a maximum of 100 beds may be considered if the following three conditions are met: (i) the number of beds needed is 100 or more; (ii) there is strong community support for a hospital; and (iii) a hospital can be determined to be economically feasible. B. Counties With Existing Hospitals MSDH shall use the following formula to determine the need for an additional hospital in a county with an existing hospital: 퐴퐷퐶+ 퐾 퐴퐷퐶

ADC = Average Daily Census K = Confidence Factor of 2.57 The formula is calculated for each facility within a given General Hospital Service Area (GHSA); then beds available and beds needed under the statistical application of the formula are totaled and subtracted to determine bed need or excess within each GHSA. Map 5-1 delineates the GHSAs. A hospital with a maximum of 100 beds may be considered if the following three conditions are met: (i) the number of beds needed is 100 or more; (ii) there is strong community support for a hospital; and (iii) a hospital can be determined to be economically feasible. C. Counties with Existing Hospitals Located in an Underdeveloped General Hospital

Service Area and With a Rapidly Growing Population If the need methodology in “B” above shows a need does not exist in that county, an Applicant may further demonstrate need for an acute care hospital not to exceed one hundred (100) beds if the county has a population in excess of 140,000 people; the county projects a population growth rate in excess of ten percent (10%) over the next ten (10) year period; and the county’s GHSA does not presently exceed a factor of three (3) beds per 1,000 population. Further, any person proposing a new hospital under this criterion must meet the following conditions: 1. Provide an amount of indigent care in excess of the average of the hospitals in the General Hospital Service Area as determined by the State Health Officer; 2. Provide an amount of Medicaid care in excess of the average of the hospitals in the General Hospital Service Area as determined by the State Health Officer; and 3. If the proposed hospital will be located in a county adjacent to a county or counties without a hospital, the applicant must establish outpatient services in the adjacent county or counties without a hospital; 4. Fully participate in the Trauma Care System at a level to be determined by the MSDH for a reasonable number of years to be determined by the State Health Officer. Fully participate means play in the Trauma Care System as provided in the Mississippi Trauma Care System Regulations and the new hospital shall not choose or elect to pay a fee not to participate or participate at a level lower than the level specified in the CON; and 5. The new hospital must also participate as a network provider in the State and School Employees’ Health Insurance Plan as defined in Miss. Code Ann. §§ 25-15-3 and 25-15-9. Need Criterion 2: Indigent/Charity Care The applicant shall affirm that the applicant will provide a “reasonable amount” of indigent/charity care as described in Chapter 1 of this Plan. 502.3 Certificate of Need Criteria and Standards for Construction, Renovation, Expansion, Capital Improvements, Replacement of Healthcare Facilities, & Addition of Hospital Beds MSDH will review applications for a Certificate of Need for the addition of beds to a healthcare facility and projects for construction, renovation, expansion, or capital improvement involving a capital expenditure in excess of $10,000,000.00 (for clinical health services) or $20,000,000.00 (for nonclinical health services). MSDH will further review applications under the applicable statutory requirements of Miss. Code Ann. §§ 41-7-173, 41-7-191, and 41-7-193. MSDH will also review applications for Certificate of Need according to the general criteria listed in the Mississippi Certificate of Need Review Manual; all adopted rules, procedures, and plans of the MSDH; and the specific criteria and standards listed below.

The construction, development, or other establishment of a new healthcare facility, the replacement and/or relocation of a healthcare facility or portion thereof, and changes of ownership of existing healthcare facilities are reviewable regardless of capital expenditure. Need Criterion 1: Acute Care Bed Need A. Projects Which Do Not Involve the Addition of Any Acute Care Beds The applicant shall document the need for the proposed project. Documentation may consist of, but is not limited to, citing of licensure or regulatory code deficiencies, institutional long-term plans (duly adopted by the governing board), recommendations made by consultant firms, and deficiencies cited by accreditation agencies (JCAHO, CAP, etc.). In addition, for projects which involve construction, renovation, or expansion of emergency department facilities, the applicant shall include a statement indicating whether the hospital will participate in the statewide trauma system and describe the level of participation, if any. B. Projects Which involve the Addition of Acute Care Beds The applicant shall document the need for the proposed project. In addition to the documentation required as stated in Need Criterion (1) (A), the applicant shall document the facility in question has maintained an occupancy rate of at least sixty percent (60%) for the most recent two (2) years or has maintained an occupancy rate of at least seventy percent (70%) for the most recent two (2) years according to the below formula: # Observation Patient Days/365/Licensed Beds + Inpatient Occupancy Rate NOTE: An observation patient day is a patient that has NOT been admitted as an inpatient but occupies an acute care bed (observation bed) and is provided observation services in a licensed, acute care hospital. Hospitals shall follow strict guidelines set forth by The Centers for Medicare & Medicaid Services, health insurance companies, and others in reporting observation bed data to the Department. For definitions that correspond with the above-referenced item, please refer to the Glossary included in the Plan. Need Criterion 2: Bed Service Transfer/Reallocation/Relocation Applications proposing the transfer, reallocation, and/or relocation of a specific category or sub- category of bed/service from another facility as part of a renovation, expansion, or replacement project shall document that the applicant will meet all regulatory/licensure requirements for the type of bed/service being transferred/reallocated/relocated. Need Criterion 3: Charity/Indigent Care The application shall affirm the applicant will provide a “reasonable amount” of indigent/charity care as described in Chapter 1 of this Plan. Need Criterion 4: Cost of Project

The application shall demonstrate the cost of the proposed project, including equipment, is reasonable in comparison with the cost of similar projects in the state. A. The applicant shall document that the cost per square foot (per bed if applicable) does not exceed the median construction costs, as determined by MSDH, for similar projects in the state within the most recent twelve-month (12) period by more than fifteen percent (15%). The Glossary of this Plan provides the formulas to be used by MSDH staff in calculating the cost per square foot for construction and/or construction/renovation projects. B. If equipment costs for the project exceed the median costs for equipment of similar quality by more than fifteen percent (15%), the applicant shall provide justification for the excessive costs. The median costs shall be based on projects submitted during the most recent six-month period and/or estimated prices provided by acceptable vendors. Need Criterion 5: Project Specifications The applicant shall specify the floor areas and space requirements, including the following factors: A. The gross square footage of the proposed project in comparison to state and national norms for similar projects. B. The architectural design of the existing facility if it places restraints on the proposed project. C. Special considerations due to local conditions. Need Criterion 6: Renovation/Expansion Justification If the cost of the proposed renovation or expansion project exceeds eighty-five percent (85%) of the cost of a replacement facility, the applicant shall document their justification for rejecting the option of replacing said facility. Need Criterion 7: Need for Service The applicant shall document the need for a specific service (i.e. perinatal, ambulatory care, psychiatric, etc.) using the appropriate service specific criteria as presented in this and other sections of the Plan. 503 Long-Term Acute Care Hospitals A Long-Term Acute Care (LTAC) hospital is a freestanding, Medicare-certified acute care hospital with an average length of inpatient stay greater than twenty-five (25) calendar days, which is primarily engaged in providing chronic or long-term medical care to patients who do not require more than three (3) hours of rehabilitation or comprehensive rehabilitation per day, and has a transfer agreement with an acute care medical center and a comprehensive medical rehabilitation facility. As of FY 2020, seven (7) long-term acute care hospitals were in operation. The following table lists specific LTAC information.

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Certificate of Need Criteria and Standards for Long-Term Acute Care Hospitals/Beds Should MSDH receive a CON application regarding the acquisition and/or otherwise control of major medical equipment or the provision of a service for which specific CON criteria and standards have not been adopted, the application shall be deferred until MSDH has developed and adopted CON criteria and standards. If MSDH has not developed CON criteria and standards within 180 days of receiving a CON application, the application will be reviewed using the general CON review criteria and standards presented in the Mississippi Certificate of Need Review Manual and all adopted rules, procedures, and plans of MSDH. 504.1 Policy Statement Regarding Certificate of Need Applications for Long- Term Acute Care Hospitals & Long-Term Acute Care Hospital Beds 1. Restorative Care Admissions: Restorative care admissions shall be identified as patients with one or more of the following conditions or disabilities: a. Neurological Disorders i. Head Injury ii. Spinal Cord Trauma iii. Perinatal Central Nervous System Insult iv. Neoplastic Compromise v. Brain Stem Trauma vi. Cerebral Vascular Accident vii. Chemical Brain Injuries b. Central Nervous System Disorders i. Motor Neuron Diseases ii. Post Polio Status iii. Developmental Anomalies iv. Neuromuscular Diseases (e.g. Multiple Sclerosis) v. Phrenic Nerve Dysfunction vi. Amyotrophic Lateral Sclerosis c. Cardio-Pulmonary Disorders i. Obstructive Diseases

ii. Adult Respiratory Distress Syndrome iii. Congestive Heart Failure iv. Respiratory Insufficiency v. Respiratory Failure vi. Restrictive Diseases vii. Broncho-Pulmonary Dysplasia viii. Post Myocardial Infarction ix. Central Hypoventilation d. Pulmonary Cases i. Presently Ventilator-Dependent/Weanable ii. Totally Ventilator-Dependent/Not Weanable iii. Requires Assisted or Partial Ventilator Support iv. Tracheostomy that Requires Supplemental Oxygen and Bronchial Hygiene. 2. Bed Licensure: All beds designated as long-term acute care hospital beds shall be licensed as general acute care. 3. Average Length of Stay: Patients’ average length of stay in a long-term acute care hospital must be twenty-five (25) calendar days or more. 4. Size of Facility: Establishment of a long-term acute care hospital shall not be for less than twenty (20) beds. 5. Long-Term Medical Care: A long-term acute care hospital shall provide chronic or long- term medical care to patients who do not require more than three (3) hours of rehabilitation or comprehensive rehabilitation per day. 6. Transfer Agreement: A long-term acute care hospital shall have a transfer agreement with an acute care medical center and a comprehensive medical rehabilitation facility. 7. Addition or Conversion of Beds: Effective July 1, 1994, no healthcare facility shall be authorized to add any beds or convert any beds to another category of beds without a CON under the authority of Section 41-7-191(1)(c), unless there is a projected need for such beds in the planning district in which the facility is located. 8. Harrison County LTAC Medicaid Status: Notwithstanding any prior certification conditions or crossover provider restrictions, and pursuant to House Bill 3 from the 2026

Legislative Session (effective February 4, 2026), the eighty-bed (80) long-term care (LTC) hospital located in Harrison County is authorized to participate in the Medicaid program as a crossover provider. In accordance with HB 3, this authorization is applied retroactively to July 1, 2023. 504.2 Certificate of Need Criteria and Standards for the Establishment of a Long-Term Acute Care Hospital & Addition of Long-Term Acute Care Hospital Beds MSDH will review applications for a CON for the construction, development, or otherwise establishment of a long-term acute care hospital and bed additions under the applicable statutory requirements of Miss. Code Ann. §§ 41-7-173, 41-7-191, and 41-7-193, Mississippi Code 1972. MSDH will also review applications for CON according to the general criteria listed in the Mississippi Certificate of Need Review Manual; all adopted rules, procedures, and plans of MSDH; and the specific criteria and standards listed below. Need Criterion 1: Projected Need The applicant shall document a minimum of 450 clinically appropriate restorative care admissions with an average length of stay of twenty-five (25) days. Need Criterion 2: Financial Feasibility A projection of financial feasibility by the end of the third year of operation. Need Criterion 3: Bed Licensure The applicant shall document that any beds which are constructed/converted will be licensed as general acute care beds offering long-term acute care hospital services. Need Criterion 4: Licensure Applicants proposing the transfer/reallocation/relocation of a specific category or sub-category of bed/service from another facility as part of a renovation, expansion, or replacement project shall document that they will meet all regulatory and licensure requirements for the type of bed/service proposed for transfer/reallocation/relocation. Need Criterion 5: Indigent/Charity Care The application shall affirm that the applicant will provide a “reasonable amount” of indigent/charity care as described in Chapter 1 of this Plan. Need Criterion 6: Project Cost The application shall demonstrate that the cost of the proposed project, including equipment, is reasonable in comparison with the cost of similar projects in the state. The applicant shall document that the cost per square foot (per bed if applicable) does not exceed the median construction costs, as determined by the MSDH, for similar projects in the state within the most

recent twelve (12) month period by more than fifteen percent (15%). The Glossary of this Plan provides the formulas MSDH staff shall use to calculate the cost per square foot of space for construction and/or construction-renovation projects. Need Criterion 7: Floor Area and Space Requirements The applicant shall specify the floor areas and space requirements, including the following factors: A. The gross square footage of the proposed project in comparison to state and national norms for similar projects. B. The architectural design of the existing facility if it places restraints on the proposed project. C. Special considerations due to local conditions. Need Criterion 8: Transfer Agreement The applicant shall provide copies of transfer agreements entered into with an acute care medical center and a comprehensive medical rehabilitation facility. 505 Swing-Bed Programs & Extended Care Services Federal law allows rural hospitals with fewer than 100 hospital beds to utilize its beds as “swing beds” to provide post-acute extended care services. 42 C.F.R. § 482.58. Hospitals must have a Medicare provider agreement and meet several eligibility and skilled nursing facility service requirements to be granted CMS approval to provide post-hospital extended care services and to be reimbursed as a swing-bed hospital. Swing-bed hospitals have the same Medicare coverage requirements and coinsurance provisions as nursing facilities. In addition to meeting acute care standards, swing-bed hospitals must also substantially comply with the eight (8) skilled nursing facility services standards listed in 42 C.F.R.§ 482.58(b). These standards include: resident rights, admission, transfer, and discharge rights; freedom from abuse, neglect, and exploitation; dental services, specialized rehabilitative services, social services, patient activities, and discharge planning. Because many patients, particularly elderly patients, no longer need acute hospital care but are not well enough to go home, swing-beds enable the hospital to provide nursing care, rehabilitation, and social services with a goal of returning patients to their homes. Many of these patients would become nursing home residents without the extended period of care received in a swing-bed. Swing-beds provide a link between inpatient acute care and home or community-based services in a continuum for the elderly and others with long-term needs. If it is not possible for the patient to return home, the swing-bed hospital assists the patient and their family with nursing home placement. Ideally, the swing-bed concept should help alleviate low utilization problems in small rural hospitals and provide a new revenue source with few additional expenses while also more efficiently utilizing hospital staff during periods of low acute care occupancy. 505.1 Swing Bed Utilization

Fifty (50) Mississippi hospitals and one (1) specialty hospital participated in the swing bed program during Fiscal Year2020. They reported 9,496 discharges from their swing beds and an average length of stay of 17.70 days. 505.2 Certificate of Need Criteria and Standards for Swing-Bed Services MSDH will review applications for a CON to establish swing-bed services under the applicable statutory requirements of Miss. Code Ann. §§ 41-7-173, 41-7-191, and 41-7-193. MSDH will also review applications for CON according to the general criteria listed in the Mississippi Certificate of Need Review Manual; all adopted rules, procedures, and plans of the MSDH; and the specific criteria and standards listed below. Need Criterion 1: Federal Requirements The application shall document that the hospital will meet all federal regulations regarding the swing-bed concept. However, a hospital may have more licensed beds or a higher average daily census (ADC) than the maximum number specified in federal regulations for participation in the swing-bed program. Need Criterion 2: Resolution Adopted for Proposed Participation The applicant shall provide a copy of the Resolution adopted by its governing board approving the proposed participation. Need Criterion 3: Hospitals Proposing Beds over the Maximum allowed by Federal Law If the applicant proposes to operate and staff more than the maximum number of beds specified in federal regulations for participation in the swing-bed program, the application shall give written assurance that only private pay patients will receive swing-bed services once the federal threshold is met. Need Criterion 4: Medicare Recipients The application shall affirm upon receiving CON approval and meeting all federal requirements for participation in the swing-bed program, the applicant shall render services provided under the swing-bed concept to any patient eligible for Medicare (Title XVIII of the Social Security Act) who is certified by a physician to need such services. Need Criterion 5: Limitation on Medicare/Medicaid Patients The application shall affirm upon receiving CON approval and meeting all federal requirements for participation in the swing-bed program, the applicant shall not permit any patient who is eligible for both Medicaid and Medicare or is eligible only for Medicaid to stay in the swing-beds of a hospital for more than thirty (30) days per admission unless the hospital receives prior approval for such patient from the Division of Medicaid.

Need Criterion 6: Hospitals with More Licensed Beds or a Higher Average Daily Census The application shall affirm that if the hospital has more licensed beds or a higher average daily census than the maximum number specified in federal regulations for participation in the swing- bed program, the applicant will develop a procedure to ensure, before a patient is allowed to stay in the swing-beds of the hospital, there are no vacant nursing home beds available within a fifty (50) mile radius (geographic area) of the hospital. The applicant shall also affirm that if the hospital has a patient staying in the swing-beds of the hospital and the hospital receives notice from a nursing home located within a fifty (50) mile radius that there is a vacant bed available for that patient, the hospital shall transfer the swing-bed patient to the nursing home within five (5) days, exclusive of holidays and weekends, unless the patient's physician certifies the transfer is not medically appropriate. Need Criterion 7: Transfer Agreements The applicant shall provide copies of transfer agreements entered into with each nursing facility within the applicant's geographic area. Need Criterion 8: Failure to Comply An applicant subject to the conditions stated in Need Criterion 5 shall affirm in the application that they will be subject to suspension from participation in the swing-bed program for a reasonable period of time by MSDH, after a hearing complying with due process, MSDH, determines that the hospital has failed to comply with any of those requirements. 506 Therapeutic Radiation Services Therapeutic radiation services include the treatment of cancer and other diseases using ionizing radiation consisting of high-energy photons (x-rays or gamma rays) or charged particles (electrons, protons, or heavy nuclei). Radiation therapy is intended to destroy, control, or inhibit the growth of abnormal cells while minimizing injury to surrounding healthy tissue. Therapeutic radiation may be used to cure or control cancer, or to alleviate some of the symptoms associated with cancer (palliative care). Radiation therapy services do not include low energy, superficial, external beam x-ray treatment of superficial skin lesions. Radiation therapy is frequently administered over a period of several days or weeks and can be directed specifically to the area requiring treatment, thereby minimizing radiation exposure to surrounding healthy tissues. This repetitive treatment is called fractionation because a small fraction of the total dose is given each treatment. External beam radiation therapy is commonly delivered using linear accelerator (LINAC) technology, proton beam systems, or other approved radiation therapy technologies. Conventional external beam radiation therapy generally delivers radiation throughout the treatment field encompassing the tumor and surrounding tissues at risk for microscopic disease. Certain disease processes may be appropriately treated using stereotactic radiosurgery, which is discussed separately in this Chapter. Therapeutic radiation services may also include brachytherapy, which involves placement of a radioactive source directly within or adjacent to the target tissue.

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General Therapeutic Radiation Services General Therapeutic Radiation Services utilize ionizing radiation to treat cancer and certain non- malignant conditions. Radiation therapy may be delivered using high-energy photons (x-rays or gamma rays) or charged particles (electrons) generated by specialized radiation therapy equipment. The objective of radiation therapy is to damage the genetic material of abnormal cells, thereby preventing continued growth and reproduction while minimizing injury to surrounding healthy tissues. External beam radiation therapy is the most commonly utilized form of therapeutic radiation and is typically delivered using linear accelerator (LINAC) technology. Modern radiation therapy techniques may include three-dimensional conformal radiation therapy (3D-CRT), intensity- modulated radiation therapy (IMRT), image-guided radiation therapy (IGRT), volumetric modulated arc therapy (VMAT), and other advanced treatment modalities designed to improve precision and reduce radiation exposure to normal tissues. Therapeutic radiation is commonly administered through a process known as fractionation, whereby the total prescribed radiation dose is divided into multiple treatment sessions delivered over several days or weeks. Fractionation allows normal tissues time to recover between treatments while maximizing the therapeutic effect on the targeted disease process. Another form of therapeutic radiation utilized in Mississippi is brachytherapy. Unlike external beam radiation therapy, in which radiation is generated by a machine outside the body and directed toward the treatment area, brachytherapy involves placement of a radioactive source directly within or adjacent to the target tissue. General Therapeutic Radiation Services do not include stereotactic radiosurgery or proton therapy, which are addressed separately in this chapter. 506.2 Stereotactic Radiosurgery Despite its name, Stereotactic Radiosurgery is a non-surgical procedure that uses highly focused x-rays (or in some cases, gamma rays) to treat certain types of tumors, inoperable lesions, and as a post-operative treatment to eliminate any leftover tumor tissue. Stereotactic Radiosurgery treatment involves the delivery of a single high-dose—or in some cases smaller multiple doses— of radiation beams that converge on the specific area of the brain where the tumor or other abnormality resides. Stereotactic Radiosurgery was once limited to the GammaKnife® for treating intra-cranial lesions and functional issues. With the introduction of CyberKnife® and other LINAC-based radiosurgery systems, there has been rapid growth in total-body radiosurgery. The modified LINAC radiosurgery modality is now being used to treat lung, liver, pancreas, prostate, and other body areas. Some modified full-body LINAC models use full-body frames as a guiding tool and others do not. Therefore, the term “Stereotactic Radiosurgery” will refer to radiosurgery regardless of whether a full-body frame is used or not. A full course of radiosurgery requires only one (1) to five (5) treatments versus thirty (30) to forty (40) for radiotherapy.

Three (3) basic types of Stereotactic Radiosurgery are in common use, each of which uses different instruments and sources of radiation: • Cobalt 60 Based (Gamma Knife®) uses 201 beams of highly focused gamma rays. The Gamma Knife is commonly used to treat small to medium-sized intracranial lesions due to its ability to deliver highly focused radiation while minimizing exposure to surrounding healthy tissue. • Linear Accelerator (LINAC) Based machines, prevalent throughout the world, deliver high-energy X-ray photons or electrons in curving paths around the patient’s head. The linear accelerator can perform radiosurgery on larger tumors in a single session or during multiple sessions (fractionated stereotactic radiotherapy). Examples of LINAC-based radiosurgery systems include CyberKnife®, Novalis®, TomoTherapy®, and other approved radiosurgery platforms. Multiple manufacturers produce Stereotactic Radiosurgery systems capable of delivering highly precise radiation treatment to intracranial and extracranial targets. Certain systems utilize robotic guidance and image- guided treatment technologies to deliver radiation with a high degree of accuracy while minimizing exposure to surrounding healthy tissues. • Particle Beam (photon) or Cyclotron Based machines are in limited use in North America. Table 5-5 presents facilities offering megavoltage therapeutic radiation therapy in Mississippi. 506.3 Proton Therapy Proton therapy is an advanced form of external beam radiation therapy that utilizes accelerated proton particles rather than conventional photon (X-ray) radiation to treat cancer and certain other diseases. Proton therapy employs specialized accelerator technology to generate and direct proton beams with a high degree of precision to the targeted treatment area. Unlike conventional photon radiation, proton particles deposit the majority of their energy at a specific depth within tissue, commonly referred to as the Bragg Peak. This characteristic allows radiation oncologists to deliver highly conformal radiation doses to tumors while reducing radiation exposure to surrounding healthy tissues and critical organs. Proton therapy may be particularly beneficial for selected pediatric cancers, tumors located near critical structures such as the brain, spinal cord, or optic system, skull-based tumors, ocular tumors, and other conditions for which minimizing radiation exposure to normal tissue is clinically important. Patient selection should be based upon accepted clinical guidelines, evidence-based medical practice, and physician judgment. Proton therapy is typically delivered on an outpatient basis and, similar to conventional radiation therapy, may be administered in a single treatment or in multiple fractions over a period of days or weeks depending upon the disease being treated and the prescribed treatment plan. Proton therapy requires substantial capital investment, highly specialized equipment, dedicated facility infrastructure, and specialized clinical expertise. As a result, proton therapy services are

generally provided on a regional or statewide basis rather than as a routine community-level radiation therapy service. 507 Diagnostic Imaging Services Diagnostic imaging equipment and services, except for magnetic resonance imaging, positron emission tomography, and invasive digital angiography, are reviewable under the state’s Certificate of Need law only when the capital expenditure for the acquisition of the equipment and related costs exceeds $3,000,000.00. The provision of invasive diagnostic imaging services (i.e. invasive Digital Angiography, Positron Emission Tomography, and Magnetic Resonance Imaging) require a Certificate of Need if the proposed provider has not offered the services on a regular basis within twelve (12) months prior to the time the services would be offered, regardless of the capital expenditure. Equipment in this category includes, but is not limited to, ultrasound equipment, diagnostic nuclear medicine equipment, digital radiography equipment, digital angiography equipment, computed tomographic (CT) scanning equipment, magnetic resonance imaging (MRI) equipment, and positron emission tomography (PET) equipment. 507.1 Computed Tomographic (CT) Scanning Computed Tomographic (CT) scanning is a diagnostic imaging modality that utilizes X-rays and computerized image reconstruction to produce detailed cross-sectional images of internal organs, tissues, and anatomical structures. CT technology plays an important role in the diagnosis, evaluation, treatment planning, and monitoring of a wide variety of medical conditions. 507.2 Magnetic Resonance Imaging (MRI) Magnetic Resonance Imaging (MRI) is a diagnostic imaging technique that employs magnetic and radio-frequency fields to produce images of the body non-invasively. MRI is similar to CT scanning in that it produces cross-sectional and digital images without potentially harmful ionizing radiation, producing an image not distorted by bone mass. The equipment and its operational specifications continue to be refined. Ninety (91) facilities (hospitals and free-standing) in Mississippi operated fixed or mobile based MRI units in FY 2020. These facilities performed a total of 253,198 MRI procedures during the year. Table 5-6 presents the location, type (fixed or mobile), number of units per facility, and utilization of MRI equipment throughout the state in fiscal years 2019 and 2020. 507.3 Invasive Digital Angiography (DA) Invasive Digital Angiography (DA) is a diagnostic and catheter based therapeutic intravascular intervention imaging procedure that combines a digital processing unit with equipment similar to that used for standard fluoroscopic procedures. Most invasive DA studies are appropriate as outpatient procedures in a freestanding facility, where proper protocols are met.

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Positron Emission Tomography (PET) Positron Emission Tomography (PET) is a minimally invasive imaging procedure in which positron-emitting radionuclides, produced either by a cyclotron or by a radio-pharmaceutical producing generator, and a gamma camera are used to create pictures of organ function rather than structure. PET scans provide physicians a crucial assessment of the ability of specific tissues to function normally. PET can provide unique clinical information in an economically viable manner, resulting in a diagnostic accuracy that affects patient management. PET scans provide diagnostic and prognostic patient information regarding cognitive disorders; for example, identifying the differences between Alzheimer’s, Parkinson's, dementia, depression, cerebral disorders, and mild memory loss. PET scans also provide information regarding psychiatric disease, brain tumors, epilepsy, cardiovascular disease, movement disorders, and ataxia. Research shows that clinical PET may obviate the need for other imaging procedures. PET installations generally take one of two forms: a scanner using only generator-produced tracers (basic PET unit) or a scanner with a cyclotron (enhanced PET unit). The Rubidium-82 is the only generator approved by the FDA to produce radiopharmaceuticals. Rubidium limits PET services to cardiac perfusion imaging. A PET scanner supported by a cyclotron can provide the capabilities for imaging a broader range of PET services, such as oncology, neurology, and cardiology. Manufacturers of PET equipment are providing more user-friendly cyclotrons, radiopharmaceutical delivery systems, and scanners which have drastically reduced personnel and maintenance requirements. These changes have made the cost of PET studies comparable to those of other high-technology studies. Cardiology Associates of North Mississippi located in Tupelo, Mississippi (Lee County) has a fixed PET unit and performs Cardiac/PET procedures (PET scans/imaging of the heart). For FY2020, Cardiology Associates of North Mississippi performed 1,170 procedures. Table 5-7 presents the location, type (fixed or mobile), and utilization of PET equipment throughout the state in 2020. 508 Certificate of Need Criteria and Standards for Therapeutic Radiation Services Should MSDH receive a CON application regarding the acquisition and/or otherwise control of major medical equipment or the provision of a service for which specific CON criteria and standards have not been adopted, the application shall be deferred until MSDH has developed and adopted CON criteria and standards. If MSDH has not developed CON criteria and standards within 180 days of receiving a CON application, the application will be reviewed using the general CON review criteria and standards presented in the Mississippi Certificate of Need Review Manual and all adopted rules, procedures, and plans of MSDH.

##### **15 Miss. Admin. Code Pt. 8, R. 508.1** Rule 508.1 {#sec-8-508.1 omnilex-key=us-ms-regs-official--title-15--8#508.1}

General Therapeutic Radiation Equipment & Services 508.1.1 Policy Statement Regarding Certificate of Need Applications for the Acquisition or Otherwise Control of General Therapeutic Radiation Equipment and/or the Offering of General Therapeutic Radiation Services 1. Service Areas: MSDH shall determine the need for General Therapeutic Radiation services equipment using the General Hospital Service Areas as presented in this chapter of the Plan. MSDH shall determine the need for General Therapeutic Radiation services and equipment within a given service area independently of all other service areas. Map 5-1 shows the General Hospital Service Areas. 2. Equipment to Population Ratio: The need for General Therapeutic Radiation units (as defined) is determined to be one unit per 117,380 population (see Methodology in Section 508.1 of the Plan). MSDH will consider out-of-state population in determining need only when the applicant submits adequate documentation acceptable to MSDH, such as valid patient origin studies. 3. Limitation of New Services: When the General Therapeutic Radiation unit-to-population ratio reaches one to 117,380 in a given general hospital service area, no new General Therapeutic Radiation services may be approved unless the utilization of all the existing machines in a given hospital service area averaged 8,000 treatments or 320 patients per year for the two most recent consecutive years as reported on the “Renewal of Hospital License and Annual Hospital Report.” For purposes of this policy, Cesium-137 teletherapy units, Cobalt-60 teletherapy units designed for use at less than 80 cm SSD (source-to-skin distance), old betatrons and van de Graaf Generators unsuitable for modern clinical use shall not be counted in the inventory of General Therapeutic Radiation units located in a hospital service area. 4. Expansion of Existing Services: MSDH may consider a CON application for the acquisition or otherwise control of an additional General Therapeutic Radiation unit by an existing provider of such services when the applicant’s existing equipment has exceeded the expected level of patient service (i.e. 320 patients per year or 8,000 treatments per year for the two most recent consecutive years) as reported on the facility’s “Renewal of Hospital License and Annual Hospital Report.” 5. Equipment Designated for Backup: General Therapeutic Radiation equipment designated by an applicant as “backup” equipment shall not be counted in the inventory for CON purposes. Any treatments performed on the “backup” equipment shall be attributed to the primary equipment for CON purposes. “Backup” equipment should only be utilized when the primary equipment is deemed out of service. 6. Definition of a Treatment: For health planning and CON purposes a patient “treatment” is defined as one individual receiving radiation therapy during a visit to a facility which provides megavoltage radiation therapy regardless of the complexity of the treatment or the number of “fields” treated during the visit.

7. Use of Equipment or Provision of Service: Before the equipment or service can be utilized or provided, the applicant desiring to provide the General Therapeutic Radiation equipment or service shall have CON approval or written evidence that the equipment or service is exempt from CON approval, as determined by MSDH through a Determination of non- Reviewability. 8. Review Threshold: Notwithstanding any prior language in this section, and pursuant to House Bill 3 from the 2026 Legislative Session (effective February 4, 2026), Certificate of Need review for the acquisition or otherwise control of Therapeutic Radiation equipment is required only if the total acquisition cost as defined in Section 1.14 of the CON Review Manual exceeds Three Million Dollars ($3,000,000.00). 508.1.2 Certificate of Need Criteria and Standards for the Acquisition or Otherwise Control of General Therapeutic Radiation Equipment and/or the Offering of General Therapeutic Radiation Services MSDH will review CON applications for the acquisition or otherwise control of General Therapeutic Radiation equipment and/or the offering of General Therapeutic Radiation services under the applicable statutory requirements of Miss. Code Ann. §§ 41-7-173, 41-7-191, and 41-7- 193. MSDH will also review applications for CON according to the general criteria listed in the Mississippi Certificate of Need Review Manual; all adopted rules, procedures, and plans of MSDH; and the specific criteria and standards listed below. The acquisition or otherwise control of General Therapeutic Radiation equipment is reviewable if the equipment cost exceeds $3,000,000.00. The offering of General Therapeutic Radiation services is reviewable if the proposed provider has not provided those services on a regular basis within the period of twelve (12) months prior to the time such services would be offered, regardless of the capital expenditure. Need Criterion 1: Project Need The applicant shall document a need for General Therapeutic Radiation equipment/services by complying with any one of the following methodologies: A. The need methodology as presented in this section of the Plan; B. Demonstrating that all existing machines in the service area in question have averaged 8,000 treatments per year or all machines have treated an average of 320 patients per year for the two most recent consecutive years; or C. Demonstrating that the applicant’s existing General Therapeutic Radiation equipment has exceeded the expected level of patient service (i.e. 320 patients per year/unit or 8,000 treatments per year/unit for the two most recent consecutive years). Need Criterion 2: Presence of Readily Available Services

The applicant must document that access to diagnostic x-ray, CT scan, and ultrasound services is readily available within fifteen (15) minutes normal driving time of the General Therapeutic Radiation unit’s location. Need Criterion 3: Staffing Requirements An applicant shall document the following: A. The service will have at a minimum the following full-time dedicated staff: 1. One board-certified radiation oncologist-in-chief, 2. One dosimetrist, 3. One certified radiation therapy technologist certified by the American Registry of Radiation Technologists, and 4. One registered nurse. B. The service will have at a minimum access to a radiation physicist certified or eligible for certification by the American Board of Radiology. NOTE: One individual may act in several capacities. However, the application shall affirm that when a staff person acts in more than one capacity that staff person shall meet, at a minimum, the requirements for each of the positions he/she fills. Need Criterion 4: Access to Additional Staff The applicant shall affirm that access will be available as needed to Brachytherapy staff, treatment aides, social workers, dietitians, and physical therapists. Need Criterion 5: Physician Location Applicants shall document that all physicians who are responsible for General Therapeutic Radiation services in a facility, including the radiation oncologist-in-chief, shall reside within sixty (60) minutes normal driving time of the facility. Need Criterion 6: Access to a Modern Stimulator The application shall affirm that the applicant will have access to a modern simulator capable of precisely producing the geometric relationships of the treatment equipment to a patient. This simulator must produce high quality diagnostic radiographs. The applicant shall also affirm that the following conditions will be met regarding use of the simulator: A. If the simulator is located at a site other than where the General Therapeutic Radiation equipment is located, protocols will be established which will guarantee that the radiation oncologist who performs the patient’s simulation will also be the same radiation oncologist who performs the treatments on the patient.

B. If the simulator uses fluoroscopy, protocols will be established to ensure that the personnel performing the fluoroscopy have received appropriate training in the required techniques related to simulation procedures. NOTE: X-rays produced by diagnostic x-ray equipment and photon beams produced by megavoltage therapy units are unsuitable for precise imaging of anatomic structures within the treatment volume and do not adequately substitute for a simulator. Need Criterion 7: Access to Computerized Treatment Planning System The application shall affirm that the applicant will have access to a computerized treatment planning system with the capability of simulation of multiple external beams, display isodose distributions in more than one plane, and performing dose calculations for brachytherapy implants. NOTE: It is highly desirable that the system has the capability of performing CT-based treatment planning. Need Criterion 8: Supervision of Treatment The applicant shall affirm that all treatments will be under the control of a board-certified or board- eligible radiation oncologist. Need Criterion 9: MSDH Division of Radiological Health Approval The applicant shall affirm that the proposed site, plans, and equipment shall receive approval from the MSDH Division of Radiological Health before service begins. Need Criterion 10: Quality Assurance Program The application shall affirm that the applicant will establish a quality assurance program for the service as follows: A. The General Therapeutic Radiation program shall meet, at a minimum, the physical aspects of quality assurance guidelines established by the American College of Radiology (ACR) within twelve (12) months of initiation of the service. B. The service shall establish a quality assurance program which meets, at a minimum, the standards established by the American College of Radiology. Need Criterion 11: Failure to Comply The applicant shall affirm understanding and agreement that failure to comply with Need Criterion 10 (A) and (B) may result in revocation of the CON (after due process) and subsequent termination of authority to provide General Therapeutic Radiation services. 508.1.3 General Therapeutic Radiation Equipment/Services Need Methodology 1. Treatment/Patient Load: A realistic treatment/patient load for a General Therapeutic

Radiation unit is 8,000 treatments or 320 patients per year. 2. Incidence of Cancer: The American Cancer Society (ACS) estimates that Mississippi will experience 18,750 new cancer cases in 2021. Based on a population of 3,095,026 (year 2025) as estimated by the State Data Center of Mississippi (University of Mississippi Center for Population Studies), the Mississippi Cancer Incidence Rate is 6.06 cases per 1,000 population. 3. Patients to Receive Treatment: The number of cancer patients expected to receive General Therapeutic Radiation treatment is set at forty-five percent (45%). 4. Population to Equipment Ratio: Using the above-stated data, a population of 100,000 will generate 606 new cancer cases each year. Assuming that forty-five percent (45%) will receive radiation therapy, a population of 117,380 will generate approximately 320 patients who will require radiation therapy. Therefore, a population of 117,380 will generate a need for one General Therapeutic Radiation unit. 508.1.4 General Therapeutic Radiation Equipment Need Determination Formula 1. Project Annual Number of Cancer Patients: General Hospital Service Area Population × 6.06 cases*/1,000 population = New Cancer Cases *Mississippi Cancer Incidence Rate 2. Project Annual Number of Radiation Therapy Patients: New Cancer Cases ×45% = Patients Who Will Likely Require Radiation Therapy 3. Estimate Number of Treatments to Be Performed Annually: Radiation Therapy Patients × 25 Treatments per Patient (Avg.) = Estimated # of Treatments 4. Project Number of Megavoltage Radiation Therapy Units Needed: Estimated # of Treatments/8,000 Treatments per Unit = Projected # of Units Needed

5. Determine Unmet Need (if any): Projected # of Units Needed - # of Existing Units = # of Units Required (Excess) 508.2 Stereotactic Radiosurgery Equipment & Services 508.2.1 Policy Statement Regarding Certificate of Need Applications for the Acquisition or Otherwise Control of Stereotactic Radiosurgery Equipment and/or the Offering of Stereotactic Radiosurgery 1. Service Areas: MSDH shall determine the need for Stereotactic Radiosurgery services and equipment by using the actual Stereotactic Radiosurgery provider’s service area. 2. Unit to Population Ratio: The need for Stereotactic Radiosurgery units is determined to be the same as for radiotherapy, for 2023 a population of 3,138,145. The General Therapeutic Radiation Equipment Need Determination formula is outlined in Section 508.1.4 above. 3. Accessibility: Nothing contained in these CON criteria and standards shall preclude the University of Mississippi School of Medicine from acquiring and operating Stereotactic Radiosurgery equipment, provided the acquisition and use of such equipment is justified by the School’s teaching and/or research mission and complies with the teaching exception as outlined in Section 102.1 of this Plan. However, the requirements listed under the section regarding the granting of “appropriate scope of privileges for access to the stereotactic radiosurgery equipment to any qualified physician” must be met. 4. Expansion of Existing Services: MSDH may consider a CON application for the acquisition or otherwise control of an additional Stereotactic Radiosurgery unit by an existing provider of such services when the applicant’s existing equipment has exceeded the expected level of patient service (i.e. 900 treatments per year for the two most recent consecutive years) as reported on the facility’s “Renewal of Hospital License and Annual Hospital Report.” 5. Addition of Services: Facilities requesting approval to add Stereotactic Radiosurgery services should have an established neurosurgery program and must be able to demonstrate previous radiosurgery service experience. 6. Discharge Planning Policy: All Stereotactic Radiosurgery services should have written procedures and policies for discharge planning and follow-up care for the patient and family as part of the institution’s overall discharge planning program. 7. Referral Policy: All Stereotactic Radiosurgery services should have established protocols for referring physicians to ensure adequate post-operative diagnostic evaluation for radiosurgery patients. 8. Service Cost Comparison: The total cost of providing Stereotactic Radiosurgery services projected by prospective providers should be comparable to the cost of other similar

services provided in the state. 9. Patient Cost Comparison: The usual and customary charge to the patient for Stereotactic Radiosurgery should be commensurate with cost. 508.2.2 Certificate of Need Criteria and Standards for the Acquisition or Otherwise Control of Stereotactic Radiosurgery Equipment and/or the Offering of Stereotactic Radiosurgery MSDH will review CON applications for the acquisition or otherwise control of Stereotactic Radiosurgery equipment and/or the offering of Stereotactic Radiosurgery services under the applicable statutory requirements of Miss. Code Ann. §§ 41-7-173, 41-7-191, and 41-7-193. MSDH will also review applications for Certificate of Need according to the general criteria listed in the Mississippi Certificate of Need Review Manual; all adopted rules, procedures, and plans of MSDH; and the specific criteria and standards listed below. The acquisition or otherwise control of Stereotactic Radiosurgery equipment is reviewable if the equipment cost exceeds $3,000,000.00. The offering of Stereotactic Radiosurgery services is reviewable if the proposed provider has not provided those services on a regular basis within the period of twelve (12) months prior to the time such services would be offered, regardless of the capital expenditure. Need Criterion 1: Minimum Procedures The applicant shall document a need for Stereotactic Radiosurgery equipment/services by reasonably projecting that the proposed new service will perform at least 900 Stereotactic Radiosurgery treatments in the third year of operation. No additional new Stereotactic Radiosurgery services should be approved unless the number of Stereotactic Radiosurgery treatments performed with existing units in the state average 900 treatments or more per year. Need Criterion 2: Staffing Requirements A. The radiosurgery programs must be established under the medical direction of two co- directors, one with specialty training and board certification in neurosurgery and the other with specialty training and board certification in radiation oncology, with experience in all phases of Stereotactic Radiosurgery. B. In addition to the medical co-directors, all Stereotactic Radiosurgery programs should have a radiation physicist who is certified in radiology, or who holds an advanced degree in physics with two to three years of experience working under the direction of a radiation oncologist, and a registered nurse present for each Stereotactic Radiosurgery performed. C. The applicant shall document that the governing body of the entity offering Stereotactic Radiosurgery services will grant an appropriate scope of privileges for access to the Stereotactic Radiosurgery equipment to any qualified physician who applies for privileges. For this criterion, “Qualified Physician” means a Doctor of Medicine or Osteopathic Medicine licensed by the State of Mississippi who possesses training in Stereotactic

Radiosurgery and other qualifications established by the governing body. Need Criterion 3: Equipment A. Facilities providing Stereotactic Radiosurgery services should have dosimetry and calibration equipment and a computer with the appropriate software for performing Stereotactic Radiosurgery. B. The facility providing Stereotactic Radiosurgery services should also have access to Magnetic Resonance Imaging, Computed Tomography, and Angiography services. 508.3 Proton Therapy Equipment & Services The Mississippi State Department of Health recognizes that proton accelerator technology represents a highly specialized form of radiation therapy requiring substantial capital investment, specialized clinical expertise, and long-term operational sustainability. The Department further recognizes that Proton Therapy may provide clinical benefit for certain patient populations while also representing one of the most resource-intensive forms of radiation oncology services. The Department finds that proton accelerator services should be developed in a manner that: • Promotes access for Mississippi residents; • Avoids unnecessary duplication of highly specialized services; • Supports clinical quality and patient safety; • Demonstrates long-term financial viability; and • Ensures efficient utilization of health care resources. The purpose of this section is to establish criteria for review of Certificate of Need applications proposing the establishment, acquisition, expansion, or relocation of proton accelerator services. 508.4 Policy Statement Regarding Certificate of Need Applications for the Acquisition or Otherwise Control of Proton Therapy Equipment and/or the Offering of Proton Therapy Services 1. Definitions: For purposes of this Policy Statement and the Certificate of Need Criteria and Standards for the Acquisition or Otherwise Control of Proton Therapy Equipment and/or the Offering of Proton Therapy Services, the following definitions shall apply: a. “Proton Accelerator Service” means a healthcare service utilizing proton beam therapy technology for the treatment of cancer or other medically appropriate conditions.

2. Planning Area: The planning area for proton accelerator services shall be statewide. 3. Limitation on Duplication: Until sufficient utilization data are available to support development of a numerical planning methodology, no additional proton accelerator service shall be approved unless the Department determines that: a. The existing proton accelerator service has operated at or above eighty percent (80%) of practical treatment capacity for two (2) consecutive years; or b. Exceptional circumstances demonstrate a substantial unmet statewide need that cannot reasonably be addressed through the existing service. 4. Annual Review: The Department shall periodically evaluate utilization data and may revise this methodology as additional information becomes available. 508.5 Certificate of Need Criteria and Standards for the Acquisition or Otherwise Control of Proton Therapy Equipment and/or the Offering of Proton Therapy Services The Mississippi State Department of Health will review applications for a Certificate of Need for the acquisition or otherwise control of Proton Therapy equipment and/or the offering of Proton Therapy services under the applicable statutory requirements of Miss. Code Ann. §§ 41- 7-173, 41-7-191, and 41-7-193. MSDH will also review applications for Certificate of Need according to the general criteria listed in the Mississippi Certificate of Need Review Manual; all adopted rules, procedures and plans of MSDH; and the specific criteria and standards listed below. The acquisition or otherwise control of Proton Therapy equipment is reviewable if the equipment costs exceed $3,000,000.00. The offering of Proton Therapy services is reviewable if the proposed provider has not provided those services on a regular basis within the period of twelve (12) months prior to the time such services would be offered. Need Criterion 1: Demonstration of Need The applicant shall demonstrate a need for the proposed proton accelerator service through documentation including: A. The estimated number of Mississippi residents currently receiving proton therapy services; B. The locations where Mississippi residents currently receive proton therapy services; C. Referral patterns from Mississippi physicians and hospitals; D. Clinical conditions and patient populations expected to utilize the service; and E. Projected annual patient volumes.

Need Criterion 2: Clinical Appropriateness The applicant shall demonstrate that the proposed service will utilize evidence-based patient selection criteria consistent with nationally recognized standards and clinical practice guidelines. Need Criterion 3: Access The applicant shall demonstrate that the proposed service will be reasonably accessible to patients throughout Mississippi. At a minimum, the applicant shall: A. Accept Medicare beneficiaries; B. Participate in Mississippi Medicaid if otherwise eligible; C. Maintain charity care policies consistent with those applicable to the applicant’s facility; and D. Accept referrals regardless of physician or hospital affiliation. Criterion 4: Financial Feasibility The applicant shall demonstrate: A. The financial feasibility of the proposed service; B. Availability of sufficient capital resources; C. Projected operating sustainability; and D. Reasonable utilization assumptions. Criterion 5: Staffing and Clinical Resources A. The applicant shall demonstrate the availability of: B. Qualified radiation oncologists; C. Qualified medical physicists; D. Radiation therapy personnel; E. Appropriate support staff; and F. Comprehensive oncology support services.

Criterion 6: Integration with Existing Cancer Services The applicant shall demonstrate coordination with existing oncology providers and continuity of care for patients receiving proton therapy. Criterion 7: Data Reporting As a condition of approval, the provider shall submit annual reports to the Department for a period of five (5) years following initiation of services. The reports shall include: A. Number of patients treated; B. Mississippi resident utilization; C. Payer mix; D. Referral sources; E. Charity care provided; and F. Other information required by the Department. Need Criterion 8: MSDH Division of Radiological Health Approval The applicant shall affirm that the proposed site, plans, and equipment shall receive approval from the MSDH Division of Radiological Health before service begins. 508.6 Proton Therapy Equipment/Service Methodology The Department finds that insufficient Mississippi-specific utilization data currently exists to support a numerical planning formula for proton accelerator services. Accordingly, need shall be determined through consideration of the criteria established in this section and evaluation of the applicant’s demonstration of statewide need, projected utilization, access, financial feasibility, and clinical appropriateness. 509 Certificate of Need Criteria and Standards for Diagnostic Imaging Services Should MSDH receive a CON application regarding the acquisition and/or otherwise control of major medical equipment or the provision of a service for which specific CON criteria and standards have not been adopted, the application shall be deferred until MSDH has developed and adopted CON criteria and standards. If MSDH has not developed CON criteria and standards within 180 days of receiving a CON application, the application will be reviewed using the general CON review criteria and standards presented in the Mississippi Certificate of Need Review Manual and all adopted rules, procedures, and plans of MSDH.

##### **15 Miss. Admin. Code Pt. 8, R. 509.1** Rule 509.1 {#sec-8-509.1 omnilex-key=us-ms-regs-official--title-15--8#509.1}

Computed Tomographic (CT) Scanning Should the capital expenditure for the acquisition of fixed or mobile CT scanning services, equipment, and related costs exceed $3,000,000.00, the CON proposal will be reviewed under the general review criteria outlined in the most recent Certificate of Need Review Manual adopted by the Mississippi State Department of Health and the following utilization standards: 1. A proposed unit must be able to generate a minimum of 2,000 HECTs by the second year of operation. See Table 5-6 for HECT conversion table. 2. Providers desiring CT capability must be properly utilizing 20,000 general radiographic imaging procedures per year. 509.2 Digital Angiography Equipment & Services 509.2.1 Policy Statement Regarding Certificate of Need Applications for the Acquisition or Otherwise Control of Digital Angiography Equipment and/or the Offering of Invasive DA Services Digital Angiography Equipment and Services in Ambulatory Surgery Centers: Applicants proposing the acquisition or otherwise control of Digital Angiography equipment and/or the offering of invasive Digital Angiography services in a single specialty ambulatory surgery center must apply for a certificate of need before providing such services. 509.2.2 Certificate of Need Criteria and Standards for Invasive Digital Angiography in a Hospital MSDH will review applications for a CON for the acquisition or otherwise control of Digital Angiography (DA) equipment and associated costs under the applicable statutory requirements of Miss. Code. Ann. §§ 41-7-173, 41-7-191, and 41-7-193. MSDH will also review applications for Certificate of Need according to the general criteria listed in the Mississippi Certificate of Need Review Manual; all adopted rules, procedures, and plans of MSDH; and the specific criteria and standards listed below. CON review is required when the capital expenditure for the purchase of Digital Angiography equipment and associated costs exceed $3,000,000.00, or when the equipment is to be used for invasive procedures (i.e. the use of catheters). The offering of diagnostic and therapeutic intravascular intervention imaging services of an invasive nature (i.e. invasive Digital Angiography) is reviewable if those services have not been provided on a regular basis by the proposed provider of such services within the period of twelve (12) months prior to the time such services would be offered regardless of the capital expenditure. Need Criterion 1: Staffing Requirements The applicant for invasive DA services shall demonstrate that proper protocols for screening and medical specialty backup are in place before services are rendered by personnel other than those with specialized training.

For example, if a radiologist without specialized training in handling cardiac arrhythmia is to perform a procedure involving the heart, a cardiologist/cardiosurgeon must be available for backup. The protocols shall include, but are not limited to, having prior arrangements for backup from: A. A cardiologist/cardiosurgeon for procedures involving the heart; B. A neurologist/neurosurgeon for procedures involving the brain; and C. A vascular surgeon, cardiologist, radiologist or nephrologist credentialed and accredited for interventional peripheral vascular procedures. Need Criterion 2: CON Exemption Before utilizing or providing the equipment or service, the applicant desiring to provide the Digital Angiography equipment or invasive DA services shall have CON approval or written evidence that the equipment or service is exempt from CON approval as determined by MSDH through a Determination of Reviewability. 509.2.3 Certificate of Need Criteria and Standards for Invasive Digital Angiography in a Freestanding Facility Need Criterion 1: Staffing Requirements A. The applicant for invasive DA services shall demonstrate that proper protocols for screening and medical specialty backup are in place before services are rendered by personnel other than those with specialized training. The protocols shall include, but are not limited to, having prior arrangements for consultation/backup from a vascular surgeon, cardiologist, radiologist or nephrologist credentialed and accredited for interventional peripheral vascular procedures. B. Identify physicians in the group and state which physicians(s) will perform intravascular interventions using DA. Certify that: 1. Each physician will maintain medical staff privileges at a full-service hospital; or 2. At least one member of the physician group has staff privileges at a full-service hospital and will be available at the facility or on call within a 30-minute travel time of the full-service hospital during the hours of operation of the facility. Need Criterion 2: Types of Procedures A. Procedures in a freestanding facility are generally non-emergent nor life threatening in nature and require a patient stay of less than twenty-four (24) consecutive hours. The procedures shall not be of a type that: 1. Generally result in blood loss of more than ten percent of estimated blood volume

in a patient with a normal hemoglobin; 2. Require major or prolonged intracranial, intrathoracic, abdominal, or major joint replacement procedures, except for laparoscopic procedures; or 3. Involve Major Blood Vessels. a. Major Blood Vessels are defined as the group of critical arteries and veins including the aorta, coronary arteries, pulmonary arteries, superior and inferior vena cava, pulmonary veins, carotid arteries, and any intra- cerebral artery or vein. Percutaneous endovascular interventions of the peripheral vessels not excluded in subsection A.1.a. above are permitted to be performed in a freestanding facility. These procedures are defined as procedures performed without open direct visualization of the target vessel, requiring only needle puncture of an artery or vein followed by insertion of catheters, wires, or similar devices which are then advanced through the blood vessels using imaging guidance. Once the catheter reaches the intended location, various maneuvers to address the diseased area may be performed which include, but are not limited to, injection of contrast for imaging, ultrasound of the vessel, treatment of vessels with angioplasty, artherectomy, covered or uncovered stenting, intentional occlusion of vessels or organs (embolization), and delivering of medications, radiation, or other energy such as laser, radiofrequency, or cryo. Need Criterion 3: Transfer Agreement The applicant must certify that the proposed facility will have a formal transfer agreement with a full-service hospital to provide services which are required beyond the scope of the freestanding facility’s programs. Need Criterion 4: CON Exemption Before utilizing or providing the equipment or service, the applicant desiring to provide the digital angiography equipment or invasive DA services shall have CON approval or written evidence that the equipment or service is exempt from CON approval as determined by MSDH through a Determination of Reviewability. 509.3 Magnetic Resonance Imaging Equipment & Services 509.3.1 Policy Statement Regarding Certificate of Need Applications for the Acquisition or Otherwise Control of Magnetic Resonance Imaging Equipment and/or the Offering of MRI Services 1. CON Review Requirements: The CON process regarding the acquisition or otherwise control of MRI equipment and/or the offering of MRI services involves separate requirements for CON review: (a) an entity proposing to acquire or otherwise control MRI equipment must obtain a CON to do so if the capital expenditure for the MRI unit and related equipment exceeds $3,000,000.00; and (b) an entity proposing to offer MRI

services which has not provided the service on a regular basis within the last twelve (12) months must obtain a CON before providing such services, regardless of the capital expenditure. 2. CON Approval Preference: MSDH shall give preference to those applicants proposing to enter into joint ventures utilizing mobile and/or shared equipment. However, the applicant must meet the applicable CON criteria and standards provided herein and the general criteria and standards contained in the currently approved Mississippi Certificate of Need Review Manual. 3. Mobile MRI: For purposes of this Plan, a mobile MRI unit is defined as an MRI unit operating at two or more host sites and that has a central service coordinator. The mobile MRI unit shall operate under a contractual agreement for the provision of MRI services at each host site on a regularly scheduled basis. 4. Conversion to Fixed: The conversion from mobile MRI service to fixed MRI service is considered the establishment of a new MRI service and requires CON review. 5. Utilization of Existing Units: No new MRI services shall be approved unless all existing MRI service in the applicant’s defined service area performed an average of 1,700 MRI procedures per existing and approved MRI scanner during the most recent twelve (12) month reporting period and the proposed new services would not reduce the utilization of existing providers in the service area. 6. Population-Based Formula: MSDH shall use a population-based formula as presented at the end of this chapter when calculating MRI need. Also, the formula will use historical and projected use rates by service area and patient origin data. The population-based formula is based on the most recent population projections prepared by the State Data Center (University of Mississippi Center for Population Studies). The applicant shall project a reasonable population base to justify the provision of 2,700 procedures (or 1,700 procedures for rural hospitals) by the second year of operation. 7. Mobile Service Volume Proration: The required minimum service volumes for the establishment of services and the addition of capacity for mobile services shall be prorated on a “site by site” basis based on the amount of time the mobile services will be operational at each site. 8. Addition of a Healthcare Facility: An equipment vendor who proposes to add a healthcare facility to an existing or proposed route must notify MSDH through the filing of a Determination of Reviewability of any proposed changes (i.e. additional healthcare facilities or route deviations, from those presented in the Certificate of Need application prior to such change). 9. Review Threshold: Notwithstanding any prior language in this section, and pursuant to House Bill 3 from the 2026 Legislative Session (effective February 4, 2026), Certificate of Need review for the acquisition or otherwise control of MRI equipment is required only if the total acquisition cost as defined in the CON Review Manual exceeds Three Million Dollars ($3,000,000.00).

##### **15 Miss. Admin. Code Pt. 8, R. 509.3.2** Rule 509.3.2 {#sec-8-509.3.2 omnilex-key=us-ms-regs-official--title-15--8#509.3.2}

Certificate of Need Criteria and Standards for the Acquisition or Otherwise Control of Magnetic Resonance Imaging Equipment and/or the Offering of MRI Services Need Criterion 1: Minimum Procedures/Population The entity desiring to acquire or otherwise control the MRI equipment shall demonstrate a minimum of 2,700 procedures per year by the end of the second year of operation; provided, however, that MRI equipment exclusively servicing rural hospitals (those located outside U.S. Census Bureau Metropolitan Statistical Areas with 75 or less beds) shall be required to demonstrate a minimum of 1,700 procedures per year by the end of the second year of operation. This criterion includes both fixed and mobile MRI equipment. The applicant must show the methodology used for the projections. A. Applicants for non-hospital-based MRI facilities may submit affidavits from referring physicians. MRI procedures projected in affidavits shall be based on actual MRI procedures referred during the year. B. The applicant shall document a reasonable population base to document that a minimum of 2,700 procedures will be performed per proposed MRI unit (or 1,700 procedures per year for a mobile MRI route exclusively serving rural hospitals). C. The applicant shall demonstrate that all existing units within its defined service area have performed an average of 1,700 procedures for the most recent 12-month period. It is recognized that an applicant desiring to acquire or otherwise control an MRI unit may make or propose to make the MRI unit available to more than one provider of MRI services, some of which may be located outside of Mississippi. In such cases all existing or proposed users of the MRI unit must jointly meet the required service volume of 2,700 (or 1,700 for mobile MRI route exclusively serving rural hospitals) procedures annually. If the MRI unit in question is presently utilized by other providers of MRI services, the actual number of procedures performed by them during the most recent twelve (12) month period and/or documented projections of physician referrals may be used. Need Criterion 2: Equipment Requirements In order to receive CON approval to acquire or otherwise control MRI equipment, the applicant shall provide a copy of the proposed contract and document the following: A. The equipment is FDA approved; B. Only qualified personnel will be allowed to operate the equipment; and C. If the equipment is to be rented, leased, or otherwise used by other qualified providers on a contractual basis, no fixed/minimum volume contracts will be permitted.

Need Criterion 3: Data Requirements Applicants shall provide written assurance that they will record and maintain, at a minimum, the following information and make it available to MSDH: A. All facilities which have access to the equipment; B. Utilization by each facility served by the equipment (e.g., days of operation, number of procedures, and number of repeat procedures); C. Financial data (e.g., copy of contracts, fee schedule, and cost per scan); and D. Demographic and patient origin data for each facility. In addition, if required by the Department, the above referenced information and other data pertaining to the use of MRI equipment will be made available to the MSDH within fifteen (15) business days of request. The required information may also be requested for entities outside of Mississippi that use the MRI equipment in question. Need Criterion 4: Business Registration The entity desiring to acquire or otherwise control the MRI equipment must be a registered entity authorized to do business in Mississippi. Need Criterion 5: CON Approval/Exemption for MRI Equipment Before the specified equipment can be utilized, the applicant desiring to provide the MRI equipment shall have CON approval or written evidence that the equipment is exempt from CON approval, as determined by MSDH through a Determination of Reviewability. Each specified piece of equipment must be exempt from or have CON approval. 509.3.3 Certificate of Need Criteria and Standards for Acquisition or Otherwise Control of MRI Equipment MSDH will review applications for a CON for the acquisition or otherwise control of MRI equipment and/or the offering of MRI services under the applicable statutory requirements of Miss. Code Ann. §§ 41-7-173, 41-7-191, and 41-7-193. MSDH will also review applications for Certificate of Need according to the general criteria listed in the Mississippi Certificate of Need Review Manual; all adopted rules, procedures, and plans MSDH; and the specific criteria and standards listed below. The acquisition or otherwise control of MRI equipment is reviewable if the equipment cost is in excess of $3,000,000.00; if the equipment and/or service is relocated; and if the proposed provider of MRI services has not provided such services on a regular basis within the period of twelve (12) months prior to the time such services would be offered, regardless of the capital expenditure.

##### **15 Miss. Admin. Code Pt. 8, R. 509.3.4** Rule 509.3.4 {#sec-8-509.3.4 omnilex-key=us-ms-regs-official--title-15--8#509.3.4}

Certificate of Need Criteria and Standards for the Offering of Fixed or Mobile MRI Services An entity proposing to offer MRI services shall obtain Certificate of Need (CON) approval before offering such services. Need Criterion 1: Minimum Procedures/Population The entity desiring to offer MRI services must document that the equipment shall perform a minimum of 2,700 procedures (or 1,700 procedures for rural hospitals) by the end of the second year of operation. This criterion includes both fixed and mobile MRI equipment. The applicant must show methodology used for the projections. A. Applicants for non-hospital-based MRI facilities may submit affidavits from referring physicians. MRI procedures projected in affidavits shall be based on actual MRI procedures referred during the year. B. The applicant shall document a reasonable population within its service area to justify 2,700 procedures per year per proposed MRI unit (1,700 procedures per year per proposed mobile MRI unit on a route exclusively serving rural hospitals). C. The applicant shall demonstrate that all existing units within its defined service area have performed an average of 1,700 procedures for the most recent 12-month period. It is recognized that a particular MRI unit may be utilized by more than one provider of MRI services, some of which may be located outside of Mississippi. In such cases all existing or proposed providers of MRI services must jointly meet the required service volume of 2,700 (or 1,700 for mobile MRI route exclusively serving rural hospitals) procedures annually by the end of the second year of operation. If the MRI unit in question is presently utilized by other providers of MRI services, the actual number of procedures performed by them during the most recent 12- month period and/or documented projection of physician referrals may be used instead of the formula projections. Need Criterion 2: Availability of Diagnostic Imaging Modalities An applicant desiring to offer MRI services must document that a full range of diagnostic imaging modalities for verification and complementary studies will be available at the time MRI services begin. These modalities shall include, but not be limited to, computed tomography (full body), ultrasound, angiography, nuclear medicine, and conventional radiology. Need Criterion 3: Non-Discrimination All applicants proposing to offer MRI services shall give written assurance that, within the scope of its available services, neither the facility where the service is provided nor its participating medical personnel shall have policies nor procedures which would exclude patients because of race, color, age, sex, ethnicity, or ability to pay.

Need Criterion 4: Staffing Requirements The applicant must document that the following staff will be available: A. Director - A full-time, board eligible radiologist or nuclear medicine imaging physician, or other board eligible licensed physician whose primary responsibility during the prior three years has been in the acquisition and interpretation of clinical images. The Director shall have knowledge of MRI through training, experience, or documented post-graduate education. The Director shall document a minimum of one week of full-time training with a functional MRI facility. B. One full-time MRI technologist radiographer or a person who has had equivalent education, training, and experience, who shall be on-site at all times during operating hours. This individual must be experienced in computed tomography or other cross-sectional imaging methods, or must have equivalent training in MRI spectroscopy. Need Criterion 5: Experimental Procedures The applicant shall document that when an MRI unit is to be used for experimental procedures with formal/approved protocols, a full-time medical physicist or MRI scientist (see definition in Glossary) with at least one year of experience in diagnostic imaging shall be available in the facility. Need Criterion 6: Data Requirements The applicant shall provide assurances that the following data regarding its use of the MRI equipment will be kept and made available to MSDH upon request: A. Total number of procedures performed, B. Number of inpatient procedures, C. Number of outpatient procedures, D. Average MRI scanning time per procedure, E. Average cost per procedure, F. Average charge per procedure, G. Demographic/patient origin data, and H. Days of operation. In addition to the above data recording requirements, the facility should maintain the source of payment for procedures and the total amounts charged during the fiscal year when it is within the scope of the recording system.

Need Criterion 7: CON Approval/Exemption for MRI Equipment Before the service can be provided, the CON applicant desiring to offer MRI services shall provide written evidence that the specified MRI equipment provider has received CON approval or is exempt from CON approval as determined by MSDH through a Determination of Reviewability. Each specified piece of equipment must be exempt from or have CON approval. 509.3.5 Population-Based Formula for Projection of MRI Service Volume X(Y) ÷1,000 = V Where: X = Applicant’s Defined Service Area Population Y = Mississippi MRI Use Rate* V = Expected Volume *Use Rate shall be based on information in the State Health Plan. 509.4 Positron Emission Tomography Equipment & Services 509.4.1 Policy Statement Regarding Certificate of Need Applications for the Acquisition or Otherwise Control of a Positron Emission Tomography Scanner and Related Equipment Including Cardiac-Only PET Scanner 1. CON Review Requirements: Applicants proposing the acquisition or otherwise control of a PET scanner shall obtain a CON to do so if the capital expenditure for the scanner and related equipment exceeds $3,000,000.00. 2. Indigent/Charity Care: An applicant shall be required to provide a "reasonable amount" of indigent/charity care as described in Chapter 1 of this Plan. 3. Service Areas: The state as a whole shall serve as a single service area in determining the need for a PET scanner. In the case of Cardiac only PET Scanner, the service area will be the General Hospital Service Areas. 4. Equipment-to-Population Ratio: The need for a PET scanner is estimated to be one scanner per 300,000 population. MSDH will consider out-of-state population in determining need only when the applicant submits adequate documentation acceptable to MSDH, such as valid patient origin studies. In the case of Cardiac only PET Scanner, this policy will not apply. 5. Access to Supplies: Applicants must have direct access to appropriate radio- pharmaceuticals.

6. Services and Medical Specialties Required: The proposed PET units must function as a component of a comprehensive inpatient or outpatient diagnostic service. The proposed PET unit must have the following modalities (and capabilities) on-site or through contractual arrangements: a. Computed Tomography – (whole body) b. Magnetic Resonance Imaging – (brain and whole body) c. Nuclear Medicine – (cardiac, SPECT) d. Conventional Radiography e. The following medical specialties during operations hours: i. Cardiology ii. Neurology iii. Neurosurgery iv. Oncology v. Psychiatry vi. Radiology. 7. Hours of Operation: PET facilities should have adequate scheduled hours to avoid an excessive backlog of cases. 8. CON Approval Preference: MSDH may approve applicants proposing to enter ventures utilizing mobile and/or shared equipment. 9. CON Requirements: The criteria and standards contained herein pertain to both fixed and/or mobile PET scanner equipment. 10. CON Exemption: Nothing contained in these CON criteria and standards shall preclude the University of Mississippi School of Medicine from acquiring and operating a PET scanner and a Cardiac only PET Scanner, provided the acquisition and use of such equipment is justified by the School’s teaching and/or research mission and complies with the teaching exception as outlined in Section 102. 2 of this Plan. However, the requirements listed under the section regarding the granting of “appropriate scope of privileges for access to the scanner to any qualified physician” must be met. MSDH shall not consider utilization of equipment/services at any hospital owned and operated by the state or its agencies when reviewing CON applications. 11. Addition to a Healthcare Facility: An equipment vendor who proposes to add a healthcare facility to an existing or proposed route must notify MSDH by submitting a Determination of Reviewability for any proposed changes from those presented in the CON application

prior to such change (i.e. additional healthcare facilities or route deviations). 12. Equipment Registration: The applicant must provide the Department with the registration/serial number of the CON-approved PET scanner. 13. Certification: If a mobile PET scanner, the applicant must certify that only the single authorized piece of equipment and related equipment vendor described in the CON application will be utilized for the PET service by the authorized facility/facilities. 14. Conversion from Mobile to Fixed Service: The conversion from a mobile PET service site to a fixed PET service site will not be considered the establishment of a new service and will not require CON review under Section 509.2.4; provided, however, that the facility submit an application for a determination of non-reviewability prior to converting the service. 15. Applicants with an Accredited Cancer Center: Applicants seeking to acquire and operate a fixed PET scanner as part of a Cancer Center accredited by the Commission on Cancer, a program of the American College of Surgeons, shall be exempt from the requirements set forth in Policy Statement number 4 (Equipment-to-Population Ratio). 16. Review Threshold: Notwithstanding any prior language in this section, and pursuant to House Bill 3 from the 2026 Legislative Session (effective February 4, 2026), Certificate of Need review for the acquisition or otherwise control of PET equipment (including PET/CT) is required only if the total acquisition cost as defined in Section 1.14 of the CON Review Manual exceeds Three Million Dollars ($3,000,000.00). 509.4.2 Certificate of Need Criteria and Standards for the Acquisition or Otherwise Control of a Positron Emission Tomography Scanner and Related Equipment Including Cardiac-Only PET Scanner MSDH will review applications for a Certificate of Need for the acquisition or otherwise control of a PET scanner and related equipment under the applicable statutory requirements of Miss. Code Ann. §§ 41-7-173, 41-7-191, and 41-7-193. MSDH will also review applications for Certificate of Need according to the general review criteria listed in the Mississippi Certificate of Need Review Manual; all adopted rules, procedures, and plans of MSDH; and the specific criteria and standards listed below. The acquisition or otherwise control of a PET scanner and related equipment is reviewable if the equipment cost is in excess of $3,000,000.00 or if the equipment is relocated. The offering of PET services is reviewable if the proposed provider has not provided those services on a regular basis within the period of twelve (12) months prior to the time such services would be offered, regardless of the capital expenditure. Need Criterion 1: Minimum Procedures/Population A. The entity desiring to acquire or to otherwise control the PET scanner must project a minimum of 1,000 clinical procedures per year and must show the methodology used for

the projection. B. The applicant shall document a minimum population of 300,000 per PET scanner unit. The Office of Health Planning and Resource Development population projections shall be used. In the case of Cardiac only PET Scanner, this Criterion will not apply. Need Criterion 2: Business Registration The entity desiring to acquire or otherwise control the PET equipment must be a registered entity authorized to do business in Mississippi. Need Criterion 3: Approval of Additional PET Equipment MSDH will approve additional PET equipment in a service area with existing equipment only when it is demonstrated that the existing PET equipment in that service area is performing an average of 1,500 clinical procedures per PET unit per year (six clinical procedures per day x 250 working days per year). For purposes of this Criterion, PET and Cardiac-Only PET are to be evaluated separately. Need Criterion 4: Division of Radiological Health Approval The application shall affirm that the applicant shall receive approval from the Division of Radiological Health for the proposed site, plans, and equipment before service begins. Need Criterion 5: Data Requirements The applicant shall provide assurances that the following data regarding the PET equipment will be kept and made available to MSDH upon request: A. Total number of procedures performed; B. Total number of inpatient procedures (indicate type of procedure); C. Total number of outpatient procedures (indicate type of procedure); D. Average charge per specific procedure; E. Hours of operation of the PET unit; F. Days of operation per year; and G. Total revenue and expense for the PET unit for the year. Need Criterion 6: Fixed/Minimum Value Contracts The applicant shall provide a copy of the proposed contract and document that if the equipment is to be rented, leased, or otherwise used by other qualified providers on a contractual basis, no fixed/minimum volume contracts will be permitted.

Need Criterion 7: CON Approval/Exemption for PET Equipment Before the specified equipment can be utilized, the applicant desiring to provide the PET equipment shall have CON approval or written evidence that the equipment is exempt from CON approval as determined by MSDH through a Determination of Reviewability. Each specified piece of equipment must be exempt from or have CON approval. Need Criterion 8: Applicants with an Accredited Cancer Center Applicants seeking to acquire and operate a fixed PET scanner as part of a Cancer Center accredited by the Commission on Cancer, a program of the American College of Surgeons, shall be exempt from the requirements set forth in Need Criterion 1B (Minimum Procedures/Populations) and Need Criterion 3 (Approval of Additional PET Equipment). 509.4.3 Certificate of Need Criteria and Standards for the Offering of Fixed or Mobile Positron Emission Tomography Services Including Cardiac-Only PET Scanner The offering of Fixed or Mobile PET services is reviewable if the proposed provider has not provided those services on a regular basis within the period of twelve (12) months prior to the time such services would be offered. Need Criterion 1: Minimum Procedures The entity desiring to offer PET services must document that the equipment shall perform a minimum of 1,000 clinical procedures per year and must show the methodology used for the projection. Need Criterion 2: PET Equipment Utilized by Multiple Providers It is recognized that a particular PET unit may be utilized by more than one provider of PET services, some of which may be located outside of Mississippi. In such cases all existing or proposed providers of PET services utilizing the same PET unit must jointly meet the required service volume of 1,000 procedures annually. If the PET unit in question is presently utilized by other providers of PET services, the actual number of procedures performed by them during the most recent 12-month period may be used. Need Criterion 3: Quality Control and Environmental Requirements An applicant proposing to provide new or expanded PET services must include written assurances in the application that the service will be offered in a physical environment that conforms to federal standards, manufacturer’s specifications, and licensing agencies’ requirements. The following areas are to be addressed: A. Quality control and assurance of radiopharmaceutical production of generator or cyclotron- produced agents; B. Quality control and assurance of PET tomograph and associated instrumentation;

C. Radiation protection and shielding; and D. Radioactive emissions to the environment. Need Criterion 4: Division of Radiological Health Approval The application shall affirm that the applicant shall receive approval from the Division of Radiological Health for the proposed site, plans, and equipment before service begins. Need Criterion 5: Provision of On-Site Medical Cyclotron The applicant shall document provision of an on-site medical cyclotron for radionuclide production and a chemistry unit for labeling radiopharmaceuticals; or an on-site rubidium-82 generator; or access to a supply of cyclotron-produced radiopharmaceuticals from an off-site medical cyclotron and a radiopharmaceutical production facility within a two-hour air transport radius. Need Criterion 6: Staffing Requirements Applicants for PET shall document that the necessary qualified staff are available to operate the proposed unit. The applicant shall document the PET training and experience of the staff. The following minimum staff shall be available to the PET unit: A. If operating a fixed PET unit, one or more nuclear medicine imaging physician(s) available to the PET unit on a full-time basis (e.g., radiologist, nuclear cardiologist) who have been licensed by the state for the handling of medical radionuclides and whose primary responsibility for at least a one-year period prior to submission of the CON application has been in acquisition and interpretation of tomographic images. This individual shall have knowledge of PET through training, experience, or documented postgraduate education. The individual shall also have training with a functional PET facility. B. If operating a cyclotron on site, a qualified PET radiochemist or radiopharmacist personnel, available to the facility during PET service hours, with at least one year of training and experience in the synthesis of short-lived positron emitting radiopharmaceuticals. The individual(s) shall have experience in the testing of chemical, radiochemical, and radionuclidic purity of PET radiopharmaceutical syntheses. C. Qualified engineering and physics personnel, available to the facility during PET service hours, with training and experience in the operation and maintenance of the PET equipment. Engineering personnel are not required on-site for mobile PET units. D. Qualified radiation safety personnel, available to the facility at all times, with training and experience in the handling of short-lived positron emitting nuclides. If a medical cyclotron is operated on-site, personnel with expertise in radiopharmacy, radiochemistry, and medical physics would also be required. E. Certified nuclear medicine technologists with expertise in computed tomographic nuclear medicine imaging procedures, at a staff level consistent with the proposed center's expected

PET service volume. F. Other appropriate personnel shall be available during PET service hours which may include certified nuclear medicine technologists, computer programmers, nurses, and radio- chemistry technicians. Need Criterion 7: Management of Medical Emergencies The applicant shall demonstrate how medical emergencies within the PET unit will be managed in conformity with accepted medical practice. Need Criterion 8: Accommodating Referred Patients The applicant shall affirm that, in addition to accepting patients from participating institutions, facilities performing clinical PET procedures shall accept appropriate referrals from other local providers. These patients shall be accommodated to the extent possible by extending the hours of service and by prioritizing patients according to standards of need and appropriateness rather than source of referral. Need Criterion 9: Medical Necessity The applicant shall affirm that protocols will be established to ensure that all clinical PET procedures performed are medically necessary and cannot be performed as well by other, less expensive, established modalities. Need Criterion 10: Notification of Procedures Offered Applicants will be required to maintain current listings of appropriate PET procedures for use by referring physicians. Need Criterion 11: Data Requirements The applicant shall provide assurances that the following data regarding the PET service will be kept and made available to MSDH upon request: A. Total number of procedures performed; total number of inpatient procedures (indicate type of procedure); B. Total number of outpatient procedures (indicate type of procedure); C. Average charge per specific procedure; D. Hours of operation of the PET unit; E. Days of operation per year; and F. Total revenue and expense for the PET unit for the year.

Need Criterion 12: CON Approval/Exemption for PET Equipment Before the specified service can be provided, the applicant desiring to offer the PET service shall provide written evidence that the specified PET equipment provider has CON approval or written evidence that the equipment is exempt from CON approval as determined by MSDH through a determination of reviewability. Each specified piece of equipment must be exempt from or have CON approval. 510 Cardiac Catheterization Cardiac Catheterization is an integral part of cardiac evaluation and brings together two disciplines: Cardiac Catheterization (the evaluation of cardiac function) and angiography (x-ray demonstration of cardiac anatomy). Cardiac Catheterization includes various therapeutic interventions, including but not limited to, percutaneous coronary interventions (PCI), thrombolysis of coronary clots in evolving myocardial infarctions, electrical ablation of abnormal conduction pathways, and closure of patent ductus arteriosus in infants. Any facility performing diagnostic Cardiac Catheterizations without open-heart surgery capability must maintain formal referral agreements with a nearby facility to provide emergency cardiac services, including open-heart surgery. Such a facility must also delineate the steps it will take to ensure that high-risk patients are not catheterized in the facility. Additionally, a facility without open-heart surgery capability must document that more complex procedures, except for percutaneous coronary interventions (PCI) as provided herein, are not performed in the facility. Such procedures include, but are not limited to: transseptal puncture, transthoracic left ventricular puncture, myocardial biopsy, trans catheter aortic valve replacement (TAVR), and left atrial occlusion devices. Section 41-7-191(1)(d), Mississippi Code 1972, as amended, requires Certificate of Need review for the establishment and/or offering of Cardiac Catheterization services if the proposed provider has not offered such services on a regular basis within twelve (12) months prior to the time the services would be offered. Table 5-8 presents the utilization of cardiac catheterization services in Fiscal Years 2019 and 2020. 511 Certificate of Need Criteria and Standards for Cardiac Catheterization & Open- Heart Surgery Services Should the Mississippi State Department of Health receive a Certificate of Need application regarding the acquisition and/or otherwise control of major medical equipment or the provision of a service for which specific CON criteria and standards have not been adopted, the application shall be deferred until the Department of Health has developed and adopted CON criteria and standards. If the Department has not developed CON criteria and standards within 180 days of receiving a CON application, the application will be reviewed using the general CON review criteria and standards presented in the Mississippi Certificate of Need Review Manual and all adopted rules, procedures, and plans of the Mississippi State Department of Health. 511.1 Joint Policy Statement Regarding Certificate of Need Applications for the Acquisition or Otherwise Control of Cardiac Catheterization Equipment and/or the Offering of Cardiac Catheterization Services and/or the

Acquisition of Open-Heart Surgery Equipment and/or the Offering of Open-Heart Surgery Services Heart disease remains the leading cause of death in Mississippi. However, it should be noted that the State has seen a decrease in mortality rates in the last few years. From 2004 to 2013, the mortality rate for African American women decreased by 25% per 100,000 and the total mortality rate decreased by 19.6% per 100,000. Studies show that minorities have a higher cardiovascular death rate than whites and are less likely to receive cardiac catheterization and open-heart surgery services than are whites. The disproportionate impact on minorities' health status in general is recognized elsewhere in this State Health Plan. Innovative approaches to address these problems in the cardiac area are needed. It has been shown that statistical methods, such as population base and optimum capacity at existing providers, are not accurate indicators of the needs of the underserved, nor do they address the accessibility of existing programs to the underserved. The goal of these revisions to the State Health Plan is to improve access to cardiac care and to encourage the establishment of additional cardiac catheterization and open-heart surgery programs within the state that can serve the poor, minorities, and the rural population in greater numbers. MSDH also adopted a provision that it shall not consider utilization of equipment/services at any hospital owned and/or operated by the state or its agencies when reviewing CON applications. MSDH further adopted standards requiring an applicant to report information regarding catheterization and open-heart programs to monitor the provision of care to the medically underserved and the quality of that care. MSDH shall interpret and implement all standards in this Plan in recognition of the stated findings and so as to achieve the stated goal. 511.2 Policy Statement Regarding Certificate of Need Applications for the Acquisition or Otherwise Control of Cardiac Catheterization Equipment and/or the Offering of Cardiac Catheterization Services 1. Cardiac Catheterization Services: For purposes of the following CON criteria and standards the term “cardiac catheterization services” or “catheterization services” shall include three levels of cardiac catheterization services an applicant may provide: Diagnostic Cardiac Catheterization services, Percutaneous Coronary Intervention (PCI) services in a hospital without on-site cardiac surgery, or Therapeutic Cardiac Catheterization services. a. Diagnostic Cardiac Catheterization services are defined as, and refer to, cardiac catheterization services which are performed for the purpose of diagnosing, identifying, or evaluating cardiac related illness or disease. Diagnostic Cardiac Catheterization services include, but are not limited to, left heart catheterizations, right heart catheterizations, left ventricular angiography, coronary procedures, and other cardiac catheterization services of a diagnostic nature. b. Percutaneous Coronary Intervention (PCI) services in a hospital without on-site cardiac surgery are defined as, and refer to, those Therapeutic Cardiac Catheterization services involving primary and elective PCIs but not involving

transseptal puncture, transthoracic left ventricular puncture, myocardial biopsy, and any other procedure that is currently defined as a structural heart disease procedure. c. Therapeutic Cardiac Catheterization services are defined as, and refer to, cardiac catheterization services which are performed for the purpose of actively treating, as opposed to merely diagnosing, cardiac-related illness or disease. Therapeutic Cardiac Catheterization services include, but are not limited to, all PCIs (including primary and elective), transseptal puncture, transthoracic left ventricular puncture, myocardial biopsy, and any procedure that is currently defined as a structural heart disease procedure. 2. Open-Heart Surgery Capability: MSDH shall not approve CON applications for the establishment of Therapeutic Cardiac Catheterization services at any facility that does not have open-heart surgery capability (i.e. new Therapeutic Cardiac Catheterization services may not be established, and existing Therapeutic Cardiac Catheterization services may not be extended without approved and operational open-heart surgery services in place). This policy does not preclude approval of a Certificate of Need application proposing the concurrent establishment of both Therapeutic Cardiac Catheterization and open-heart surgery services. This policy also does not preclude approval of a Certificate of Need application to perform Percutaneous Coronary Intervention (PCI) services in a hospital without on-site cardiac surgery or in a Cardiac Ambulatory Surgical Facility as defined in Section 511.7. 3. Service Areas: The State has nine designated Cardiac Catheterization/Open-Heart Surgery Planning Areas (CC/OHSPAs) presented in the Open-Heart Surgery section of this chapter of the Plan. Map 5-2 shows the CC/OHSPAs. 4. Pediatric Cardiac Catheterization: Because the number of pediatric patients requiring study is relatively small, the provision of cardiac catheterization for neonates, infants, and young children shall be restricted to those facilities currently providing the service. National standards indicate that a minimum of 150 cardiac catheterization cases should be done per year and that catheterization of infants should not be performed in facilities which do not have active pediatric cardiac surgical programs. 5. Present Utilization of Cardiac Catheterization Equipment/Services: MSDH shall consider utilization of existing equipment/services and the presence of valid CONs for equipment/services within a given CC/OHSPA when reviewing CON applications. MSDH shall not consider utilization of equipment/services at any hospital owned and/or operated by the state or its agencies when reviewing CON applications. MSDH may collect and consider any additional information it deems essential, including information regarding access to care, to render a decision regarding any application. 6. Minimum Caseload: Applicants for a Diagnostic Cardiac Catheterization Certificate of Need must be able to project a caseload of at least 300 diagnostic catheterizations per year by the end of the third year of operation. Applicants for a Therapeutic Cardiac Catheterization Certificate of Need must be able to project a caseload of at least 450 catheterizations, diagnostic and therapeutic, per year by the end of the third year of

operation. Applicants for a Certificate of Need to provide PCI services in a hospital without on-site cardiac surgery must be able to project a caseload of at least 300 catheterizations, diagnostic and PCI, with at least 100 being PCIs, per year by the end of the third year of operation. 7. Residence of Medical Staff: Cardiac catheterizations must be under the control of and performed by personnel living and working within the specific hospital area. No site shall be approved for the provision of services by traveling teams. 8. Hospital-Based: All cardiac catheterizations and open-heart surgery services shall be located in acute care hospitals or in a Cardiac Ambulatory Surgical Facility, subject to the policy statements, and need criteria and standards set forth in Sections 511.3 and 511.4 of this Plan. 9. Conversion of Existing Therapeutic Cardiac Catheterization Services to PCI Services in a Hospital without On-Site Cardiac Surgery Capabilities: A hospital currently providing Therapeutic Cardiac Catheterization services may convert their cardiac catheterization program to provide PCI services in the hospital without on-site cardiac surgery capability without Certificate of Need review; provided, however, that the facility shall submit a Determination of Reviewability application prior to eliminating on-site cardiac surgery. The hospital must attest in the Determination of Reviewability application that it will meet the CON Criteria and Standards set out in Section 511.4 of this Plan. If the hospital goes twelve (12) consecutive months of providing PCI services without on-site cardiac surgery and wants to convert back to a Therapeutic Cardiac Catheterization program, the hospital must submit a Certificate of Need application for review. 511.3 Certificate of Need Criteria and Standards for the Acquisition or Otherwise Control of Cardiac Catheterization Equipment and/or the Offering of Cardiac Catheterization Services The Mississippi State Department of Health will review applications for a Certificate of Need for the acquisition or otherwise control of diagnostic cardiac catheterization equipment and/or the offering of diagnostic cardiac catheterization services under the applicable statutory requirements of Miss. Code Ann. §§ 41-7-173, 41-7-191, and 41-7-193. MSDH will also review applications for Certificate of Need according to the general criteria listed in the Mississippi Certificate of Need Review Manual; all adopted rules, procedures and plans of the Mississippi State Department of Health; and the specific criteria and standards listed below. The acquisition or otherwise control of diagnostic cardiac catheterization equipment is reviewable if the equipment costs exceed $3,000,000.00. The offering of diagnostic cardiac catheterization services is reviewable if the proposed provider has not provided those services on a regular basis within the period of twelve (12) months prior to the time such services would be offered, regardless of the capital expenditure.

Need Criterion 1: Minimum Procedures An applicant proposing the establishment of diagnostic cardiac catheterization services only shall demonstrate that the proposed equipment/service utilization will be a minimum of 300 diagnostic cardiac catheterizations per year by its third year of operation. Need Criterion 2: Staffing Standards The applicant shall document that it has, or can obtain, the ability to administer the proposed services, provide sufficiently trained and experienced professional staff, and evaluate the performance of the programs. Need Criterion 3: Recording and Maintenance of Data Applicants shall provide, as required under licensure standards, written assurance that they will record and maintain utilization data for diagnostic cardiac catheterization procedures (e.g., morbidity data, number of diagnostic cardiac catheterization procedures performed, and mortality data, all reported by race, sex, and payor status) and make such data available to the Mississippi State Department of Health annually. Need Criterion 4: Referral Agreement An applicant proposing the establishment of diagnostic cardiac catheterization services only shall document that a formal referral agreement with a facility for the provision of emergency cardiac services (including open-heart surgery) will be in place and operational at the time of the inception of cardiac catheterization services. Need Criterion 5: Patient Selection An applicant proposing to provide diagnostic cardiac catheterization services must (a) delineate the steps which will be taken to insure that high risk patients are not catheterized in the facility, and (b) certify that therapeutic cardiac catheterization services and/or PCI services in a hospital without on-site cardiac surgery will not be performed in the facility unless and until the applicant has received CON approval to provide said services. Need Criterion 6: Regulatory Approval Before utilizing or providing the equipment or service, the applicant desiring to provide the diagnostic cardiac catheterization equipment or service shall have CON approval or written evidence that the equipment or service is exempt from CON approval as determined by the Mississippi State Department of Health. Each specified piece of equipment must be exempt from or have CON approval.

##### **15 Miss. Admin. Code Pt. 8, R. 511.4** Rule 511.4 {#sec-8-511.4 omnilex-key=us-ms-regs-official--title-15--8#511.4}

Certificate of Need Criteria and Standards for the Acquisition or Other Control of Therapeutic Cardiac Catheterization Equipment for the Performance of PCI Services in a Hospital without On-Site Cardiac Surgery and/or the Offering of PCI Services in a Hospital without On-Site Cardiac Surgery The Mississippi State Department of Health will review applications for a Certificate of Need for the acquisition or otherwise control of Therapeutic Cardiac Catheterization equipment for the performance or offering of PCI services in a hospital without on-site cardiac surgery under the applicable statutory requirements of Miss. Code. Ann. §§ 41-7-173, 41-7-191, and 41-7-193. MSDH will also review applications for Certificate of Need according to the general criteria listed in the Mississippi Certificate of Need Review Manual; all adopted rules, procedures and plans of MSDH; and the specific criteria and standards listed below. The acquisition or otherwise control of Therapeutic Cardiac Catheterization equipment for the performance of PCI services in a hospital without on-site cardiac surgery is reviewable if the equipment costs exceed $3,000,000.00. The offering of PCI services in a hospital without on-site cardiac surgery is reviewable if the proposed provider has not provided those services on a regular basis within the period of twelve (12) months prior to the time such services would be offered, regardless of the capital expenditure. Need Criterion 1: Minimum Procedures An applicant proposing the establishment of PCI services in a hospital without on-site cardiac surgery shall demonstrate that the proposed equipment/service utilization will be a minimum of 300 cardiac catheterizations, both diagnostic and PCI, with at least 100 being total PCIs, per year by its third year of operation. Applicants must certify they will submit volume data to demonstrate and verify the utilization of the service at a minimum of every three (3) years. Need Criterion 2: Staffing Requirements The applicant shall document that it has, or can obtain, the ability to administer the proposed services, provide sufficiently trained and experienced professional staff, and evaluate the performance of the programs. Need Criterion 3: Staff Residency The applicant shall certify that medical staff performing PCI procedures shall be onsite within thirty (30) minutes. Need Criterion 4: Recording and Maintenance of Data In addition to the certification in Need Criterion 1, applicants shall provide, as required under licensure standards, written assurance that they will record and maintain separate utilization data for diagnostic and PCI catheterization procedures (e.g., morbidity data, number of diagnostic cardiac catheterization and PCI procedures performed and mortality data, all reported by race, sex and payor status) and make that data available to the Mississippi State Department of Health annually.

Need Criterion 5: Open-Heart Surgery An applicant proposing the establishment of PCI services without on-site cardiac surgery shall: A. Document that Open-Heart Surgery services will be available through a formal emergency transfer agreement to a hospital providing open heart surgery. Such transfer must be done at a minimum of less than 120 minutes to accomplish transfer from the onset of PCI complications to cardiopulmonary bypass. Transporting of the patient to the receiving hospital must include the capability to provide an intra-aortic balloon pump (IABP). B. Programs must project and annually perform a minimum of 100 total PCIs per year to include at a minimum twelve (12) primary PCIs per year by the end of the third year of operation. New programs should have three years to reach the absolute minimum volume, but after that, programs failing to reach this volume for two consecutive years should not remain open. MSDH has the discretion under a finding of rare or unique circumstances to grant an exception to the above based on a finding of need of access and quality of care by the program. C. Certify that the proposed primary operators for the service have a lifetime experience of greater than 150 total PCIs with acceptable outcomes as primary operators after completing a cardiology fellowship. Successful completion of an Interventional Cardiology fellowship is considered adequate certification. D. New and Existing Programs must actively participate in the STEMI (“ST”-Segment Elevation Myocardial Infarction) Network, including, but not limited to, the submission of data to the STEMI databank. E. At the present time, there is no justification for a PCI program without on-site surgery to perform only elective procedures or not provide availability to primary PCI 24 hours/365 days per year. The Mississippi State Department of Health has the discretion under a finding of rare or unique circumstances to grant exception to the above based on a finding of need of access and quality of care by the program. F. Certify that the applicant will provide educational programs to underserved patient populations (low income, racial and ethnic minorities, women, Medicaid eligible, and handicapped persons) with the goal of decreasing cardiac mortality rates in such populations. G. Certify that the applicant will provide a reasonable amount of charity care. H. Certify that the applicant will hold monthly multi-disciplinary meetings to evaluate patient outcomes, review quality improvement data, and to identify and implement solutions for any operational issues. I. Certify that the following guideline from the Society of Cardiovascular Angiography and Interventions (SCAI)-ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention or such sections’ update(s), if applicable, at the time of filing the certificate of need application will be met:

1. Certify the applicant will have available in the catheterization lab the equipment in Section 4.1.1 entitled “Equipment” and that such will be routinely tested; 2. Certify the availability of adequate staff in the catheterization lab as set forth in Section 4.1.2 entitled “Staffing” and that such staff will be certified on both basic life support and advanced cardiovascular life support; 3. Certify that “time-out” procedures will be implemented as discussed in Section 4.1.3 entitled “‘Time-Out’ Procedures”; and 4. Certify that the applicant will operate a quality improvement program and participate in a national PCI registry as discussed in Section 7.1 entitled “Quality Performance: Recommendations”. Need Criterion 6: Applicants for PCI Services in a Hospital without On-Site Cardiac Surgery Capabilities Currently Providing Diagnostic Catheterization Services In addition to Need Criteria 1-5, an applicant proposing the establishment of PCI services in a hospital without Open-Heart Surgery capabilities, who is already an existing provider of diagnostic catheterization services, shall demonstrate that its diagnostic cardiac catheterization unit has been utilized for a minimum of 300 procedures per year for the two most recent years as reflected in the data supplied to and/or verified by the Mississippi State Department of Health or that its primary operators for the service have a life-time experience of greater than 250 total procedures (including both diagnostic catheterizations and PCIs) with acceptable outcomes after completing a cardiology fellowship. Successful completion of an Interventional Cardiology fellowship is considered adequate certification. Need Criterion 7: Regulatory Approval Before utilizing or providing the equipment or service, the applicant desiring to provide the Cardiac Catheterization equipment or service shall have CON approval or written evidence that the equipment or service is exempt from CON approval as determined by the Mississippi State Department of Health through a Determination of Reviewability. Each specified piece of equipment must be exempt from or have CON approval. 511.5 Certificate of Need Criteria and Standards for the Acquisition or Otherwise Control of Therapeutic Cardiac Catheterization Equipment and/or the Offering of Therapeutic Cardiac Catheterization Services The Mississippi State Department of Health will review applications for a Certificate of Need for the acquisition or otherwise control of therapeutic cardiac catheterization equipment and/or the offering of therapeutic cardiac catheterization services under the applicable statutory requirements of Miss. Code Ann. §§ 41- 7-173, 41-7-191, and 41-7-193. MSDH will also review applications for Certificate of Need according to the general criteria listed in the Mississippi Certificate of Need Review Manual; all adopted rules, procedures and plans of MSDH; and the specific criteria and standards listed below.

The acquisition or otherwise control of therapeutic cardiac catheterization equipment is reviewable if the equipment costs exceed $3,000,000.00. The offering of therapeutic cardiac catheterization services is reviewable if the proposed provider has not provided those services on a regular basis within the period of twelve (12) months prior to the time such services would be offered. Need Criterion 1: Minimum Procedures An applicant proposing the establishment of therapeutic cardiac catheterization services shall demonstrate that the proposed equipment/service utilization will be a minimum of 450 cardiac catheterizations, both diagnostic and therapeutic, of which at least 100 should be PCIs, per year by its third year of operation. Need Criterion 2: Staffing Standards The applicant shall document that it has, or can obtain, the ability to administer the proposed services, provide sufficiently trained and experienced professional staff, and evaluate the performance of the programs. Need Criterion 3: Staff Residency The applicant shall certify that medical staff performing therapeutic cardiac catheterization procedures shall be onsite within thirty (30) minutes. Need Criterion 4: Recording and Maintenance of Data Applicants shall provide, as required under licensure standards, written assurance that they will record and maintain separate utilization data for diagnostic and therapeutic cardiac catheterization procedures (e.g., morbidity data, number of diagnostic and therapeutic cardiac catheterization procedures performed and mortality data, all reported by race, sex and payor status) and make that data available to the Mississippi State Department of Health annually. Need Criterion 5: Open-Heart Surgery An applicant proposing the establishment of therapeutic cardiac catheterization services shall document that Open-Heart Surgery services are available or will be available on-site where the proposed therapeutic Cardiac Catheterization services are to be offered before such procedures are performed. Need Criterion 6: Regulatory Approval Before utilizing or providing the equipment or service, the applicant desiring to provide the cardiac catheterization equipment or service shall have CON approval or written evidence that the equipment or service is exempt from CON approval as determined by the Mississippi State Department of Health. Each specified piece of equipment must be exempt from or have CON approval.

Need Criterion 7: Applicants for Therapeutic Cardiac Catheterization Currently Providing Diagnostic Catheterization Services or PCI Services in a Hospital without On-Site Cardiac Surgery In additional to Need Criteria 1-6, an applicant proposing the establishment of therapeutic cardiac catheterization services, who is already an existing provider of diagnostic catheterization services and/or PCI services in a hospital without on-site cardiac surgery, shall demonstrate that it has provided a minimum of 300 procedures (including both diagnostic catheterizations and PCIs) per year for the two most recent years as reflected in the data supplied to and/or verified by the Mississippi State Department of Health. 511.6 Policy Statement Regarding Certificate of Need Applications for the Establishment of Cardiac Ambulatory Surgical Facilities 1. Definitions: For purposes of this Policy Statement and the Certificate of Need Criteria and Standards for the Establishment of Cardiac Ambulatory Surgical Facilities, the following definitions shall apply. a. “Cardiac Ambulatory Surgical Facility (CASF)” means an ambulatory surgical facility which is established and operated for the purpose of providing Cardiac Catheterization procedures. A JV-CASF (as defined below) is a type of CASF. b. “Joint Venture Cardiac Ambulatory Surgical Facility (JV-CASF)” means a CASF which is jointly owned by (i) an acute care hospital which offers Cardiac Catheterization services and PCI services, and (ii) one or more cardiologists who are licensed to practice medicine by the Mississippi State Board of Medical Licensure, or a group practice comprised of such cardiologists. 2. Offering of Cardiac Catheterization Services: Cardiac Catheterization services may be performed only in (a) an acute care hospital, (b) a hospital-owned CASF, or (c) JV-CASF. Exception: MSDH may consider an application for a CASF which does not have hospital ownership if the applicant obtains and provides MSDH a written letter of support for the proposed project from all acute care hospitals which offer Cardiac Catheterization services and/or PCI services and are located within a 25-mile radius of the proposed facility. A CASF must maintain appropriate third-party accreditation. A CASF must be located within twenty-five (25) miles of an acute care hospital that provides Cardiac Catheterization services and PCI services. In order to encourage local ownership and operation of joint ventures and CASFs, a CASF with hospital ownership must be located within a 25-mile radius of the main campus of the acute care hospital that has an ownership interest in the JV-CASF and/or the hospital-owned CASF. 3. Types of Procedures: A CASF or JV-CASF may perform only those Cardiac Catheterization procedures which have been approved by the federal Centers for Medicare and Medicaid Services (CMS) for Medicare payment in an ambulatory surgical center. Primary (i.e. acute infarct) PCIs shall not be performed in a CASF. A PCI-only hospital may perform any procedure that is allowed in a CASF or JV-CASF. 4. Multispecialty and Single-Specialty Ambulatory Surgical Facilities: Cardiac

Catheterization procedures may be performed in a multispecialty ambulatory surgical facility, or in a single-specialty ambulatory surgical facility if they meet the need criteria and standards for the establishment of a CASF (as set forth in Policy Statement 2). The multispecialty ambulatory surgical facility or single-specialty ambulatory surgical facility which proposes to offer Cardiac Catheterization services, and which does not have hospital ownership must be located within twenty-five (25) miles of an acute care hospital that provides Cardiac Catheterization services and PCI services. MSDH may consider an application to offer Cardiac Catheterization services by a multispecialty ambulatory surgical facility or a single-specialty ambulatory surgical facility which does not have hospital ownership if the applicant obtains and provides MSDH a written letter of support for the proposed project from all hospitals which offer Cardiac Catheterization services and PCI services and are located within a 25-mile radius of the proposed project. 5. CON-Exempt Single-Specialty CASFs Prohibited: MSDH shall not approve any Determination of Reviewability that exempts a single-specialty cardiac ambulatory surgical facility from Certificate of Need review. All single-specialty CASFs must obtain a Certificate of Need from the MSDH prior to the commencement of operations or services. 6. Application of Policy Statement: In reviewing CON applications for the establishment of a CASF, MSDH shall apply the policies set forth in Section 511.2 of this Plan (Policy Statement Regarding Certificate of Need Applications for the Acquisition or Otherwise Control of Cardiac Catheterization Equipment and/or the Offering of Cardiac Catheterization Services). 511.7 Certificate of Need Criteria and Standards for the Establishment of Cardiac Ambulatory Surgical Facilities The Mississippi State Department of Health will review applications for a Certificate of Need for the establishment of Cardiac Ambulatory Surgical Facilities (CASFs and JV-CASFs) under the applicable statutory requirements of Miss. Code Ann. §§ 41-7-173, 41-7-191, and 41-7-193, MSDH will also review applications for Certificate of Need according to the general criteria listed in the Mississippi Certificate of Need Review Manual; all adopted rules, procedures and plans of MSDH; and the specific criteria and standards listed below. Need Criterion 1: Minimum Procedures An applicant proposing the establishment of a CASF shall demonstrate that the proposed service utilization will be a minimum of 300 Cardiac Catheterization procedures, diagnostic and therapeutic, per year, by the third year of operation. Applicants must certify they will submit volume data to demonstrate and verify the utilization of the service at a minimum of every three (3) years. Need Criterion 2: Minimum Population The applicant must document that the proposed Cardiac Catheterization/Open-Heart Surgery Planning Area (Map 5-2) has a population base of at least 60,000 within thirty (30) minutes travel time of the facility.

Need Criterion 3: Minimum Number of Procedure Rooms All CASFs shall establish and have available for service no fewer than two (2) procedure rooms used exclusively for Cardiac Catheterization and PCI services. Need Criterion 4: Financial Feasibility The applicant must provide documentation that the CASF will be economically viable within two (2) years of commencement of services. Need Criterion 5: Letters of Support The applicant must show support from the cardiologists who will be expected to utilize the CASF. Need Criterion 6: Staffing Standards The applicant shall document that it has, or can obtain, the ability to administer the proposed services, provide sufficiently trained and experienced professional staff, and evaluate the performance of the programs. The applicant shall also certify that all cardiologists and providers who perform Cardiac Catheterization and/or PCI procedures in the CASF will maintain active medical staff and clinical privileges at an acute care hospital with which the facility has a formal emergency transfer agreement (as required by Need Criterion 8). Need Criterion 7: Recording and Maintenance of Data In addition to the certification in Need Criterion 1, applicants shall provide, as required under licensure standards, written assurance that they will record and maintain separate utilization data for diagnostic Cardiac Catheterization and PCI procedures (e.g., morbidity data, number of diagnostic Cardiac Catheterization and PCI procedures performed and mortality data, all reported by race, sex and payor status) and make that data available to the Mississippi State Department of Health annually. Need Criterion 8: Service Specific An applicant proposing the establishment of a CASF shall: A. Document that Open-Heart Surgery services will be available through a formal emergency transfer agreement to a hospital providing open heart surgery. Such transfer must be done at a minimum of less than 120 minutes to accomplish transfer from the onset of PCI complications to cardiopulmonary bypass. Transporting of the patient to the receiving hospital must include the capability to provide a ventricular support devise, such as an intra-aortic balloon pump (IABP), or an Impella. B. Certify that the proposed primary operators performing PCI’s have a lifetime experience of greater than 150 total PCIs with acceptable outcomes as primary operators after completing a cardiology fellowship. Successful completion of an Interventional Cardiology fellowship is considered adequate certification.

C. The CASF shall participate in and submit quality data to the appropriate Cardiac Catheterization registries. D. Certify that the applicant will hold quarterly multi-disciplinary meetings to evaluate patient outcomes, review quality improvement data, and to identify and implement solutions for any operational issues. E. Certify that the following guideline from the Society of Cardiovascular Angiography and Interventions (SCAI)-ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention or such sections’ update(s), if applicable, at the time of filing the certificate of need application will be met: 1. Certify the applicant will have available in the catheterization lab the equipment in Section 4.1.1 entitled “Equipment” and that such will be routinely tested; 2. Certify the availability of adequate staff in the catheterization lab as set forth in Section 4.1.2 entitled “Staffing” and that such staff will be certified on both basic life support and advanced cardiovascular life support; 3. Certify that “time-out” procedures will be implemented as discussed in Section 4.1.3 entitled “‘Time-Out’ Procedures”; and 4. Certify that the applicant will operate a quality improvement program and participate in a national PCI registry as discussed in Section 7.1 entitled “Quality Performance: Recommendations”. Need Criterion 9: Medicaid Participation All CASFs shall participate in the Mississippi Medicaid program. Need Criterion 10: Indigent/Charity Care The applicant shall certify that the CASF will provide care to Medicaid patients. Also, the applicant shall certify that the CASF will provide indigent/charity care, including care to underinsured patients, of no less than five percent (5%) of the total volume of procedures performed at the CASF. Each approved facility shall report the total volume of indigent/charity care to the Office of Health Planning and Resource Development annually and shall publish their indigent/charity care policy to their facility website. Need Criterion 11: Regulatory Approval Before utilizing the equipment or providing the service, the applicant desiring to establish a CASF shall have CON approval or written evidence that the equipment or service is exempt from CON approval as determined by the Mississippi State Department of Health through a Determination of Reviewability. Each specified piece of equipment must be exempt from or have CON approval.

##### **15 Miss. Admin. Code Pt. 8, R. 512** Rule 512 {#sec-8-512 omnilex-key=us-ms-regs-official--title-15--8#512}

Open-Hear Surgery Open-Heart Surgery, defined as any surgical procedure in which a heart-lung machine is used to maintain cardiopulmonary functioning, involves a few procedures, including valve replacement, repair of cardiac defects, coronary bypass, heart transplantation, and artificial heart implant. Mississippi Code Ann. § 41-7-191(1)(d), requires Certificate of Need review for the establishment and/or offering of Open-Heart Surgery services if the proposed provider has not offered such services on a regular basis within twelve (12) months prior to the time the services would be offered. Table 5-9 presents the utilization of existing facilities. Map 5-2 in the Open-Heart Surgery criteria and standards section shows the Cardiac Catheterization/Open-Heart Surgery Planning Areas (CC/OHSPAs) and the location of existing services. 512.1 Policy Statement Regarding Certificate of Need Applications for the Acquisition of Open-Heart Surgery Equipment and/or the Offering of Open-Heart Surgery Services 1. Service Areas: The need for Open-Heart Surgery equipment/services shall be determined using the nine designated Cardiac Catheterization/Open-Heart Surgery Planning Areas (CC/OHSPAs) presented in this chapter of the Plan. Map 5-2 shows the CC/OHSPAs. 2. CC/OHSPA Need Determination: The need for Open-Heart Surgery equipment/services within a given CC/OHSPA shall be determined independently of all other CC/OHSPAs. 3. Pediatric Open-Heart Surgery: Because the number of pediatric patients requiring open- heart surgery is relatively small, the provision of open-heart surgery for neonates, infants, and young children shall be restricted to those facilities currently providing the service. 4. Present Utilization of Open-Heart Surgery Equipment/Services: MSDH shall consider utilization of existing Open-Heart Surgery equipment/ services and the presence of valid CONs for Open-Heart Surgery equipment/services within a given CC/OHSPA when reviewing CON applications. MSDH shall not consider utilization of equipment/services at any hospital owned and/or operated by the state or its agencies when reviewing CON applications. MSDH may collect and consider any additional information it deems essential, including information regarding access to care, to render a decision regarding any application. 5. CON Application Analysis: At its discretion, MSDH may use market share analysis and other methodologies in the analysis of a CON application for the acquisition or otherwise control of open-heart surgery equipment and/or the offering of open-heart surgery services. The Department shall not rely upon market share analysis or other statistical evaluations if they are found inadequate to address access to care concerns. 6. Minimum CC/OHSPA Population: A minimum population base of 100,000 in a CC/OHSPA (as projected by the Office of Health Planning and Resource Development) is required before such equipment/services may be considered. The total population within a

given CC/OHSPA shall be used when determining the need for services. Population outside an applicant’s CC/OHSPA will be considered in determining need only when the applicant submits adequate documentation acceptable to MSDH, such as valid patient origin studies. 7. Minimum Caseload: Applicants proposing to offer adult Open-Heart Surgery services must be able to project a caseload of at least 150 open-heart surgeries per year. 8. Residence of Medical Staff: Open-Heart Surgery must be under the control of and performed by personnel living and working within the specific hospital area. No site shall be approved for the provision of services by traveling teams. 9. Review Threshold: Notwithstanding any prior language in this section, and pursuant to House Bill 3 from the 2026 Legislative Session (effective February 4, 2026), Certificate of Need review for the acquisition or otherwise control of equipment for the provision of Open-Heart Surgery services is required only if the total acquisition cost as defined in the CON Review Manual exceeds Three Million Dollars ($3,000,000.00). 512.2 Certificate of Need Criteria and Standards for the Acquisition or Otherwise Control of Open-Heart Surgery Equipment and/or the Offering of Open-Heart Surgery Services MSDH will review applications for a CON for the acquisition or otherwise control of open-heart surgery equipment and/or the offering of open-heart surgery services under the applicable statutory requirements of Sections 41-7-173, 41-7-191, and 41-7-193, Mississippi Code 1972, as amended. MSDH will also review applications for Certificate of Need according to the general criteria listed in the Mississippi Certificate of Need Review Manual; all adopted rules, procedures and plans of MSDH; and the specific criteria and standards listed below. The acquisition or otherwise control of open-heart surgery equipment is reviewable if the equipment cost more than $3,000,000.00. The offering of open-heart surgery services is reviewable if the proposed provider has not provided those services on a regular basis within twelve (12) months prior to the time such services would be offered, regardless of the capital expenditure. Need Criterion 1: Minimum Population The applicant shall document a minimum population base of 100,000 in the CC/OHSPA where the proposed open-heart surgery equipment/service is to be located. Division of Health Planning and Resource Development population projections shall be used. Need Criterion 2: Minimum Procedures The applicant shall demonstrate that it will perform a minimum of 150 open-heart surgeries per year by its third year of operation. Need Criterion 3: Impact on Existing Providers An applicant proposing to acquire or otherwise control open-heart surgery equipment and/or offer open-heart surgery services shall document that each facility offering open-heart surgery services

which is (a) in the CC/OHSPA and (b) within forty-five (45) miles of the applicant, has performed a minimum of 150 procedures per year for the two most recent years as reflected in data supplied to and/or verified by MSDH. No hospital owned and/or operated by the state or its agencies shall be considered an existing unit in the CC/OHSPA under this section. MSDH may collect and consider any additional information it deems essential, including information regarding access to care, to render a decision regarding any application. Need Criterion 4: Staffing Requirements The applicant shall document that it has, or can obtain, the ability to administer the proposed services, provide sufficiently trained and experienced professional staff, and evaluate the performance of the programs. MSDH staff shall use guidelines presented in Optimal Resources for Examination of the Heart and Lungs: Cardiac Catheterization and Radiographic Facilities, published under the auspices of the Inter-Society Commission for Heart Disease Resources, and Guidelines and Indications for Coronary Artery Bypass Graft Surgery: A Report of the American College of Cardiology/American Heart Association Task Force on Assessment of Diagnostic and Therapeutic Cardiovascular Procedures (Subcommittee on Coronary Artery Bypass Graft Surgery), published under the auspices of the American College of Cardiology, as resource materials when reviewing these items in an application. Need Criterion 5: Staff Residency The applicant shall certify that medical staff performing open-heart surgery procedures shall reside within forty-five (45) minutes normal driving time of the facility. The applicant shall document that proposed open-heart surgery procedures shall not be performed by traveling teams. Need Criterion 6: Data Requirements Applicants shall provide, as required under licensure standards, written assurance that they will record and maintain utilization data for open-heart surgeries (e.g., morbidity data, number of open- heart surgeries performed and mortality data, all reported by race, sex, and payor status) and make such data available to MSDH annually. Need Criterion 7: CON Approval/Exemption for Open-Heart Surgery Equipment/Service Before utilizing or providing the equipment or service, the applicant desiring to provide the open- heart surgery equipment or service shall have CON approval or written evidence that the equipment or service is exempt from CON approval as determined by MSDH through a determination of reviewability. Each specified piece of equipment must be exempt from or have CON approval. 513 Systems of Care There are three systems of care: the Trauma Care System, the ST-Elevation Myocardial Infarction (STEMI) System, and the Stroke System. Mississippi is one of only six states that has multiple acute systems of care and is the only state that has statewide systems for trauma, STEMI, and stroke.

Each system of care has five key components: an organizational structure, protocols for the transport and transfer of patients, an advisory group process, a performance/quality improvement process, and a data collection system. These components work together to accomplish the ultimate goal of the systems – to deliver the right patient to the right hospital the first time, an approach shown to improve outcomes. 514 Emergency Medical Services In Mississippi, the Emergency Medical Services (EMS) system is extraordinary in that ninety-nine percent (99%) of the state’s population is covered by paramedic level agencies. EMS provides services not only to certified pre-hospital personnel but also provides the highest standards of pre- hospital healthcare to the citizens and visitors of Mississippi ensuring patients are delivered to the right hospital the first time. 514.1 Organization The Emergency Medical Services Act of 1973 (Miss. Code Ann. § 63-13-11) establishes standards for the organization of emergency services. Prior to 1974, government involvement in emergency medical services was primarily limited to providing an emergency department in the public hospital. Private operators, predominantly funeral homes, provided emergency transportation. Within MSDH, the Bureau of Emergency Medical Services organizes, regulates, and maintains a statewide program to improve emergency medical care. Further, it coordinates agency resources in “all-hazard” planning and in response to disasters. This includes incidents involving weapons of mass destruction as well as natural disasters, from hurricanes on the coast to ice storms in the Delta. EMS Services are typically provided in response to a medical emergency reported through the 9- 1-1 system. A 9-1-1 call placed from any telephone is automatically routed to the appropriate designated Public Safety Answering Point (PSAP). Once the call is received, the nature of the medical emergency is determined, the call is prioritized, appropriate personnel and equipment are dispatched, and pre-arrival instructions are given if appropriate. The dispatcher may ask a few questions to help assess the nature and severity of the injury or illness. At times the dispatcher may give the caller specific patient care instructions to maximize the success of the injury or illness outcome. 514.2 Protocols When EMS professionals are called, the injured or ill person is often transported to the hospital in an ambulance. EMS professionals work under protocols approved by physicians designated as Offline Medical Control. The physician oversees the care of patients in EMS systems and is knowledgeable about out-of-hospital patient care interventions and delivery systems. Typically, the physicians work in conjunction with local EMS managers to assure quality patient care. EMS may be provided by a fire department, a private ambulance service, a county or government-based service, a hospital-based service, or a combination of the above. EMS professionals may be paid or serve as volunteers in the community.

##### **15 Miss. Admin. Code Pt. 8, R. 514.3** Rule 514.3 {#sec-8-514.3 omnilex-key=us-ms-regs-official--title-15--8#514.3}

Advisory Council In accordance with Miss. Code Ann. § 41-59-7, the Emergency Medical Services Advisory Council (EMSAC) was created, with membership appointed by the Governor. 514.4 Performance Improvement The Medical Directors’ Training and Quality Assurance (MDTQA) Committee provides performance improvement review of the EMS system and develops model protocols for adoption by EMS services. The committee is chaired by the State EMS Medical Director, a board-certified emergency physician, and membership includes physicians who provide medical control to EMS services, and EMS practitioners. 514.5 Data System The Mississippi EMS Information System (MEMSIS) uses a web-based system hosted by ImageTrend. The ImageTrend EMS State Bridge is a pre-hospital emergency data collection, analysis, and reporting system. EMS State Bridge integrates information across the entire emergency medical community, whether in the ambulance, the local station, or state offices. With the EMS State Bridge, ambulance services can satisfy reporting requirements easily, without major investment and without learning complex new technology. The system provides for: • Data collection based upon the NHTSA V2.2.1 data set. Data will be migrated to the NHTSA V3.4 data set in FY2018. • The aggregation of information from various units and services with the possibility of sharing secured data with other systems and agencies. • Electronic transport of information to improve communications. • Standard and ad hoc reporting for using data to support evidence-based practices. • Easy expansion through its open architecture as needs grow and evolve. • Scalability to conform to the needs of small, medium and large services as required. Additionally, the system is HIPAA compliant and sensitive to medical data security issues. The application meets and exceeds state and federal data privacy requirements. 515 Mississippi Trauma Care System Trauma is the leading cause of death for all age groups in Mississippi from birth to age forty-four (44). Serious injury and death resulting from trauma events such as vehicle crashes, falls, and firearms claim 500 lives and disable 6,000 Mississippians each year. Trauma victims require immediate, expert attention.

##### **15 Miss. Admin. Code Pt. 8, R. 515.1** Rule 515.1 {#sec-8-515.1 omnilex-key=us-ms-regs-official--title-15--8#515.1}

Organization Mississippi Code Ann. § 41-59-5 (5) establishes MSDH as the lead agency to develop a uniform, non- fragmented, inclusive statewide Trauma Care System, that provides excellent patient care. Through the State Trauma Plan, MSDH has designated seven trauma care regions; each incorporated as a 501c-3 organization which contracts with MSDH to administer the plan within their respective region. The State Trauma Plan includes the seven regional plans, allows for transfer protocols between trauma facilities, and for trauma patients to be transported to the “most appropriate” trauma facility for their injuries. To increase participation in the Trauma Care System, the Mississippi Legislature enacted legislation (House Bill 1405) in 2008, which required MSDH to develop regulations mandating all licensed acute-care facilities participate in the Mississippi Trauma Care System (“Play or Pay”). Hospitals must participate at a level commensurate with their capabilities or pay a non- participation fee to the Trauma Care Trust Fund. Each hospital’s capability to participate in the Trauma Care System is reviewed annually by their respective Trauma Care Region and MSDH, which determines the appropriate level of participation and any associated fee. Trauma facility designation levels set specific criteria and standards of care that guide hospital and emergency personnel in determining the level of care a trauma victim needs and whether that hospital can care for the patient or transfer the patient to a trauma center that can administer more definitive care. Level I Trauma Centers must have a full range of trauma capabilities, including an emergency department, a full-service surgical suite, intensive care unit, and diagnostic imaging. Level I centers must have a surgical residency program, ongoing trauma research, and provide 24-hour trauma service. These hospitals provide a variety of other services to comprehensively care for both trauma patients. Level I Trauma Centers act as referral facilities for Level II, III, and IV Trauma Centers. The University of Mississippi Medical Center (UMMC) in Jackson is the only Level I facility in the state. Two Level I Trauma Centers border the northern and southeastern part of the state and are in Tennessee and Alabama. Additionally, a “stand-alone” Tertiary Pediatric Trauma Center located in Tennessee participates in the system. Level II Trauma Centers must be able to provide comprehensive care to the severely injured patient. These facilities must have a full range of trauma capabilities, including an emergency department, a full-service surgical suite, an intensive care unit, and diagnostic imaging. Level II Trauma Centers act as referral facilities for Level III and IV Trauma Centers. Level III Trauma Centers must offer general/trauma surgery and orthopedic surgery and have the ability to manage the initial care of multi-system trauma patients. Transfer protocols must be in place with Level I and II Trauma Centers for patients that exceed the Level III Trauma Center’s resources. Level IV Trauma Centers provide initial evaluation and assessment of injured patients. Most patients will require transfer to facilities with more resources dedicated to providing optimal care for the injured patients. Level IV Trauma Centers must have transfer protocols in place with Level I, II, and III Trauma Centers.

##### **15 Miss. Admin. Code Pt. 8, R. 515.2** Rule 515.2 {#sec-8-515.2 omnilex-key=us-ms-regs-official--title-15--8#515.2}

Protocols The Trauma Care System has developed uniform trauma activation criteria for all hospitals participating in the system to ensure that patients receive appropriate care, regardless of locale. EMS Field Destination Guidelines, based on the Center for Disease Control (CDC) Field Triage Decision Scheme, provide for the transport of trauma patients to the most appropriate facility. The approved Trauma Activation Criteria, based on the publication Resources for Optimal Care of the Injured Patient, provide the criteria used by trauma center staff for trauma team activation. 515.3 Advisory Committee In accordance with Miss. Code Ann. § 41-59-7, the Mississippi Trauma Advisory Committee (MTAC) was created as a committee of the Emergency Medical Services Advisory Council (EMSAC). This committee is comprised of members of EMSAC, appointed by the Governor. The committee acts as the advisory body for trauma care system development and provides technical support to MSDH in all areas of trauma care system design, trauma standards, data collection and evaluation, continuous quality improvement, trauma care system funding, and evaluation of the trauma care system and trauma care programs. 515.4 Performance Improvement A systems approach to trauma care provides the best means to protect the public from pre-mature death and prolonged disability. The development of a statewide system of care for the injured must include a mechanism to monitor, measure, assess, and improve the processes and outcome of care. The process must be a continuous, multidisciplinary effort to reduce inappropriate variation in the care of trauma patients and improve the effectiveness of the system and its components, including pre-hospital care (communication, dispatch, medical control, triage, and transport), hospital care, inter-facility management, rehabilitative care, and mass casualty disaster response. Statewide Performance Improvement (PI) consists of multiple layers of continuous monitoring and evaluation of treatment processes to identify opportunities to optimize care and improve outcomes. The continuous cycle of evaluation extends from the PI programs of EMS providers and hospitals to review committees established at the regional and state levels. The State Trauma PI Committee is appointed by the MSDH Director of Health Protection. The committee is independent from MTAC and EMSAC. The PI Committee is chaired by the state Trauma System of Care Medical Director. Membership shall include, but may not be limited to, representatives from the following areas: • Emergency Medicine • State EMS PI Committee • Trauma Registry Committee • One representative from each Trauma Care Region • Nursing representative from each Trauma Center level

• Tertiary Pediatric Trauma Center • Trauma Medical Directors from each Level I Trauma Center. The PI Committee establishes specific statewide performance measures. Subject Matter Experts (SME) participate in committee activities appropriate to their expertise. MSDH Division of Trauma provides administrative support to the PI Committee and all meetings of the Committee, PI Committee meetings are by invitation only and are not open to the public. 515.5 Data System There are four objectives of the trauma registry: performance improvement, enhanced hospital operations, injury prevention, and medical research. In July 2006, MSDH deployed "Collector" Trauma Registry software to all hospitals that participated in the Mississippi Trauma Care System. Today, every Mississippi licensed acute care facility (hospital) having an organized emergency service or department uses the Collector software to submit their data to the State Trauma Registry. Collector is a trauma registry system that helps users meet changing requirements of collection and evaluation of trauma data for quality assurance, accreditation, management, prevention, and research. Collector is a complete data management and report generating package which includes a user-friendly data entry and verification system, querying capabilities and integration with expert coding software. Collector offers coding, database, and analysis capabilities. In addition to its use as the trauma registry, Collector is also used as the state’s burn registry and the registry for Traumatic Brain and Spinal Cord Injuries (TBI/SCI). 516 STEMI System of Care ST-Elevation Myocardial Infarction (STEMI) is a significant public health problem and carries a high risk of death and disability. The American Heart Association (AHA) estimates that as many as 400,000 people will suffer from a STEMI heart attack each year in the United States. Mississippi currently leads the nation in mortality and morbidity from cardiovascular disease. STEMI patients should be recognized as quickly as possible to identify those eligible for thrombolytic or primary PCI therapy. Research has shown that both morbidity and mortality can be reduced by the approach of rapid interventional reperfusion within ninety (90) minutes of hospital arrival. Additional research has demonstrated that in-the-field recognition by pre-hospital providers utilizing 12-lead ECG, coupled with pre-hospital notification of the receiving facilities, can further reduce time to reperfusion, resulting in improved outcomes. 516.1 Organization The STEMI System of Care is a voluntary system comprised of several separate components, which are organized and work together, as a system. The individual components and elements are described below: • STEMI Regions – This component facilitates system organization, coordination, and education requirements for both practitioners and the public. Each STEMI Region (North,

Central, and South) will have a regional STEMI Coordinator, who will schedule and facilitate quarterly regional meetings. • Pre-Hospital Component – EMS units are an integral part of the STEMI System. All EMTs, Paramedics, on-line and off-line medical control physicians need to have a basic knowledge and awareness of the STEMI System Plan elements and system function. Specifically, this knowledge refers to the alert criteria (identification of a STEMI), and communication procedures. • Hospital Component – Hospitals may participate in the STEMI System on a voluntary basis but must meet the criteria prescribed in the STEMI Standards to be designated as a STEMI Receiving or STEMI Referral Center. • Program oversight is provided by MSDH’s Bureau of Acute Care Systems. Map 5-2 identifies those hospitals participating in the STEMI System. 516.2 Protocols Standard treatment protocols for both STEMI Receiving Centers and STEMI Referral Centers have been developed and published by the Mississippi Healthcare Alliance (MHCA), the practitioners’ organization which initiated the development of the system of care. The current protocols may be found on the MHCA website at https://mshealthcarealliance.org. 516.3 Advisory Committee The STEMI Advisory Committee meets quarterly. Membership is compromised of the following membership categories as prescribed by the STEMI System of Care Plan: • Cardiology Co-Chairman • Emergency Medicine Co-Chairman • Emergency Medicine Representative – Northern Region • Emergency Medicine Representative – Central Region • Emergency Medicine Representative – Southern Region • Emergency Nursing Representative – Northern Region • Emergency Nursing Representative – Central Region • Emergency Nursing Representative – Southern Region • Hospital Administration Representative – Northern Region • Hospital Administration Representative – Central Region

• Hospital Administration Representative – Southern Region • Cardiology Representative – Northern Region • Cardiology Representative – Central Region • Cardiology Representative – Southern Region • STEMI Nursing Representative – Northern Region • STEMI Nursing Representative – Central Region • STEMI Nursing Representative – Southern Region • Southern Regional STEMI Coordinator • Registry Representative – Northern Region • Registry Representative – Central Region • Registry Representative – Southern Region • EMS Provider Representative – Northern Region • EMS Provider Representative – Central Region • EMS Provider Representative – Southern Region • EMS Administration Representative – Northern Region • EMS Administration Representative – Central Region • EMS Administration Representative – Southern Region • Northern Regional STEMI Coordinator • Central Regional STEMI Coordinator • Southern Regional STEMI Coordinator • American Heart Association Representative. 516.4 Performance Improvement Statewide Performance Improvement (PI) consists of multiple layers of continuous monitoring and evaluation of treatment processes to identify opportunities to optimize care and improve outcomes. The continuous cycle of evaluation extends from the PI programs of EMS providers and hospitals to review committees established at the regional and state levels.

The STEMI PI Committee meets quarterly. Membership is comprised of the following: • Cardiology Chair • Emergency Medicine Vice Chair • Cardiologist (one from each region) • Emergency Department Physician (one from each region) • Representative from each PCI hospital (minimum of one per region) • Non-PCI hospital representative (minimum of one per region) • EMS Representatives (minimum of three). The PI Committee establishes specific system-wide performance measures. Subject Matter Experts (SME) participate in committee activities appropriate to their expertise. The MSDH Bureau of Acute Care Systems provides administrative support to the PI Committee and all meetings of the Committee. PI committee meetings are by invitation only and are not open to the public. 516.5 Data System The data system for the STEMI System of Care is the ACTION Registry-GWTG (Get with The Guidelines) system. The ACTION Registry-GWTG is a risk-adjusted, outcomes-based quality improvement program that focuses exclusively on high-risk STEMI/NSTEMI patients. It helps hospitals apply American College of Cardiology (ACC) and American Heart Association (AHA) clinical guideline recommendations in their facilities and provides invaluable tools to measure care and achieve quality improvement goals. Use of the ACTION Registry-GWTG is a requirement for participation in the STEMI System of Care. 517 Acute Ischemic Stroke System of Care Mississippi ranks fourth (4 th ) in the nation in occurrence of death from the immediate and long- term effects of stroke. Moreover, stroke continues to be the fifth leading cause of death and a leading cause of disability in Mississippi. However, eighty-three percent (83%) of stroke occurrences in Calendar Year 2015 were potentially treatable ischemic strokes. The primary goal of the Mississippi Stroke System of Care is to get the patient suffering from a stroke to an appropriate hospital so that patients who are candidates for thrombolytic and interventional therapies may receive appropriate care in a timely manner. This approach is supported by research that shows early thrombolytics for ischemic stroke and interventional therapy for large vessel occlusion improve outcomes in patients suffering from these types of strokes. Therefore, the Stroke System of Care has focused on early recognition of strokes by educating individuals to call 911 when a stroke occurs, minimizing door to CT-times and ensuring early administration of thrombolytics.

In Mississippi, most of the specialty physicians, like neurologists, are in select large medical centers; therefore, access to a stroke specialist is a primary concern in stroke care. Unlike trauma and STEMI systems of care, where it is essential to get the patient to a specialty facility in the shortest amount of time, stroke care can be initiated at a rural facility in conjunction with input from a nurse practitioner trained in stroke care, either by telephone or telemedicine. A careful patient history and examination, laboratory analysis, and a head CT can be done at “Stroke-Ready” hospitals, allowing the timely decision to treat the patient with thrombolytic therapy at that hospital before transfer to a “Stroke Center” (“Drip and Ship”) if needed for neurological, neurosurgical, or neuro-interventional support. 517.1 Organization The Stroke System of Care is a voluntary system comprised of several separate components, which are organized and work together, as a system. The individual components and elements are described below: • Stroke Regions – This component facilitates system organization, coordination, and education requirements for both practitioners and the public. Each Stroke Region (North, Central, and South) will have a regional Coordinator, who will schedule and facilitate quarterly regional meetings. • Pre-Hospital Component – EMS units are an integral part of the STEMI System. All EMTs and paramedics need to have a basic knowledge and awareness of the Stroke System elements and system function. Specifically, this knowledge refers to entry criteria (identification of an acute ischemic stroke), triage and destination guidelines, and communication procedures. On-line and off-line medical control physicians will also need to be involved with the Stroke System elements and system function. • Hospital Component – Hospitals may participate in the Stroke System on a voluntary basis. • Program oversight is provided by MSDH’s Bureau of Acute Care Systems. 517.2 Protocols Standard treatment protocols for Stroke Ready and Non-Stroke hospitals have been developed and published by the Mississippi Healthcare Alliance (MHCA), the practitioners’ organization which initiated the development of the system of care. The current protocols may be found on the MHCA website at: https://mshealthcarealliance.org/. The protocols are centered on the “Drip and Ship” model, where outlying hospitals identify the presence of an acute ischemic stroke through a head CT and initiate thrombolytic therapy (tPA- Alteplase) prior to transferring the patient to a Stroke Center. EMS protocols include the use of the Cincinnati Stroke Scale to identify potential stroke victims, and their delivery to a Stroke Ready hospital for diagnosis.

##### **15 Miss. Admin. Code Pt. 8, R. 517.3** Rule 517.3 {#sec-8-517.3 omnilex-key=us-ms-regs-official--title-15--8#517.3}

Advisory Committee The Stroke Advisory Committee meets quarterly. Membership is compromised of the following as prescribed in the Stroke System of Care Plan: • Chairperson • Emergency Medicine Representative – Northern Region • Emergency Medicine Representative – Central Region • Emergency Medicine Representative – Southern Region • Emergency Nursing Representative – Northern Region • Emergency Nursing Representative – Central Region • Emergency Nursing Representative – Southern Region • Hospital Administration Representative – Northern Region • Hospital Administration Representative – Central Region • Hospital Administration Representative – Southern Region • Neurology Representative – Northern Region • Neurology Representative – Central Region • Neurology Representative – Southern Region • Stroke Nursing Representative – Northern Region • Stroke Nursing Representative – Central Region • Stroke Nursing Representative – Southern Region • Registry Representative – Northern Region • Registry Representative – Central Region • Registry Representative – Southern Region • EMS Provider Representative – Northern Region • EMS Provider Representative – Central Region • EMS Provider Representative – Southern Region

• EMS Administration Representative – Northern Region • EMS Administration Representative – Central Region • EMS Administration Representative – Southern Region • Northern Regional STROKE Coordinator • Central Regional STROKE Coordinator • Southern Regional STROKE Coordinator • American Heart Association Representative. 517.4 Performance Improvement Statewide Performance Improvement (PI) consists of multiple layers of continuous monitoring and evaluation of treatment processes to identify opportunities to optimize care and improve outcomes. The continuous cycle of evaluation extends from the PI programs of EMS providers and hospitals to review committees established at the regional and state levels. The Stroke PI Committee meets quarterly and is appointed by the State Health Officer. Membership is comprised of the following: • Neurology Chair • Emergency Medicine Vice Chair • Neurologist (one from each region) • One Emergency Department Physician (one from each region) • Representative from each stroke participating hospital (minimum of one per region) • EMS representative (minimum of three). Subject Matter Experts (SME) participate in committee activities appropriate to their expertise. The MSDH Bureau of Acute Care Systems provides administrative support to the PI Committee and all meetings of the Committee. PI Committee meetings are by invitation only and are not open to the public. 517.5 Data System The American Heart Association/American Stroke Association GWTG (Get with The Guidelines) – Stroke Program is a performance improvement program for hospitals that uses a stroke registry to support its aims. GWTG-Stroke collects patient level data on characteristics, diagnostic testing, treatments, adherence to quality measures, and in-hospital outcomes on patients hospitalized with

stroke and transient ischemic attack (TIA). Collection of comprehensive, continuous stroke data supports data analysis and the development of interventions to improve stroke care. The primary goal of GWTG-Stroke program is to improve the quality of care and outcomes for patients hospitalized with stroke and TIA. The GWTG-Stroke registry helps achieve this goal in a variety of ways, including: • Enabling high caliber stroke research. • Promoting stroke center designation. • Supporting hospital level quality improvement. • Driving the creation of a regional stroke system. Chapter 6 Comprehensive Medical Rehabilitation Services 600 Comprehensive Medical Rehabilitation Services Comprehensive medical rehabilitation (CMR) services are intensive care services that treat patients with severe physical disabilities by providing a coordinated multidisciplinary approach that requires an organized program of integrated services. Level I facilities offer a full range of CMR services to treat disabilities such as spinal cord injury, brain injury, stroke, congenital deformity, amputations, major multiple trauma, polyarthritis, fractures of the femur, and neurological disorders. Level II facilities offer CMR services to treat disabilities other than spinal cord injury, congenital deformity, and brain injury. The bed capacity, number of discharges, average length of stay, and occupancy rates for Level I and Level II CMR facilities are listed in Tables 6-1 and 6-2, respectively. 601 The Need for Comprehensive Medical Rehabilitation Services A total of 241 Level I and 85 Level II rehabilitation beds were operational in Mississippi during FY 2020 (the Singing River Hospital bed conversion is reflected in the total numbers mentioned previously; therefore, the totals reflected in the tables may not match). Map 6-3 at the end of this chapter shows the location of all CMR facilities in the state. The state as a whole serves as a single service area when determining the need for comprehensive medical rehabilitation beds/services. Based on the bed need formula found in the criteria and standards section of this chapter, Mississippi currently needs seven (7) Level I beds and ninety-four (94) additional Level II CMR beds. 602 The Need for Children’s Comprehensive Medical Rehabilitation Services No universally accepted methodology exists for determining the need of children’s comprehensive medical rehabilitation services. The bed need methodology in the previous section addresses need for all types of comprehensive medical rehabilitation beds, including those for children.

##### **15 Miss. Admin. Code Pt. 8, R. 603** Rule 603 {#sec-8-603 omnilex-key=us-ms-regs-official--title-15--8#603}

Certificate of Need Criteria and Standards for Comprehensive Medical Rehabilitation Beds/Services 603.1 Policy Statement Regarding Certificate of Need Criteria and Standards for Comprehensive Medical Rehabilitation Beds/Services 1. Definition: Comprehensive Medical Rehabilitation (CMR) Services provided in a freestanding CMR hospital or a CMR distinct part unit are defined as an intensive care service providing a coordinated multidisciplinary approach to patients with severe physical disabilities that require an organized program of integrated services. These disabilities include stroke, spinal cord injury, congenital deformity, amputation, major multiple trauma, fractures of the femur (hip fracture), brain injury, polyarthritis, including rheumatoid arthritis, or neurological disorders, including multiple sclerosis, motor neuron disease, polyneuropathy, muscular dystrophy, and Parkinson’s Disease. 2. Planning Areas: The state as a whole shall serve as a single planning area for determining the need of CMR beds/services. 3. CMR Services: Level I - Level I CMR providers may provide treatment services for all rehabilitation diagnostic categories. Level II - Level II CMR providers may provide treatment services for all rehabilitation diagnostic categories except: (1) spinal cord injuries, (2) congenital deformity, and (3) brain injury. 4. CMR Need Determination: MSDH shall determine the need for Level I CMR beds/services based upon a formula of 0.08 beds per 1,000 population for the state as a whole. MSDH shall determine the need for Level II CMR beds/services based upon a formula of 0.0623 beds per 1,000 population for the state as a whole. Table 6-3 shows the current need for CMR beds. 5. Present Utilization of Rehabilitation Services: When reviewing CON applications, MSDH shall consider the utilization of existing services and the presence of valid CONs for services. 6. Minimum Sized Facilities/Units: Hospital-based Level I CMR units shall not contain less than twenty (20) beds. If the established formula reveals a need for more than ten (10) beds, MSDH may consider a twenty (20) bed (minimum sized) unit for approval. Hospital-based Level II CMR facilities are limited to a maximum of thirty (30) beds. 7. Expansion of Existing CMR Beds: Before any additional CMR beds, for which CON review is required, are approved for any facility presently having CMR beds, the currently

licensed CMR beds at said facility shall have maintained an occupancy rate of at least eighty percent (80%) for the most recent twelve (12) month licensure reporting period or at least seventy percent (70%) for the most recent two (2) years. 8. Priority Consideration: When reviewing two or more competing CON applications, MSDH shall use the following factors in the selection process, including, but not limited to, a hospital having a minimum of 160 licensed acute care beds as of January 1, 2000; the highest average daily census of the competing applications; proposed comprehensive range of services; and the patient base needed to sustain a viable CMR service. 9. Children’s Beds/Services: Should a CON applicant intend to serve children, the application shall include a statement to that effect. 10. Other Requirements: Applicants proposing to provide CMR beds/services shall meet all requirements set forth in CMS regulations as applicable, except where additional or different requirements as stated in the State Health Plan or in the licensure regulations are required. Level II CMR units are limited to a maximum size of thirty (30) beds. 11. Enforcement: In any case in which MSDH finds a Level II provider has failed to comply with the diagnosis and admission criteria as set forth above, the provider shall be subject to the sanctions and remedies as set forth in Section 41-7-209 of the Mississippi Code 1972, as amended, and other remedies available to MSDH in law or equity. 12. Addition/Conversion of Beds: Effective July 1, 1994, no healthcare facility shall be authorized to add any beds or convert any beds to another category of beds without a CON under the authority of Section 41-7-191(1)(c) of the Mississippi Code1972, as amended, unless there is a projected need for such beds in the planning district in which the facility is located. 13. Delicensed Beds: Effective March 4, 2003, if a healthcare facility has voluntarily delicensed some of its existing bed complement, it may later relicense some or all of its delicensed beds without the necessity of having to acquire a CON. MSDH shall maintain a record of the delicensing healthcare facility and its voluntarily delicensed beds and continue counting those beds as part of the state’s total bed count for health care planning purposes. 603.2 Certificate of Need Criteria and Standards for Comprehensive Medical Rehabilitation Beds/Services MSDH will review applications for a CON for the establishment, offering, or expansion of comprehensive medical rehabilitation beds and/or services under the statutory requirements of Miss. Code Ann. §§ 41-7-173, 41-7-191, and 41-7-193. MSDH will also review applications for Certificate of Need according to the general criteria listed in the Mississippi Certificate of Need Review Manual, all adopted rules, procedures, and plans of MSDH, and the specific criteria and standards listed below. In addition, comprehensive rehabilitation services are reviewable if the proposed provider has not provided such services on a regular basis within twelve (12) months prior to the time such services

would be offered. The twenty (20) bed hospital-based comprehensive medical rehabilitation facilities which were operational or approved on January 1, 2001, are grandfathered and shall not be required to obtain a Certificate of Need as long as the services are provided continuously by those facilities and are limited to the diagnoses set forth below for Level II comprehensive medical rehabilitation facilities. Need Criterion 1: Projected Need A. New/Existing CMR Beds/Services: The need for Level I CMR beds in the state shall be determined using a methodology of 0.08 beds per 1,000 population. The state as a whole shall be considered as a single planning area. The need for Level II CMR beds in the state shall be determined using a methodology of 0.0623 comprehensive medical rehabilitation beds per 1,000 population. The state as a whole shall be considered a planning area. B. Projects which do not Involve the Addition of any CMR Beds: The applicant shall document the need for the proposed project. Documentation may consist of, but is not necessarily limited to, citing of licensure or regulatory code deficiencies, institutional long- term plans (duly adopted by the governing board), recommendations made by consultant firms, and deficiencies cited by Accreditation Agencies (JCAHO, CAP). C. Projects which Involve the Addition of CMR Beds: The applicant shall document the need for the proposed project. Exception: Notwithstanding the service specific need requirements as stated in "a" above, MSDH may approve additional beds for facilities which have maintained an occupancy rate of at least eighty percent (80%) for the most recent twelve (12) month licensure reporting period or at least seventy percent (70%) for the most recent two (2) years. D. Level II Trauma Centers: The applicant shall document the need for the proposed CMR project. Exception: MSDH may approve the establishment of a twenty (20) bed Level II CMR unit for any hospital without CMR beds which held a Level II Trauma care designation on July 1, 2003, as well as on the date the CON application is filed. E. Conversion of Level II CMR Beds to Level I CMR Beds: Notwithstanding any other policy statement, standard or criterion, including, but not limited to, Need Criterion 1(a) above, an existing Level II CMR unit may convert no more than eight (8) beds to Level I CMR status if the Level II facility meets the following requirements: 1. The Level II CMR unit demonstrates high utilization by documenting that it has maintained an occupancy rate of at least eighty percent (80%) for the most recent twelve (12) month licensure reporting period or at least seventy percent (70%) for the most recent two (2) years, as reported in the Mississippi State Health Plan.

2. The Level II CMR unit establishes the need for Level I CMR status for no more than eight (8) beds by documenting that the facility expects to have a minimum of sixty (60) patient admissions annually with one (1) or more of the following rehabilitation diagnostic categories: spinal cord injuries, congenital deformity, and/or brain injury. This documentation may include, without limitation, the Level II CMR unit’s patient data or any other data or documentation acceptable to MSDH. 3. The Level II CMR unit shall document compliance with the standards for Level I CMR units set forth below in Criterion 2 (Treatment and Programs) and Criterion 3 (Staffing and Services). 4. The Department shall assess the potential of the project on any adverse impact on any Level I CMR facilities operating in the state and such assessment shall be continually reviewed by the Department. The Department may revoke or suspend any Level II CMR unit operating a Level I program for non-compliance or finding of adverse impact to any Level I CMR units or programs in the state. Need Criterion 2: Level 1 CMR Services Applicants proposing to establish Level I CMR services shall provide treatment and programs for one (1) or more of the following conditions: A. Stroke B. Spinal cord injury C. Congenital deformity D. Amputation E. Major multiple trauma F. Fractures of the femur (hip fracture) G. Brain injury H. Polyarthritis, including rheumatoid arthritis, or neurological disorders, including multiple sclerosis, motor neuron disease, polyneuropathy, muscular dystrophy, and Parkinson's Disease. Applicants proposing to establish Level II CMR services shall be prohibited from providing treatment services for the following rehabilitation diagnostic categories: (1) spinal cord injury, (2) congenital deformity, and (3) brain injury. Facilities providing Level I and Level II CMR services shall include on their Annual Report of Hospitals submitted to MSDH the following: total admissions, average length of stay by diagnosis, patient age, sex, race, zip code, payor source, and length of stay by diagnosis.

Need Criterion 3: Staffing and Services A. Freestanding Level I Facilities 1. Shall have a Director of Rehabilitation who: a. Provides services to the hospital and its inpatient clientele on a full-time basis; b. Is a Doctor of Medicine or Osteopathy licensed under state law to practice medicine or surgery; and c. Has had, after completing a one (1) year hospital internship, at least two (2) years of training in the medical management of inpatients requiring rehabilitation services. 2. The following services shall be provided by full-time designated staff: a. Speech therapy b. Occupational therapy c. Physical therapy d. Social services 3. Other services shall be provided as required but may be by a consultant or on a contractual basis. B. Hospital-Based Units 1. Both Level I and Level II hospital-based units shall have a Director of Rehabilitation who: a. Is a Doctor of Medicine or Osteopathy licensed under state law to practice medicine or surgery; b. Has had, after completing a one (1) year hospital internship, at least two (2) years of training or experience in the medical management of inpatients requiring rehabilitation services; and c. Provides services to the unit and its inpatients for at least twenty (20) hours per week. 2. The following services shall be available full-time by designated staff: a. Physical therapy b. Occupational therapy

c. Social services 3. Other services shall be provided as required but may be by a consultant or on a contractual basis. 603.3 Certificate of Need Criteria and Standards for Children’s Comprehensive Medical Rehabilitation Beds/Services Until such time as specific criteria and standards are developed, the MSDH will review CON applications for the establishment of children's CMR services under the general criteria and standards listed in the Mississippi Certificate of Need Review Manual in effect at the time of submission of the application, and the preceding criteria and standards listed. 603.4 Comprehensive Medical Rehabilitation Bed Need Methodology The determination of need for Level I CMR beds/services will be based on 0.08 beds per 1,000 population in the state as a whole for the year 2025. Table 6-3 presents Level I CMR bed need. The determination of need for Level II CMR beds/services will be based on 0.0623 beds per 1,000 population in the state as a whole for the year 2025. Table 6-3 presents Level II CMR bed need. 604 Certificate of Need Criteria and Standards for Comprehensive Medical Residential Medical Rehabilitation Beds/Services for Patients with Traumatic Brain Injury (CRMR-TBI) 604.1 Policy Statement Regarding Certificate of Need Applications for Comprehensive Medical Residential Medical Rehabilitation Beds/Services for Patients with Traumatic Brain Injury 1. Definitions: a. Comprehensive Residential Medical Rehabilitation Services (CRMR) for Patients with a Traumatic Brain Injury (TBI) are defined as a place which is devoted to the provision of residential treatment and rehabilitative care in a transitional living program or a lifelong living program for periods of twenty-four (24) hours or longer for persons who have traumatic brain injury. b. A transitional living program is treatment and rehabilitative care delivered to traumatic brain injury patients who require education and training for independent living with a focus on compensation for skills which cannot be restored; such care prepares clients for maximum independence, teaches necessary skills for community interaction, works with clients pre-vocational and vocational training and stresses cognitive, speech, and behavioral therapies structured to the individual needs of patients. c. Lifelong living programs are treatment and rehabilitative care for traumatic brain injury patients who have been discharged from advanced treatment and rehabilitation facilities, but who cannot live at home independently, and who

require on-going lifetime support and rehabilitation. d. A TBI is traumatic harm to the brain and its related parts resulting in organic damage thereto that may cause physical, intellectual, emotional, social, and/or vocational changes in a person. 2. Planning Areas: The state as a whole shall serve as a single planning area for determining the need of CRMR beds/services for patients with a TBI. 3. Any application for a CRMR-TBI shall document the need for such a program in the state. Any application for an expansion through the addition of beds at a CRMR-TBI shall document an occupancy rate in excess of seventy percent (70%) for the most recent two (2) years. 4. Present Utilization of Rehabilitation Services: When reviewing CON applications for CRMR- TBI, MSDH shall consider the utilization of existing services and the presence of valid CONs for services. 5. Minimum Size Facilities/Units: CRMR-TBI facilities shall contain not less than six (6) beds and no more than thirty (30) beds. MSDH shall give a preference for CRMR-TBI facilities that are not located within a forty-five (45) mile radius of any other CRMR-TBI facility. 6. Children’s Beds/Services: Should a CON applicant intend to serve children, the application shall include a statement to that effect. 7. Other Requirements: Applicants proposing to provide CRMR-TBI beds/services shall meet all requirements set forth in CMS regulations as applicable, except where additional or different requirements, as stated in the State Health Plan or in the licensure regulations, are required. 8. Effective July 1, 1994, no healthcare facility shall be authorized to add any beds or convert any beds to another category of beds without a CON under the authority of §41-7- 191(1)(c), unless there is a projected need for such beds in the planning district in which the facility is located. 9. Effective March 4, 2003, if a healthcare facility has voluntarily delicensed some of its existing bed complement, it may later relicense some or all of its delicensed beds without the necessity of having to acquire a CON. MSDH shall maintain a record of the delicensing healthcare facility and its voluntarily delicensed beds and continue counting those beds as part of the state’s total bed count for health care planning purposes. 604.2 Certificate of Need Criteria and Standards for Comprehensive Medical Residential Medical Rehabilitation Beds/Services for Patients with Traumatic Brain Injury (CRMR-TBI) MSDH will review applications for a CON for the establishment, offering, or expansion of CRMR beds and/or services for patients with TBI under the statutory requirements of Miss. Code Ann. §§

41-7-173, 41-7-191, and 41-7-193, MSDH will also review applications for Certificate of Need according to the general criteria listed in the Mississippi Certificate of Need Review Manual; all adopted rules, procedures, and plans of MSDH; and the specific criteria and standards listed below. In addition, comprehensive rehabilitation services are reviewable if the proposed provider has not provided such services on a regular basis within twelve (12) months prior to the time such services would be offered. Need Criterion 1: Projected Need A. New/Existing CRMR Beds/Services for Patients with TBI: shall be determined considering the current and projected population of the state as whole and the current and projected incidence of TBIs. The state as a whole shall be considered a planning area. B. Projects which do Not Involve the Addition of any CRMR-TBI beds: The applicant shall document the need for the proposed project. Documentation may consist of, but is not necessarily limited to, citing of licensure or regulatory code deficiencies, institutional long- term plans (duly adopted by the governing board), recommendations made by consultant firms, and deficiencies cited by Accreditation Agencies (JCAHO, CAP). C. Projects which Involve the Addition of Beds: The applicant shall document the need for the proposed project. MSDH may approve additional beds for facilities, which have maintained an occupancy rate of at least seventy percent (70%) for the most recent two (2) years. Need Criterion 2: Federal/State Requirements Applicants proposing to establish CRMR services for patients with TBI shall demonstrate the ability to meet all CMS and state licensure requirements. Chapter 7 Other Health Services Other ambulatory health services consist of primary, specialty, and supportive medical services provided on an outpatient basis, in contrast to services provided in the home or to persons who are inpatients. The term ambulatory care implies that patients must travel to a location outside the home to receive services that do not require an overnight hospital stay. This chapter describes several organizations which provide ambulatory care in Mississippi. In addition, this chapter discusses home health services in Mississippi. 700 Ambulatory Surgery Services During FY 2020, the state’s medical/surgical hospitals reported a total of 225,867 general surgical procedures. This number included 150,178 outpatient surgeries, almost a 19.40 percent decrease of the 186,324 surgeries performed in hospitals during 2016. The percentage of surgeries performed on an outpatient basis in hospitals has decreased from 67.2 percent in 2016 to 66.49 percent in 2020. Table 7-1 displays hospital affiliated surgery data by general hospital service area.

Mississippi licenses eighteen (18) freestanding ambulatory surgery facilities. Table 7-2 shows the distribution of facilities and related ambulatory surgery data. The eighteen (18) facilities reported 66,789 procedures during fiscal year 2020. Total outpatient surgeries (hospitals and freestanding facilities combined) comprised 74.11 percent of all surgeries performed in the state. The number of procedures performed in freestanding facilities was 22.81 percent of total surgeries in 2020. 701 Certificate of Need Criteria and Standards for Ambulatory Surgery Services Should MSDH receive a CON application regarding the acquisition and/or otherwise control of major medical equipment or the provision of a service for which specific CON criteria and standards have not been adopted, the application shall be deferred until MSDH has developed and adopted CON criteria and standards. If MSDH has not developed CON criteria and standards within 180 days of receiving a CON application, the application will be reviewed using the general CON review criteria and standards presented in the Mississippi Certificate of Need Review Manual and all adopted rules, procedures, and plans of MSDH. 701.1 Policy Statement Regarding Certificate of Need Applications for Ambulatory Surgery Services 1. Ambulatory Surgery Planning Areas (ASPAs): MSDH shall use the Ambulatory Surgery Planning Areas as outlined on Map 7-1 of this Plan for planning and CON decisions. The need for ambulatory surgery facilities in any given ASPA shall be calculated independently of all other ASPAs. 2. Ambulatory Surgery Facility Service Areas: An applicant's Ambulatory Surgery Facility Service Area must have a population base of approximately 60,000 within thirty (30) minutes normal driving time or twenty-five (25) miles, whichever is greater, of the proposed/established facility. Note: Licensure standards require a freestanding facility to be within fifteen (15) minutes traveling time of an acute care hospital and a transfer agreement with said hospital must be in place before a CON may be issued. Additionally, the ambulatory surgery facility service area must have a stable or increasing population. 3. Definitions: The Glossary of this Plan includes the definitions in the state statute regarding ambulatory surgery services. 4. Surgeries Offered: MSDH shall not approve single service ambulatory surgery centers. Only multi-specialty ambulatory surgery center proposals may be approved for a CON. 5. Minimum Surgical Operations: The minimum of 1,000 surgeries required to determine need is based on five (5) surgeries per operating room per day times five (5) days per week x times fifty (50) weeks per year times eighty percent (80%) utilization rate. 6. Present Utilization of Ambulatory Surgery Services: MSDH shall consider the utilization of existing services and the presence of valid CONs for services within a given ASPA when reviewing CON applications. 7. Optimum Capacity: The optimum capacity of an ambulatory surgery facility is 800 surgeries per operating room per year. MSDH shall not issue a CON for the establishment

of an additional facility(ies) unless the existing facilities within the ASPA have performed in aggregate at least 800 surgeries per operating room per year for the most recent 12- month reporting period, as reflected in data supplied to and/or verified by MSDH. MSDH may collect additional information it deems essential to render a decision regarding any application. Optimum capacity is based on four (4) surgeries per operating room per day times five (5) days per week times fifty (50) weeks per year times eighty percent (80%) utilization rate. This Policy Statement 7 shall not apply to applications proposing the expansion of an existing and licensed ambulatory surgery facility. 8. Conversion of Existing Service: Applications proposing the conversion of existing inpatient capacity to hospital affiliated ambulatory surgical facilities located within the hospital shall receive approval preference over detached or freestanding ambulatory surgical facilities if the applicant can show that such conversion is less costly than new construction and if the application substantially meets other adopted criteria. 9. Construction/Expansion of Facility: Any applicant proposing to construct a new facility or major renovation to provide ambulatory surgery must propose to build/renovate no fewer than two (2) operating rooms. 10. Indigent/Charity Care: The applicant shall be required to provide a “reasonable amount” of indigent/charity care as described in Chapter 1 of this Plan. 11. Single-Specialty Ambulatory Surgery Facility: A single-specialty ambulatory surgical center (“ASC”) is not considered an integral part of an institutional health service if a hospital or hospital’s parent, subsidiary or affiliated entity directly or indirectly (i) employs or contracts with physicians, dentists, or health care professionals who own the ASC or practice at the ASC; (ii) owns, in whole or in part, the incorporated medical group that owns the ASC; (iii) jointly owns the ASC with physicians, dentists, or health care professionals, independently or by incorporated medical groups; or (iv) solely owns the ASC for credentialed physicians (whether employed, contracted or independent) to perform surgical procedures in the ASC that qualify for single-specialty status. The establishment of a single-specialty ASC does not require CON review; however, the facility must submit a Determination of Reviewability application prior to establishment of the single-specialty ASC. 701.2 Certificate of Need Criteria and Standards for Ambulatory Surgery Services MSDH will review applications for a CON for new ambulatory surgery facilities, as defined in Mississippi law, under the statutory requirements of Miss. Code Ann. §§ 41-7-173, 41-7-191, and 41-7-193, MSDH will also review applications submitted for CON in accordance with the rules and regulations in the Mississippi Certificate of Need Review Manual; all adopted rules, procedures, and plans of MSDH; and the specific criteria and standards listed below. Ambulatory surgery services require CON review when the establishment or expansion of the services involves a capital expenditure in excess of $20,000,000.00. In addition, the offering of ambulatory surgery services is reviewable if the proposed provider has not provided those services

on a regular basis within twelve (12) months prior to the time such services would be offered, regardless of the capital expenditure. Need Criteria 1: Minimum Surgeries A. An applicant proposing the establishment of a new ambulatory surgery facility shall demonstrate that the proposed ambulatory surgery facility shall perform a minimum average of 1,000 surgeries per operating room per year. B. An applicant proposing the expansion of an existing and licensed ambulatory surgery facility through the addition of operating rooms shall demonstrate that the applicant’s facility has performed in aggregate at least 800 surgeries per operating room per year for the most recent twelve (12) month reporting period, as reflected in data supplied to and/or verified by MSDH. Need Criteria 2: Minimum Population The applicant must document that the proposed Ambulatory Surgery Facility Service Area has a population base of approximately 60,000 within 30 minutes travel time. Need Criteria 3: Present Utilization of Ambulatory Surgery Services The applicant proposing to offer ambulatory surgery services shall document that the existing facilities in the ambulatory surgery planning area have been utilized for a minimum of 800 surgeries per operating room per year for the most recent 12-month reporting period as reflected in data supplied to and/or verified by MSDH. MSDH may collect additional information it deems essential to render a decision regarding any application. Need Criteria 4: Affirmation of Provision of Surgical Services The applicant must affirm that the proposed program shall provide a full range of surgical services in general surgery. Need Criteria 5: Financial Feasibility The applicant must provide documentation that the facility will be economically viable within two (2) years of initiation. Need Criteria 6: Letters of Support The proposed facility must show support from the local physicians who will be expected to utilize the facility. Need Criteria 7: Staffing Requirements Medical staff of the facility must live within a twenty-five (25) mile radius of the facility.

Need Criteria 8: Transfer Agreements/Follow-Up Services The proposed facility must have a formal agreement with a full-service hospital to provide services which are required beyond the scope of the ambulatory surgical facility’s programs. The facility must also have a formal process for providing follow-up services to the patients (e.g., home health care, outpatient services) through proper coordination mechanisms. Need Criteria 9: Indigent/Charity Care The applicant shall affirm that the applicant will provide a “reasonable amount” of indigent/charity care by stating the amount of indigent/charity care the applicant intends to provide. 702 Home Health Care Mississippi licensure regulations define a home health agency as: a public or privately owned agency or organization, or a subdivision of such an agency or organization, properly authorized to conduct business in Mississippi, which is primarily engaged in providing to individuals at the written direction of a licensed physician, in the individual's place of residence, skilled nursing services provided by or under the supervision of a registered nurse licensed to practice in Mississippi, and one or more of the following additional services or items: 1. Physical, occupational, or speech therapy, 2. Medical social services, 3. Home Health aide services, 4. Other services as approved by the licensing agency, 5. Medical supplies, other than drugs and biologicals, and the use of medical appliances, or 6. Medical services provided by a resident in training at a hospital under a teaching program of such hospital. All skilled nursing services and the services listed in items 1 through 4 must be provided directly by the licensed home health agency. For the purposes of this Plan, “directly” means either through an agency employee or by an arrangement with another individual not defined as a healthcare facility in Miss. Code Ann. § 41-7-173(h). The requirements of this paragraph do not apply to healthcare facilities which had contracts for the above services with a home health agency on January 1, 1990. 702.1 Home Health Status The 2016 Report on Home Health Agencies (the latest available) indicated that 56,051 Mississippians received home health services during the year. The reported noted there were 2,024,397 home health care visits made in 2016 in Mississippi. Each patient (all payor sources) received an average of thirty-four (34) visits.

##### **15 Miss. Admin. Code Pt. 8, R. 703** Rule 703 {#sec-8-703 omnilex-key=us-ms-regs-official--title-15--8#703}

Certificate of Need Criteria and Standards for Home Health Agencies/Services Should MSDH receive a CON application regarding the acquisition and/or otherwise control of major medical equipment or the provision of a service for which specific CON criteria and standards have not been adopted, the application shall be deferred until MSDH has developed and adopted CON criteria and standards. If MSDH has not developed CON criteria and standards within 180 days of receiving a CON application, the application will be reviewed using the general CON review criteria and standards presented in the Mississippi Certificate of Need Review Manual and all adopted rules, procedures, and plans of MSDH. In the event a statutory or regulatory moratorium applicable to a particular health care service is judicially invalidated or otherwise rendered unenforceable, and existing Certificate of Need (CON) criteria and standards for that particular service have not been applied or evaluated due to the moratorium, MSDH may temporarily defer final action on CON applications for that service for a period not to exceed 180 days to allow time for the development, adoption and implementation of well-conceived criteria and standards by which CON applications for the service may be reviewed. 703.1 Policy Statement Regarding Certificate of Need Applications for the Establishment of a Home Health Agency and/or the Offering of Home Health Services 1. 2026 Legislative Findings Regarding Continuation of Moratoria: Effective April 17, 2026, the Mississippi Legislature reaffirmed its determination that continuation of the moratorium on the issuance of Certificates of Need for new home health agencies remains in the public interest. The Legislature found that the state maintains a network of licensed home health agencies serving all geographic regions and that there is currently no comprehensive statewide demonstration of systemic service shortages or unmet need requiring additional home health agency licensure. The Legislature further found that expansion of provider supply in utilization-driven reimbursement systems may increase service volume and aggregate Medicaid expenditures. Accordingly, the Legislature determined that continuation of the moratorium is rationally related to preventing unnecessary expansion, avoiding duplication of services, cost containment, ensuring appropriate allocation of healthcare resources, and protecting the fiscal sustainability of publicly funded healthcare programs. 2. Service Areas: The need for home health agencies/services shall be determined on a county-by-county basis. 3. Determination of Need: A potential need for home health services may exist in a county if, for the most recent calendar year available, that county had fewer home health visits per 1,000 elderly (65+) population than the average number of visits received per 1,000 elderly (65+) in the ten-state region consisting of Alabama, Arkansas, Florida, Georgia, Kentucky, Louisiana, Mississippi, North Carolina, South Carolina, and Tennessee. Because county- level datasets measuring Medicare-paid home health visits per 1,000 population age sixty- five (65) and older are no longer publicly available in a form that permits direct application of the historical methodology, county home health visits shall be estimated using current Centers for Medicare and Medicaid Services (CMS) fee-for-service (FFS) Medicare utilization data.

The Department has adopted a reconstructed historical methodology that estimates county home health visits using current CMS fee-for-service utilization data and expresses utilization relative to the county population age sixty-five (65) and older, thereby preserving the core analytical framework of the historical State Health Plan methodology to the greatest extent practicable. The regional benchmark shall be calculated in accordance with Section 703.03 and reported in Table 7-3 using the most recent available data. 4. Unmet Need Determination: If it is determined that a potential need exists in a given county, the applicant shall document that the unmet need in that county is greater than or equal to fifty (50) home health patients. Unmet need shall be determined in accordance with the methodology contained in Section 703.3. 5. All CON applications for the establishment of a home health agency and/or the offering of home health services shall be considered substantive and will be reviewed accordingly. 703.2 Certificate of Need Criteria and Standards for the Establishment of a Home Health Agency and/or the Offering of Home Health Services If the present moratorium were removed or partially lifted, MSDH would review applications for a CON for the establishment of a home health agency and/or the offering of home health services under the applicable statutory requirements of Miss. Code Ann. § 41-7-173, 41-7-191, and 41-7- 193. MSDH will also review applications submitted for CON according to the general criteria as listed in the Mississippi Certificate of Need Review Manual; all adopted rules, procedures, and plans of MSDH; and the specific criteria and standards listed below. The development or otherwise establishment of a home health agency requires CON. The offering of home health services is reviewable if the proposed provider has not provided those services on a regular basis within the period of twelve (12) months prior to the time such services would be offered. Need Criteria 1: Establishment of Need The applicant shall document that a possible need for home health services exists in each county proposed to be served using the methodology contained in this section of the Plan. Need Criteria 2: Home Health Service Area Boundaries The applicant shall state the boundaries of the proposed home health service area in the application. Need Criteria 3: Unmet Need The applicant shall document that each county proposed to be served has an unmet need equal to fifty (50) patients as determined by the methodology contained in Section 703.3, including calculation of HC, C, R, VR, and N.

Need Criteria 4: Home Office of New Home Health Agency The applicant shall document that the home office of a new home health agency shall be located in a county included in the approved service area of the new agency. An existing agency receiving CON approval for the expansion of services may establish a sub-unit or branch office if such meets all licensing requirements of the Division of Licensure. Need Criteria 5: Application Requirements The application shall document the following for each county to be served: A. Letters of intent from physicians who will utilize the proposed services. B. Information indicating the types of cases physicians would refer to the proposed agency and the projected number of cases by category expected to be served each month for the initial year of operation. C. Information from physicians who will utilize the proposed service indicating the number and type of referrals to existing agencies over the previous twelve (12) months. D. Evidence that patients or providers in the area proposed to be served have attempted to find services and have not been able to secure such services. E. Projected operating statements for the first three years, including: 1. Total cost per licensed unit; 2. Average cost per visit by category of visit; and 3. Average cost per patient based on the average number of visits per patient. Need Criteria 6: Difference in Existing Services Already Provided Information concerning whether proposed agencies would provide services different from those available from existing agencies. 703.3 Statistical Need Methodology for Home Health Services The Department has adopted a reconstructed historical methodology that estimates county home health visits using current Centers for Medicare and Medicaid Services (CMS) fee-for-service utilization data and expresses utilization relative to the county population age sixty-five (65) and older, thereby preserving the core analytical framework of the historical State Health Plan methodology to the greatest extent practicable. The methodology used to calculate home health utilization rates and unmet need within the ten- state region consists of the following: 1. The ten-state region consists of Alabama, Arkansas, Florida, Georgia, Kentucky, Louisiana, Mississippi, North Carolina, South Carolina, and Tennessee.

2. County and regional population age sixty-five (65) years and older shall be obtained from the United States Census Bureau Population Estimates Program, Population Estimates: Annual County and Puerto Rico Municipio Resident Population Estimates by Selected Age Groups and Sex, using the July 1 estimate for the most recent calendar year available. 3. Table 7-3 shall show estimated home health visits, home health users, average visits per patient, population age sixty-five (65) and older, and utilization rates for the ten-state region using the most recent Centers for Medicare and Medicaid Services (CMS) utilization data and United States Census Bureau population estimates available. Figure 7-1 shall show the corresponding utilization rates for the ten-state region. 4. Estimated county home health visits shall be calculated as follows: HC = (RC÷ 1,000) × BC where: ▪ HC= Estimated annual home health visits in the county; ▪ RC = County home health visits per 1,000 fee-for-service Medicare beneficiaries; and ▪ BC = County fee-for-service Medicare beneficiaries. The county utilization rate shall be calculated as follows: C = (HC ÷ PC) × 1,000 where: ▪ C = County utilization rate; and ▪ PC = County population age sixty-five (65) and older. The regional utilization rate shall be calculated as follows: R = (HR ÷ PR) × 1,000 where: ▪ R = Regional utilization rate; ▪ HR = Total annual home health visits in the ten-state region; and ▪ PR = Total population age sixty-five (65) and older in the ten-state region. A potential need for home health services may exist when:

C < R The estimated visit deficit shall be calculated as follows: Visit Deficit: (R − C) × (PC÷ 1,000) The regional average number of visits per patient shall be calculated as follows: VR= HR ÷ Regional Home Health Users where: ▪ VR

= Regional average visits per patient.

Estimated unmet need shall be calculated as follows: N = [(R − C) × (PC ÷ 1,000)] ÷ VR where: ▪ N = Estimated unmet need expressed as patient equivalents.

An unmet need exists if: N ≥ 50 NOTE: This methodology functions as a utilization-based planning methodology and does not constitute a direct measure of actual unmet need for home health services. Rather, the methodology estimates potential need by comparing relative utilization levels among geographic areas using available Medicare utilization data and population estimates. 704 End Stage Renal Disease End-Stage Renal Disease (ESRD) describes the loss of kidney function from chronic renal failure to the extent that the remaining kidney function will no longer sustain life. The kidney’s function of filtering waste products from the blood and removing fluid and salts from the body is essential for life; consequently, if untreated, end-stage renal disease results in death. ESRD treatment generally consists of either a kidney transplant or dialysis. Dialysis treatment consists of either peritoneal dialysis or hemodialysis. Peritoneal dialysis uses a dialyzing fluid which is placed in the abdominal cavity through a plastic tube (catheter), and waste products (fluid and salts) exchange across the peritoneal membrane between the patient's blood and the dialyzing fluid. Hemodialysis is the process by which an artificial kidney machine "washes" metabolic waste products from the bloodstream and removes fluids and salts.

Both hemodialysis and peritoneal dialysis mimic the function normally performed by the kidney. Dialysis can be done by the patient and an assistant in the home, in a facility, or by professional staff in a hospital or limited care facility. Mississippi has sixty-two (62) ESRD facilities and twenty-two (22) Satellite ESRD facilities providing maintenance dialysis services as of FY 2020. Map 7-1 shows the facility locations and Table 7-4 shows the number of existing and CON approved ESRD facilities by county. Kidney transplantation is the treatment of choice for most patients with end-stage renal failure. Unfortunately, suitable kidneys will probably never be available in the number that would be required to treat everyone with this mode of therapy. In kidney transplantation, a healthy kidney is removed from a donor and placed into an ESRD patient. Donors for kidney transplantation may come either from a close relative, such as a sibling or parent, or from an emotionally connected donor, such as a spouse or close associate. Kidneys may also be obtained from cadaver donors who have the closest matching tissue type. Living donors are preferred because they function longer than cadaver kidneys (i.e. thirty (30) years for a living donor versus fifteen (15) years for a cadaver kidney). The University of Mississippi Medical Center, the only kidney transplant program in the state, performed 114 cadaver and eleven (11) living-donor transplants during the calendar year 2020. It is certified by membership in the Organ Procurement and Transplant Network (OPTN) as managed by the United Network of Organ Sharing, a private agency under contract from the Health Resources and Services Administration. Transplant results are comparable to those with transplant programs with similar population basis and can be viewed on the Internet under the Scientific Registry for Transplant Recipients (SRTR) website at www.srtr.org. Approximately, seventy-five (75) additional transplants in Mississippi residents are performed in neighboring states. 705 Certificate of Need Criteria and Standards for End-Stage Renal Disease (ESRD) Facilities If MSDH receives a CON application regarding the acquisition and/or otherwise control of major medical equipment or the provision of a service for which specific CON criteria and standards have not been adopted, the application shall be deferred until MSDH has developed and adopted CON criteria and standards. If MSDH has not developed CON criteria and standards within 180 days of receiving a CON application, the application will be reviewed using the general CON review criteria and standards presented in the Mississippi Certificate of Need Review Manual and all adopted rules, procedures, and plans of MSDH. 705.1 Policy Statement Regarding Certificate of Need Applications for the Establishment of End-Stage Renal Disease Facilities 1. Establishment of an ESRD Facility: The provision or proposed provision of maintenance dialysis services constitutes the establishment of an ESRD facility if the proposed provider has not provided those services on a regular basis within the period of twelve (12) months prior to the time such services would be offered. 2. Type of Review: CON applications for ESRD services shall be considered substantive as defined under the appropriate Mississippi State Health Plan.

3. ESRD Facility Service Area: An ESRD Facility Service Area is defined as the area within a thirty (30) mile radius of an existing or proposed ESRD facility. ESRD Facility Service Areas, including the Service Areas of existing facilities which overlap with the proposed Service Area, shall be used for planning purposes. 4. Utilization Definitions: These utilization definitions are based upon three (3) shifts per day six (6) days per week, or eighteen (18) shifts per week. Only equipment (peritoneal or hemodialysis) that requires staff assistance for dialysis and is in operation shall be counted in determining the utilization rate. Utilization of equipment in operation less than twelve (12) months shall be prorated for the period of time in actual use. a. Full Utilization: For planning and CON purposes, full (100 percent) utilization is defined as an average of 936 dialyses per station per year. b. Optimum Utilization: For planning and CON purposes, optimum (65 percent) utilization is defined as an average of 608 dialyses per station per year. c. Need Utilization: For planning and CON purposes, need (80 percent) utilization is defined as an average of 749 dialyses per station per year. 5. Outstanding CONs: ESRD facilities that have received CON approval but are not operational shall be considered to be operating at 50 percent, which is the minimum utilization rate for a facility the first year of operation. 6. Utilization Data: The Department may use any source of data, subject to verification by the Department, it deems appropriate to determine current utilization or projected utilization of services in existing or proposed ESRD facilities. The source of data may include, but is not limited to, Medicare Certification records maintained by the Division of Licensure and Certification, ESRD Network #8 data, and Centers for Medicare and Medicaid Services (CMS) data. 7. Minimum Expected Utilization: It is anticipated that a new ESRD facility may not be able to reach optimum utilization (65 percent) of ten (10) ESRD stations during the initial phase of operation. Therefore, for the purposes of CON approval, an application must demonstrate how the applicant can reasonably expect to have 50 percent utilization of a minimum of ten ESRD stations by the end of the first full year of operation and 65 percent utilization by the end of the third full year of operation. 8. Minimum Size Facility: No CON application for the establishment of a new ESRD facility shall be approved for less than ten (10) stations. 9. Expansion of Existing ESRD Facilities: Existing ESRD facilities may add ESRD stations as follows: a. An existing ESRD facility with a CMS star rating of 1 or 2, may add ESRD stations without certificate of need review as long as the facility does not add, over the period of one (1) year, more than four (4) stations.

b. An existing ESRD facility with a CMS star rating of 3, may add ESRD stations without certificate of need review as long as the facility does not add, over the period of one (1) year, more than six (6) stations. c. An existing ESRD facility with a CMS star rating of 4 or 5, may add ESRD stations without certificate of need review, as long as the facility does not add, over the period of one (1) year, more than eight (8) stations. NOTE: An ESRD facility that has not yet been given a CMS star rating may add ESRD stations without certificate of need review as long as the facility does not add, over the period of one(1) year, more than four (4) stations. 10. Home Dialysis Training Programs: Each existing ESRD facility may establish or relocate a Home Dialysis Training Program to any location within a 10-mile radius of the existing facility without Certificate of Need review; provided, however, that the facility shall submit a Determination of Reviewability prior to the establishment of the Home Dialysis Training Program. If such established or relocated Home Dialysis Training Program is a freestanding program, the freestanding Home Dialysis Training Program shall document that it has a back-up agreement for the provision of any necessary dialysis services with the existing ESRD facility. If an existing ESRD facility wants to create, either through establishment or relocation, more than two (2) Home Dialysis Training Programs, the project shall be subject to CON review as the establishment of a new ESRD facility. Existing freestanding Home Dialysis Training Programs may add home training stations as follows: a. An existing freestanding Home Dialysis Training facility with a CMS star rating of 1 or 2, may add home training stations without Certificate of Need review as long as the facility does not add, over the period of one (1) year, more than four (4) stations. b. An existing freestanding Home Dialysis Training facility with a CMS star rating of 3, may add home training stations without Certificate of Need review as long as the facility does not add, over the period of one (1) year, more than six (6) stations. c. An existing freestanding Home Dialysis Training facility that has not yet been given a CMS star rating may add home training stations without Certificate of Need review as long as the facility does not add, over the period of one (1) year, more than eight (8) stations. d. An existing ESRD facility with a CMS star rating of 4 or 5, may add home training stations without Certificate of Need review, as long as the facility does not add, over the period of one (1) year, more than eight (8) stations. 11. Individual Home Dialysis Stations/Equipment: Dialysis stations or dialysis equipment located in an individual patient’s home or residence and used solely for the treatment of that individual patient shall not be considered an ESRD facility, Satellite ESRD facility, or Home Dialysis Training Program for purposes of Certificate of Need review and shall not be subject to Certificate of Need review under this Section.

Nothing herein shall be construed to exempt from Certificate of Need review the establishment, relocation, expansion, or operation of an ESRD facility, Satellite ESRD facility, Home Dialysis Training Program, or Home Training Program operated by or affiliated with an ESRD provider. 12. Establishment of Satellite ESRD Facilities: Any existing ESRD facility which reaches a total of thirty (30) ESRD stations, may establish a ten (10) station satellite facility. If a proposed Satellite ESRD facility is to be located more than one (1) mile from the existing facility, a Certificate of Need must be obtained by the facility prior to the establishment of the satellite facility. 13. Non-Discrimination: An applicant shall affirm that within the scope of its available services, neither the facility nor its staff shall have policies or procedures which would exclude patients because of race, color, age, sex, or ethnicity. 14. Indigent/Charity Care: An applicant shall be required to provide a “reasonable amount” of indigent/charity care as described in Chapter 1 of this Plan. 15. Staffing: The facility must meet, at a minimum, the requirements and qualifications for staffing as contained in 42 CFR § 494.140. In addition, the facility must meet all staffing requirements and qualifications contained in the service specific criteria and standards. 16. Federal Definitions: The definitions contained in 42 CFR § 494.10 shall be used as necessary in conducting health planning and CON activities. 17. Affiliation with a Renal Transplant Center: ESRD facilities shall be required to enter into a written affiliation agreement with a renal transplant center. 18. Small Community Hospital Pilot Program — ESRD Exemption: Notwithstanding the standard statistical need methodologies governing the establishment of ESRD facilities, the State Health Officer is authorized to issue a Certificate of Need exemption to operate an ESRD facility for not more than eight (8) qualifying Small Community Hospitals statewide in accordance with applicable law and the Mississippi Certificate of Need Manual. Operational Parameters: a. No more than two (2) such exempted ESRD facilities may be located within each of the four (4) Public Health Regions designated by the Department as of January 1, 2026. b. In the event that more than two (2) eligible hospitals within a single Public Health Region apply, preference and issuance shall be granted to those Small Community Hospitals located in areas most remote from existing dialysis units. c. Any exemption obtained under this pilot shall be counted toward the Small Community Hospital’s General Pilot Program Exemption allotment as set for in the Mississippi Certificate of Need Manual.

##### **15 Miss. Admin. Code Pt. 8, R. 705.2** Rule 705.2 {#sec-8-705.2 omnilex-key=us-ms-regs-official--title-15--8#705.2}

Certificate of Need Criteria and Standards for End-Stage Renal Disease Facilities MSDH will review applications for a CON for the establishment of an ESRD facility under the applicable statutory requirements of Miss. Code Ann. § 41-7-173, 41-7-191, and 41-7-193, MSDH will also review applications for CON according to the general criteria as listed in the Mississippi Certificate of Need Review Manual; all adopted rules, procedures, and plans of MSDH; and the specific criteria and standards listed below. When a provider proposes to offer ESRD services in an ESRD facility service area where he does not currently provide services or proposes to transfer an existing ESRD unit(s) from a current location into a different ESRD facility service area, it will constitute the establishment of a new ESRD healthcare facility. NOTE: The transfer of dialysis stations from an existing ESRD facility to any other location is a relocation of a healthcare facility or portion thereof and requires CON review. Likewise, new dialysis stations placed into service at a site separate and distinct from an existing ESRD facility constitutes the establishment of a new healthcare facility and requires CON review. For purposes of determining reviewability, individual home dialysis equipment shall be governed by ESRD Policy Statement 11. 705.2.1 Establishment of End-Stage Renal Disease (ESRD) Facility Need Criterion 1: For Establishment of New ESRD Facilities An applicant proposing the establishment of a limited care renal dialysis facility or the relocation of a portion of an existing ESRD facility’s dialysis stations to another location shall demonstrate, subject to verification by the Mississippi State Department of Health, that each individual existing ESRD facility in the proposed ESRD Facility Service Area has maintained a minimum annual utilization rate of eighty percent (80%). Need Criterion 2: For Expansion of Existing ESRD Facilities A. Expansion of Existing ESRD Facilities – Non-Satellite: If an existing ESRD facility, other than a satellite facility that has operated for two (2) years or less, proposes to add stations in excess of the limits established in ESRD Policy Statement 9, the facility shall obtain a Certificate of Need. The applicant shall demonstrate either: (a) that the facility maintained a minimum annual utilization rate of sixty-five percent (65%) during the twelve (12) months immediately preceding submission of the CON application; or (b) that the facility is reasonably projected to achieve and maintain a minimum annual utilization rate of sixty- five percent (65%). Evidence supporting a projected utilization rate may include, but is not limited to, historical utilization trends, patient demand, physician referral patterns, population growth, or other relevant evidence. NOTE: ESRD Policy Statement 3 and Need Criteria 1 are inapplicable to applications for the expansion of existing ESRD facilities. B. Expansion of Existing ESRD Facilities – Satellite: If an existing ESRD facility that has

operated as a satellite facility for two (2) years or less proposes to add stations in excess of the limits established in ESRD Policy Statement 9, the facility shall obtain a Certificate of Need. The applicant shall demonstrate that the facility has maintained, or is reasonably projected to maintain, a minimum annual utilization rate of sixty-five percent (65%). Such demonstration may include, but is not limited to, patient support letters, documentation regarding the distance between patients’ residences or transportation sources and the facility, transportation-related concerns, patient access considerations, or other evidence supporting the projected utilization rate. NOTE: ESRD Policy Statement 3 and Need Criteria 1 are inapplicable to applications for the expansion of existing ESRD facilities. Need Criterion 3: For Establishment of ESRD Satellite Facilities In order for a thirty (30) station ESRD facility to be approved for the establishment of a ten (10) station satellite facility through the transfer and relocation of existing stations within a five-mile radius or less from the existing facility, the facility must (a) document that it has maintained a minimum annual utilization rate of fifty-five percent (55%) for the twelve (12) months immediately preceding submission of the CON application; (b) justify the need for the project, which may include, but is not limited to, physical or space limitations at the existing facility; and (c) document that it is more cost effective to establish a satellite facility than to expand the existing facility. If the proposed satellite facility will be established at a location within a radius of five to thirty (30) miles of the existing facility, the facility must (a) document that it has maintained a minimum annual utilization rate of fifty-five percent (55%) for the twelve (12) months prior to the submission of the CON application; (b) justify the need for the project, which may include, but is not limited to, physical or space limitations at the existing facility; and (c) document that it is more cost effective to establish a satellite facility than to expand the existing facility; and (d) demonstrate that the proposed satellite facility’s location is not within thirty miles of an existing facility without obtaining the existing facility’s written support. NOTE: ESRD Policy Statements 2, 4, 5 and 6, and Need Criterion 1, are inapplicable to applications for the establishment of ESRD Satellite facilities. An ESRD Satellite facility established under this Need Criterion 3 shall not be used or considered for purposes of establishing or determining an ESRD Facility Service Area. Need Criterion 4: Number of Stations The applicant shall state the number of ESRD stations that are to be located in the proposed facility. No new facility shall be approved for less than ten (10) dialysis stations. Need Criterion 5: Minimum Utilization The application shall demonstrate that the applicant can reasonably expect to meet the minimum utilization requirements as stated in ESRD Policy Statement 10.

Need Criterion 6: Minimum Services The application shall affirm that the facility will provide, at a minimum, social, dietetic, and rehabilitative services. Rehabilitative services may be provided on a referral basis. Need Criterion 7: Access to Needed Services The application shall affirm that the applicant will provide for reasonable access to equipment/facilities for such needs as vascular access and transfusions required by stable maintenance ESRD patients. Need Criterion 8: Access to Needed Services The application shall affirm that the applicant will provide for reasonable access to equipment/facilities for such needs as vascular access and transfusions required by stable maintenance ESRD patients. Need Criterion 9: Home Dialysis Training Program The application shall affirm that the applicant will make a Home Dialysis Training Program available to those patients who are medically eligible and receptive to such a program. The application shall affirm that the applicant will counsel all patients on the availability of and eligibility requirements to enter the home/self-dialysis program. Need Criterion 10: Indigent/Charity Care The application shall affirm that the applicant will provide a “reasonable amount” of indigent/charity care. The application shall also state the amount of indigent/charity care the applicant intends to provide. Need Criterion 11: Facility Staffing The application shall describe the facility’s staffing by category (i.e. registered nurse, technologist, technician, technician, social worker, dietician) as follows: A. Qualifications (minimum education and experience requirements), B. Specific Duties, and C. Full-Time Equivalents (FTE) based upon expected utilization Need Criterion 12: Staffing Qualifications The applicant shall affirm that the staff of the facility will meet, at a minimum, all requirements and qualifications as stated in 42 CFR, Subpart D § 494.140. Need Criterion 13: Staffing Time A. The applicant shall affirm that when the unit is in operation, at least one (1) Registered

Nurse (R.N.) will be on duty. There shall be a minimum of two (2) persons for each dialysis shift, one of whom must be an R.N. B. The applicant shall affirm that the medical director or a designated physician will be on- site or on call at all times when the unit is in operation. It is desirable to have one other physician to supplement the services of the medical director. C. The applicant shall affirm that when the unit is not in operation, the medical director or designated physician and a registered nurse will be on call. Need Criterion 14: Data Collection The application shall affirm that the applicant will record and maintain, at a minimum, the following utilization data and make this data available to the Mississippi State Department of Health as required. The time frame for the submission of the utilization data shall be established by the Department. A. Utilization data (e.g., days of operation, shifts, inventory and classification of all stations, number of patients in dialysis, transplanted, or expired). B. The number of charity/indigent patients (as defined in this Plan) served by the facility and the number of dialysis procedures provided to these patients free of charge or at a specified reduced rate. Need Criterion 15: Staff Training The application shall affirm that the applicant will provide an ongoing program of training in dialysis techniques for nurses and technicians at the facility. Need Criterion 16: Scope of Privileges The applicant shall affirm that the facility shall provide access to Doctors of Medicine or Osteopathic Medicine licensed by the State of Mississippi who possess qualifications established by the governing body of the facility. Need Criterion 17: Affiliation with a Renal Transplant Center The applicant shall affirm that within one year of commencing operation the facility will enter into an affiliation agreement with a transplantation center. The written agreement shall describe the relationship between the transplantation facility and the ESRD facility and the specific services that the transplantation center will provide to patients of the ESRD facility. The agreement must include at least the following: A. Time frame for initial assessment and evaluation of patients for transplantation; B. Composition of the assessment/evaluation team at the transplant center; C. Method for periodic re-evaluation;

D. Criteria by which a patient will be evaluated and periodically re-evaluated for transplantation; and E. Signatures of the duly authorized persons representing the facilities and the agency providing the services. F. Furthermore, the application shall affirm that the applicant understands and agrees that failure to comply with this criterion may (after due process) result in revocation of the Certificate of Need. 705.2.2 Establishment of Renal Transplant Center Need Criterion 1: The applicant shall document that the proposed renal transplant center will serve a minimum population of 3.5 million people. Need Criterion 2: The applicant shall document that the proposed facility will provide, at a minimum, the following: A. Medical-surgical specialty services required for the care of ESRD transplant patients; B. Acute dialysis services; C. An organ procurement system; D. An organ preservation program; and E. A tissue typing laboratory. Need Criterion 3: The applicant shall document that the facility will perform a minimum of twenty-five (25) transplants annually. Glossary Accessibility — a measure of the degree to which the health care delivery system inhibits or facilitates an individual's ability to receive services, including geographic, architectural, transportation, social, time, and financial considerations. Ambulatory Surgery — surgical procedures that are more complex than office procedures performed under local anesthesia but less complex than major procedures requiring prolonged post-operative monitoring and hospital care to ensure safe recovery and desirable results. General anesthesia is used in most cases. The patient must arrive at the facility and expect to be discharged on the same day. Ambulatory surgery shall be performed only by physicians or dentists licensed to practice in the state of Mississippi.

Examples of procedures performed include, but are not limited to: • Tonsillectomies and adenoidectomies • Nasal polypectomy • Submucosa resection • Some cataract procedures • Cosmetic procedures • Breast biopsy • Augmentation mammoplasty • Hand surgery • Cervical conization • Laparoscopy and tubal sterilization • Circumcision • Urethral dilation • Simple hernia repairs • Stripping and ligation of varicose veins Ambulatory Surgical Facility — a publicly or privately owned institution that is primarily organized, constructed, renovated, or otherwise established for the purpose of providing elective surgical treatment to outpatients whose recovery, under normal and routine circumstances, will not require inpatient care. Such facilities as herein defined do not include the offices of private physicians or dentists whether practicing individually or in groups but does include organizations or facilities primarily engaged in such outpatient surgery, whether using the name "ambulatory surgical facility" or a similar or different name. Such organization or facility, if in any manner considered to be operated or owned by a hospital or a hospital holding, leasing, or management company, either for-profit or not-for-profit, is required to comply with all Mississippi State Department of Health ambulatory surgical licensure standards governing a hospital-affiliated facility as adopted under Section 41-9-1 et seq., Mississippi Code of 1972, provided that such organization or facility does not intend to seek federal certification as an ambulatory surgical facility as provided for in 42 CFR, Parts 405 and 416. Further, if such organization or facility is to be operated or owned by a hospital or a hospital holding, leasing, or management company and intends to seek federal certification as an ambulatory facility, then such facility is considered to be freestanding and must comply with all Mississippi State Department of Health ambulatory surgical licensure standards governing a freestanding facility. If such organization or facility is to be owned or operated by an entity or person other than a hospital or hospital holding, leasing, or management

company, then such organization or facility must comply with all Mississippi State Department of Health ambulatory surgical facility standards governing a freestanding facility. Bed Need Methodologies — quantitative approaches to determining present and future needs for inpatient beds. Capital Improvements — costs other than construction which will yield benefits over a period of years. Examples of capital improvements are painting, refurbishing, and land improvements, such as improving driveways, fences, parking lots, and sprinkler systems. Capitalized Interest — interest incurred during the construction period, which is included in debt borrowing. Construction Formulas — ▪ New Construction/Renovation (Prorated Project): Cost/square foot = A+C+D+(E+F+G(A%*)) New Const. Square Feet

Cost/square foot = B+(E+F+G(B%))**+H Renov. Square Feet ▪ New Construction (No Renovation Involved): Cost/square foot = A+C+D+E+F+G Square Feet ▪ Renovation (No New Construction): Cost/square foot = B+C+E+F+G+H Square Feet When: A = New Construction E = Fees B = Renovation F = Contingency C = Fixed Equipment G = Capitalized Interest D = Site Preparation H = Capital Improvement *A% - refers to the percentage of square feet allocated to new construction. **B% - refers to the percentage of square feet allocated to renovation. Example: ABC Health Care's project for construction/renovation consists of 10,000 square feet of new construction and 9,000 square feet of renovation, for a total of 19,000 square feet.

A% = 10,000 or 53% 19,000 B% = 9,000 or 47% 19,000 Continuing Care Retirement Community — a comprehensive, cohesive living arrangement for the elderly which is offered under a contract that lasts for more than one year or for the life of the resident and describes the service obligations of the CCRC and the financial obligations of the resident. The contract must obligate the CCRC to provide, at a minimum, room, board, and nursing care to an individual not related by consanguinity or affinity to the provider furnishing such care. The contract explicitly provides for full lifetime nursing home care as required by the resident. The resident may be responsible for the payment of some portion of the costs of his/her nursing home care, and the CCRC sponsor is responsible for the remaining costs as expressly set forth in the contract. Depletion of the contractee’s personal resources does not affect the contribution of the CCRC sponsor. Conversion — a major or proportional change that a healthcare facility undertakes in its overall mission, such as the change from one licensure category to another, from one organizational tax status to another, or from one type of healthcare facility to another. Cost Containment — maintaining control of expenses within the healthcare delivery system to prevent and reduce unnecessary spending. Criteria — guidelines or pre-determined measurement characteristics on which judgment or comparison of need, appropriateness, or quality of health services may be made. Distinct Part Skilled Nursing Unit- Medicare eligible certified units which are a “distinct part” (i.e. distinguishable from the larger institution and fiscally separate for cost reporting purposes) of an institution that is certified to provide Skilled Nursing Facility services as by the Centers for Medicare and Medicaid Services (CMS). Existing Provider — an entity that has provided a service on a regular basis during the most recent 12-month period. Facilities — collectively, all buildings constructed for the purpose of providing healthcare including hospitals, nursing homes, clinics, or health centers, but not including physician offices; encompasses physical plant, equipment, and supplies used in providing health services. Feasibility Study — a report prepared by the chief financial officer, CPA or an independently recognized firm of accountants demonstrating that the cash flow generated from the operation of the facility will be sufficient to complete the project being financed and to pay future annual debt service. The study includes the financial analyst’s opinion of the ability of the facility to undertake the debt obligation and the probable effect of the expenditure on present and future operating costs. Freestanding Ambulatory Surgical Facility — a separate and distinct facility or a separate and distinct organized unit of a hospital owned, leased, rented, or utilized by a hospital or other persons for the primary purpose of performing ambulatory surgery procedures. Such facility must be

separately licensed as herein defined and must comply with all licensing standards promulgated by the Mississippi State Department of Health regarding a freestanding ambulatory surgical facility. Further, such facility must be a separate, identifiable entity and must be physically, administratively, and financially independent and distinct from other operations of any other health facility and shall maintain a separate organized medical and administrative staff. Furthermore, once licensed as a freestanding ambulatory surgical facility, such facility shall not become a component of any other health facility without securing a Certificate of Need to do so. Group Home — a single dwelling unit whose primary function is to provide a homelike residential setting for a group of individuals, generally 8 to 20 persons, who neither live in their own home nor require institutionalization. Group homes are used as a vehicle for normalization. Habilitation — the combined and coordinated use of medical, social, educational, and vocational measures for training individuals who are born with limited functional ability as contrasted with people who have lost abilities because of disease or injury. Home Health Agency — certain services must be provided directly by a licensed home health agency and must include all skilled nursing services; physical, occupational, or speech therapy; medical social services; part-time or intermittent services of a home health aide; and other services as approved by the licensing agency for home health agencies. In this instance, "directly" means either through an agency employee or by an arrangement with another individual not defined as a healthcare facility. Hospital Affiliated Ambulatory Surgical Facility — a separate and distinct organized unit of a hospital or a building owned, leased, rented, or utilized by a hospital and located in the same county in which the hospital is located for the primary purpose of performing ambulatory surgery procedures. Such facility is not required to be separately licensed and may operate under the hospital's license in compliance with all applicable requirements of Section 41-9-1 et seq. Limited Care Renal Dialysis Facility — a healthcare facility which provides maintenance or chronic dialysis services on an ambulatory basis for stable ESRD patients. The limited care renal dialysis facility is considered a substitute for home dialysis to be used by patients who cannot dialyze at home. The facility provides follow-up and back-up services for home dialysis patients. Magnetic Resonance Imaging (MRI) Scientist — a professional with similar skills and job qualifications as a medical physicist, who holds a comparable degree in an allied science, such as chemistry or engineering, and shows similar experience as the medical physicist with medical imaging and MRI imaging spectroscopy. Market Share — historical data used to define a primary or secondary geographic service area (i.e. patient origin study, using counties, zip codes, census tracts). Observation Bed — a licensed, acute care bed on the premise of a licensed, short-term, acute care facility. The hospital bed shall be used by a physician and/or nursing/medical staff to periodically monitor/evaluate a patient’s medical condition. A bed that is occupied by a patient who is admitted to the hospital for a period of 23 hours and 59 minutes or ≤ (less than) 48 hours will be counted as an observation bed. Also, the status of a patient will be documented by a physician as an outpatient.

Observation Services — a well-defined set of specific, clinically appropriate services, which include ongoing short-term treatment, assessment, and reassessment, that are furnished while a decision is being made regarding whether patients will require further treatment as hospital inpatients or if they are able to be discharged from the hospital. Observation services begin at the clock time documented in the patient’s medical record, which coincides with the time that observation services are initiated in accordance with a physician’s order for observation services. In most cases, a beneficiary (patient) may not remain in observation status for more than 24 or 48 hours. The hospital status of a patient will be documented as an outpatient until the physician writes an order to admit a person as an inpatient. Billing and coding of physician services are expected to be billed consistent with the patient’s status as an outpatient or an inpatient. General standing orders for observation services following all outpatient surgery are not recognized. Hospitals should not report postoperative monitoring during a standard recovery period (e.g. 4-6 hours) as observation services because those hours may be considered recovery room services. Occupancy Rate — measure of average percentage of hospital beds occupied; determined by dividing available bed-days (bed capacity) by patient days actually used during a specified time period. Outpatient Facility — a medical institution designed to provide a limited or full spectrum of health and medical services (including health education and maintenance services, preventive services, diagnosis, treatment, and rehabilitation) to individuals who do not require hospitalization or institutionalization. Pediatric Skilled Nursing Facility — a pediatric skilled nursing facility is an institution or a distinct part of an institution that is primarily engaged in providing to inpatients skilled nursing care and related services for persons under 21 years of age who require medical, nursing care, or rehabilitation services for the rehabilitation of injured, disabled, or sick persons. Policy Statement — a definite course of action selected in light of given conditions to guide and determine present and future decisions. Positron Emission Tomography (PET) — a non-invasive imaging procedure in which positron- emitting radionuclides, that are produced either by a cyclotron or a radiopharmaceutical producing generator, and a nuclear camera are used to create pictures of organ function rather than structure. PET, therefore, has the potential for providing unique, clinically important information about disease processes. Key applications for PET are in coronary artery disease and myocardial infarction, epilepsy, cerebral gliomas, and dementia. Radiation Therapy — the use of ionizing radiations for the treatment of tumors. Renal Dialysis Center — a healthcare facility which provides dialysis services to hospital patients who require such services. The dialysis provided in a renal dialysis center functions primarily as a backup program for ESRD patients dialyzing at home or in a limited care facility who are placed in a hospital. A renal dialysis center may also serve as an initial dialysis setting for newly diagnosed ESRD patients who are in the hospital. A center may also provide acute dialysis services as needed.

Renal Transplant Center — a healthcare facility which provides direct transplant and other medical-surgical specialty services required for the care of the ESRD transplant patient. Services provided include, but are not limited to, acute renal dialysis, organ procurement system, organ preservation program, and tissue typing laboratory. Standard — a quantitative level to be achieved regarding a particular criterion to represent acceptable performance as judged by the agency establishing the standard. Therapeutic Radiation Services — shall have the meaning set forth in Section 41-7-173, Mississippi Code of 1972, as amended.

Appendix

Table 7-3 Medicare Home Health Statistics – Ten-State Region January 1, 2023 – December 31, 2024 State Estimated HH Visits Population 65+ HH Users Avg. Visits/ Patient Visits per 1,000 Age 65+ Alabama 1,054,364 929,867 42,652 24.72 1,133.89 Arkansas 631,317 549,766 27,013 23.37 1,148.34 Florida 6,574,712 4,935,427 233,472 28.16 1,332.15 Georgia 1,329,390 1,697,554 58,197 22.84 783.12 Kentucky 714,306 805,637 32,619 21.90 886.64 Louisiana 1,135,809 793,190 38,301 29.65 1,431.95 Mississippi 1,139,553 517,325 40,340 28.25 2,202.78 North Carolina 1,468,645 1,908,545 71,461 20.55 769.51 South Carolina 1,108,231 1,036,937 55,056 20.13 1,068.75 Tennessee 1,415,405 1,240,957 52,667 26.87 1,140.58 REGION TOTAL 16,571,732 14,415,205 651,778 25.43 1,149.60

**History**
- *Source: Center for Medicare & Medicaid Services: 2023 Geographic Variation Data for Home Health; U.S Census: Annual County and Puerto Rico Municipio Resident Population Estimates by Selected Age Groups and Sex: April 1, 2020 to July 1, 2024 (CC-EST2024-AGESEX)*

### **Part 9** CERTIFICATE OF NEED REVIEW MANUAL

##### **15 Miss. Admin. Code Pt. 9, R. 1.2** Purpose {#sec-9-1.2 omnilex-key=us-ms-regs-official--title-15--9#1.2}

This Manual governs the administration of the Mississippi Certificate of Need Program by MSDH. The purpose of this Manual is to establish procedures, administrative standards, review criteria, and interpretive provisions for the administration of the Certificate of Need Program. This Manual is intended to: 1. Provide orderly procedures for filing, reviewing, and deciding CON applications; 2. Establish procedures for Determinations of Reviewability, Emergency Certificates of Need, Change of Ownership Reviews, and other administrative determinations; 3. Provide procedures for public notice, public comment, hearings, appeals, and post-approval administration; 4. Establish general review criteria applicable to CON applications; 5. Clarify administrative interpretations necessary for consistent application of the CON statutes; and 6. Distinguish administrative rules and procedures from planning methodologies and service-specific standards contained in the State Health Plan.

**History**
- *Source: Miss. Code Ann. § 41-7-171 et seq.*

##### **15 Miss. Admin. Code Pt. 9, R. 1.3** Applicability {#sec-9-1.3 omnilex-key=us-ms-regs-official--title-15--9#1.3}

This Manual applies to all persons and entities seeking, holding, opposing, or otherwise participating in matters involving: a Certificate of Need; a

Page 3 — Mississippi State Department of Health Determination of Reviewability; a Change of Ownership Review; an Emergency CON; a request for extension, modification, withdrawal, revocation, rescission, or other post-approval action; a public hearing, administrative appeal, or judicial review arising under the CON Program; or any other approval, determination, or administrative action administered by the Department under the CON Program.

**History**
- *Source: Miss. Code Ann. § 41-7-171 et seq.*

##### **15 Miss. Admin. Code Pt. 9, R. 1.4** Construction {#sec-9-1.4 omnilex-key=us-ms-regs-official--title-15--9#1.4}

This Manual shall be construed consistently with applicable federal law, Mississippi law, and the State Health Plan. Nothing in this Manual shall be construed to expand, limit, modify, create, or eliminate any requirement, exemption, exception, moratorium, prohibition, right, or remedy established by statute. If any provision of this Manual conflicts with applicable statute, the statute controls. The omission from this Manual of statutory text, statutory exemptions, statutory moratoria, or statutory requirements shall not be construed as eliminating, limiting, or modifying any such statutory provision.

**History**
- *Source: Miss. Code Ann. § 41-7-171 et seq.*

##### **15 Miss. Admin. Code Pt. 9, R. 1.5** Relationship to State Health Plan {#sec-9-1.5 omnilex-key=us-ms-regs-official--title-15--9#1.5}

The State Health Plan establishes planning methodologies, inventories, need methodologies, utilization methodologies, planning districts, service-specific criteria, and other planning standards applicable to Certificate of Need review. This Manual establishes administrative procedures, general review criteria, and interpretive rules governing administration of the CON Program. An applicant shall demonstrate consistency with the State Health Plan in effect on the date the application is deemed complete, unless otherwise required by law.

**History**
- *Source: Miss. Code Ann. § 41-7-171 et seq.*

##### **15 Miss. Admin. Code Pt. 9, R. 1.6** Severability {#sec-9-1.6 omnilex-key=us-ms-regs-official--title-15--9#1.6}

If any provision of this Manual, or the application of any provision to any person or circumstance, is held invalid, the invalidity shall not affect other provisions or applications of the Manual that can be given effect without the invalid provision or application. The provisions of this Manual are severable.

Page 4 — Mississippi State Department of Health Rule 1.7 Definitions. For purposes of this Manual, unless the context clearly requires otherwise, the following terms have the meanings set forth below. Terms defined by Miss. Code Ann. §§ 41-7-171 through 41-7-209 retain the meanings assigned by statute; the definitions below supply administrative interpretations necessary for implementation and do not modify statutory definitions. 1. Affected Person — a person or entity entitled by applicable law to notice, participation, hearing, appeal, or other procedural rights in connection with a CON matter, including: (i) the applicant; (ii) a person residing within the geographic area to be served by the applicant's proposal; (iii) a person who regularly uses health care facilities or health maintenance organizations located in the geographic area of the proposal that provide similar services to those proposed; (iv) health care facilities and health maintenance organizations that, before receipt of the application under review, have formally indicated an intention to provide services similar to those of the proposal; (v) third-party payers who reimburse health care facilities located in the geographical area of the proposal; and (vi) any agency that establishes rates for health care services or health maintenance organizations located in the geographic area of the proposal. 2. Aggrieved Party — a person or entity that has actively participated in proceedings before the Department, including by requesting a hearing during the course of review or by the timely filing of written comments that completely and formally set out objections to the application and the reasons therefor, and otherwise meets the requirements of applicable law for administrative or judicial review. 3. Applicant — any person or entity seeking a CON, Determination of Reviewability, Change of Ownership Review, Emergency CON, exemption determination, extension, modification, or other approval or determination administered under the CON Program. 4. Application — a request submitted to the Department seeking a CON or other approval administered under the CON Program, including all required forms, attachments, supporting documentation, certifications, and fees. 5. Bed Abeyance — the voluntary temporary removal from active licensure of one or more licensed beds without relinquishment of the facility’s ability to seek their return to active licensure as authorized by law. 6. By or On Behalf of — a capital expenditure, acquisition, lease, financing arrangement, construction activity, contractual commitment, or other transaction undertaken directly or indirectly for the benefit of a health care facility.

Page 5 — Mississippi State Department of Health 7. Capital Expenditure — has the meaning assigned by Miss. Code Ann. § 41- 7-173, including the administrative interpretations set forth in Chapter 2 of this Manual. NOTE: The capital expenditure thresholds were amended by H.B. 3, 2026 Regular Session, effective February 4, 2026. Current statutory thresholds: major medical equipment — exceeds Three Million Dollars ($3,000,000.00); clinical health services other than major medical equipment — exceeds Ten Million Dollars ($10,000,000.00); nonclinical health services other than major medical equipment — exceeds Twenty Million Dollars ($20,000,000.00). These thresholds are subject to annual adjustment as provided by applicable law; the Department publishes current adjusted thresholds annually on its website. 8. Certificate of Need or CON — a written order issued by the State Health Officer setting forth the affirmative finding that a proposal in prescribed application form sufficiently satisfies the plans, standards, and criteria prescribed for such service or other project by Miss. Code Ann. §§ 41-7-171 et seq. and by rules and regulations promulgated thereunder. 9. Change in Project Scope — any material change to an approved project, including a substantial change in construction, renovation, capital expenditure, services to be offered, bed capacity, project location, ownership, major medical equipment, or other approved project characteristics. 10. Change of Ownership — a transaction or series of transactions resulting in a transfer of ownership, operation, management, control, controlling interest, assets, or other interest in a health care facility, health service, institutional health service, or major medical equipment. 11. Commencement of Construction — substantial initiation of approved construction, renovation, remodeling, alteration, replacement, or expansion activities, as documented by the evidence described in Chapter 6 of this Manual. 12. Complete Application — an application containing the information required by statute, this Manual, applicable State Health Plan provisions, Department forms and instructions, and any required filing fee, sufficient for the Department to begin substantive review. 13. Department — the Mississippi State Department of Health (“MSDH”). References to the “Division” or the “Division of Health Planning and Resource Development” in this Manual refer to an organizational unit of the Department; all such references are to the Department acting through that Division.

Page 6 — Mississippi State Department of Health 14. Determination of Reviewability — a written determination issued by the Department under Miss. Code Ann. § 41-7-205 regarding whether a proposed activity is subject to CON review. 15. Electronic Filing — filing by electronic mail, electronic portal, or other electronic method authorized by the Department. 16. Emergency Certificate of Need — a CON issued on an emergency basis in accordance with applicable law and Chapter 3 of this Manual. 17. Final Order — the written decision of the State Health Officer approving, approving with conditions, denying, revoking, rescinding, withdrawing, or otherwise finally disposing of a matter under the CON Program. The Final Order constitutes final agency action from which appeal rights under Miss. Code Ann. § 41-7-201 and Chapter 5 of this Manual run. 18. Good Faith Effort — objective action taken by a CON holder to implement an approved project, including expenditures, contracts, design work, financing commitments, site development, licensure activities, staffing preparation, or acquisition of equipment. 19. Health Care Facility — has the meaning assigned by Miss. Code Ann. § 41- 7-173. 20. Health Service — has the meaning assigned by applicable law. 21. Institutional Health Service — has the meaning assigned by applicable law. 22. Major Medical Equipment — has the meaning assigned by Miss. Code Ann. § 41-7-173. 23. Material Project Modification — a change to an approved project that materially affects the project's nature, scope, location, cost, service capacity, ownership, timetable, equipment, bed complement, or consistency with the findings supporting approval. See also Chapter 6. 24. Notice of Intent — a filing submitted to the Department before submission of an application when required by applicable law or this Manual. 25. Person — has the meaning assigned by Miss. Code Ann. § 41-7-173. 26. Project — the activity, service, facility, equipment, expenditure, transaction, or undertaking proposed in an application or approved by a CON. 27. Similar Equipment — equipment having substantially comparable clinical function, purpose, capability, and use, even if differing in manufacturer, model, capacity, generation, or technical specifications.

Page 7 — Mississippi State Department of Health 28. Small Community Hospital — has the meaning assigned by applicable law. See H.B. 1622 § 1 and S.B. 2474 § 8, 2026 Regular Session, and Chapter 9 of this Manual. 29. State Health Officer — the State Health Officer of the Mississippi State Department of Health or the State Health Officer’s authorized designee. 30. State Health Plan — the officially adopted State Health Plan in effect for purposes of CON review. 31. Substantial Progress — objective progress toward implementation of an approved project sufficient to demonstrate that the CON-holder is actively and materially pursuing completion of the approved project. 32. Working Day or Business Day — a day on which the Department is open for official business, excluding Saturdays, Sundays, legal holidays, and days on which the Department is closed.

Rule 1.8 Use of Department Forms and Instructions. The Department may prescribe forms, formats, filing instructions, checklists, and other administrative materials necessary to implement this Manual. Applicants and other persons filing materials with the Department shall use Department- prescribed forms and comply with Department filing instructions. Department forms and instructions shall not supersede applicable statutes, this Manual, or the State Health Plan.

**History**
- *Source: Miss. Code Ann. § 41-7-171 et seq.*
- *Source: Miss. Code Ann. §§ 41-7-173 and 41-7-191; H.B. 3 § 2, 2026 Reg. Sess.; H.B. 1622 § 1, 2026 Reg. Sess.; S.B. 2474 § 8, 2026 Reg. Sess.*
- *Source: Miss. Code Ann. § 41-7-171 et seq.*

##### **15 Miss. Admin. Code Pt. 9, R. 1.9** Computation of Time {#sec-9-1.9 omnilex-key=us-ms-regs-official--title-15--9#1.9}

Unless otherwise required by law: 1. The day of the act, event, decision, notice, or filing from which a period begins to run is not included; 2. The last day of the period is included; 3. If the last day falls on a Saturday, Sunday, legal holiday, or a day on which the Department is closed, the period extends to the next business day; and 4. A filing received after the close of business on a business day may be deemed filed on the next business day.

Page 8 — Mississippi State Department of Health Where a statute expressly measures a period in calendar days, this Rule shall not be construed to extend or modify the statutory period.

**History**
- *Source: Miss. Code Ann. § 41-7-171 et seq.*

##### **15 Miss. Admin. Code Pt. 9, R. 1.10** Filing and Service {#sec-9-1.10 omnilex-key=us-ms-regs-official--title-15--9#1.10}

Filings shall be submitted in the manner prescribed by the Department. The Department may accept filings by electronic means, mail, hand delivery, courier, or other approved method. A filing is not complete until received by the Department in the required form and accompanied by any required fee. Electronic submissions shall be deemed filed when successfully received by the Department.

**History**
- *Source: Miss. Code Ann. § 41-7-171 et seq.*

##### **15 Miss. Admin. Code Pt. 9, R. 1.11** Public Records and Confidential Information {#sec-9-1.11 omnilex-key=us-ms-regs-official--title-15--9#1.11}

Records maintained by the Department in connection with the Certificate of Need Program shall be available in accordance with the Mississippi Public Records Act, Miss. Code Ann. § 25-61-1 et seq., and other applicable law. A person submitting information claimed to be confidential shall clearly identify the information and provide the legal basis for the claim. The Department shall determine whether information is subject to disclosure in accordance with applicable law. Nothing in this Manual requires disclosure of records or information made confidential or privileged by law.

**History**
- *Source: Miss. Code Ann. § 25-61-1 et seq.*

##### **15 Miss. Admin. Code Pt. 9, R. 1.12** Notices {#sec-9-1.12 omnilex-key=us-ms-regs-official--title-15--9#1.12}

Unless a specific method of notice is required by law, the Department may provide notice by website posting, electronic mail, mail, publication, electronic publication, or any other method reasonably calculated to provide notice to affected persons or interested persons.

**History**
- *Source: Miss. Code Ann. § 41-7-171 et seq.*

##### **15 Miss. Admin. Code Pt. 9, R. 1.13** Waiver of Non-Statutory Procedural Requirements {#sec-9-1.13 omnilex-key=us-ms-regs-official--title-15--9#1.13}

The Department may waive formatting, filing, service, or other ministerial procedural requirements that do not affect substantive rights, notice, public participation, or statutory review requirements. The Department may not waive statutory requirements.

**History**
- *Source: Miss. Code Ann. § 41-7-171 et seq.*

#### **Chapter 2** SCOPE OF COVERAGE Rule 2.1 Administrative Interpretation. In administering the Certificate of Need Program, the Department may consider the substance of a transaction, project, expenditure, acquisition, relocation, ownership arrangement, contractual relationship, or other activity in addition to its form. The Department may examine all relevant facts and circumstances to determine whether a proposed activity is subject to CON review. Nothing in this rule shall be construed to expand the scope of activities subject to CON review beyond those identified by applicable law.

##### **15 Miss. Admin. Code Pt. 9, R. 2.2** Aggregation of Related Expenditures {#sec-9-2.2 omnilex-key=us-ms-regs-official--title-15--9#2.2}

For purposes of determining whether a proposed activity exceeds an applicable capital expenditure threshold, the Department may aggregate expenditures associated with related activities. Transactions separated in time but planned to be undertaken within twelve (12) months of one another and constituting components of an overall plan to accomplish a common project or patient care objective shall be evaluated collectively and not individually. In determining whether expenditures should be aggregated, the Department may consider whether the expenditures involve the same project or service; whether they are part of a common development plan; whether they are undertaken by related persons or entities; whether they are dependent upon one another; and whether they serve a common operational purpose. Nothing in this rule shall be construed to subject to CERTIFICATE OF NEED review any transaction or expenditure that is not independently subject to review under Miss. Code Ann. §§ 41-7-173(c) and 41-7-191. The twelve-month aggregation standard is an administrative interpretation of the statutory definition. Where application of this rule’s aggregation analysis would produce a result inconsistent with applicable statute, the statute controls.

**History**
- *Source: Miss. Code Ann. § 41-7-173*

##### **15 Miss. Admin. Code Pt. 9, R. 2.3** Split-Party Capital Expenditures {#sec-9-2.3 omnilex-key=us-ms-regs-official--title-15--9#2.3}

Where a health care facility, health service provider, physician group, management company, developer, lessor, affiliate, related organization, or other

Page 10 — Mississippi State Department of Health person proposes to provide or support a health service and the capital expenditure necessary to provide the service is divided among multiple persons or entities, the Department may consider the total capital expenditure required to implement the service. The Department may consider expenditures associated with facilities and equipment to provide services in Mississippi regardless of: (1) the location where the expenditure is incurred; (2) the location of the equipment or facility at the time of acquisition; (3) the domicile of the person making the expenditure; or (4) the form of the transaction. Nothing in this rule shall be construed to require Certificate of Need review of an expenditure that does not independently trigger review under applicable law solely by reason of its association with another party's expenditure. Where application of this rule would produce a result inconsistent with Miss. Code Ann. § 41-7-173(c), the statute controls.

**History**
- *Source: Miss. Code Ann. § 41-7-173*

##### **15 Miss. Admin. Code Pt. 9, R. 2.4** Acquisitions Other Than Purchase {#sec-9-2.4 omnilex-key=us-ms-regs-official--title-15--9#2.4}

A capital expenditure may include acquisition by lease, gift, donation, devise, legacy, trust distribution, assignment, transfer, merger, consolidation, or other means. An acquisition for less than fair market value may be evaluated based upon fair market value when determining whether review is required. In determining fair market value, the Department may consider the following: 1. Independent Appraisals; 2. Market Data; 3. Industry Valuation Standards; 4. Purchase Agreements; 5. Lease Agreements; 6. Financing Documents; 7. Tax Records; 8. Asset Valuations; and 9. Other Relevant Information Deemed Appropriate by the Department.

Page 11 — Mississippi State Department of Health Rule 2.5 Capital Expenditures By or On Behalf of a Health Care Facility. In determining whether an activity is undertaken by or on behalf of a health care facility, the Department may consider all relevant facts and circumstances. Factors that may be considered include, but are not limited to: 1. Ownership of land by a health care facility, or construction on land adjacent to a health care facility; 2. Leasing arrangements involving a health care facility, including leasing of land from a health care facility; 3. Options to purchase a structure or property retained by a health care facility; 4. Authority to approve tenants or occupants of a structure; 5. Rights to assume control of a structure or to collect rent; 6. Shared infrastructure, governance, management, branding, staffing, or patient services; 7. Revenue-sharing or financial support arrangements; and 8. Any other comparable factor demonstrating that the activity is undertaken primarily for the benefit of a health care facility. No single factor shall be dispositive.

**History**
- *Source: Miss. Code Ann. § 41-7-173*
- *Source: Miss. Code Ann. § 41-7-191*

##### **15 Miss. Admin. Code Pt. 9, R. 2.6** Date Capital Expenditure Incurred {#sec-9-2.6 omnilex-key=us-ms-regs-official--title-15--9#2.6}

Unless otherwise required by law, a capital expenditure shall be deemed incurred upon the earliest of: 1. Execution of an enforceable contract for construction, acquisition, lease, or financing of a capital asset; 2. Formal action by the governing body of a health care facility committing its own funds to a project undertaken by facility personnel (force account expenditure); or 3. In the case of donated property, the date on which the gift is complete under applicable state law. The Department may consider additional facts demonstrating commitment to a project.

**History**
- *Source: Miss. Code Ann. § 41-7-173*

##### **15 Miss. Admin. Code Pt. 9, R. 2.7** Relocation {#sec-9-2.7 omnilex-key=us-ms-regs-official--title-15--9#2.7}

Relocation of a health care facility means the physical movement of a health care facility from one location or site to another. A portion of a health care facility, for purposes of relocation review, includes a wing, unit, department, service line, clinical program, patient care area, or licensed beds. Relocation of major medical equipment includes movement of such equipment from one physical facility to another physical facility. The Department may evaluate whether a proposed activity constitutes relocation subject to review under applicable law, considering the physical movement of operations, movement of licensed beds or health services, closure of one location and opening of another, transfer of patient care functions, continuity of operations, and other relevant factors.

**History**
- *Source: Miss. Code Ann. § 41-7-191*

##### **15 Miss. Admin. Code Pt. 9, R. 2.8** Determinations of Reviewability — Administrative Framework {#sec-9-2.8 omnilex-key=us-ms-regs-official--title-15--9#2.8}

Any person may request a written Determination of Reviewability concerning whether a proposed activity is subject to Certificate of Need review. Requests shall be submitted and processed in accordance with Chapter 3 of this Manual. A Determination of Reviewability is an administrative determination concerning the applicability of CON review requirements to a proposed activity based upon the facts presented to the Department. A Determination of Reviewability does not constitute approval of a project and does not authorize commencement of any activity requiring a CON. The rights, obligations, limitations, reliance provisions, and procedures governing Determinations of Reviewability are set forth in Chapter 3 of this Manual.

**History**
- *Source: Miss. Code Ann. § 41-7-205*

##### **15 Miss. Admin. Code Pt. 9, R. 2.9** UMMC Academic Exemption {#sec-9-2.9 omnilex-key=us-ms-regs-official--title-15--9#2.9}

The University of Mississippi Medical Center is subject to the Certificate of Need requirements of Miss. Code Ann. §§ 41-7-171 et seq., except as provided in Miss. Code Ann. § 41-7-191(22), as enacted by H.B. 3, 2026 Regular Session, effective February 4, 2026.

Page 13 — Mississippi State Department of Health Pursuant to § 41-7-191(22): 1. UMMC need not obtain a CON for hospital beds, services, health care facilities, or medical equipment that have been approved and continuously operated under a CON exemption for a teaching hospital, or that are approved or applied for before February 4, 2026, so long as they do not undergo a physical relocation; and 2. From and after February 4, 2026, UMMC has an academic exemption from the CON requirements of Miss. Code Ann. §§ 41-7-171 et seq. only within the geographic boundary described in Miss. Code Ann. § 41-7-191(22). To qualify for the academic exemption, the State Health Officer must determine that the proposed equipment or facility fulfills a substantial and meaningful academic function. Any activity by UMMC that falls outside the geographic boundary described in Miss. Code Ann. § 41-7-191(22) and that is not covered by item 1 of this rule remains subject to CON review under applicable law. Persons proposing activities at UMMC that may otherwise be subject to CON review should contact the Department for a written Determination of Reviewability before proceeding.

**History**
- *Source: Miss. Code Ann. § 41-7-191; H.B. 3 § 1, 2026 Reg. Sess.*

##### **15 Miss. Admin. Code Pt. 9, R. 2.10** Geographically Limited Statutory Exemptions {#sec-9-2.10 omnilex-key=us-ms-regs-official--title-15--9#2.10}

Certain statutory exemptions apply on a geographic basis. Nothing in this Manual expands or limits the scope of any geographically limited statutory exemption. Persons proposing activities in counties or areas subject to a geographically limited statutory exemption should contact the Department for a written Determination of Reviewability before proceeding. NOTE: Effective upon passage of H.B. 1622, 2026 Regular Session, Miss. Code Ann. § 41-7-191(24) exempts from CON review any activity in Issaquena County or Humphreys County that would otherwise require a CON, subject to the continued application of the statutory moratoria under § 41-7-191. The exemption does not apply to any entity seeking to establish a licensed hospital within thirty-five (35) miles of another licensed hospital, or if the exemption would jeopardize a licensed hospital’s federal critical access hospital designation.

Page 14 — Mississippi State Department of Health Rule 2.11 Statutory Moratoria and Exemptions — General Principle. Statutory moratoria and exemptions established by Miss. Code Ann. §§ 41-7-171 through 41-7-209 govern the issuance of Certificates of Need notwithstanding any provision of this Manual. The omission from this Manual of a specific moratorium or exemption does not eliminate or modify that moratorium or exemption. Where a statutory amendment modifies the scope of review, a moratorium, or an exemption, the amendment shall control notwithstanding any prior Department interpretation or determination.

**History**
- *Source: Miss. Code Ann. § 41-7-191; H.B. 1622 § 3, 2026 Reg. Sess.*
- *Source: Miss. Code Ann. § 41-7-191*

##### **15 Miss. Admin. Code Pt. 9, R. 2.12** Dissemination of Scope of Coverage {#sec-9-2.12 omnilex-key=us-ms-regs-official--title-15--9#2.12}

Before reviewing new institutional health services or other proposals not previously within the scope of the Certificate of Need Program, the Department shall make available a description of the scope of coverage of the Certificate of Need Program in accordance with applicable law. The Department shall publish such information on its official website and may disseminate such information through additional methods authorized by applicable law. Whenever the scope of coverage is revised, the Department shall publish a revised description on its official website and may disseminate the revised description through additional methods authorized by applicable law. The Department may publish guidance, notices, policy statements, frequently asked questions, and other informational materials concerning the scope of CON review. Such materials shall not supersede applicable law, this Manual, or the State Health Plan.

**History**
- *Source: Miss. Code Ann. § 41-7-191*

##### **15 Miss. Admin. Code Pt. 9, R. 2.13** Financing Prohibition Prior to Certificate of Need {#sec-9-2.13 omnilex-key=us-ms-regs-official--title-15--9#2.13}

No person may enter into any financing arrangement or commitment for financing a new institutional health service or any other project requiring a Certificate of Need unless a CON has been granted for such purpose. This prohibition applies regardless of whether the person proposing the financing arrangement is the health care facility, an affiliate, a developer, a lender, or any other entity, if the financing arrangement or commitment is for a project that would require a CON.

Page 15 — Mississippi State Department of Health A Determination of Reviewability or other informal guidance from the Department does not constitute a CON and does not satisfy this prohibition. Only a CON issued pursuant to applicable law and this Manual satisfies the requirement of § 41-7-193(1).

**History**
- *Source: Miss. Code Ann. § 41-7-193*

##### **15 Miss. Admin. Code Pt. 9, R. 2.14** Ownership Concentration Limitation {#sec-9-2.14 omnilex-key=us-ms-regs-official--title-15--9#2.14}

Miss. Code Ann. § 41-7-190 prohibits any corporation, partnership, individual, or association of persons from owning, possessing, or exercising control over, in any manner, more than twenty percent (20%) of the beds in health care facilities defined as skilled nursing facilities under § 41-7-173(h)(iv) and intermediate care facilities under § 41-7-173(h)(vi) in any defined health service area of the State of Mississippi. Health care facilities owned, operated, or under control of the United States government, the State government, or a political subdivision of either are excluded from the limitation of this rule. The ownership concentration limitation of § 41-7-190 operates independently of the Certificate of Need review process. A CON issued pursuant to this Manual does not authorize or excuse a violation of § 41-7-190. The Department shall consider compliance with § 41-7-190 in reviewing applications for Certificates of Need involving skilled nursing facilities and intermediate care facilities. Nothing in this rule limits the authority of the Department to take action under Miss. Code Ann. § 41-7-209 against any person violating § 41-7-190.

**History**
- *Source: Miss. Code Ann. § 41-7-190*

##### **15 Miss. Admin. Code Pt. 9, R. 2.15** Swing Bed Program {#sec-9-2.15 omnilex-key=us-ms-regs-official--title-15--9#2.15}

The Department may issue a Certificate of Need to any hospital in the State to utilize a portion of its beds for the swing bed concept, pursuant to Miss. Code Ann. § 41-7-191(7). Any such hospital must be in conformance with the federal regulations regarding the swing bed concept at the time it submits its CON application, except that such hospital may have more licensed beds or a higher average daily census than the maximum number specified in federal regulations for participation in the swing bed program. Any hospital meeting all federal requirements for participation in the swing bed program that receives a CON shall render services provided under the swing bed concept to any patient eligible for Medicare (Title XVIII of the Social Security Act) who is certified by a physician to be in need of such services.

Page 16 — Mississippi State Department of Health No such hospital shall permit any patient who is eligible for both Medicaid and Medicare, or eligible only for Medicaid, to stay in the swing beds of the hospital for more than thirty (30) days per admission unless the hospital receives prior approval from the Division of Medicaid, Office of the Governor. Any hospital having more licensed beds or a higher average daily census than the maximum number specified in federal regulations for participation in the swing bed program that receives a CON shall develop a procedure to ensure that before a patient is allowed to stay in the swing beds of the hospital, there are no vacant nursing home beds available for that patient within a fifty (50) mile radius of the hospital. When any such hospital has a patient staying in its swing beds and the hospital receives notice from a nursing home within that radius that a vacant bed is available for that patient, the hospital shall transfer the patient to the nursing home within a reasonable time after receipt of the notice. Any hospital subject to the requirements of the two (2) preceding paragraphs may be suspended from participation in the swing bed program for a reasonable period of time if the Department, after a hearing complying with due process, determines that the hospital has failed to comply with any of those requirements. Suspension from the swing bed program shall be in the form of a written order. The hearing and appeal procedures of Chapter 5 of this Manual shall apply to such proceedings to the extent consistent with applicable law.

**History**
- *Source: Miss. Code Ann. § 41-7-191*

#### **Chapter 3** APPLICATIONS AND ADMINISTRATIVE DETERMINATIONS Rule 3.1 Department Forms. Applications, requests, notices, reports, certifications, and other submissions required under this Manual shall be submitted on forms prescribed by the Department. The Department may revise forms, instructions, filing formats, and submission requirements as necessary. Department forms and instructions shall not supersede applicable statutes, this Manual, or the State Health Plan.

##### **15 Miss. Admin. Code Pt. 9, R. 3.2** Notice of Intent {#sec-9-3.2 omnilex-key=us-ms-regs-official--title-15--9#3.2}

A Notice of Intent outlining the general scope of a planned project requiring a Certificate of Need shall be submitted to the Department as early as possible in the course of planning, but no later than fifteen (15) calendar days before any person files a CON application. A Notice of Intent shall be valid for six (6) months from the date of receipt.

Page 17 — Mississippi State Department of Health Review of an application filed by a person who has not submitted a Notice of Intent at least fifteen (15) calendar days before the application shall be deferred until the fifteen (15) calendar day notice requirement is met. Under no circumstances shall a CON application be reviewed unless a Notice of Intent has been filed first. Submission of a Notice of Intent does not constitute approval of a project and creates no vested right in the applicant.

**History**
- *Source: Miss. Code Ann. § 41-7-191*

##### **15 Miss. Admin. Code Pt. 9, R. 3.3** Certificate of Need Applications {#sec-9-3.3 omnilex-key=us-ms-regs-official--title-15--9#3.3}

Applications shall be submitted on forms prescribed by the Department and shall include all information required by applicable law, this Manual, the State Health Plan, Department forms and instructions, and any applicable Department requests for information. Pursuant to Miss. Code Ann. § 41-7-193(2), every application for a Certificate of Need shall specify the time, within the period that would be granted, during which the proposed project shall be functional or operational, according to a time schedule submitted with the application. The time schedule shall be realistic, consistent with the proposed capital expenditure, and sufficient to allow the Department to periodically review the progress of the project if a CON is issued. The Applicant shall certify the accuracy and completeness of all information submitted. An application may be submitted by an authorized representative; the Department may require documentation of authority to act on behalf of the Applicant.

**History**
- *Source: Miss. Code Ann. § 41-7-193*

##### **15 Miss. Admin. Code Pt. 9, R. 3.4** Completeness Review {#sec-9-3.4 omnilex-key=us-ms-regs-official--title-15--9#3.4}

Within fifteen (15) calendar days of receipt, each Certificate of Need application shall be reviewed to determine whether sufficient information required to conduct substantive review is contained in the application and whether the required processing fee has been paid. If these criteria are met, the application shall be deemed complete. NOTE: A shell application — one that lacks sufficient information to begin processing at the time of original filing — shall not be treated as an incomplete application. Shell applications shall not be accepted. Within fifteen (15) calendar days of receipt, a shell application shall be returned to the submitter along with the fee. The applicant may resubmit a completed application at any time.

Page 18 — Mississippi State Department of Health A determination that an application is complete does not constitute a determination that the application satisfies applicable review criteria or that the project is entitled to approval.

**History**
- *Source: Miss. Code Ann. § 41-7-171 et seq.*

##### **15 Miss. Admin. Code Pt. 9, R. 3.5** Incomplete Applications {#sec-9-3.5 omnilex-key=us-ms-regs-official--title-15--9#3.5}

If the Department determines that an application is incomplete, the information required to render it complete shall be requested of the Applicant in writing within fifteen (15) calendar days of the application’s filing. The request shall specify what additional information is required. Failure to provide the requested information within fifteen (15) calendar days of the request shall result in administrative withdrawal of the application unless the Applicant has timely requested a deferral. Notice of administrative withdrawal or deferral shall be published on the Department’s website. When an application is administratively withdrawn, the Applicant may not proceed with the proposed project until a new application is submitted, deemed complete, reviewed, and a Certificate of Need is issued.

**History**
- *Source: Miss. Code Ann. § 41-7-171 et seq.*

##### **15 Miss. Admin. Code Pt. 9, R. 3.6** Public Notice of Complete Applications {#sec-9-3.6 omnilex-key=us-ms-regs-official--title-15--9#3.6}

Upon deeming an application complete, the Department shall publish notice on its website that the application has been accepted and entered into review, that the public is invited to submit written comments for a period of fifteen (15) calendar days from the deemed-complete date, and that the deadline for submission is clearly specified. Notification to Affected Persons shall be made on the day an application is deemed complete. The notice shall: A. State the date of entry into review; B. Identify the Applicant and provide a general description of the proposal; C. State the proposed schedule for review; D. Specify the public comment period begin and end dates; E. Identify the approximate date of publication of the staff analysis; F. Specify how a copy of the staff analysis may be obtained; and

Page 19 — Mississippi State Department of Health G. Advise that a hearing may not be requested until the staff analysis is published, that any Affected Person may request a hearing within ten (10) calendar days of the date of publication of the staff analysis, and specify the manner in which notice of any scheduled hearing will be provided. Notification to the public and third-party payors shall be by website posting. Notification to the Applicant shall be by electronic correspondence. The date of notification is the date on which notice is sent electronically and posted on the Department’s website.

**History**
- *Source: Miss. Code Ann. § 41-7-171 et seq.*

##### **15 Miss. Admin. Code Pt. 9, R. 3.7** Requests for Additional Information {#sec-9-3.7 omnilex-key=us-ms-regs-official--title-15--9#3.7}

A. The Department may request additional or clarifying information at any time during review. If additional information is requested after review has begun, the Applicant shall have fifteen (15) calendar days to respond. Upon request of the Applicant, the review period shall be extended fifteen (15) calendar days. Until an application is deemed complete, the Applicant may submit additional material. Members of the public, third-party payors, and other Affected Persons may submit material to the Department at any time during the first fifteen (15) calendar days following the deemed-complete date. Failure to provide requested information may result in suspension of review, delay in processing, administrative closure, or dismissal without prejudice. B. Failure to provide requested information may result in: 1. Suspension of review; 2. Delay in processing; 3. Administrative closure; or 4. Dismissal without prejudice. Before taking such action, the Department may provide notice and an opportunity to cure deficiencies.

**History**
- *Source: Miss. Code Ann. § 41-7-171 et seq.*

##### **15 Miss. Admin. Code Pt. 9, R. 3.8** Withdrawal of Applications {#sec-9-3.8 omnilex-key=us-ms-regs-official--title-15--9#3.8}

An Applicant may request withdrawal of an application at any time before issuance of a final decision. The Department may establish procedures governing

Page 20 — Mississippi State Department of Health withdrawal requests. Unless otherwise required by law, withdrawal terminates review of the application.

**History**
- *Source: Miss. Code Ann. § 41-7-171 et seq.*

##### **15 Miss. Admin. Code Pt. 9, R. 3.9** Determinations of Reviewability {#sec-9-3.9 omnilex-key=us-ms-regs-official--title-15--9#3.9}

Any person may request a written Determination of Reviewability concerning whether a proposed activity is subject to Certificate of Need review. The request shall be submitted in writing, identify the requesting party, describe the proposed activity, include all relevant facts and supporting documentation, and include the required fee specified in Rule 3.10. A person seeking a determination that an activity is exempt from review, not subject to review, or otherwise outside the scope of CON review shall provide all information reasonably necessary for the Department to evaluate the request. Upon receipt of a request, notification to Affected Persons shall be made within five (5) business days by publication on the Department’s website. The Department shall issue its written determination within forty-five (45) calendar days after receipt of a complete request. A request for additional information tolls the response period until the requested information is received. The Department may request additional information reasonably necessary to evaluate the request and may decline to issue a determination where sufficient information is not provided. Applicants proposing certification as a Single Specialty Ambulatory Surgery Center, a Distinct Part Skilled Nursing Facility, or a Geropsychiatric Distinct Part Unit shall obtain a written Determination of Reviewability before proceeding. A Determination of Reviewability: 1. Applies only to the facts presented to the Department; 2. Does not constitute approval of a project; 3. Does not authorize commencement of any activity requiring a CON; 4. Does not supersede applicable law; and 5. May be relied upon only with respect to the facts presented to the Department.

Page 21 — Mississippi State Department of Health A Determination of Reviewability may be modified, withdrawn, superseded, or deemed inapplicable where: 1. Material facts were omitted; 2. Material facts were inaccurately represented; 3. Circumstances materially change; 4. Applicable law changes; 5. The Department determines that continued reliance upon the determination would be inconsistent with law; or 6. The requesting party fails to provide notice of a material change as required by this Rule. A person who has requested or received a Determination of Reviewability shall notify the Department in writing within ten (10) business days after becoming aware of any material change in the facts upon which the determination was requested or issued.

**History**
- *Source: Miss. Code Ann. §§ 41-7-205; 25-43-2.103*

##### **15 Miss. Admin. Code Pt. 9, R. 3.10** Determination of Reviewability Processing Fee {#sec-9-3.10 omnilex-key=us-ms-regs-official--title-15--9#3.10}

A fee of Two Thousand Five Hundred Dollars ($2,500.00) shall accompany each application for a Determination of Reviewability and is payable to the Department by check, draft, or money order. No application for a Determination of Reviewability shall be processed until the required fee is received.

**History**
- *Source: Miss. Code Ann. § 41-7-205*

##### **15 Miss. Admin. Code Pt. 9, R. 3.11** Change of Ownership Review {#sec-9-3.11 omnilex-key=us-ms-regs-official--title-15--9#3.11}

Any person proposing a transaction that may constitute a Change of Ownership of an existing health care facility, major medical equipment, a health service, or an institutional health service shall submit a written Notice of Intent to Change Ownership to the Department at least thirty (30) days prior to the proposed date of the change. For proposed Changes of Ownership of a skilled nursing facility, intermediate care facility, or intermediate care facility for the mentally retarded, the Executive Director of the Division of Medicaid, Office of the Governor, must certify in writing that there will be no increase in allowable costs to Medicaid from

Page 22 — Mississippi State Department of Health revaluation of assets or from increased interest and depreciation resulting from the proposed change, consistent with Miss. Code Ann. § 41-7-191(1)(i). The Department may require information concerning ownership and management structure, financing arrangements, operational control, asset transfers, lease arrangements, licensure implications, Medicaid implications, and other matters relevant to review.

**History**
- *Source: Miss. Code Ann. § 41-7-191(1)*

##### **15 Miss. Admin. Code Pt. 9, R. 3.12** Change of Ownership Processing Fee {#sec-9-3.12 omnilex-key=us-ms-regs-official--title-15--9#3.12}

A fee of Two Thousand Five Hundred Dollars ($2,500.00) shall accompany each Notice of Intent to Change Ownership and is payable to the Department by check, draft, or money order. No Notice of Intent to Change Ownership shall be processed until the required fee is received.

**History**
- *Source: Miss. Code Ann. § 41-7-171 et seq.*

##### **15 Miss. Admin. Code Pt. 9, R. 3.13** Transfer of Home Health Agency County {#sec-9-3.13 omnilex-key=us-ms-regs-official--title-15--9#3.13}

The Department is authorized to issue an approval to an existing home health agency for the transfer of a county from that agency to another existing home health agency, and to charge a fee not to exceed one-half of the authorized fee assessed for the original agency application. The fee shall be calculated as 0.25 of 1% of the capital expenditure stated in the notice of transfer. The fee shall not exceed Twelve Thousand Five Hundred Dollars ($12,500.00) and shall not be less than Two Thousand Five Hundred Dollars ($2,500.00). The Transfer of Home Health Agency County form must be filed with the Department thirty (30) calendar days before the transition. During that thirty-day period, the matter shall be presented to the State Health Officer for a final decision. If the Department denies the request, it shall notify the Applicant and follow the same procedures applicable to denial of an extension request.

**History**
- *Source: Miss. Code Ann. § 41-7-191*

##### **15 Miss. Admin. Code Pt. 9, R. 3.14** Emergency Certificate of Need — Eligibility and Procedures {#sec-9-3.14 omnilex-key=us-ms-regs-official--title-15--9#3.14}

Any health care facility that finds it a matter of immediate necessity to make a capital expenditure for replacement of or repair to equipment or a facility caused by unforeseen or unpredictable events that may jeopardize the health or safety of its patients may file a request for an Emergency Certificate of Need. Emergency expenditures include those required for repair of fixed equipment to maintain the

Page 23 — Mississippi State Department of Health provision of quality care, including but not limited to heating and air conditioning equipment, elevators, electrical transformers and switch gear, sterilization equipment, emergency generators, water supply, and other utility connections. A request shall be initiated by the facility’s administrative executive officer (or a designated administrative assistant) contacting a member of the Department’s staff responsible for administration of the CON Program. Justification shall be fully explained, including: the nature of the incurred loss or damage; the result or probable result of such loss or damage; the estimated cost or expenditure contemplated; the anticipated commencement date; the anticipated completion date; and such other information as requested by Department staff. Written notification confirming the emergency and all pertinent details shall be submitted to the Department as soon as possible following the initial contact. A nonrefundable fee of Five Thousand Dollars ($5,000.00) shall accompany each request for an Emergency CON. The fee shall be payable to the Department in a form approved by the Department. The Department shall not be required to process an Emergency CON request until the required fee has been received; provided, however, that the State Health Officer may waive the requirement that the fee accompany the initial request when necessary to address an immediate threat to the health or safety of patients. In such cases, the fee shall be submitted within five (5) business days of the Department’s acceptance of the request unless otherwise authorized by the Department. The State Health Officer, after obtaining required information, shall grant or deny the Emergency CON as expeditiously as possible and shall provide timely public notice of the decision. An Emergency CON shall not be valid for more than ninety (90) calendar days. A recipient must submit a formal CON application within fifteen (15) calendar days of the effective date of the Emergency CON addressing the same project. Normal CON procedures apply to such subsequent applications, except that no Notice of Intent shall be required. If the Department determines that the alleged emergency did not exist, that material facts were misrepresented, or that there was an intent to commit fraud, any Emergency CON previously granted may be revoked or rescinded by the State Health Officer.

**History**
- *Source: Miss. Code Ann. § 41-7-207*

##### **15 Miss. Admin. Code Pt. 9, R. 3.15** Emergency Replacement Procedure {#sec-9-3.15 omnilex-key=us-ms-regs-official--title-15--9#3.15}

Pursuant to Miss. Code Ann. § 41-7-207, when the need for an emergency replacement occurs involving a health care facility or equipment, the Certificate of Need review process shall be expedited by the promulgation and application

Page 24 — Mississippi State Department of Health of administrative procedures for expenditures necessary to alleviate an emergency condition and restore health care access. For purposes of this rule, emergency replacement means the replacement, and/or necessary relocation, of all or the damaged part of facilities or equipment, the replacement of which is not otherwise exempt from CON review under the medical equipment replacement exemption in Miss. Code Ann. § 41-7-191(1)(f), without which the operation of the facility and the health and safety of patients would be immediately jeopardized and health care access would be denied to such patients. Expenditures under this rule shall be limited to the replacement of those necessary facilities or equipment the loss of which constitutes the emergency; however, in the case of the destruction or major damage to a health care facility, the Department is authorized to issue a CON to address the current and future health care needs of the community, including but not limited to the expansion or relocation of the health care facility. A health care facility whose repair or rebuilding qualifies for the exemption provided by Miss. Code Ann. § 41-7-191(13) (natural disaster exemption) may apply for relief under that exemption rather than under this rule. Application Fee Waiver. The Department may waive all or part of the required CON application fee for any application filed under this rule if the payment of the fee would create a further hardship or undue burden on the health care facility. A request for fee waiver shall be submitted in writing to the Department concurrently with or before the filing of the application and shall include documentation sufficient to demonstrate the claimed hardship. Expedited Procedures. The Department shall establish and apply expedited review procedures for applications filed under this rule. Expedited procedures may differ from standard review procedures to the extent necessary to address the emergency circumstances. The Department shall communicate the applicable expedited procedures to the applicant upon receipt of the application.

**History**
- *Source: Miss. Code Ann. § 41-7-207*

##### **15 Miss. Admin. Code Pt. 9, R. 3.16** Certificate of Need Processing Fee {#sec-9-3.16 omnilex-key=us-ms-regs-official--title-15--9#3.16}

Pursuant to Miss. Code Ann. § 41-7-188, the Certificate of Need processing fee shall be calculated as follows: 1. CON Fee = 0.50 × 1% of proposed capital expenditure. 2. Minimum fee: Five Thousand Dollars ($5,000.00).

Page 25 — Mississippi State Department of Health 3. Maximum fee: Twenty-Five Thousand Dollars ($25,000.00). If the capital expenditure stated in the application differs from that in the Notice of Intent, the Applicant must adjust the fee payment to conform to the amount stated in the application. Fee payment shall accompany the CON application and is payable to the Department by check, draft, or money order. The assessed CON fee, once paid, is non-refundable. When an application is received, the Department shall determine the capital expenditure and the applicable fee. If the Applicant has overpaid, the overpayment shall be refunded. If partial payment has been submitted, the balance due must be received within fifteen (15) calendar days of receipt of partial payment. No application shall be deemed complete for purposes of review until the required fee is received. No filing fee shall be required for: A. Any application submitted by an agency, department, institution, or facility operated, owned, or controlled by the State of Mississippi that receives operating or capital funds solely by legislative appropriation; or B. Any application submitted by a health care facility for repairs or renovation determined in writing by the Health Facilities Licensure and Certification Division to be necessary to avoid revocation of license or loss of Medicare or Medicaid certification, provided that any expenditure in excess of the amount determined necessary shall be subject to applicable fee requirements.

**History**
- *Source: Miss. Code Ann. § 41-7-188*

##### **15 Miss. Admin. Code Pt. 9, R. 3.17** Small Community Hospital Pilot Program — Referral to Chapter 9 {#sec-9-3.17 omnilex-key=us-ms-regs-official--title-15--9#3.17}

Requests for exemptions under the Small Community Hospital Pilot Program established by H.B. 1622, 2026 Regular Session, as amended by S.B. 2474, 2026 Regular Session, shall be submitted and processed in accordance with Chapter 9 of this Manual. Such requests shall not be processed under the standard Certificate of Need application procedures of this Chapter.

**History**
- *Source: H.B. 1622 § 1, 2026 Reg. Sess.; S.B. 2474 § 8, 2026 Reg. Sess.*

##### **15 Miss. Admin. Code Pt. 9, R. 3.18** Applications Unacceptable for Review {#sec-9-3.18 omnilex-key=us-ms-regs-official--title-15--9#3.18}

An application for a Certificate of Need shall not be accepted from the same person for a proposal in a health planning area from which a previously submitted application for the same or a substantially similar service or equipment, as

Page 26 — Mississippi State Department of Health determined by the Department, has been disapproved, unless one or more of the following conditions exist: 1. A substantial change has occurred in the existing or proposed health services of the type proposed by the applicant; 2. A substantial change has occurred in the need for the health service proposed by the applicant; or 3. At least one (1) year has elapsed from the date of the finding that resulted in disapproval of the previous application. A substantial change in existing or proposed services or facilities means the closure of a facility or service, or revocation of a CON, for that facility or service, which when taken into account results in an actual need for the proposed facility or service. Actual need means need as reflected by the appropriate plans, standards, or criteria in the most recent or current version of the State Health Plan. A substantial change in the need for a facility or service means an amendment, correction, or replacement of a standard, criterion, or plan of the Department that, when taken into account, results in an actual need for the type of service or facility proposed. The Department shall determine whether a substantial change has occurred as a threshold matter before accepting an otherwise barred application for review. A determination that a substantial change has occurred shall be made in writing and shall be included in the administrative record.

**History**
- *Source: Miss. Code Ann. § 41-7-171 et seq.*

#### **Chapter 4** APPLICATION REVIEW PROCEDURES Rule 4.1 Scope of Review. The Department shall review each application to determine whether the proposed project satisfies applicable statutory requirements, this Manual, the State Health Plan, and other applicable requirements of law. Review shall be based upon the administrative record developed during the review process.

##### **15 Miss. Admin. Code Pt. 9, R. 4.2** Staff Analysis {#sec-9-4.2 omnilex-key=us-ms-regs-official--title-15--9#4.2}

Page 27 — Mississippi State Department of Health Each application shall be assigned to a member of the Department’s staff responsible for administration of the Certificate of Need Program for analysis and review. Applications shall be reviewed for consistency with the State Health Plan and the criteria contained in Chapter 7 of this Manual. A written staff analysis and recommendation with respect to approval or disapproval shall be prepared and made available on the Department’s website and shall be transmitted by electronic mail to the Applicant and to those persons who have filed a written request for the specific staff analysis in response to the notice to Affected Persons. The Department shall not delay review of an application. The Department shall prepare its staff analysis and recommendation approving or disapproving a complete application within forty-five (45) calendar days of the date the application was filed, or within fifteen (15) calendar days of receipt of any additional information requested by the Department, whichever is later. Any request by the Department for additional information shall be made within fifteen (15) calendar days of the filing of the application. If the staff recommendation is disapproval, the Applicant shall have five (5) calendar days from the date of publication of the staff analysis on the Department’s website to submit additional material relating to its application for further analysis that may resolve the basis for the recommendation of disapproval. The Applicant shall be notified of the deadline. Additional material submitted by an Applicant that was not requested by the Department, and any material submitted after the fifth (5th) calendar day following publication of a recommendation of disapproval, shall not be considered during the review process. Nothing in this Rule shall be construed to modify any review period established by applicable law. NOTE: Only one submission of additional information in response to a recommendation of disapproval is permitted, and only by the Applicant. No additional submissions from the public shall be accepted in response to a recommendation of disapproval.

**History**
- *Source: Miss. Code Ann. § 41-7-171 et seq.*

##### **15 Miss. Admin. Code Pt. 9, R. 4.3** State Health Officer Decision {#sec-9-4.3 omnilex-key=us-ms-regs-official--title-15--9#4.3}

Unless a hearing is requested under Miss. Code Ann. § 41-7-197, the State Health Officer’s final order approving or disapproving an application shall be issued within ninety (90) calendar days of the date the application was filed.

Page 28 — Mississippi State Department of Health The State Health Officer shall consider the Department’s staff analysis before making a decision. The decision shall be based on whether the proposal substantially complies with the plans, standards, and criteria established by the Department and substantially complies with the projection of need as reported in the State Health Plan in effect at the time the application was submitted. If the staff recommends approval and the State Health Officer does not concur, the Applicant shall have one opportunity only to submit additional information, and the State Health Officer shall delay the decision until evaluation of that information is completed. Additional information must be received within fifteen (15) calendar days of the date the applicant is notified. The State Health Officer may approve a proposal, approve it with conditions, approve it by modification (by reduction only, with written agreement of the applicant), or disapprove it. The decision shall be published on the Department’s website and followed by written notice to the Applicant within ten (10) calendar days of the announcement. When a hearing has been held, the completed record shall be certified to the State Health Officer, who shall consider only the record in making the decision. The State Health Officer’s written decision shall constitute the final order of the Department and shall be the final agency action from which appeal rights run.

**History**
- *Source: Miss. Code Ann. § 41-7-193*

##### **15 Miss. Admin. Code Pt. 9, R. 4.4** Maximum Capital Expenditure Specification {#sec-9-4.4 omnilex-key=us-ms-regs-official--title-15--9#4.4}

Pursuant to Miss. Code Ann. § 41-7-193(2), each Certificate of Need issued by the Department shall specify the maximum amount of capital expenditure that may be obligated under the CON. The maximum capital expenditure stated in the CON constitutes the authorized ceiling for expenditures under that Certificate. Any proposed expenditure in excess of the authorized ceiling shall require cost overrun approval in accordance with Chapter 6 of this Manual. The Department shall state the maximum authorized capital expenditure on the face of each CON issued.

**History**
- *Source: Miss. Code Ann. § 41-7-193*

##### **15 Miss. Admin. Code Pt. 9, R. 4.5** Review Standards {#sec-9-4.5 omnilex-key=us-ms-regs-official--title-15--9#4.5}

Applications shall be evaluated under applicable statutes, this Manual, the State Health Plan, applicable federal requirements, and other applicable requirements of law. No Certificate of Need shall be issued unless the proposed project

Page 29 — Mississippi State Department of Health substantially complies with the projection of need as reported in the State Health Plan in effect at the time the application was submitted to the Department.

**History**
- *Source: Miss. Code Ann. § 41-7-193*

##### **15 Miss. Admin. Code Pt. 9, R. 4.6** Burden of Demonstration {#sec-9-4.6 omnilex-key=us-ms-regs-official--title-15--9#4.6}

The Applicant bears the burden of demonstrating that the proposed project satisfies applicable review criteria. The Department is not required to establish the absence of need or the inadequacy of a proposal.

**History**
- *Source: Miss. Code Ann. § 41-7-171 et seq.*

##### **15 Miss. Admin. Code Pt. 9, R. 4.7** Public Comment Period {#sec-9-4.7 omnilex-key=us-ms-regs-official--title-15--9#4.7}

The Department shall provide an opportunity for public comment as required by applicable law. Members of the public, third-party payors, and other Affected Persons may submit written material during the first fifteen (15) calendar days following the deemed-complete date. The Department may consider public comments submitted during review and may assign such weight as deemed appropriate based upon relevance, reliability, and consistency with the administrative record.

**History**
- *Source: Miss. Code Ann. § 41-7-171 et seq.*

##### **15 Miss. Admin. Code Pt. 9, R. 4.8** Ex Parte Communications {#sec-9-4.8 omnilex-key=us-ms-regs-official--title-15--9#4.8}

After publication of a staff analysis and before a written decision by the State Health Officer, there shall be no ex parte contacts between: (a) any person acting on behalf of the Applicant, any CON-holder, or any person opposed to or in favor of the issuance or withdrawal of a Certificate of Need; and (b) the State Health Officer, the Chief of Staff, the hearing officer, or Department staff responsible for administration of the CON Program. This prohibition does not apply to communications between and among Department staff members, the hearing officer, the Director, the Chief of Staff, the State Health Officer, and the staff of the Mississippi Attorney General’s Office. Violations may be subject to penalties authorized by applicable law.

Page 30 — Mississippi State Department of Health Rule 4.9 Verification and Independent Evaluation. The Department may independently evaluate information submitted by an applicant and may consider information obtained from public records, governmental sources, published studies, surveys, utilization data, licensure records, accreditation records, and other reliable sources. The Department may conduct site visits, inspections, meetings, conferences, or other investigative activities reasonably necessary to evaluate an application, and may consult with experts, advisors, governmental agencies, and other qualified individuals.

**History**
- *Source: Miss. Code Ann. § 41-7-197*
- *Source: Miss. Code Ann. § 41-7-171 et seq.*

##### **15 Miss. Admin. Code Pt. 9, R. 4.10** Conditions of Approval {#sec-9-4.10 omnilex-key=us-ms-regs-official--title-15--9#4.10}

The Department may recommend or impose conditions reasonably necessary to ensure compliance with applicable law and project parameters, protect the public interest, promote access to care, ensure project implementation, or address issues identified during review. Conditions shall be stated in writing. Failure to comply with conditions may constitute grounds for enforcement action, revocation, rescission, denial of future requests, or other action authorized by law.

**History**
- *Source: Miss. Code Ann. § 41-7-171 et seq.*

##### **15 Miss. Admin. Code Pt. 9, R. 4.11** Competing Applications {#sec-9-4.11 omnilex-key=us-ms-regs-official--title-15--9#4.11}

Where multiple applications involve substantially similar projects, services, or service areas, the Department may evaluate the applications comparatively to the extent permitted by law. In conducting a comparative review, the Department may consider each Applicant’s ability to meet the criteria of need, access, relationship to the existing health care system, availability of resources, and financial feasibility, and may use statistical methodologies including but not limited to market share analysis and patient origin data.

**History**
- *Source: Miss. Code Ann. § 41-7-171 et seq.*

##### **15 Miss. Admin. Code Pt. 9, R. 4.12** Required Findings on Access {#sec-9-4.12 omnilex-key=us-ms-regs-official--title-15--9#4.12}

Findings on access shall be included in the written findings of the Department for each project approved, except where: 1. The project is undertaken to eliminate or prevent imminent safety hazards or to comply with licensure or accreditation standards regarding life safety codes;

Page 31 — Mississippi State Department of Health 2. The project proposes a capital expenditure not directly related to the provision of health services or to beds or major medical equipment; or 3. The project is proposed by or on behalf of a health care facility controlled directly or indirectly by a health maintenance organization. In making written findings on access, the Department shall take into account the current accessibility of the facility as a whole. The Department may impose a condition requiring affirmative steps to meet access criteria where a project does not fully satisfy those criteria. The Department shall state in its written findings if a project is disapproved for failure to meet need and access criteria.

**History**
- *Source: Miss. Code Ann. § 41-7-171 et seq.*

##### **15 Miss. Admin. Code Pt. 9, R. 4.13** Misrepresentation {#sec-9-4.13 omnilex-key=us-ms-regs-official--title-15--9#4.13}

If the Department determines that an application contains material misrepresentations or omissions, the Department may request corrective information, suspend review, deny the application, revoke an approval, refer the matter for investigation, or take other action authorized by law.

**History**
- *Source: Miss. Code Ann. § 41-7-171 et seq.*

##### **15 Miss. Admin. Code Pt. 9, R. 4.14** Notification of Status of Review {#sec-9-4.14 omnilex-key=us-ms-regs-official--title-15--9#4.14}

The Department, upon request by persons subject to review, shall provide timely notification of the status of review, the Department’s findings, and other appropriate information respecting the review.

**History**
- *Source: Miss. Code Ann. § 41-7-171 et seq.*

##### **15 Miss. Admin. Code Pt. 9, R. 4.15** Closure of Administrative Record {#sec-9-4.15 omnilex-key=us-ms-regs-official--title-15--9#4.15}

The Department may establish a date upon which the administrative record shall close for purposes of review. The Department shall notify Affected Persons of the record closure date in accordance with Chapter 3 of this Manual. Information submitted after closure of the administrative record may be excluded from consideration unless otherwise permitted by the Department for good cause shown. Upon closure of the administrative record, the Department shall transmit the complete administrative record and any staff recommendation to the State Health Officer or authorized decision-maker.

Page 32 — Mississippi State Department of Health Pursuant to Miss. Code Ann. § 41-7-197(2), the State Health Officer shall consider only the record in making the decision and shall not consider any evidence or material not included therein.

**History**
- *Source: Miss. Code Ann. § 41-7-197*

##### **15 Miss. Admin. Code Pt. 9, R. 4.16** Effective Date of Approval {#sec-9-4.16 omnilex-key=us-ms-regs-official--title-15--9#4.16}

A Certificate of Need approval shall become effective upon issuance of the State Health Officer’s written final order, subject to any applicable stay of proceedings under Miss. Code Ann. § 41-7-201(2)(a) and Rules 5.19 and 5.20 of this Manual, and subject to any conditions of approval requiring completion of specified actions before the approval becomes operative. The validity period of a CON shall be computed from the effective date of approval in accordance with Miss. Code Ann. § 41-7-195(2) and Chapter 6 of this Manual.

**History**
- *Source: Miss. Code Ann. §§ 41-7-195 and 41-7-201*

#### **Chapter 5** HEARINGS, APPEALS, AND JUDICIAL REVIEW Rule 5.1 Right to Hearing. Any Affected Person may, within ten (10) calendar days of publication of the staff analysis, request a public hearing during the course of review. A request for hearing must be received by the Department no later than 5:00 p.m. on the tenth (10th) calendar day after the date the staff analysis is published. If the tenth (10th) calendar day falls on a Saturday, Sunday, or legal holiday when the Department is closed for business, the request must be received by 5:00 p.m. on the next business day. An Applicant may request a hearing on its own application only if the staff recommendation is disapproval. If no request for a hearing is received, the State Health Officer may take action on the application. Nothing in this Manual creates a right to a hearing where no such right exists under applicable law.

##### **15 Miss. Admin. Code Pt. 9, R. 5.2** Hearing Request — Requirements {#sec-9-5.2 omnilex-key=us-ms-regs-official--title-15--9#5.2}

A request for a hearing during the course of review shall be submitted in writing and shall:

Page 33 — Mississippi State Department of Health 1. Identify the party requesting the hearing; 2. Identify the application or action being challenged; 3. State the basis for the request; 4. Include sufficient information to identify the issues to be considered; and 5. Be accompanied by the required hearing fee deposit specified in Rule 5.3. A request not accompanied by the required fee deposit shall not be deemed timely filed.

**History**
- *Source: Miss. Code Ann. § 41-7-197*

##### **15 Miss. Admin. Code Pt. 9, R. 5.3** Hearing Fee {#sec-9-5.3 omnilex-key=us-ms-regs-official--title-15--9#5.3}

The fee assessed to cover the cost of conducting a public hearing during the course of review shall be Three Thousand Dollars ($3,000.00) per day. A deposit of Six Thousand Dollars ($6,000.00), payable by the requestor (or shared equally by all requestors), shall accompany the request for hearing. The deposit covers the cost of a hearing for a two-day period only. When a hearing exceeds two days, an additional fee of Three Thousand Dollars ($3,000.00) per additional day shall be assessed to the requestor or shared equally by all requestors. If fees collected exceed actual costs, the remaining funds shall be refunded once all invoices are paid. If fees collected are insufficient to cover actual reasonable costs, the requestor(s) shall be responsible for remitting additional fees. In the case of multiple requestors, remaining funds shall be divided equally. Refund of fees shall be made as follows: A. When an application is withdrawn by the Applicant and a pending hearing has not yet commenced, the requestor(s) must request a refund within five (5) business days of the withdrawal. B. When the person or entity requesting the hearing withdraws the request, the withdrawal must be received no later than five (5) business days before the day on which the hearing was scheduled. Any notice of withdrawal received later than five (5) business days before the scheduled hearing date shall not entitle the requestor to a refund. C. When an application is administratively withdrawn by the Department before commencement of the hearing, a full refund of the hearing fee deposit shall be made.

Page 34 — Mississippi State Department of Health D. In all other refund situations, a minimum of One Thousand Dollars ($1,000.00) shall be retained by the Department. Any extraordinary expenses incurred — such as publication costs, court reporter fees, and extraordinary administrative time — shall be deducted at a reasonable rate before any refund is made.

**History**
- *Source: Miss. Code Ann. § 41-7-197*

##### **15 Miss. Admin. Code Pt. 9, R. 5.4** Designation and Authority of Hearing Officer {#sec-9-5.4 omnilex-key=us-ms-regs-official--title-15--9#5.4}

If a public hearing is requested, the Department shall designate an independent hearing officer who shall not be an employee of the Department and who shall be a licensed attorney in the State of Mississippi. A public hearing shall be commenced by the designated hearing officer within sixty (60) calendar days of the filing of the hearing request unless all parties agree to extend the time for commencement. A hearing officer may: 1. Administer oaths and affirmations; 2. Establish schedules; 3. Conduct pre-hearing conferences; 4. Rule upon procedural matters; 5. Regulate the course of proceedings; 6. Receive evidence; 7. Rule upon evidentiary issues; 8. Establish deadlines; 9. Issue procedural orders; 10. Encourage stipulations; 11. Address discovery matters authorized by law; and 12. Take all actions necessary for the orderly conduct of proceedings. The hearing officer shall have authority to issue subpoenas to compel the attendance of witnesses and the production of relevant documents and things.

Page 35 — Mississippi State Department of Health Rule 5.5 Notice of Hearing. Notification of the time, date, and place of the hearing shall be given to all affected parties and the public no later than fifteen (15) calendar days before the hearing. Notice shall identify the date, time, and location of the hearing; the nature of the proceeding; and the matters to be considered. The general public shall be notified through the Department's website.

**History**
- *Source: Miss. Code Ann. § 41-7-197*
- *Source: Miss. Code Ann. § 41-7-197*

##### **15 Miss. Admin. Code Pt. 9, R. 5.6** Conduct of Hearings {#sec-9-5.6 omnilex-key=us-ms-regs-official--title-15--9#5.6}

All Certificate of Need hearings are open to the public. To expedite the conduct of the hearing, persons attending should sign in, listing their name, address, and organization. The hearing officer shall open the hearing, identify the participants responsible for recording, administer oaths, and admit into the record as Exhibit One the legal notice, as Exhibit Two the Department’s file, and as Exhibit Three the staff analysis. The hearing officer shall advise those present that the hearing is being conducted to discuss the merits of the application under consideration and that evidence concerning other pending or yet-to-be-offered applications not relevant to the matter in issue shall not be presented. Any Affected Person shall have the right to be represented by counsel, to present oral or written arguments and evidence relevant to the matter, and to conduct reasonable questioning of persons who make relevant factual allegations. A record of the hearing shall consist of a transcript of all testimony received, all documents and other material introduced by any interested person, the staff analysis and recommendation, and such other material as the hearing officer considers relevant, including the hearing officer’s recommendation.

**History**
- *Source: Miss. Code Ann. § 41-7-197*

##### **15 Miss. Admin. Code Pt. 9, R. 5.7** Order of Proof {#sec-9-5.7 omnilex-key=us-ms-regs-official--title-15--9#5.7}

Unless otherwise determined by the hearing officer, the order of proof shall be as follows: 1. A member of the Department’s staff, who may give a brief summary of the staff analysis and recommendation and may be questioned by any Affected Person and by the hearing officer. 2. The Applicant.

Page 36 — Mississippi State Department of Health 3. Opponent(s), if any, in an order established by agreement between the opponent(s), or if no agreement is reached, by the hearing officer. If no opponent(s) are present, the Department may present witnesses, exhibits, and testimony, conduct questioning of the Applicant’s witnesses, make objections, argue, and submit proposed findings and conclusions. In this instance the Department should be represented by a staff attorney, who may be an employee of the Mississippi Attorney General’s Office. 4. Persons who wish to give evidence for themselves or on behalf of a group or organization. 5. Persons who wish to give evidence but are not listed on the sign-in sheet and who have not been sworn, who shall be sworn before giving testimony. 6. Rebuttal by the Applicant, limited to matters raised during the opponent’s case in chief. 7. Closing statements or arguments of counsel or Affected Persons. Waiver of closing statements at the hearing shall not entitle any party or Affected Person to argument before the State Health Officer. Argument shall normally be by simultaneous briefs submitted to the hearing officer within thirty (30) calendar days of the close of the hearing. 8. The hearing officer shall then close the hearing. All persons giving testimony shall state their name and organizational affiliation.

**History**
- *Source: Miss. Code Ann. § 41-7-197*

##### **15 Miss. Admin. Code Pt. 9, R. 5.8** Comparative Hearings {#sec-9-5.8 omnilex-key=us-ms-regs-official--title-15--9#5.8}

The conduct of a comparative hearing shall differ from a non-comparative hearing only in the following respects: 1. Applicants shall present their cases in the order in which their requests for hearing were received by the Department; 2. Rebuttal proof shall be offered by the Applicants in the order in which they presented their cases in chief; and 3. Opponents shall present in the order specified in Rule 5.7(3). All other procedures for conducting a non-comparative hearing during the course of review apply to comparative hearings.

Page 37 — Mississippi State Department of Health Rule 5.9 Pre-Hearing Procedures and Discovery. Parties to a hearing shall exchange in writing the following information on or before the fortieth (40th) calendar day before the first date of the hearing: A. A list of proposed issues that the parties reasonably believe shall be the subject of the hearing; B. A list of witnesses, including full name, address, telephone number, whether fact or expert, and a brief summary of the matters on which the witness is expected to testify; C. A true and correct copy of every document anticipated to be introduced at the hearing (except those introduced solely for rebuttal); D. Copies of underlying documentation supporting the admissibility of charts, graphs, compilations, and professional and expert reports (except where privileged), produced for inspection if reasonable and exchanged if reasonably necessary; and E. A true and correct copy of every subpoena sought from non-parties, with documents received from non-parties in response to subpoenas to be furnished to all other parties no later than twenty (20) calendar days before the hearing. All documents should be pre-marked for admission into evidence. Parties are under a continuing duty to supplement this exchange; final supplementation shall be completed no later than the twentieth (20th) calendar day before the first day of the hearing. On or before the twentieth (20th) calendar day before the first day of the hearing, parties shall exchange proposed pre-hearing orders. The pre-hearing order shall be agreed upon and entered by the hearing officer on or before the tenth (10th) calendar day before the hearing. If agreement cannot be reached, the hearing officer shall adjudicate a pre-hearing order by the same deadline. The pre-hearing order shall include: the order of proof; a list of witnesses for each party; a statement that the parties have reached agreement as to pre-marked documents and that there is no question as to their authenticity and admissibility; a brief list and summation of the issues to be tried; any stipulations; and any other matters the parties agree upon or the hearing officer requires.

Page 38 — Mississippi State Department of Health Rule 5.10 Motions. Motions may be heard at any time after receipt of a valid request for hearing, at a date and time selected at the discretion of the hearing officer. Except for motions to quash subpoenas, motions in limine, motions for protective order, and other evidentiary motions, all pretrial motions shall be noticed for and heard no less than ten (10) calendar days before the hearing. Motions to quash subpoenas, motions in limine, motions for protective order, and other evidentiary motions shall be noticed for and heard no less than twenty (20) calendar days before the hearing. Except for good cause shown, no motion shall be served on opposing parties less than three (3) business days before the scheduled motion hearing. Opposing parties may serve a written response to the motion before the scheduled hearing time. The hearing officer’s ruling on a motion, whether oral or in writing, shall be entered into the record and shall be final as to all matters regarding the conduct of the hearing.

**History**
- *Source: Miss. Code Ann. § 41-7-197*
- *Source: Miss. Code Ann. § 41-7-197*
- *Source: Miss. Code Ann. § 41-7-197*

##### **15 Miss. Admin. Code Pt. 9, R. 5.11** Subpoenas {#sec-9-5.11 omnilex-key=us-ms-regs-official--title-15--9#5.11}

A duly appointed hearing officer may issue subpoenas sua sponte or upon application by any party. Except for good cause shown, no subpoena shall be issued less than thirty-five (35) calendar days, nor served less than thirty (30) calendar days, before the date of the hearing for which it is sought. Any subpoena duces tecum shall specify a date, time, and place for the production of documents or things no less than twenty (20) calendar days before the hearing, unless the hearing officer orders otherwise. The person to whom a subpoena is directed may, no less than twenty-five (25) calendar days before the first day of the hearing, serve upon the parties and the hearing officer a written objection together with a notice of a motion on the objection, in which case attendance or production shall not be compelled except pursuant to an order of the hearing officer. At least twenty (20) calendar days before the hearing, the hearing officer shall hear motions concerning issued subpoenas. The hearing officer’s rulings shall be entered into the record and shall be final as to all matters involving subpoenas. If a party refuses to comply with a subpoena, the hearing officer shall certify such facts and enter them into the record, at which point any party may move the appropriate court for relief. The hearing shall not be delayed while such a matter is being resolved in court.

Page 39 — Mississippi State Department of Health Rule 5.12 Consolidation of Hearings. When applications involving a common question of law or fact, or multiple proceedings involving the same or related parties, are pending before a hearing officer, the hearing officer may — on the motion of any party, the Department’s motion, or the hearing officer’s own motion — order a joint hearing on any or all matters and issues. The hearing officer may order cases consolidated and may make such other orders as may tend to avoid unnecessary cost or delay.

**History**
- *Source: Miss. Code Ann. § 41-7-197*
- *Source: Miss. Code Ann. § 41-7-197*

##### **15 Miss. Admin. Code Pt. 9, R. 5.13** Sanctions {#sec-9-5.13 omnilex-key=us-ms-regs-official--title-15--9#5.13}

Upon the motion of any party, a hearing officer may impose reasonable sanctions on parties who fail or refuse to comply with the rules and regulations of the Department or who violate a hearing officer’s order. Reasonable sanctions may also be imposed upon parties or non-parties who fail or refuse to comply with subpoenas. Reasonable sanctions include, but are not limited to, denial or exclusion of information or documents, exclusion from the record of testimony of witnesses, or other reasonable measures. Sanctions shall not be imposed to punish but to compel fairness and to deny any advantage gained by non- compliance.

**History**
- *Source: Miss. Code Ann. § 41-7-197*

##### **15 Miss. Admin. Code Pt. 9, R. 5.14** Evidence and Official Notice {#sec-9-5.14 omnilex-key=us-ms-regs-official--title-15--9#5.14}

The hearing officer may receive evidence commonly relied upon by reasonably prudent persons in the conduct of serious affairs and may exclude evidence that is irrelevant, immaterial, unduly repetitive, unreliable, or otherwise inappropriate. Official notice may be taken of statutes, regulations, public records, State Health Plan provisions, Department records, government publications, and other matters appropriate for official notice. Parties shall be afforded an opportunity to contest matters officially noticed.

**History**
- *Source: Miss. Code Ann. § 41-7-197*

##### **15 Miss. Admin. Code Pt. 9, R. 5.15** Service of Documents and Copies {#sec-9-5.15 omnilex-key=us-ms-regs-official--title-15--9#5.15}

One copy of each document — including pleadings, motions, briefs, and letters — shall be served on each attorney of record in a particular matter, on the hearing officer, and one copy furnished to the Department for inclusion in the file. Any

Page 40 — Mississippi State Department of Health document furnished to the Department for filing shall plainly state on its face or in an accompanying letter that it is being furnished for filing. Any document sought to be introduced into the record shall be accompanied by sufficient copies for all other counsel, the hearing officer, and the court reporter. Submittals shall be on paper not less than 8.5” x 11”, shall have margins of not less than 1” at top and bottom, not less than 1.5” on the left, and not less than 0.5” on the right, shall be of good quality and easily readable, and shall not exceed five (5) pages per exhibit unless designated as a bulky exhibit.

**History**
- *Source: Miss. Code Ann. § 41-7-197*

##### **15 Miss. Admin. Code Pt. 9, R. 5.16** Hearing Officer Recommendation {#sec-9-5.16 omnilex-key=us-ms-regs-official--title-15--9#5.16}

After the hearing is closed and after the hearing officer has had an opportunity to review, study, and analyze the evidence, the hearing officer shall prepare a written recommendation. The recommendation shall be issued no later than forty-five (45) calendar days after the hearing is closed. A copy of the hearing officer’s recommendation shall be sent to the parties before the State Health Officer’s decision is announced.

**History**
- *Source: Miss. Code Ann. § 41-7-197*

##### **15 Miss. Admin. Code Pt. 9, R. 5.17** Withdrawal of a Certificate of Need — Revocation Procedures {#sec-9-5.17 omnilex-key=us-ms-regs-official--title-15--9#5.17}

If commencement of construction or other preparation is not substantially undertaken during a valid Certificate of need period, or if the Department determines that the CON-holder is not making a good faith effort to obligate the approved expenditure, the Department shall have the right to withdraw, revoke, or rescind the Certificate pursuant to Miss. Code Ann. § 41-7-195. In considering such action, the Department shall: 1. Notify the Applicant, Affected Persons, and the general public by appropriate means that withdrawal is under consideration and the reasons therefor; 2. Afford the Applicant thirty (30) calendar days from the date of written notice to respond and, if desired, to request a public hearing. If no response is received during the thirty-day period, the Department may conclude that the Applicant concurs with the proposed action; 3. If a public hearing is requested by any Affected Party, conduct the hearing within forty-five (45) calendar days of receipt of the written request; and 4. Issue a written decision within thirty (30) calendar days following conclusion of any hearing on withdrawal.

Page 41 — Mississippi State Department of Health Written notice of any hearing on withdrawal shall be provided to Affected Persons at least five (5) calendar days before the hearing and shall be published on the Department’s website. Action taken to revoke, withdraw, or rescind a CON shall be in the form of a final written order. The same appeal rights that apply to initial review of applications apply to hearings or reviews to withdraw an existing CON.

**History**
- *Source: Miss. Code Ann. § 41-7-195*

##### **15 Miss. Admin. Code Pt. 9, R. 5.18** Final Administrative Decision {#sec-9-5.18 omnilex-key=us-ms-regs-official--title-15--9#5.18}

The State Health Officer shall issue a written final decision after reviewing the administrative record. The decision may affirm, reverse, modify, remand, dismiss, or otherwise dispose of the matter. The State Health Officer’s decision shall be published on the Department’s website and followed by written notice to the Applicant.

**History**
- *Source: Miss. Code Ann. § 41-7-197*

##### **15 Miss. Admin. Code Pt. 9, R. 5.19** Stay of Proceedings {#sec-9-5.19 omnilex-key=us-ms-regs-official--title-15--9#5.19}

There shall be a stay of proceedings of any final order issued by the Department pertaining to the issuance of a Certificate of Need for the establishment, construction, expansion, or replacement of a health care facility (other than a home health agency) for a period of thirty (30) days from the date of the order, if an existing provider located in the same service area has requested a hearing during the course of review in opposition to the issuance of the CON. The stay shall expire at the termination of thirty (30) days; however, no construction, renovation, or other capital expenditure that is the subject of the order shall be undertaken, no license to operate any facility that is the subject of the order shall be issued, and no certification to participate in the Medicare or Medicaid programs shall be granted, until all statutory appeals have been exhausted or the time for those appeals has expired. The filing of an appeal shall not prevent the purchase of medical equipment or development or offering of institutional health services granted in the CON.

**History**
- *Source: Miss. Code Ann. § 41-7-201*

##### **15 Miss. Admin. Code Pt. 9, R. 5.20** Stay of Proceedings — Home Health Agency Certificates of Need {#sec-9-5.20 omnilex-key=us-ms-regs-official--title-15--9#5.20}

Pursuant to Miss. Code Ann. § 41-7-202, there shall be a stay of proceedings of any written decision of the Department pertaining to a Certificate of Need for a home health agency, as defined in Miss. Code Ann. § 41-7-173, for a period of thirty (30) days from the date of that decision.

Page 42 — Mississippi State Department of Health The stay shall expire at the termination of thirty (30) days; however, no license to operate any such home health agency that is the subject of the decision shall be issued by the licensing agency, and no certification for such home health agency to participate in the Title XVIII or Title XIX programs of the Social Security Act shall be granted, until all statutory appeals have been exhausted or the time for such appeals has expired. The stay of proceedings provided by this rule applies exclusively to home health agency CON decisions under § 41-7-202. It does not apply to final orders pertaining to CONs for any other health care facility, which are governed by Rule 5.19 of this Manual. The two stay provisions are separate and independent.

**History**
- *Source: Miss. Code Ann. § 41-7-202*

##### **15 Miss. Admin. Code Pt. 9, R. 5.21** Rule 5.21 {#sec-9-5.21 omnilex-key=us-ms-regs-official--title-15--9#5.21}

Judicial Review — Health Care Facilities Other Than Home Health Agencies Any party aggrieved by a final order of the Department pertaining to a Certificate of Need for any health care facility other than a home health agency shall have the right of direct appeal to the Chancery Court of the First Judicial District of Hinds County, Mississippi. The appeal must be filed within twenty (20) days after the date of the final order. An appeal of an order disapproving an application may alternatively be made to the chancery court of the county where the proposed construction, expansion, or alteration was to be located or the new service was to be provided and must be filed within twenty (20) days. Any appeal shall state briefly the nature of the proceedings before the Department and shall specify the order complained of. Any person whose rights may be materially affected may appear and become a party, or the court may order that such person be joined as a necessary party. Upon filing of an appeal, the clerk of the chancery court shall serve notice upon the Department, whereupon the Department shall, within thirty (30) days, or within such additional time as the court may allow for cause, certify to the chancery court the complete record in the case, including a transcript of all testimony, all exhibits or copies thereof, all pleadings, proceedings, orders, findings, and opinions. The parties and the Department may stipulate that only a specified portion of the record shall be certified. The chancery court shall give preference to appeals from CON proceedings and shall render a final order no later than one hundred twenty (120) days from the date of the Department’s final order. If the chancery court has not rendered a final order within the one hundred twenty (120)-day period, the Department’s final order shall be deemed affirmed and any party shall have the right to appeal to the Supreme Court on the record certified by the Department. Awards of costs,

Page 43 — Mississippi State Department of Health fees, reasonable expenses, and attorney fees arising from such proceedings shall be governed by Rule 5.23 of this Manual and applicable law. Any appeal shall require the giving of a bond approved by the chancery court within five (5) days of the filing of the appeal. The bond shall secure obligations imposed pursuant to Rule 5.23 of this Manual and applicable law. No new or additional evidence shall be introduced in the chancery court. The case shall be determined upon the certified record. The court may sustain or dismiss the appeal, or modify or vacate the order complained of, in whole or in part. Awards of costs, fees, reasonable expenses, and attorney fees shall be governed by Rule 5.23 of this Manual and applicable law. The order shall not be vacated or set aside, except for errors of law, unless the court finds that the order of the Department is not supported by substantial evidence, is contrary to the manifest weight of the evidence, is in excess of the statutory authority or jurisdiction of the Department, or violates vested constitutional rights of a party. An order reversing the denial of a Certificate of Need shall not entitle the applicant to effectuate the Certificate of Need until either: 1. The order of the chancery court has become final and has not been appealed to the Supreme Court; or 2. The Supreme Court has entered a final order affirming the chancery court. Appeals in accordance with law may be had to the Supreme Court from any final judgment of the chancery court. The Supreme Court shall give preference to and conduct expedited review of such appeals and shall render a final order no later than one hundred twenty (120) days from the date the final judgment of the chancery court is certified to the Supreme Court. Within thirty (30) days after a final order of the Supreme Court, or a final order of the chancery court that is not appealed to the Supreme Court, modifying or vacating a Department order granting a Certificate of Need, the Department shall issue a further order in conformity with the court's decision.

**History**
- *Source: Miss. Code Ann. § 41-7-201*

##### **15 Miss. Admin. Code Pt. 9, R. 5.22** Judicial Review — Home Health Agencies {#sec-9-5.22 omnilex-key=us-ms-regs-official--title-15--9#5.22}

Judicial review of final orders pertaining to a Certificate of Need for a home health agency, as defined in Miss. Code Ann. § 41-7-173, shall be governed by Miss. Code Ann. § 41-7-201(1). Appeals shall be filed within thirty (30) days after the date of the final order in the Chancery Court of the First Judicial District of Hinds County, Mississippi,

Page 44 — Mississippi State Department of Health or, in the case of an order disapproving an application, in the chancery court of the county where the proposed service was to be provided. The standards of review and record-certification requirements applicable to CON appeals shall apply to home health agency appeals to the extent provided by Miss. Code Ann. § 41-7-201(1). Awards of costs, fees, reasonable expenses, and attorney fees shall be governed by Rule 5.23 of this Manual and applicable law. The appeal-bond requirement applicable to appeals governed by Rule 5.21 does not apply to home health agency appeals unless otherwise provided by law. Supreme Court review of home health agency Certificate of Need appeals shall be governed by Miss. Code Ann. § 41-7-201(1)(d).

**History**
- *Source: Miss. Code Ann. § 41-7-201; H.B. 1622 § 4, 2026 Reg. Sess.*

##### **15 Miss. Admin. Code Pt. 9, R. 5.23** Rule 5.23 {#sec-9-5.23 omnilex-key=us-ms-regs-official--title-15--9#5.23}

Fee-Shifting on Appeal Beginning July 1, 2026, any party aggrieved by a final order of the Department approving a Certificate of Need application that exercises the right of appeal to the Chancery Court of the First Judicial District of Hinds County, Mississippi under Miss. Code Ann. § 41-7-201(1) or (2), including any additional appeal to the Supreme Court of the State of Mississippi, shall be required to reimburse the Applicant whose application was approved for all reasonable attorney, consultant, and other fees related to the appeal if the Department’s final order approving the CON is not vacated or set aside by the chancery court or by the Supreme Court. This fee-shifting obligation applies to any appeal of an order approving a CON filed on or after July 1, 2026, regardless of when the underlying application was filed or the CON was issued. The fee-shifting obligation established by this rule is cumulative of, and does not limit or replace, any award of costs, fees, expenses, or attorney fees otherwise authorized by applicable law. The appeal bond required by Rule 5.21 constitutes security for obligations arising under this rule and for any costs, fees, expenses, or attorney fees otherwise recoverable under applicable law.

Page 45 — Mississippi State Department of Health Rule 5.24 Proponent’s Right to Compel Decision. Unless a hearing is held, if review by the Department is not complete with a final decision issued within ninety (90) calendar days from the filing of the application, the proponent (i.e., the CON Applicant) may, within thirty (30) calendar days after the expiration of that period, commence legal action in the Chancery Court of the First Judicial District of Hinds County, Mississippi, or in the chancery court of the county in which the service or facility is proposed to be provided, to compel the Department to issue written findings and a written order approving or disapproving the proposal.

**History**
- *Source: Miss. Code Ann. § 41-7-201; H.B. 1622 § 4, 2026 Reg. Sess.*
- *Source: Miss. Code Ann. § 41-7-201*

##### **15 Miss. Admin. Code Pt. 9, R. 5.25** Designation of Record on Appeal {#sec-9-5.25 omnilex-key=us-ms-regs-official--title-15--9#5.25}

In order to allow the Department to adequately prepare the record for appeal, any party filing an appeal, cross-appeal, or other responsive pleading to a notice of appeal shall specifically designate the record for purposes of appeal in a manner similar to that required by the Mississippi Rules of Appellate Procedure. Such designation must specifically set out any documents received or generated by the Department after publication of the staff analysis that the party desires included in the appellate record.

**History**
- *Source: Miss. Code Ann. § 41-7-201*

##### **15 Miss. Admin. Code Pt. 9, R. 5.26** Electronic Proceedings {#sec-9-5.26 omnilex-key=us-ms-regs-official--title-15--9#5.26}

To the extent permitted by law, hearings, conferences, and related proceedings may be conducted by electronic means, including videoconference, teleconference, or other technology approved by the Department.

**History**
- *Source: Miss. Code Ann. § 41-7-201*

#### **Chapter 6** POST-APPROVAL ADMINISTRATION Rule 6.1 Continuing Compliance. A CON-holder shall remain responsible for compliance with applicable law, this Manual, the State Health Plan where applicable, all conditions of approval, and representations made to the Department in connection with approval of the project. Issuance of a Certificate of Need does not authorize operation without required licensure, eliminate the need for other governmental approvals, supersede zoning requirements, guarantee reimbursement eligibility, or create rights beyond those granted in the approval.

##### **15 Miss. Admin. Code Pt. 9, R. 6.2** Certificate of Need Validity — Scope, Location, and Person {#sec-9-6.2 omnilex-key=us-ms-regs-official--title-15--9#6.2}

Pursuant to Miss. Code Ann. § 41-7-195(1), a Certificate of Need is valid only for the defined scope, physical location, and person named in the application. A CON is not transferable or assignable, nor shall a project or capital expenditure project be transferred from one person to another, except with the approval of the Department. A CON-holder may not operate outside the approved scope, outside the approved physical location, or under the authority of a CON held by a different person, without prior Department approval. Any material change in the approved scope, physical location, or ownership of a CON shall be reported to the Department in accordance with this chapter and may require a new CON or Department approval of a modification.

**History**
- *Source: Miss. Code Ann. § 41-7-195*

##### **15 Miss. Admin. Code Pt. 9, R. 6.3** Progress Reports {#sec-9-6.3 omnilex-key=us-ms-regs-official--title-15--9#6.3}

The CON-holder is required to submit a written progress report every six (6) months from the effective date of the Certificate of Need and upon project completion. Completion means when the approved project is sufficiently complete to be operational for the purpose for which the CON was issued. The holder shall certify each report and submit documentation demonstrating good faith effort to implement the CON by showing substantial progress. A fee of One Thousand Dollars ($1,000.00) shall be assessed for the processing and handling of six-month progress reports associated with extension requests and is payable to the Department by check, money order, or any other manner approved by the Department.

**History**
- *Source: Miss. Code Ann. § 41-7-171 et seq.*

##### **15 Miss. Admin. Code Pt. 9, R. 6.4** Duty to Notify of Material Changes {#sec-9-6.4 omnilex-key=us-ms-regs-official--title-15--9#6.4}

A CON-holder shall promptly notify the Department of any material change affecting an approved project. Material changes may include changes in ownership, project delays, financing changes, construction changes, location changes, changes in approved services, equipment changes, or other significant project developments.

Page 47 — Mississippi State Department of Health Rule 6.5 Change in Scope of Approved Project. If an approved project is substantially changed in scope — in construction, services, or capital expenditure — the existing Certificate of Need is void and a new CON application is required before the holder may lawfully proceed further. See Rule 6.6 for standards governing determination of whether a modification is material and Rule 6.7 for the cost overrun process.

**History**
- *Source: Miss. Code Ann. § 41-7-171 et seq.*
- *Source: Miss. Code Ann. § 41-7-171 et seq.*

##### **15 Miss. Admin. Code Pt. 9, R. 6.6** Material Project Modifications {#sec-9-6.6 omnilex-key=us-ms-regs-official--title-15--9#6.6}

In determining whether a modification is material, the Department may consider changes in approved capital expenditure, project location, ownership or control, approved services, bed capacity, major medical equipment, project size or scope, service area, or implementation schedule. No single factor shall be dispositive. The Department may determine that a proposed modification: 1. May be approved administratively; 2. Requires additional review; 3. Requires a formal application; 4. Requires a new Certificate of Need application; or 5. Does not require further review. Requests for project modification shall be submitted in writing, describe the proposed modification, explain the reason for the modification, provide supporting documentation, and include any information requested by the Department.

**History**
- *Source: Miss. Code Ann. § 41-7-171 et seq.*

##### **15 Miss. Admin. Code Pt. 9, R. 6.7** Cost Overrun Approval {#sec-9-6.7 omnilex-key=us-ms-regs-official--title-15--9#6.7}

Changes in capital expenditure not associated with substantive construction or service changes require application for cost overrun approval. When actual or projected capital expenditures exceed the amount authorized by the Certificate of Need, the holder shall submit a request for cost overrun approval in accordance with this Rule and include: A. For construction projects: a revised estimate signed by an architect licensed to practice in Mississippi or a contractor authorized by law to do business in Mississippi; a description of the method used to determine the revised cost

Page 48 — Mississippi State Department of Health estimate; justification for each line item for which a cost overrun is requested; a revised capital expenditure budget outlining all associated costs; and copies of any bid quotations. Any cost overrun on a construction or renovation project locating cost in or above the upper one-fourth range for U.S. construction or renovation cost shall require additional documentation to explain the reasons. B. For equipment purchases: an official price quotation from the vendor or manufacturer. C. For cost overruns resulting in part or in whole from requirements of the licensure and certification authority: appropriate documentation from the licensing or certification authority. Construction cost overrun requests may be compared with nationally recognized construction cost data, including RS Means or comparable industry references, or other bona fide reference. The fee for cost overrun approval shall be calculated as: 0.50 of 1% of the revised capital expenditure, less the original fee, not to exceed Twenty-Five Thousand Dollars ($25,000.00) and not less than Five Thousand Dollars ($5,000.00). For any proposal in which the estimated or actual cost exceeds the amount originally approved, a review by the State Health Officer shall be required.

**History**
- *Source: Miss. Code Ann. § 41-7-171 et seq.*

##### **15 Miss. Admin. Code Pt. 9, R. 6.8** Extensions — Six-Month Extension {#sec-9-6.8 omnilex-key=us-ms-regs-official--title-15--9#6.8}

Certificates of Need are valid for a period not to exceed one (1) year and may be extended by the Department for an additional period not to exceed six (6) months. To continue authority under a CON following the initial twelve-month issuance period, the holder must document substantial progress toward completion and be granted a six-month extension. A request for a six-month extension shall be filed at least thirty (30) calendar days before the expiration of the original or any extended period. Six-month extensions shall be based upon and supported by documentation demonstrating good faith effort to implement the CON through substantial progress. Substantial progress shall be determined based upon review of the documentation submitted and whether a change in project status has occurred since the previous progress reporting period. A fee of Two Thousand Five Hundred Dollars ($2,500.00) shall be assessed for the processing and handling of six-month extension requests and is payable to the Department by check, draft, or money order.

**History**
- *Source: Miss. Code Ann. § 41-7-195*

##### **15 Miss. Admin. Code Pt. 9, R. 6.9** Denial of Extension — Hearing Right {#sec-9-6.9 omnilex-key=us-ms-regs-official--title-15--9#6.9}

If the Department denies a request for a six-month extension, the Department shall afford the CON-holder fifteen (15) calendar days notice within which to request a hearing. If a public hearing is requested, the Department shall conduct the hearing within forty-five (45) calendar days of receipt of the written request, utilizing the hearing procedures set forth in Chapter 5 to the extent practicable. A written request for such a hearing must be received no later than fifteen (15) calendar days from the date of the notice of denial and must be accompanied by the Six Thousand Dollar ($6,000.00) hearing fee deposit required by Rule 5.3. The State Health Officer shall render a written decision within thirty (30) calendar days following conclusion of any hearing on the denial of a six-month extension.

**History**
- *Source: Miss. Code Ann. § 41-7-171 et seq.*

##### **15 Miss. Admin. Code Pt. 9, R. 6.10** Good Cause for Extension {#sec-9-6.10 omnilex-key=us-ms-regs-official--title-15--9#6.10}

In evaluating whether good cause exists to grant a six-month extension, the Department may consider all relevant circumstances, including but not limited to: 1. Construction delays; 2. Financing delays; 3. Regulatory delays including delays in licensure, permitting, or required governmental approvals; 4. Litigation affecting the project; 5. Supply-chain disruptions; 6. Acts of God or natural disasters; 7. Public health emergencies; 8. Workforce shortages; and 9. Other circumstances beyond the reasonable control of the CON-holder, provided the holder has acted diligently to mitigate and overcome such circumstances.

Page 50 — Mississippi State Department of Health Rule 6.11 Good Faith Efforts. In determining whether a CON-holder has made a good faith effort to implement an approved project and to obligate the approved expenditure, the Department may consider all relevant circumstances, including but not limited to: 1. Capital expenditures incurred to date; 2. Construction or renovation activities undertaken; 3. Financing commitments obtained or actively pursued; 4. Efforts to acquire land, equipment, or materials; 5. Staffing efforts, including recruitment and contracting; 6. Licensure or certification activities; and 7. Other implementation activities demonstrating intent and ability to complete the approved project. No single factor shall be dispositive. The Department shall evaluate the totality of the circumstances in determining whether a good faith effort has been made.

**History**
- *Source: Miss. Code Ann. § 41-7-195*
- *Source: Miss. Code Ann. § 41-7-195*

##### **15 Miss. Admin. Code Pt. 9, R. 6.12** Substantial Progress {#sec-9-6.12 omnilex-key=us-ms-regs-official--title-15--9#6.12}

In determining whether substantial progress has occurred toward implementation of an approved project during a valid Certificate of Need period, the Department may consider the totality of circumstances, including but not limited to: 1. Total project expenditures incurred; 2. Construction or renovation progress; 3. Financing commitments obtained; 4. Equipment acquisition or orders placed; 5. Contracts executed with contractors, vendors, or staff; 6. Site development activities; and 7. Other implementation efforts demonstrating active and material pursuit of project completion.

Page 51 — Mississippi State Department of Health No single factor shall be determinative. Substantial progress shall be evaluated based upon the nature and scope of the approved project and the stage of implementation at the time of review.

**History**
- *Source: Miss. Code Ann. § 41-7-195*

##### **15 Miss. Admin. Code Pt. 9, R. 6.13** Documentation of Commencement of Construction and Substantial Progress {#sec-9-6.13 omnilex-key=us-ms-regs-official--title-15--9#6.13}

The following documentation may be reviewed to determine whether commencement of construction or other preparation has been substantially undertaken during a valid Certificate of Need period and whether the holder is making a good faith effort to obligate approved expenditures. A. Commencement of Construction — all of the following must be demonstrated: 1. A letter from the Director of the Health Facilities Licensure and Certification Division stating that final plans have been submitted and approved, prepared by an architect or architectural firm licensed in Mississippi, and that the site is approved. 2. A copy of a legally binding written contract executed by the holder and a contractor to construct and complete the project within a reasonable designated time, stating the specific capital expenditure amount conforming to the amount previously approved. 3. A copy of the contractor’s Mississippi license. 4. A copy of the building permit issued by the applicable governing authority, or if no building permit is required, a letter from the applicable authority stating such. 5. A letter from the applicable governing authority that the proposed project is in compliance with applicable zoning regulations, or if no regulations exist, a letter to that effect. 6. A statement in writing that the proposed construction is not in violation of the Coastal Wetlands Protection Act, Miss. Code Ann. § 49-27-1 et seq., or any federal law pertaining to construction in a federally designated wetlands area. 7. Documentary proof that a progress payment of at least one percent (1%) of the total construction cost stated in the contract has been paid by the holder to the contractor, exclusive of site preparation costs.

Page 52 — Mississippi State Department of Health 8. A written statement signed by the holder and the contractor that all site preparation work has been completed. 9. A written statement signed by the holder and the contractor that actual bona fide construction has commenced and describing the details of such preliminary construction. 10. A copy of the Proceed to Construction Written Order previously given to the contractor. B. Other Preparation Substantially Undertaken During the Valid CON Period — evidence may include but is not limited to: For construction projects: acquisition of property (title, evidence of payment); completion of topographic or boundary surveys; site preparation (contractor selection, contract, evidence of payment); completion of site development plan; and architectural plans and drawings (architect selection, contract, evidence of payment, submission to Health Facilities Licensure and Certification, and any letter of findings, comments, or approval of commencement of construction). For establishment of service: hiring or entering contracts with necessary staff or medical professionals; submission of a fire/life safety code inspection request; submission of an application for facility inspection or licensure; and acquisition of equipment (title, lease, etc.). C. Good Faith Effort to Obligate Approved Expenditure — documentation may include, in addition to items under A and B above: documentation of capital expenditure made to date; evidence that permanent financing has been obtained if the approved capital expenditure has not been obligated; if financing has not been obtained, evidence of fund commitment from a lending institution; and evidence of contractual obligation to expend funds.

**History**
- *Source: Miss. Code Ann. § 41-7-171 et seq.*

##### **15 Miss. Admin. Code Pt. 9, R. 6.14** Expiration of a Certificate of Need {#sec-9-6.14 omnilex-key=us-ms-regs-official--title-15--9#6.14}

The valid period for a Certificate of Need is the period stated on the Certificate or any subsequent extension approved by the State Health Officer. A CON- holder is authorized to proceed with and make expenditures on the project only during the valid period or any extension thereof. Once a CON is no longer in a valid period, it is expired and void by operation of law, and the holder must immediately refrain from taking any action under it. If a holder fails to request an extension before the Certificate’s expiration date, the

Page 53 — Mississippi State Department of Health Certificate shall be automatically void by operation of law without any further action on the part of the Department.

**History**
- *Source: Miss. Code Ann. § 41-7-171 et seq.*

##### **15 Miss. Admin. Code Pt. 9, R. 6.15** Extension or Renewal of an Expired Certificate of Need {#sec-9-6.15 omnilex-key=us-ms-regs-official--title-15--9#6.15}

Extenuating circumstances may prevent a holder from proceeding with a proposed project within the valid period of the approved Certificate of Need. The Department has adopted a format for Extension/Renewal of an Expired CON to be used when the increase in capital expenditure does not exceed the rate of inflation and no change in the intent or scope of the project has occurred. This application shall be submitted and reviewed under the procedures and criteria set forth in this Manual. The following criteria shall be considered: 1. Reason for expiration; 2. How long the CON has been expired; 3. Status of the project at the time of expiration and current status; 4. Continued need for the project; 5. Applicant’s ability to complete the project; and 6. Timeline for completion. The Department shall not consider a CON for extension or renewal that has been expired for more than eighteen (18) months, or that is not shown in the current State Health Plan. The fee shall be one-half of the original assessment. The minimum fee shall not be less than Two Thousand Five Hundred Dollars ($2,500.00) and the maximum fee shall not exceed Twelve Thousand Five Hundred Dollars ($12,500.00).

**History**
- *Source: Miss. Code Ann. § 41-7-171 et seq.*

##### **15 Miss. Admin. Code Pt. 9, R. 6.16** Amendments to Certificates of Need {#sec-9-6.16 omnilex-key=us-ms-regs-official--title-15--9#6.16}

A Certificate of Need may be amended to reflect changes in the defined scope or physical location if the amendment is necessary to comply with the licensing laws of the State or for certification under Title XVIII or Title XIX of the Social Security Act. Any such necessity shall be documented in writing from the Director of the Health Facilities Licensure and Certification Division.

Page 54 — Mississippi State Department of Health A CON may also be amended when no substantial change exists in construction, service, or capital expenditure and when extenuating circumstances or events, as determined by the Department, inhibit completion as originally presented. Requests for amendments shall be submitted in writing to the Department only during the valid CON period and in the form and detail required by the Department. The fee for amendment shall be calculated as: 0.50 of 1% of the additional capital expenditure, not to exceed Twenty-Five Thousand Dollars ($25,000.00) and not less than Five Thousand Dollars ($5,000.00). NOTE: Amendments resulting from an additional capital expenditure or a change in scope of project will be reviewed as a separate project and will require an additional fee. No CON shall be amended after the holder has submitted a final report indicating project completion and the Department has acknowledged receipt in writing.

**History**
- *Source: Miss. Code Ann. § 41-7-171 et seq.*

##### **15 Miss. Admin. Code Pt. 9, R. 6.17** Bed Abeyance {#sec-9-6.17 omnilex-key=us-ms-regs-official--title-15--9#6.17}

A health care facility seeking to place licensed beds in abeyance (voluntary temporary de-licensure) or to remove beds from abeyance (re-licensure) shall submit a written request letter to the Department. A fee of Five Hundred Dollars ($500.00) shall be assessed for the processing and handling of all abeyance requests and is payable to the Department by check, draft, or money order. No abeyance request shall be processed until the required fee is received. The Department shall maintain a record of all de-licensing facilities and their voluntarily de-licensed beds and shall continue to count those beds as part of the state's total bed count for health care planning purposes. If a health care facility that has voluntarily de-licensed beds later desires to re- license some or all of those beds, it shall notify the Department of its intent to increase the number of licensed beds. The Department shall survey the health care facility within thirty (30) calendar days of that notice and, if appropriate, issue the facility a new license reflecting the new bed complement. In no event shall a health care facility be re-issued a license to operate beds in excess of its bed count before voluntary de-licensure without seeking CON approval.

Page 55 — Mississippi State Department of Health Rule 6.18 Post-Approval Change of Ownership. Any post-approval ownership transaction shall be reported to the Department in accordance with applicable law and Department procedures. The Department may require submission of documentation concerning ownership and management structure, financing arrangements, operational control, asset transfers, and other matters relevant to review. A Certificate of Need is not transferable from one person or entity to another except with the approval of the Department.

**History**
- *Source: Miss. Code Ann. § 41-7-191*
- *Source: Miss. Code Ann. § 41-7-191*

##### **15 Miss. Admin. Code Pt. 9, R. 6.19** Revocation and Rescission {#sec-9-6.19 omnilex-key=us-ms-regs-official--title-15--9#6.19}

The Department may revoke or rescind a Certificate of Need where authorized by law. Grounds may include material misrepresentation, fraud, failure to comply with conditions of approval, failure to comply with applicable law, or other grounds authorized by law. Before revocation, rescission, or other adverse action, the Department shall provide any notice and opportunity for hearing required by law.

**History**
- *Source: Miss. Code Ann. § 41-7-195*

##### **15 Miss. Admin. Code Pt. 9, R. 6.20** Penalties for Violations {#sec-9-6.20 omnilex-key=us-ms-regs-official--title-15--9#6.20}

Any person or entity violating the provisions of Miss. Code Ann. §§ 41-7-171 through 41-7-209 by not obtaining a Certificate of Need, by deviating from the provisions of a CON, or by refusing or failing to cooperate with the Department in the exercise or execution of its functions, responsibilities, and powers shall be subject to the following: A. Revocation of the license of a health care facility, including any designated section, component, or bed service thereof, or revocation of the license of any other person or entity for whom the Department serves as the licensing authority. If the Department lacks jurisdiction to revoke such license, the State Health Officer shall recommend and show cause to the appropriate licensing agency that such license should be revoked. B. Non-licensure by the Department of specific or designated bed services offered by the entity or person. C. Non-licensure by the Department where infractions concern the acquisition or control of major medical equipment. D. Revoking, rescinding, or withdrawing a CON previously issued.

Page 56 — Mississippi State Department of Health Violations of Miss. Code Ann. §§ 41-7-171 et seq., or any rules or regulations promulgated thereunder, by intent, fraud, deceit, unlawful design, willful or deliberate misrepresentation, or by careless, negligent, or incautious disregard, either by persons acting individually or in concert, shall constitute a misdemeanor punishable by a fine not to exceed One Thousand Dollars ($1,000.00) for each offense. Each day of continuing violation constitutes a separate offense. Prosecution shall be in the county where the violation or portion thereof occurred. The Attorney General, upon certification by the State Health Officer, shall seek injunctive relief in a court of proper jurisdiction to prevent violations in cases where other administrative penalties and legal sanctions have failed or to cause discontinuance of any such violation. Major third-party payors, public and private, shall be notified of any violation or infraction under this rule and shall be required to take such appropriate punitive action as is provided by law.

**History**
- *Source: Miss. Code Ann. §§ 41-7-171 et seq.*

##### **15 Miss. Admin. Code Pt. 9, R. 6.21** Department Periodic Review of Approved Projects {#sec-9-6.21 omnilex-key=us-ms-regs-official--title-15--9#6.21}

The Department shall periodically review the progress and time schedule of any holder issued or granted a Certificate of Need for any purpose, consistent with the mandate of Miss. Code Ann. § 41-7-193(2). The Department may conduct site visits, audits, inspections, correspondence reviews, file reviews, or other activities reasonably necessary to verify that approved projects are progressing in accordance with the approved time schedule and within the approved scope and capital expenditure. A CON-holder shall cooperate with the Department in the exercise of its periodic review authority. Failure to cooperate may constitute grounds for enforcement action, revocation, rescission, or other action authorized by law.

**History**
- *Source: Miss. Code Ann. §§ 41-7-193 and 41-7-209*

##### **15 Miss. Admin. Code Pt. 9, R. 6.22** Project Completion {#sec-9-6.22 omnilex-key=us-ms-regs-official--title-15--9#6.22}

A CON-holder shall notify the Department in writing upon completion of an approved project. For purposes of this rule, completion means that the approved project is sufficiently complete to be operational for the purpose for which the Certificate of Need was issued. The completion notice shall include:

Page 57 — Mississippi State Department of Health A. Identification of the CON, including the CON number and approved project description; B. The date on which the project became operational; C. A certification by the CON-holder that the project was completed in accordance with the approved scope, physical location, and capital expenditure authorized by the CON; and D. Such other information as the Department may require. The Department shall acknowledge receipt of the completion notice in writing. The date of that written acknowledgment shall constitute the project completion date for purposes of this chapter, including the prohibition on post-completion amendments. The Department may establish forms and procedures governing completion notices.

**History**
- *Source: Miss. Code Ann. § 41-7-193*

##### **15 Miss. Admin. Code Pt. 9, R. 6.23** Failure to Implement {#sec-9-6.23 omnilex-key=us-ms-regs-official--title-15--9#6.23}

Failure to implement an approved project within the applicable Certificate of Need validity period and any authorized extension thereof may constitute grounds for expiration, rescission, revocation, or other action authorized by law, including the actions described in this Chapter. The Department shall follow the applicable procedures of Chapter 5 and this Chapter before taking any adverse action based on failure to implement.

**History**
- *Source: Miss. Code Ann. § 41-7-195*

##### **15 Miss. Admin. Code Pt. 9, R. 6.24** Voluntary Surrender {#sec-9-6.24 omnilex-key=us-ms-regs-official--title-15--9#6.24}

A CON-holder may voluntarily surrender an approval by submitting written notice to the Department at any time before project completion as defined in Rule 6.22 of this Manual. The notice of voluntary surrender shall: A. Identify the Certificate of Need being surrendered, including the CON number and approved project description; B. State the reason for the surrender; and

Page 58 — Mississippi State Department of Health C. Certify that no construction, renovation, equipment acquisition, or other capital expenditure has been undertaken under the CON in violation of applicable law, or if such activities have been undertaken, describe their current status. Upon receipt of a written notice of voluntary surrender that satisfies the requirements of this rule, the Department shall acknowledge the surrender in writing. The CON shall be deemed relinquished as of the date of the Department’s written acknowledgment. Voluntary surrender shall not constitute a finding of violation, non-compliance, or wrongdoing on the part of the CON-holder and shall not be used as evidence against the holder in any subsequent proceeding, unless the surrender is accompanied by evidence of fraud, misrepresentation, or willful violation of applicable law. Voluntary surrender of a CON does not preclude the former holder from submitting a new application for a CON in the future, subject to applicable law and rules in this Manual regarding applications unacceptable for review.

**History**
- *Source: Miss. Code Ann. § 41-7-195*

#### **Chapter 7** GENERAL CERTIFICATE OF NEED REVIEW CRITERIA Rule 7.1 Applicability and Balancing. The Department shall evaluate each Certificate of Need application in accordance with applicable law, this Manual, and any applicable criteria and standards contained in the State Health Plan. Unless otherwise required by law, this Manual, or the State Health Plan, no single review criterion shall be determinative. The Department may consider and weigh applicable review criteria based upon the facts and circumstances of each application. No Certificate of Need shall be approved unless the Department determines that the proposal substantially complies with applicable law, this Manual, and the State Health Plan. In determining whether substantial compliance exists, the Department may deny an application if it determines that the application fails to satisfy one or more applicable review criteria to a degree that warrants denial.

##### **15 Miss. Admin. Code Pt. 9, R. 7.3** Consistency with State Health Plan {#sec-9-7.3 omnilex-key=us-ms-regs-official--title-15--9#7.3}

The Applicant shall demonstrate consistency with the applicable provisions of the State Health Plan, including need methodologies, inventories, planning districts, utilization methodologies, service-specific criteria, and other applicable planning standards. Certificate of Need applications shall be reviewed under the State Health Plan in effect at the time the application is received by the Department.

**History**
- *Source: Miss. Code Ann. § 41-7-193*

##### **15 Miss. Admin. Code Pt. 9, R. 7.4** Long-Range Development Plan {#sec-9-7.4 omnilex-key=us-ms-regs-official--title-15--9#7.4}

The Department may consider the relationship of the proposed services to the long-range development plan, if any, of the institution proposing or providing the services.

**History**
- *Source: Miss. Code Ann. § 41-7-171 et seq.*

##### **15 Miss. Admin. Code Pt. 9, R. 7.5** Need for the Project {#sec-9-7.5 omnilex-key=us-ms-regs-official--title-15--9#7.5}

The Applicant shall demonstrate a need for the proposed project. In evaluating need, the Department may consider: A. The need of the population to be served for the proposed services and the extent to which all residents of the area — in particular low-income persons, racial and ethnic minorities, women, handicapped persons, other underserved groups, and the elderly — are likely to have access to those services. B. In the case of relocation, the need of the population presently served, the extent to which that need will be met adequately by the proposed relocation or by alternative arrangements, and the effect of the relocation on the ability of low-income persons, racial and ethnic minorities, women, handicapped persons, other underserved groups, and the elderly to obtain needed health care. C. The current and projected utilization of like facilities or services within the proposed service area, based on data where available from the Office of

Page 60 — Mississippi State Department of Health Health Planning and Resource Development, which shall be considered the most reliable data unless clearly shown otherwise. D. The probable effect of the proposed facility or service on existing facilities providing similar services, including any overlap in service areas and the appropriate and efficient use of existing facilities or services. E. Community reaction to the proposed facility or service, including endorsements from community officials and individuals and any significant written opposition or opposition expressed at a public hearing, which may be considered an adverse factor and weighed against endorsements received.

**History**
- *Source: Miss. Code Ann. § 41-7-171 et seq.*

##### **15 Miss. Admin. Code Pt. 9, R. 7.6** Alternatives Considered {#sec-9-7.6 omnilex-key=us-ms-regs-official--title-15--9#7.6}

The Applicant shall identify reasonable alternatives considered and explain why the proposed project is preferred. The Department may consider renovation of existing facilities, expansion of existing services, shared services, cooperative arrangements, technological alternatives, and operational alternatives. For new construction projects, modernization of existing facilities shall be considered as an alternative, and rejection of this alternative by the Applicant should be justified.

**History**
- *Source: Miss. Code Ann. § 41-7-171 et seq.*

##### **15 Miss. Admin. Code Pt. 9, R. 7.7** Access to Care {#sec-9-7.7 omnilex-key=us-ms-regs-official--title-15--9#7.7}

The Applicant shall demonstrate the contribution of the proposed service in meeting the health-related needs of members of medically underserved groups that have traditionally experienced difficulties in obtaining equal access to health services. The Department shall consider: A. The extent to which medically underserved populations currently use the Applicant’s services compared to the percentage of the population in the service area that is medically underserved, and the extent to which those populations are expected to use the proposed services if approved; B. The Applicant’s performance in meeting obligations under applicable federal regulations requiring provision of uncompensated care, community service, or access by minorities and handicapped persons, including the existence of any civil rights access complaints against the applicant; C. The extent to which the unmet needs of Medicare, Medicaid, and medically indigent patients are proposed to be served by the Applicant; and

Page 61 — Mississippi State Department of Health D. The extent to which the Applicant offers a range of means by which a person may access the proposed facility or services, including geographic access, transportation considerations, travel times, and service-area characteristics.

**History**
- *Source: Miss. Code Ann. § 41-7-171 et seq.*

##### **15 Miss. Admin. Code Pt. 9, R. 7.8** Financial Feasibility {#sec-9-7.8 omnilex-key=us-ms-regs-official--title-15--9#7.8}

The Applicant shall demonstrate that the project is financially feasible. The Department may consider capital costs, financing arrangements, operating projections, revenue projections, utilization projections, debt obligations, financial resources, and economic conditions. The proposed charges shall be comparable to those established by other facilities for similar services within the service area or the state, and the Applicant shall document how proposed charges were calculated. Projected utilization levels shall be reasonably consistent with those experienced by similar facilities in the service area or the state and shall be consistent with the need level of the service area. If the capital expenditure of the proposed project is Two Million Dollars ($2,000,000.00) or more, the Applicant shall submit a financial feasibility study prepared by an accountant, CPA, or the facility’s financial officer. The study shall include the financial analyst’s opinion of the ability of the facility to undertake the obligation and the probable effect of the expenditure on present and future operating costs, and must be signed by the preparer.

**History**
- *Source: Miss. Code Ann. § 41-7-171 et seq.*

##### **15 Miss. Admin. Code Pt. 9, R. 7.9** Cost Containment and Efficiency {#sec-9-7.9 omnilex-key=us-ms-regs-official--title-15--9#7.9}

The Applicant shall demonstrate that the proposed project promotes efficient use of health care resources. The Department may consider duplication of services, utilization of existing resources, operational efficiency, cost-effectiveness, resource allocation, shared services, and technological efficiency. The immediate and long-term financial feasibility of the proposal and the probable effect on costs and charges for providing health services shall be considered.

**History**
- *Source: Miss. Code Ann. § 41-7-171 et seq.*

##### **15 Miss. Admin. Code Pt. 9, R. 7.10** Utilization of Existing Services {#sec-9-7.10 omnilex-key=us-ms-regs-official--title-15--9#7.10}

The Department shall consider the current and projected utilization of existing facilities and services when evaluating a proposed project. The utilization of

Page 62 — Mississippi State Department of Health existing services is relevant to the need determination, the cost containment analysis, and the evaluation of competing applications. Factors that may be considered include: 1. Occupancy rates of existing facilities providing similar services; 2. Utilization rates of existing services; 3. Service volumes and trends; 4. Existing capacity levels relative to demand; 5. Wait times for existing services; 6. Existing and projected demand for the proposed services; and 7. Other relevant utilization indicators. Unless clearly shown otherwise, utilization data from the Office of Health Planning and Resource Development shall be considered the most reliable data available for purposes of this rule.

**History**
- *Source: Miss. Code Ann. § 41-7-193*

##### **15 Miss. Admin. Code Pt. 9, R. 7.11** Construction Projects {#sec-9-7.11 omnilex-key=us-ms-regs-official--title-15--9#7.11}

All construction projects shall be designed and constructed with the objective of maximizing cost containment, protecting the environment, and conserving energy. Each proposal involving construction shall be accompanied by a cost estimate and, where applicable, schematic drawings. Space allocations shall conform to applicable local, state, or minimum standards. The cost per square foot shall be calculated based on the total project cost, minus the cost of land and non-fixed equipment, using the following formulas: New Construction/Renovation (Prorated Project): Cost per sq. ft. (New Construction) = A+C+D+(E+F+G(A%)) ÷ New Construction Sq. Ft.; Cost per sq. ft. (Renovation) = B+(E+F+G(B%)) ÷ Renovation Sq. Ft. New Construction Only: Cost per Sq. Ft. = (A+C+D+E+F+G) ÷ Total Sq. Ft. Renovation Only: Cost per Sq. Ft. = (B+C+E+F+G) ÷ Total Sq. Ft. Where: A = New Construction; B = Renovation; C = Fixed Equipment; D = Site Preparation; E = Fees; F = Contingency; G = Capitalized

Page 63 — Mississippi State Department of Health Interest; A% = percentage of sq. ft. for new construction; B% = percentage of sq. ft. for renovation. Any cost overrun on a construction or renovation project that locates cost in or above the upper one-fourth range for U.S. construction or renovation cost shall require additional documentation. Construction cost overrun requests shall be with nationally recognized construction cost data, including RS Means or comparable industry references or other bona fide reference.

**History**
- *Source: Miss. Code Ann. § 41-7-171 et seq.*

##### **15 Miss. Admin. Code Pt. 9, R. 7.12** Medicaid Participation {#sec-9-7.12 omnilex-key=us-ms-regs-official--title-15--9#7.12}

The Department shall consider the Applicant’s participation in the Medicaid program and the anticipated impact of the project on Medicaid beneficiaries, including existing Medicaid participation, projected Medicaid utilization, accessibility to Medicaid beneficiaries, historical participation, and commitments regarding future participation. The Department shall disapprove a Certificate of Need application if the Applicant fails to provide or confirm that the Applicant shall provide a reasonable amount of indigent care, or if the Applicant’s admission policies deny access to care by indigent patients. The Department shall also disapprove an application if approval would have a significant adverse effect on the ability of an existing facility or service to provide Medicaid or indigent care. The State Health Officer shall determine whether the amount of indigent care provided or proposed is reasonable. A reasonable amount of indigent care is an amount comparable to that offered by other providers of the requested service within the same or proximate geographic area.

**History**
- *Source: Miss. Code Ann. § 41-7-193*

##### **15 Miss. Admin. Code Pt. 9, R. 7.13** Charity Care and Information Reporting Obligations {#sec-9-7.13 omnilex-key=us-ms-regs-official--title-15--9#7.13}

The Department shall consider the Applicant’s provision of charity care and services to medically underserved populations, including existing charity care policies, historical levels, proposed commitments, service to underserved populations, and access initiatives. An Applicant shall affirm in its application that it will record and maintain, at a minimum, the following information and shall make it available to the Department within fifteen (15) business days of request:

Page 64 — Mississippi State Department of Health A. Utilization data, including the number of indigent, Medicaid, and charity admissions and inpatient days of care; B. Age, race, sex, zip code, and county of origin of patient; C. Cost and charges per patient day or per procedure, if applicable; and D. Any other data pertaining directly or indirectly to the utilization of services by medically indigent, Medicaid, or charity patients that may be requested, including discharge diagnosis, service provided, and similar information.

**History**
- *Source: Miss. Code Ann. § 41-7-171 et seq.*

##### **15 Miss. Admin. Code Pt. 9, R. 7.14** Relationship to Existing Health Care System {#sec-9-7.14 omnilex-key=us-ms-regs-official--title-15--9#7.14}

The Department may consider the effect of the proposed project on the health care delivery system, including existing providers, existing services, regional resources, health care infrastructure, continuity of care, referral relationships, and other system impacts. The Department shall also consider the relationship of the proposed services to ancillary or support services, including the organizational relationship.

**History**
- *Source: Miss. Code Ann. § 41-7-171 et seq.*

##### **15 Miss. Admin. Code Pt. 9, R. 7.15** Availability of Resources {#sec-9-7.15 omnilex-key=us-ms-regs-official--title-15--9#7.15}

The Applicant shall demonstrate the availability of resources — including health personnel, management personnel, and funds for capital and operating needs — for the services proposed. The Department may consider: A. Whether the Applicant has a reasonable plan for the provision of all required staff, including physicians, nursing, allied health, and support staff; B. Whether sufficient physicians are available to ensure proper implementation and utilization of the project; C. If the Applicant presently owns existing facilities or services, whether the Applicant has demonstrated a satisfactory staffing history; and D. Alternative uses of resources for the provision of other health services.

Page 65 — Mississippi State Department of Health Rule 7.16 Quality of Care. The Applicant shall demonstrate the ability to provide quality services. The Department shall consider accreditation status, licensure history, regulatory compliance history, quality assurance programs, performance improvement activities, clinical protocols, patient safety initiatives, and other quality indicators. In the case of existing services or facilities, the quality of care provided in the past shall be considered.

**History**
- *Source: Miss. Code Ann. § 41-7-171 et seq.*
- *Source: Miss. Code Ann. § 41-7-171 et seq.*

##### **15 Miss. Admin. Code Pt. 9, R. 7.17** Access by Health Professional Schools {#sec-9-7.17 omnilex-key=us-ms-regs-official--title-15--9#7.17}

The Department may consider the effect of the proposed means of delivery of health services on the clinical needs of health professional training programs in the area in which the services are to be provided. Where proposed health services are to be available in a limited number of facilities, the extent to which any health professional school in the area will have access to the services for training purposes shall be considered. The special needs and circumstances of entities that provide a substantial portion of their services or resources to individuals not residing in the health services area in which the entities are located — including medical and other health professional schools, multi-disciplinary clinics, and specialty centers — may also be considered.

**History**
- *Source: Miss. Code Ann. § 41-7-171 et seq.*

##### **15 Miss. Admin. Code Pt. 9, R. 7.18** Community Support and Community Impact {#sec-9-7.18 omnilex-key=us-ms-regs-official--title-15--9#7.18}

The Department may consider the effect of the project upon the community to be served, including community support, community opposition, public comments, community health needs, economic impact, and public health considerations.

**History**
- *Source: Miss. Code Ann. § 41-7-171 et seq.*

##### **15 Miss. Admin. Code Pt. 9, R. 7.19** Service Availability and Continuity {#sec-9-7.19 omnilex-key=us-ms-regs-official--title-15--9#7.19}

The Department may consider whether the proposed project promotes or adversely affects the continuity and availability of health care services to the population to be served. This criterion is particularly relevant in applications involving relocation, change of ownership, consolidation of services, or discontinuation of any existing service. Factors that may be considered include:

Page 66 — Mississippi State Department of Health 1. The effect of the project on the maintenance of essential services currently provided in the service area; 2. The degree to which the project promotes or disrupts coordination of care and continuity of care for existing patients; 3. The degree to which the project promotes or disrupts integration of health services in the service area; 4. The Applicant’s emergency preparedness planning and its effect on continuity of operations; 5. The effect of the project on the continuity of operations of other health care facilities in the service area; and 6. Other relevant considerations concerning the ongoing availability of health care services to the population to be served. Nothing in this rule shall require approval of a project solely because it maintains existing services, nor shall it require denial of a project solely because it may alter existing service patterns, provided the applicant demonstrates that the health care needs of the affected population will continue to be adequately served.

**History**
- *Source: Miss. Code Ann. § 41-7-193*

##### **15 Miss. Admin. Code Pt. 9, R. 7.20** Non-Discrimination {#sec-9-7.20 omnilex-key=us-ms-regs-official--title-15--9#7.20}

Services provided pursuant to an approved project shall be offered in accordance with applicable federal and state non-discrimination requirements.

**History**
- *Source: Miss. Code Ann. § 41-7-171 et seq.*

##### **15 Miss. Admin. Code Pt. 9, R. 7.21** Competing Applications {#sec-9-7.21 omnilex-key=us-ms-regs-official--title-15--9#7.21}

Where applications from competing Applicants are under review, the Department may evaluate the applications comparatively to determine which entity is the most appropriate applicant. The Department may use a variety of statistical methodologies, including market share analysis, patient origin data, and state agency reports. In the matter of competing applications for nursing facility beds, the Department shall conduct a comparative analysis and make a determination based upon ranking of all competing applications according to the following factors: size of facility; capital expenditure; cost per square foot; cost per bed; staffing; Medicare utilization; total cost to Medicaid; per diem cost to Medicaid; continuum of care services; and community support. Each factor shall be assigned an equal weight.

Page 67 — Mississippi State Department of Health The application obtaining the lowest composite score shall be considered the most appropriate application. NOTE: Community support letters submitted by or on behalf of an Applicant for a nursing facility Certificate of Need are valid only if signed by individuals who are eighteen (18) years of age or older and who reside in the county in which the proposed nursing facility will be located. Each letter shall contain the name, address, occupation, and telephone number of the signee, and certification that the signee is eighteen (18) years of age or older. Any nursing facility applicant who signs a written agreement to maintain continuous ownership and operation of the proposed nursing facility for not less than three (3) years after initial licensure and who includes that agreement as part of the Certificate of Need application shall have one point deducted from the total composite score. In the event of default (selling or leasing the facility within three years from initial licensure), the Applicant shall be barred from filing a CON application for a nursing facility for a period of three (3) years from the date of default.

**History**
- *Source: Miss. Code Ann. § 41-7-171 et seq.*

##### **15 Miss. Admin. Code Pt. 9, R. 7.22** Supplemental Service-Specific Criteria {#sec-9-7.22 omnilex-key=us-ms-regs-official--title-15--9#7.22}

Service-specific criteria have been developed for a number of health services and are contained in the State Health Plan. Applications that propose to develop or expand such services shall be evaluated against the applicable general criteria in this chapter and also against the service-specific criteria contained in the State Health Plan and the adopted rules and regulations of the Department. NOTE: Should the Department receive a Certificate of Need application regarding the acquisition or control of major medical equipment or the provision of a service for which specific CON criteria and standards have not been adopted, the application shall be deferred until the Department has developed and adopted applicable criteria and standards. If the Department has not developed and adopted applicable criteria and standards within one hundred eighty (180) days of receiving such an application, the application shall be reviewed using the general review criteria in this chapter and all adopted rules, procedures, and plans of the Department.

Page 68 — Mississippi State Department of Health Rule 7.23 Historical Compliance. The Department may consider an Applicant’s history of compliance with applicable law, licensure requirements, Certificate of Need requirements, conditions of approval, reporting requirements, and other regulatory obligations.

**History**
- *Source: Miss. Code Ann. § 41-7-171 et seq.*
- *Source: Miss. Code Ann. § 41-7-171 et seq.*

##### **15 Miss. Admin. Code Pt. 9, R. 7.24** Special Circumstances {#sec-9-7.24 omnilex-key=us-ms-regs-official--title-15--9#7.24}

The Department may consider special circumstances relevant to the proposed project, including circumstances not specifically identified elsewhere in this chapter, to the extent authorized by applicable law.

**History**
- *Source: Miss. Code Ann. § 41-7-171 et seq.*

#### **Chapter 8** ADMINISTRATIVE PROVISIONS Rule 8.1 Fees — General Provisions. Fees shall be assessed and collected in accordance with applicable law and this Manual. The Department may establish administrative procedures, forms, instructions, and payment methods necessary to administer fees authorized by law. Required fees shall be paid in the manner prescribed by the Department. The Department may decline to process applications, requests, or filings until required fees have been received. Fee refunds shall be governed by the provisions of this Manual and applicable law. Nothing in this Manual requires a refund not otherwise authorized by law.

##### **15 Miss. Admin. Code Pt. 9, R. 8.2** Electronic Technology and Filing {#sec-9-8.2 omnilex-key=us-ms-regs-official--title-15--9#8.2}

The Department may utilize electronic systems, document-management systems, electronic filing systems, virtual meeting platforms, electronic publication systems, and other technologies necessary for efficient administration of the Certificate of Need Program. To the extent permitted by law, the Department may accept electronic signatures, certifications, attestations, acknowledgments, and filings, which may be given the same force and effect as original paper submissions. The Department may establish technical requirements, file formats, and electronic submission procedures. Miss. Code Ann. § 41-7-171 et seq.

Page 69 — Mississippi State Department of Health Rule 8.3 Communications. The Department may communicate with Applicants, CON-holders, Affected Persons, interested persons, governmental entities, and other parties through electronic means, mail, hand delivery, telephone, virtual meeting platforms, or other appropriate methods. Unless otherwise required by law, notices may be served by electronic mail, United States mail, hand delivery, commercial delivery service, electronic filing systems, or other methods reasonably calculated to provide notice. Miss. Code Ann. § 41-7-171 et seq. Rule 8.4 Guidance Documents. The Department may publish guidance documents, policy statements, advisory materials, frequently asked questions, instructions, and other informational materials to assist regulated persons in understanding and complying with the Certificate of Need Program. Guidance materials shall not constitute binding regulations unless adopted in accordance with the Mississippi Administrative Procedures Act.

**History**
- *Source: Miss. Code Ann. § 25-43-1.101 et seq.*

##### **15 Miss. Admin. Code Pt. 9, R. 8.5** Proceedings — Subsidiary Rules {#sec-9-8.5 omnilex-key=us-ms-regs-official--title-15--9#8.5}

If the Department’s rules and procedures are silent on any question arising in a proceeding, the rules and procedures stated in Robert’s Rules of Order, Newly Revised, and the Mississippi Rules of Civil Procedure may be utilized. In the event of conflict between the adopted rules of the Department and those outlined in Robert’s Rules of Order or the Mississippi Rules of Civil Procedure, the rules adopted by the Department shall prevail. All meetings of the Department in connection with Certificate of Need matters shall be open to the public. The public shall be notified of meetings through the Department’s website not less than ten (10) calendar days before such meetings are held. The agenda shall be made available to the State Health Officer in advance and shall be available to the public at the place of assembly and to applicants at least ten (10) calendar days before the meeting or hearing. Interested persons may attend CON review meetings and, at the discretion of the State Health Officer, may be allowed to address the Department on any item under consideration.

Page 70 — Mississippi State Department of Health Rule 8.6 Record Retention and Public Records. The Department may establish policies and procedures governing retention, maintenance, preservation, and disposition of records related to the Certificate of Need Program. Public records maintained in connection with the CON Program are subject to Rule 1.11 of this Manual and the Mississippi Public Records Act, Miss. Code Ann. § 25-61-1 et seq. Nothing in this Manual requires disclosure of records made confidential by law. The index of CON files is maintained by the Department. A CON application shall be available for public inspection and copying only after it has been deemed complete. Applicants and their authorized representatives may review their own files at any time during regular business hours without prior written request.

**History**
- *Source: Miss. Code Ann. § 25-41-1 et seq.*
- *Source: Miss. Code Ann. § 25-61-1 et seq.*

##### **15 Miss. Admin. Code Pt. 9, R. 8.7** Fees for Public Records Requests {#sec-9-8.7 omnilex-key=us-ms-regs-official--title-15--9#8.7}

Standard fees per copy are established for public records requests, calculated to cover the cost of paper, printing, binding, and handling: 1. Black and white copies: $0.20 per page. 2. Color copies: $0.50 per page. 3. Scanned copies: $0.50 per page. 4. Minimum administrative processing fee for all public records requests: $35.00. Advance payment is required for any information received from the Department. Requests to review individual CON files must be made in writing and must state specifically what information is desired. Requests shall be filled no later than seven (7) business days following receipt. If the Department is unable to produce the records within seven (7) business days, it shall provide a written explanation stating that the record will be produced and specifying with particularity why it cannot be produced within seven (7) days. Unless there is mutual agreement of the parties, in no event shall production be later than fourteen (14) business days from the date of the original request.

Page 71 — Mississippi State Department of Health Rule 8.8 Administrative Error. Clerical errors, typographical errors, mathematical errors, formatting errors, or other non-substantive administrative errors shall not invalidate an application, determination, approval, review, proceeding, or other Department action unless substantial prejudice is demonstrated. The Department may correct such errors.

**History**
- *Source: Miss. Code Ann. § 25-61-5*
- *Source: Miss. Code Ann. § 41-7-171 et seq.*

##### **15 Miss. Admin. Code Pt. 9, R. 8.9** Procedures for Adoption and Revision of Review Procedures and Criteria {#sec-9-8.9 omnilex-key=us-ms-regs-official--title-15--9#8.9}

The Department shall comply with the Mississippi Administrative Procedures Act whenever Certificate of Need criteria and review procedures require revision or amendment.

**History**
- *Source: Miss. Code Ann. § 25-43-1.101 et seq.*

##### **15 Miss. Admin. Code Pt. 9, R. 8.10** Cooperation with Governmental Entities {#sec-9-8.10 omnilex-key=us-ms-regs-official--title-15--9#8.10}

The Department may communicate and coordinate with federal agencies, state agencies, local governmental entities, licensing authorities, Medicaid authorities, accreditation organizations, and other governmental or regulatory entities concerning matters relevant to administration of the Certificate of Need Program.

**History**
- *Source: Miss. Code Ann. § 41-7-171 et seq.*

##### **15 Miss. Admin. Code Pt. 9, R. 8.11** Incorporation by Reference {#sec-9-8.11 omnilex-key=us-ms-regs-official--title-15--9#8.11}

The Department may incorporate by reference into this Manual forms, schedules, application materials, filing instructions, checklists, guidance documents, and other administrative materials necessary for administration of the Certificate of Need Program, to the extent permitted by applicable law. Materials incorporated by reference shall be made available to the public on the Department’s website and at the Department’s offices during regular business hours. Incorporation by reference shall not be used to adopt substantive rules or criteria that would otherwise require rulemaking under the Mississippi Administrative Procedures Act. The Department shall publish on its website, and shall update annually, the current inflation-adjusted capital expenditure thresholds applicable to CON review under Miss. Code Ann. § 41-7-173(c)(ii). The published thresholds shall constitute the operative thresholds for determining whether CON review is required for the applicable review period.

**History**
- *Source: Miss. Code Ann. §§ 41-7-185(c); 25-43-1.101 et seq.*

#### **Chapter 9** SMALL COMMUNITY HOSPITAL PILOT PROGRAM Rule 9.1 Statutory Authority. The Small Community Hospital Pilot Program is established by Section 1 of H.B. 1622, 2026 Regular Session, as amended by Section 8 of S.B. 2474, 2026 Regular Session. The scope, eligibility requirements, exemption types, allocation limitations, and non-transferability provisions are governed by those enactments as amended from time to time. Nothing in this chapter modifies the terms of the governing statutes. To the extent any provision of this chapter conflicts with the governing statutes, the statutes control.

##### **15 Miss. Admin. Code Pt. 9, R. 9.2** Definitions {#sec-9-9.2 omnilex-key=us-ms-regs-official--title-15--9#9.2}

For purposes of this chapter: 1. Small Community Hospital — a hospital, as defined in Miss. Code Ann. § 41-7-173, which is located: (a) in a county that does not contain a municipality whose population exceeds fifteen thousand (15,000) according to the 2020 decennial census, and that does not contain any portion of a municipality whose population exceeds fifteen thousand (15,000) according to the 2020 decennial census; or (b) within the region designated by the Mississippi State Department of Health as the Delta Public Health Region as of January 1, 2026. A Small Community Hospital does not include a licensed Rural Emergency Hospital designated by the federal Centers for Medicare and Medicaid Services. 2. Delta Public Health Region — the public health region designated as such by the Mississippi State Department of Health as of January 1, 2026. 3. Main Building Campus — the main building campus of the Small Community Hospital as of January 1, 2026. 4. Five-Mile Radius — the area within five (5) miles of the main building campus of the Small Community Hospital. 5. General Exemption — an exemption from the requirement to obtain a Certificate of Need for an activity that would otherwise require a CON, issued under the governing statutes, limited to the Main Building Campus and the Five-Mile Radius.

Page 73 — Mississippi State Department of Health 6. ESRD Exemption — an exemption to operate an end-stage renal disease facility issued to an eligible Small Community Hospital under the governing statutes. 7. Geriatric Psychiatric Unit Exemption — an exemption to operate a geriatric psychiatric unit issued to any Small Community Hospital under the governing statutes, limited to the Main Building Campus and the Five-Mile Radius.

**History**
- *Source: H.B. 1622 § 1, 2026 Reg. Sess.; S.B. 2474 § 8, 2026 Reg. Sess.*

##### **15 Miss. Admin. Code Pt. 9, R. 9.3** Types of Exemptions Available {#sec-9-9.3 omnilex-key=us-ms-regs-official--title-15--9#9.3}

Under the Pilot Program, eligible Small Community Hospitals may apply for the following exemptions: A. Geriatric Psychiatric Unit Exemption — The State Health Officer shall issue a Geriatric Psychiatric Unit Exemption to any hospital in a small community. This exemption is limited to the Main Building Campus and the Five-Mile Radius. A Geriatric Psychiatric Unit Exemption shall not be counted toward the General Exemption allotment. B. General Exemption — Each Small Community Hospital qualifying under Rule 9.2(1)(a) shall receive one (1) General Exemption. Each Small Community Hospital qualifying under Rule 9.2(1)(b) shall receive two (2) General Exemptions. General Exemptions are limited to the Main Building Campus and the Five-Mile Radius and shall not extend to clinics or other facilities owned or operated by the Small Community Hospital that are not located on the main campus. A General Exemption shall not apply to: (1) a service for which there is a general Certificate of Need moratorium; or (2) an application that would place the licensed hospital within thirty-five (35) miles of another licensed hospital or otherwise jeopardize a licensed hospital’s federal critical access hospital designation. C. ESRD Exemption — The State Health Officer may issue an ESRD Exemption to operate an end-stage renal disease facility for not more than eight (8) hospitals in a small community. No more than two (2) such facilities may be located within each of the four (4) Public Health Regions designated by the Department as of January 1, 2026. If more than two (2) Small Community Hospitals within the same Public Health Region apply for an ESRD Exemption, the hospitals in areas most remote from existing dialysis units shall be issued exemptions. An ESRD Exemption shall be counted toward the General Exemption allotment. If a Small Community Hospital applies for an ESRD Exemption but is not granted one, that hospital may use its General Exemption for another service.

Page 74 — Mississippi State Department of Health The fee treatment and procedure applicable to a small community hospital redirecting its application in these circumstances are governed by Rule 9.5 of this Manual.

**History**
- *Source: H.B. 1622 § 1(3)–(4), 2026 Reg. Sess.; S.B. 2474 § 8(3)–(4), 2026 Reg. Sess.*

##### **15 Miss. Admin. Code Pt. 9, R. 9.4** Non-Transferability and Application Deadline {#sec-9-9.4 omnilex-key=us-ms-regs-official--title-15--9#9.4}

An exemption issued under the Pilot Program is specific to and solely for the Small Community Hospital to which it was issued and may not be transferred to another entity unless the hospital itself is transferred. If a Small Community Hospital does not apply for an exemption on or before June 30, 2027, that hospital’s eligibility for an exemption under the Pilot Program shall expire.

**History**
- *Source: H.B. 1622 § 1(5), 2026 Reg. Sess.; S.B. 2474 § 8, 2026 Reg. Sess.*

##### **15 Miss. Admin. Code Pt. 9, R. 9.5** Application Procedures {#sec-9-9.5 omnilex-key=us-ms-regs-official--title-15--9#9.5}

A Small Community Hospital seeking an exemption under the Pilot Program shall submit a written application to the Department on the Pilot Program application form prescribed by the Department. The Pilot Program application form is distinct from, and shall not be submitted on, the standard Determination of Reviewability form described in Rule 3.9 of this Manual. The application shall: 1. Identify the requesting hospital by name, address, and licensure number; 2. Identify the type of exemption sought and the statutory subsection under which the hospital claims eligibility, specifying whether eligibility is claimed under Rule 9.2(1)(a) or Rule 9.2(1)(b); 3. Provide documentation sufficient to establish eligibility as a small community hospital under the definition in Rule 9.2(1); 4. Describe the proposed activity for which the exemption is sought; 5. For ESRD Exemption requests only: identify the hospital's Public Health Region and provide information relevant to the determination of remoteness from existing dialysis units; and 6. Include any other information the Department requires for eligibility verification.

Page 75 — Mississippi State Department of Health The Department may request additional information reasonably necessary to evaluate the application. The application deadline of June 30, 2027, established by Rule 9.4, is established by statute and may not be waived by the Department. Application Fee and Public Notice. An application filed under this rule shall be accompanied by a processing fee of One Thousand Five Hundred Dollars ($1,500.00), payable to the Department by check, draft, or money order, and is subject to the same public notice requirement applicable to Determination of Reviewability requests under Rule 3.9. Notification to affected persons shall be made within five (5) business days of receipt of a complete application by publishing notice on the Department's website. Department Tracking. The Department shall assign a tracking number to each application filed under this rule and shall maintain a record of each small community hospital's cumulative exemption usage against its statutory allotment under Rule 9.3, including any ESRD Exemption or Geriatric Psychiatric Unit Exemption issued. ESRD Exemption — Comparative Review Window. Because award of the ESRD Exemption depends on a comparison among all small community hospitals that have filed an application for that exemption within the same Public Health Region, the following procedure applies: 1. The comparative review window for each Public Health Region opens on July 1, 2026, and remains open for forty-five (45) calendar days from that date, during which the Department shall accept and hold for comparison all complete ESRD Exemption applications filed for that region. An ESRD Exemption application filed for a Public Health Region after the close of that region's comparative review window, where exemptions remain available for that region, shall be processed and decided individually as received in accordance with the time periods otherwise applicable under this rule. 2. The Department shall not issue a decision on any individual ESRD Exemption application for a given Public Health Region until the comparative review window for that region has closed. The forty-five (45) calendar day response period otherwise applicable to a Pilot Program application under this rule is tolled, as to ESRD Exemption applications only, until the comparative review window closes. 3. Upon closure of the comparative review window for a Public Health Region, the Department shall decide all ESRD Exemption applications pending for that region together, applying the remoteness priority standard in Rule 9.3(C). 4. A small community hospital whose ESRD Exemption application is not granted because the available exemptions for its Public Health Region have already been awarded to other applicants under the remoteness priority standard shall have the processing fee paid under this rule applied, without

Page 76 — Mississippi State Department of Health additional charge, toward an application for the General Exemption under Rule 9.3(B), consistent with Rule 9.3(C)’s provision that such a hospital may use its exemption allotment for another eligible service. This subsection does not apply where an application is denied for failure to establish eligibility or for any reason other than the regional allocation limit. An application filed under this rule outside the comparative review window described above for the ESRD Exemption, or at any time for the General Exemption or the Geriatric Psychiatric Unit Exemption, shall be processed individually in accordance with the time periods otherwise applicable under this rule.

**History**
- *Source: H.B. 1622 § 1(3)–(5), 2026 Reg. Sess.; S.B. 2474 § 8(3)–(5), 2026 Reg. Sess.*

##### **15 Miss. Admin. Code Pt. 9, R. 9.6** State Health Officer Decision {#sec-9-9.6 omnilex-key=us-ms-regs-official--title-15--9#9.6}

Except as provided in Rule 9.7 regarding requests for reconsideration, the State Health Officer’s decision concerning an exemption under the Pilot Program is final and not subject to judicial review as provided by applicable law.

**History**
- *Source: H.B. 1622 § 1(6), 2026 Reg. Sess.; S.B. 2474 § 8(6), 2026 Reg. Sess.*

##### **15 Miss. Admin. Code Pt. 9, R. 9.7** Reconsideration {#sec-9-9.7 omnilex-key=us-ms-regs-official--title-15--9#9.7}

Any person or entity that wishes to challenge the issuance of an exemption under the Pilot Program may file with the State Health Officer a written request for reconsideration within seven (7) calendar days of the State Health Officer’s decision. If a timely request for reconsideration is filed, the State Health Officer or the State Health Officer’s designee shall conduct a hearing no sooner than fourteen (14) days and no later than twenty-one (21) days from the date of the original decision. Parties shall receive reasonable advance notice of the hearing date, time, and location. The hearing shall be informal in nature, and there shall be no right to engage in discovery. The purpose of the hearing is to allow a party to offer an objection to the issuance of the exemption or to present, in a summary fashion, matters that may have been overlooked. After the hearing, the State Health Officer may decide not to issue the exemption, to further consider the issuance of the exemption, or to reaffirm the original decision.

Page 77 — Mississippi State Department of Health The State Health Officer’s decision following reconsideration is final and not subject to judicial review, as provided by applicable law.

**History**
- *Source: H.B. 1622 § 1(6), 2026 Reg. Sess.; S.B. 2474 § 8(6), 2026 Reg. Sess.*

##### **15 Miss. Admin. Code Pt. 9, R. 9.8** Scope of Exemption {#sec-9-9.8 omnilex-key=us-ms-regs-official--title-15--9#9.8}

An exemption issued under the Pilot Program is solely an exemption from the requirement to obtain a Certificate of Need under Miss. Code Ann. §§ 41-7-171 et seq. for the specific activity described in the exemption, within the applicable geographic limitations. A Pilot Program exemption does not constitute, replace, or substitute for any other license, certification, permit, or approval required under state or federal law to operate a health care facility or health care service, including but not limited to licensure by the Division of Health Facilities Licensure and Certification, Medicare certification, Medicaid enrollment, and any other required regulatory approval. A Small Community Hospital that receives a Pilot Program exemption must obtain all other required regulatory approvals before beginning operation of the exempted service. An exemption issued under this chapter does not: 1. Authorize operation without required licensure from the Division of Health Facilities Licensure and Certification or any other applicable licensing authority; 2. Eliminate the need for Medicare certification, Medicaid enrollment, or other federal program enrollment; 3. Eliminate the need for any other governmental approval, permit, or certification required by state or federal law; 4. Supersede applicable zoning requirements; 5. Override applicable statutory moratoria under Miss. Code Ann. § 41-7-191, except as expressly provided by the Pilot Program statute; 6. Apply to services or locations excluded by applicable law or rules in this chapter; or 1. Create any vested right in the exemption holder beyond the specific activity and geographic location for which the exemption was issued.

**History**
- *Source: Miss. Code Ann. § 41-7-171 et seq.*

##### **15 Miss. Admin. Code Pt. 9, R. 9.9** Reporting and Monitoring {#sec-9-9.9 omnilex-key=us-ms-regs-official--title-15--9#9.9}

Page 78 — Mississippi State Department of Health The Department may collect information reasonably necessary to carry out responsibilities assigned by applicable law and to verify continued compliance with the eligibility and exemption requirements of the Pilot Program.

**History**
- *Source: Miss. Code Ann. § 41-7-171 et seq.*

##### **15 Miss. Admin. Code Pt. 9, R. 9.10** Revocation and Suspension of an Exemption {#sec-9-9.10 omnilex-key=us-ms-regs-official--title-15--9#9.10}

The State Health Officer may suspend, revoke, modify, restrict, or condition an exemption issued under the Pilot Program upon a determination that: 1. The Small Community Hospital no longer qualifies for the statutory exemption; 2. The Small Community Hospital has violated applicable law, rule, regulation, exemption condition, or departmental requirement; 3. Material facts submitted in support of the exemption were inaccurate, incomplete, or misleading; or 4. Continued operation under the exemption would otherwise conflict with applicable law or public health and safety requirements. Before suspending, revoking, modifying, restricting, or conditioning an exemption under this rule, the Department shall provide the Small Community Hospital with written notice of the grounds for the proposed action and a reasonable opportunity to respond, except where the Department determines that the continued exercise of the exemption poses an immediate threat to public health or safety, in which case the Department may act immediately and shall provide notice and an opportunity to respond as soon as practicable thereafter. This rule does not affect the finality of the State Health Officer’s original decision to issue the exemption under Rule 9.6, nor does it create any right to the reconsideration procedure described in Rule 9.7, which applies only to a challenge to the issuance of an exemption and not to its subsequent suspension, revocation, modification, restriction, or conditioning.

**History**
- *Source: Miss. Code Ann. §§ 41-3-15, 41-3-17, 41-7-171 et seq.; H.B. 1622 § 1, 2026 Reg. Sess.*

##### **15 Miss. Admin. Code Pt. 9, R. 9.11** Material Change Reporting {#sec-9-9.11 omnilex-key=us-ms-regs-official--title-15--9#9.11}

A Small Community Hospital holding an exemption issued under the Pilot Program shall notify the Department in writing within thirty (30) calendar days of any material change in: 1. Ownership or control of the hospital;

Page 79 — Mississippi State Department of Health 2. The scope of the exempted service; 3. The location at which the exempted service is provided; 4. Bed capacity associated with the exempted service; 5. The operational model under which the exempted service is provided; or 6. The hospital's eligibility under the statutory qualification basis on which the exemption was issued. A material change described in this rule is subject to further review and approval by the Department and may require modification of the exemption, a new application under Rule 9.5, or other action authorized by Rule 9.10. This rule does not modify the notice and reporting obligations applicable to a change of ownership under Rules 3.11 and 3.12 of this Manual, which continue to apply independently where the underlying transaction otherwise meets the definition of a Change of Ownership under Rule 1.7.

**History**
- *Source: Miss. Code Ann. §§ 41-3-15, 41-3-17, 41-7-171 et seq.; H.B. 1622 § 1, 2026 Reg. Sess.*

### **Part 10** Boiler and Pressure Vessel Safety

##### **15 Miss. Admin. Code Pt. 10, R. 60** Rule 60 {#sec-10-60 omnilex-key=us-ms-regs-official--title-15--10#60}

÷ 300 = Min. Net Area Req. Sq. Ft.

2. When mechanical ventilation is used in lieu of (a) the supply of combustion and ventilation air to the boiler room and the firing device shall be interlocked with the fan so the firing device will not operate with the fan off. The velocity of the air through the ventilating fan shall not exceed 500 feet per minute, and the total air delivered shall be equal to or greater than shown in (1.).

Rule 3.4.16. Fired Jacketed Steam Kettles 1. Fired jacketed steam kettles are acceptable for installation if constructed and stamped in accordance with Section I, IV, or VIII, Division 1, of the ASME Boiler Code and registered with the National Board.

2. Gas-fired jacketed steam kettles may be constructed under the rules of the ASME Pressure Vessel Code, Section VIII, provided the following additional requirements are met:

3. Welded joints in contact with products of combustion shall be of Type No. 1 of Table UW-12. 4. When parts subjected to pressure are made of carbon steel material, the minimum thickness shall be 1/2 inch. The minimum thickness of stainless steel or nonferrous pressure parts shall be as specified in the applicable part of Subsection C. 5. When in contact with products of combustion, carbon steel material shall be pressure vessel quality and austenitic stainless steel parts shall be of either extra- low carbon or stabilized grades. 6. Structural grade carbon steel shall not be used for any pressure part. 7. The operating pressure of the jacket shall not exceed 50 psig. 8. Vessels constructed under this rule shall be inspected by an authorized inspector and shall not be marked with the UM Symbol regardless of volume. 9. No steam or water shall be withdrawn from the jacket for use externally to the vessel. 10. The capacity of the safety valve in pounds of steam per hour shall be at least equal to the BTU rating of burner divided by 1,000. 11. The jacket shall be furnished with the following minimum appurtenances and controls:

a. A pressure gauge. b. A water gauge glass. c. A separate connection, fitted with a check valve and stop valve, for adding water to the jacket (the water may be added while the vessel is not under pressure.) 12. An automatic gas valve controlled by pressure or temperature to maintain the steam pressure in the jacket below the safety valve setting. 13. A low water cut-off that will cut off the level to the burner if the water in the jacket below the lowest permissible water level as established by the manufacturer. 14. A safety pilot control that will cut off the fuel to both the main burner and the pilot burner in case of pilot flame failure.

Rule 3.4.17. Shop Inspection and Inspection of Secondhand or Used Boilers or Pressure Vessels 1. Shop inspections and inspections of secondhand or used boilers or pressure vessels made by the Chief Inspector or a Deputy Inspector shall be charged for in accordance with fee schedule.

2. Note: The shop inspections required by an applicable section of the ASME Boiler & Pressure Vessel Code shall be made by an inspector who holds a valid license or commission recognized by the Department.

3. Pressure vessels which are covered under the Liquefied Compressed Gas Equipment Inspection Law of Mississippi, being Sections 75-57-1 through 75- 57-63, Mississippi Code of 1972, are exempt from these Regulations.

Rule 3.4.18. Manufacturers: Boilers and pressure vessels and component parts to be installed for use in the State of Mississippi except those exempted by the provisions of Section 45-23-15 of the Act shall be designed, constructed, inspected, stamped and installed in accordance with current applicable section of the ASME Boiler and Pressure Vessel Code and/or the Rules and Regulations of the Department. Boilers and pressure vessels shall be stamped with applicable:

1. ASME Code stamping, Or Mississippi Special number or Mississippi Standard number ASME Code Symbol and the word "User," see Par. UG-116 (a)(1)(a), and Underwriters' Laboratory label on electrically heated boilers, pressure vessels and water heaters. 2. Manufacturer's data reports on boilers, pressure vessels, and component parts which are to be installed and operated in the State of Mississippi except those exempted by the provisions of Section 45-23-15 of the Act shall be filed with the Chief Inspector, Boiler and Pressure Vessel Safety Branch. 3. If a boiler or pressure vessel is of special design and will not bear the ASME Code Symbol and National Board or user stampings, a permit for a State Special must be applied for in writing by the Mississippi user. Blueprints, design data, calculations and material showing details of the proposed construction shall be submitted to the Branch and approval obtained before construction is started.

Rule 3.4.19. Conditions Not Covered by These Rules and Regulations: For any condition not covered by these requirements, the applicable provisions of the ASME Code and/or the National Board Inspection Code shall apply.

Rule 3.4.20. Accessibility for Inspection 1. All unfired pressure vessels hereafter installed or reinstalled shall be placed above ground where possible and so installed that all parts of the vessels can be readily inspected.

2. Where necessary to install a vessel under ground, it shall be enclosed in a concrete, brick or steel enclosure with a removable cover, so that regular inspections of the entire shell and heads of the vessel can be made.

3. Exceptions: Vessels not in excess of 100 psi design working pressure having adequate cathodic protection with epoxy or bitumastic coating and containing non-toxic or non-flammable material may be buried without a pit enclosure provided such vessels shall have means of internal inspection.

Rule 3.4.21. Boilers Exposed to the Elements: Boilers not contained in boiler rooms that are exposed to freezing temperatures shall have their water and steam lines either steam traced or wrapped with electric heating tape where needed.

Rule 3.4.22. Fired Storage Water Heaters and Supply Vessels 1. Minimum Controls -- All fired storage water heaters and supply vessels shall be equipped with the following controls and devices:

a. Operating temperature control; b. High-limit temperature control; c. Positive flame failure cut-off; d. Approved pressure-temperature relief valve, set at or below the safe working pressure of the vessel, with such setting satisfactory for the application. 2. Location -- All fired vessels and heaters shall be so located as to provide access to the controls, safety relief valve and drain.

3. Discharge Lines -- When a discharge line from a relief valve is installed, it shall not be reduced but shall be full size and be piped to a safe location, graded down.

4. Relief Valve Testing -- The operator shall manually test the relief valve once each month.

5. Alternative Use -- Storage water heaters and supply vessels, fired or unfired, shall not be used as a heating boiler.

Rule 3.4.23. Safety Valves and Rupture Disk Notes 1. Any safety valve, piping, valve, or appurtenance exposed to freezing temperatures shall be properly positioned against collecting moisture and properly drained to prevent freeze-up.

2. Safety valves on Dowtherm and similar vaporizers shall be removed annually for cleaning and testing, at time of certificate inspection. Safety valves for compressed-air tanks shall not exceed three inches in diameter and shall be proportioned for the maximum number of cubic feet of free air that can be applied per minute.

3. Rupture disks or heads may be used as the pressure safety device on vessels containing non-toxic gases provided they are designed to fail at not more than the design pressure of the vessel.

Rule 3.4.24. Portable Boilers and Pressure Vessels: Every owner or user of portable boilers or pressure vessels shall furnish in writing to the Branch, on or before the effective date of these regulations and yearly thereafter, a list of their portable boilers and unfired pressure vessels, giving the location of each and indicating whether it is insured and inspected by an Insurance Company licensed in Mississippi to inspect boilers and pressure vessels. No such boiler or pressure vessel shall be used until it has been inspected by an authorized boiler inspector and a certificate of inspection has been issued.

Rule 3.4.25. Fuel Conversions and Increases in Size of Fuel Burning Apparatus: Either of these shall nullify the current operating certificate and a re-inspection by a licensed inspector is mandatory prior to returning the boiler to service.

Rule 3.4.26. Inspection Openings -- Not To Be Used for Any Other Purpose: Any and all inspection openings shall not be obstructed; they shall have adequate clearance for their purpose of being used as an inspection opening. They shall not be used for pipe connection. They shall not be increased in size unless with the concurrence of a licensed inspector, and then only according to and in compliance with the ASME Code's pertinent paragraphs.

Rule 3.4.27. Boilers and Pressure Vessels That Are Exempt: The fact that boilers and pressure vessels are exempt from the Act does not preclude them from having the normal and proper safety controls and devices.

Rule 3.4.28. Exit from Boiler Room: All boiler rooms exceeding 500 square feet floor area and containing one or more boilers having fuel burning capacity of 1,000,000 BTU per hour, or equivalent electrical heat input, shall have at least two means of exit. Each exit shall be remotely located from the other.

Rule 3.4.29. Return Loop Connection: It is recommended that the return water connections to all low pressure, steam heating boilers supplying a gravity return heating

system be so arranged as to form what is known as the "return pipe loop connection," so that the water cannot be forced out of the boiler below the safe water level. This connection is shown in Figure HG-703-1 of Section IV, ASME Heating Boiler Code.

Rule 3.4.30. Authorization Required for Repairs 1. No repair or alteration affecting the safety of the boiler or pressure vessel shall be made until the contemplated repair or alteration has been authorized by a licensed inspector. Nothing in this requirement shall prohibit the exchange or interchange of valves, fittings, and accessories for the same purpose.

2. No pressure vessel that has been subject to a fire shall be returned to service until it has been inspected by a licensed inspector and found safe. Any vessel that has been altered or repaired or subjected to a fire shall be prepared for hydrostatic test if one is considered necessary by the licensed inspector. Any welding on which the strength of any boiler or pressure vessel is dependent shall be made by a welder suitably certified under the ASME Code, Section IX.

Subchapter 5. Recommended Safe Practices - Non-Mandatory Rule 3.5.1. Design Changes and Alterations of Boilers or Pressure Vessels: No repairs or alterations involving flame, arc, or other method of welding shall be made on any pressure vessel or system unless such vessel or system shall first have been certified as gas free or oxygen free by competent personnel.

Rule 3.5.2. Operators 1. All power boilers (over 15 psi) with fully automatic control, having a rated output of 1000 or more pounds of steam or vapor per hour and high pressure, high temperature water boilers, shall not be operated without being periodically checked by an operator at intervals of not less than once every two hours, regardless of whether or not the boiler is equipped with automatic feedwater regulator, fuel or damper regulator, high and low water alarm or any other form of automatic control while the boiler is in service.

2. All power boilers and high pressure/high temperature water boilers without fully automatic control shall have a full-time operator while the boiler is in service. Operator -- a competent attendant who is familiar with the particular boilers to be operated and who has received proper instruction in their safe operation.

Rule 3.5.3. Fuel Burning Apparatus and Systems (Flame Safeguard): Fuel burning apparatus and systems should be equipped with regulating and protective controls in accordance with applicable standards of the National Fire Protection Association, American Gas Association, and Underwriters' Laboratories.

Rule 3.5.4. Electric Boilers 1. Electric boilers 600 volts or less subject to the requirements of the Safety Act and these rules and regulations shall bear the Underwriter's laboratories label on the completed unit or assembly by the manufacturer. This label shall be in addition to the code symbol stamping requirements of the ASME and the National Board.

2. All appliances required for electric boilers shall be attached in accordance with the following rules:

3. A cable at least as large as the income power line to the boiler shall be provided for grounding the boiler shell. This cable shall be permanently fastened to the boiler and grounded in an approved manner.

4. Conductor or conductors shall be attached by means of suitable connectors, lugs, pressure connectors, clamps or other approved means, Connectors that depend on solder to maintain connection shall not be used.

5. A suitable screen or guard shall be provided around high tension bushings and a sign posted warning of high voltage. This screen or guard shall be so located that it will be impossible for anyone working around the boiler to come in contact accidentally with the high tension circuit.

6. When adjusting safety valves, the power circuit to the boiler shall be open. The boiler may be under steam pressure, but the power line shall be open while the operator is making the necessary adjustment.

7. Safety or relief valves shall have a relieving capacity of three and one-half (3 1/2) pounds per hour for each kilowatt maximum rating.

Rule 3.5.5. Fire Safety Precautions: All fired boiler and fired pressure vessel installations shall be on a non-combustible floor or base, and breeching or flue shall not pass through combustible wall, ceiling, roof or partition unless suitably guarded against excess heat

Rule 3.5.6. Precautions To Be Taken Prior to Entering Boilers and Pressure Vessels 1. All confined spaces shall be kept well purged and ventilated of all atmospheric contaminants. 2. All internal space and surfaces shall be at reasonable temperatures. 3. All electrical equipment and electrical cords shall be adequately grounded and preferably of the low voltage (12 volt) type. 4. Pressure vessels that have contained flammable, toxic, corrosive, or irritant contents shall be properly cleaned and certified as safe to enter by an Industrial Hygienist or other person qualified to make the necessary required tests. 5. Pressure vessels that are being lined or coated with a vaporous compound shall be well purges at all times during the process, and anyone in the vessel shall be attached to an adequate life-line and attended by a competent person stationed at the vessel's entrance. 6. Common sense shall be exercised at all times.

Rule 3.5.7. Hydrostatic Testing Precautions 1. When performing or witnessing any hydrostatic test, only properly instructed and qualified personnel should actually perform the test.

2. Protective barriers or pits should surround or enclose the object being tested.

3. No personnel should be in the immediate vicinity of the object being tested while pressure is being raised or is above the allowable working pressure.

4. No vessel shall be left unattended while pressure is being raised and no vessel under pressure (hydrostatic) shall be left overnight in a heated area unless it is equipped with a pressure relief device.

5. For water temperature and high pressure incrementation procedure, it is recommended that reference be made to the proper engineering manuals.

6. Only qualified inspectors shall check the object under hydrostatic test, and then only after the pressure has been reduced to the approved allowable working pressure, for any deformation, tightness, distress or integrity.

7. When strain gauge readings are necessary, it is recommended that remote reading and/or recording tape be used.

8. Glass lined or concrete lined pressure vessels shall not be hydrostatically tested in excess of their allowable working pressure, as indicated on the stamping or manufacturer's data report.

a. Petition

b. Petition: For the modification of any of these rules, the following shall be the method of procedure.

c. Any employer or employee, or other person interested or affected by such rules may petition for a hearing on the reasonableness of such rules by filing a petition with the Technical Advisory Committee of Boiler and Pressure Vessel Safety, setting forth the rule or rules upon which a change is desired and the reasons for said change.

d. Upon the receipt of a petition, the Technical Advisory Committee will determine its merits and if a hearing is necessary, notice of time and place will be given to the petitioner and to such other persons as the State Board of Health may find directly interested.

**History**
- *SOURCE: Miss. Code Ann. §45-23-9*
- *SOURCE: Miss. Code Ann. §45-23-9*
- *SOURCE: Miss. Code Ann. §45-23-9*
- *SOURCE: Miss. Code Ann. §45-23-9*
- *SOURCE: Miss. Code Ann. §45-23-9*
- *SOURCE: Miss. Code Ann. §45-23-9*
- *SOURCE: Miss. Code Ann. §45-23-9*
- *SOURCE: Miss. Code Ann. §45-23-9*
- *SOURCE: Miss. Code Ann. §45-23-9*
- *SOURCE: Miss. Code Ann. §45-23-9*
- *SOURCE: Miss. Code Ann. §45-23-9*
- *SOURCE: Miss. Code Ann. §45-23-9*
- *SOURCE: Miss. Code Ann. §45-23-9*
- *SOURCE: Miss. Code Ann. §45-23-9*
- *SOURCE: Miss. Code Ann. §45-23-9*
- *SOURCE: Miss. Code Ann. §45-23-9*
- *SOURCE: Miss. Code Ann. §45-23-9*
- *SOURCE: Miss. Code Ann. §45-23-9*
- *SOURCE: Miss. Code Ann. §45-23-9*
- *SOURCE: Miss. Code Ann. §45-23-9*
- *SOURCE: Miss. Code Ann. §45-23-9*
- *SOURCE: Miss. Code Ann. §45-23-9*
- *SOURCE: Miss. Code Ann. §45-23-9*

### **Part 11** Bureau of Child Care Facilities

#### **Chapter 1** REGULATIONS GOVERNING LICENSURE OF CHILD CARE FACILITIES Subchapter 1: GENERAL Rule 1.1.1 Legal Authority The "Mississippi Child Care Licensing Law," Section 43- 20-1 et seq. of the Mississippi Code of 1972 provides the legal authority under which the Mississippi State Department of Health prescribes minimum regulations for child care facilities defined under the law.

##### **15 Miss. Admin. Code Pt. 11, R. 1.1.2** Purpose 1 {#sec-11-1.1.2 omnilex-key=us-ms-regs-official--title-15--11#1.1.2}

The purpose of these regulations is to protect and promote the health and safety of children in this state by providing for the licensing of child care facilities as defined herein to assure that certain minimum standards are maintained in such facilities. This policy is predicated upon the fact that a child is not capable of protecting himself, and when his parents for any reason have relinquished his care to others, there arises the probability of exposure of that child to certain risks to his health and safety that require the offsetting statutory protection of licensing. This document and its appendices constitute the "Regulations Governing the Licensure of Child Care Facilities." 2. A child care facility may exceed the minimum quality standards required in these regulations, but may not operate without meeting the minimum standards set forth in these regulations. 3. The maximum capacity of a child care facility is determined by the indoor square footage, kitchen square footage, outdoor playground area, and the number of toilets, urinals, and hand washing lavatories, with the lowest capacity determination controlling. The maximum capacity of each room that is utilized by the children in a child care facility is calculated individually and may not be exceeded except when provided in these regulations. 4. A child care facility is subject to inspection at anytime at the discretion of the licensing agency. 5. The Mississippi State Department of Health shall maintain a complaint hotline to accommodate reporting of complaints. The department shall investigate each complaint and maintain a log of such complaints. The identity of the reporting party shall not be disclosed to any other person than the Child Care Licensing Bureau staff unless upon order of a court of competent jurisdiction.

**History**
- *Source: Miss. Code Ann. §43-20-8.*

##### **15 Miss. Admin. Code Pt. 11, R. 1.1.3** Rule 1.1.3 {#sec-11-1.1.3 omnilex-key=us-ms-regs-official--title-15--11#1.1.3}

Severability If any provision of these regulations or the application thereof to any persons or circumstances shall be held invalid, such invalidity shall not affect the provisions or application of these regulations that can be given effect without the invalid provision or application, and to this end, the provisions of these regulations are declared severable.

**History**
- *Source: Miss. Code Ann. §43-20-8.*

##### **15 Miss. Admin. Code Pt. 11, R. 1.1.4** Definitions 1 {#sec-11-1.1.4 omnilex-key=us-ms-regs-official--title-15--11#1.1.4}

Act The "Mississippi Child Care Licensing Law," Section 43-20-1 et seq. of the Mississippi Code of 1972. 2. Agency Representative An authorized representative of the Mississippi State Department of Health. 3. Caregiver A person who provides direct care, supervision, and guidance to children in a child care facility, regardless of title or occupation. 4. Child Care Facility (Facility) A place which provides shelter and personal care for six or more children who are not related within the third degree computed according to the civil law to the operator and who are under 13 years of age, for any part of the twenty-four hour day, whether such place be organized or operated for profit or not. The term “child care facility” includes day nurseries, day care centers, child care centers, preschool programs, and any other facility that fall within the scope of the definition set forth above. EXEMPTIONS To the extent provided by law, including those facilities or programs which satisfy one or more of the requirements for exemption provided in Miss. Code Ann. § 43- 20-5(a), an exemption from the provisions of the Act shall be recognized by the licensing agency. Facilities or programs claiming exemption shall be required, upon the written request of the licensing agency, to provide documentation of the facts claimed to support the basis for the exemption, which documentation shall be provided within 30 days of the request by the licensing agency and shall be sworn by affidavit to be true and accurate under the penalties of perjury. However, any entity exempt from the requirements to be licensed but voluntarily chooses to obtain a license is subject to all provisions of the licensing law and these regulations. 5. Children with Special Needs A child needing adaptation in a particular child care facility to access programming and the physical environment 6. Director Any individual, designated by the operator, who has met minimum state requirements and who has on-site responsibility for the operation of a child care facility. This person may or may not be the operator.

7. Director Designee Any individual designated to act as the director, having all responsibility and authority of a director, during the director’s short-term absence. A director designee shall, at a minimum, be at least 21 years of age, have a high school diploma or GED, and 2 years paid experience in a licensed child care facility. Director Designees shall not retain sole director authority in a facility for more than 24 total hours per calendar week. EXCEPTION: A facility may have a Director Designee serve for a maximum of 14 consecutive calendar days during a licensure year. This exception may be used once during the licensure year for allowing the director personal leave, i.e., vacation, jury duty, etc. 8. Group The children assigned to a caregiver or team of caregivers, occupying an individual classroom, or well-defined physical space within a larger room. 9. Hazardous Condition A situation or place that presents a possible source of injury or danger. 10. Health The condition of being sound in mind and body and encompassing an individual's physical, mental and emotional welfare. 11. Infant Any child under the age of 12 months. 12. Licensing Agency The Mississippi State Department of Health. 13. Operator Any person, acting individually or jointly with another person or persons, who shall establish, own, operate, conduct or maintain a child care facility. The child care facility license shall be issued in the name of the operator, or if there is more than one operator, in the name of one of the operators. In the event that there is more than one operator, all statutory and regulatory provisions concerning the background checks of operators shall be equally applied to all operators of a facility, including, but not limited to, a spouse who jointly owns, operates, or maintains the child care facility regardless of which operator is named on the license. 14. Parent As used in these regulations, parent shall mean custodial parent, legal guardian, foster parent, guardian ad litem, and other individuals or institutions to which a court of competent jurisdiction has granted legal authority over the child. 15. Person Any person, firm, partnership, corporation or association. 16. Personal Care Assistance rendered by personnel of the child care facility in performing one or more of the activities of daily living, which includes but is not limited to the feeding, personal grooming, supervising, and dressing of children placed in the child care facility. 17. Physical Confines The space inside the walls of the child care facility. 18. Safety The condition of being protected from hurt, harm, injury or loss.

19. School Age Child A child of 5 years of age or older and eligible to be enrolled in public school. Note: A child that is five (5) years old age must have turned five (5) on or before September 1 to be considered a school age child. 20. Service Staff A person who provides support services such as cooking, cleaning, or driving a vehicle, but is not a caregiver. 21. Toddler Any child the age of 12 months and under the age of 24 months. 22. Usable Space In measuring facilities for square footage per child, usable space shall mean space measured on the inside, wall-to-wall dimensions. These spaces are exclusive of food preparation areas, kitchens, bathrooms, toilets, areas for the care of ill children, offices, staff rooms, corridors, hallways, stairways, closets, lockers, laundries, furnace rooms, fixed or permanent cabinets, fixed or permanent storage shelving spaces, and areas not inhabited and used by children. Usable space shall be areas dedicated to children’s activities (play, learning, rest, and eating) and shall be utilized for those purposes on a daily basis. Furnishings shall be equipment that is both size and age appropriate for children receiving care. The space occupied by inappropriate or adult size equipment shall be deducted from the children’s usable space. 23. Volunteer Any person who is not an employee who is at the facility or assists with children. Individuals who volunteer for 120 or more hours in a given licensure year shall meet the requirements of (1) criminal record and child abuse central registry checks to include being fingerprinted, and (2) valid Immunization Compliance Form #121. The facility shall document the time that a volunteer is at the facility. Further, any individual who has not been fingerprinted and received the Letter of Suitability for Employment shall never be left alone with children. 24. Emergency Preparedness Plan: Each child care center is required to have an emergency preparedness plan – all activities and processes designed to prepare for an unsafe event and deal with the immediate emergency conditions created by or associated with the event, per the Robert T. Stafford Disaster Relief and Emergency Assistance Act (42U.S.C. 5195a(a)(1)).

Subchapter 2: LICENSURE Rule 1.2.1 Requirement for Licensure 1. No person shall establish, own, operate, conduct, or maintain a child care

facility in this state without a license issued pursuant to these regulations. 2. The licensing authority will require no entity exempt from the licensure requirement to apply for a license. However, should an exempt entity desire to obtain a license, it will be subject to these regulations.

**History**
- *Source: Miss. Code Ann. §43-20-8.*
- *Source: Miss. Code Ann. §43-20-8.*

##### **15 Miss. Admin. Code Pt. 11, R. 1.2.2** Types of Licenses 1 {#sec-11-1.2.2 omnilex-key=us-ms-regs-official--title-15--11#1.2.2}

Temporary License The licensing agency may issue a temporary license to any child care facility. This license will allow the child care facility to operate pending the issuance of a regular license. The temporary license will reflect the date of issuance of the license, the expiration date, and the number of children for which the facility is licensed. The license issue date is the actual date documentation is received and approval for initial temporary license is granted; the expiration date is the last day of the sixth month following the issue date; examples: January 01 through June 30 or January 15 through June 30. NOTE: Before a Temporary License is issued and the facility allowed to begin operation the following items must be submitted to and/or verified by the licensing authority, i.e., Mississippi State Department of Health: a. License Application and $130.00 application fee. b. License fee - the amount of fee is determined by the licensed capacity of the facility. c. Documentation that the facility has a qualified director for the child care program that meets the standards set forth in Rule 1.5.3. d. “Letter of Suitability for Employment” for every employee or volunteer as appropriate that is to begin work when the facility starts operation. The “Letter of Suitability for Employment” issued by the Mississippi State Department of Health verifies that a criminal records check, sex offender registry, and child abuse central registry check has been conducted on an individual. e. An MSDH Certification of Immunization Form #121 or Medical Exemption Form #122 for every employee or volunteer that is to begin work when the facility starts operation and/or have documentation indicating that they comply with the immunization requirements of the Mississippi State Department of Health. Religious Exemption Form #122 does not apply to staff or volunteers f. Valid MSDH Fire Inspection Form #333. g. Verification of passing an American National Standards Institute – Conference for Food Protection (ANSI-CFP) Accredited food manager training. Currently the following providers are authorized by the MSDH to provide the required training:

i. National Restaurant Association, Inc., i.e., ServSafe®, ii. Environmental Health Testing, Inc., i.e., National Registry of Food Safety Professionals, iii. Prometic, Inc., or iv. Mississippi State University Extension Service, i.e., TummySafe©. NOTE: For information on ServSafe® or TummySafe© contact the Mississippi State University Extension Service at www.msucares.com. In addition, the Mississippi Restaurant Association (MRA) also provides ServSafe® training. The MRA can be contacted at www.msra.org. For information on the National Registry of Food Safety Professionals or Prometric, contact the MSDH Office of Environmental Heath at 601.364.5780. h. Wastewater disposal approval. i. Potable water source approval - drinking water. j. Zoning approval. k. Lead Testing approval i. Building - if constructed before 1978. ii. Playground

l. Adult, Child and Infant CPR and First Aid certification as required for a person or persons who will be present at the facility during all hours of operation. m. Menu if applicable. n. Floor Plan. o. MSDH Maximum Capacity Worksheet (Form #28). p. MSDH Child Care Facility Inspection Report (Form #281). q. MSDH Child Care Facility Data Sheet (Form #286). r. MSDH Food Service Inspection (Form #301-302) - if applicable. s. Daily Schedule of Activities - developed by provider. t. Arrival and Departure Procedures - developed by provider. u. Emergency Policy – developed by provider. v. Verification of Two Emergency Relocation Sites – developed by provider. i. One site must be a minimum of one mile distant from the facility. ii. One site must be a minimum of five miles distant from the facility. w. Transportation Policy – not required if facility does not transport children.

NOTE: An emergency transportation policy is required even if the facility does not plan to transport children. An emergency transportation policy shall encompass such events as emergency evacuation of the facility and emergency transporting of a child to receive medical attention. x. Proof of Vehicle Insurance – not required if facility does not transport children. y. Verification, in writing, that the operator has or does not have accident/liability insurance covering the business and the children enrolled in the facility. z. Verification that the owner/operator and director have completed mandatory training on: i. Regulations Governing Licensure of Child Care Facilities. ii. Directors Orientation. iii. Playground Safety. NOTE: Training classes provided by the Bureau of Child Care Licensure are listed under the heading “LIFT-ED Training Calendar and Courses.” Other approved providers of training for child care facility operators and staff are listed under the headings “MSDH - Approved Child Care Courses” and “Training Organizations with Standing Approval.” Only the Bureau of Childcare Licensure staff are allowed to conduct mandatory trainings except for the Health and Safety training which is also offered by MS Department of Human Services. Other approved providers of training for child care facility operators and staff are listed under the headings “MSDH Approved Staff Development Trainers” and “Approved Child Care Staff Development Providers.” aa. Discipline Policy – developed by the provider. NOTE: The discipline policy developed by the provider shall not allow any of the prohibited behaviors listed in Subchapter 14 of these regulations. bb. Emergency Policy – Emergency preparedness and response planning for emergencies resulting from a natural disaster, or a man- caused event (such as violence at a child care facility), within the meaning of those terms under section 602(a)(1) of the Robert T. Stafford Disaster Relief and emergency Assistance Act (42 U.S.C. 5195a(a)(1)) that shall include procedures for evacuation, relocation, shelter-in-place and lock down, staff and volunteer emergency preparedness training and practice drills, communication and reunification with families, continuity of operations, and accommodation of infants and toddlers, children with disabilities, and children with chronic medical conditions.

2. Regular License The licensing agency may issue a regular license when all conditions and requirements for licensure have met compliance.

The duration of a regular license shall not exceed one year. 3. Probational License The licensing agency may issue a probational license, at its discretion, where violations may endanger the health or safety of the children, but only when such violations may be corrected within a specified period. There shall be a written corrective action plan agreed upon between the operator and the licensing agency. The period of time for which a probational license is issued shall be at the discretion of the licensing agency but in no instance shall exceed six months. 4. Restricted License The licensing agency may issue any type of license with conditions/restrictions when, at its discretion, the health or safety of the children require such a conditional/restrictive statement on the license. Such conditions/restrictions shall include but not be limited to certain individuals to be barred from the premises or any other situations that may endanger children and that should be so recorded on the license. Any violation of any such condition/restriction shall result in immediate emergency suspension of the license. When such conditions/restrictions no longer pose a threat to the children, the conditional/restrictive statement may be removed.

**History**
- *Source: Miss. Code Ann. §43-20-8.*

##### **15 Miss. Admin. Code Pt. 11, R. 1.2.3** Rule 1.2.3 {#sec-11-1.2.3 omnilex-key=us-ms-regs-official--title-15--11#1.2.3}

Application for License An application for a license under these regulations shall be made to the licensing agency upon forms provided by it and shall contain such information as the licensing agency may reasonably require.

**History**
- *Source: Miss. Code Ann. §43-20-8.*

##### **15 Miss. Admin. Code Pt. 11, R. 1.2.4** Rule 1.2.4 {#sec-11-1.2.4 omnilex-key=us-ms-regs-official--title-15--11#1.2.4}

License Fee: All application fees, licensure fees, renewal fees, and administrative charges shall be paid online at www.healthyms.com and are nonrefundable. Insufficient funds fee must be paid with money order. 1. Application Fee .............................................................................................. $130.00 2. Initial Licensure Fee a. Maximum capacity 12 or fewer ........................................................... $ 97.50 b. Maximum capacity 13 to 30 ................................................................... $195.00 c. Maximum capacity 31 to 50 ................................................................... $260.00 d. Maximum capacity 51 to 100 ................................................................. $390.00 e. Maximum capacity 101 to 150 ............................................................... $455.00 f. Maximum capacity 151 or more ............................................................. $520.00

3. Renewal Fee

a. Maximum capacity 12 or fewer ........................................................... $ 97.50 b. Maximum capacity 13 to 30 ................................................................... $195.00 c. Maximum capacity 31 to 50 ................................................................... $260.00 d. Maximum capacity 51 to 100 ................................................................. $390.00 e. Maximum capacity 101 to 150 ............................................................... $455.00 f. Maximum capacity 151 or more ............................................................. $520.00

4. Reinstatement Fee ......................................................................................... $260.00 5. Returned Check Fee .................................................................................. $ 50.00 6. LateFee...........................................................................................................$ 25.00 7. Fingerprinting Fee (Per Fingerprint Card) .............................................. $ 50.00

NOTE: Except for the fingerprinting fee, no governmental entity or agency that operates a child care facility shall be required to pay the fees set forth in this section. Third party providers that contract with a state agency for the provision of child care services are subject to all fees, monetary penalties, etc. Further, should an entity exempt from licensure apply for a license it shall be subject to all fees listed in this section.

**History**
- *Source: Miss. Code Ann. §43-20-8.*

##### **15 Miss. Admin. Code Pt. 11, R. 1.2.4** Rule 1.2.4 {#sec-11-1.2.4 omnilex-key=us-ms-regs-official--title-15--11#1.2.4}

Certificate of Inspection by Fire Department A certificate of inspection and approval by the fire department of the municipality or other political subdivision in which the child care facility is located shall be submitted to the licensing agency with the application and license fees. Except that if no fire department exists where the facility is located, the State Fire Marshall shall certify as to the inspection for safety from fire hazards. The inspection form to be used for fire inspections shall be MSDH Form #333 and shall be signed by a signatory authority of the fire inspection authority making the inspection.

**History**
- *Source: Miss. Code Ann. §43-20-8.*

##### **15 Miss. Admin. Code Pt. 11, R. 1.2.5** Rule 1.2.5 {#sec-11-1.2.5 omnilex-key=us-ms-regs-official--title-15--11#1.2.5}

Inspection An agency representative(s) shall inspect each child care facility prior to issuing or renewing a license to assure compliance with these regulations.

**History**
- *Source: Miss. Code Ann. §43-20-8.*

##### **15 Miss. Admin. Code Pt. 11, R. 1.2.6** Rule 1.2.6 {#sec-11-1.2.6 omnilex-key=us-ms-regs-official--title-15--11#1.2.6}

Record of Inspection Whenever an inspection is made of a child care facility, the findings shall be recorded on an official inspection form and furnished to the operator, director, and/or their representative, at the time the inspection is made.

**History**
- *Source: Miss. Code Ann. §43-20-8.*

##### **15 Miss. Admin. Code Pt. 11, R. 1.2.7** Renewal of License 1 {#sec-11-1.2.7 omnilex-key=us-ms-regs-official--title-15--11#1.2.7}

The licensing agency shall issue licenses that may be renewed annually. The licensing agency shall email a renewal notice, at least 75 days prior to the expiration date of the license, to the email address of the operator registered with the licensing agency. The operator shall: a. Complete the online renewal form. b. Submit any and all certificates of inspection and approval required by the licensing agency. c. Submit the renewal fee. d. File the above with the licensing agency at least 30 days prior to the expiration date on the license. e. Renewal applications submitted online less than 30 days prior to the expiration date of the license shall be assessed a $25.00 late fee. Applications and fees are to be paid online at Home - Mississippi State Department of Health (healthyms.com).

2. An operator who does not submit the renewal application prior to the date that the license expires will be deemed to have allowed the license to lapse. Said license may be reinstated by the licensing agency, in its discretion, by payment of both the renewal fee and the reinstatement fee, provided said application for reinstatement is made within one month of the expiration date of the license. After the one month reinstatement period, it shall be required that an application for an initial license be submitted. All licensure requirements in effect at the time the new initial application is filed shall be met.

**History**
- *Source: Miss. Code Ann. §43-20-8.*

##### **15 Miss. Admin. Code Pt. 11, R. 1.2.8** Rule 1.2.8 {#sec-11-1.2.8 omnilex-key=us-ms-regs-official--title-15--11#1.2.8}

License Not Transferable or Assignable Each license shall be issued only for the premises and operator named in the application and shall not be transferable or assignable. A change of ownership includes, but is not limited to, inter vivo gifts, purchases, transfers, lease arrangements, cash and/or stock transactions or other comparable arrangements whenever any person or entity acquires or controls a majority interest of the child care facility or service. Changes of ownership from partnerships, single proprietorships, or corporations to another form of ownership are specifically included.

**History**
- *Source: Miss. Code Ann. §43-20-8.*

##### **15 Miss. Admin. Code Pt. 11, R. 1.2.9** Rule 1.2.9 {#sec-11-1.2.9 omnilex-key=us-ms-regs-official--title-15--11#1.2.9}

Display of Licenses The current license issued by the licensing agency to the named child care facility and operator shall be posted and displayed

in a conspicuous place and in easy view of all persons who enter the child care facility. The facility operator shall also post next to the license, in plain view, a notice provided by the MSDH that informs the public of where and how they may report a complaint against the facility.

Subchapter 3: RIGHT OF ENTRY AND VIOLATIONS Rule 1.3.1 Right of Entry An agency representative may enter any child care facility for making inspections or investigations to determine compliance with these regulations.

**History**
- *Source: Miss. Code Ann. §43-20-8.*
- *Source: Miss. Code Ann. §43-20-8.*

##### **15 Miss. Admin. Code Pt. 11, R. 1.3.2** Rule 1.3.2 {#sec-11-1.3.2 omnilex-key=us-ms-regs-official--title-15--11#1.3.2}

Violations If violations noted on the inspection form are not corrected within the period specified by the licensing agency, a license may be denied, suspended, or revoked in accordance with these regulations.

Subchapter 4: FACILITY POLICY AND PROCEDURES Rule 1.4.1 Parental Information Before a child's enrollment, the parent shall be provided with the following: 1. Operating information: a. The child care facility's purpose, scope of service provided, philosophy, and any religious affiliation. b. Name(s), business address, and home phone number of the operator, director or an individual in authority who can be reached after the facility’s normal hours of operation. c. The business phone number of the child care facility. d. Organization chart or other description of established lines of authority of persons responsible for the child care facility's management within the organization. e. The program and services provided and the ages of children accepted. f. The hours and days of operation and holidays or other times closed. g. The procedures for admission and registration of children. h. Tuition, plans for payment, and policies regarding delinquent payments. i. Types of insurance coverage for children, or a statement that accident insurance is not provided or available. j. If a facility does not provide liability insurance there shall be a

statement in the child’s record, signed by the parent indicating that the parent is aware that the facility does not carry liability insurance. k. Reasons/circumstances and procedures for removal of children from rolls when parents are requested by facility staff to remove a child. l. Procedures to include the amount of notice a parent is required to give the facility before removing a child. m. Policy governing the maximum hours per day or week that a child can be left at the child care facility. 2. Arrival and departure procedures for children: a. Procedure, approved by the licensing authority, for assuring a child's safe arrival and departure (All children shall be signed in and out of the facility by an authorized individual.). b. Procedures for protecting children from traffic and other hazards during arrival and departure and when crossing streets. c. Policy for release of children from the child care facility only to responsible persons for whom the child care facility has written authorization. d. Policy governing a parent picking up a child after closing hours and procedures if a child is not picked up. 3. Program and activities information: a. Policies and procedures about accepting and storing a child's personal belongings. b. Discipline policies including acceptable and unacceptable discipline measures. c. Transportation and safety policies and procedures. d. Policies prohibiting the photographing of a child without parental consent. e. Policies regarding a child's participation in extracurricular activities not sponsored by the child care facility, including but not limited to baseball, softball, soccer, ballet, or gymnastics. f. Policies regarding water activities and safety procedures. These policies shall include those water activities that take place away from the child care facility property, e.g., taking children to a public swimming pool. g. Policies encouraging sun safety practices and activities. 4. Health and emergency procedures:

a. Procedures for storing and giving a child medication. b. Policy for reporting suspected child abuse. c. Provision for emergency medical care, treatment of illnesses and accidents, which include: i. A plan to handle a child in a medical crisis. ii. A plan to obtain prompt services of physician and hospitalization, if needed. iii. A plan for immediately notifying the parent of any illness, accident or injury to the child. iv. A plan to acquire the services of a certified practitioner for a child exempt from medical care on religious grounds. d. Evacuation plan including procedures for notifying the parents of the relocation site. e. Policy and procedures for handling dangerous situations, including but not limited to, dealing with violent individuals, individuals entering facility with weapons, bomb threats, or conditions posing an immediate threat to children. 5. State regulations: a. A summary of the licensing regulations and any appendices thereto, provided by the licensing agency. b. Each child's record shall contain a statement signed by the child's parent, indicating that they have received a summary of licensing standards and other materials designated by the licensing agency for such distribution. c. The name and phone number of the MSDH licensing official responsible for the inspection of the facility. d. The toll free phone number (1-866-489-8734) of the Child Care Facility Complaint Hot Line.

**History**
- *Source: Miss. Code Ann. §43-20-8.*
- *Source: Miss. Code Ann. §43-20-8.*

##### **15 Miss. Admin. Code Pt. 11, R. 1.4.2** Smoking, Tobacco Products, and Prohibited Substances 1 {#sec-11-1.4.2 omnilex-key=us-ms-regs-official--title-15--11#1.4.2}

Smoking or the use of tobacco products in any form is prohibited within the physical confines or the campus of a child care facility at any time. 2. The use of alcohol, illegal use of prescription drugs, or use of illegal drugs is prohibited within the physical confines or the campus of a child care facility at any time.

3. Smoking or the use of tobacco products in any form, use of alcohol, illegal use of prescription drugs, or use of illegal drugs by a caregiver is prohibited anytime a child is under the care of such caregiver regardless of location. A caregiver is defined as a person who provides direct care, supervision, and guidance to children in a child care facility, regardless of title or occupation. This definition includes volunteers and parents.

**History**
- *Source: Miss. Code Ann. §43-20-8.*

##### **15 Miss. Admin. Code Pt. 11, R. 1.4.3** Rule 1.4.3 {#sec-11-1.4.3 omnilex-key=us-ms-regs-official--title-15--11#1.4.3}

Parental Access Child care facilities shall assure the parent that they have welcome access to the child care facility at all times. Welcome access shall be defined as a parent having access to areas of the facility available to his child and non-disruptive to normal daily activities.

**History**
- *Source: Miss. Code Ann. §43-20-8.*

##### **15 Miss. Admin. Code Pt. 11, R. 1.4.4** Rule 1.4.4 {#sec-11-1.4.4 omnilex-key=us-ms-regs-official--title-15--11#1.4.4}

Changes in Facility Operations The operator shall immediately notify the licensing agency of any major changes affecting areas of the child care facility's operations. Such major changes include, but are not limited to, operator, director, location, physical plant, or number of children served.

**History**
- *Source: Miss. Code Ann. §43-20-8.*

##### **15 Miss. Admin. Code Pt. 11, R. 1.4.5** Rule 1.4.5 {#sec-11-1.4.5 omnilex-key=us-ms-regs-official--title-15--11#1.4.5}

Notice of Legal Action The licensing agency shall be notified within seven days, in writing, if notice is received of legal action against the child care facility.

**History**
- *Source: Miss. Code Ann. §43-20-8.*

##### **15 Miss. Admin. Code Pt. 11, R. 1.4.6** Posting of Information The following items shall be posted conspicuously in the child care facility at all times: 1 {#sec-11-1.4.6 omnilex-key=us-ms-regs-official--title-15--11#1.4.6}

Accessible to employees and parents: a. License. b. Daily activity schedule posted in each classroom. c. Menus and Food Service Permit, if applicable. d. Evacuation route. e. The facility operator shall also post next to the license, in plain view, a notice provided by the MSDH that informs the public of where and how they may report a complaint against the facility. 2. In kitchens: a. Menus. b. Evacuation route.

3. The evacuation route in all rooms utilized by children.

**History**
- *Source: Miss. Code Ann. §43-20-8.*

##### **15 Miss. Admin. Code Pt. 11, R. 1.4.7** Weapons Prohibited 1 {#sec-11-1.4.7 omnilex-key=us-ms-regs-official--title-15--11#1.4.7}

There shall be no firearms or other dangerous weapons allowed in a child care facility. 2. If a facility is located in an occupied dwelling, all firearms shall be equipped with trigger locks and kept in a locked room out of the sight of all children. All other dangerous weapons shall be kept under lock in a room not accessible to children. 3. Other dangerous weapons include, but are not limited to, hunting knives, spears, machetes, archery equipment, etc.

**History**
- *Source: Miss. Code Ann. §43-20-8.*

##### **15 Miss. Admin. Code Pt. 11, R. 1.4.8** Rule 1.4.8 {#sec-11-1.4.8 omnilex-key=us-ms-regs-official--title-15--11#1.4.8}

Prevention of Shaken Baby syndrome and Abusive Head Trauma: Each child care center licensed to care for children up to five years of age shall develop and adopt policies to prevent shaken baby syndrome and abusive head trauma prior to licensure. The policy shall include the following:

1. How to recognize, respond to, and report the signs and symptoms of shaken baby syndrome and abusive head trauma. Signs and symptoms include: irritability, difficulty staying awake, difficulty breathing, inability to lift the head, seizures, lack of appetite, vomiting, and bruises;

2. Strategies to assist staff members in coping with a crying, fussing, or distraught child;

3. Strategies to assist staff members in understanding how to care for infants;

4. Strategies to ensure staff members understand the brain development of children up to five years of age;

5. A list of prohibited behaviors that shall include, but not be limited to, shaking a child, tossing a child into the air or into a crib, chair, or car seat, and pushing a child into walls, doors, and furniture; and

6. Resources to assist staff members and families in preventing shaken baby syndrome and abusive head trauma.

**History**
- *Source: Miss. Code Ann. §43-20-8.*

##### **15 Miss. Admin. Code Pt. 11, R. 1.4.9** Rule 1.4.9 {#sec-11-1.4.9 omnilex-key=us-ms-regs-official--title-15--11#1.4.9}

Emergency Preparedness and Evacuation Planning: Each child care provider shall develop, implement, and maintain a comprehensive, written multi-hazard emergency preparedness, response, and recovery plan to ensure the safety and protection of all children in care during emergencies. This plan must

address the following components: 1. Multi-Hazard Emergency Plan Requirements: The plan shall: A. Address potential disasters and emergencies—natural or human-caused—that could affect the facility based on its geographic location B. Include procedures to control access to all buildings and outdoor play areas C. Include emergency procedures for: a. Evacuation b. Relocation to a pre-determined safe location c. Shelter-in-place d. Lockdown e. Communication with families f. Continuity of operations D. Include specific procedures and accommodation for: a. Infants and toddlers (including food and formula needs) b. Children with disabilities or chronic medical conditions, including medication, medical equipment, evacuation, and transportation E. Include a system for quickly accounting for all children during and after an emergency F. Include both a primary and backup communication system to contact parents and authorized third-party release caretakers G. Include procedures for reunification of children and parents following an emergency H. Include procedures for providing parents with information about the emergency plan upon enrollment and whenever changes or updates are made I. Be reviewed annually for accuracy and updated as necessary J. Be reviewed with all staff and volunteers: a. At the time of orientation b. At least once every six (6) months thereafter 1. K. Be available for review during inspections and at any time upon request by licensing staff.

L. Individualized Emergency Plan for Children with Special Health Care Needs: Child care providers shall develop an individual emergency plan for each child with special health care needs. This plan must include: a. Medical contact information; b. A list of necessary supplies, medications, and equipment specific to the child. M. Evacuation Pack: Child care providers must maintain an evacuation pack, accessible to all staff and containing at a minimum: a. A list of emergency phone numbers b. Updated emergency contact information and emergency medical authorizations for all enrolled children c. Emergency pickup forms d. First aid supplies, hand sanitizer, wet wipes, and tissue e. Diapers for non-toilet trained children and plastic bags for disposal f. A battery-powered or crank flashlight and radio with batteries g. Disposable cups and bottled water. h. A designated staff member must be assigned to maintain and ensure the pack is complete and that medications and other time-sensitive items are not expired. N. Records Retention and Backup: Child care providers shall maintain essential records, documents, and computer files necessary for the continuation of operations post- emergency. These must be stored either in a portable file, or off-site, preferably with an electronic backup of all information. O. Emergency Drills: Child care providers shall: a. Conduct monthly fire and tornado drills b. Conduct all other disaster drills at least once every six (6) months c. Vary the day and time of each drill to ensure readiness d. Maintain documentation on-site for the previous 12 months of all drills, including:

i. Type of drill (e.g., fire, tornado, flood, violence, power outage) ii. Date and time of the drill iii. Number of children participating iv. Name of staff member supervising the drill v. Total time to complete the drill vi. Any problems encountered and corrective actions taken. P. F. First Aid and CPR Certification: During all hours of operation, including arrival and departure, child care providers shall have at least one staff member present that: a. Holds a valid infant, child, and adult First Aid and CPR certification. b. Renewal certifications must be obtained through in- person, hands-on training (online-only courses are not acceptable). Rule 1.4.10 All policies and procedures referenced above in Subchapter 4 shall apply to all operators, staff and parents/guardians, as applicable.

Subchapter 5: PERSONNEL REQUIREMENTS Rule 1.5.1 General Requirements For Personnel 1. Each employee or potential employee of a child care facility, whether full time, part time, temporary, substitute, or volunteer, shall be of good moral character and shall meet the minimum qualifications for the respective job classification, as set forth in these regulations. 2. Any individual who, in the opinion of the licensing authority, appears to be unable to physically or mentally care for children on a daily basis and/or in emergency situations will not be allowed to act as a caregiver or caregiver assistant. Any person whose ability is in question shall, at the request of the licensing authority, be able to demonstrate the ability to perform, at a minimum but not limited to the following: a. Physical ability to exit the children during a fire drill in under two minutes. b. Ability to read medication directions and properly dispense medication to children (required only if the facility dispenses medication).

**History**
- *Source: Miss. Code Ann. §43-20-8.*
- *Source: Miss. Code Ann. §43-20-8.*

##### **15 Miss. Admin. Code Pt. 11, R. 1.5.2** Rule 1.5.2 {#sec-11-1.5.2 omnilex-key=us-ms-regs-official--title-15--11#1.5.2}

Comprehensive Background Check: Pursuant to Section 43-20-1 et seq., of the Mississippi Code of 1972, Section 658(d) of the Child Care Development Block Grant Act of 2014, and Federal Rules and Regulations 45 CFR 98.43, a comprehensive, finger-print based, criminal history records check, consisting of a FBI national criminal history records check (NCIC), state criminal history records check (MCIC), state child abuse registry check, National Sex Offender Registry check (NSOR), a state sex offender registry check and an interstate check, if applicable, must be completed on all operators, employees, and prospective employees of a licensed, regulated, and/or registered child care facility as well as all child care providers eligible to deliver services for which Child Care Development Funds assistance is provided. Further, a comprehensive background must be completed every five years. 1. Before a prospective staff member may begin work in a child care facility, a valid Letter of Suitability must have been issued by the MSDH Criminal Records Check Unit.

2. Each licensed, regulated, and/or registered child care facility will electronically access, monitor, verify, and maintain the suitability status of any submitted employee through the agency maintained website.

3. If an individual has been separated from employment (break in service) in a child care facility for more than 180 consecutive days a new comprehensive criminal history records check must be submitted and approved before the individual may begin work in a child care family home.

4. In the event a child care applicant has a disqualifying event a letter of non-suitability will be issued. Both the child care provider and the applicant will be notified through the agency- maintained website.

5. Individuals under the age of 18 who are employed by a child care provider for compensation are required to complete a comprehensive background check.

6. Volunteers

a. The facility shall maintain the following on any individual who volunteers in a child care facility for less than 120 hours per licensure year: i. A provider will maintain a timesheet on all volunteers indicating the number

of hours they worked each time they were at the facility. ii. Immunization Compliance Form 121.

b. The facility shall maintain the following on any individual who volunteers in a child care facility for 120 or more hours per licensure year:

i. Letter of Suitability that reflects the completion of a full criminal records check, child abuse registry check, and sex offender check. Also, if required an out-of-state criminal records check, child abuse registry check, and sex offender check. ii. Immunization Compliance Form 121.

**History**
- *Source: Miss. Code Ann. §43-20-8.*

##### **15 Miss. Admin. Code Pt. 11, R. 1.5.3** Child Care Director Qualifications A child care director shall be least 21 years of age and shall have at a minimum: 1 {#sec-11-1.5.3 omnilex-key=us-ms-regs-official--title-15--11#1.5.3}

A bachelor’s degree in early childhood education, child development, elementary education, child care, special education, psychology (with emphasis on child psychology), or family and consumer sciences (with emphasis on child development), or equivalent degree from another child- related field or course of study. OR 2. A two-year associate degree from an accredited community or junior college in child development technology which must include a minimum of 480 hours of practical training, supervised by college instructors, in a college operated child care learning laboratory. OR 3. A two-year associate degree from an accredited community or junior college in child development technology or child care and two years paid experience in a licensed child care facility. OR 4. Two years paid experience as a caregiver in a licensed child care facility, and either (1) a current Child Development Associate (CDA) credential from the Council for Early Childhood Professional Recognition (CECPR), or (2) a Mississippi Department of Human Services (MDHS) Division of Early Childhood Care and Development (DECCD) Child Care Director’s Credential or MDHS OCY Child Care Director’s Credential, or

(3) 24 semester hours credit with a grade of “C” or better from an accredited college or university in courses specific to early childhood. OR 5. A verified certificate from the licensing agency certifying that the individual was qualified to be the director of a licensed child care facility prior to January 1, 2000 in the State of Mississippi.

**History**
- *Source: Miss. Code Ann. §43-20-8.*

##### **15 Miss. Admin. Code Pt. 11, R. 1.5.4** Caregivers Caregivers shall be at least 18 years of age, and shall have at a minimum: 1 {#sec-11-1.5.4 omnilex-key=us-ms-regs-official--title-15--11#1.5.4}

A high school diploma or equivalent (GED). OR 2. A current CECPR Child Development Associate (CDA) credential, a MDHS DECCD Child Care Director’s Credential, or MDHS OCY Director’s Child Care Credential. OR 3. Three years prior documented experience caring for children who are under 13 years of age and who are not related to the caregiver within the third degree computed according to civil law. Staff failing to meet the requirements of education and/or experience to act as a caregiver shall be designated as caregiver assistants.

**History**
- *Source: Miss. Code Ann. §43-20-8.*

##### **15 Miss. Admin. Code Pt. 11, R. 1.5.5** Caregiver Assistants Caregiver assistants shall be at least 16 years of age {#sec-11-1.5.5 omnilex-key=us-ms-regs-official--title-15--11#1.5.5}

Caregiver assistants shall work under the direct on-site supervision of a director or caregiver at all times. They shall not have the direct responsibility for a group of children as the sole caregiver. Caregiver assistants under the age of 18 shall not be given the authority to discipline children.

**History**
- *Source: Miss. Code Ann. §43-20-8.*

##### **15 Miss. Admin. Code Pt. 11, R. 1.5.6** Students 1 {#sec-11-1.5.6 omnilex-key=us-ms-regs-official--title-15--11#1.5.6}

Students in a field study placement, a practicum, or vocational child care training program may assist in the care of the children when the following conditions have been met. 2. Students who are 18 years of age or older and who are in a child care facility for 120 or more hours per licensure year shall have a record on file in the facility which shall contain the following: a. Name, date of birth, address, and phone number.

b. Name and phone number of a contact person from the school or university placing the student. c. Date placement began and daily record of the hours a student is present. d. Mississippi State Department of Health Certificate of Immunization Compliance Form 121. e. Documentation that the criminal records check (fingerprinting) and child abuse central registry check have been completed and no records found, i.e., Letter of Suitability for Employment. f. Documentation of a minimum of one hour of orientation, within one week of placement, including but not limited to, the child abuse law and reporting procedures, emergency procedures, and facility discipline and transportation policies. 3. Students who are under 18 years of age and who are in a child care facility for 120 or more hours per licensure year shall have a record on file in the facility that shall contain all of the above listed material with the exception of Item e. The facility shall document the time that a student is at the facility. No student shall be left alone with children unless an approved Letter of Suitability is on file.

**History**
- *Source: Miss. Code Ann. §43-20-8.*

##### **15 Miss. Admin. Code Pt. 11, R. 1.5.7** Use of Director Designee 1 {#sec-11-1.5.7 omnilex-key=us-ms-regs-official--title-15--11#1.5.7}

A director designee is an individual designated to act as the director, having all responsibility and authority of a director, during the director’s short-term absence. 2. A director designee shall, at a minimum have a high school diploma or GED two years paid experience in a licensed child care facility or licensed/accredited kindergarten program. A director designee shall not retain sole director authority in a facility for more than 24 total hours per calendar week. EXCEPTION: Facility may have a Director Designee serve for a maximum of 14 consecutive days during a licensure year. This exception may be used once during the licensure year for allowing the director personal leave, i.e., vacation, jury duty, etc. In addition, if a Director has a medical condition (illness, recovery from surgery, accident, etc.) that requires more than 14 consecutive day’s recovery time, the time a Director Designee may be utilized may be extended. The facility is responsible to notify the Child Care Division of such circumstances and provide documentation supporting the need to extend the time the Director Designee needs to be utilized. Approval of this exception is at the discretion of the Child Care Licensure Division. 3. When the director designee is in charge of the facility, they shall have

full access to all documents of the facility that are necessary for the licensing agency to conduct an inspection or complaint investigation. These documents shall include, but are not limited to, staff records, children’s records, safety inspections, and any other material or documents required by the inspecting official.

**History**
- *Source: Miss. Code Ann. §43-20-8.*

##### **15 Miss. Admin. Code Pt. 11, R. 1.5.8** Staff Development 1 {#sec-11-1.5.8 omnilex-key=us-ms-regs-official--title-15--11#1.5.8}

Owners, Directors, and Director Designees - Before a new license to operate is issued, owners, directors and director designees of the child care facility shall complete mandatory training on courses covering Child Care Regulations, Director Orientation, and Playground Safety. If a new director or director designee is appointed by the child care facility after the license issuance, the mandatory training courses shall be completed by such individual(s) within the first six months of appointment. In the sole discretion of the licensing agency, mandatory training may be waived upon the submission of documentation of the individual’s prior completion of relevant training. 2. All child care staff, directors, director designees, and caregivers shall be required to complete 15 contact hours of staff development, accrued during the licensure year, annually. The National Association for the Education of Young Children (NAEYC), a leading organization in child care and early childhood education recommends annual training based on the needs of the program and the pre-service qualifications of the staff. Training should address the following: a. Health and safety. b. Child growth and development. c. Nutrition. d. Planning learning activities. e. Guidance and discipline techniques. f. Linkages with community services. g. Communications and relations with families. h. Detection of child abuse. i. Advocacy for early childhood programs. j. Professional issues. 3. Contact hours for staff development shall be approved by the

licensing agency. The licensing agency, in its sole discretion, may accept suitable educational credits, programs, or degrees in lieu of those specified in Subchapter 5 upon the submission of adequate documentation by the individual. 4. No more than five contact hours of approved in-service training provided by the child care facility may be counted toward the total number of hours required each year. More than five hours of in-service training may be provided by the child care facility but no more than five hours may be counted toward the required total of 15 hours. 5. All volunteers shall receive, at a minimum, one hour of orientation by the facility director. Such orientation at a minimum shall include a review of the child abuse law and reporting requirements, emergency exit procedures, and the facility transportation policy.

**History**
- *Source: Miss. Code Ann. §43-20-8.*

##### **15 Miss. Admin. Code Pt. 11, R. 1.6.2** Records Retention: 1 {#sec-11-1.6.2 omnilex-key=us-ms-regs-official--title-15--11#1.6.2}

All records, unless otherwise specified, shall be kept for a period of at least three years. 2. A child's records shall be retained for a period of one year after the child is no longer in attendance at the facility.

**History**
- *Source: Miss. Code Ann. §43-20-8.*

##### **15 Miss. Admin. Code Pt. 11, R. 1.6.3** Facility Records: 3 {#sec-11-1.6.3 omnilex-key=us-ms-regs-official--title-15--11#1.6.3}

Attendance records for children and employees. 4. A current alphabetical roster of children enrolled in the child care facility, to include the child's full name and date of birth. 5. A current alphabetical roster of staff employed or volunteers in the child care facility. 6. Current license. 7. Records of monthly fire/disaster evacuation drills. 8. A record shall be maintained of any medication administered by the director or caregiver showing the date, time, and signature of dispensing employee. A medication record may be destroyed 90 days after administering the medication. 9. A record shall be maintained on each volunteer to document the date and number of hours of volunteer service.

10. Licensed child care facilities shall require proof of vaccination or

a valid exemption for all children enrolled, as specified by the Mississippi State Department of Health (MSDH) through forms 121 and 122. a. Each child care facility shall maintain a notebook containing copies of the MSDH Certificate of Immunization Compliance (MSDH Form #121or MSDH Form #122) for both staff and/or children. The notebook shall contain separate current alphabetical rosters of both staff and children. All children must have one of the following forms before enrollment in a licensed child care facility: Certificate of Immunization Compliance (Form 121) or Certificate of Medical/Religious Exemption (Form 122) b. An MSDH Certificate of Immunization Religious Exemption Form #122 does not apply to staff. c. The MSDH Office of Immunizations shall provide assistance to licensed child care facilities, case workers, foster families, and families experiencing hardship and/or homelessness. For additional information contact the MSDH Office of Immunization.

11. Each licensed child care provider is required to enter into the Child Care LARS Database the hourly rate that they charge to care for a child in a particular age group they serve, i.e., Infant, Preschool, School Age. The following is used for calculating the hourly rate for each age group. Calculation of the daily rate Current Monthly Rate (CMR) Calculated Yearly Rate = (CMR X 12 months) Calculated Weekly Rate = (Calculated Yearly Rate ÷ 52) Calculated Daily Rate = (Calculated Weekly Rated ÷ 5) Age Group Current Monthly Rate (CMR) Yearly Rate CMR X 12 Weekly Rate Yearly Rate ÷

Daily Rate Before Rounding Weekly Rate ÷ 5 Daily Rate Rounded Up to the Next Cent Infant $480.00 $5,760.00 110.7692308 22.15385 $22.16 Preschool $440.00 $5,280.00 101.5384615 20.30769 $20.31

School Age $320.00 $3,840.00 73.84615385 14.76923 $14.77

**History**
- *Source: Miss. Code Ann. §43-20-8.*

##### **15 Miss. Admin. Code Pt. 11, R. 1.6.4** Personnel Records: 1 {#sec-11-1.6.4 omnilex-key=us-ms-regs-official--title-15--11#1.6.4}

Employee Records: Each employee's personnel record shall contain the following: a. Name, date of birth, address, and phone number.

b. Documentation of education, training, and experience necessary for employment.

c. Records of staff development accrued during each licensure year, beginning with the date employed.

d. Date of employment and date of separation.

e. Mississippi State Department of Health Certificate of Immunization Compliance Form 121.

f. Documentation that the criminal record checks (fingerprinting), Child Abuse Central Registry checks, and Sex Offender Registry checks, have been conducted (Letter of Suitability for Employment); and the information shall be included in each employee's personnel file. NOTE: Each person living in a private residence used as a child care facility shall meet the same requirements as employed personnel, relative to health, criminal record, fingerprinting, child abuse central registry checks, and sex offender registry checks. g. Documentation of orientation, within one week of being hired, including but not limited to emergency procedures (to include policies for handling dangerous situations), staffing and supervision requirements, daily schedules, physical/emotional/developmental problems of children, discipline policies, and child abuse and neglect. h. Upon resignation or termination, personnel records shall be kept on file and be made available to the licensing agency for at least one year after the last day of employment. 2. Required Employee information to be entered into the Child Care Database – Licensure and Reporting System (LARS)

The following information will be entered in the Child Care LARS Database for the Owner, Director, and all staff of the child care facility. The information will be entered during the Child Care Initial Application, Renewal Application, and Provider Portal “Manage Contacts” sections.

a. First Name b. Last Name c. Date of Birth d. Last 4 of SSN e. Hire Date f. Email Address g. Mailing Address h. Contact Phone Number The required information entered into the LARS Child Care Database under this rule is confidential and not viewable by the general public. The information will be used to authenticate the required contact hours taken by staff each licensure year. This information will also provide the ability for the child care operator to retrieve information regarding whether an employee is up-to-date or deficient regarding the required staff development hours (15 hours required) each licensure year.

Further, this information will allow an individual employee or a supervisor of an employee, i.e., Owner and/or Director to register an employee for courses to maintain the continuing education hours required for the continued licensing of the child care facility.

**History**
- *Source: Miss. Code Ann. §43-20-8.*

##### **15 Miss. Admin. Code Pt. 11, R. 1.6.5** Rule 1.6.5 {#sec-11-1.6.5 omnilex-key=us-ms-regs-official--title-15--11#1.6.5}

Volunteer Records (120 or more hours per year): For any person who volunteers in a child care facility for 120 or more hours per licensure year, a record shall be kept which contains the following: 1. Name, date of birth, address, and phone number. 2. Documentation of education, training, and experience that may help them in their role as a volunteer. 3. Date individual began volunteering and last date individual volunteered at the facility. 4. Mississippi State Department of Health Certificate of Immunization Compliance Form 121.

5. Documentation that the criminal records check (fingerprinting), child abuse central registry check, and sex offender registry check has been conducted (Letter of Suitability for Employment), and the information is included in each volunteer’s file. 6. Documentation of a minimum of one hour of volunteer orientation, within one week of volunteering, including but not limited to, the child abuse law and reporting requirements, emergency exit procedures, policies for handling dangerous situations, and the facility transportation policy. 7. A volunteer’s record shall be retained for a period of one year after they are no longer volunteering at the facility. 8. A record shall be maintained on each volunteer to document the date and number of hours of volunteer service.

**History**
- *Source: Miss. Code Ann. §43-20-8.*

##### **15 Miss. Admin. Code Pt. 11, R. 1.6.6** Rule 1.6.6 {#sec-11-1.6.6 omnilex-key=us-ms-regs-official--title-15--11#1.6.6}

Volunteer Records (Less than 120 hours per year): For any person who volunteers in a child care facility for less than 120 hours per licensure year, a record shall be kept which contains the following: 9. Documentation of a minimum of one hour of volunteer orientation within one week of volunteering, including but not limited, to the child abuse law and reporting requirements, emergency exit procedures, policies for handling dangerous situations, and the facility transportation policy and special needs of children. 10. A volunteer’s record shall be retained for a period of one year after they are no longer volunteering at the facility. 11. A record shall be maintained on each volunteer to document the date and number of hours of volunteer service. 12. Mississippi State Department of Health Certificate of Immunization Compliance Form 121.

**History**
- *Source: Miss. Code Ann. §43-20-8.*

##### **15 Miss. Admin. Code Pt. 11, R. 1.6.7** Rule 1.6.7 {#sec-11-1.6.7 omnilex-key=us-ms-regs-official--title-15--11#1.6.7}

Child Records The facility shall maintain an individual file for each child under its current care, and for any withdrawn child who withdrew during the preceding twelve months, containing the following identification and contact information, parental instructions, authorizations and other documents required by its policy manual: 1. Identification and Contact Information a. The name of the child and names of parents/guardians. b. Home address and home phone number.

c. The parent’s business name, address and phone number. d. The child’s date of birth. e. Date of acceptance at facility and date of withdrawal, if any, with the parent’s stated reason for withdrawal. f. Other contact information required to be maintained in accordance with the facility’s policy manual. 2. Parental Instructions a. If the parent provides written instructions to the facility, those instructions concerning the child’s growth and development, medical needs, allergies, toilet training and other information relevant to the child’s well-being shall be maintained and kept updated. b. Written identification of an authorized, responsible person(s) for pickup of the child. c. Documentation of any limitation of parental rights of the other parent or stepparent. d. Documentation of any limitation or restriction, if any, on activities of child, or other participation by the child in certain events such as holiday celebrations or being photographed or other parental concerns. 3. Authorizations a. Signed written authorization to obtain emergency medical treatment and to administer medication. b. A parent may choose either (a) to give written consent allowing their child to participate in all field trips, excursions, or series of events outside the child care facility, or (b) to give written consent only for specific trips or events that include an approved date, time, and location.

c. Signed acknowledgment by parent that the written policies and procedures described in subchapter 4 have been received. 4. Signed acknowledgment by parent that a summary of licensing standards and other materials designated by the licensing agency has been received by the parent. 5. Documents Required by Policy Manual or Contract a. If agreed by the facility in its policy manual or caregiver contracts, method in which facility will inform the parent or contact person if a child does not arrive at the facility within a

reasonable time after a scheduled drop-off. b. Any other documents or identification records agreed to be maintained by the facility. 6. Confidentiality of Records and Information a. Individual child records are confidential and shall not be disclosed or released without prior written authorization by the parent. b. Individual personnel records are confidential and shall not be disclosed or released without prior written authorization by the employee.

**History**
- *Source: Miss. Code Ann. §43-20-8.*

##### **15 Miss. Admin. Code Pt. 11, R. 1.7.1** Subchapter 7: REPORTS {#sec-11-1.7.1 omnilex-key=us-ms-regs-official--title-15--11#1.7.1}

Serious Occurrences Involving Children The child care facility shall document any serious occurrences involving a child in the child’s record and immediately notify the child’s parent and the licensing agency either verbally or in writing, such as email. If the facility is unable to reach the parent or the licensing agency immediately, this must be noted in writing in the child’s record. All verbal notifications must be followed by written confirmation, sent within two days of the occurrence. Serious occurrences include, but are not limited to, accidents or injuries requiring significant medical attention (e.g., the child is taken to a doctor or hospital), alleged abuse or neglect, fires, or other emergencies.

**History**
- *Source: Miss. Code Ann. §43-20-8.*

##### **15 Miss. Admin. Code Pt. 11, R. 1.7.2** Rule 1.7.2 {#sec-11-1.7.2 omnilex-key=us-ms-regs-official--title-15--11#1.7.2}

Child Abuse Any operator or employee of a child care facility who has suspicion or evidence of child abuse or neglect shall report it immediately to the Mississippi Department of Human Services in accordance with the state's Youth Court Act. (Appendix "A")

**History**
- *Source: Miss. Code Ann. §43-20-8.*

##### **15 Miss. Admin. Code Pt. 11, R. 1.7.3** Rule 1.7.3 {#sec-11-1.7.3 omnilex-key=us-ms-regs-official--title-15--11#1.7.3}

Communicable Disease: The child care facility shall promptly report any known or suspected case or carrier of any reportable disease to the Mississippi State Department of Health, as published in the Mississippi Reportable Disease List.

**History**
- *Source: Miss. Code Ann. §43-20-8.*

##### **15 Miss. Admin. Code Pt. 11, R. 1.7.4** Rule 1.7.4 {#sec-11-1.7.4 omnilex-key=us-ms-regs-official--title-15--11#1.7.4}

Infants and Toddlers For infants and toddlers, the child care facility shall provide, to the child's parent, daily written reports that include liquid intake, child’s disposition, bowel movements, and eating and sleep patterns.

Subchapter 8: STAFFING Rule 1.8.1 General 1. The staff-to-child ratio shall be maintained at all times, to include when children are arriving and departing the facility. 2. Children shall not be left unattended at any time. Video monitors cannot be used as a substitute for the physical presence of a caregiver in a room. 3. During all hours of operation, including arrival and departure of children, a child care facility employee shall be present to whom administrative and supervisory responsibilities have been assigned. This child care facility employee shall meet the minimum qualifications of a director or director designee. Note: Operators of child care facilities shall provide to the licensing official a list of all individuals who meet the qualifications of a director or director designee and may be assigned administrative and supervisory responsibility for the facility when the director is absent. Documentation that an individual meets the qualifications of a director shall be submitted to and approved by the local licensing official. Director designee qualifications shall be maintained on site and available to the licensing official during site visits. 4. During all hours of operation, including the arrival and departure of children, a child care facility employee shall be present who holds a valid Adult, Child/Infant CPR and First Aid certification, at any location where the children are present. Said certificate shall be issued by an agent recognized by the licensing authority.

Note: When initially acquiring or renewing the Adult, Child/Infant CPR and First Aid CPR certifications required in rule number 4, online training is not acceptable. Training must be face-to-face and hands-on.

**History**
- *Source: Miss. Code Ann. §43-20-8.*
- *Source: Miss. Code Ann. §43-20-8.*

##### **15 Miss. Admin. Code Pt. 11, R. 1.8.2** Ratio 1 {#sec-11-1.8.2 omnilex-key=us-ms-regs-official--title-15--11#1.8.2}

The minimum ratio of caregiver staff-to-children present at all times shall be as follows:

Age of Children Number of Children to Caregiver Staff Less than 1 year 5 1 year 9 2 years 12

3 years 14 4 years 16 5 through 9 years 20 10 through 12 years 25 2. Staff-to-child ratios shall be met at all times, including during opening/closing, field trips and swimming or water activities whether at the child care premises or off-site. 3. In mixed age groups, the age of the youngest child in the group determines the staff-to-child ratio. Preschool children shall not be grouped with school age children in any single area during normal classroom and playground or water activities. 4. With the exception of children under two years of age, children may be under the direct supervision (staff in the same room) of 50 percent of the staff required by this section during rest period times, provided the required staff-to-child ratio is maintained on the premises. 5. At no time will a single individual be responsible for the supervision of children located in more than one classroom at any given time. 6. Compliance with group sizes is not required during normal arrival and departure time periods, or during special events. However, the age- appropriate staff-to-child ratio shall be maintained at all times.

**History**
- *Source: Miss. Code Ann. §43-20-8.*

##### **15 Miss. Admin. Code Pt. 11, R. 1.8.3** Grouping When children are placed in groups, the maximum group size shall be determined by the following chart {#sec-11-1.8.3 omnilex-key=us-ms-regs-official--title-15--11#1.8.3}

Age of Children in the Group

MAXIMUM number of children ALLOWED in a group of children this age

MINIMUM number of caregivers REQUIRED for a group of children this age

MINIMUM square footage REQUIRED for a group of children this age Infant (Birth through12 months)

##### **15 Miss. Admin. Code Pt. 11, R. 10** infants {#sec-11-10 omnilex-key=us-ms-regs-official--title-15--11#10}

2 caregivers 40 square feet per child

Toddler (12 months to under 24 months)

##### **15 Miss. Admin. Code Pt. 11, R. 18** toddlers {#sec-11-18 omnilex-key=us-ms-regs-official--title-15--11#18}

2 caregivers

##### **15 Miss. Admin. Code Pt. 11, R. 45** square feet per child {#sec-11-45 omnilex-key=us-ms-regs-official--title-15--11#45}

2 years

##### **15 Miss. Admin. Code Pt. 11, R. 24** children {#sec-11-24 omnilex-key=us-ms-regs-official--title-15--11#24}

2 caregivers 35 square feet per child

3 years

##### **15 Miss. Admin. Code Pt. 11, R. 28** children {#sec-11-28 omnilex-key=us-ms-regs-official--title-15--11#28}

2caregivers 35 square feet per child

4 years

##### **15 Miss. Admin. Code Pt. 11, R. 32** children {#sec-11-32 omnilex-key=us-ms-regs-official--title-15--11#32}

2 caregivers 35 square feet per child

5-9 years

##### **15 Miss. Admin. Code Pt. 11, R. 40** children {#sec-11-40 omnilex-key=us-ms-regs-official--title-15--11#40}

2 caregivers 35 square feet per child

10-12 years

##### **15 Miss. Admin. Code Pt. 11, R. 50** children {#sec-11-50 omnilex-key=us-ms-regs-official--title-15--11#50}

2 caregivers 35 square feet per child

Subchapter 9: PROGRAM OF ACTIVITIES Rule 1.9.1 General 1. The child care facility shall provide a basic program of activities geared to the age levels and developmental needs of the children served. 2. The child care facility shall provide for the reading of age- appropriate materials to children. 3. The child care facility shall incorporate programs to encourage sun safety practices, into activities for all age levels.

**History**
- *Source: Miss. Code Ann. §43-20-8.*
- *Source: Miss. Code Ann. §43-20-8.*

##### **15 Miss. Admin. Code Pt. 11, R. 1.9.2** Daily Routines All daily routines, such as eating and rest periods, shall be scheduled for the same time each day {#sec-11-1.9.2 omnilex-key=us-ms-regs-official--title-15--11#1.9.2}

**History**
- *Source: Miss. Code Ann. §43-20-8.*

##### **15 Miss. Admin. Code Pt. 11, R. 1.9.3** Eating Meal periods are breakfast, lunch, dinner, and snacks {#sec-11-1.9.3 omnilex-key=us-ms-regs-official--title-15--11#1.9.3}

A minimum of 30 minutes shall be scheduled for each breakfast, lunch, and dinner meal period. A minimum of 15 minutes shall be scheduled for each snack meal period.

**History**
- *Source: Miss. Code Ann. §43-20-8.*

##### **15 Miss. Admin. Code Pt. 11, R. 1.9.4** Rest Periods 1 {#sec-11-1.9.4 omnilex-key=us-ms-regs-official--title-15--11#1.9.4}

For preschool children, rest periods shall be scheduled for a minimum period of one hour and shall not exceed two and one-half (2½) hours. Infant and

toddler nap times shall be individualized to meet each child’s needs as sleeping patterns can vary greatly. Half-day programs must provide for rest periods as is appropriate when the children/child indicates or is observed to require some rest time. 2. Physical force shall not be used in requiring children to lie down or go to sleep during rest periods. 3. Rest periods are not required for children in attendance for less than six hours. 4. Rest periods are not required for school age children. 5.A safe sleep environment for infants to lower the risk of Sudden Infant Death Syndrome (SIDS) is required as follows: a. An infant shall be placed on his/her back for sleeping unless written physician orders to the contrary are in the child's record. Sleeping infants shall be within the view of the staff and visually checked regularly when sleeping. Nothing shall obstruct the view of the staff or prevent the staff from clearly seeing infants or children. b. Infants shall be dressed in clothing appropriate for sleeping that is designed to keep the infant warm without the possible hazard of head covering or entrapment. The room shall be kept at a draft-free seasonally appropriate temperature of 65 degrees Fahrenheit to 78 degrees Fahrenheit. If a child is already asleep and not dressed in clothing appropriate for sleeping, the caregiver does not need to awaken the infant to change his or her clothes. c. Facilities shall use a firm mattress covered by a fitted sheet. d. Items such as but not limited to pillows, blankets, sheepskins, bumpers, soft objects, stuffed toys, loose bedding, etc., shall not be in the crib.

**History**
- *Source: Miss. Code Ann. §43-20-8.*

##### **15 Miss. Admin. Code Pt. 11, R. 1.9.5** Outdoor Activities 1 {#sec-11-1.9.5 omnilex-key=us-ms-regs-official--title-15--11#1.9.5}

Each infant shall have a minimum of 30 minutes of outdoor activities per day, weather permitting. 2. Toddler, preschool, and school age children shall have a minimum of two hours of outdoor activities per day, weather permitting. Children who attend at a facility for seven hours per day or less shall have a minimum of 30 minutes of outdoor activity per day, weather permitting. 3. Sun safe practices shall be used during outdoor activities. Refer to sun safe practices available on the MSDH Sun and Heat Safety webpage.

4. Sun safe practices shall be evident in the planning of all outdoor events. 5. Outdoor activities shall be held in areas providing shade or covered spaces.

**History**
- *Source: Miss. Code Ann. §43-20-8.*

##### **15 Miss. Admin. Code Pt. 11, R. 1.9.6** Infant and Toddler Activities 1 {#sec-11-1.9.6 omnilex-key=us-ms-regs-official--title-15--11#1.9.6}

Infants and toddlers shall be free to creep, crawl, toddle, and walk as they are physically able. a. Cribs, car seats, and high chairs are to be used only for their primary purpose, i.e. cribs for sleeping, car seats for vehicle travel, and high chairs for eating. b. Providers should limit the use of equipment such as strollers, swings, and bouncer seats/chairs for holding infants while they are awake. c. Providers should implement activities for toddlers and preschoolers that limit sitting or standing to no more than 30 minutes at a time. d. Providers should use strollers for toddlers and preschoolers only when necessary. 2. Infants and toddlers shall be taken outdoors every day, weather permitting. 3. For infants who cannot move about the room, caregivers shall frequently change the place and position of the infant and the selection of toys available, and the child shall be held, rocked, and carried about. 4. Television viewing, including video tapes and/or electronic media, is not allowed for children under the age of two or for staff in the infant and toddler area. The playing of soothing music in the infant and toddler area is acceptable. 5. Television viewing, including video tapes and/or other electronic media, cell phone, or other digital media, e.g., computer, iPad®, iTouch®, etc., for children, age two and older, is limited to one hour per day, must be of educational content and a scheduled part of the approved daily plan of activities posted in the facility. The use of an “audio player” to play music is acceptable. 6. In half-day programs, television viewing, including video tapes and/or other electronic media, cell phone, or other digital media, e.g., computer, iPad®, iTouch®, etc., for children, age two and older, is limited to 30 minutes per day, must be of educational content and a scheduled part of the approved daily plan of activities posted in the facility. The use of an “audio player” to play music is acceptable. 7. Television viewing by staff is not permitted in areas occupied by

children except for the purposes as described in item 5 and 6, above.

**History**
- *Source: Miss. Code Ann. §43-20-8.*

##### **15 Miss. Admin. Code Pt. 11, R. 1.9.7** Rule 1.9.7 {#sec-11-1.9.7 omnilex-key=us-ms-regs-official--title-15--11#1.9.7}

Indoor or Outdoor Physical Activity: Child care providers are to provide infants, toddlers, and preschool children with opportunities to be physically active throughout the day. 1. Toddlers and preschool children will be provided the opportunity for light physical activity for at least 15 minutes per hour when children are not involved in their scheduled rest period. 2. Toddlers should accumulate a minimum of 60 minutes of structured moderate to vigorous physical activity per day. 3. Preschoolers should accumulate a minimum of 60 minutes of structured moderate to vigorous physical activity per day. 4. Caregivers should join in and lead the structured moderate to vigorous physical activities in which the children participate. 5. Structured physical activity should involve the performance of large muscle activities. 6. Half-day programs are only required to provide for physical activity for one-half (½) the time as stated above.

NOTE: Examples of “light physical activity” may be found in the Child Care Licensure section of the MSDH website at www.HealthyMS.com. Examples of “moderate physical activity” are aerobic dancing, light calisthenics, getting up and down from the floor, dancing, playing on school ground equipment, singing while actively moving about, etc. Examples of “vigorous physical activity” are running, jumping rope, performing jumping jacks, playing soccer, skipping, etc. Regardless of the activity, it should be age appropriate and within the physical ability limits of the child. Please, understand the above requirement does not mean 60 minutes vigorous activity at one time. The 60 minutes of vigorous physical activity can and should be spread out in short time intervals, (e.g., 5-15 minute intervals) throughout the day.

Subchapter 10: EQUIPMENT, TOYS, AND MATERIALS Rule 1.10.1 General 1. Equipment, toys, and materials for both indoor and outdoor use shall be appropriate to the age and developmental needs of the children served. 2. Developmentally age-appropriate toys shall be available and accessible for infants, and shall include but not be limited to the following:

a. Simple, lightweight, open-ended, easily washable toys such as containers, balls, large pop-beads, and nesting cups. b. Rattles, squeak toys, action/reaction toys. c. Cuddly toys. d. Toys to mouth such as teethers and rings. e. Pictures of real objects. f. A crawling area with sturdy, stable furniture for pulling up self. 3. Developmentally age-appropriate toys shall be available and accessible for toddlers, and shall include but not be limited to the following: a. Push and pull toys. b. Stacking toys, large wooden spools/beads/cubes. c. Sturdy picture books, music. d. Pounding bench, simple puzzles. e. Play phone, dolls, and toys to appeal to child’s imagination. f. Large paper, crayons. g. Sturdy furniture to hold on to while walking. h. Sand and water toys. 4. Developmentally age-appropriate toys shall be available and accessible for preschoolers, and shall include but not be limited to the following: a. Active play equipment for climbing and balancing. b. Unit blocks and accessories. c. Puzzles and manipulative toys. d. Picture books, records, and musical instruments. e. Art materials such as finger and tempera paints, clay, play dough, crayons, collage materials, markers, scissors, and paste. f. Dramatic play materials such as dolls, dress-up clothes and props, child- sized furniture, and puppets.

g. Sand and water toys. 5. Children's original work shall be displayed in the child care facility. 6. Books shall be on shelves and tables for children to look at and read. Every child shall have age-appropriate materials (including picture books) read to and discussed with him or her every day. Where appropriate, the materials should cover topics with which the children are involved. 7. Television viewing by preschool children shall be limited to one hour per day and shall be educational programming only. Television viewing by staff is not permitted in areas occupied by children except for the purposes as described herein. 8. The daily activity schedule shall demonstrate that preschoolers are given opportunities to do a variety of activities, including both quiet and active, such as block play, art activities, puzzles, books, and learning games, and that stories are read to and discussed with each child every day.

**History**
- *Source: Miss. Code Ann. §43-20-8.*
- *Source: Miss. Code Ann. §43-20-8.*

##### **15 Miss. Admin. Code Pt. 11, R. 1.10.2** Playground Equipment 1 {#sec-11-1.10.2 omnilex-key=us-ms-regs-official--title-15--11#1.10.2}

All playgrounds and playground equipment used by children 2 - 12 years of age shall meet the safety standards set forth in the Handbook for Public Playground Safety, Publication No. 325, published by the U.S. Consumer Product Safety Commission. 2. Playground equipment shall be of safe design and in good repair. Outdoor playground climbing equipment and swings shall be set in concrete footings located at least six inches below ground surface. Indoor playground equipment shall be installed according to the manufacturer's specifications. Swings shall have soft and/or flexible seats. Access to playground equipment shall be limited to age groups for which the equipment is developmentally appropriate. 3. Equipment designed for outdoor use by infants and toddlers shall be accessible to shaded areas to ensure sun safe practices.

**History**
- *Source: Miss. Code Ann. §43-20-8.*

##### **15 Miss. Admin. Code Pt. 11, R. 1.10.3** Paint Paint on toys, equipment, furniture, walls, and other items shall be lead-free and non-poisonous {#sec-11-1.10.3 omnilex-key=us-ms-regs-official--title-15--11#1.10.3}

**History**
- *Source: Miss. Code Ann. §43-20-8.*

##### **15 Miss. Admin. Code Pt. 11, R. 1.10.4** Chairs and Tables Chairs and tables shall be of a size appropriate to the size and age of the children {#sec-11-1.10.4 omnilex-key=us-ms-regs-official--title-15--11#1.10.4}

There shall be an adequate number of chairs and tables to accommodate the children present at the facility.

**History**
- *Source: Miss. Code Ann. §43-20-8.*

##### **15 Miss. Admin. Code Pt. 11, R. 1.10.5** Rule 1.10.5 {#sec-11-1.10.5 omnilex-key=us-ms-regs-official--title-15--11#1.10.5}

Hooks and Compartments Individual hooks or compartments shall be provided for each child for hanging or storing outer and/or extra clothing as well as for personal possessions. Hooks shall be spaced well apart so that clothes and belongings do not touch those of another child. Hooks shall also be placed at a height suitable to prevent an injury to a child.

**History**
- *Source: Miss. Code Ann. §43-20-8.*

##### **15 Miss. Admin. Code Pt. 11, R. 1.10.6** Sand Boxes 1 {#sec-11-1.10.6 omnilex-key=us-ms-regs-official--title-15--11#1.10.6}

Sand boxes shall be constructed to permit drainage, shall be covered tightly and securely when not in use, and shall be kept free from cat or other animal excrement. 2. Sand contained in sand boxes shall not contain toxic or harmful materials.

**History**
- *Source: Miss. Code Ann. §43-20-8.*

##### **15 Miss. Admin. Code Pt. 11, R. 1.10.7** Cribs 1 {#sec-11-1.10.7 omnilex-key=us-ms-regs-official--title-15--11#1.10.7}

The facility shall provide a crib or other similar commercially purchased bed unit, approved and designated for the purpose of sleeping. Mobile infants, at a minimum of eight months, may be placed on a mat during the transition period of crawling to walking. If such mat is used, it shall be a flame retardant, minimum of two (2) inch commercially purchased sleep mat, especially designated for the purpose of sleeping. All cribs, sleep units, and mats must be maintained clean, in sanitary condition and without chips, holes, fraying, tears, or stains. 2. The use of stackable cribs is prohibited.

**History**
- *Source: Miss. Code Ann. §43-20-8.*

##### **15 Miss. Admin. Code Pt. 11, R. 1.10.8** High Chairs High chairs, if used, shall have a wide base and a T- shaped safety strap {#sec-11-1.10.8 omnilex-key=us-ms-regs-official--title-15--11#1.10.8}

They shall be labeled or warranted by the manufacturer in documents provided at the time of purchase or verified thereafter by the manufacturer as meeting the American Society for Testing Materials (ASTM) Standard F-404 (Consumer Safety Specifications for High Chairs).

**History**
- *Source: Miss. Code Ann. §43-20-8.*

##### **15 Miss. Admin. Code Pt. 11, R. 1.10.9** Rest Period Equipment 1 {#sec-11-1.10.9 omnilex-key=us-ms-regs-official--title-15--11#1.10.9}

Individual beds, cots, mattresses, pads, or other acceptable equipment shall be used for rest periods, and children shall not be placed directly on the floor for rest periods. Bed linens, such as blankets or sheets, cannot be used in place of a bed, cot, mattress, or pad. These shall be kept in a sanitary condition. Once a sheet or blanket has been used by a child, it shall

not be used by another child until it has been laundered. 2. Rest period equipment shall be clean and covered with a waterproof cover. 3. Nap pads/cots are designed for use by one child only at a time. No child is allowed to sleep in shared space. 4. Nap pads utilized by more than one child shall be sanitized after each child’s use. Nap pads utilized by only one child shall be sanitized immediately when soiled or at least weekly. 5. Nap pads and nap cots without mattresses are not acceptable for use in 24 hour programs. Beds, cribs, or roll away cots are the only acceptable bedding for 24 hour centers. 6. The facility shall provide a crib or other similarly commercially purchased bed unit, approved and designated for the purpose of sleeping. Mobile infants, at a minimum of eight months, may be placed on a mat during the transition period of crawling to walking. If such mat is used, it shall be a flame retardant, minimum of two (2) inch commercially purchased sleep mat, especially designated for the purpose of sleeping. All cribs, sleep units, and mats must be maintained clean, in sanitary condition and without chips, holes, fraying, tears, or stains. Cribs, cots, and mats are to be a minimum of 24” apart or separated by a solid barrier. A minimum of 36 inches is recommended

**History**
- *Source: Miss. Code Ann. §43-20-8.*

##### **15 Miss. Admin. Code Pt. 11, R. 1.10.10** Play Equipment 1 {#sec-11-1.10.10 omnilex-key=us-ms-regs-official--title-15--11#1.10.10}

Play equipment, toys, and materials shall be provided that meets the standards of the Consumer Product Safety Commission and/or the American Society for Testing and Materials (ASTM) for juvenile products. Play equipment, toys, and materials shall be found to be appropriate to the development needs, individual interests, and ages of the children as identified as age-appropriate by a label provided by the manufacturer on the product package. 2. Projectile toys, i.e., dart guns, toy guns, etc., are prohibited. 3. Water play tables, if used, shall be cleaned and sanitized daily. 4. Tricycles and other riding toys used by the children shall be spokeless, steerable, and of a size appropriate for the child, and shall have low centers of gravity. All such toys shall be in good condition and free of sharp edges or protrusions that may injure the children. When not in use, such toys shall be stored in a location where they will not present a physical obstacle to the children and employees. Riding toys shall be inspected at

least monthly for protrusions and rough edges that could lead to injury.

**History**
- *Source: Miss. Code Ann. §43-20-8.*

##### **15 Miss. Admin. Code Pt. 11, R. 1.10.11** School Age Programs 1 {#sec-11-1.10.11 omnilex-key=us-ms-regs-official--title-15--11#1.10.11}

The foregoing provisions in Subchapter 10 shall not be applied to any facility licensed solely for School age children unless specifically required in Subchapter 10, Rule 1.10.11. 2. All playgrounds and playground equipment used by children 2 - 12 years of age shall meet the safety standards set forth in Appendix “D” of these regulations. 3. Projectile toys are prohibited. Projectile toys are toys which, when projected, have the ability to penetrate body or eye tissue. Play equipment, toys, and materials shall be provided that meets the standards of the Consumer Product Safety Commission and/or the American Society for Testing and Materials (ASTM) for juvenile products. 4. Possessions, belongings, and extra clothing for each school age child must be stored in such a manner as to not touch those of another child.

Subchapter 11: BUILDINGS AND GROUNDS Rule 1.11.1 Building 1. A child care facility shall be physically separated from any other business or enterprise. Other occupants, visitors, and/or employees of other businesses or enterprises within the same building shall not be allowed within the physical confines of the child care facility for the purpose of entering the building or exiting the building or passing through the child care facility for the purpose of gaining access to another part of the building. 2. All child care facility buildings shall meet all fire safety standards listed on the MSDH Form #333 and all applicable local fire safety standards and/or ordinances. 3. No house trailers, relocatable classrooms, or portable buildings shall be used to house a child care facility unless such structure was originally designed specifically for educational purposes and meet the Mississippi State Department of Education’s current standards for a relocatable classroom. Further, such portable structure shall meet all applicable fire safety codes. 4. Current licensees operating facilities housed in such structures are exempted from this provision. Any change of ownership, need for major

renovation, or other significant change in the facility’s status shall revoke such exemption. 5. Plans and specifications shall be submitted to the licensing agency for review and approval on all proposed construction and/or major renovations. 6. A separate space shall be provided for the use of an ill or injured child until the child can be picked up by the parent. Space shall be located in an area that is supervised at all times by an employee. 7. The ceiling, floor, and/or floor covering shall be properly installed, kept clean and in good condition, and maintained in good repair. Carpeting is prohibited in kitchen areas. 8. All parts of the child care facility used by children shall be lead-safe, well lighted, ventilated, and free of hazardous or potentially hazardous conditions, such as but not limited to, open stairs and unprotected low windows. a. All buildings intended for use as a child care facility constructed before 1978 shall be tested for lead. It is the responsibility of the facility applicant/operator to have a lead hazard screen or lead-based paint risk assessment of the facility done by an individual or company certified as a risk assessor by the Mississippi Commission on Environmental Quality. If the facility is found not to be lead- safe, it will not be allowed to operate as a child care facility until all required corrective measures have been taken and the facility is determined to be lead-safe by a certified risk assessor. b. All buildings intended for use as a child care facility, constructed prior to 1978, shall utilize MDEQ Lead Safe Certified individuals or companies for all renovation, repair and maintenance activities which disturb painted surfaces unless the paint to be disturbed has been documented to be lead- free by an individual or company that is MDEQ Lead Safe Certified as a risk assessor or inspector. NOTE: It is recommended that child care facility operators contact the Mississippi Department of Environmental Quality at 601-961-5630 regarding any questions they may have about compliance with the laws and regulations related to lead and lead based paint.

9. All parts of the child care facility used by children shall be lead-safe, well lighted, ventilated, and free of hazardous or potentially hazardous conditions, such as but not limited to, open stairs and unprotected low windows. 10. All buildings intended for use as a child care facility constructed before 1978 shall be tested for lead. It is the responsibility of the facility

applicant/operator to have a lead hazard screen or lead-based paint risk assessment of the facility done by an individual or company certified as a risk assessor by the Mississippi Commission on Environmental Quality. If the facility is found not to be lead-safe, it will not be allowed to operate as a child care facility until all required corrective measures have been taken and the facility is determined to be lead-safe by a certified risk assessor. 11. All glass in doors, windows, mirrors, etc., shall have a protective barrier at least four feet high when measured from the floor. Doors, windows, mirrors, etc., using safety-grade glass or polymer (e.g., Lexan®) are not required to have a protective barrier. Glass windows and glass door panels shall be equipped with a vision strip 36 inches from the floor. Safety glass must be so certified by the installer and the statement kept on file at the child care facility. 12. Walls shall be kept clean and free of torn wall covering, chipped paint, broken plaster, and holes. No paint that contains lead compounds shall be applied to interior walls or woodwork. 13. All ceiling lighting shall be shielded completely and encased in shatterproof materials. 14. A child care facility shall have a working phone available to all staff at all times. Telephones shall also be available for incoming calls and shall not be unplugged or disconnected during business hours. 15. All fire extinguishers, as required in the fire safety plan, shall be serviced on an annual basis by a qualified fire extinguisher technician. 16. Unused electrical outlets shall be protected by a safety plug cover. 17. All child care facilities are to be kept clean and in good repair. 18. Every child care facility which uses nonelectric heating and/or cooling systems, cooking stoves, and/or hot water heaters or other nonelectric equipment, shall have sufficient carbon monoxide monitors placed appropriately throughout the child care facility. 19. No extension cords shall be used in areas accessible to children.

**History**
- *Source: Miss. Code Ann. §43-20-8.*
- *Source: Miss. Code Ann. §43-20-8.*

##### **15 Miss. Admin. Code Pt. 11, R. 1.11.2** Indoor Square Footage 1 {#sec-11-1.11.2 omnilex-key=us-ms-regs-official--title-15--11#1.11.2}

Every license shall set forth the licensed facility’s maximum licensed capacity, which shall be based upon a minimum of thirty-five (35) square feet of usable indoor space per child. Likewise, the capacity for each room where children are kept shall have a minimum of thirty five (35) square feet of usable space per child, measured on the inside, wall-to-wall dimensions, subject to the following exceptions:

a. During group activity periods such as film viewing, parties, dining, and sleeping, provided child-to-staff ratio is maintained; b. During periods when child pick-up or delivery is normally done, provided child-to staff ratio is maintained; c. In infant and toddler rooms as required in subsections 2-7 below; d. In school age only and summer day camp programs as outlined in Subchapter 23 and Subchapter 24 of these regulations. The usable space in determining the facility’s maximum licensed capacity is measured exclusive of food preparation areas, kitchens, bathrooms, toilets, areas for the care of ill children, offices, staff room, corridors, hallways, stairways, closets, lockers, laundries, furnace rooms, fixed or permanent cabinets, fixed or permanent storage shelving spaces, and areas not inhabited and used by children.

2. Rooms in which infants both play and sleep shall have a minimum of 40 square feet of usable space per child. There shall be at least 24” between each crib. A minimum of 36” is recommended. Cribs with solid ends may be placed end-to- end. 3. Rooms where infants play but do not sleep shall have a minimum of 15 square feet of usable space per child. NOTE: No other age group shall use this space nor can it be used for any purpose other than infant play. 4. Rooms where infants sleep but do not play shall have a minimum of 25 square feet of usable space per child. There shall be at least two feet between each crib. Cribs with solid ends may be placed end-to-end. 5. Rooms in which toddlers both play and sleep shall have a minimum of 45 square feet of usable space per child. There shall be at least 24” between each crib. A minimum of 36” is recommended. Cribs with solid ends may be placed end-to-end. However, if stackable cots, mats, or other storable sleeping equipment is utilized for sleeping the room shall be measured using the standard of 35 square feet per child. Should it be determined that the sleeping equipment is not properly stored when not in use the capacity of the room will be determined using 45 square feet per child 6. Rooms where toddlers play but do not sleep shall have a minimum of 25 square feet of usable space per child. NOTE: No other age group shall use this space nor can it be used for any purpose other than toddler play. 7. Rooms where toddlers sleep but do not play shall have a minimum of 25 square feet of usable space per child. There shall be at least 24” between each crib. A minimum of 36” is recommended. Cribs with solid ends may be

placed end-to- end. 8. The licensing agency may re-measure the play of licensed operating child care facilities, or such parts impacted by the following circumstances, for purposes of determining licensed facility or classroom capacity only under the following circumstances: a. Major renovations; b. Significant change in layout and use of space; c. A change of ownership of an existing facility should the layout or use of space change. 9. “Grandfather Provision” for regulatory changes regarding maximum facility capacity or room capacity. Whenever the Mississippi State Board of Health amends these rules regarding square footage and/or licensed maximum capacity of child care facilities, and such change would result in a reduction in the number of children to be served in a licensed and operating facility or any of its classrooms, any such facility in operation at the time of final adoption of said rule change, and in compliance with all other child care regulations, shall be “grandfathered” in and exempt from application of the new regulation regarding capacity. This exemption shall continue for said facility through changes of ownership so long as the building is used continuously as a licensed child care facility and so long as there is no change in the layout or use of the space, as set out in subsection 8 above. Any break in use of the building as a licensed child care facility shall moot the grandfather exemption, and thereafter, any child facility opened and operated in said building shall be required to comply with the square footage/capacity regulation in affect at the time of the new license.

**History**
- *Source: Miss. Code Ann. §43-20-8.*

##### **15 Miss. Admin. Code Pt. 11, R. 1.11.3** Openings {#sec-11-1.11.3 omnilex-key=us-ms-regs-official--title-15--11#1.11.3}

1. Each window, exterior door, and basement or cellar hatchway shall be weather tight and watertight. 2. All windows above ground level in areas used by children under five years of age shall be constructed, adapted, or adjusted to limit the exit opening accessible to children to less than six inches, or be otherwise protected with guards that do not block outdoor light. 3. Openable windows shall be of a safety type (not fully openable) that are child proofed and screened when open. When there are no openable windows, or when windows are not kept open, rooms shall be adequately ventilated.

4. All openings used for ventilation shall be screened. 5. The width of doors shall accommodate wheelchairs and the needs of individuals with physical disabilities. 6. Exit doors shall open outward. Boiler room doors shall swing inward. 7. Doorways and exits shall be free of debris and equipment to allow unobstructed traffic to and from the room. 8. The hand contact and splash areas of doors and walls shall be covered with an easily cleanable finish, at least as cleanable as an epoxy finish or enamel paint.

**History**
- *Source: Miss. Code Ann. §43-20-8.*

##### **15 Miss. Admin. Code Pt. 11, R. 1.11.4** Kitchens 1 {#sec-11-1.11.4 omnilex-key=us-ms-regs-official--title-15--11#1.11.4}

Children are not allowed in the kitchen area. In School Age/After School programs, children may be allowed in the kitchen but not during times when food is being cooked. Supervision in the kitchen when children are present must meet the staffing requirements as referenced in Subchapter 8 of the regulations. 2. Barriers, approved by the local fire authority, shall be erected and doors shall be closed at all times. 3. The kitchen area shall be designed and constructed to be totally enclosed with walls, doors, and/or barriers. Serving counter openings that conform to local fire codes and MSDH food service regulations are permitted. 4. Kitchens shall have the following minimum square footage, based upon the maximum number of children allowed pursuant to the license:

Licensed Capacity Minimum Sq. Footage 1-50 90 sq. ft. 51-70 150 sq. ft. 71-100 210 sq. ft. over 100 300 sq. ft.

5. Child care facilities serving 50 or more children shall have a separate, stand alone freezer for storage of frozen foods. 6. All kitchens providing food for child care facilities with 13 or more children, and all kitchens in child care facilities not located in occupied dwellings, shall comply with the Mississippi State Department of Health's

##### **15 Miss. Admin. Code Pt. 11, R. 10.0** Rule 10.0 {#sec-11-10.0 omnilex-key=us-ms-regs-official--title-15--11#10.0}

Regulation Food Code, with the exception that kitchens in facilities located in an occupied dwelling that are licensed for 13 or more children need not have a separate kitchen to serve the child care facility. 7. All kitchens and/or food/snack preparation areas in a child care facility shall be inspected as part of the child care inspection process.

**History**
- *Source: Miss. Code Ann. §43-20-8.*

##### **15 Miss. Admin. Code Pt. 11, R. 1.11.5** Toilets and Hand Washing Lavatories 1 {#sec-11-1.11.5 omnilex-key=us-ms-regs-official--title-15--11#1.11.5}

Toilets and hand washing lavatories shall be located within the physical confines of child care facility and shall be convenient to outside playground areas. 2. The following ratios shall apply: Toilets, urinals, and hand washing lavatories shall be apportioned at a ratio of 1:15. Urinals shall not exceed 33 percent of the total required toilet fixtures. When the number of children in the ratio is exceeded by one, an additional fixture shall be required. 3. The hand washing lavatories located in a diapering area shall not be included in the ratio of hand washing lavatories to children for determining a child care facility's capacity. Diaper changing sinks shall not be used for any other purpose such as, but not limited to, rinsing or washing baby bottles, pacifiers, teething rings, or for food preparation. 4. All hand washing lavatories shall have both hot and cold running water. Hot water temperature shall not exceed 120 degrees Fahrenheit. 5. Toilets, urinals, hand washing lavatories, and sinks shall be clean and operational. Bathrooms, hand washing lavatories, and sinks shall be supplied with soap, and individual towels for drying hands. Each toilet shall be supplied with toilet paper.

**History**
- *Source: Miss. Code Ann. §43-20-8.*

##### **15 Miss. Admin. Code Pt. 11, R. 1.11.6** Rule 1.11.6 {#sec-11-1.11.6 omnilex-key=us-ms-regs-official--title-15--11#1.11.6}

Water The water supply shall be from a public water system or a private system approved by the Mississippi State Department of Health. Water shall be dispensed by the following: 1. Fountain. 2. Disposable paper cups. 3. Labeled cup for each child, which shall be washed and sanitized daily.

**History**
- *Source: Miss. Code Ann. §43-20-8.*

##### **15 Miss. Admin. Code Pt. 11, R. 1.11.7** Exits {#sec-11-1.11.7 omnilex-key=us-ms-regs-official--title-15--11#1.11.7}

1. At least two separate exit doors shall be provided from every floor level. 2. Exit doors shall be remote from each other. 3. Dead end corridors shall not exceed 20 feet in length. 4. Exit doors necessitating passage through a kitchen shall not be counted as one of the two remote exits. 5. Exit doors shall be a minimum of 32 inches wide and open outward. No single leaf in an exit door shall be less than 28 inches wide or more than 48 inches wide. 6. Any latch or other fastening device on an exit door shall be provided with a knob, handle, panic bar, or other simple type of releasing device. Dual action door fasteners are not permitted. 7. The force required to open fully exit doors shall not exceed 50 pounds applied to the latch stile (panic bar). 8. An exit door shall not reduce the effective width of a landing.

**History**
- *Source: Miss. Code Ann. §43-20-8.*

##### **15 Miss. Admin. Code Pt. 11, R. 1.11.8** Heating, Cooling, and Ventilation 1 {#sec-11-1.11.8 omnilex-key=us-ms-regs-official--title-15--11#1.11.8}

A draft-free seasonally appropriate temperature of 65 degrees Fahrenheit to 78 degrees Fahrenheit shall be maintained. 2. All rooms used by children shall be heated, cooled, and adequately ventilated to maintain the required temperatures, and air exchange, and to avoid the accumulation of objectionable odors and harmful fumes. 3. Ventilation may be in the form of openable windows as specified in these regulations. 4. Areas where art and craft activities are conducted shall be well ventilated. In areas where substances are used that create toxic fumes, exhaust hood systems or other devices shall be installed. 5. Electric fans, if used, shall be mounted high on the wall or ceiling or shall be guarded to limit the size of the opening in the blade guard to less than one-half (½) inch. 6. When air-cooling is needed, draft-free cooling units shall be used. They shall present no safety hazard to the children. 7. Filters on recirculation systems shall be checked and cleaned or replaced monthly. 8. Window draft deflectors shall be provided if necessary. 9. Thermometers that do not present a hazard to children shall be

placed on interior walls in every activity area at children's height. 10. Portable, open flame and kerosene space heaters are prohibited. Portable gas stoves shall not be used for heating. 11. Electric space heaters shall be UL-approved; inaccessible to children; and stable; shall have protective covering; and shall be placed at least three feet from curtains, papers, and furniture. 12. Fireplaces and fireplace inserts shall be screened securely or equipped with protective guards while in use. They shall be properly drafted. The child care facility shall provide evidence of cleaning the chimney at least once a year, or as frequently as necessary to prevent excessive buildup of combustibles in the chimney. Records of chimney cleaning shall be retained in the center files. 13. Heating units that utilize gas shall be installed and maintained in accordance with the manufacturer’s instructions, are vented properly to the outside, and be supplied with sufficient combustion air as required by the International Fuel Gas Code. 14. If the area of the state where the facility is located does not utilize the International Fuel Gas Code, the installation and maintenance of any heating units that utilize gas shall be in accordance with the manufacturer’s instructions and any local ordinances that apply. 15. It is the responsibility of the licensee to provide to the licensing authority documentation that the heating units meet the above stated standards. 16. Heating units, including water pipes and baseboard heaters hotter than 110 degrees Fahrenheit, shall be made inaccessible to children by barriers such as guards or other devices.

**History**
- *Source: Miss. Code Ann. §43-20-8.*

##### **15 Miss. Admin. Code Pt. 11, R. 1.11.9** Outdoor Playground Area All licensed child care facilities are required to have an adequate outdoor playground area {#sec-11-1.11.9 omnilex-key=us-ms-regs-official--title-15--11#1.11.9}

All playgrounds and playground equipment intended for use by children 2-12 years of age shall meet the standards set forth in the Handbook for Public Playground Safety, Publication No. 325, published by the U.S. Consumer Product Safety Commission. 1. The child care facility shall be equipped with an outdoor playground area that directly adjoins the indoor facilities or that can be reached by a route free of hazards and is no farther than 1/8 mile (660 feet) from the child care facility. The outdoor playground area shall comprise a minimum of 75 square feet for each child using the outdoor playground area at any one time. 2. The total outdoor playground area shall accommodate at least 33 percent of the licensed capacity at one time.

3. A rooftop used as an outdoor playground area shall be enclosed with a fence not less than six feet high and designed to prevent children from climbing it. An approved fire escape shall lead from the roof to an open space at the ground level that meets safety standards for outdoor playground areas. 4. The outdoor playground area shall be well arranged so that all areas are visible to staff at all times. 5. The outdoor playground area shall be free of hazards and not less than 30 feet (measured horizontally parallel to the ground) from electrical transformers, high- voltage power lines, electrical substations, railroad tracks, or sources of toxic fumes or gases. Hazards, including but not limited to air conditioner units and utility mains, meters, tanks, and/or cabling shall be inaccessible to children. Fencing at least four feet high shall be provided around the outdoor playground area. Fencing higher than four feet but not to exceed eight feet may be required if the licensing authority determines that a hazard exists. Fencing twist wires and bolts shall face away from the playground. As an alternative, exposed bolt ends may be cut to no more than two exposed threads. Then the bolt ends shall be ground/sanded smooth or capped. 6. Outdoor playground areas shall be free from unprotected swimming and wading pools, ditches, quarries, canals, excavations, fishponds, or other bodies of water. 7. Sunlit areas and shaded areas shall be provided by means of open space and tree plantings or other cover in outdoor spaces. Outdoor spaces shall be laid out to ensure ample shaded space for each child. 8. The outdoor playground area shall be enclosed with a fence. The fence shall be at least four feet in height and the bottom edge shall be no more than three and

one-half (3½) inches off the ground. There shall be at least two exits from such areas, with at least one remote from the buildings. The gate latch or securing device shall be high enough or of such a type that it cannot be opened by small children. The openings in the fence shall be no greater than three and one-half (3½) inches, e.g., between the building and the fence. The fence shall be constructed to discourage climbing. 9. The soil in outdoor playground areas shall not contain hazardous levels of any toxic chemical or substances. The child care facility shall have soil samples and analyses performed where there is good reason to believe a problem may exist. 10. The soil in outdoor playground areas shall be analyzed for lead content initially. It shall be analyzed at least once every two years where the exteriors of adjacent buildings and structures are painted with lead- containing paint. Lead in soil shall not exceed 400 ppm. Testing and analyses shall be in accordance with procedures specified by the licensing agency.

**History**
- *Source: Miss. Code Ann. §43-20-8.*

##### **15 Miss. Admin. Code Pt. 11, R. 1.11.10** Rule 1.11.10 {#sec-11-1.11.10 omnilex-key=us-ms-regs-official--title-15--11#1.11.10}

Indoor Playground Area In addition to the required outdoor playground area a licensed child care facility may also provide an indoor playground area. Child care facilities licensed prior to July 1, 2009 that have been granted permission to have an indoor playground area in lieu of an outdoor playground area shall be not be required to have an outdoor playground. However, it is highly recommended that if possible an outdoor playground area should also be provided. For child care facilities which provide such an indoor playground area the following items apply: 1. The total indoor playground area shall accommodate at least 33 percent of the licensed capacity at one time. 2. The indoor playground area shall be well arranged so that all areas are visible to staff at all times. 3. The indoor playground area shall be free of hazards. 4. Indoor playground areas shall be laid out to ensure ample clearance space for the use of each item: nine feet around fixed items and 15 feet around any moving part. Equipment shall be situated so that clearance space allocated to one piece of equipment does not encroach on that of another piece of equipment. 5. Swings shall have a clearance area of nine feet in all directions beyond the swing beam. 6. All fixed playground equipment shall have a minimum of nine feet clearance space from walkways and other structures that are not used as part of play activities.

7. All equipment shall be arranged so that children playing on one piece of equipment will not interfere with children playing on or running to another piece of equipment. 8. Moving equipment (e.g., swings, merry-go-rounds) shall be located toward the edge or corner of an indoor playground area or shall be designed in such a way as to discourage children from running into the path of moving equipment. 9. All pieces of indoor playground equipment shall be surrounded by a resilient surface of an acceptable depth or by rubber mats manufactured for such use, consistent with the guidelines of the Consumer Product Safety Commission, and the Standard of the American Society for Testing and Materials, extending beyond the external limits of the piece of equipment for at least four feet beyond the fall zone of the equipment. These resilient surfaces shall conform to the standard stating that the impact from falling from the height of the structure will be less than or equal to peak deceleration 200G. Organic materials that support colonization of molds and bacteria shall not be used. 10. Indoor space designated as playground may be used by other individuals when the area is not in use by children attending the facility. However, children of the child care facility shall have priority use of the indoor playground area and the area may not be used by others when children are using it. The indoor playground space shall not count as additional classroom space when determining the maximum capacity of the facility.

**History**
- *Source: Miss. Code Ann. §43-20-8.*

##### **15 Miss. Admin. Code Pt. 11, R. 1.11.11** Grounds 1 {#sec-11-1.11.11 omnilex-key=us-ms-regs-official--title-15--11#1.11.11}

The grounds, including the outdoor playground area, shall be free of hazardous or potentially hazardous objects. 2. In-ground swimming pools are prohibited unless protected by a six- foot fence and a locked gate. All fencing shall be placed at a minimum five feet from the pool edge. 3. Above ground pools, including decking and pool structures, are prohibited unless protected by a six-foot fence and a locked gate. All fencing shall be placed at a minimum ten feet from the pool/deck edge. 4. All paved surfaces shall be well drained to avoid water accumulation and ice formation. 5. All walking surfaces, such as walkways, ramps, and decks, shall have a non- slip finish, and shall be free of holes and sudden irregularities in the surface.

**History**
- *Source: Miss. Code Ann. §43-20-8.*

##### **15 Miss. Admin. Code Pt. 11, R. 1.11.12** Rule 1.11.12 {#sec-11-1.11.12 omnilex-key=us-ms-regs-official--title-15--11#1.11.12}

Garbage Removal Garbage and trash shall be removed from the child care facility daily and from the grounds at least once a week. Garbage and trash shall be stored inaccessible to the children, and in insect and rodent resistant containers.

**History**
- *Source: Miss. Code Ann. §43-20-8.*

##### **15 Miss. Admin. Code Pt. 11, R. 1.11.13** Rule 1.11.13 {#sec-11-1.11.13 omnilex-key=us-ms-regs-official--title-15--11#1.11.13}

Environmental Health The child care facility shall comply with all regulations promulgated by the Division of Sanitation of the Mississippi Department of Health for: 1. Food Service. 2. On-site Wastewater Systems. 3. Vector (pest) Control.

**History**
- *Source: Miss. Code Ann. §43-20-8.*

##### **15 Miss. Admin. Code Pt. 11, R. 1.11.14** Rule 1.11.14 {#sec-11-1.11.14 omnilex-key=us-ms-regs-official--title-15--11#1.11.14}

Pest Control All child care facilities are to use a contractor licensed by the State of Mississippi to control pests, e.g., rats, mice, insects, etc. Before a pest control contractor is used, it is the responsibility of the operator to ensure that the pest control contractor is properly licensed. Use of agricultural chemicals for pest control is strictly prohibited.

Subchapter 12: HEALTH, HYGIENE, AND SAFETY Rule 1.12.1 Employee Health 1. Employees manifesting symptoms or otherwise suspected of having upper respiratory, gastrointestinal, skin, or other serious contagious conditions shall be excluded from work until either free from symptoms or certified by a physician to be no longer infectious. 2. Staff shall use universal precautions when changing diapers or being exposed to biocontaminants to include blood, body fluids, or excretions that may spread infectious disease. Refer to Caring for Our Children: National Health and Safety Performance Standards for guidelines on cleaning bodily fluids. 3. Staff shall follow the procedures noted on the MSDH Handwashing website to prevent the spread of infection.

.

**History**
- *Source: Miss. Code Ann. §43-20-8.*
- *Source: Miss. Code Ann. §43-20-8.*

##### **15 Miss. Admin. Code Pt. 11, R. 1.12.2** Child Health 1 {#sec-11-1.12.2 omnilex-key=us-ms-regs-official--title-15--11#1.12.2}

A child who is suspected of having a serious contagious condition shall be isolated and returned to the parent as soon as possible. 2. A child having a serious contagious condition shall not be allowed to return to the child care facility until they have been certified by a physician to be no longer contagious. 3. Parents of all children shall be notified of a contagious illness in the child care facility as soon as possible. 4. A child with a physical injury shall be treated by a staff member with valid first aid certificate issued by an agent recognized by the licensing authority. A child with a serious physical injury shall be treated by a staff member with valid first aid certificate issued by an agent recognized by the licensing authority and transported to a hospital or medical facility as soon as appropriate.

**History**
- *Source: Miss. Code Ann. §43-20-8.*

##### **15 Miss. Admin. Code Pt. 11, R. 1.12.3** Child Hygiene 1 {#sec-11-1.12.3 omnilex-key=us-ms-regs-official--title-15--11#1.12.3}

A child's wet or soiled clothing shall be changed immediately. 2. A child's hands shall be washed: a. Immediately before and after eating. b. After using the toilet or having their diapers changed. c. After playing on the playground. d. After handling pets, pet cages, or other pet objects.

e. Whenever hands are visibly dirty. f. Before going home. 3. A child shall have a shower, tub, or sponge bath to

.

ensure bodily cleanliness when necessary. 4. Individual toilet articles (e.g., combs, brushes, toothbrushes, towels, and wash cloths) used by children shall be provided by the parent or child care facility and plainly marked and stored individually in a sanitary manner in areas which promote drying. Single use and disposable articles are acceptable. Grooming accessories, including but not limited to brushes, combs, barrettes, or picks, shall not be used jointly by children or on children.

**History**
- *Source: Miss. Code Ann. §43-20-8.*

##### **15 Miss. Admin. Code Pt. 11, R. 1.12.4** Toys and Equipment Toys and equipment used by infants or toddlers shall be cleansed daily with a germicidal solution {#sec-11-1.12.4 omnilex-key=us-ms-regs-official--title-15--11#1.12.4}

A resource regarding sanitation of equipment and toys can be located on the National Resource Center for Health and Safety in Child Care and Early Education website. Chapter 3: Health Promotion and Protection; Cleaning, Sanitizing, and Disinfecting (nrckids.org).

**History**
- *Source: Miss. Code Ann. §43-20-8.*

##### **15 Miss. Admin. Code Pt. 11, R. 1.12.5** First Aid Supply 1 {#sec-11-1.12.5 omnilex-key=us-ms-regs-official--title-15--11#1.12.5}

A first aid supply shall be kept on-site and easily accessible to employees, but not in reach of the children. 2. A first aid supply shall be taken on all field trips and excursions and shall be easily accessible to employees, but not in reach of the children. 3. Medicine shall be kept out of the reach of the children. 4. All vehicles used by the facility in transporting children shall be equipped with a first aid kit. 5. It is recommended that first aid kits contain at a minimum the following items: scissors; tweezers; gauze pads; adhesive tape; thermometer; band-aids, assorted sizes; antibacterial ointment; insect-sting preparation; an antiseptic cleansing solution; triangular bandages; rubber gloves; protective eye wear; a protective face mask; and cold pack. The first aid kit, together with a first aid instruction manual which must be always kept with the

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kit, shall be stored so that it is not accessible to children but is easily accessible to employees. 6. All first aid kits should be periodically inspected for contents. Depleted and out of date materials should be replaced. 7. Special attention should be exercised when utilizing first aid supplies or any medication for children who have allergies or other special medical needs. 8. For additional information on supplies for first aid kits contact your local office of the American Red Cross.

**History**
- *Source: Miss. Code Ann. §43-20-8.*

##### **15 Miss. Admin. Code Pt. 11, R. 1.12.6** Animals and Pets 1 {#sec-11-1.12.6 omnilex-key=us-ms-regs-official--title-15--11#1.12.6}

Any pet or animal present at a child care facility, indoors or outdoors, shall be in good health, show no evidence of carrying any disease, and be a friendly companion for the children. 2. Dogs or cats, where allowed, shall be immunized for any disease that can be transmitted to humans, and shall be maintained on a flea, tick, and worm control program. 3. All pets shall be cared for as recommended by the regulating health agency. When pets are kept at the child care facility, procedures for their care and maintenance shall be written and followed. When immunizations are required, proof of current compliance signed by a veterinarian shall be on file at the child care facility where the pet is kept. a. A caregiver shall always be present when children are exposed to animals (including dogs and cats). Children shall be instructed on safe procedures to follow when in close proximity to these animals (e.g., not to provoke or startle them or remove their food). Potentially aggressive animals (e.g., pit bulls, boxers, etc.) shall not be in the same physical space with the children.

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b. Each child’s hands shall be properly washed after being exposed to animals.

Subchapter 13: General Nutritional Standards: Proper nutrition and healthy eating habits are essential to a child's overall development, as well as their long-term health. Cultivating healthy habits by choosing a variety of well-planned, balanced meals and snacks helps lower the risk of chronic disease and supports a healthy, active lifestyle.

**History**
- *Source: Miss. Code Ann. §43-20-8.*
- *Source: Miss. Code Ann. §43-20-8.*

##### **15 Miss. Admin. Code Pt. 11, R. 1.13.1** Rule 1.13.1 {#sec-11-1.13.1 omnilex-key=us-ms-regs-official--title-15--11#1.13.1}

Meals and Snacks: All meals and snacks served to children in a child care center shall comply with the Meal Patterns for Children in Child Care Programs from the United States Department of Agriculture (USDA). The types of food, number and size of servings shall be appropriate for the ages and developmental levels of the children in care. The Meal Patterns for Children in Child Care Programs are incorporated by reference and offer a minimum standard by which a facility shall follow. A copy of the Meal Patterns for Children in Child Care Programs is available online at Nutrition Standards for CACFP Meals and Snacks | Food and Nutrition Service. When children bring their own food for meals or snacks to the center, if the food does not meet the nutritional requirements specified above, the center must provide a food substitution necessary to meet the minimum requirements.

**History**
- *Source: Miss. Code Ann. §43-20-8.*

##### **15 Miss. Admin. Code Pt. 11, R. 1.13.2** Rule 1.13.2 {#sec-11-1.13.2 omnilex-key=us-ms-regs-official--title-15--11#1.13.2}

Feeding Infants and Children: A signed written feeding plan for children less than one (1) year of age shall be obtained from Parent(s). Instructions from the parent(s) shall be updated 2x annually or as new foods are added, or as other dietary changes are made. The feeding plan shall be posted in the child's assigned room and must include the child's feeding schedule, the amount of formula or breast milk to be given, instructions for the introduction of solid foods, the amount of food to be given and notation of any type(s) of commercially premixed formula which may not be used in an emergency because of food allergies. 1. Employees shall wash their hands prior to preparing or serving food. 2. Center personnel shall hold and feed infants less than six (6) months of age and older children/infants who require assistance with feeding. Baby bottles shall never be propped; the infant's

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head shall be elevated while feeding. 3. Honey shall not be served to children less than one (1) year of age. 4. Age-appropriate solid foods (including cereal) shall not be given to infants or children less than one (1) year of age until recommended as developmentally appropriate by the child’s primary care physician and indicated in writing by the Parent(s). As soon as the feeding plan indicates that a child is ready for solid foods, the child shall be fed from individual spoons and individual containers or dishes. A child shall not be fed directly from the original baby food container if the contents are to be fed to the child at more than one (1) meal. 5. As soon as the child exhibits a desire to feed him/herself, the child shall be assisted and encouraged to use their fingers for self-feeding, eat with a spoon, and drink from individual cups. 6. The Center shall encourage and support breastfeeding. Centers shall have a designated area set aside for breastfeeding mothers to breastfeed. 7. Food for infants or children less than one (1) year of age shall be cut into pieces one-quarter inch or smaller, and food for toddlers shall be cut into pieces one-half inch or smaller to prevent choking. 8. Center Personnel shall ensure that children do not have excessive amounts of food in their mouths while eating and are chewing their food appropriately to prevent instances of choking. 9. Children shall always be seated when eating and shall not be allowed to lie down or be put to sleep while food is present in their mouths.

**History**
- *Source: Miss. Code Ann. §43-20-8.*

##### **15 Miss. Admin. Code Pt. 11, R. 1.13.3** Baby Bottles and Formula: All baby bottles shall be clearly labeled with the individual child's name and date {#sec-11-1.13.3 omnilex-key=us-ms-regs-official--title-15--11#1.13.3}

Formula or breast milk shall be supplied by the Parent daily in bottles. Only the current day's formula or breast milk shall be served. Bottles shall be

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refrigerated at a temperature of forty-one (41) degrees Fahrenheit or less. If formula must be provided by the Center, only commercially prepared, ready-to-feed formula shall be used. Refrigerated or frozen breast milk shall only be heated or thawed under warm running water or in a container of warm water. Do not use microwaves to heat breast milk or formula.

**History**
- *Source: Miss. Code Ann. §43-20-8.*

##### **15 Miss. Admin. Code Pt. 11, R. 1.13.4** Rule 1.13.4 {#sec-11-1.13.4 omnilex-key=us-ms-regs-official--title-15--11#1.13.4}

Feeding Chairs: A feeding chair or similar equipment designed for feeding children shall be provided for the use of each child being fed who can sit up but who is unable to sit unassisted at a table. The chair or similar equipment must be cleaned with a disinfectant after each use. Such chair or similar equipment shall have a broad base to prevent tipping; a surface that the child cannot raise; a strap or other device which prevents the child from sliding out of the chair; and a feeding surface free of cracks.

**History**
- *Source: Miss. Code Ann. §43-20-8.*

##### **15 Miss. Admin. Code Pt. 11, R. 1.13.5** Menus: The Center shall provide a menu listing all meals and snacks to be served during the current week {#sec-11-1.13.5 omnilex-key=us-ms-regs-official--title-15--11#1.13.5}

Meal and/or snack substitutions shall be recorded on the posted menu. Menus shall be retained at the Center for six (6) months. Use the following when planning menus: 1. Offer a variety of nutrient dense foods. 2. Serve meals and snacks that help maintain a healthy weight. 3. Serve a variety of vegetables, fruits, and whole grain-rich products.

4. Avoid foods high in sugar and saturated fat. Limit fried food to one time e a c h w e e k .

5. Limit high sodium products and the use of added salt.

6. Promote and encourage daily physical activity.

**History**
- *Source: Miss. Code Ann. §43-20-8.*

##### **15 Miss. Admin. Code Pt. 11, R. 1.13.6** Meal Service: Children shall be served all meals and snacks scheduled for the period during which they are present {#sec-11-1.13.6 omnilex-key=us-ms-regs-official--title-15--11#1.13.6}

Meals and snacks shall be scheduled and served by the Center when

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appropriate: breakfast or a morning snack, lunch, an afternoon snack, supper if the Center operates evening care and an evening snack prior to bed time if a Center operates night time care. In those Centers where the Parent(s) of children enrolled provide the meals and snacks, the Center shall ensure that no child remains at the Center without receiving the scheduled nutritious meals and snacks. 1. There shall be a period of at least two (2) hours and no more than four (4) hours between each required meal or snack. 2. Food and beverages shall be served in individual plates or bowls and with individual glasses or cups. 3. Children shall be encouraged but not forced to eat. 4. Caregivers shall not use food to punish or reward children. 5. Children shall be given necessary assistance in feeding and encouraged to develop good nutritional habits. 6. Hot food shall not be served at a temperature which would cause the children to burn their mouths upon consuming the food. 7. Drinking water shall be offered to all children regularly throughout the day, including during meals and snacks, as well as before, during, and after physical activity. 8. Meals shall be served at tables where each child may be seated. 9. Children shall not share food. 10. Each individual child’s lunch brought from home shall be clearly labeled with the child’s name and date. 11. All food brought from home shall be stored at an appropriate temperature until eaten.

**History**
- *Source: Miss. Code Ann. §43-20-8.*

##### **15 Miss. Admin. Code Pt. 11, R. 1.13.7** Restrictions: Food shall be served according to the manufacturer’s instructions and recommendations {#sec-11-1.13.7 omnilex-key=us-ms-regs-official--title-15--11#1.13.7}

Foods that are associated with young children’s choking incidents, such as, but not limited to, peanuts, hot dogs, raw carrots, popcorn, fish with bones, cheese cubes, grapes, chunks of peanut butter, and any other food that

.

is of similar shape and size of the trachea/windpipe shall not be served to children less than four (4) years of age. Children older than four (4) years of age may be served these foods provided that the food is cut in such a way as to minimize choking. Food shall not be accessible or served to children until it has been chopped, diced, cut or mashed and is appropriate for each child’s age and individual eating, chewing and swallowing ability.

**History**
- *Source: Miss. Code Ann. §43-20-8.*

##### **15 Miss. Admin. Code Pt. 11, R. 1.13.8** Rule 1.13.8 {#sec-11-1.13.8 omnilex-key=us-ms-regs-official--title-15--11#1.13.8}

Beverages: Food and drink with little or no nutritional value, i.e., sweets, soft drinks, sport drinks, fruit-flavored drinks, artificially sweetened drinks, etc. shall be served only on special occasions and only in addition to the required nutritious meals and snacks. Breast milk or formula is served until 12 months of age at each meal and/or snack. Twelve-twenty-four month olds must be offered whole milk at each meal and/or snack, while children aged two and older must be provided non-fat or 1% milk. Powdered nonfat dry milk shall only be used for cooking purposes.

**History**
- *Source: Miss. Code Ann. §43-20-8.*

##### **15 Miss. Admin. Code Pt. 11, R. 1.13.9** Rule 1.13.9 {#sec-11-1.13.9 omnilex-key=us-ms-regs-official--title-15--11#1.13.9}

Modified Diets: When a child requires a modified diet for medical reasons, a written statement from a physician, RDN, or physician assistant shall be on file. When a child requires a modified diet for religious reasons, a written statement to that effect from the child's Parent(s) shall be on file. All caregiver personnel shall be informed of the diet restrictions for the child and only food that complies with the prescribed dietary regimen but still meets the food and nutrition requirements shall be served to the child.

**History**
- *Source: Miss. Code Ann. §43-20-8.*

##### **15 Miss. Admin. Code Pt. 11, R. 1.13.10** Rule 1.13.10 {#sec-11-1.13.10 omnilex-key=us-ms-regs-official--title-15--11#1.13.10}

Unconsumed Food: Any portions of food or drink which are served to children or placed on the table for service and are not consumed at that meal or snack by the children to whom the portions are served shall be thrown away. Any formula or breast milk remaining one hour from the beginning of the feeding shall be discarded or returned to Parent(s).

**History**
- *Source: Miss. Code Ann. §43-20-8.*

##### **15 Miss. Admin. Code Pt. 11, R. 1.13.11** Rule 1.13.11 {#sec-11-1.13.11 omnilex-key=us-ms-regs-official--title-15--11#1.13.11}

Catered Food: Food purchased from a caterer shall be prepared in a facility with a current food service permit and shall be maintained at a safe temperature until served. [Forty-one (41) degrees Fahrenheit or below for foods requiring refrigeration or one hundred forty (140) degrees Fahrenheit for foods which must be heated prior to

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serving].

**History**
- *Source: Miss. Code Ann. §43-20-8.*

##### **15 Miss. Admin. Code Pt. 11, R. 1.13.12** Vending Machines: Soft drink or snack vending shall not be maintained on Center premises for children's use {#sec-11-1.13.12 omnilex-key=us-ms-regs-official--title-15--11#1.13.12}

Vending machines and dispensers for staff shall be outside of the children's areas. Rule 1.13.13 Food Safety and Food Manager 1. All kitchens and/or food/snack preparation areas in a child care facility must be inspected as part of the child care inspection process. 2. Each child care facility must have a Certified Food Manager meeting the standards set forth in Rule 1.2.2 (1)(g) The only exception would be if two facilities had different operating hours. If this situation exists, then one Certified Food Manager could serve more than one facility and documentation to that effect must be in each facility’s file. 3. A Certified Food Manager shall be present during meal preparation. In the absence of the Certified Food Manager, an individual trained in food service must be present.

Citation: U.S. Department of Agriculture and U.S. Department of Health and Human Services. Dietary Guidelines for Americans, 2020- 2025. 9th Edition. December 2020. Available at DietaryGuidelines.gov.

Subchapter 14: DISCIPLINE AND GUIDANCE Rule 1.14.1 Prohibited Behavior The following behaviors are prohibited by anyone (i.e., parent, caregiver, or child) in all child care settings: 1. Corporal punishment, including hitting, spanking, beating, shaking, pinching, biting, and other measures that produce physical pain. 2. Withdrawal or the threat of withdrawal of food, rest, or bathroom opportunities.

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3. Abusive or profane language to include but not limited to yelling at, and/or using harsh tones toward the children or in close proximity (hearing distance) to children. 4. Any form of public or private humiliation, including threats of physical punishment. 5. Any form of emotional abuse, including rejecting, terrorizing, ignoring, isolating (out of view of a caregiver), or corrupting a child. 6. Use of any food product or medication in any manner or for any purpose other than that for which it was intended. 7. Inappropriate disciplinary behavior includes, but is not limited to, putting soap or pepper in a child's mouth. 8. Any acceptable disciplinary action that is not age- appropriate for the child or is excessive in time or duration.

**History**
- *Source: Miss. Code Ann. §43-20-8.*
- *Source: Miss. Code Ann. §43-20-8.*

##### **15 Miss. Admin. Code Pt. 11, R. 1.14.2** Rule 1.14.2 {#sec-11-1.14.2 omnilex-key=us-ms-regs-official--title-15--11#1.14.2}

Restraint of a Child Children shall not be physically restrained except as necessary to ensure their own safety or that of others, and then for only as long as is necessary for control of the situation. Children shall not be given medicines or drugs that will affect their behavior except as prescribed by a licensed physician and with specific written instructions from the licensed physician for use of the medicines or drugs.

**History**
- *Source: Miss. Code Ann. §43-20-8.*

##### **15 Miss. Admin. Code Pt. 11, R. 1.14.3** Rule 1.14.3 {#sec-11-1.14.3 omnilex-key=us-ms-regs-official--title-15--11#1.14.3}

Time Out "Time out" that enables the child to regain self-control and keeps the child in visual contact with a caregiver shall be used selectively, taking into account the child's developmental stage and the usefulness of "time out" for the particular child.“Time out” means that the child is given time away from an activity which involved inappropriate behavior. Isolation from a caregiver is not acceptable. “Time out” is not allowed for children younger than three years of age.

**History**
- *Source: Miss. Code Ann. §43-20-8.*

##### **15 Miss. Admin. Code Pt. 11, R. 1.14.4** Children Shall Not Discipline Other Children: {#sec-11-1.14.4 omnilex-key=us-ms-regs-official--title-15--11#1.14.4}

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Children shall neither be allowed nor be instructed to discipline other children.

Subchapter 15: TRANSPORTATION Rule 1.15.1 General Regardless of transportation provisions, the child care facility is responsible for the safety of the children.

**History**
- *Source: Miss. Code Ann. §43-20-8.*
- *Source: Miss. Code Ann. §43-20-8.*

##### **15 Miss. Admin. Code Pt. 11, R. 1.15.2** Requirements: 1 {#sec-11-1.15.2 omnilex-key=us-ms-regs-official--title-15--11#1.15.2}

All drivers are appropriately licensed. 2. All vehicles have current safety inspection stickers, licenses, and registrations. 3. Insurance adequately covers the transportation of children. 4. Children board or leave the vehicle from the curb-side of the street and/or are safely accompanied to their destinations. 5. A parent is present if the child is delivered home. 6. Seat restraints are used.

**History**
- *Source: Miss. Code Ann. §43-20-8..*

##### **15 Miss. Admin. Code Pt. 11, R. 1.15.3** Occupant Restraints 1 {#sec-11-1.15.3 omnilex-key=us-ms-regs-official--title-15--11#1.15.3}

All children will be properly restrained whenever they are being transported in a motor vehicle. a. Every person transporting a child under the age of four (4) years in a passenger motor vehicle, and operated on a public roadway, street or highway, shall provide for the protection of the child by properly using a child passenger restraint device or system meeting applicable federal motor vehicle safety standards, e.g., child safety seat. b. Every person transporting a child in a passenger motor vehicle operated on a public roadway, street or

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highway, shall provide for the protection of the child by properly using a belt positioning booster seat system meeting applicable federal motor vehicle safety standards if the child is at least four (4) years of age, but less than seven (7) years of age and measures less than four (4) feet nine (9) inches in height or weighs less than sixty-five (65) pounds. c. Any vehicle equipped with seatbelts is subject to the requirements in items a. and b. above. 2. No vehicle shall be occupied by more individuals than its rated capacity. 3. No children shall be transported in the front seat of vehicles equipped with passenger-side air bags. 4. All vehicles under 10,000 lbs. GVWR (Gross Vehicle Weight Rated) shall be equipped with occupant restraints appropriate for the age and/or weight of the children being transported. A child under the age of four shall be transported only if the child is securely fastened in a child safety seat that meets Federal Motor Vehicle Safety Standards (FMVSS, 49 CFR 571.213), which shall be indicated on the child safety seat. The child safety seat shall be appropriate to the child's weight and be installed and used according to the manufacturer's instructions. 5. Vehicles (e.g., school buses) with a GVWR 10,000 lbs. or more at a minimum shall meet the current Federal Motor Vehicle Safety Standards (FMVSS) for buses of that size. It is the responsibility of the child care facility operator to have documentation verifying that a bus meets the current FMVSS. NOTE: Federal Motor Vehicle Safety Standards (FMVSS) means the National Highway and Traffic Safety Administration's standards for motor vehicles and motor vehicle equipment established under Section 103 of the Motor Vehicle Safety Act of 1966 (49 CFR Part 571) as they apply to school buses.

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6. An individual seat restraint must be used for each child. The use of an individual seat restraint for two or more children is not allowed.

**History**
- *Source: Miss. Code Ann. §43-20-8.*

##### **15 Miss. Admin. Code Pt. 11, R. 1.15.4** Staff-to-Child Ratio 1 {#sec-11-1.15.4 omnilex-key=us-ms-regs-official--title-15--11#1.15.4}

On vehicles with a GVWR of less than 10,000 lbs., the staff-to-child ratio shall be maintained at all times. The driver of the vehicle shall not be counted as a caregiver while transporting the children. 2. On vehicles with at GVWR of 10,000 lbs. or more, the staff-to-child ratio shall be one caregiver to each 25 children or fraction thereof. The driver of the vehicle shall not be counted as a caregiver while transporting the children. In facilities that are dually licensed, i.e., licensed to provide care for both preschool and school age children, if the vehicle is only transporting school age children (no preschool children, infants, or toddlers are being transported), the driver may be counted as a caregiver while transporting the school age children.

Subchapter 16: DIAPERING AND TOILETING Rule 1.16.1 Diaper Changing Area Each room in which diaper- wearing children play shall contain a diapering area. A diapering area shall contain a hand washing lavatory with hot and cold running water, a smooth and easily cleanable surface, a plastic- lined, covered garbage receptacle, and sanitizing solution. The hand washing lavatories located in a diapering area shall not be included in the ratio of hand washing lavatories to children for determining a child care facility's capacity nor shall they be used for any other purpose. Example: The diaper-changing sink may not be used for washing/rinsing cups, baby bottles, food, dishes, utensils, pacifiers, etc. In addition, the diaper changing area is not to be used as a storage area for anything other than those items used when changing diapers, such as but not limited to, gloves, towels, soap, etc. Diapering changing procedures can be located in the following resource, National Resource Center for Health and Safety in Child Care and Early Education.

.

**History**
- *Source: Miss. Code Ann. §43-20-8.*
- *Source: Miss. Code Ann. §43-20-8.*

##### **15 Miss. Admin. Code Pt. 11, R. 1.16.2** Rule 1.16.2 {#sec-11-1.16.2 omnilex-key=us-ms-regs-official--title-15--11#1.16.2}

Non-Disposable Diapers and Training Pants The fecal contents of non- disposable diapers or training pants shall be disposed of into a toilet. The soiled non- disposable diaper or training pants shall then be placed into a plastic bag, sealed, and placed in the child's individual container.

**History**
- *Source: Miss. Code Ann. §43-20-8.*

##### **15 Miss. Admin. Code Pt. 11, R. 1.16.3** Rule 1.16.3 {#sec-11-1.16.3 omnilex-key=us-ms-regs-official--title-15--11#1.16.3}

Disposable Diapers Disposable diapers shall be placed into a plastic bag and sealed or shall be rolled up and taped securely, then placed into a plastic-lined covered garbage receptacle.

**History**
- *Source: Miss. Code Ann. §43-20-8.*

##### **15 Miss. Admin. Code Pt. 11, R. 1.16.4** Potty Chairs Potty chairs, if used, shall be placed in the bathroom area and sanitized after each child’s use {#sec-11-1.16.4 omnilex-key=us-ms-regs-official--title-15--11#1.16.4}

**History**
- *Source: Miss. Code Ann. §43-20-8.*

##### **15 Miss. Admin. Code Pt. 11, R. 1.16.5** Hand Washing Employees shall wash their hands with soap and running water before and after each diaper change {#sec-11-1.16.5 omnilex-key=us-ms-regs-official--title-15--11#1.16.5}

Individual or disposable towels shall be used for drying. Hand washing sinks at diaper changing stations shall not be used for any other purpose. Example: The diaper changing sink may not be used for washing cups, baby bottles, food, dishes, utensils, etc.

**History**
- *Source: Miss. Code Ann. §43-20-8.*

##### **15 Miss. Admin. Code Pt. 11, R. 1.16.6** Parental Consultation A parent caregiver consultation is required prior to toilet training {#sec-11-1.16.6 omnilex-key=us-ms-regs-official--title-15--11#1.16.6}

Subchapter 17: REST PERIODS Rule 1.17.1 Equipment Each child shall be placed on a separate bed, crib, cot, or mat. Cribs shall be labeled so that the child's name is visible.

**History**
- *Source: Miss. Code Ann. §43-20-8.*
- *Source: Miss. Code Ann. §43-20-8.*

##### **15 Miss. Admin. Code Pt. 11, R. 1.17.2** Cleaning of Linens and Bed Coverings Linens and bed coverings shall be changed immediately when soiled {#sec-11-1.17.2 omnilex-key=us-ms-regs-official--title-15--11#1.17.2}

All linens and bed coverings shall be changed, at a minimum, two times per week.

.

**History**
- *Source: Miss. Code Ann. §43-20-8.*

##### **15 Miss. Admin. Code Pt. 11, R. 1.17.3** Cleaning of Rest Period Equipment All rest period equipment shall be wiped clean immediately when soiled {#sec-11-1.17.3 omnilex-key=us-ms-regs-official--title-15--11#1.17.3}

All rest period equipment shall be cleaned twice a week with a germicidal solution. Additional cleaning may be required by the licensing authority if there is an outbreak of a communicable disease.

**History**
- *Source: Miss. Code Ann. §43-20-8.*

##### **15 Miss. Admin. Code Pt. 11, R. 1.17.4** Rule 1.17.4 {#sec-11-1.17.4 omnilex-key=us-ms-regs-official--title-15--11#1.17.4}

Sharing of Rest Period Equipment At no time will two or more children be allowed to share the same bed, crib, cot, or mat during their time of enrollment, unless it is cleaned with a germicidal solution between each child's use.

Subchapter 18: FEEDING OF INFANTS AND TODDLERS Rule 1.18.1 Hand Washing Employees shall wash their hands with soap and water, and dry their hands with individual or disposable towels, before and after each feeding. The infant and toddler's hands shall be washed with soap and water, and dried with individual or disposable towels, before and after each feeding.

**History**
- *Source: Miss. Code Ann. §43-20-8.*
- *Source: Miss. Code Ann. §43-20-8.*

##### **15 Miss. Admin. Code Pt. 11, R. 1.18.2** Bottle Feeding Infants shall be held while being bottle fed {#sec-11-1.18.2 omnilex-key=us-ms-regs-official--title-15--11#1.18.2}

Bottles shall not be propped at any time. With parental consent and when infants are old enough to hold their own bottles, they may feed themselves without being held. The bottle shall be removed at once when empty or when the child has fallen asleep.

**History**
- *Source: Miss. Code Ann. §43-20-8.*

##### **15 Miss. Admin. Code Pt. 11, R. 1.18.3** Formula Storage Formula shall be labeled with the child's name, dated, and placed in the refrigerator upon arrival {#sec-11-1.18.3 omnilex-key=us-ms-regs-official--title-15--11#1.18.3}

**History**
- *Source: Miss. Code Ann. §43-20-8.*

##### **15 Miss. Admin. Code Pt. 11, R. 1.18.4** Baby Food Any food left over from the serving dish shall be discarded {#sec-11-1.18.4 omnilex-key=us-ms-regs-official--title-15--11#1.18.4}

Leftovers remaining in a jar shall be labeled with the child's name, dated, refrigerated, and used within the next 24 hours or be discarded.

**History**
- *Source: Miss. Code Ann. §43-20-8.*

##### **15 Miss. Admin. Code Pt. 11, R. 1.18.5** Refrigerator A refrigerator shall be available and easily accessible to the infant or toddler's room(s) {#sec-11-1.18.5 omnilex-key=us-ms-regs-official--title-15--11#1.18.5}

.

**History**
- *Source: Miss. Code Ann. §43-20-8.*

##### **15 Miss. Admin. Code Pt. 11, R. 1.18.6** Heating Unit A heating unit for warming bottles and food shall be accessible only to adults {#sec-11-1.18.6 omnilex-key=us-ms-regs-official--title-15--11#1.18.6}

**History**
- *Source: Miss. Code Ann. §43-20-8.*

##### **15 Miss. Admin. Code Pt. 11, R. 1.18.7** Rule 1.18.7 {#sec-11-1.18.7 omnilex-key=us-ms-regs-official--title-15--11#1.18.7}

Breast-Feeding Accommodations and Staff Training This section applies to all mothers choosing to breast-feed their child regardless of the child’s age. 1. Breast-feeding mothers, including employees, shall be provided a sanitary place that is not a toilet stall to breast- feed their child or to express milk. This area shall provide an electrical outlet, comfortable chair, and nearby access to running water. 2. A refrigerator must be available to accommodate storage of expressed breast milk. It is acceptable to store expressed milk in the same refrigerator as other milk/bottles provided each bottle is appropriately labeled with the child’s name and the time of expected expiration of the milk. Milk must be stored in accordance with the American Academy of Pediatrics and Centers for Disease Control guidelines. Universal precautions are not required in handling human milk. 3. Child care staff shall be trained in the safe and proper storage and handling of human milk. Although other training materials may be utilized, training materials will be available through MSDH. Guidelines for Milk Storage and Use for All Infants

Storage Method and Temperature Maximum Amount of Time For Storage Room (25 C or 77 F) Refrigerator (4 C or 39 F) Previously thawed – Refrigerated milk Freezer (-20 C or 0 F) 4 hours 48 hours

##### **15 Miss. Admin. Code Pt. 11, R. 24** Rule 24 {#sec-11-24 omnilex-key=us-ms-regs-official--title-15--11#24}

hours 3 months From the ACOG/AAP publication: Breastfeeding Handbook for Physicians

Subchapter 19: SWIMMING AND WATER ACTIVITIES

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**History**
- *Source: Miss. Code Ann. §43-20-8.*

##### **15 Miss. Admin. Code Pt. 11, R. 1.19.1** Rule 1.19.1 {#sec-11-1.19.1 omnilex-key=us-ms-regs-official--title-15--11#1.19.1}

General This section shall apply to any child care facility that, as part of its program, allows the children to swim, wade, or participate in any water activities whether on site or at any other location during the time staff has responsibility for children enrolled.

**History**
- *Source: Miss. Code Ann. §43-20-8.*

##### **15 Miss. Admin. Code Pt. 11, R. 1.19.2** Lifeguard Supervision 1 {#sec-11-1.19.2 omnilex-key=us-ms-regs-official--title-15--11#1.19.2}

Swimming pools, lakes, etc. a. A person having an American Red Cross lifeguard certificate, or the equivalent as recognized by the licensing agency, shall be present at all swimming and water activities. b. One lifeguard is required for every 25 children or any portion thereof (i.e., two lifeguards are required for groups of 26 - 50, three for 51 - 75, etc.). This required ratio also includes activities that occur near water such as fishing or beach activities. c. Lifeguards are not counted in the staff-to-child ratio. d. The staff-to-child ratio shall be maintained at all times. e. It is the child care facility operator’s responsibility to provide adequate certified lifeguards if the pool or lake operator does not. f. Each child will be tested by a certified lifeguard prior to participating in swimming lessons or any pool activities. Children will be assigned to swim groups according to the results of the test. g. Staff, as well as lifeguards, shall be responsible for enforcing general safety rules. h. Staff is responsible for requiring children to obey all swimming/water rules. These rules shall be explained each day that swimming/water activities occur so that all ages can understand what is expected. 2. Wading pools For activities taking place in wading pools with a water depth of one foot or less the following is

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required: a. There shall be a person(s) with a valid Adult, Child/Infant CPR and First Aid certification present at all times. b. The staff-to-child ratio shall be maintained at all times. c. Wading pools shall be cleaned after each use.

**History**
- *Source: Miss. Code Ann. §43-20-8.*

##### **15 Miss. Admin. Code Pt. 11, R. 1.19.3** Health and Safety 1 {#sec-11-1.19.3 omnilex-key=us-ms-regs-official--title-15--11#1.19.3}

All piers, floats, and platforms shall be in good repair, and where applicable, the water depth shall be indicated by printed numerals on the deck or planking. 2. There shall be a minimum water depth of 10 feet for a one-meter diving board and 13 feet for a three-meter board or diving tower. 3. For outdoor swimming areas in natural bodies of water, the bottom shall be cleared of stumps, rocks, and other obstacles. 4. Diving boards shall be mounted on a firm foundation and never on an insecure base, such as a float that can be affected by shifting weight loads and wave action. The entire length of the top surface of diving boards shall be covered with nonskid material. The diving board shall be level. All diving boards shall be installed in accordance with manufacturer’s guidelines for the board by professional swimming pool installers who shall certify in writing to the facility that the diving board is adequately installed in accordance with manufacturer’s guidelines for the board, in a commercially reasonable manner, located so as to allow a child to safely enter the water from the diving board, and that the diving board is safe for its intended use. Facilities with existing pools equipped with diving boards that are unable to obtain the required certification within 60 days of the adoption of this regulation shall have the diving boards removed.

.

pH Minimum Free Available Residual Chlorine-mg/L

7.2. 0.40 7.3. 0.40 7.4. 0.40 7.5. 0.40 7.6. 0.50 7.7. 0.60 7.8. 0.70 7.9. 0.80 8.0. 1.00 5. Swimming pools, when in use, shall be continuously disinfected by a chemical that imparts an easily measured free available residual effect. When chlorine is used, a free chlorine residual of at least 0.4 ppm shall be maintained throughout the pool whenever it is open or in use. If other halogens are used, residuals of equivalent disinfecting strength shall be maintained. 6. A testing kit for measuring the concentration of the disinfectant, accurate within 0.1 ppm, shall be provided at each swimming pool. Swimming pool water shall be maintained in an alkaline condition as indicated by a pH of not less than 7.2 and not over 8.2. A pH testing kit accurate to the nearest 0.2 pH unit shall be provided at each swimming pool. The alkalinity of the water shall be at least 50 ppm, as measured by the methyl-orange test. The following chart may be used for reference:

7. If cyanuric acid is used to stabilize the free available residual chlorine, or if one of the chlorinated isocyanurate compounds is used as the disinfecting chemical in a swimming pool, the concentration of cyanuric acid in the water shall be at least 30 mg/L but shall not exceed 100 mg/L. The free available residual chlorine, of at least the following concentrations, depending upon the pH of the water, shall be maintained:

.

pH Minimum Free Available Residual Chlorine-mg/L

7.2 1.00 7.3 1.00 7.4 1.00 7.5 1.00 7.6 1.25 7.7 1.50 7.8 1.75 7.9 2.00 8.0 2.50

8. The water in a swimming pool shall have sufficient clarity at all times so that a black disk, six inches in diameter, is readily visible when placed on a white field at the deepest point of the pool. The pool shall be closed immediately if this requirement cannot be met. 9. For natural bodies of water (e.g., lakes, rivers, streams, etc.), sewage treatment plants or other discharge lines shall not be within 750 feet of swimming areas.

Subchapter 20: CHILDREN WITH SPECIAL NEEDS Rule 1.20.1 Facility Adaptation 1. The child care facility areas to be utilized by a child with special needs shall be adapted as necessary to accommodate special devices that may be required for the child to function independently, as appropriate. 2. A separate area shall be available for providing privacy for diapering, dressing, and other personal care procedures.

**History**
- *Source: Miss. Code Ann. §43-20-8.*
- *Source: Miss. Code Ann. §43-20-8.*

##### **15 Miss. Admin. Code Pt. 11, R. 1.20.2** Activity Plan A child with special needs shall have an individual activity plan {#sec-11-1.20.2 omnilex-key=us-ms-regs-official--title-15--11#1.20.2}

The individual activity plan shall have

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been developed by a person with a bachelor’s or advanced degree in a discipline dealing with disabilities, as appropriate. The individual activity plan shall be reviewed, at a minimum, once every 12 months.

**History**
- *Source: Miss. Code Ann. §43-20-8.*

##### **15 Miss. Admin. Code Pt. 11, R. 1.20.3** Rule 1.20.3 {#sec-11-1.20.3 omnilex-key=us-ms-regs-official--title-15--11#1.20.3}

Caregiver Staff Development Caregivers serving children with special needs shall receive staff development related to the specific needs of the children served.

**History**
- *Source: Miss. Code Ann. §43-20-8.*

##### **15 Miss. Admin. Code Pt. 11, R. 1.20.4** Rule 1.20.4 {#sec-11-1.20.4 omnilex-key=us-ms-regs-official--title-15--11#1.20.4}

Staffing Caregiver staffing shall be appropriate and adequate to meet the specific physical and/or developmental needs of the special needs children served at the child care facility. Staff-to-child ratio shall be determined by the needs of the child rather than the child’s chronological age as based upon the child’s individual plan (i.e., individual education plan, individual habilitation plan, individual family service plan, etc.). The facility is encouraged to be an active participant in the child’s individual plan development.

Subchapter 21: NIGHT CARE Rule 1.21.1 General This section shall apply to any child care facility that is open past 11:30 p.m., as part of their regular hours of operation.

**History**
- *Source: Miss. Code Ann. §43-20-8.*
- *Source: Miss. Code Ann. §43-20-8.*

##### **15 Miss. Admin. Code Pt. 11, R. 1.21.2** Nutrition 1 {#sec-11-1.21.2 omnilex-key=us-ms-regs-official--title-15--11#1.21.2}

A child care facility that is open prior to 7:00 p.m. shall provide a dinner meal period. 2. A child care facility that remains open after 5:00 a.m. shall provide a breakfast meal period. 3. A snack period shall be provided to children in attendance for more than two and one-half (2½) hours prior to bedtime. 4. Menu plans for lunch and dinner meals shall be varied. No single menu shall be repeated in a 24 hour period.

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**History**
- *Source: Miss. Code Ann. §43-20-8.*

##### **15 Miss. Admin. Code Pt. 11, R. 1.21.3** Sleeping 1 {#sec-11-1.21.3 omnilex-key=us-ms-regs-official--title-15--11#1.21.3}

Mats shall not be used for sleeping. 2. Bedtime schedules shall be established in consultation with the child's parent. 3. Provisions shall be made in sleeping areas for the use and storage of clothing and personal belongings and they shall be within easy reach of the child using them. 4. A child shall be provided with a bed or cot equipped with a comfortable mattress (a minimum of three inches thick), sheets, a pillow with a pillowcase, and a blanket. 5. The upper level of double-deck beds shall not be used for children under ten years of age. The upper level of double-deck beds are allowed for children ten years of age or older if a bed rail and safety ladder is provided. 6. Each child shall have clean and comfortable sleeping garments.

**History**
- *Source: Miss. Code Ann. §43-20-8.*

##### **15 Miss. Admin. Code Pt. 11, R. 1.21.4** Bathroom Facilities 1 {#sec-11-1.21.4 omnilex-key=us-ms-regs-official--title-15--11#1.21.4}

There shall be a bathtub or shower available for children of toddler age or older. 2. Bathtubs and showers shall be equipped to prevent slipping. 3. If night care is provided for infants, there shall be age appropriate bathing facilities for these children. 4. Bathrooms shall be located near the sleeping areas. 5. No children under six years of age shall be left alone or with another child while in the bathtub or shower. 6. All children shall be bathed separately. 7. All children shall be provided with an individual washcloth, towel, and soap for bathing, with fresh water for each child.

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Subchapter 22: SCHOOL AGE CARE & SUMMER DAY CAMP Rule 1.22.1 General For a child care facility operating pursuant to a license for "School Age Care,” or Summer Day Camp, the regulations for child care facilities shall apply, except when inconsistent with the requirements of this section and then the requirements of this section take precedence.

**History**
- *Source: Miss. Code Ann. §43-20-8.*
- *Source: Miss. Code Ann. §43-20-8.*

##### **15 Miss. Admin. Code Pt. 11, R. 1.22.2** Definition 1 {#sec-11-1.22.2 omnilex-key=us-ms-regs-official--title-15--11#1.22.2}

A summer day camp is defined as a child care facility serving children ages 5 to 12 that operates during May, June, July, and/or August only, for a minimum of 22 days and a maximum of 16 weeks. 2. A school age program is defined as a child care facility that operates during the school year serving children ages 5 to 12. These programs may also operate 12 months a year. School age programs that operate 12 months a year shall meet “School Age Program” space requirements for determining maximum capacity.

**History**
- *Source: Miss. Code Ann. §43-20-8.*

##### **15 Miss. Admin. Code Pt. 11, R. 1.22.3** Rule 1.22.3 {#sec-11-1.22.3 omnilex-key=us-ms-regs-official--title-15--11#1.22.3}

Indoor Square Footage and Grouping A minimum of 25 square feet of usable indoor floor space, per child per room, shall be maintained for each child. This shall not include hallways, bathrooms, closets, storage rooms, offices, or kitchens. When a room is used during meals time, the minimum square footage requirement will not apply. When children are placed in groups, the maximum group size shall be determined by the following chart

Age of Children in the Group MAXIMUM number of children ALLOWED in a group of children this age MINIMUM number of caregivers REQUIRED for a group of children this age MINIMUM square footage REQUIRED for a group of children this age 5-9 years 40 children 2 caregivers 25 square feet per child 10-12 years 50 children 2 caregivers 25 square feet per child

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1. When Summer Day Camp activities for children are routinely conducted outdoors or off the premises for six or more hours each day, the following requirements shall apply: a. There shall be a permanent structure that serves as a home base where parents deliver and pick up children. b. There shall be a minimum of ten square feet per child usable indoor space available in the event of inclement weather. 2. School age programs require that a minimum of 25 square feet of usable indoor floor space, per child per room shall be maintained for each child. This shall not include hallways, bathrooms, closets, storage rooms, offices, or kitchens. When a room is used for meals, the minimum square footage per child requirement will not apply.

**History**
- *Source: Miss. Code Ann. §43-20-8.*

##### **15 Miss. Admin. Code Pt. 11, R. 1.22.4** Nutrition 1 {#sec-11-1.22.4 omnilex-key=us-ms-regs-official--title-15--11#1.22.4}

In School Age and Summer Day Programs meals and/or snacks may be provided by parents/guardians. 2. Parents/Guardians must be given and adhere to the policies regarding acceptable nutritional standards, as in Subchapter 12. 3. When nutritional standards are not met by meals and/or snacks provided by the parent/guardian, it is the program’s responsibility to see that children are provided an acceptable meal and/or snack. 4. For Summer Day Camps operating primarily as an outdoor program, the following exceptions may apply: a. Milk is not required. b. If food is brought from home or catered, cold storage must be available.

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c. All School Age/Summer Day Programs shall have an adequate supply of potable fresh water from a Mississippi State Department of Health approved source.

**History**
- *Source: Miss. Code Ann. §43-20-8.*

##### **15 Miss. Admin. Code Pt. 11, R. 1.22.5** Transportation 1 {#sec-11-1.22.5 omnilex-key=us-ms-regs-official--title-15--11#1.22.5}

The staff-to-child ratio shall be maintained at all times. 2. The driver of the vehicle may be counted as a caregiver while transporting school age children only. 3. A licensed child care program must never leave children unattended inside or outside of a vehicle.

**History**
- *Source: Miss. Code Ann. §43-20-8.*

##### **15 Miss. Admin. Code Pt. 11, R. 1.22.6** Toilets and Lavatories 1 {#sec-11-1.22.6 omnilex-key=us-ms-regs-official--title-15--11#1.22.6}

For every thirty (30) children, one (1) toilet and one (1) lavatory is required. 2. Urinals shall count as one-half (½) a toilet. 3. Separate facilities for boys and girls shall be provided. 4. School age programs that are located in schools are exempt from the requirements of hot water at sinks utilized by the children in attendance.

**History**
- *Source: Miss. Code Ann. §43-20-8.*

##### **15 Miss. Admin. Code Pt. 11, R. 1.22.7** Rule 1.22.7 {#sec-11-1.22.7 omnilex-key=us-ms-regs-official--title-15--11#1.22.7}

Playgrounds: School age programs serving only school age children that are located in schools are exempt from the requirements Subchapter 9, Rule 1.9.2 Playground Equipment and Subchapter 10, rule 1.10.9 Indoor Playground Area of these regulations except that playground equipment shall be in good repair. Rule 1.22.8 In after school programs, screen time is limited to one hour per day. Screen or media used for educational purposes is acceptable.

**History**
- *Source: Miss. Code Ann. §43-20-8.*

##### **15 Miss. Admin. Code Pt. 11, R. 1.22.9** Summer Day Camp & School Age Program Director Qualifications 1 {#sec-11-1.22.9 omnilex-key=us-ms-regs-official--title-15--11#1.22.9}

A summer day camp director shall be at least 21 years of age, and

.

shall have, at a minimum: a. A bachelor's degree with a minimum of 18 semester hours in elementary or secondary education or a field such as recreation, physical education, psychology (with emphasis in child/adolescent psychology), or special education, or one related to day camp or school age program operations. OR b. A two-year associate degree in child development technology or related field. OR c. A Mississippi Department of Human Services Office for Children and Youth Director’s Child Care Credential, or 15 semester hours credit with a grade of “C” or better from an accredited college or university in courses listed in #1 above with an additional two years of experience as a caregiver or caregiver assistant in a licensed child care facility (Any college course(s) submitted for consideration are subject to approval by the licensing authority). OR d. A high school diploma or equivalent (GED) and four years’ experience in a school age program or four summers in a day camp program. 2. Transcripts shall be provided for review by the licensing agency.

**History**
- *Source: Miss. Code Ann. §43-20-8.*

##### **15 Miss. Admin. Code Pt. 11, R. 1.22.10** Caregiver CPR and First Aid Certification 1 {#sec-11-1.22.10 omnilex-key=us-ms-regs-official--title-15--11#1.22.10}

All caregivers in summer day camps are required to have current CPR and first aid certification, copies of which shall be kept with their personnel records. 2. In school age programs that operate in a central location there

.

shall be at least one caregiver on the premises at all times the facility is in operation that has a current certification in CPR and first aid. When groups of children are away from the central location for field trips etc., there shall be at least one caregiver with the group that holds a current certification in CPR and first aid.

**History**
- *Source: Miss. Code Ann. §43-20-8.*

##### **15 Miss. Admin. Code Pt. 11, R. 1.22.11** Facility Record Storage Facility records may be retained in the administrative office {#sec-11-1.22.11 omnilex-key=us-ms-regs-official--title-15--11#1.22.11}

**History**
- *Source: Miss. Code Ann. §43-20-8.*

##### **15 Miss. Admin. Code Pt. 11, R. 1.22.12** Rule 1.22.12 {#sec-11-1.22.12 omnilex-key=us-ms-regs-official--title-15--11#1.22.12}

Equipment Archery equipment, firearms (e.g., skeet shooting, target practice, etc.), power equipment, and other potentially hazardous items shall be stored in a locked area when not in use. These items shall be used by children only under the direction and supervision of a program staff member.

**History**
- *Source: Miss. Code Ann. §43-20-8.*

##### **15 Miss. Admin. Code Pt. 11, R. 1.22.13** Rule 1.22.13 {#sec-11-1.22.13 omnilex-key=us-ms-regs-official--title-15--11#1.22.13}

Immunization Requirements Children properly enrolled in a Summer Day Camp or School Age Program are not required to have a Certificate of Immunization Compliance (MSDH Form 121) in their record.

Subchapter 24: HOURLY CHILD CARE Rule 1.24.1 General For a child care facility operating pursuant to a license for an "Hourly Child Care,” the regulations for child care facilities shall apply, except when inconsistent with the requirements of this section, and then the requirements of this section take precedence.

**History**
- *Source: Miss. Code Ann. §43-20-8.*
- *Source: Miss. Code Ann. §43-20-8.*

##### **15 Miss. Admin. Code Pt. 11, R. 1.24.2** Definition 1 {#sec-11-1.24.2 omnilex-key=us-ms-regs-official--title-15--11#1.24.2}

An "Hourly Child Care Facility" is defined as a facility that meets the provisions of these regulations for a "Child Care Facility" and: a. Limits the care of a child to no more than eight hours per stay not to exceed a total of

.

##### **15 Miss. Admin. Code Pt. 11, R. 45** Rule 45 {#sec-11-45 omnilex-key=us-ms-regs-official--title-15--11#45}

hours in any calendar month period. b. Provides supervised, short term, hourly care on a temporary basis in conjunction with a specific facility or business complex such as, but not limited to, hotels; shopping malls; recreational, sporting, or entertainment facilities. 2. Hourly child care facilities are not appropriate for full time child care and will not be allowed to provide that type of service. When it is determined by the licensing agency that a facility provides child care services on a full time basis, the facility shall meet all requirements for a regular child care facility as set forth in the preceding sections of these regulations.

**History**
- *Source: Miss. Code Ann. §43-20-8.*

##### **15 Miss. Admin. Code Pt. 11, R. 1.24.3** Facility Policy and Procedures 1 {#sec-11-1.24.3 omnilex-key=us-ms-regs-official--title-15--11#1.24.3}

Parents shall be provided a written statement of policies pertaining to emergencies, meals, snacks, procedures for releasing a child to parent, and any other information regarding hourly child care facility operation. All policies and procedures will be submitted to the licensing agency and reviewed prior to a license being issued. Written guidelines will be provided to applicants as part of the application packet. 2. The care of a child shall be no more than eight hours per stay and shall not exceed a total of 45 hours in any calendar month period. 3. When business hours exceed 12 hours in a 24-hour period, the program will be reviewed on an individual basis for compliance with regulations addressing evening and overnight care.

**History**
- *Source: Miss. Code Ann. §43-20-8.*

##### **15 Miss. Admin. Code Pt. 11, R. 1.24.4** Rule 1.24.4 {#sec-11-1.24.4 omnilex-key=us-ms-regs-official--title-15--11#1.24.4}

Personnel Requirements Students in a field study placement, a practicum, or vocational child care training program may not assist in the care of the children in hourly child care facilities.

.

**History**
- *Source: Miss. Code Ann. §43-20-8.*

##### **15 Miss. Admin. Code Pt. 11, R. 1.24.5** Rule 1.24.5 {#sec-11-1.24.5 omnilex-key=us-ms-regs-official--title-15--11#1.24.5}

Records and Reports In addition to all records and reports required in these regulations, hourly child care facilities shall maintain a log containing the name, address, and home phone number of each child along with the date and time of arrival and departure. The hourly child care facility shall maintain information necessary to contact local law enforcement officials and the Mississippi Department of Human Services when a child is left at the facility past its hours of operation, or for an extended period.

**History**
- *Source: Miss. Code Ann. §43-20-8.*

##### **15 Miss. Admin. Code Pt. 11, R. 1.24.6** Rule 1.24.6 {#sec-11-1.24.6 omnilex-key=us-ms-regs-official--title-15--11#1.24.6}

Health Records Sample forms for duplication will be provided to operators to ensure adequate health information is taken on the children served. Only forms that substantially comply with the sample forms will be acceptable. Registration forms will include a signed statement that will serve as verification that a child has received all age-appropriate immunizations. Other information to be included on the form will be the home or forwarding phone numbers and addresses to be used when the parent must be informed of situations or conditions after the child is no longer at the hourly child care facility.

**History**
- *Source: Miss. Code Ann. §43-20-8.*

##### **15 Miss. Admin. Code Pt. 11, R. 1.24.7** Rule 1.24.7 {#sec-11-1.24.7 omnilex-key=us-ms-regs-official--title-15--11#1.24.7}

Program of Activities Hourly child care facility programs are exempt from the requirement that a planned written program of activities be submitted as part of the licensing process. However, the facility shall provide adequate space and equipment to allow children to choose between quiet and active play. Appropriate toys and books for quiet play shall be maintained in a physically separate area that is a sufficient distance from active play to reduce noise and to assure a quiet, relaxed environment.

**History**
- *Source: Miss. Code Ann. §43-20-8.*

##### **15 Miss. Admin. Code Pt. 11, R. 1.24.8** Buildings and Grounds 1 {#sec-11-1.24.8 omnilex-key=us-ms-regs-official--title-15--11#1.24.8}

A certificate of inspection and approval by the fire department of the municipality or other political subdivision in which the child care facility is located shall be submitted to the licensing agency with the application and license fee. Except that if no fire department exists where the facility is located, the State Fire Marshall shall certify as to the inspection for safety from fire hazards.

.

The inspection form to be used for fire inspections shall be MSDH Form #333 and shall be signed by a signatory authority of the fire inspection authority making the inspection. 2. In non-land-based facilities, only ground level space with exits directly to the outside will be approved. 3. A written emergency evacuation route shall be posted in a conspicuous location within each room used by children. The plan will be subject to review, evaluation, and approval by the licensing agency. 4. Space requirements shall comply with the standards set forth in these regulations. However, in the absence of adequate outdoor playground area, not less than 25 percent nor more than 50 percent of the space allocated for children three to 13 years of age shall be set aside and dedicated to large muscle development activities. Such areas shall contain appropriate play equipment for large muscle development. Such equipment may include but is not limited to indoor gyms specifically designed and approved for children in the three- to 13-year-old age group. Final approval of the appropriateness of the equipment to be located in the designated area shall be made by the licensing agency. 5. If outdoor playground space is provided, but inadequate for the maximum capacity of the building, a schedule shall be provided to show how outdoor playtime will be made available to all the children. At no time will there be more children on the playground than the maximum number allowed computed at 75 square feet per child. Maximum outdoor playground area capacity shall be posted and adhered to at all times the area is in use. 6. When kitchens are not on-site, the hourly child care facility is required to maintain adequate storage and refrigeration for snacks. In addition, food shall be served in disposable containers unless an acceptable method of dishwashing is available such as described in (Appendix B). All food served shall come from a permitted kitchen or catering facility. Food service shall comply with the standard

.

set in the current 10.0 Regulation Food Code as published by the Mississippi State Department of Health. 7. The ratio of one hand washing lavatory and one toilet for every 30 children shall be maintained. Separate facilities are required for boys and girls. 8. Facilities must meet the requirements of Rule 1.2.2 (1)(k) and Rule 1.11.1 (8) of these regulations. Referenced Rule 1.2.2 (1)(k) and Rule 1.11.1 (8) refer to required testing for lead in child care facilities.

**History**
- *Source: Miss. Code Ann. §43-20-8.*

##### **15 Miss. Admin. Code Pt. 11, R. 1.24.9** Rule 1.24.9 {#sec-11-1.24.9 omnilex-key=us-ms-regs-official--title-15--11#1.24.9}

Nutrition Parents of children being cared for in an hourly child care facility shall be informed in writing of the availability of meals and the following requirements: 1. When a child is in a facility for three or more hours, a snack shall be provided. 2. Children under five years of age will be provided snacks on request, regardless of the length of time spent in the facility. 3. At regular meal times, all children present shall be offered a meal. Regular meal times are defined as follows: a. Breakfast - between 7 a.m. and 9 a.m. b. Lunch - between 11 a.m. and 1 p.m. c. Supper - between 5 p.m. and 7 p.m. 4. All meals shall meet the minimum nutritional standards.

**History**
- *Source: Miss. Code Ann. §43-20-8.*

##### **15 Miss. Admin. Code Pt. 11, R. 1.24.10** Abuse and Neglect Reports 1 {#sec-11-1.24.10 omnilex-key=us-ms-regs-official--title-15--11#1.24.10}

All employees will be informed by the hourly child care facility director of the individual's responsibility in reporting suspected abuse and neglect. Copies of the child abuse law shall be provided to each employee (Appendix "A"). 2. Reports of suspected child abuse or neglect will be made to the Mississippi Department of Human Services and/or local law enforcement officials in accordance with

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state law. Because abused or neglected children requiring immediate attention are often identified after traditional business hours of the Mississippi Department of Human Services, reports of this nature shall also be made to local law enforcement. 3. Hourly child care facility operators and/or directors are encouraged to establish a working relationship with local law enforcement authorities and the Mississippi Department of Human Services. In extreme situations where local county Department of Human Services staff cannot be reached, operators and/or directors will report to the statewide 24-hour Child Abuse Hotline at 1-800-222-8000. 4. Operators and/or directors will work in conjunction with the local law enforcement and the Mississippi Department of Human Services to establish a workable procedure for reporting cases when a child has been left at the hourly child care facility for an extended period of time after business hours or when allowing a child to leave the hourly child care facility will place that child at risk or in potential danger.

Subchapter 25: HEARINGS, EMERGENCY SUSPENSIONS, LEGAL ACTIONS AND PENALTIES Rule 1.25.1 Emergency Suspensions of License 1. Any license issued pursuant to these regulations may be suspended prior to a hearing if the licensing agency has reasonable cause to believe that the operation of the child care facility constitutes a substantial hazard to the health or safety of the children cared for by the child care facility. 2. Whenever a license is to be suspended, the operator or director shall be notified in writing that the license, upon service of the notice, is immediately suspended. The notice shall contain the reason for the emergency suspension, and shall set a date for a hearing, which shall be within 14 days

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of the service of notice.

**History**
- *Source: Miss. Code Ann. §43-20-8.*
- *Source: Miss. Code Ann. §43-20-8.*

##### **15 Miss. Admin. Code Pt. 11, R. 1.25.2** Rule 1.25.2 {#sec-11-1.25.2 omnilex-key=us-ms-regs-official--title-15--11#1.25.2}

Denial, Revocation, or Suspension of License The licensing agency may deny, refuse to renew, suspend, revoke, or restrict a license of any child care facility upon one more of the following grounds: 1. Fraud, misrepresentation, or concealment of a material fact by the operator in securing the issuance or renewal of a license. 2. Conviction of an operator of any crime, if the licensing agency finds that the acts of which the operator has been convicted could have a detrimental effect on the children cared for by the child care facility. 3. Violation of any of the provisions of the act or of these rules and regulations. 4. Any conduct or failure to act, which is determined by the licensing agency to threaten the health or safety of a child. 5. Failure by the child care facility to have all criminal records and child abuse central registry checks on file at the facility. 6. Information received by the licensing authority as a result of the criminal records check (fingerprinting) or the child abuse central registry check on an operator.

**History**
- *Source: Miss. Code Ann. §43-20-8.*

##### **15 Miss. Admin. Code Pt. 11, R. 1.25.3** Rule 1.25.3 {#sec-11-1.25.3 omnilex-key=us-ms-regs-official--title-15--11#1.25.3}

Notification Prior to the denial, refusal to renew, suspension, revocation or restriction of a license, and at the time of the imposition of any monetary penalty, written notice of the contemplated action shall be given to the applicant or person named on the license of the child care facility, at the address on record with the licensing agency. Such notice shall specify the reasons for the proposed action and shall notify the operator of the right to a hearing on the matter.

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**History**
- *Source: Miss. Code Ann. §43-20-8.*

##### **15 Miss. Admin. Code Pt. 11, R. 1.25.4** District Level Hearing for Monetary Penalties: 1 {#sec-11-1.25.4 omnilex-key=us-ms-regs-official--title-15--11#1.25.4}

If requested in writing within ten calendar days of receipt of notice of the imposition of a monetary penalty, a district level hearing shall be provided in which the operator or applicant may show cause why the monetary penalty should not be imposed. The District Health Officer or his/her designee will preside at said hearing. 2. Any hearing requested pursuant to Subchapter 1.25.4(1) shall be held no less than five calendar days and no more than 20 calendar days from the receipt of any request for a hearing, unless both parties agree to an alternate period. 3. The district level hearing shall be informal. There will be no court reporter present and the Department will not be represented by counsel. However, the hearing officer will take notes of the proceedings and will provide the licensee with a written order outlining his decision within ten calendar days of conclusion of the district level hearing. 4. Within ten calendar days of the receipt of the district level decision the licensee may make a written request for a hearing at the state level.

**History**
- *Source: Miss. Code Ann. §43-20-8.*

##### **15 Miss. Admin. Code Pt. 11, R. 1.25.5** State Level Hearing 2 {#sec-11-1.25.5 omnilex-key=us-ms-regs-official--title-15--11#1.25.5}

If requested in writing within ten calendar days of receipt of a notice of revocation, non-renewal, probation, restriction, or suspension, or after a district level hearing has been held on a monetary penalty, a hearing shall be held at the state level. At the state level hearing a hearing officer shall be appointed by the State Health Officer. A court reporter shall transcribe the proceeding. The hearing shall be held within 30 calendar days of receipt of the request for such hearing, unless waived in writing by the licensee. 3. Within 30 calendar days of the hearing, or such period as

.

determined during the hearing, written findings of fact, together with a recommendation for action, shall be forwarded to the State Health Officer. The State Health Officer shall decide what, if any, action is to be taken on the recommendation within 14 calendar days of receipt of the recommendation. Written notice of the decision of the State Health Officer shall be provided to the operator. 4. At the state level hearing, the licensee shall be entitled to legal representation at his or her own expense.

**History**
- *Source: Miss. Code Ann. §43-20-8.*

##### **15 Miss. Admin. Code Pt. 11, R. 1.25.6** Rule 1.25.6 {#sec-11-1.25.6 omnilex-key=us-ms-regs-official--title-15--11#1.25.6}

Appeal: Any operator who disagrees with or is aggrieved by a decision of the licensing agency concerning the suspension, revocation, or restriction of a license may appeal to the Chancery Court of the county in which the child care facility is located. The appeal shall be filed no later than 30 calendar days after the operator receives written notice of the final administrative action by the licensing agency as to the suspension, revocation, or restriction of the license. The operator shall have the burden of proving that the decision of the licensing agency was not in accordance with applicable law and these regulations. If a facility is allowed to continue to operate during the appeal process, it will remain under the regulation of the licensing agency and will be subject to all current licensure regulations to include, but not limited to, inspection of the facility, review of facility and children’s records, submission of all required or requested documents, and payment of all applicable fees and/or monetary penalties.

**History**
- *Source: Miss. Code Ann. §43-20-8.*

##### **15 Miss. Admin. Code Pt. 11, R. 1.25.7** Rule 1.25.7 {#sec-11-1.25.7 omnilex-key=us-ms-regs-official--title-15--11#1.25.7}

Injunction: Notwithstanding the existence of any other remedy, the licensing agency may, in the manner provided by law, in term time or in vacation, upon the advice of the Attorney General who shall represent the licensing agency in the proceedings, maintain an action in the name of the state for injunction or other proper remedy against any person to restrain or prevent the establishment, conduct, management, or operation of a child care facility with or without a license under the act, or otherwise in violation of these regulations.

**History**
- *Source: Miss. Code Ann. §43-20-8.*

##### **15 Miss. Admin. Code Pt. 11, R. 1.25.8** Criminal Penalties: Any person establishing, {#sec-11-1.25.8 omnilex-key=us-ms-regs-official--title-15--11#1.25.8}

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conducting, managing, or operating a child care facility without a license pursuant to these regulations shall be guilty of a misdemeanor, and, upon conviction, shall be fined not more than one hundred dollars ($100.00) for the first offense, and not more than two hundred dollars ($200.00) for each subsequent offense.

**History**
- *Source: Miss. Code Ann. §43-20-8.*

##### **15 Miss. Admin. Code Pt. 11, R. 1.25.9** Violations and Penalties 1 {#sec-11-1.25.9 omnilex-key=us-ms-regs-official--title-15--11#1.25.9}

In the event of an emergency occurring at a child care facility which makes it difficult or impossible to comply with any of these Rules, the facility shall not be considered to be in violation of these specific Rules. For purposes of this Rule 1.25.9, the term “emergency” shall include only the following:

a. Inclement weather; b. Damage to the facility and/or structure which might require moving, transferring or consolidation or children; c. Traumatic injury or acute illness of a caregiver or the caregiver’s immediate family while the caregiver is on-site resulting in the caregiver having to leave the premises; d. During any declaration of emergency by local or state officials; e. An injury or illness of a child at the facility requiring the immediate attention of one or more caregivers, resulting in non-compliance with child- to-staff ratio or room capacity; and f. During a period when Department inspectors or other government official require facility staff to temporarily not be able to perform their normal supervisory duties.

2. Any Class I violation of these regulations is the discretion of the licensing agency and is punishable by a monetary penalty of five hundred dollars ($500.00) for a first occurrence and a monetary penalty of one thousand dollars ($1000.00) for each subsequent occurrence of the same violation. Each violation is considered a separate offense. The following are Class I violations:

a. Failure to prevent the death, burns, dismemberment, or permanent disability of a child. b. Allowing a child to be unattended at a licensed

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child care facility before or after operating hours. This also includes a child being left alone during operating hours when no staff is present at the facility. Further, a child left unattended outside of a child care facility is also considered to be a Class I violation. c. Allowing a child to be unattended when not at the licensed facility but under the care of the licensed facility.

3. Should a facility be cited for Class I violations on two separate occasions, it may be cause for suspension or revocation of the facility license for habitual noncompliance with the Regulations Governing Licensure of Child Care Facilities.

4. Any Class II violation of these regulations is the discretion of the licensing agency and is punishable by a monetary penalty of fifty dollars ($50.00) for the first occurrence and a monetary penalty of one hundred dollars ($100.00) for each subsequent occurrence within the same licensure term. Each violation is considered a separate offense. The following are Class II violations:

a. Failure to comply with Personnel Requirements and Records. b. Failure to comply with Emergency Preparedness and Evacuation Planning. c. Failure to comply with Staff to Child Ratio, Group Size, and Supervision. d. Failure to comply with Discipline and Guidance. e. Exceeding the maximum capacity for a facility or room. f. Allowing a child to leave the child care facility with an unauthorized individual. g. Violation of environmental health regulation. h. Failure to report a serious occurrence. i. Failure to report a communicable disease. j. Violation of transportation and safety policies, procedures, and regulations. k. Failure to have proper immunization documentation in each child's record and each employee's record. l. Failure to display license and/or complaint notice. m. Failure to meet conditions or restrictions placed on a license. The monetary penalty will be in addition

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to the immediate closure of the facility for failure to meet any conditions or restrictions as stated on the restricted license. n. Failure to comply with the nutrition standards. o. Failure to comply with the requirements of Smoking, Tobacco Products, and Prohibited Substances. p. Altering of any documents supporting suitability for employment in a child care facility.

5. Should a facility be cited for Class II violation on four separate inspection dates, it may be cause for suspension or revocation of the facility license for habitual noncompliance with the Regulations Governing Licensure of Child Care Facilities.

6. A Class III violation of these regulations, at the discretion of the licensing agency, is punishable by a monetary penalty of twenty-five dollars ($25.00) for each occurrence. A Class III violation is any violation of these regulations not listed as a Class I or Class II violation.

7. Unless they are appealed, all monetary penalties shall be payable within 30 business days of being levied. If monetary penalties are appealed, they shall be payable within 30 business days of final disposition.

8. An operator shall have the right to appeal a monetary penalty imposed pursuant to this section of the regulations, in accordance with the policy of the licensing agency. Any appeal of a monetary penalty must be filed with the licensing agency within ten business days of being levied.

9. An operator shall not be granted a license, nor shall a license be renewed for any operator with outstanding monetary penalties.

10. If a license expires during the appeal process, it shall be administratively extended, and documentation of the extension shall be provided to the licensee. A facility given an administrative extension during the appeal process, shall remain under the regulation of the licensing agency and will be subject to all current licensure regulations to include, but not limited to, inspection of the facility, review of facility and children’s records, submission of all

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required or requested documents, and payment of all applicable fees and/or monetary penalties.

Subchapter 26: RELEASE OF INFORMATION Rule 1.26.1 Information in the possession of the licensing agency concerning the license of individual child care facilities may be disclosed to the public, except such information shall not be disclosed in such manner as to identify children or families of children cared for at a child care facility. Nothing in this section shall affect the agency’s authority to release findings of investigation into allegations of abuse pursuant to either Sections 43- 21-353(8) and Section 43-21-257 Mississippi Code of 1972, annotated.

APPENDIX A

§ 43-21-353. Duty to inform state agencies and officials; duty to inform individual about whom report has been made of specific allegations.

(1) Any attorney, physician, dentist, intern, resident, nurse, psychologist, social worker, family protection worker, family protection specialist, child caregiver, minister, law enforcement officer, public or private school employee or any other person having reasonable cause to suspect that a child is a neglected child or an abused child, shall cause an oral report to be made immediately by telephone or otherwise and followed as soon thereafter as possible by a report in writing to the Department of Human Services, and immediately a referral shall be made by the Department of Human Services to the youth court intake unit, which unit shall promptly comply with Section 43-21-357. In the course of an investigation, at the initial time of contact with the individual(s) about whom a report has been made under this Youth Court Act or with the individual(s) responsible for the health or welfare of a child about whom a report has been made under this chapter, the Department of Human Services shall inform the individual of the specific complaints or allegations made against the individual. Consistent with subsection (4), the identity of the person who reported his or her suspicion shall not be disclosed. Where appropriate, the Department of Human Services shall additionally make a referral to the youth court prosecutor.

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Upon receiving a report that a child has been sexually abused, or burned, tortured, mutilated or otherwise physically abused in such a manner as to cause serious bodily harm, or upon receiving any report of abuse that would be a felony under state or federal law, the Department of Human Services shall immediately notify the law enforcement agency in whose jurisdiction the abuse occurred and shall notify the appropriate prosecutor within forty-eight (48) hours, and the Department of Human Services shall have the duty to provide the law enforcement agency all the names and facts known at the time of the report; this duty shall be of a continuing nature. The law enforcement agency and the Department of Human Services shall investigate the reported abuse immediately and shall file a preliminary report with the appropriate prosecutor's office within twenty- four (24) hours and shall make additional reports as new or additional information or evidence becomes available. The Department of Human Services shall advise the clerk of the youth court and the youth court prosecutor of all cases of abuse reported to the department within seventy- two (72) hours and shall update such report as information becomes available.

(2) Any report to the Department of Human Services shall contain the names and addresses of the child and his parents or other persons responsible for his care, if known, the child's age, the nature and extent of the child's injuries, including any evidence of previous injuries and any other information that might be helpful in establishing the cause of the injury and the identity of the perpetrator.

(3) The Department of Human Services shall maintain a statewide incoming wide-area telephone service or similar service for the purpose of receiving reports of suspected cases of child abuse; provided that any attorney, physician, dentist, intern, resident, nurse, psychologist, social worker, family protection worker, family protection specialist, child caregiver, minister, law enforcement officer or public or private school employee who is required to report under subsection (1) of this section shall report in the manner required in subsection (1). (4) Reports of abuse and neglect made under this chapter and the identity of the reporter are confidential except when the court in which the investigation report is filed, in its discretion, determines the testimony of the person reporting to be material to a judicial proceeding or when the identity of the reporter is released to law enforcement agencies and the appropriate prosecutor pursuant to subsection (1). Reports made under this section to any law enforcement agency or prosecutorial officer are for the purpose of criminal investigation and prosecution only and no information

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from these reports may be released to the public except as provided by Section 43-21-261. Disclosure of any information by the prosecutor shall be according to the Mississippi Uniform Rules of Circuit and County Court Procedure. The identity of the reporting party shall not be disclosed to anyone other than law enforcement officers or prosecutors without an order from the appropriate youth court. Any person disclosing any reports made under this section in a manner not expressly provided for in this section or Section 43-21-261, shall be guilty of a misdemeanor and subject to the penalties prescribed by Section 43-21-267.

(5) All final dispositions of law enforcement investigations described in subsection (1) of this section shall be determined only by the appropriate prosecutor or court. All final dispositions of investigations by the Department of Human Services as described in subsection (1) of this section shall be determined only by the youth court. Reports made under subsection (1) of this section by the Department of Human Services to the law enforcement agency and to the district attorney's office shall include the following, if known to the department: (a) The name and address of the child; (b) The names and addresses of the parents; (c) The name and address of the suspected perpetrator; (d) The names and addresses of all witnesses, including the reporting party if a material witness to the abuse; (e) A brief statement of the facts indicating that the child has been abused and any other information from the agency files or known to the family protection worker or family protection specialist making the investigation, including medical records or other records, which may assist law enforcement or the district attorney in investigating and/or prosecuting the case; and (f) What, if any, action is being taken by the Department of Human Services. (6) In any investigation of a report made under this chapter of the abuse or neglect of a child as defined in Section 43-21-105(m), the Department of Human Services may request the appropriate law enforcement officer with jurisdiction to accompany the department in its investigation, and in such cases the law enforcement officer shall comply with such request.

(7) Anyone who willfully violates any provision of this section shall be,

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upon being found guilty, punished by a fine not to exceed Five Thousand Dollars ($5,000.00), or by imprisonment in jail not to exceed one (1) year, or both.

(8) If a report is made directly to the Department of Human Services that a child has been abused or neglected in an out-of-home setting, a referral shall be made immediately to the law enforcement agency in whose jurisdiction the abuse occurred and the department shall notify the district attorney's office within forty-eight (48) hours of such report. The Department of Human Services shall investigate the out-of-home setting report of abuse or neglect to determine whether the child who is the subject of the report, or other children in the same environment, comes within the jurisdiction of the youth court and shall report to the youth court the department's findings and recommendation as to whether the child who is the subject of the report or other children in the same environment require the protection of the youth court. The law enforcement agency shall investigate the reported abuse immediately and shall file a preliminary report with the district attorney's office within forty-eight (48) hours and shall make additional reports as new information or evidence becomes available. If the out-of-home setting is a licensed facility, an additional referral shall be made by the Department of Human Services to the licensing agency. The licensing agency shall investigate the report and shall provide the Department of Human Services, the law enforcement agency and the district attorney's office with their written findings from such investigation as well as that licensing agency's recommendations and actions taken.

Sources: Laws, 1979, ch. 506, § 41; Laws, 1980, ch. 550, § 17; Laws, 1984, ch. 342; Laws, 1985, ch. 360; Laws, 1993, ch. 522, § 1; Laws, 1994, ch. 387, § 1; Laws, 1994, ch. 591, § 3; Laws, 1995, ch. 335, § 1; Laws, 1996, ch. 323, § 2; Laws, 1997, ch. 440, § 10; Laws, 1998, ch. 340, § 1; Laws, 1998, ch. 557, § 1; Laws, 2004, ch. 489, § 3; Laws, 2006, ch. 600, § 4; Laws, 2007, ch. 337, § 3, eff from and after July 1, 2007. § 43-21-355. Immunity for reporting information. Any attorney, physician, dentist, intern, resident, nurse, psychologist, social worker, family protection worker, family protection specialist, child caregiver, minister, law enforcement officer, school attendance

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officer, public school district employee, nonpublic school employee, licensed professional counselor or any other person participating in the making of a required report pursuant to Section 43-21-353 or participating in the judicial proceeding resulting therefrom shall be presumed to be acting in good faith. Any person or institution reporting in good faith shall be immune from any liability, civil or criminal, that might otherwise be incurred or imposed.

Sources: Laws, 1979, ch. 506, § 42; Laws, 1980, ch. 550, § 18; Laws, 1982, Ex Sess, ch. 17, § 22; Laws, 1993, ch. 522, § 2; Laws, 1994, ch. 591, § 4; Laws, 2004, ch. 489, § 4; Laws, 2006, ch. 430, § 1; Laws, 2006, ch. 600, § 5, eff from and after July 1, 2006.

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APPENDIX B

DISHWASHING PROCEDURE

The best way to wash, rinse, and disinfect dishes and eating utensils is to use a dishwasher with a sanitizing cycle. The final sanitizing rinse of a dishwasher must reach a temperature of 180 degrees. If a dishwasher is not available or cannot be installed, a three-compartment sink will be needed to wash, rinse, and disinfect dishes. A two-compartment or one- compartment sink can be used in child care facilities (located in an occupied residence) licensed for 12 or fewer children by adding one or two dishpans, as needed. In addition to three compartments or dishpans, you will need a dish rack with a drain board to allow dishes and utensils to air dry. To wash, rinse, and disinfect dishes by hand: • Fill one sink compartment or dishpan with hot tap water and a dishwashing detergent. • Fill the second compartment or dishpan with hot tap water. • Fill the third compartment or dishpan with hot tap water and 1-1/2 tablespoons of liquid chlorine bleach for each gallon of water. • Scrape dishes and utensils and dispose of excess food. • Immerse scraped dish or utensil in first sink compartment or dishpan and wash • thoroughly. • Rinse dish or utensil in second dishpan of clear water. • Immerse dish or utensil in third dishpan of chlorinated water for at least 1 minute. • Place dish or utensil in a rack to air dry.

Note: Food preparation and dishwashing sinks should only be used for these activities and should never be used for routine hand washing or diaper changing activities.

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APPENDIX C See Public Playground Safety Handbook. As published by the United States Consumer Product Safety Commission – Saving Lives and Keeping Families SafeCHAPTER 2: REGULATIONS GOVERNING LICENSURE OF CHILD CARE FACILITIES FOR 12 OR FEWER CHILDREN IN THE OPERATOR’S HOME Subchapter 1. GENERAL Rule 2.1.1 Legal Authority; The "Mississippi Child Care Licensing Law," Section 43-20-1 et seq. of the Mississippi Code of 1972 provides the legal authority under which the Mississippi State Department of Health prescribes minimum regulations for child care facilities defined under the law.

**History**
- *Source: Miss. Code Ann. §43-20-8.*
- *Source: Miss. Code Ann. §43-20-8.*
- *Source: The ABCs of Safe and Healthy Child Care: A Handbook for Child Care Providers, Department of Health and Human Services, U.S. Public Health Service, Centers for Disease Control and Prevention.*
- *Source: Miss. Code Ann. §43-20-8.*
- *Source: Miss. Code Ann. §43-20-8.*

##### **15 Miss. Admin. Code Pt. 11, R. 2.1.2** Purpose 1 {#sec-11-2.1.2 omnilex-key=us-ms-regs-official--title-15--11#2.1.2}

The purpose of these regulations is to protect and promote the health and safety of children in this state by providing for the licensing of child care facilities as defined herein to assure that certain minimum standards are maintained in such facilities. This policy is predicated upon the fact that a child is not capable of protecting himself, and when his parents for any reason have relinquished his care to others, there arises the probability of exposure of that child to certain risks to his health and safety that require the offsetting statutory protection of licensing. This document and its appendices constitute the "Regulations Governing the Licensure of Child Care Facilities." 2. A child care facility may exceed the minimum quality standards required in these regulations, but may not operate without meeting the minimum standards set forth in these regulations. 3. The maximum capacity of a child care facility is determined by the indoor square footage, kitchen square footage, outdoor playground area, and the number of toilets, urinals, and hand washing lavatories, with the lowest capacity determination being controlling. The maximum capacity of each room that is utilized by the children in a child care facility is calculated individually and may not be exceeded except when provided in these regulations. 4. A child care facility is subject to inspection at anytime at the discretion of the licensing agency. 5. The Mississippi State Department of Health shall maintain a complaint hotline to accommodate reporting of complaints. The department shall investigate each complaint and maintain a log of such complaints. The identity of the reporting party

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shall not be disclosed to any other person than the Child Care Licensing Division staff unless upon order of a court of competent jurisdiction.

**History**
- *Source: Miss. Code Ann. §43-20-8.*

##### **15 Miss. Admin. Code Pt. 11, R. 2.1.3** Rule 2.1.3 {#sec-11-2.1.3 omnilex-key=us-ms-regs-official--title-15--11#2.1.3}

Severability: If any provision of these regulations or the application thereof to any persons or circumstances shall be held invalid, such invalidity shall not affect the provisions or application of these regulations that can be given effect without the invalid provision or application, and to this end, the provisions of these regulations are declared severable.

**History**
- *Source: Miss. Code Ann. §43-20-8.*

##### **15 Miss. Admin. Code Pt. 11, R. 2.1.4** Definitions 1 {#sec-11-2.1.4 omnilex-key=us-ms-regs-official--title-15--11#2.1.4}

Act: The "Mississippi Child Care Licensing Law," Section 43-20-1 et seq. of the Mississippi Code of 1972. 2. Agency Representative: An authorized representative of the Mississippi State Department of Health. 3. Caregiver: A person who provides direct care, supervision, and guidance to children in a child care facility, regardless of title or occupation. 4. Child Care Facility (Facility): A place which provides shelter and personal care for six or more children who are not related within the third degree computed according to the civil law to the operator and who are under 13 years of age, for any part of the 24 hour day, whether such place be organized or operated for profit or not. The term “child care facility” includes day nurseries, day care centers, child care centers, preschool programs, and any other facility that fall within the scope of the definition set forth above. a. Exemptions: To the extent provided by law, including those facilities or programs which satisfy one or more of the requirements for exemption provided in Miss. Code Ann. § 43-20-5(a), an exemption from the provisions of the Act shall be recognized by the licensing agency. Facilities or programs claiming exemption shall be required, upon the written request of the licensing agency, to provide documentation of the facts claimed to support the basis for the exemption, which documentation shall be provided within 30 days of the request by the licensing agency and shall be sworn by affidavit to be true and accurate under the penalties of perjury. However, any entity exempt from the requirements to be licensed but voluntarily chooses to obtain a license is subject to all provisions of the licensing law and these regulations.

5. Children with Special Needs: A child needing adaptation in a particular child care facility to access programming and the physical environment

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6. Director Any individual, designated by the operator, who has met minimum state requirements and who has on-site responsibility for the operation of a child care facility. This person may or may not be the operator. 7. Director Designee: Any individual designated to act as the director, having all responsibility and authority of a director, during the director’s short-term absence. A director designee shall, at a minimum, be at least 21 years of age, have a high school diploma or GED, and 2 years paid experience in a licensed child care facility. Director Designees shall not retain sole director authority in a facility for more than 24 total hours per calendar week. Exception: A facility may have a Director Designee serve for a maximum of 14 consecutive calendar days during a licensure year. This exception may be used once during the licensure year for allowing the director personal leave, i.e., vacation, jury duty, etc. 8. Group: The children assigned to a caregiver or team of caregivers, occupying an individual classroom, or well-defined physical space within a larger room. 9. Hazardous Condition: A situation or place that presents a possible source of injury or danger. 10. Health: The condition of being sound in mind and body and encompassing an individual's physical, mental and emotional welfare. 11. Infant: Any child under the age of 12 months. 12. Licensing Agency: The Mississippi State Department of Health. 13. Operator; Any person, acting individually or jointly with another person or persons, who shall establish, own, operate, conduct or maintain a child care facility. The child care facility license shall be issued in the name of the operator, or if there is more than one operator, in the name of one of the operators. In the event that there is more than one operator, all statutory and regulatory provisions concerning the background checks of operators shall be equally applied to all operators of a facility, including, but not limited to, a spouse who jointly owns, operates, or maintains the child care facility regardless of which operator is named on the license. 14. Parent: As used in these regulations, parent shall mean custodial parent, legal guardian, foster parent, guardian ad litem, and other individuals or institutions to which a court of competent jurisdiction has granted legal authority over the child. 15. Person: Any person, firm, partnership, corporation or association. 16. Personal Care: Assistance rendered by personnel of the child care facility in performing one or more of the activities of daily living, which includes but is not

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limited to the feeding, personal grooming, supervising, and dressing of children placed in the child care facility. 17. Physical Confines: The space inside the walls of the child care facility. 18. Safety The condition of being protected from hurt, injury or loss. 19. School Age Child: A child five years of age or older and eligible to be enrolled in public school. Note: A child that is five (5) years old age must have turned five (5) on or before September 1 to be considered a school age child. 20. Service Staff: A person who provides support services such as cooking, cleaning, or driving a vehicle, but is not a caregiver. 21. Toddler: Any child the age of 12 months and under the age of 24 months. 22. Usable Space: In measuring facilities for square footage per child, usable space shall mean space measured on the inside, wall-to-wall dimensions. These spaces are exclusive of food preparation areas, kitchens, bathrooms, toilets, areas for the care of ill children, offices, staff rooms, corridors, hallways, stairways, closets, lockers, laundries, furnace rooms, fixed or permanent cabinets, fixed or permanent storage shelving spaces, and areas not inhabited and used by children. Usable space shall be areas dedicated to children’s activities (play, learning, rest, and eating) and shall be utilized for those purposes on a daily basis. Furnishings shall be equipment that is both size and age appropriate for children receiving care. The space occupied by inappropriate or adult size equipment shall be deducted from the children’s usable space. 23. Volunteer: Any person who is not an employee who is at the facility or assists with children. a. Individuals who volunteer for 120 or more hours in a given licensure year shall meet the requirements of (1) criminal record and child abuse central registry checks to include being fingerprinted, and (2) valid Immunization Compliance Form #121. The facility shall document the time that a volunteer is at the facility. b. Further, any individual who has not been fingerprinted and has not had a child abuse central registry check completed, and received the Letter of Suitability for Employment shall never be left alone with children.

Subchapter 2. LICENSURE Rule 2.2.1 Requirement for Licensure

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1. No person shall establish, own, operate, conduct, or maintain a child care facility in this state without a license issued pursuant to these regulations. 2. The licensing authority will require no entity exempt from the licensure requirement to apply for a license. However, should an exempt entity desire to obtain a license, it will be subject to these regulations.

**History**
- *Source: Miss. Code Ann. §43-20-8.*
- *Source: Miss. Code Ann. §43-20-8.*

##### **15 Miss. Admin. Code Pt. 11, R. 2.2.2** Types of Licenses 1 {#sec-11-2.2.2 omnilex-key=us-ms-regs-official--title-15--11#2.2.2}

Temporary License: The licensing agency may issue a temporary license to any child care facility. This license will allow the child care facility to operate pending the issuance of a regular license. The temporary license will reflect the date of issuance of the license, the expiration date, and the number of children for which the facility is licensed. The license issue date is the actual date documentation is received and approval for initial temporary license is granted; the expiration date is the last day of the sixth month following the issue date; examples: January 01 through June 30 or January 15 through June 30. NOTE: Before a Temporary License is issued and the facility allowed to begin operation the following items must be submitted to and/or verified by the licensing authority, i.e., Mississippi State Department of Health: a. License Application and $100.00 application fee. b. License fee - the amount of fee is determined by the licensed capacity of the facility. c. Documentation that the facility has a qualified director for the child care program that meets the standards set forth in Rule 2.5.3. d. “Letter of Suitability for Employment” for every employee or volunteer as appropriate that is to begin work when the facility starts operation. The “Letter of Suitability for Employment” issued by the Mississippi State Department of Health verifies that a criminal records check, sex offender registry, and child abuse central registry check has been conducted on an individual. e. An MSDH Immunization Form #121 for every employee or volunteer that is to begin work when the facility starts operation and/or have documentation indicating that they comply with the immunization requirements of the Mississippi State Department of Health. f. Valid MSDH Fire Inspection Form #333. g. Verification of passing an American National Standards Institute – Conference for Food Protection (ANSI-CFP) Accredited food manager training. Currently

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the following providers are authorized by the MSDH to provide the required training: i. National Restaurant Association, Inc., i.e., ServSafe®, ii. Environmental Health Testing, Inc., i.e., National Registry of Food Safety Professionals, iii. Prometic, Inc., or iv. Mississippi State University Extension Service, i.e., TummySafe©. NOTE: For information on ServSafe® or TummySafe© contact the Mississippi State University Extension Service at www.msucares.com. In addition, the Mississippi Restaurant Association (MRA) also provides ServSafe® training. The MRA can be contacted at www.msra.org. For information on the National Registry of Food Safety Professionals or Prometric, contact the MSDH Office of Environmental Heath at 601-576-7690. h. Wastewater disposal approval. i. Potable water source approval - drinking water. j. Zoning approval. k. Lead Testing approval: i. Building - if constructed before 1965 ii. Playground l. Adult, Child and Infant CPR and First Aid certification as required for a person or persons who will be present at the facility during all hours of operation. m. Approved Menu if applicable. n. Floor Plan. o. MSDH Maximum Capacity Worksheet (Form #28). p. MSDH Child Care Facility Inspection Report (Form #281). q. MSDH Child Care Facility Data Sheet (Form #286). r. MSDH Food Service Inspection (Form #301-302) - if applicable. s. Daily Schedule of Activities - developed by provider. t. Arrival and Departure Procedures - developed by provider.

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u. Emergency Policy – developed by provider. v. Verification of Two Emergency Relocation Sites – developed by provider: i. One site must be a minimum of one mile distant from the facility. ii. One site must be a minimum of five miles distant from the facility. w. Transportation Policy – not required if facility does not transport children. NOTE: An emergency transportation policy is required even if the facility does not plan to transport children. An emergency transportation policy shall encompass such events as emergency evacuation of the facility and emergency transporting of a child to receive medical attention. x. Proof of Vehicle Insurance – not required if facility does not transport children. y. Verification, in writing, that the operator has or does not have accident/liability insurance covering the business. z. Verification, in writing, that the operator has or does not have accident/liability insurance covering the children enrolled at the facility. aa. Discipline Policy – developed by the provider. NOTE: The discipline policy developed by the provider shall not allow any of the prohibited behaviors listed in Subchapter 14 of these regulations. bb. Verification that the owner/operator and director have completed mandatory training on: i. Regulations Governing Licensure of Child Care Facilities. ii. New Directors Orientation. iii. Playground Safety. NOTE: Contact the Mississippi State Department of Health, Child Care Facilities Licensure Division at 601-364-2827 for more information on the availability and location of the above referenced training. Information on available training classes and approved training providers is listed on the MSDH website at www.HealthyMS.com. Training classes provided by the Child Care Licensing Division are listed under the heading “MSDH Child Care Provider Training Calendar.” Other approved providers of training for child care facility operators and staff are listed under the headings “MSDH Approved Staff Development Trainers” and “Approved Child Care Staff Development Providers.”

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2. Regular License: The licensing agency may issue a regular license when all conditions and requirements for licensure have met compliance. The duration of a regular license shall not exceed one year. 3. Probational License: The licensing agency may issue a probational license, at its discretion, where violations may endanger the health or safety of the children, but only when such violations may be corrected within a specified period. There shall be a written corrective action plan agreed upon between the operator and the licensing agency. The period of time for which a probational license is issued shall be at the discretion of the licensing agency but in no instance shall exceed six months. 4. Restricted License: The licensing agency may issue any type of license with conditions/restrictions when, at its discretion, the health or safety of the children require such a conditional/restrictive statement on the license. Such conditions/restrictions shall include but not be limited to certain individuals to be barred from the premises or any other situations that may endanger children and that should be so recorded on the license. Any violation of any such condition/restriction shall result in immediate emergency suspension of the license. When such conditions/restrictions no longer pose a threat to the children, the conditional/restrictive statement may be removed.

**History**
- *Source: Miss. Code Ann. §43-20-8.*

##### **15 Miss. Admin. Code Pt. 11, R. 2.2.3** Rule 2.2.3 {#sec-11-2.2.3 omnilex-key=us-ms-regs-official--title-15--11#2.2.3}

Application for License: An application for a license under these regulations shall be made to the licensing agency upon forms provided by it and shall contain such information as the licensing agency may reasonably require.

**History**
- *Source: Miss. Code Ann. §43-20-8.*

##### **15 Miss. Admin. Code Pt. 11, R. 2.2.4** Rule 2.2.4 {#sec-11-2.2.4 omnilex-key=us-ms-regs-official--title-15--11#2.2.4}

License Fee: All application fees, licensure fees, renewal fees, and administrative charges shall be paid by certified check or money order payable to the Mississippi State Department of Health, are nonrefundable. Checks returned for insufficient funds, closed account, etc., shall be assessed an additional $50 fee. 1. Application Fee...............................................................................................$130.00

2. Initial Licensure Fee ......................................................................................$ 97.50

3. Renewal Fee ....................................................................................................$ 97.50

4. Reinstatement Fee ..........................................................................................$260.00

5. Returned Check Fee ......................................................................................$ 50.00

6. Late Fee ...........................................................................................................$ 25.00

7. Fingerprinting Fee (Per Fingerprint Card) .................................................$ 50.00

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NOTE: Except for the fingerprinting fee, no governmental entity or agency that operates a child care facility shall be required to pay the fees set forth in this section. Third party providers that contract with a state agency for the provision of child care services are subject to all fees, monetary penalties, etc. Further, should an entity exempt from licensure apply for a license it shall be subject to all fees listed in this section.

**History**
- *Source: Miss. Code Ann. §43-20-8.*

##### **15 Miss. Admin. Code Pt. 11, R. 2.2.5** Rule 2.2.5 {#sec-11-2.2.5 omnilex-key=us-ms-regs-official--title-15--11#2.2.5}

Certificate of Inspection by Fire Department: A certificate of inspection and approval by the fire department of the municipality or other political subdivision in which the child care facility is located shall be submitted to the licensing agency with the application and license fees. Except that if no fire department exists where the facility is located, the State Fire Marshall shall certify as to the inspection for safety from fire hazards. The inspection form to be used for fire inspections shall be MSDH Form #333 and shall be signed by a signatory authority of the fire inspection authority making the inspection.

**History**
- *Source: Miss. Code Ann. §43-20-8.*

##### **15 Miss. Admin. Code Pt. 11, R. 2.2.6** Rule 2.2.6 {#sec-11-2.2.6 omnilex-key=us-ms-regs-official--title-15--11#2.2.6}

Inspection: An agency representative(s) shall inspect each child care facility prior to issuing or renewing a license to assure compliance with these regulations.

**History**
- *Source: Miss. Code Ann. §43-20-8.*

##### **15 Miss. Admin. Code Pt. 11, R. 2.2.7** Rule 2.2.7 {#sec-11-2.2.7 omnilex-key=us-ms-regs-official--title-15--11#2.2.7}

Record of Inspection : Whenever an inspection is made of a child care facility, the findings shall be recorded on an official inspection form and furnished to the operator, director, and/or their representative, at the time the inspection is made.

**History**
- *Source: Miss. Code Ann. §43-20-8.*

##### **15 Miss. Admin. Code Pt. 11, R. 2.2.8** Renewal of License 1 {#sec-11-2.2.8 omnilex-key=us-ms-regs-official--title-15--11#2.2.8}

The licensing agency shall issue licenses that may be renewed annually. The licensing agency shall mail a renewal notice, at least 75 days prior to the expiration date of the license, to the address of the operator registered with the licensing agency. The operator shall: a. Complete the renewal form. b. Submit all certificates of inspection and approval required by the licensing agency. c. Enclose the renewal fee. d. File the above with the licensing agency at least 30 days prior to the expiration date on the license.

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NOTE: Renewal applications postmarked less than 30 days prior to the expiration date of the license shall be assessed a $25.00 late fee. 2. An operator who does not file the renewal application prior to the date that the license expires will be deemed to have allowed the license to lapse. Said license may be reinstated by the licensing agency, in its discretion, by payment of both the renewal fee and the reinstatement fee, provided said application for reinstatement is made within one month of the expiration date of the license. After the one month reinstatement period, it shall be required that an application for an initial license be submitted. All licensure requirements in effect at the time the new initial application is filed shall be met.

**History**
- *Source: Miss. Code Ann. §43-20-8.*

##### **15 Miss. Admin. Code Pt. 11, R. 2.2.9** Rule 2.2.9 {#sec-11-2.2.9 omnilex-key=us-ms-regs-official--title-15--11#2.2.9}

License Not Transferable or Assignable: Each license shall be issued only for the premises and operator named in the application and shall not be transferable or assignable. A change of ownership includes, but is not limited to, inter vivo gifts, purchases, transfers, lease arrangements, cash and/or stock transactions or other comparable arrangements whenever any person or entity acquires or controls a majority interest of the child care facility or service. Changes of ownership from partnerships, single proprietorships, or corporations to another form of ownership are specifically included.

**History**
- *Source: Miss. Code Ann. §43-20-8.*

##### **15 Miss. Admin. Code Pt. 11, R. 2.2.10** Rule 2.2.10 {#sec-11-2.2.10 omnilex-key=us-ms-regs-official--title-15--11#2.2.10}

Display of Licenses: The current license issued by the licensing agency to the named child care facility and operator shall be posted and displayed in a conspicuous place and in easy view of all persons who enter the child care facility. The facility operator shall also post next to the license, in plain view, a notice provided by the MSDH that informs the public of where and how they may report a complaint against the facility.

Subchapter 3. RIGHT OF ENTRY AND VIOLATIONS Rule 2.3.5 Right of Entry: An agency representative may enter any child care facility for making inspections or investigations to determine compliance with these regulations.

**History**
- *Source: Miss. Code Ann. §43-20-8.*
- *Source: Miss. Code Ann. §43-20-8.*

##### **15 Miss. Admin. Code Pt. 11, R. 2.3.6** Rule 2.3.6 {#sec-11-2.3.6 omnilex-key=us-ms-regs-official--title-15--11#2.3.6}

Violations: If violations noted on the inspection form are not corrected within the period specified by the licensing agency, a license may be denied, suspended, or revoked in accordance with these regulations.

Subchapter 4. FACILITY POLICY AND PROCEDURES

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**History**
- *Source: Miss. Code Ann. §43-20-8.*

##### **15 Miss. Admin. Code Pt. 11, R. 2.4.5** Parental Information Before a child's enrollment, the parent shall be provided with the following: 1 {#sec-11-2.4.5 omnilex-key=us-ms-regs-official--title-15--11#2.4.5}

Operating information: a. The child care facility's purpose, scope of service provided, philosophy, and any religious affiliation. b. Name(s), business phone number, business address, and home phone number of the operator, director or an individual in authority who can be reached after the facility’s normal hours of operation. c. The phone number of the child care facility. d. Organization chart or other description of established lines of authority of persons responsible for the child care facility's management within the organization. e. The program and services provided and the ages of children accepted. f. The hours and days of operation and holidays or other times closed. g. The procedures for admission and registration of children. h. Tuition, plans for payment, and policies regarding delinquent payments. i. Types of insurance coverage for children, or a statement that accident insurance is not provided or available. j. If a facility does not provide liability insurance there shall be a statement in the child’s record, signed by the parent indicating that the parent is aware that the facility does not carry liability insurance. k. Reasons/circumstances and procedures for removal of children from rolls when parents are requested by facility staff to remove a child. l. Procedures to include the amount of notice a parent is required to give the facility before removing a child. m. Policy governing the maximum hours per day or week that a child can be left at the child care facility. 2. Arrival and departure procedures for children: a. Procedure, approved by the licensing authority, for assuring a child's safe arrival and departure (All children shall be signed in and out of the facility by an authorized individual.). b. Procedures for protecting children from traffic and other hazards during arrival and departure and when crossing streets.

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c. Policy for release of children from the child care facility only to responsible persons for whom the child care facility has written authorization. d. Policy governing a parent picking up a child after closing hours and procedures if a child is not picked up. 3. Program and activities information: a. Policies and procedures about accepting and storing a child's personal belongings. b. Discipline policies including acceptable and unacceptable discipline measures. c. Transportation and safety policies and procedures. d. Policies prohibiting the photographing of a child without parental consent. e. Policies regarding a child's participation in extracurricular activities not sponsored by the child care facility, including but not limited to baseball, softball, soccer, ballet, or gymnastics. f. Policies regarding water activities and safety procedures. These policies shall include those water activities that take place away from the child care facility property, e.g., taking children to a public swimming pool. g. Policies encouraging sun safety practices and activities. 4. Health and emergency procedures: a. Procedures for storing and giving a child medication. b. Policy for reporting suspected child abuse. c. Provision for emergency medical care, treatment of illnesses and accidents, which include: i. A plan to handle a child in a medical crisis. ii. A plan to obtain prompt services of physician and hospitalization, if needed. iii. A plan for immediately notifying the parent of any illness, accident, or injury to the child. iv. A plan to acquire the services of a certified practitioner for a child exempt from medical care on religious grounds. d. Evacuation plan including procedures for notifying the parents of the relocation site.

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e. Policy and procedures for handling dangerous situations, including but not limited to, dealing with violent individuals, individuals entering facility with weapons, bomb threats, or conditions posing an immediate threat to children. 5. State regulations: a. A summary of the licensing regulations and any appendices thereto, provided by the licensing agency. b. Each child's record shall contain a statement signed by the child's parent, indicating that they have received a summary of licensing standards and other materials designated by the licensing agency for such distribution. c. The name and phone number of the MSDH licensing official responsible for the inspection of the facility. d. The toll free 1-866-489-8734 Child Care Facility Complaint Hot Line phone number.

**History**
- *Source: Miss. Code Ann. §43-20-8.*

##### **15 Miss. Admin. Code Pt. 11, R. 2.4.6** Smoking, Tobacco Products, and Prohibited Substances 1 {#sec-11-2.4.6 omnilex-key=us-ms-regs-official--title-15--11#2.4.6}

Smoking or the use of tobacco products in any form is prohibited within the physical confines or the campus of a child care facility. 2. The use of alcohol, illegal use of prescription drugs, or use of illegal drugs is prohibited within the physical confines or the campus of a child care facility. 3. Smoking or the use of tobacco products in any form, use of alcohol, illegal use of prescription drugs, or use of illegal drugs by a caregiver is prohibited anytime a child is under the care of such caregiver regardless of location. A caregiver is defined as a person who provides direct care, supervision, and guidance to children in a child care facility, regardless of title or occupation. This definition includes volunteers and parents.

**History**
- *Source: Miss. Code Ann. §43-20-8.*

##### **15 Miss. Admin. Code Pt. 11, R. 2.4.7** Rule 2.4.7 {#sec-11-2.4.7 omnilex-key=us-ms-regs-official--title-15--11#2.4.7}

Parental Access; Child care facilities shall assure the parent that they have welcome access to the child care facility at all times. Welcome access shall be defined as a parent having access to areas of the facility available to his child and non-disruptive to normal daily activities.

**History**
- *Source: Miss. Code Ann. §43-20-8.*

##### **15 Miss. Admin. Code Pt. 11, R. 2.4.8** Rule 2.4.8 {#sec-11-2.4.8 omnilex-key=us-ms-regs-official--title-15--11#2.4.8}

Changes in Facility Operations: The operator shall immediately notify the licensing agency of any major changes affecting areas of the child care facility's

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operations. Such major changes include, but are not limited to, operator, director, location, physical plant, or number of children served.

**History**
- *Source: Miss. Code Ann. §43-20-8.*

##### **15 Miss. Admin. Code Pt. 11, R. 2.4.9** Rule 2.4.9 {#sec-11-2.4.9 omnilex-key=us-ms-regs-official--title-15--11#2.4.9}

Notice of Legal Action; The licensing agency shall be notified within seven days, in writing, if notice is received of legal action against the child care facility.

**History**
- *Source: Miss. Code Ann. §43-20-8.*

##### **15 Miss. Admin. Code Pt. 11, R. 2.4.10** Posting of Information: The following items shall be posted conspicuously in the child care facility at all times: 1 {#sec-11-2.4.10 omnilex-key=us-ms-regs-official--title-15--11#2.4.10}

Accessible to employees and parents: a. License. b. Daily activity schedule posted in each classroom. c. Inspection form, if applicable, or Menus and Food Service Permit, if applicable. d. Evacuation route. e. The facility operator shall also post next to the license, in plain view, a notice provided by the MSDH that informs the public of where and how they may report a complaint against the facility. 2. In kitchens: a. Menus. b. Evacuation route. 3. The evacuation route in all rooms utilized by children.

**History**
- *Source: Miss. Code Ann. §43-20-8.*

##### **15 Miss. Admin. Code Pt. 11, R. 2.4.11** Rule 2.4.11 {#sec-11-2.4.11 omnilex-key=us-ms-regs-official--title-15--11#2.4.11}

Weapons Prohibited : All firearms in the home shall be equipped with trigger locks and kept in a locked room out of the sight of all children. All other dangerous weapons shall be kept under lock in a room not accessible to children. Other dangerous weapons include, but are not limited to, hunting knives, spears, machetes, archery equipment, etc.

Subchapter 5. PERSONNEL REQUIREMENTS Rule 2.5.5 General Requirements For Personnel

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1. Each employee or potential employee of a child care facility, whether full time, part time, temporary, substitute, or volunteer, shall be of good moral character and shall meet the minimum qualifications for the respective job classification, as set forth in these regulations. 2. Any individual who, in the opinion of the licensing authority, appears to be unable to physically or mentally care for children on a daily basis and/or in emergency situations will not be allowed to act as a caregiver or caregiver assistant. Any person whose ability is in question shall, at the request of the licensing authority, be able to demonstrate the ability to perform, at a minimum but not limited to the following: a. Physical ability to exit the children during a fire drill in under two minutes; b. Ability to read medication directions and properly dispense medication to children (required only if the facility dispenses medication)

**History**
- *Source: Miss. Code Ann. §43-20-8.*
- *Source: Miss. Code Ann. §43-20-8.*

##### **15 Miss. Admin. Code Pt. 11, R. 2.5.2** Rule 2.5.2 {#sec-11-2.5.2 omnilex-key=us-ms-regs-official--title-15--11#2.5.2}

Criminal Record (Fingerprinting), Child Abuse Central Registry Checks, and Sex Offender Records Checks: Pursuant to Section 43-20-1 et seq., of the Mississippi Code of 1972, Section 658(d) of the Child Care Development Block Grant (CCDBG) Act of 2014, and Federal Rules and Regulations 45 CFR 98.43 Criminal Background Checks all operators, employees, and prospective employees of a child care facility and any individual residing in a residence licensed as a child care facility shall have an FBI national criminal history records check (fingerprint), State criminal history records check (fingerprint), State child abuse registry check, National Crime Information Center (NCIC) National Sex Offender Registry (NSOR) sex offender registry check, and State sex offender registry check. Further, such checks must be completed at least every five years on the owner and staff of a child care facility. 1. Before a prospective staff member may begin work in a child care facility a valid Letter of Suitability must have been issued by the MSDH Criminal Records Check Unit. The child care facility shall submit the following for processing:

a. A completed fingerprint card and fees, as appropriate, shall be submitted to the Mississippi State Department of Health (MSDH) for processing. A copy of the submitted fingerprint card, fees paid, and evidence of mailing shall be maintained in the employee’s personnel file until the facility receives notification from the Mississippi State Department of Health (Department) verifying the employee’s suitability for employment.

If the facility is notified that the fingerprints submitted were incomplete or of such poor quality that prevented processing, the facility shall reprint the individual and/or resubmit the necessary information within ten days of the dated letter on the notification.

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b. A Child Abuse Registry Form shall be submitted to the Department of Human Services for processing. A copy of the submitted form and evidence of mailing shall be maintained in the employee’s personnel file until the facility receives notification from the Department of the employee’s suitability for employment.

2. Each licensed child care facility with internet capabilities may electronically access, monitor, and verify the suitability status of any submitted employee through a Department maintained webpage: http://www.HealthyMS.com. (Licensed providers without electronic capabilities will receive hardcopy notification of an employee’s suitability status.)

3. Upon receipt of notification, either electronically or hardcopy, that the employee has been deemed suitable for employment in a child care facility, the facility shall provide the employee the original Letter of Suitability and shall maintain a copy of the suitability letter for the facility files.

a. Unless otherwise voided, the letter confirming an employee’s Suitability for Employment is valid for a period of five years from the date of the letter. However, if an individual has been separated from employment (break in service) in a child care facility for more than 180 consecutive days a new criminal history records check must be submitted and approved before the individual may begin work in a child care facility regardless of the date of issuance on the letter.

b. The facility owner and each employee shall have criminal history records checks (fingerprint), child abuse registry checks, and sex offender registry checks completed at least every five years.

c. The Letter of Suitability is not transferable to another program licensed by the Child Care Licensure Bureau after the date of expiration as specified within the suitability letter.

d. If an individual has been separated from employment (break in service) in a child care facility for more than 180 consecutive days a new criminal history records check must be submitted and approved before the individual may begin work in a child care facility.

4. Individuals under the age of 18 that are employed by a child care provider for compensation are required to complete a comprehensive background check that includes everything an adult criminal history records check requires.

5. Child care providers shall require each applicant that lives outside of Mississippi and/or has lived outside of Mississippi within the last 5 years to complete an interstate background check for the previous state(s) of residence, which includes at a minimum a state criminal history record check, state sex offender registry check,

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and state child abuse and neglect registry check. The interstate background check must be completed within 45 days of the submission of the prospective employee’s child care employment application.

6. Volunteers

a. The facility shall maintain the following on any individual who volunteers in a child care facility for less than 120 hours per licensure year:

i. A provider will maintain a timesheet on all volunteers indicating the number of hours they worked each time they were at the facility.

ii. Immunization Compliance Form 121.

b. The facility shall maintain the following on any individual who volunteers in a child care facility for 120 or more hours per licensure year:

i. Letter of Suitability that reflects the completion of a full criminal records check, child abuse registry check, and sex offender check. Also, if required an out-of-state criminal records check, child abuse registry check, and sex offender check.

ii. Immunization Compliance Form 121.

**History**
- *Source: Miss. Code Ann. §43-20-8.*

##### **15 Miss. Admin. Code Pt. 11, R. 2.5.6** Rule 2.5.6 {#sec-11-2.5.6 omnilex-key=us-ms-regs-official--title-15--11#2.5.6}

Criminal Record (Fingerprinting), Child Abuse Central Registry Checks, and Sex Offender Records Checks Pursuant to Section 43-20-1 et seq., of the Mississippi Code of 1972, all operators, employees and prospective employees of a child care facility and any individual residing in a residence licensed as a child care facility shall have a criminal history records check (fingerprint), child abuse registry check and a sex offender registry check.

1. Within ten working days from the date of employment, the child care facility shall submit the following for processing:

a. A completed fingerprint card and fees, as appropriate, shall be submitted to the Mississippi State Department of Health for processing. A copy of the submitted fingerprint card, fees paid and evidence of mailing shall be maintained in the employee’s personnel file until the facility receives notification from the Department (MSDH) verifying the employee’s suitability for employment.

Should the facility be notified that the fingerprints submitted were incomplete or of such poor quality that prevented processing, the facility shall reprint the

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individual and/or resubmit the necessary information within ten days of the dated letter on the notification.

b. A Child Abuse Registry Form shall be submitted to the Department of Human Services for processing. A copy of the submitted form and evidence of mailing shall be maintained in the employee’s personnel file until the facility receives notification from the Department (MSDH) of the employee’s suitability for employment.

2. Although an individual is allowed to begin employment prior to the receiving confirmation of the employee’s status for employment suitability, at no time shall the facility allow that individual to provide unsupervised care or be left alone with a child until the facility receives notification from the Department (MSDH) verifying that employee’s suitability for employment. Each licensed child care facility with internet capabilities may electronically access, monitor, and verify the suitability status of any submitted employee through a MSDH maintained webpage: http://www.msdh.state.ms.us. (Licensed providers without electronic capabilities will receive hardcopy notification of an employee’s suitability status.)

3. Upon receipt of notification, either electronically or hardcopy, that the employee has been deemed suitable for employment in a child care facility, the facility shall provide the employee the original Letter of Suitability and shall maintain a copy of the suitability letter for the facility files.

Unless otherwise voided, the letter confirming an employee’s Suitability for Employment is valid for a period of five years. However, if there is no break in service from the submitting licensed provider of origin and/or the same campus, as specified on the suitability letter, the Letter of Suitability will remain valid for as long as the individual remains employed at the licensed facility of origin. The Letter of Suitability is not transferable to another program licensed by the Child Care Licensure Division after the date of expiration as specified within the suitability letter.

4. Individuals under the age of 18 are not required to be fingerprinted. However, that individual must never be left alone with children.

5. The facility shall maintain the following on any individual who volunteers in a child care facility for 120 or more hours per licensure year:

a. Letter of Suitability for Employment that reflects the completion of the criminal records check, child abuse registry check, and sex offender check.

b. Immunization Compliance Form 121.

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**History**
- *Source: Miss. Code Ann. §43-20-8.*

##### **15 Miss. Admin. Code Pt. 11, R. 2.5.7** Child Care Director Qualifications: A child care director shall be least 21 years of age and shall have at a minimum: 1 {#sec-11-2.5.7 omnilex-key=us-ms-regs-official--title-15--11#2.5.7}

A bachelors degree in early childhood education, child development, elementary education, child care, special education, psychology (with emphasis on child psychology), or family and consumer sciences (with emphasis on child development), or equivalent degree from another child-related field or course of study. OR 2. two-year associate degree from an accredited community or junior college in child development technology which must include a minimum of 480 hours of practical training, supervised by college instructors, in a college operated child care learning laboratory. OR 3. A two-year associate degree from an accredited community or junior college in child development technology or child care and two years paid experience in a licensed child care facility. OR 4. Two years paid experience as a caregiver in a licensed child care facility, and either (1) a current Child Development Associate (CDA) credential from the Council for Early Childhood Professional Recognition (CECPR), or (2) a Mississippi Department of Human Services (MDHS) Division of Early Childhood Care and Development (DECCD) Child Care Director’s Credential or MDHS OCY Child Care Director’s Credential, or (3) 24 semester hours credit with a grade of “C” or better from an accredited college or university in courses specific to early childhood. OR 5. A verified certificate from the licensing agency certifying that the individual was qualified to be the director of a licensed child care facility prior to January 1, 2000 in the State of Mississippi.

**History**
- *Source: Miss. Code Ann. §43-20-8.*

##### **15 Miss. Admin. Code Pt. 11, R. 2.5.8** Caregivers: Caregivers shall be at least 18 years of age, and shall have at a minimum: 1 {#sec-11-2.5.8 omnilex-key=us-ms-regs-official--title-15--11#2.5.8}

A high school diploma or equivalent (GED). OR 2. A current CECPR Child Development Associate (CDA) credential, a MDHS DECCD Child Care Director’s Credential, or MDHS OCY Director’s Child Care Credential.

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OR 3. Three years prior documented experience caring for children who are under 13 years of age and who are not related to the caregiver within the third degree computed according to civil law. Staff failing to meet the requirements of education and/or experience to act as a caregiver shall be designated as caregiver assistants.

**History**
- *Source: Miss. Code Ann. §43-20-8.*

##### **15 Miss. Admin. Code Pt. 11, R. 2.5.9** Caregiver Assistants: Caregiver assistants shall be at least 16 years of age {#sec-11-2.5.9 omnilex-key=us-ms-regs-official--title-15--11#2.5.9}

Caregiver assistants shall work under the direct on-site supervision of a director or caregiver at all times. They shall not have the direct responsibility for a group of children as the sole caregiver. Caregiver assistants under the age of 18 shall not be given the authority to discipline children.

**History**
- *Source: Miss. Code Ann. §43-20-8.*

##### **15 Miss. Admin. Code Pt. 11, R. 2.5.10** Students 1 {#sec-11-2.5.10 omnilex-key=us-ms-regs-official--title-15--11#2.5.10}

Students in a field study placement, a practicum, or vocational child care training program may assist in the care of the children when the following conditions have been met. 2. Students who are 18 years of age or older and who are in a child care facility for 120 or more hours per licensure year shall have a record on file in the facility which shall contain the following: a. Name, date of birth, address, and phone number. b. Name and phone number of a contact person from the school or university placing the student. c. Date placement began and daily record of hours the student is present. d. Mississippi State Department of Health Certificate of Immunization Compliance Form 121. e. Documentation that the criminal records check (fingerprinting), and child abuse central registry check have been completed and no records found. f. Documentation of a minimum of one hour of orientation, within one week of placement, including but not limited to, the child abuse law and reporting procedures, emergency procedures, and facility discipline and transportation policies.

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Students who are under 18 years of age and who are in a child care facility for 120 or more hours per licensure year shall have a record on file in the facility that shall contain all of the above listed material with the exception of Item e. The facility shall document the time that a student is at the facility. No student shall be left alone with children unless an approved letter of suitability is on file.

**History**
- *Source: Miss. Code Ann. §43-20-8.*

##### **15 Miss. Admin. Code Pt. 11, R. 2.5.11** Use of Director Designee 1 {#sec-11-2.5.11 omnilex-key=us-ms-regs-official--title-15--11#2.5.11}

A director designee is an individual designated to act as the director, having all responsibility and authority of a director, during the director’s short-term absence. 2. A A director designee shall, at a minimum have a high school diploma or GED and two years paid experience in a licensed child care facility or licensed/accredited kindergarten program. A director designee shall not retain sole director authority in a facility for more than 24 total hours per calendar week Exception: Facility may have a Director Designee serve for a maximum of 14 consecutive days during a licensure year. This exception may be used once during the licensure year for allowing the director personal leave, i.e., vacation, jury duty, etc. In addition, if a Director has a medical condition (illness, recovery from surgery, accident, etc.) that requires more than 14 consecutive day’s recovery time, the time a Director Designee may be utilized may be extended. The facility is responsible to notify the Child Care Division of such circumstances and provide documentation supporting the need to extend the time the Director Designee needs to be utilized. Approval of this exception is at the discretion of the Child Care Licensure Division. 3. When the director designee is in charge of the facility, they shall have full access to all documents of the facility that are necessary for the licensing agency to conduct an inspection or complaint investigation. These documents shall include, but are not limited to, staff records, children’s records, safety inspections, and any other material or documents required by the inspecting official.

**History**
- *Source: Miss. Code Ann. §43-20-8.*

##### **15 Miss. Admin. Code Pt. 11, R. 2.5.12** Staff Development 1 {#sec-11-2.5.12 omnilex-key=us-ms-regs-official--title-15--11#2.5.12}

Owners, Directors and Director Designees. Before a new license to operate is issued, owners, directors, and director designees of the child care facility shall each complete mandatory training on courses covering Child Care Regulations, Director Orientation, and Playground Safety. If a new director or director designee is appointed by the child care facility after the license issuance, the mandatory training courses shall be completed by such individual(s) within the first six months of appointment. In the sole discretion of the licensing agency, mandatory training may be waived upon the submission of documentation of the individual’s prior completion of relevant training.

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2. All child care staff, directors, director designees, and caregivers shall be required to complete 15 contact hours of staff development, accrued during the licensure year, annually. The National Association for the Education of Young Children (NAEYC), a leading organization in child care and early childhood education recommends annual training based on the needs of the program and the pre-service qualification of the staff. Training should address the following: a. Health and safety. b. Child growth and development. c. Nutrition. d. Planning learning activities. e. Guidance and discipline techniques. f. Linkages with community services. g. Communications and relations with families. h. Detection of child abuse. i. Advocacy for early childhood programs. j. Professional issues. 3. Contact hours for staff development shall be approved by the licensing agency. 4. No more than five contact hours of approved in-service training provided by the child care facility may be counted toward the total number of hours required each year. More than five hours of in-service training may be provided by the child care facility but no more than five hours may be counted toward the required total of 15 hours. 5. All volunteers shall receive, at a minimum, one hour of orientation by the facility director. Such orientation, at a minimum, shall include a review of the child abuse law and reporting requirements, emergency exit procedures, and the facility transportation policy.

**History**
- *Source: Miss. Code Ann. §43-20-8.*

##### **15 Miss. Admin. Code Pt. 11, R. 2.5.13** Review by Licensing Agency 1 {#sec-11-2.5.13 omnilex-key=us-ms-regs-official--title-15--11#2.5.13}

The satisfaction of the personnel requirements applicable to any individual shall be determined by the licensing agency acting pursuant to its authority under applicable statutes and regulations.

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2. The licensing agency, in its sole discretion, may accept suitable educational credits, programs, or degrees in lieu of those specified in Subchapter 5 upon the submission of adequate documentation by the individual.

**History**
- *Source: Miss. Code Ann. §43-20-8 Subchapter 6. RECORDS Rule 2.6.1 Records: Records listed in this section shall be kept within the physical confines of the child care facility and shall be made available to the licensing agency on request.*
- *Source: Miss. Code Ann. §43-20-8.*

##### **15 Miss. Admin. Code Pt. 11, R. 2.6.2** Records Retention: 1 {#sec-11-2.6.2 omnilex-key=us-ms-regs-official--title-15--11#2.6.2}

All records, unless otherwise specified, shall be kept for a period of at least three years. 2. A child's records shall be retained for a period of one year after the child is no longer in attendance at the facility.

**History**
- *Source: Miss. Code Ann. §43-20-8.*

##### **15 Miss. Admin. Code Pt. 11, R. 2.6.3** Facility Records: 1 {#sec-11-2.6.3 omnilex-key=us-ms-regs-official--title-15--11#2.6.3}

Attendance records for children and employees. 2. A current alphabetical roster of children enrolled in the child care facility, to include the child's full name and date of birth. 3. A current alphabetical roster of staff employed or volunteers in the child care facility. 4. Current license. 5. Records of monthly fire/disaster evacuation drills. 6. A record shall be maintained of any medication administered by the director or caregiver showing the date, time, and signature of dispensing employee. A medication record may be destroyed 90 days after administering the medication. 7. A record shall be maintained on each volunteer to document the date and number of hours of volunteer service. 8. Each facility shall maintain a notebook containing copies of the MSDH Certificate of Immunization Compliance (MSDH Form #121) for both staff and children at the facility. The notebook shall contain separate current alphabetical rosters of both

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staff and children. The certificates shall be filed in alphabetical order to match the current staff and child rosters. 9. Each facility shall maintain a notebook containing a copy of the Letter of Suitability for Employment from the licensing agency on all employees and, when applicable, volunteers. The notebook shall contain an alphabetical roster of staff and volunteers. Along with the name, date-of-birth, the initial date of hire or volunteering must be given for cross-reference to individual personnel/volunteer files. The Letter of Suitability for Employment shall be filed in order matching the alphabetical roster. NOTE: Items required by 8 and 9 above may be placed within the same notebook.

10. Each licensed child care provider is required to enter into the Child Care LARS Database the hourly rate that they charge to care for a child in a particular age group they serve, i.e., Infant, Preschool, School Age. The following is used for calculating the hourly rate for each age group. Calculation of the daily rate Current Monthly Rate (CMR) Calculated Yearly Rate = (CMR X 12 months) Calculated Weekly Rate = (Calculated Yearly Rate ÷ 52) Calculated Daily Rate = (Calculated Weekly Rated ÷ 5) Age Group Current Monthly Rate (CMR) Yearly Rate CMR X 12 Weekly Rate Yearly Rate ÷

Daily Rate Before Rounding Weekly Rate ÷ 5 Daily Rate Rounded Up to the Next Cent Infant $480.00 $5,760.00 110.7692308 22.15385 $22.16 Preschool $440.00 $5,280.00 101.5384615 20.30769 $20.31 School Age $320.00 $3,840.00 73.84615385 14.76923 $14.77

**History**
- *Source: Miss. Code Ann. §43-20-8.*

##### **15 Miss. Admin. Code Pt. 11, R. 2.6.4** Personnel Records: 1 {#sec-11-2.6.4 omnilex-key=us-ms-regs-official--title-15--11#2.6.4}

Employee Records: Each employee's personnel record shall contain the following:

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a. Name, date of birth, address, and phone number. b. Documentation of education, training, and experience necessary for employment. c. Records of staff development accrued during each licensure year, beginning with the date employed. d. Date of employment and date of separation. e. Mississippi State Department of Health Certificate of Immunization Compliance Form 121. f. Documentation that the criminal record checks (fingerprinting), Child Abuse Central Registry checks, and Sex Offender Registry checks, have been conducted (Letter of Suitability for Employment); and the information shall be included in each employee's personnel file. NOTE: Each person living in a private residence used as a child care facility shall meet the same requirements as employed personnel, relative to health, criminal record, fingerprinting, child abuse central registry checks, and sex offender registry checks. g. Documentation of orientation, within one week of being hired, including but not limited to emergency procedures (to include policies for handling dangerous situations), staffing and supervision requirements, daily schedules, physical/emotional/developmental problems of children, discipline policies, and child abuse and neglect. h. Upon resignation or termination, personnel records shall be kept on file and be made available to the licensing agency for at least one year after the last day of employment. 2. Required Employee information to be entered into the Child Care Database – Licensure and Reporting System (LARS) The following information will be entered in the Child Care LARS Database for the Owner, Director, and all staff of the child care facility. The information will be entered during the Child Care Initial Application, Renewal Application, and Provider Portal “Manage Contacts” sections. a. First Name b. Last Name c. Date of Birth d. Last 4 of SSN e. Hire Date f. Email Address g. Mailing Address

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h. Contact Phone Number

The required information entered into the LARS Child Care Database under this rule is confidential and not viewable by the general public. The information will be used to authenticate the required contact hours taken by staff each licensure year. This information will also provide the ability for the child care operator to retrieve information regarding whether an employee is up-to-date or deficient regarding the required staff development hours (15 hours required) each licensure year.

Further, this information will allow an individual employee or a supervisor of an employee, i.e., Owner and/or Director to register an employee for courses to maintain the continuing education hours required for the continued licensing of the child care facility.

**History**
- *Source: Miss. Code Ann. §43-20-8.*

##### **15 Miss. Admin. Code Pt. 11, R. 2.6.5** Rule 2.6.5 {#sec-11-2.6.5 omnilex-key=us-ms-regs-official--title-15--11#2.6.5}

Volunteer Records (120 or more hours per year): For any person who volunteers in a child care facility for 120 or more hours per licensure year, a record shall be kept which contains the following: 1. Name, date of birth, address, and phone number. 2. Documentation of education, training, and experience that may help them in their role as a volunteer. 3. Date individual began volunteering and last date individual volunteered at the facility. 4. Mississippi State Department of Health Certificate of Immunization Compliance Form 121. 5. Documentation that the criminal records check (fingerprinting), child abuse central registry check, and sex offender registry check has been conducted (Letter of Suitability for Employment), and the information is included in each volunteer’s file. 6. Documentation of a minimum of one hour of volunteer orientation, within one week of volunteering, including but not limited to, the child abuse law and reporting requirements, emergency exit procedures, policies for handling dangerous situations, and the facility transportation policy. 7. A volunteer’s record shall be retained for a period of one year after they are no longer volunteering at the facility. 8. A record shall be maintained on each volunteer to document the date and number of hours of volunteer service.

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**History**
- *Source: Miss. Code Ann. §43-20-8.*

##### **15 Miss. Admin. Code Pt. 11, R. 2.6.6** Rule 2.6.6 {#sec-11-2.6.6 omnilex-key=us-ms-regs-official--title-15--11#2.6.6}

Volunteer Records (Less than 120 hours per year): For any person who volunteers in a child care facility for less than 120 hours per licensure year, a record shall be kept which contains the following: 1. Documentation of a minimum of one hour of volunteer orientation within one week of volunteering, including but not limited, to the child abuse law and reporting requirements, emergency exit procedures, policies for handling dangerous situations, and the facility transportation policy and special needs of children. 2. A volunteer’s record shall be retained for a period of one year after they are no longer volunteering at the facility. 3. A record shall be maintained on each volunteer to document the date and number of hours of volunteer service. 4. Mississippi State Department of Health Certificate of Immunization Compliance Form 121.

**History**
- *Source: Miss. Code Ann. §43-20-8.*

##### **15 Miss. Admin. Code Pt. 11, R. 2.6.7** Facility Records 1 {#sec-11-2.6.7 omnilex-key=us-ms-regs-official--title-15--11#2.6.7}

Attendance records for children and employees. 2. A current alphabetical roster of children enrolled in the child care facility, to include the child's full name and date of birth. 3. A current alphabetical roster of staff employed or volunteers in the child care facility. 4. Current license. 5. Records of monthly fire/disaster evacuation drills. 6. A record shall be maintained of any medication administered by the director or caregiver showing date, time, and signature of dispensing employee. A medication record may be destroyed 90 days after administering the medication. 7. A record shall be maintained on each volunteer to document date and number of hours of volunteer service. 8. Each facility shall maintain a notebook containing copies of the MSDH Certificate of Immunization Compliance (MSDH Form #121) for both staff and children at the facility. The notebook shall contain separate current alphabetical rosters of both staff and children. The certificates shall be filed in alphabetical order to match the current staff and child rosters.

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9. Each facility shall maintain a notebook containing a copy of the Letter of Suitability for Employment from the licensing agency on all employees and, when applicable, volunteers. The notebook shall contain an alphabetical roster of staff and volunteers. Along with name, date-of-birth, the initial date of hire or volunteering must be given for cross-reference to individual personnel/volunteer files. The Letter of Suitability for Employment shall be filed in order matching the alphabetical roster. 10. Items required by items 8 and 9 above may be placed within the same notebook.

**History**
- *Source: Miss. Code Ann. §43-20-8.*

##### **15 Miss. Admin. Code Pt. 11, R. 2.6.8** Personnel Records 1 {#sec-11-2.6.8 omnilex-key=us-ms-regs-official--title-15--11#2.6.8}

Employee Records: Each employee's personnel record shall contain the following: a. Name, date of birth, address, and phone number. b. Documentation of education, training, and experience necessary for employment. c. Records of staff development accrued during each licensure year, beginning with date employed. d. Date of employment and date of separation. e. Mississippi State Department of Health Certificate of Immunization Compliance Form #121. f. Documentation that the criminal record checks (fingerprinting), Child Abuse Central Registry checks, and Sex Offender Registry checks, have been conducted; and the information shall be included in each employee's personnel file. NOTE: Each person living in a private residence used as a child care facility shall meet the same requirements as employed personnel, relative to health, criminal record, fingerprinting, child abuse central registry checks, and sex offender registry checks. g. Documentation of orientation, within one week of being hired, including but not limited to emergency procedures (to include policies for handling dangerous situations), staffing and supervision requirements, daily schedules, physical/emotional/developmental problems of children, discipline policies, and child abuse and neglect. h. Upon resignation or termination, personnel records shall be kept on file and be made available to the licensing agency for at least one year after the last day of employment.

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**History**
- *Source: Miss. Code Ann. §43-20-8.*

##### **15 Miss. Admin. Code Pt. 11, R. 2.6.9** Rule 2.6.9 {#sec-11-2.6.9 omnilex-key=us-ms-regs-official--title-15--11#2.6.9}

Volunteer Records (120 or more hours per year): For any person who volunteers in a child care facility for 120 or more hours per licensure year, a record shall be kept which contains the following: 1. Name, date of birth, address, and phone number. 2. Documentation of education, training, and experience that may help them in their role as a volunteer. 3. Date individual began volunteering and last date individual volunteered at facility. 4. Mississippi State Department of Health Certificate of Immunization Compliance Form #121. 5. Documentation that the criminal records check (fingerprinting), child abuse central registry check, and sex offender registry check have been conducted, and the information included in each volunteer’s file. 6. Documentation of a minimum of one hour of volunteer orientation, within one week of volunteering including but not limited to the child abuse law and reporting requirements, emergency exit procedures, policies for handling dangerous situations, and the facility transportation policy. 7. A volunteer’s record shall be retained for a period of one year after they are no longer volunteering at the facility. 8. A record shall be maintained on each volunteer to document date and number of hours of volunteer service.

**History**
- *Source: Miss. Code Ann. §43-20-8.*

##### **15 Miss. Admin. Code Pt. 11, R. 2.6.10** Rule 2.6.10 {#sec-11-2.6.10 omnilex-key=us-ms-regs-official--title-15--11#2.6.10}

Volunteer Records (Less than 120 hours per year): For any person who volunteers in a child care facility for less than 120 hours per licensure year, a record shall be kept which contains the following: 1. Documentation of a minimum of one hour of volunteer orientation within one week of volunteering, including but not limited, to the child abuse law and reporting requirements, emergency exit procedures, policies for handling dangerous situations, and the facility transportation policy and special needs of children. 2. A volunteer’s record shall be retained for a period of one year after they are no longer volunteering at the facility. 3. A record shall be maintained on each volunteer to document date and number of hours of volunteer service.

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**History**
- *Source: Miss. Code Ann. §43-20-8.*

##### **15 Miss. Admin. Code Pt. 11, R. 2.6.11** Rule 2.6.11 {#sec-11-2.6.11 omnilex-key=us-ms-regs-official--title-15--11#2.6.11}

Child Records: The facility shall maintain an individual file for each child under its current care, and for any withdrawn child who withdrew during the preceding twelve months, containing the following identification and contact information, parental instructions, authorizations and other documents required by its policy manual: 1. Identification and Contact Information a. The name of the child and names of parents/guardians. b. Home address and home phone number. c. The parent’s business name, address and phone number. d. The child’s date of birth. e. Date of acceptance at facility and date of withdrawal, if any, with the parents’ stated reason for withdrawal. f. Other contact information required to be maintained in accordance with facility’s policy manual. 2. Parental Instructions a. If the parent provides written instructions to the facility, those instructions concerning the child’s growth and development, medical needs, allergies, toilet training and other information relevant to the child’s well-being shall be maintained and updated as provided from time to time. b. Written identification of an authorized, responsible person(s) for pick up of the child. c. Documentation of any limitation of parental rights of the other parent or stepparent. d. Documentation of any limitation or restriction, if any, on activities of child, or other participation by the child in certain events such as holiday celebrations or being photographed or other parental concerns. 3. Authorizations a. Signed written authorization to obtain emergency medical treatment and to administer medication. b. Election by parent either (a) to provide written authorization consenting to any and all field trips, excursions, or series of events outside the child care facility, or (b) to provide written consent only for those specific field trips, excursions, or series of events for which a date, time and location are specifically approved.

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c. Signed acknowledgment by parent that the written policies and procedures described in Rule 2.4.1 has been received by the parent. d. Signed acknowledgment by parent that a summary of licensing standards and other materials designated by the licensing agency has been received by the parent. 4. Documents Required by Policy Manual or Contract a. If agreed by the facility in its policy manual or caregiver contracts, method in which facility will inform the parent or contact person if a child does not arrive at the facility within a reasonable time after a scheduled drop-off. b. Any other documents or identification records agreed to be maintained by the facility. 5. Confidentiality of Records and Information a. Individual child records are confidential and shall not be disclosed or released without prior written authorization by the parent. b. Individual personnel records are confidential and shall not be disclosed or released without prior written authorization by the employee.

Subchapter 7. REPORTS Rule 2.7.7 Serious Occurrences Involving Children: The child care facility shall enter into the child’s record and immediately report, orally to the child’s parent and either orally or in writing, via email or fax, to the licensing agency, any serious occurrences involving children. If the child care facility is unable to contact the parent and the licensing official immediately, it shall document this fact, in writing, in the child’s record. Oral reports and/or emailed/faxed reports shall be confirmed in writing and mailed within two days of the occurrence. Serious occurrences include accidents or injuries requiring extensive medical care, e.g., child is taken to the doctor or hospital or hospitalizations, alleged abuse and neglect, fire or other emergencies.

**History**
- *Source: Miss. Code Ann. §43-20-8.*
- *Source: Miss. Code Ann. §43-20-8.*

##### **15 Miss. Admin. Code Pt. 11, R. 2.7.8** Rule 2.7.8 {#sec-11-2.7.8 omnilex-key=us-ms-regs-official--title-15--11#2.7.8}

Child Abuse: Any operator or employee of a child care facility who has suspicion or evidence of child abuse or neglect shall report it immediately to the Mississippi Department of Human Services in accordance with the state's Youth Court Act. (Appendix "A")

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**History**
- *Source: Miss. Code Ann. §43-20-8.*

##### **15 Miss. Admin. Code Pt. 11, R. 2.7.9** Rule 2.7.9 {#sec-11-2.7.9 omnilex-key=us-ms-regs-official--title-15--11#2.7.9}

Communicable Disease: The child care facility shall promptly report any known or suspected case or carrier of any reportable disease to the Mississippi State Department of Health, as published in the "List of Reportable Diseases.” (Appendix "B")

**History**
- *Source: Miss. Code Ann. §43-20-8.*

##### **15 Miss. Admin. Code Pt. 11, R. 2.7.10** Rule 2.7.10 {#sec-11-2.7.10 omnilex-key=us-ms-regs-official--title-15--11#2.7.10}

Infants and Toddlers: For infants and toddlers, the child care facility shall provide, to the child's parent, daily written reports that include liquid intake, child’s disposition, bowel movements, and eating and sleep patterns.

Subchapter 8. STAFFING Rule 2.8.7 General 1. The staff-to-child ratio shall be maintained at all times, to include when children are arriving and departing the facility. 2. Children shall not be left unattended at any time. Video monitors cannot be used as a substitute for the physical presence of a caregiver in a room. 3. During all hours of operation, including arrival and departure of children, a child care facility employee shall be present to whom administrative and supervisory responsibilities have been assigned. This child care facility employee shall meet the minimum qualifications of a director or director designee. Note: Operators of child care facilities shall provide to the local licensing official a list of all individuals who meet the qualifications of a director or director designee and may be assigned administrative and supervisory responsibility for the facility when the director is absent. Documentation that an individual meets the qualifications of a director shall be submitted to and approved by the local licensing official. Director designee qualifications shall be maintained on site and available to the licensing official during site visits. 4. During all hours of operation, including the arrival and departure of children, a child care facility employee shall be present who holds a valid CPR certification, at any location where the children are present. Said certificate shall be issued by an agent recognized by the licensing authority. 5. During all hours of operation, including the arrival and departure of children, a child care facility employee shall be present, at any location where the children are present, who holds a valid first aid certificate. Said certificate shall be issued by an agent recognized by the licensing authority. Note: When initially acquiring or renewing the CPR and First Aid certifications required in items 4 and 5 above, online (internet, etc.) training is not acceptable. Training must be face-to-face and hands on.

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**History**
- *Source: Miss. Code Ann. §43-20-8.*
- *Source: Miss. Code Ann. §43-20-8.*

##### **15 Miss. Admin. Code Pt. 11, R. 2.8.8** Ratio 1 {#sec-11-2.8.8 omnilex-key=us-ms-regs-official--title-15--11#2.8.8}

The minimum ratio of caregiver staff-to-children present at all times shall be as follows: Age of Children Number of Children to Caregiver Staff Less than 1 year 4 1 year 8 2 years 12 3 years 14 4 years 16 5 through 9 years 20 10 through 12 years 25 2. Staff-to-child ratios shall be met at all times, including during opening/closing, field trips and swimming or water activities whether at the child care premises or off-site. 3. In mixed age groups, the age of the youngest child in the group determines the staff- to-child ratio. Preschool children shall not be grouped with school age children in any single area during normal classroom and playground or water activities. 4. With the exception of children under two years of age, children may be under the direct supervision (staff in the same room) of 50 percent of the staff required by this section during rest period times, provided the required staff-to-child ratio is maintained on the premises. 5. At no time will a single individual be responsible for the supervision of children located in more than one classroom at any given time.

Subchapter 9. PROGRAM OF ACTIVITIES Rule 2.9.7 General 1. The child care facility shall provide a basic program of activities geared to the age levels and developmental needs of the children served. 2. The child care facility shall provide for the reading of age-appropriate materials to children.

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3. The child care facility shall incorporate programs to encourage sun safety practices (skin cancer prevention), into activities for all age levels.

**History**
- *Source: Miss. Code Ann. §43-20-8.*
- *Source: Miss. Code Ann. §43-20-8.*

##### **15 Miss. Admin. Code Pt. 11, R. 2.9.8** Daily Routines: All daily routines, such as eating and rest periods, shall be scheduled for the same time each day {#sec-11-2.9.8 omnilex-key=us-ms-regs-official--title-15--11#2.9.8}

**History**
- *Source: Miss. Code Ann. §43-20-8.*

##### **15 Miss. Admin. Code Pt. 11, R. 2.9.9** Eating: Meal periods are breakfast, lunch, dinner, and snacks {#sec-11-2.9.9 omnilex-key=us-ms-regs-official--title-15--11#2.9.9}

A minimum of 30 minutes shall be scheduled for each breakfast, lunch, and dinner meal period. A minimum of 15 minutes shall be scheduled for each snack meal period.

**History**
- *Source: Miss. Code Ann. §43-20-8.*

##### **15 Miss. Admin. Code Pt. 11, R. 2.9.10** Rest Periods 1 {#sec-11-2.9.10 omnilex-key=us-ms-regs-official--title-15--11#2.9.10}

For preschool children, rest periods shall be scheduled for a minimum period of one hour, and shall not exceed two and one-half (2½) hours. Infant and toddler nap times shall be individualized to meet each child’s needs as sleeping patterns can vary greatly. Half-day programs must provide for rest periods as is appropriate when the children/child indicates or is observed to require some rest time. 2. Physical force shall not be used in requiring children to lie down or go to sleep during rest periods. 3. Rest periods are not required for children in attendance for less than six hours. 4. Rest periods are not required for school age children. 5. A safe sleep environment for infants to lower the risk of Sudden Infant Death Syndrome (SIDS) is required as follows: a. An infant shall be placed on his/her back for sleeping unless written physician orders to the contrary are in the child's record. Sleeping infants shall be within the view of the staff and visually checked regularly when sleeping. Nothing shall obstruct the view of the staff or prevent the staff from clearly seeing infants or children. b. Infants shall be dressed in clothing appropriate for sleeping that is designed to keep the infant warm without the possible hazard of head covering or entrapment. The room shall be kept at a draft-free seasonally appropriate temperature of 65 degrees Fahrenheit to 78 degrees Fahrenheit. If a child is already asleep and not dressed in clothing appropriate for sleeping, the caregiver does not need to awaken the infant to change his or her clothes. c. Facilities shall use a firm mattress covered by a fitted sheet.

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d. Items such as but not limited to pillows, blanket, sheepskins, bumpers, soft objects, stuffed toys, loose bedding, etc., shall not be in the crib.

**History**
- *Source: Miss. Code Ann. §43-20-8.*

##### **15 Miss. Admin. Code Pt. 11, R. 2.9.11** Outdoor Activities 1 {#sec-11-2.9.11 omnilex-key=us-ms-regs-official--title-15--11#2.9.11}

Each infant shall have a minimum of 30 minutes of outdoor activities per day, weather permitting. 2. Toddler, preschool, and school age children shall have a minimum of two hours of outdoor activities per day, weather permitting. Children who are in attendance at a facility for seven hours per day or less shall have a minimum of 30 minutes of outdoor activity per day, weather permitting. 3. Sun safe practices shall be used during outdoor activities scheduled between 10 A.M. and 2 P.M. during the period April 1 to September 15. 4. Sun safe practices shall be evident in the planning of all outdoor events. 5. Outdoor activities shall be held in areas providing shade or covered spaces

**History**
- *Source: Miss. Code Ann. §43-20-8.*

##### **15 Miss. Admin. Code Pt. 11, R. 2.9.12** Infant and Toddler Activities 1 {#sec-11-2.9.12 omnilex-key=us-ms-regs-official--title-15--11#2.9.12}

Infants and toddlers shall be free to creep, crawl, toddle, and walk as they are physically able. a. Cribs, car seats, and high chairs are to be used only for their primary purpose, i.e., cribs for sleeping, car seats for vehicle travel, and high chairs for eating. b. Providers should limit the use of equipment such as strollers, swings, and bouncer seats/chairs for holding infants while they are awake. c. Providers should implement activities for toddlers and preschoolers that limit sitting or standing to no more than 30 minutes at a time. d. Providers should use strollers for toddlers and preschoolers only when necessary. 2. Infants and toddlers shall be taken outdoors every day, weather permitting. 3. For infants who cannot move about the room, caregivers shall frequently change the place and position of the infant and the selection of toys available, and the child shall be held, rocked, and carried about.

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4. Television viewing, including video tapes and/or electronic media, is not allowed for children under the age of two or for staff in the infant and toddler area. The playing of soothing music in the infant and toddler area is acceptable. 5. Television viewing, including video tapes and/or other electronic media, cell phone, or other digital media, e.g., computer, iPad®, iTouch®, etc., for children, age two and older, is limited to one hour per day, must be of educational content and a scheduled part of the approved daily plan of activities posted in the facility. The use of an “audio player” to play music is acceptable. 6. In half-day programs, television viewing, including video tapes and/or other electronic media, cell phone, or other digital media, e.g., computer, iPad®, iTouch®, etc., for children, age two and older, is limited to 30 minutes per day, must be of educational content and a scheduled part of the approved daily plan of activities posted in the facility. The use of an “audio player” to play music is acceptable. 7. Television viewing by staff is not permitted in areas occupied by children except for the purposes as described in items 5 and 6 above.

**History**
- *Source: Miss. Code Ann. §43-20-8.*

##### **15 Miss. Admin. Code Pt. 11, R. 2.9.7** Rule 2.9.7 {#sec-11-2.9.7 omnilex-key=us-ms-regs-official--title-15--11#2.9.7}

Indoor or Outdoor Physical Activity: Child care providers are to provide infants, toddlers, and preschool children with opportunities to be physically active throughout the day. 1. Toddlers and preschool children will be provided the opportunity for light physical activity for at least 15 minutes per hour when children are not involved in their scheduled rest period. 2. Toddlers should accumulate a minimum of 60 minutes of structured moderate to vigorous physical activity per day. 3. Preschoolers should accumulate a minimum of 60 minutes of structured moderate to vigorous physical activity per day. 4. Caregivers should join in and lead the structured moderate to vigorous physical activities in which the children participate. 5. Structured physical activity should involve the performance of large muscle activities. 6. Half-day programs are only required to provide for physical activity for one-half (½) the time as stated above. NOTE: Examples of “light physical activity” may be found in the Child Care Licensure section of the MSDH website at www.HealthyMS.com. Examples of “moderate physical activity” are aerobic dancing, light calisthenics, getting up and down from the floor, dancing, playing on school ground equipment, singing while

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actively moving about, etc. Examples of “vigorous physical activity” are running, jumping rope, performing jumping jacks, playing soccer, skipping, etc. Regardless of the activity, it should be age appropriate and within the physical ability limits of the child. Please, understand the above requirement does not mean 60 minutes vigorous activity at one time. The 60 minutes of vigorous physical activity can and should be spread out in short time intervals, (e.g., 5-15 minute intervals) throughout the day.

Subchapter 10. EQUIPMENT, TOYS, AND MATERIALS Rule 2.10.7 General 1. Equipment, toys, and materials for both indoor and outdoor use shall be appropriate to the age and developmental needs of the children served. 2. Developmentally age-appropriate toys shall be available and accessible for infants, and shall include but not be limited to the following: a. Simple, lightweight, open-ended, easily washable toys such as containers, balls, large pop-beads, nesting cups. b. Rattles, squeak toys, action/reaction toys. c. Cuddly toys. d. Toys to mouth such as teethers and rings. e. Pictures of real objects. f. A crawling area with sturdy, stable furniture for pulling up self. 3. Developmentally age-appropriate toys shall be available and accessible for toddlers, and shall include but not be limited to the following: a. Push and pull toys. b. Stacking toys, large wooden spools/beads/cubes. c. Sturdy picture books, music. d. Pounding bench, simple puzzles. e. Play phone, dolls, and toys to appeal to child’s imagination. f. Large paper, crayons. g. Sturdy furniture to hold on to while walking.

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h. Sand and water toys. 4. Developmentally age-appropriate toys shall be available and accessible for preschoolers, and shall include but not be limited to the following: a. Active play equipment for climbing and balancing. b. Unit blocks and accessories. c. Puzzles, manipulative toys. d. Picture books and records, musical instruments. e. Art materials such as finger and tempera paints, clay, play dough, crayons, collage materials, markers, scissors, and paste. f. Dramatic play materials such as dolls, dress-up clothes and props, child-sized furniture, puppets. g. Sand and water toys. 5. Children's original work shall be displayed in the child care facility. 6. Books shall be on shelves and tables for children to look at and read. Every child shall have age-appropriate materials (including picture books) read to and discussed with him or her every day. Where appropriate, the materials should cover topics with which the children are involved. 7. Television viewing by preschool children shall be limited to one hour per day and shall be educational programming only. Television viewing by staff is not permitted in areas occupied by children except for the purposes as described herein. 8. The daily activity schedule shall demonstrate that preschoolers are given opportunities to do a variety of activities, including both quiet and active, such as block play, art activities, puzzles, books, and learning games, and that stories are read to and discussed with each child every day.

**History**
- *Source: Miss. Code Ann. §43-20-8.*
- *Source: Miss. Code Ann. §43-20-8.*

##### **15 Miss. Admin. Code Pt. 11, R. 2.10.8** Playground Equipment 1 {#sec-11-2.10.8 omnilex-key=us-ms-regs-official--title-15--11#2.10.8}

All playgrounds and playground equipment used by children 2 - 12 years of age shall meet the safety standards set forth in Appendix “D” of these regulations. 2. Playground equipment shall be of safe design and in good repair. Outdoor playground climbing equipment and swings shall be set in concrete footings located at least six inches below ground surface. Indoor playground equipment shall be installed according to the manufacturer's specifications. Swings shall have soft

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and/or flexible seats. Access to playground equipment shall be limited to age groups for which the equipment is developmentally appropriate. 3. Equipment designed for outdoor use by infants and toddlers shall be accessible to shaded areas to ensure sun safe practices.

**History**
- *Source: Miss. Code Ann. §43-20-8.*

##### **15 Miss. Admin. Code Pt. 11, R. 2.10.9** Paint: Paint on toys, equipment, furniture, walls, and other items shall be lead-free and non-poisonous {#sec-11-2.10.9 omnilex-key=us-ms-regs-official--title-15--11#2.10.9}

**History**
- *Source: Miss. Code Ann. §43-20-8.*

##### **15 Miss. Admin. Code Pt. 11, R. 2.10.10** Chairs and Tables: Chairs and tables shall be of a size appropriate to the size and age of the children {#sec-11-2.10.10 omnilex-key=us-ms-regs-official--title-15--11#2.10.10}

There shall be an adequate number of chairs and tables to accommodate the children present at the facility.

**History**
- *Source: Miss. Code Ann. §43-20-8.*

##### **15 Miss. Admin. Code Pt. 11, R. 2.10.11** Rule 2.10.11 {#sec-11-2.10.11 omnilex-key=us-ms-regs-official--title-15--11#2.10.11}

Hooks and Compartments: Individual hooks or compartments shall be provided for each child for hanging or storing outer and/or extra clothing as well as for personal possessions. Hooks shall be spaced well apart so that clothes and belongings do not touch those of another child. Hooks shall also be placed at a height suitable to prevent an injury to a child.

**History**
- *Source: Miss. Code Ann. §43-20-8.*

##### **15 Miss. Admin. Code Pt. 11, R. 2.10.12** Sand Boxes 1 {#sec-11-2.10.12 omnilex-key=us-ms-regs-official--title-15--11#2.10.12}

Sand boxes shall be constructed to permit drainage, shall be covered tightly and securely when not in use, and shall be kept free from cat or other animal excrement. 2. Sand contained in sand boxes shall not contain toxic or harmful materials.

**History**
- *Source: Miss. Code Ann. §43-20-8.*

##### **15 Miss. Admin. Code Pt. 11, R. 2.10.13** Cribs: 1 {#sec-11-2.10.13 omnilex-key=us-ms-regs-official--title-15--11#2.10.13}

The facility shall provide a crib or other similarly commercially purchased bed unit, approved and designated for the purpose of sleeping. Mobile infants, at a minimum of eight months, may be placed on a mat during the transition period of crawling to walking. If such mat is used, it shall be a flame retardant, minimum of two (2) inch commercially purchased sleep mat, especially designated for the purpose of sleeping. All cribs, sleep units, and mats must be maintained clean, in sanitary condition and without chips, holes, fraying, tears, or stains. 2. The use of stackable cribs is prohibited.

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**History**
- *Source: Miss. Code Ann. §43-20-8.*

##### **15 Miss. Admin. Code Pt. 11, R. 2.10.14** High Chairs: High chairs, if used, shall have a wide base and a T-shaped safety strap {#sec-11-2.10.14 omnilex-key=us-ms-regs-official--title-15--11#2.10.14}

They shall be labeled or warranted by the manufacturer in documents provided at the time of purchase or verified thereafter by the manufacturer as meeting the American Society for Testing Materials (ASTM) Standard F-404 (Consumer Safety Specifications for High Chairs).

**History**
- *Source: Miss. Code Ann. §43-20-8.*

##### **15 Miss. Admin. Code Pt. 11, R. 2.10.15** Rest Period Equipment 1 {#sec-11-2.10.15 omnilex-key=us-ms-regs-official--title-15--11#2.10.15}

Individual beds, cots, mattresses, pads, or other acceptable equipment shall be used for rest periods, and children shall not be placed directly on the floor for rest periods. Bed linens, such as blankets or sheets, cannot be used in place of a bed, cot, mattress, or pad. These shall be kept in a sanitary condition. Once a sheet or blanket has been used by a child, it shall not be used by another child until it has been laundered. 2. Rest period equipment shall be clean and covered with a waterproof cover. 3. Nap pads/cots are designed for use by one child only at a time. 4. Nap pads utilized by more than one child shall be sanitized after each child’s use. Nap pads utilized by only one child shall be sanitized immediately when soiled or at least weekly. 5. Nap pads and nap cots without mattresses are not acceptable for use in 24-hour programs. Beds, cribs, or rollaway cots are the only acceptable bedding for 24-hour centers. 6. All infants shall have a crib. The use of “Pack and Plays” for infant sleeping is not allowed. Cribs, cots, and mats are to be a minimum of 24” apart or separated by a solid barrier. A minimum of 36 inches is recommended. 7. Children are not allowed to sleep in shared places, such as infant seats, strollers, swings, cozy areas, or on tables. If a child falls asleep in such shared place, he or she should be moved immediately to a sanitary individual sleeping place.

**History**
- *Source: Miss. Code Ann. §43-20-8.*

##### **15 Miss. Admin. Code Pt. 11, R. 2.10.16** Play Equipment 1 {#sec-11-2.10.16 omnilex-key=us-ms-regs-official--title-15--11#2.10.16}

Play equipment, toys, and materials shall be provided that meets the standards of the Consumer Product Safety Commission and/or the American Society for Testing and Materials (ASTM) for juvenile products. Play equipment, toys, and materials shall be found to be appropriate to the development needs, individual interests, and ages of the children as identified as age-appropriate by a label provided by the manufacturer on the product package.

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2. Projectile toys, i.e., dart guns, toy guns, etc., are prohibited. 3. Water play tables, if used, shall be cleaned and sanitized daily. 4. Tricycles and other riding toys used by the children shall be spokeless, steerable, and of a size appropriate for the child, and shall have low centers of gravity. All such toys shall be in good condition and free of sharp edges or protrusions that may injure the children. When not in use, such toys shall be stored in a location where they will not present a physical obstacle to the children and employees. Riding toys shall be inspected at least monthly for protrusions and rough edges that could lead to injury.

**History**
- *Source: Miss. Code Ann. §43-20-8.*

##### **15 Miss. Admin. Code Pt. 11, R. 2.10.17** School Age Programs 1 {#sec-11-2.10.17 omnilex-key=us-ms-regs-official--title-15--11#2.10.17}

The foregoing provisions in Subchapter 10 shall not be applied to any facility licensed solely for School age children unless specifically required in Rule 2.10.11. 2. All playgrounds and playground equipment used by children 2 - 12 years of age shall meet the safety standards set forth in Appendix “D” of these regulations. 3. Projectile toys are prohibited. Projectile toys are toys which, when projected, have the ability to penetrate body or eye tissue. Play equipment, toys, and materials shall be provided that meets the standards of the Consumer Product Safety Commission and/or the American Society for Testing and Materials (ASTM) for juvenile products. 4. Possessions, belongings, and extra clothing for each school age child must be stored in such a manner as to not touch those of another child.

Subchapter 11. BUILDINGS AND GROUNDS Rule 2.11.7 Building 1. A child care facility shall be physically separated from any other business or enterprise. Other occupants, visitors, and/or employees of other businesses or enterprises within the same building shall not be allowed within the physical confines of the child care facility for the purpose of entering the building or exiting the building, or passing through the child care facility for the purpose of gaining access to another part of the building. 2. All child care facility buildings shall meet all fire safety standards listed on the MSDH Form #333 and all applicable local fire safety standards and/or ordinances. 3. No house trailers, relocatable classrooms, or portable buildings shall be used to house a child care facility unless such structure was originally designed specifically for educational purposes and meets the Mississippi State Department of Education’s

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current standards for a relocatable classroom. Further, such portable structure shall meet all applicable fire safety codes. Current licensees operating facilities housed in such structures are exempted from this provision. Any change of ownership, need for major renovation, or other significant change in the facility’s status shall revoke such exemption. 4. Plans and specifications shall be submitted to the licensing agency for review and approval on all proposed construction and/or major renovations. 5. A separate space shall be provided for the use of an ill or injured child until the child can be picked up by the parent. Space shall be located in an area that is supervised at all times by an employee. 6. Separate space for infants and toddlers shall be provided away from older children except in facilities licensed for 12 or fewer children. 7. Children are not allowed to sleep in shared places, such as infant seats, strollers, swings, cozy areas, or on tables. If a child falls asleep in such shared place, he or she should be moved immediately to a sanitary individual sleeping place. 8. All parts of the child care facility used by children shall be lead-safe, well lighted, ventilated, and free of hazardous or potentially hazardous conditions, such as but not limited to, open stairs and unprotected low windows. a. All buildings intended for use as a child care facility constructed before 1965 shall be tested for lead. It is the responsibility of the facility applicant/operator to have a lead hazard screen or lead-based paint risk assessment of the facility done by an individual or company certified as a risk assessor by the Mississippi Commission on Environmental Quality. If the facility is found not to be lead-safe, it will not be allowed to operate as a child care facility until all required corrective measures have been taken and the facility is determined to be lead-safe by a certified risk assessor. b. All buildings intended for use as a child care facility, constructed prior to 1978, shall utilize MDEQ Lead Safe Certified individuals or companies for all renovation, repair and maintenance activities which disturb painted surfaces unless the paint to be disturbed has been documented to be lead-free by an individual or company that is MDEQ Lead Safe Certified as a risk assessor or inspector. NOTE: It is recommended that child care facility operators contact the Mississippi Department of Environmental Quality at 601-961-5630 regarding any questions they may have about compliance with the laws and regulations related to lead and lead based paint.

9. All glass in doors, windows, mirrors, etc., shall have a protective barrier at least four feet high when measured from the floor. Doors, windows, mirrors, etc., using safety- grade glass or polymer (e.g., Lexan®) are not required to have a protective barrier.

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Glass windows and glass door panels shall be equipped with a vision strip 36 inches from the floor. Safety glass must be so certified by the installer and the statement kept on file at the child care facility. 10. Walls shall be kept clean and free of torn wall covering, chipped paint, broken plaster, and holes. No paint that contains lead compounds shall be applied to interior walls or woodwork. 11. All ceiling lighting shall be shielded completely and encased in shatterproof materials. 12. A child care facility shall have a working phone available to all staff at all times. Phones shall also be available for incoming calls and shall not be unplugged or disconnected during business hours. 13. All fire extinguishers, as required in the fire safety plan, shall be serviced on an annual basis by a qualified fire extinguisher technician. 14. Unused electrical outlets shall be protected by a safety plug cover. 15. No extension cords shall be used in areas accessible to children. 16. Every child care facility which uses nonelectric heating and/or cooling systems, cooking stoves, and/or hot water heaters or other nonelectric equipment, shall have sufficient carbon monoxide monitors placed appropriately throughout the child care facility. 17. All child care facilities are to be kept clean and in good repair.

**History**
- *Source: Miss. Code Ann. §43-20-8.*
- *Source: Miss. Code Ann. §43-20-8.*

##### **15 Miss. Admin. Code Pt. 11, R. 2.11.8** Indoor Square Footage 1 {#sec-11-2.11.8 omnilex-key=us-ms-regs-official--title-15--11#2.11.8}

Every license shall set forth the licensed facility’s maximum licensed capacity, which shall be based upon a minimum of thirty-five (35) square feet of usable indoor space per child. Likewise, the capacity for each room where children are kept shall have a minimum of thirty five (35) square feet of usable space per child, measured on the inside, wall-to-wall dimensions, subject to the following exceptions: a. During group activity periods such as film viewing, parties, dining, and sleeping, provided child-to-staff ratio is maintained; b. During periods when child pick-up or delivery is normally done, provided child-to staff ratio is maintained; c. In infant and toddler rooms as required in subsections 2-7 below.

The usable space in determining the facility’s maximum licensed capacity is measured exclusive of food preparation areas, kitchens, bathrooms, toilets, areas for the care of ill children, offices, staff room, corridors, hallways, stairways, closets, lockers, laundries,

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furnace rooms, fixed or permanent cabinets, fixed or permanent storage shelving spaces, and areas not inhabited and used by children. 2. Rooms in which infants both play and sleep shall have a minimum of 40 square feet of usable space per child. There shall be at least 24” between each crib. A minimum of 36” is recommended. Cribs with solid ends may be placed end-to-end. 3. Rooms where infants play but do not sleep shall have a minimum of 15 square feet of usable space per child. NOTE: No other age group shall use this space nor can it be used for any purpose other than infant play. 4. Rooms where infants sleep but do not play shall have a minimum of 25 square feet of usable space per child. There shall be at least two feet between each crib. Cribs with solid ends may be placed end-to-end. 5. Rooms in which toddlers both play and sleep shall have a minimum of 45 square feet of usable space per child. There shall be at least 24” between each crib. A minimum of 36” is recommended. Cribs with solid ends may be placed end-to-end. However, if stackable cots, mats, or other storable sleeping equipment is utilized for sleeping the room shall be measured using the standard of 35 square feet per child. Should it be determined that the sleeping equipment is not properly stored when not in use the capacity of the room will be determined using 45 square feet per child 6. Rooms where toddlers play but do not sleep shall have a minimum of 25 square feet of usable space per child. NOTE: No other age group shall use this space nor can it be used for any purpose other than toddler play. 7. Rooms where toddlers sleep but do not play shall have a minimum of 25 square feet of usable space per child. There shall be at least 24” between each crib. A minimum of 36” is recommended. Cribs with solid ends may be placed end-to-end. 8. The licensing agency will re-measure the square footage of licensed operating child care facilities for purposes of determining licensed facility or classroom capacity only under the following circumstances: a. Major renovations; b. Significant change in layout and use of space; c. A change of ownership of an existing facility should the layout or use of space change.

9. “Grandfather Provision” for regulatory changes regarding maximum facility capacity or room capacity. Whenever the Mississippi State Board of Health amends these rules regarding square footage and/or licensed maximum capacity of child care facilities, and such change would result in a reduction in the number of children to be served in a licensed and operating facility or any of its classrooms, any such facility

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in operation at the time of final adoption of said rule change, and in compliance with all other child care regulations, shall be “grandfathered” in and exempt from application of the new regulation regarding capacity. This exemption shall continue for said facility through changes of ownership so long as the building is used continuously as a licensed child care facility and so long as there is no change in the layout or use of the space, as set out in subsection 8 above. Any break in use of the building as a licensed child care facility shall moot the grandfather exemption, and thereafter, any child facility opened and operated in said building shall be required to comply with the square footage/capacity regulation in affect at the time of the new license.

**History**
- *Source: Miss. Code Ann. §43-20-8.*

##### **15 Miss. Admin. Code Pt. 11, R. 2.11.9** Openings 1 {#sec-11-2.11.9 omnilex-key=us-ms-regs-official--title-15--11#2.11.9}

Each window, exterior door, and basement or cellar hatchway shall be weather tight and watertight. 2. All windows above ground level in areas used by children under five years of age shall be constructed, adapted, or adjusted to limit the exit opening accessible to children to less than six inches, or be otherwise protected with guards that do not block outdoor light. 3. Openable windows shall be of a safety type (not fully openable) that are child proofed and screened when open. When there are no openable windows, or when windows are not kept open, rooms shall be adequately ventilated. 4. All openings used for ventilation shall be screened. 5. The width of doors shall accommodate wheelchairs and the needs of individuals with physical disabilities. 6. Exit doors shall open outward. Boiler room doors shall swing inward. 7. Doorways and exits shall be free of debris and equipment to allow unobstructed traffic to and from the room. 8. The hand contact and splash areas of doors and walls shall be covered with an easily cleanable finish, at least as cleanable as an epoxy finish or enamel paint.

**History**
- *Source: Miss. Code Ann. §43-20-8.*

##### **15 Miss. Admin. Code Pt. 11, R. 2.11.10** Kitchens 1 {#sec-11-2.11.10 omnilex-key=us-ms-regs-official--title-15--11#2.11.10}

Children are not allowed in the kitchen area. In School Age/After School programs, children may be allowed in the kitchen but not during times when food is being cooked. Supervision in the kitchen when children are present must meet the staffing requirements as referenced in Subchapter 8 of the regulations.

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2. Barriers, approved by the local fire authority, shall be erected and doors shall be closed at all times. 3. Kitchens shall have a minimum area of 90 square feet, measured wall to wall. 4. For a child care facility with 12 or fewer children, located in an occupied dwelling, the following regulations shall replace the Mississippi State Department of Health's 10.0 Regulation Food Code: a. No game or home canned foods shall be served. b. Other than fresh or frozen vegetables and fruit, all foods shall be from commercial sources. c. Food shall be cooked or reheated to a temperature of 165 degrees Fahrenheit. Hot food shall be held at a minimum temperature of 140 degrees Fahrenheit. d. Cold food shall be stored at a temperature of 41 degrees Fahrenheit or below. e. All food shall be covered while in the refrigerator or freezer. f. Any prepared foods not properly refrigerated at a temperature of 41 degrees Fahrenheit or less, or frozen, shall be discarded. g. If manual washing is utilized, a sanitizer shall be used. Rinsing in a chlorine solution using one and one-half tablespoons of household bleach per gallon of water is sufficient. (Appendix "E"). If a dishwasher is utilized, the nozzle ports shall be free of obstructions, and the interior of the machine shall be clean. Dishwashers shall have a sanitizing cycle that shall reach a temperature 165 degrees at the incoming water valve. h. Hot water, under pressure, shall be available. i. Insecticides, poisons, cleaning agents, and medications, shall be stored away from food, separately from each other, and out of the reach of children. j. Children shall not be exposed to insecticides or pesticides, or other toxic agents. k. Hands shall be washed frequently, when switching between working with raw and ready-to-eat foods, and after all non-food preparation activities. l. Clean clothing shall be worn. m. Gloves shall be worn if there are any cuts or abrasions on the hands. 5. All kitchens and/or food/snack preparation areas in a child care facility shall be inspected as part of the child care inspection program.

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**History**
- *Source: Miss. Code Ann. §43-20-8.*

##### **15 Miss. Admin. Code Pt. 11, R. 2.11.11** Toilets and Hand Washing Lavatories 1 {#sec-11-2.11.11 omnilex-key=us-ms-regs-official--title-15--11#2.11.11}

Toilets and hand washing lavatories shall be located within the physical confines of child care facility and shall be convenient to outside playground areas. 2. The following ratios shall apply: Toilets, urinals, and hand washing lavatories shall be apportioned at a ratio of 1:15. Urinals shall not exceed 33 percent of the total required toilet fixtures. When the number of children in the ratio is exceeded by one, an additional fixture shall be required. 3. The hand washing lavatories located in a diapering area shall not be included in the ratio of hand washing lavatories to children for determining a child care facility's capacity. Diaper changing sinks shall not be used for any other purpose such as, but not limited to, rinsing or washing baby bottles, pacifiers, teething rings, or for food preparation. 4. All hand washing lavatories shall have both hot and cold running water. Hot water temperature shall not exceed 120 degrees Fahrenheit. 5. Toilets, urinals, hand washing lavatories, and sinks shall be clean and operational. Bathrooms, hand washing lavatories, and sinks shall be supplied with soap, and individual towels for drying hands. Each toilet shall be supplied with toilet paper.

**History**
- *Source: Miss. Code Ann. §43-20-8.*

##### **15 Miss. Admin. Code Pt. 11, R. 2.11.12** Rule 2.11.12 {#sec-11-2.11.12 omnilex-key=us-ms-regs-official--title-15--11#2.11.12}

Water The water supply shall be from a public water system or a private system approved by the Mississippi State Department of Health. Water shall be dispensed by the following: 1. Fountain; or 2. Disposable paper cups; or 3. Labeled cup for each child that shall be washed and sanitized daily.

**History**
- *Source: Miss. Code Ann. §43-20-8.*

##### **15 Miss. Admin. Code Pt. 11, R. 2.11.13** Exits 1 {#sec-11-2.11.13 omnilex-key=us-ms-regs-official--title-15--11#2.11.13}

At least two separate exit doors shall be provided from every floor level. 2. Exit doors shall be remote from each other. 3. Dead end corridors shall not exceed 20 feet in length. 4. Exit doors necessitating passage through a kitchen shall not be counted as one of the two remote exits.

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5. Exit doors shall be a minimum of 32 inches wide and open outward. No single leaf in an exit door shall be less than 28 inches wide or more than 48 inches wide. 6. Any latch or other fastening device on an exit door shall be provided with a knob, handle, panic bar, or other simple type of releasing device. Dual action door fasteners are not permitted. 7. The force required to open fully exit doors shall not exceed 50 pounds applied to the latch stile (panic bar). 8. An exit door shall not reduce the effective width of a landing.

**History**
- *Source: Miss. Code Ann. §43-20-8.*

##### **15 Miss. Admin. Code Pt. 11, R. 2.11.14** Heating, Cooling, and Ventilation 1 {#sec-11-2.11.14 omnilex-key=us-ms-regs-official--title-15--11#2.11.14}

A draft-free seasonally appropriate temperature of 65 degrees Fahrenheit to 78 degrees Fahrenheit shall be maintained. 2. All rooms used by children shall be heated, cooled, and adequately ventilated to maintain the required temperatures, and air exchange, and to avoid the accumulation of objectionable odors and harmful fumes. 3. Ventilation may be in the form of openable windows as specified in these regulations. 4. Areas where art and craft activities are conducted shall be well ventilated. In areas where substances are used that create toxic fumes, exhaust hood systems or other devices shall be installed. 5. Electric fans, if used, shall be mounted high on the wall or ceiling or shall be guarded to limit the size of the opening in the blade guard to less than one-half inch. 6. When air-cooling is needed, draft-free cooling units shall be used. They shall present no safety hazard to the children. 7. Filters on recirculation systems shall be checked and cleaned or replaced monthly. 8. Window draft deflectors shall be provided if necessary. 9. Thermometers that do not present a hazard to children shall be placed on interior walls in every activity area at children's height. 10. Portable, open flame and kerosene space heaters are prohibited. Portable gas stoves shall not be used for heating. 11. Electric space heaters shall be UL-approved; inaccessible to children; and stable; shall have protective covering; and shall be placed at least three feet from curtains, papers, and furniture.

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12. Fireplaces and fireplace inserts shall be screened securely or equipped with protective guards while in use. They shall be properly drafted. The child care facility shall provide evidence of cleaning the chimney at least once a year, or as frequently as necessary to prevent excessive buildup of combustibles in the chimney. Records of chimney cleaning shall be retained in the center files. 13. Heating units that utilize gas shall be installed and maintained in accordance with the manufacturer’s instructions, are vented properly to the outside, and be supplied with sufficient combustion air as required by the International Fuel Gas Code. If the area of the state where the facility is located does not utilize the International Fuel Gas Code, the installation and maintenance of any heating units that utilize gas shall be in accordance with the manufacturer’s instructions and any local ordinances that apply. It is the responsibility of the licensee to provide to the licensing authority documentation that the heating units meet the above stated standards. 14. Heating units, including water pipes and baseboard heaters hotter than 110 degrees Fahrenheit, shall be made inaccessible to children by barriers such as guards or other devices.

**History**
- *Source: Miss. Code Ann. §43-20-8.*

##### **15 Miss. Admin. Code Pt. 11, R. 2.11.15** Rule 2.11.15 {#sec-11-2.11.15 omnilex-key=us-ms-regs-official--title-15--11#2.11.15}

Outdoor Playground Area All playgrounds and playground equipment intended for use by children 2-12 years of age shall meet the standards set forth in the Handbook for Public Playground Safety, Publication No. 325, published by the U.S. Consumer Product Safety Commission or its successor as shown in Appendix “D.” 1. The child care facility shall be equipped with an outdoor playground area that directly adjoins the indoor facilities or that can be reached by a route free of hazards and is no farther than 1/8 mile (660 feet) from the child care facility. The outdoor playground area shall comprise a minimum of 75 square feet for each child using the outdoor playground area at any one time. 2. The total outdoor playground area shall accommodate at least 33 percent of the licensed capacity at one time. 3. A rooftop used as an outdoor playground area shall be enclosed with a fence not less than six feet high and designed to prevent children from climbing it. An approved fire escape shall lead from the roof to an open space at the ground level that meets safety standards for outdoor playground areas. 4. The outdoor playground area shall be well arranged so that all areas are visible to staff at all times. 5. The outdoor playground area shall be free of hazards and not less than 30 feet (measured horizontally parallel to the ground) from electrical transformers, high-

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voltage power lines, electrical substations, railroad tracks, or sources of toxic fumes or gases. Hazards, including but not limited to air conditioner units and utility mains, meters, tanks, and/or cabling shall be inaccessible to children. Fencing at least four feet high shall be provided around the outdoor playground area. Fencing higher than four feet but not to exceed eight feet may be required if the licensing authority determines that a hazard exists. Fencing twist wires and bolts shall face away from the playground. As an alternative, exposed bolt ends may be cut to no more than two exposed threads. Then the bolt ends shall be ground/sanded smooth or capped. 6. Outdoor playground areas shall be free from unprotected swimming and wading pools, ditches, quarries, canals, excavations, fishponds, or other bodies of water. 7. Sunlit areas and shaded areas shall be provided by means of open space and tree plantings or other cover in outdoor spaces. Outdoor spaces shall be laid out to ensure ample shaded space for each child. 8. The outdoor playground area shall be enclosed with a fence. The fence shall be at least four feet in height and the bottom edge shall be no more than three and one-half inches off the ground. There shall be at least two exits from such areas, with at least one remote from the buildings. The gate latch or securing device shall be high enough or of such a type that it cannot be opened by small children. The openings in the fence shall be no greater than three and one-half inches, e.g., between the building and the fence. The fence shall be constructed to discourage climbing. 9. The soil in outdoor playground areas shall not contain hazardous levels of any toxic chemical or substances. The child care facility shall have soil samples and analyses performed where there is good reason to believe a problem may exist. 10. The soil in outdoor playground areas shall be analyzed for lead content initially. It shall be analyzed at least once every two years where the exteriors of adjacent buildings and structures are painted with lead-containing paint. Lead in soil shall not exceed 400 ppm. Testing and analyses shall be in accordance with procedures specified by the licensing agency.

**History**
- *Source: Miss. Code Ann. §43-20-8.*

##### **15 Miss. Admin. Code Pt. 11, R. 2.11.16** Grounds 1 {#sec-11-2.11.16 omnilex-key=us-ms-regs-official--title-15--11#2.11.16}

The grounds, including the outdoor playground area, shall be free of hazardous or potentially hazardous objects. 2. In-ground swimming pools are prohibited unless protected by a six-foot fence and a locked gate. All fencing shall be placed at a minimum five feet from the pool edge. Above ground pools, including decking and pool structures, are prohibited unless protected by a six-foot fence and a locked gate. All fencing shall be placed at a minimum ten feet from the pool/deck edge.

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3. All paved surfaces shall be well drained to avoid water accumulation and ice formation. 4. All walking surfaces, such as walkways, ramps, and decks, shall have a non-slip finish, and shall be free of holes and sudden irregularities in the surface.

**History**
- *Source: Miss. Code Ann. §43-20-8*

##### **15 Miss. Admin. Code Pt. 11, R. 2.11.17** Rule 2.11.17 {#sec-11-2.11.17 omnilex-key=us-ms-regs-official--title-15--11#2.11.17}

Garbage Removal: Garbage and trash shall be removed from the child care facility daily and from the grounds at least once a week. Garbage and trash shall be stored inaccessible to the children, and in insect and rodent resistant containers.

**History**
- *Source: Miss. Code Ann. §43-20-8.*

##### **15 Miss. Admin. Code Pt. 11, R. 2.11.18** Rule 2.11.18 {#sec-11-2.11.18 omnilex-key=us-ms-regs-official--title-15--11#2.11.18}

Environmental Health: The child care facility shall comply with all regulations promulgated by the Division of Sanitation of the Mississippi State Department of Health for: 1. Food Service 2. On-site Wastewater Systems 3. Vector (pest) Control

**History**
- *Source: Miss. Code Ann. §43-20-8.*

##### **15 Miss. Admin. Code Pt. 11, R. 2.11.19** Rule 2.11.19 {#sec-11-2.11.19 omnilex-key=us-ms-regs-official--title-15--11#2.11.19}

Pest Control All child care facilities are to use a contractor licensed by the State of Mississippi to control pests, e.g., rats, mice, insects, etc. Before a pest control contractor is used, it is the responsibility of the operator to ensure that the pest control contractor is properly licensed. Use of agricultural chemicals for pest control is strictly prohibited.

Subchapter 12. HEALTH, HYGIENE, AND SAFETY Rule 2.12.7 Employee Health 1. Employees manifesting symptoms or otherwise suspected of having upper respiratory, gastrointestinal, skin, or other serious contagious conditions shall be excluded from work until either free from symptoms or certified by a physician to be no longer infectious. 2. Staff shall use universal precautions when changing diapers or being exposed to blood, fecal material, or urine. Refer to Appendix “F” for instructions on how to properly wash hands. 3. Staff shall wash their hands upon:

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a. Immediately before handling food, preparing bottles, or feeding children. b. After using the toilet, assisting a child in using the toilet, or changing diapers. c. After contacting a child’s body fluids, including wet or soiled diapers, runny noses, spit, vomit, etc. d. After handling pets, pet cages, or other pet objects. e. Whenever hands are visibly dirty or after cleaning up a child, the room, bathroom items, or toys. f. After removing gloves used for any purpose. g. Before giving or applying medication or ointment to a child or self. Refer to Appendix “F” for instructions on how to properly wash hands.

**History**
- *Source: Miss. Code Ann. §43-20-8.*
- *Source: Miss. Code Ann. §43-20-8.*

##### **15 Miss. Admin. Code Pt. 11, R. 2.12.8** Child Health 1 {#sec-11-2.12.8 omnilex-key=us-ms-regs-official--title-15--11#2.12.8}

A child who is suspected of having a serious contagious condition shall be isolated and returned to the parent as soon as possible. 2. A child having a serious contagious condition shall not be allowed to return to the child care facility until they have been certified by a physician to be no longer contagious. 3. Parents of all children shall be notified of a contagious illness in the child care facility as soon as possible. 4. A child with a physical injury shall be treated by a staff member with valid first aid certificate issued by an agent recognized by the licensing authority. A child with a serious physical injury shall be treated by a staff member with valid first aid certificate issued by an agent recognized by the licensing authority and transported to a hospital or medical facility as soon as appropriate.

**History**
- *Source: Miss. Code Ann. §43-20-8.*

##### **15 Miss. Admin. Code Pt. 11, R. 2.12.9** Child Hygiene 1 {#sec-11-2.12.9 omnilex-key=us-ms-regs-official--title-15--11#2.12.9}

A child's wet or soiled clothing shall be changed immediately. 2. A child's hands shall be washed: a. Immediately before and after eating. b. After using the toilet or having their diapers changed.

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c. After playing on the playground. d. After handling pets, pet cages, or other pet objects. e. Whenever hands are visibly dirty. f. Before going home. 3. A child shall have a shower, tub, or sponge bath to ensure bodily cleanliness when necessary. 4. Individual toilet articles (e.g., combs, brushes, toothbrushes, towels, and wash cloths) used by children shall be provided by the parent or child care facility and plainly marked and stored individually in a sanitary manner in areas which promote drying. Single use and disposable articles are acceptable. Grooming accessories, including but not limited to brushes, combs, barrettes, or picks, shall not be used jointly by children or on children.

**History**
- *Source: Miss. Code Ann. §43-20-8.*

##### **15 Miss. Admin. Code Pt. 11, R. 2.12.10** Toys and Equipment: Toys and equipment used by infants or toddlers shall be cleansed daily with a germicidal solution {#sec-11-2.12.10 omnilex-key=us-ms-regs-official--title-15--11#2.12.10}

Refer to (Appendix – “H” for instructions on cleaning and disinfection procedures. A recommended resource regarding sanitation of equipment and toys can be found in the National Health and Safety Performance Standards: Guidelines for out of home Child Care, Second Edition (Standard 3.030) website: www.nrc.uchsc.edu

**History**
- *Source: Miss. Code Ann. §43-20-8.*

##### **15 Miss. Admin. Code Pt. 11, R. 2.12.11** First Aid Supply 1 {#sec-11-2.12.11 omnilex-key=us-ms-regs-official--title-15--11#2.12.11}

A first aid supply shall be kept on-site and easily accessible to employees, but not in reach of the children. 2. A first aid supply shall be taken on all field trips and excursions and shall be easily accessible to employees, but not in reach of the children. 3. Medicine shall be kept out of the reach of the children. 4. All vehicles used by the facility in transporting children shall be equipped with a first aid kit. 5. It is recommended that first aid kits contain the following items, according to American Red Cross guidelines: a. 20 Antiseptic Toweletts b. 50 Plastic Strips (Band Aids)

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c. 5 Fingertip Bandages d. 5 Knuckle Bandages e. 5 Butterfly Closures f. 5 Non Adherent Pads 2" x 3" g. 2 Sterile Eye Pads h. 1 pressure Bandage 4" i. 1 Bandage Scissors j. 1 Triangular Bandage k. 1 Instant Cold Compress l. 2 Tongue Depressors/Finger Splints m. 1 Elastic Bandage 2: x 5 yards n. 5 3" x 3" Gauze Pads o. 1 Trauma Pad 5" x 9" p. 5 Insect Sting Relief Pads q. 10 First Aid Ointment 1 gr. r. 5 Non Adherent Pads 3: x 4" s. 5 Pair of Examination Gloves t. 2 Conforming Bandage 2" x 5 yards u. 1 Tweezers v. 2 Poison Ivy Relief Treatment w. 1 Booklet “Till Help Arrives” x. 1 Emergency Rescue Blanket y. 1 Adhesive Tape ½" x 5 yards 6. Some items in this kit may have expiration dates. All first aid kits should be periodically inspected for contents. Depleted and out of date materials should be replaced.

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7. Special attention should be exercised when utilizing first aid supplies or any medication for children who have allergies or other special medical needs. 8. For additional information on supplies for first aid kits contact your local office of the American Red Cross.

**History**
- *Source: Miss. Code Ann. §43-20-8.*

##### **15 Miss. Admin. Code Pt. 11, R. 2.12.12** Animals and Pets 1 {#sec-11-2.12.12 omnilex-key=us-ms-regs-official--title-15--11#2.12.12}

Any pet or animal present at a child care facility, indoors or outdoors, shall be in good health, show no evidence of carrying any disease, and be a friendly companion for the children. 2. Dogs or cats, where allowed, shall be immunized for any disease that can be transmitted to humans, and shall be maintained on a flea, tick, and worm control program. 3. All pets shall be cared for as recommended by the regulating health agency. When pets are kept at the child care facility, procedures for their care and maintenance shall be written and followed. When immunizations are required, proof of current compliance signed by a veterinarian shall be on file at the child care facility where the pet is kept. 4. A caregiver shall always be present when children are exposed to animals (including dogs and cats). Children shall be instructed on safe procedures to follow when in close proximity to these animals (e.g., not to provoke or startle them or remove their food). Potentially aggressive animals (e.g., pit bulls, boxers, etc.) shall not be in the same physical space with the children. 5. Each child’s hands shall be properly washed after being exposed to animals.

**History**
- *Source: Miss. Code Ann. §43-20-8.*

##### **15 Miss. Admin. Code Pt. 11, R. 2.12.13** Fire/Disaster Evacuation Drills 1 {#sec-11-2.12.13 omnilex-key=us-ms-regs-official--title-15--11#2.12.13}

Monthly fire/disaster (e.g., tornados, severe weather, floods, earthquakes, hurricanes, etc.) evacuation drills are required and a record of each drill shall be maintained in the facility records; to include date, time, number of children and staff present, and amount of time required to totally exit the building. 2. During fire/disaster evacuation drills, all staff and children present shall be required to exit the building.

Subchapter 13. NUTRITION AND MEALS

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**History**
- *Source: Miss. Code Ann. §43-20-8.*

##### **15 Miss. Admin. Code Pt. 11, R. 2.13.7** General 1 {#sec-11-2.13.7 omnilex-key=us-ms-regs-official--title-15--11#2.13.7}

A child care facility shall provide adequate and nutritious meals prepared in a safe and sanitary manner. 2. Meal periods are breakfast, lunch, dinner, and snacks. A minimum of 30 minutes shall be scheduled for each breakfast, lunch, and dinner meal period. A minimum of 15 minutes shall be scheduled for each snack meal period. 3. Meals shall be served at tables where each child may be seated. 4. Meals shall be served by employees only. 5. Employees shall wash hands prior to preparing or serving food. 6. Children shall not share food.

**History**
- *Source: Miss. Code Ann. §43-20-8.*

##### **15 Miss. Admin. Code Pt. 11, R. 2.13.8** Rule 2.13.8 {#sec-11-2.13.8 omnilex-key=us-ms-regs-official--title-15--11#2.13.8}

Nutritional Standards: Meals shall meet the nutritional standards as prescribed in Appendix “C” Minimum Standards for Nutritional Care in Child Care Facilities.

**History**
- *Source: Miss. Code Ann. §43-20-8.*

##### **15 Miss. Admin. Code Pt. 11, R. 2.13.9** Refreshments 1 {#sec-11-2.13.9 omnilex-key=us-ms-regs-official--title-15--11#2.13.9}

Refreshments may be provided by parents only on a child's birthday or other special celebration such as Valentine's Day, Easter, Christmas, Graduation, etc. Food provided to children, including vending machines at the facility, must meet nutritional guidelines as set forth in Appendix “C.” 2. It is recommended that foods for the event that are brought to the facility by parents should be “store bought” and not “home cooked.” 3. Food items for the event may include cake, ice cream, fresh fruit, cheese and crackers, etc. Other items, i.e., party favors such as stickers, books, toothbrushes, and crayons, etc., are encouraged.

**History**
- *Source: Miss. Code Ann. §43-20-8.*

##### **15 Miss. Admin. Code Pt. 11, R. 2.13.10** Rule 2.13.10 {#sec-11-2.13.10 omnilex-key=us-ms-regs-official--title-15--11#2.13.10}

Sack Lunches : Sack lunches prepared by parents may be permitted as included on approved menu plans but shall not exceed one day per month per child. Exceptions may be made for specific activities such as field trips outside the child care facility. Measures to assure proper storage and refrigeration of sack lunches are required of the child care facility.

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**History**
- *Source: Miss. Code Ann. §43-20-8.*

##### **15 Miss. Admin. Code Pt. 11, R. 2.13.11** Rule 2.13.11 {#sec-11-2.13.11 omnilex-key=us-ms-regs-official--title-15--11#2.13.11}

Snacks: All snacks shall meet acceptable nutritional standards, as prescribed in Appendix “C” Minimum Standards for Nutritional Care in Child Care Facilities.

**History**
- *Source: Miss. Code Ann. §43-20-8.*

##### **15 Miss. Admin. Code Pt. 11, R. 2.12.6** Food Safety and Food Manager 1 {#sec-11-2.12.6 omnilex-key=us-ms-regs-official--title-15--11#2.12.6}

All kitchens and/or food/snack preparation areas in a child care facility must be inspected as part of the child care inspection process. 2. Each child care facility must have a Certified Food Manager meeting the standards set forth in Rule 1.2.2 (1)(g). The only exception would be if two facilities had COMPLETELY different operating hours. If this situation exists then one Certified Food Manager could serve more than one facility. Should such occur, documentation to that affect must be in the each facility’s file. 3. A Certified Manager does NOT have to be present at all times. However, a person in charge of food preparation does have to be present at all times

Subchapter 14. DISCIPLINE AND GUIDANCE Rule 2.14.7 Prohibited Behavior The following behaviors are prohibited by anyone (i.e., parent, caregiver, or child) in all child care settings: 1. Corporal punishment, including hitting, spanking, beating, shaking, pinching, biting, and other measures that produce physical pain. 2. Withdrawal or the threat of withdrawal of food, rest, or bathroom opportunities. 3. Abusive or profane language to include but not limited to yelling at, and/or using harsh tones toward the children or in close proximity (hearing distance) to children. 4. Any form of public or private humiliation, including threats of physical punishment. 5. Any form of emotional abuse, including rejecting, terrorizing, ignoring, isolating (out of view of a caregiver), or corrupting a child. 6. Use of any food product or medication in any manner or for any purpose other than that for which it was intended. 7. Inappropriate disciplinary behavior includes, but is not limited to, putting soap or pepper in a child's mouth. 8. Any acceptable disciplinary action that is not age-appropriate for the child or is excessive in time or duration.

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**History**
- *Source: Miss. Code Ann. §43-20-8.*
- *Source: Miss. Code Ann. §43-20-8.*

##### **15 Miss. Admin. Code Pt. 11, R. 2.14.8** Rule 2.14.8 {#sec-11-2.14.8 omnilex-key=us-ms-regs-official--title-15--11#2.14.8}

Restraint of a Child: Children shall not be physically restrained except as necessary to ensure their own safety or that of others, and then for only as long as is necessary for control of the situation. Children shall not be given medicines or drugs that will affect their behavior except as prescribed by a licensed physician and with specific written instructions from the licensed physician for use of the medicines or drugs.

**History**
- *Source: Miss. Code Ann. §43-20-8.*

##### **15 Miss. Admin. Code Pt. 11, R. 2.14.9** Rule 2.14.9 {#sec-11-2.14.9 omnilex-key=us-ms-regs-official--title-15--11#2.14.9}

Time Out : "Time out" that enables the child to regain self-control and keeps the child in visual contact with a caregiver shall be used selectively, taking into account the child's developmental stage and the usefulness of "time out" for the particular child. “Time out” means that the child is given time away from an activity which involved inappropriate behavior. Isolation from a caregiver is not acceptable. “Time out” is not allowed for children younger than three years of age.

**History**
- *Source: Miss. Code Ann. §43-20-8.*

##### **15 Miss. Admin. Code Pt. 11, R. 2.14.10** Rule 2.14.10 {#sec-11-2.14.10 omnilex-key=us-ms-regs-official--title-15--11#2.14.10}

Children Shall Not Discipline Other Children Children shall neither be allowed nor be instructed to discipline other children.

Subchapter 15. TRANSPORTATION Rule 2.15.7 General: Regardless of transportation provisions, the child care facility is responsible for the safety of the children.

**History**
- *Source: Miss. Code Ann. §43-20-8.*
- *Source: Miss. Code Ann. §43-20-8.*

##### **15 Miss. Admin. Code Pt. 11, R. 2.15.8** Requirements: It is required that: 1 {#sec-11-2.15.8 omnilex-key=us-ms-regs-official--title-15--11#2.15.8}

All drivers are appropriately licensed. 2. All vehicles have current safety inspection stickers, licenses, and registrations. 3. Insurance adequately covers the transportation of children. 4. Children board or leave the vehicle from the curbside of the street and/or are safely accompanied to their destinations. 5. A parent is present if the child is delivered home. 6. Seat restraints are used.

**History**
- *Source: Miss. Code Ann. §43-20-8.*

##### **15 Miss. Admin. Code Pt. 11, R. 2.15.9** Occupant Restraints {#sec-11-2.15.9 omnilex-key=us-ms-regs-official--title-15--11#2.15.9}

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1. All children will be properly restrained whenever they are being transported in a motor vehicle. a. Every person transporting a child under the age of four (4) years in a passenger motor vehicle, and operated on a public roadway, street or highway, shall provide for the protection of the child by properly using a child passenger restraint device or system meeting applicable federal motor vehicle safety standards, e.g., child safety seat. b. Every person transporting a child in a passenger motor vehicle operated on a public roadway, street or highway, shall provide for the protection of the child by properly using a belt positioning booster seat system meeting applicable federal motor vehicle safety standards if the child is at least four (4) years of age, but less than seven (7) years of age and measures less than four (4) feet nine (9) inches in height or weighs less than sixty-five (65) pounds. c. Any vehicle equipped with seatbelts is subject to the requirements in items a. and b. above. 2. No vehicle shall be occupied by more individuals than its rated capacity. 3. No children shall be transported in the front seat of vehicles equipped with passenger- side air bags. 4. All vehicles under 10,000 lbs. GVWR (Gross Vehicle Weight Rated) shall be equipped with occupant restraints appropriate for the age and/or weight of the children being transported. A child under the age of four shall be transported only if the child is securely fastened in a child safety seat that meets Federal Motor Vehicle Safety Standards (FMVSS, 49 CFR 571.213), which shall be indicated on the child safety seat. The child safety seat shall be appropriate to the child's weight and be installed and used according to the manufacturer's instructions. 5. Vehicles (e.g., school buses) with a GVWR 10,000 lbs. or more, at a minimum, shall meet the current Federal Motor Vehicle Safety Standards (FMVSS) for buses of that size. It is the responsibility of the child care facility operator to have documentation verifying that a bus meets the current FMVSS. NOTE: Federal Motor Vehicle Safety Standards (FMVSS) means the National Highway and Traffic Safety Administration's standards for motor vehicles and motor vehicle equipment established under Section 103 of the Motor Vehicle Safety Act of 1966 (49 CFR Part 571) as they apply to school buses. 6. An individual seat restraint must be used for each child. The use of an individual seat restraint for two or more children is not allowed.

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**History**
- *Source: Miss. Code Ann. §43-20-8.*

##### **15 Miss. Admin. Code Pt. 11, R. 2.15.10** Staff-to-Child Ratio: The staff to child ratio shall be maintained at all times {#sec-11-2.15.10 omnilex-key=us-ms-regs-official--title-15--11#2.15.10}

The driver of the vehicle shall not be counted as a caregiver while transporting the children.

Subchapter 16. DIAPERING AND TOILETING Rule 2.16.7 Diaper Changing Area: Each room in which diaper-wearing children play shall contain a diapering area. A diapering area shall contain a hand washing lavatory with hot and cold running water, a smooth and easily cleanable surface, a plastic-lined, covered garbage receptacle, and sanitizing solution. The hand washing lavatories located in a diapering area shall not be included in the ratio of hand washing lavatories to children for determining a child care facility's capacity nor shall they be used for any other purpose. Example: The diaper-changing sink may not be used for washing/rinsing cups, baby bottles, food, dishes, utensils, pacifiers, etc. In addition, the diaper changing area is not to be used as a storage area for anything other than those items used when changing diapers, such as but not limited to, gloves, towels, soap, etc. For proper diaper changing procedure, see Appendix G - PROCEDURE FOR DIAPERING A CHILD.

**History**
- *Source: Miss. Code Ann. §43-20-8.*
- *Source: Miss. Code Ann. §43-20-8.*

##### **15 Miss. Admin. Code Pt. 11, R. 2.16.8** Rule 2.16.8 {#sec-11-2.16.8 omnilex-key=us-ms-regs-official--title-15--11#2.16.8}

Non-Disposable Diapers and Training Pants: The fecal contents of non- disposable diapers or training pants shall be disposed of into a toilet. The soiled non- disposable diaper or training pants shall then be placed into a plastic bag, sealed, and placed in the child's individual container.

**History**
- *Source: Miss. Code Ann. §43-20-8.*

##### **15 Miss. Admin. Code Pt. 11, R. 2.16.9** Rule 2.16.9 {#sec-11-2.16.9 omnilex-key=us-ms-regs-official--title-15--11#2.16.9}

Disposable Diapers: Disposable diapers shall be placed into a plastic bag and sealed or shall be rolled up and taped securely, then placed into a plastic-lined covered garbage receptacle.

**History**
- *Source: Miss. Code Ann. §43-20-8.*

##### **15 Miss. Admin. Code Pt. 11, R. 2.16.10** Potty Chairs: Potty chairs, if used, shall be placed in the bathroom area and sanitized after each child’s use {#sec-11-2.16.10 omnilex-key=us-ms-regs-official--title-15--11#2.16.10}

**History**
- *Source: Miss. Code Ann. §43-20-8.*

##### **15 Miss. Admin. Code Pt. 11, R. 2.16.11** Hand Washing: Employees shall wash their hands with soap and running water before and after each diaper change {#sec-11-2.16.11 omnilex-key=us-ms-regs-official--title-15--11#2.16.11}

Individual or disposable towels shall be used for drying. Hand washing sinks at diaper changing stations shall not be used for any other purpose. Example: The diaper-changing sink may not be used for washing cups, baby bottles, food, dishes, utensils, etc.

.

**History**
- *Source: Miss. Code Ann. §43-20-8.*

##### **15 Miss. Admin. Code Pt. 11, R. 2.16.12** Parental Consultation: A parent-caregiver consultation is required prior to toilet training {#sec-11-2.16.12 omnilex-key=us-ms-regs-official--title-15--11#2.16.12}

Subchapter 17. REST PERIODS Rule 2.17.7 Equipment: Each child shall be placed on a separate bed, crib, cot, or mat. Cribs shall be labeled so that the child's name is visible.

**History**
- *Source: Miss. Code Ann. §43-20-8.*
- *Source: Miss. Code Ann. §43-20-8.*

##### **15 Miss. Admin. Code Pt. 11, R. 2.17.8** Cleaning of Linens and Bed Coverings: Linens and bed coverings shall be changed immediately when soiled {#sec-11-2.17.8 omnilex-key=us-ms-regs-official--title-15--11#2.17.8}

All linens and bed coverings shall be changed, at a minimum, two times per week.

**History**
- *Source: Miss. Code Ann. §43-20-8.*

##### **15 Miss. Admin. Code Pt. 11, R. 2.17.9** Cleaning of Rest Period Equipment: All rest period equipment shall be wiped clean immediately when soiled {#sec-11-2.17.9 omnilex-key=us-ms-regs-official--title-15--11#2.17.9}

All rest period equipment shall be cleaned twice a week with a germicidal solution. Additional cleaning may be required by the licensing authority if there is an outbreak of a communicable disease, including but not limited to, rotavirus, giardiasis, etc., or a noninfectious condition such as, but not limited to, an infestation of head lice.

**History**
- *Source: Miss. Code Ann. §43-20-8.*

##### **15 Miss. Admin. Code Pt. 11, R. 2.17.10** Rule 2.17.10 {#sec-11-2.17.10 omnilex-key=us-ms-regs-official--title-15--11#2.17.10}

Sharing of Rest Period Equipment: At no time will two or more children be allowed to share the same bed, crib, cot, or mat during their time of enrollment, unless it is cleaned with a germicidal solution between each child's use.

Subchapter 18. FEEDING OF INFANTS AND TODDLERS Rule 2.18.7 Hand Washing: Employees shall wash their hands with soap and water, and dry their hands with individual or disposable towels, before and after each feeding. The infant and toddler's hands shall be washed with soap and water, and dried with individual or disposable towels, before and after each feeding.

**History**
- *Source: Miss. Code Ann. §43-20-8.*
- *Source: Miss. Code Ann. §43-20-8.*

##### **15 Miss. Admin. Code Pt. 11, R. 2.18.8** Bottle Feeding: Infants shall be held while being bottle-fed {#sec-11-2.18.8 omnilex-key=us-ms-regs-official--title-15--11#2.18.8}

Bottles shall not be propped at any time. With parental consent and when infants are old enough to hold their own bottles, they may feed themselves without being held. The bottle shall be removed at once when empty or when the child has fallen asleep.

.

**History**
- *Source: Miss. Code Ann. §43-20-8.*

##### **15 Miss. Admin. Code Pt. 11, R. 2.18.9** Formula Storage: Formula shall be labeled with the child's name, dated, and placed in the refrigerator upon arrival {#sec-11-2.18.9 omnilex-key=us-ms-regs-official--title-15--11#2.18.9}

**History**
- *Source: Miss. Code Ann. §43-20-8.*

##### **15 Miss. Admin. Code Pt. 11, R. 2.18.10** Baby Food: Foods stored or prepared in jars shall be served from a separate dish for each infant or toddler {#sec-11-2.18.10 omnilex-key=us-ms-regs-official--title-15--11#2.18.10}

Any leftovers from the serving dish shall be discarded. Leftovers in the jar shall be labeled with the child's name, dated, refrigerated, and used within the next 24 hours or discarded.

**History**
- *Source: Miss. Code Ann. §43-20-8.*

##### **15 Miss. Admin. Code Pt. 11, R. 2.18.11** Refrigerator: A refrigerator shall be available and easily accessible to the infant or toddler's room(s) {#sec-11-2.18.11 omnilex-key=us-ms-regs-official--title-15--11#2.18.11}

**History**
- *Source: Miss. Code Ann. §43-20-8.*

##### **15 Miss. Admin. Code Pt. 11, R. 2.18.12** Heating Unit and Microwave Use 1 {#sec-11-2.18.12 omnilex-key=us-ms-regs-official--title-15--11#2.18.12}

A heating unit for warming bottles and food shall be accessible only to adults. 2. Microwave ovens shall not be used for warming bottles or baby/infant food.

**History**
- *Source: Miss. Code Ann. §43-20-8.*

##### **15 Miss. Admin. Code Pt. 11, R. 2.18.13** Rule 2.18.13 {#sec-11-2.18.13 omnilex-key=us-ms-regs-official--title-15--11#2.18.13}

Breast-Feeding Accommodations and Staff Training: This section applies to all mothers choosing to breast-feed their child regardless of the child’s age. 1. Breast-feeding mothers, including employees, shall be provided a sanitary place that is not a toilet stall to breast-feed their child or to express milk. This area shall provide an electrical outlet, comfortable chair, and nearby access to running water.

2. A refrigerator must be available to accommodate storage of expressed breast milk. It is acceptable to store expressed milk in the same refrigerator as other milk/bottles provided each bottle is appropriately labeled with the child’s name and the time of expected expiration of the milk. Milk must be stored in accordance with the American Academy of Pediatrics and Centers for Disease Control guidelines. Universal precautions are not required in handling human milk.

3. Child care staff shall be trained in the safe and proper storage and handling of human milk. Although other training materials may be utilized, training materials will be available through MSDH.

Guidelines for Milk Storage and Use for All Infants

Storage Method and Temperature Maximum Amount of Time For Storage Room (25 C or 77 F)

4 hours

.

Refrigerator (4 C or 39 F)

Previously thawed – Refrigerated milk

Freezer (-20 C or 0 F) 48 hours

##### **15 Miss. Admin. Code Pt. 11, R. 24** hours {#sec-11-24 omnilex-key=us-ms-regs-official--title-15--11#24}

3 months

From the ACOG/AAP publication: Breastfeeding Handbook for Physicians

Subchapter 19. SWIMMING AND WATER ACTIVITIES Rule 2.19.7 General: This section shall apply to any child care facility that, as part of its program, allows the children to swim, wade, or participate in any water activities whether on site or at any other location during the time staff has responsibility for children enrolled.

**History**
- *Source: Miss. Code Ann. §43-20-8.*
- *Source: Miss. Code Ann. §43-20-8.*

##### **15 Miss. Admin. Code Pt. 11, R. 2.19.8** Lifeguard Supervision 1 {#sec-11-2.19.8 omnilex-key=us-ms-regs-official--title-15--11#2.19.8}

Swimming pools, lakes, etc. a. A person having an American Red Cross lifeguard certificate, or the equivalent as recognized by the licensing agency, shall be present at all swimming and water activities. b. One lifeguard is required for every 25 children or any portion thereof (i.e., two lifeguards are required for groups of 26 - 50, three for 51 - 75, etc.). This required ratio also includes activities that occur near water such as fishing or beach activities. c. Lifeguards are not counted in the staff-to-child ratio. d. The staff-to-child ratio shall be maintained at all times. e. It is the child care facility operator’s responsibility to provide adequate certified lifeguards if the pool or lake operator does not. f. Each child will be tested by a certified lifeguard prior to participating in swimming lessons or any pool activities. Children will be assigned to swim groups according to the results of the test. g. Staff, as well as lifeguards, shall be responsible for enforcing general safety rules. h. Staff is responsible for requiring children to obey all swimming/water rules. These rules shall be explained each day that swimming/water activities occur so that all ages can understand what is expected.

.

2. Wading pools For activities taking place in wading pools with a water depth of one foot or less the following is required: a. There shall be a person(s) with a valid CPR certificate and a valid first aid certificate present at all times. b. The staff-to-child ratio shall be maintained at all times. c. Wading pools shall be cleaned after each use.

**History**
- *Source: Miss. Code Ann. §43-20-8.*

##### **15 Miss. Admin. Code Pt. 11, R. 2.19.9** Health and Safety 1 {#sec-11-2.19.9 omnilex-key=us-ms-regs-official--title-15--11#2.19.9}

All piers, floats, and platforms shall be in good repair, and where applicable, the water depth shall be indicated by printed numerals on the deck or planking. 2. There shall be a minimum water depth of ten feet for a one-meter diving board and 13 feet for a three-meter board or diving tower. 3. For outdoor swimming areas in natural bodies of water, the bottom shall be cleared of stumps, rocks, and other obstacles. 4. Diving boards shall be mounted on a firm foundation and never on an insecure base, such as a float that can be affected by shifting weight loads and wave action. The entire length of the top surface of diving boards shall be covered with nonskid material. The diving board shall be level. All diving boards shall be installed in accordance with manufacturer’s guidelines for the board by professional swimming pool installers who shall certify in writing to the facility that the diving board is adequately installed in accordance with manufacturer’s guidelines for the board, in a commercially reasonable manner, located so as to allow a child to safely enter the water from the diving board, and that the diving board is safe for its intended use. Facilities with existing pools equipped with diving boards that are unable to obtain the required certification within 60 days of the adoption of this regulation shall have the diving boards removed. 5. Swimming pools, when in use, shall be continuously disinfected by a chemical that imparts an easily measured free available residual effect. When chlorine is used, a free chlorine residual of at least 0.4 ppm shall be maintained throughout the pool whenever it is open or in use. If other halogens are used, residuals of equivalent disinfecting strength shall be maintained. 6. A testing kit for measuring the concentration of the disinfectant, accurate within 0.1 ppm, shall be provided at each swimming pool. 7. Swimming pool water shall be maintained in an alkaline condition as indicated by a pH of not less than 7.2 and not over 8.2. A pH testing kit accurate to the nearest 0.2 pH unit shall be provided at each swimming pool. The alkalinity of the water shall be

.

at least 50 ppm, as measured by the methyl-orange test. The following chart may be used for reference: pH Minimum Free Available Residual Chlorine-mg/L (not stabilized with cyanuric acid)

7.2.............................................0.40 7.3.............................................0.40 7.4.............................................0.40 7.5.............................................0.40 7.6.............................................0.50 7.7.............................................0.60 7.8.............................................0.70 7.9.............................................0.80 8.0.............................................1.00

8. If cyanuric acid is used to stabilize the free available residual chlorine, or if one of the chlorinated isocyanurate compounds is used as the disinfecting chemical in a swimming pool, the concentration of cyanuric acid in the water shall be at least 30 mg/L but shall not exceed 100 mg/L. The free available residual chlorine, of at least the following concentrations, depending upon the pH of the water, shall be maintained:

pH Minimum Free Available Residual Chlorine-mg/L (cyanuric acid is at least equal to 30 mg/L, but not greater than 100 mg/L)

7.2............................................1.00 7.3............................................1.00 7.4............................................1.00 7.5............................................1.00 7.6............................................1.25 7.7............................................1.50 7.8............................................1.75 7.9............................................2.00 8.0............................................2.50

9. The water in a swimming pool shall have sufficient clarity at all times so that a black disk, six inches in diameter, is readily visible when placed on a white field at the deepest point of the pool. The pool shall be closed immediately if this requirement cannot be met.

.

10. For natural bodies of water (e.g., lakes, rivers, streams, etc.), sewage treatment plants or other discharge lines shall not be within 750 feet of swimming areas.

Subchapter 20. CHILDREN WITH SPECIAL NEEDS Rule 2.20.7 Facility Adaptation 1. The child care facility areas to be utilized by a child with special needs shall be adapted as necessary to accommodate special devices that may be required for the child to function independently, as appropriate. 2. A separate area shall be available for providing privacy for diapering, dressing, and other personal care procedures.

**History**
- *Source: Miss. Code Ann. §43-20-8.*
- *Source: Miss. Code Ann. §43-20-8.*

##### **15 Miss. Admin. Code Pt. 11, R. 2.20.8** Activity Plan: A child with special needs shall have an individual activity plan {#sec-11-2.20.8 omnilex-key=us-ms-regs-official--title-15--11#2.20.8}

The individual activity plan shall have been developed by a person with a bachelors or advanced degree in a discipline dealing with disabilities, as appropriate. The individual activity plan shall be reviewed, at a minimum, once every 12 months.

**History**
- *Source: Miss. Code Ann. §43-20-8.*

##### **15 Miss. Admin. Code Pt. 11, R. 2.20.9** Rule 2.20.9 {#sec-11-2.20.9 omnilex-key=us-ms-regs-official--title-15--11#2.20.9}

Caregiver Staff Development: Caregivers serving children with special needs shall receive staff development related to the specific needs of the children served.

**History**
- *Source: Miss. Code Ann. §43-20-8.*

##### **15 Miss. Admin. Code Pt. 11, R. 2.20.10** Rule 2.20.10 {#sec-11-2.20.10 omnilex-key=us-ms-regs-official--title-15--11#2.20.10}

Staffing: Caregiver staffing shall be appropriate and adequate to meet the specific physical and/or developmental needs of the special needs children served at the child care facility. Staff-to-child ratio shall be determined by the needs of the child rather than child’s chronological age as based upon the child’s individual plan (i.e., individual education plan, individual habilitation plan, individual family service plan, etc.). The facility is encouraged to be an active participant in the child’s individual plan development.

Subchapter 21. NIGHT CARE Rule 2.21.7 General This section shall apply to any child care facility that is open past 11:30 p.m., as part of their regular hours of operation.

**History**
- *Source: Miss. Code Ann. §43-20-8.*
- *Source: Miss. Code Ann. §43-20-8.*

##### **15 Miss. Admin. Code Pt. 11, R. 2.21.8** Nutrition {#sec-11-2.21.8 omnilex-key=us-ms-regs-official--title-15--11#2.21.8}

.

1. A child care facility that is open prior to 7:00 p.m. shall provide a dinner meal period. 2. A child care facility that remains open after 5:00 a.m., shall provide a breakfast meal period. 3. A snack period shall be provided to children in attendance for more than two and one- half hours prior to bedtime. 4. Menu plans for lunch and dinner meals shall be varied. No single menu shall be repeated in a 24-hour period.

**History**
- *Source: Miss. Code Ann. §43-20-8.*

##### **15 Miss. Admin. Code Pt. 11, R. 2.21.9** Sleeping 1 {#sec-11-2.21.9 omnilex-key=us-ms-regs-official--title-15--11#2.21.9}

Mats shall not be used for sleeping. 2. Bedtime schedules shall be established in consultation with the child's parent. 3. Provisions shall be made in sleeping areas for the use and storage of clothing and personal belongings and they shall be within easy reach of the child using them. 4. A child shall be provided with a bed or cot equipped with a comfortable mattress (a minimum of three inches thick), sheets, a pillow with a pillowcase, and a blanket. 5. The upper level of double-deck beds shall not be used for children under ten years of age. The upper level of double-deck beds are allowed for children ten years of age or older if a bed rail and safety ladder is provided. 6. Each child shall have clean and comfortable sleeping garments.

**History**
- *Source: Miss. Code Ann. §43-20-8.*

##### **15 Miss. Admin. Code Pt. 11, R. 2.21.10** Bathroom Facilities 1 {#sec-11-2.21.10 omnilex-key=us-ms-regs-official--title-15--11#2.21.10}

There shall be a bathtub or shower available for children of toddler age or older. 2. Bathtubs and showers shall be equipped to prevent slipping. 3. If night care is provided for infants, there shall be age appropriate bathing facilities for these children. 4. Bathrooms shall be located near the sleeping areas. 5. No children under six years of age shall be left alone or with another child while in the bathtub or shower. 6. All children shall be bathed separately.

.

7. All children shall be provided an individual washcloth, towel, and soap for bathing, with fresh water for each child.

Subchapter 22. HEARINGS, EMERGENCY SUSPENSIONS, LEGAL ACTIONS AND PENALTIES Rule 2.22.7 Emergency Suspensions of License 1. Any license issued pursuant to these regulations may be suspended prior to a hearing if the licensing agency has reasonable cause to believe that the operation of the child care facility constitutes a substantial hazard to the health or safety of the children cared for by the child care facility. 2. Whenever a license is to be suspended, the operator or director shall be notified in writing that the license, upon service of the notice, is immediately suspended. The notice shall contain the reason for the emergency suspension, and shall set a date for a hearing, which shall be within 14 days of the service of notice.

**History**
- *Source: Miss. Code Ann. §43-20-8.*
- *Source: Miss. Code Ann. §43-20-8.*

##### **15 Miss. Admin. Code Pt. 11, R. 2.22.8** Rule 2.22.8 {#sec-11-2.22.8 omnilex-key=us-ms-regs-official--title-15--11#2.22.8}

Denial, Revocation, or Suspension of License The licensing agency may deny, refuse to renew, suspend, revoke, or restrict a license of any child care facility upon one or more of the following grounds: 1. Fraud, misrepresentation, or concealment of a material fact by the operator in securing the issuance or renewal of a license. 2. Conviction of an operator of any crime, if the licensing agency finds that the acts of which the operator has been convicted could have a detrimental effect on the children cared for by the child care facility. 3. Violation of any of the provisions of the act or of these rules and regulations. 4. Any conduct or failure to act, which is determined by the licensing agency to threaten the health or safety of a child. 5. Failure by the child care facility to have all criminal records and child abuse central registry checks on file at the facility. 6. Information received by the licensing authority because of the criminal records check (fingerprinting) or the child abuse central registry check on an operator.

**History**
- *Source: Miss. Code Ann. §43-20-8.*

##### **15 Miss. Admin. Code Pt. 11, R. 2.22.9** Notification {#sec-11-2.22.9 omnilex-key=us-ms-regs-official--title-15--11#2.22.9}

.

Prior to the denial, refusal to renew, suspension, revocation or restriction of a license, and at the time of the imposition of any monetary penalty, written notice of the contemplated action shall be given to the applicant or person named on the license of the child care facility, at the address on record with the licensing agency. Such notice shall specify the reasons for the proposed action and shall notify the operator of the right to a hearing on the matter.

**History**
- *Source: Miss. Code Ann. §43-20-8.*

##### **15 Miss. Admin. Code Pt. 11, R. 2.22.10** District Level Hearing 1 {#sec-11-2.22.10 omnilex-key=us-ms-regs-official--title-15--11#2.22.10}

If requested in writing within ten calendar days of receipt of notice of the imposition of a monetary penalty, a district level hearing shall be provided in which the operator or applicant may show cause why the monetary penalty should not be imposed. The District Health Officer or his/her designee will preside at said hearing. 2. Any hearing requested pursuant to Subchapter 22, Rule 2.22.4(1) shall be held no less than five calendar days and no more than 20 calendar days from the receipt of any request for a hearing, unless both parties agree to an alternate period. 3. The district level hearing shall be informal. There will be no court reporter present and the Department will not be represented by counsel. However, the hearing officer will take notes of the proceedings and will provide the licensee with a written order outlining his decision within ten calendar days of conclusion of the district level hearing. 4. Within ten calendar days of the receipt of the district level decision the licensee may make a written request for a hearing at the state level.

**History**
- *Source: Miss. Code Ann. §43-20-8.*

##### **15 Miss. Admin. Code Pt. 11, R. 2.22.11** State Level Hearing 1 {#sec-11-2.22.11 omnilex-key=us-ms-regs-official--title-15--11#2.22.11}

If requested in writing within ten calendar days of receipt of a notice of revocation, non-renewal, probation, or suspension, or after a district level hearing has been held on a monetary penalty, a hearing shall be held at the state level. At the state level hearing a hearing officer shall be appointed by the State Health Officer. A court reporter shall transcribe the proceeding. The hearing shall be held within 30 calendar days of receipt of the request for such hearing, unless waived in writing by the licensee. 2. Within 30 calendar days of the hearing, or such period as determined during the hearing, written findings of fact, together with a recommendation for action, shall be forwarded to the State Health Officer. The State Health Officer shall decide what, if any, action is to be taken on the recommendation within 14 calendar days of receipt of the recommendation. Written notice of the decision of the State Health Officer shall be provided to the operator.

.

3. At the state level hearing, the licensee shall be entitled to legal representation at his or her own expense. 4. For the Rules and Procedures for State Level Administrative Hearings refer to APPENDIX J of these regulations.

**History**
- *Source: Miss. Code Ann. §43-20-8.*

##### **15 Miss. Admin. Code Pt. 11, R. 2.22.12** Rule 2.22.12 {#sec-11-2.22.12 omnilex-key=us-ms-regs-official--title-15--11#2.22.12}

Appeal Any operator who disagrees with or is aggrieved by a decision of the licensing agency concerning the suspension, revocation, or restriction of a license may appeal to the Chancery Court of the county in which the child care facility is located. The appeal shall be filed no later than 30 calendar days after the operator receives written notice of the final administrative action by the licensing agency as to the suspension, revocation, or restriction of the license. The operator shall have the burden of proving that the decision of the licensing agency was not in accordance with applicable law and these regulations. If a facility is allowed to continue to operate during the appeal process, it will remain under the regulation of the licensing agency and will be subject to all current licensure regulations to include, but not limited to, inspection of the facility, review of facility and children’s records, submission of all required or requested documents, and payment of all applicable fees and/or monetary penalties.

**History**
- *Source: Miss. Code Ann. §43-20-8.*

##### **15 Miss. Admin. Code Pt. 11, R. 2.22.13** Rule 2.22.13 {#sec-11-2.22.13 omnilex-key=us-ms-regs-official--title-15--11#2.22.13}

Injunction Notwithstanding the existence of any other remedy, the licensing agency may, in the manner provided by law, in term time or in vacation, upon the advice of the Attorney General who shall represent the licensing agency in the proceedings, maintain an action in the name of the state for injunction or other proper remedy against any person to restrain or prevent the establishment, conduct, management, or operation of a child care facility with or without a license under the act, or otherwise in violation of these regulations.

**History**
- *Source: Miss. Code Ann. §43-20-8.*

##### **15 Miss. Admin. Code Pt. 11, R. 2.22.14** Rule 2.22.14 {#sec-11-2.22.14 omnilex-key=us-ms-regs-official--title-15--11#2.22.14}

Criminal Penalties Any person establishing, conducting, managing, or operating a child care facility without a license pursuant to these regulations shall be guilty of a misdemeanor, and, upon conviction, shall be fined not more than one hundred dollars ($100.00) for the first offense, and not more than two hundred dollars ($200.00) for each subsequent offense.

**History**
- *Source: Miss. Code Ann. §43-20-8.*

##### **15 Miss. Admin. Code Pt. 11, R. 2.22.15** Rule 2.22.15 {#sec-11-2.22.15 omnilex-key=us-ms-regs-official--title-15--11#2.22.15}

Violations and Penalties In the event of an emergency occurring at a child care facility which makes it difficult or impossible to comply with any of these Rules, the facility shall not be considered to be in violation of those specific Rules. For purposes of this Rule 2.22.9, the term “emergency” shall include only the following:

.

a. Inclement weather; b. Damage to the facility and/or structure which might require moving, transferring or consolidation of children; c. Traumatic injury or acute illness of a caregiver or the caregiver’s immediate family while the caregiver is on-site resulting in the caregiver having to leave the premises; or d. During any declaration of emergency by local or state officials. e. An injury or illness of a child at the facility requiring the immediate attention of one or more caregivers, resulting in non-compliance of child-to-staff ratio or room ratio; and f. During a period when Department inspectors or other government officials requires facility staff to temporarily not be able to perform their normal supervisory duties.

Subchapter 23. RELEASE OF INFORMATION Rule 2.23.1 Information in the possession of the licensing agency concerning the license of individual child care facilities may be disclosed to the public, except such information shall not be disclosed in such manner as to identify children or families of children cared for at a child care facility. Nothing in this section shall affect the agency’s authority to release findings of investigation into allegations of abuse pursuant to either Sections 43- 21-353(8) and Section 43-21-257 Mississippi Code of 1972, annotated.

**History**
- *Source: Miss. Code Ann. §43-20-8.*
- *Source: Miss. Code Ann. §43-20-8.*

#### **Chapter 3** REGULATIONS GOVERNING REGISTRATION OF CHILD RESIDENTIAL HOMES Subchapter 1: GENERAL Rule 3.1.1 Legal Authority The Child Residential Home Notification Act, §43-16-1 et seq. of the Mississippi Code of 1972 provides the legal authority under which the Mississippi State Department of Health prescribes minimum regulations for child residential homes defined under the law. The Mississippi State Department of Health shall be the notification agency for all child residential homes, and the department shall discharge the provisions the Child Residential Home Notification Act, §43-16-1 et. seq. of the Mississippi Code of 1972.

##### **15 Miss. Admin. Code Pt. 11, R. 3.1.2** Purpose 1 {#sec-11-3.1.2 omnilex-key=us-ms-regs-official--title-15--11#3.1.2}

The purpose of these regulations is to protect and promote the health and safety of children in this state by providing for the registration of child residential homes as defined herein to assure that certain minimum standards are maintained in such

##### **15 Miss. Admin. Code Pt. 11, R. 3.1.3** Rule 3.1.3 {#sec-11-3.1.3 omnilex-key=us-ms-regs-official--title-15--11#3.1.3}

Severability If any provision of these regulations or the application thereof to any persons or circumstances shall be held invalid, such invalidity shall not affect the provisions or application of these regulations which can be given effect without the invalid provision or application, and to this end the provisions of these regulations are declared to be severable.

**History**
- *Source: Miss. Code Ann. § 43-16-5.*

##### **15 Miss. Admin. Code Pt. 11, R. 3.1.4** Definitions 1 {#sec-11-3.1.4 omnilex-key=us-ms-regs-official--title-15--11#3.1.4}

Act: The Child Residential Home Notification Act, §43-16-1 et. seq. of the Mississippi Code of 1972. 2. Agency Representative: An authorized representative of the Mississippi State Department of Health. 3. Child: A person who has not reached the age of 18 years or who has not otherwise been legally emancipated. 4. Child Residential Home: Any place, facility or home operated by any person which receives children who are not related to the operators and whose parents or guardians are not residents of the same facility for supervision, care, lodging and maintenance for 24 hours a day, with or without transfer of custody. The term “A Child Residential Home” shall not include:

a. residential homes which are licensed by the Mississippi Department of Human Services under the provisions of §43-15-5, Mississippi Code of 1972 (such facility shall hereafter be known as a Residential Child-Caring Agency); b. any public school; c. any such home operated by a state agency;

##### **15 Miss. Admin. Code Pt. 11, R. 3.2.2** Rule 3.2.2 {#sec-11-3.2.2 omnilex-key=us-ms-regs-official--title-15--11#3.2.2}

Eligibility for Registration Any Child Residential Home not meeting the following criteria is required by §43-15-101 through §43-15-125 to be licensed by the Mississippi Department of Human Services. It is the responsibility of operator of the home claiming exemption from licensure to provide the required documentation to both the Mississippi State Department of Health (MSDH) and the Mississippi Department of Human Services (MDHS). To be exempt from MDHS licensure and eligible to register with the MSDH, a Child Residential Home shall: 1. Operate under the auspices of a religious institution. a. Such religious institution must have a tax exempt status as a nonprofit religious institution in accordance with §501(c) of the Internal Revenue Code of 1954, as amended, or b. The real property owned and exclusively occupied by the religious institution must be exempt from location taxation. 2. The agency or institution must be in compliance with the requirements of the Child Residential Notification Act, §43-16-1 et seq., Mississippi Code of 1972 and these regulations. 3. The agency or institution must not be in violation of §43-16-21(c) regarding the abuse and/or neglect of any child served by such home who has been adjudicated by the youth court as an abused and/or neglected child.

**History**
- *Source: Miss. Code Ann. § 43-16-5.*

##### **15 Miss. Admin. Code Pt. 11, R. 3.2.3** Rule 3.2.3 {#sec-11-3.2.3 omnilex-key=us-ms-regs-official--title-15--11#3.2.3}

Application for Registration An application for registration under these regulations shall be made to the registering agency upon forms provided by it and shall contain such information as the registering agency may reasonably require.

**History**
- *Source: Miss. Code Ann. § 43-16-5.*

##### **15 Miss. Admin. Code Pt. 11, R. 3.2.4** Rule 3.2.4 {#sec-11-3.2.4 omnilex-key=us-ms-regs-official--title-15--11#3.2.4}

Registration Fee All registration fees, registration renewal fees, and administrative charges shall be paid by certified check or money order payable to the Mississippi State Department of Health, and are non-refundable. Checks returned for insufficient funds, closed account, etc., shall be assessed an additional $50 fee. 1. Initial Registration Fee......................................................$100.00 2. Registration Renewal Fee..................................................$100.00 3. Reinstatement Fee...........................................................$200.00 4. Returned Check Fee.........................................................$ 50.00 5. Late Fee.......................................................................$ 25.00 6. Fingerprinting Fee (Per Fingerprint Card)...............................$ 50.00 NOTE: Except for the fingerprinting fee, no governmental entity or agency that operates a child care facility shall be required to pay the fees set forth in this section. Third party providers that contract with a state agency for the provision of child care services are subject to all fees, fines, etc. Further, should an entity exempt from licensure apply for a license, it shall be subject to all fees listed in this section.

**History**
- *Source: Miss. Code Ann. § 43-16-5*

##### **15 Miss. Admin. Code Pt. 11, R. 3.2.5** Certificate of Inspection by Fire Department 1 {#sec-11-3.2.5 omnilex-key=us-ms-regs-official--title-15--11#3.2.5}

A certificate of inspection and approval by the fire department of the municipality or other political subdivision in which the child residential home is located shall be submitted to the licensing agency with the application and registration fee. Except that if no fire department exists where the facility is located, the State Fire Marshall shall certify as to the inspection for safety from fire hazards 2. The inspection form to be used for fire inspections shall be MSDH Form #333 and shall be signed by a signatory authority of the fire inspection authority making the inspection

**History**
- *Source: Miss. Code Ann. § 43-16-5.*

##### **15 Miss. Admin. Code Pt. 11, R. 3.2.6** Rule 3.2.6 {#sec-11-3.2.6 omnilex-key=us-ms-regs-official--title-15--11#3.2.6}

Inspection: An agency representative(s) shall inspect each child care facility prior to issuing or renewing a registration to assure compliance with these regulations.

**History**
- *Source: Miss. Code Ann. § 43-16-5.*

##### **15 Miss. Admin. Code Pt. 11, R. 3.2.7** Rule 3.2.7 {#sec-11-3.2.7 omnilex-key=us-ms-regs-official--title-15--11#3.2.7}

Record of Inspection: Whenever an inspection is made of a child residential home, the findings shall be recorded on an official inspection form and furnished to the operator, director, and/or their representative, at the time the inspection is made.

##### **15 Miss. Admin. Code Pt. 11, R. 3.2.8** Renewal of Registration 1 {#sec-11-3.2.8 omnilex-key=us-ms-regs-official--title-15--11#3.2.8}

The registering agency shall issue licenses which may be renewed annually. The registering agency shall mail renewal notices, at least 75 days prior to the expiration date of the license to the address of the operator registered with the registering agency. The operator shall: a. Complete the renewal form; b. Submit any and all certificates of inspection and approval required by the registering agency; c. Enclose the renewal fee; and d. File the above with the registering agency at least 30 days prior to the expiration date on the registration. NOTE: Renewal applications postmarked less than 30 days prior to the expiration date of the registration shall be assessed a $25.00 late fee.

2. An operator who does not file the renewal application prior to the date that the registration expires will be deemed to have allowed the registration to lapse. Said registration may be reinstated by the registering agency, in its discretion, by payment of both the renewal fee and the reinstatement fee, provided said application for reinstatement is made within one (1) month of the expiration date of the registration. After the one month reinstatement period, it shall be required that an application for an initial registration be submitted. All registration requirements in effect at the time the new initial application is filed shall be met. In addition all delinquent fees shall be paid.

**History**
- *Source: Miss. Code Ann. § 43-16-5.*

##### **15 Miss. Admin. Code Pt. 11, R. 3.2.9** Rule 3.2.9 {#sec-11-3.2.9 omnilex-key=us-ms-regs-official--title-15--11#3.2.9}

Registration Not Transferable or Assignable Each registration shall be issued only for the premises and operator named in the application and shall not be transferable or assignable. A change of ownership includes, but is not limited to, inter vivos gifts, purchases, transfers, lease arrangements, cash and/or stock transactions or other comparable arrangements whenever any person or entity acquires or controls a majority interest of the child residential home. Changes of ownership from partnerships, single proprietorships, or corporations to another form of ownership are specifically included.

**History**
- *Source: Miss. Code Ann. § 43-16-5.*

##### **15 Miss. Admin. Code Pt. 11, R. 3.2.10** Rule 3.2.10 {#sec-11-3.2.10 omnilex-key=us-ms-regs-official--title-15--11#3.2.10}

Display of Registration The current registration issued by the registering agency to the named child residential home and operator shall be posted and displayed in a conspicuous place and in easy view of all persons who enter the child care facility. The facility operator shall also post next to the license, in plain view, a notice provided by the

##### **15 Miss. Admin. Code Pt. 11, R. 3.3.2** Rule 3.3.2 {#sec-11-3.3.2 omnilex-key=us-ms-regs-official--title-15--11#3.3.2}

Violations: If violations noted on the inspection form are not corrected within the period of time specified by the registering agency, a registration may be denied, suspended, or revoked in accordance with these regulations.

Subchapter 4: INITIAL NOTIFICATION REQUIREMENTS Rule 3.4.1 When making the initial notification that a Child Residential Home is operating or intending to operate, the executive director of the Child Residential Home shall provide the following information to the department on forms provided by the department: 1. Documentation that the agency is exempt from the licensure requirements of the MDHS. 2. Name, street address, mailing address and phone number of the home. 3. Name of the executive director and all staff members of the home. 4. Name and description of the agency or organization operating the home, which shall 1include a statement as to whether or not the agency or organization is incorporated. 5. Name and address of the sponsoring organization of the home, if applicable.

**History**
- *Source: Miss. Code Ann. § 43-16-5.*
- *Source: Miss. Code Ann. § 43-16-5.*

##### **15 Miss. Admin. Code Pt. 11, R. 3.4.2** The names of all children living at the home which shall include the following personal data: 1 {#sec-11-3.4.2 omnilex-key=us-ms-regs-official--title-15--11#3.4.2}

Full name and a copy of the child’s birth certificate; 2. Name and address of parent(s) or guardian(s); and 3. Name and address of other nearest relative.

##### **15 Miss. Admin. Code Pt. 11, R. 3.4.3** Rule 3.4.3 {#sec-11-3.4.3 omnilex-key=us-ms-regs-official--title-15--11#3.4.3}

Criminal Record (Fingerprinting), Child Abuse Central Registry Checks, and Sex Offender Records Checks: Pursuant to Section 43-20-1 et seq., of the Mississippi Code of 1972, Section 658(d) of the Child Care Development Block Grant (CCDBG) Act of 2014, and Federal Rules and Regulations 45 CFR 98.43 Criminal Background Checks all operators, employees, and prospective employees of a child residential home and any individual residing in a residence licensed as a child residential home shall have an FBI national criminal history records check (fingerprint), State criminal history records check (fingerprint), State child abuse registry check, National Crime Information Center (NCIC) National Sex Offender Registry (NSOR) sex offender registry check, and State sex offender registry check. Further, such checks must be completed at least every five years on the owner and staff of a child residential home.

1. Before a prospective staff member may begin work in a child residential home a valid Letter of Suitability must have been issued by the MSDH Criminal Records Check Unit. The child residential home shall submit the following for processing:

A. A completed fingerprint card and fees, as appropriate, shall be submitted to the Mississippi State Department of Health (MSDH) for processing. A copy of the submitted fingerprint card, fees paid, and evidence of mailing shall be maintained in the employee’s personnel file until the facility receives notification from the Mississippi State Department of Health (Department) verifying the employee’s suitability for employment. If the facility is notified that the fingerprints submitted were incomplete or of such poor quality that prevented processing, the facility shall resubmit the necessary information within ten days of the dated letter on the notification.

B. A Child Abuse Registry Form shall be submitted to the Department of Human Services for processing. A copy of the submitted form and evidence of mailing shall be maintained in the employee’s personnel file until the facility receives notification from the Department of the employee’s suitability for employment.

2. Each licensed child residential home with internet capabilities may electronically access, monitor, and verify the suitability status of any submitted employee through a department-maintained webpage: http://www.HealthyMS.com.

3. Upon receipt of notification, that the employee has been deemed suitable for

##### **15 Miss. Admin. Code Pt. 11, R. 3.4.3** Rule 3.4.3 {#sec-11-3.4.3 omnilex-key=us-ms-regs-official--title-15--11#3.4.3}

Proof, to be shown by sworn affidavit of the executive director of the home, that medical records are maintained for each child.

Subchapter 5: ACKNOWLEDGMENT OF NOTIFICATION AND CERTIFICATE OF REGISTRATION Rule 3.5.1 Upon the submission of a properly completed notification form accompanied by 1. A certificate of inspection and approval by the fire department of the municipally or other political subdivision in which the home is located, and 2. a certificate of inspection and approval by the health department of the county in which the home is located, the department will acknowledge that the home has properly notified the department regarding its operation and issue a “Certificate of Registration.”

**History**
- *Source: Miss. Code Ann. § 43-16-5.*
- *Source: Miss. Code Ann. § 43-16-5.*

##### **15 Miss. Admin. Code Pt. 11, R. 3.5.2** Rule 3.5.2 {#sec-11-3.5.2 omnilex-key=us-ms-regs-official--title-15--11#3.5.2}

Upon issuing the acknowledgment of notification and certificate of registration the MSDH shall provide copies of the notification form to the chancery court or the youth court, as appropriate, of the county in which the home is located.

Subchapter 6: MONTHLY REPORTS Rule 3.6.1 Each child residential home shall file monthly reports with the department, on forms provided by the department. Said monthly report shall indicate any changes in the notification information originally provided in accordance with Subchapter 4 of these regulations which have occurred, if any.

Subchapter 7: ANNUAL INSPECTION OF HOMES Rule 3.7.1 The department, once a year, shall make or cause to be made inspections limited to health, nutrition, cleanliness, sanitation, written medical records for children, discipline

**History**
- *Source: Miss. Code Ann. § 43-16-5.*
- *Source: Miss. Code Ann. § 43-16-5.*

##### **15 Miss. Admin. Code Pt. 11, R. 3.7.2** Rule 3.7.2 {#sec-11-3.7.2 omnilex-key=us-ms-regs-official--title-15--11#3.7.2}

Reasonable additional inspections may be made as often a may be deemed necessary by the department, but shall not be scheduled so as to disrupt the normal activities of the home.

**History**
- *Source: Miss. Code Ann. § 43-16-5.*

##### **15 Miss. Admin. Code Pt. 11, R. 3.7.3** Annual fire inspections are required and shall be made of the home {#sec-11-3.7.3 omnilex-key=us-ms-regs-official--title-15--11#3.7.3}

**History**
- *Source: Miss. Code Ann. § 43-16-5.*

##### **15 Miss. Admin. Code Pt. 11, R. 3.7.4** Rule 3.7.4 {#sec-11-3.7.4 omnilex-key=us-ms-regs-official--title-15--11#3.7.4}

Any violation of state law on the premises of a child residential home shall immediately be reported by such inspection personnel to the appropriate law enforcement official.

Subchapter 8: REQUIRED WRITTEN POLICIES Rule 3.8.1 Every child residential home shall have a written discipline policy and written family communication policy which shall be approved in writing, if possible, by the parent(s) or guardian(s) of the children residing at such home, and shall be made available to authorized inspection personnel upon request.

Subchapter 9: ENFORCEMENT OF NOTIFICATION/REGISTRATION REQUIREMENTS Rule 3.9.1 Whenever the department is advised or has reason to believe that any child residential home is operating without proper notification in accordance with this chapter, it shall request a meeting with the governing board and executive director of such home to ascertain the fact. If the department finds that such home is providing supervision, care, lodging or maintenance for any children without such notification, it shall give the executive director of the home written notice by certified mail that such person shall file notification in accordance with this chapter within 60 days after receipt of such notice or the department may request a court injunction as provided in §43-16-21.

Subchapter 10: COURT ACTION FOR INJUNCTION OR RESTRAINING ORDER AGAINST HOME: GROUNDS

**History**
- *Source: Miss. Code Ann. § 43-16-5.*
- *Source: Miss. Code Ann. § 43-16-5.*
- *Source: Miss. Code Ann. § 43-16-5.*

##### **15 Miss. Admin. Code Pt. 11, R. 3.10.1** Rule 3.10.1 {#sec-11-3.10.1 omnilex-key=us-ms-regs-official--title-15--11#3.10.1}

Notwithstanding the existence of any other remedy, the department may, in the manner provided by law, in term time or in vacation, upon the advice of the Attorney General who shall represent the department in the proceedings, maintain an action in the name of the state for an injunction or restraining order to cease the operation of the home, and to provide for the appropriate removal of the children from the home and placement in the custody of the parents or legal guardians, the Department of Human Services, or any other appropriate entity in the discretion of the court. Such action shall be brought in the chancery court or the youth court, as appropriate, of the county in which such child residential home is located, and shall only be initiated for the following violations: 1. Providing supervision, care, lodging, or maintenance for any children in such home without filing notification in accordance with this chapter. 2. Failure to satisfactorily comply with local health department or State Fire Marshal inspections made pursuant to §43-16-15, regarding the health, nutrition, cleanliness, safety, sanitation, written records and discipline policy of such home. 3. Suspected abuse and/or neglect of the children served by such home, as defined in §43-21-105, Mississippi Code of 1972.

Subchapter 11: REGULATION OF PROGRAM CONTENT Rule 3.11.1 No governmental agency shall have jurisdiction or authority to regulate or attempt to regulate, control or influence the form, manner or content of the religious curriculum, program or ministry of a school or of a facility sponsored by a church or religious organization.

**History**
- *Source: Miss. Code Ann. § 43-16-5.*
- *Source: Miss. Code Ann. § 43-16-5.*

##### **15 Miss. Admin. Code Pt. 11, R. 4.2.2** Submission of Plans 1 {#sec-11-4.2.2 omnilex-key=us-ms-regs-official--title-15--11#4.2.2}

Sanitary Facilities for New Camps and Modification of Existing Camps In accordance with applicable state and local laws, ordinances and regulations, plans and specifications for the construction, reconstruction or extensive alteration of any plumbing system, water supply, sewage system, garbage or refuse disposal system, kitchen, food service or dining facilities, swimming and/or diving area at any residential camp shall be submitted to the Department for review at least 60 days prior to the initiation of construction, to be returned by the Department within 30 days. This review is to determine that the facility meets all rules and regulations as stipulated for Youth Camp Licensure. 2. Camps on New Site a. In accordance with applicable State and local laws, ordinances and regulations, plans and specifications for the construction and operation of a residential camp on a new site should be submitted to the Department for review at least 60 days prior to the initiation of construction and shall contain at least the following information: i. Name and address of owner or operator of camp ii. Location, boundaries and dimensions of campsite and lots iii. Entrance and exit roads, access roads and trails iv. Location, use and floor plans of all proposed and existing buildings; detailed plans and specifications of swimming pools and other swimming areas v. Location of all proposed or existing water supplies and sewage systems vi. Source and method of protecting water supply vii. Documentation of an approved sewage disposal method

##### **15 Miss. Admin. Code Pt. 11, R. 4.3.2** Camp Director/Program Manager 1 {#sec-11-4.3.2 omnilex-key=us-ms-regs-official--title-15--11#4.3.2}

Each Residential Camp shall have a camp director or permitted program manager on the premises who shall: a. Be at least 25 years of age and

b. Have successfully completed a documented course in camping administration such as those offered by professional camping associations, national agencies or their equivalent as determined by the Youth Camp Safety Advisory Council

##### **15 Miss. Admin. Code Pt. 11, R. 4.3.3** Rule 4.3.3 {#sec-11-4.3.3 omnilex-key=us-ms-regs-official--title-15--11#4.3.3}

Supervision of Specialized Activities When campers participate in specialized activities such as, but not limited to, horseback riding, hiking, scuba diving, rock climbing, firearms, canoeing, aquatic events, and ropes challenge courses, the counselors supervising the activity shall possess evidence of appropriate training and experience in their program specialties. When applicable, camp operators shall assure any special training necessary for camp personnel to protect the health and safety of special needs campers. 1. Aquatics Activities including those events associated with swimming, boating, canoeing, water craft and water skiing shall be directed by individuals currently certified as having passed American National Red Cross Lifeguard Training, Boy Scouts of America Lifeguard Training, Y.M.C.A. Lifeguard Training or the equivalent, as determined by the Advisory Council on Youth Camp Safety. The aquatics director shall be at least 18 years of age. 2. Swimming Activity Supervision a. There shall be a minimum ratio of one counselor with at least a current Lifeguard Certificate as issued by the American National Red Cross, Boy Scouts of America, Y.M.C.A. or its equivalent* per 25 campers in the water. There shall be a minimum of one to 10 total staff to camper ratio maintained at all times. b. A system shall be devised and on file for checking participants in and out during swimming and boating activities. 3. Water Craft Activities A Coast Guard approved personal flotation device (PFD) must be worn by all campers and counselors when in water craft regardless of swimming ability. All Mississippi Boating Safety Act regulations must be followed in water craft activities. (Refer to current Mississippi regulations, available through Coast Guard and Coast Guard Auxiliaries) a. There shall be a minimum ratio of one counselor with at least a current Lifeguard Certificate as issued by the American Red Cross, Boy Scouts of America, YMCA, or equivalent, as determined by the Youth Camp Advisory Council, per 25 campers on the water. All water craft activities shall be supervised by a minimum of one staff on the water to each 10

##### **15 Miss. Admin. Code Pt. 11, R. 4.3.4** Rule 4.3.4 {#sec-11-4.3.4 omnilex-key=us-ms-regs-official--title-15--11#4.3.4}

Personnel Records The camp shall keep on site a record of all employees and staff, which shall include at least: name, address, age, training, education, experience and other qualifications and the names and telephone numbers of persons to be notified in the event of an emergency.

**History**
- *Source: Miss. Code Ann. § 75-74-9.*

##### **15 Miss. Admin. Code Pt. 11, R. 4.3.5** Rule 4.3.5 {#sec-11-4.3.5 omnilex-key=us-ms-regs-official--title-15--11#4.3.5}

All camps are to conduct an orientation period to acquaint all staff and personnel with health safety and welfare programs of the camp. This must be documented in personnel records.

Subchapter 4: GENERAL HEALTH and SAFETY Rule 4.4.1 General Health 1. Health Records a. Campers records shall be readily available to health authorized personnel and shall include: i. Camper's name and address ii. Name, address, and telephone number of parent, legal guardian and designated adult emergency contact iii. Authorization from the parent/guardian of all minors for emergency care. b. Every camper and staff member entering camp shall furnish a health history which should emphasize those potential conditions for which camp personnel should be prepared.

**History**
- *Source: Miss. Code Ann. § 75-74-9.*

##### **15 Miss. Admin. Code Pt. 11, R. 4.4.2** General Safety 1 {#sec-11-4.4.2 omnilex-key=us-ms-regs-official--title-15--11#4.4.2}

Equipment and Facilities a. All equipment and facilities used in youth camp programs, whether owned by the camp or not, shall be of good quality and not present undue risk. b. Archery equipment, firearms, and ammunition shall be stored in a locked cabinet or building when not in use. c. Power equipment shall not be stored, operated, or left unattended without proper safeguards in camper areas. All power tools shall be stored in a locked place not occupied by campers. Power tools and outboard motors shall be used by campers only under the direct supervision of counselors. d. Equipment used for arts and crafts shall be in good repair, of safe design and properly installed. e. Commercial playground equipment shall be securely anchored to imbedded concrete or other approved footing, acceptable to the Department. f. All water craft shall be equipped with U.S. Coast Guard approved personal flotation devices of types I, II, or III as prescribed for the specific type of craft and number and age of occupants. Water skiers shall wear a vest as approved by the U.S. Coast Guard for that particular activity. Water craft towing a skier shall have an observer on board.

##### **15 Miss. Admin. Code Pt. 11, R. 4.6.2** Safety and Rescue Equipment 1 {#sec-11-4.6.2 omnilex-key=us-ms-regs-official--title-15--11#4.6.2}

Safety equipment provided for swimming and diving areas shall be in good, usable condition.

##### **15 Miss. Admin. Code Pt. 11, R. 4.6.3** Plumbing Fixtures 1 {#sec-11-4.6.3 omnilex-key=us-ms-regs-official--title-15--11#4.6.3}

Cross-connections shall not be permitted. 2. A cross-connection shall be considered broken where a minimum air gap of at least twice the diameter of the water pipe is provided, where potable water enters the pool and where pool water or water from the recirculation system is discharged to a sewer system. 3. Back flow shall not be permitted. A potable water distributing pipe shall be considered as protected against back flow from any plumbing fixture or other piece of equipment or from any appliance capable of affecting the quality of the water in the potable water supply where as air gap of at least twice the diameter of the water supply pipe has been provided. Where it is not practicable to provide such minimum air gap, the connection of the fixture, equipment or appliance shall be equipped with a back flow preventer assembly of a type and at a location provided by the Board. 4. The Board may require that a back flow preventer assembly of an approved type be installed at any fixed potable water outlet to which a hose may be connected and used in contact with liquids and other substances. 5. The Southern Plumbing Code shall be final authority.

##### **15 Miss. Admin. Code Pt. 11, R. 4.6.4** Electrical Safety 1 {#sec-11-4.6.4 omnilex-key=us-ms-regs-official--title-15--11#4.6.4}

The electrical installation at all newly constructed swimming and diving areas shall comply with and be maintained in accordance with requirements of the latest edition of the National Electrical Code. 2. Existing installations shall, upon application, be inspected and granted a variance if a hazard does not exist. 3. All swimming pools, regardless of construction date, shall comply with the latest edition of the National Electrical Code requirements pertaining to underwater lights. 4. Defects in the electrical installation of underwater lights shall be repaired, removed, or disconnected immediately. 5. All electrical wiring where exposed and accessible to bathers shall be in rigid conduit or electrical metallic tubing and all boxes, fittings, and accessories used in damp or wet locations shall be installed and equipped to prevent the entrance of water. 6. Distribution centers where fused switches or circuit breakers are grouped shall be enclosed in inaccessible to all except authorized individuals. 7. The crossing of outdoor swimming and diving areas by open overhead electrical conductors shall be prohibited. 8. Overhead electrical conductors crossing playgrounds contiguous to outdoor swimming and diving areas shall comply with the requirements of the latest edition of the National Electrical Code. 9. All metal fences or railings on which a broken electrical conductor might fall shall be effectively grounded. 10. All water and other piping to and from the swimming and diving areas, including inlet and outlet pipes, shall be metallically bonded together and adequately connected to the same grouping electrode used to ground the neutral conductor of the electrical system. This shall be in addition to the grounding requirements for electrical equipment and circuits as required by the latest edition of the National Electrical Code. 11. Pumps, filters and other mechanical and electrical equipment shall be enclosed in such a manner as to be accessible only to authorized individuals. 12. Construction and drainage shall be such as to avoid the entrance of accumulation of water in the vicinity of electrical equipment.

##### **15 Miss. Admin. Code Pt. 11, R. 4.7.2** Rule 4.7.2 {#sec-11-4.7.2 omnilex-key=us-ms-regs-official--title-15--11#4.7.2}

Only potable water shall be used for drinking, brushing teeth, cooking or reconstituting dehydrated or concentrated products.

**History**
- *Source: Miss. Code Ann. § 75-74-9.*

##### **15 Miss. Admin. Code Pt. 11, R. 4.7.3** Rule 4.7.3 {#sec-11-4.7.3 omnilex-key=us-ms-regs-official--title-15--11#4.7.3}

Supplies shall be constructed, protected, operated, and maintained in conformance with applicable State and local laws, ordinances and regulations.

**History**
- *Source: Miss. Code Ann. § 75-74-9.*

##### **15 Miss. Admin. Code Pt. 11, R. 4.7.4** The supply servicing a youth camp may consist of: 1 {#sec-11-4.7.4 omnilex-key=us-ms-regs-official--title-15--11#4.7.4}

A public water supply system 2. An on-site individual water supply system 3. Water which has been transported to the camp for dispensing to campers 4. Water which has been purified before use in accordance with approved procedures of the board, or 5. A combination of the above sources acceptable to the Board.

Subchapter 8: Waste Disposal and Sanitary Facilities Rule 4.8.1 Solid Wastes All refuse and other solid wastes shall be stored, collected and disposed of in a manner approved by the Board.

**History**
- *Source: Miss. Code Ann. § 75-74-9.*
- *Source: Miss. Code Ann. § 75-74-9.*

##### **15 Miss. Admin. Code Pt. 11, R. 4.8.2** Rule 4.8.2 {#sec-11-4.8.2 omnilex-key=us-ms-regs-official--title-15--11#4.8.2}

Sewage and Liquid Waste Disposal The sewage and waste water from all youth camps shall be disposed of in a manner approved by the Board. This shall consist of:

##### **15 Miss. Admin. Code Pt. 11, R. 4.8.3** Sanitary Facilities 1 {#sec-11-4.8.3 omnilex-key=us-ms-regs-official--title-15--11#4.8.3}

Toilet Facilities a. Toilet facilities shall be provided in youth camps. The minimum number of toilet facilities shall be provided in a ratio of 1 to 12. In residential camps, flush urinals may be substituted for not more than one-half the required number of toilet facilities. b. Covered trash receptacles shall be provided in all permanent toilets. c. Pit privies and latrines shall be located at least 100 feet from any well, stream, or lake and not less than 50 feet from any sleeping area. d. Pit privies and latrines shall be located at least 200 feet from a kitchen or food service area. 2. Installation, Operation, and Maintenance Requirements for Toilet Facilities and Urinals a. Water-flushed toilets, chemical toilets, pit privies or latrines (slit-trench, deep pit, mound or bored hole latrines) and urinals shall be provided and maintained in a clean and sanitary condition. b. The underground water level and soil conditions shall be considered when determining the appropriate type of toilets and urinals to be provided as shall applicable State and local laws, ordinances and regulations. 3. Hand-washing and Bathing Facilities a. Camps shall provide hand-washing facilities at a ratio of 1 to 12 and bathing facilities shall meet the ratio of 1 to 15. b. Primitive or Outpost Camps shall not be required to adhere to the hand- washing or bathing facility requirements outlined above.

##### **15 Miss. Admin. Code Pt. 11, R. 4.9.2** Rodent and Insect Control 1 {#sec-11-4.9.2 omnilex-key=us-ms-regs-official--title-15--11#4.9.2}

Buildings and structures shall be maintained free of insect and rodent harborages and infestation. 2. Extermination methods or other measures to control rodents and insects shall conform to the requirements of the Board.

**History**
- *Source: Miss. Code Ann. § 75-74-9.*

##### **15 Miss. Admin. Code Pt. 11, R. 4.9.3** Weed Control 1 {#sec-11-4.9.3 omnilex-key=us-ms-regs-official--title-15--11#4.9.3}

The growth of brush, weeds, grass, and plants shall be controlled in central camp areas to prevent harborage of ticks, chiggers and other insects of public health importance. 2. The central camp area shall be maintained to retard growth of ragweed, poison ivy, poison oak, sumac and other noxious plants considered detrimental to health.

**History**
- *Source: Miss. Code Ann. § 75-74-9.*

##### **15 Miss. Admin. Code Pt. 11, R. 4.10.2** Stable Sanitation 1 {#sec-11-4.10.2 omnilex-key=us-ms-regs-official--title-15--11#4.10.2}

Horses or other farm animals shall not be permanently quartered within 500 feet of living quarters, kitchens, or mess halls. 2. A temporary shelter, corral, tie-rail, or hitching post shall not be located within 200 feet of dining hall, kitchen, or other place where food is prepared, cooked, or served. 3. Manure shall not be allowed to remain for more than 24 hours at such locations as temporary shelter, corrals, tie-rails, or hitching posts. 4. Manure from permanent and shelter quarters shall be removed at least weekly. Interim storage shall be in fly-tight enclosures or an area isolated from camp activity. 5. Adequate measures shall be taken at all times to keep fly, mosquito and rodent populations to a minimum.

Subchapter 11: Food Service Rule 4.11.1 Food handling establishments which are located on the premises of licensed camps shall meet the Regulations Governing Food Service Sanitation of the Mississippi State Department of Health.

**History**
- *Source: Miss. Code Ann. § 75-74-9.*
- *Source: Miss. Code Ann. § 75-74-9.*

##### **15 Miss. Admin. Code Pt. 11, R. 4.11.2** Rule 4.11.2 {#sec-11-4.11.2 omnilex-key=us-ms-regs-official--title-15--11#4.11.2}

Since meals in camp are considered a part of the program, all camps that are serving in a manner known as "family style" should be allowed to continue this means as long as existing guidelines governing food preparation and protection are followed.

**History**
- *Source: Miss. Code Ann. § 75-74-9.*

##### **15 Miss. Admin. Code Pt. 11, R. 4.12.2** Responsibilities in Transit 1 {#sec-11-4.12.2 omnilex-key=us-ms-regs-official--title-15--11#4.12.2}

When two or more vehicles are traveling to the same distant point, there shall be a prearranged method of communication with each other. 2. Only that number of children or adults for whom there is seating space shall be transported in a vehicle. Adequate space for luggage and other equipment shall also be provided. 3. The gross weight of vehicles (GVW) when loaded with passengers, gear and trailer-tongue weight should not exceed the manufacturer's GVW regardless of whether or not the number of passengers is within the specified number of seats. 4. Standing while in transit and projection of head or limbs outside the vehicle is prohibited. 5. In addition to the driver, there shall be at all times at least one adult or counselor in a vehicle on a public thoroughfare when 9 or more campers are being transported where the driver and the campers are not physically separated. When physically separated, an adult or counselor must ride in the compartment with the campers. 6. Speed limits shall be posted on the campgrounds and observed by all vehicle operators. 7. In all vehicles used, seats or benches must be securely fastened to the floor. Open-body or stake-bed vehicles shall not be permitted for transportation of passengers outside the confines of the campgrounds. 8. Persons shall not be permitted to sit in the front seat unless each such individual is secured with a seat belt. 9. For specialized trips from camp, each camper shall have evidence of previous experience and ability with each method of transportation to be used such as horseback riding, backpacking and canoeing.

**History**
- *Source: Miss. Code Ann. § 75-74-9.*

##### **15 Miss. Admin. Code Pt. 11, R. 4.12.3** Responsibility for Drivers and Vehicles 1 {#sec-11-4.12.3 omnilex-key=us-ms-regs-official--title-15--11#4.12.3}

All drivers and vehicles shall be in compliance with applicable regulations of the Mississippi Highway Safety Patrol and ordinances of the municipality in which the vehicle is operated. Drivers operating vehicles designed for 16 or more persons must have a commercial license in accordance with Sections 63-173 through 63-190 of the Mississippi Code, 1972, revised 1989. 2. The driver of a camp vehicle shall be at least 18, shall have at least 1 year's experience as a licensed driver, and shall possess the required license. 3. All camp vehicles shall be maintained in safe operating condition and be equipped with a first-aid kit. 4. A current state inspection sticker shall be exhibited on vehicles transporting campers. 5. All vehicles transporting campers off site shall be equipped with a first-aid kit, fire extinguisher, flares, and reflectors and must meet current seat belt requirements. 6. Campers shall not be allowed to repair, or assist in the repair, of any vehicles where dangers are involved either by the process of repair or from the environment in which the repair is to be conducted. 7. Trailers whose loaded weight when added to the GVW of the towing vehicle exceed the normal braking ability of that vehicle, shall be equipped with auxiliary brakes. 8. Trailers shall be designed and equipped to prevent sway or other influence(s) that significantly affect the control of the towing vehicle. 9. The GVW of towed trailers shall exceed by at least 10 percent the load being carried. 10. Annual inspection schedules for trailer under-pinnings, brakes and hitches shall be documented and maintained.

Subchapter 13: Penalties and Legal Action Rule 4.13.1 Emergency Suspension of License 1. Any license issued pursuant to this regulation may be suspended prior to a hearing if the licensing agency has reasonable cause to suspect that the continued operation of the licensed youth camp facility constitutes a substantial hazard to the health and safety of the children entrusted to or cared for by such facility.

**History**
- *Source: Miss. Code Ann. § 75-74-9.*

##### **15 Miss. Admin. Code Pt. 11, R. 4.13.2** Denial, Revocation, or Suspension of License 1 {#sec-11-4.13.2 omnilex-key=us-ms-regs-official--title-15--11#4.13.2}

The licensing agency may refuse to issue or renew, or may suspend or revoke the license of any facility upon one (1) or more of the following grounds: a. Fraud or misrepresentation by the owner or operator in securing the issuance or renewal of a license. b. Conviction of a youth camp operator of a crime, if the acts for which he or she is convicted are found by the licensing agency to have a direct and detrimental effect on the children entrusted to or cared for by such licensee. c. Violation of any of the provisions of the Mississippi Youth Camp Safety and Health law or of the rules and regulations adopted pursuant to that act. d. Any conduct or failure to act, which threatens the health or safety of the children at the facility.

**History**
- *Source: Miss. Code Ann. § 75-74-9.*

##### **15 Miss. Admin. Code Pt. 11, R. 4.13.3** Rule 4.13.3 {#sec-11-4.13.3 omnilex-key=us-ms-regs-official--title-15--11#4.13.3}

Notification Prior to the denial, revocation or suspension of a license, written notice of the contemplated action shall be given to the owner of the facility. Such notice shall specify the reasons for the proposed action and shall notify the applicant of the right to a hearing on the matter.

**History**
- *Source: Miss. Code Ann. § 75-74-9.*

##### **15 Miss. Admin. Code Pt. 11, R. 4.13.4** Hearings 1 {#sec-11-4.13.4 omnilex-key=us-ms-regs-official--title-15--11#4.13.4}

If requested in writing ten (10) days of receipt of said notice, a hearing shall be provided in which the operator may show cause why the license should not be denied, suspended or revoked. Any such hearing shall be conducted by a hearing officer designated by the State Health Officer.

##### **15 Miss. Admin. Code Pt. 11, R. 4.13.5** Rule 4.13.5 {#sec-11-4.13.5 omnilex-key=us-ms-regs-official--title-15--11#4.13.5}

Appeal Any licensee who disagrees with or is aggrieved by a decision of the licensing agency in regard to the suspension or revocation of such license, may appeal, in accordance with the applicable law.

**History**
- *Source: Miss. Code Ann. § 75-74-9.*

##### **15 Miss. Admin. Code Pt. 11, R. 24** Rule 24 {#sec-11-24 omnilex-key=us-ms-regs-official--title-15--11#24}

hours 3 months From the ACOG/AAP publication: Breastfeeding Handbook for Physicians

When centers are reimbursed for meals and must supply formula for their infants, only ready to use formula may be purchased for use. The center may require the parents to supply clean bottles daily. If the center supplies the bottles, there must be provisions in place for the proper cleaning, sanitizing, and drying of all bottles and supplies outside of the infant room.

FEEDING SCHEDULE FOR INFANTS THROUGH ONE YEAR

INFANT’S FOOD NEEDS ARE BASED ON THE AMOUNT OF TIME SPENT IN THE CHILD CARE FACILITY.

ANY INFANT IN A CHILD CARE FACILITY AT THE TIME OF SERVICE OF A MEAL OR SNACK SHALL BE SERVED FOODS APPROPRIATE TO THE AGE.

MEAL/SNACK

BIRTH THROUGH 5 MONTHS

6 THROUGH 12 MONTHS Breakfast 4-6 fl. oz. breast milk or formula 6-8 fl. oz. breast milk or formula 2-4 Tbsp. prepared infant cereal (optional) 1-4 Tbsp. fruit and/or vegetable(infant or mashed) Lunch or Supper 4-6 fl. oz. breast milk or formula 6-8 fl. oz. breast milk or formula 2-4 Tbsp. prepared infant cereal (optional) 1-4 Tbsp. fruit and/or vegetable(infant or mashed) 1-4 Tbsp. infant meat Supplement/Snack 4-6 fl. oz. breast milk or formula 2-4 fl. oz. breast milk or formula 0-1/2 dry bread or 0-2 crackers (optional)

Infant cereal and formulas shall be iron fortified. Infant feeding is individualized after consultation with the parent and by hunger cues from the infant.

MENU PLANNING

Dietary Guidelines for Americans provide assistance in planning meals for ages two and older, which will promote health and prevent disease.

The guidelines, applied to child care feeding are:

1. Offer a variety of foods.

2. Serve meals and snacks that help maintain a healthy weight.

3. Serve fresh, frozen, canned, or dried vegetables, fruits whenever possible, and whole grain products.

4. Avoid excessive fat, saturated fat, and cholesterol. No fried foods or foods with transfats shall be served.

5. Use and serve sugar only in meal preparation and then in moderation. No concentrated sweets, such as candy, syrup, sweetened drinks sodas, or flavored milks may be served.

6. Limit sodium products and the use of salt.

7. Promote an alcohol, tobacco and drug free lifestyle for children, parents, and caregivers.

8. Promote and encourage daily physical activity.

PARTIES AND SPECIAL OCCASIONS

Parties and special party type events should not be held more that once a month. Food for parties should be prepared at the facility when possible. It is recommended that if foods for the event are brought to the facility by parents it should be “store bought” and not “home cooked.”

It is suggested that a plain “store bought” cake be served. Other items may include ice cream, fresh fruit, cheese and crackers, and party favors such as stickers, books, toothbrushes, crayons, etc., are encouraged.

Meal Pattern Points to Remember

Keep in mind the following points when you plan menus to meet meal pattern requirements for each of the food groups. • Plan your meats first. Then select fruits and vegetables, making sure that you have a Vitamin C source daily and a Vitamin A source every other day, or three times a week. Refer to the vitamin tables. Limit starchy vegetables to once/day - these include lima beans, butterbeans, white/sweet potatoes, English peas, black-eye peas, field peas, Crowder peas, cream and whole kernel corn, any dried pea/bean(unless counted for a meat substitute).

• Two vegetables or two fruits may be served at the mealtime, but it is recommended to serve a vegetable and a fruit for variety. Including brightly colored fruits and vegetables, such as tomatoes, broccoli, carrots, greens, strawberries, melon, peaches, will help to meet the vitamin requirements.

• The same meal may not be served more than once in a day (i.e. facilities who are open for lunch and supper may not serve the same meal for both meals).

• Snacks are to be served mid-morning (if required), early afternoon, and late afternoon, usually 30-60 minutes before closing. Water can be used as the beverage while foods are served. Snack time is an excellent time to introduce fruits and vegetables.

• Use only 100-percent-strength juice for snack no more than once a day. Give fruit for breakfast/morning snack instead of juice.

• Juice should not be served as part of the snack when milk is the only other component. It is poor menu planning to offer such a combination since it provides too much liquid for children.

• Fruit-flavored drinks, sport drinks, soft drinks, caffeinated beverages, artificially sweetened beverages shall not be served.

• Avoid serving two forms of the same fruit or vegetable in the same day. Example: an orange and orange juice or an apple and applesauce are combinations that should not be used. Serve a variety of vegetables and fruits to ensure a nutritionally well-balanced meal.

• Dry milk shall not be used as a milk beverage, but may be used for cooking purposes.

• Guidelines from USDA FNS (US Department of Agriculture Food Nutrition Supplement) program are used as the standard for menu planning and guidelines. However, when one set of guidelines are stricter then the stricter guidelines shall be enforced (in comparing MSDH and USDA FNS). Emphasis shall be placed on serving more whole grains and fewer foods high in fat, sugar, and sodium.

• Drinking water shall be freely available to children of all ages and offered at frequent

intervals. Extra water served with meals, snacks, and during and after physical activity is encouraged. Facilities may have water fountains in the classroom or dining area. This water source should be encouraged before and after all meals and snacks and takes the place of water served at the table.

• To prevent nutrient and vitamin loss from foods during preparation, cooking, or storage, try to o Serve fruits and vegetables raw as appropriate for the age. The risk of choking is greater for the child under the age of two. o Steam, boil, or simmer foods in a very small amount of water, or microwave for the shortest time possible. o Cook potatoes in their skins. Be sure to wash the dirt off the outside of the potato. o Refrigerate prepared juices and store them for no more than two to three days. o Store cut raw fruits and vegetables in an airtight container and refrigerate—do not soak or store in water. Nutrients may be diluted from soaking in water. Manufacturer packaged fresh fruits and vegetables are the exception due to packaging processes.

MEAL PATTERNS FOR CHILDREN IN CHILDCARE FACILITIES: BREAKFAST

BREAKFAST AGES 1YR-2YR AGES 3 YR-5 YR AGES 6 YR–12 YR Milk (Must be fluid, skim/fat free) ½ c. ¾ c. 1 c. Fruit or Vegetable ¼ c. ½ c. ½ c. Grains/Breads Enriched, Whole Grain Bread OR Enriched Dry Cereal OR Enriched Hot Cereal OR Enriched, Whole Grain Pasta, Noodles, Rice

½ slice

¼ c. OR 1/3oz. ¼ c.

¼ c.

½ slice

1/3 c. OR ½ oz. 1/3 c.

1/3 c.

½ slice

¾ c. OR 1oz. ½ c.

½ c. Water ½ c. ¾ c. 1 c.

Milk:

Milk shall be served at Breakfast. The milk shall be pasteurized fluid milk, fortified with vitamin A and D. Whole milk is served to infants and toddlers less than 2 years of age. After age two, skim/fat free milk shall be served

Soymilk may be served when indicated with dietary restrictions.

Bread and Bread Alternates:

Use enriched whole-grain breads and bread alternatives. Dry cereals need to be of high fiber and not sugar coated. Hot cereals cannot be instant. Whole grain pasta, noodles, or brown rice may be used occasionally for the breakfast meal.

Breakfast breads may include muffins, biscuit, toast, breakfast bread, no more than weekly pancake or waffle (with no syrup). Crust used as part of the main dish (i.e., for quiche) is allowed as a bread alternate. These items may not be served: doughnuts, honey buns, breakfast tarts, pastries, packaged snack cakes, and other high fat/sugar foods.

Fruits and Vegetables:

Use fresh, canned, dried, or frozen fruit for breakfast. No sugar may be used in the packaging or preparation of the fruit. Canned or frozen fruit should be packed in juice or water - not syrup or sugar packed.

Vegetables, such as tomatoes, may be used occasionally for the breakfast meal. Cultural differences may also dictate that items such as tomatoes, peppers, onions, or salsas may be served with brown rice for the vegetable and bread component at breakfast.

Water:

Water is to be made available with all meals and snacks. Tap or bottled water may used. Facilities may have water fountains in the classroom or dining area. This water source should be encouraged before and after all meals and snacks and takes the place of water served at the table.

Meat and Meat Alternates:

The Meat component is not required for the breakfast meal. IF the facility desires to serve a meat item with the breakfast, that would be allowed. Meats and meat alternates that would be acceptable include eggs, fat free yogurt, low fat cheese, fat free cottage cheese, lean ham, Canadian bacon, and peanut butter.

MEAL PATTERNS FOR CHILDREN IN CHILDCARE FACILITIES: LUNCH/SUPPER/DINNER

LUNCH/SUPPER/DINNER AGES 1 YR – 2 YR AGES 3 YR - 5 YR AGES 6 YR - 12 YR Meat/Meat Alternate Cooked Meat, No Bone Cooked Dry Beans/Peas Low Fat Cheese Egg

1 oz. ¼ c. 1 oz. 1 small

1 ½ oz. 3/8 c. 1 ½ oz. 1 medium

2 oz. ½ c. 2 oz. 1 medium

Peanut Butter Fat Free Yogurt/Cottage Cheese 2 Tbsp. 4 oz/1/2 c. 3 Tbsp. 6 oz./3/4 c. 4 Tbsp. 8 oz./1 c. Fruit or Vegetable: Must include 2 different foods- 1 vegetable/1 fruit OR 2 vegetable OR 2 fruit ¼ c. total 1/8 c. of 2 foods ½ c. total ¼ c. of 2 foods 3/4 c. total 3/8 c. of 2 foods Grains/Breads Enriched, Whole Grain Bread OR Enriched Dry Cereal OR Enriched Hot Cereal OR Enriched, Whole Grain Pasta, Noodles, Rice

½ slice

¼ c. OR 1/3oz. ¼ c.

¼ c.

½ slice

1/3 c. OR ½ oz. 1/3 c.

1/3 c.

½ slice

¾ c. OR 1oz. ½ c.

½ c. Milk (Must be fluid, skim/fat free) ½ c. ¾ c. 1 c. Water ½ c. ¾ c. 1 c.

Meat and Meat Alternates:

It is recommended to have at least one meatless meal a week. An alternate for meat could be cooked, dried beans, or peas. Cooked dried beans and peas cannot count for a vegetable and meat alternate in the same meal. Canned beans and peas will include the canned kidney, black bean, garbanzo, etc. Note: Canned beans are much higher in sodium/salt.

Edible portion for meats and meat alternates is used. Bone and skin shall not be counted as servings. No bones may be served. Note: 1 ounce of cooked meat is equal to one medium cooked chicken leg wtih bone removed.

Processed, pre-fried meats are not allowed due to the sodium/salt and fat content. Meats not allowed include hot dogs, bologna, bacon, sausage, pancake sticks, small chicken nuggets, fish sticks, and steak fingers.

Processed cheese, such as cheese spread, canned cheese sauce, and cheese in packaged snack crackers is not allowed. Low fat or fat free cheese would be a meat alternate that is allowed.

For menu variety, use meat, and low fat cheese in combination to equal a full serving portion.

It is not recommended serving nuts and seeds due to nut/seed allergies prevalent in the youth today.

Bread and Bread Alternates:

Use enriched whole-grain breads and bread alternatives. Whole grain pasta, noodles, brown rice, wheat rolls, and cornbread are encouraged for the lunch/supper/dinner meals.

Bread alternates may include crust used as part of the main dish (i.e. pizza or quiche), Dry oatmeal used in a fruit crisp.

Pre-fried items, such as hash browns, French fries, and tater tots are not recommended due to the fat and sodium content Any pre-fried item served is limited to once a week.

Cookies, pastries, packaged snack cakes, and other high fat/sugar foods cannot be counted for any bread serving at the lunch/supper/dinner meal.

Fruits and Vegetables:

Must serve a Vitamin C source daily and must serve a Vitamin A source every other day, three times a week – refer to the guidelines. Fruits and vegetables supply these nutrients. More than once vitamin source a day is also encouraged.

Use a different combination of two or more servings for the meal service. Use fresh, canned, dried, or frozen vegetables and fruits for lunch/supper/dinner. No sugar may be used in the packaging or preparation of the fruit. Canned or frozen fruit should be packed in juice or water - not syrup or sugar packed.

Vegetables and fruits may be served as combination dishes (i.e., beef stew with meat, potatoes, carrots, English peas, OR shredded carrot salad with diced pineapple).

Avoid serving two forms of the same fruit or vegetable in the same day. Example: an orange and orange juice or an apple and applesauce are combinations that should not be used. Serve a variety of vegetables and fruits to ensure a nutritionally well-balanced meal.

It is highly recommended to either serve at least one raw vegetable and two raw fruits per week, for a meal or snack

Limit serving starchy vegetables to once per meal. Starchy vegetables include white/sweet potatoes, lima beans, butter beans, English peas, black-eye peas, field peas, Crowder peas, cream and whole kernel corn, any dried bean/pea (unless counted for a meat alternate).

Vegetables shall be seasoned with powders, spices, and herbs. The use of high sodium/salt and high fat seasonings should be restricted as much as possible.

Small amounts (less than 1/8 cup) of lettuce, tomatoes, onions, relish, catsup, salsa, jams, jellies, or other condiments may be added for flavor or garnish as "other foods," but do not count as a fruit or vegetable.

Milk:

Milk shall be served at Lunch/Supper/Dinner. The milk shall be pasteurized fluid milk, fortified with vitamin A and D. Whole milk is served to infants and toddlers less than 2 years of age. After age two, skim/fat free milk shall be served. Flavored milk may be served no more than once a week, using flavoring added to whole/skim/fat free milk.

Soymilk may be served when indicated with dietary restrictions.

Provisions must be made to serve calcium in alternate forms when no milk/substitute may be served to the child due to dietary restrictions.

If a child cannot be served milk for medical reasons or upon parent’s instructions, then that child is not to be served high content milk products, e.g., pudding, ice cream, etc.

All milk equivalent used as a meat alternate must be low in fat.

Water:

Water is to be made available at all meals and snacks. Tap or bottled water may used. Facilities may have water fountains in the classroom or dining area. This water source should be encouraged before and after all meals and snacks and takes the place of water served at the table.

MEAL PATTERNS FOR CHILDREN IN CHILDCARE FACILITIES: SNACK

SNACK – MUST SELECT TWO OF THE FOUR COMPONENTS, PLUS WATER AGES 1YR- 2YR AGES 3 YR-5 YR AGES 6 YR–12 YR Meat/Meat Alternate Cooked Meat, No Bone Cooked Dry Beans/Peas Low Fat Cheese Egg Peanut Butter Fat Free Yogurt/Cottage Cheese

1/2 oz. 1/8 c. 1/2 oz. 1 small 1 Tbsp. 2 oz/1/4 c.

½ OZ. 1/8 c. 1/2 oz. 1 medium 1 Tbsp. 2 oz./1/4 c.

1 oz. 1/4 c. 1 oz. 1 medium 2 Tbsp. 4 oz./1/2 c. Fruit or Vegetable 1/2 c.

½ c.

3/4 c.

Grains/Breads Enriched, Whole Grain Bread OR Enriched Dry Cereal OR Enriched Hot Cereal OR

½ slice

¼ c. OR 1/3oz. ¼ c.

¼ c.

½ slice

1/3 c. OR ½ oz. 1/3 c.

1/3 c.

½ slice

¾ c. OR 1oz. ½ c.

½ c.

Enriched, Whole Grain Pasta, Noodles, Rice Milk (Must be fluid, skim/fat free) ½ c. 1/2 c. 1 c. Water ½ c. 1 c. 1 c.

Meat and Meat Alternates:

It is recommended to have at least one meatless meal a week. An alternate for meat could be cooked, dried beans or peas. Cooked dried beans and peas cannot count for a vegetable and meat alternate in the same meal. Canned beans and peas will include the canned kidney, black bean, garbanzo, etc. Note: Canned beans are much higher in sodium/salt.

Edible portion for meats and meat alternates is used. Bone and skin shall not be counted as servings. No bones may be served. Note: 1 ounce of cooked meat is equal to one medium cooked chicken leg with bone removed.

Processed, pre-fried meats are not allowed due to the sodium/salt and fat content. Meats not allowed include hot dogs, bologna, bacon, sausage, pancake sticks, small chicken nuggets, fish sticks, and steak fingers.

Processed cheese, such as cheese spread, canned cheese sauce, and cheese in packaged snack crackers is not allowed. Low fat or fat free cheese would be a meat alternate that is allowed.

For menu variety, use meat, and low fat cheese in combination to equal a full serving portion.

Nuts or seeds may be used as a meat alternate for snack time, but is not recommended due to nut/seed allergies prevalent in the youth today.

Bread and Bread Alternates:

Use enriched whole-grain breads and bread alternatives. Whole grain pasta, noodles, brown rice, wheat rolls, and cornbread are encouraged for the lunch/supper/dinner meals.

Bread alternates may include crust used as part of the main dish (i.e. pizza or quiche), dry oatmeal used in a fruit crisp.

Pre-fried items, such as hash browns, French fries, tater tots are not recommended due to the fat and sodium content Any pre-fried item served is limited to once a week. Fresh, “homemade” oven baked fries or wedges would be allowed.

Plain, low sugar type cookies may be served occasionally for a snack component. These cookies may include animal crackers, graham crackers, vanilla wafers, oatmeal, oatmeal raisin, peanut butter, and ginger snaps. Items that may not be served include chocolate chip, most packaged cookies/cakes.

Low fat granola bars, cereal bars, whole grain fruit bars, rice krispie treats may be used for a snack bread component. Packaged crackers with cheese/peanut butter filling are discouraged due to the fat/sodium content. The cheese/peanut butter filling cannot count as a meat serving.

Baked chips, chips, popcorn, hard pretzels, and other low-moisture, high sodium foods cannot meet the bread requirement for a snack. Crackers, cheese and vegetable flavored crackers are allowed. Trail mixes made of various dry, no sugar coated cereals, dried fruits, and small marshmallows are a suggested snack item to meet a bread component.

Fruits and Vegetables:

Use fresh, canned, dried, or frozen vegetables and fruits for snack. No sugar may be used in the packaging or preparation of the fruit. Canned or frozen fruit should be packed in juice or water- not syrup or sugar packed.

Vegetables and fruits may be served as combination dishes (i.e., shredded carrot salad with diced pineapple, fat free yogurt parfait with fresh fruit).

Avoid serving two forms of the same fruit or vegetable in the same day. Example: an orange and orange juice or an apple and applesauce are combinations that should not be used. Serve a variety of vegetables and fruits to ensure a nutritionally well-balanced meal.

It is highly recommended to either serve at least one raw vegetable and two raw fruits per week, for a meal or snack. Younger children may have an appropriate substitution due to the choking hazard or the item may be cooked first.

Small amounts (less than 1/8 cup) of lettuce, tomatoes, onions, relish, catsup, salsa, jams, jellies, or other condiments may be added for flavor or garnish as "other foods," but do not count as a fruit or vegetable.

Juice should not be served as part of the snack when milk is the only other component. It is poor menu planning to offer such a combination since it provides too much liquid for children.

100% Fruit juice is allowed once a day. Vitamin fortified fruit juices, such as apple juice, with extra Vitamin C, will not be recognized as a good vitamin source.

The best time to serve this juice would be at the late 4:30/5:30 p.m., snack period.

Milk:

The milk shall be pasteurized fluid milk, fortified with vitamin A and D. Whole milk is served to infants and toddlers less than 2 years or age. After age two, skim/fat free milk shall be served.

Flavored milk may be served no more than once a week, using flavoring added to whole/skim/fat free milk.

Soymilk may be served when indicated with dietary restrictions.

Provisions must be made to serve calcium in alternate forms when no milk/substitute may be served to the child due to dietary restrictions.

If a child cannot be served milk for medical reasons or upon parent’s instructions, then that child is not to be served high content milk products, e.g., pudding, ice cream, etc.

All milk equivalents used as a meat alternate must be low in fat.

Water:

Water is to be made available with all meals and snacks. Tap or bottled water may used. Facilities may have water fountains in the classroom or dining area. This water source should be encouraged before and after all meals and snacks and takes the place of water served at the table.

VITAMIN C SOURCES VITAMIN C SOURCE MUST BE SERVED DAILY **BEST CHOICE *GOOD CHOICE #ACCEPTABLE CHOICE (ONLY COUNT FOR A VITAMIN SOURCE ONCE PER WEEK) Fruits Vegetables Food Serving Size Food Serving Size Blackberries ¼ c. # Asparagus ¼ c. * Blueberries ¼ c. # Artichoke ¼ medium * Cantaloupe ¼ c ** Bok Choy ¼ c. * Grapefruit ¼ medium ** Broccoli ¼ c. ** Grapefruit Juice ½ c ** Brussel Sprouts ¼ c. ** Grapefruit-Orange Juice ½ c. ** Cabbage ¼ c. * Guava ¼ c. ** Cauliflower ¼ c. * Honeydew Melon ½ c. * Chicory ¼ c. * Kiwi ½ medium ** Collard Greens ¼ c. * Mandarin Orange Sections ¼ c. * Kale ¼ c. # Mango ¼ medium * Kohlrabi ¼ c. ** Melon balls ¼ c. * Orange ½ medium ** Mustard Greens ¼ c. #

Orange Juice ¼ c. ** Okra, not fried ¼ c. # Papaya ¼ c. * Peppers, green & red ¼ c. ** Peach, frozen only ¼ c. ** Potato, White, or Red Skinned Baked only-no instant/fries/tots ½ medium * Pineapple ¼ c. # Rutabagas ¼c. # Pineapple Juice ¼ c. * Snow Peas ¼ c. # Pineapple- grapefruit or orange juice ¼c. ** Spinach ¼ c. # Raspberries ¼ c. * Sweet Potato ½ medium * Starfruit ¼ c. # Tomato ½ medium * Strawberries ¼ c. ** Tomato or V-8 Juice ¼ c. ** Tangelo ½ medium ** Turnip Greens ¼ c. * Tangerine ½ medium ** Miscellaneous Tropical fruit mix ¼ c. * Watermelon ½ c. # Liver, beef 1 oz. **

VITAMIN A SOURCES VITAMIN A SOURCE MUST BE SERVED EVERY OTHER DAY, 3 TIMES PER WEEK ** BEST CHOICE * GOOD CHOICE #ACCEPTABLE CHOICE (ONLY COUNT FOR A VITAMIN SOURCE ONCE PER WEEK) Fruits Vegetables Food Serving Size Food Serving Size

Avocado ¼ medium # Asparagus ¼ c. # Apricot 2 halves * Artichoke ½ medium # Cantaloupe ¼ c. * Bok Choy ¼ c. * Cherries, red sour ¼ c. * Broccoli ¼ c. * Mandarin Orange Segments ¼ c. * Brussels Sprouts ¼ c. * Mango ¼ medium ** Carrots ¼ c. ** Melon Balls ¼ c. * Collard Greens ¼ c. ** Nectarine ¼ medium # Papaya ¼ c. * Kale ¼ c. ** Peaches ¼ c. # Lettuce, Green, Romaine, or Red NOT Iceberg (Iceberg is not high in vitamins) ½ c. #

Plantain ¼ c. # Mixed Vegetables ¼ c. ** Prunes ¼ c. * Mustard Greens ¼ c. ** Tangerine ½ medium * Okra, not fried ¼ c. # Peas & Carrots ¼ c. ** Peppers, red ¼ c. ** Miscellaneous Pumpkin ¼ c. ** Egg 1 medium * Rutabagas ¼ c. # Liver, beef 1 oz. ** Spinach ¼ c. ** Liver, chicken 1 oz. ** Sweet Potato ½ medium ** Tomato or V-8 Juice ¼ c. ** Turnip Greens ¼ c. ** Winter Squash, Butternut or Hubbard ¼ c. **

DENTAL CARE

Dental care is encouraged after each meal service. Parents shall supply toothbrushes and tooth powders or pastes for the child's individual use. Recommendations include replacing the brush every three months or when bristles are bent.

Each toothbrush and powder or paste must be: • Labeled with the child's full name • Stored out of children's reach when not in use • Stored in a manner that prevents the toothbrushes from touching each other during storage

Staff is encouraged to attend trainings on dental care that includes: • Proper tooth brushing technique as appropriate for the child’s age and skills. • Education to train parents about proper oral healthcare techniques. • Education for staff and parents to learn the appropriate techniques to feed infants and children that minimize damage to teeth and facial development.

Children must have adult supervision during tooth brushing activities.

GARDENING AND FRESH PRODUCE

Gardening is an excellent opportunity to incorporate physical activity with nutrition education. Facilities are encouraged to have gardening projects with the children. Produce that is grown in the gardens may be washed and handled properly to allow the items to be served for a snack time or education activity.

Purchasing local produce from Mississippi farmers is one way to offer fresh items to the children. This also helps the local economy and raising families’ awareness of food sources. The child care center must ensure the safety of foods served. Steps must be taken to demonstrate reasonable care has been taken to ensure the safety of foods purchased. Steps include: Investigating the local farm and production practices, communicating with the local farmer on the needs of the facility including packaging, delivery, and payment procedures, and promoting the use of local produce with families and the community. There are several resources available to use as a safety checklist, such as the Iowa State University Checklist for Retail Purchasing of Local Produce. The checklist is on the www.Healthyms.com website under Nutrition and Farm to School and Preschool.

REFERENCES

Dietary Guidelines for Americans, 2005. http://www.health.gov/dietaryguidelines/dga2005/document/

United States Department of Agriculture; Food and Nutrition Service; Child and Adult Care Food Program: Nutrition Guidance for Child Care Centers. http://www.fns.usda.gov/cnd/care/ProgramBasics/Meals/Meal_Patterns.

Dietary Reference Intakes, (DRIs), Food and Nutrition board, Institute of Medicine, National Academies

USDA National Nutrient Database for Standard Reference, Release 18.

Promoting good Nutrition and Physical Activity in Child-Care Settings, A Research Brief, May 2007, Robert Wood Johnson Foundation.

Position of the American Dietetic Association: Benchmarks for Nutrition Programs in Child Care Settings, Journal of the American Dietetic Association, June 2005.

Nemours, Health and Prevention Services, Best Practices for Health Eating: A Guide to Help Children Grow Up Healthy, Version 2, 2008

The Wellness Child Care Assessment Tool: A Measure to Assess the Quality of Written Nutrition and Physical Activity Policies, The American Dietetic Associations, December 2011

Institute of Medicine, Child and Adult Care Food Programs: Aligning Dietary Guidance for All, November 4, 2011

APPENDIX D

See Public Playground Safety Handbook. As published by the United States Consumer Product Safety Commission – Saving Lives and Keeping Families Safe.

This document is located at http://www.cpsc.gov/ . This document is available only in .pdf format. To read and print a PDF file, you must have Adobe® Acrobat® Reader installed on your PC. You can download a version suitable for your system, free of charge, from Adobe (http://www.adobe.com/).

APPENDIX E

DISHWASHING PROCEDURE

The best way to wash, rinse, and disinfect dishes and eating utensils is to use a dishwasher with a sanitizing cycle. The final sanitizing rinse of a dishwasher must reach a temperature of 180 degrees. If a dishwasher is not available or cannot be installed, a three-compartment sink will be needed to wash, rinse, and disinfect dishes. A two-compartment or one-compartment sink can be used in child care facilities (located in an occupied residence) licensed for 12 or fewer children by adding one or two dishpans, as needed. In addition to three compartments or dishpans, you will need a dish rack with a drain board to allow dishes and utensils to air dry. To wash, rinse, and disinfect dishes by hand: o Fill one sink compartment or dishpan with hot tap water and a dishwashing detergent.

o Fill the second compartment or dishpan with hot tap water.

o Fill the third compartment or dishpan with hot tap water and 1-1/2 tablespoons of liquid chlorine bleach for each gallon of water.

o Scrape dishes and utensils and dispose of excess food.

o Immerse scraped dish or utensil in first sink compartment or dishpan and wash thoroughly.

o Rinse dish or utensil in second dishpan of clear water.

o Immerse dish or utensil in third dishpan of chlorinated water for at least 1 minute.

o Place dish or utensil in a rack to air dry.

Note: Food preparation and dishwashing sinks should only be used for these activities and should never be used for routine hand washing or diaper changing activities.

APPENDIX F

HAND WASHING PROCEDURE

!Always use warm, running water and a mild, preferably liquid, soap. Antibacterial soaps may be used, but are not required. Pre-moistened cleansing toweletts do not effectively clean hands and do not take the place of hand washing.

!Wet the hands and apply a small amount (dime to quarter size) of liquid soap to hands.

!Rub hands together vigorously until a soapy lather appears and continue for at least 15 seconds. Be sure to scrub between fingers, under fingernails, and around the tips and palms of the hands.

!Rinse hands under warm running water. Leave the water running while drying hands.

!Dry hands with a clean, disposable (or single use) towel, being careful to avoid touch the faucet handles or towel holder with clean hands.

!Turn the faucet off using the towel as a barrier between your hands and the faucet handle.

!Discard the used towel in a trash can lined with a fluid-resistant (plastic) bag. Trash cans with foot-petal operated lids are preferable.

!Consider using hand lotion to prevent chapping of hands. If using lotions, use liquids or tubes that can be squirted so that the hands do not have direct contact with container spout. Direct contact with the spout could contaminate the lotion inside the container.

!When assisting a child in hand washing, either hold the child (if an infant) or have the child stand on a safety step at a height at which the child’s hands can hang freely under the running water. Assist the child in performing all of the above steps and then wash your own hands.

APPENDIX G

PROCEDURE FOR DIAPERING A CHILD

Either of the following two procedures is acceptable in a child care facility for licensing purposes.

Procedure #1 1. Organize needed supplies within reach: a. fresh diaper and clean clothes (if necessary) b. dampened paper towels or premoistened toweletts for Cleaning child’s bottom c. child’s personal, labeled, ointment (if provided by parents) d. trash disposal bag 2. Place a disposable covering (such as roll paper) on the portion of the diapering table where you will place the child’s bottom. Diapering surfaces should be smooth, nonabsorbent, and easy to clean. Don’t use areas that come in close contact with children during play such as couches, floor areas where children play, etc. 3. If using gloves, put them on now. 4. Using only your hands, pick up and hold the child away from your body. Don’t cradle the child in your arms and risk soiling your cloths. 5. Lay the child on the paper or towel. 6. Remove soiled diaper (and soiled clothes). 7. Put disposable diapers in a plastic-lined trash receptacle. 8. Put soiled reusable diaper and /or soiled clothes WITHOUT RINSING in a plastic bag to give to parents. 9. Clean child’s bottom with some premoistened disposable toweletts or a dampened, single-use, disposable towel. 10. Place the soiled toweletts or towel in a plastic-lined trash receptacle. 11. If the child needs a more thorough washing, use soap, running water, and paper towels. 12. Remove the disposable covering from beneath the child. Discard it in a plastic-lined receptacle. 13. If you are wearing gloves, remove and dispose of them now in a plastic-lined receptacle.

14. Wash your hands. NOTE: The diapering table should be next to a sink with running water so that you can wash your hands without leaving the diapered child unattended. However, if a sink is not within reach of the diapering table, don’t leave the child unattended on the diapering table to go to a sink; wipe your hands with some premoistened toweletts instead. NEVER leave a child alone on the diapering table. 15. Wash the child’s hands under running water. 16. Diaper and dress the child. 17. Disinfect the diapering surface immediately after you finish diapering the child. 18. Return the child to the activity area. 19. Clean and disinfect: a. The diapering area, b. all equipment or supplies that were touched, and c. soiled crib or cot, if needed. 20. Wash your hands under running water.

Procedure #2

1. Caregiver washes hands

2. Prepare for diapering by gathering wipes, diaper, plastic bag, clean clothes, gloves and other supplies needed. Bring materials to the diaper changing area but not on the changing table

3. Place child on diapering table. Remove clothing to access diaper. If soiled, place clothes into plastic bag.

4. Remove soiled diaper and place into plastic-lined, hands-free covered trash container. (To limit odor, seal in a plastic bag before placing into trash containers.)

5. Use wipes to clean child’s bottom from front to back. Use a fresh wipe for each swipe.

6. If gloves were used, remove at this point.

7. Use a wipe to remove soil from adult’s hands.

8. Use another wipe to remove soil from child’s hands.

9. Throw soiled wipes into plastic-lined, hands-free covered trash container.

10. Put on clean diaper and redress child.

11. Place child at sink and wash hands using the proper hand washing procedure. Return child to a supervised play area without contaminating any surface

12. Spray the surface of the diapering table with soap-water solution to remove gross soil. Wipe clean using a disposable towel and throw away in a plastic-lined, hands-free covered trash container. Be sure the surface is dried completely.

13. Spray the surface of the diapering table with clear water (recommended). Wipe dry using a disposable towel and throw away in a plastic-lined, hands-free covered trash container.

14. Spray the diapering surface with disinfecting strength bleach-water solution (completely cover table; table should glisten) and wait for 2 minutes before wiping dry with a disposable towel or allow to air dry. Dispose of the towel in a plastic-lined, hands-free covered trash container.

15. Adult washes hands using the proper hand washing procedure.

Guidelines for Early Care and Education Programs, 3 rd Edition, American Academy of Pediatrics, American Public Health Association, National Resource Center for Health and Safety in Child Care and Early Education, 2011.

APPENDIX H

CLEANING AND DISINFECTION PROCEDURES

Keeping the child care environment clean and orderly is very important for health, safety, and the emotional well-being of both children and providers. One of the most important steps in reducing the number of germs, and therefore the spread of disease, is the thorough cleaning of surfaces that could possibly pose a risk to children or staff. Surfaces considered most likely to be contaminated are those with which children are most likely to have close contact. These include toys that children put in their mouths, crib rails, food preparation areas, and surfaces likely to become very contaminated with germs, such as diaper-changing areas.

Routine cleaning with soap and water is the most useful method for removing germs from surfaces in the child care setting. Good mechanical cleaning (scrubbing with soap and water) physically reduces the numbers of germs from the surface, just as hand washing reduces the numbers of germs from the hands. Removing germs in the child care setting is especially important for soiled surfaces which cannot be treated with chemical disinfectants, such as some upholstery fabrics.

However, some items and surfaces should receive an additional step, disinfection, to kill germs after cleaning with soap and rinsing with clear water. Items that can be washed in a dishwasher or hot cycle of a washing machine do not have to be disinfected because these machines use water that is hot enough for a long enough period of time to kill most germs. The disinfection process uses chemicals that are stronger than soap and water. Disinfection also usually requires soaking or drenching the item for several minutes to give the chemical time to kill the remaining germs. Commercial products that meet the Environmental Protection Agency’s (EPA’s standards for “hospital grade” germicides (solutions that kill germs) may be used for this purpose. One of the most commonly used chemicals for disinfection in child care settings is a homemade solution of household bleach and water. Bleach is cheap and easy to get. The solution of bleach and water is easy to mix, is nontoxic, is safe if handled properly, and kill most infectious agents. (Be aware that some infectious agents are not killed by bleach. For example, cryptosporidia is only killed ammonia or hydrogen peroxide.)

A solution of bleach and water loses its strength very quickly and easily. It is weakened by organic material, evaporation, heat, and sunlight. Therefore, bleach solutions should be mixed fresh each day to make sure it is effective. Any leftover solution should be discarded and the end of the day. NEVER mix bleach with anything but fresh tap water! Other chemicals may react with bleach and create and release a toxic chlorine gas.

Keep the bleach solution you mix each day in a cool place out of direct sunlight and out of the reach of children. (Although a solution of bleach and water mixed as shown in the accompanying box should not be harmful if accidentally swallowed, you should keep all chemicals away from children.)

If a child care facility uses a commercial cleaner, sanitizer, or disinfectant it must be a U.S. Environmental Protection Agency (EPA)-registered product that has an EPA registration number on the label. Such products shall only be used according to the manufacturer’s instructions.

NOTE: All EPA-registered products may not be appropriate for use in a child care facility. Therefore, it is the responsibility of the facility to make sure any product use is appropriate for use in a child care facility.

Recipe for Bleach Disinfecting Solution (For use on non-porous surfaces such as diaper change tables, counter tops, door and cabinet handles toilets, etc.)

¼ - ¾ cup bleach 1 gallon of cool water

OR

1 - 3 tablespoon bleach 1 quart of cool water

Apply as a spray or poured fresh solution, not by dipping into a container with a cloth that has been in contact with a contaminated surface.

Add the household bleach (5.25% sodium hypochlorite) to the water.

Recipe for Weaker Bleach Sanitizing Solution For food contact surfaces sanitizing (dishes, utensils, cutting boards high chare trays), toys that children may place in their mouths, and pacifiers.

1 tablespoon bleach 1 gallon cool water

Add the bleach to the water

Washing and Disinfecting Toys

! Infants and toddlers should not share toys. Toys that children (particularly infants and toddlers) put in their mouths should be washed and disinfected between uses by individual children. Toys for infants and toddlers should be chosen with this in mind. If you cannot wash a toy, it probably is not appropriate for an infant or toddler.

! When an infant or toddler finishes playing with a toy, you should retrieve it form the play area and put it in a bin reserved for dirty toys. This bin should be out of reach of the children. Toys can be washed at a later, more convenient time, and then transferred to a bin for clean toys and safely reused by the other children.

! To wash and disinfect a hard plastic toy: • Scrub the toy in warm, soapy water. Use a brush to reach into the crevices. • Rinse the toy in clean water. • Immerse the toy in a mild bleach solution (see above) and allow it to soak in the solution for 10-20 minutes. • Remove the toy from the bleach and rinse well in cool water. • Air dry.

! Hard plastic toys that are washed in a dishwasher or cloth toys washed in the hot water cycle of the hot water cycle of a washing machine do not need to be additionally disinfected.

! Children in diapers should only have washable toys. Each group of children should have its own toys. Toys should not be shared with other groups.

! Stuffed toys used by only a single child should be cleaned in a washing machine every week or more frequently if heavily soiled.

! Toys and equipment used by older children and not put into their mouths should be cleaned at least weekly and when obviously soiled. A soap and water wash followed by clear water rinsing and air drying should be adequate. No disinfection is required. (These types of toys and equipment include blocks, dolls, tricycles, trucks, and other similar toys.).

! Do not use wading pools for children in diapers.

! Water play tables can spread germs. To prevent this: • Disinfect the table with chlorine bleach solution before filling it with water. • Disinfect the all toys to be used in the table with chlorine bleach solution. Avoid using sponge toys. They can trap bacteria and are difficult to clean. • Have all children wash their hands before and after playing in the water table. • Do not allow children with open sores or wounds to play in the water table. • Carefully supervise the children to make sure they do not drink the water. • Discard water after play is over

Washing and Disinfecting Bathroom and Other Surfaces

Bathroom surfaces, such as faucet handles and toilet seats, should be washed and disinfected several times a day, if possible, but at least once a day or when soiled. The bleach and water solution or chlorine-containing scouring powers or other commercial bathroom surface

cleaner/disinfectants can be used in these areas. Surfaces that infants and young toddlers are likely to touch or mouth, such as crib rails, should be washed with soap and water and disinfected with a nontoxic disinfectant, such as bleach solution, at least once every day, more often if visibly soiled. After the surface has been drenched or soaked with the disinfectant for at least 10 minutes, surfaces likely to be mouthed should be thoroughly wiped with a fresh towel moistened with tap water. Be sure not to use a toxic cleaner on surfaces likely to be mouthed. Floors should be washed and disinfected at least once a day and whenever soiled.

Washing and Disinfecting Diaper Changing Areas

Diaper Changing Areas should: • Only be used for changing diapers. • Be smooth and nonporous, such as Formica (NOT wood). • Have a raised edge or low fence around the area to prevent a child from falling off. • Be next to a sink with hot and cold running water. • Not be used to prepare food, mix formula, or rinse pacifiers. • Be easily accessible to providers. • Be out of reach of children.

Diaper changing areas should be cleaned and disinfected after each diaper changer as follows: • Clean the surface with soap and water and rinse with clear water. • Dry the surface with a paper towel. • Thoroughly wet the surface with the recommended bleach solution. • Wipe dry with a clean disposable towel or air dry. If using a commercial disinfectant/sanitizer, follow labeled manufacturer’s instructions.

Washing and Disinfecting Clothing, Linen, and Furnishings

Do not wash or rinse clothing soiled with fecal material in the child care setting. You may empty solid stool into the toilet, but be careful not to splash or touch toilet water with your hands. Put the soiled clothes in a plastic bag and seal the bag to await pick up by the child’s parent or guardian at the end of the day. Always wash your hands after handling soiled clothing.

Explain to parents that washing or rinsing soiled diapers and clothing increases the chances that you and the children may be exposed to germs that cause diseases. Although receiving soiled clothes is not pleasant, remind parents that this policy protects the health of all children and providers. Each item of sleep equipment, including cribs, cots, mattresses, blankets, sheets, etc., should be cleaned and sanitized before being assigned to a specific child. The bedding items should be labeled with that child’s name, and should only be used by that child. Children shall not share bedding. Infants linens (sheets, pillowcases, blankets) shall be cleaned and sanitized daily, and crib mattresses shall be cleaned and sanitized weekly and when soiled or wet. Linens from beds of older children shall be laundered at least weekly and whenever soiled. However, if a child inadvertently used another child’s bedding, you shall change the linen and mattress cover

before allowing the assigned child to use it again. All blankets shall be changed and laundered routinely at least once a week.

Cleaning up Body Fluid Spills

Spills of body fluids, including blood, feces, nasal and eyed discharges, saliva, urine, and vomit shall be cleaned up immediately. Wear gloves unless the fluid can be easily contained by the material (e.g., paper tissue or cloth) that is being used to clean it up. Be careful not to get any of the fluid you are cleaning in your eyes, nose, mouth or any open sores you may have. Clean and disinfect any surfaces, such as counter tops and floors, on which body fluids have been spilled. Discard fluid-contaminated material in a plastic bag that has been securely sealed. Mops used to clean up body fluids should be (1) cleaned, (2) rinsed with a disinfecting solution, (3) wrung as dry as possible, and (4) hung to dry completely. Be sure to wash your hands after cleaning up any spill.

APPENDIX I

TABLE OF CONTENTS

INTRODUCTION ..........................................................................................................................3

GENERAL INFORMATION .........................................................................................................4

IMMUNIZATION REQUIREMENTS ..........................................................................................5

EXCLUSION CRITERIA ..............................................................................................................7

CHICKENPOX (VARICELLA) & SHINGLES (VARICELLA ZOSTER) ..................................8

CYTOMEGALOVIRUS (CMV) ....................................................................................................9

DIARRHEAL DISEASES ..............................................................................................................9

E. COLI O157:H7 .........................................................................................................................10

FIFTH DISEASE ..........................................................................................................................10

“FLU” (INFLUENZA) .................................................................................................................11

HAND-FOOT-AND-MOUTH DISEASE ....................................................................................11

HEAD LICE...................................................................................................................................12

HEPATITIS A ..............................................................................................................................12

HEPATITIS B ...............................................................................................................................13

HEPATITIS C ...............................................................................................................................13

HIV/AIDS .....................................................................................................................................13

IMPETIGO ...................................................................................................................................14

MEASLES ....................................................................................................................................14

MENINGITIS ...............................................................................................................................15

MUMPS ........................................................................................................................................15

“PINK EYE” (CONJUNCTIVITIS) .............................................................................................16 PINWORMS .................................................................................................................................16

RESPIRATORY SYNCYTIAL VIRUS (RSV) ...........................................................................16

RINGWORM ................................................................................................................................17

SCABIES ......................................................................................................................................17

“STREP THROAT” (STREPTOCOCCAL PHARYNGITIS) & SCARLET FEVER. .......................................................................................................18

TUBERCULOSIS (TB) ................................................................................................................18

WHOOPING COUGH (PERTUSSIS) .........................................................................................18

EXAMPLE PERMISSION SLIP TO COLLECT STOOL SPECIMENS AND RECEIVE TEST RESULTS FOR OUTBREAKS OF DIARRHEAL DISEASES .....................20

ATTACHMENT A “RECOMMENDATIONS FOR THE CONTROL OF HEAD LICE IN THE CHILD CARE SETTING”

INTRODUCTION

COMMUNICABLE DISEASES/CONDITIONS AND RETURN TO CHILD CARE

Childcare providers frequently must make decisions regarding when children with communicable diseases/conditions should be allowed to attend or return to the out-of-home child care setting (a large child care center or where child care is provided in a private residence for more than one child). We hope the information provided in this booklet will help with these decisions. It contains information about the most common or important communicable diseases/conditions and how they are spread. Information is listed about the different times during which infectious agents may be transmitted from one person to another, and when it is usually safe for someone who has one of these conditions to return to the center. The “return to child care times” are based on the usual period of time that a person is considered to be contagious — not on the period of time that may be necessary for full clinical recovery from the signs or symptoms of an illness which may vary a great deal from person to person.

While this booklet will serve as a guide for child care attendance of children with communicable conditions, the Mississippi State Department of Health (MSDH) welcomes the opportunity to help with your decisions. You may contact your district health department office (see district map on page18) or the Division of Epidemiology at the MSDH in Jackson to speak with a consultant.

****

*** THIS booklet is NOT intended to be used to DIAGNOSE an illness or infection. It SHOULD NOT REPLACE a diagnosis by trained MEDICAL personnel.***

GENERAL INFORMATION

Small children who are cared for in out-of-home group settings are at a greater risk of acquiring and spreading a contagious disease. Small children are highly susceptible to contagious diseases since most of them have not been exposed to many of the most common germs and therefore do not have any immunity to them. Young children also have certain habits (e.g., putting their fingers and other objects in their mouths) that can easily spread germs. Even though contagious diseases/conditions will occur in a child care setting, the child care provider must do everything he or she can to prevent and control the spread of disease. The use of common sense hygienic practices, especially frequent and thorough hand washing cannot be stressed enough! Also, making sure that staff and children are up to date on their immunizations helps to lessen the risk of exposure to contagious diseases.

Reportable diseases: There are 4 classes of reportable diseases. Class I diseases are those of major public health importance and are to be reported upon first knowledge or suspicion and are usually reported by the physician, hospital or laboratory. However, the MSDH encourages child care providers who know of a child in their facility who has been diagnosed with a disease such as meningitis or measles to report it to the Health Department. This can sometimes help to expedite the investigation. Class II diseases may require public health intervention also, especially if there are several cases in one room (e.g., diarrheal diseases such as shigella and giardia).

When a Class I reportable disease is reported to the MSDH, there will be an investigation. The immediacy of the response by the MSDH and the extent of the investigation depends on the disease the person has. For example, if a child has been reported to have meningococcal meningitis, an investigation would take place as soon as the report is received. It is the goal of the MSDH to provide preventive medication to those for whom it would be indicated within 24 hours of receiving the report. A current list of the reportable diseases is provided in Appendix B of the Child Care Rules and Regulations.

Outbreaks/parental permission for laboratory tests: During times when there are outbreaks of Giardia, Shigella infection, etc., large numbers of stool specimens may be requested by the MSDH. The MSDH recommends that child care facilities obtain permission from parents or guardians at the time of enrollment for the child care facility to collect these stool specimens and receive the laboratory results if and when such an outbreak occurs. These laboratory tests would be done by the MSDH Laboratory free of charge. The laboratory test results would be sent to the child care facility and given to the parents/guardians by the child care facility for them to give to the child’s physician. (See sample permission slip on page 17)

Handouts: It is good practice to keep parents informed as to what diseases might be occurring in the child care facility so that they can be alert to signs and symptoms of diseases and observe their children for them. We have provided a packet with fact sheets/handouts on certain diseases for you to give to parents.

CHILD CARE IMMUNIZATION REQUIREMENTS (FOR ATTENDEES AND STAFF)

ATTENDEES

The MSDH regulations governing the licensure of child care facilities mandate that each child in a licensed facility have immunizations according to the recommended immunization schedule. These children are to be age-appropriately immunized and must have a Certificate of Immunization Compliance (Form 121) or a Certificate of Medical Exemption (Form 122) on file at the child care facility and readily accessible for review by the MSDH. The Form 121 must be signed by the District Health Officer, a physician, nurse or designee. The medical exemption, Form 122, MUST be signed by the District Health Officer. Children enrolled in licensed child care facilities and public and private schools in Mississippi may be exempt for medical reasons only and not for religious reasons.

Children usually begin their routine immunizations between 6 weeks and 2 months of age. The immunizations that are currently required at the age-appropriate times for child care are: DTaP (diphtheria, tetanus, pertussis), polio, MMR (measles, mumps, rubella), and HIB (H. Influenzae type b). Hepatitis B vaccine is a recommended vaccine, and is usually started at birth to 2 months of age. Hepatitis B is not required for child care attendance but is required for entry into 5 year old kindergarten.

As of August 01, 2002, one (1) dose of Varicella (chicken pox) vaccine is required on or after the 1st birthday and is required for entry into five (5) year-old kindergarten. Varicella is not required if a history of the disease is documented.

Children enrolled in a licensed child care facility or Head Start Center are expected to be age appropriately immunized. All children must have one of the following forms before enrollment in a licensed Child Care/Head Start facility.

1. Certificate of Immunization Compliance (Form 121). This form must be signed by the District Health Officer, a physician, nurse or designee.

2. Certificate of Medical Exemption (Form 122). This form must be approved and signed by the Mississippi Department of Health District Health Officer from the public health district or the State Epidemiologist.

STAFF

Anyone (whether full or part-time and even if they are the owner/director) who works in a licensed child care facility must have a Certificate of Immunization Compliance (Form 121) or a Certificate of Medical Exemption from Immunization Requirements for Adults (Form 132) on file and readily accessible for review by the MSDH. The requirement for adults is that they must show proof of immunity to measles (rubeola or “red” measles) and rubella (“German”or “3-day” measles).

Proof of immunity to measles: Persons born prior to 01-01-1957 are assumed to have natural immunity to measles. Persons born on or after 01-01-1957 must show proof of immunity in one of the following ways:

1. A physician’s statement saying that the person has had measles disease. 2. Serological (a blood test) confirmation of measles immunity. 3. A record of 2 doses of measles-containing vaccine (usually given as MMR) given on or after the first birthday and on or after 01-01-1968. There must be a minimum time interval of 30 days between the 2 doses.

Proof of immunity to rubella: All child care workers, regardless of age, must show proof of immunity to rubella in one of the following ways: 1. Serological (blood test) confirmation of rubella immunity. 2. A rubella vaccination received on or after 12 months of age and on or after 01-01-1969.

The MSDH does not provide serological testing for measles and rubella for the purpose of child care/school attendance or private employment. Those who wish to have a blood test for proof of immunity to measles and/or rubella should see their private physician.

The Child Care Licensure Division of the MSDH checks the immunization records in child care facilities during regular program reviews. District Immunization Representatives also visit child care centers on a random basis to inspect the immunization records of the children and the employees. The purpose of these visits is to verify the presence of the Certificates of Immunization Compliance. These visits also help to ensure adequate immunization of children enrolled in child care facilities.

EXCLUSION CRITERIA

Small children can become ill very quickly. The child care provider should observe each child’s health throughout the time the child is in their care. If the child care provider observes signs and symptoms of illness that would require removal from the facility, he/she should contact the parents/guardians to have the child picked up and continue to observe the child for other signs and symptoms. If the child is not responding to you, is having trouble breathing, or is having a seizure or convulsion, call 911.

The following conditions require exclusion from child care:

Fever : Defined as 100°F or higher taken under the arm, 101°F taken orally, or 102°F taken rectally. For children 4 months or younger, the lower rectal temperature of 101°F is considered a fever threshold.

Diarrhea: Frequent (3 or more episodes in a 24-hour period) runny, watery, or bloody stools. According to CDC recommendations, a child who is not toilet trained and has diarrhea should be excluded from child care settings regardless of the cause.

Vomiting: Two or more times in a 24-hour period

Rash: Body rash with a fever

Sore throat: Sore throat with fever and swollen glands

Severe coughing: The child gets red or blue in the face or makes high-pitched whooping sound after coughing.

Eye discharge: Thick mucus or pus draining from the eye

Jaundice: Yellow eyes and skin

Irritability: Continuous irritability and crying

CHICKENPOX (VARICELLA)

Chickenpox is a highly infectious viral disease that begins with small red bumps that turn into blisters after several hours. The blisters generally last for 3-4 days and then begin to dry up and form scabs. These lesions (bumps/blisters) almost always appear first on the trunk rather than the extremities.

Mode of transmission: Airborne droplets of nose and throat secretions coughed into the air by someone who has chickenpox. Also by direct contact with articles freshly soiled with discharge from the blisters and/or discharge from the nose and mouth (e.g., tissues, handkerchiefs, etc.).

Notification: Notify parents/guardians and staff members that a case of chickenpox has occurred, especially those parents whose child is taking steroid medications, being treated with cancer or leukemia drugs or has a weakened immune system for some reason. Staff members who are pregnant and have never had chickenpox disease or the chickenpox vaccine should consult their physician immediately. A special preventive treatment may be indicated for those with a weakened immune system and non-immune pregnant women. This treatment must be given within 96 hours of the exposure to be effective.

Vaccine: As of August 01, 2002, one (1) dose of Varicella (chicken pox) vaccine is required on or after the 1st birthday and is required for entry into five (5) year-old kindergarten. Varicella is not required if a history of the disease is documented.

Return to child care: Once the diagnosis has been made, determine the day that the blisters first appeared. The child may return to child care on the 6 th day after the blisters first appeared or earlier if all the lesions are crusted and dry and no new ones are forming. Keeping the child home until all the lesions are completely healed is unnecessary and results in excessive absences.

SHINGLES (VARICELLA ZOSTER)

Shingles (varicella zoster) is a reactivation of the chickenpox virus (varicella). After the initial infection with chickenpox, the virus continues to lie dormant (inactive) in a nerve root. We tend to think of the elderly and immunosuppressed individuals as the ones who have shingles; however, it can and does occur sometimes in children. The lesions or blisters of shingles resemble those of chickenpox and usually appear in just one area or on one side (unilateral) of the body and run along a nerve pathway. A mild shingles-like illness has been reported in healthy children who have had the chickenpox vaccine. This is a rare occurrence.

Mode of transmission: It is possible for someone who has never had chickenpox disease or the vaccine to get chickenpox by coming in contact with the fluid from the lesions of someone who has shingles. Shingles itself is not transmissible. A person who has shingles does not transmit chickenpox through the air as does someone who has chickenpox disease.

Return to child care: The child who has shingles may attend child care if the lesions can be covered by clothing. If the lesions cannot be covered, the child should be excluded until the lesions are crusted and dry. Staff members who have shingles pose little risk to others since the lesions would be covered by clothing or a dressing on exposed areas. Thorough hand washing is warranted whenever there is contact with the lesions.

NOTE: Staff members, especially those who are pregnant, who have no history of chickenpox disease or chickenpox vaccine, should not take care of children with shingles during the time they have active or fluid-filled lesions.

CYTOMEGALOVIRUS (CMV)

CMV is a viral illness that most people become infected with during childhood. Small children usually have no symptoms when they become infected, but older children may develop an illness similar to mononucleosis with a fever, sore throat, malaise or feeling very tired and an enlarged liver.

Mode of transmission: CMV is spread from person to person by direct contact with body fluids such as urine, saliva or blood. The virus can also be passed from the mother to the baby before birth.

Pregnancy: Rarely, a woman may contract the disease for the first time during pregnancy which may pose a risk to the fetus causing certain birth defects. CDC recommends that women who are

child care providers and who expect to become pregnant should be tested for antibodies to CMV and if the test shows no evidence of previous CMV infection, they should reduce their contact with infected children by working, at least temporarily, with children 2 years of age and older where there is less circulation of the virus. Also, they should avoid kissing an infected child on the lips, and as with any child care situation, wash hands thoroughly after each diaper change and contact with a child’s saliva. If contact with children does not involve exposure to saliva or urine, there should be no fear of potential infection with CMV.

Return to child care: There is no need to exclude children with CMV from child care as long as they do not have a fever since the virus may be excreted in urine and saliva for many months and may persist or there may be recurring episodes for several years following the initial infection. CMV is a virus that may persist as a latent infection and recur when a person becomes immunosuppressed with conditions such as cancer, AIDS, etc.

DIARRHEAL DISEASES (e.g., campylobacteriosis, cryptosporidiosis, giardiasis, rotavirus, salmonellosis, shigellosis) - See E. coli O157:H7 and Hepatitis A sections for specific return-to- child- care recommendations regarding these 2 diseases.

Diarrhea is defined as frequent (3 or more episodes within a 24 hour period), runny, watery stools and can be caused by different types of organisms such as viruses, bacteria and parasites.

Mode of transmission: Diarrheal diseases are generally transmitted or spread by ingesting food or water or by putting something in the mouth such as a toy that has been contaminated with the feces (stool/poop) of an infected person or animal. In some cases such as with Salmonella and E. coli O157:H7, the disease is transmitted by eating raw or undercooked meats (especially ground beef and poultry) and unpasteurized milk and fruit juices.

Notification: Notify parents/guardians of children in the involved room of the illness. Ask that they have any child with diarrhea, severe cramping or vomiting evaluated by a physician and that they inform the day care of diarrheal illness in their child and family.

Outbreak situation: Most diarrheal diseases are reportable to the State Department of Health. When there are 2 or more cases of a diarrheal disease in one room, more extensive notification may need to be done as stool specimens may need to be collected. In this case, the director of the child care should consult with the Public Health District Epidemiology Nurse or the Division of Epidemiology at the State Department of Health. (See Public Health District Map on page 18 for addresses and telephone numbers)

Return to child care: In most cases, a child may return to child care after a diarrheal illness once he or she is free of fever and the diarrhea has ceased.

E.COLI O157:H7

Escherichia (E.) coli bacteria are found in the intestines of most humans and many animals. These infections are usually harmless. However, certain strains of the bacteria such as the O157:H7 can cause severe illness. Some persons who are infected with E. coli O157:H7 may have a mild disease while others develop a severe, bloody diarrhea. In some cases, the infection may cause a breakdown of the red blood cells which can lead to HUS or hemolytic uremic syndrome.

Mode of transmission: E. coli O157:H7 is usually the result of eating undercooked meat, especially hamburger. There have also been cases reported from drinking unpasteurized apple juice. Person-to-person transmission may occur by contact with the feces or stool of an infected person.

Notification: Notify the staff and parents/guardians that a case of E. coli O157:H7 has occurred and ask that they have their child evaluated by a physician if they have diarrhea, especially bloody diarrhea. E. coli O157:H7 is a Class I reportable disease and a follow-up investigation will be done by the Health Department.

Return to child care: The infected child should not be in or allowed to return to a child care center until his/her diarrhea has ceased and 2 consecutive negative stool samples are obtained (collected not less than 24 hours apart and not sooner than 48 hours after the last dose of antibiotics).

FIFTH DISEASE (ERYTHEMA INFECTIOSUM)

This is an infectious disease characterized by a “slapped -face” (redness) appearance of the cheeks followed by a rash on the trunk and extremities.

Mode of transmission: Person-to-person spread by direct contact with nose and throat secretions of an infected person. Transmission of infection can be lessened by routine hygienic practices which include hand washing and the proper disposal of facial tissues containing respiratory secretions.

Notification: Notify parents/guardians and staff members that fifth disease is occurring in the child care facility. Staff members who are pregnant should consult their obstetrician if children in their room have fifth disease.

Return to child care: Children with fifth disease may attend child care if they are free of fever, since by the time the rash begins they are no longer contagious. The rash may come and go for several weeks.

“FLU” (INFLUENZA)

Influenza is an acute (sudden onset) viral disease of the respiratory tract characterized by fever, headache, muscle aches, joint pain, malaise, nasal congestion, sore throat and cough. Influenza in children may be indistinguishable from diseases caused by other respiratory viruses.

Mode of transmission: Direct contact with nose and throat secretions of someone who has influenza - airborne spread by these secretions coughed into the air.

Return to child care: The child may return to child care when free of fever and feeling well. The closing of individual schools and child care centers has not proven to be an effective control measure. By the time absenteeism is high enough to warrant closing, it is too late to prevent spread.

HAND-FOOT- AND- MOUTH DISEASE

This is a common childhood disease caused by a strain of coxsackievirus. In some people, the virus causes mild to no symptoms. In others, it may result in painful blisters in the mouth and on the palms of the hands and the soles of the feet.

Mode of transmission: The virus can be spread through saliva from the blisters in the mouth and from the fluid from the blisters on the hands and feet. It is also spread through the feces or stool of an infected person.

Notification: Notify parents/guardians and staff that there are cases of hand-foot-and-mouth disease in the child care facility so that they can be alert to the signs and symptoms.

Return to child care: The virus may be excreted in the stool for weeks after the symptoms have disappeared. Children who have blisters in their mouths and drool or who have weeping or active lesions/blisters on their hands should be excluded from child care until the lesions are crusted and dry and the child is free of fever.

HEAD LICE

This is an infestation of the scalp by small “bugs” called lice. They firmly attach egg sacs called “nits” to the hairs, and these nits are difficult to remove. Treatment may be accomplished with prescription or over-the-counter medicines applied to the scalp.

Mode of transmission: Direct contact with an infested person’s hair (head-to-head) and, to a lesser extent, direct contact with their personal belongings, especially shared clothing and headgear. Head lice do not jump or fly from one person to another, but they can crawl very quickly when heads are touching.

Notification: When a case of head lice occurs in a room, notify the parents/guardians that a case of head lice has occurred. Check the other children in that room for head lice and if found, notify their parents/.guardians that the child needs treatment. Ask the parents/guardians to be alert to anyone in their family who may have signs and symptoms of head lice (e.g., excessive itching of the scalp, especially at the nape of the neck and around the ears) so that they may also receive treatment.

Infants and children less than 2 yrs. of age: It is a rare occurrence for children in this age group to have head lice. It is generally not recommended to treat this age group prophylactically or just because someone else in the family has been treated. If a child of this age is found to have head lice, the parent/guardian should consult the child’s physician for treatment recommendations.

Return to child care: The child may return to child care after the first treatment has been given. (See Attachment A - “ Recommendations for the Control of Head Lice in the Child Care Setting”)

HEPATITIS A

This is an infectious viral disease characterized by jaundice (yellowing of the eyes and skin), loss of appetite, nausea, and general weakness. Child care centers can be a major source of hepatitis A spread in the community. This is because small children usually do not show any specific signs and symptoms of the disease. Symptomatic illness primarily occurs among adult contacts of infected, asymptomatic children.

Mode of transmission: Hepatitis A virus is found in the stool of persons infected with hepatitis A. The virus is usually spread from person to person by putting something in the mouth that has been contaminated with the stool of an infected person; for this reason, the virus is more easily spread under poor sanitary conditions, and when good personal hygiene, especially good handwashing, is not observed. Rarely, the virus is contracted by eating raw seafood (e.g., raw oysters) that has been collected from contaminated waters.

Notification: Notify the staff and parents/guardians that a case has occurred. Hepatitis A is a Class I reportable disease. A follow-up investigation will be done by the MSDH to determine who in the center may need to receive preventive treatment.

Return to child care: The child may return to child care one week after the onset of jaundice (yellowing of the eyes and skin) or one week after the onset of other signs and symptoms if no jaundice is present.

HEPATITIS B

Hepatitis B is a viral disease that affects the liver. It is a contagious condition characterized by loss of appetite, abdominal discomfort, jaundice (yellowing of the eyes and skin), joint aches, and fever

in some cases. It is different from Hepatitis A. There should not be any risk of exposure to hepatitis B in a normal child care setting unless a child who is infected with hepatitis B is bleeding. Also, since the hepatitis B vaccine is now a part of the routine immunization schedule, more and more children should be immune.

Mode of transmission: The most common mode of transmission is through having sex with someone who has the virus; however, it can be transmitted when infected blood enters the body through cuts, scrapes or other breaks in the skin. Injecting drug users are at risk when they share needles with an infected person. It is also possible for infected pregnant women to transmit the virus to their babies during pregnancy or at delivery.

If an exposure to a person who is infected with hepatitis B has occurred, the person exposed should be referred to his/her physician since hepatitis B vaccine and hepatitis B immune globulin may be indicated. Since hepatitis B and HIV/AIDS are both transmitted through blood exposure, the precautionary measures for HIV/AIDS would also apply to hepatitisB. (See HIV/AIDS section below)

HEPATITIS C

Hepatitis C is also a viral disease that affects the liver. Again, hepatitis C should pose no risk of exposure in the normal child care setting unless the infected child is bleeding. There is no vaccine available for hepatitis C at this time. Since it is also transmitted through blood exposure, the same precautionary measures for hepatitis B and HIV/AIDS would be apply to hepatitis C. (See HIV/AIDS section below)

HUMAN IMMUNODEFICIENCY VIRUS (HIV) INFECTION/ ACQUIRED IMMUNODEFICIENCY SYNDROME (AIDS)

Mode of transmission: The most common mode of transmission is through having sex with someone who has the virus; however, it can be transmitted when infected blood enters the body through cuts, scrapes or other breaks in the skin. Injecting drug users are at risk when they share needles with an infected person. It is also possible for infected pregnant women to transmit the virus to their babies during pregnancy or at delivery. Although HIV and hepatitis B are transmitted in the same way, HIV is much more difficult to transmit from one person to another than hepatitis B.

HIV infection in children causes a broad spectrum of disease manifestations and a varied clinical course. Children with HIV infection should be monitored closely by their physician. They are more susceptible to infectious diseases than other children. Parents of children known to have HIV infection should be notified when certain infectious diseases occur in the child care facility. There is no vaccine available for HIV at this time. According to CDC, HIV is not likely to be spread from one child to another in the child care setting and no case has ever been reported. Parents or guardians of HIV-positive children should inform the child care director of their child’s HIV status.

Because of concern over stigmatization, the person aware of a child’s HIV infection should be limited to those who need such knowledge to care for the children in the child care setting. In a situation where there is concern of possible exposure of others to the blood or body fluids of an infected person, CDC recommends that a team including the child’s parents or guardians, the child’s physician, public health personnel, and the proposed child care provider evaluate the situation to determine the most appropriate child care setting. The team should weigh the risks and benefits to both the infected child and to others in the child care setting.

It should always be remembered that there those who are known to be infected with HIV, hepatitis B and C and other blood borne diseases, but on the other hand there are those we do not know about and some people are not even aware themselves that they may have an infectious blood borne disease. Therefore, we must always employ universal precautions (treating everyone’s blood as though it is infectious) when dealing with blood and body fluids. There is no evidence that HIV, hepatitis B or hepatitis C is transmitted through tears, perspiration, urine or saliva unless these body fluids contain visible blood.

Child care providers should be prepared to handle blood and blood-containing body fluids using the principles of universal precautions. Supplies of gloves, disposable towels and disinfectants should be readily available.

The Mississippi State Department of Health is available for consultation in these situations.

IMPETIGO

This is a contagious skin disease characterized by spreading pustular lesions (sores with pus) and should receive medical treatment. This is quite important to avoid the risk of complications involving the heart and kidneys.

Mode of transmission: Skin-to-skin contact with the sores.

Return to child care: The child may return to child care 24 hours after treatment has been started if free of fever and the lesions are not draining.

MEASLES

Measles is a serious viral infection characterized by a rash (red, flat lesions) starting on the head and neck, which enlarge and coalesce (run together), and spread to the trunk, then to the extremities. Other symptoms include a high fever, conjunctivitis (red, inflamed eyes), cough and nasal congestion. The Health Department must be notified on first suspicion. With our present immunization laws, measles is a rare occurrence today. It is imperative, however, that immunization records be kept current.

Mode of transmission: Direct contact with nose and throat secretions of an infected person. May be airborne by droplets of these secretions coughed into the air. Tiny droplets can be suspended in the air for two hours or more. Measles is very easily spread.

Notification: Notify staff and parents/guardians that a case has occurred. Measles is a Class I reportable disease and there will be a follow-up investigation by the Health Department. Parents of children with weakened immune systems (those being treated for cancer, leukemia or taking steroid medication, etc.) should consult their child’s physician and keep the child out of the center until after the investigation by the Health Department and it is considered safe for them to return.

Return to child care: The child may return to child care when free of fever and the rash is fading (this usually takes 5-7 days).

MENINGITIS

Meningitis is an inflammation or infection of the meninges ( the membranes that cover the brain and spinal cord). Meningitis can be caused by a variety of organisms or germs. Most people exposed to these germs do not develop meningitis or serious illness. Some people may carry a particular germ and have no symptoms at all. Anyone exhibiting signs and symptoms of meningitis (e.g., severe headache, fever, vomiting, stiffness and pain in the neck, shoulders and back, drowsiness) should seek medical attention promptly.

Meningitis is a reportable disease. The Department of Health evaluates each case individually to determine what public health intervention, if any, might be required. The two types of meningitis that require public health intervention most often are caused by the organisms Haemophilus influenzae type b (HIB) and Neisseria meningitidis (meningococcal).

Mode of transmission: These germs are most commonly spread by direct contact with nose and throat secretions from a infected person.

Notification: Notify parents/guardians that a case has occurred and to have their children evaluated by a physician should they have any of the signs or symptoms listed above.

Return to child care: The child may return to the center whenever he or she has been released by his/her personal physician.

MUMPS

Mumps is an infectious disease that is characterized by swelling and pain of the salivary glands. Mode of transmission: Person- to- person spread by direct contact with the saliva of an infected person.

Return to child care: The child may return to child care 9 days after the beginning of the salivary gland swelling.

“PINK EYE” (CONJUNCTIVITIS)

This is an infectious disease characterized by redness of the eye(s), excessive tearing, itching, and discharge. Some cases may require antibiotics; therefore, the child should see a physician.

Mode of transmission: Contact with discharges from the eye, nose or throat of an infected person. Also, from contact with fingers, clothing and other articles that have been contaminated with the discharge.

Return to child care: Children may return to child care after they have seen a physician or when the redness/discharge is improving.

PINWORMS

Pinworms are tiny worms that live in the large intestine and can cause anal itching, sleeplessness and irritability. They may also be present without any symptoms. Pinworms occur worldwide and affect all socioeconomic classes. They are the most common worm infection in the United States. Prescription medication must be obtained to treat the infection.

Mode of transmission: Pinworms can be spread when an uninfected person touches the anal area of an infected person and then puts their hands/fingers in their mouth. They can also be spread when an infected person scratches the anal area and then contaminates food or other objects that are touched or eaten. Pinworms can be spread as long as the worms or the eggs are present.

Return to child care: The child may return to child care 24 hours after they have received the first treatment. Employ thorough hand washing especially before eating and after toilet use and change and wash any bed linens and towels in hot water that have been used for those children. Ask the parents/guardians to do the same at home. Also, discourage children from scratching the anal area.

RESPIRATORY SYNCYTIAL VIRUS (RSV)

RSV can cause an upper respiratory disease like a cold or a disease of the lower respiratory tract such as pneumonia. It is the most common cause of lower respiratory tract infections and pneumonia in infants and children under the age of 2. Almost 100% of children in child care programs get RSV during the first year of life. This usually occurs during outbreaks in the winter months. RSV can range from a very mild disease to life-threatening.

Mode of transmission: Direct contact with nose and throat secretions of an infected person. A young child can be infectious with RSV 1 to 3 weeks after signs and symptoms have subsided.

Return to child care: Most of the time a child is infectious before signs and symptoms appear. An infected child does not need to be excluded from child care unless he/she has a fever and/or is not well enough to participate in the activities. Make sure that procedures pertaining to hand washing, proper disposal of tissues and disinfection of toys are followed.

RINGWORM

Ringworm is a skin infection caused by a fungus that can affect the scalp, skin, fingers, toe nails and feet. Ringworm anyplace except on the scalp or under the nails can be successfully treated with several over-the-counter medicines. Ringworm of the scalp is characterized by inflammation, redness, and hair loss and does not respond to over-the-counter medicines; therefore, the child should see his/her physician.

Mode of transmission: Direct skin-to-skin contact or indirect contact (e.g., toilet articles such as combs and hair brushes, used towels, clothing and hats contaminated with hair from infected persons or animals).

Notification: When the lesions (red, circular places) are found, notify the parent/guardian that the child needs treatment.

Return to child care: The child may return to child care after the treatment has been started. Treatment for ringworm of the scalp and nails usually lasts for several weeks. Strict infection control measures should be taken (e.g., blankets, towels or anything that is used on the infected child should not be used on another child, make sure that staff caring for these children practice good handwashing and that disinfecting procedures are followed.

SCABIES

Scabies is a disease of the skin caused by a mite. The mite burrows beneath the skin and causes a rash that is usually found around finger webs, wrists and elbows. The rash may appear on the head, neck and body on infants. Any child with evidence of severe itching especially in these areas should be referred to his/her physician. Scabies requires treatment by prescription drugs.

Mode of transmission: Direct skin-to-skin contact with an infested person. Transfer of the mites from undergarments and bedclothes can occur, but only if contact takes place immediately after the infested person has been in contact with the undergarments and bedclothes.

Notification: Notify parents/guardians and staff that scabies has occurred in the facility so that they can be alert to signs and symptoms and seek treatment.

Return to child care: The child may return to child care 24 hours after the treatment has been completed. It must be noted that itching may continue for several days, but this does not indicate treatment failure or that the child should be sent home.

“STREP THROAT” (STREPTOCOCCAL PHARYNGITIS) & SCARLET FEVER

Strep throat is a communicable disease characterized by sore throat, fever, and tender, swollen lymph glands in the neck. The child should see a physician to obtain prescription medication; this is quite important to avoid the risk of complications involving the heart and kidneys. Scarlet fever is a streptococcal infection with a rash (scarlatinaform rash). It is most commonly associated with strep throat. In addition to the signs and symptoms of strep throat, the person with scarlet fever has an inflamed, sandpaper-like rash and sometimes a very red or “strawberry” tongue. The rash is due to a toxin produced by the infecting strain of bacteria. The treatment and exclusion criteria for scarlet fever would be the same as for strep throat.

Mode of transmission: Direct or indirect contact (e.g., contaminated hands, drinking glasses, straws) with throat secretions of an infected person.

Return to child care: The child may return to child care 24 hours after treatment has been started if free of fever.

TUBERCULOSIS (TB)

Mode of transmission: Airborne droplets of respiratory secretions coughed or sneezed into the air by a person with active TB disease.

Notification: TB is a class one reportable disease. If a child or a staff member in a child care facility is diagnosed with active TB, the MSDH will conduct an investigation. The MSDH will notify the facility and the parents/guardians of the type of follow-up that will be necessary.

Return to child care: Persons diagnosed with TB infection are evaluated by the Mississippi State Department of Health on an individual basis. Those who have a positive TB skin test only may attend child care since they have no disease process that is contagious. Persons suspected of or diagnosed with active TB disease will need written permission from the Mississippi State Department of Health Tuberculosis Control Program to return to the center.

Small children are highly susceptible to contracting TB disease, but do not transmit the disease as easily as an older child or adult. Children who do not have active TB disease, but who have been exposed to an active case in their household are considered high risk contacts and are placed on preventive medication. These children may attend child care since they are not infectious.

WHOOPING COUGH (PERTUSSIS)

Pertussis or whooping cough is a contagious disease characterized by upper respiratory tract symptoms with a cough, often with a characteristic inspiratory (breathing in) whoop.

Mode of transmission: Direct or indirect contact (contaminated articles) with nose and throat secretions of an infected person. Airborne transmission can also occur by droplets of these secretions coughed into the air.

Notification: Notify parents/guardians that a case has occurred. Pertussis is a class one reportable disease. The Health Department will conduct an investigation to determine those who may need preventive treatment.

Return to child care: The child may return to child care 5 days after their treatment has begun.

PERMISSION TO COLLECT STOOL SPECIMENS AND RECEIVE TEST RESULTS

If and when an outbreak of diarrheal diseases such as giardiasis, salmonellosis, shigellosis, etc. occurs in a child care facility, the Mississippi State Department (MSDH) investigates and may request that stool specimens be collected. In an outbreak situation, the stool specimen collection bottles are provided by the MSDH and the tests are done in the MSDH Lab free of charge. The collection bottle, with instructions, would either be given to the parent/guardian to collect the stool specimen or it may need to be collected at the child care facility. The child care facility would receive the test results and recommendations would be made by the MSDH. The test results would be given to the parents/guardians by the child care facility and the parents/guardians should give them to their child’s physician.

I give my permission for (name of child care facility) to collect stool specimens from (name of child) when it is recommended by the MSDH and also for them to receive the test results. I understand that I will receive a copy of the test results and be informed of the recommendations made by the MSDH.

Date Parent/Guardian

ATTACHMENT - A

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RECOMMENDATIONS FOR THE CONTROL OF HEAD LICE IN THE CHILD CARE SETTING

Head lice, Pediculus humanus capitis, are a common problem in children who attend child care in Mississippi. Although they do not transmit any human disease, they may be a considerable nuisance, and require conscious effort on the part of the child care staff and parents to control. It should be understood that head lice can only be controlled in the child care center, not eliminated; they will occur sporadically, and will recur even after control efforts. The goal of control efforts is to reduce the problem and its impact, and minimize spread.

Head lice are not a product of poor personal hygiene or lack of cleanliness, and their presence is not a reflection on the child care center or the family. More harm is probably caused by misconceptions about head lice than by the lice themselves.

1. IDENTIFYING INFESTED CHILDREN

By Screening: It is important to establish a screening program. Children should be screened for head lice upon entry into the child care setting and periodically during the year. Staff members should be instructed in the technique of detecting head lice.

By Individual Case: Any child suspected of having head lice (usually because he/she is scratching his/her head a lot) should be examined by a staff member who has been instructed in the technique. If infested, the child should be handled as described in Section 2, "HANDLING OF INFESTED CHILDREN."

If one child in a room is found to be infested, the whole room should be screened.

2. HANDLING OF INFESTED CHILDREN

Exclusion: An infested child’s parent/guardians should be notified that the child has been found to have head lice and must receive the proper treatment before returning to child care. Treatment and removal of nits are described in Section 3, "TREATMENT." Care must be taken not to embarrass or stigmatize the child.

Return to Child Care: The child should return to the child care center as soon as the first treatment has been given. Nits (eggs) may still be seen even in an adequately treated child. This is not evidence of continuing infestation if the child has been properly treated and no adult lice are present.

3. TREATMENT

Individual: Several effective pediculicides (lice-killing products) are available such as Nix ® * (permethrin) creme rinse (10 minute hair rinse) which is available over the counter and has ovicidal

(egg or nit-killing) capability. It is the only over-the-counter pediculicide covered by Medicaid. The pyrethrin/pyrinate products (10 minute shampoos) include such products as Rid ® *, A-1000 ® *, R&C ® *, Clear ® * and Triple-X ® * and are available over the counter at pharmacies. Kwell ® * (1% lindane), a 4 minute shampoo, requires a prescription. Central nervous system toxicity with lindane has been documented with prolonged administration. Ovide ®* lotion (Malathion 0.5%) has been re-approved by the Food and Drug Administration (FDA) as a prescription drug for the treatment of head lice infestation in the United States. Treatment with any approved pediculicidal (lice-killing) product should be adequate.

One Treatment vs. Two Treatments: Most products require 2 treatments. An initial treatment will kill adult and larval lice, but will not kill all the eggs. A second treatment 7 to 10 days later, after the eggs left by the first treatment have all hatched, will kill the newly hatched lice before they mature and reproduce and will complete the treatment process. Nix ® * requires only one treatment since it is an ovicidal (also kills the eggs or nits); however, a second treatment is desirable since the product is not likely to kill 100% of the nits. Ovide ® * lotion is also ovicidal and requires a second treatment 7 to 10 days after the first one only if crawling lice are seen.

Retreatment: Pediculicides should kill lice soon after application. However, in some situations (e.g., a person is too heavily infested, pediculicide is used incorrectly, reinfestation or possible resistance to the medication), the lice may still be present. Immediate retreatment with a different class or type of pediculicide is generally recommended if live lice are detected on the scalp 24 hours or longer after the initial treatment.

Treatment of Infants and Children Less Than 2 Years of Age: It is a rare occurrence for children in this age group to have head lice. It is generally not recommended to treat this age group preventively or just because someone else in the family has been treated. If a child of this age is found to have head lice, the parent/guardian should consult the child’s physician for treatment. The safety of head lice medications has not been tested in children 2 years of age and under.

Removal of nits: The need to remove nits is somewhat controversial. However, removing the nits may prevent reinfestation by those nits hatching that may have been missed by the treatment. It may also decrease confusion about infestation when the person who has been treated is being re- examined for the presence of head lice, and it will avoid possible embarrassment to the infested child. Nits may be removed by the use of a nit comb or by manually (“nit-picking”) removing them. Most of the nits that are easily seen and more easily removed with the nit comb are those that are grayish-white in color, have grown out one or more inches on the hair shaft and have already hatched. The new, viable nits are closer to the scalp (within about 1/4 inch) and are more of a brownish color. These nits are firmly attached to the hair shaft with a glue-like substance. There are commercial products available to help loosen the glue-like substance for easier removal.

Family: Household members of a child with head lice should be examined for lice (by a family member who knows how or someone else knowledgeable about lice) and any infested persons treated as described above. The one exception is any person over 2 years of age who shares a bed with the infested child should simply be treated presumptively. If the child is less than 2 years of age, consult the child’s physician for treatment recommendations.

4. ENVIRONMENTAL CONTROL

Child Care Facility/Household: Clothing, cloth toys, and personal linens (such as towels and bedclothes used within the previous 48 hours by an infested person) can be disinfected by washing in hot water and drying in the dryer using hot cycles. Non-washables should be dry cleaned, or stored in airtight plastic bags for 2 weeks. Spraying with insecticides is NOT recommended. Fumigants and room sprays can be toxic if inhaled or absorbed through the skin. If there are cloth surfaces, such as furniture or carpet, with which the infested person's hair has had extensive contact, they should be vacuumed thoroughly. The head louse will not survive off the human scalp for more than 24 - 48 hours. ************ Questions about control methods, specific treatments, or special problems can be addressed to the local health department, the district public health office, or to the Office of Community Health Services - Division of Epidemiology, State Department of Health in Jackson.

************

(*Use of specific product names is for example purposes only, and is not intended as endorsement of specific brands over others.)

SAMPLE LETTER TO PARENTS/GUARDIANS

Dear Parent or Guardian:

Your child has been found to have head lice. Head lice do not transmit disease and they are not a result of lack of cleanliness. Children in child care settings get them commonly, sometimes more than once.

You should consult a pharmacist or your child’s physician for a recommendation as to which of several effective products to use to treat your child. As soon as you have treated your child with an approved pediculicidal (lice-killing) product, he or she may return to child care.

There are 3 steps in the successful management of head lice:

1. Treatment (killing the lice with an approved medical treatment) - It is very important to follow the instructions given by your physician when using prescription medication. If you use over-the-counter medication, you should follow the package directions. The other members of your family should be checked for head lice and treated if they are found to have them. Persons over 2 years of age who sleep in the same bed with the infested child should be treated regardless. If a child less than 2 years of age is found to have head lice, consult the child’s physician for treatment recommendations.

2. Removal of the nits - The Mississippi State Department of Health recommends that you attempt to remove the nits to avoid reinfestation by those nits hatching that may have been missed by the treatment. The nits can be removed by dividing the hair into sections and working each section separately. Look for

small grayish-white or yellowish-brown specks that are attached to the hair shaft close to the scalp. Nits are attached to the hair shaft very firmly with a glue-like substance and are not easily brushed out. They must be picked out with the fingernails or combed with the nit comb that usually comes with the lice-killing product. This can be done outdoors under bright sunlight or indoors with a good reading lamp as nits are sometimes hard to see.

3. Environmental control - Clothing and personal linens (such as towels and bedclothes used by infested persons) should be machine washed using hot water and dried using the hot cycle. Non-washables can be dry cleaned or stored in an airtight plastic bag for 2 weeks. Cloth-covered furniture and carpet that have been in extensive contact with an infested person’s head should be thoroughly vacuumed. Lice-killing sprays are generally not necessary.

Signature: Date

APPENDIX J

RULES AND PROCEDURES FOR STATE LEVEL ADMINISTRATIVE HEARINGS

1. Hearing Officer - The Hearing Officer shall be appointed by the State Health Officer or his/her designee. The Hearing Officer shall preside at the hearing, shall be charged with maintaining order at the hearing, and shall rule on all questions of evidence and procedure in accordance with the provisions of these rules.

2. Appearance by Licensee/registrant - The licensee/registrant shall appear at the date and time set for the hearing, and failure to do so without reasonable notice to the Department may result in admission of the charges and adverse action taken against the licensee/registrant.

3. Representation by Counsel - The licensee /registrant may, but is not required to be, represented by counsel at the hearing and shall have the right to cross-examine all witnesses, present evidence, written or oral, on his or her own behalf, and to refute any testimony or evidence presented by the Department. The Department shall be represented by the Office of the Attorney General.

4. Rules of Evidence and Discovery - Formal rules of evidence and procedure, including Discovery, do not apply in administrative hearings; however, the rules of evidence may be used as a guide during the hearing. A record of the hearing shall be made by a court reporter.

5. Attendance of Witnesses - The licensee/registrant or counsel for the Department may make a written request to the Hearing Officer at least 10 days prior to the hearing to ensure the attendance of a witness or the production of documents through the issuance of an administrative subpoena. The issuance of the subpoena shall be at the discretion of the Hearing Officer.

6. Order of Proceedings - The Department shall present its case first, followed by the licensee/registrant, and any rebuttal evidence by either party. At the request of either party, all prospective witnesses shall be excluded from the proceedings except while actually testifying.

7. Standard of Proof - In order for the Department’s decision to be upheld, the Hearing Officer must find that the regulatory violation has been proved by clear and convincing evidence and that the disciplinary action is supported by substantial evidence.

8. Recommendation and Final Decision - At the conclusion of the hearing, or within a reasonable time thereafter, considering the amount of testimony and evidence and the complexity of the issues, the Hearing Officer shall submit his/her “Findings of Fact, Conclusions of Law and Recommendation” to the State Health Officer, outlining the proof presented and containing his/her recommendation to the State Health Officer as to the appropriate action to be taken. The State Health Officer shall in a reasonable time thereafter issue his/her Final Order adopting, modifying, or rejecting the Recommendation. This Final Order becomes the final appealable order of the Mississippi State Department of Health as to those proceedings.

9. Appeal of the Department’s Final Order shall be accomplished as provided by the appropriate statute.

**History**
- *Source: The ABCs of Safe and Healthy Child Care: A Handbook for Child Care Providers, Department of Health and Human Services, U.S. Public Health Service, Centers for Disease Control and Prevention.*
- *Source: The ABCs of Safe and Healthy Child Care: A Handbook for Child Care Providers, Department of Health and Human Services, U.S. Public Health Service, Centers for Disease Control and Prevention.*
- *Source: The ABCs of Safe and Healthy Child Care: A Handbook for Child Care Providers, Department of Health and Human Services, U.S. Public Health Service, Centers for Disease Control and Prevention.*
- *Source: Caring for Our Children: National Health and Safety Performance Standards;*
- *Source: Miss. Code Ann. §43-20-8*
- *Source: The ABCs of Safe and Healthy Child Care: A Handbook for Child Care Providers, Department of Health and Human Services, U.S. Public Health Service, Centers for Disease Control and Prevention (as amended by MSDH).*
- *Source: Miss. Code Ann. §43-20-8.*
- *Source: Miss. Code Ann. §43-20-8*

#### **Chapter 3** REGULATIONS GOVERNING LICENSURE OF CHILDCARE FAMILY HOMES FOR 5 OR FEWER CHILDREN Subchapter 1. GENERAL Rule 3.1.1 Legal Authority: The "Mississippi Childcare Licensing Law," Section 43-20-1 et seq. of the Mississippi Code of 1972 provides the legal authority under which the Mississippi State Department of Health prescribes minimum regulations for childcare facilities defined under the law.

##### **15 Miss. Admin. Code Pt. 11, R. 3.1.2** Purpose: 1 {#sec-11-3.1.2 omnilex-key=us-ms-regs-official--title-15--11#3.1.2}

The purpose of these regulations is to protect and promote the health and safety of children in this state by providing for the licensing of childcare family homes as defined herein to assure that certain minimum standards are maintained in such homes. This policy is predicated upon the fact that a child is not capable of protecting himself, and when his parents for any reason have relinquished his care to others, there arises the probability of exposure of that child to certain risks to his health and safety that require the offsetting statutory protection of licensing. 2. A childcare family home may exceed the minimum quality standards required in these regulations but may not operate without meeting the minimum standards set forth in these regulations.

**History**
- *Source: Miss. Code Ann. §43-20-8*

##### **15 Miss. Admin. Code Pt. 11, R. 3.1.3** Rule 3.1.3 {#sec-11-3.1.3 omnilex-key=us-ms-regs-official--title-15--11#3.1.3}

Severability: If any provision of these regulations or the application thereof to any persons or circumstances shall be held invalid, such invalidity shall not affect the provisions or application of these regulations that can be given effect without the invalid provision or application, and to this end, the provisions of these regulations are declared severable.

**History**
- *Source: Miss. Code Ann. §43-20-8*

##### **15 Miss. Admin. Code Pt. 11, R. 3.1.4** Definitions: 1 {#sec-11-3.1.4 omnilex-key=us-ms-regs-official--title-15--11#3.1.4}

Act: The "Mississippi Childcare Licensing Law," Section 43-20-1 et seq. of the Mississippi Code of 1972.

2. Accident: Accident means an incident that results in damage or creates observable injuries (scratch, bite mark, scraped knee, first aid given, etc.). 3. Agency Representative: An authorized representative of the Mississippi State Department of Health. 4. Caregiver: An individual at least 18 years of age with a minimum of one-year prior documented experience caring for children who are under thirteen years of age who provides direct childcare, supervision, and guidance to children. 5. Caregiver Assistant: An individual at least 16 years of age. Caregiver assistants shall always work under the direct on-site supervision of a director or caregiver. They shall not have direct responsibility for a group of children as the sole caregiver. Caregiver assistants under the age of 18 shall not be given the authority to discipline children. 6. Children with Special Needs: A child needing adaptation in a particular childcare family home to access programming and the physical environment. 7. Critical Violation: Violation of rules(s) identified by the Mississippi State Department of Health (MSDH) in the Regulations Governing Licensure of Childcare Facilities as most critical because non- compliance with those rules pose a threat to the health, safety, or well- being of the children in care and to the operation of the center. 8. Developmentally Appropriate Practice (DAP): Principles of guidelines that are appropriate to each child’s age and developmental status and responsive to the social and cultural context in which they live. 9. Director: An individual at least 21 years of age with a minimum of high school diploma or equivalent GED and two years prior documented experience caring for children who are under 13 years of age who provides direct childcare, supervision, and guidance to children. 10. Emergency Preparedness Plan: Each childcare family home is required to have an emergency preparedness plan which includes all activities and processes designed to prepare for an unsafe event and deal with the immediate emergency conditions created by or associated with the event, per the Robert T. Stafford Disaster Relief and Emergency Assistance Act (42U.S.C. 5195a(a)(1)). 11. Childcare Family Home: Homes that care for five or fewer children. In a licensed childcare home, the registered primary caregiver provides care in the caregiver's residence for not more than five children from

birth through 13 years and may provide care after school hours for elementary school children. The total number of children in care at any given time, including the children related to the caregiver, must not exceed five. 12. Field Trip: Activities conducted off the premises of the childcare family home, or outside of the approved playground areas, while under the supervision of center staff, whether a child walks or is transported. 13. Group: The children assigned to a caregiver or team of caregivers occupying an individual classroom or well-defined physical space within a larger room. 14. Hazardous Condition: A situation or place that presents a possible source of injury or danger. 15. Health: The condition of being sound in mind and body and encompassing an individual's physical, mental, and emotional welfare. 16. Health-Care Professional: A licensed physician, nurse practitioner, dentist, or other licensed medical personnel who provide health care to the child. 17. Infant: Children from birth through 12 months. 18. Licensing Agency: The Mississippi State Department of Health. 19. Operator: Any person, acting individually or jointly with another person or persons, who shall establish, own, operate, conduct or maintain a childcare family home. The childcare family home license shall be issued in the name of the operator or operators. If there is more than one operator, all statutory and regulatory provisions concerning the background checks of operators shall be equally applied to all, including a spouse who jointly owns, operates, or maintains the childcare family home regardless of which operator is named on the license. 20. Parent: As used in these regulations, parent shall mean custodial parent, legal guardian, foster parent, guardian ad litem, and other individuals or institutions to which a court of competent jurisdiction has granted legal authority over the child. 21. Person: Any person, firm, partnership, corporation, or association. 22. Personal Care: Assistance rendered by personnel of the home in performing one or more of the activities of daily living, which includes but is not limited to the feeding, personal grooming, supervising, and dressing of children placed in the home.

23. Physical Confines: The space inside the walls of the home. 24. Premises: Includes any parcel of land where the childcare center is located and any building, other structure, body of water, play equipment, street, sidewalk, walkway, driveway, parking garage, or parking lot on the parcel. 25. Preschool Aged Children: Children from three years of age up to their first day of kindergarten. 26. Professional Development: Participation by family home staff, in workshops, conferences, educational or provider associations, formal education, in-service training, or planned learning opportunities provided by qualified individuals. Training shall be age appropriate for the child population served by the family home and in such subject areas related to: childcare, child growth and development and/or early childhood education, nutrition, infection control/communicable disease management and causes, health and safety, signs and treatment of child abuse and/or neglect and shall include alternatives to corporal punishment. Training for directors may also be in areas related to supervision of childcare staff or program administration. 27. Resident: Any person living in the childcare family home. 28. Safety: The condition of being protected from hurt, injury or loss. 29. School Age Child: A child five years of age or older and eligible to be enrolled in a public school. A child that is five years old must have turned five on or before September 1 to be considered a school-age child. 30. Serious Occurrence: A serious occurrence includes but is not limited to, accidents or injuries requiring care by a health-care professional, deaths, alleged abuse and neglect, or other emergencies requiring the presence of law enforcement, fire personnel, EMT, or other emergency responders. Additionally, transportation accidents involving children in vehicles are considered serious occurrences and must be addressed by the appropriate authorities and childcare staff. 31. Supervision: Care that is provided to an individual child or a group of children. Children shall always be supervised appropriate to the individual age, needs, and capabilities of each child. Such supervision must include, but not be limited to, indoor and outdoor activities, mealtimes, naptime, transportation, field trips, and transitions between activities. Adequate supervision means that the appropriate number of staff members are physically present in the area where children are being cared for and are providing watchful oversight to the children and volunteers. The persons supervising in the childcare area must be alert, positioned to maximize their ability to always hear and see the children,

able to respond promptly to the needs and actions of the children being supervised, as well as the actions of the volunteers, provide timely attention to the children's actions and needs and promptly intervene in the case of an emergency. Staff shall also be attentive and participate with children during mealtimes and shall stay within proximity to the children while they are eating. 32. Time Out: The child is given time away from an activity which involved inappropriate behavior. 33. Toddler: Any child aged 12 months and under the age of 24 months. 34. Watchful Oversight: The process of actively monitoring a child’s activities. 35. Weather Permitting: Daily weather conditions that do not pose any concerns for health and safety. This includes conditions in which children may still play safely outdoors for shorter periods with appropriate adjustments to clothing and access to water, shade, or shelter.

Subchapter 2. LICENSURE Rule 3.2.1 Types of Licenses: 1. Temporary License: The licensing agency may issue a temporary license to any childcare family home. This license will allow the childcare family home to operate six months pending the issuance of a regular license. The temporary license will reflect the date of issuance of the license, the expiration date, and the number of children for which the home is licensed. Before a Temporary License is issued and the home is allowed to begin operation, the following items must be submitted to and approved by the licensing agency: a. License application and $130.00 application fee. b. License fee - $50.00 c. Documentation that the provider has a qualified director for the childcare program that meets the standards set forth in Rule 3.5.3. d. “Letter of Suitability for Employment” for every employee as appropriate that is to begin work when the provider starts operation.

e. An MSDH Certificate of Immunization Form #121 or Medical Exemption Form #122 for every employee. Religious Exemption Form #122 does not apply to staff. f. Valid MSDH Fire Inspection Form #333. g. Wastewater disposal approval. h. Potable water source approval for drinking water. i. Zoning approval. Follow local zoning requirements. j. Lead Testing approval: i. Building – required when high levels of lead are identified. ii. Playground k. Adult, Child and Infant CPR and First Aid certification as required for a person or persons who will be present at the home during all hours of operation. l. Daily Schedule of Activities - developed by provider. m. Arrival and Departure Procedures - developed by provider.

n. Emergency Policy – Emergency preparedness and response planning for emergencies resulting from a natural disaster, or a man- caused event (such as violence at a childcare home), within the meaning of those terms under section 602(a)(1) of the Robert T. Stafford Disaster Relief and Emergency Assistance Act (42 U.S.C. 5195a(a)(1)) that shall include procedures for evacuation, relocation, shelter-in-place, and lockdown; staff emergency preparedness training and practice drills; communication and reunification with families, continuity of operations; and accommodation of infants and toddlers, children with disabilities, and children with chronic medical conditions. o. Verification of Emergency Relocation Site – developed by provider. i. One site must be a minimum of one mile from the family home. ii. One site must be a minimum of five miles from the

family home. iii. Alternate site in case the other two locations are compromised. p. Transportation Policy-If children are transported daily. If children are not transported daily, the provider must include a statement in the Parent Handbook. q. Emergency Transportation Policy-An emergency transportation policy shall encompass such events as emergency evacuation of the family home and emergency transporting of a child to receive medical attention. It is required even if the provider does not plan to transport children. r. Vehicle Insurance-Proof of insurance is required if the provider transports children. s. Verification, in writing, that the provider has or does not have accident/liability insurance covering the business. t. Verification, in writing, that the provider has or does not have accident/liability insurance covering the children enrolled at the family home. u. Discipline Policy v. Verification that the owner/operator and director have completed mandatory training on: i. Regulations Governing Licensure of Childcare Family Homes: Five or Fewer ii. Health and Safety 2. Regular License: The licensing agency may issue a regular license when all conditions and requirements for licensure have been approved. 3. Probational License: The licensing agency may issue a probational license, at its discretion, where violations may endanger the health or safety of the children, but only when such violations may be corrected within a specified period. There shall be a written corrective action plan agreed upon between the operator and the licensing agency. The period for which a probational license is issued shall be at the discretion of the licensing agency but in no instance shall exceed six months. 4. Restricted License: The licensing agency may issue any type of license with conditions or restrictions when the health and safety of children require such limitations. These conditions or restrictions may

include, but are not limited to, barring certain individuals from the premises or addressing any other situation that could endanger children, and such details must be recorded on the license. Any violation of these conditions or restrictions will result in the immediate emergency suspension of the license. Once the conditions or restrictions no longer pose a threat to the children, they may be lifted from the license.

**History**
- *Source: Miss. Code Ann. §43-20-8*
- *Source: Miss. Code Ann. §43-20-8*

##### **15 Miss. Admin. Code Pt. 11, R. 3.2.2** Rule 3.2.2 {#sec-11-3.2.2 omnilex-key=us-ms-regs-official--title-15--11#3.2.2}

Application for License: An electronic application for a license under these regulations shall be made to the licensing agency upon forms provided by it and shall contain such information as the licensing agency may reasonably require.

**History**
- *Source: Miss. Code Ann. §43-20-8*

##### **15 Miss. Admin. Code Pt. 11, R. 3.2.3** Rule 3.2.3 {#sec-11-3.2.3 omnilex-key=us-ms-regs-official--title-15--11#3.2.3}

License Fee: Each initial and renewal licensure application, unless suspended or revoked, shall be accompanied by a fee as set by the Board, made payable to the Mississippi State Department of Health by electronic means. Renewal of licenses shall occur on an annual basis. Fees are non- refundable order, or electronic means.

**History**
- *Source: Miss. Code Ann. §43-20-8*

##### **15 Miss. Admin. Code Pt. 11, R. 3.2.4** Rule 3.2.4 {#sec-11-3.2.4 omnilex-key=us-ms-regs-official--title-15--11#3.2.4}

Certificate of Inspection by Fire Department: A certificate of inspection and approval by the fire department of the municipality or other political subdivision in which the childcare family home is located shall be submitted to the licensing agency with the application and license fees. Except that if no fire department exists where the family home is located, the State Fire Marshall shall certify the inspection for safety from fire hazards. The inspection form to be used for fire inspections shall be MSDH Form #333, or other approved inspection forms used and completed by the local fire authority or State Fire Marshal designee, along with any other fire safety inspection forms required by the city and/or county and shall be signed by a signatory authority of the fire inspection authority making the inspection.

**History**
- *Source: Miss. Code Ann. §43-20-8*

##### **15 Miss. Admin. Code Pt. 11, R. 3.2.5** Rule 3.2.5 {#sec-11-3.2.5 omnilex-key=us-ms-regs-official--title-15--11#3.2.5}

Inspection: An agency representative(s) shall inspect each childcare family home prior to issuing or renewing a license to assure compliance with these regulations. Agency representatives have the right to enter upon arrival.

**History**
- *Source: Miss. Code Ann. §43-20-8*

##### **15 Miss. Admin. Code Pt. 11, R. 3.2.6** Rule 3.2.6 {#sec-11-3.2.6 omnilex-key=us-ms-regs-official--title-15--11#3.2.6}

Record of Inspection: Whenever an inspection is made of a childcare family home, the findings shall be recorded on an official inspection form and furnished to the operator, director, and/or their representative. Rule 3.2.7 Renewal of License: 1. The licensing agency shall issue licenses that may be renewed annually. The licensing agency shall email a renewal notice to the address of the operator registered with the licensing agency. The operator shall: a. Complete the renewal application. b. Submit all required documents for approval by the licensing agency. c. Submit the renewal fee. d. File the above with the licensing agency at least 30 days prior to the expiration date on the license. Renewal applications submitted online less than 30 days prior to the expiration date of the license shall be assessed a $25.00 late fee. Application and fees are to be paid online at the Mississippi State Department of Health website (healthyms.com). 2. An operator who does not file the renewal application prior to the date that the license expires will be deemed to have allowed the license to lapse. In its discretion, the license may be reinstated by the licensing agency, by payment of both the renewal and the reinstatement fee, provided the application for reinstatement is made within one month of the expiration date of the license. 3. After the one-month reinstatement period, an application for an initial license must be submitted. All licensure requirements in effect at the time the new initial application is filed shall be met.

**History**
- *Source: Miss. Code Ann. §43-20-8*

##### **15 Miss. Admin. Code Pt. 11, R. 3.2.8** Rule 3.2.8 {#sec-11-3.2.8 omnilex-key=us-ms-regs-official--title-15--11#3.2.8}

License Not Transferable or Assignable: Each license shall be issued only for the premises and operator named in the application and shall not be transferable or assignable. A change of ownership includes, but is not limited to, inter vivo gifts, purchases, transfers, lease arrangements, cash and/or stock transactions or other comparable arrangements whenever any person or entity acquires or controls a majority interest of the childcare family home, home, or service. Changes of ownership from partnerships, single proprietorships, or corporations to another form of ownership are specifically included.

**History**
- *Source: Miss. Code Ann. §43-20-8*

##### **15 Miss. Admin. Code Pt. 11, R. 3.2.9** Rule 3.2.9 {#sec-11-3.2.9 omnilex-key=us-ms-regs-official--title-15--11#3.2.9}

Display of Licenses: The current license issued by the licensing agency to the named childcare family home and operator shall be posted and displayed in a conspicuous place and in easy view of all persons who enter the childcare family home. The home operator shall also post next to the license, in plain view, a notice provided by the MSDH that informs the public of where and how they may report a complaint against the family home. Rule 3.2.10 Changes in Home Operations: Before implementing any changes, the operator must obtain approval from the licensing agency for any significant alterations affecting areas of the family home. Such major changes include, but are not limited to, changes in operator, director, location, hours of operation, renovations, use of areas within the home, or the number and ages of children served. Additional examples include changes in the evacuation plan or emergency relocations, damages to or changes in the condition of the family home, loss of electricity, heat, air conditioning, or water supply to the family home for over one hour while children are present.

Subchapter 3. RIGHT OF ENTRY AND VIOLATIONS Rule 3.3.1 Right of Entry: A representative from the licensing agency has the authority to conduct inspections or investigations at any childcare family home to ensure compliance with these regulations. Applying for a license or permit to operate a center, or receiving one from the agency, implies consent from the applicant, the prospective license holder, and the premises owner for the agency's representative, upon displaying proper identification, to enter the premises. The home shall provide access to personnel from other state agencies or any individuals conducting inspections at the agency’s request.

**History**
- *Source: Miss. Code Ann. §43-20-8*

##### **15 Miss. Admin. Code Pt. 11, R. 3.3.2** Rule 3.3.2 {#sec-11-3.3.2 omnilex-key=us-ms-regs-official--title-15--11#3.3.2}

Failure to Allow Access: Refusing the agency's representative access to all areas of the childcare family home, including the premises, staff, children, and all records maintained by or for the family home (including but not limited to audio, video, photos, written documents, social media posts, and electronic data), may warrant restrictions, revocation, or suspension of a license. The agency is entitled to photocopy or reproduce any record held by or for the center as necessary for inspections or investigations. Rule 3.3.3 Right of Entry-Parent(s)/Guardian(s): Parent(s)/Guardian(s) of enrolled children must be granted permission for access to all areas of the childcare family home used by the child(ren). Access shall be defined as a parent/guardian having access to areas of the family home available to their

child and non-disruptive to normal daily activities Rule 3.3.4 Violations: If violations noted on the inspection or investigation form are not corrected within the period specified by the licensing agency, a license may be denied, suspended, or revoked in accordance with these regulations.

b. The phone number of the childcare family home. c. The program and services provided, and the ages of children accepted. d. The hours and days of operation and holidays or other times closed. e. The procedures for admission and registration of children. f. Family home tuition, payment methods, and late payment policies. g. Types of insurance coverage for children, or a statement that accident insurance is not provided or available. h. If a home does not provide liability insurance there shall be a statement in the child’s record, signed by the parent indicating that the parent is aware that the family home does not carry liability insurance. i. Arrival and departure procedures for children. 2. Health and Emergency Procedures: a. Procedures for storing and giving a child medication. Medications for children shall be kept in a storage cabinet or container that is locked or otherwise not accessible to children and shall be stored separate from cleaning chemicals, supplies or poisons. Medication

requiring refrigeration shall be placed in a leakproof container in a refrigerator that is not accessible to the children. b. Policy for reporting suspected child abuse. c. Policy for reporting accidents. d. Provision for emergency medical care, treatment of illnesses and serious occurrences, which include: i. A plan to handle a child in a medical crisis including choking and allergic reactions. ii. A plan to obtain prompt services of physicians and hospitalization, if needed. iii. A plan for immediately notifying the parent of any illness, or serious incidents involving children. iv. A plan to acquire the services of a certified practitioner for a child exempt from medical care on religious grounds. e. Evacuation plan including procedures for notifying the parents of the relocation sites. f. Policy and procedures for handling dangerous situations, including but not limited to, dealing with violent individuals, individuals entering the home with weapons, bomb threats, or conditions posing an immediate threat to children. 3. State regulations: a. A statement signed by the child's parent, indicating that they have received a summary of licensing standards and other materials designated by the licensing agency. b. The name and phone number of the MSDH licensing official responsible for the inspection of the home. c. The childcare family home complaint hot line or web link.

**History**
- *Source: Miss. Code Ann. §43-20-8 Subchapter 4. FAMILY HOME POLICY AND PROCEDURES Rule 3.4.1 Parental Information: Before a child's enrollment, the parent shall be provided with the following: 1. Operating Information: a. Name(s), business phone number, business address, and home phone number of the operator, director or an individual in authority who can be reached after the family home’s normal hours of operation.*
- *Source: Miss. Code Ann. §43-20-8*

##### **15 Miss. Admin. Code Pt. 11, R. 3.4.2** Smoking, Tobacco Products, and Prohibited Substances: 1 {#sec-11-3.4.2 omnilex-key=us-ms-regs-official--title-15--11#3.4.2}

Smoking or the use of tobacco products in any form is prohibited within the physical confines or the campus of a childcare family home. 2. The use of alcohol, illegal use of prescription drugs, or use of illegal

drugs is prohibited within the physical confines or the campus of a childcare family home. 3. Smoking or the use of tobacco products in any form, use of alcohol, illegal use of prescription drugs, or use of illegal drugs by a caregiver is prohibited anytime a child is under the care of such caregiver regardless of location. A caregiver is defined as a person who provides direct care, supervision, and guidance to children in a childcare family home, regardless of title or occupation. This definition includes parents.

**History**
- *Source: Miss. Code Ann. §43-20-8*

##### **15 Miss. Admin. Code Pt. 11, R. 3.4.3** Documents to Post: The following items shall be posted conspicuously in the childcare family home: 1 {#sec-11-3.4.3 omnilex-key=us-ms-regs-official--title-15--11#3.4.3}

MSDH License 2. Daily activity schedule 3. Evacuation route 4. MSDH complaint form

**History**
- *Source: Miss. Code Ann. §43-20-8*

##### **15 Miss. Admin. Code Pt. 11, R. 3.4.4** Rule 3.4.4 {#sec-11-3.4.4 omnilex-key=us-ms-regs-official--title-15--11#3.4.4}

Weapons Prohibited: All firearms in the home shall be equipped with trigger locks and kept in a locked room out of the sight of all children. All other dangerous weapons shall be kept under a lock in a room not accessible to children. Other dangerous weapons include, but are not limited to, hunting knives, spears, machetes, archery equipment, etc.

**History**
- *Source: Miss. Code Ann. §43-20-8*

##### **15 Miss. Admin. Code Pt. 11, R. 3.4.5** Rule 3.4.5 {#sec-11-3.4.5 omnilex-key=us-ms-regs-official--title-15--11#3.4.5}

Serious Occurrences Involving Children: The childcare family home must report to the licensing agency, notify the child’s parents, and place a copy in the child’s record immediately after the serious occurrence. If the family home is unable to contact the parent, documentation should be recorded in the record. Written reports must be submitted within two days of the occurrence. Examples of serious occurrences may include the following: 1. Any incident that results in a child requiring a visit to a medical professional or hospitalization. 2. Alleged abuse, neglect, or inappropriate physical contact with child or adult 3. A lost or unsupervised child

4. Transportation incident or accident 5. Death 6. Incorrect medication given to a child or children 7. Physical altercation between adults on the premises. 8. Any other incident that poses a danger to the life, health, and/or well- being of a child, children, or staff member at the family home Rule 3.4.6 Child Abuse: Any operator or employee of a childcare family home who has suspicion or evidence of child abuse or neglect shall report it immediately to the Mississippi Department of Child Protective Services in accordance with Miss. Code Ann. § 43-21-353; 43-21-357; 43-21-261; 43- 21-267; 43-21-105(m). A provider must not interview staff or children regarding the specific allegation(s) of child abuse or child neglect until the Department of Child Protective Services and/or local law enforcement agency has had the opportunity to interview all appropriate individuals and completed their investigation. Rule 3.4.7 Prevention of Shaken Baby Syndrome and Abusive Head Trauma: Each childcare family home licensed to care for children up to five years of age shall develop and adopt policies to prevent shaken baby syndrome and abusive head trauma prior to licensure. The policy shall include the following: 1. How to recognize, respond to, and report the signs and symptoms of shaken baby syndrome and abusive head trauma. Signs and symptoms include irritability, difficulty staying awake, difficulty breathing, inability to lift the head, seizures, lack of appetite, vomiting, and bruises. 2. Strategies to assist staff members in coping with a crying, fussing, or distraught child. 3. Strategies to assist staff members in understanding how to care for infants. 4. Strategies to ensure staff members understand the brain development of children up to five years of age. 5. A list of prohibited behaviors that shall include, but not be limited to, shaking a child, tossing a child into the air or into a crib, chair, or car seat, and pushing a child into walls, doors, and furniture; and 6. Resources to assist staff members and families in preventing shaken baby syndrome and abusive head trauma.

Subchapter 5: PERSONNEL REQUIREMENTS Rule 3.5.1 General Requirements for Personnel: 1. Each employee or potential employee of a childcare family home, whether full-time, part-time, temporary, or substitute, shall meet the minimum qualifications for the respective job classification, as set forth in these regulations. 2. Any individual who, in the opinion of the licensing agency, appears to be unable to physically or mentally care for the children daily and/or in emergency situations will not be allowed to act as a caregiver or caregiver assistant. Any person whose ability is in question shall, at the request of the licensing agency, be able to demonstrate the ability to perform, at a minimum but not limited to the following: a. Physical ability to exit the children during a fire drill in under two minutes; b. Ability to read medication directions and properly dispense medication to children (required only if the family home dispenses medication)

**History**
- *Source: Miss. Code Ann. §43-20-8*

##### **15 Miss. Admin. Code Pt. 11, R. 3.5.2** Rule 3.5.2 {#sec-11-3.5.2 omnilex-key=us-ms-regs-official--title-15--11#3.5.2}

Comprehensive Background Check: Pursuant to Section 43-20-1 et seq., of the Mississippi Code of 1972, Section 658(d) of the Childcare Development Block Grant Act of 2014, and Federal Rules and Regulations 45 CFR 98.43, a comprehensive, finger-print based, criminal history records check, consisting of a FBI national criminal history records check (NCIC), state criminal history records check (MCIC), state child abuse registry check, National Sex Offender Registry check (NSOR), a state sex offender registry check and an interstate check, if applicable, must be completed on all operators, employees, and prospective employees of a licensed, regulated, and/or registered childcare family home as well as all childcare providers eligible to deliver services for which Childcare Development Funds assistance is provided. Further, a comprehensive background must be completed every five years. 1. Before a prospective staff member may begin work in a childcare family home, a valid Letter of Suitability must have been issued by the MSDH Criminal Records Check Unit. 2. Each licensed, regulated, and/or registered childcare family home provider will electronically access, monitor, verify, and maintain the

suitability status of any submitted employee through the agency maintained website. 3. If an individual has been separated from employment (break in service) in a childcare family home for more than 180 consecutive days a new comprehensive criminal history records check must be submitted and approved before the individual may begin work in a childcare family home. 4. In the event a childcare applicant has a disqualifying event a letter of non-suitability will be issued. Both the childcare family home provider and the applicant will be notified through the agency- maintained website. 5. Individuals under the age of 18 who are employed by a family home provider for compensation are required to complete a comprehensive background check. 6. A comprehensive background check must be completed on any individual 18 years of age and older residing in a residence designated as a childcare family home.

**History**
- *Source: Miss. Code Ann. §43-20-8*

##### **15 Miss. Admin. Code Pt. 11, R. 3.5.3** Rule 3.5.3 {#sec-11-3.5.3 omnilex-key=us-ms-regs-official--title-15--11#3.5.3}

Childcare Director Qualifications: A childcare family home director shall be at least 21 years of age and shall have at a minimum high school diploma or equivalent (GED) and two years prior documented experience caring for children who are under 13 years of age.

**History**
- *Source: Miss. Code Ann. §43-20-8*

##### **15 Miss. Admin. Code Pt. 11, R. 3.5.4** Rule 3.5.4 {#sec-11-3.5.4 omnilex-key=us-ms-regs-official--title-15--11#3.5.4}

Caregivers: Caregivers shall be at least 18 years of age and shall have at a minimum one-year prior documented experience caring for children who are under 13 years of age.

**History**
- *Source: Miss. Code Ann. §43-20-8*

##### **15 Miss. Admin. Code Pt. 11, R. 3.5.5** Rule 3.5.5 {#sec-11-3.5.5 omnilex-key=us-ms-regs-official--title-15--11#3.5.5}

Caregiver Assistants: Caregiver assistants shall be at least 16 years of age and shall work under the direct supervision of a director or caregiver. They shall not have direct responsibility for a group of children as the sole caregiver. Caregiver assistants under the age of 18 shall not be given the authority to discipline children.

**History**
- *Source: Miss. Code Ann. §43-20-8*

##### **15 Miss. Admin. Code Pt. 11, R. 3.5.6** Staff Development: 1 {#sec-11-3.5.6 omnilex-key=us-ms-regs-official--title-15--11#3.5.6}

Owners and Directors. Before a new license to operate is issued, owners and directors of the childcare family home shall each complete mandatory training on courses covering Regulations Governing Licensure of Childcare Family Homes of 5 or Fewer and Health and Safety. If a new director is appointed by the childcare family home after the license issuance, the mandatory training courses shall be completed by such individual(s) within the first three months of appointment. 2. The owner/director is required to obtain Health and Safety training prior to the home being licensed. All staff members must acquire it within 90 days of being hired. Health and Safety training must be completed every two years thereafter that consists of the following topics: a. Prevention and control of infectious diseases including immunizations; b. Prevention of sudden infant death syndrome and use of safe sleeping practices; c. Administration of medication, consistent with standards for parental or guardian consent; d. Prevention and response to emergencies due to food and allergic reactions; e. Building and physical premises safety, including identification of and protection from hazards, bodies of water, and vehicular traffic; f. Prevention of shaken baby syndrome, abusive head trauma, and child maltreatment; g. Emergency preparedness and response planning for emergencies resulting from a natural disaster, or a man-caused event (such as violence at a childcare family home); h. Handling and storage of hazardous materials and the appropriate disposal of bio-contaminants; i. Precautions in transporting children, if applicable; j. Infant, child, and adult first aid and infant, child, and adult CPR; k. Recognition and reporting of child abuse and neglect; and

l. Child development (including the major domains: cognitive, social, emotional, physical development and approaches to learning). 3. All childcare employees shall be required to complete five contact hours of staff development, accrued during the licensure year, annually. Training should address the following: a. Health and safety. b. Child growth and development. c. Nutrition. d. Planning learning activities. e. Guidance and discipline techniques. f. Linkages with community services. g. Communications and relations with families. h. Detection of child abuse. i. Advocacy for early childhood programs. j. Professional issues. k. First aid and cardiopulmonary resuscitation (CPR) for infant, child, and adult. l. Special needs, as applicable. 4. Contact hours for staff development shall be approved by the licensing agency.

**History**
- *Source: Miss. Code Ann. §43-20-8*

##### **15 Miss. Admin. Code Pt. 11, R. 3.5.7** Review by Licensing Agency: 1 {#sec-11-3.5.7 omnilex-key=us-ms-regs-official--title-15--11#3.5.7}

The satisfaction of the personnel requirements applicable to any individual shall be determined by the licensing agency acting pursuant to its authority under applicable statutes and regulations. 2. The licensing agency, in its sole discretion, may accept suitable educational credits, programs, or degrees in lieu of those specified in Subchapter 5 upon the submission of adequate documentation by the individual.

**History**
- *Source: Miss. Code Ann. §43-20-8 Subchapter 6. RECORDS Rule 3.6.1 Records: Records listed in this section shall be kept in the childcare family home and shall be made available to the licensing agency on request.*
- *Source: Miss. Code Ann. §43-20-8*

##### **15 Miss. Admin. Code Pt. 11, R. 3.6.2** Records Retention: 1 {#sec-11-3.6.2 omnilex-key=us-ms-regs-official--title-15--11#3.6.2}

All records, unless otherwise specified, shall be kept for a period of at least three years, whether the childcare family home is open or closed. 2. A child's records shall be retained for a period of one year after the child is no longer in attendance at the family home.

**History**
- *Source: Miss. Code Ann. §43-20-8*

##### **15 Miss. Admin. Code Pt. 11, R. 3.6.3** Childcare Family Home Records: 1 {#sec-11-3.6.3 omnilex-key=us-ms-regs-official--title-15--11#3.6.3}

Attendance records for children and employees. 2. A current alphabetical roster of children enrolled in the childcare

family home, to include the child's full name and date of birth. 3. A current alphabetical roster of staff employed in the childcare family home. 4. Current license. 5. Records of monthly fire/disaster evacuation drills and 9-1-1 drills. 6. A record shall be maintained of any medication administered by the director or caregiver showing the date, time, and signature of dispensing employee. A medication record may be destroyed 90 days after administering the medication. 7. Each family home shall maintain a notebook containing copies of the MSDH Certificate of Immunization Compliance (MSDH Form #121) for both staff and children at the home. The notebook shall contain separate current alphabetical rosters of both staff and children. The certificates shall be filed in alphabetical order to match the current staff and child rosters. Children enrolled in a licensed family childcare home are expected to be age appropriately immunized. All children must have one of the following forms before enrollment in a licensed family childcare home: Certificate of Immunization Compliance (Form 121) or Certificate of Medical/Religious Exemption (Form 122). 8. Each family home shall maintain a notebook containing a copy of the Letter of Suitability from the licensing agency on all employees. The notebook shall contain an alphabetical roster of staff including, staff name, date of birth, and the initial date of hire. The Letter of Suitability shall be filed in an order matching the alphabetical roster. 9. Each licensed family home provider is required to enter into the childcare LARS Database the hourly rate that they charge to care for a child in a particular age group they serve, i.e., Infant, Preschool, School Age. The following is used for calculating the hourly rate for each age group. Calculated Daily Rate = (Calculated Weekly Rated ÷ 5) Current Monthly Rate (CMR)Calculated Yearly Rate = (CMR X 12 months) Calculated Weekly Rate = (Calculated Yearly Rate ÷ 52)

**History**
- *Source: Miss. Code Ann. §43-20-8*

##### **15 Miss. Admin. Code Pt. 11, R. 3.6.4** Personnel Records: 1 {#sec-11-3.6.4 omnilex-key=us-ms-regs-official--title-15--11#3.6.4}

Employee Records: Each employee's personnel record shall contain

the following: a. Name, date of birth, address, phone number and photo identification. b. Documentation of education, training, and experience necessary for employment. c. Documentation of staff development accrued during each licensure year, beginning with the date employed. d. Date of employment and date of separation. e. Mississippi State Department of Health Certificate of Immunization Compliance Form 121 or Form 122 Medical Exemption. f. Valid Letter of Suitability for employment. g. Documentation of orientation, within one week of being hired, including, but not limited to, emergency procedures (to include policies for handling dangerous situations), staffing and supervision requirements, daily schedules, physical/emotional/developmental problems of children, discipline policies, and child abuse and neglect. h. Upon resignation or termination, personnel records shall be kept on file and be made available to the licensing agency for at least one year after the last day of employment. 2. The required Employee Information to be entered into the Childcare Licensure and Reporting System (LARS) for the Owner, Director, and all staff of the childcare family home is as follows: a. First Name b. Last Name c. Date of Birth d. Last 4 of SSN e. Hire Date f. Email Address g. Mailing Address h. Contact Phone Number

3. The above information will be entered at the time of initial application, renewal, and contacts must be updated within the “Manage Contacts” section. The required information entered under this rule is confidential and not viewable by the public.

**History**
- *Source: Miss. Code Ann. §43-20-8*

##### **15 Miss. Admin. Code Pt. 11, R. 3.6.5** Rule 3.6.5 {#sec-11-3.6.5 omnilex-key=us-ms-regs-official--title-15--11#3.6.5}

Child Records: The family home shall maintain an individual file for each child under its current care, and for any child who withdrew during the preceding twelve months, containing the following identification and contact information, parental instructions, authorizations and other documents required by its policy manual: Identification and Contact Information: a. The name of the child and names of parents/guardians. b. Home address and phone number. c. The parent’s business name, address and phone number. d. The child’s date of birth. e. Date of acceptance at family home and date of withdrawal, if any, with the parents’ stated reason for withdrawal. f. Other contact information required to be maintained in accordance with family home’s policy manual. 2. Parental Instructions: a. If the parent provides written instructions to the family home, those instructions concerning the child’s growth and development, medical needs, allergies, toilet training and other information relevant to the child’s well-being shall be maintained and updated as provided from time to time. b. Written identification of an authorized, responsible person(s) for pick-up of the child. c. Official legal documentation of any limitation of parental rights of the other parent or stepparent. d. Documentation of any limitation or restriction, if any, on activities of a child, or other participation by the child in certain events such as holiday celebrations. 3. Authorizations: a. Signed, written authorization to obtain emergency medical treatment and to administer medication.

b. Election by a parent to either i. provide written authorization consenting to any and all field trips, excursions, or series of events outside the childcare family home, or ii. provide written consent only for those specific field trips, excursions, or series of events for which date, time and location are specifically approved. c. Signed acknowledgment by a parent that the written policies and procedures described in Rule 3.4.1 have been received by the parent. d. Signed acknowledgment by a parent that a summary of licensing standards and other materials designated by the licensing agency has been received by the parent. e. Parental authorization of child being photographed, having photos posted or shared on social media, or other parental concerns. 4. Documents Required by Policy Manual or Contract: a. If agreed by the family home in its policy manual or caregiver contracts, the method in which the provider will inform the parent or contact person if a child does not arrive at the family home within a reasonable time after a scheduled drop-off. b. Any other documents or identification records agreed to be maintained by the family home. 5. Confidentiality of Records and Information: a. Individual child records are confidential and shall not be disclosed or released without prior written authorization by the parent. b. Individual personnel records are confidential and shall not be disclosed or released without prior written authorization by the employee.

minimum shall: 1. Address any potential disaster, natural or human-caused event, related to the area in which the family home is located; 2. Include procedures to control access to buildings and outdoor play areas; 3. Include procedures for evacuation, relocation to one of the family home’s pre-determined places, shelter-in-place, lock down, communication with families, and continuity of operations; 4. Include specific procedure for accommodations for infants and toddlers, including food and formula; 5. Include specific procedures for caring for children with disabilities and chronic medical conditions, including the evacuation and transportation, as well as any required medication or medical equipment; 6. Include a system to quickly account for all children; 7. Include a system, and a back-up system, for contacting parents and authorized third party release caretakers; 8. Include a system to reunite children and parents following an emergency; 9. Include procedures for providing information about the emergency plan to parents at the time of enrollment and when changes and/or updates occur; 10. Be reviewed annually for accuracy and updated as changes are needed; 11. Be reviewed with all staff and volunteers during orientation and at least once every six months; 12. Be available at the time of inspection and any other time requested by the licensing agency.

**History**
- *Source: Miss. Code Ann. §43-20-8 Subchapter 7. EMERGENCY PREPAREDNESS AND EVACUATION PLANNING Rule 3.7.1 Emergency and Evacuation Plan: The provider shall establish and follow a written, multi-hazard emergency preparedness, response, and recovery plan to protect children in the event of emergencies that at a*
- *Source: Miss. Code Ann. §43-20-8*

##### **15 Miss. Admin. Code Pt. 11, R. 3.7.2** Rule 3.7.2 {#sec-11-3.7.2 omnilex-key=us-ms-regs-official--title-15--11#3.7.2}

Individualized Emergency Plan: An individual emergency plan shall be in place for each child with special health care needs and shall include medical contact information and additional supplies and equipment as needed.

**History**
- *Source: Miss. Code Ann. §43-20-8*

##### **15 Miss. Admin. Code Pt. 11, R. 3.7.3** Rule 3.7.3 {#sec-11-3.7.3 omnilex-key=us-ms-regs-official--title-15--11#3.7.3}

Evacuation Pack: The family home shall have an evacuation pack, the location of which shall be known to all staff, that at a minimum shall contain: 1. A list of area emergency phone numbers; 2. An updated list of emergency contact information and emergency medical authorization for all enrolled children; 3. An emergency pick up form; 4. First aid supplies, hand sanitizer, wet wipes, and tissue; 5. Diapers for children who are not toilet trained and plastic bags for diaper disposal; 6. A battery-powered flashlight and radio and batteries or a crank flashlight and radio; 7. Disposable cups and bottled water. 8. A designated staff member shall be responsible for maintaining the pack to ensure that all contents, including medications are current and not expired.

**History**
- *Source: Miss. Code Ann. §43-20-8*

##### **15 Miss. Admin. Code Pt. 11, R. 3.7.4** Rule 3.7.4 {#sec-11-3.7.4 omnilex-key=us-ms-regs-official--title-15--11#3.7.4}

Records: A childcare family home shall maintain a copy of records, documents, and computer files necessary for its continued operation following an emergency in ether a portable file or at an off-site location (an electronic back up copy of all information is strongly recommended).

**History**
- *Source: Miss. Code Ann. §43-20-8*

##### **15 Miss. Admin. Code Pt. 11, R. 3.7.5** Rule 3.7.5 {#sec-11-3.7.5 omnilex-key=us-ms-regs-official--title-15--11#3.7.5}

Drills: The provider shall conduct fire and tornado drills monthly and all other disaster drills at least once every six months. The provider shall vary the days and times on which fire and other disaster drills are held. The provider shall keep documentation of the previous 12 months of all drills on- site for review by licensing agency. Documentation of the drill shall include: 1. The type of drill (i.e.,fire, tornado, flood, violence, loss of electrical power) 2. The date and time of the drill; 3. The number of children participating; 4. The name of the individual supervising the drill;

5. The total time to complete the drill; and 6. Any problems encountered and remediation.

**History**
- *Source: Miss. Code Ann. §43-20-8*

##### **15 Miss. Admin. Code Pt. 11, R. 3.7.6** First Aid and CPR 1 {#sec-11-3.7.6 omnilex-key=us-ms-regs-official--title-15--11#3.7.6}

During all hours of operation, including the arrival and departure of children, a childcare family home employee shall be present, at any location where the children are present, who holds a valid infant, child, and adult first aid certificate. This certificate shall be issued by an agent recognized by the licensing agency. 2. During all hours of operation, including the arrival and departure of children, a childcare family home employee shall be present who holds a valid infant, child, and adult CPR certification, at any location where the children are present. Said certificate shall beissued by an agent recognized by the licensing agency. 3. When initially acquiring or renewing the CPR and First Aid certifications, online (internet, etc.) training is not acceptable. Training must be face-to-face and hands on. Subchapter 8. STAFF TO CHILD RATIO, GROUP SIZE, AND SUPERVISION Rule 3.8.1 General: 1. During all hours of operation, including arrival and departure of children, a childcare family home employee shall be present to whom administrative and supervisory responsibilities have been assigned. This employee shall meet the minimum qualifications of a director. 2. During all hours of operation, including the arrival and departure of children, a childcare family home employee shall be present who holds a valid infant, child, and adult CPR certification, at any location where the children are present. Said certificate shall be issued by an agent recognized by the licensing agency. 3. During all hours of operation, including the arrival and departure of children, a childcare family home employee shall be present, at any location where the children are present, who holds a valid infant, child, and adult first aid certificate. This certificate shall be issued by an agent recognized by the licensing agency.

**History**
- *Source: Miss. Code Ann. §43-20-8*

##### **15 Miss. Admin. Code Pt. 11, R. 3.8.2** Staff-to-Child Ratio: The minimum staff to child ratio present shall be five children to one staff {#sec-11-3.8.2 omnilex-key=us-ms-regs-official--title-15--11#3.8.2}

**History**
- *Source: Miss. Code Ann. §43-20-8*

##### **15 Miss. Admin. Code Pt. 11, R. 3.8.3** Grouping: When children are placed in groups, the maximum group size shall be five children to one staff {#sec-11-3.8.3 omnilex-key=us-ms-regs-official--title-15--11#3.8.3}

**History**
- *Source: Miss. Code Ann. §43-20-8*

##### **15 Miss. Admin. Code Pt. 11, R. 3.8.4** Supervision: A caregiver must maintain watchful oversight {#sec-11-3.8.4 omnilex-key=us-ms-regs-official--title-15--11#3.8.4}

Staff must always be aware of all children in their care and must be alert, able to respond quickly to children’s actions and needs, and be able to intervene promptly in case of an emergency. 1. Staff shall refrain from using electronic devices or any object that will distract one’s attention while supervising children or performing classroom duties. 2. The responsible caregiver shall stay on the same floor or level of the house with the children. 3. When children are outdoors, the caregiver must be present outside providing direct supervision to the children. 4. Provide closer supervision to ensure children are within easy reach when risks are higher and when children’s age and behavioral tendencies require it. Subchapter 9. PROGRAM OF ACTIVITIES Rule 3.9.1 General: 1. The childcare family home shall provide a basic program of activities geared to the age levels and developmental needs of the children served. 2. The childcare family home shall provide for the reading of age- appropriate materials to children.

**History**
- *Source: Miss. Code Ann. §43-20-8*

##### **15 Miss. Admin. Code Pt. 11, R. 3.9.2** Daily Routines: All daily routines, such as eating and rest periods, shall be scheduled for the same time each day {#sec-11-3.9.2 omnilex-key=us-ms-regs-official--title-15--11#3.9.2}

**History**
- *Source: Miss. Code Ann. §43-20-8*

##### **15 Miss. Admin. Code Pt. 11, R. 3.9.3** Eating: Meal periods are breakfast, lunch, dinner, and snacks {#sec-11-3.9.3 omnilex-key=us-ms-regs-official--title-15--11#3.9.3}

**History**
- *Source: Miss. Code Ann. §43-20-8*

##### **15 Miss. Admin. Code Pt. 11, R. 3.9.4** Rest Periods: 1 {#sec-11-3.9.4 omnilex-key=us-ms-regs-official--title-15--11#3.9.4}

Rest period shall be individualized to meet each child’s needs. 2. Physical force shall not be used in requiring children to lie down or go to sleep during rest periods. Rule 3.9.5 Infant Safe Sleep: A safe sleep environment for infants to lower the risk of Sudden Infant Death Syndrome (SIDS) is required as follows: 1. An infant MUST be placed on his/her back for sleeping unless written physician orders to the contrary, with medical reasons listed, are in the child's record. Sleeping infants shall be within site or sound of the staff and visually checked regularly when sleeping. Nothing shall obstruct the view of the staff or prevent the staff from clearly seeing infants or children. All children MUST be visually checked during naptime. 2. Infants shall be dressed in clothing appropriate for sleeping that is

designed to keep the infant warm without the possible hazard of head covering or entrapment. Clothing used for swaddling and swaddling blankets are not to be used at any time. The room shall be kept at a draft-free seasonally appropriate temperature of 65 degrees Fahrenheit to 78 degrees Fahrenheit. If a child is already asleep and not dressed in clothing appropriate for sleeping, the caregiver does not need to awaken the infant to change his or her clothes. Facilities shall use a firm mattress covered by a fitted sheet. 3. The lighting in the room must allow the caregiver to see each infant’s face, to view the color of the infant’s skin, and to check on the infant’s breathing. 4. Item such as but not limited to pillows, blankets, sheepskins, bumpers, soft objects, stuffed toys, loose bedding, etc., shall not be in the crib. Additionally, no items shall be hanging on the crib.

**History**
- *Source: Miss. Code Ann. §43-20-8*

##### **15 Miss. Admin. Code Pt. 11, R. 3.9.6** Outdoor Activities: 1 {#sec-11-3.9.6 omnilex-key=us-ms-regs-official--title-15--11#3.9.6}

All children shall have daily outdoor activities appropriate for the children’s chronological ages and developmental levels unless the weather poses a significant health risk identified by the National Weather Service. 2. Sun safe practices shall be used during outdoor activities throughout the year. 3. Sun safe practices shall be evident in the planning of all outdoor activities. 4. Outdoor activities shall be held in areas providing shade or covered spaces.

**History**
- *Source: Miss. Code Ann. §43-20-8*

##### **15 Miss. Admin. Code Pt. 11, R. 3.9.7** Infant, Toddler, and Preschool Activities: 1 {#sec-11-3.9.7 omnilex-key=us-ms-regs-official--title-15--11#3.9.7}

Infants, toddlers, and preschoolers shall be free to creep, crawl, toddle, and walk as they are physically able. a. Cribs, car seats, and highchairs are to be used appropriately only for their primary purpose, i.e., cribs for sleeping, car seats for vehicle travel, and highchairs for eating. b. Providers should limit the use of equipment such as strollers, swings, and bouncer seats/chairs for holding infants while they

are awake. c. Providers should implement activities for toddlers and preschoolers that limit sitting or standing to no more than 30 minutes at a time. d. Providers should use strollers for toddlers and preschoolers only when necessary. 2. For infants who cannot move about the room, caregivers shall frequently change the place and position of the infant and the selection of toys available, and the child shall be held, rocked, and carried about. 3. Television viewing shall be kept at a minimum.

**History**
- *Source: Miss. Code Ann. §43-20-8*

##### **15 Miss. Admin. Code Pt. 11, R. 3.9.8** Rule 3.9.8 {#sec-11-3.9.8 omnilex-key=us-ms-regs-official--title-15--11#3.9.8}

Indoor or Outdoor Physical Activity: Family home providers are to provide infants, toddlers, and preschool children with opportunities to be physically active throughout the day.

2. Equipment, toys, and materials for both indoor and outdoor shall be clean, safe, and in good repair. 3. The daily activity schedule shall demonstrate that preschoolers are given opportunities to do a variety of activities, including both quiet and active, such as block play, art activities, puzzles, books, and learning games, and that stories are read to and discussed with each child every day. Rule 3.10.2 Paint: Paint on toys, equipment, furniture, walls, and other items shall be lead-free and non-poisonous.

**History**
- *Source: Miss. Code Ann. §43-20-8 Subchapter 10. EQUIPMENT, TOYS, AND MATERIALS Rule 3.10.1 General: 1. Equipment, toys, and materials for both indoor and outdoor use shall be appropriate to the age and developmental needs of the children served.*
- *Source: Miss. Code Ann. §43-20-8*

##### **15 Miss. Admin. Code Pt. 11, R. 3.10.3** High Chairs: High chairs, if used, shall have a wide base and a T-shaped safety strap {#sec-11-3.10.3 omnilex-key=us-ms-regs-official--title-15--11#3.10.3}

They shall be labeled or warranted by the manufacturer in documents provided at the time of purchase or verified thereafter by the manufacturer as meeting the American Society for Testing

Materials (ASTM) Standard F-404 (Consumer Safety Specifications for High Chairs).

**History**
- *Source: Miss. Code Ann. §43-20-8*

##### **15 Miss. Admin. Code Pt. 11, R. 3.10.4** Rest Period Equipment: In accordance with the U.S {#sec-11-3.10.4 omnilex-key=us-ms-regs-official--title-15--11#3.10.4}

Consumer Product Safety Act of 2008, any crib provided by a childcare family home must meet federal safety standards. To verify compliance with federal standards, any crib manufactured prior to June 28, 2011, there shall be a Certificate of Compliance on file in the family home and the crib must have a label attached to show the date of manufacture. Any crib manufactured after June 28, 2011, must have a label attached to show the date of manufacture. 1. The family home shall provide a crib or other similarly commercially purchased bed unit, approved and designated for the purpose of sleeping. Children shall not be placed directly on the floor for rest periods. 2. Mobile infants, at a minimum of eight months, may be placed on a mat during the transition period of crawling to walking. If such mat is used, it shall be commercially purchased, flame retardant, a minimum of two inches thick, and designated for the purpose of sleeping. 3. Cribs, cots, and mats are to be a minimum of 24 inches apart or separated by a solid barrier. A minimum of 36 inches is recommended. 4. Once a sheet or blanket has been used by a child, it shall not be used by another child until it has been laundered. 5. Rest period equipment shall be covered with a waterproof cover. 6. Nap pads/cots are designed for use by one child only at a time and sanitized after each use or when soiled. 7. Children are not allowed to sleep in shared places, such as infant seats, strollers, swings, cozy areas, or on tables. If a child falls asleep in such shared place, he or she should be moved immediately. 8. Stackable cribs are not allowed.

1. A childcare family home shall be physically separated from any other business or enterprise. Other occupants, visitors, and/or employees of other businesses or enterprises within the same building shall not be allowed within the physical confines of the childcare family home for the purpose of entering the building or exiting the building or passing through the childcare home for the purpose of gaining access to another part of the building. 2. A childcare family home can only utilize approved, lower-level areas of the home. 3. All childcare family homes shall meet all fire safety standards listed on the MSDH Form #333 and all applicable local fire safety standards and/or ordinances. 4. A separate space shall be provided for the use of an ill or injured child until the child can be picked up by the parent. 5. The ceiling, floor, and/or floor covering shall be properly installed, kept clean and in good condition, and maintained in good repair. 6. All parts of the childcare family home used by children shall be lead- safe, well-lighted, ventilated, and free of hazardous or potentially hazardous conditions, such as, open stairs and unprotected low windows. 7. All glass in doors, windows, mirrors, etc., shall have a protective barrier at least four feet high when measured from the floor. Doors, windows, mirrors, etc., using safety-grade glass or polymer (e.g., Lexan®) are not required to have a protective barrier. Glass windows and glass door panels shall be equipped with a vision strip 36 inches from the floor. Safety glass must be certified by the installer and the statement kept on file at the childcare family home. 8. Walls shall be kept clean and free of torn wall covering, chipped paint, broken plaster, and holes. No paint that contains lead compounds shall be applied to interior walls or woodwork. 9. A childcare family home shall maintain a primary and secondary communication device, one of which shall be a telephone. 10. All fire extinguishers, as required in the fire safety plan, shall be serviced on an annual basis by a qualified fire extinguisher technician. 11. Unused electrical outlets shall be protected by a safety plug cover. 12. No extension cords shall be used in areas accessible to children. 13. Every childcare family home that uses nonelectric heating and/or

cooling systems, cooking stoves, and/or water heaters, or other nonelectric equipment, shall have sufficient carbon monoxide monitors placed appropriately throughout the childcare family home. 14. All childcare family homes are to be kept clean and in good repair.

**History**
- *Source: Miss. Code Ann. §43-20-8 Subchapter 11. BUILDINGS AND GROUNDS Rule 3.11.1 Building:*
- *Source: Miss. Code Ann. §43-20-8*

##### **15 Miss. Admin. Code Pt. 11, R. 3.11.2** Openings: 1 {#sec-11-3.11.2 omnilex-key=us-ms-regs-official--title-15--11#3.11.2}

Each window, exterior door, and basement or cellar hatchway shall be weather-tight and watertight. 2. The width of doors shall accommodate wheelchairs and the needs of individuals with physical disabilities, if applicable 3. Doorways and exits shall be free of debris and equipment to allow unobstructed traffic to and from the room.

**History**
- *Source: Miss. Code Ann. §43-20-8*

##### **15 Miss. Admin. Code Pt. 11, R. 3.11.3** Kitchens: 1 {#sec-11-3.11.3 omnilex-key=us-ms-regs-official--title-15--11#3.11.3}

Children shall only be permitted in meal preparation areas when under direct supervision of staff, when there is no danger of injury from equipment, or for instruction/teaching purposes. 2. The following regulations shall apply: a. No game or home canned foods shall be served. b. Other than fresh or frozen vegetables and fruit, all foods shall be from commercial sources. c. Food shall be cooked or reheated to a temperature of 165 degrees Fahrenheit. Hot food shall be held at a minimum temperature of 140 degrees Fahrenheit. d. Cold food shall be stored at a temperature of 41 degrees Fahrenheit or below. e. All food shall be covered while in the refrigerator or freezer. f. Any prepared foods not properly refrigerated at a temperature of 41 degrees Fahrenheit or less, or frozen, shall be discarded. g. If manual washing is utilized, a sanitizer shall be used. Rinsing in a chlorine solution using one and one-half tablespoons of household bleach per gallon of water is sufficient. If a dishwasher

is utilized, the nozzle ports shall be free of obstructions, and the interior of the machine shall be clean. h. Hot water, under pressure, shall be available. i. Insecticides, poisons, cleaning agents, and medications, shall be stored away from food, separately from each other, and out of the reach of children. j. Children shall not be exposed to insecticides or pesticides, or other toxic agents. k. Hands shall be washed frequently, when switching between working with raw and ready-to-eat foods, and after all non-food preparation activities. l. Clean clothing shall be worn. m. Gloves shall be worn if there are any cuts or abrasions on the hands. 3. All kitchens and/or food/snack preparation areas in a childcare family home shall be inspected as part of the childcare inspection process.

**History**
- *Source: Miss. Code Ann. §43-20-8*

##### **15 Miss. Admin. Code Pt. 11, R. 3.11.4** Toilets and Hand Washing Lavatories: 1 {#sec-11-3.11.4 omnilex-key=us-ms-regs-official--title-15--11#3.11.4}

Toilets and hand washing lavatories shall be located within the physical confines of childcare family home and shall be convenient to outside playground areas. 2. All hand washing lavatories shall have both hot and cold running water. Hot water temperature shall not exceed 120 degrees Fahrenheit. 3. Toilets, and hand washing lavatories, and sinks shall be clean and operational. Bathrooms, hand washing lavatories, and sinks shall be supplied with soap, and individual towels for drying hands. Each toilet shall be supplied with toilet paper.

**History**
- *Source: Miss. Code Ann. §43-20-8*

##### **15 Miss. Admin. Code Pt. 11, R. 3.11.5** Rule 3.11.5 {#sec-11-3.11.5 omnilex-key=us-ms-regs-official--title-15--11#3.11.5}

Water: The water supply shall be from a public water system or a private system approved by the Mississippi State Department of Health. Water shall be dispensed by the following: 1. Disposable paper cups; or

2. Labeled cup for each child that shall be washed and sanitized daily.

**History**
- *Source: Miss. Code Ann. §43-20-8*

##### **15 Miss. Admin. Code Pt. 11, R. 3.11.6** Exits: Must comply with local fire codes and municipalities {#sec-11-3.11.6 omnilex-key=us-ms-regs-official--title-15--11#3.11.6}

**History**
- *Source: Miss. Code Ann. §43-20-8*

##### **15 Miss. Admin. Code Pt. 11, R. 3.11.7** Heating, Cooling, and Ventilation: 1 {#sec-11-3.11.7 omnilex-key=us-ms-regs-official--title-15--11#3.11.7}

A draft-free seasonally appropriate temperature of 65 degrees Fahrenheit to 78 degrees Fahrenheit shall be maintained. 2. All rooms used by children shall be heated, cooled, and adequately ventilated to maintain the required temperatures, and air exchange, and to avoid the accumulation of objectionable odors and harmful fumes. 3. Ventilation may be in the form of openable windows. 4. Electric fans, if used, shall be guarded to limit the size of the opening in the blade guard to less than one-half inch. 5. When air-cooling is needed, draft-free cooling units shall be used. They shall present no safety hazard to the children. 6. Filters on recirculation systems shall be checked and cleaned or replaced as needed. 7. Thermometers that do not present a hazard to children shall be present. 8. Portable, open flame and kerosene space heaters are prohibited. Portable gas stoves shall not be used for heating. 9. Electric space heaters shall be UL-approved, inaccessible to children, and utilized in compliance with all manufacturer’s recommendations. 10. Fireplaces and fireplace inserts shall be properly vented, inaccessible to children through a barrier device, and in compliance with all manufacturer’s recommendations. 11. Heating units, including water pipes and baseboard heaters shall be made inaccessible to children.

**History**
- *Source: Miss. Code Ann. §43-20-8*

##### **15 Miss. Admin. Code Pt. 11, R. 3.11.8** Rule 3.11.8 {#sec-11-3.11.8 omnilex-key=us-ms-regs-official--title-15--11#3.11.8}

Outside Grounds and Play Area: Outside play areas shall be free of hazardous or potentially hazardous objects and/or conditions that may result in injury. The outdoor play area shall be well arranged so that all areas are visible to staff. 1. Outside play areas shall be protected from traffic or other hazards by barriers approved by the licensing agency. 2. All equipment shall be securely anchored to prevent accidents or injuries. 3. Outdoor playground areas shall be free from unprotected swimming and wading pools, ditches, and other bodies of water. 4. Outdoor spaces shall be laid out to ensure ample shaded space for children. 5. Protective surfacing is required beneath climbing and swinging equipment.

**History**
- *Source: Miss. Code Ann. §43-20-8*

##### **15 Miss. Admin. Code Pt. 11, R. 3.11.9** Rule 3.11.9 {#sec-11-3.11.9 omnilex-key=us-ms-regs-official--title-15--11#3.11.9}

Garbage Removal: Garbage and trash shall be removed from the childcare family home daily and from the grounds at least once a week. Garbage and trash shall be stored inaccessible to the children and in insect and rodent- resistant containers.

**History**
- *Source: Miss. Code Ann. §43-20-8*

##### **15 Miss. Admin. Code Pt. 11, R. 3.11.10** Pest Control: The home shall be free of insects and rodents {#sec-11-3.11.10 omnilex-key=us-ms-regs-official--title-15--11#3.11.10}

Use of agricultural chemicals for pests is strictly prohibited.

2. Staff shall use universal precautions when changing diapers or being exposed to blood, fecal material, or urine.

3. Refer to the MSDH website for proper handwashing procedures.

**History**
- *Source: Miss. Code Ann. §43-20-8 Subchapter 12. HEALTH, HYGIENE, AND SAFETY Rule 3.12.1 Employee Health: 1. Employees manifesting symptoms or otherwise suspected of having upper respiratory, gastrointestinal, skin, or other serious contagious conditions shall be excluded from work until either free from symptoms or certified by a physician to be no longer infectious.*
- *Source: Miss. Code Ann. §43-20-8*

##### **15 Miss. Admin. Code Pt. 11, R. 3.12.2** Child Health: 1 {#sec-11-3.12.2 omnilex-key=us-ms-regs-official--title-15--11#3.12.2}

A child who is suspected of having a serious contagious condition shall be isolated and returned to the parent as soon as possible. 2. A child having a serious contagious condition shall not be allowed to return to the childcare family home until they have been certified by a physician to be no longer contagious. 3. A child with a physical injury shall be treated by a staff member with infant, child, and adult valid first aid certificate issued by an agent recognized by the licensing agency. A child with a serious physical injury shall be treated by a staff member with a valid first aid certificate issued by an agent recognized by the licensing agency and transported to a hospital or medical facility as soon as appropriate.

**History**
- *Source: Miss. Code Ann. §43-20-8*

##### **15 Miss. Admin. Code Pt. 11, R. 3.12.3** Child Hygiene: 1 {#sec-11-3.12.3 omnilex-key=us-ms-regs-official--title-15--11#3.12.3}

A child's wet or soiled clothing shall be changed immediately. 2. A child's hands shall be washed: a. Immediately before and after eating.

b. After using the toilet or having their diapers changed. c. After playing on the playground. d. After handling pets, pet cages, or other pet objects. e. Whenever hands are visibly dirty. f. Before going home. 3. A child shall have a shower, tub, or sponge bath to ensure bodily cleanliness when necessary.

**History**
- *Source: Miss. Code Ann. §43-20-8*

##### **15 Miss. Admin. Code Pt. 11, R. 3.12.4** Toys and Equipment: Toys and equipment used by infants or toddlers shall be cleansed daily with a germicidal solution {#sec-11-3.12.4 omnilex-key=us-ms-regs-official--title-15--11#3.12.4}

Refer to the National Resource Center for Health and Safety in Childcare and Early Education for cleaning and disinfecting procedures.

**History**
- *Source: Miss. Code Ann. §43-20-8*

##### **15 Miss. Admin. Code Pt. 11, R. 3.12.5** First Aid Supply: 1 {#sec-11-3.12.5 omnilex-key=us-ms-regs-official--title-15--11#3.12.5}

A first aid supply shall be kept on-site and easily accessible to employees, but not in reach of the children. 2. A first aid supply shall be taken on all field trips and excursions and shall be easily accessible to employees, but not in reach of the children. 3. All vehicles used by the family home in transporting children shall be equipped with a first aid kit. 4. All first aid kits should be periodically inspected for contents. Depleted and out-of-date materials should be replaced. 5. Special attention should be exercised when utilizing first aid supplies or any medication for children who have allergies or other special medical needs. 6. For additional information on supplies for first aid kits contact your local office of the American Red Cross.

**History**
- *Source: Miss. Code Ann. §43-20-8*

##### **15 Miss. Admin. Code Pt. 11, R. 3.12.6** Animals and Pets: 1 {#sec-11-3.12.6 omnilex-key=us-ms-regs-official--title-15--11#3.12.6}

Any pet or animal present at a childcare family home, indoors or

outdoors, shall be in good health, show no evidence of carrying any disease, and be a friendly companion for the children. 2. Dogs or cats, where allowed, shall be immunized for any disease thatcan be transmitted to humans and shall be maintained on a flea, tick, and worm control program. 3. All pets shall be cared for as recommended by the regulating health agency. When pets are kept at the childcare family home, procedures for their care and maintenance shall be written and followed. When immunizations are required, proof of current compliance signed by a veterinarian shall be on file at the home where the pet is kept. 4. A caregiver shall always be present when children are exposed to animals (including dogs and cats). Children shall be instructed on safe procedures to follow when near these animals (e.g., not to provoke or startle them or remove their food). Potentially aggressive animals (e.g., pit bulls, boxers, etc.) shall not be in the same physical space as the children. 5. Each child’s and staff’s hands shall be properly washed after being exposed to animals.

2. Meal periods are breakfast, lunch, dinner, and snacks. 3. Meals shall be served where each child may be seated. 4. Meals shall be served by employees only. 5. Employees shall wash their hands before preparing or serving food. 6. Children shall not share food.

**History**
- *Source: Miss. Code Ann. §43-20-8 Subchapter 13. NUTRITION, MEALS, AND FOOD SAFETY Rule 3.13.1 General: 1. A childcare family home shall provide adequate and nutritious meals prepared in a safe and sanitary manner.*
- *Source: Miss. Code Ann. §43-20-8*

##### **15 Miss. Admin. Code Pt. 11, R. 3.13.2** Rule 3.13.2 {#sec-11-3.13.2 omnilex-key=us-ms-regs-official--title-15--11#3.13.2}

Nutritional Standards: Meals shall meet the nutritional standards as prescribed in Appendix “A” Minimum Standards for Nutritional Care in Childcare Facilities.

**History**
- *Source: Miss. Code Ann. §43-20-8*

##### **15 Miss. Admin. Code Pt. 11, R. 3.13.5** Rule 3.13.5 {#sec-11-3.13.5 omnilex-key=us-ms-regs-official--title-15--11#3.13.5}

Snacks: All snacks shall meet acceptable nutritional standards, as prescribed in Appendix “A” Minimum Standards for Nutritional Care in Childcare Facilities.

Subchapter 14. DISCIPLINE AND GUIDANCE Rule 3.14.1 Prohibited Behavior: The following behaviors are prohibited by anyone (parent, caregiver, or child) in all family home settings: 1. Corporal punishment, including hitting, spanking, beating, shaking, pinching, biting, and other measures that produce physical pain. 2. Withdrawal or the threat of withdrawal of food, rest, or bathroom opportunities. 3. Abusive or profane language, yelling, and/or harsh tones toward or around children is not allowed. 4. Any form of public or private humiliation, including threats of physical punishment. 5. Any form of emotional abuse, including rejecting, terrorizing, ignoring, isolating, or corrupting a child. 6. Use of any food product or medication in any manner or for any purpose other than that for which it was intended. 7. Inappropriate disciplinary behavior including putting soap or pepper in a child's mouth is not allowed. 8. Any acceptable disciplinary action that is not age-appropriate for the child or is excessive in time or duration.

**History**
- *Source: Miss. Code Ann. §43-20-8*

##### **15 Miss. Admin. Code Pt. 11, R. 3.14.2** Rule 3.14.2 {#sec-11-3.14.2 omnilex-key=us-ms-regs-official--title-15--11#3.14.2}

Restraint of a Child: Children shall not be physically restrained except as necessary to ensure their own safety or that of others, and then for only as long as is necessary for control of the situation. Children shall not be given medicines or drugs that will affect their behavior except as prescribed by a licensed physician and with specific written instructions from the licensed physician for use of the medicines or drugs.

**History**
- *Source: Miss. Code Ann. §43-20-8*

##### **15 Miss. Admin. Code Pt. 11, R. 3.14.3** Rule 3.14.3 {#sec-11-3.14.3 omnilex-key=us-ms-regs-official--title-15--11#3.14.3}

Time Out: "Time out" that enables the child to regain self-control and keeps the child in visual contact with a caregiver shall be used selectively, considering the child's developmental stage and the usefulness of "time out" for the child. Isolation from a caregiver is not acceptable. “Time out” is not allowed for children younger than (3) three years of age.

**History**
- *Source: Miss. Code Ann. §43-20-8*

##### **15 Miss. Admin. Code Pt. 11, R. 3.14.4** Rule 3.14.4 {#sec-11-3.14.4 omnilex-key=us-ms-regs-official--title-15--11#3.14.4}

Children Shall Not Discipline Other Children: Children shall neither be allowed nor be instructed to discipline other children.

**History**
- *Source: Miss. Code Ann. §43-20-8 Subchapter 15. TRANSPORTATION Rule 3.15.1 General: The childcare family home is responsible for the safety of the children.*
- *Source: Miss. Code Ann. §43-20-8*

##### **15 Miss. Admin. Code Pt. 11, R. 3.15.2** Requirements: 1 {#sec-11-3.15.2 omnilex-key=us-ms-regs-official--title-15--11#3.15.2}

All drivers shall be appropriately licensed. 2. All vehicles shall have current licenses and registrations. 3. Insurance is required and shall adequately cover the transportation of children. 4. Children shall board or leave the vehicle from the curbside of the street and shall be safely accompanied to their destinations. 5. A parent shall be present if the child is delivered home. 6. Age and weight appropriate seat restraints shall be used.

**History**
- *Source: Miss. Code §43-20-8.*

##### **15 Miss. Admin. Code Pt. 11, R. 3.15.3** Occupant Restraints: 1 {#sec-11-3.15.3 omnilex-key=us-ms-regs-official--title-15--11#3.15.3}

All children will be properly restrained whenever they are being transported in a motor vehicle. a. Every person transporting a child under the age of four years in a passenger motor vehicle, and operated on a public roadway, street or highway, shall provide for the protection of the child by properly using a child passenger restraint device or system meeting applicable federal motor vehicle safety standards. b. Every person transporting a child in a passenger motor vehicle operated on a public roadway, street or highway, shall provide for the protection of the child by properly using a belt positioning booster seat system meeting applicable federal motor vehicle safety standards if the child is at least four years of age, but less than seven years of age and measures less than four feet nine inches in height or weighs less than 65 pounds.

c. Any vehicle equipped with seatbelts is subject to the requirements in items a. and b. above 2. No vehicle shall be occupied by more individuals than its rated capacity. 3. No children shall be transported in the front seat of vehicles equipped with passenger-side airbags. 4. An individual seat restraint must be used for each child. The use of an individual seat restraint for two or more children is not allowed.

**History**
- *Source: Miss. Code Ann. §43-20-8*

##### **15 Miss. Admin. Code Pt. 11, R. 3.15.4** Staff-to-Child Ratio: The staff to child ratio shall be always maintained {#sec-11-3.15.4 omnilex-key=us-ms-regs-official--title-15--11#3.15.4}

The driver of the vehicle shall not be counted as a caregiver while transporting the children.

**History**
- *Source: Miss. Code Ann. §43-20-8 Subchapter 16. DIAPERING AND TOILETING Rule 3.16.1 Diaper Changing Area: A diapering area shall be in a designated place of the home accessible to a hand-washing lavatory with hot and cold running water, a smooth and easily cleanable surface, a plastic-lined, covered garbage receptacle, and sanitizing solution. Refer to the National Resource Center for Health and Safety in Childcare and Early Education for proper diaper changing procedures.*
- *Source: Miss. Code Ann. §43-20-8*

##### **15 Miss. Admin. Code Pt. 11, R. 3.16.2** Rule 3.16.2 {#sec-11-3.16.2 omnilex-key=us-ms-regs-official--title-15--11#3.16.2}

Non-Disposable Diapers and Training Pants: The fecal contents of non-disposable diapers or training pants shall be disposed of into a toilet. The soiled non-disposable diaper or training pants shall then be placed into a plastic bag, sealed, and placed in the child's individual container.

**History**
- *Source: Miss. Code Ann. §43-20-8*

##### **15 Miss. Admin. Code Pt. 11, R. 3.16.3** Rule 3.16.3 {#sec-11-3.16.3 omnilex-key=us-ms-regs-official--title-15--11#3.16.3}

Disposable Diapers: Disposable diapers shall be placed into a plastic bag and sealed or shall be rolled up and taped securely, then placed into a plastic-lined covered garbage receptacle.

**History**
- *Source: Miss. Code Ann. §43-20-8*

##### **15 Miss. Admin. Code Pt. 11, R. 3.16.4** Potty Chairs: Potty chairs, if used, shall be placed in the bathroom area and sanitized after each child’s use {#sec-11-3.16.4 omnilex-key=us-ms-regs-official--title-15--11#3.16.4}

##### **15 Miss. Admin. Code Pt. 11, R. 3.16.5** Parental Consultation: A parent-caregiver consultation is required prior to toilet training {#sec-11-3.16.5 omnilex-key=us-ms-regs-official--title-15--11#3.16.5}

**History**
- *Source: Miss. Code Ann. §43-20-8 Subchapter 17. FEEDING OF INFANTS AND TODDLERS Rule 3.17.1 Hand Washing: Employees shall wash their hands with soap and water and dry their hands with individual or disposable towels before and after each feeding. The infant and toddler's hands shall be washed with soap and water and dried with individual or disposable towels before and after each feeding.*
- *Source: Miss. Code Ann. §43-20-8*

##### **15 Miss. Admin. Code Pt. 11, R. 3.17.2** Bottle Feeding: Infants shall be held while being bottle-fed {#sec-11-3.17.2 omnilex-key=us-ms-regs-official--title-15--11#3.17.2}

Bottles shall not be propped at any time. With parental consent and when infants are old enough to hold their own bottles, they may feed themselves without being held. The bottle shall be removed at once when empty or when the child has fallen asleep.

**History**
- *Source: Miss. Code Ann. §43-20-8*

##### **15 Miss. Admin. Code Pt. 11, R. 3.17.3** Formula Storage: Formula shall be labeled with the child's name, dated, and placed in the refrigerator upon arrival {#sec-11-3.17.3 omnilex-key=us-ms-regs-official--title-15--11#3.17.3}

**History**
- *Source: Miss. Code Ann. §43-20-8*

##### **15 Miss. Admin. Code Pt. 11, R. 3.17.4** Baby Food: Foods stored or prepared in jars shall be served from a separate dish for each infant or toddler {#sec-11-3.17.4 omnilex-key=us-ms-regs-official--title-15--11#3.17.4}

Any leftovers from the serving dish shall be discarded. Leftovers in the jar shall be labeled with the child's name, dated, refrigerated, and used within the next 24 hours or discarded.

**History**
- *Source: Miss. Code Ann. §43-20-8*

##### **15 Miss. Admin. Code Pt. 11, R. 3.17.5** Refrigerator: A refrigerator shall be available and easily accessible to the infant or toddler's room(s) {#sec-11-3.17.5 omnilex-key=us-ms-regs-official--title-15--11#3.17.5}

**History**
- *Source: Miss. Code Ann. §43-20-8*

##### **15 Miss. Admin. Code Pt. 11, R. 3.17.6** Heating Unit and Microwave Use: 1 {#sec-11-3.17.6 omnilex-key=us-ms-regs-official--title-15--11#3.17.6}

A heating unit for warming bottles and food shall be accessible only to adults. 2. Microwave ovens shall not be used for warming bottles or baby/infant food.

**History**
- *Source: Miss. Code Ann. §43-20-8*

##### **15 Miss. Admin. Code Pt. 11, R. 3.17.7** Rule 3.17.7 {#sec-11-3.17.7 omnilex-key=us-ms-regs-official--title-15--11#3.17.7}

Breast-Feeding Accommodations and Staff Training: This section applies to all mothers choosing to breast-feed their child regardless of the child’s age. 1. Breast-feeding mothers, including employees, shall be provided a sanitary place that is not a toilet stall to breast-feed their child or to express milk. This area shall provide an electrical outlet, comfortable chair, and nearby access to running water. 2. A refrigerator must be available to accommodate storage of expressed breast milk. It is acceptable to store expressed milk in the same refrigerator as other milk/bottles provided each bottle is appropriately labeled with the child’s name and the time of expected expiration of the milk. Milk must be stored in accordance with the American Academy of Pediatrics and Centers for Disease Control guidelines.

**History**
- *Source: Miss. Code Ann. §43-20-8 Subchapter 18. SWIMMING AND WATER ACTIVITIES Rule 3.18.1 General: This section shall apply to any childcare family home that, as part of its program, allows the children to swim, wade, or participate in any water activities whether on-site or at any other location during the time staff has responsibility for children enrolled.*
- *Source: Miss. Code Ann. §43-20-8*

##### **15 Miss. Admin. Code Pt. 11, R. 3.18.2** Lifeguard Supervision: 1 {#sec-11-3.18.2 omnilex-key=us-ms-regs-official--title-15--11#3.18.2}

Swimming pools, lakes, etc.: a. A person having an American Red Cross lifeguard certificate, or the equivalent as recognized by the licensing agency, shall be present at all swimming and water activities. b. Lifeguards, or the equivalent as recognized by the licensing agency, are not counted in the staff-to-child ratio. c. The staff-to-child ratio shall be always maintained. d. Staff, as well as lifeguards, shall be responsible for enforcing general safety rules. e. Staff is responsible for requiring children to obey all swimming/water rules. These rules shall be explained each day that swimming/water activities occur so that all ages can

understand what is expected. 2. Wading pools: For activities taking place in wading pools with a water depth of one foot or less the following is required: a. There shall always be a person(s) with a valid CPR and first aid certificate present. b. The staff-to-child ratio shall be always maintained. c. Wading pools shall be cleaned after each use.

**History**
- *Source: Miss. Code Ann. §43-20-8*

##### **15 Miss. Admin. Code Pt. 11, R. 3.18.3** Health and Safety: 1 {#sec-11-3.18.3 omnilex-key=us-ms-regs-official--title-15--11#3.18.3}

Swimming pools equipped with a diving board shall be level. All diving boards shall be installed in accordance with manufacturer’s guidelines. 2. Swimming pools, when in use, shall be properly maintained and monitored for appropriate concentration of disinfectant based on the manufacturer’s guidelines. 3. A testing kit for measuring the concentration of the disinfectant, shall be available at each swimming pool. 4. The water in a swimming pool shall have sufficient clarity to ensure visibility to the floor of the pool. The pool shall be closed immediately if this requirement cannot be met.

2. A separate area shall be available for providing privacy for diapering, dressing, and other personal care procedures.

**History**
- *Source: Miss. Code Ann. §43-20-8 Subchapter 19. CHILDREN WITH SPECIAL NEEDS Rule 3.19.1 Family Home Adaptation: 1. The family home areas to be utilized by a child with special needs shall be adapted as necessary to accommodate special devices that may be required for the child to function independently, as appropriate.*
- *Source: Miss. Code Ann. §43-20-8*

##### **15 Miss. Admin. Code Pt. 11, R. 3.19.2** Activity Plan: A child with special needs shall have an individual activity plan {#sec-11-3.19.2 omnilex-key=us-ms-regs-official--title-15--11#3.19.2}

The individual activity plan shall have been developed by a person with a bachelor’s or advanced degree in a discipline dealing with disabilities, as appropriate. The individual activity plan shall be reviewed, at a minimum, once every 12 months.

**History**
- *Source: Miss. Code Ann. §43-20-8*

##### **15 Miss. Admin. Code Pt. 11, R. 3.19.3** Rule 3.19.3 {#sec-11-3.19.3 omnilex-key=us-ms-regs-official--title-15--11#3.19.3}

Caregiver Staff Development: Caregivers serving children with special needs shall receive staff development related to the specific needs of the children served.

**History**
- *Source: Miss. Code Ann. §43-20-8*

##### **15 Miss. Admin. Code Pt. 11, R. 3.19.4** Staffing: Caregiver staffing shall be appropriate and adequate to {#sec-11-3.19.4 omnilex-key=us-ms-regs-official--title-15--11#3.19.4}

meet the specific physical and/or developmental needs of the special needs children served at the childcare home. Staff-to-child ratio shall be determined by the needs of the child rather than child’s chronological age as

based upon the child’s individual plan (individual education plan, individual habilitation plan, individual family service plan, etc.). The family home is encouraged to be an active participant in the child’s individual plan development.

2. Whenever a license is to be suspended, the operator or director shall be notified in writing that the license, upon service of the notice, is immediately suspended. The notice shall contain the reason for the emergency suspension, and shall set a date for a hearing, which shall be within 14 days of the service of notice.

**History**
- *Source: Miss. Code Ann. §43-20-8 Subchapter 20. HEARINGS, EMERGENCY SUSPENSIONS, LEGAL ACTIONS AND PENALTIES Rule 3.20.1 Emergency Suspensions of License: 1. Any license issued pursuant to these regulations may be suspended prior to a hearing if the licensing agency has reasonable cause to believe that the operation of the childcare family home constitutes a substantial hazard to the health or safety of the children cared for by the childcare family home.*
- *Source: Miss. Code Ann. §43-20-8*

##### **15 Miss. Admin. Code Pt. 11, R. 3.20.2** Rule 3.20.2 {#sec-11-3.20.2 omnilex-key=us-ms-regs-official--title-15--11#3.20.2}

Denial, Revocation, or Suspension of License: The licensing agency may deny, refuse to renew, suspend, revoke, or restrict a license of any childcare family home upon one or more of the following grounds: 1. Fraud, misrepresentation, or concealment of a material fact by the operator in securing the issuance or renewal of a license. 2. Conviction of an operator of any crime, if the licensing agency finds that the acts of which the operator has been convicted could have a detrimental effect on the children cared for by the childcare family home. 3. Violation of any of the provisions of the act or of these rules and regulations. 4. Any conduct or failure to act, which is determined by the licensing agency to threaten the health or safety of a child. 5. Failure by the childcare family home to have all criminal records and child abuse central registry checks on file at the family home. 6. Information received by the licensing agency as a result of the criminal

records check or the child abuse central registry check on an operator.

**History**
- *Source: Miss. Code Ann. §43-20-8*

##### **15 Miss. Admin. Code Pt. 11, R. 3.20.3** Rule 3.20.3 {#sec-11-3.20.3 omnilex-key=us-ms-regs-official--title-15--11#3.20.3}

Notification: Prior to the denial, refusal to renew, suspension, revocation or restriction of a license, and at the time of the imposition of any monetary penalty, written notice of the contemplated action shall be given to the applicant or person named on the license of the childcare family home, at the address on record with the licensing agency. Such notice shall specify the reasons for the proposed action and shall notify the operator of the right to a hearing on the matter.

**History**
- *Source: Miss. Code Ann. §43-20-8*

##### **15 Miss. Admin. Code Pt. 11, R. 3.20.4** District Level Hearing for Monetary Penalties: 1 {#sec-11-3.20.4 omnilex-key=us-ms-regs-official--title-15--11#3.20.4}

If requested in writing within ten calendar days of receipt of notice of the imposition of a monetary penalty, a district level hearing shall be provided in which the operator or applicant may show cause why the monetary penalty should not be imposed. The District Health Officer or his/her designee will preside at said hearing. 2. Any hearing requested shall be held no less than five calendar days and no more than 20 calendar days from the receipt of any request for a hearing, unless both parties agree to an alternate period. 3. The district level hearing shall be informal. There will be no court reporter present and the Department will not be represented by counsel. However, the hearing officer will take notes of the proceedings and will provide the licensee with a written order outlining his decision within ten calendar days of conclusion of the district level hearing. 4. Within ten calendar days of the receipt of the district level decision the licensee may make a written request for a hearing at the state level.

**History**
- *Source: Miss. Code Ann. §43-20-8*

##### **15 Miss. Admin. Code Pt. 11, R. 3.20.5** State Level Hearing: 1 {#sec-11-3.20.5 omnilex-key=us-ms-regs-official--title-15--11#3.20.5}

If requested in writing within ten calendar days of receipt of a notice of revocation, non-renewal, probation, or suspension, or after a district level hearing has been held on a monetary penalty, a hearing shall be held at the state level. At the state level hearing a hearing officer shall be appointed by the State Health Officer. A court reporter shall transcribe the proceeding. The hearing shall be held within 30 calendar days of receipt of the request for such hearing, unless waived in writing by the licensee. 2. Within 30 calendar days of the hearing, or such period as determined during the hearing, written findings of fact, together with a recommendation for action, shall be forwarded to the State Health

Officer. The State Health Officer shall decide what, if any, action is to

be taken on the recommendation within 14 calendar days of receipt of the recommendation. Written notice of the decision of the State Health Officer shall be provided to the operator. 3. At the state level hearing, the licensee shall be entitled to legal representation at his or her own expense.

**History**
- *Source: Miss. Code Ann. §43-20-8*

##### **15 Miss. Admin. Code Pt. 11, R. 3.20.6** Appeal: 1 {#sec-11-3.20.6 omnilex-key=us-ms-regs-official--title-15--11#3.20.6}

Any operator who disagrees with or is aggrieved by a decision of the licensing agency concerning the suspension, revocation, or restriction of a license may appeal to the Chancery Court of the county in which the childcare family home is located. The appeal shall be filed no later than 30 calendar days after the operator receives written notice of the final administrative action by the licensing agency as to the suspension, revocation, or restriction of the license. The operator shall have the burden of proving that the decision of the licensing agency was not in accordance with applicable law and these regulations. 2. If a family home is allowed to continue to operate during the appeal process, it will remain under the regulation of the licensing agency and will be subject to all current licensure regulations to include, but not limited to, inspection of the family home, review of family home and children’s records, submission of all required or requested documents, and payment of all applicable fees and/or monetary penalties.

**History**
- *Source: Miss. Code Ann. §43-20-8*

##### **15 Miss. Admin. Code Pt. 11, R. 3.20.7** Rule 3.20.7 {#sec-11-3.20.7 omnilex-key=us-ms-regs-official--title-15--11#3.20.7}

Injunction: Notwithstanding the existence of any other remedy, the licensing agency may, in the manner provided by law, in term time or in vacation, upon the advice of the Attorney General who shall represent the licensing agency in the proceedings, maintain an action in the name of the state for injunction or other proper remedy against any person to restrain or prevent the establishment, conduct, management, or operation of a childcare family home with or without a license under the act, or otherwise in violation of these regulations.

**History**
- *Source: Miss. Code Ann. §43-20-8*

##### **15 Miss. Admin. Code Pt. 11, R. 3.20.8** Rule 3.20.8 {#sec-11-3.20.8 omnilex-key=us-ms-regs-official--title-15--11#3.20.8}

Criminal Penalties: Any person establishing, conducting, managing, or operating a childcare family home without a license pursuant to these regulations shall be guilty of a misdemeanor, and, upon conviction, shall be fined not more than one hundred dollars ($100.00) for the first offense, and not more than two hundred dollars ($200.00) for each subsequent offense.

**History**
- *Source: Miss. Code Ann. §43-20-8*

##### **15 Miss. Admin. Code Pt. 11, R. 3.20.9** Rule 3.20.9 {#sec-11-3.20.9 omnilex-key=us-ms-regs-official--title-15--11#3.20.9}

Violations and Penalties: In the event of an emergency occurring at a childcare family home which makes it difficult or impossible to comply with any of these Rules, the family home shall not be in violation of those specific Rules. The term “emergency” shall include only the following: 1. Inclement weather; 2. Damage to the family home and/or structure which might require moving, transferring or consolidation of children; 3. Traumatic injury or acute illness of a caregiver or the caregiver’s immediate family while the caregiver is on-site resulting in the caregiver having to leave the premises; 4. Declaration of a state of emergency by local or state officials; 5. An injury or illness of a child at the family home requiring the immediate attention of one or more caregivers, resulting in non- compliance of child-to-staff ratio or room ratio; and/or 6. During a period when licensing agency inspectors or other government officials require childcare family home staff to temporarily not be able to perform their normal supervisory duties. Any violation of these regulations, in the discretion of the licensing agency, is punishable by a monetary penalty. Subchapter 21. RELEASE OF INFORMATION Rule 3.21.1 Information in the possession of the licensing agency concerning the license of individual childcare family homes may be disclosed to the public, except such information shall not be disclosed in such manner as to identify children or families of children cared for at a childcare family home. Nothing in this section shall affect the agency’s authority to release findings of investigation into allegations of abuse pursuant to either Sections 43-21- 353(8) and Section 43-21-257 Mississippi Code of 1972, annotated.

APPENDIX A

Nutritional Standards for Family Childcare Home Meals shall meet the nutritional standards as prescribed in this section. A childcare family home shall provide adequate and nutritious meals prepared in a safe and sanitary manner. Healthy diets help children grow, develop, and perform well in learning environments. Proper nutritional care during the early years is essential for intellectual, social, and emotional growth. It is also necessary that a meal environment be provided which encourages the development of good eating habits. Nutritional Goals: 1. Menus shall be nutritionally adequate. 2. Foods shall be provided in quantities that balance energy and nutrients with children’s ages, appetites, activity levels, special needs, and cultural and ethnic differences in food habits. 3. Parents shall be involved in the nutrition component of the childcare family home. 4. A variety of fruits, vegetables, and whole-grain products shall be offered to children for meals and snacks. Mealtime should be used as an opportunity to teach nutrition concepts. 5. The addition of fat, sugar, and sources of sodium shall be minimal in food preparation and service. 6. Food preparation and service shall be consistent with best practices for food safety and sanitation. 7. Furniture and eating utensils shall be age-appropriate and developmentally suitable to encourage children to accept and enjoy mealtime. 8. Childcare caregivers shall encourage positive experiences with food and eating. 9. Childcare family homes shall obtain assistance as needed from the MSDH Childcare Licensure Bureau. 10. Nutrition education for children and for their parents shall be encouraged as a component of the childcare program.

11. Family style dining is encouraged.

Mealtime Environment: 1. Meals and snacks shall be served at regularly scheduled times each day. 2. Age-appropriate utensils, plates, bowls, cups, and dining area shall be provided. 3. Children shall not wait longer than fifteen minutes at the table for food to be served. 3. Sufficient time shall be allowed for children to wash their hands and prepare for the meal. 4. Mealtime shall be used for socialization, and shall be a relaxed, happy time for the children. No televisions, videos, or DVD’s may be viewed during meal and snack times. 5. Family style dining is encouraged with serving platters, bowls, and pitchers on the table so that everyone can serve him/herself. Children are encouraged to assist with table setting. 6. A caregiver shall sit and join the children while they are eating. It is suggested that the staff eat the same food items that are served to the children. The staff will encourage social interaction, conversation, and use the mealtime for education purposes. Extra assistance and time shall be provided for slow eaters. 7. Additional servings shall be provided for the child who requests more food at a meal or snack. This is a time to teach children on portion control, monitoring extra intake, and better food selections. 9. Meals and snacks provided by a parent must not be shared with other children, unless a parent is providing baked goods for a celebration or party being held at the operation. 10. Children will be permitted in meal preparation areas when under the direct supervision of a staff person, when there is no danger of injury from equipment, and for instruction/teaching purposes only. Choking Prevention 1. Raw vegetables and foods that may cause choking in young children shall not be served to children less than two years of age.

2. Children should be encouraged to eat slowly, take small bites, and chew well before swallowing. 3. Cook food until soft and cut into thin slices or small pieces. Remove bones from meat, chicken, and fish, and remove seeds and pits from fruit. With toddlers, cutting foods into “pea” size is recommended. FOODS THAT MAY CAUSE CHOKING Sausage shaped meats (hot dogs)* Pop Corn Hard Candy* Chips* Nuts Dried Fruits Grapes Chunks of peanut butter Gum* Marshmallows Thick Pretzels Rods* Thin pretzel sticks and rounds would be allowed. *Not allowed to be served Child Requiring a Special Diet: A child requiring a special diet due to medical reasons, allergic reactions, or religious beliefs, shall be provided meals and snacks in accordance with the child's needs. If medical reasons exist for the special diet, a medical diagnosis from the child’s physician stating that the special diet is medically necessary is required. Information required for dietary modifications include: • Child’s full name and date of instructions, updated annually • Any dietary restrictions based on the special needs • Any special feeding or eating utensils • Any foods to be omitted from the diet and any foods to be substituted • Limitations of life activities • Any other pertinent special needs information • What, if anything, needs to be done if the child is exposed to restricted foods. 1. Religious or ethnic requests should include the above information as needed, plus a certified statement of request based upon the religious or ethnic beliefs of the family. 2. The child’s parent shall meet with the operator to review the written

instructions. 3. Parents of children with severe restrictions and special dietary needs will need to provide written documentation to the operator. 4. The childcare family home may request the parent to supplement food served by the childcare family home. When food is supplied by the parent, the childcare family home shall be responsible for assuring that it is properly stored and served to the child in accordance with the diet instructions on file. Meals and snacks provided by a parent must not be shared with other children, unless a parent is providing baked goods for a celebration or party being held at the operation. 5. Records of food intake shall be maintained when indicated by the child's physician. 6. Request for a vegetarian/vegan diet shall be accommodated with the same information completed as for dietary modifications. Specialty items may be supplied by the parent to meet nutritional needs. Infants 1. Breast milk or formula shall be brought to the childcare family home daily, ready to be warmed and fed. Each bottle shall be labeled with the infant's name and the date. No cereal, juice or other foods may be added to the infant’s breast milk/formula without a physician’s written request. 2. Bottles should not be warmed in the microwave. 3. At the end of each feeding, discard any milk left in the bottle. Staff will send all used bottles home with the parent for proper cleaning and sanitizing. 4. Age-appropriate solid foods (complimentary foods) may be introduced no sooner than when the child has reached four months of age, but ideally at six months. The first food introduced usually is cereal mixed with breast milk or formula (not in a bottle). Adding juice to dry cereal is not allowed. 5. Commercially prepared baby foods shall be brought in unopened jars and labeled with the infant's name. A childcare family home may choose to mash and puree the foods served to older children for the infants seven months to one year. No additional juice, sauces, or fats may be added to the pureed foods. 6. Iron-fortified dry infant cereal shall be brought in sealed container premeasured for each feeding and labeled with the infant’s name. 7. Breast milk is the recommended feeding for infants and should be

encouraged and supported by childcare family home personnel. The mother may choose to come to the childcare family home to nurse her infant or may choose to supply bottles of expressed breast milk for the childcare personnel to feed the infant. To help a mother be successful with breastfeeding the childcare family home may provide the following:

• A quiet, comfortable and private place for feeding. • A place to wash the hands. • A comfortable chair, stool for feet while breast feeding. 8. If infant is breast-fed, encourage the mother to provide a back-up supply of frozen breast milk that is labeled with the infant’s name and date of expression. The mother’s expressed milk shall be used for her infant only. 9. Refer to the Centers for Disease Control for guidelines on the storage and preparation of breast milk. 10. For a breast fed infant, it is acceptable to introduce iron-fortified cereal earlier, at four months if desired, but preferably at 6 months. 11. A written schedule for feeding a breast-fed infant shall be provided by the parent and posted for reference by the childcare family home staff. 12. Feeding should be by hunger cues whenever possible. Hunger cues may include: • Sucking on tongue, lips, hands, or fingers while asleep • Moving his arms and hands toward mouth • Restless movements while asleep • Opening mouth when his lips are touched • “Rooting” or searching for the nipple 13. Infants are fed when hungry by noting hunger cues, such as crying, being restless. Feeding is stopped when it is determined that the infant is satisfied. Signs of satiety include, refusing the nurse, turning away from the nipple, falling asleep. 14. Infants shall be held cradled in the arms during feeding. At no time shall an infant be fed by propping a bottle.

15. Introduction of solid foods to an infant should be done in consultation with the parent. 16. Juice shall not be served to infants (children less than 12 months of age). 17. A small amount of water is encouraged at 8-12 months. 18. Solid foods must be spoon-fed. No solid food shall be fed by bottle or infant feeder without written direction from a physician. 19. Infants are encouraged to start using a cup at six to nine months, based upon motor skills. By the age of one, all children should be off a bottle. 20. Older infants are encouraged to hold and drink from cups and to use child appropriate eating and serving utensils. Self-feeding should be encouraged. 21. Breast milk or formula is served to at least 12 months of age. Children ages one to two, shall be served whole milk, after age two, toddlers should be served fat-free/skim milk or 1% milk. 22. When centers are reimbursed for meals and must supply formula for their infants, only ready to use formula may be purchased for use. The center may require the parents to supply clean bottles daily. If the center supplies the bottles, there must be provisions in place for the proper cleaning, sanitizing, and drying of all bottles and supplies outside of the infant room. Meal Planning for Infants through One Year 1. Infant food needs are based on the amount of time spent in the childcare family home. 2. Any infant in a childcare family home at the time of a meal or snack, shall be served foods appropriate to age. Meal/Snack Birth through 5 Months 6 Months through 12 Months Breakfast 4-6 fl. oz. breast milk or formula 6-8 fl. oz. breast milk or formula 2-4 Tbsp. prepared infant cereal (optional) 1-4 Tbsp. fruit and/or Vegetable (infant or mashed)

Lunch or Supper 4-6 fl. oz. breast milk or formula 6-8 fl. oz. breast milk or formula 2-4 Tbsp. prepared infant cereal (optional) 1-4 Tbsp. fruit and/or vegetable (infant or mashed) 1-4 Tbsp. infant meat Supplement/Snack 4-6 fl. oz. breast milk or formula 2-4 fl. oz. breast milk or formula 0-1/2 dry bread or 0-2 crackers (optional) Meal Schedule for Children One year and older: 1. Children’s food needs are based on the amount of time spent in the childcare family home. 2. Any child in a childcare family home at the time of a meal or snack will be served that meal or snack. IF YOU ARE OPEN YOU MUST SERVE Nine hours or less Two snacks and one meal OR One snack and two meals Over nine hours Two snacks and two meals OR Three snacks and one meal 24 hours or during all meals Three meal and three snacks: one snack should be a late night snack only served to children who are awake. Parties and Special Occasions: Parties and party events should not be held more than once a month. Meal Planning for Children in Family Childcare Homes: Breakfast/Lunch/Dinner/Snack

Milk: Milk shall be served at breakfast, lunch, and dinner. The milk shall be pasteurized fluid milk, fortified with vitamin A and D. Whole milk is served to infants and toddlers less than two years of age. After age two fat-free/skim milk or 1% milk shall be served. Milk alternatives may be served when indicated with dietary restrictions. Provisions must be made to serve calcium in alternate forms when no milk/substitute may be served to the child due to dietary restrictions.

If a child cannot be served milk for medical reasons or upon parent’s instructions, then that child is not to be served high content milk products, e.g., pudding, ice cream, cheese, etc. Bread and Bread Alternates: Use enriched whole-grain breads and bread alternatives. Dry cereals need to be high fiber and not sugar coated. Whole grain pasta, noodles, or brown rice are encouraged at all meals. The following breakfast breads may be served: muffin, biscuit, toast, breakfast bread, pancake or waffle. These items should be limited: doughnuts, honey buns, breakfast tarts, pastries, packaged snack cakes, and other high fat/sugar foods. Plain, low sugar type cookies and snacks, including animal crackers, graham crackers, vanilla wafers, oatmeal, oatmeal raisin, peanut butter, low-fat granola bars, whole grain fruit and cereal bars, and Rice Krispie treats, and ginger snaps may be served as a snack occasionally. Other snack suggestions include cheddar cheese, plain or vegetable flavored crackers or trail mix made of various dry, no sugar-coated cereals, dried fruits, and small marshmallows Items that may not be served include chocolate chip cookies and most pre-packaged cookies/snack cakes. Fruits and Vegetables: Use fresh, canned, dried, or frozen fruit for every meal. No sugar may be used in the packaging or preparation of the fruit. Canned or frozen fruit should be packed in juice or water - not syrup or sugar packed. Vegetables may be used for the breakfast meal. Serve a variety of fruits and vegetables. Use a different combination of two or more fruit/vegetables during meals. Use fresh, canned, dried, or frozen vegetables and fruits for meals. Avoid serving two forms of the same fruit or vegetable in the same day. Limit serving starchy vegetables. Starchy vegetables include white/sweet potatoes, lima beans, butter beans, English peas, black-eye peas, field peas, crowder peas, cream and whole kernel corn, and any dried bean/pea (unless counted for a meat alternate). The use of high sodium/salt and high fat seasonings should be limited. Fruit juice (100%) is allowed once a day.

Water: Water is to be made available with all meals and snacks. Tap or bottled water may be served. Water should be encouraged before and after all meals and snacks. Meat and Meat Alternates: Meats and meat alternates that would be acceptable include eggs, fat-free yogurt, low-fat cheese, fat-free cottage cheese, lean ham, Canadian bacon, and peanut butter. Bacon is not considered a meat and shall not be served infrequently. Edible portion for meats and meat alternates is used. No bones may be served. One ounce of cooked meat is equal to one medium cooked chicken leg with bone removed. Processed, pre-fried meats should be limited due to the sodium/salt and fat content. Meats not allowed include hot dogs, corndogs, bologna, bacon, sausage, pancake sticks, small chicken nuggets, fish sticks, and steak fingers. Processed cheese, such as cheese spread, canned cheese sauce, and cheese in packaged snack crackers is not allowed. Low-fat or fat-free cheese can be served. Serving nuts and seeds is not recommended due to the prevalence of nut/seed allergies.

VITAMIN C SOURCES VITAMIN C SOURCE MUST BE SERVED DAILY **BEST CHOICE *GOOD CHOICE #ACCEPTABLE CHOICE (ONLY COUNT FOR A VITAMIN SOURCE ONCE PER WEEK) Fruits Vegetables Food Serving Size

Food Serving Size

Blackberries ¼ c. # Asparagus ¼ c. * Blueberries ¼ c. # Artichoke ¼ medium * Cantaloupe ¼ c ** Bok Choy ¼ c. * Grapefruit ¼ medium ** Broccoli ¼ c. ** Grapefruit Juice ½ c ** Brussel Sprouts ¼ c. ** Grapefruit-Orange Juice ½ c. ** Cabbage ¼ c. * Guava ¼ c. ** Cauliflower ¼ c. * Honeydew Melon ½ c. * Chicory ¼ c. * Kiwi ½ medium ** Collard Greens ¼ c. * Mandarin Orange Sections ¼ c. * Kale ¼ c. # Mango ¼ medium * Kohlrabi ¼ c. ** Melon balls ¼ c. *

Orange ½ medium ** Mustard Greens ¼ c. # Orange Juice ¼ c. ** Okra, not fried ¼ c. # Papaya ¼ c. * Peppers, green & red ¼ c. ** Peach, frozen only ¼ c. ** Potato, White, or Red Skinned Baked only-no instant/fries/tots ½ medium *

Pineapple ¼ c. # Rutabagas ¼ c. # Pineapple Juice ¼ c. * Snow Peas ¼ c. # Pineapple- grapefruit or orange juice ¼ c. ** Spinach ¼ c. # Raspberries ¼ c. * Sweet Potato ½ medium * Starfruit ¼ c. # Tomato ½ medium * Strawberries ¼ c. ** Tomato or V-8 Juice ¼ c. ** Tangelo ½ medium ** Turnip Greens ¼ c. * Tangerine ½ medium ** Miscellaneous Tropical fruit mix ¼ c. *

Watermelon ½ c. # Liver, beef 1 oz. **

VITAMIN A SOURCES VITAMIN A SOURCE MUST BE SERVED EVERY OTHER DAY, 3 TIMES PER WEEK ** BEST CHOICE * GOOD CHOICE #ACCEPTABLE CHOICE (ONLY COUNT FOR A VITAMIN SOURCE ONCE PER WEEK) Fruits Vegetables Food Serving Size

Food Serving Size

Avocado ¼ medium # Asparagus ¼ c. # Apricot 2 halves * Artichoke ½ medium # Cantaloupe ¼ c. * Bok Choy ¼ c. * Cherries, red sour ¼ c. * Broccoli ¼ c. * Mandarin Orange Segments ¼ c. * Brussels Sprouts ¼ c. * Mango ¼ medium ** Carrots ¼ c. ** Melon Balls ¼ c. * Collard Greens ¼ c. ** Nectarine ¼ medium #

Papaya ¼ c. * Kale ¼ c. ** Peaches ¼ c. # Lettuce, Green, Romaine, or Red - NOT Iceberg ½ c. # Plantain ¼ c. # Mixed Vegetables ¼ c. ** Prunes ¼ c. * Mustard Greens ¼ c. ** Tangerine ½ medium * Okra, not fried ¼ c. #

Peas & Carrots ¼ c. **

Peppers, red ¼ c. **

Miscellaneous Pumpkin ¼ c. ** Egg 1 medium * Rutabagas ¼ c. # Liver, beef 1 oz. ** Spinach ¼ c. ** Liver, chicken 1 oz. ** Sweet Potato ½ medium **

Tomato or V-8 Juice ¼ c. **

Turnip Greens ¼ c. **

Winter Squash, Butternut or Hubbard ¼ c. **

APPENDIX B CLEANING AND DISINFECTION PROCEDURES Keeping the childcare environment clean is very important for the health and safety of both children and providers. One of the most important steps in reducing the number of germs, and therefore the spread of disease, is the thorough cleaning of surfaces that could possibly pose a risk to children or staff. Surfaces considered most likely to be contaminated are those which the children are most likely to have close contact. These include toys that children put in their mouths, crib rails, food preparation areas, and other surfaces, such as diaper-changing areas. Routine cleaning with soap and water is the most useful method for removing germs from surfaces in the childcare setting. Physically scrubbing with soap and water reduces the number of germs from the surface, just as hand washing reduces the numbers of germs from the hands. Removing germs in the childcare setting is especially important for soiled surfaces which cannot be treated with chemical disinfectants, such as some upholstery fabrics. However, some items and surfaces should receive an additional disinfection, to kill germs after cleaning with soap and rinsing with clean water. Items that can be washed in a dishwasher on the hot cycle of a washing machine are not required to be disinfected because these machines use high temperature water for a period long enough to kill most germs. The disinfection process uses chemicals that are stronger than soap and water. Disinfection also usually requires soaking the item for several minutes to give the chemical time to kill the remaining germs. Commercial products that meet the Environmental Protection Agency’s (EPA) standards may be used for this purpose. One of the most used chemicals for disinfection in childcare settings is a homemade solution of household bleach and water. The solution of bleach and water is easy to mix, is nontoxic, is safe if handled properly, and kills most infectious agents. Be aware that some infectious agents are not killed by bleach. A solution of bleach and water loses its strength quickly and easily. It is weakened by organic material, evaporation, heat, and sunlight. Therefore, bleach solutions should be mixed fresh each day to ensure its effectiveness. Any leftover solution should be discarded at the end of the day. NEVER mix bleach with anything but fresh tap water! Other chemicals may react with bleach and create and release a toxic gas. Keep the bleach solution you mix each day in a cool, dry place out of direct sunlight and out of the reach of children. If a childcare family home uses a commercial cleaner, sanitizer, or disinfectant it must be a EPA registered product that has an EPA registration number on the label. Such products shall only be used according to the manufacturer’s instructions. NOTE: All EPA-registered products may not be appropriate for use in a childcare family home. Therefore, it is the responsibility of the operator to make sure any product use is appropriate for use in a childcare family home. Recipe for Bleach Disinfecting Solution

For use on non-porous surfaces such as diaper change tables, counter tops, door cabinet handles toilets, etc. 1/3 cup or 5 tablespoons bleach added to 1 gallon of cool water OR

teaspoo ns bleach added to 1 quart of cool water Recipe for Weaker Bleach Sanitizing Solution For food contact surfaces sanitizing, e.g., dishes, utensils, cutting boards, highchair trays, toys that children may place in their mouths, and pacifiers.

tablespo on bleach added to 1 gallon of cool water Washing and Disinfecting Toys Infants and toddlers should not share toys. Toys that children (particularly infants and toddlers) put in their mouths should be washed and disinfected between uses by individual children. Toys for infants and toddlers should be chosen with this in mind. If you cannot wash a toy, it probably is not appropriate for an infant or toddler. When an infant or toddler finishes playing with a toy, you should retrieve it from the play area and put it in a bin reserved for dirty toys. This bin should be out of reach of the children. Toys can be washed at a later, more convenient time, and then transferred to a bin for clean toys and safely reused by the other children.

To wash and disinfect a hard plastic toy: • Scrub the toy in warm, soapy water. Use a brush to reach into the crevices. • Rinse the toy in clean water. • Immerse the toy in a mild bleach solution (see above) and allow it to soak in the solution for 10-20 minutes. • Remove the toy from the bleach and rinse well in cool water. • Air dry. Hard plastic toys that are washed in a dishwasher or cloth toys washed in the hot water cycle of the hot water cycle of a washing machine do not need to be additionally disinfected. Children in diapers should only have washable toys. Each group of children should have its own toys. Toys should not be shared with other groups. Stuffed toys used by only a single child should be cleaned in a washing machine every week or more frequently if heavily soiled. Toys and equipment used by older children and not put into their mouths should be cleaned at a minimum of weekly and/or when soiled. A soap and water wash followed by clear water rinsing and air drying should be adequate. No disinfection is required. (These types of toys and equipment include blocks, dolls, tricycles, trucks, and other similar toys.). Do not use wading pools for children in diapers. Water play tables can spread germs. To prevent this: • Disinfect the table with chlorine bleach solution before filling it with water. • Disinfect all toys to be used in the table with chlorine bleach solution. Avoid using sponge toys. They can trap bacteria and are difficult to clean. • Have all children wash their hands before and after playing in the water table. • Do not allow children with open sores or wounds to play in the water table. • Carefully supervise the children to make sure they do not drink the water. • Discard the water after play is over.

Washing and Disinfecting Bathroom and Other Surfaces Bathroom surfaces, such as faucet handles and toilet seats, should be washed and disinfected several times a day, if possible, but at least once a day or when soiled. The bleach and water solution or chlorine-containing scouring powers or other commercial bathroom surface cleaner/disinfectants can be used in these areas. Surfaces that infants and young toddlers are likely to touch or mouth, such as crib rails, should be washed with soap and water and disinfected with a nontoxic disinfectant, such as bleach solution, at least once every day, more often if visibly soiled. After the surface has been cleaned with the disinfectant, it should be thoroughly wiped with a fresh towel moistened with tap water. Be sure not to use a toxic cleaner on surfaces likely to be mouthed. Floors should be washed and disinfected at least once a day and whenever soiled. Washing and Disinfecting Diaper Changing Areas Diaper Changing Areas should: • Only be used for changing diapers. • Be smooth and nonporous, such as Formica (NOT wood). • Have a raised edge or low fence around the area to prevent a child from falling off. • Be next to a sink with hot and cold running water. • Not be used to prepare food, mix formula, or rinse pacifiers. • Be easily accessible to providers. • Be out of reach of children. Diaper changing areas should be cleaned and disinfected after each diaper changer as follows: • Clean the surface with soap and water and rinse with clear water. • Dry the surface with a paper towel. • Thoroughly wet the surface with the recommended bleach solution. • Wipe dry with a clean disposable towel or air dry. If using a commercial disinfectant/sanitizer, follow labeled manufacturer’s instructions.

Washing and Disinfecting Clothing, Linen, and Furnishings Do not wash or rinse clothing soiled with fecal material in the childcare setting. You may empty solid stool into the toilet. Put the soiled clothes in a plastic bag and seal the bag to await pick up by the child’s parent or guardian at the end of the day. Always wash your hands after handling soiled clothing. Explain to parents that washing or rinsing soiled diapers and clothing increases the chances that you and the children may be exposed to germs that cause disease. Although receiving soiled clothes is not pleasant, remind parents that this policy protects the health of all children and providers. Each item of sleep equipment, including cribs, cots, mattresses, blankets, sheets, etc., should be cleaned and sanitized before being assigned to a specific child. The bedding should be labeled with that child’s name and should only be used by that child. Children shall not share bedding. Infant linens (sheets, pillowcases, blankets) shall be cleaned and sanitized daily, and crib mattresses shall be cleaned and sanitized weekly or when soiled. Linens from beds of older children shall be laundered at least weekly and whenever soiled. However, if a child inadvertently uses another child’s bedding, you shall change the linen and mattress cover before allowing the assigned child to use it again. Cleaning Body Fluid Spills Spills of body fluids, including blood, feces, nasal and eyed discharges, saliva, urine, and vomit shall be cleaned up immediately. Wear gloves while cleaning. Be careful not to get any of the fluid you are cleaning in your eyes, nose, mouth or any open sores you may have. Clean and disinfect any surfaces, such as counter tops and floors, on which body fluids have been spilled. Discard fluid-contaminated material in a plastic bag that has been securely sealed. Mops used to clean up body fluids should be cleaned, rinsed with a disinfecting solution, wrung dry, and hung to dry. Be sure to wash your hands after cleaning up any spill.

**History**
- *Source: Miss. Code Ann. §43-20-8*
- *Source: Centers for Disease Control*

### **Part 12** Bureau of Emergency Medical Services

##### **15 Miss. Admin. Code Pt. 12, R. 1.1.2** Definitions {#sec-12-1.1.2 omnilex-key=us-ms-regs-official--title-15--12#1.1.2}

EMS Provider Levels of Care

MS EMS provider levels of care, their definitions, and respective scope of practice shall follow nationally recognized levels of care in the field of Emergency Medical Services, as defined in the current iteration of the National EMS Scope of Practice Model. Approved MS EMS education programs shall educate EMS providers in competencies for each respective level of care as prescribed in the current iteration of the National EMS Education Standards. The State EMS Medical Director may approve EMS protocols for ambulance services and Non-Transport EMS entities that follow the National Model EMS Clinical Guidelines. EMS protocols submitted to BEMS for approval shall delineate emergency care authorized for each respective level of EMS provider, not to exceed the National EMS Scope of Practice Model and National Model EMS Clinical Guidelines. State approved nationally recognized levels of EMS provider include: 1. Emergency Medical Responder (titled Medical First Responder) 2. Emergency Medical Technician (EMT) 3. Advanced EMT (AEMT) 4. Paramedic On request of the off-line medical director, and approval of MDTQA, skills beyond those prescribed in the National EMS Scope of Practice Model may be approved at any of the preceding provider levels through the adoption of approved clinical standards; however, the off-line medical director must verify skill competencies annually for any skill approved by MDTQA beyond those included in the National EMS Scope of Practice Model. BEMS shall publish the list of any skills and clinical standards approved beyond those included in the National EMS Scope of Practice Model along with the expected competencies to be verified annually. MS EMS provider levels shall also include EMS Driver and Critical Care Paramedic (as defined in this Part). The following terms shall have the following meanings as used in this Part: 1. "Advanced Life Support" means the provision of an ALS assessment by ALS personnel or the provision of at least one ALS intervention which includes basic life support functions including cardiopulmonary resuscitation( CPR), plus cardiac defibrillation, telemetered electrocardiography, administration antiarrhythmic agents, intravenous therapy, administration of specific medications, drugs and solutions, use of adjunctive ventilation devices, trauma care and other authorized techniques and procedures. Advanced life support (ALS) assessment is an assessment performed by an ALS crew as part of an emergency response that was necessary because the

patient's reported condition at the time of dispatch was such that only an ALS crew was qualified to perform the assessment. An ALS assessment does not necessarily result in a determination that the patient requires an ALS level of service. In the case of an appropriately dispatched ALS emergency service, if the ALS crew completes an ALS assessment, the services provided are at the ALS emergency level. This is regardless of whether the patient required ALS intervention services during the transport and provided the ambulance transportation itself was medically reasonable. 2. "Advanced Life Support personnel" means persons other than physicians engaged in the provision of advanced life support, as defined, and regulated by rules and regulations promulgated pursuant to Section 41-60-13. 3. "Advanced Life Support services" means implementation of the 15 components of an EMS system to a level capability which provides noninvasive and invasive emergency patient care designed to optimize the patient's chances of surviving the emergency situation. Services shall include use of sophisticated transportation vehicles, a communications capability (two-way voice and/or biomedical telemetry) and staffing by Advanced EMTs and Paramedics providing on- site, pre-hospital mobile and hospital intensive care under medical control. 4. "Ambulance" means any privately or publicly owned land or air vehicle that is specially designed, constructed, modified, or equipped to be used, maintained and operated upon the streets, highway or airways of this state to assist persons who are sick, injured, wounded or otherwise incapacitated or helpless, and as required by this Part properly licensed by BEMS.

5. "Ambulance Placement Strategy (System Status Plan)" means a planned outline or protocol governing the deployment and event-driven redeployment of the ambulance service's resources, both geographically and by time-of-day/day-of-week.

6. "Ambulance Post" means a designated location for ambulance placement within the system status plan. Depending upon its frequency and type of use, a "post" may be a facility with sleeping quarters, and/or day rooms for crews, or simply a street-corner or parking lot location to which units are sometimes deployed.

7. "Ambulance Service Area" means the geographic response area of the licensed ambulance service. The service area must correspond to each

individual service license. The service's employee staffing plan, ambulance placement strategy, and available resources must be commensurate with the service area.

8. "Area wide EMS System" means an emergency medical service area (trade, catchment, market, patient flow) that provides essentially all the definitive emergency medical care (95%) for all emergencies, including the most critically ill and injured patients. Only highly specialized and limited-use services may need to be obtained outside of the area. The area must contain adequate population and available medical resources to implement and sustain an EMS operation. At least three major modes exist: (a) multiple urbanized communities and their related suburbs; (b) a metropolitan center and its surrounding rural areas; and (c) a metropolitan center and extreme rural-wilderness settings. The areas may be inter- or intra-state.

9. "Automated External Defibrillator (AED)" means a defibrillator which: a) is capable of cardiac rhythm analysis; b) will charge and deliver a shock after electrically detecting the presence of a cardiac dysrhythmia or is a shock-advisory device in which the defibrillator will analyze the rhythm and display on-screen advising the operator to press a "shock" control to deliver the shock; c) must be capable of printing a post event summary (at a minimum the post event summary should include times, joules delivered, ECG), and d) an on screen display of the ECG (optional).

10. "Basic Life Support Services (BLS)" means implementation of the 15 components of and EMS system to a level of capability which provides pre-hospital noninvasive emergency patient care designed to optimize the patient's chance of surviving the emergency situation. There would be universal access to and dispatch of national standard ambulances, with appropriate medical and communication equipment operated by Emergency Medical Technicians-Ambulance. Regional triage protocols should be used to direct patients to appropriately categorized hospitals.

11. "Board" means the Mississippi State Board of Health.

12. “Bypass” (diversion) means a medical protocol or medical order for the transport of an EMS patient past a normally used EMS receiving facility to a designated medical facility for the purpose for accessing more readily available or appropriate medical care.

13. "Certificate” means official acknowledgment that an individual has successfully completed (i) the recommended basic emergency medical technician training course referred to in this chapter which entitles that individual to perform the functions and duties of an emergency medical technician, or (ii) the recommended medical first responder training

course referred to in this chapter which entitles that individual to perform the functions and duties of a medical first responder.

14. "Critical Care Units (Centers)" means sophisticated treatment facilities in large medical centers and hospitals that provide advanced definitive care for the most critically ill patients. The units are available for the diagnosis and care of specific patient problems including major trauma, burn, spinal cord injury, poisoning, acute cardiac, high-risk infant, and behavioral emergencies.

15. "Communication Resource" means an entity responsible for implementation of direct medical control (See detailed description in section on Medical Direction).

16. "Delegated Practice" means only physicians are licensed to practice medicine. Pre-hospital providers must act only under the medical direction of a physician.

17. “Department” means the Mississippi State Department of Health, Bureau of Emergency Medical Services.

18. "Direct Medical Control" means when a physician provides immediate medical direction to pre- hospital providers in remote locations.

19. “Diversion” - see "Bypass."

20. "DOT" means the United States Department of Transportation.

21. "Emergency Medical Condition" means a medical condition manifesting itself by acute symptoms of sufficient severity, including severe pain, psychiatric disturbances and/or symptoms of substance abuse, such that a prudent layperson who possesses an average knowledge of health and medicine could reasonably expect the absence of immediate medical attention to result in placing the health of the individual (or, with respect to a pregnant woman, the health of the woman or her unborn child) in serious jeopardy, serious impairment to bodily functions, or serious dysfunction of any bodily organ or part;

22. "Emergency Medical Services (EMS)" means services utilized in responding to a perceived individual's need for immediate medical care to prevent death or aggravation of physiological or psychological illness or injury.

23. "EMS Personnel" means key individual EMS providers. This includes physician, emergency, and critical care nurse, EMT, Advanced EMT, Paramedic, dispatchers, telephone screeners, first

aid responders, project administrators and medical consultants and system coordinators.

24. "EMS System" means a system which provides for the arrangement of personnel, facilities, and equipment of the effective and coordinated delivery of health care services in an appropriate geographical area under emergency conditions (occurring as a result of the patient's condition or because of natural disasters or similar conditions). The system is managed by a public or nonprofit private entity. The components of an EMS System include:

A. Manpower

B. Training

C. Communications

D. Transportation

E. Facilities

F. Critical Care Units

G. Public Safety Agencies

H. Consumer Participation

I. Access to Care

J. Patient Transfer

K. Coordinated Patient Recordkeeping

L. Public Information and Education

M. Review and Evaluation

N. Disaster Plan

O. Mutual Aid

25. "Emergency mode" means an ambulance or special use EMS vehicle operating with emergency lights and warning siren (or warning siren and air horn) while engaged in an emergency medical call.

26. "Emergency response" means responding immediately at the basic life support or advanced life support level of service to an emergency medical call. An immediate response is one in which the ambulance supplier begins as quickly as possible to take the steps necessary to respond to the call.

27. "Emergency medical call" means a situation that is presumptively classified at time of dispatch to have a high index of probability that an emergency medical condition or other situation exists that requires medical intervention as soon as possible to reduce the seriousness of the situation, or when the exact circumstances are unknown, but the nature of the request is suggestive of a true emergency where a patient may be at risk.

28. "Executive officer" means the executive officer of the State Department of Health or his designated representative.

29. “Field Categorization” (classification) means a medical emergency classification procedure for patients that is applicable under conditions encountered at the site of a medical emergency.

30. “Field Triage” means classification of patients according to medical need at the scene of an injury or onset of an illness.

31. "First responder" means a person who uses a limited amount of equipment to perform the initial assessment of and intervention with sick, wounded or otherwise incapacitated persons.

32. “Inclusive Trauma Care System” means a trauma care system that incorporates every health care facility in a community in a system in order to provide a continuum of services for all injured persons who require care in an acute care facility; in such a system, the injured patient's needs are matched to the appropriate hospital resources.

33. "Implied Consent" means legal position that assumes an unconscious patient, or one so badly injured or ill that he cannot respond, would consent to receiving emergency care. Implied consent applies to children when a parent or guardian is not at the scene.

34. "Intervener Physicians" means a licensed M.D. or D.O., having not previously established a doctor/patient relationship with the emergency patient and willing to accept responsibility for a medical emergency scene, and can provide proof of a current Medical Licensure.

35. "Lead Agency" means an organization which has been delegated the responsibility for coordinating all components and care aspects for an EMS system.

36. “Level I” means hospitals that have met the requirements for Level I as stated in the Mississippi Trauma Rules and Regulations.

37. “Level II” means hospitals that have met the requirements for Level II as stated in Mississippi Trauma Rules and Regulations.

38. “Level III” means hospitals that have met the requirements for Level III as stated in Mississippi Trauma Rules and Regulations.

39. “Level IV” means hospitals that have met the requirements for Level IV as stated in Mississippi Trauma Rules and Regulations.

40. "Licensure" means an authorization to any person, firm, cooperation, or governmental division or agency to provide ambulance services in the State of Mississippi.

41. "License Location" means a fixed location where the ambulance service conducts business or controls the deployment of ambulances to the service area.

42. “Major Trauma” means that subset of injuries that encompasses the patient with or at risk for the most severe or critical types of injury and therefore requires a system approach in order to save life and limb.

43. “Major Trauma Patient” (or "major trauma" or " critically injured patient") means a person who has sustained acute injury and by means of a standardized field triage criteria (anatomic, physiology, and mechanism of injury) is judged to be at significant risk of mortality or major morbidity.

44. “Mechanism of Injury” means the source of forces that produce mechanical deformations and physiological responses that cause an anatomic lesion of functional change in humans.

45. "Medical Control" means directions and advice provided from a centrally designated medical facility staffed by appropriate personnel, operating under medical supervision, supplying professional support through radio or telephonic communication for on-site and in-transit basic and advanced life support services given by field and satellite facility personnel. Statewide medical control may be approved by BEMS for Primary Agencies of Emergency Support Function 8 (ESF-8) in the Mississippi Comprehensive Emergency Management Plan.

46. "Medical Direction" - (medical accountability) means when a physician is identified to develop, implement, and evaluate all medical aspects of an EMS system.

47. "Medical Director" means (offline, administrative) should be a physician both credible and knowledgeable in EMS systems planning, implementation, and operations. This off-line physician assumes total responsibility for the system's activities. He is appointed by the local EMS lead agency. The administrative medical director works in close

liaison with government agencies, public safety and disaster operations, legislative and executive offices, professional societies, and the public. Off-line program activities include liaison with other state and regional EMS medical directors to conceptualize clinical and component system designs, establish standards, monitor, and evaluate the integration of component and system activities.

A. This off-line physician assures medical soundness and appropriateness of all aspects of the program and is responsible for the conceptual and systems design and overall supervision of the EMS program.

B. The administrative (off-line) medical director develops all area protocols. These protocols serve as the basis for EMS system role definition of EMS personnel, curriculum development, competency determination, and maintenance, monitoring, and evaluation.

C. The off-line medical director meets on a regular basis with on- line medical directors and the EMS training director to evaluate on-line system performance, to review problems, and suggest changes in treatment, triage, or operational protocols. All on- line medical directors must be approved by the off-line medical director.

48. “Mississippi Trauma Advisory Committee” (MTAC) - (See Appendix A) means the advisory body created by legislature for the purpose of providing assistance in all areas of trauma care system development and technical support to the Department of Health; members are comprised of EMS Advisory Council members appointed by the chairman.

49. “Mississippi Trauma Care System Plan” (State Trauma Plan) means a formally organized plan developed by the Mississippi State Department of Health, pursuant to legislative directive, which sets out a comprehensive system of prevention and management of major traumatic injuries.

50. "On-Line (Supervising ALS) Medical Director" means On-Line medical control is provided through designated Primary Resource and Base Station Hospitals under the area direction of a supervisory ALS medical director who is on-line to the pre-hospital system stationed at the designated Base Station Hospital. Each provider of ALS must also have an on-line medical director. The system must also have an on-line medical director for EMS training. These

supervisory medical directors are organizationally responsible to the administrative off-line medical director of the local EMS lead agency for program implementation and operations within his area of jurisdiction.

A. The ALS (on-line) medical director supervises the advanced life support, pre- and inter-hospital system and is responsible for the actual day-to-day operation of the EMS system. He carries out the "EMS systems design" in terms of pre-and inter-hospital transportation care and provides ALS direction to EMS providers depending on the transportation care and provides ALS direction to EMS providers depending on the system's configuration. He monitors all pre- hospital ALS activities within that system's region or area of responsibility. The ALS physician must review and monitor compliance to protocols for both the pre-and inter- hospital settings.

B. The ALS (on-line) medical director in conjunction with the EMS training medical director reviews paramedics, Advanced EMTs, EMTs, mobile intensive care nurses, and physician competencies and recommends certification, re-certification, and decertification of these personnel to the EMS health officer of the lead agency responsible for the certification decertification, and recertification of EMS personnel. Monitoring the competency of all pre- hospital EMS personnel activities is within his responsibility.

C. He or she attends medical control meetings where area system performance and problems are discussed and recommendations to the administrative off-line director are made. He also conducts regular case reviews and other competency evaluation and maintenance procedures and reports back to the administrative (off-line) medical director.

D. This ALS (on-line) physician assumes the supervision and responsibility for all advanced care rendered in an emergency at the scene of an accident and en route to the hospital under his area jurisdiction. Each on-line medical director representing the hospitals providing medical control has the authority to delegate his duties to other emergency department physicians who may be on duty and placed in a position of giving medical direction to pre-hospital ALS personnel.

51. “Pediatric Trauma Center” means either (a) a licensed acute care hospital which typically treats persons fourteen (14) years of age or less, which meets all relevant criteria contained in these Regulations and which has been designated as a pediatric Trauma Center; or (b) the pediatric component of a Trauma Center with pediatric specialist and a pediatric intensive care unit.

52. “Performance Improvement” (or "quality improvement") means a method of evaluating and improving processes of patient care which emphasizes a multi-disciplinary approach to problem solving, and focuses not on individuals, but systems of patient care which might cause variations in patient outcome.

53. "Permit" means an authorization issued for an ambulance vehicle as meeting the standards adopted pursuant to this chapter.

54. "Pre-hospital Provider" means all personnel providing emergency medical care in a location remote from facilities capable of providing definitive medical care.

55. “Protocols” means standards for EMS practice in a variety of situations within the EMS system.

56. “Service Area” (or "catchment area") means that geographic service area defined by the local EMS agency licensure. Statewide medical control may be approved by BEMS for Primary Agencies of Emergency Support Function 8 (ESF-8) in the Mississippi Comprehensive Emergency Management Plan.

57. “Standing Orders” are those specific portions of the treatment protocols that may be carried out by ALS personnel without having to establish contact with medical control facility. These standing orders represent nationally recognized treatment modalities and allow the ALS personnel to treat life-threatening problems without delay.

58. “State EMS Medical Director” means a Mississippi licensed physician, employed by the Mississippi Department of Health, who is responsible for the development, implementation, and evaluation of standards and guidelines for the provision of emergency medical services and EMS medical direction in the state. This physician must have experience in EMS medical direction and be board certified in emergency medicine. This physician must be experienced with EMS systems, EMS medical direction, evaluation processes, teaching, and curriculum development. It is the goal of the State EMS Medical Director to ensure the care delivered by EMS systems in the state is consistent with recognized standards and that quality is maintained in a manner that assures professional and public accountability. The State EMS Medical Director must serve as an advocate for efficient and effective emergency medical services

throughout the state.

The Responsibilities of the State EMS Medical Director include but are not limited to:

A. Oversight of all aspects of EMS Medical direction in the state Oversight of the of standards and minimum qualifications for EMS Medical Directors

B. Approval of Offline Medical Directors for ambulance services

C. Approval of protocols for ambulance services

D. Approve training programs, training standards, and curricula for EMS providers and medical directors

E. Oversight of all aspects of EMS quality assurance and performance improvement in the state

F. Approval of the Quality Assurance and Performance Improvement plans for ambulance services

G. Serve as Chairman of the Committee on Medical Direction, Training, and Quality Assurance

H. Serve as Chairman of the EMS Performance Improvement Committee

I. Serve as Chairman of the EMS Protocol Committee

J. Act as a liaison with public safety and disaster planning agencies

K. Act as a liaison with national EMS agencies

L. Oversight of issues related to complaints, investigations, disciplinary procedures involving patient care, performance standards, and medical direction

59. “State Trauma Plan” – See Mississippi Trauma Care Plan

60. “Subscription” means a program that allows customers to pay an up- front established fee to offset any future emergency medical transport expenses.

61. “Surveillance” means the ongoing and systematic collection, analysis, and interpretation of health data in the process of describing and monitoring a health event. “Trauma” - a term derived from the Greek for "wound"; it refers to any bodily injury (see "Injury").

62. “Trauma Care Facility” (or "trauma center") means a hospital that has been designated by the department to perform specified trauma care services within a Trauma Care Region pursuant to standards adopted by the department.

63. “Trauma Care System Planning and Development Act of 1990” means the federal law that amended the Public Health Service Act to add Title XII - Trauma Programs. The purpose of the legislation being to assist State governments in developing, implementing, and improving regional systems of trauma care, and to fund research and demonstration projects to improve rural EMS and trauma.

64. “Trauma Care System” means an organized approach to treating patients with acute injuries; it provides dedicated (available 24 hours a day) personnel, facilities, and equipment for effective and coordinated trauma care in an appropriate geographical region, known as a Trauma Care Region.

65. “Trauma Center Designation” means the process by which the Department identifies facilities within a Trauma Care Region.

66. “Trauma Program Manager” means a designated individual with responsibility for coordination of all activities on the trauma service and works in collaboration with the trauma service director.

67. "Transfer" - The movement (including the discharge) of a patient outside a hospital's facilities at the direction of any person employed by (or affiliated or associated, directly or indirectly with) the hospital, but does not include such a movement of a patient who (a) has been declared dead, or (b) leaves the facility without the permission of any

such person.

68. "Treatment Protocols" means written uniform treatment and care plans for emergency and critical patients. These treatment plans must be approved and signed by the off-line medical director and/or medical groups. (Appendix 2)

69. “Triage” means the process of sorting injured patients on the basis of the actual or perceived degree of injury and assigning them to the most effective and efficient regional care resources, in order to insure optimal care and the best chance of survival.

**History**
- *SOURCE: Miss. Code Ann. §41-59-5*

##### **15 Miss. Admin. Code Pt. 12, R. 1.1.3** To apply for ambulance licensure an applicant service must complete and submit the following: 1 {#sec-12-1.1.3 omnilex-key=us-ms-regs-official--title-15--12#1.1.3}

Application for Ambulance Service Licensure; 2. Roster of all proposed employees, including Emergency Vehicle Operators (EMS-Driver), EMTs, AEMTs, Paramedics, Critical Care Paramedics, RNs and Emergency Medical Dispatchers, and others if appropriate (this list must include state-issued certification and/or license numbers where applicable); 3. The proposed medical control plan, including protocols (at least 30 days prior to intended service start date); 4. Patient destination guidelines which comply with all state approved system of care plans and standards; 5. Documentation describing communications capabilities, including capability to communicate with dispatch and primary resource hospital; 6. Documentation describing the methods to be used for communicating with on-line medical control, conducting quality assurance and ensuring skill maintenance; 7. Letter of attestation from the off-line medical director approving of the proposed medical control plan, approving of the proposed the ambulance provider’s protocols, and acknowledging he/she understands his/her responsibilities as prescribed in this document (Title 15, Part 12, Subpart 31); and 8. Letter of attestation from the ambulance owner acknowledging intent to provide 24/7 coverage, providing evidence of capabilities, describing

staffing patterns, providing plans for backup, and listing mutual aid agreements.

**History**
- *SOURCE: Miss. Code Ann. §41-59-5*

##### **15 Miss. Admin. Code Pt. 12, R. 1.1.4** Proposed off-line/on-line medical directors must provide documentation including: 1 {#sec-12-1.1.4 omnilex-key=us-ms-regs-official--title-15--12#1.1.4}

Proof of physician credentials; 2. Proof of Mississippi physician licensure; and 3. Documentation required for control substances, including relevant DEA documentation and registration number.

**History**
- *SOURCE: Miss. Code Ann. §41-59-5*

##### **15 Miss. Admin. Code Pt. 12, R. 1.1.5** Rule 1.1.5 {#sec-12-1.1.5 omnilex-key=us-ms-regs-official--title-15--12#1.1.5}

The overall application for ambulance licensure must be approved by the State EMS Director and State EMS Medical Director and requires a successful on-site inspection of the ambulance service operations site. BEMS may immediately issue licensure following a successful on-site inspection. BEMS will issue an official license within thirty (30) days; however, BEMS will issue a temporary document to serve as proof of licensure until the ambulance service receives the official license. Ambulance service licensure is valid for one (1) year from date of issuance. Revisions to the medical control plan must be submitted prior to implementation. At a minimum, medical control plans shall be resubmitted to the BEMS every three (3) years for approval.

**History**
- *SOURCE: Miss. Code Ann. §41-59-5*

##### **15 Miss. Admin. Code Pt. 12, R. 1.1.6** Rule 1.1.6 {#sec-12-1.1.6 omnilex-key=us-ms-regs-official--title-15--12#1.1.6}

Licensed ambulance services shall submit Mississippi Uniform Accident Reports for any EMS permitted vehicles involved in an accident within thirty (30) days.

**History**
- *SOURCE: Miss. Code Ann. §41-59-5*

##### **15 Miss. Admin. Code Pt. 12, R. 1.1.7** 911 is the universal emergency phone number for public access of Emergency Medical Services in the State {#sec-12-1.1.7 omnilex-key=us-ms-regs-official--title-15--12#1.1.7}

Ambulance service providers shall only advertise 911 as their emergency number. Exception: If a municipality or county has not implemented 911, then for that area, a seven-digit phone number may be used. This exception must have prior approval in writing by the BEMS. It is the intent of this regulation that 911, the universal access number for EMS, be the only emergency number advertised to the public. Any advertisement of a non- emergency phone number must include a prominent display of 911 or other BEMS approved emergency phone number.

Subchapter 2 Periodic inspections. Rule 1.2.1 Inspections to ensure compliance with the law will be made not less than two (2) times each year licensed and in most cases four (4) times.

**History**
- *SOURCE: Miss. Code Ann. §41-59-5*
- *SOURCE: Miss. Code Ann. §41-59-5*

##### **15 Miss. Admin. Code Pt. 12, R. 1.2.2** Rule 1.2.2 {#sec-12-1.2.2 omnilex-key=us-ms-regs-official--title-15--12#1.2.2}

No employer shall employ or permit any employee to perform any services for which a license/certificate or other authorization (as required by this act or by the rules and regulations promulgated pursuant to this act) unless and until the person possesses all the licenses, certificates or authorization that are so required.

**History**
- *SOURCE: Miss. Code Ann. §41-59-5*

##### **15 Miss. Admin. Code Pt. 12, R. 1.2.3** Rule 1.2.3 {#sec-12-1.2.3 omnilex-key=us-ms-regs-official--title-15--12#1.2.3}

No owner of a publicly or privately owned ambulance service shall permit the operation of the ambulance in emergency service unless the attendant on duty therein possesses evidence of that specialized training as is necessary to insure that the attendant or operator is competent to care for the sick or injured persons, according to their degree of illness or injury, who may be transported by the ambulance, as set forth in the emergency medical training and education standards for emergency medical service personnel established by the State Department of Health, Bureau of EMS.

**History**
- *SOURCE: Miss. Code Ann. §41-59-5*

##### **15 Miss. Admin. Code Pt. 12, R. 1.2.4** Rule 1.2.4 {#sec-12-1.2.4 omnilex-key=us-ms-regs-official--title-15--12#1.2.4}

The owner/manager or medical director of each publicly or privately owned ambulance service shall immediately inform the State Department of Health, Bureau of EMS of the termination or other disciplinary action taken against an employee for any of the following: 1. Fraud or any misstatement of fact in the procurement of any certifications or in any other statement of representation to the Board or its representative. 2. Gross negligence. 3. Repeated negligent acts. 4. Incompetence. 5. Disturbing the peace while on duty. 6. Disregarding the speed regulations prescribed by law while on duty. 7. Failure to maintain current registration by National Registry of EMTs. 8. Failure to maintain all current Advanced training standards as required by the BEMS. 9. The commission of any fraudulent dishonest, or corrupt act which is

substantially related to the qualifications, functions, and duties of the pre- hospital personnel. 10. Conviction of any crime which is directly related to the qualification, functions, and duties of pre-hospital personnel. The record of conviction or certified copy thereof will be conclusive evidence of such conviction. 11. Violating or attempting to violate directly or indirectly, or assisting in or abetting the violation of, or conspiring to violate, any provision of this part of the regulations promulgated by the BEMS, pertaining to pre-hospital personnel. 12. Violating or attempting to violate any federal or state statute or regulation which regulates narcotics, dangerous drugs, or controlled substances. 13. Unauthorized, misuse or excessive use of narcotics, dangerous drugs, or controlled substances or alcoholic beverages. 14. Functioning outside the supervision of medical control in the field care system operating at the local level, except as authorized by certification and license issued to the BLS provider. 15. Permitting, aiding, or abetting an unlicensed or uncertified person to perform activities requiring a license or certification. 16. Suspension or revocation of any BEMS issued certification may affect other BEMS issued certifications at all levels. 17. Failure to comply with an employer’s request for drug and alcohol testing. 18. Failure to wear high visibility apparel that meets the requirements of the American National Standards for High Visibility Apparel (ANSI/ISEA 107- 2004 Performance Class 2 or Performance Class 3, or the ANSI/IseA 207- 2006 Standard while functioning within the right-of-way of any road, street, highway, or other area where vehicle or machinery traffic is present. 19. Any conduct, regardless of whether convicted, which constitutes a crime of violence, or which constitutes any of the following crimes: a. Assault b. Stalking c. False imprisonment d. Sexual assault or battery e. Crimes against a vulnerable person

20. Failure to comply with reporting requirements for submission of Patient Care Report to the BEMS containing Mississippi minimum EMS data set.

**History**
- *SOURCE: Miss. Code Ann. §41-59-5*

##### **15 Miss. Admin. Code Pt. 12, R. 1.2.5** Rule 1.2.5 {#sec-12-1.2.5 omnilex-key=us-ms-regs-official--title-15--12#1.2.5}

A Mississippi licensed EMS Agency shall comply with the mandatory system of care plans as approved by the Mississippi State Department of Health, Bureau of Emergency Medical Services.

**History**
- *SOURCE: Miss. Code Ann. §41-59-5*

##### **15 Miss. Admin. Code Pt. 12, R. 1.2.6** Other common grounds for suspension or revocation are for example, but not limited to: 1 {#sec-12-1.2.6 omnilex-key=us-ms-regs-official--title-15--12#1.2.6}

Lack of State certified EMT attending patient. 2. Lack of driver with valid driver's license and state EMS driver certification. 3. Lack of proper equipment required by law. 4. Not adhering to sanitation of vehicle and equipment requirements. 5. Failure to adhere to record keeping or reporting requirements required by BEMS. 6. Failure to maintain proper insurance required by law.

**History**
- *SOURCE: Miss. Code Ann. §41-59-5*

##### **15 Miss. Admin. Code Pt. 12, R. 1.2.7** Rule 1.2.7 {#sec-12-1.2.7 omnilex-key=us-ms-regs-official--title-15--12#1.2.7}

A license can be temporarily suspended or revoked by any staff member of the BEMS at time of violation and will be followed up by a letter of temporary suspension or revocation. This letter will be certified, return receipt requested. This action may be taken with just cause in an effort to protect the public. Within five days from the time of temporary suspension or revocation, BEMS may extend the suspension, reinstate, or revoke the license.

**History**
- *SOURCE: Miss. Code Ann. §41-59-5*

##### **15 Miss. Admin. Code Pt. 12, R. 1.2.8** Rule 1.2.8 {#sec-12-1.2.8 omnilex-key=us-ms-regs-official--title-15--12#1.2.8}

The owner, manager, or medical director of each publicly or privately owned ambulance service shall inform the State Department of Health, Bureau of EMS of the termination of service in a licensed county or defined service area no less than 30 days prior to ceasing operations. This communication should also be sent by the owner, manager, or medical director of each publicly or privately owned ambulance service to related parties and local governmental entities such as, but not limited to, emergencies management agency, local healthcare facilities, and the public via mass media.

**History**
- *SOURCE: Miss. Code Ann. §41-59-5*

##### **15 Miss. Admin. Code Pt. 12, R. 1.2.9** The right to appeal process is discussed in section 41-59-49 {#sec-12-1.2.9 omnilex-key=us-ms-regs-official--title-15--12#1.2.9}

**History**
- *SOURCE: Miss. Code Ann. §41-59-5*

##### **15 Miss. Admin. Code Pt. 12, R. 1.2.10** Rule 1.2.10 {#sec-12-1.2.10 omnilex-key=us-ms-regs-official--title-15--12#1.2.10}

To maintain situation awareness of coverage within Mississippi, the owner, manager, or medical director of each publicly or privately owned ambulance service shall inform the State Department of Health, Bureau of EMS of any assets being placed on alert and/or deployed as part of the Federal Emergency Management Agency National Ambulance Contract immediately upon written notification. #24068

**History**
- *SOURCE: Miss. Code Ann. §41-59-5 Subchapter 3 Ownership Changes Rule 1.3.1 Any change of ownership or location voids original license and permit(s). Such changes constitute issuance of new service license and permit(s). (Application process must be initiated and completed by the new owner).*
- *SOURCE: Miss. Code Ann. §41-59-5 Subchapter 4 Permits, All Vehicles Rule 1.4.1 Permits are issued by the BEMS to a licensed ambulance service after an inspection of the vehicles and equipment has been completed and a determination made by BEMS that all requirements have been met.*
- *SOURCE: Miss. Code Ann. §41-59-5*

##### **15 Miss. Admin. Code Pt. 12, R. 1.4.2** Permits issued shall expire concurrently with the service license {#sec-12-1.4.2 omnilex-key=us-ms-regs-official--title-15--12#1.4.2}

**History**
- *SOURCE: Miss. Code Ann. §41-59-5*

##### **15 Miss. Admin. Code Pt. 12, R. 1.4.3** Rule 1.4.3 {#sec-12-1.4.3 omnilex-key=us-ms-regs-official--title-15--12#1.4.3}

To apply for an EMS vehicle permit the owner or designated representative of the entity seeking permit must submit an Application for Permit and select one of the following options: 1. Ambulance;

2. Special use vehicle; or

3. Non-emergency medical transport vehicle.

Only complete applications will be accepted for review, and the owner or designated representative must sign the complete application.

**History**
- *SOURCE: Miss. Code Ann. §41-59-5*

##### **15 Miss. Admin. Code Pt. 12, R. 1.4.4** BEMS will conduct an inspection of vehicle prior to issuing the permit {#sec-12-1.4.4 omnilex-key=us-ms-regs-official--title-15--12#1.4.4}

BEMS may issue the permit immediately following successful inspection. BEMS will issue an official permit within thirty (30) days; however, BEMS will issue a temporary document to serve as proof of permit until the official license arrives.

**History**
- *SOURCE: Miss. Code Ann. §41-59-5*

##### **15 Miss. Admin. Code Pt. 12, R. 1.4.5** All permits for vehicles are issued by licensed location {#sec-12-1.4.5 omnilex-key=us-ms-regs-official--title-15--12#1.4.5}

If, at any time, a vehicle is permanently moved to a new location a new inspection must be made and a new permit issued in accordance with the service license for the new location.

**History**
- *SOURCE: Miss. Code Ann. §41-59-5*

##### **15 Miss. Admin. Code Pt. 12, R. 1.4.6** Common grounds for suspension or revocation of vehicle permit are, for example: 1 {#sec-12-1.4.6 omnilex-key=us-ms-regs-official--title-15--12#1.4.6}

Improper or lack of essential required equipment, design, and construction standards 2. Sanitary requirements not maintained 3. Lack of properly certified personnel in rear of vehicle when patient is present or lack of properly qualified driver 4. Failure to maintain insurance as required 5. Change in location of vehicle 6. Failure to carry BEMS issued permit card on vehicle 7. Lack of properly functioning equipment. #22474

**History**
- *SOURCE: Miss. Code Ann. §41-59-5*

##### **15 Miss. Admin. Code Pt. 12, R. 1.4.7** Common grounds for issuance of temporary permit (limited to 90 days) are for example: 1 {#sec-12-1.4.7 omnilex-key=us-ms-regs-official--title-15--12#1.4.7}

Minor equipment items missing, but to be replaced within a reasonable time period. 2. Permitted vehicle is under repair and a replacement vehicle, meeting standards, is needed on a temporary basis.

**History**
- *SOURCE: Miss. Code Ann. §41-59-5 Subchapter 5 Vehicle Standards Rule 1.5.1 Standards for the design, construction, and equipment of ambulance vehicles.*
- *SOURCE: Miss. Code Ann. §41-59-5*

##### **15 Miss. Admin. Code Pt. 12, R. 1.5.2** Rule 1.5.2 {#sec-12-1.5.2 omnilex-key=us-ms-regs-official--title-15--12#1.5.2}

All new ambulance vehicles, before being issued an original ambulance permit as authorized by Mississippi Code 41-59-23, shall conform to current Federal Specification `Star-of-Life Ambulance' as published by the General Services Administration, Specification Section. Ambulances that were constructed prior to the

implementation of the current Federal Specifications shall conform to the applicable Federal Specifications that were in effect at the time of original construction. The following are exceptions and additions: 1. Height: Overall height of the ambulance at curb weight shall not exceed 110 inches, excluding roof-mounted light bars and communications accessories. 2. Color Paint and Finish: The base color(s) of the ambulance shall be determined by the licensed owner/operator. A retroreflective stripe, a combination of retroreflective stripes, or Battenburg markings shall be affixed to the ambulance in the following proportions: a. 25% of the length of each side of the cab surfaces when approached from each side, b. 75% of the length of each patient compartment side surfaces when approached from each side, c. 50% of the rear facing vertical surfaces, other than glass or lenses, visible when facing from the rear of the ambulance, shall be equipped with retroreflective material. Where chevrons are used, each stripe shall be 6-inches (152mm) in width, each stripe of the chevron shall be a single-color alternating between two high contrast colors. The stripe or combination of stripes shall be a minimum of 6 inches (152mm) in total vertical width and shall be a contrasting color from the base color of the ambulance. The stripe or combination of stripes shall be permitted to be interrupted by objects (e.g., receptacles, slats between roll-up doors), provided the full stripe is conspicuous as the ambulance is approached. A retroreflective graphic design shall be permitted to replace all or part of the required striping on the front or sides of the vehicle if the design or combination thereof cover at least the same surface area. A retroreflective “Star of Life” emblem shall be affixed to each side and rear of the vehicle.

3. Additional lettering and markings are allowed in, above and below the stripe. 4. The name of the ambulance company shall be printed in minimum 4- inch- high letters of contrasting color on each side of the ambulance. 5. Letters, words, phrases, or designs suggesting special services, i.e., advanced life support, etc., shall be allowed provided such specialty services are in fact available in the vehicle at all times when in operation. 6. The word “Ambulance” shall be displayed on each side, rear, and

front of the vehicle in a retroreflective contrasting color from the background. If the construction and design of an ambulance prohibits the placement of the ambulance (reverse) decal on the front hood, it shall be an acceptable exemption. BEMS shall have the authority to grant exceptions to requirements for color, paint, finish, and essential equipment for certain transport capable vehicles that are used exclusively for special situations, i.e. neonatal transport.

7. Emergency lighting shall be in accordance with Mississippi Code 63-7- 19.

**History**
- *SOURCE: Miss. Code Ann. §41-59-5*

##### **15 Miss. Admin. Code Pt. 12, R. 1.5.3** Rule 1.5.3 {#sec-12-1.5.3 omnilex-key=us-ms-regs-official--title-15--12#1.5.3}

The BEMS shall have the authority to grant exceptions to requirements for color, paint, finish, and essential equipment for certain transport capable vehicles that are used exclusively for special situations, i.e. neonatal transport, etc. If the special needs of the patient-types for these special use vehicles are not met by the standards required in these regulations, the vehicles shall be exempt from said regulations and instead should be equipped with essential equipment needed to manage the individual patient types.

**History**
- *SOURCE: Miss. Code Ann. §41-59-5*

##### **15 Miss. Admin. Code Pt. 12, R. 1.5.4** Suction aspirator system: Shall be electrically powered {#sec-12-1.5.4 omnilex-key=us-ms-regs-official--title-15--12#1.5.4}

Shall provide a free airflow of at least 30 lpm at the distal end of the connected patient hose. It shall achieve a vacuum of at least 300 mmHG (11.8 inches) within 4 seconds after the suction tube is clamped closed.

**History**
- *SOURCE: Miss. Code Ann. §41-59-5*

##### **15 Miss. Admin. Code Pt. 12, R. 1.5.5** Rule 1.5.5 {#sec-12-1.5.5 omnilex-key=us-ms-regs-official--title-15--12#1.5.5}

Portable suction aspirator: The unit will be self-contained, portable, battery operated, suction apparatus with wide-bore tubing. Gas powered or manual, portable suction aspirators may be substituted for battery operated suction units provided that they meet the same operational standards.

**History**
- *SOURCE: Miss. Code Ann. §41-59-5*

##### **15 Miss. Admin. Code Pt. 12, R. 1.5.6** Rule 1.5.6 {#sec-12-1.5.6 omnilex-key=us-ms-regs-official--title-15--12#1.5.6}

Two-way (mobile) radio equipment: One two-way radio (155.340 MHZ) or acceptable alternative that is compatible or interoperable for communication on radio frequency 155.340.

**History**
- *SOURCE: Miss. Code Ann. §41-59-5*

##### **15 Miss. Admin. Code Pt. 12, R. 1.5.7** Rule 1.5.7 {#sec-12-1.5.7 omnilex-key=us-ms-regs-official--title-15--12#1.5.7}

Standard mandatory miscellaneous equipment: Unless otherwise precluded elsewhere in this specification, each ambulance shall be equipped with, but not limited to, the following: 1. Fire extinguisher: one, ABC dry chemical, multi-purpose (Halon, C02) minimum 5-pound unit in a quick-release bracket mounted in the patient compartment. 2. Hazardous Material Reference Guide. 3. Reflective Safety wear for each crewmember (must meet or exceed ANSI/ISEA performance class II or III).

**History**
- *SOURCE: Miss. Code Ann. §41-59-5*

##### **15 Miss. Admin. Code Pt. 12, R. 1.5.8** Rule 1.5.8 {#sec-12-1.5.8 omnilex-key=us-ms-regs-official--title-15--12#1.5.8}

Medical, surgical, and bio-medical equipment for all levels: When specified, the ambulance shall be equipped with, but not limited to, the following: #24068 1. One stretcher for primary patient as specified in current Federal Specifications for ambulances, dimensions as per KKK-A-1822. 2. 3 strap type restraining devices (chest, hip, knee, and shoulder) attached to stretcher. Straps shall not be less than two inches wide, nylon, and consist of quick release buckles. 3. Portable and fixed oxygen equipment with variable flow regulator capable of delivering 15 lpm in calibrated increments. Cylinder must contain 300 psi of medical grade 02 at a minimum. 4. Three oxygen masks, adult. (Non-rebreathing face mask) 5. One oxygen mask, child. (Non-rebreathing face mask) 6. One oxygen mask, infant. 7. Three oxygen bi-pronged nasal cannulas. 8. One oxygen bi-pronged nasal cannula - pediatric. 9. One mouth-to-mask artificial ventilation device with supplemental oxygen inlet port with one-way valve, i.e., "pocket mask", etc. 10. Bag Valve Mask (manual resuscitator) hand operated, self-re-expanding bag, adult (>1000 ml), without pop-off valve, with oxygen reservoir capable of delivering 80-100 percent oxygen. 11. Bag Valve Mask (manual resuscitator) hand operated, self-re-expanding bag, pediatric (450-750 ml), without pop-off valve, with oxygen reservoir capable of delivering 80-100 percent oxygen.

12. Bag Valve Mask (manual resuscitator) hand operated, self-re-expanding bag, infant, without pop-off valve, with oxygen reservoir capable of delivering 80-100 percent oxygen. 13. Bag Valve Mask (manual resuscitator) hand operated, self-re-expanding bag, neonate, without pop-off valve, with oxygen reservoir capable of delivering 80-100 percent oxygen. May substitute infant bag and utilize neonate specific mask. 14. Two adult oropharyngeal airways, one each, sizes 4-5. 15. Two child oropharyngeal airways, one each, sizes 2-3. 16. Two infant oropharyngeal airways, one each, sizes 0-1. 17. One adult nasopharyngeal airway 28-36 fr. or 7.0-9.0 mm. 18. One child nasopharyngeal airway 20-26 fr. or 5.0-6.0 mm. 19. Lubricating jelly (water soluble). 20. One bite stick. 21. Six large, sterile, individually wrapped, trauma dressings (minimal six 8" x 10"). Must include one ABD pad, 10”x12” or larger. 22. Twelve sterile, individually wrapped (or in twos), dressings 4" x 4". 23. Three soft roller bandages, 4" or larger. 24. Three triangular bandages or commercial arm slings. 25. Adhesive tape 26. Various sizes (including 1” and 2”) hypoallergenic 27. Various sizes (including 1” and 2”) adhesive 28. Arterial Tourniquet 29. One pair heavy bandage or EMT shears for cutting clothing, belts, and boots. 30. Cold Packs 31. One sterile, occlusive dressing or equivalent, 3" x 8”, or larger. 32. Cervical Collars; minimum one rigid for children ages 2 years or older; one each, child and adult sizes (small, medium, large). Other available

sizes are recommended. NOTE: Two adjustable, rigid collars may be substituted. 33. One lower extremity traction splint, limb-support slings, padded ankle hitch, padded pelvic support, traction strap. 34. Assorted sized extremity immobilization devices which will provide for immobilization of joint above and joint below fracture and rigid support and be appropriate material (cardboard, metal, pneumatic, wood, plastic, etc.). Sizes shall be appropriate for adult and pediatric patients. 35. One short spine board with accessories or commercial equivalent (KED, Kansas Board, etc.). 36. Two long spine boards multi-use impervious to blood and body fluid or single use disposable - with accessories. (Radiolucent preferred.) 37. One folding stretcher as specified in current Federal Specifications for Ambulances, style 3 (folding legs optional) or a combination stretcher chair designed to permit a patient to be carried on stairways and/or through narrow areas. 38. Head Immobilization Device multi-use impervious to blood and body fluid or single use disposable. 39. Two sterile or clean burn sheets (packaged and stored separately from other linens). 40. Six clean sheets (2 on cot and 4 spare). 41. Three pillowcases (1 on pillow and 2 spare). 42. Two blankets. 43. Towels. 44. Triage tags. Color code must be (from top to bottom) black (deceased), red (immediate), yellow (delayed), and green (minor). White for worried well, etc. is optional. 45. One sterile OB kit. 46. One Sphygmomanometer (adult with regular and large size cuffs). 47. One Sphygmomanometer (pediatric). 48. One length-based tape or appropriate reference material for pediatric equipment sizing and drug dosing based on estimated or known weight.

49. One stethoscope. 50. One roll aluminum foil or silver swaddler (enough to cover newborn). 51. Infant blood pressure cuff with aneroid gauge. 52. Flashlights (2). 53. Two liters of sterile water for irrigation. One liter shall be sterile saline solution for irrigation. May be packaged in bottles or bags. Unbroken seal required. 54. One container of water for purging fixed suction device. 55. One container of water for purging portable suction devices. 56. One 15g. glucose or other commercial derivative for oral administration. 57. 50g. activated charcoal. 58. Automated external defibrillator (AED) (EMT or AEMT Level Ambulance Only). AED shall have pediatric capabilities, including pediatric sized pads and cables as appropriate. #22474 59. Glucometer or blood glucose measuring device 60. High Visibility Safety Apparel for Staff: Each Special Use EMS Vehicle must be equipped with high visibility safety apparel for each person staffing or participating in the operation of the vehicle. All garments must meet the requirements of the American National Standard for High Visibility Apparel ANSI/ISEA 107-2004 Performance Class 2 or Performance Class 3, or the ANSI/ISEA 207-2006 Standard. All garments must have labels, affixed by the manufacturer in accordance with the standard, that indicate compliance with the Performance Class 2, Performance Class 3, or 207-2006 standard.

**History**
- *SOURCE: Miss. Code Ann. §41-59-5*

##### **15 Miss. Admin. Code Pt. 12, R. 1.5.9** Infectious disease precaution materials: NOTE: Latex-free equipment should be available {#sec-12-1.5.9 omnilex-key=us-ms-regs-official--title-15--12#1.5.9}

#24068 1. Disposable latex gloves (6 pairs). Gloves shall meet NFPA 1999 requirements. 2. Disposable goggles and masks (2 pair) or face shields (4) 3. Impervious gown or apron (2) and 2 pair shoe covers. 4. Respiratory protection (i.e. N95 or N100 mask) (2)

5. Disinfectant for hands (waterless hand cleanser, commercial antimicrobial. May be towelette, spray or liquid.) and equipment. 6. Sharps container (see OSHA regulations in Appendix 8) one each, fixed and portable. 7. Two leak-proof plastic bags for contaminated or biohazard waste. 8. Two disposable rigid non-metallic suction tips with wide bore inside diameter of at least 18 fr. 9. Two of each size sterile disposable suction catheters: (2 each - 5-6 fr.); (2 each - 8-10 fr.); (2 each - 14-18 fr.) 10. One bedpan, one urinal, and at least two emesis basins or bags or commercial equivalent. 11. NOTE: In addition to the previously listed BLS regulations, the following additional ALS requirements must be met: a. Only vehicles meeting current state regulations for emergency ambulance classifications may be approved and permitted as ALS vehicles. b. All ALS vehicles shall conform to the advanced equipment guidelines established by the American College of Surgeons, Committee on Trauma, and as may be modified by the State Board of Health. c. If not stored on the ambulance, the equipment and supplies required for advanced life support at the AEMT or Paramedic level, must be stored and packaged in such a manner that they can be delivered to the scene on or before the response of the ALS personnel. This may be accomplished by rapid response units or other non-ambulance emergency vehicles. NOTE: ALS services are required to have ALS equipment commensurate with the ALS staffing plan submitted as part of the application for service licensure. #22474

**History**
- *SOURCE: Miss. Code Ann. §41-59-5*

##### **15 Miss. Admin. Code Pt. 12, R. 1.5.10** Rule 1.5.10 {#sec-12-1.5.10 omnilex-key=us-ms-regs-official--title-15--12#1.5.10}

The Bureau of EMS and the Committee on Medical Direction, Training, and Quality Assurance (MDTQA) will approve pharmaceuticals available for use by EMS providers. A list of ‘Required’, ‘Optional’, and ‘Transport only’ drugs for EMS providers in the State is compiled and maintained by the BEMS and the MDTQA. NOTE: An Offline Medical Director may make requests for changes to the list. These requests should be submitted in writing to the BEMS. All requests must detail the rationale for the additions, modifications, or deletions. #24068

5. Venous tourniquet. 6. Syringes, various sizes, including tuberculin. 7. Needles, various sizes (one at least 1 ½ “for IM injection 8. Three (3) Intravenous administration sets (microdrip and macrodrip) 9. Intravenous arm boards (adult and pediatric) 10. Airway a. Rescue Airway (e.g. Combitube, Extraglottic Device) – Adult b. Rescue Airway (e.g. Combitube, Extraglottic Device) – Pediatric (AEMT Only) c. End-tidal CO2 Detectors (may be made onto bag valve mask assemblies or separate) d. Pulse Oximeter with pediatric and adult probes. (Pulse ox may be independent or integrated with a monitor/defibrillator or other device). 11. Nebulizer (#22474)

1. Laryngoscope handle with extra batteries and bulbs. May be substituted with disposable handles and/or blades. 2. One each Laryngoscope blades, sizes 0-4, straight (Miller); sizes 2-4, curved (McIntosh). 3. Endotracheal tubes, 2 each, sizes 2.5 - 8 mm. Other sizes optional. 4. 10 cc non-Luer lock syringes. 5. Stylettes for endotracheal tubes (adult and pediatric). 6. One pair each Magill forceps (adult and pediatric). 7. End-tidal CO2 detection capability. 8. Portable, battery-operated Manual monitor defibrillator (with tape write- out), defibrillation pads or gel, quick-look paddles (adult and pediatric) or electrodes (adult and pediatric) or hands-free patches (adult and pediatric), EKG leads, chest attachment pads (adult and pediatric) (telemetry transmission capability optional). Transcutaneous cardiac pacemaker, including adult and pediatric capabilities and supplies (either stand alone or integrated into monitor/defibrillator).

2. Equipment shall be made of smooth and easily cleanable construction. 3. Freshly laundered linen or disposable linen shall be used on cots and pillows and linens shall be changed after each patient is transported. 4. Clean linen storage shall be provided on each ambulance. 5. Closed compartments shall be provided within the ambulance for medical supplies. 6. Pillows and mattresses shall be kept clean and in good repair. 7. Closed containers shall be provided for soiled supplies. 8. Exterior and interior surfaces of ambulance shall be cleaned routinely.

9. Blankets and hand towels used in any ambulance shall be clean. 10. Implements inserted into the patient's nose or mouth shall be single service, wrapped and properly stored and handled. When multi-use items are used, the local health care facilities should be consulted for instructions in sanitation and handling of such items. 11. When an ambulance has been utilized to transport a patient known to the operator to have a communicable disease, the vehicle shall be placed "out of service" until a thorough cleansing is conducted. 12. All storage spaces used for storage of linens, equipment, medical supplies, and other supplies at base stations shall be kept clean and free from unnecessary articles. The contents shall be arranged so as to permit thorough cleaning. 13. In addition, current CDC and OSHA requirements apply.

**History**
- *SOURCE: Miss. Code Ann. §41-59-5 Subchapter 6 Advanced EMT Required Equipment Rule 1.6.1 For the AEMT all the equipment for the EMT as previously listed plus the following equipment and supplies: #24068 1. Intravenous administration equipment (fluid should be in bags, not bottles): Ringer’s Lactate and/or normal saline solution (4,000 ml minimum) 2. Antiseptic Solution (i.e. alcohol wipes) 3. IV Pole or Roof Hook 4. Intravenous catheter with needle (1”-3” in length) minimum 6 each, sizes 14G-24G.*
- *SOURCE: Miss. Code Ann. §41-59-5 Subchapter 7 Paramedic Required Equipment Rule 1.7.1 All the equipment and supplies listed above plus the following additional equipment and supplies: #24068*
- *SOURCE: Miss. Code Ann. §41-59-5 Subchapter 8 Sanitation regulations Rule 1.8.1 The following shall apply regarding sanitation standards for all types of ambulance vehicles: 1. The interior of the ambulance and the equipment within the ambulance shall be sanitary and maintained in good working order at all times.*
- *SOURCE: Miss. Code Ann. §41-59-5 Subchapter 9 Storage of Prescription Items: Rule 1.9.1 Ambulance services and personnel should not store or carry prescription drugs or items which they are prohibited from using. Personnel who are allowed to administer prescription drugs or use prescription items should carry these drugs and/or items only when they are on duty and actively functioning under their ambulance service's medical control authority.*
- *SOURCE: Miss. Code Ann. §41-59-5*

##### **15 Miss. Admin. Code Pt. 12, R. 1.9.2** Rule 1.9.2 {#sec-12-1.9.2 omnilex-key=us-ms-regs-official--title-15--12#1.9.2}

Prescription items and drugs should always be stored and carried in secure locations accessible only to authorized personnel. These items and drugs should be stored within temperature ranges as recommended by the manufacturer.

**History**
- *SOURCE: Miss. Code Ann. §41-59-5*

##### **15 Miss. Admin. Code Pt. 12, R. 1.9.3** Rule 1.9.3 {#sec-12-1.9.3 omnilex-key=us-ms-regs-official--title-15--12#1.9.3}

Narcotics: Certified ALS personnel (paramedics and RNs) functioning under approved medical control jurisdiction may be issued approved controlled substances for pre-hospital use upon the discretion of the off-line medical director. For ALS services that are not hospital-based, the Drug Enforcement Administration (DEA) requires the off-line medical director to secure a separate CONTROLLED SUBSTANCES REGISTRATION CERTIFICATE to store, issue and prescribe controlled substances to ALS personnel. This CERTIFICATE should list the medical director as a "practitioner" at the physical address of the ambulance service where the drugs are stored. The off-line medical director will determine who may issue and administer the controlled substances and who will have access to storage of these narcotics. #24068

1. Controlled substances must be secured in accordance with applicable state and federal regulations. The paramedic's narcotics should be secured in a designated location when he is not on duty and actively functioning under the service's medical control. When on duty, each paramedic should keep his controlled drugs in his immediate possession or securely locked in the vehicle at all times. 2. Whenever an order is received from medical control for administration of a narcotic, the paramedic must keep track of the vial/ampule being utilized. If the full amount of the narcotic was not administered, the remainder must be wasted in the presence of a witness and the witness must sign the patient report documenting the same. The witness should preferably be a licensed health care provider who is authorized to administer narcotics themselves. 3. Narcotics should be replaced and logged within 24 hours of administration. Narcotics logs should be maintained by the ALS service. Paramedics should individually document the following minimum information in the narcotics log: Date of administration; Time of administration; Amount administered; Amount wasted; Witness to wasted amount; Patient's name; Call number; Ordering physician 4. Any paramedic/RN that is separated from the ALS service's medical control authority shall surrender his narcotics upon demand or be subject to prosecution under applicable statutes

**History**
- *SOURCE: Miss. Code Ann. §41-59-5*

##### **15 Miss. Admin. Code Pt. 12, R. 1.9.4** Prescription Items: All ambulance services licensed by the BEMS are required to have approved medical directors {#sec-12-1.9.4 omnilex-key=us-ms-regs-official--title-15--12#1.9.4}

BLS ambulance services are required to have designated an off-line medical director only. These physician directors are necessary to allow the services to store and administer certain prescription items as required in the Rules and Regulations of the BEMS. #24068

2. Strobe, light emitting diode (LED) or quartz halogen incandescent red or combination red/clear emergency lights providing the vehicle with a conspicuous appearance for safety during emergency response. The emergency lights must display highly perceptible and attention-getting signals designed to convey the message "clear the right-of-way."

3. Use of emergency warning devices by SUEMSV is restricted to actual EMS responses as authorized and requested by the licensed ambulance service or BEMS.

**History**
- *SOURCE: Miss. Code Ann. §41-59-5 Subchapter 10 Special Use EMS Vehicles Rule 1.10.1 Special Use Emergency Medical Services Vehicles (SUEMSV) used on roadways shall be equipped with the following minimum emergency warning devices: 1. A combination electronic siren with integral public address system.*
- *SOURCE: Miss. Code Ann. §41-59-5*

##### **15 Miss. Admin. Code Pt. 12, R. 1.10.2** Rule 1.10.2 {#sec-12-1.10.2 omnilex-key=us-ms-regs-official--title-15--12#1.10.2}

Permits for special use EMS vehicles are issued by BEMS to a licensed ambulance service after an inspection of the vehicles has been completed and a determination made by BEMS that all requirements have been met.

**History**
- *SOURCE: Miss. Code Ann. §41-59-5*

##### **15 Miss. Admin. Code Pt. 12, R. 1.10.3** Permits issued shall expire concurrently with the service license {#sec-12-1.10.3 omnilex-key=us-ms-regs-official--title-15--12#1.10.3}

**History**
- *SOURCE: Miss. Code Ann. §41-59-5*

##### **15 Miss. Admin. Code Pt. 12, R. 1.10.4** All permits for vehicles are issued by licensed location {#sec-12-1.10.4 omnilex-key=us-ms-regs-official--title-15--12#1.10.4}

If, at any time, a vehicle is moved to a new location, a new inspection must be made, and a new permit issued in accordance with the service license for the new location.

**History**
- *SOURCE: Miss. Code Ann. §41-59-5*

##### **15 Miss. Admin. Code Pt. 12, R. 1.10.5** Payment of a renewal fee to be fixed by the Board, which shall be paid to the Board {#sec-12-1.10.5 omnilex-key=us-ms-regs-official--title-15--12#1.10.5}

**History**
- *SOURCE: Miss. Code Ann. §41-59-5*

##### **15 Miss. Admin. Code Pt. 12, R. 1.10.6** Personnel operating ground SUEMSV must be certified as EMS-D {#sec-12-1.10.6 omnilex-key=us-ms-regs-official--title-15--12#1.10.6}

**History**
- *SOURCE: Miss. Code Ann. §41-59-5*

##### **15 Miss. Admin. Code Pt. 12, R. 1.10.7** Each SUEMSV must be insured as per Section 41-59-27, Mississippi Code of 1972, Annotated {#sec-12-1.10.7 omnilex-key=us-ms-regs-official--title-15--12#1.10.7}

**History**
- *SOURCE: Miss. Code Ann. §41-59-5*

##### **15 Miss. Admin. Code Pt. 12, R. 1.10.8** Rule 1.10.8 {#sec-12-1.10.8 omnilex-key=us-ms-regs-official--title-15--12#1.10.8}

All Special Use EMS Vehicles must be marked with flashing red lights front and back and may be marked with white and amber lights in addition to red lights.

**History**
- *SOURCE: Miss. Code Ann. §41-59-5*

##### **15 Miss. Admin. Code Pt. 12, R. 1.10.9** Rule 1.10.9 {#sec-12-1.10.9 omnilex-key=us-ms-regs-official--title-15--12#1.10.9}

High Visibility Safety Apparel for Staff: Each Special Use EMS Vehicle must be equipped with high visibility safety apparel for each person staffing or participating in the operation of the vehicle. All garments must meet the requirements of the American National Standard for High Visibility Apparel ANSI/ISEA 107-2004 Performance Class 2 or Performance Class 3, or the ANSI/ISEA 207-2006 Standard. All garments must have labels, affixed by the manufacturer in accordance with the standard, that indicate compliance with the Performance Class 2, Performance Class 3, or 207-2006 standard.

however, said protocols must be approved by the ambulance service’s off- line medical director and the State EMS Medical Director; a. Required documentation to be submitted to BEMS: i. A letter from the ambulance service’s owner/operator requesting approval to operate tiered response; ii. A copy of the ambulance service’s tiered response protocol with a letter from the ambulance service’s off-line medical director verifying his/her approval of said protocol; 1. Said protocol shall allow for paramedics, AEMTs or EMTs to respond to emergency calls, care for patients experiencing emergency conditions, transport patients experiencing emergency conditions, and transfer the care of patients experiencing said conditions to providers in the clinical setting; 2. Said protocol shall include the use of computerized dispatch resources, and specifically for the purpose of prioritizing calls and assigning the proper level of care for response (services which do not possess this resource may partner with a third-party vendor for dispatch resources to meet this requirement); all incoming emergency calls must be screened at dispatch and assigned the most appropriate level of care response; 3. Said protocols shall provide for on-line medical control guidance to field crews as needed during

response and operations; 2. Tiered response ambulance services shall provide one (1) paramedic capable unit for every 3-tiered response units in the event advanced life support proves necessary; 3. When paramedic level of care is warranted and initiated, the paramedic shall continue care until care is turned over to clinical staff of equal or greater level of training/education in the emergency department as required by regulation and local protocol; 4. Ambulance services utilizing tiered response shall provide specific performance improvement data relevant to tiered response as requested from BEMS; 5. While the rules in this Part provide an option for tiered response, each respective ambulance service is responsible for ensuring compliance with county contractual obligations.

**History**
- *SOURCE: Miss. Code Ann. §41-59-5 Subchapter 11 Required Personnel Rule 1.11.1 Every ALS ambulance, when responding to and transporting patients requiring care beyond the basic life support level, must be occupied by a driver with a valid EMS driver's license and one (1) person who possesses a valid Advanced EMT or Paramedic state certificate or one (1) person who possesses a valid medical/nursing license. Specific considerations apply to tiered response. Tiered response may be used to maximize capabilities and improve outcomes. Tiered response requires the use of technology and resources to prioritize incoming EMS calls and assign the proper level of care response. Ambulance services proposing to operate tiered response shall meet the following criteria in order to be approved by BEMS: 1. Licensed 911 EMS providers may utilize tiered response protocols;*
- *SOURCE: Miss. Code Ann. §41-59-5*

##### **15 Miss. Admin. Code Pt. 12, R. 1.11.2** Rule 1.11.2 {#sec-12-1.11.2 omnilex-key=us-ms-regs-official--title-15--12#1.11.2}

In addition, any ambulance service that wishes to provide ALS and employ ALS personnel to function in an ALS role, intermittently or consistently, must be licensed at the ALS level by the State Department of Health, Bureau of Emergency Medical Services.

**History**
- *SOURCE: Miss. Code Ann. §41-59-5*

##### **15 Miss. Admin. Code Pt. 12, R. 1.11.3** Rule 1.11.3 {#sec-12-1.11.3 omnilex-key=us-ms-regs-official--title-15--12#1.11.3}

Anyone driving an ambulance or (invalid) vehicle must possess a valid emergency medical service driver (EMS-D) state certificate in addition to a valid driver's license.

**History**
- *SOURCE: Miss. Code Ann. §41-59-5*

##### **15 Miss. Admin. Code Pt. 12, R. 1.11.4** Rule 1.11.4 {#sec-12-1.11.4 omnilex-key=us-ms-regs-official--title-15--12#1.11.4}

Certification of training for personnel functioning in an out-of-hospital Advanced Life Support (ALS) role may be as follows: 1. Current registration as an Advanced EMT or Paramedic by the National Registry of EMTs. 2. Letter/statement signed by the ambulance service owner/manager which attests to equivalency of training for each employee possessing a medical/nursing license. #22474/ #24068

**History**
- *SOURCE: Miss. Code Ann. §41-59-5 Subchapter 12 Record Keeping*

##### **15 Miss. Admin. Code Pt. 12, R. 1.12.1** Rule 1.12.1 {#sec-12-1.12.1 omnilex-key=us-ms-regs-official--title-15--12#1.12.1}

All licensed ambulance services operating in the State of Mississippi must submit electronically, the State of Mississippi minimum EMS data set and/or information contained on the form via network, or direct computer link, for each ambulance run made and/or for each patient transported. #22474

**History**
- *SOURCE: Miss. Code Ann. §41-59-5*

##### **15 Miss. Admin. Code Pt. 12, R. 1.12.2** Rule 1.12.2 {#sec-12-1.12.2 omnilex-key=us-ms-regs-official--title-15--12#1.12.2}

A completed copy of a Patient Care Report containing Mississippi minimum EMS data set shall be left with or electronically submitted to hospital staff for all patients delivered to licensed Hospitals. within 24 hours. Written exceptions may be submitted to the BEMS for consideration. #22474/ #24068

**History**
- *SOURCE: Miss. Code Ann. §41-59-5*

##### **15 Miss. Admin. Code Pt. 12, R. 1.12.3** All Mississippi minimum EMS data set are due within fourteen (14) days to the BEMS office {#sec-12-1.12.3 omnilex-key=us-ms-regs-official--title-15--12#1.12.3}

More frequent submissions may be required by the State Health Officer or his/her designee for real time syndromic surveillance. #22474

**History**
- *SOURCE: Miss. Code Ann. §41-59-5*

##### **15 Miss. Admin. Code Pt. 12, R. 1.12.4** Rule 1.12.4 {#sec-12-1.12.4 omnilex-key=us-ms-regs-official--title-15--12#1.12.4}

All Mississippi minimum EMS data set or computer disk information returned to an ambulance service for correction must be corrected and returned to the BEMS office within two weeks calculated from the date of their return. #22474

**History**
- *SOURCE: Miss. Code Ann. §41-59-5*

##### **15 Miss. Admin. Code Pt. 12, R. 1.12.5** Returns may result in a penalty as outlined under Section 41-59-45, paragraph 3 {#sec-12-1.12.5 omnilex-key=us-ms-regs-official--title-15--12#1.12.5}

#22474

2. The vehicle will have at least two doors leading into the patient compartment; one at the rear for patient loading and one on the curbside so that the patient may be easily removed should the rear door become jammed. All doors should be constructed so that they may be opened from inside or outside.

3. To preclude substitution of services or the negligent or adverse delivery of medical transportation, after January 1, 2016, no ambulance service shall be authorized permits for invalid vehicles.

**History**
- *SOURCE: Miss. Code Ann. §41-59-5 Subchapter 13 Invalid Services Rule 1.13.1 Standards for invalid vehicles: #22474 1. No vehicle used exclusively for invalid transfer is to have any markings, flashing lights, sirens, or other equipment that might indicate it is an Emergency Vehicle. The word "Ambulance" is not to appear on the vehicle. All advertising and vehicles used for invalid transfer shall display in a conspicuous manner a placard, visible from the exterior, or a notice on advertisements as follows: INVALID TRANSPORT – THIS SERVICE DOES NOT PROVIDE MEDICAL CARE.*
- *SOURCE: Miss. Code Ann. §41-59-5*

##### **15 Miss. Admin. Code Pt. 12, R. 1.13.2** Required equipment: #22474 1 {#sec-12-1.13.2 omnilex-key=us-ms-regs-official--title-15--12#1.13.2}

First aid kit: Commercially available kit containing gauze pads, roller bandages, and adhesive tape acceptable 2. Fire extinguisher: one, ABC dry chemical, multi-purpose (Halon, C02) minimum 5-pound unit in a quick-release bracket mounted in the patient compartment. 3. 1 box disposable tissues 4. 1 bed pan (fracture type acceptable) and urinal as needed for personal hygiene during transport. 5. 1 emesis basin 6. 2 towels 7. 1 blanket 8. 4 sheets 9. 2 pillowcases 10. Communication equipment to notify emergency services in case of emergency. At minimum, shall have two-way (mobile) radio equipment: One two-way radio (155.340 MHZ) or acceptable alternative that is compatible or interoperable for communication on radio frequency 155.340. 11. Each vehicle shall have a crash stable device for securing the stretcher meeting all applicable standards. At minimum shall have one stretcher for primary patient as specified in current Federal Specifications for ambulances, dimensions as per KKK-A-1822. 5-point type restraining devices (chest, hip, knee, and shoulder) attached to stretcher. Straps shall not be less than two inches wide, nylon, and consist of quick release buckles. 12. Automated external defibrillator (AED) (Basic Level Ambulance Only). AED shall have pediatric capabilities, including pediatric sized pads and cables as appropriate.

13. Hazardous Material Reference Guide.

**History**
- *SOURCE: Miss. Code Ann. §41-59-5*

##### **15 Miss. Admin. Code Pt. 12, R. 1.13.3** Vehicle Standards: 1 {#sec-12-1.13.3 omnilex-key=us-ms-regs-official--title-15--12#1.13.3}

Patient Compartment: a. 42" high, floor to ceiling b. 48" wide, measured 15" above floor from side to side c. 92" long, measured 15" above floor from divider to rear door 2. Emblems and markings: The name of the company shall be printed on each side of the vehicle or the cab doors of the vehicle.

**History**
- *SOURCE: Miss. Code Ann. §41-59-5*

##### **15 Miss. Admin. Code Pt. 12, R. 1.13.4** Rule 1.13.4 {#sec-12-1.13.4 omnilex-key=us-ms-regs-official--title-15--12#1.13.4}

High Visibility Safety Apparel for Staff: Each invalid vehicle must be equipped with high visibility safety apparel for each person staffing or participating in the operation of the vehicle. All garments must meet the requirements of the American National Standard for High Visibility Apparel ANSI/ISEA 107-2004 Performance Class 2 or Performance Class 3, or the ANSI/ISEA 207-2006 Standard. All garments must have labels, affixed by the manufacturer in accordance with the standard, that indicate compliance with the Performance Class 2, Performance Class 3, or 207-2006 standard.

**History**
- *SOURCE: Miss. Code Ann. §41-59-5*

##### **15 Miss. Admin. Code Pt. 12, R. 1.13.5** The invalid vehicle shall be used only for the transport of an “invalid” {#sec-12-1.13.5 omnilex-key=us-ms-regs-official--title-15--12#1.13.5}

“Invalid” shall mean persons who are convalescent or otherwise non-ambulatory and do not require the service of an emergency medical technician while in transit. #22474

**History**
- *SOURCE: Miss. Code Ann. §41-59-5*

##### **15 Miss. Admin. Code Pt. 12, R. 1.13.6** The following shall apply regarding sanitation standards for vehicles: #22474 1 {#sec-12-1.13.6 omnilex-key=us-ms-regs-official--title-15--12#1.13.6}

The interior of the vehicle shall be sanitary and maintained in good working order at all times. (e.g. environmental system.) 2. Freshly laundered linen or disposable linen shall be used on cots and pillows and linens shall be changed after each patient is transported. 3. Clean linen storage shall be provided on each vehicle. 4. Pillows and mattresses shall be kept clean and in good repair.

5. Closed containers shall be provided for soiled supplies. 6. Exterior and interior surfaces of vehicle shall be cleaned routinely. 7. Blankets and hand towels used in any vehicle shall be clean. 8. All storage spaces used for storage of linens and other supplies at base stations shall be kept clean and free from unnecessary articles. The contents shall be arranged so as to permit thorough cleaning.

**History**
- *SOURCE: Miss. Code Ann. §41-59-5*

##### **15 Miss. Admin. Code Pt. 12, R. 1.13.7** Infectious disease precaution materials: NOTE: Latex-free equipment should be available {#sec-12-1.13.7 omnilex-key=us-ms-regs-official--title-15--12#1.13.7}

#22474 1. Disposable latex gloves (6 pairs). Gloves shall meet NFPA 1999 requirements. 2. Disposable goggles and masks (2 pairs) or face shields (4). 3. Disinfectant for hands (waterless hand cleanser, commercial antimicrobial. May be towelette, spray or liquid) and equipment. 4. Two leak proof plastic bags for contaminated or biohazard waste.

**History**
- *SOURCE: Miss. Code Ann. §41-59-5*

##### **15 Miss. Admin. Code Pt. 12, R. 1.13.8** Rule 1.13.8 {#sec-12-1.13.8 omnilex-key=us-ms-regs-official--title-15--12#1.13.8}

Permits for invalid vehicles are issued by BEMS to a licensed invalid service after an inspection of the vehicles has been completed and a determination made by BEMS that all requirements have been met. #22474

**History**
- *SOURCE: Miss. Code Ann. §41-59-5*

##### **15 Miss. Admin. Code Pt. 12, R. 1.13.9** Permits issued shall expire concurrently with the service license {#sec-12-1.13.9 omnilex-key=us-ms-regs-official--title-15--12#1.13.9}

#22474

**History**
- *SOURCE: Miss. Code Ann. §41-59-5*

##### **15 Miss. Admin. Code Pt. 12, R. 1.13.10** All permits for vehicles are issued by licensed location {#sec-12-1.13.10 omnilex-key=us-ms-regs-official--title-15--12#1.13.10}

If, at any time, a vehicle is moved to a new location, a new inspection must be made, and a new permit issued in accordance with the service license for the new location. #22474

**History**
- *SOURCE: Miss. Code Ann. §41-59-5*

##### **15 Miss. Admin. Code Pt. 12, R. 1.13.11** Payment of a renewal fee to be fixed by the Board, which shall be paid to the Board {#sec-12-1.13.11 omnilex-key=us-ms-regs-official--title-15--12#1.13.11}

#22474

**History**
- *SOURCE: Miss. Code Ann. §41-59-5*

##### **15 Miss. Admin. Code Pt. 12, R. 1.13.12** Personnel operating invalid vehicles must possess a valid EMS-D in addition to a valid driver’s license {#sec-12-1.13.12 omnilex-key=us-ms-regs-official--title-15--12#1.13.12}

#22474

**History**
- *SOURCE: Miss. Code Ann. §41-59-5*

##### **15 Miss. Admin. Code Pt. 12, R. 1.13.13** Records for invalid transport shall be maintained as follows: #22474 1 {#sec-12-1.13.13 omnilex-key=us-ms-regs-official--title-15--12#1.13.13}

Employee records for all drivers and attendant personnel. 2. Each licensee shall maintain accurate records and contain such information as may be required by BEMS concerning the transportation of each individual within this state and beyond its limits.

**History**
- *SOURCE: Miss. Code Ann. §41-59-5*

##### **15 Miss. Admin. Code Pt. 12, R. 1.13.14** Rule 1.13.14 {#sec-12-1.13.14 omnilex-key=us-ms-regs-official--title-15--12#1.13.14}

Required personnel: In addition to vehicle operator, there shall be at least one person trained in adult and pediatric First Aid and AED/CPR in accordance with the standards of the American Heart Association or the American Red Cross available to attend the patient. Both will be needed to properly operate the loaded stretcher. #22474

**History**
- *SOURCE: Miss. Code Ann. §41-59-5*

##### **15 Miss. Admin. Code Pt. 12, R. 1.13.15** Rule 1.13.15 {#sec-12-1.13.15 omnilex-key=us-ms-regs-official--title-15--12#1.13.15}

License Requirements: Application for licensed to conduct invalid transport program shall be made to the Bureau by completion of forms with: #22474 1. The name and address of the owner of the service. 2. The name in which the applicant is doing business. 3. A description of each unit including the make, model, year of manufacture, motor and chassis numbers, color scheme, insignia, name, monogram, or other distinguishing characteristics to be used to designate applicant’s service; and 4. The location and description of the place or places from which the services are intended to operate.

**History**
- *SOURCE: Miss. Code Ann. §41-59-5 Subchapter 14 Complaints/Investigation Process*

##### **15 Miss. Admin. Code Pt. 12, R. 1.14.1** Complaints: All complaints concerning certified personnel or licensed service shall be reviewed by the BEMS {#sec-12-1.14.1 omnilex-key=us-ms-regs-official--title-15--12#1.14.1}

Each complaint shall be logged, recording at minimum the following information: 1. Date of Complaint Submission. 2. Name of the complainant with contact information (if known). 3. Nature of the complaint.

4. Date and Time of Event. 5. Brief statement of the complaint 6. Disposition

##### **15 Miss. Admin. Code Pt. 12, R. 1.14.2** Investigations: All complaints will be thoroughly investigated and evaluated by the BEMS {#sec-12-1.14.2 omnilex-key=us-ms-regs-official--title-15--12#1.14.2}

Subchapter 15 Appeal Process Rule 1.15.1 The State Board of Health and the Bureau of EMS shall provide an opportunity for a fair hearing for every certified personnel or licensed ambulance service who is dissatisfied with administrative decisions made in the denial and/or suspension/revocation of a certificate or license.

**History**
- *SOURCE: Miss. Code Ann. §41-59-5*

##### **15 Miss. Admin. Code Pt. 12, R. 1.15.2** Rule 1.15.2 {#sec-12-1.15.2 omnilex-key=us-ms-regs-official--title-15--12#1.15.2}

BEMS shall notify the certified personnel or licensed service by registered mail, the particular reason for denial or revocation/suspension of the certification or license, if requested in writing within ten (10) days of a notification receipt of a notice of revocation, non-renewal, or suspension. Upon written request of the certified personnel or licensed service, within ten (10) business days of the notification, BEMS shall fix a date not less than thirty days from the date of such service at which time the licensee shall be given an opportunity for a prompt and fair hearing before officials of the Mississippi State Department of Health. A hearing shall be held at the Mississippi State Department of Health. A hearing officer shall be appointed by the State Health Officer, and a court reporter shall transcribe the proceedings. The hearing shall be held within thirty (30) days of receipt of the request for such hearing, unless waived in writing by the certified personnel or licensed service. The certified personnel or licensed service shall be entitled to legal representation at his or her own expense.

**History**
- *SOURCE: Miss. Code Ann. §41-59-5*

##### **15 Miss. Admin. Code Pt. 12, R. 1.15.3** Rule 1.15.3 {#sec-12-1.15.3 omnilex-key=us-ms-regs-official--title-15--12#1.15.3}

Within thirty (30) calendar days of the hearing, or such period determined during the hearing, written findings of fact, together with a recommendation for action, shall be forwarded to the State Health Officer. The State Health Officer shall decide what, if any, action is to be taken on the recommendation within fourteen (14) days of receipt of the recommendation. Written notice of the decision of the State Health Officer shall be provided to the certified personnel or licensed service.

**History**
- *SOURCE: Miss. Code Ann. §41-59-5*

##### **15 Miss. Admin. Code Pt. 12, R. 1.15.4** Rule 1.15.4 {#sec-12-1.15.4 omnilex-key=us-ms-regs-official--title-15--12#1.15.4}

The decision to suspend, revoke or deny a license shall become final thirty days after it is mailed or served unless the applicant or licensee within such thirty days,

appeals the decision to the Chancery Court of the county where the applicant or licensee is domiciled. The certified personnel or licensed service shall have the burden of proving that the decision of the State Health Officer was not in accordance with applicable law and these regulations. If a certified personnel or licensed service is allowed to operate during the appeal process, they will remain under the regulation of MSDH and will be subject to all certification and licensure regulations.

This period is from January 1 through December 31. Regardless of date of issuance, all subscription permits expire on December 31 of each calendar year.

**History**
- *SOURCE: Miss. Code Ann. §41-59-5 Subchapter 16 Subscription Services Rule 1.16.1 All subscription permits issued are valid for a maximum period of one (1) year.*
- *SOURCE: Miss. Code Ann. §41-59-5*

##### **15 Miss. Admin. Code Pt. 12, R. 1.16.2** The Five Hundred Dollars ($500.00) permit fee is in addition to the fee for BLS or ALS licensure {#sec-12-1.16.2 omnilex-key=us-ms-regs-official--title-15--12#1.16.2}

**History**
- *SOURCE: Miss. Code Ann. §41-59-5 Subchapter 17 Program Requirements Rule 1.17.1 Each membership subscription ambulance service provided must forward a copy (copies) of all surety bonds purchased along with an official statement of total subscribers covered. Such information is made part of the application for subscription permit. During the permit period, should bonds be cancelled, voided, or changed in any way, BEMS must be notified by the service provider.*
- *SOURCE: Miss. Code Ann. §41-59-5*

##### **15 Miss. Admin. Code Pt. 12, R. 1.17.2** Rule 1.17.2 {#sec-12-1.17.2 omnilex-key=us-ms-regs-official--title-15--12#1.17.2}

Proof of the establishment of a reserve fund must be provided to BEMS as a prerequisite to BEMS issuance of a subscription permit. Monthly reserve statements of cash balances must be forwarded to BEMS by either the EMS provider and/or the bank in which the reserve account is established.

**History**
- *SOURCE: Miss. Code Ann. §41-59-5 Subchapter 18 Annual Reports Rule 1.18.1 Each subscription ambulance service must submit its annual report with all information as required in Section 41-59-69 within 45 days after the expiration of the subscription permit period (February 14).*
- *SOURCE: Miss. Code Ann. §41-59-5*

##### **15 Miss. Admin. Code Pt. 12, R. 1.18.2** The annual report may be submitted in letter form to BEMS with supporting documentation as is necessary {#sec-12-1.18.2 omnilex-key=us-ms-regs-official--title-15--12#1.18.2}

**History**
- *SOURCE: Miss. Code Ann. §41-59-5*

##### **15 Miss. Admin. Code Pt. 12, R. 1.18.3** Rule 1.18.3 {#sec-12-1.18.3 omnilex-key=us-ms-regs-official--title-15--12#1.18.3}

BEMS will suspend all subscription permits of ambulance services failing to file annual reports within the prescribed period.

Subchapter 19 Patient Transfer Rule 1.19.1 Transfer of patient care upon arrival at the Mississippi licensed hospital shall occur as timely as possible, but no longer than 30 minutes after arrival of the Mississippi licensed ambulance, to release the ambulance for 911 availability. 1. Upon delivery of a patient to a Mississippi licensed hospital, EMS personnel attending the patient shall find the most appropriate location to place the patient, which may include any space indicated by emergency room management, waiting room, disaster chair, disaster stretcher, or any other preidentified area of the emergency department. 2. Failure to abide by this requirement shall not be grounds for denial of application for certification or recertification of EMS personnel.

Said agencies must submit an application for licensure as a Non-Transport EMS site.

**History**
- *SOURCE: Miss. Code Ann. §41-59-5*
- *SOURCE: Miss. Code Ann. §41-59-5 Subchapter 20 Non-Transport EMS Rule 1.20.1 BEMS will license non-transport EMS operators, including fire department and law enforcement agencies with statewide off-line medical control agreements.*
- *SOURCE: Miss. Code Ann. §41-59-3*

##### **15 Miss. Admin. Code Pt. 12, R. 1.20.2** To obtain license as a Non-Transport EMS Site, applicant sites must: 1 {#sec-12-1.20.2 omnilex-key=us-ms-regs-official--title-15--12#1.20.2}

Submit an Application for Non-Transport EMS Site Licensure; 2. Submit a roster of all proposed employees who will require certification to practice as EMTs, AEMTs, and Paramedics at the site (to include NREMT certification numbers and state numbers for those already certified in MS as an EMS provider); 3. Submit a proposed medical control plan, including protocols (at least 30 days prior to intended service start date);

4. Submit documents specific to the proposed off/on-line medical control physician(s), including physician credentials, proof Mississippi physician licensure, and the control substances registration number; 5. Submit documentation describing proposed communications capabilities, including capability to communicate with responding ambulances and other emergency response agencies serving the primary service area and describe methods to be used for communicating with on-line medical control 24/7, conducting quality assurance, and ensuring skill maintenance; 6. Submit a letter of attestation from the off-line medical director approving of the proposed plan, approving of the proposed protocols, and acknowledging he/she understands responsibilities associated with serving as a Non-Transport EMS Off-Line Medical Director as prescribed in this document; and 7. Submit a letter of attestation from the fire chief, commanding officer, or person otherwise responsible for the Non-Emergency EMS site acknowledging intent to provide coverage in the prescribed coverage area (letter must also address evidence of capabilities).

**History**
- *SOURCE: Miss. Code Ann. §41-59-3*

##### **15 Miss. Admin. Code Pt. 12, R. 1.20.3** Rule 1.20.3 {#sec-12-1.20.3 omnilex-key=us-ms-regs-official--title-15--12#1.20.3}

Final approval of non-transport EMS sites requires submission of the application outlined above and approval by the State EMS Director and State EMS Medical Director. Non-transport sites may be subject to inspection by BEMS. BEMS will issue an official license within thirty (30) days; however, BEMS will issue a temporary document to serve as proof of licensure until the Non-Transport EMS site receives the official license. Non-Transport EMS site licensure is valid for one (1) year from date of issuance.

**History**
- *SOURCE: Miss. Code Ann. §41-59-3*

##### **15 Miss. Admin. Code Pt. 12, R. 1.20.4** BEMS will collect, and process fees approved by the Board for Non-Transport EMS site licenses {#sec-12-1.20.4 omnilex-key=us-ms-regs-official--title-15--12#1.20.4}

**History**
- *SOURCE: Miss. Code Ann. §41-59-3*

##### **15 Miss. Admin. Code Pt. 12, R. 1.19.5** Pharmaceuticals in the Non-Transport Setting: Non-Transport EMS protocols will be approved as prescribed in this Chapter {#sec-12-1.19.5 omnilex-key=us-ms-regs-official--title-15--12#1.19.5}

**History**
- *SOURCE: Miss. Code Ann. §41-59-3 Subchapter 21 Non-emergency Medical Transport (NEMT or NET)*

##### **15 Miss. Admin. Code Pt. 12, R. 1.21.1** Rule 1.21.1 {#sec-12-1.21.1 omnilex-key=us-ms-regs-official--title-15--12#1.21.1}

BEMS will regulate non-emergency medical transport and issue permits to entities or persons seeking to operate non-emergency medical transport within the

state of Mississippi. BEMS will issue permits to entities or persons, who have completed an application to offer said services, providing the application is found to be complete, without error, and is not otherwise found to be misleading or non- factual, and after inspection of the operation site and vehicles listed on the application. The application requires information on the entity or person proposing to offer said services, a complete list of vehicles to be used in transporting patients, and a complete list of proposed drivers. Non-emergency medical transport services issued vehicle permits under these rules shall not put new vehicles in service until issuance of permit or allow new hire drivers to drive before submitting an updated driver list and obtaining BEMS approval for said drivers listed on the updated list.

**History**
- *SOURCE: Miss. Code Ann. §41-59-5*

##### **15 Miss. Admin. Code Pt. 12, R. 1.21.2** Rule 1.21.2 {#sec-12-1.21.2 omnilex-key=us-ms-regs-official--title-15--12#1.21.2}

Non-emergency medical transport services must comply with the standards for drivers included in this document (Title,15, Part 12, Subpart 31). Failure to do so may result in suspension or revocation of permit privileges in the state of Mississippi or a fine assessed as provided for by the Board.

**History**
- *SOURCE: Miss. Code Ann. §41-59-5*

##### **15 Miss. Admin. Code Pt. 12, R. 1.21.3** Non-emergency medical transport drivers must meet the following standards as verified by BACS: {#sec-12-1.21.3 omnilex-key=us-ms-regs-official--title-15--12#1.21.3}

1. Initial and annual criminal background check with fingerprint clearance processed through the Department’s Healthcare Background Check process;

2. Initial and annual motor vehicle records (MVR) check clearance from the Department of Public Safety, verifying driving license at the level required for driving vehicles assigned to him/her;

3. Initial and annual negative result urine drug screen;

4. Initial and annual verification that the driver does not appear on the Office of Inspector General (OIG) exclusion list(s);

5. Initial and annual verification of appropriate training in use of the vehicle assigned to him/her, safety equipment recommended for the vehicle assigned to him/her; equipment installed in the vehicle assigned to him/her used in the transfer and/or transport of patients; and

6. Current certification in cardiopulmonary resuscitation.

**History**
- *SOURCE: Miss. Code Ann. §41-59-5*

##### **15 Miss. Admin. Code Pt. 12, R. 1.21.4** Rule 1.21.4 {#sec-12-1.21.4 omnilex-key=us-ms-regs-official--title-15--12#1.21.4}

Permits issued to new applicants must include information on the operations site, initial roster of vehicles, and initial proposed list of drivers. The initial issuance of permit(s) to the new applicant requires visit of the proposed operations site by BEMS inspectors, inspection of proposed vehicles, and processing of proposed driver lists as prescribed in this subchapter. The State EMS Director must approve the initial request for Non-emergency Medical Transport Vehicle Permit(s). Thereafter, permits may be issued to a recognized operator on-site. On-site vehicle inspections may be offered at advertised locations or on-site at the operation site. Non-emergency medical transport vehicles shall display a placard on the exterior of each door and exterior rear of the vehicle a visible placard, visible from other vehicles, which states, specifically: NON-EMERGENCY MEDICAL TRANSPORT VEHICLE – THIS SERVICE DOES NOT PROVIDE MEDICAL CARE.

**History**
- *SOURCE: Miss. Code Ann. §41-59-5*

##### **15 Miss. Admin. Code Pt. 12, R. 1.21.5** Required minimum equipment: {#sec-12-1.21.5 omnilex-key=us-ms-regs-official--title-15--12#1.21.5}

1. Cell phone capability to access 911;

2. Two-way communications equipment to facilitate communications with operations base;

3. Fire extinguisher;

4. First aid kit;

5. Seat belt cutter;

6. Seat belt extender;

7. Wheelchair loading and transport system for vehicles transporting wheelchair patients; and

8. Pocket mask device for CPR.

**History**
- *SOURCE: Miss. Code Ann. §41-59-5*

##### **15 Miss. Admin. Code Pt. 12, R. 1.21.6** Rule 1.21.6 {#sec-12-1.21.6 omnilex-key=us-ms-regs-official--title-15--12#1.21.6}

High Visibility Safety Apparel for Staff: Non-transport vehicles must be equipped with high visibility safety apparel for each person staffing or participating in the operation of the vehicle. All garments must meet the requirements of the American National Standard for High Visibility Apparel ANSI/ISEA 107-2004 Performance Class 2 or Performance Class 3, or the ANSI/ISEA 207-2006 Standard. All garments must have labels, affixed by the manufacturer in accordance with the standard, that indicate compliance with the Performance Class 2, Performance Class 3, or 207-2006 standard.

**History**
- *SOURCE: Miss. Code Ann. §41-59-5*

##### **15 Miss. Admin. Code Pt. 12, R. 1.21.7** Permits are valid for a period of one (1) year from the date of issue {#sec-12-1.21.7 omnilex-key=us-ms-regs-official--title-15--12#1.21.7}

After initial permits are issued, permits are re-issued by BEMS following the respective annual inspection of each respective vehicle.

**History**
- *SOURCE: Miss. Code Ann. §41-59-5*

##### **15 Miss. Admin. Code Pt. 12, R. 1.21.8** Rule 1.21.8 {#sec-12-1.21.8 omnilex-key=us-ms-regs-official--title-15--12#1.21.8}

Payment of the renewal fee for non-emergency medical transport vehicles permits will be fixed by the Board and paid through BEMS.

**History**
- *SOURCE: Miss. Code Ann. §41-59-5*

##### **15 Miss. Admin. Code Pt. 12, R. 1.21.9** Rule 1.21.9 {#sec-12-1.21.9 omnilex-key=us-ms-regs-official--title-15--12#1.21.9}

Non-emergency medical transport operators shall collect and maintain records accounting for all patients transported, including date of service, time of service, vehicle used, and driver in attendance. Relatedly, operators shall maintain employee records on all drivers for a period not less than five (5) years. Operators shall also maintain records related to the issuance of permits and present the same on request of BEMS staff.

**History**
- *SOURCE: Miss. Code Ann. §41-59-5*

##### **15 Miss. Admin. Code Pt. 12, R. 1.21.10** Rule 1.21.10 {#sec-12-1.21.10 omnilex-key=us-ms-regs-official--title-15--12#1.21.10}

There shall be at least one person trained in adult and pediatric cardiopulmonary resuscitation in accordance with the standards of the American Heart Association or the American Red Cross available to attend the patient.

Chapter 2 TRANSFERS Subchapter 1 General Information Rule 2.1.1 EMS personnel are restricted to performance of those skills as authorized by the State Department of Health, Bureau of Emergency Medical Services. EMS personnel cannot transport patients with needs or reasonably perceived needs for care which exceed the scope of practice for the ambulance attendant.

**History**
- *SOURCE: Miss. Code Ann. §41-59-5*
- *SOURCE: Miss. Code Ann. §41-59-5*

##### **15 Miss. Admin. Code Pt. 12, R. 2.1.2** The only exception to the above is as follows: 1 {#sec-12-2.1.2 omnilex-key=us-ms-regs-official--title-15--12#2.1.2}

EMT's may attend and transport by ambulance, patients who have pre-existing procedures or devices that are beyond the EMT's scope of practice if: 2. There is no need, or reasonably perceived need, for the device or procedure during transport; and

3. An individual (including the patient himself) that has received training and management of the procedure or device accompanies the patient to the destination.

**History**
- *SOURCE: Miss. Code Ann. §41-59-5*

##### **15 Miss. Admin. Code Pt. 12, R. 2.1.3** Rule 2.1.3 {#sec-12-2.1.3 omnilex-key=us-ms-regs-official--title-15--12#2.1.3}

Should doubt exist in regard to the transport of any device or procedure, medical control should be contacted for medical direction.

**History**
- *SOURCE: Miss. Code Ann. §41-59-5*

##### **15 Miss. Admin. Code Pt. 12, R. 2.1.4** Rule 2.1.4 {#sec-12-2.1.4 omnilex-key=us-ms-regs-official--title-15--12#2.1.4}

Ambulance personnel aiding in the transfer should confirm that the facility to which the patient is to be transferred has been notified and has agreed to accept the patient. They should also inquire whether the patient's condition is stable (no material deterioration of the condition is likely, within reasonable medical probability, to result from the transfer of the individual from the facility) and whether a nurse, physician or other medical personnel should accompany the patient during transfer.

**History**
- *SOURCE: Miss. Code Ann. §41-59-5*

##### **15 Miss. Admin. Code Pt. 12, R. 2.1.5** Rule 2.1.5 {#sec-12-2.1.5 omnilex-key=us-ms-regs-official--title-15--12#2.1.5}

If a patient at a hospital has an emergency medical condition which has not been stabilized (as defined herein), the hospital should not request the transfer and the ambulance service should not transfer the patient unless: 1. the patient (or legally responsible person acting on the patient's behalf) request that the transfer be affected. 2. a physician or other qualified medical personnel when a physician is not readily available, has verified that, based upon the reasonable risks and benefits to the patient, and based upon the information available at the time, the medical benefits reasonably expected from the provision of appropriate medical treatment at another medical facility outweigh the increased risk to the individual's medical condition from effecting the transfer; or, 3. the transfer is an appropriate transfer to that facility.

**History**
- *SOURCE: Miss. Code Ann. §41-59-5*

##### **15 Miss. Admin. Code Pt. 12, R. 2.1.6** Rule 2.1.6 {#sec-12-2.1.6 omnilex-key=us-ms-regs-official--title-15--12#2.1.6}

Interfacility transport is defined as the movement a patient from one licensed health care facility (hospitals, skilled nursing facilities, long term healthcare facilities) to another in a licensed ground or air ambulance. The transfer of patients between facilities is a fundamental component of the health care system.

**History**
- *SOURCE: Miss. Code Ann. §41-59-5 Subchapter 2 INTERFACILITY PATIENT TRANSFERS*

##### **15 Miss. Admin. Code Pt. 12, R. 2.2.1** Rule 2.2.1 {#sec-12-2.2.1 omnilex-key=us-ms-regs-official--title-15--12#2.2.1}

Medical direction is a critical component of all ground and air ambulance services, including interfacility transfer services. Air and ground ambulances that transfer patients must be capable of providing emergency care during transport. Optimal planning for transfer considers individual patient medical requirements and an understanding of the capabilities of the personnel and system used for patient transfer. The system design, determination of the scope of practice of its providers, and the assurance that patient care is rendered consistent with this scope of practice, are essential medical direction functions.

**History**
- *SOURCE: Miss. Code Ann. §41-59-5*

##### **15 Miss. Admin. Code Pt. 12, R. 2.2.2** Medical direction of the transferred patient is a shared responsibility {#sec-12-2.2.2 omnilex-key=us-ms-regs-official--title-15--12#2.2.2}

The transferring physician is responsible under Federal laws for assuring that the patient is transferred by qualified personnel and appropriate equipment. The designation of on-line medical control for the interfacility transfer of patients is the responsibility of the EMS system and its off-line medical director.

2. In which the transferring hospital provides the receiving facility with appropriate medical records of the examination and treatment effected at the transferring hospital. 3. In which the transfer is affected through qualified personnel and transportation equipment, as required including the use of necessary and medically appropriate life support measures during the transfer.

**History**
- *SOURCE: Miss. Code Ann. §41-59-5 Subchapter 3 Definitions - Inter-Hospital and Other Medical Facilities Rule 2.3.1 Appropriate Transfer - An appropriate transfer to a medical facility is 1. A transfer in which the receiving facility: a) has available space and qualified personnel for the treatment of the patient, and b) has agreed to accept transfer of the patient and to provide appropriate medical treatment.*
- *SOURCE: Miss. Code Ann. §41-59-5*

##### **15 Miss. Admin. Code Pt. 12, R. 2.3.2** Medical Control During Interfacility Transfers 1 {#sec-12-2.3.2 omnilex-key=us-ms-regs-official--title-15--12#2.3.2}

Once an emergency patient arrives for initial evaluation at a medical facility the patient becomes the responsibility of that facility, and its medical staff. This responsibility continues until the patient is appropriately discharged, or until the patient is transferred and the responsibility is assumed by personnel and a facility of equal or greater capability for the patient's existing condition. 2. Should questions or problems arise during transfer, or in event of an emergency, one of the following (whichever is most appropriate based on service’s approved Medical Control Plan) shall be contacted for medical guidance, as outlined in

BEMS approved medical control plan: Online Medical Direction; Transferring Physician; or Receiving Physician.

**History**
- *SOURCE: Miss. Code Ann. §41-59-5 Subchapter 4 Interhospital Transfers Rule 2.4.1 If a transfer is being made for the convenience of the patient or patient's physicians, and the patient is not receiving treatment, and is expecting to remain stable during transport, the transfer may be conducted by and appropriately trained medical provider (EMT-Basic or higher).*
- *SOURCE: Miss. Code Ann. §41-59-5*

##### **15 Miss. Admin. Code Pt. 12, R. 2.4.2** Rule 2.4.2 {#sec-12-2.4.2 omnilex-key=us-ms-regs-official--title-15--12#2.4.2}

Routinely, the transferring physician is responsible for securing the acceptance of the patient by an appropriate physician at the receiving facility. Care provided by the transferring facility may need to be continued during transport. The transferring physician in collaboration with the service’s medical control will determine the treatment to be provided during the period of the patient transport.

**History**
- *SOURCE: Miss. Code Ann. §41-59-5*

##### **15 Miss. Admin. Code Pt. 12, R. 2.4.3** Rule 2.4.3 {#sec-12-2.4.3 omnilex-key=us-ms-regs-official--title-15--12#2.4.3}

Should questions or problems arise during transfer, or in event of an emergency, one of the following (whichever is most appropriate based on service’s approved Medical Control Plan) shall be contacted for medical guidance: Online Medical Direction; Transferring Physician; or Receiving Physician.

**History**
- *SOURCE: Miss. Code Ann. §41-59-5*

##### **15 Miss. Admin. Code Pt. 12, R. 2.4.4** Rule 2.4.4 {#sec-12-2.4.4 omnilex-key=us-ms-regs-official--title-15--12#2.4.4}

Documentation must include the interventions performed en-route and by whom the intervention was performed, and condition of patient upon transfer to the receiving facility.

equipment specific to the patient’s special care needs. Patients requiring this level of care should be identified during medical screening so that special staffing and equipment requirements can meet the patient’s potential needs. These patients are considered at risk for de-compensation during transport which may require close attention or intervention.

**History**
- *SOURCE: Miss. Code Ann. §41-59-5 Subchapter 5 Specialty Care Services Rule 2.5.1 Specialty Care Services (SCS) shall provide the level of care (quantity and type of staff member(s), equipment, and procedures) that is consistent with a patient whose condition requires special care specific to their age and/or diagnosis. The patient may or may not be stable or in an acute situation prior to transport. These patients are being cared for in an acute care facility environment such as the emergency department, coronary care unit, intensive care unit, pediatric or neonatal unit, burn care or other similar unit where continuous monitoring of vital signs, cardiac rhythm, oxygen saturation and maintenance of continuous infusions of IV medications or control of ventilator functions by artificial means are being performed. This level of care must be rendered by medical personnel of appropriate training. This level of care requires monitoring and diagnostic*
- *SOURCE: Miss. Code Ann. §41-59-5 Chapter 3 AERO MEDICAL SERVICES Subchapter 1 Definitions Relative to Aero Medical EMS: #21600 Rule 3.1.1 Advanced Life Support Care (ALSC) - a sophisticated level of pre-hospital and inter-hospital emergency care which includes basic life support functions including cardiopulmonary resuscitation (CPR), plus cardiac defibrillation, telemetered electrocardiography, administration of anti-arrhythmic agents, intravenous therapy, administration of specific medications, drugs and solutions, use of adjunctive ventilation devices, trauma care and other authorized techniques and procedures. This level of care (quantity and type of staff member(s), equipment, and procedures) is consistent with a patient in a pre-hospital emergency or non-emergency incident. In addition, this level of care (quantity and type of staff member(s), equipment and procedures) is consistent with a patient in an inter-hospital incident who is in a non-acute situation and is being cared for in an environment where monitoring of cardiac rhythm, neurological status, and/or continuous infusions of anti-arrhythmic and/or vasopressors, are part of the patient's care needs.*
- *SOURCE: Miss. Code Ann. §41-59-5*

##### **15 Miss. Admin. Code Pt. 12, R. 3.1.2** Rule 3.1.2 {#sec-12-3.1.2 omnilex-key=us-ms-regs-official--title-15--12#3.1.2}

Aeromedical Physiology - (altitude physiology, flight physiology) the physiological changes imposed on humans when exposed to changes in altitude and atmospheric pressure and the physical forces of aircraft in flight. Persons whose physiologic state is already compromised may be more susceptible to these changes and the potential physiologic responses they may experience while in flight in an aircraft. It is directly related to physical gas laws and the physics of flight. See also Stressor of Flight.

**History**
- *SOURCE: Miss. Code Ann. §41-59-5*

##### **15 Miss. Admin. Code Pt. 12, R. 3.1.3** Rule 3.1.3 {#sec-12-3.1.3 omnilex-key=us-ms-regs-official--title-15--12#3.1.3}

Air Ambulance Aircraft - a fixed-wing or rotor-wing aircraft specially constructed or modified that is equipped and designated for transportation of sick or injured persons. It does not include transport of organ transplant teams or organs.

**History**
- *SOURCE: Miss. Code Ann. §41-59-5*

##### **15 Miss. Admin. Code Pt. 12, R. 3.1.4** Rule 3.1.4 {#sec-12-3.1.4 omnilex-key=us-ms-regs-official--title-15--12#3.1.4}

Air Ambulance Service - (service, provider) an entity or a division of an entity (sole proprietorship, partnership, or corporation) that is authorized by the Federal Aviation Administration (FAA) and BEMS to provide patient transport and/or

transfer by air ambulance aircraft. The patient(s) may be ambulatory or non- ambulatory and may or may not require medical intervention of basic or advanced nature. It uses aircraft, equipped, and staffed to provide a medical care environment on board appropriate to patient's needs. The term air ambulance service is not synonymous with and does not refer to the FAA air carrier certificate holder unless they also maintain and control the medical aspects that make up a complete service.

**History**
- *SOURCE: Miss. Code Ann. §41-59-5*

##### **15 Miss. Admin. Code Pt. 12, R. 3.1.5** Rule 3.1.5 {#sec-12-3.1.5 omnilex-key=us-ms-regs-official--title-15--12#3.1.5}

Air Medical Personnel - a licensed physician, registered nurse, respiratory therapist, State of Mississippi current certified Paramedic, Critical Care Paramedic who has successfully completed a course in aeromedical physiology and flight safety training and orientation.

**History**
- *SOURCE: Miss. Code Ann. §41-59-5*

##### **15 Miss. Admin. Code Pt. 12, R. 3.1.6** Rule 3.1.6 {#sec-12-3.1.6 omnilex-key=us-ms-regs-official--title-15--12#3.1.6}

Air Ambulance Transport System Activation - Formerly referred to as Dispatch, the term was changed to avoid conflict with the meaning in the FAR's - the process of receiving a request for transport or information and the act of allocating, sending and controlling an air ambulance and air medical personnel in response to such request as well as monitoring the progress of the transport.

**History**
- *SOURCE: Miss. Code Ann. §41-59-5*

##### **15 Miss. Admin. Code Pt. 12, R. 3.1.7** Rule 3.1.7 {#sec-12-3.1.7 omnilex-key=us-ms-regs-official--title-15--12#3.1.7}

Authorized Representative - any person delegated by a licensee to represent the provider to county, municipal or federal regulatory officials.

**History**
- *SOURCE: Miss. Code Ann. §41-59-5*

##### **15 Miss. Admin. Code Pt. 12, R. 3.1.8** Rule 3.1.8 {#sec-12-3.1.8 omnilex-key=us-ms-regs-official--title-15--12#3.1.8}

Aviation Crew Member - (pilot, co-pilot, and flight crew) a pilot, co-pilot, flight engineer, or flight navigator assigned to duty in an aircraft cockpit.

**History**
- *SOURCE: Miss. Code Ann. §41-59-5*

##### **15 Miss. Admin. Code Pt. 12, R. 3.1.9** Rule 3.1.9 {#sec-12-3.1.9 omnilex-key=us-ms-regs-official--title-15--12#3.1.9}

Critical Care Life Support (CCLS) - the level of care (quantity and type of staff member(s), equipment and procedures) that is consistent with a patient who may or may not be stable and who is in an acute situation or at high risk of decompensating prior to transport. The following patient categories are included: cardiovascular, pulmonary, neurologic, traumatic injury including spinal or head injury, burns, poisonings and toxicology. These patients are being cared for in an acute care facility such as the emergency department, intensive, critical, coronary, or cardiac rhythm, oxygen saturation and maintenance of continuous infusions of IV medications or control of ventilatory functions by artificial means is being performed. This level of care must be rendered by at least two air medical personnel, one of which is a Mississippi Critical Care Paramedic, registered nurse, or physician. This level of care requires specific monitoring and diagnostic equipment above the advanced level.

**History**
- *SOURCE: Miss. Code Ann. §41-59-5*

##### **15 Miss. Admin. Code Pt. 12, R. 3.1.10** FAA - the Federal Aviation Administration {#sec-12-3.1.10 omnilex-key=us-ms-regs-official--title-15--12#3.1.10}

**History**
- *SOURCE: Miss. Code Ann. §41-59-5*

##### **15 Miss. Admin. Code Pt. 12, R. 3.1.11** FAR - the Federal Aviation Regulation {#sec-12-3.1.11 omnilex-key=us-ms-regs-official--title-15--12#3.1.11}

**History**
- *SOURCE: Miss. Code Ann. §41-59-5*

##### **15 Miss. Admin. Code Pt. 12, R. 3.1.12** FCC - the Federal Communications Commission {#sec-12-3.1.12 omnilex-key=us-ms-regs-official--title-15--12#3.1.12}

**History**
- *SOURCE: Miss. Code Ann. §41-59-5*

##### **15 Miss. Admin. Code Pt. 12, R. 3.1.13** Rule 3.1.13 {#sec-12-3.1.13 omnilex-key=us-ms-regs-official--title-15--12#3.1.13}

Fixed-wing Air Ambulance - (fixed-wing) a fixed-wing type aircraft that is constructed or modified to transport at least one sick or injured patient in the supine or prone position on a medically appropriate, FAA approved stretcher.

**History**
- *SOURCE: Miss. Code Ann. §41-59-5*

##### **15 Miss. Admin. Code Pt. 12, R. 3.1.14** Rule 3.1.14 {#sec-12-3.1.14 omnilex-key=us-ms-regs-official--title-15--12#3.1.14}

Inter-facility Transfer - (transfer) the transportation of a patient, by an air ambulance service provider, initiating at a health care facility whose destination is another health care facility.

**History**
- *SOURCE: Miss. Code Ann. §41-59-5*

##### **15 Miss. Admin. Code Pt. 12, R. 3.1.15** Rule 3.1.15 {#sec-12-3.1.15 omnilex-key=us-ms-regs-official--title-15--12#3.1.15}

Medical Director - a licensed physician (MD or DO) who is specifically designated by an air ambulance provider and has accepted the responsibility for providing medical direction to the air ambulance service. He or she must be a Mississippi licensed physician, M.D. or D.O., and show evidence of board certification in emergency medicine or board eligibility in emergency medicine. Air Ambulances which operate from or based in Mississippi, must have an Offline Medical Director whose primary practice is in Mississippi or at a Mississippi trauma center. (Air Ambulance provided from and based out-of-state must have a Offline Medical Director that is board certified in emergency medicine or board eligible in emergency medicine.) The medical director is ultimately responsible for all aspects of a service's operation which effect patient care. The medical director is responsible for assuring that appropriately trained medical personnel and equipment are provided for each patient transported and that individual aircraft can provide appropriate care environments for patients. The Air Ambulance Service Medical Director must be approved by the State EMS Medical Director.

**History**
- *SOURCE: Miss. Code Ann. §41-59-5*

##### **15 Miss. Admin. Code Pt. 12, R. 3.1.16** Rule 3.1.16 {#sec-12-3.1.16 omnilex-key=us-ms-regs-official--title-15--12#3.1.16}

Patient - an individual who is sick, injured, or otherwise incapacitated or whose condition requires or may require skilled medical care for intervention.

**History**
- *SOURCE: Miss. Code Ann. §41-59-5*

##### **15 Miss. Admin. Code Pt. 12, R. 3.1.17** Rule 3.1.17 {#sec-12-3.1.17 omnilex-key=us-ms-regs-official--title-15--12#3.1.17}

Permit - a document issued by BEMS indicating that the aircraft has been approved for use as an air ambulance vehicle by BEMS in the state of Mississippi.

**History**
- *SOURCE: Miss. Code Ann. §41-59-5*

##### **15 Miss. Admin. Code Pt. 12, R. 3.1.18** Rule 3.1.18 {#sec-12-3.1.18 omnilex-key=us-ms-regs-official--title-15--12#3.1.18}

Physician - (doctor) a person licensed to practice medicine as a physician (MD or DO) by the state where the air ambulance service is located.

**History**
- *SOURCE: Miss. Code Ann. §41-59-5*

##### **15 Miss. Admin. Code Pt. 12, R. 3.1.19** Pilot - a person who holds a valid certificate issued by the FAA to operate an aircraft {#sec-12-3.1.19 omnilex-key=us-ms-regs-official--title-15--12#3.1.19}

**History**
- *SOURCE: Miss. Code Ann. §41-59-5*

##### **15 Miss. Admin. Code Pt. 12, R. 3.1.20** Public Aircraft - an aircraft used only in the service of a government agency {#sec-12-3.1.20 omnilex-key=us-ms-regs-official--title-15--12#3.1.20}

It does not include government-owned aircraft engaged in carrying persons or property for commercial purposes.

**History**
- *SOURCE: Miss. Code Ann. §41-59-5*

##### **15 Miss. Admin. Code Pt. 12, R. 3.1.21** Rule 3.1.21 {#sec-12-3.1.21 omnilex-key=us-ms-regs-official--title-15--12#3.1.21}

Reciprocal Licensing - (reciprocity) mutual acceptance of an air ambulance service provider's valid license to operate an air ambulance service in a state other than the one in which it is licensed.

**History**
- *SOURCE: Miss. Code Ann. §41-59-5*

##### **15 Miss. Admin. Code Pt. 12, R. 3.1.22** Rule 3.1.22 {#sec-12-3.1.22 omnilex-key=us-ms-regs-official--title-15--12#3.1.22}

Registered Nurse - (RN) an individual who holds a valid license issued by the state licensing agency to practice professional nursing as a registered nurse.

**History**
- *SOURCE: Miss. Code Ann. §41-59-5*

##### **15 Miss. Admin. Code Pt. 12, R. 3.1.23** Rule 3.1.23 {#sec-12-3.1.23 omnilex-key=us-ms-regs-official--title-15--12#3.1.23}

Rotor-wing Air Ambulance - (rotor-wing) a rotor-wing type aircraft that is constructed or modified to transport at least one sick or injured patient in the supine or prone position on a medically appropriate, FAA approved stretcher/litter (as per FAR Section 23.785 and 23.561). It also includes an array of medical equipment and an appropriate number of trained air medical personnel to care for the patient's needs.

**History**
- *SOURCE: Miss. Code Ann. §41-59-5*

##### **15 Miss. Admin. Code Pt. 12, R. 3.1.24** Rule 3.1.24 {#sec-12-3.1.24 omnilex-key=us-ms-regs-official--title-15--12#3.1.24}

Specialty Care Transport (SCS) - the level of care (quantity and type of staff member(s), equipment, and procedures) that is consistent with a patient whose condition requires special care specific to their age and/or diagnosis. The patient may or may not be stable or in an acute situation prior to transport. The following patient categories are included: pediatric intensive care, maternal care, neonatal

intensive care and burn care. These patients are being cared for in an acute care facility environment such as the emergency department, coronary care unit, intensive care unit, pediatric or neonatal unit, burn care or other similar unit where continuous monitoring of vital signs, cardiac rhythm, oxygen saturation and maintenance of continuous infusions of IV medications or control of ventilator functions by artificial means are being performed. This level of care must be rendered by medical personnel of appropriate training. This level of care requires monitoring and diagnostic equipment specific to the patient’s special care needs. Patients requiring this level of care should be identified during medical screening so that special staffing and equipment requirements can meet the patient’s potential needs. These patients are considered at risk for de- compensation during transport which may require close attention or intervention.

**History**
- *SOURCE: Miss. Code Ann. §41-59-5*

##### **15 Miss. Admin. Code Pt. 12, R. 3.1.25** Rule 3.1.25 {#sec-12-3.1.25 omnilex-key=us-ms-regs-official--title-15--12#3.1.25}

Stressors of Flight - the factors which humans may be exposed to during flight which can have an effect on the individual's physiologic state and ability to perform. The stressors include - hypoxia, barometric changes (expanding and contracting gas), fatigue (sometimes self induced), thermal variations (extremes of temperature), dehydration, noise, vibration, motion, and G-forces.

**History**
- *SOURCE: Miss. Code Ann. §41-59-5 Subchapter 2 Air Ambulance Licensure Rule 3.2.1 Licensure as an air ambulance service shall only be granted to a person or entity that directs and controls the integrated activities of both the medical and aviation components. Note: Air ambulance requires the teaming of medical and aviation functions. In many instances, the entity that is providing the medical staffing, equipment and control is not the certificate aircraft operator but has an arrangement with another entity to provide the aircraft. Although the aircraft operator is directly responsible to the FAA for the operation of the aircraft, one organization, typically the one in charge of the medical functions directs the combined efforts of the aviation and medical components during patient transport operations.*
- *SOURCE: Miss. Code Ann. §41-59-5*

##### **15 Miss. Admin. Code Pt. 12, R. 3.2.2** Rule 3.2.2 {#sec-12-3.2.2 omnilex-key=us-ms-regs-official--title-15--12#3.2.2}

No person or organization may operate an air ambulance service unless such person or organization has a valid license issued by BEMS. Any person desiring to provide air ambulance services shall, prior to operation, obtain a license from BEMS. To obtain such license, each applicant for an air ambulance license shall pay the required fee and submit an application on the prescribed air ambulance licensure application forms. Applicant must submit one copy of the plan of medical control at least 30 days prior to service start date for approval by BEMS

and State EMS Medical Director. The license shall automatically expire at the end of the licensing period.

**History**
- *SOURCE: Miss. Code Ann. §41-59-5*

##### **15 Miss. Admin. Code Pt. 12, R. 3.2.3** Rule 3.2.3 {#sec-12-3.2.3 omnilex-key=us-ms-regs-official--title-15--12#3.2.3}

Prior to operation as an air ambulance, the applicant shall obtain a permit for each aircraft it uses to provide its service.

**History**
- *SOURCE: Miss. Code Ann. §41-59-5*

##### **15 Miss. Admin. Code Pt. 12, R. 3.2.4** Rule 3.2.4 {#sec-12-3.2.4 omnilex-key=us-ms-regs-official--title-15--12#3.2.4}

Each licensee shall be able to provide air ambulance service within 90 days after receipt of its license to operate as an air ambulance from the licensing authority.

**History**
- *SOURCE: Miss. Code Ann. §41-59-5*

##### **15 Miss. Admin. Code Pt. 12, R. 3.2.5** Rule 3.2.5 {#sec-12-3.2.5 omnilex-key=us-ms-regs-official--title-15--12#3.2.5}

Each aircraft configured for patient transport shall meet the structural, equipment and supply requirements set forth in these regulations.

**History**
- *SOURCE: Miss. Code Ann. §41-59-5*

##### **15 Miss. Admin. Code Pt. 12, R. 3.2.6** Rule 3.2.6 {#sec-12-3.2.6 omnilex-key=us-ms-regs-official--title-15--12#3.2.6}

An air ambulance license is dependent on, and concurrent with, proper FAA certification of the aircraft operator(s) to concurrent with proper FAA certification of the aircraft operator(s) to conduct operations under the applicable parts of the Federal Aviation Regulations. Certificate holder must meet all national authority regulations specific to the operations of the medical service in the country of residence, as applicable. This includes a national authority regulator’s certificate (public service medical transport agencies are included in this requirement) and Ambulance Operations Specifications specific to EMS operations. The transport service demonstrates compliance with the legal requirements and regulations of all local, state, and federal agencies under whose authority it operates. #21600

**History**
- *SOURCE: Miss. Code Ann. §41-59-5*

##### **15 Miss. Admin. Code Pt. 12, R. 3.2.7** Rule 3.2.7 {#sec-12-3.2.7 omnilex-key=us-ms-regs-official--title-15--12#3.2.7}

Current, full accreditation by the Certified Association of Air Medical Transport Services (CAMTS) or equivalent program will be accepted by BEMS as compliance with the requirements set forth. #21600

**History**
- *SOURCE: Miss. Code Ann. §41-59-5*

##### **15 Miss. Admin. Code Pt. 12, R. 3.2.8** A provider's license will be suspended or revoked for failure to comply with the requirements of these regulations {#sec-12-3.2.8 omnilex-key=us-ms-regs-official--title-15--12#3.2.8}

**History**
- *SOURCE: Miss. Code Ann. §41-59-5*

##### **15 Miss. Admin. Code Pt. 12, R. 3.2.9** No licensee shall operate a service if their license has been suspended or revoked {#sec-12-3.2.9 omnilex-key=us-ms-regs-official--title-15--12#3.2.9}

**History**
- *SOURCE: Miss. Code Ann. §41-59-5*

##### **15 Miss. Admin. Code Pt. 12, R. 3.2.10** Rule 3.2.10 {#sec-12-3.2.10 omnilex-key=us-ms-regs-official--title-15--12#3.2.10}

Any provider that maintains bases of operation in more than one state jurisdiction shall be licensed at each base by BEMS having jurisdiction.

**History**
- *SOURCE: Miss. Code Ann. §41-59-5*

##### **15 Miss. Admin. Code Pt. 12, R. 3.2.11** Rule 3.2.11 {#sec-12-3.2.11 omnilex-key=us-ms-regs-official--title-15--12#3.2.11}

The owner, manager, or medical director of each publicly or privately owned ambulance service shall inform the State Department of Health, Bureau of EMS of the termination of service in a licensed county or defined service area no less than 30 days prior to ceasing operations. This communication should also be sent by the owner, manager or medical director of each publicly or privately owned ambulance service to related parties and local governmental entities such as, but not limited to, emergencies management agency, local healthcare facilities, and the public via mass media.

**History**
- *SOURCE: Miss. Code Ann. §41-59-5 Subchapter 3 RECIPROCITY Rule 3.3.1 Any provider who is licensed in another jurisdiction whose regulations are at least as stringent as these, and provides proof of such license, and who meets all other regulatory requirements shall be regarded as meeting the specifications of these regulations.*
- *SOURCE: Miss. Code Ann. §41-59-5*

##### **15 Miss. Admin. Code Pt. 12, R. 3.3.2** Access - Inspection of records; equipment/supply categories, and air ambulance aircraft {#sec-12-3.3.2 omnilex-key=us-ms-regs-official--title-15--12#3.3.2}

1. BEMS, after presenting proper identification, shall be allowed to inspect any aircraft, equipment, supplies or records of any licensee to determine compliance with these regulations. BEMS shall inspect the licensee at least twice every licensing period. 2. The finding of any inspection shall be recorded on a form provided for this purpose. BEMS shall furnish a copy of the inspection report form to the licensee or the licensee's authorized representative. Upon completion of an inspection, any violations shall be noted on the form.

**History**
- *SOURCE: Miss. Code Ann. §41-59-5*

##### **15 Miss. Admin. Code Pt. 12, R. 3.3.3** Issuance of Notices {#sec-12-3.3.3 omnilex-key=us-ms-regs-official--title-15--12#3.3.3}

1. Whenever BEMS makes an inspection of an air ambulance aircraft and discovers that any of the requirements of these regulations have been violated or have not been complied with in any manner, BEMS shall notify the licensee of the infraction(s) by means of an inspection report or other written notice.

2. The report shall: Set forth the specific violations found; establish a specific period of time for the correction of the violation(s) found, in accordance with the provisions in Violations.

**History**
- *SOURCE: Miss. Code Ann. §41-59-5*

##### **15 Miss. Admin. Code Pt. 12, R. 3.3.4** Reports #21600 1 {#sec-12-3.3.4 omnilex-key=us-ms-regs-official--title-15--12#3.3.4}

Notification a. Each holder of a license shall notify BEMS of the disposition of any criminal or civil litigation or arbitration based on their actions as a licensee within 5 days after a verdict has been rendered. b. The licensee will notify BEMS when it removes a permitted aircraft from service or replaces it with a substitute aircraft meeting the same transport capabilities and equipment specifications as the out-of-service aircraft for a period of time greater than 7 days but not to exceed 90 calendar days. Upon receipt of notification, BEMS shall issue a temporary permit for the operation of said aircraft. 2. Patient Reports a. Each licensee shall maintain accurate records upon such forms as may be provided and contain such information as may be required by BEMS concerning the transportation of each patient within this state and beyond its limits. Such records shall be available for inspection by BEMS at any reasonable time, and copies thereof shall be furnished to BEMS upon request. b. All licensed ambulance services operating in the State of Mississippi must electronically submit electronically, the State of Mississippi Patient Encounter Form and/or information contained on the form via network, or direct computer link, for each ambulance run made and/or for each patient transported. c. A completed copy of a Mississippi Patient Encounter Form or Patient Care Report containing the data elements of the Mississippi Patient Encounter Form shall be left with or electronically submitted to hospital staff for all patients delivered to license Hospitals. If in the best interest of the public good, an immediate response to a patient is required of an ambulance delivering a patient to a licensed Hospital, a complete oral report on the patient being delivered will be given to the receiving facility and a completed copy of a Mississippi Patient Encounter Form or Patient Care Report containing the data elements of the Mississippi Patient Encounter Form for that patient shall be delivered to the hospital staff of the licensed Hospital within 24 hours.

d. All Mississippi Patient Encounter Forms are due in the BEMS office by the seventh day after the close of the preceding month. e. All Mississippi Patient Encounter Forms or computer disk information returned to a licensee for correction must be corrected and returned to the BEMS office within two weeks calculated from the date of their return. f. Returns to a licensee greater than 3 times may result in a penalty as outlined under Section 41-59-45, paragraph 3. g. The licensee shall maintain a copy of all the run records according to statutory requirements, accessible for inspection upon request by BEMS. h. A copy of the patient encounter form shall be given to the person accepting care of the patient.

**History**
- *SOURCE: Miss. Code Ann. §41-59-5*

##### **15 Miss. Admin. Code Pt. 12, R. 3.3.5** Rule 3.3.5 {#sec-12-3.3.5 omnilex-key=us-ms-regs-official--title-15--12#3.3.5}

Location identification: The Licensee shall identify on the prescribed form any and all physical locations where a function of their operations are conducted. These locations include permanent business office, aircraft storage, repair, communications/activation facilities, training and sleeping areas.

**History**
- *SOURCE: Miss. Code Ann. §41-59-5*

##### **15 Miss. Admin. Code Pt. 12, R. 3.3.6** Aero Medical Advertisement #21600 1 {#sec-12-3.3.6 omnilex-key=us-ms-regs-official--title-15--12#3.3.6}

No person, entity or organization shall advertise via printed or electronic media as an air ambulance service provider in the state of Mississippi unless they hold a valid license in the state of Mississippi or has licensure in another state which is reciprocally honored by BEMS. 2. The licensee's advertising shall be done only under the name stated on their license. 3. The licensee's advertising and marketing shall demonstrate consistency with the licensee's actual licensed level of medical care capabilities and aircraft resources. Clear identification of the FAA Part 135 Certificate Holder as the identity that is operating the aircraft is one the program’s website, in marketing materials, and on the aircraft.

**History**
- *SOURCE: Miss. Code Ann. §41-59-5*

##### **15 Miss. Admin. Code Pt. 12, R. 3.3.7** Property & Casualty Liability 1 {#sec-12-3.3.7 omnilex-key=us-ms-regs-official--title-15--12#3.3.7}

Every licensee or applicant shall ensure that the Part 135 Air Carrier Operating certificate holder operating the aircraft carries bodily injury and property damage insurance with solvent insurers licensed to do business in the state of Mississippi,

to secure payment for any loss or damage resulting from any occurrence arising out of or caused by the operation or use of any of the certificate holders aircraft. Each aircraft shall be insured for the minimum amount of $1,000,000 for injuries to, or death of, any one person arising out of any one incident or accident; the minimum amount of $3,000,000 for injuries to, or death of, more than one person in any one accident; and, for the minimum amount of $500,000 for damage to property from any one accident. 2. Government-operated service aircraft shall be insured for the sum of at least $500,000 for any claim or judgment and the sum of $1,000,000 total for all claims or judgments arising out of the same occurrence. Every insurance policy or contract for such insurance shall provide for the payment and satisfaction of any financial judgment entered against the licensee or any aircraft owner or pilot(s) operating the insured aircraft. All such insurance policies shall provide for a certificate of insurance to be issued to BEMS.

**History**
- *SOURCE: Miss. Code Ann. §41-59-5*

##### **15 Miss. Admin. Code Pt. 12, R. 3.3.8** Professional Medical Liability (Malpractice) #21600 1 {#sec-12-3.3.8 omnilex-key=us-ms-regs-official--title-15--12#3.3.8}

Every air ambulance licensee or applicant shall carry professional liability coverage with solvent insurers licensed to do business in the state of Mississippi, to secure payment for any loss or damage resulting from any occurrence arising out of or caused by the care or lack of care of a patient. The licensee or applicant shall maintain professional liability coverage in the minimum amount of $1,000,000. 2. In lieu of such insurance, the licensee or applicant may furnish a certificate of self-insurance establishing that the licensee or applicant has a self-insurance plan to cover such risks and that the plan has been approved by the State of Mississippi Insurance Commissioner.

2. Permits issued by BEMS for an aircraft pursuant to this rule shall be carried inboard the aircraft and readily available for inspection.

3. If ownership of any permitted aircraft is transferred to any other person or entity, the permit is void and the licensee shall remove the permit from the aircraft at the time the aircraft is transferred and return the permit to the licensing authority within 10 days of the transfer.

**History**
- *SOURCE: Miss. Code Ann. §41-59-5 Subchapter 4 Aircraft Permits Required Rule 3.4.1 BEMS shall issue a permit to the licensee when the licensee initially places the aircraft into service or when the licensee changes the level of service relative to that aircraft. The permit shall remain valid as long as the aircraft is operated or leased by the licensee subject to the following conditions: 1. The licensee submits an aircraft permit application for the aircraft and pays the required fees.*
- *SOURCE: Miss. Code Ann. §41-59-5*

##### **15 Miss. Admin. Code Pt. 12, R. 3.4.2** If a substitute aircraft is in service for longer than 90 days, this aircraft shall be required to be permitted {#sec-12-3.4.2 omnilex-key=us-ms-regs-official--title-15--12#3.4.2}

An un-permitted aircraft cannot be placed into service, nor can an aircraft be used unless it is replacing aircraft that has been temporarily taken out of service. When such a substitution is made, the following information shall be maintained by the licensee and shall be accessible to BEMS: Registration number of permitted aircraft taken out of service; Registration number of substitute aircraft; The date on which the substitute aircraft was placed into service and the date on which it was removed from service and the date on which the permitted aircraft was returned to service.

**History**
- *SOURCE: Miss. Code Ann. §41-59-5*

##### **15 Miss. Admin. Code Pt. 12, R. 3.4.3** Aircraft permits are not transferable {#sec-12-3.4.3 omnilex-key=us-ms-regs-official--title-15--12#3.4.3}

**History**
- *SOURCE: Miss. Code Ann. §41-59-5*

##### **15 Miss. Admin. Code Pt. 12, R. 3.4.4** Duplicate aircraft permits can be obtained by submitting a written request to BEMS {#sec-12-3.4.4 omnilex-key=us-ms-regs-official--title-15--12#3.4.4}

The request shall include a letter signed by the licensee certifying that the original permit has been lost, destroyed, or rendered unusable.

**History**
- *SOURCE: Miss. Code Ann. §41-59-5*

##### **15 Miss. Admin. Code Pt. 12, R. 3.4.5** Rule 3.4.5 {#sec-12-3.4.5 omnilex-key=us-ms-regs-official--title-15--12#3.4.5}

Each licensee shall obtain a new aircraft permit from BEMS prior to returning an aircraft to service following a modification, change or any renovation that results in a change to the stretcher placement or seating in the aircraft's interior configuration.

**History**
- *SOURCE: Miss. Code Ann. §41-59-5*

##### **15 Miss. Admin. Code Pt. 12, R. 3.4.6** Rule 3.4.6 {#sec-12-3.4.6 omnilex-key=us-ms-regs-official--title-15--12#3.4.6}

The holder of a permit to operate an air ambulance service shall file an amended list of its permitted aircraft with BEMS within 10 days after an air ambulance is removed permanently from service.

transport team members and the regulations in which the transport team practices, competency and currency of all medical personnel working with the service. #21600 1. Qualifications: Each air ambulance service shall designate or employ an off- line medical director. The off-line medical director shall meet the following qualifications: a. The off-line medical director shall be a physician (MD or DO) currently licensed and in practice. b. The physician shall be licensed to practice medicine in the state(s) where the service is domiciled. c. Services having multiple bases of operation shall have an off-line medical director for each base. If the off-line medical director for the service's primary location is licensed in the state where the base(s) is/are located, they may function as the off-line medical director for that base in place of a separate individual. d. Must be a Mississippi licensed physician, M.D. or D.O., and show evidence of board certification in emergency medicine or board eligibility in emergency medicine. Air Ambulances which operate from or based in Mississippi, must have a Offline Medical Director whose primary practice is in Mississippi or at a Mississippi trauma center. (Air Ambulance provided from and based out-of-state must have a Offline Medical Director that is board certified in emergency medicine or board eligible in emergency medicine.) The medical director is ultimately responsible for all aspects of a service's operation which effect patient care. The medical director is responsible for assuring that appropriately trained medical personnel and equipment are provided for each patient transported and that individual aircraft can provide appropriate care environments for patients. The Air Ambulance Service Medical Director must be approved by the State EMS Medical Director. e. The off-line medical director shall have knowledge and experience consistent with the transport of patient's by air. f. Beginning January 2013, all Mississippi Off-Line Medical Directors shall take Medical Director’s course as prescribed by the Mississippi State Department of Health, Bureau of Emergency Medical Services and the Medical Direction, Training and Quality Assurance Committee.

**History**
- *SOURCE: Miss. Code Ann. §41-59-5 Subchapter 5 Medical Direction Rule 3.5.1 The medical director(s) of the program is a physician who is responsible and accountable for supervising and evaluating the quality of medical care provided by the medical personnel. The medical director ensures, by working with the clinical supervisor and by being familiar with the scope of practice of the*
- *SOURCE: Miss. Code Ann. §41-59-5*

##### **15 Miss. Admin. Code Pt. 12, R. 3.5.2** Rule 3.5.2 {#sec-12-3.5.2 omnilex-key=us-ms-regs-official--title-15--12#3.5.2}

Responsibilities: The physician shall be knowledgeable in aeromedical physiology, stresses of flight, aircraft safety, patient care, and resource limitations

of the aircraft, medical staff, and equipment. The medical director shall be actively involved in the care of the critically ill and/or injured patient. #21600 1. The off-line medical director shall have access to consult with medical specialists for patient(s) whose illness and care needs are outside his/her area of practice. The medical director must have education experience in those areas of medicine that are commensurate with the mission statement of the medical transport service or utilize specialty physicians as consultants when appropriate. 2. The off-line medical director shall ensure that there is a comprehensive plan/policy to address selection of appropriate aircraft, staffing, and equipment. 3. The off-line medical director shall be involved in the selection, hiring, training and continuing education of all medical personnel. The medical director is actively involved in the hiring process, training, and continuing education of all medical personnel for the service that includes involvement in skills labs, medical protocol or guideline changes or additions. 4. The off-line medical director shall be responsible for overseeing the development and maintenance of a quality assurance or a continuous quality improvement program. The medical director is actively involved in the quality management program for the service. 5. The off-line medical director shall ensure that there is a plan to provide direction of patient care to the air medical personnel during transport. The system shall include on-line (radio/telephone) medical control, and/or an appropriate system for off-line medical control such as written guidelines, protocols, procedures patient specific written orders or standing orders. The medical director should maintain an open communication system with referring and accepting physicians and be accessible for concerns expressed by referring and accepting physicians regarding controversial issues and patient management. 6. The off-line medical director shall participate in any administrative decision- making processes that affects patient care. The medical director is actively involved in administrative decisions affecting medical care or the service. 7. The off-line medical director will ensure that there is an adequate method for on- line medical control, and that there is a well-defined plan or procedure and resources in place to allow off-line medical control. The medical director is actively involved in orienting physicians providing online medical direction according to the policies, procedures, and patient care protocols of the medical transport service. 8. In the case where written policies are instituted for medical control, the off-line medical director will oversee the review, revision, and validation of them annually. The medical director sets and annually reviews medical guidelines for current accepted medical practice, and medical guidelines are in a written format.

9. The plan for medical control must be submitted to BEMS at least 30 days prior to the service start date for approval by BEMS and the State EMS Medical Director. 10. Revisions in the medical control plan must be submitted prior to implementation. At a minimum, medical control plans shall be resubmitted to BEMS every three (3) years. 11. The transport service will know the capabilities and resources of receiving facilities and will transport patients to appropriate facilities within the service region based on direct referral, approved EMS plan, or services available when no direction is provided. Whenever possible, services that respond directly to the scene will transport patients to the nearest appropriate hospital.

**History**
- *SOURCE: Miss. Code Ann. §41-59-5*

##### **15 Miss. Admin. Code Pt. 12, R. 3.5.3** On-line Medical Control: #21600 1 {#sec-12-3.5.3 omnilex-key=us-ms-regs-official--title-15--12#3.5.3}

The licensee's off-line medical director shall ensure that there is a capability and method to provide on-line medical control to air medical personnel on board any of its air ambulance aircraft at all times. If patient specific orders are written, there shall be a formal procedure to use them. In addition to on-line medical control capabilities, the licensee shall have a written plan, procedure, and resources in place for off-line medical control. This may be accomplished by use of comprehensive written, guidelines, procedures, or protocols. 2. All Mississippi On-Line Medical Directors are recommended and encouraged to take Medical Director’s course as prescribed by the Mississippi State Department of Health, Bureau of Emergency Medical Services and the Medical Direction, Training and Quality Assurance Committee.

**History**
- *SOURCE: Miss. Code Ann. §41-59-5*

##### **15 Miss. Admin. Code Pt. 12, R. 3.5.4** Quality Management process #21600 1 {#sec-12-3.5.4 omnilex-key=us-ms-regs-official--title-15--12#3.5.4}

The licensee shall have an ongoing collaborative process within the organization that identifies issues affecting patient care. 2. These issues should address the effectiveness and efficiency of the organization, its support systems, as well as that of individuals within the organization. 3. When an issue is identified, a method of information gathering shall be developed. This shall include outcome studies, chart review, case discussion, or other methodology. 4. Findings, conclusions, recommendations, and actions shall be made and recorded. Follow-up, if necessary, shall be determined, recorded, and performed.

5. Training and education needs, individual performance evaluations, equipment or resource acquisition, safety, and risk management issues all shall be integrated with the CQI Performance Improvement process. 6. The QM program has written objective evidence of actions taken in problem areas and the evaluation of the effectiveness of that action. 7. The QM program must be integrated and include activities related to patient care, communications and all aspects of transport operations and equipment maintenance pertinent to the service’s mission statement. 8. QM plan should include the following components: a. Responsibility/assignment of accountability. b. Scope of care. c. Quality metrics that are identified, measured and compared to metrics/outcomes of evidence based standards. d. Indicators. e. Thresholds for evaluation, which are appropriate to the individual service. f. Methodology – the QI process and QI tools utilized; and g. Evaluation of the improvement process.

**History**
- *SOURCE: Miss. Code Ann. §41-59-5*

##### **15 Miss. Admin. Code Pt. 12, R. 3.5.5** Rule 3.5.5 {#sec-12-3.5.5 omnilex-key=us-ms-regs-official--title-15--12#3.5.5}

Certification of Air Medical Personnel: There shall be at least one certified air medical provider on board an air ambulance to perform patient care duties on that air ambulance as certified by the Bureau of EMS. The requirements for air medical personnel shall consist of not less than the following: 1. A valid license or certificate to practice their level of care (MD, DO, RN, Advanced Practice Provider – Licensed Nurse Practitioner and Physician’s Assistant, Critical Care Paramedic, Paramedic, RT) in the state. 2. Note: The requirements of this section are established in regard to scope of practice for air medical personnel and the mission of the air ambulance service. The medical director of the service will outline requirements in the medical control plan of the service and upon approval of BEMS, verification of these requirements will be required. 3. The licensee shall maintain documentation of each clinician’s training and qualifications and shall insure that the attendant meets the continuing education requirements for their licensed specialty.

**History**
- *SOURCE: Miss. Code Ann. §41-59-5*

##### **15 Miss. Admin. Code Pt. 12, R. 3.5.6** Staffing must be commensurate with the mission statement and scope of care of the medical transport service {#sec-12-3.5.6 omnilex-key=us-ms-regs-official--title-15--12#3.5.6}

The aircraft or ambulance, by virtue of medical staffing and retrofitting of medical equipment becomes a patient care unit specific to the needs of the patient. A well-developed position description for each discipline is written. #21600 1. Advanced level care (ALS) – Paramedic: An advanced life support (ALS) mission is defined as the transport of a patient from emergency department, critical care unit or scene who receives care commensurate with scope of practice of a Paramedic. a. Fixed-wing aircraft requires at least two personnel, one of which must be at least a state of Mississippi current certified Paramedic. b. Rotor-wing aircraft requires at least a state of Mississippi current certified Paramedic. 2. Critical care (CCLS): A critical care mission is defined as the transport of a patient from a scene or clinical setting whose condition warrants care commensurate with the scope of practice of critical care transport professionals. (i.e. physician or registered nurse) a. The medical team must – at minimum – consist of at least two patient care givers, one of which must be at least a Mississippi current certified Critical Care Paramedic, registered nurse, or physician.

**History**
- *SOURCE: Miss. Code Ann. §41-59-5*

##### **15 Miss. Admin. Code Pt. 12, R. 3.5.7** Rule 3.5.7 {#sec-12-3.5.7 omnilex-key=us-ms-regs-official--title-15--12#3.5.7}

Additional medical staff not certified as air medical personnel can be added to or in place of licensed air medical personnel as long a s at least one certified air medical personnel with the highest level of certification (EMT-P, RN) required to care for the patient is also on board. #21600

**History**
- *SOURCE: Miss. Code Ann. §41-59-5*

##### **15 Miss. Admin. Code Pt. 12, R. 3.5.8** Air medical personnel will not assume cockpit duties when it may interfere with patient care responsibilities {#sec-12-3.5.8 omnilex-key=us-ms-regs-official--title-15--12#3.5.8}

**History**
- *SOURCE: Miss. Code Ann. §41-59-5*

##### **15 Miss. Admin. Code Pt. 12, R. 3.5.9** The aircraft shall be operated by a pilot or pilots certified in accordance with applicable FAR's {#sec-12-3.5.9 omnilex-key=us-ms-regs-official--title-15--12#3.5.9}

The captain or pilot in command will meet the following requirements: #21600 1. Fixed-wing air ambulance:

a. The pilot-in-command must possess airplane flight hours, as outlined in the tables below, prior to assignment with a medical service. If the aircraft is to be operated using a single pilot-in-command, with no second in command, the following applies: Cat/Class of Aircraft Total Flight Exp Multi Engine Exp PIC Exp Make/Model Single Engine Turbo Prop 2500 N/A 1000 50 Multi Eng Piston 2500 500 1000 50 Multi Eng Turbo Prop 2500 500 1000 100

b. Must possess airplane flight hours as outline in the table below if the aircraft is to be operated with two fully trained and qualified pilots: Cat/Class of Aircraft Total Flight Exp Multi Engine Exp PIC Exp SIC Total Exp Single Engine Turbo Prop 2000 N/A 1000 500 Multi Eng Piston 2000 500 1000 500 Multi Eng Turbo Prop 2000 500 1000 800 Multi Eng Turbo Jet 2000 500 1500 1000

c. Possess an Airline Transport Pilot (ATP) certificate. 2. Rotor-wing air ambulance: a. The pilot must possess at least a commercial rotorcraft-helicopter and instrument helicopter rating. b. If not exceeded by applicable national authority regulations, the pilot in command must possess 2000 total flight hours prior to an assignment with a medical service with the following stipulations i. A minimum of 1200 helicopter flight hours

ii. At least 1000 of those hours must be as Pilot in Command in rotorcraft. iii. 100 hours unaided (if pilot is NOT assigned to a Night Vision Goggles (NVG) base/aircraft) iv. 100 hours unaided or 50 hours unaided as long as the pilot has 100 hours aided (if assigned to an NVG base aircraft) v. A minimum of 500 hours of turbine time – 1000 hours of turbine time strongly encouraged. c. ATP certificate and instrument currency are strongly encouraged.

**History**
- *SOURCE: Miss. Code Ann. §41-59-5*

##### **15 Miss. Admin. Code Pt. 12, R. 3.5.10** A First Officer or co-pilot, if used, will meet the following requirements: 1 {#sec-12-3.5.10 omnilex-key=us-ms-regs-official--title-15--12#3.5.10}

Fixed-wing air ambulance; Has accumulated at least 500 hours total time as a pilot; Must have accumulated at least 100 hours as pilot of a multi-engine aircraft; Has accumulated at least 25 hours as pilot in command of the specific make and model of aircraft being used as an air ambulance; Possess a Commercial Pilot certificate; 2. Rotor-wing air ambulance: Has accumulated at least 500 rotor craft flight hours total time as a pilot; Factory school or equivalent in aircraft type (ground and flight); Must possess at least a commercial rotor craft-helicopter rating.

2. Didactic Component of Initial Training must be specific and appropriate for the mission statement and scope of care of the medical transport service. Measurable objectives need to be developed and documented for each experience.

3. Continuing Education/Staff Development – must be provided and documented for all full time and part time Critical Care and ALS providers. These must be specific and appropriate for the mission statement and scope of care of the medical transport service. a. Didactic continuing education must include an annual review of Human factors; Infection Control; “Just Culture”; Sleep Deprivation; State EMS rules and regulations; Stress recognition and management; safety and risk management training. b. Clinical and laboratory continuing education must be developed and documented on an annual basis as pertinent to scope of care. 4. Drills - The licensee shall make provisions for actual practice of those procedures that require complicated physical work or those that are technically complex such as enplaning and deplaning of patients, emergency evacuation, medical equipment identification, and mock situational problem annually. 5. Documentation - The licensee will document the completed training for each air medical staff member.

**History**
- *SOURCE: Miss. Code Ann. §41-59-5 Subchapter 6 Training Rule 3.6.1 The orientation, training and continuing education must be directed and guided by the transport program’s scope of care and patient population, mission statement and medical direction. #21600 1. Initial - The licensee shall ensure that all full-time and part-time Critical Care and ALS providers successfully complete a comprehensive training program as approved by the Bureau. Air medical personnel successfully complete initial training and orientation to their position including adequate instruction, practice, and drills.*
- *SOURCE: Miss. Code Ann. §41-59-5*

##### **15 Miss. Admin. Code Pt. 12, R. 3.6.2** Rule 3.6.2 {#sec-12-3.6.2 omnilex-key=us-ms-regs-official--title-15--12#3.6.2}

Flight Crew Member: The licensee shall have a structured program of initial and recurrent training for the aviation personnel specific to their function in the medical transport environment. The aviation specific requirements of FAR (section 135.345) are controlling, however, BEMS recommended guidelines are listed below: 1. Initial - The licensee shall ensure that all cockpit crew members successfully complete initial training and orientation to the skills and knowledge necessary to perform their functions in air medical transport operations. Training shall include the following topics: a. Pre-flight planning to accommodate special patient needs including weather considerations, altitude selection, fuel requirements, weight and balance, effective range and performance and selection of alternate airports appropriate for a medial or aviation diversion. b. Flight release - effective communication between communications specialist, air medical personnel and pilot(s). Aviation considerations for release (approval to proceed) based on the latest weather and aircraft status. c. Ground ambulance handling in direct vicinity of aircraft; Baggage and equipment handling (pressurized and non-pressurized compartments) (fixed-wing pilots); Patient enplaning - passenger briefing. (fixed-wing

pilots); Coordination of aircraft movement with air medical personnel activities prior to taxi to ensure their safety; Smooth and coordinated control of the aircraft when maneuvering, transition of control surface configurations and ground operations for patient, air medical personnel and passenger comfort; Intermediate stop procedures - (fueling, fire equipment standby, customs); Medical emergencies during flight; Aircraft emergency procedures - evacuations including patient; Cabin temperature control to maintain comfortable cabin temperature for the occupants. 2. Recurrent - The licensee shall ensure that all aviation personnel receive recurrent training - at least annually –on the topics included in their initial indoctrination as well as any changes or updates made to policies or procedures. 3. Drills - The licensee shall make provisions for actual practice of those procedures that require complicated physical work or that is technically complex such as enplaning and deplaning of patients, emergency evacuation, medical equipment identification, and mock situational problem solving. 4. Documentation - The licensee will document the completed training for each air medical staff member.

2. Pilot is able to control and override radio transmission from the cockpit in the event of an emergency situation. 3. Medical Team must be able to communicate with each other during flight. 4. If cellular phones are part of the onboard communications equipment, they are to be used in accordance with FCC regulations.

**History**
- *SOURCE: Miss. Code Ann. §41-59-5 Subchapter 7 Communications Rule 3.7.1 Activation Capability: #21600 1. The licensee shall have facilities and plans in place to provide the telephonic and radio systems necessary to carry verbal communication. The system should be consistent with the services scope of care and includes three elements: receipt of incoming inquiries and transport requests; activation and communications with aircraft flight crews and air medical personnel during transport operations; and medical control communications.*
- *SOURCE: Miss. Code Ann. §41-59-5*

##### **15 Miss. Admin. Code Pt. 12, R. 3.7.2** Rule 3.7.2 {#sec-12-3.7.2 omnilex-key=us-ms-regs-official--title-15--12#3.7.2}

Initial contact/coordination point - The licensee shall have a plan to receive requests for service and assign resources to handle the transport requests.

**History**
- *SOURCE: Miss. Code Ann. §41-59-5*

##### **15 Miss. Admin. Code Pt. 12, R. 3.7.3** Rule 3.7.3 {#sec-12-3.7.3 omnilex-key=us-ms-regs-official--title-15--12#3.7.3}

Contact data resources - The licensee shall maintain an information file available to the person handling communications that contains the necessary contact person's phone numbers and other pertinent data to manage routine and emergency communication needs.

**History**
- *SOURCE: Miss. Code Ann. §41-59-5*

##### **15 Miss. Admin. Code Pt. 12, R. 3.7.4** Documentation - The licensee shall record the chronological events of each transport {#sec-12-3.7.4 omnilex-key=us-ms-regs-official--title-15--12#3.7.4}

The following data elements shall be included: Time of initial request; Time of aircraft liftoff; Time of aircraft arrival at pickup point; Time of aircraft liftoff; Time of any intermediate aircraft stops; Time of aircraft arrival at destination; and Time aircraft and crew are returned to service and available.

**History**
- *SOURCE: Miss. Code Ann. §41-59-5*

##### **15 Miss. Admin. Code Pt. 12, R. 3.7.5** Rule 3.7.5 {#sec-12-3.7.5 omnilex-key=us-ms-regs-official--title-15--12#3.7.5}

Communications Continuity and Flight Following Capability: There shall be a well-defined process to track transport activities and provide the necessary support to efficiently follow aircraft, flight crews and air medical personnel movement. The licensee shall have a written emergency plan which addresses the actions to be taken in the event of an aircraft incident or accident, breakdown, or patient deterioration during transport operations. #21600 A readily accessible post accident/incident plan must be part of the transport following protocol so that appropriate search and rescue efforts may be initiated in the event the aircraft is overdue, radio communications cannot be established, nor location verified. There must be a written plan to initiate assistance in the event the ambulance is disabled.

**History**
- *SOURCE: Miss. Code Ann. §41-59-5*

##### **15 Miss. Admin. Code Pt. 12, R. 3.7.6** Rule 3.7.6 {#sec-12-3.7.6 omnilex-key=us-ms-regs-official--title-15--12#3.7.6}

Communications Equipment: on the aircraft and ambulance – All communications must be maintained in full operating condition and in good repair. Radios on aircraft (as range permits) must be capable of transmitting and receiving the following: #21600 1. Medical Control Communications: The licensee shall have a means of providing communications between the aircraft, the coordination point, medical control personnel and other agencies by telephonic or radio as appropriate. This shall be accomplished by local or regional EMS radio systems; and/or radio or flight phone as available inboard the aircraft. All aircraft shall have 155.340 statewide hospitals net available for air crew member(s) in the patient area. 2. Communications Center 3. Air Traffic Control 4. Emergency Medical Services.

**History**
- *SOURCE: Miss. Code Ann. §41-59-5*

##### **15 Miss. Admin. Code Pt. 12, R. 3.7.7** Rule 3.7.7 {#sec-12-3.7.7 omnilex-key=us-ms-regs-official--title-15--12#3.7.7}

There is a policy designed to discourage “shopping” by first responders and other requesting agents that specifically addresses how the program interfaces with other air medical services in the same coverage area to alert them of a weather turn-down. It is recognized that programs in a common geographic area may experience differing weather conditions and that programs may have differing capabilities. #21600

2. Pressurized aircraft with air conditioning are strongly preferred for medical transports. A physician familiar with altitude physiology must be consulted or written policies address altitude limits for specific disease processes of the patient to be transported in an unpressurized cabin. 3. Be equipped for Instrument Flight Rules (IFR) flight. 4. Note: Fixed-wing aircraft should be equipped and rated for IFR operations in accordance with Federal Aviation Regulations (FAR)'s. Rotor-wing aircraft should be equipped for inadvertent IFR if operating as a Visual Flight Rules (VFR) operator.

**History**
- *SOURCE: Miss. Code Ann. §41-59-5 Subchapter 8 Requirements for Aircraft Rule 3.8.1 When being used as an air ambulance, in addition to meeting other requirements set forth in these rules, and aircraft shall: #21600 1. The aircraft should be a twin-engine or turbine single engine aircraft appropriate to the mission statement and scope of care of the medical service and listed on the air carrier’s Operations Specifications.*
- *SOURCE: Miss. Code Ann. §41-59-5*

##### **15 Miss. Admin. Code Pt. 12, R. 3.8.2** Rule 3.8.2 {#sec-12-3.8.2 omnilex-key=us-ms-regs-official--title-15--12#3.8.2}

Have a door large enough to allow a patient on a stretcher to be enplaned without excessive maneuvering or tipping of the patient which compromises the function of monitoring devices, IV lines or ventilation equipment. The aircraft/ambulance configuration and patient placement allow for safe medical personnel egress. Doors must be fully operable from the interior. Doors must be capable of being opened fully and held by a mechanical device. #21600

**History**
- *SOURCE: Miss. Code Ann. §41-59-5*

##### **15 Miss. Admin. Code Pt. 12, R. 3.8.3** Be designed or modified to accommodate at least 1 stretcher patient {#sec-12-3.8.3 omnilex-key=us-ms-regs-official--title-15--12#3.8.3}

**History**
- *SOURCE: Miss. Code Ann. §41-59-5*

##### **15 Miss. Admin. Code Pt. 12, R. 3.8.4** Rule 3.8.4 {#sec-12-3.8.4 omnilex-key=us-ms-regs-official--title-15--12#3.8.4}

Have a lighting system which can provide adequate intensity to illuminate the patient care area and an adequate method (curtain, distance) to limit the cabin light from entering the cockpit and impeding cockpit crew vision during night operations. Use of red lighting or low intensity lighting in the patient care area is acceptable if not able to isolate the patient care area from effects on the cockpit or on a driver. #21600

**History**
- *SOURCE: Miss. Code Ann. §41-59-5*

##### **15 Miss. Admin. Code Pt. 12, R. 3.8.5** The interior of the aircraft must be climate controlled to avoid adverse effects on patients and personnel on board {#sec-12-3.8.5 omnilex-key=us-ms-regs-official--title-15--12#3.8.5}

Cabin temperatures must be measured and documented every 15 minutes during a patient transport until temperatures are maintained within the range of 50 – 95 degrees F (10 - 35 degrees C) for aircraft and range of 68-78 degrees F (20-25.5 degrees C) for ground vehicles. Thermometer is to be mounted inside the cabin. #21600

**History**
- *SOURCE: Miss. Code Ann. §41-59-5*

##### **15 Miss. Admin. Code Pt. 12, R. 3.8.6** Rule 3.8.6 {#sec-12-3.8.6 omnilex-key=us-ms-regs-official--title-15--12#3.8.6}

Have an interior cabin configuration large enough to accommodate the number of air medical personnel needed to provide care to the patient in accordance with Required Staffing, as well as an adult stretcher in the cabin area with access to the patient. The configuration shall not impede the normal or emergency evacuation routes.

**History**
- *SOURCE: Miss. Code Ann. §41-59-5*

##### **15 Miss. Admin. Code Pt. 12, R. 3.8.7** Have an electrical system capable of servicing the power needs of electrically powered on-board patient care equipment {#sec-12-3.8.7 omnilex-key=us-ms-regs-official--title-15--12#3.8.7}

Electric power outlet must be provided with an inverter or appropriate power source of sufficient output to meet the requirements of the complete specialized equipment package without compromising the operation of any electrical aircraft/ambulance equipment. Extra batteries are required for critical patient care equipment. #21600

**History**
- *SOURCE: Miss. Code Ann. §41-59-5*

##### **15 Miss. Admin. Code Pt. 12, R. 3.8.8** Rule 3.8.8 {#sec-12-3.8.8 omnilex-key=us-ms-regs-official--title-15--12#3.8.8}

All aircraft equipment (including specialized equipment) and supplies must be secured according to national aviation regulations. #21600

**History**
- *SOURCE: Miss. Code Ann. §41-59-5*

##### **15 Miss. Admin. Code Pt. 12, R. 3.8.9** Rule 3.8.9 {#sec-12-3.8.9 omnilex-key=us-ms-regs-official--title-15--12#3.8.9}

Have sufficient space in the cabin area where the patient stretcher is installed so that equipment can be stored and secured with FAA approved devices in such a manner that it is accessible to the air medical personnel.

**History**
- *SOURCE: Miss. Code Ann. §41-59-5*

##### **15 Miss. Admin. Code Pt. 12, R. 3.8.10** Rule 3.8.10 {#sec-12-3.8.10 omnilex-key=us-ms-regs-official--title-15--12#3.8.10}

A fire extinguisher – fully charged with valid inspection - must be accessible to medical transport personnel and pilot/driver while in motion. If not accessible, two fire extinguishers are required. #21600

**History**
- *SOURCE: Miss. Code Ann. §41-59-5 Subchapter 9 Medical Equipment and Supplies Rule 3.9.1 Medical transport personnel must ensure that all medical equipment is in working order and all equipment/supplies are validated through documented checklists for both the primary and backup aircraft/ambulance. Each air ambulance aircraft shall carry the following minimum equipment set forth in the following section unless a substitution is approved by BEMS and an off-line medical director.*
- *SOURCE: Miss. Code Ann. §41-59-5*

##### **15 Miss. Admin. Code Pt. 12, R. 3.9.2** Medical Equipment for All Levels of Care Shall Include: #21600 1 {#sec-12-3.9.2 omnilex-key=us-ms-regs-official--title-15--12#3.9.2}

STRETCHER - The aircraft/ambulance design and configuration must not compromise patient stability in loading, unloading or in-flight operations. There shall be 1 or more stretcher(s) installed in the aircraft cabin which meets the following criteria: a. The stretcher must be large enough to carry the 95th percentile adult patient, full length in the supine position. (Estimated 95th percentile adult American male is 6 ft. and 232 lbs. and may differ internationally.) Patients under 40 pounds must be provided with an appropriately sized restraining device (for patient’s height and weight), which is further secured by a locking device. All patients from 10 to 40 pounds must be secured in a five-point safety strap device that allows good access to the patient from all sides and permits the patient’s head to be raised at least 30 degrees. For infants up to 10 pounds, a baby pod or commercial equivalent may be used. b. Shall have at least two shoulder harnesses and three cross-body patient restraining straps, one of which secures the chest area and the other about the area of the knee and thigh area. c. The stretcher shall be installed in the aircraft cabin so that it is sufficiently isolated by distance or physical barrier from the cockpit so that the patient cannot reach the cockpit crew from a supine or prone position on the stretcher. d. Attachment points of the stretcher to the aircraft, the stretcher itself, and the straps securing the patient to the stretcher, shall meet FAR restraint requirements.

e. The aircraft must have an entry that allows loading and unloading without excessive maneuvering (no more than 45 degrees about the lateral axis and 30 degrees about the longitudinal axis) of the patient, and does not compromise functioning of monitoring systems, intravenous lines, and manual or mechanical ventilation. f. The stretcher shall be positioned in the cabin to allow the air medical personnel clear view of the patient's body. g. Air medical personnel shall always have access to the patient's head and upper body for airway control procedures as well as sufficient space over the area where the patient's chest is to adequately perform chest compressions on the patient. Note: The licensee may be required to demonstrate to the licensing authority that airway control procedures and cardiac compressions/abdominal thrusts can be adequately performed on a training manikin in any of its aircraft. h. The stretcher mattress must be sealed to prevent absorption of blood and other body fluids, easily cleanable and disinfected according to OSHA blood borne pathogens requirements.

i. The stretcher must be sturdy and rigid enough that it can support cardiopulmonary resuscitation. If a backboard or equivalent device is required to achieve this, such device will be readily available. j. A supply of linen for each patient. 2. Use of occupant restraint devices: a. Air medical personnel must be in seat belts (and shoulder harnesses if installed) that are properly worn and secured for all takeoffs and landings according to FAA regulations. A policy should be written that defines when seat belts/ shoulder harnesses can be unfastened.

b. Patients transported by air are restrained with a minimum of three cross straps. Cross straps are expected to restrain the patient at the chest, hips, and knees. Patients that are loaded head forward must additionally be restrained with a shoulder harness restraint.

**History**
- *SOURCE: Miss. Code Ann. §41-59-5*

##### **15 Miss. Admin. Code Pt. 12, R. 3.9.3** Respiratory Care #21600 1 {#sec-12-3.9.3 omnilex-key=us-ms-regs-official--title-15--12#3.9.3}

OXYGEN - Oxygen is installed according to FAA regulations. Medical transport personnel can determine how oxygen is functioning by pressure gauges mounted in the patient care area.

a. There shall be an adequate and manually controlled supply of gaseous or liquid medical oxygen, attachments for humidification, and a variable flow regulator for each patient. A humidifier, if used, shall be a sterile, disposable, one-time usage item. b. The licensee shall have and demonstrate the method used to calculate the volume of oxygen required to provide sufficient oxygen for the patients needs for the duration of the transport. The licensee will have a plan to provide the calculated volume of oxygen plus a reserve equal 1000 liters or the volume required to reach an appropriate airport whichever is longer. All necessary regulators, gauges and accessories shall be present and in good working order. The system shall be securely fastened to the airframe using FAA approved restraining devices. c. Each gas outlet is clearly identified. d. Oxygen flow can be stopped at or near the oxygen source from inside the aircraft. e. The following indicators are accessible to medical transport personnel while enroute: i. Quantity of oxygen remaining ii. Measurement of liter flow f. A separate emergency backup supply of oxygen of not less than one E cylinder with regulator and flow meter. Note: "D" cylinder with regulator and flow meter is permissible for rotor-wing aircraft in place of the "E" cylinder requirement.

g. 1 adult and 1 pediatric size non-rebreathing oxygen mask; 1 adult size nasal cannula and necessary connective tubing and appliances. 2. SUCTION - As the primary source, an electrically powered suction apparatus with wide bore tubing, a large reservoir, and various sizes suction catheters. Two suction units are required, one of which is portable and both of which must deliver adequate suction. (Minimum required suction 300 mm Hg) 3. BAG-VALVE-MASK - Hand operated bag-valve-mask ventilators of adult, pediatric and infant size with clear masks in adult, pediatric and infant sizes. It shall be capable of use with a supplemental oxygen supply and have an oxygen reservoir. 4. AIRWAY ADJUNCTS

a. Oropharyngeal airways in at least 5 assorted sizes, including adult, child, and infant. b. Nasopharyngeal airways in at least 3 sizes with water soluble lubricant.

**History**
- *SOURCE: Miss. Code Ann. §41-59-5*

##### **15 Miss. Admin. Code Pt. 12, R. 3.9.4** Patient Assessment Equipment: #21600 1 {#sec-12-3.9.4 omnilex-key=us-ms-regs-official--title-15--12#3.9.4}

Automatic blood pressure device, sphygmomanometer, doppler or arterial line monitoring capability onboard or immediately available to determine blood pressure of the adult, pediatric and infant patient(s) during flight, as appropriate. 2. Stethoscope. 3. Penlight/Flashlight. 4. Bandage scissors, heavy duty. 5. Pulse oximetry 6. Bandages & Dressings 7. Sterile Dressings such as 4x4's, ABD pads. 8. Bandages such as Kerlix, Kling. 9. Tape - various sizes. 10. Devices for decompressing a pneumothorax and performing an emergency cricothyroidotomy available if applicable to scope of care of the medical transport service 11. Fetal (Doppler heart rate) monitoring required for high risk OB transports

**History**
- *SOURCE: Miss. Code Ann. §41-59-5*

##### **15 Miss. Admin. Code Pt. 12, R. 3.9.5** Miscellaneous Equipment and Supplies 1 {#sec-12-3.9.5 omnilex-key=us-ms-regs-official--title-15--12#3.9.5}

Potable or sterile water. 2. Container(s) and methods to collect contain and dispose of body fluids such as emesis, oral secretions, and blood consistent with OSHA blood borne pathogens requirements.

**History**
- *SOURCE: Miss. Code Ann. §41-59-5*

##### **15 Miss. Admin. Code Pt. 12, R. 3.9.6** Infection control equipment {#sec-12-3.9.6 omnilex-key=us-ms-regs-official--title-15--12#3.9.6}

The licensee shall have a sufficient quantity of the following supplies for all air medical personnel, each flight crew member, and all

ground personnel with incidental exposure risks according to OSHA requirements, but is not limited to #21600 1. Protective gloves. 2. Protective gowns. 3. Protective eyewear. 4. Protective face masks. 5. There shall be an approved bio-hazardous waste plastic bag or impervious container to receive and dispose of used supplies. 6. Hand washing capabilities or antiviral towellets. 7. An adequate trash disposal system exclusive of bio-hazardous waste control provisions.

**History**
- *SOURCE: Miss. Code Ann. §41-59-5*

##### **15 Miss. Admin. Code Pt. 12, R. 3.9.7** Survival Kit: The licensee shall maintain supplies to be used in a survival situation {#sec-12-3.9.7 omnilex-key=us-ms-regs-official--title-15--12#3.9.7}

It shall include, but not be limited to, the following items which are appropriate to the terrain and environments the licensee operates over: Instruction manual; water; shelter - space blanket; knife; signaling device - mirror, whistle, flares, dye marker; compass; fire starting items - matches, candle, flint, battery.

**History**
- *SOURCE: Miss. Code Ann. §41-59-5*

##### **15 Miss. Admin. Code Pt. 12, R. 3.9.8** ALS level equipment: To function at the ALS level, the following additional equipment is required: #21600 1 {#sec-12-3.9.8 omnilex-key=us-ms-regs-official--title-15--12#3.9.8}

Advanced Airway and Ventilatory Support Equipment: a. Laryngoscope and tracheal intubation supplies, including laryngoscope blades, bag-valve- mask and oxygen supplies, including PEEP valves; appropriate for ages and potential needs of patients transported. At minimum, one Laryngoscope handle; one each adult, pediatric and infant blades. b. Two of each size of assorted disposable endotracheal tubes according to the scope of the licensee's service and patient mixture with assorted stylets, syringes. c. End-tidal CO2 detectors (may be made onto bag valve mask assemblies or separate); End-tidal CO2 continuous waveform monitoring capabilities available.

d. Alternate airway management equipment. Equipment for alternative airways on-board transport vehicles at all times and protocol for management of missed airway attempts. 2. IV Equipment and Supplies: a. IV supplies and fluids are readily available. b. Sterile crystalloid solutions in plastic containers, IV catheters, and administration tubing sets. c. Hanger for IV solutions or a mechanism to provide high flow fluids if needed; All IV hooks are padded, flush mounted, or so located to prevent head trauma to the medical transport personnel in the event of a hard landing in the aircraft.

d. Tourniquets, tape, dressings. e. Suitable equipment and supplies to allow for collection and temporary storage of two blood samples. f. A container appropriate to contain used sharp devices - needles, scalpels - which meets OSHA requirements.

3. Medications: Security of medications, fluids and controlled substances shall be maintained by each air ambulance licensee. Controlled substances are in a locked system and kept in a manner consistent with Drug Enforcement Agency (DEA) regulations and approved by the service’s medical director. Medication inventory techniques and schedules shall be maintained in compliance with all applicable local, state, and federal drug laws. 4. Medications shall be easily accessible. 5. There is a method to check expiration dates of medications and supplies on a regular basis. 6. The Bureau of EMS and the Committee on Medical Direction, Training, and Quality Assurance (MDTQA) will approve pharmaceuticals available for use by EMS providers. A list of ‘Required’, ‘Optional’, and ‘Transport only’ drugs for EMS providers in the State is compiled and maintained by the BEMS and the MDTQA.

7. A current list of fluids and medications approved for initiation and transport by Mississippi EMS providers is available from the BEMS office or the BEMS website (www.ems.ms.gov). NOTE: Offline Medical Director may make requests for changes to the list. These requests should be submitted in writing to the

BEMS. All requests must detail the rationale for the additions, modifications, or deletions.

a. The medical director can modify the medication inventory as required to meet the care needs of their patient mix and in compliance with section (111.06-3C) below. b. The licensee shall have a sufficient quantity of needles, syringes, and accessories necessary to administer the medications in the inventory supply. c. The medical director of the licensee may authorize the licensee with justification to substitute medication(s) listed provided that he first obtains approval from BEMS and provided further that he signs such authorization. 8. Cardiac Monitor-Defibrillator – a. D.C. battery powered portable monitor/defibrillator with paper printout and spare batteries, accessories, and supplies. b. 12-lead cardiac monitor, defibrillator and external pacemaker are secured and positioned so that displays are visible.

c. Extra batteries or power source are available for cardiac monitor/defibrillator or external pacemaker.

d. Defibrillator is secured and positioned for easy access.

e. Pediatric paddles/pads are available if applicable to the scope of care of the medical transport service.

f. A defibrillator with appropriate size pads and settings must be available for neonatal transports (if neonatal transports are conducted).

9. External pacemaker on board or immediately available as a carry-on item. 10. Non-Invasive Automatic Blood Pressure Monitor 11. IV Infusion Pump capable of strict mechanical control of an IV infusion drip rate. Passive devices such as dial-a-flows are not acceptable. A minimum of three IV infusion pumps (may be in the same device if individually metered lines with back up available) are on the aircraft or immediately available for critical care transports and as appropriate to the scope of care. 12. Electronic Monitoring Devices - Any electronic or electrically powered medical equipment to be used on board an aircraft should be tested prior to actual patient

use to insure that it does not produce Radio Frequency Interference (RFI) or Electro Magnetic Interference (EMI) which would interfere with aircraft radio communications or radio navigation systems. This may be accomplished by reference to test data from organizations such as the military or by actual tests performed by the licensee while airborne.

**History**
- *SOURCE: Miss. Code Ann. §41-59-5*

##### **15 Miss. Admin. Code Pt. 12, R. 3.9.9** Rule 3.9.9 {#sec-12-3.9.9 omnilex-key=us-ms-regs-official--title-15--12#3.9.9}

To function at the CCLS or SPECIALTY level of care the following additional equipment shall be available as required to the scope of care of the medical transport service: #21600 1. Mechanical Ventilator - A mechanical ventilator that can deliver up to 100% oxygen concentration at pressures, rates, and volumes appropriate for the size of patient being cared for.

2. Isolette - for services performing transport of neonatal patients. 3. Intraaortic Balloon Pump (IABP) 4. Invasive Line (ARTERIAL AND SWAN-GANZ CATHETERS) monitoring capability.

**History**
- *SOURCE: Miss. Code Ann. §41-59-5 Subchapter 10 Equipment Maintenance and Inspection Program Rule 3.10.1 The licensee shall have a program to inspect and maintain the effective operation of its medical equipment. The program should include daily or periodic function checks and routine preventive inspection and maintenance. There should be a plan for securing replacement or backup equipment when individual items are in for repair. There should be manufacturer's manuals as well as brief checklist available for reference. The equipment maintenance and inspection program shall include:*
- *SOURCE: Miss. Code Ann. §41-59-5*

##### **15 Miss. Admin. Code Pt. 12, R. 3.10.2** Rule 3.10.2 {#sec-12-3.10.2 omnilex-key=us-ms-regs-official--title-15--12#3.10.2}

Daily or periodic checks - shall include a checklist based on the manufacturer's recommendations which verifies proper equipment function and sterile package integrity.

**History**
- *SOURCE: Miss. Code Ann. §41-59-5*

##### **15 Miss. Admin. Code Pt. 12, R. 3.10.3** Rule 3.10.3 {#sec-12-3.10.3 omnilex-key=us-ms-regs-official--title-15--12#3.10.3}

Routine preventive maintenance - shall include a program of cleaning and validating proper performance, supply packaging integrity.

**History**
- *SOURCE: Miss. Code Ann. §41-59-5*

##### **15 Miss. Admin. Code Pt. 12, R. 3.10.4** A documentation system which tracks the history of each equipment item {#sec-12-3.10.4 omnilex-key=us-ms-regs-official--title-15--12#3.10.4}

**History**
- *SOURCE: Miss. Code Ann. §41-59-5*

##### **15 Miss. Admin. Code Pt. 12, R. 3.10.5** A procedure for reporting defective or malfunctioning equipment when patient care has been affected {#sec-12-3.10.5 omnilex-key=us-ms-regs-official--title-15--12#3.10.5}

**History**
- *SOURCE: Miss. Code Ann. §41-59-5*

##### **15 Miss. Admin. Code Pt. 12, R. 3.10.6** Rule 3.10.6 {#sec-12-3.10.6 omnilex-key=us-ms-regs-official--title-15--12#3.10.6}

High Visibility Safety Apparel for Staff: Each air ambulance must be equipped with high visibility safety apparel for each person staffing or participating in the operation of the vehicle. All garments must meet the requirements of the American National Standard for High Visibility Apparel ANSI/ISEA 107-2004 Performance Class 2 or Performance Class 3, or the ANSI/ISEA 207-2006 Standard. All garments must have labels, affixed by the manufacturer in accordance with the standard, that indicate compliance with the Performance Class 2, Performance Class 3, or 207-2006 standard.

**History**
- *SOURCE: Miss. Code Ann. §41-59-5 Subchapter 11 Violations Rule 3.11.1 Violations should be corrected at the time of the inspection, if possible.*
- *SOURCE: Miss. Code Ann. §41-59-5*

##### **15 Miss. Admin. Code Pt. 12, R. 3.11.2** Violations of the requirements set forth in this section will require appropriate corrective action by the licensee {#sec-12-3.11.2 omnilex-key=us-ms-regs-official--title-15--12#3.11.2}

**History**
- *SOURCE: Miss. Code Ann. §41-59-5*

##### **15 Miss. Admin. Code Pt. 12, R. 3.11.3** Rule 3.11.3 {#sec-12-3.11.3 omnilex-key=us-ms-regs-official--title-15--12#3.11.3}

Category "A" Violations: Category “A” violations require the air ambulance aircraft be immediately removed from service until it has been reinspected and found to be in compliance with these regulations. Category "A" violations include: Missing equipment or disposable supply items; Insufficient number of trained air medical personnel to fill the services staffing requirements; The provider has no medical director; Violation or non-compliance of FAR or OSHA mandates.

**History**
- *SOURCE: Miss. Code Ann. §41-59-5*

##### **15 Miss. Admin. Code Pt. 12, R. 3.11.4** Rule 3.11.4 {#sec-12-3.11.4 omnilex-key=us-ms-regs-official--title-15--12#3.11.4}

Category "B" Violations: Category “B” violations must be corrected within 72 hours of receiving notice and a written report shall be sent to BEMS verifying the correction. Category "B" violations include: Unclean or unsanitary equipment or aircraft environment; Non-functional or improperly functioning equipment; Expired shelf life of supplies such as medications, IV fluids and items having limited shelf life; Package integrity of sealed or sterile items is compromised;

Failure to produce requested documentation of patient records, attendant training or other reports required by BEMS.

**History**
- *SOURCE: Miss. Code Ann. §41-59-5 Subchapter 12 Suspension; Revocation of License Rule 3.12.1 May occur as outlined in 41-59-17 and 41-59-45. Appeals from decision of the board can also be referred to in 41-59-49.*
- *SOURCE: Miss. Code Ann. §41-59-5*

##### **15 Miss. Admin. Code Pt. 12, R. 3.12.2** Rule 3.12.2 {#sec-12-3.12.2 omnilex-key=us-ms-regs-official--title-15--12#3.12.2}

A Mississippi licensed ambulance service shall comply with the Mississippi State Trauma Plan as approved by the Mississippi State Department of Health, Bureau of Emergency Medical Services. Licensed service must follow the state patient destination criteria and treatment protocols for the patient as delineated by these regulations. All Medical Control Plans shall comply with the Mississippi State Trauma Plan and all other applicable system of care plans as directed by the Mississippi State Department of Health, Bureau of Emergency Medical Services. #21600

Chapter 4 MEDICAL FIRST RESPONDER Subchapter 1 Training Authority Medical First Responder Rule 4.1.1 BEMS may approve Medical First Responder courses offered by a community college, Institutes of Higher Learning, Mississippi State Fire Academy, or an organized EMS district recognized by BEMS.

Proposed Medical First Responder instructors must be state certified with at least two years of experience at the EMT level or a higher level as an EMS provider in Mississippi and possess current certification as a Healthcare Provider level CPR instructor. Subchapter 4 Medical First Responder Training Programs: Rule 4.4.1 Medical First Responder students shall receive a handbook or syllabus no later than the first session of their respective course that relates the days and hours of the course, objectives, expected outcomes, and information related to the methods used in determining grades, in addition to any mechanism for appeal of grades and any other practical course information. Conditions governing dismissal from the course must be included in the handbook or syllabus and distributed to the student before training begins. Any options for remediation shall also be included in the handbook or syllabus. Course coordinators and instructors are responsible for maintaining documentation including grades, documentation of assessments and evaluations, documentation of remediation, and documentation related to retention and NREMT pass rates. Course coordinators shall follow the policy of their entity in terms of the length of time related to document retention. Said documentation may be requested by BEMS staff in the course of an investigation. Medical First Responder curricula shall also include appropriate classroom, lab, and practicum learning that meets or exceeds the most recent National Emergency Medical Services Education Standards for “Emergency Medical Responder.”

**History**
- *SOURCE: Miss. Code Ann. §41-59-5 Subchapter 13 Medical Control: See Appendix 1.*
- *SOURCE: Miss. Code Ann. §41-59-81 Subchapter 2 Medical First Responder Curriculum Rule 4.2.1 BEMS shall approve only proposed Medical First Response courses that meet or exceed the most recent National Emergency Medical Services Education Standards, as documented by the course’s prescribed curriculum.*
- *SOURCE: Miss. Code Ann. §41-59-81 Subchapter 3 Request for approval of Medical First Responder training programs Rule 4.3.1 To obtain approval for a proposed Medical First Responder course, the requesting entity must submit the online request available via the BEMS website at least thirty (30) days prior to the proposed start date. A copy of the proposed curriculum with anticipated learning outcomes and the instruments used for documenting outcome assessment/evaluation must be included with the request to offer the proposed course.*
- *SOURCE: Miss. Code Ann. §41-59-81*

##### **15 Miss. Admin. Code Pt. 12, R. 4.4.2** Rule 4.4.2 {#sec-12-4.4.2 omnilex-key=us-ms-regs-official--title-15--12#4.4.2}

Healthcare Provider level CPR with AED that meets or exceeds current American Heart Association standards shall be a pre-requisite to Medical First Responder training in MS.

satisfactory recertification training and refresher requirements for BEMS Medical First Responder re-certification.

**History**
- *SOURCE: Miss. Code Ann. §41-59-81 Subchapter 5 Medical First Responder Classes, Initial Course Roster Rule 4.5.1 Medical First Responder coordinators shall provide an initial roster of all student participants enrolled in their respective courses to BEMS prior to the third-class session using the Initial Program/Course Roster Form available via the BEMS website.*
- *SOURCE: Miss. Code Ann. §41-59-81 Subchapter 6 Medical First Responder classes, Final Program/Course Roster Rule 4.6.1 Medical First Responder coordinators shall provide a final roster of all student participants who completed their respective courses to BEMS within three (3) days of course completion using the Final Program/Course Roster Form available via the BEMS website.*
- *SOURCE: Miss. Code Ann. §41-59-81 Subchapter 7 Medical First Responder Refresher Training Rule 4.7.1 Medical First Responders, who meet prescribed recertification training and refresher requirements for Emergency Medical Responder (EMR) through the National Registry of EMTs (NREMT) and are currently certified as an EMR with the NREMT, meet all*
- *SOURCE: Miss. Code Ann. §41-59-81*

##### **15 Miss. Admin. Code Pt. 12, R. 4.7.2** Prerequisite to MS certification as a Medical First Responder 1 {#sec-12-4.7.2 omnilex-key=us-ms-regs-official--title-15--12#4.7.2}

National Registry certification at minimum level of Emergency Medical Responder.

2. Gross negligence. 3. Repeated negligent acts. 4. Incompetence. 5. Disturbing the peace while on duty. 6. Recklessly disregarding the speed regulations prescribed by law while on duty. 7. Failure to maintain current registration by the National Registry of EMTs. 8. Failure to maintain all current training standards as required by BEMS. 9. The commission of any fraudulent, dishonest, or corrupt act which is substantially related to the qualifications, functions, and duties of pre-hospital personnel. 10. Conviction of any crime that is directly related to the qualifications, functions, and duties of pre-hospital personnel. The record of conviction or certified copy thereof will be conclusive evidence of such conviction.

11. Violating or attempting to violate directly or indirectly, or assisting in or abetting the violation of, or conspiring to violate, any provision of this part of the regulations promulgated by the State Department of Health, BEMS, pertaining to pre-hospital personnel. 12. Violating or attempting to violate any federal or state statute or regulation which regulates narcotics, dangerous drugs, or controlled substances. 13. Unauthorized, misuse or excessive use of narcotics, dangerous drugs, or controlled substances or alcoholic beverages. 14. Functioning outside the Medical First Responder scope of practice. 15. Permitting, aiding, or abetting an unlicensed or uncertified person to perform activities requiring a license or certification. 16. Failure to comply with an employer’s request for drug and alcohol testing. 17. Failure to wear high visibility safety apparel that meets the requirements of the American National Standard for High Visibility Apparel ANSI/ISEA 107-2004 Performance Class 2 or Performance Class 3, or the ANSI/ISEA 207-2006 Standard while functioning within the right-of-way of any road, street, highway, or other area where vehicle or machinery traffic is present. (Suspension only for first offense.) 18. Any conduct, regardless of whether convicted, which constitutes a crime of violence, or which constitutes any of the following crimes: a. Assault b. Stalking c. False imprisonment d. Sexual assault or battery e. Crimes against a vulnerable person

**History**
- *SOURCE: Miss. Code Ann. §41-59-81 Subchapter 8 Medical First Responder Certification Rule 4.8.1 Any person desiring certification as a Medical First Responder shall apply to the BEMS using forms provided via the MSDH BEMS website (Application for State EMS Provider Certification), submit a copy of current NREMT EMR certification and remit payment to BEMS, payable to MS State Department of Health – BEMS via electronic payment per the process described on the MSDH BEMS website.*
- *SOURCE: Miss. Code Ann. §41-59-81 Subchapter 9 Grounds for Suspension or Revocation of Medical First Responder Rule 4.9.1 Grounds for Suspension or Revocation include: 1. Fraud or any misstatement of fact in the procurement of any certifications or in any other statement of representation to the Board or its representatives.*
- *SOURCE: Miss. Code Ann. §41-59-81*

##### **15 Miss. Admin. Code Pt. 12, R. 4.9.2** Rule 4.9.2 {#sec-12-4.9.2 omnilex-key=us-ms-regs-official--title-15--12#4.9.2}

If BEMS finds that public health, safety, and welfare requires emergency action and a finding to that effect is incorporated in its order, summary suspension of a certification may be ordered pending proceedings for revocation or other action.

**History**
- *SOURCE: Miss. Code Ann. §41-59-81 Subchapter 10 Recertification of Medical First Responders Rule 4.10.1 Any person desiring re-certification as a Medical First Responder shall apply to BEMS using forms provided (Application for State EMS Provider certification).*
- *SOURCE: Miss. Code Ann. §41-59-81*

##### **15 Miss. Admin. Code Pt. 12, R. 4.10.2** Rule 4.10.2 {#sec-12-4.10.2 omnilex-key=us-ms-regs-official--title-15--12#4.10.2}

Any person desiring re-certification as a Medical First Responder shall apply to the BEMS using forms provided via the MSDH BEMS website (Application for State EMS

Provider Certification), submit a copy of current NREMT EMR certification and remit payment to BEMS, payable to MS State Department of Health – BEMS via electronic payment per the process described on the MSDH BEMS website.

**History**
- *SOURCE: Miss. Code Ann. §41-59-81*

##### **15 Miss. Admin. Code Pt. 12, R. 4.10.3** Rule 4.10.3 {#sec-12-4.10.3 omnilex-key=us-ms-regs-official--title-15--12#4.10.3}

Medical First Responders failing to re-certify with BEMS on or before the expiration date of his/her certification period will be considered officially expired.

**History**
- *SOURCE: Miss. Code Ann. §41-59-81*

##### **15 Miss. Admin. Code Pt. 12, R. 4.10.4** Rule 4.10.4 {#sec-12-4.10.4 omnilex-key=us-ms-regs-official--title-15--12#4.10.4}

Medical First Responder certificates shall be valid for a period not exceeding two and one-half (2 ½) years from date of issuance.

Subchapter 11 Job Summary and Functional Description Rule 4.11.1 Mississippi follows the summary and functional job description for Emergency Medical Responders (EMR) provided for in the National EMS Scope of Practice Model for the Medical First Responder certification level. Medical First Responders must possess the education, critical thinking skills, general aptitude, and physical requirements required for the various roles they occupy with paid and voluntary organizations as per the job descriptions of their respective organizations.

Chapter 5 EMERGENCY MEDICAL SERVICES (EMS) DRIVER Subchapter 1 Training Authority Rule 5.1.1 These guidelines and minimum standards are set forth in order to establish a minimum level of training for the EMS Driver in the state of Mississippi. These guidelines and minimum standards shall be met by all EMS Driver courses in the state. Additionally, organized EMS districts as recognized by the BEMS, are authorized to provide this training. The BEMS may approve EMS Driver programs if it is determined after review by the BEMS staff, State EMS Medical Director, and the Medical Direction, Training and Quality Assurance Committee that the objectives of the training program equal or exceed those of the state of

Mississippi. All EMS Driver training programs must have the BEMS approval prior to the start of class.

Written permission from the BEMS must be obtained prior to the start of an EMS Driver course.

**History**
- *SOURCE: Miss. Code Ann. §41-59-81*
- *SOURCE: Miss. Code Ann. §41-59-81 Subchapter 12 Performance Standards for Medical First Responder Rule 4.12.1 MS Medical First Responders’ primary responsibility is to the patient and shall include appropriate patient assessment and care and in accordance with the National EMS scope of Practice Model.*
- *SOURCE: Miss. Code Ann. §41-59-81*
- *SOURCE: Miss. Code Ann. §41-59-5 Subchapter 2 EMS Driver Curriculum Rule 5.2.1 EMS Driver Curriculum must conform, at minimum, to the National Standard Emergency Vehicle Operator Curriculum developed by the United States Department of Transportation and all current revisions as approved for use by the BEMS. Minimum hours required for EMS Driver are: 4 didactic, and lab instruction sufficient to ensure operator competency, minimum 4 hours. BEMS and the State EMS Medical Director must approve all training curriculums.*
- *SOURCE: Miss. Code Ann. §41-59-5 Subchapter 3 Request for Approval of EMS Driver training programs Rule 5.3.1 A list of BEMS approved EMS Driver training programs will be available at the BEMS office and BEMS web site. (www.ems.ms.gov) #18982*
- *SOURCE: Miss. Code Ann. §41-59-5*

##### **15 Miss. Admin. Code Pt. 12, R. 5.3.2** Rule 5.3.2 {#sec-12-5.3.2 omnilex-key=us-ms-regs-official--title-15--12#5.3.2}

Request for approval of EMS Driver training programs not contained on the approved list shall be sent to BEMS with evidence and verification that: 1. the EMS Driver training program meets, at minimum, the requirements of the EMS Driver curriculum as given in this section. 2. there are EMS Driver Instructor certification and re-certification requirements, including an evaluation of instructor terminal competencies, provided in the requested training program.

**History**
- *SOURCE: Miss. Code Ann. §41-59-5*

##### **15 Miss. Admin. Code Pt. 12, R. 5.3.3** Rule 5.3.3 {#sec-12-5.3.3 omnilex-key=us-ms-regs-official--title-15--12#5.3.3}

Note: Credentialed EMS Instructors of BEMS as trained through the MS EMS Instructor Training Program, and in good standing, are considered as meeting the above requirement.

**History**
- *SOURCE: Miss. Code Ann. §41-59-5*

##### **15 Miss. Admin. Code Pt. 12, R. 5.3.4** Rule 5.3.4 {#sec-12-5.3.4 omnilex-key=us-ms-regs-official--title-15--12#5.3.4}

Approval of any EMS Driver training program curriculum must be given by the Medical Direction, Training and Quality Assurance Committee (MDTQA), State EMS Medical Director, and the BEMS staff, prior to the start of any classes.

Subchapter 4 EMS Driving Training Programs Rule 5.4.1 The length of the EMS Driver course shall not be less than eight (8) hours (didactic and practical).

**History**
- *SOURCE: Miss. Code Ann. §41-59-5*
- *SOURCE: Miss. Code Ann. §41-59-5*

##### **15 Miss. Admin. Code Pt. 12, R. 5.4.2** Rule 5.4.2 {#sec-12-5.4.2 omnilex-key=us-ms-regs-official--title-15--12#5.4.2}

The complete EMS Driver educational program shall be designed to provide the knowledge that will allow the student to safely operate emergency vehicles.

**History**
- *SOURCE: Miss. Code Ann. §41-59-5*

##### **15 Miss. Admin. Code Pt. 12, R. 5.4.3** The program shall consist of, at minimum, two components: didactic instruction and practical evaluation {#sec-12-5.4.3 omnilex-key=us-ms-regs-official--title-15--12#5.4.3}

The time required to complete each component may vary, in part being dependent on the ability of students to demonstrate their mastery of the educational objectives by written, verbal, and practical examination.

**History**
- *SOURCE: Miss. Code Ann. §41-59-5*

##### **15 Miss. Admin. Code Pt. 12, R. 5.4.4** Rule 5.4.4 {#sec-12-5.4.4 omnilex-key=us-ms-regs-official--title-15--12#5.4.4}

The program shall maintain on file, for each component of the curriculum, a reasonable comprehensive list of the terminal performance objectives to be achieved by the student. These objectives shall delineate mastery in all competencies identified, including curriculum documentation, measurement techniques used, and the records maintained on each student's work.

**History**
- *SOURCE: Miss. Code Ann. §41-59-5*

##### **15 Miss. Admin. Code Pt. 12, R. 5.4.5** The student shall be informed about the methods and data used in determining grades and about the mechanism for appeal {#sec-12-5.4.5 omnilex-key=us-ms-regs-official--title-15--12#5.4.5}

Conditions governing dismissal from the program should be clearly defined in writing and distributed to the student at the beginning of the training program.

**History**
- *SOURCE: Miss. Code Ann. §41-59-5*

##### **15 Miss. Admin. Code Pt. 12, R. 5.4.6** Evidence of student competence in achieving the educational objectives of the program shall be kept on file {#sec-12-5.4.6 omnilex-key=us-ms-regs-official--title-15--12#5.4.6}

Documentation must be in the form of both written and practical examinations.

**History**
- *SOURCE: Miss. Code Ann. §41-59-5*

##### **15 Miss. Admin. Code Pt. 12, R. 5.4.7** Classroom and field practical faculty must prepare written evaluations on each student {#sec-12-5.4.7 omnilex-key=us-ms-regs-official--title-15--12#5.4.7}

Documentation should be maintained identifying the counseling given to individual students regarding their performance and the recommendations given to students must be maintained. Instruction must be supported by performance assessments.

**History**
- *SOURCE: Miss. Code Ann. §41-59-5*

##### **15 Miss. Admin. Code Pt. 12, R. 5.4.8** Rule 5.4.8 {#sec-12-5.4.8 omnilex-key=us-ms-regs-official--title-15--12#5.4.8}

Faculty must be presented with the program's educational objectives for uses in preparation of lectures and field practicals. The course coordinator must ensure that stated educational objectives are covered and should answer any questions from students or clarify information presented by a lecturer. The field practical is a period of supervised experience.

**History**
- *SOURCE: Miss. Code Ann. §41-59-5*

##### **15 Miss. Admin. Code Pt. 12, R. 5.4.9** Rule 5.4.9 {#sec-12-5.4.9 omnilex-key=us-ms-regs-official--title-15--12#5.4.9}

Policy for Administration - Operational Policies: Student matriculation practices and student and faculty recruitment should be non-discriminatory with respect to race, color, creed, sex, or national origin. Student matriculation and student and faculty recruitment practices are to be consistent with all laws regarding non- discrimination. It is recommended that records be kept for a reasonable period of time on the number of students who apply and the number who successfully complete training.

**History**
- *SOURCE: Miss. Code Ann. §41-59-5 Subchapter 5 EMS Driver classes, class approved Rule 5.5.1 BEMS may approve EMS Driver training classes if it is determined, after review of EMS Driver class request forms that the objectives of the class equal or exceed those of the State of Mississippi.*
- *SOURCE: Miss. Code Ann. §41-59-5*

##### **15 Miss. Admin. Code Pt. 12, R. 5.5.2** Note: EMS Driver class approval forms can be requested from the BEMS or be completed on the BEMS website {#sec-12-5.5.2 omnilex-key=us-ms-regs-official--title-15--12#5.5.2}

(www.msems.org)

**History**
- *SOURCE: Miss. Code Ann. §41-59-5*

##### **15 Miss. Admin. Code Pt. 12, R. 5.5.3** Rule 5.5.3 {#sec-12-5.5.3 omnilex-key=us-ms-regs-official--title-15--12#5.5.3}

Credentialed EMS Driver instructors must complete the class approval form and submit to the BEMS, at minimum, fourteen (14), preferably thirty (30) calendar days prior to the first day of class. The BEMS will assign a class number to all approved requests and return to the credentialed EMS Driver instructor. Incomplete paperwork will be returned without action.

**History**
- *SOURCE: Miss. Code Ann. §41-59-5 Subchapter 6 EMS Driver classes, final roster Rule 5.6.1 Final rosters shall be completed by the credentialed EMS Driver instructor immediately following the end of training. The final roster shall be inclusive of all students successfully completing the course. The final roster will note students who withdrew, failed, and completed the EMS Driver class.*
- *SOURCE: Miss. Code Ann. §41-59-5*

##### **15 Miss. Admin. Code Pt. 12, R. 5.6.2** Note: The final roster form can be obtained from the BEMS or be completed on the BEMS web site {#sec-12-5.6.2 omnilex-key=us-ms-regs-official--title-15--12#5.6.2}

(www.msems.org)

**History**
- *SOURCE: Miss. Code Ann. §41-59-5*

##### **15 Miss. Admin. Code Pt. 12, R. 5.6.3** Rule 5.6.3 {#sec-12-5.6.3 omnilex-key=us-ms-regs-official--title-15--12#5.6.3}

Students successfully completing an EMS Driver course will not be eligible for state certification until a final roster is on file with the BEMS.

**History**
- *SOURCE: Miss. Code Ann. §41-59-5 Subchapter 7 EMS Driver Training Programs, minimum admittance criteria: Rule 5.7.1 Possession of a valid driver's license*
- *SOURCE: Miss. Code Ann. §41-59-5*

##### **15 Miss. Admin. Code Pt. 12, R. 5.7.2** Age of at least 18 years {#sec-12-5.7.2 omnilex-key=us-ms-regs-official--title-15--12#5.7.2}

**History**
- *SOURCE: Miss. Code Ann. §41-59-5 Subchapter 8 EMS Driver Refresher Training Rule 5.8.1 EMS Drivers are required to complete an initial EMS Driver course. There is currently no BEMS approved refresher training course for EMS Driver re- certification with the exception of BEMS approved vehicle operation monitoring system.*
- *SOURCE: Miss. Code Ann. §41-59-5*

##### **15 Miss. Admin. Code Pt. 12, R. 5.8.2** Rule 5.8.2 {#sec-12-5.8.2 omnilex-key=us-ms-regs-official--title-15--12#5.8.2}

Note: Licensed ambulance services operating approved vehicle operation monitoring systems are required to repeat the didactic section of their training program and submit a copy of the latest employer approved performance driver monitor strip/record.

**History**
- *SOURCE: Miss. Code Ann. §41-59-5 Subchapter 9 Prerequisites to certification as an EMS Driver (training obtained in Mississippi): Rule 5.9.1 Age of at least 18 years.*
- *SOURCE: Miss. Code Ann. §41-59-5*

##### **15 Miss. Admin. Code Pt. 12, R. 5.9.2** Completion of the Board's approved EMS Driver Training Program {#sec-12-5.9.2 omnilex-key=us-ms-regs-official--title-15--12#5.9.2}

**History**
- *SOURCE: Miss. Code Ann. §41-59-5*

##### **15 Miss. Admin. Code Pt. 12, R. 5.9.3** Possession of valid driver's license {#sec-12-5.9.3 omnilex-key=us-ms-regs-official--title-15--12#5.9.3}

**History**
- *SOURCE: Miss. Code Ann. §41-59-5 Subchapter 10 Prerequisites to certification as an EMS Driver (training obtained in another state: Rule 5.10.1 Age of at least 18 years.*
- *SOURCE: Miss. Code Ann. §41-59-5*

##### **15 Miss. Admin. Code Pt. 12, R. 5.10.2** Completion of the Board's approved EMS Driver Training Program {#sec-12-5.10.2 omnilex-key=us-ms-regs-official--title-15--12#5.10.2}

**History**
- *SOURCE: Miss. Code Ann. §41-59-5*

##### **15 Miss. Admin. Code Pt. 12, R. 5.10.3** Possession of valid driver's license {#sec-12-5.10.3 omnilex-key=us-ms-regs-official--title-15--12#5.10.3}

**History**
- *SOURCE: Miss. Code Ann. §41-59-5*

##### **15 Miss. Admin. Code Pt. 12, R. 5.10.4** Rule 5.10.4 {#sec-12-5.10.4 omnilex-key=us-ms-regs-official--title-15--12#5.10.4}

Written verification that training obtained out of state meets the guidelines of the Mississippi EMS Driver Training Program(s).

**History**
- *SOURCE: Miss. Code Ann. §41-59-5*

##### **15 Miss. Admin. Code Pt. 12, R. 5.10.5** Rule 5.10.5 {#sec-12-5.10.5 omnilex-key=us-ms-regs-official--title-15--12#5.10.5}

Verification of training within the past two years, or written verification of training from sending state and of current status.

**History**
- *SOURCE: Miss. Code Ann. §41-59-5*

##### **15 Miss. Admin. Code Pt. 12, R. 5.10.6** Submission of official driver's license history concurrent with date of application {#sec-12-5.10.6 omnilex-key=us-ms-regs-official--title-15--12#5.10.6}

**History**
- *SOURCE: Miss. Code Ann. §41-59-5*

##### **15 Miss. Admin. Code Pt. 12, R. 5.10.7** Rule 5.10.7 {#sec-12-5.10.7 omnilex-key=us-ms-regs-official--title-15--12#5.10.7}

Note: The BEMS maintains the right to refuse reciprocity to any EMS Driver if the submitted curriculum does not meet the requirements of this section.

Rule 5.11.1 The BEMS may issue temporary EMS driver certification not to exceed 90 days. Temporary certification will be issued only upon receipt of a written request from an owner/manager of a licensed ambulance provider. Licensed ambulance providers may utilize personnel awaiting temporary EMS driver certification provided that such providers notify the BEMS prior to employment.

**History**
- *SOURCE: Miss. Code Ann. §41-59-5 Subchapter 11 Temporary EMS Driver Certification.*
- *SOURCE: Miss. Code Ann. §41-59-5*

##### **15 Miss. Admin. Code Pt. 12, R. 5.11.2** Rule 5.11.2 {#sec-12-5.11.2 omnilex-key=us-ms-regs-official--title-15--12#5.11.2}

A temporary EMS Driver certification will not be granted to an individual who has previously been issued a Mississippi BEMS EMS Driver certification.

**History**
- *SOURCE: Miss. Code Ann. §41-59-5 Subchapter 12 EMS Driver Certification Rule 5.12.1 Any person desiring certification as an EMS Driver shall apply to the BEMS using forms provided (application for state certification). All certification applications must be accompanied by a fee fixed by the Board, which shall be payable to the Board. Also include a copy of EMS Driver course certificate of completion, a copy of a current state driver’s license and complete a successful review by the BEMS of the driver's license history from the Mississippi Highway Patrol or applicable state driver’s license history.*
- *SOURCE: Miss. Code Ann. §41-59-5*

##### **15 Miss. Admin. Code Pt. 12, R. 5.12.2** Rule 5.12.2 {#sec-12-5.12.2 omnilex-key=us-ms-regs-official--title-15--12#5.12.2}

An EMS Driver certificate shall be issued and may be renewed provided that the holder meets qualifications as required by the Board. The expiration date of each EMS Driver certificates shall be the same as the holder's driver's license.

Rule 5.14.1 Grounds for suspension or revocation include #22087 1. Fraud or any misstatement of fact in the procurement of any certification or in any other statement of representation to the BEMS or its representatives. 2. Gross negligence. 3. Repeated negligent acts. 4. Incompetence. 5. Disregarding the speed regulations prescribed by law while on duty. 6. Revocation or any other loss of Mississippi driver's license.

7. Failure to maintain all current EMS Driver training standards as required by the BEMS. 8. The commission of any fraudulent, dishonest, or corrupt act which is substantially related to the qualifications, functions, and duties of pre-hospital personnel. 9. Conviction of any crime which is directly related to the qualification, functions, and duties of pre-hospital personnel, or the conviction of any felony. The record of conviction or a certified copy thereof will be conclusive evidence of such conviction.#24551 10. Violating or attempting to violate directly or indirectly or assisting in or abetting the violation of, or conspiring to violate, any provision of this part of the regulations promulgated by the BEMS, pertaining to pre-hospital personnel. 11. Violating or attempting to violate any federal or state statute or regulation which regulates narcotics, dangerous drugs, or controlled substances. 12. Unauthorized, misuse or excessive use of narcotics, dangerous drugs, or controlled substances or alcoholic beverages. 13. Failure to comply with the requirements of a Mississippi EMS Scholarship program. 14. Failure to comply with an employer’s request for drug and alcohol testing. 15. Failure to wear high visibility safety apparel that meets the requirements of the American National Standard for High Visibility Apparel ANSI/ISEA 107-2004 Performance Class 2 or Performance Class 3, or the ANSI/ISEA 207-2006 Standard while functioning within the right-of-way of any road, street, highway, or other area where vehicle or machinery traffic is present. All garments must have labels, affixed by the manufacturer in accordance with the standard, that indicate compliance with the Performance Class 2, Performance Class 3, or 207- 2006 standard. 16. Any conduct, regardless of whether convicted, which constitutes a crime of violence, or which constitutes any of the following crimes: a. Assault b. Stalking c. False imprisonment d. Sexual assault or battery e. Crimes against a vulnerable person

**History**
- *SOURCE: Miss. Code Ann. §41-59-5 Subchapter 13 EMS Driver Re-certification Rule 5.13.1 Any person desiring re-certification as an EMS Driver shall apply to the BEMS using forms provided (Application for state certification). All re-certification applications must be accompanied by a fee fixed by the Board, which shall be payable to the Board. Also include a copy of EMS Driver course certificate of completion and a copy of current state driver's license. The BEMS will conduct a review of the applicant's driver license history from the Mississippi Highway Patrol or applicable state driver’s license history.*
- *SOURCE: Miss. Code Ann. §41-59-5 Subchapter 14 EMS Driver, Grounds for Suspension or Revocation.*
- *SOURCE: Miss. Code Ann. §41-59-5*

##### **15 Miss. Admin. Code Pt. 12, R. 5.14.2** Rule 5.14.2 {#sec-12-5.14.2 omnilex-key=us-ms-regs-official--title-15--12#5.14.2}

If the Bureau finds that public health, safety, and welfare requires emergency action and a finding to that effect is incorporated in its order, summary suspension of a certification may me ordered pending proceedings for revocation or other action.

**History**
- *SOURCE: Miss. Code Ann. §41-59-5 Chapter 6 EMERGENCY MEDIAL TECHNICIAN Subchapter 1 Training Authority EMT Rule 6.1.1 BEMS may approve Emergency Medical Technician (EMT) courses offered by a community college, Institutes of Higher Learning, Mississippi State Fire Academy, or an organized EMS district recognized by BEMS.*
- *SOURCE: Miss. Code Ann. §41-59-5 & 45-11-12 Subchapter 2 EMT Curriculum Rule 6.2.1 BEMS shall approve only proposed EMT courses that meet or exceed the most recent National Emergency Medical Services Education Standards, as documented by the course’s prescribed curriculum.*
- *SOURCE: Miss. Code Ann. §41-59-5 Subchapter 3 Request for Approval of EMT training programs Rule 6.3.1 To obtain approval for a proposed EMT course, the requesting entity must submit the online request available via the BEMS website at least thirty (30) days prior to the proposed start date. A copy of the proposed curriculum with anticipated learning outcomes and the instruments used for documenting outcome assessment/evaluation must be included with the request to offer the proposed course. Proposed EMT instructors must be state certified with at least two years of experience at the EMT level or a higher level as an EMS provider in Mississippi and possess current certification as a Healthcare Provider level CPR instructor.*
- *SOURCE: Miss. Code Ann. §41-59-5*

##### **15 Miss. Admin. Code Pt. 12, R. 6.3.2** Rule 6.3.2 {#sec-12-6.3.2 omnilex-key=us-ms-regs-official--title-15--12#6.3.2}

Request for approval of EMT training programs not contained on the approved list shall be sent to BEMS with evidence and verification that: #24068 / #24988 1. EMT training program meets, at minimum, the requirements of the National EMS Education Standards 2. EMT Instructors must be approved by the BEMS. Community college instructor standards may meet this requirement.

Subchapter 4 EMT Training Programs Rule 6.4.1 EMT students shall receive a handbook or syllabus no later than the first session of their respective course that relates the days and hours of the course, objectives, expected outcomes, and information related to the methods used in determining grades, in addition to any mechanism for appeal of grades and any other practical course information. Conditions governing dismissal from the course must be included in the handbook or syllabus and distributed to the student before training begins. Any options for remediation shall also be included in the handbook or syllabus. Course coordinators and instructors are responsible for maintaining documentation including grades, documentation of assessments and evaluations, documentation of remediation, and documentation related to retention and NREMT pass rates. Course coordinators shall follow the policy of their entity in terms of the length of time related to document retention. Said documentation may be requested by BEMS staff in the course of an investigation. Medical First Responder curricula shall also include appropriate classroom, lab, and practicum learning that meets or exceeds the most recent National Emergency Medical Services Education Standards for “Emergency Medical Responder.”

**History**
- *SOURCE: Miss. Code Ann. §41-59-5*
- *SOURCE: Miss. Code Ann. §41-59-5 Subchapter 5 EMT Classes, Initial Course Roster Rule 6.5.1 EMT coordinators shall provide an initial roster of all student participants enrolled in their respective courses to BEMS prior to the third-class session using the Initial Program/Course Roster Form available via the BEMS website.*
- *SOURCE: Miss. Code Ann. §41-59-5 Subchapter 6 EMT classes, Final Program/Course Roster Rule 6.6.1 EMT coordinators shall provide a final roster of all student participants who completed their respective courses to BEMS within three (3) days of course completion using the Final Program/Course Roster Form available via the BEMS website.*
- *SOURCE: Miss. Code Ann. §41-59-5 Subchapter 7 EMT Refresher Training Rule 6.7.1 Emergency Medical Technicians who meet prescribed recertification training and refresher requirements for EMT through the National Registry of EMTs (NREMT) and are currently certified as an EMT with the NREMT, meet all satisfactory recertification training and refresher requirements for BEMS EMT re- certification.*

##### **15 Miss. Admin. Code Pt. 12, R. 6.7.2** Rule 6.7.2 {#sec-12-6.7.2 omnilex-key=us-ms-regs-official--title-15--12#6.7.2}

All Refresher training classes shall conform to the National Continued Competency Program (NCCP) standards and approved by the BEMS and MDTQA. Rule 6.7.3 The local component of the NCCP constitutes specific topic requirements decided by the BEMS and/or MDTQA shall be included. Examples include state protocols, areas of specialization, or tasks that require additional focus based on QA/QI.

**History**
- *SOURCE: Miss. Code Ann. §41-59-5 Subchapter 8 Prerequisites to certification and recertification as an EMT Rule 6.8.1 Completion of the Board's approved Emergency Technician Training Program.*
- *SOURCE: Miss. Code Ann. §41-59-5*

##### **15 Miss. Admin. Code Pt. 12, R. 6.8.2** #24988 {#sec-12-6.8.2 omnilex-key=us-ms-regs-official--title-15--12#6.8.2}

Any person desiring certification as an EMT shall apply to the BEMS using forms provided via the MSDH BEMS website (Application for State EMS Provider Certification), submit a copy of current NREMT EMT certification and remit payment to BEMS, payable to MS State Department of Health – BEMS via electronic payment per the process described on the MSDH BEMS website. Rule 6.8.3 EMTs failing to re-certify with BEMS on or before the expiration date of his/her certification period will be considered officially expired. #24988

Rule 6.9.1 Grounds for suspension or revocation include: #22087 / #24068 1. Fraud or any misstatement of fact in the procurement of any certifications or in any other statement of representation to the Board or its representatives. 2. Gross negligence. 3. Repeated negligent acts. 4. Incompetence. 5. Disturbing the peace while on duty 6. Disregarding the speed regulations prescribed by law while on duty. 7. Failure to maintain current registration by the National Registry of EMTs.

8. Failure to maintain all current EMT training standards as required by the BEMS. 9. The commission of any fraudulent, dishonest, or corrupt act which is substantially related to the qualifications, functions, and duties of pre- hospital personnel. 10. Conviction of any crime which is directly related to the qualification, functions, and duties of pre-hospital personnel. The record of conviction or certified copy thereof will be conclusive evidence of such conviction. #24551 11. Violating or attempting to violate directly or indirectly, or assisting in or abetting the violation of, or conspiring to violate, any provision of this part of the regulations promulgated by the BEMS, pertaining to pre-hospital personnel. 12. Violating or attempting to violate any federal or state statute or regulation which regulates narcotics, dangerous drugs, or controlled substances. 13. Unauthorized, misuse or excessive use of narcotics, dangerous drugs, or controlled substances or alcoholic beverages. 14. Functioning outside the supervision of medical control in the field care system operating at the local level, except as authorized by certification and license issued to the BLS provider. 15. Permitting, aiding, or abetting an unlicensed or uncertified person to perform activities requiring a license or certification. 16. Suspension or revocation of any BEMS issued certification may affect other BEMS issued certifications at all levels. 17. Failure to comply with an employer’s request for drug and alcohol testing. 18. Failure to wear high visibility safety apparel that meets the requirements of the American National Standard for High Visibility Apparel ANSI/ISEA 107-2004 Performance Class 2 or Performance Class 3, or the ANSI/ISEA 207-2006 Standard while functioning within the right-of-way of any road, street, highway, or other area where vehicle or machinery traffic is present. (Suspension only for first offense.) 19. Any conduct, regardless of whether convicted, which constitutes a crime of violence, or which constitutes any of the following crimes: a. Assault b. Stalking c. False imprisonment

d. Sexual assault or battery e. Crimes against a vulnerable person

20. Failure to comply with reporting requirements for submission of Patient Care Report to the BEMS containing Mississippi minimum EMS data set. #24988

**History**
- *SOURCE: Miss. Code Ann. §41-59-5 Subchapter 9 EMT, Grounds for Suspension or Revocation.*
- *SOURCE: Miss. Code Ann. §41-59-5*

##### **15 Miss. Admin. Code Pt. 12, R. 6.9.2** Rule 6.9.2 {#sec-12-6.9.2 omnilex-key=us-ms-regs-official--title-15--12#6.9.2}

If BEMS finds that public health, safety, and welfare requires emergency action and a finding to that effect is incorporated in its order, summary suspension of a certification may be ordered pending proceedings for revocation or other action.

must be included with the request to offer the proposed course. Proposed AEMT instructors must be state certified with at least two years of experience at the AEMT level or a higher level as an EMS provider in Mississippi and possess current certification as a Healthcare Provider level CPR instructor.

**History**
- *SOURCE: Miss. Code Ann. §41-59-5 Subchapter 10 Functional Job Analysis Rule 6.10.1 Mississippi follows the summary and functional job description for Emergency Medical Technician (EMT) provided for in the National EMS Scope of Practice Model for the Emergency Medical Technician certification level. EMT’s must possess the education, critical thinking skills, general aptitude, and physical requirements required for the various roles they occupy with paid and voluntary organizations as per the job descriptions of their respective organizations.*
- *SOURCE: Miss. Code Ann. §41-59-5 Chapter 7 Advanced Emergency Medical Technician (AEMT) Subchapter 1 Training Authority AEMT Rule 7.1.1 BEMS may approve Advanced Emergency Medical Technician (AEMT) courses offered by a community college, the Institutes of Higher Learning, Mississippi State Fire Academy, or an organized EMS district recognized by BEMS.*
- *SOURCE: Miss. Code Ann. §41-59-5 & 45-11-12 Subchapter 2 AEMT Curriculum Rule 7.2.1 BEMS shall approve only proposed AEMT courses that meet or exceed the most recent National Emergency Medical Services Education Standards, as documented by the course’s prescribed curriculum.*
- *SOURCE: Miss. Code Ann. §41-59-5 Subchapter 3 Request for Approval of AEMT training programs Rule 7.3.1 To obtain approval for a proposed AEMT course, the requesting entity must submit the online request available via the BEMS website at least thirty (30) days prior to the proposed start date. A copy of the proposed curriculum with anticipated learning outcomes and the instruments used for documenting outcome assessment/evaluation*
- *SOURCE: Miss. Code Ann. §41-59-5*

##### **15 Miss. Admin. Code Pt. 12, R. 7.3.2** Rule 7.3.2 {#sec-12-7.3.2 omnilex-key=us-ms-regs-official--title-15--12#7.3.2}

Request for approval of AEMT training programs not contained on the approved list shall be sent to the BEMS with evidence and verification that: 1. AEMT training program meets, at minimum, the requirements of the National EMS Education Standards 2. AEMT Instructors must be approved by the BEMS. 3. AEMT Instructors must be approved by the BEMS. Community college instructor standards may meet this requirement. #24988

**History**
- *SOURCE: Miss. Code Ann. §41-59-5 Subchapter 4 AEMT Training Programs Rule 7.4.1 AEMT students shall receive a handbook or syllabus no later than the first session of their respective course that relates the days and hours of the course, objectives, expected outcomes, and information related to the methods used in determining grades, in addition to any mechanism for appeal of grades and any other practical course information. Conditions governing dismissal from the course must be included in the handbook or syllabus and distributed to the student before training begins. Any options for remediation shall also be included in the handbook or syllabus. Course coordinators and instructors are responsible for maintaining documentation including grades, documentation of assessments and evaluations, documentation of remediation, and documentation related to retention and NREMT pass rates. Course coordinators shall follow the policy of their entity in terms of the length of time related to document retention. Said documentation may be requested by BEMS staff in the course of an investigation. Advanced Emergency Medical Technician curricula shall also include appropriate classroom, lab, and practicum learning that meets or exceeds the most recent National Emergency Medical Services Education Standards for “Advanced Emergency Medical Technician.”*
- *SOURCE: Miss. Code Ann. §41-59-5 Subchapter 5 AEMT Classes, Initial Course Roster Rule 7.5.1 AEMT coordinators shall provide an initial roster of all student participants enrolled in their respective courses to BEMS prior to the third class session using the Initial Program/Course Roster Form available via the BEMS website.*
- *SOURCE: Miss. Code Ann. §41-59-5 Subchapter 6 AEMT classes, final roster Final Program/Course Roster*

##### **15 Miss. Admin. Code Pt. 12, R. 7.6.1** Rule 7.6.1 {#sec-12-7.6.1 omnilex-key=us-ms-regs-official--title-15--12#7.6.1}

AEMT coordinators shall provide a final roster of all student participants who completed their respective courses to BEMS within three (3) days of course completion using the Final Program/Course Roster Form available via the BEMS website.

1. All Refresher training classes shall conform to the National Continued Competency Program (NCCP) standards. 2. The local component of the NCCP constitutes specific topic requirements decided by the BEMS and/or MDTQA shall be included. Examples include state protocols, areas of specialization, or tasks that require additional focus based on QA/QI.

**History**
- *SOURCE: Miss. Code Ann. §41-59-5 Subchapter 7 AEMT Refresher Training Rule 7.7.1 AEMTs, who meet prescribed recertification training and refresher requirements for Advanced Emergency Medical Technician (AEMT) through the National Registry of EMTs (NREMT) and are currently certified as an AEMT with the NREMT, meet all satisfactory recertification training and refresher requirements for BEMS AEMT re-certification.*
- *SOURCE: Miss. Code Ann. §41-59-5 Subchapter 8 Prerequisites to certification and certification as an AEMT #24988 Rule 7.8.1 Any person desiring certification as a AEMT shall apply to the BEMS using forms provided via the MSDH BEMS website (Application for State EMS Provider Certification), submit a copy of current NREMT AEMT certification and remit payment to BEMS, payable to MS State Department of Health – BEMS via electronic payment per the process described on the MSDH BEMS website.*
- *SOURCE: Miss. Code Ann. §41-59-5*

##### **15 Miss. Admin. Code Pt. 12, R. 7.8.2** Rule 7.8.2 {#sec-12-7.8.2 omnilex-key=us-ms-regs-official--title-15--12#7.8.2}

AEMTs failing to re-certify with BEMS on or before the expiration date of his/her certification period will be considered officially expired. #24988

AEMT’s must possess the education, critical thinking skills, general aptitude, and physical requirements required for the various roles they occupy with paid and voluntary organizations as per the job descriptions of their respective organizations.

Subchapter 10 AEMT, Grounds for Suspension or Revocation. Rule 7.10.1 Grounds for suspension or revocation include: 1. The BEMS may suspend or revoke a certificate so issued at any time it is determined that the holder no longer meets the prescribed qualifications. 2. Fraud or any misstatement of fact in the procurement of any certifications or in any other statement of representation to the Board or its representatives. 3. Gross negligence. 4. Repeated negligent acts. 5. Incompetence. 6. Disturbing the peace while on duty 7. Recklessly disregarding the speed regulations prescribed by law while on duty. 8. Failure to maintain current registration by the National Registry of EMTs. 9. Failure to maintain all current Advanced EMT training standards as required by the BEMS. 10. The commission of any fraudulent dishonest, or corrupt act which is substantially related to the qualifications, functions, and duties of pre- hospital personnel. 11. Conviction of any crime which is directly related to the qualification, functions, and duties of pre-hospital personnel. The record of conviction or certified copy thereof will be conclusive evidence of such conviction. #24551 12. Violating or attempting to violate directly or indirectly, or assisting in or abetting the violation of, or conspiring to violate, any provision of this part of the regulations promulgated by the BEMS, pertaining to pre-hospital personnel. 13. Violating or attempting to violate any federal or state statute or regulation which regulates narcotics, dangerous drugs, or controlled substances. 14. Unauthorized misuse or excessive use of narcotics, dangerous drugs, or controlled substances or alcoholic beverages. 15. Functioning outside the supervision of medical control in the field care system operating at the local level, except as authorized by certification and license issued to the ALS provider.

16. Permitting, aiding, or abetting an unlicensed or uncertified person to perform activities requiring a license or certification. 17. Suspension or revocation of any BEMS issued certification may affect other BEMS issued certifications at all levels. 18. Failure to comply with an employer’s request for drug and alcohol testing. 19. Failure to wear high visibility safety apparel that meets the requirements of the American National Standard for High Visibility Apparel ANSI/ISEA 107- 2004 Performance Class 2 or Performance Class 3, or the ANSI/ISEA 207- 2006 Standard while functioning within the right-of-way of any road, street, highway, or other area where vehicle or machinery traffic is present. (Suspension only for first offense) 20. Any conduct, regardless of whether convicted, which constitutes a crime of violence, or which constitutes any of the following crimes: a. Assault b. Stalking c. False imprisonment d. Sexual assault or battery e. Crimes against a vulnerable person 21. Failure to comply with reporting requirements for timely submission of Patient Care Report to the BEMS containing Mississippi minimum EMS data set.

**History**
- *SOURCE: Miss. Code Ann. §41-59-5 Subchapter 9 Functional Job Analysis Rule 7.9.1 Mississippi follows the summary and functional job description for Advanced Emergency Medical Technician (AEMT) provided for in the National EMS Scope of Practice Model for the Emergency Medical Technician certification level.*
- *SOURCE: Miss. Code Ann. §41-59-5*
- *SOURCE: Miss. Code Ann. §41-59-5*

##### **15 Miss. Admin. Code Pt. 12, R. 7.10.2** Rule 7.10.2 {#sec-12-7.10.2 omnilex-key=us-ms-regs-official--title-15--12#7.10.2}

If BEMS finds that public health, safety, and welfare requires emergency action and a finding to that effect is incorporated in its order, summary suspension of a certification may be ordered pending proceedings for revocation or other action.

Chapter 8 PARAMEDIC

Subchapter 1 Training Authority for Paramedic Rule 8.1.1 BEMS may approve Paramedic courses offered by a community college, and the Institutes of Higher Learning.

**History**
- *SOURCE: Miss. Code Ann. §41-59-5*
- *SOURCE: Miss. Code Ann. §41-59-5; Miss. Code Ann. §41-60-13*

##### **15 Miss. Admin. Code Pt. 12, R. 8.1.2** Rule 8.1.2 {#sec-12-8.1.2 omnilex-key=us-ms-regs-official--title-15--12#8.1.2}

BEMS is authorized to approve or disapprove in-state clinical and field practicum education activities for out-of-state CoAEMSP accredited paramedic programs. Out-of-state paramedic students participating in clinical or field practicum must be Mississippi certified at the EMT or AEMT level.

**History**
- *SOURCE: Miss. Code Ann. §41-59-5; Miss. Code Ann. §41-60-13 Subchapter 2 Paramedic Curriculum Rule 8.2.1 BEMS shall approve only proposed Paramedic courses that meet or exceed the most recent National Emergency Medical Services Education Standards, as documented by the course’s prescribed curriculum.*
- *SOURCE: Miss. Code Ann. §41-59-5; Miss. Code Ann. §41-60-13 Subchapter 3 Request for Approval of Paramedic Training Programs Rule 8.3.1 To obtain approval for a proposed Paramedic course, the requesting entity must submit the online request available via the BEMS website at least thirty (30) days prior to the proposed start date. A copy of the proposed curriculum with anticipated learning outcomes and the instruments used for documenting outcome assessment/evaluation must be included with the request to offer the proposed course. Proposed Paramedic instructors must be state certified with at least two years of experience at the Paramedic level or a higher level as an EMS provider in Mississippi and possess current certification as a Healthcare Provider level CPR instructor.*
- *SOURCE: Miss. Code Ann. §41-59-5; Miss. Code Ann. §41-60-13*

##### **15 Miss. Admin. Code Pt. 12, R. 8.3.2** Rule 8.3.2 {#sec-12-8.3.2 omnilex-key=us-ms-regs-official--title-15--12#8.3.2}

All BEMS approved Paramedic training programs must be accredited by the Committee on Accreditation of Education Programs for the EMS Professions (CoAEMSP). BEMS shall be present for any site visit conducted by the Committee on Accreditation of Education Programs for the EMS Professions (CoAEMSP). #23517

**History**
- *SOURCE: Miss. Code Ann. §41-59-5; Miss. Code Ann. §41-60-13*

##### **15 Miss. Admin. Code Pt. 12, R. 8.3.3** Programs seeking accreditation must first seek a Letter of Review (LOR) issued by COAEMSP {#sec-12-8.3.3 omnilex-key=us-ms-regs-official--title-15--12#8.3.3}

A copy of the Letter of Review Self Study Report (LSSR) must be submitted to the BEMS prior to submitting to COAEMSP. #24685 1. Upon receipt of the LOR, the Program must submit an official copy to the BEMS along with the start date of the next LOR class and the on-time end date of that class. 2. BEMS must be notified within ten (10) days of any suspension, revocation, or voluntary withdrawal of program LOR.

**History**
- *SOURCE: Miss. Code Ann. §41-59-5; Miss. Code Ann. §41-60-13*

##### **15 Miss. Admin. Code Pt. 12, R. 8.3.4** Rule 8.3.4 {#sec-12-8.3.4 omnilex-key=us-ms-regs-official--title-15--12#8.3.4}

The following requirements are to be met and approved by the BEMS before the approval will be issued to begin the programs instructional component: #23517 1. Accredited programs or Letter of Review (LOR) programs adding or identifying a Lead Instructor/Program Director must fill the position with an individual meeting all qualifications prescribed under the current CAAHEP Standards and Guidelines. Any personnel changes must be reported to the BEMS within fifteen (15) calendar days. 2. Accredited programs or Letter of Review (LOR) programs adding or identifying a Medical Director must fill the position with an individual meeting all qualifications prescribed under the current CAAHEP Standards and Guidelines. Any personnel changes must be reported to the BEMS within fifteen (15) calendar days. 3. Accredited programs or Letter of Review (LOR) programs adding or identifying Instructional Faculty must fill the position with an individual meeting all qualifications prescribed under the current CAAHEP Standards and Guidelines. Any personnel changes must be reported to the BEMS within fifteen (15) calendar days. 4. Clinical Resources as prescribed under the current CAAHEP Standards and Guidelines. This must be verified by a copy of a contractual agreement from each site to the BEMS #24685

**History**
- *SOURCE: Miss. Code Ann. §41-59-5; Miss. Code Ann. §41-60-13*

##### **15 Miss. Admin. Code Pt. 12, R. 8.3.5** Before a consecutive class will be authorized to commence, the program shall adhere to all required CoAEMSP processes {#sec-12-8.3.5 omnilex-key=us-ms-regs-official--title-15--12#8.3.5}

Further, to maintain training authority, the programs must submit to BEMS: #23517 #24685 1. Reports of training activities as specified by BEMS; copies of any and all written communications to and from the school and the Committee on Accreditation of Education Programs for the EMS Professions (CoAEMSP) and/or CAAHEP, will be submitted within (10) ten working days from submitting or receiving. 2. Program updates and revisions as specified by BEMS. All reports and updates must be submitted to the BEMS no later than June 30 of each year. 3. Proof of minimum acceptable pass rates determined by the BEMS and Medical Direction, Training and Quality Assurance Committee. Approved Instructors not meeting this requirement may be placed on probationary status by the BEMS.

Subchapter 4 Paramedic Classes, Initial Course Roster Rule 8.4.1 Paramedic coordinators shall provide an initial roster of all student participants enrolled in their respective courses to BEMS prior to the third class session using the Initial Program/Course Roster Form available via the BEMS website.

1. All Refresher training classes shall conform to the National Continued Competency Program (NCCP) standards. 2. The local component of the NCCP constitutes specific topic requirements decided by the BEMS and/or MDTQA shall be included. Examples include state protocols, areas of specialization, or tasks that require additional focus based on QA/QI.

and remit payment to BEMS, payable to MS State Department of Health – BEMS via electronic payment per the process described on the MSDH BEMS website.

**History**
- *SOURCE: Miss. Code Ann. §41-59-5; Miss. Code Ann. §41-60-13*
- *SOURCE: Miss. Code Ann. §41-59-5; Miss. Code Ann. §41-60-13 Subchapter 5 Paramedic Classes, Final Program/Course Roster Rule 8.5.1 Paramedic coordinators shall provide a final roster of all student participants who completed their respective courses to BEMS within three (3) days of course completion using the Final Program/Course Roster Form available via the BEMS website.*
- *SOURCE: Miss. Code Ann. §41-59-5; Miss. Code Ann. §41-60-13 Subchapter 6 Paramedic Training Programs, minimum admittance criteria #23517 Rule 8.6.1 Must be a Mississippi certified EMT, or Advanced EMT*
- *SOURCE: Miss. Code Ann. §41-59-5; Miss. Code Ann. §41-60-13 Subchapter 7 Paramedic Refresher Training #23517 Rule 8.7.1 Paramedics, who meet prescribed recertification training and refresher requirements for Paramedic through the National Registry of EMTs (NREMT) and are currently certified as a Paramedic with the NREMT, meet all satisfactory recertification training and refresher requirements for BEMS Paramedic re- certification.*
- *SOURCE: Miss. Code Ann. §41-59-5; Miss. Code Ann. §41-60-13 Subchapter 8 Prerequisites to certification and recertification as a Paramedic #23517 #24685 Rule 8.8.1 Any person desiring certification as a Paramedic shall apply to the BEMS using forms provided via the MSDH BEMS website (Application for State EMS Provider Certification), submit a copy of current NREMT Paramedic certification*
- *SOURCE: Miss. Code Ann. §41-59-5; Miss. Code Ann. §41-60-13*

##### **15 Miss. Admin. Code Pt. 12, R. 8.8.2** Rule 8.8.2 {#sec-12-8.8.2 omnilex-key=us-ms-regs-official--title-15--12#8.8.2}

All Paramedics failing to re-certify with BEMS on or before the expiration date of his/her certification period will be considered officially expired. #24685

2. Fraud or any misstatement of fact in the procurement of any certifications or in any other statement of representation to the Board or its representatives. 3. Gross negligence. 4. Repeated negligent acts. 5. Incompetence. 6. Disturbing the peace while on duty 7. Disregarding the speed regulations prescribed by law while on duty. 8. Failure to maintain current registration by the National Registry of EMTs. 9. Failure to maintain all current Advanced training standards as required by the BEMS. 10. The commission of any fraudulent dishonest, or corrupt act which is substantially related to the qualifications, functions, and duties of pre-hospital personnel. 11. Conviction of any crime which is directly related to the qualification, functions, and duties of pre-hospital personnel. The record of conviction or certified copy thereof will be conclusive evidence of such conviction. #24551 12. Violating or attempting to violate directly or indirectly, or assisting in or abetting the violation of, or conspiring to violate, any provision of this part of the regulations promulgated by the BEMS, pertaining to pre-hospital personnel. 13. Violating or attempting to violate any federal or state statute or regulation which regulates narcotics, dangerous drugs, or controlled substances.

14. Unauthorized, misuse or excessive use of narcotics, dangerous drugs, or controlled substances or alcoholic beverages. 15. Functioning outside the supervision of medical control in the field care system operating at the local level, except as authorized by certification and license issued to the ALS provider. 16. Permitting, aiding, or abetting an unlicensed or uncertified person to perform activities requiring a license or certification. 17. Suspension or revocation of any BEMS issued certification may affect other BEMS issued certifications at all levels. 18. Failure to comply with an employer’s request for drug and alcohol testing. 19. Failure to wear high visibility safety apparel that meets the requirements of the American National Standard for High Visibility Apparel ANSI/ISEA 107-2004 Performance Class 2 or Performance Class 3, or the ANSI/ISEA 207-2006 Standard while functioning within the right-of-way of any road, street, highway, or other area where vehicle or machinery traffic is present. (Suspension for first offense) 20. Any conduct, regardless of whether convicted, which constitutes a crime of violence, or which constitutes any of the following crimes: a. Assault b. Stalking c. False imprisonment d. Sexual assault or battery e. Crimes against a vulnerable person

21. Failure to comply with reporting requirements for timely submission of Patient Care Report to the BEMS containing Mississippi minimum EMS data set

**History**
- *SOURCE: Miss. Code Ann. §41-59-5; Miss. Code Ann. §41-60-13 Subchapter 9 Paramedic, Grounds for Suspension or Revocation. #23517 Rule 8.9.1 Grounds for suspension or revocation include: #24068 1. The BEMS may suspend or revoke a certificate so issued at any time it is determined that the holder no longer meets the prescribed qualifications.*
- *SOURCE: Miss. Code Ann. §41-59-5; Miss. Code Ann. §41-60-13*

##### **15 Miss. Admin. Code Pt. 12, R. 8.9.2** Rule 8.9.2 {#sec-12-8.9.2 omnilex-key=us-ms-regs-official--title-15--12#8.9.2}

If the Bureau finds that public health, safety, and welfare requires emergency action and a finding to that effect is incorporated in its order, summary suspension of a certification may be ordered pending proceedings for revocation or other action.

1. Drug Assisted Intubation, using MDTQA approved medications for this procedure, in strict adherence with the following measures: a. A specific verbal order from online medical direction must be obtained to institute DAI; b. Initiate and continue, before, during and after each DAI, continuous monitoring and recording of heart rate and rhythm, oxygen saturation, and end-tidal carbon dioxide using a capnography or capnometric device (to exclude colormetric only devices); c. Appropriate resources for drug storage and delivery must be present and used; d. DAI protocols must contain continuing quality assurance, quality control and performance review measures, and when indicated, supplemental training; e. DAI protocols must include requirements for initial training and continuing education in: i. Proper patient selection for DAI; ii. Demonstrating initial and continuing competency in the DAI procedure; iii. Confirming initial and verifying ongoing tube placement, including training in the utilization of appropriate instrumentation; iv. Airway management of patients who cannot be intubated; v. The use of backup rescue airway methods in the event of failed DAI;. vi. Every instance of the initiation or attempted initiation of an airway by DAI shall be reported to BEMS by the local EMS on forms or in a format approved by BEMS. Every instance of the institution or attempted institution of an airway by DAI shall be reviewed by the State Medical Director, who shall submit a quarterly report to MDTQA and the EMS Advisory Council.

**History**
- *SOURCE: Miss. Code Ann. §41-59-5; Miss. Code Ann. §41-60-13 Subchapter 10 Performance Standards for Paramedic #23517 #24685 Rule 8.10.1 Optional skills: Performances of these skills are optional however; they must be taught in all training programs. #24068*
- *SOURCE: Miss. Code Ann. §41-59-5; Miss. Code Ann. §41-60-13 Subchapter 11 Area and Scope of Practice of the Paramedic #23517 Rule 8.11.1 The paramedic scope of practice shall be defined as in Appendix*
- *SOURCE: Miss. Code Ann. §41-59-5; Miss. Code Ann. §41-60-13*

##### **15 Miss. Admin. Code Pt. 12, R. 8.11.2** Paramedics may routinely or periodically participate in patient care in the emergency department of a licensed hospital {#sec-12-8.11.2 omnilex-key=us-ms-regs-official--title-15--12#8.11.2}

Their presence may be in the form of: 1. graduates participating in a clinical rotation for skill retention. 2. field units stationed out of the emergency department under direct physician supervision (i.e., hospital-based ALS services). BEMS Certified Paramedics will be able to function in the emergency service area of the hospital. They would also be permitted to function in life-threatening emergency situations in other areas of the hospital if directed to do so by the medical command authority. 3. providing assistance to the emergency department staff after delivering a patient. Paramedics must, when functioning in the hospital, only do so under the direct supervision of a physician. This is necessary because the scope of practice of a Paramedics does not coincide with that of any other licensed personnel. Paramedics of a hospital owned and based ambulance service may function in the Emergency Department under the direct supervision of a Mississippi licensed physician, physically located in Mississippi, via telemedicine. Paramedics may not function in other areas of hospitals which do not have on-site 24-hour physician availability. #24685

**History**
- *SOURCE: Miss. Code Ann. §41-59-5; Miss. Code Ann. §41-60-13*

##### **15 Miss. Admin. Code Pt. 12, R. 8.11.3** Rule 8.11.3 {#sec-12-8.11.3 omnilex-key=us-ms-regs-official--title-15--12#8.11.3}

Because the Paramedic’s primary responsibility is to respond to emergency situations outside the hospital, they cannot be utilized to replace any members of the hospital emergency service area staff but may be utilized to support and assist the staff in the care of patients in accordance with their performance standards. Since their scope of practice is limited to a number of specific procedures, which can only be performed under the direction of a physician, all emergency patients clearly require nursing intervention in order to ensure that all the patients' needs are met.

**History**
- *SOURCE: Miss. Code Ann. §41-59-5; Miss. Code Ann. §41-60-13*

##### **15 Miss. Admin. Code Pt. 12, R. 8.11.4** Rule 8.11.4 {#sec-12-8.11.4 omnilex-key=us-ms-regs-official--title-15--12#8.11.4}

It is appropriate to transport patients whose urgent needs or reasonably perceived needs for care exceed the scope of practice for the EMS provider, if the following conditions are present: 1. The patient has existing advanced therapeutics or treatment modalities for a preexisting condition and /or 2. The patient is located in a non-hospital setting, and /or

3. The patient's condition is considered to be so urgent that the benefits of prompt transport by available personnel to an appropriate hospital outweigh the increased risk to the patient from affecting a delay waiting for qualified medical personnel to arrive.

**History**
- *SOURCE: Miss. Code Ann. §41-59-5; Miss. Code Ann. §41-60-13*

##### **15 Miss. Admin. Code Pt. 12, R. 8.11.5** Rule 8.11.5 {#sec-12-8.11.5 omnilex-key=us-ms-regs-official--title-15--12#8.11.5}

EMS Providers of all levels, may attend and transport by ambulance, patients who have pre-existing procedures or devices that are beyond the EMS Providers scope of practice if: 1. there is no need, or reasonably perceived need, for the device or procedure during transport; or 2. an individual (including the patient himself) that has received training and management of the procedure or device accompanies the patient to the destination. Note: Should doubt exist in regards to the transport of any device or procedure, medical control should be contacted for medical direction.

Chapter 9 Emergency Medical Services Operating Fund (EMSOF) Subchapter 1 Eligibility Rule 9.1.1 Applicants are restricted to counties, municipalities and emergency medical service districts formed and recognized pursuant to §41-59-53 through §41-59-59. Political subdivisions are not eligible to receive Emergency Medical Services Operating Funds (EMSOF).

**History**
- *SOURCE: Miss. Code Ann. §41-59-5; Miss. Code Ann. §41-60-13*
- *SOURCE: Miss. Code Ann. §41-59-5*

##### **15 Miss. Admin. Code Pt. 12, R. 9.1.2** Rule 9.1.2 {#sec-12-9.1.2 omnilex-key=us-ms-regs-official--title-15--12#9.1.2}

To be eligible for EMSOF, in part, governmental units must have expended from local funds directly to the ambulance service, at minimum, an amount equal to or greater than $0.15 per capita, with population computed from the most current federal census, in the year the EMSOF was collected. For governmental units that own and operate governmental ambulance service, to be eligible, in part, the governmental unit must show equal to or greater than $0.15 per capita, with population computed from the most current federal census, in the year the EMSOF fund was collected.

Subchapter 2 Process Rule 9.2.1 Applications for EMSOF will be forwarded to applicants receiving EMSOF funds for the prior year. Other counties, municipalities and legal EMS districts wishing to receive applications shall submit, in writing, a request for application on or before October 1 of the year in which they plan to request EMSOF. Original applications, as provided by BEMS, for EMSOF must be received at the Bureau of Emergency Medical Services office by 5:00 PM on the second Friday of November each year. Applications received after this date will not be processed.

**History**
- *SOURCE: Miss. Code Ann. §41-59-5*
- *SOURCE: Miss. Code Ann. §41-59-5*

##### **15 Miss. Admin. Code Pt. 12, R. 9.2.2** Rule 9.2.2 {#sec-12-9.2.2 omnilex-key=us-ms-regs-official--title-15--12#9.2.2}

Applications for EMSOF must have satisfactory proof of the maintenance of the funding effort by the governmental unit in the form of a line item local fund expense for ambulance in the fiscal year in which EMSOF funds were collected. Satisfactory proof must also be provided in the form of a line item budget of local funds for ambulance in the fiscal year that EMSOF is being requested.

**History**
- *SOURCE: Miss. Code Ann. §41-59-5*

##### **15 Miss. Admin. Code Pt. 12, R. 9.2.3** Rule 9.2.3 {#sec-12-9.2.3 omnilex-key=us-ms-regs-official--title-15--12#9.2.3}

It is important that applicants create their EMSOF applications with input from their licensed ambulance service provider and/or county EMS regulatory programs. Evidence of this collaboration will be a memorandum or letter of support for the application from the licensed ambulance service provider(s) and/or county EMS regulatory programs and must be attached to the EMSOF application. Applications received by BEMS without these memorandum or letters of support will be returned without action.

**History**
- *SOURCE: Miss. Code Ann. §41-59-5*

##### **15 Miss. Admin. Code Pt. 12, R. 9.2.4** Applications must be signed by: 1 {#sec-12-9.2.4 omnilex-key=us-ms-regs-official--title-15--12#9.2.4}

Counties: Chancery Clerk, County Administrator or President Board of Supervisors 2. Municipalities: Mayor 3. EMS Districts: District Administer or President of the Board.

**History**
- *SOURCE: Miss. Code Ann. §41-59-5*

##### **15 Miss. Admin. Code Pt. 12, R. 9.2.5** Rule 9.2.5 {#sec-12-9.2.5 omnilex-key=us-ms-regs-official--title-15--12#9.2.5}

Applicants are required to attend an “EMSOF grantee meeting” to be held in their public health region before grant approval.

**History**
- *SOURCE: Miss. Code Ann. §41-59-5*

##### **15 Miss. Admin. Code Pt. 12, R. 9.2.6** All EMSOF funds must be deposited into the governmental units’ treasury {#sec-12-9.2.6 omnilex-key=us-ms-regs-official--title-15--12#9.2.6}

Items purchased with EMSOF funds must be purchased in the name of the

governmental unit. The Governmental unit must follow its existing rules for the purchasing, inventory, and disposal of these items. A sticker which states “This equipment purchased by the citizens of the State of Mississippi” shall identify equipment purchased with EMSOF funds.

1. EMSOF must be expended to the direct benefit of a Mississippi Licensed Ambulance Service (as described in Chapter 59 of the Mississippi Code Ann.). These funds may not be used in support of “EMS Support Services” including, but not limited to, the following 2. local or county fire service rescue operations, and 3. local or county first responders other than training, medical supplies, or medical equipment to be used for direct patient care. 4. Additionally, EMSOF may not be used for hospital equipment or supplies. If a licensed ambulance service is hospital-based, EMSOF funds can only be used for items that are to the direct benefit of the hospital-based licensed ambulance service. The director of the hospital-based licensed ambulance service must indicate by memorandum or letter of support that the request will provide direct benefit to the hospital-based licensed ambulance service.

**History**
- *SOURCE: Miss. Code Ann. §41-59-5 Subchapter 3 Eligible Uses of EMSOF Funds Rule 9.3.1 EMSOF must be used for improvements in the Bureau of Emergency Medical Services regulated Emergency Medical Services and may not be used for operating expenses. All EMSOF funds must be expended or escrowed by the end of the local fiscal year in which the EMSOF funds were disbursed to the governmental unit. “Escrow” is defined as depositing the funds in an interest- bearing account in accordance with Miss. Code Ann. §27-105-1, et seq. and applicable state fiscal and financial control regulations, said funds to be used only in accordance with the provisions of the EMSOF grant. No funds granted hereunder may be escrowed for more than three (3) years. All expenditures of funds from an EMSOF grant must be done in accordance with Mississippi purchasing and property accounting laws, rules, and regulations. A detailed justification for all EMSOF expenditures or funds escrowed, indicating their compliance with purchasing laws and regulations, as well as how they will improve local emergency medical services, must be provided.*
- *SOURCE: Miss. Code Ann. §41-59-5*

##### **15 Miss. Admin. Code Pt. 12, R. 9.3.2** Personnel Expenses {#sec-12-9.3.2 omnilex-key=us-ms-regs-official--title-15--12#9.3.2}

EMSOF may be used to pay payroll and benefit differential pay for governmental units for the first year that a governmental unit applies to the BEMS to improves its’ level of ambulance service licensure. No other personnel expenses are allowed under EMSOF.

**History**
- *SOURCE: Miss. Code Ann. §41-59-5*

##### **15 Miss. Admin. Code Pt. 12, R. 9.3.3** Regionalization {#sec-12-9.3.3 omnilex-key=us-ms-regs-official--title-15--12#9.3.3}

EMSOF may be used to pay dues to an EMS district formed and recognized pursuant to §41-59-53 through §41-59-59, for regional medical control, training, or improvements in Bureau of Emergency Medical Services. Based on support of the licensed ambulance service, EMSOF may also be used for governmental support of trauma care systems.

**History**
- *SOURCE: Miss. Code Ann. §41-59-5*

##### **15 Miss. Admin. Code Pt. 12, R. 9.3.4** Training {#sec-12-9.3.4 omnilex-key=us-ms-regs-official--title-15--12#9.3.4}

EMSOF may be used for initial training or continuing education of EMS Drivers, EMT-Basic, EMT-Intermediate, or EMT-Paramedic. EMSOF may not be used for the initial training of first responders. These funds may be used for re-certification of Medical First Responders (as regulated by the Bureau of EMS).

**History**
- *SOURCE: Miss. Code Ann. §41-59-5*

##### **15 Miss. Admin. Code Pt. 12, R. 9.3.5** Commodities {#sec-12-9.3.5 omnilex-key=us-ms-regs-official--title-15--12#9.3.5}

EMSOF may be used for the purchase of commodities that improve local Emergency Medical Services. EMSOF may not be used to purchase any commodities that will be billed to a patient. Applicant must show that the requested commodity is a direct benefit to the licensed ambulance service. This must be acknowledged by the county recognized lead licensed ambulance service director by letter or memorandum of support.

**History**
- *SOURCE: Miss. Code Ann. §41-59-5*

##### **15 Miss. Admin. Code Pt. 12, R. 9.3.6** Equipment {#sec-12-9.3.6 omnilex-key=us-ms-regs-official--title-15--12#9.3.6}

EMSOF may be used to purchase equipment or capital outlay items that improve local Emergency Medical Services. Equipment purchased with EMSOF by a governmental unit must appear on the governmental units equipment inventory and be accounted for in accordance with State of Mississippi property inventory laws, rules and regulations. This is not intended to limit the temporary use of equipment in adjacent counties or jurisdictions within Mississippi or during patient transport either inside or outside the state. Applicant must show that the requested equipment is a direct benefit to the licensed ambulance service. This must be acknowledged by the county recognized lead licensed ambulance service director by letter or memorandum of support.

**History**
- *SOURCE: Miss. Code Ann. §41-59-5*

##### **15 Miss. Admin. Code Pt. 12, R. 9.3.7** Escrow {#sec-12-9.3.7 omnilex-key=us-ms-regs-official--title-15--12#9.3.7}

EMSOF may be escrowed (up to a maximum of three years) for local improvements in Emergency Medical Services regulated by the Bureau of Emergency Medical Services. (Example: Purchasing a new ambulance or radio system that cost more than grant amount.) Grant awards may be escrowed up to three years from the disbursement. All escrow amounts and interest must be fully expended by the end of the fourth grant year. (Example: ABC County received $10,000 in EMSOF for FY2008, $10,000 for FY2009 and $10,000 for FY2010 and wishes to replace a high mileage ambulance that will cost $40,400. ABC

County received $10,000 in EMSOF for FY 2011 and must fully expend the $40,000 plus interest accrued on escrowed amounts prior to the end of the governmental fiscal year for FY2011.) Escrow funds not fully expended by the end of the fourth grant year must be returned to the State. All interest posted must be reported and expended consistent with these regulations.

**History**
- *SOURCE: Miss. Code Ann. §41-59-5 Subchapter 4 Reports Rule 9.4.1 Prior to EMSOF proceeds being distributed to any governmental unit, proof, or proper expenditure of EMSOF in the previous year, if applicable, must be submitted to include the signature of the signing authority of the governmental unit indicating all expenditures were made properly.*
- *SOURCE: Miss. Code Ann. §41-59-5*

##### **15 Miss. Admin. Code Pt. 12, R. 9.4.2** Rule 9.4.2 {#sec-12-9.4.2 omnilex-key=us-ms-regs-official--title-15--12#9.4.2}

The director of the Bureau of Emergency Medical Services or his designee will perform random program reviews of governmental units to assure that EMSOF law, rules, regulations, and policies are followed.

Instructors must be knowledgeable regarding new developments in emergency medical services and critical care through reading, research, professional organizations, and continuing academic training. They must be strong in oral and written communication skills and relate well to a variety of professional disciplines.

**History**
- *SOURCE: Miss. Code Ann. §41-59-5 Subchapter 5 Appeal Process Rule 9.5.1 Any county, municipality or organized medical service districts whose application for EMSOF has been rejected shall have the right to appeal such decision, within thirty (30) days after receipt of the Bureau of Emergency Medical Services’ written decision, to a hearing officer who will make a final recommendation to the State Health Officer.*
- *SOURCE: Miss. Code Ann. §41-59-5 1. Chapter 10 Critical Care Paramedic Subchapter 1 Training Authority for Critical Care Paramedic Rule 10.1.1 Critical Care Paramedic Program Coordinator: Must be an existing Accredited Mississippi ALS Program coordinator or Licensed or Certified Flight Paramedic (FP-C) or Critical Care Paramedic (CCP) for a minimum of three years. The Program Director and Instructors must be comfortable with the majority of the lecture components and skill stations and can answer questions with credibility.*
- *SOURCE: Miss. Code Ann. §41-59-5*

##### **15 Miss. Admin. Code Pt. 12, R. 10.1.2** Rule 10.1.2 {#sec-12-10.1.2 omnilex-key=us-ms-regs-official--title-15--12#10.1.2}

Critical Care Paramedic training programs shall be advised regarding qualifications of program directors and instructors by a Critical Care Paramedic Advisory Committee as appointed by the Chairman of the Emergency Medical Services Advisory Council in consultation with the Chairman of the Medical Direction, Training and Quality Assurance.

Subchapter 2 Request for Approval of Critical Care Paramedic Training Programs Rule 10.2.1 Note: A list of BEMS approved Critical Care Paramedic training programs will be available at the BEMS office.

**History**
- *SOURCE: Miss. Code Ann. §41-59-5*
- *SOURCE: Miss. Code Ann. §41-59-5*

##### **15 Miss. Admin. Code Pt. 12, R. 10.2.2** Rule 10.2.2 {#sec-12-10.2.2 omnilex-key=us-ms-regs-official--title-15--12#10.2.2}

Request for approval of Critical Care Paramedic training programs not contained on the approved list shall be sent to BEMS with evidence and verification that: 1. The education institution and its program director have been approved by the BEMS. 2. Critical Care Paramedic training programs meet, at minimum, the curriculum requirements set forth in this section.

**History**
- *SOURCE: Miss. Code Ann. §41-59-5*

##### **15 Miss. Admin. Code Pt. 12, R. 10.2.3** Rule 10.2.3 {#sec-12-10.2.3 omnilex-key=us-ms-regs-official--title-15--12#10.2.3}

Mississippi Critical Care Paramedic (CCP) Educational Site Requirements: In order to qualify for approval to offer the Mississippi Critical Care Paramedic program, an educational institution must: 2. Be a BEMS approved Advanced Life Support (ALS) education site in good standing. 3. Have in place an adequate number of qualified faculty to offer the program. Individual training programs will be responsible for credentialing their instructors. Individuals instructing within this curriculum must be knowledgeable in the area being presented. It is highly recommended that individual instructors have experience and expertise in their topic area. It is also recommended that instructors have Critical Care experience. A Critical Care Paramedic Program Coordinator must oversee all phases of the course.

**History**
- *SOURCE: Miss. Code Ann. §41-59-5*

##### **15 Miss. Admin. Code Pt. 12, R. 10.2.4** Instructor qualifications: 1 {#sec-12-10.2.4 omnilex-key=us-ms-regs-official--title-15--12#10.2.4}

Instructor qualifications: Critical Care Paramedic Program Coordinator:

a. Must be an existing Accredited Mississippi ALS Program coordinator or Licensed or Certified Flight Paramedic (FP-C) or Registered Nurse with EMS experience or Critical Care Paramedic (CCP). b. Minimum of three years’ experience. c. The Program Director and Instructors must be comfortable with the majority of the lecture components and skill stations and can answer questions with credibility. d. The Program Coordinator should ensure instructors are knowledgeable regarding new developments in emergency medical services and critical care through reading, research, professional organizations, and continuing academic training. They must be strong in oral and written communication skills and relate well to a variety of professional disciplines. 2. Instructor qualifications: Physician instructor qualifications: a. Emergency Medicine or Critical Care Medicine Board Certified or board eligible. b. Minimum of three years clinical teaching experience. 3. Instructor qualifications: Nurse Practitioner/Physician Assistant instructor qualifications: a. Minimum of five years emergency or critical care clinical experience. b. Minimum of three years teaching experience. c. Current certification in AHA ACLS; PEPP or AHA PALS course; Trauma Course (Trauma Nursing Core Course (TNCC), Course for Advanced Trauma Nursing (CATN), etc. 4. Instructor qualifications: Registered Nurse instructor qualifications a. Minimum of five years critical care transport experience. b. Minimum of three years teaching experience. c. Current certification in AHA ACLS; PEPP or AHA PALS course; Trauma Course (TNCC, CATN, etc.) d. Certified Flight Registered Nurse (CFRN), Critical Care Nursing Course (CCRN), Certified Transport Registered Nurse (CTRN), or Certified Emergency Nurse Certified Emergency Nurse (CEN) preferred.

5. Instructor qualifications: Paramedic instructor qualifications: a. Licensed or Certified Flight Paramedic (FP-C) or Critical Care Paramedic (CCP) for a minimum of two years. b. Minimum of five years’ experience. c. Minimum of three years teaching experience. d. Current certifications in: i. AHA ACLS ii. AHA PALS, EPC or PEPP iii. PHTLS or equivalent course. 6. Instructor qualifications: Content Expert Instructor: Course Content Expert is an authority in a specific field of medicine. Experts must have a letter of recommendation or curriculum vitae (CV) detailing the extent and percentage of time spent in their area of expertise and must be approved by the program director of the sponsoring Advanced Life Support program. Each content expert can teach up to ten percent of the course.

**History**
- *SOURCE: Miss. Code Ann. §41-59-5*

##### **15 Miss. Admin. Code Pt. 12, R. 10.2.5** Facility Requirements 1 {#sec-12-10.2.5 omnilex-key=us-ms-regs-official--title-15--12#10.2.5}

A designated medical director. The medical director must be board certified or board eligible in emergency medicine with optional co-medical director(s) in pediatric critical care medicine and/or adult critical care medicine. 2. Have adequate facilities to support the program. 3. Classroom and laboratory space adequate for the number of students enrolled. 4. A cadaver laboratory or high-fidelity simulation laboratory (may be on-site or offered through a hospital or other educational institution with which there is a formal agreement.) If a simulation laboratory is utilized, manikins must be capable of simulating a variety of critical care scenarios including, but not limited to, unstable angina, acute myocardial infarction, cardiogenic shock, dysrhythmias, aortic dissection, stroke, electrolyte disturbances, pediatric specific emergencies, and traumatic injuries for all age groups. 5. Have in effect formal agreement(s) with medical center(s) offering the following services: a. Current trauma center capability or designation of Level I or Level II;

b. Percutaneous Coronary Intervention (PCI) Center (with a 24- hour interventional cardiac catheterization laboratory); c. A 24-hour emergency department staffed by full time board certified or board eligible emergency medicine physicians; and d. Critical care units offering: i. Insertion and maintenance of intra-aortic balloon pump and/or ventricular assist devices; ii. Pulmonology; iii. Neurology; iv. Pediatric care

**History**
- *SOURCE: Miss. Code Ann. §41-59-5 Subchapter 3 Critical Care Paramedic Training Programs Rule 10.3.1 The programs must meet the same operational and record keeping standards for ALS training programs as established in these regulations.*
- *SOURCE: Miss. Code Ann. §41-59-5*

##### **15 Miss. Admin. Code Pt. 12, R. 10.3.2** Rule 10.3.2 {#sec-12-10.3.2 omnilex-key=us-ms-regs-official--title-15--12#10.3.2}

The critical care paramedic curriculum must be approved and follow guidelines established by the Mississippi Community College Board (MCCB) the Mississippi Emergency Medical Services Advisory Council (EMSAC) and the Medical Direction, Training and Quality Assurance Committee (MDTQA).

**History**
- *SOURCE: Miss. Code Ann. §41-59-5*

##### **15 Miss. Admin. Code Pt. 12, R. 10.3.3** Rule 10.3.3 {#sec-12-10.3.3 omnilex-key=us-ms-regs-official--title-15--12#10.3.3}

The program shall consist of, at minimum, three components: didactic instruction, lab instruction, and hospital based clinical instruction. The time required to complete each component may vary, in part being dependent on the ability of students to demonstrate their mastery of the educational objectives by written, verbal, and practical examination. Students should demonstrate evidence of competency within the practice of Critical Care Transport Medicine.

**History**
- *SOURCE: Miss. Code Ann. §41-59-5*

##### **15 Miss. Admin. Code Pt. 12, R. 10.3.4** Rule 10.3.4 {#sec-12-10.3.4 omnilex-key=us-ms-regs-official--title-15--12#10.3.4}

Faculty must be presented with the program's educational objectives for use in preparation of lectures and clinical rotations. The Critical Care Paramedic Program Coordinator must ensure that stated educational objectives are covered and should answer any questions from students or clarify information presented by a lecturer.

**History**
- *SOURCE: Miss. Code Ann. §41-59-5 Subchapter 4 Critical Care Paramedic Training Programs, minimum admittance criteria Rule 10.4.1 Certified as a Mississippi Paramedic;*
- *SOURCE: Miss. Code Ann. §41-59-5*

##### **15 Miss. Admin. Code Pt. 12, R. 10.4.2** No less than three years’ experience as a nationally registered paramedic {#sec-12-10.4.2 omnilex-key=us-ms-regs-official--title-15--12#10.4.2}

**History**
- *SOURCE: Miss. Code Ann. §41-59-5*

##### **15 Miss. Admin. Code Pt. 12, R. 10.4.3** Rule 10.4.3 {#sec-12-10.4.3 omnilex-key=us-ms-regs-official--title-15--12#10.4.3}

Other licensed healthcare providers may be admitted on a case-by-case basis with approval of the Critical Care Paramedic Program Coordinator. Subchapter 5 Prerequisites for certification and recertification as a Critical Care Paramedic Rule 10.5.1 Must be currently certified as a Mississippi Paramedic in good standing.

**History**
- *SOURCE: Miss. Code Ann. §41-59-5*

##### **15 Miss. Admin. Code Pt. 12, R. 10.5.2** Completion of BEMS approved Critical Care Paramedic training program {#sec-12-10.5.2 omnilex-key=us-ms-regs-official--title-15--12#10.5.2}

**History**
- *SOURCE: Miss. Code Ann. §41-59-5*

##### **15 Miss. Admin. Code Pt. 12, R. 10.5.3** Rule 10.5.3 {#sec-12-10.5.3 omnilex-key=us-ms-regs-official--title-15--12#10.5.3}

Must successfully complete International Board of Specialty Certifications as Flight Paramedic (FP-C) or Critical Care Paramedic (CCP-C) examination.

**History**
- *SOURCE: Miss. Code Ann. §41-59-5*

##### **15 Miss. Admin. Code Pt. 12, R. 10.5.4** Must possess at a minimum an associate’s degree from a regionally accredited college/university {#sec-12-10.5.4 omnilex-key=us-ms-regs-official--title-15--12#10.5.4}

##### **15 Miss. Admin. Code Pt. 12, R. 10.5.5** Must demonstrate proof of continuing education requirements as defined by this chapter for recertification {#sec-12-10.5.5 omnilex-key=us-ms-regs-official--title-15--12#10.5.5}

2. An associate degree or higher from a regionally accredited college/university. Prior Mississippi Critical Care Paramedic

certification may serve as evidence of compliance for recertification. 3. Current certification (FP-C or CCP-C); must maintain certification through licensure period. 4. Must have Statewide or Jurisdictional Medical Control Agreement. 5. Must provide documentation of continuing education requirements as defined in the chapter for recertification.

**History**
- *SOURCE: Miss. Code Ann. §41-59-5 Subchapter 6 Procedure to Obtain Certification and Recertification as Critical Care Paramedic Rule 10.6.1 Must submit an application and fees to BEMS for certification and provide proof of: 1. Successful completion of a BEMS approved Critical Care Paramedic Training Program; prior Mississippi Critical Care Paramedic certification may serve as evidence of compliance for recertification.*
- *SOURCE: Miss. Code Ann. §41-59-5*

##### **15 Miss. Admin. Code Pt. 12, R. 10.6.2** Critical care paramedic shall expire with the EMT-Paramedic certification {#sec-12-10.6.2 omnilex-key=us-ms-regs-official--title-15--12#10.6.2}

Rule 10.6.3 Reciprocity for Critical Care Paramedic Certification An individual holding a valid out-of-state Critical Care Paramedic certification may be granted reciprocity for Mississippi Critical Care Paramedic certification, provided the following conditions are met: 1. A current and unrestricted National Registry Paramedic (NRP) certification with a minimum of three (3) years of experience as a Nationally Registered Paramedic; 2. A current and unrestricted paramedic license or certification in good standing from the individual's home state; 3. A current and unrestricted Critical Care Paramedic license or certification in good standing from the individual’s home state; 4. Completion of a Critical Care Paramedic training program that is approved by the EMS authority in the issuing state; 5. The training program must have included didactic instruction, laboratory skills, and clinical exposures; 6. The program must have consisted of a minimum of 150 hours of combined didactic and laboratory instruction, and at least 80 hours of clinical experience; 7. Submission of documentation demonstrating successful completion of the Critical Care Paramedic course; 8. Current certification as a Flight Paramedic-Certified (FP-C) or Critical Care Paramedic-Certified (CCP-C); 9. Jurisdictional Medical Control Agreement with a Mississippi-licensed physician who will serve as the applicant's offline medical director; 10. Prior to application for reciprocity, the agency’s offline medical director shall evaluate the individual’s cognitive and clinical competencies in critical care practice and validate the skills outlined in the Critical Care Paramedic Student Minimum Competency matrix as specified in Appendix; 11. Completion and submission of the Application for Mississippi EMS

Certification form, along with all required supporting documentation and applicable fees.

**History**
- *SOURCE: Miss. Code Ann. §41-59-5 Subchapter 7 Critical Care Paramedic Continuing Education Training Rule 10.7.1 Continuing Education (CE) hours should have a clear and direct application to the practice of critical care medicine.*
- *SOURCE: Miss. Code Ann. §41-59-5*
- *SOURCE: Miss. Code Ann. §41-59-5*

##### **15 Miss. Admin. Code Pt. 12, R. 10.7.2** Fifty Hours of critical care continuing education hours Bi-Annually {#sec-12-10.7.2 omnilex-key=us-ms-regs-official--title-15--12#10.7.2}

**History**
- *SOURCE: Miss. Code Ann. §41-59-5*

##### **15 Miss. Admin. Code Pt. 12, R. 10.7.3** Rule 10.7.3 {#sec-12-10.7.3 omnilex-key=us-ms-regs-official--title-15--12#10.7.3}

The EMS agency’s off-line medical director shall sign off on each critical care paramedic continuing education requirement for submission to BEMS each certification period. A letter validating total number of continuing education hours, individual topic break down, and course dates signed by the medical director may serve as evidence of completion.

Rule 10.8.1 Fraud or any misstatement of fact in the procurement of any certifications or in any other statement of representation to the Board or its representatives.

**History**
- *SOURCE: Miss. Code Ann. §41-59-5 Subchapter 8 Critical Care Paramedic, Grounds for Suspension or Revocation The BEMS may suspend or revoke a certificate at any time it is determined that the holder no longer meets the prescribed qualifications.*
- *SOURCE: Miss. Code Ann. §41-59-5*

##### **15 Miss. Admin. Code Pt. 12, R. 10.8.2** Gross negligence {#sec-12-10.8.2 omnilex-key=us-ms-regs-official--title-15--12#10.8.2}

**History**
- *SOURCE: Miss. Code Ann. §41-59-5*

##### **15 Miss. Admin. Code Pt. 12, R. 10.8.3** Repeated negligent acts {#sec-12-10.8.3 omnilex-key=us-ms-regs-official--title-15--12#10.8.3}

**History**
- *SOURCE: Miss. Code Ann. §41-59-5*

##### **15 Miss. Admin. Code Pt. 12, R. 10.8.4** Incompetence {#sec-12-10.8.4 omnilex-key=us-ms-regs-official--title-15--12#10.8.4}

**History**
- *SOURCE: Miss. Code Ann. §41-59-5*

##### **15 Miss. Admin. Code Pt. 12, R. 10.8.5** Rule 10.8.5 {#sec-12-10.8.5 omnilex-key=us-ms-regs-official--title-15--12#10.8.5}

**History**
- *SOURCE: Miss. Code Ann. §41-59-5*

##### **15 Miss. Admin. Code Pt. 12, R. 10.8.6** Recklessly disregarding the speed regulations prescribed by law while on duty {#sec-12-10.8.6 omnilex-key=us-ms-regs-official--title-15--12#10.8.6}

**History**
- *SOURCE: Miss. Code Ann. §41-59-5*

##### **15 Miss. Admin. Code Pt. 12, R. 10.8.7** Rule 10.8.7 {#sec-12-10.8.7 omnilex-key=us-ms-regs-official--title-15--12#10.8.7}

Failure to maintain current registration by the National Registry of EMTs and current state certifications (Paramedic and Critical Care Paramedic) through BEMS approved process.

**History**
- *SOURCE: Miss. Code Ann. §41-59-5*

##### **15 Miss. Admin. Code Pt. 12, R. 10.8.8** Failure to maintain all current Critical Care training standards as required by the BEMS {#sec-12-10.8.8 omnilex-key=us-ms-regs-official--title-15--12#10.8.8}

**History**
- *SOURCE: Miss. Code Ann. §41-59-5*

##### **15 Miss. Admin. Code Pt. 12, R. 10.8.9** Rule 10.8.9 {#sec-12-10.8.9 omnilex-key=us-ms-regs-official--title-15--12#10.8.9}

The commission of any fraudulent dishonest, or corrupt act which is substantially related to the qualifications, functions, and duties of pre-hospital personnel.

**History**
- *SOURCE: Miss. Code Ann. §41-59-5*

##### **15 Miss. Admin. Code Pt. 12, R. 10.8.10** Conviction of any crime which is directly related to the qualification, functions, and duties of pre-hospital personnel {#sec-12-10.8.10 omnilex-key=us-ms-regs-official--title-15--12#10.8.10}

The record of conviction or certified copy thereof will be conclusive evidence of such conviction. #24551

**History**
- *SOURCE: Miss. Code Ann. §41-59-5*

##### **15 Miss. Admin. Code Pt. 12, R. 1** 0 {#sec-12-1 omnilex-key=us-ms-regs-official--title-15--12#1}

8 . 1 1 Violating or attempting to violate directly or indirectly, or assisting in or abetting the violation of, or conspiring to violate, any provision of this part of the regulations promulgated by the BEMS, pertaining to pre-hospital personnel.

**History**
- *SOURCE: Miss. Code Ann. §41-59-5*

##### **15 Miss. Admin. Code Pt. 12, R. 10.8.12** Rule 10.8.12 {#sec-12-10.8.12 omnilex-key=us-ms-regs-official--title-15--12#10.8.12}

Violating or attempting to violate any federal or state statute or regulation which regulates narcotics, dangerous drugs, or controlled substances.

**History**
- *SOURCE: Miss. Code Ann. §41-59-5*

##### **15 Miss. Admin. Code Pt. 12, R. 10.8.13** Addiction to, excessive use of, or misuse of, alcoholic beverages, narcotics, dangerous drugs, or controlled substances {#sec-12-10.8.13 omnilex-key=us-ms-regs-official--title-15--12#10.8.13}

**History**
- *SOURCE: Miss. Code Ann. §41-59-5*

##### **15 Miss. Admin. Code Pt. 12, R. 10.8.14** Rule 10.8.14 {#sec-12-10.8.14 omnilex-key=us-ms-regs-official--title-15--12#10.8.14}

Functioning outside the supervision of medical control in the field care system operating at the local level, except as authorized by certification and license issued to the ALS provider.

**History**
- *SOURCE: Miss. Code Ann. §41-59-5*

##### **15 Miss. Admin. Code Pt. 12, R. 10.8.15** Rule 10.8.15 {#sec-12-10.8.15 omnilex-key=us-ms-regs-official--title-15--12#10.8.15}

Permitting, aiding, or abetting an unlicensed or uncertified person to perform activities requiring a license or certification.

**History**
- *SOURCE: Miss. Code Ann. §41-59-5*

##### **15 Miss. Admin. Code Pt. 12, R. 10.8.16** Suspension or revocation of any BEMS issued certification may affect other BEMS issued certifications at all levels {#sec-12-10.8.16 omnilex-key=us-ms-regs-official--title-15--12#10.8.16}

**History**
- *SOURCE: Miss. Code Ann. §41-59-5*

##### **15 Miss. Admin. Code Pt. 12, R. 10.8.17** Failure to comply with the requirements of a Mississippi EMS scholarship program {#sec-12-10.8.17 omnilex-key=us-ms-regs-official--title-15--12#10.8.17}

**History**
- *SOURCE: Miss. Code Ann. §41-59-5*

##### **15 Miss. Admin. Code Pt. 12, R. 10.8.18** Failure to comply with an employer’s request for drug and alcohol testing {#sec-12-10.8.18 omnilex-key=us-ms-regs-official--title-15--12#10.8.18}

**History**
- *SOURCE: Miss. Code Ann. §41-59-5*

##### **15 Miss. Admin. Code Pt. 12, R. 10.8.19** Rule 10.8.19 {#sec-12-10.8.19 omnilex-key=us-ms-regs-official--title-15--12#10.8.19}

Failure to wear high visibility safety apparel that meets the requirements of the American National Standard for High Visibility Apparel ANSI/ISEA 107- 2004 Performance Class 2 or Performance Class 3, or the ANSI/ISEA 207- 2006 Standard while functioning within the right-of-way of any road, street, highway, or other area where vehicle or machinery traffic is present. All garments must have labels, affixed by the manufacturer in accordance with the standard, that indicate compliance with the Performance Class 2, Performance Class 3, or 207- 2006 standard.

**History**
- *SOURCE: Miss. Code Ann. §41-59-5*

##### **15 Miss. Admin. Code Pt. 12, R. 10.8.20** Rule 10.8.20 {#sec-12-10.8.20 omnilex-key=us-ms-regs-official--title-15--12#10.8.20}

Any conduct, regardless of whether convicted, which constitutes a crime of violence, or which constitutes any of the following crimes: a. Assault b. Stalking c. False imprisonment d. Sexual assault or battery e. Crimes against a vulnerable person

**History**
- *SOURCE: Miss. Code Ann. §41-59-5; Miss. Code Ann. §41-60-13*

##### **15 Miss. Admin. Code Pt. 12, R. 10.8.21** Rule 10.8.21 {#sec-12-10.8.21 omnilex-key=us-ms-regs-official--title-15--12#10.8.21}

If the Bureau finds that public health, safety, and welfare requires emergency action and a finding to that effect is incorporated in its order, summary suspension of a certification may be ordered pending proceedings for revocation or other action.

Subchapter 9 Occupation and Scope of Practice of Critical Care Paramedic Rule 10.9.1 The Scope of Practice for the Mississippi Critical Care Paramedic is defined in Appendix 9 of these Regulations.

**History**
- *SOURCE: Miss. Code Ann. §41-59-5; Miss. Code Ann. §41-60-13*
- *SOURCE: Miss. Code Ann. §41-59-5*

##### **15 Miss. Admin. Code Pt. 12, R. 10.9.2** Occupation: 1 {#sec-12-10.9.2 omnilex-key=us-ms-regs-official--title-15--12#10.9.2}

The Critical Care Paramedic shall be utilized for critical care intervention and transport under the supervision of offline and/or online medical control.

Subchapter 10 Procedure to Obtain Re-Certification as Critical Care Paramedic Rule 10.10.1 Must submit an application and fees to BEMS for modification of the license by demonstrating:

**History**
- *SOURCE: Miss. Code Ann. §41-59-5*
- *SOURCE: Miss. Code Ann. §41-59-5*

##### **15 Miss. Admin. Code Pt. 12, R. 10.10.2** Provide proof of current certification (FP-C or CCP-C); and, {#sec-12-10.10.2 omnilex-key=us-ms-regs-official--title-15--12#10.10.2}

**History**
- *SOURCE: Miss. Code Ann. §41-59-5*

##### **15 Miss. Admin. Code Pt. 12, R. 10.10.3** Proof of completion of BEMS Approved CE Hours; {#sec-12-10.10.3 omnilex-key=us-ms-regs-official--title-15--12#10.10.3}

**History**
- *SOURCE: Miss. Code Ann. §41-59-5*

##### **15 Miss. Admin. Code Pt. 12, R. 10.10.4** Proof of completion of BEMS Approved 24 hour Critical Care Bi-Annual Refresher {#sec-12-10.10.4 omnilex-key=us-ms-regs-official--title-15--12#10.10.4}

**History**
- *SOURCE: Miss. Code Ann. §41-59-5*

##### **15 Miss. Admin. Code Pt. 12, R. 10.10.5** Statewide or Jurisdictional Medical Control Agreement {#sec-12-10.10.5 omnilex-key=us-ms-regs-official--title-15--12#10.10.5}

Rule 10.11.1 Fraud or any mis-statement of fact in the procurement of any certifications or in any other statement of representation to the Board or its representatives.

**History**
- *SOURCE: Miss. Code Ann. §41-59-5 Subchapter 11 Critical Care Paramedic, Grounds for Suspension or Revocation.: The BEMS may suspend or revoke a certificate at any time it is determined that the holder no longer meets the prescribed qualifications.*
- *SOURCE: Miss. Code Ann. §41-59-5*

##### **15 Miss. Admin. Code Pt. 12, R. 10.11.2** Gross negligence {#sec-12-10.11.2 omnilex-key=us-ms-regs-official--title-15--12#10.11.2}

**History**
- *SOURCE: Miss. Code Ann. §41-59-5*

##### **15 Miss. Admin. Code Pt. 12, R. 10.11.3** Repeated negligent acts {#sec-12-10.11.3 omnilex-key=us-ms-regs-official--title-15--12#10.11.3}

**History**
- *SOURCE: Miss. Code Ann. §41-59-5*

##### **15 Miss. Admin. Code Pt. 12, R. 10.11.4** Incompetence {#sec-12-10.11.4 omnilex-key=us-ms-regs-official--title-15--12#10.11.4}

**History**
- *SOURCE: Miss. Code Ann. §41-59-5*

##### **15 Miss. Admin. Code Pt. 12, R. 10.11.5** Rule 10.11.5 {#sec-12-10.11.5 omnilex-key=us-ms-regs-official--title-15--12#10.11.5}

**History**
- *SOURCE: Miss. Code Ann. §41-59-5*

##### **15 Miss. Admin. Code Pt. 12, R. 10.11.6** Disregarding the speed regulations prescribed by law while on duty {#sec-12-10.11.6 omnilex-key=us-ms-regs-official--title-15--12#10.11.6}

**History**
- *SOURCE: Miss. Code Ann. §41-59-5*

##### **15 Miss. Admin. Code Pt. 12, R. 10.11.7** Rule 10.11.7 {#sec-12-10.11.7 omnilex-key=us-ms-regs-official--title-15--12#10.11.7}

Failure to maintain current registration by the National Registry of EMTs and current state certifications (Paramedic and Critical Care Paramedic) through BEMS approved process.

**History**
- *SOURCE: Miss. Code Ann. §41-59-5*

##### **15 Miss. Admin. Code Pt. 12, R. 10.11.8** Failure to maintain all current Critical Care training standards as required by the BEMS {#sec-12-10.11.8 omnilex-key=us-ms-regs-official--title-15--12#10.11.8}

**History**
- *SOURCE: Miss. Code Ann. §41-59-5*

##### **15 Miss. Admin. Code Pt. 12, R. 10.11.9** Rule 10.11.9 {#sec-12-10.11.9 omnilex-key=us-ms-regs-official--title-15--12#10.11.9}

The commission of any fraudulent dishonest, or corrupt act which is substantially related to the qualifications, functions, and duties of pre-hospital personnel.

**History**
- *SOURCE: Miss. Code Ann. §41-59-5*

##### **15 Miss. Admin. Code Pt. 12, R. 10.11.10** Conviction of any crime which is directly related to the qualification, functions, and duties of pre-hospital personnel {#sec-12-10.11.10 omnilex-key=us-ms-regs-official--title-15--12#10.11.10}

The record of conviction or certified copy thereof will be conclusive evidence of such conviction. #24551

**History**
- *SOURCE: Miss. Code Ann. §41-59-5*

##### **15 Miss. Admin. Code Pt. 12, R. 10.11.11** Rule 10.11.11 {#sec-12-10.11.11 omnilex-key=us-ms-regs-official--title-15--12#10.11.11}

Violating or attempting to violate directly or indirectly, or assisting in or abetting the violation of, or conspiring to violate, any provision of this part of the regulations promulgated by the BEMS, pertaining to pre-hospital personnel.

**History**
- *SOURCE: Miss. Code Ann. §41-59-5*

##### **15 Miss. Admin. Code Pt. 12, R. 10.11.12** Rule 10.11.12 {#sec-12-10.11.12 omnilex-key=us-ms-regs-official--title-15--12#10.11.12}

Violating or attempting to violate any federal or state statute or regulation which regulates narcotics, dangerous drugs, or controlled substances.

**History**
- *SOURCE: Miss. Code Ann. §41-59-5*

##### **15 Miss. Admin. Code Pt. 12, R. 10.11.13** Addiction to, excessive use of, or misuse of, alcoholic beverages, narcotics, dangerous drugs, or controlled substances {#sec-12-10.11.13 omnilex-key=us-ms-regs-official--title-15--12#10.11.13}

**History**
- *SOURCE: Miss. Code Ann. §41-59-5*

##### **15 Miss. Admin. Code Pt. 12, R. 10.11.14** Rule 10.11.14 {#sec-12-10.11.14 omnilex-key=us-ms-regs-official--title-15--12#10.11.14}

Functioning outside the supervision of medical control in the field care system operating at the local level, except as authorized by certification and license issued to the ALS provider.

**History**
- *SOURCE: Miss. Code Ann. §41-59-5*

##### **15 Miss. Admin. Code Pt. 12, R. 10.11.15** Rule 10.11.15 {#sec-12-10.11.15 omnilex-key=us-ms-regs-official--title-15--12#10.11.15}

Permitting, aiding, or abetting an unlicensed or uncertified person to perform activities requiring a license or certification.

**History**
- *SOURCE: Miss. Code Ann. §41-59-5*

##### **15 Miss. Admin. Code Pt. 12, R. 10.11.16** Suspension or revocation of any BEMS issued certification may effect other BEMS issued certifications at all levels {#sec-12-10.11.16 omnilex-key=us-ms-regs-official--title-15--12#10.11.16}

**History**
- *SOURCE: Miss. Code Ann. §41-59-5*

##### **15 Miss. Admin. Code Pt. 12, R. 10.11.17** Failure to comply with the requirements of a Mississippi EMS scholarship program {#sec-12-10.11.17 omnilex-key=us-ms-regs-official--title-15--12#10.11.17}

**History**
- *SOURCE: Miss. Code Ann. §41-59-5*

##### **15 Miss. Admin. Code Pt. 12, R. 10.11.18** Failure to comply with an employer’s request for drug and alcohol testing {#sec-12-10.11.18 omnilex-key=us-ms-regs-official--title-15--12#10.11.18}

**History**
- *SOURCE: Miss. Code Ann. §41-59-5*

##### **15 Miss. Admin. Code Pt. 12, R. 10.11.19** Rule 10.11.19 {#sec-12-10.11.19 omnilex-key=us-ms-regs-official--title-15--12#10.11.19}

Failure to wear high visibility safety apparel that meets the requirements of the American National Standard for High Visibility Apparel ANSI/ISEA 107-2004 Performance Class 2 or Performance Class 3, or the ANSI/ISEA 207-2006 Standard while functioning within the right-of-way of any road, street, highway, or other area where vehicle or machinery traffic is present. All garments must have labels, affixed by the manufacturer in accordance with the standard, that indicate compliance with the Performance Class 2, Performance Class 3, or 207- 2006 standard.

a. Assault b. Stalking c. False imprisonment d. Sexual assault or battery e. Crimes against a vulnerable person

**History**
- *SOURCE: Miss. Code Ann. §41-59-5 Rule 10.11.20. Any conduct, regardless of whether convicted, which constitutes a crime of violence, or which constitutes any of the following crimes:*
- *SOURCE: Miss. Code Ann. §41-59-5; Miss. Code Ann. §41-60-13 Rule 10.11.21. If the Bureau finds that public health, safety, and welfare requires emergency action and a finding to that effect is incorporated in its order, summary suspension of a certification may me ordered pending proceedings for revocation or other action.*
- *SOURCE: Miss. Code Ann. §41-59-5; Miss. Code Ann. §41-60-13 Subchapter 12 Occupation and Competency of Critical Care Paramedic Rule 10.12.1 Description of the Occupation and Competency of the Critical Care Paramedic is to provide for the on going care of a critically injured or ill patient during interfacility transport or while on duty aboard a Specialty Care licensed vehicle.*
- *SOURCE: Miss. Code Ann. §41-59-5*

##### **15 Miss. Admin. Code Pt. 12, R. 10.12.2** Rule 10.12.2 {#sec-12-10.12.2 omnilex-key=us-ms-regs-official--title-15--12#10.12.2}

Job Summary: The following skills shall be utilized for critical care transport under the supervision of offline and/or online medical control. Provide patient care during transport and in special situations.

**History**
- *SOURCE: Miss. Code Ann. §41-59-5*

##### **15 Miss. Admin. Code Pt. 12, R. 10.12.3** Rule 10.12.3 {#sec-12-10.12.3 omnilex-key=us-ms-regs-official--title-15--12#10.12.3}

Note: Critical Care Paramedics may attend and transport by ambulance, patients who have pre-existing procedures or devices that are beyond the EMT's scope of practice if: 1. there is no need, or reasonably perceived need, for the device or procedure during transport; and 2. an individual (including the patient himself) that has received training and management of the procedure or device accompanies the patient to the destination. 3. Note: Should doubt exist in regards to the transport of any device or procedure, medical control should be contacted for medical direction.

**History**
- *SOURCE: Miss. Code Ann. §41-59-5*

##### **15 Miss. Admin. Code Pt. 12, R. 10.12.4** Initiate and manage ventilators; {#sec-12-10.12.4 omnilex-key=us-ms-regs-official--title-15--12#10.12.4}

**History**
- *SOURCE: Miss. Code Ann. §41-59-5*

##### **15 Miss. Admin. Code Pt. 12, R. 10.12.5** Insert and/or manage surgical cricothyrotomy; {#sec-12-10.12.5 omnilex-key=us-ms-regs-official--title-15--12#10.12.5}

**History**
- *SOURCE: Miss. Code Ann. §41-59-5*

##### **15 Miss. Admin. Code Pt. 12, R. 10.12.6** Initiate (with direct verbal order from medical control) and manage chest tubes; {#sec-12-10.12.6 omnilex-key=us-ms-regs-official--title-15--12#10.12.6}

**History**
- *SOURCE: Miss. Code Ann. §41-59-5*

##### **15 Miss. Admin. Code Pt. 12, R. 10.12.7** Provide care for cardiac patients with, but not limited to, cardiac interventions and advanced therapeutic devices; {#sec-12-10.12.7 omnilex-key=us-ms-regs-official--title-15--12#10.12.7}

**History**
- *SOURCE: Miss. Code Ann. §41-59-5*

##### **15 Miss. Admin. Code Pt. 12, R. 10.12.8** Rule 10.12.8 {#sec-12-10.12.8 omnilex-key=us-ms-regs-official--title-15--12#10.12.8}

Initiate (with direct verbal order from medical control), access, monitor and manage arterial lines, to include any necessary anchoring techniques;

**History**
- *SOURCE: Miss. Code Ann. §41-59-5*

##### **15 Miss. Admin. Code Pt. 12, R. 10.12.9** Access, monitor and manage central and arterial lines, to include hemodynamic monitoring; {#sec-12-10.12.9 omnilex-key=us-ms-regs-official--title-15--12#10.12.9}

**History**
- *SOURCE: Miss. Code Ann. §41-59-5*

##### **15 Miss. Admin. Code Pt. 12, R. 10.12.10** Rapid Sequence Induction; {#sec-12-10.12.10 omnilex-key=us-ms-regs-official--title-15--12#10.12.10}

**History**
- *SOURCE: Miss. Code Ann. §41-59-5*

##### **15 Miss. Admin. Code Pt. 12, R. 10.12.11** Initiate blood and blood products; {#sec-12-10.12.11 omnilex-key=us-ms-regs-official--title-15--12#10.12.11}

**History**
- *SOURCE: Miss. Code Ann. §41-59-5*

##### **15 Miss. Admin. Code Pt. 12, R. 10.12.12** Interpret laboratory results of blood and urine specimens; {#sec-12-10.12.12 omnilex-key=us-ms-regs-official--title-15--12#10.12.12}

**History**
- *SOURCE: Miss. Code Ann. §41-59-5*

##### **15 Miss. Admin. Code Pt. 12, R. 10.12.13** Rule 10.12.13 {#sec-12-10.12.13 omnilex-key=us-ms-regs-official--title-15--12#10.12.13}

Initiate/administer, maintain and manage medications (excluding chemotherapeutic agents) required for the care of the critical care patient;

**History**
- *SOURCE: Miss. Code Ann. §41-59-5*

##### **15 Miss. Admin. Code Pt. 12, R. 10.12.14** Initiate and manage urinary draining devices; {#sec-12-10.12.14 omnilex-key=us-ms-regs-official--title-15--12#10.12.14}

**History**
- *SOURCE: Miss. Code Ann. §41-59-5*

##### **15 Miss. Admin. Code Pt. 12, R. 10.12.15** Perform escharotomy/fasciotomy (with direct verbal order from medical control); {#sec-12-10.12.15 omnilex-key=us-ms-regs-official--title-15--12#10.12.15}

**History**
- *SOURCE: Miss. Code Ann. §41-59-5*

##### **15 Miss. Admin. Code Pt. 12, R. 10.12.16** Monitor and manage intracranial monitoring devices/drainage devices {#sec-12-10.12.16 omnilex-key=us-ms-regs-official--title-15--12#10.12.16}

Implementation of this standard practice will insure that the EMS system has the authority, commensurate with the responsibility, to insure adequate medical direction of all pre-hospital providers, as well as personnel and facilities that meet minimum criteria to implement medical direction of pre-hospital services. OFF-LINE (PROSPECTIVE AND RETROSPECTIVE) MEDICAL DIRECTION Off-line medical direction includes the administrative promulgation and enforcement of accepted standards for out-of-hospital care. Off-line medical direction can be accomplished through both prospective and retrospective methods. Prospective methods include, but are not limited to, training, testing, and credentialing of providers, protocol development, operational policy and procedures development, and legislative activities. Off-line medical direction shall ensure the qualifications of out-of-hospital personnel involved in patient care and dispatch are maintained on an ongoing basis through education, testing, and credentialing as the local/state authorities have determined. Retrospective activities include, but are not limited to medical audit and review of care, (process improvement), direction of remedial education, and limitation of patient care functions if needed. Committees functioning under the medical director with representation from appropriate medical and provider personnel can perform various aspects of prospective and retrospective medical direction. Each EMS agency providing pre-hospital care shall be licensed by the Mississippi State Department of Health, BEMS, and shall have an identifiable off-line Medical Director who after consultation with others involved and interested in the agency is responsible for the

development, implementation and evaluation of standards for provision for medical care within the agency. All pre-hospital providers (including EMT-Bs) shall be medically accountable for their actions and are responsible to the off-line Medical Director of the licensed EMS agency that approves their continued participation. All pre-hospital providers, with levels of certification EMT-B or above, shall be responsible to an identifiable physician who directs their medical care activity. The off-line Medical Director shall be appointed by, and accountable to, the appropriate licensed EMS agency. The licensee's off-line medical director shall ensure that there is a capability and method to provide on-line medical control to EMS personnel on board any permitted unit at all times. If patient specific orders are written, there shall be a formal procedure to use them. In addition to on-line medical control capabilities, the licensee shall have a written plan, procedure, and resources in place for off-line medical control. This may be accomplished by use of comprehensive written, guidelines, procedures, or protocols. Qualifications of a Medical Director To optimize off-line medical direction of all out-of-hospital emergency medical services, these services should be managed by physicians who have demonstrated the following: 1. Mississippi licensed physician, M.D. or D.O. 2. Familiarity with the design and operation of out-of-hospital EMS systems. 3. Experience or training in the out-of-hospital emergency care of the acutely ill or injured patient. 4. Experience or training in medical direction of out-of-hospital emergency units. 5. Active participation or reasonable associated experience in the ED management of the acutely ill or injured patient. 6. Experience or training in the instruction of out-of-hospital personnel. 7. Active involvement in the training of pre-hospital personnel. 8. Experience or training in the EMS performance improvement process. 9. Active involvement in the medical audit, review and critique of medical care provided by pre-hospital personnel. 10. Knowledge of EMS laws and regulations. 11. Knowledge of EMS dispatch and communications.

12. Knowledge of local mass casualty and disaster plans including preparation for responding to terrorism and weapons of mass destruction. 13. By July 1, 2017, board certification in emergency medicine by the American Board of Emergency Medicine or the American Board of Osteopathic Emergency Medicine. Substitutions may be approved by the State Medical Director. 14. Completion of an EMS Medical Directors training course. (Effective January, 2013) 15. Familiarity with base station operations where applicable, including communication with, and direction of, pre-hospital emergency units. 16. Knowledgeable of the administrative and legislative process affecting the local, regional and/or state pre-hospital EMS system. 17. Knowledgeable of laws and regulations affecting local, regional, and state EMS. 18. Approved by the State EMS Medical Director Authority of an off-line Medical Director includes, but is not limited to: Unless otherwise defined or limited by state or regional requirements, the medical director shall have authority over all clinical and patient care aspects of the EMS system including, but not limited to, the following: 1. Recommend certification, recertification, and decertification of non-physician out-of-hospital personnel to the appropriate certifying agency. 2. Establish, implement, revise, and authorize the use of system-wide protocols, policies, and procedures for all patient care activities from dispatch through triage, treatment, transport, and/or non-transport. 3. Establish criteria for determining patient destination in a non-discriminatory manner in compliance with state guidelines as appropriate. 4. Ensure the competency of personnel who provide on-line medical direction to out-of-hospital personnel including, but not limited to, physicians, EMTs, Advanced EMTs, Paramedics and nurses. 5. Establish the procedures or protocols under which non-transport of patients may occur. 6. Require education and testing to the level of proficiency approved for the following personnel within the EMS system:

a. EMTs b. Advanced EMTs c. Paramedics d. Critical Care Paramedics e. Nurses involved in out-of-hospital care f. Dispatchers g. Educational coordinators h. On-line physicians i. Off-line physicians 7. Implement and supervise an effective process improvement program. The medical director shall have access to all relevant records needed to accomplish this task. 8. Remove a provider from medical care duties for due cause, using an appropriate review and appeals mechanism. 9. Set or approve hiring standards for personnel involved in patient care. 10. Set or approve standards for equipment used in patient care. 11. Establishing system-wide medical and trauma protocols in consultation with appropriate specialists. 12. Recommending certification or decertification of non-physician pre-hospital personnel to the appropriate certifying agencies. Every licensed agency shall have an appropriate review and appeals mechanism, when decertification is recommended, to assure due process in accordance with law and established local policies. The Director shall promptly refer the case to the appeals mechanism for review, if requested. 13. Requiring education to the level of approved proficiency for personnel within the EMS system. This includes all pre-hospital personnel, EMTs at all levels, pre- hospital emergency care nurses, dispatchers, educational coordinators, and physician providers of on-line direction. 14. Suspending a provider from medical care duties for due cause pending review and evaluation. Because the pre-hospital provider operates under the license (delegated practice) or direction of the Medical Director, the Director shall have

ultimate authority to allow the pre-hospital provider to provide medical care within the pre-hospital phase of the EMS system. 15. Establishing medical standards for dispatch procedures to assure that the appropriate EMS response unit(s) is dispatched to the medical emergency scene when requested, and the duty to evaluate the patient is fulfilled. 16. Establishing under which circumstances a patient may be transported against his will; in accordance with, state law including, procedures, appropriate forms, and review process. 17. Establishing criteria for level of care and type of transportation to be used in pre- hospital emergency care (i.e., advanced life support vs. basic life support, ground air, or specialty unit transportation). 18. Establishing criteria for selection of patient destination. 19. Establishing educational and performance standards for communication resource personnel. 20. Establishing operational standards for communication resource. 21. Conducting effective system audit and quality assurance. The Medical Director shall have access to all relevant EMS records needed to accomplish this task. These documents shall be considered quality assurance documents and shall be privileged and confidential information. 22. Insuring the availability of educational programs within the system and that they are consistent with accepted local medical practice. 23. May delegate portions of his/her duties to other qualified individuals. 24. The owner, manager, or medical director of each publicly or privately owned ambulance service shall inform the State Department of Health, Bureau of EMS of the termination of service in a licensed county or defined service area no less than 30 days prior to ceasing operations. This communication should also be sent by the owner, manager or medical director of each publicly or privately owned ambulance service to related parties and local governmental entities such as, but not limited to, emergencies management agency, local healthcare facilities, and the public via mass media. 25. Medical direction with concurrent and retrospective oversight supervision; 26. Standardized protocols;

27. Actively engaged in a continuous quality assurance, quality control, performance review, and when necessary, supplemental training. Medical Direction (Online, Direct Medical Control) On-line medical direction is the medical direction provided directly to out-of-hospital providers by the medical director or designee, as defined in the BEMS approved medical control plan, generally in an emergency situation, either on-scene or by direct voice communication. The mechanism for this contact may be radio, telephone, or other means as technology develops, but must include person-to-person communication of patient status, and orders to be carried out. Ultimate authority and responsibility for concurrent medical direction rests with the off-line medical director. The practice of on-line medical direction shall exist and be available within the EMS system, unless impossible due to distance or geographic considerations. All credentialed pre-hospital providers shall be assigned to a specific on-line communication resource by a predetermined policy and this shall be included in the application for ALS licensure. When EMS personnel are transporting patients to locations outside of their geographic medical control area, they may utilize recognized communication resources outside of their own area. Specific local protocols shall exist which define those circumstances under which on-line medical direction is required. On-line medical direction is the practice of medicine and all orders to which the pre-hospital provider shall originate from/or be under the direct supervision and responsibility of a physician. The receiving hospital shall be notified prior to the arrival of each patient transported by the EMS system unless directed otherwise by local protocol. Requirements of a Medical Director 1. This physician shall be approved to serve in this capacity by system (Off-Line) Medical Director. 2. This physician shall have received education to the level of proficiency approved by the off-line Medical Director for proper provision of on-line medical direction, including communications equipment, operation, and techniques. (January 2013) All Mississippi On-Line Medical Directors are encouraged to complete the Medical Director’s course as prescribed by the Mississippi State Department of Health, Bureau of Emergency Medical Services and the Medical Direction, Training and Quality Assurance Committee. 3. This physician shall be appropriately trained in pre-hospital protocols, familiar with the capabilities of the pre-hospital providers, as well as local EMS operational policies and regional critical care referral protocols.

4. This physician shall have demonstrated knowledge and expertise in the pre- hospital care of critically ill and injured patients. 5. This physician assumes responsibility for appropriate actions of the pre-hospital provider to the extent that the on-line physician is involved in patient care direction. 6. The on-line physician is responsible to the system Medical Director (off-line) regarding proper implementation of medical and system protocols. 7. The licensee's off-line medical director shall ensure that there is a capability and method to provide on-line medical control to air medical personnel on board any of its air ambulance aircraft at all times. If patient specific orders are written, there shall be a formal procedure to use them. In addition to on-line medical control capabilities, the licensee shall have a written plan, procedure, and resources in place for off-line medical control. This may be accomplished by use of comprehensive written, guidelines, procedures, or protocols. 8. There must be – at all times - Medical direction with concurrent and retrospective oversight supervision; Standard Protocols; Continuing quality assurance, quality control, performance review, and when necessary, supplemental training. Authority for Control of Medical Services at the Scene of Medical Emergency. Authority for patient management in a medical emergency shall be the responsibility of the individual in attendance who is most appropriately trained and knowledgeable in providing pre- hospital emergency stabilization and transport. When an advanced life support (ALS) squad, under medical direction, is requested and dispatched to the scene of an emergency, a doctor/patient relationship has been established between the patient and the physician providing medical direction. The pre-hospital provider is responsible for the management of the patient and acts as the agent of medical direction. Authority for Scene Management. Authority for the management of the scene of a medical emergency shall be vested in appropriate public safety agencies. The scene of a medical emergency shall be managed in a manner designed to minimize the risk of death or health impairment to the patient and to other persons who may be exposed to the risks as a result of the emergency condition, and priority shall be placed upon the interests of those persons exposed to the more serious risks to life and health. Public safety personnel shall ordinarily consult emergency medical services personnel or other authoritative medical professionals at the scene in the determination of relevant risks. Patient's Private Physician Present

The EMT should defer to the orders of the private physician. The base station should be contacted for record keeping purposes if on-line medical direction exists. The ALS squad's responsibility reverts back to medical direction or on-line medical direction at any time when the physician is no longer in attendance. Intervener Physician Present and Non-Existent On-Line Medical Direction When the intervener physician has satisfactorily identified himself as a licensed physician and has expressed his willingness to assume responsibility and document his intervention in a manner acceptable to the local emergency medical services system (EMSS); the pre-hospital provider should defer to the orders of the physician on the scene if they do not conflict with system protocol. If treatment by the intervener physicians at the emergency scene differs from that outlined in a local protocol, the physician shall agree in advance to assume responsibility for care, including accompanying the patient to the hospital. In the event of a mass casualty incident or disaster, patient needs may require the intervener physician to remain at the scene. Intervener Physician Present and Existent On-Line Medical Direction If an intervener physician is present and on-line medical direction does exist, the on-line physician should be contacted and the on-line physician is ultimately responsible. The on-line physician has the option of managing the case entirely, working with the intervener physician, or allowing him to assume responsibility. If there is any disagreement between the intervener physician and the on-line physician, the pre- hospital provider should take orders from the on-line physician and place the intervener physician in contact with on-line physician. In the event the intervener physician assumes responsibility, all orders to the pre-hospital provider shall be repeated to the communication resource for purposes of record-keeping. The intervener physician should document his intervention in a manner acceptable to the local EMS system. The decision of the intervener physician to accompany the patient to the hospital should be make in consultation with the on-line physician. Nothing in this section implies that the pre-hospital provider CAN be required to deviate from system protocols. Communication Resource A communication resource is an entity responsible for implementation of direct (on-line) medical control. This entity/facility shall be designated to participate in the EMS system according to a plan developed by the licensed ALS provider and approved by the system (off-line) medical director and the State Department of Health, BEMS.

The communication resource shall assure adequate staffing for the communication equipment at all times by health care personnel who have achieved a minimal level of competence and skill and are approved by the system medical director. The communication resource shall assure that all requests for medical guidance assistance or advice by pre-hospital personnel will be promptly accommodated with an attitude of utmost participation, responsibility, and cooperation. The communication resource shall provide assurance that they will cooperate with the EMS system in collecting and analyzing data necessary to evaluate the pre-hospital care program as long as patient confidentiality is not violated. 1. The communication resource will consider the pre-hospital provider to be the agent of the on-line physician when they are in communication, regardless of any other employee/employer relationship. 2. The communication resource shall assure that the on-line physicians will issue transportation instructions and hospital assignments based on system protocols and objective analysis of patient's needs and facility capability and proximity. 3. No effort will be made to obtain institutional or commercial advantages through use of such transportation instructions and hospital assignments. 4. When the communication resource is acting as an agent for another hospital, the information regarding patient treatment and expected time of arrival will be relayed to the receiving hospital in an accurate and timely fashion. 5. Communication resource shall participate in regular case conferences involving the on-line physicians and pre-hospital personnel for purposes of problem identification and provide continuing education to correct any identified problems. 6. If the communication resource is located within a hospital facility, the hospital shall meet the requirements listed herein and the equipment used for on-line medical direction shall be located within the emergency department. Educational Responsibilities Because the on-line and off-line medical directors allow the use of their medical licenses, specific educational requirements should be established. This is not only to insure the best available care, but also to minimize liability. All personnel brought into the system must meet minimum criteria established by state law for each level; however, the law should in no way preclude a medical director from enforcing standards beyond this minimum. Personnel may come to the system untrained (in which case the medical director will design and implement the educational program directly or through the use of ancillary instructors), or they may have previous training and/or experience. Although the Department of Transportation has defined curricula for training, the curricula are not standardized nationally, and often are not

standardized within a state or county. Certification or licensure in one locale does not automatically empower an individual to function as an EMT within another system. The medical director must evaluate applicants trained outside the system in order to determine their level of competence. Such evaluation may be made in the form of written examinations, but should also include practical skills and a field internship with competent peers and time spent with the medical director. The educational responsibilities of the medical director do not end with initial training; skills maintenance must be considered. To insure the knowledge does not stagnate, programs should cover all aspects of the initial training curriculum on a cyclical basis. Continuing education should comprise multiple formats, including lectures, discussions, and case presentations, as well as practical situations that allow the EMT to be evaluated in action. The continuing education curriculum should also include topics suggested by audits, and should be utilized to introduce new equipment or skills. Paramedics are allowed to administer any pharmaceutical that is approved in these Rules and Regulations; through any route that falls within the skill set taught consistent with the National Standard Curriculum; and approved by off line medical director. Review and Audit Personnel may be trained to the highest standards and many protocols may be written, but if critical review is not performed, the level of patient care will deteriorate. Review is intended to determine inadequacies of the training program and inconsistencies in the protocols. The data base required includes pre-hospital care data, emergency department and inpatient (summary) data, and autopsy findings as appropriate. The cooperation of system administrators, hospital administrators, and local or state medical societies must be elicited. On occasion, the state legislature may be required to provide access to vital information. The medical director or a designated person should audit pre-hospital run records, either randomly or inclusively. The data must be specifically evaluated for accuracy of charting and assessment; appropriateness of treatment; patterns of error, morbidity, and mortality; and need for protocol revision. It cannot be assumed that all pre-hospital care will be supervised by on-line physicians. When proper or improper care is revealed by the audit process, prompt and appropriate praise or censorship should be provided by the medical director after consultation with the system administrator. Individual Case Review. Compliance with system rules and regulations is most commonly addressed by state and regional EMS offices. Audit by individual case review requires a more detailed plan. Each of the components defined in detail by the individual EMS system must be agreed on prior to the institution of any case review procedures. Case review may involve medical audit, including reviews of morbidity and mortality data (outcome-oriented review), and system audit, including compliance with rules and regulations as well as adherence to protocols and standing orders (process-oriented review). The personnel to be involved in a given case review process should

include the off-line medical director; emergency department and critical care nurses; and EMS, technical and other support personnel who were involved in the specific cases. The following must be written and agreed to in advance: Procedural guidelines of how the individuals will interact during meetings. Because considerations of medical malpractice may be present when issues concerning appropriateness of care and compliance with guidelines are raised, legal advice for procedural guidelines must be obtained prior to the institution of any medical audit program in order that medical malpractice litigation will neither result from nor become the subject of the meeting. Confidentiality of case review in terms of local open meeting laws and public access to medical records and their distribution. Format for recording the meeting and its outcome. Access to overall system performance records, both current and historical, to allow comparison. Overall outcome data (morbidity and mortality) and individual, unit-specific, and system-wide performance can be measured by the following means: The severity of presentation of patients must be known, and a scale for that measurement must be agreed on, included in all EMT education, and periodically checked for reliability. Appropriate treatment on scene and in transit should be recorded and subsequently evaluated for its effect on overall patient outcome. At the emergency department, the severity of cases presenting (according to a severity scoring technique) and treatment needed should be recorded in detail. An emergency department diagnosis and outcome in terms of admission to a general medical bed, critical care unit, or morgue must be known. The length of stay in the hospital, cost of stay, discharge status, and pathologic diagnosis should be made available. Specialty Care Transport (SCT) Services Specialty Care Transport (SCT) Services provide interfacility transportation of a critically injured or ill beneficiary by a ground ambulance vehicle including the provision of medically necessary supplies and services, at a level of service beyond the scope of the EMT-Paramedic. SCT is necessary when a beneficiary’s condition requires ongoing care that must be furnished by one or more health professionals in an appropriate specialty area, for example, emergency or critical care nursing, emergency medicine, respiratory care, cardiovascular care, or a paramedic with additional training.

The off-line medical director for SCT agencies shall have access to consult with medical specialists for patient(s) whose illness and care needs are outside his/her area of practice. The medical director must have education experience in those areas of medicine that are

commensurate with the mission statement of the medical transport service or utilize specialty physicians as consultants when appropriate. APPENDIX 2 - PROTOCOLS General Provisions Protocols are designed by the off-line (system) medical control system to provide a standardized approach to each commonly encountered patient problem. This provides a consistently defined level of pre-hospital care. When treatment is based on such protocols, the on-line physician assists the pre-hospital personnel in their interpretation of the patient's complaint, the findings of their evaluation, and the application of the appropriate treatment protocol. The process should be reviewed periodically in order to consider changing medical standards, new therapies, and data generated from audits of patient care. In the realm of pre-hospital emergency medicine, there are a limited number of interventions to cover the myriad of problems that may be present. Although advanced life support may be skilled in many maneuvers, there are limitations on what they can accomplish in the pre-hospital setting. Basic life support personnel can do even less. The goal of pre-hospital care is to respond correctly and consistently. Because the types of illnesses and inquiries commonly encountered in a given EMS system may be grouped into broad categories, protocols and standing orders may be established to help accomplish this goal. There are three major advantages to using protocols: Pre-hospital personnel may be trained to respond to a given medical problem in a defined manner. Regardless of the weather, the hostility of the crowd, the immediate danger of any other outside stress, the pre-hospital personnel can consistently treat the problem in a defined manner with minimal chance of omission. The EMS system will have a set standard by which care may be audited. The system and its successes or failures may be measured against consistent standards allowing for necessary change and improvement based on documented evidence, and not on the notion of this year's medical director or any other outside influence not based in fact and logic. Protocols provide a standard of medical treatment for each patient problem so that individual variations necessary for non-routine patient problems may have a context to aid the on-line physician in a complex treatment regimen. Protocol Development The development of protocols may include the following steps: List the common illnesses and injuries that are currently encountered by the local EMS system. A chart review on a random basis for all months of the preceding year should suffice. All months are important, for there may be significant seasonal variations with particular illnesses or injuries.

This list must also include any life-threatening problems that can be affected positively in the pre-hospital setting, but that are not seen routinely (e.g., anaphylaxis, snake bite). This list may be divided into two general categories-pediatric problems and adult problems-even though there will be duplication within these two lists. Asthma, seizures, trauma, and other illnesses and injuries are common to both groups, but the physical interventions and medications are sufficiently different to justify this separation. Similar problems (e.g., cardiopulmonary, trauma, poisons/overdose, etc.) may be combined into groups. Some problems that will not fit easily into groupings (e.g., hypothermia) may be listed separately or included in a miscellaneous group called "other." In each of these groups, there will be common parameters, such as the ABCs, vital signs, history of the current illness/injury, medical history, and medications, allergy history. For each of the problems within the group, additional parameters or interventions may be added to further reduce the patient's morbidity or mortality. Additional treatments for special cases may be added to create a more specifically detailed protocol. For a given region, the level of training of the pre-hospital personnel involved, the capabilities of the EMS response system as a whole, the capabilities of the receiving hospital and the medical opinion in the region must be considered before applying protocols synthesized outside the EMS system. Protocol Implementation Protocols are the responsibility of the medical director, who often delegates their development to a committee consisting of emergency physicians and other appropriate physicians. This committee implements the protocols, which reflect the currently optimal method for pre-hospital treatment of the defined problems. All levels of controllers, the medical director, and off-line and on-line physicians, must be cognizant of the adopted protocols, and must agree to function "by the book." Discrepancies of disagreements that evolve should be brought back to the committee for consideration. Pre-hospital personnel are then trained in the use of the protocols and held accountable through the audit and review process. Variance from protocol must be clearly documented and justified. Consistently occurring variances, whether or not justified and documented, should induce review of that protocol. Even when no problems emerge, the committee should review all protocols at least annually in light of past experience and new medical insight.

APPENDIX 3 – EMS DRIVER TRANING PROGRAMS State Approval Process Each EMS Driver Training Program must be formally approved by the Mississippi State Board of Health. The Mississippi EMS Advisory Council and the BEMS jointly reviews all proposals for BEMS training. Affirmative reviews are submitted as recommendations to the Board for adoption (state approval). All inquiries relative to EMS Driver Training and/or requests for state approval for the establishment of EMS Driver Training programs should be submitted in triplicate as follows: Address Mississippi State Department of Health Bureau of Emergency Medical Services P.O. Box 1700 Jackson, Mississippi 39215-1700 Format (application content) As governed by state regulations, all applications for the establishment of Emergency Medical Services Driver Training Programs must demonstrate adherence to the Department of Transportation's Training Program for Operation of Emergency Vehicles as a minimum. The skid pad requirement is not required. The proposal for training must include as a minimum the following requirements: Faculty profile - Provide names and resumes of all faculty (include instructor training obtained); indicate whether faculty are full-time, part-time, or consultants; and indicate those that are classroom vs. field preceptors. Entry requirements - Taking all applicable state requirements into consideration, list all additional student selection criteria. Class size - Indicate minimum and maximum numbers of students per class. Facilities - Name and describe all facilities used for classroom and field training. Course Implementation - Provide copies of all instructor lesson plans; provide testing and evaluation of student competencies and skills. Budget - List sources of funds supporting the training program. Equipment - Identify equipment and training materials available.

APPENDIX 4 – EMERGENCY TRANSPORT TO MEDICAL FACILITIES Emergency Ambulance Transport To Medical Facilities Patients who are transported under the direction of an emergency medical service system should be taken whenever possible to an in hospital facility that meets the Emergency Care Guidelines of the American College of Emergency Physicians. The EMS Medical Control Authority should have the discretion to authorize transport to non-in hospital medical facilities that meet the Emergency Care Guidelines under that extraordinary circumstance when lack of timely availability of such an in hospital facility necessitates earlier patient stabilization. If an area does not have a facility that meets the Emergency Care Guidelines, it may be necessary for the responsible EMS Medical Control Authority to designate some medical facility to receive patients by ambulance. The American College of Emergency Physicians strongly encourages the modification of such facilities to meet the Emergency Care Guidelines of the College, so that every area has a facility capable of providing emergency care.

APPENDIX 5 – RELATED OSHA REGULATIONS General Industry Part 1910 of title 29 of the Code of Federal Regulations is amended as follows: PART 1910-[AMENDED] Subpart Z-[Amended] The general authority citation for subpart Z of 29 CFR part 1910 continues to read as follows and a new citation for 1910.1030 is added: Authority: Sec. 6 and 8, Occupational Safety and Health Act, 29 U.S.C. 655.657. Secretary of Labor's Orders Nos. 12-71 (36 FR 8754). 8-76 (41 FR 25059), or 9-83 (48 FR 35736), as applicable; and 29 CFR part 1911. Section 1910.1030 also issued under 29 U.S.C. 653. Section 1910.1030 is added to read as follows: 1910.1030 Blood borne Pathogens. Scope and Application. This section applies to all occupational exposure to blood or other potentially infectious materials as defined by paragraph (b) of this section. Definitions. For purposes of this section, the following shall apply: Assistant Secretary means the Assistant Secretary of Labor for Occupational Safety and Health, or designated representative. Blood means human blood, human blood components, and products made from human blood. Blood borne Pathogens means pathogenic microorganisms that are present in human blood and can cause disease in humans. These pathogens include, but are not limited to, hepatitis B virus (HBV) and human immunodeficiency virus (HIV). Clinical Laboratory means a workplace where diagnostic or other screening procedures are performed on blood or other potentially infectious materials. Contaminated means the presence or the reasonably anticipated presence of blood or other potentially infectious materials on an item or surface. Contaminated Laundry means laundry which has been soiled with blood or other potentially infectious materials on an item or surface. Contaminated Sharps means any contaminated object that can penetrate the skin including, but not limited to, needles, scalpels, broken glass, broken capillary tubes, and exposed ends of dental wires.

Decontamination means the use of physical or chemical means to removed, inactivate, or destroy blood borne pathogens on a surface or item to the point where they are no longer capable of transmitting infectious particles and the surface or item is rendered safe for handling, use, or disposal. Director means the Director of the National Institute for Occupational Safety and Health, U.S. Department of Health and Human Services, or designated representative. Engineering Controls means controls (e.g., sharps disposal containers, self-sheathing needles) that isolate or remove the blood borne pathogens hazard for the workplace. Exposure Incident means a specific eye, mouth, other mucous membrane, non-intact skin, or parenteral contact with blood or other potentially infectious materials that result from the performance of an employee's duties. Handwashing Facilities means a facility providing an adequate supply of running potable water soap and single use towels or hot air drying machines. Licensed Healthcare Professional is a person whose legally permitted scope of practice allows him or her to independently perform the activities required by paragraph (f) Hepatitis B Vaccination and Post-exposure Evaluation and Follow-up. HBV means hepatitis B virus. HIV means human immunodeficiency virus. Occupational Exposure means reasonably anticipated skin, eye, mucous membrane, or parenteral contact with blood or other potentially infectious materials that may result from the performance of an employee's duties. Other Potentially Infectious Materials means The following human blood fluids: semen, vaginal secretions, cerebrospinal fluid, synovial fluid, pleural fluid, pericardial fluid, peritoneal fluid, amniotic fluid, saliva in dental procedures, any body fluid that is visibly contaminated with blood, and all body fluids in situations where it is difficult or impossible to differentiate between body fluids; Any unfixed tissue or organ (other than intact skin) from a human (living or dead); and HIV-containing cell or tissue cultures, organ cultures, and HIV- or HBV-containing culture medium or other solutions; and blood, organs, or other tissues from experimental animals infected with HIV or HBV. Parenteral means piercing mucous membranes or the skin barrier through such events as needlesticks, human bites cuts, and abrasions. Personal Protective Equipment is specialized clothing or equipment worn by an employee for protection against a hazard. General work clothes (e.g., uniforms, pants, shirts, or blouses) not

intended to function as protection against a hazard is not considered to be personal protective equipment. Production Facility means a facility engaged in industrial-scale, large-volume or high concentration production of HIV or HBV. Regulated Waste means liquid or semi-liquid blood or other potentially infectious materials; contaminated items that would release blood or other potentially infectious materials in a liquid or semi-liquid state if compressed; items that are caked with dried blood or potentially infectious materials are capable of releasing these materials during handling; contaminated sharps; and pathological and microbiological wastes containing blood or other potentially infectious materials. Research Laboratory means a laboratory producing or using research laboratory-scale amounts of HIV or HBV. Research laboratories may product high concentrations of HIV or HBV but not in the volume found in production facilities. Source Individual means any individual living or dead, whose blood or other potentially infectious materials may be a source of occupational exposure to the employee. Examples include but are not limited to hospital and clinic patients; clients in institutions for the developmentally disabled; trauma victims; clients of drug and alcohol treatment facilities; residents of hospices and nursing homes; human remains; and individuals who donate or sell blood or blood components. Sterilize means the use of a physical or chemical procedure to destroy all microbial life including highly resistant bacterial endospores. Universal Precautions is an approach to infection control. According to the concept of Universal Precautions, all human blood and certain human body fluids are treated as if know to be infectious for HIV, HBV, and other blood borne pathogens. Work Practice Controls means controls that reduce the likelihood of exposure by altering the manner in which a task is performed (e.g., prohibiting recapping of needles by a two-handed technique). EXPOSURE CONTROL Exposure Control Plan: Each employer having an employee(s), with occupational exposure as defined by paragraph (b) of this section shall establish a written Exposure Control Plan designed to eliminate or minimize employee exposure. The Exposure Control Plan shall contain at least the following elements; The exposure determination required by paragraph(c)(2). The schedule and method of implementation for paragraphs (d) Methods of Compliance, (e) HIV and HBV Research Laboratories and Production Facilities, (f) Hepatitis B Vaccination and Post-

Exposure Evaluation and Follow-up, (g) Communication of Hazards to Employees, and (h) Recordkeeping, of this standard and The procedure for the evaluation of circumstances surrounding exposure incidents as required by paragraph(f)(3)(i) of this standard. Each employer shall ensure that a copy of the Exposure Control Plan is accessible to employees in accordance with 29 CFR 1910.20(e). The Exposure Control Plan shall be reviewed and updated at least annually and whenever necessary to reflect new or modified tasks and procedures which effect occupational exposure and to reflect new or revised employee positions with occupational exposure. The Exposure Control Plan shall be made available to the Assistant Secretary and the Director upon request for examination and copying. Exposure determination. Each employer who has an employee(s) with occupational exposure as defined by paragraph (b) of this section shall prepare an exposure determination. This exposure determination shall contain the following: A list of all job classifications in which all employees in those job classifications have occupational exposure; A list of job classifications in which some employees have occupational exposure, and A list of all tasks and procedures or groups of closely related task and procedures in which occupational exposure occurs and that are performed by employees in job classifications listed in accordance with the provisions of paragraph(c)(2)(i)(B) of this standard. This exposure determination shall be made without regard to the use of personal protective equipment. METHODS OF COMPLIANCE General-Universal precautions shall be observed to prevent contact with blood or other potentially infectious materials. Under circumstances in which differentiation between body fluid types is difficult or impossible, all body fluids shall be considered potentially infectious materials. Engineering and work practice controls. Engineering and work practice controls shall be used to eliminate or minimize employee exposure. Where occupational exposure remains after institution of these controls personal protective equipment shall also be used.

Engineering controls shall be examined and maintained or replaced on a regular schedule to ensure their effectiveness. Employees shall provide handwashing facilities which are readily accessible to employees. When provision of handwashing facilities is not feasible, the employer shall provide either an appropriate antiseptic hand cleanser in conjunction with clean cloth/paper towels or antiseptic towelettes. When antiseptic hand cleaners or towelettes are used, hands shall be washed with soap and running water as soon as feasible. Employers shall ensure that employees wash their hands immediately or as soon as feasible after removal of gloves or other personal protective equipment. Employers shall ensure that employees wash their hands and any other skin with soap and water, or flush mucous membranes with water immediately or as soon as feasible following contact of such body areas with blood or other potentially infectious materials. Contaminated needles and other contaminated sharps shall not be net, recapped, or removed except as noted in paragraphs (d)(2)(vii)(A) and (d)(2)(vii)(B) below. Shearing or breaking of contaminated needles is prohibited. Contaminated needles and other contaminated sharps shall not be recapped or removed unless the employer can demonstrate that no alternative is feasible or that such action is required by a specific medical procedure. Such recapping or needle removal must be accomplished through the use of a mechanical device or a one-handed technique. Immediately or as soon as possible after use, contaminated reusable sharps shall be placed in appropriate containers until properly processed. These containers shall be: Puncture resistant; Labeled or color-coded in accordance with this standard; Leak proof on the sides and bottom; and In accordance with the requirements set forth in paragraph (d)(4)(ii)(E) for reusable sharps. Eating, drinking, smoking applying cosmetics or lip balm, and handling contact lenses are prohibited in work areas where there is a reasonable likelihood of occupational exposure. Food and drink shall not be kept in refrigerators, freezers, shelves, cabinets or on countertops or bench tops where blood or other potentially infectious materials are present. All procedures involving blood or other potentially infectious materials shall be performed in such a manner as to minimize splashing, spraying, spattering, and generation of droplets of these substances.

Mouth pipetting/suctioning of blood or other potentially infectious materials is prohibited. Specimens of blood or other potentially infectious materials shall be placed in a container which prevents leakage during collection, handling, processing, storage, transport, or shipping. The container for storage, transport, or shipping shall be labeled or color-coded according to paragraph(g)(1)(i) and closed prior to being stored, transported, or shipped. When a facility utilizes Universal Precautions in the handling of all specimens, the labeling/color-coding of specimens is not necessary provided containers are recognizable as containing specimens. This exemption only applies while such specimens/containers remain within the facility. Labeling or color-coding in accordance with paragraph(g)(1)(i) is required when such specimens/containers leave the facility. If outside contaminations of the primary container occurs, the primary container which prevents leakage during handling, processing, storage, transport, or shipping and is labeled or color-coded according to the requirements of this standard. If the specimen could puncture the primary container, the primary container shall be placed within a secondary container which is puncture-resistant in addition to the above characteristics. Equipment which may become contaminated with blood or other potentially infectious materials shall be examined prior to servicing or shipping and shall be decontaminated as necessary, unless the employer can demonstrate that decontamination of such equipment is not feasible. A readily observable label in accordance with paragraph (g)(1)(i)(H) shall be attached to the equipment stating which portions remain contaminated. The employer shall ensure that this information is conveyed to all affected employees, the servicing representative, and/or the manufacturer, as appropriate prior to handling, servicing, or shipping so that appropriate precautions will be taken. Personal protective equipment- Provision. When there is occupational exposure, the employer shall provide, at no cost to the employee, appropriate personal protective equipment such as, but not limited to, gloves, gowns, laboratory coats, face shields or masks and eye protection, and mouthpieces, resuscitation bags, pocket masks, or other ventilation devices. Personal protective equipment will be considered "appropriate" only if it does not permit blood or other potentially infectious materials to pass through to or reach the employee's work clothes, street clothes, undergarments, skin, eyes, mouth, or other mucous membranes under normal conditions of use and for the duration of time which the protective equipment will be used. Use. The employer shall ensure that the employee uses appropriate personal protective equipment unless the employer shows that the employee temporarily and briefly declined to use personal protective equipment when, under rare and extraordinary circumstances, it was the employee's professional judgment that in the specific instance its use would have prevented the delivery of health care or public safety services or would have posed an increased hazard to the safety of the worker or co-worker. When the employee makes this judgment, the circumstances

shall be investigated and documented in order to determine whether changes can be instituted to prevent such occurrences in the future. Accessibility. The employer shall ensure that appropriate personal protective equipment in the appropriate sizes is readily accessible at the worksite or is issued to employees. Hypoallergenic gloves, glove liners, powderless gloves, or other similar alternatives shall be readily accessible to those employees who are allergic to the gloves normally provided. Cleaning, Laundering, and Disposal. The employer shall clean, launder, and dispose of personal protective equipment required by paragraphs(d) and (e) of this standard, at not cost to the employee. Repair and Replacement. The employer shall repair or replace personal protective equipment as needed to maintain its effectiveness, at no cost to the employee. If a garment(s) is penetrated by blood or other potentially infectious materials, the garment(s) shall be removed immediately or as soon as feasible. All personal protective equipment shall be removed prior to leaving the work area . When personal protective equipment is removed prior to leaving the work site. When personal protective equipment is removed it shall be placed in an appropriately designated area or container for storage or disposal. Gloves. Gloves shall be worn when it can be reasonably anticipated that the employee may have hand contact with blood, other potentially infectious materials, mucous membranes, and on- intact skin; when performing vascular access procedures except as specified in paragraph(d)(3)(ix)(D); and when handling or touching contaminated items or surfaces. Disposal (single use) gloves such as surgical or examination gloves, shall be replaced as soon as practical when contaminated or as soon as feasible if they are torn, punctured, or when their ability to function as a barrier is compromised. Disposable (single use) gloves shall not be washed or decontaminated for re-use. Utility gloves may be decontaminated for re-use if the integrity of the glove is not compromised. However, they must be discarded if they are cracked, peeling, torn, punctured, or exhibits other signs of deterioration or when their ability to function as a barrier is compromised. If an employer in a volunteer blood donation center judges that routine gloving for all phlebotomies is not necessary then the employer shall: Periodically reevaluate this policy; Make gloves available to all employees who wish to use them for phlebotomy; and Require that gloves be used for phlebotomy in the following circumstances:

When the employee has cuts, scratches, or other breaks in his or her skin; When the employee judges that hand contamination with blood may occur, for example, when performing phlebotomy on an uncooperative source individual; and When the employee is receiving training in phlebotomy. Make, Eye Protection, and Face Shields. Masks in combination with eye protection devices, such as goggles or glasses with solid side shields, or chin length face shields, shall be worn whenever splashes, spray, spatter, or droplets of blood or other potentially infectious materials may be generated and eye, nose, or mouth contamination can be reasonably anticipated. Gowns, Aprons, and Other Protective Body Clothing. Appropriate protective clothing such as, but not limited to, gowns, aprons, lab coats, clinic jackets, or similar outer garments shall be worn in occupational exposure situations. The type and characteristics will depend upon the task and degree of exposure anticipated. Surgical caps or hoods and/or shoe covers or boots shall be worn in instances when gross contamination can reasonably be anticipated (e.g., autopsies, orthopedic surgery). Housekeeping. General. Employers shall ensure that the worksite is maintained in a clean and sanitary condition. The employer shall determine and implement an appropriate written schedule for cleaning and method of decontamination based upon the location within the facility, type of surface to be cleaned, type of soil present, and tasks or procedures being performed in the area. All equipment and environmental and working surfaces shall be cleaned and decontaminated after contact with blood or other potentially infectious materials. Contaminated work surfaces shall be decontaminated with an appropriate disinfectant after completion of procedures; immediately or as soon as feasible when surfaces are overtly contaminated or after any spill of blood or other potentially infectious materials; and at the end of the work shift if the surface may have become contaminated since the last cleaning. Protective coverings, such as plastic wrap, aluminum foil, or imperviously-backed absorbent paper used to cover equipment and environmental surfaces, shall be removed and replaced as soon as feasible when they become overtly contaminated or at the end of the work shift if they may have become contaminated during the shift. All bins, pails, cans, and similar receptacles intended for reuse which have a reasonable likelihood for becoming contaminated with blood or other potentially infectious materials shall be inspected and decontaminated on a regularly scheduled basis and cleaned and decontaminated immediately or as soon as feasible upon visible contamination. Broken glassware which may be contaminated shall not be picked up directly with the hands. It shall be cleaned up using mechanical means, such as a brush and dust pan, tongs, or forceps.

Reusable sharps that are contaminated with blood or other potentially infectious materials shall not be stored or processed in a manner that requires employees to reach by hand into the containers where these sharps have been placed. Regulated Waste. Contaminated sharps shall be discarded immediately or as soon as feasible in containers that are: Closable; Puncture resistant; Leakproof on sides and bottom; and Labeled or color-coded in accordance with paragraph(g)(1)(i) of this standard. During use, containers for contaminated sharps shall be: Easily accessible to personnel and located as close as is feasible to the immediate area where sharps are used or can be reasonably anticipated to be found (e.g., laundries); Maintained upright throughout use; and Replaced routinely and not be allowed to overfill. When moving containers of contaminated sharps from the area of use, the containers shall be: Closed immediately prior to removal or replacement to prevent spillage or protrusion of contents during handling, storage, transport, or shipping; Placed in a secondary container if leakage is possible. The second container shall be: Closable; Constructed to contain all contents and prevent leakage during handling, storage, transport, or shipping; and Labeled or color-coded according to paragraph(g)(1)(i) of this standard. Reusable containers shall not be opened, emptied, or cleaned manually or in any other manner which would expose employees to the risk of percutaneous injury. Regulated waste shall be placed in containers which are: Closable; Constructed to contain all contents and prevent leakage of fluids during handling, storage, transport or shipping;

Labeled or color-coded in accordance with paragraph(g)(1)(i) this standard; and Closed prior to removal to prevent spillage or protrusion of contents during handling, storage, transport, or shipping. If outside contamination of the regulated waste container occurs, it shall be placed in a second container. The second container shall be: Closable; Constructed to contain all contents and prevent leakage of fluids during handling, storage, transport or shipping; Labeled or color-coded in accordance with paragraph(g)(1)(i) of this standard; and Closed prior to removal to prevent spillage or protrusion of contents during handling, storage, transport, or shipping. Disposal of all regulated waste shall be in accordance with applicable regulations of the United States, States and Territories, and political subdivisions of States and Territories. Laundry. Contaminated laundry shall be handled as little as possible with a minimum of agitation. Contaminated laundry shall be bagged or containerized at the location where it was used and shall not be sorted or rinsed in the location of use. Contaminated laundry shall be placed and transported in bags or containers labeled or color- coded in accordance with paragraph(g)(1)(i) of this standard. When a facility utilizes Universal Precautions in the handling of all soiled laundry, alternative labeling or color-coding is sufficient if it permits all employees to recognize the container as requiring compliance with Universal Precautions. Whenever contaminated laundry is wet and presents a reasonable likelihood of soak-through of or leakage from the bag or container, the laundry shall be placed and transported in bags or containers which prevent soak-through and/or leakage of fluids to the exterior. The employer shall ensure that employees who have contact with contaminated laundry wear protective gloves and other appropriate personal protective equipment. When a facility ships contaminated laundry off-site to a second facility which does not utilize Universal Precautions in the handling of all laundry, the facility generating the contaminated laundry must place such laundry in bags or containers which are labeled or color-coded in accordance with paragraph(g)(1)(i). HIV and HBV Research Laboratories and Production Facilities.

This paragraph applies to research laboratories and production facilities engaged in the culture, production, concentration, experimentation, and manipulation of HIV and HBV. It does not apply to clinical or diagnostic laboratories engaged solely in the analysis of blood, tissues, or organs. These requirements apply in addition to the other requirements of the standard. Research laboratories and production facilities shall meet the following criteria: Standard microbiological practices. All regulated waste shall either be incinerated or decontaminated by a method such as autoclaving known to effectively destroy blood borne pathogens. Special practices. Laboratory doors shall be kept closed when work involving HIV or HBV is in progress. Contaminated materials that are to be decontaminated at a site away from the work area shall be placed in a durable, leak proof, labeled or color-coded container that is closed before being removed from the work area. Assess to the work area shall be limited to authorized persons. Written policies and procedures shall be established whereby only persons who have been advised of the potential biohazard, who meet any specific entry requirements, and who comply with all entry and exit procedures shall be allowed to enter the work areas and animal rooms. When other potentially infectious materials or infected animals are present in the work area or containment module, a hazard warning sign incorporating the universal biohazard symbol shall be posted on all access doors. The hazard warning sign shall comply with paragraph(g)(1)(ii) of this standard. All activities involving other potentially infectious materials shall be conducted in biological safety cabinets or other physical-containment devices within the containment module. No work with these other potentially infectious materials shall be conducted on the open bench. Laboratory coats, gowns, smocks, uniforms, or other appropriate protective clothing shall be used in the work area and animal rooms. Protective clothing shall not be worn outside of the work area and shall be decontaminated before being laundered. Special care shall be taken to avoid skin contact with other potentially infectious materials. Gloves shall be worn when handling infected animals and when making band contact with other potentially infectious materials is unavoidable. Before disposal, all waste from work areas and from animal rooms shall either be incinerated or decontaminated by a method such as autoclaving known to effectively destroy blood borne pathogens. Vacuum lines shall be protected with liquid disinfectant traps and high-efficiency particulate air (HEPA) filters or filters of equivalent or superior efficiency and which are checked routinely and maintained or replaced, as necessary.

Hypodermic needles and syringes shall be used only for parenteral injection and aspiration of fluids from laboratory animals and diaphragm bottles. Only needle-locking units (i.e., the needle is integral to the syringe) shall be used for the injection or aspiration of other potentially infectious materials. Extreme caution shall be used when handling needles and syringes. A needle shall not be bent, sheared, replaced in the sheath or guard, or removed from the syringe following use. The needle and syringe shall be promptly placed in a puncture-resistant container and autoclaved or decontaminated before reuse or disposal. All spills shall be immediately contained and cleaned up by appropriate professional staff or others properly trained and equipped to work with potentially concentrated infectious materials. A spill or accident that results in an exposure incident shall be immediately reported to the laboratory director or other responsible person. A biosafety manual shall be prepared or adopted and periodically reviewed and updated at least annually or more often if necessary. Personnel shall be advised of potential hazards, shall be required to read instructions on practices and procedures, and shall be required to follow them. Containment equipment. Certified biological safety cabinets (Class I, II, or III) or other appropriate combinations of personal protection or physical containment devices, such as special protective clothing, respirators, centrifuge safety cups, sealed centrifuge rotors, and containment caging for animals, shall be used for all activities with other potentially infectious materials that pose a threat of exposure to droplets, splashes, spills, or aerosols. Biological safety cabinets shall be certified when installed, whenever they are moved and at least annually. HIV and HBV research laboratories shall meet the following criteria: Each laboratory shall contain a facility for hand washing and an eye wash facility which is readily available within the work area. An autoclave for decontamination of regulated waste shall be available. HIV and HBV production facilities shall meet the following criteria: The work areas shall be separated from areas that are open to unrestricted traffic flow within the building. Passage through two sets of doors shall be the basic requirement for entry into the work area from access corridors or other contiguous areas. Physical separation of the high- containment work area from access corridors or other areas or activities may also be provided by a double-doored clothes-change room (showers may be included), airlock, or other access facility that requires passing through two sets of doors before entering the work area. The surfaces of doors, walls, floors, and ceilings in the work area shall be water resistant so that they can be easily cleaned. Penetrations in these surfaces shall be sealed or capable of being sealed to facilitate decontamination.

Each work area shall contain a sink for washing hands and a readily available eye wash facility. The sink shall be foot, elbow, or automatically operated and shall be located near the exit door of the work area. Access doors to the work area or containment module shall be self-closing. An autoclave for decontamination of regulated waste shall be available within or as near as possible to the work area. A ducted exhaust-air ventilation system shall be provided. This system shall create directional airflow that draws air into the work area through the entry area. The exhaust air shall not be recirculated to any other area of the building, shall be discharged to the outside, and shall be dispersed away from occupied areas and air intakes. The proper direction of the airflow shall be verified (i.e., into the work area). Training Requirements. Additional training requirements for employees in HIV and HBV research laboratories and HIV and HBV production facilities are specified in paragraph(g)(2)(ix). Hepatitis B vaccination and post-exposure evaluation and follow-up- General. The employer shall make available the hepatitis B vaccine and vaccination series to all employees who have occupational exposure, and pot-exposure evaluation and follow-up to all employees who have had an exposure incident. The employer shall ensure that all medical evaluations and procedures including the hepatitis B vaccine and vaccination series and post-exposure evaluation and follow-up, including prophylaxis are: Made available at not cost to the employee; Made available to the employee at a reasonable time and place; Performed by or under the supervision of a licensed physician or by or under the supervision of another licensed healthcare professional; and Provided according to recommendations of the U.S. Public Health Service current at the time these evaluations and procedures take place, except as specified by this paragraph(f). The employers hall ensure that all laboratory at no cost to the employee. Hepatitis B Vaccination Hepatitis B vaccination shall be made available after the employee has received the training required in paragraph (g)(2)(vii)(I) and within 10 workings days of initial assignment to all employees who have occupational exposure unless the employee has previously received the

complete hepatitis B vaccination series, antibody testing has revealed that the employee is immune, or the vaccine is contraindicated for medical reasons. The employee shall not make participation in a pre-screening program a prerequisite for receiving hepatitis B vaccination. If the employee initially declines Hepatitis B vaccination but at a later date while still covered under the standard decides to accept the vaccination, the employer shall make available hepatitis B vaccination at that time. The employer shall assure that employees who decline to accept hepatitis B vaccination offered by the employer sign the statement in appendix A. If a routine booster dose(s) of hepatitis B vaccine is recommended by the U.S. Public Health Service at a future date, such booster dose(s) shall be made available in accordance with section(f)(1)(ii). Post-exposure Evaluation and Follow-up. Following a report of an exposure incident, the employer shall make immediately available to the exposed employee a confidential medical evaluation and follow-up, including at least the following elements: Documentation of the route(s) of exposure, and the circumstances under which the exposure incident occurred; Identification and documentation of the source individual, unless the employer can establish that identification is infeasible or prohibited by state or local law; The source individual's blood shall be tested as soon as feasible and after consent is obtained in order to determine HBV and HIV infectivity. If consent is not obtained, the employer shall establish that legally required consent cannot be obtained. When the source individual's consent is not required by law, the source individual's blood, if available, shall be tested and the results documented. When the source individual is already known to be infected with HBV or HIV, testing for source individual's known HBV or HIV status need not be repeated. Results of the source individual's testing shall be made available to the exposed employee, and the employee shall be informed of applicable laws and regulations concerning disclosure of the identity and infectious status of the source individual. Collection and testing of blood for HBV and HIV serological status; The exposed employee's blood shall be collected as soon as feasible and tested after consent is obtained. If the employee consents to baseline blood collection, but does not give consent at that time for HIV serologic testing, the sample shall be preserved for at least 90 days. If within 90 days of the

exposure incident, the employee elects to have the baseline sample tested, such testing shall be done as soon as feasible. Post-exposure prophylaxis, when medically indicated, as recommended by the U.S. Public Health Service; Counseling; and Evaluation of reported illnesses. Information Provided to the Healthcare Professional. The employer shall ensure that the healthcare professional responsible for the employee’s Hepatitis B vaccination is provided a copy of this regulation. The employer shall ensure that the healthcare professional evaluating an employee after an exposure incident is provided the following information: A copy of this regulation; A description of the exposed employee's duties as they relate to the exposure incident: Documentation of the route(s) of exposure and circumstances under which exposure occurred; Results of the source individual's blood testing, if available; and All medical records relevant to the appropriate treatment of the employee including vaccination status which are the employer's responsibility to maintain. Healthcare Professional's Written Opinion. The employer shall obtain and provide the employee with a copy of the evaluating healthcare professional's written opinion within 15 days of the completion of the evaluation. The healthcare professional's written opinion for Hepatitis B vaccination shall be limited to whether Hepatitis B vaccination is indicated for an employee, and if the employee has received such vaccination. The healthcare professional's written opinion for post-exposure evaluation and follow-up shall be limited to the following information: That the employee has been informed of the results of the evaluation; and That the employee has been told about any medical conditions resulting from exposure to blood or other potentially infectious materials which require further evaluation or treatment. All other findings or diagnoses shall remain confidential and shall not be included in the written report.

Medical recordkeeping. Medical records required by this standard shall be maintain in accordance with paragraph(h)(1) of this section. Communication of hazards to employees- Labels and signs. Labels. Warning labels shall be affixed to containers of regulated waste, refrigerators and freezers containing blood or other potentially infectious material; and other containers used to store, transport or ship blood or other potentially infectious material; except as provided in paragraph(g)(1)(i)(E), (F) and (G). Labels required by this section shall include the following legend: Biohazard These labels shall be fluorescent orange or orange-red or predominantly so, with lettering or symbols in contrasting color. Labels required by affixed as close as feasible to the container by string, wire, adhesive, or other method that prevents their loss or unintentional removal. Red bags or red containers may be substituted for labels. Containers of blood, blood components, or blood products that are labeled as to their contents and have been released for transfusion or other clinical use are exempted from the labeling requirements of paragraph (g). Individual containers of blood or other potentially infectious materials that are placed in a labeled container during storage, transport, shipment, or disposal are exempted from the labeling requirement. Labels required for contaminated equipment shall be in accordance with this paragraph and shall also state which portions of the equipment remain contaminated. Regulated waste that has been decontaminated need not be labeled or color-coded. Signs. The employer shall post signs at the entrance to work areas specified in paragraph(e), HIV and HBV Research Laboratory and Production Facilities, which shall bear the following legend: Biohazard (Name of the Infectious Agent) (Special requirements for entering the area) (Name, telephone number of the laboratory director or other responsible person). These signs shall be fluorescent orange-red or predominantly so, with lettering or symbols in a contrasting color.

Information and Training. Employers shall ensure that all employees with occupational exposure participate in a training program which must be provided at no cost to the employee and during working hours. Training shall be provided as follows: At the time of initial assignment to tasks where occupational exposure may take place; Within 90 days after the effective date of the standard; and At least annually thereafter. For employees who have received training on blood borne pathogens in the year preceding the effective date of the standard, only training with respect to the provisions of the standard which were not included need be provided. Annual training for all employees shall be provided within one year of their previous training. Employers shall provide additional training when changes such as modification of tasks or procedures or institution of new tasks or procedures affect the employee's occupational exposure. The additional training may be limited to addressing the new exposures created. Material appropriate in content and vocabulary to educational level, literacy, and language of employees shall be used. The training program shall contain at a minimum the following elements; Inaccessible copy of the regulatory text of this standard and an explanation of its contents; A general explanation of the epidemiology and symptoms of blood borne diseases; An explanation of the modes of transmission of blood borne pathogens; An explanation of the employer's exposure control plan and the means by which the employee can obtain a copy of the written plan; An explanation of the appropriate methods for recognizing tasks and other activities that may involve exposure to blood and other potentially infectious materials; An explanation of the use and limitations of methods that will prevent or reduce exposure including appropriate engineering controls, work practices and personal protective equipment; Information on the types, proper use, location, removal, handling, decontamination and disposal of personal protective equipment; An explanation of the basis for selection of personal protective equipment;

Information on the hepatitis B vaccine, including information on its efficacy, safety, method of administration, the benefits of being vaccinated, and that the vaccine and vaccination will be offered free of charge; Information on the appropriate actions to take and persons to contact in an emergency involving blood or other potentially infectious materials; An explanation of the procedure to follow if an exposure incident occurs, including the method of reporting the incident and the medical follow-up that will be made available; Information on the post-exposure evaluation and follow-up that the employer is required to provide for the employee following and exposure incident; An explanation of the signs and label and/or color coding required by paragraph(g)(1); and An opportunity for interactive questions and answers with the person conducting the training session. The person conducting the training shall be knowledgeable in the subject matter covered by the elements contained in the training program as it relates to the workplace that the training will address. Additional Initial Training for Employees in HIV and HBV Laboratories and Production Facilities. Employees in HIV or HBV research laboratories and HIV or HBV production facilities shall receive the following initial training in addition to the above training requirements. The employer shall assure that employees demonstrate proficiency in standard microbiological practices and techniques and in the practices and operations specific to the facility before being allowed to work with HIV or HBV. The employer shall assure that employees have prior experience in the handling of human pathogens or tissue cultures before working with HIV or HBV. The employer shall provide a training program to employees who have no prior experience in handling human pathogens. Initial work activities shall not include the handling of infectious agents. A progression of work activities shall be assigned as technique are learned and proficiency is developed. The employer shall assure that employees participate in work activities involving infectious agents only after proficiency has been demonstrated. Recordkeeping- Medical Records. The employer shall establish and maintain an accurate record for each employee with occupational exposure, in accordance with 29 CFR 1910.20. This record shall include: The name and social security number of the employee;

A copy of the employee's hepatitis B vaccination status including the dates of all the hepatitis B vaccinations and any medical records relative to the employee's ability to receive vaccination as required by paragraph(f)(2); A copy of all results of examinations, medical testing, and follow-up procedures as required by paragraph (f)(3); The employer's copy of the healthcare professional's written opinion as required by paragraph (f)(5); and A copy of the information provided to the healthcare professional as required by paragraphs (f)(4)(ii)(B)(C) and (D). Confidentiality. The employer shall ensure that employee medical records required by paragraph (h)(1) are: Kept confidential; and Are not disclosed or reported without the employee's express written consent to any person within or outside the workplace except as required by this section or as may be required by law. The employer shall maintain the records required by paragraph(h) for at least the duration of employment plus 30 years in accordance with 29 CFR 1910.20. Training Records. Training records shall include the following information: The dates of the training sessions; The contents or a summary of the training sessions; The names and qualifications of persons conducting the training; and The names and job titles of all persons attending the training sessions. Training records shall be maintained for 3 years from the date on which the training occurred. Availability. The employer shall ensure that all records required to be maintained by this section shall be made available upon request to the Assistant Secretary and the Director for examination and copying. Employee training records required by this paragraph shall be provided upon request for examination and copying to employees, to employee representatives, to the Director, and to the Assistant Secretary in accordance with 29 CFR 1910.20. Employee medical records required by this paragraph shall be provided upon request for examination and copying to the subject employee, to anyone having written consent of the subject employee, to the Director, and to the Assistant Secretary in accordance with 29 CFR 1910.20.

Transfer of Records. The employer shall comply with the requirements involving transfer of records set forth in 29 CFR 1910.20(h). If the employer ceases to do business and there is no successor employer to receive and retain the records for the prescribed period, the employer shall notify the Director, at least three months prior to their disposal and transmit them to the Director, if required by the Director to do so, within that three month period. Dates- Effective Date. The standard shall become effective on March 6, 1992. The Exposure Control Plan required by paragraph(c)(2) of this section shall be completed on or before May 5, 1992. Paragraph (g)(2) Information and Training and (h) Recordkeeping shall take effect on or before June 4, 1992. Paragraphs (d)(2) Engineering and Work Practice Controls, (d)(3) Housekeeping, (e) HIV and HBV Research Laboratories and Production Facilities, (f) Hepatitis B Vaccination and Post- Exposure Evaluation and Follow-up, and (g) (1) Labels and Signs, shall take effect July 6, 1992. Appendix A to Section 1910.1030-Hepatitis B Vaccine Declination (Mandatory) I understand that due to my occupational exposure to blood or other potentially infectious materials I may be at risk of acquiring hepatitis B virus (HBV)a infection, I have been given the opportunity to be vaccinated with hepatitis B vaccine, at no charge to myself. However, I decline hepatitis B vaccination at this time. I understand that by declining this vaccine, I continue to be at risk of acquiring hepatitis B, a serious disease. If in the future I continue to have occupational exposure to blood or other potentially infectious materials and I want to be vaccinated with hepatitis B vaccine, I can receive the vaccination series at no charge to me. (FR Doc.91-28886 Filed 12-2-91; 8:45 am) Billing Code 4510-26-M APPENDIX 6 TRANSFERS: INTERHOSPITAL AND OTHER MEDICAL FACILITIES Definitions - Inter-Hospital And Other Medical Facilities Appropriate Transfer - An appropriate transfer to a medical facility is a transfer in which the receiving facility: a) has available space and qualified personnel for the treatment of the patient, and b) has agreed to accept transfer of the patient and to provide appropriate medical treatment; in which the transferring hospital provides the receiving facility with appropriate medical records of the examination and treatment effected at the transferring hospital;

In which the transfer is affected through qualified personnel and transportation equipment, as required including the use of necessary and medically appropriate life support measures during the transfer. Medical Control During Interhospital Transfers Once an emergency patient arrives for initial evaluation at a medical facility the patient becomes the responsibility of that facility, and its medical staff. This responsibility continues until the patient is appropriately discharged, or until the patient is transferred and the responsibility is assumed by personnel and a facility of equal or greater capability for the patient's existing condition. Routine Interhospital Transfers If a transfer is being made for the convenience of the patient or patient's physicians, and the patient is not receiving treatment, and is expecting to remain stable during transport, the transfer may be conducted by and appropriately trained medical provider (EMT-Basic or higher). Emergency Interhospital Transfers Conducted by the Transferring Facility If the patient is being transferred to another facility for other convenience, is receiving treatment, is medically unstable, or is potentially unstable, it is the responsibility of the transferring physician and hospital to provide medical records and assure that appropriately qualified personnel and transportation equipment are utilized. The transferring personnel will act as the agents of the transferring hospital and the physician approving the transfer, regardless of any other employer/employee relationship. The transferring physician must provide written orders to non-physician personnel for use during the interhospital transfer. If the patient experiences complications beyond situations addressed in these written orders, the provider should, if possible. Contact the transferring hospital or the receiving facility for additional orders or, if necessary, contact a recognized communications resource for medical direction. Emergency Interhospital Transfers Conducted by Receiving Facility (Transferring personnel are agents of the receiving hospital) If the transferring personnel include a physician, the patient becomes the responsibility of the receiving facility as soon as the patient leaves the transferring facility. If the transferring team does not include a physician, the responsibility for the patient's well being may be shared between the receiving and transferring facility. The transferring facility retains the responsibility to assure that the transport agency has qualified personnel and transportation equipment. Critical Care Transfers If the patient is receiving treatment beyond the scope of practice of available transferring nonphysician providers or if the patient’s needs or reasonably perceived needs cannot be managed within the scope of practice of non-physician personnel, the transfer shall be managed by an appropriately trained physician.

APPENDIX 7 – RELATED COBRA REGULATIONS H.R. 3128-83 Subpart B- Miscellaneous Provisions Sec. 9121. Responsibilities of Medicare Hospitals in Emergency Cases. Requirement of Medicare Hospital Provider Agreements.-Section 1866(a)(1) of the Social Security Act (42 USC 1395cc (a)(1) is amended- by striking out "and" at the end of subparagraph (G), by striking out the period at the end of subparagraph (H) and inserting in lieu thereof", and ", and by inserting after subparagraph (H) the following new subparagraph: "(I) in the case of a hospital, to comply with the requirements of section 1867 to the extent applicable." Requirements-Title XVIII of such Act is amended by inserting after section 1866 the following new section: Examination and Treatment for Emergency Medical Conditions and Women in Active Labor: "Spec. 1867 (a) Medical Screening Requirement.-In the case of a hospital that has a hospital emergency department, if any individual (whether or not eligible for benefits under this title) comes to the emergency department and a request is made on the individual's behalf for examination or treatment for a medical condition, the hospital must provide for an appropriate medical screening examination within the capability of the hospital's emergency department to determine whether or not an emergency medical condition (within the meaning of subsection (3)(1) exists or to determine if the individual is in active labor (within the meaning of subsection (e)(2)). Necessary Stabilizing Treatment for Emergency Medical Conditions and Active Labor.- In general.-If any individual (whether or not eligible for benefits under this title) comes to a hospital and the hospital determines that the individual has an emergency medical condition or is in active labor, the hospital must provide either- within the staff and facilities available at the hospital, for such further medical examination and such treatment as may be required to stabilize the medical condition or to provide for treatment of the labor, or for transfer of the individual to another medical facility in accordance with subsection (c). Refusal to Consent to Treatment - A hospital is deemed to meet the requirement of paragraph (1)(A) with respect to an individual if the hospital offers the individual the further medical examination and treatment described in that paragraph but the individual (or a legally responsible person acting on the individual's behalf) refuses to consent to the examination or treatment. H.R.3128-84

Refusal to Consent to Transfer - A hospital is deemed to meet the requirement of paragraph (1) with respect to an individual if the hospital offers to transfer the individual to another medical facility in accordance with subsection (c) but the individual (or a legally responsible person acting on the individual's behalf) refuses to consent to the transfer. Restricting Transfers Until Patient Stabilized - Rule. - If a patient at a hospital has an emergency medical condition which has not been stabilized (with the meaning of subsection (e)(4)(B) or is in active labor, the hospital may transfer the patient unless- (i) the patient (or a legally responsible person acting on the patient's behalf) requests that the transfer be effected, or a physician (within the meaning of section 1861(r)(1), or other qualified medical personnel when a physician is not readily available in the emergency department, has signed a certification that, based upon the reasonable risks and benefits to the patient, and based upon the information available at the time, the medical benefits reasonably expected from the provision of appropriate medical treatment at another medical facility outweigh the increased risks to the individual's medical condition from effecting the transfer; and in which the transferring hospital provides the receiving facility with appropriate medical records (or copies thereof) of the examination and treatment effected at the transferring hospital; in which the transfer is effected through qualified personnel and transportation equipment, as required including the use of necessary and medically appropriate life support measures during the transfer; and which meets such other requirements as the Secretary may find necessary in the interest of the health and safety of patients transferred. Enforcement- As Requirement of Medicare Provider Agreement. - If a hospital knowingly and willfully, or negligently, fails to meet the requirements of this section, such hospital is subject to- termination of its provider agreement under this title in accordance with section 1866(b), or at the option of the Secretary, suspension of such agreement for such period of time as the Secretary determines to be appropriate, upon reasonable notice to the hospital and to the public. Civil Monetary Penalties. - In addition to the other grounds for imposition of a civil money penalty under section 1128A(a), a participating hospital that knowingly violates a requirement of this section and the responsible physician in the hospital with respect to such a violation are each subject, under that section, to a civil money penalty of not more than $25,000 for each such violation. As used in the previous sentence, the term "responsible physician" means, with respect to a hospital's, a physician who-

is employed by, or under contract with, the participating hospital, and acting as such an employee or under such a contract, has professional responsibility for the provision of examinations or treatments for the individual, or transfers of the individual, with respect to which the violation occurred. Civil Enforcement- Personal Harm.- Any individual who suffers personal harm as a direct result of a participating hospital's violation of a requirement of this section may, in a civil action against the participating hospital, obtain those damages available for personal injury under the law of the State in which the hospital is located, and such equitable relief as appropriate. Financial Loss To Other Medical Facility.- Any medical facility that suffers a financial loss as a direct result of participating hospital's violation of a requirement of this section may, in a civil action against the participating hospital, obtain those damages available for financial loss, under the law of the State in which the hospital is located, and such equitable relief as is appropriate. Limitations On Actions.- No action may be brought under this paragraph more than two years after the date of the violation with respect to which the action is brought. Definitions.- In this section: The term `emergency medical condition' means a medical condition manifesting itself by acute symptoms of sufficient severity (including severe pain) such that a prudent layperson, who possesses an average knowledge of health and medicine, could reasonably expect the absence of immediate medical attention to result in placing the health of the individual (or with respect to a pregnant woman, the health of the woman or her unborn child) in serious jeopardy, serious impairment of bodily functions, or serious dysfunction of any bodily organ or part. The term `participating hospital' means hospital that has entered into a provider agreement under section 1866 and has, under the agreement, obligated itself to comply with the requirements of this section. (A) The term `to stabilize' means, with respect to an emergency medical condition, to provide such medical treatment of the condition as may be necessary to assure, within reasonable medical probability, that no material deterioration of the condition is likely to result from the transfer of the individual from a facility. The term `stabilized' means with respect to an emergency medical condition, that no material deterioration of the condition is likely, within reasonable medical probability, to result from the transfer of the individual from a facility. The term `transfer' means the movement (including the discharge) of a patient outside a hospital's facilities at the direction of any person employed by (or affiliated or associated, directly or indirectly, with) the hospital, but does not include such movement of a patient who (A) has been declared dead, or (B) leaves the facility without the permission of any such person.

Preemption.- The provisions of this section do not preempt any State or local law requirement, except to the extent that the requirement directly conflicts with a requirement of this section. Effective Date.- The amendments made by this section shall take effect on the first day of the first month that begins at least 90 days after the date of the enactment of this Act. Report.- The Secretary of Health and Human Services shall, not later than 6 months after the effective date described in subsection (c), report to Congress on the methods to be used for monitoring and enforcing compliance with section 1867 of the Social Security Act. Sec. 9122. Requirement For Medicare Hospitals for Participate In Champus and Champva Programs. In General.- Section 1866(a)(1) of the Social Security Act (42 U.S.C. 1395cc(a)(1) is amended- by striking out "and" at the end of subparagraph (H), by striking out the period at the end of subparagraph (I) and inserting in lieu thereof", and", and by inserting after subparagraph (I) the following new subparagraph: in the case of hospitals which provide inpatient hospital services for which payment may be made under this title, to be a participating provider of medical care under any health plan contracted for under section 1079 or 1086 of title 10, or under section 613 of title 38, United States Code, in accordance with admission practices, payment methodology, and amounts as prescribed under joint regulations issued by the Secretary and by the Secretaries of Defense and Transportation, in implementation of sections 1079 and 1086 of title 10, United States Code." Effective Date.- The amendments made by subsection (a) shall apply to agreements entered into our renewed on or after the date of the enactment of this Act, but shall apply only to inpatient hospital services provided pursuant to admissions to hospitals occurring on or after January 1, 1987. Reference to Study Required.- For a study of the use by Champus of the Medicare prospective payment system, see section 634 of the Department of Defense Authorization Act, 1985 (Public Law 98-525), the deadline for which is extended under section 2002 of this Act. Report.- The Secretary of Health and Human Services shall report to Congress periodically on the number of hospitals that have terminated or failed to renew an agreement under section 1866 of the Social Security Act as a result of the additional conditions imposed under the amendments made by subsection(a). APPENDIX 8 – DEATHS - PRONOUNCEMENTS/REPORTING/MOVING BODIES/PENALTIES FOR VIOLATIONS When to resuscitate

The statute in no way attempts to define when resuscitation should be initiated or withheld. This always has been and still is a medical and not a legal decision. The American Heart Association has established guidelines on decision-making and CPR, and the National Registry of Emergency Medical Technicians recognizes these as acceptable standards. They are as follows: Few reliable criteria exist by which death can be defined immediately. Decapitation, rigor mortis, and evidence of tissue decomposition and dependent lividity are reliable criteria. In the absence of such findings, CPR generally should be initiated immediately unless there is an acceptable reason to withhold it. If the decision not to initiate CPR is made by medical professional functioning in his professional capacity, the basis of the decision should not be arbitrary. The reason to withhold CPR should be sufficiently firm so that, should it later be subject to question, a decision can be effectively supported. Contact Medical Control in any questionable decision. Laws As They Relate To Emergency Medical Services The source of the laws which pertain to death is the Medical Examiners Act of 1986 and its revisions. For the purpose of this appendix only the portions of the laws that directly effect EMS will be quoted. It should be pointed out that in any case and under any circumstances, if it is felt by EMS personnel that the patient is resuscitable, neither the Medical Examiner nor Law Enforcement personnel can force the withholding of treatment. APPENDIX 9 – GLOSSARY REPEALED Effective 07/01/2022

Consolidated Trauma Activation Criteria and Destination Guidelines

Chapter 11 AUTOMATED EXTERNAL DEFIBRILLATOR GRANT PROGRAM

**History**
- *SOURCE: Miss. Code Ann. §41-59-5 Subchapter 13 Standards for the Critical Care Paramedic Rule 10.13.1 The Critical Care Paramedic who functions within the State of Mississippi must be able to demonstrate the skills and understand the elements of total emergency care to the satisfaction of the local Critical Care Paramedic Program Coordinator.*
- *SOURCE: Miss. Code Ann. §41-59-5 APPENDIX I – MEDICAL DIRECTION: STANDARD PRACTICE FOR QUALIFICATIONS, RESPONSIBILITIES, AND AUTHORITY #24068 Medical Direction (pre-hospital Emergency Medical Services) All aspects of the organization and provision of emergency medical services (EMS), including both basic and advanced life support, require the active involvement and participation of physicians. These aspects should incorporate design of the EMS system prior to its implementation; continual revisions of the system; and operation of the system from initial access, to pre-hospital contact with the patient, through stabilization in the emergency department. All pre-hospital medical care may be considered to have been provided by one or more agents of the physician who controls the pre-hospital system, for this physician has assumed responsibility for such care.*

##### **15 Miss. Admin. Code Pt. 12, R. 11.1.1** Subchapter 1 Eligibility {#sec-12-11.1.1 omnilex-key=us-ms-regs-official--title-15--12#11.1.1}

Only Department of Education approved public and charter schools may apply for the Automated External Defibrillator (AED) Grant Program.

**History**
- *SOURCE: Miss. Code Ann. §41-60-34*

##### **15 Miss. Admin. Code Pt. 12, R. 11.2.1** Subchapter 2 Application Process {#sec-12-11.2.1 omnilex-key=us-ms-regs-official--title-15--12#11.2.1}

Applicants may access the application for the AED Grant Program online via the Department website or by contacting the Bureau of EMS. Applications must be submitted prior to December 15 th by 5 p.m. Applications received after this date will not be processed as part of the current fiscal year.

**History**
- *SOURCE: Miss. Code Ann. §41-60-34*

##### **15 Miss. Admin. Code Pt. 12, R. 11.2.2** Applications must be signed by the superintendent, principal, or headmaster {#sec-12-11.2.2 omnilex-key=us-ms-regs-official--title-15--12#11.2.2}

**History**
- *SOURCE: Miss. Code Ann. §41-60-34*

##### **15 Miss. Admin. Code Pt. 12, R. 11.3.1** AED Program Grant funds must be deposited into the school treasury account {#sec-12-11.3.1 omnilex-key=us-ms-regs-official--title-15--12#11.3.1}

Items purchased with grant funds must be purchased in the name of the school. The school must follow state procurement law and policies for the purchasing, inventory, and disposal of AEDs. A sticker which states “this equipment purchased by the citizens of the State of Mississippi” shall identify AEDs purchased with grant funds.

**History**
- *SOURCE: Miss. Code Ann. §41-60-34*

##### **15 Miss. Admin. Code Pt. 12, R. 11.4.1** Funds must be expended by the end of the state fiscal year in which the funds are disbursed {#sec-12-11.4.1 omnilex-key=us-ms-regs-official--title-15--12#11.4.1}

A detailed justification for all grant expenditures must be submitted to the Bureau of EMS by December 15 th by 5 p.m. of the following fiscal year.

**History**
- *SOURCE: Miss. Code Ann. §41-60-34*

##### **15 Miss. Admin. Code Pt. 12, R. 11.4.2** Rule 11.4.2 {#sec-12-11.4.2 omnilex-key=us-ms-regs-official--title-15--12#11.4.2}

AED Grant Program awards will be audited according to Department policies and procedures to ensure grantee compliance and confirm eligibility for future program awards.

**History**
- *SOURCE: Miss. Code Ann. §41-60-34*

##### **15 Miss. Admin. Code Pt. 12, R. 11.5.1** Subchapter 5 Appeal Process {#sec-12-11.5.1 omnilex-key=us-ms-regs-official--title-15--12#11.5.1}

Any school district whose application for AED Grant Program funding has been rejected shall have the right to appeal such decision, within thirty (30) days after receipt of said decision, to the Bureau of EMS, who may refer the matter to a hearing officer, and/or make a final recommendation to the State Health Officer.

**History**
- *SOURCE: Miss. Code Ann. §41-60-34*

### **Part 13** Food Protection

##### **15 Miss. Admin. Code Pt. 13, R. 1.1.2** Rule 1.1.2 {#sec-13-1.1.2 omnilex-key=us-ms-regs-official--title-15--13#1.1.2}

Authorization: The State Board of Health is authorized to promulgate these rules under and by virtue of section 41-3-15, 41-3-18 and 75-29-801 through 75- 29-809 of the Mississippi Code of 1972, annotated.

**History**
- *SOURCE: Miss. Code Ann.§ 75-29-19*

##### **15 Miss. Admin. Code Pt. 13, R. 1.1.3** Adoption by Reference: The Code of Federal Regulations 21 CFR Parts 103, 129, 165, and 184, recommended by the U.S {#sec-13-1.1.3 omnilex-key=us-ms-regs-official--title-15--13#1.1.3}

Department of Health and Human Services/Food and Drug Administration is adopted by reference. Copies of this Regulation may be obtained from the Milk Plant and Bottled Water Inspection Branch.

**History**
- *SOURCE: Miss. Code Ann.§ 75-29-19*

##### **15 Miss. Admin. Code Pt. 13, R. 1.1.4** Rule 1.1.4 {#sec-13-1.1.4 omnilex-key=us-ms-regs-official--title-15--13#1.1.4}

Modifications of the Adoption by Reference: The provisions in sections 104 thru 110 of this Regulation make amendments, additions, and deletions to the Code of Federal Regulations Parts 110, 129, 165, and 184.1563 adopted by reference.

2 Bottled Water Plant means any place or establishment where water is received, prepared, processed, packaged and provided for human consumption or other consumer uses. 3 Department shall mean the Mississippi State Department of Health or its designated employees. 4 Health Authority shall mean the Mississippi State Department of Health or its representative. 5 Plant Operator means any person who owns or operates a bottled water plant. 6 Water Dealer means any person who imports bulk water or causes bulk water to be transported for bottling for human consumption or other consumer use. 7 Vended Water means water dispensed by a water vending machine. 8 Water Vending Machine means any self-service device that upon insertion of money or tokens or upon receipt of payment by other means, dispenses unit servings of water in bulk into a container, without the necessity of refilling the machine between each operation. For the purpose of this rule, bottled water coolers or dispensers providing individual servings are not included. 9 Water Vending Machine Operator means any person who owns, leases, manages, or is otherwise responsible for the operation of a water vending machine.

**History**
- *SOURCE: Miss. Code Ann.§ 75-29-19 Subchapter 2 Definitions Rule 1.2.1 For this regulation, the following words and phrases shall have the meanings indicated: 1 Approved Laboratory means a laboratory approved by the United States Environmental Protection Agency, Mississippi State Department of Health or any agency of another state or foreign country to perform drinking water analyses in accordance with water quality testing procedures outlined by the United States Environmental Protection Agency.*
- *SOURCE: Miss. Code Ann.§ 75-29-19 Subchapter 3 Permits Rule 1.3.1 Each person who establishes, maintains, or operates a bottled water plant in the state shall first secure an annual bottled water plant operating permit from the Mississippi State Department of Health.*
- *SOURCE: Miss. Code Ann.§ 75-29-19*

##### **15 Miss. Admin. Code Pt. 13, R. 1.3.2** Rule 1.3.2 {#sec-13-1.3.2 omnilex-key=us-ms-regs-official--title-15--13#1.3.2}

Each person who imports water or causes water to be transported into or within the state for human consumption or other consumer uses shall secure an annual water dealer permit from the Mississippi State Department of Health. Bulk water that is transported into the state shall be from approved sources.

**History**
- *SOURCE: Miss. Code Ann.§ 75-29-19*

##### **15 Miss. Admin. Code Pt. 13, R. 1.3.3** Rule 1.3.3 {#sec-13-1.3.3 omnilex-key=us-ms-regs-official--title-15--13#1.3.3}

Each person who is both a bottled water plant operator and water dealer shall be issued a combination permit and shall be required to pay one fee only.

**History**
- *SOURCE: Miss. Code Ann.§ 75-29-19*

##### **15 Miss. Admin. Code Pt. 13, R. 1.3.4** Rule 1.3.4 {#sec-13-1.3.4 omnilex-key=us-ms-regs-official--title-15--13#1.3.4}

Bottled water that is imported into and offered for sale in the state shall be processed and packaged in an approved bottled water plant that holds a valid annual bottled water operating permit issued by the Mississippi State Department of Health.

**History**
- *SOURCE: Miss. Code Ann.§ 75-29-19*

##### **15 Miss. Admin. Code Pt. 13, R. 1.3.5** Rule 1.3.5 {#sec-13-1.3.5 omnilex-key=us-ms-regs-official--title-15--13#1.3.5}

An out-of-state bottler or water dealer that has a permit to bottle or transport water in that state in which the facility is located may receive a permit under this law based on reciprocity provided the finished water meets the quality standards as provided in this regulation. All information submitted shall be legible and in English or have an adequate English translation attached.

**History**
- *SOURCE: Miss. Code Ann.§ 75-29-19*

##### **15 Miss. Admin. Code Pt. 13, R. 1.3.6** Rule 1.3.6 {#sec-13-1.3.6 omnilex-key=us-ms-regs-official--title-15--13#1.3.6}

A bottler outside the United States may receive a permit under this law based on a showing satisfactory to the Department that the permit requirements and regulations for the source, bottling facility, treatment and bottling practices, and product water be at least as stringent as the requirements of this regulation. All information submitted shall be legible and in English or have an adequate English translation attached.

**History**
- *SOURCE: Miss. Code Ann.§ 75-29-19*

##### **15 Miss. Admin. Code Pt. 13, R. 1.3.7** Rule 1.3.7 {#sec-13-1.3.7 omnilex-key=us-ms-regs-official--title-15--13#1.3.7}

An out- of-state or out-of-country bottled water plant or bottled water dealer that is located in an area absent of any bottled water regulation may receive a permit under this law based on a showing satisfactory to the Department that the source, bottling facility, treatment and bottling practices and product water meet the requirements of this regulation. All information submitted shall be legible and in English or have an adequate English translation attached.

**History**
- *SOURCE: Miss. Code Ann.§ 75-29-19*

##### **15 Miss. Admin. Code Pt. 13, R. 1.3.8** Rule 1.3.8 {#sec-13-1.3.8 omnilex-key=us-ms-regs-official--title-15--13#1.3.8}

If, after considering the source of water and the treatment process provided by a bottled water plant operator or water dealer, the Department finds that the finished water will meet the quality standards as defined by this regulation and the inspection determines the plant complies with the physical requirements set forth in this regulation, the permit will be issued.

**History**
- *SOURCE: Miss. Code Ann.§ 75-29-19*

##### **15 Miss. Admin. Code Pt. 13, R. 1.3.9** Rule 1.3.9 {#sec-13-1.3.9 omnilex-key=us-ms-regs-official--title-15--13#1.3.9}

Emergency Suspension of Permit 1 Any permit issued pursuant to this regulation may be suspended prior to a hearing if the Health Authority has reasonable cause to suspect that the continued operation of the permitted bottled water plant or water dealer constitutes a substantial hazard to the public health,

2 Whenever a permit is suspended the holder of the permit or person in charge shall be notified in writing that the permit is, upon service of the notice, immediately suspended and that an opportunity for hearing will be provided if requested in writing within ten days of the receipt of the notice of suspension. If no written request for hearing is filed within ten days, the suspension is sustained. 3 The Health Authority may relinquish the suspension at any time if reasons for the suspension no longer exist.

**History**
- *SOURCE: Miss. Code Ann.§ 75-29-19*

##### **15 Miss. Admin. Code Pt. 13, R. 1.3.10** Rule 1.3.10 {#sec-13-1.3.10 omnilex-key=us-ms-regs-official--title-15--13#1.3.10}

Denial or Revocation of Permit: Grounds for denial or revocation of a permit shall include but not limited to: 1 Failure to complete the information requested on the application. 2 Falsification of information submitted on an application for permit. 3 Refusal to allow inspections by the Health Authority, or other interference in the inspection. 4 Violation of the Regulation Governing Bottled Water. 5 Failure to correct violations of inspection standards within the time specified following inspection. 6 Any circumstances where the operation of the bottled water plant or water dealer constitutes a hazard to the public health.

**History**
- *SOURCE: Miss. Code Ann.§ 75-29-19*

##### **15 Miss. Admin. Code Pt. 13, R. 1.3.11** Notice {#sec-13-1.3.11 omnilex-key=us-ms-regs-official--title-15--13#1.3.11}

Prior to revocation or denial of a permit, the owner of the bottled water plant or water dealer shall be notified, in writing, of the proposed action, together with the reasons for the same. Said notice shall provide owners/applicants ten days in which to request a hearing.

**History**
- *SOURCE: Miss. Code Ann.§ 75-29-19*

##### **15 Miss. Admin. Code Pt. 13, R. 1.3.12** Hearing {#sec-13-1.3.12 omnilex-key=us-ms-regs-official--title-15--13#1.3.12}

If requested in writing, a hearing shall be scheduled within the State Department of Health not less than ten days nor more than 30 days following receipt of the request. On the basis of such hearing, the State Department of Health shall make a decision with respect to proposed action. This decision, together with the finding of the hearing officer, and reasons for the decision, shall be forwarded to the owner/applicant within 30 days of the hearing.

Subchapter 4 Inspections Rule 1.4.1 The Health Authority shall inspect annually each instate bottled water plant prior to issuing a permit, and shall make as many additional inspections as necessary for the enforcement of this regulation.

**History**
- *SOURCE: Miss. Code Ann.§ 75-29-19*
- *SOURCE: Miss. Code Ann.§ 75-29-19*

##### **15 Miss. Admin. Code Pt. 13, R. 1.4.2** Rule 1.4.2 {#sec-13-1.4.2 omnilex-key=us-ms-regs-official--title-15--13#1.4.2}

Whenever an inspection is made of a bottled water plant the findings shall be recorded on an official inspection form, and finished to the person in charge of the bottled water plant at the time of the inspection, or posted in a conspicuous place.

**History**
- *SOURCE: Miss. Code Ann.§ 75-29-19*

##### **15 Miss. Admin. Code Pt. 13, R. 1.4.3** Rule 1.4.3 {#sec-13-1.4.3 omnilex-key=us-ms-regs-official--title-15--13#1.4.3}

If violations noted on the inspection form are not corrected within the period specified by the Health Authority, a permit may be denied, suspended or revoked in accordance with this regulation.

**History**
- *SOURCE: Miss. Code Ann.§ 75-29-19*

##### **15 Miss. Admin. Code Pt. 13, R. 1.4.4** Rule 1.4.4 {#sec-13-1.4.4 omnilex-key=us-ms-regs-official--title-15--13#1.4.4}

The Health Authority may enter any bottled water plant, water dealer warehouse or distribution center during normal hours of operation, for the purpose of making inspections, or investigations to determine compliance with this regulation.

**History**
- *SOURCE: Miss. Code Ann.§ 75-29-19*

##### **15 Miss. Admin. Code Pt. 13, R. 1.4.5** Rule 1.4.5 {#sec-13-1.4.5 omnilex-key=us-ms-regs-official--title-15--13#1.4.5}

Out-of-state and out-of-country bottled water plants shall submit copies of current inspection and reports as prescribed in 105 items 105.06 and 105.07 of this section and as often as deemed necessary by the Department in order to assure compliance with this regulation.

**History**
- *SOURCE: Miss. Code Ann.§ 75-29-19 Subchapter 5 Permit Applications Rule 1.5.1 Application for an original or renewal permit for a bottled water plant operator or water dealer shall be made in writing to the Mississippi State Department of Health on forms provided by the Department. The application, incorporated by reference herein and titled Application for Water Dealer Permit or Application for Bottled Water Plant Operating Permit, shall state the location of the source of water, the location of the bottled water plant; the mailing address of the dealer and/or bottler, the treatment the water receives; the physical, microbiological, chemical and radiological qualities of the water, and other information determined necessary by the Department to carry out the provisions of this regulation. All information submitted shall be legible and in English or have an adequate English translation attached.*
- *SOURCE: Miss. Code Ann.§ 75-29-19*

##### **15 Miss. Admin. Code Pt. 13, R. 1.5.2** Rule 1.5.2 {#sec-13-1.5.2 omnilex-key=us-ms-regs-official--title-15--13#1.5.2}

Each permit shall be issued only for the water dealer or the bottled water plant named in the application, and shall not be transferable or assignable.

**History**
- *SOURCE: Miss. Code Ann.§ 75-29-19*

##### **15 Miss. Admin. Code Pt. 13, R. 1.5.3** Each permit shall be issued from date permitted until December 31st each year {#sec-13-1.5.3 omnilex-key=us-ms-regs-official--title-15--13#1.5.3}

**History**
- *SOURCE: Miss. Code Ann.§ 75-29-19*

##### **15 Miss. Admin. Code Pt. 13, R. 1.5.4** Rule 1.5.4 {#sec-13-1.5.4 omnilex-key=us-ms-regs-official--title-15--13#1.5.4}

Prior to approval of any application for a permit, the State Department of Health shall inspect the proposed instate bottled water plant to determine compliance with the requirements of this regulation.

**History**
- *SOURCE: Miss. Code Ann.§ 75-29-19 Subchapter 6 Review of Plans and Specifications Rule 1.6.1 Prior to construction, remodeling or conversion for use as a bottled water plant, plans and specifications shall be submitted to the Health Authority for review and approval. The plans and specifications shall indicate the proposed layout, arrangement, and construction materials of work areas and the type and model of proposed equipment and facilities to the extent necessary to determine whether the proposed facility will comply with the Regulation Governing Bottled Water.*
- *SOURCE: Miss. Code Ann.§ 75-29-19 Subchapter 7 Penalties Rule 1.7.1 Any person who operates a bottled water plant or causes water to be transported into or within the state for sale without first obtaining a permit as required by Section 105 of this regulation; or who operates a bottled water plant or water transportation vehicle violating an order to cease operations; or who maintains or operates a bottled water plant or water transport vehicle or vessel after revocation of the permit; or who at any time during the plant's working hours or downtime during the normal workday fails to allow a duly authorized representative of the Department to enter the premises to conduct an inspection is guilty of a misdemeanor, punishable as provided by law.*
- *SOURCE: Miss. Code Ann.§ 75-29-19*

##### **15 Miss. Admin. Code Pt. 13, R. 1.7.2** Fees: The annual permit fee for a bottled water plant and/or dealer is specified in Chapter 5 of this Subpart {#sec-13-1.7.2 omnilex-key=us-ms-regs-official--title-15--13#1.7.2}

Subchapter 8 Transportation of Bulk Water Rule 1.8.1 All water transported in bulk shall be from an approved source that meets the standards of protection, microbiological, chemical, radiological and physical qualities as outlined in this regulation.

**History**
- *SOURCE: Miss. Code Ann.§ 75-29-19*
- *SOURCE: Miss. Code Ann.§ 75-29-19*

##### **15 Miss. Admin. Code Pt. 13, R. 1.8.2** Rule 1.8.2 {#sec-13-1.8.2 omnilex-key=us-ms-regs-official--title-15--13#1.8.2}

As part of the pre-treatment process, bulk tanks, hoses, pumps and connections used for loading, transporting and unloading water shall be cleaned and sanitized. Raw water for transport shall be treated with an effective disinfectant.

**History**
- *SOURCE: Miss. Code Ann.§ 75-29-19*

##### **15 Miss. Admin. Code Pt. 13, R. 1.8.3** Tanks and filling and delivery hose connections shall be cleaned and sanitized regularly {#sec-13-1.8.3 omnilex-key=us-ms-regs-official--title-15--13#1.8.3}

The tank shall be sealed always unless being filled, being cleaned and sanitized and when the water is being delivered. A record of such cleaning and sanitizing shall be maintained with the vehicle and shall be available when requested by the Department. Pumps, hoses, connections and fittings shall be capped and protected from contamination when not in use. The tank manhole shall not be used as a means of filling the tank. During delivery of bulk water, to prevent collapse of the tank, the manhole may be opened but shall be provided with a single service air filter to prevent contamination.

**History**
- *SOURCE: Miss. Code Ann.§ 75-29-19*

##### **15 Miss. Admin. Code Pt. 13, R. 1.8.4** Rule 1.8.4 {#sec-13-1.8.4 omnilex-key=us-ms-regs-official--title-15--13#1.8.4}

All surfaces that come into contact with water during storage prior to transport, during transport or during storage after transport, shall be made of smooth impervious, non-absorbent, corrosion resistant and non-toxic material such as stainless steel of the American Iron and Steel Institute 300 Series, or equally corrosion-resistant non-toxic material. All water contact surfaces shall be free of substances that may render the water injurious to health or which may adversely affect the flavor, color, turbidity, odor, radiological, microbiological or chemical quality of the water.

**History**
- *SOURCE: Miss. Code Ann.§ 75-29-19*

##### **15 Miss. Admin. Code Pt. 13, R. 1.8.5** Rule 1.8.5 {#sec-13-1.8.5 omnilex-key=us-ms-regs-official--title-15--13#1.8.5}

Bulk water transport is intended to move raw water from one area to another for the purpose of treatment, packaging and human consumption. Such water shall not be dispensed directly to consumers from a bulk water transport or indirectly through some other vending device. In the case of an emergency such as a drinking water shortage or outage or a contaminated water supply, treated water may be dispensed directly from a properly sanitized water transport vehicle to the affected consumers provided such operation has been approved by a state or local health, environmental or emergency management group.

**History**
- *SOURCE: Miss. Code Ann.§ 75-29-19*

##### **15 Miss. Admin. Code Pt. 13, R. 1.8.6** Rule 1.8.6 {#sec-13-1.8.6 omnilex-key=us-ms-regs-official--title-15--13#1.8.6}

Suitable shelter shall be provided that protects the transport tank and its content from rain, dust, aerosols or other contaminants during the filling and delivery process. Overhead protection of the entire transport tanker including a work space at the rear of the tank and an overhead work space of adequate size shall be provided for use during the unloading process.

**History**
- *SOURCE: Miss. Code Ann.§ 75-29-19*

##### **15 Miss. Admin. Code Pt. 13, R. 1.8.7** Rule 1.8.7 {#sec-13-1.8.7 omnilex-key=us-ms-regs-official--title-15--13#1.8.7}

Any plant that is to receive bulk water must be constructed in a manner to receive water properly and to clean and sanitize the tanker after unloading. The tanker must be tagged and sealed after cleaning and sanitizing by the plant.

**History**
- *SOURCE: Miss. Code Ann.§ 75-29-19*

##### **15 Miss. Admin. Code Pt. 13, R. 1.8.8** Rule 1.8.8 {#sec-13-1.8.8 omnilex-key=us-ms-regs-official--title-15--13#1.8.8}

The cleaning tag shall be removed by the receiving plant and attached to the invoice or load manifest and provide the information as directed in item 109.09 of this section.

**History**
- *SOURCE: Miss. Code Ann.§ 75-29-19*

##### **15 Miss. Admin. Code Pt. 13, R. 1.8.9** Rule 1.8.9 {#sec-13-1.8.9 omnilex-key=us-ms-regs-official--title-15--13#1.8.9}

The cleaning tag shall specify: 1 name and address of plant where cleaned and sanitized 2 date of cleaning 3 signature of person who sanitized the unit

**History**
- *SOURCE: Miss. Code Ann.§ 75-29-19*

##### **15 Miss. Admin. Code Pt. 13, R. 1.8.10** Rule 1.8.10 {#sec-13-1.8.10 omnilex-key=us-ms-regs-official--title-15--13#1.8.10}

All vehicles and transport tanks containing bulk raw water for processing, processed water for bottling, or bottled water shall be legibly marked with the name and. address of the water bottling plant or water dealer in possession of the contents.

**History**
- *SOURCE: Miss. Code Ann.§ 75-29-19*

##### **15 Miss. Admin. Code Pt. 13, R. 1.8.11** Rule 1.8.11 {#sec-13-1.8.11 omnilex-key=us-ms-regs-official--title-15--13#1.8.11}

Tanks or vehicles transporting raw water for processing and bottling or processed water for bottling shall be sealed; and, in addition, for each shipment a shipping statement, invoice, or manifest shall be prepared by the dealer making the shipment indicating at least the following information: 1 Shipper's (dealer) name, address, and permit number. 2 Source and/or point of origin of shipment. 3 Tanker identity.

4 Name of product. 5 Net content. 6 Date of loading and date of shipment. 7 Name of supervising Health Authority at the source and at the point of origin if different. 8 Whether the contents are raw or processed.

**History**
- *SOURCE: Miss. Code Ann.§ 75-29-19*

##### **15 Miss. Admin. Code Pt. 13, R. 1.8.12** Rule 1.8.12 {#sec-13-1.8.12 omnilex-key=us-ms-regs-official--title-15--13#1.8.12}

Discontinuance of Operation: The Department shall order a bottled water plant or water dealer to discontinue operation if conditions represent a threat to the life or health of any person, or if the finished water or bulk water does not meet standards established by these rules. Such bottled water plant shall not operate until such time as the Department determines that the conditions that caused the operation to be discontinued no longer exist.

**History**
- *SOURCE: Miss. Code Ann.§ 75-29-19 Subchapter 9 Water Vending Machines Rule 1.9.1 A water vending machine shall comply with the regulation for bottled water plants except when inconsistent with the special requirements prescribed in this section and then the following requirements take precedent.*
- *SOURCE: Miss. Code Ann.§ 75-29-19*

##### **15 Miss. Admin. Code Pt. 13, R. 1.9.2** Rule 1.9.2 {#sec-13-1.9.2 omnilex-key=us-ms-regs-official--title-15--13#1.9.2}

Water vending machines shall be designed and constructed to allow easy cleaning and maintenance of all exterior and interior surfaces and component parts.

**History**
- *SOURCE: Miss. Code Ann.§ 75-29-19*

##### **15 Miss. Admin. Code Pt. 13, R. 1.9.3** Rule 1.9.3 {#sec-13-1.9.3 omnilex-key=us-ms-regs-official--title-15--13#1.9.3}

Water contact surfaces and parts of the water vending machine shall be of non- toxic, corrosion-resistant, non-absorbent material capable of withstanding repeated cleaning and sanitizing treatment.

**History**
- *SOURCE: Miss. Code Ann.§ 75-29-19*

##### **15 Miss. Admin. Code Pt. 13, R. 1.9.4** Water vending machines shall have a guarded corrosion resistant dispensing spout {#sec-13-1.9.4 omnilex-key=us-ms-regs-official--title-15--13#1.9.4}

**History**
- *SOURCE: Miss. Code Ann.§ 75-29-19*

##### **15 Miss. Admin. Code Pt. 13, R. 1.9.5** Rule 1.9.5 {#sec-13-1.9.5 omnilex-key=us-ms-regs-official--title-15--13#1.9.5}

Water vending machines shall be equipped to disinfect the vended water by ultra- light, ozone, or equally effective methods prior to delivery into the customer's container.

**History**
- *SOURCE: Miss. Code Ann.§ 75-29-19*

##### **15 Miss. Admin. Code Pt. 13, R. 1.9.6** Rule 1.9.6 {#sec-13-1.9.6 omnilex-key=us-ms-regs-official--title-15--13#1.9.6}

Water vending machines shall be equipped with monitoring devices designed to shut down operations of the machine when the treatment or disinfectant unit fails to function properly.

**History**
- *SOURCE: Miss. Code Ann.§ 75-29-19*

##### **15 Miss. Admin. Code Pt. 13, R. 1.9.7** Water vending machines shall be equipped with a self-closing, tight-fitting door on the vending compartment {#sec-13-1.9.7 omnilex-key=us-ms-regs-official--title-15--13#1.9.7}

**History**
- *SOURCE: Miss. Code Ann.§ 75-29-19*

##### **15 Miss. Admin. Code Pt. 13, R. 1.9.8** Rule 1.9.8 {#sec-13-1.9.8 omnilex-key=us-ms-regs-official--title-15--13#1.9.8}

Water vending machines shall be located only in retail food establishments or may be considered in other establishments routinely regulated by the Mississippi State Department of Health.

**History**
- *SOURCE: Miss. Code Ann.§ 75-29-19*

##### **15 Miss. Admin. Code Pt. 13, R. 1.9.9** The floor on which a water vending machine is located shall be smooth and of cleanable construction {#sec-13-1.9.9 omnilex-key=us-ms-regs-official--title-15--13#1.9.9}

**History**
- *SOURCE: Miss. Code Ann.§ 75-29-19*

##### **15 Miss. Admin. Code Pt. 13, R. 1.9.10** Rule 1.9.10 {#sec-13-1.9.10 omnilex-key=us-ms-regs-official--title-15--13#1.9.10}

Each machine shall have an adequate system for collecting and disposing drippage, spillage, and overflow of water to prevent creation of a nuisance.

**History**
- *SOURCE: Miss. Code Ann.§ 75-29-19*

##### **15 Miss. Admin. Code Pt. 13, R. 1.9.11** Each machine shall have a backflow prevention device for all connections with the water supply source {#sec-13-1.9.11 omnilex-key=us-ms-regs-official--title-15--13#1.9.11}

**History**
- *SOURCE: Miss. Code Ann.§ 75-29-19*

##### **15 Miss. Admin. Code Pt. 13, R. 1.9.12** The source of the water supply shall be an approved public water system {#sec-13-1.9.12 omnilex-key=us-ms-regs-official--title-15--13#1.9.12}

**History**
- *SOURCE: Miss. Code Ann.§ 75-29-19*

##### **15 Miss. Admin. Code Pt. 13, R. 1.9.13** Rule 1.9.13 {#sec-13-1.9.13 omnilex-key=us-ms-regs-official--title-15--13#1.9.13}

Owners, managers and operators of water vending machines shall ensure that the methods used for treatment of vended water are acceptable to the Department. Acceptable treatment includes distillation, ion-exchange, filtration, ultraviolet light, mineral addition and reverse osmosis.

**History**
- *SOURCE: Miss. Code Ann.§ 75-29-19*

##### **15 Miss. Admin. Code Pt. 13, R. 1.9.14** Operator Requirements 1 All water vending operators shall have a program that includes: {#sec-13-1.9.14 omnilex-key=us-ms-regs-official--title-15--13#1.9.14}

2 Cleaning, sanitizing and servicing of machines monthly. 3 Written servicing instructions. 4 Technical manuals for the machines. 5 Technical manuals for the water treatment appurtenances involved.

**History**
- *SOURCE: Miss. Code Ann.§ 75-29-19*

##### **15 Miss. Admin. Code Pt. 13, R. 1.9.15** Parts and surfaces of water vending machines shall be kept clean and maintained by the water vending machine operator {#sec-13-1.9.15 omnilex-key=us-ms-regs-official--title-15--13#1.9.15}

The vending chamber and the vending nozzle shall be cleaned and sanitized each time the machine is serviced. A record of cleaning and maintenance operations shall be kept by the operator for each water vending machine. These records shall be made available to the Department's employees upon request.

**History**
- *SOURCE: Miss. Code Ann.§ 75-29-19*

##### **15 Miss. Admin. Code Pt. 13, R. 1.9.16** Rule 1.9.16 {#sec-13-1.9.16 omnilex-key=us-ms-regs-official--title-15--13#1.9.16}

Water vending machine operators shall ensure that machines are maintained and monitored to dispense water meeting quality standards specified in this regulation. Analyses shall be performed by a laboratory certified by the Department to perform microbiological analyses of drinking water. Each machine's finished product shall be sampled at least once every 3 months to determine total coliform content. However, provided a satisfactory method of post-treatment disinfection is utilized and based on a sustained record of satisfactory total coliform analyses, the Department shall allow modification of the 3-month sampling requirement as follows: 1 When three consecutive 3-month samples are each found to contain zero coliform colonies per 100 milliliters of the vended water, microbiological sampling intervals shall be extended to a period not exceeding 6-months. Should a subsequent 6-month sample test positive for total coliform, the required sampling frequency shall revert to the 3-month frequency until 3 consecutive samples again test negative for total coliform bacteria. 2 If any sample collected from a machine is determined to be unsatisfactory, the machine shall be cleaned, sanitized and resampled immediately. If, after being cleaned and sanitized, the vended product is determined to be positive for coliform, the machine shall be taken out of service until the source of contamination has been located and corrected.

**History**
- *SOURCE: Miss. Code Ann.§ 75-29-19*

##### **15 Miss. Admin. Code Pt. 13, R. 1.9.17** Rule 1.9.17 {#sec-13-1.9.17 omnilex-key=us-ms-regs-official--title-15--13#1.9.17}

All records pertaining to the sampling and analyses shall be retained by the operator for a period of not less than 2 years. Results of the analyses shall be available for Department review upon request.

**History**
- *SOURCE: Miss. Code Ann.§ 75-29-19*

##### **15 Miss. Admin. Code Pt. 13, R. 1.9.18** Rule 1.9.18 {#sec-13-1.9.18 omnilex-key=us-ms-regs-official--title-15--13#1.9.18}

Each water vending machine shall have in a position clearly visible to customers the following information: 1 Name and address of operator. 2 The operator's permit issued by the department. 3 Name of the water supply purveyor. 4 The method of treatment that is utilized. 5 The method of post-treatment disinfection utilized. 6 A local or toll-free number that may be called for further information, problems, or complaints; or the name of the store or building manager can be listed when the machine is located within a business establishment and the establishment manager is responsible for the operation of the machine.

**History**
- *SOURCE: Miss. Code Ann.§ 75-29-19*

##### **15 Miss. Admin. Code Pt. 13, R. 1.9.19** Rule 1.9.19 {#sec-13-1.9.19 omnilex-key=us-ms-regs-official--title-15--13#1.9.19}

The vending machine shall bear the following label in type at least one inch in height: NOTICE: USE ONLY CONTAINERS THAT HAVE BEEN PROPERLY WASHED AND SANITIZED.

**History**
- *SOURCE: Miss. Code Ann.§ 75-29-19*

##### **15 Miss. Admin. Code Pt. 13, R. 1.9.20** Rule 1.9.20 {#sec-13-1.9.20 omnilex-key=us-ms-regs-official--title-15--13#1.9.20}

When containers are provided by the operator, the caps, closures and containers shall be stored and dispensed in a manner that prevents contamination of the article and also the remaining stock. Consumers may provide their own containers.

**History**
- *SOURCE: Miss. Code Ann.§ 75-29-19*

##### **15 Miss. Admin. Code Pt. 13, R. 1.9.21** Rule 1.9.21 {#sec-13-1.9.21 omnilex-key=us-ms-regs-official--title-15--13#1.9.21}

The Department shall collect and analyses samples of vended water when necessary to determine if the vended water meets the standards of potable water.

**History**
- *SOURCE: Miss. Code Ann.§ 75-29-19*

##### **15 Miss. Admin. Code Pt. 13, R. 1.9.22** Fees {#sec-13-1.9.22 omnilex-key=us-ms-regs-official--title-15--13#1.9.22}

Each person seeking an operating permit to install, operate, or maintain a water vending machine shall pay an annual fee as specified in Chapter 5 of this Subpart, for each machine to the Department. Fees shall be non-refundable. Specific authority: Section 41-3-18, MS Code of 1972, Annotated.

**History**
- *SOURCE: Miss. Code Ann.§ 75-29-19*

##### **15 Miss. Admin. Code Pt. 13, R. 1.9.23** Rule 1.9.23 {#sec-13-1.9.23 omnilex-key=us-ms-regs-official--title-15--13#1.9.23}

The Department shall order a water vending machine operator to discontinue the operation of any water vending machine that represents a threat to the life or

health of any person, or whose finished water does not meet the minimum standards provided for in this chapter. Such water vending machines shall not be returned to use or used until such time the Department determines that the conditions that caused the discontinuance of operation no longer exist.

**History**
- *SOURCE: Miss. Code Ann.§ 75-29-19*

##### **15 Miss. Admin. Code Pt. 13, R. 1.9.24** Rule 1.9.24 {#sec-13-1.9.24 omnilex-key=us-ms-regs-official--title-15--13#1.9.24}

The Department shall revoke a permit when it is determined that there has been a substantial failure to comply with the provisions of the rule by which the health or life of an individual, or the health or lives of individuals is threatened or impaired, or by which or through which, directly or indirectly, disease is caused.

**History**
- *SOURCE: Miss. Code Ann.§ 75-29-19 Chapter 2 FOOD CODE Subchapter 1 Purpose Rule 2.1.1 This regulation consists of requirements for the design, construction, management and operation of food service establishments. It provides for plans submission and approval, issuance of permits, and collection of fees. The requirements are to safeguard the public health.*
- *SOURCE: Miss. Code Ann.§ 75-29-19*

##### **15 Miss. Admin. Code Pt. 13, R. 2.1.2** Rule 2.1.2 {#sec-13-2.1.2 omnilex-key=us-ms-regs-official--title-15--13#2.1.2}

Authorization: The Mississippi State Department of Health is authorized to promulgate these regulations under and by virtue of Sections 41-3-15(4)(I)(I) and 41-3-17 of the Mississippi Code of 1972, Annotated.

**History**
- *SOURCE: Miss. Code Ann.§ 75-29-19*

##### **15 Miss. Admin. Code Pt. 13, R. 2.1.3** Rule 2.1.3 {#sec-13-2.1.3 omnilex-key=us-ms-regs-official--title-15--13#2.1.3}

Adoption of the Food Code: This Regulation adopts by reference the current revision of the Food Code, Recommendations of the United States Public Health Service / Food and Drug Administration, as published by the U.S. Department of Health and Human Services, Public Health Service, Food and Drug Administration.

**History**
- *SOURCE: Miss. Code Ann.§ 75-29-19 Subchapter 2 Insertions and Changes to the 2001 FDA Food Code Rule 2.2.1 Chapter 1, Subpart 1-201.10 (B)(36)(a): "Food Establishment" means an operation that stores, prepares, packages, serves, vends or otherwise provides FOOD for human consumption (for pay):*
- *SOURCE: Miss. Code Ann.§ 75-29-19*

##### **15 Miss. Admin. Code Pt. 13, R. 2.2.2** Food Protection {#sec-13-2.2.2 omnilex-key=us-ms-regs-official--title-15--13#2.2.2}

Chapter 1, Subpart 1-201.10 (B)(36)(b)(ii): An operation that is conducted in a mobile, stationary, temporary or permanent facility or location; where consumption is on or off the PREMISES.

**History**
- *SOURCE: Miss. Code Ann.§ 75-29-19*

##### **15 Miss. Admin. Code Pt. 13, R. 2.2.3** Rule 2.2.3 {#sec-13-2.2.3 omnilex-key=us-ms-regs-official--title-15--13#2.2.3}

Chapter 2, Subpart 2-101.11: Assignment: The PERMIT HOLDER shall be the PERSON IN CHARGE or shall designate a PERSON IN CHARGE and shall ensure that a PERSON IN CHARGE is present at the FOOD ESTABLISHMENT during all hours of operation. The permit holder, or his/her designee, must have successfully completed a manager certification course approved by the Regulatory Authority. This course shall include knowledge as specified in 2- 102.11. This shall be effective for any new facility from July 1, 1998. It shall be effective for existing facilities from January, 1999.

**History**
- *SOURCE: Miss. Code Ann.§ 75-29-19*

##### **15 Miss. Admin. Code Pt. 13, R. 2.2.4** Rule 2.2.4 {#sec-13-2.2.4 omnilex-key=us-ms-regs-official--title-15--13#2.2.4}

Chapter 3, Subpart 303-1.11: Preventing Contamination from Hands: (B) Except when washing fruits and vegetables as specified under § 3-302.15, FOOD EMPLOYEES may not contact exposed, READY-TO-EAT FOOD with their bare hands and shall use suitable UTENSILS such as deli tissue, spatulas, tongs, SINGLE-USE gloves, or dispensing EQUIPMENT.

**History**
- *SOURCE: Miss. Code Ann.§ 75-29-19*

##### **15 Miss. Admin. Code Pt. 13, R. 2.2.5** Rule 2.2.5 {#sec-13-2.2.5 omnilex-key=us-ms-regs-official--title-15--13#2.2.5}

Chapter 8, Subpart 8-403.50: Public Information: (B) Post the current Food Permit/Inspection Record in a location in the food establishment conspicuous to consumers, as directed by the Health Authority.

**History**
- *SOURCE: Miss. Code Ann.§ 75-29-19*

##### **15 Miss. Admin. Code Pt. 13, R. 2.2.6** Rule 2.2.6 {#sec-13-2.2.6 omnilex-key=us-ms-regs-official--title-15--13#2.2.6}

Chapter 8, Subpart 8-405.11: Timely Correction: (C) When the same critical violation is identified during a subsequent inspection within a 12-month period, establishment management is required to develop a "Risk Control Plan" to prevent the recurrence of the same hazard.

Food Protection

4. Annex 6. Food Processing

**History**
- *SOURCE: Miss. Code Ann.§ 75-29-19 Subchapter 3 Annexes Rule 2.3.1 The following Annexes to the Food Code are hereby inserted as Appendices of this Regulation: 1. Annex 1. Compliance and Enforcement 2. Annex 3. Public Health Reasons 3. Annex 5. HACCP Guidelines*
- *SOURCE: Miss. Code Ann.§ 75-29-19*

##### **15 Miss. Admin. Code Pt. 13, R. 2.3.2** Rule 2.3.2 {#sec-13-2.3.2 omnilex-key=us-ms-regs-official--title-15--13#2.3.2}

Annex 1, Subparagraph 8-801.10: The REGULATORY AUTHORITY may seek an administrative or judicial remedy to achieve compliance with the provisions of this Code if a PERSON operating a FOOD ESTABLISHMENT or EMPLOYEE: (C) Allows serious or repeated code violations to remain uncorrected beyond time frames for correction APPROVED, directed, or ordered by the REGULATORY AUTHORITY under 8-405.11(A), (B) and (C), and 8-406.11(A) and (B);

**History**
- *SOURCE: Miss. Code Ann.§ 75-29-19*

##### **15 Miss. Admin. Code Pt. 13, R. 2.3.3** Rule 2.3.3 {#sec-13-2.3.3 omnilex-key=us-ms-regs-official--title-15--13#2.3.3}

Annex 1, Subparagraph 8-804.10: Conditions Warranting Action: The REGULATORY AUTHORITY may summarily suspend a PERMIT to operate a FOOD ESTABLISHMENT: If it determines through inspection or examination of EMPLOYEES, FOOD, records or other means as specified in this Code, that an IMMINENT HEALTH HAZARD exists, or (B) when 6 or more critical items have been identified during the two most recent routine inspections of a FOOD ESTABLISHMENT.

**History**
- *SOURCE: Miss. Code Ann.§ 75-29-19*

##### **15 Miss. Admin. Code Pt. 13, R. 2.3.4** Rule 2.3.4 {#sec-13-2.3.4 omnilex-key=us-ms-regs-official--title-15--13#2.3.4}

Annex 1, Subparagraph 8-811.10: Authorities, Methods, Fines and Sentences: (B)(1) A fine of not more than $500 dollars, or by imprisonment not exceeding 1 year, or both the fine and imprisonment.

**History**
- *SOURCE: Miss. Code Ann.§ 75-29-19*

#### **Chapter 3** REGULATION GOVERNING THE MANUFACTURE, STORAGE AND HANDLING OF ICE Subchapter 1 Purpose Rule 3.1.1 To establish a uniform regulation for all plants within the State of Mississippi for the purpose of protecting public health.

##### **15 Miss. Admin. Code Pt. 13, R. 3.2.2** An “ice plant” is any place or establishment where ice is manufactured, stored, or processed for sale as ice {#sec-13-3.2.2 omnilex-key=us-ms-regs-official--title-15--13#3.2.2}

**History**
- *SOURCE: Miss. Code Ann.§ 75-29-19*

##### **15 Miss. Admin. Code Pt. 13, R. 3.2.3** “Adequate” means that which is needed to accomplish the intended purpose in keeping with good public health practice {#sec-13-3.2.3 omnilex-key=us-ms-regs-official--title-15--13#3.2.3}

**History**
- *SOURCE: Miss. Code Ann.§ 75-29-19*

##### **15 Miss. Admin. Code Pt. 13, R. 3.2.4** Rule 3.2.4 {#sec-13-3.2.4 omnilex-key=us-ms-regs-official--title-15--13#3.2.4}

“Plant” means the building or buildings or parts thereof, used in connection with the manufacturing, processing, packaging, labeling, or holding of ice intended for human consumption.

**History**
- *SOURCE: Miss. Code Ann.§ 75-29-19*

##### **15 Miss. Admin. Code Pt. 13, R. 3.2.5** Rule 3.2.5 {#sec-13-3.2.5 omnilex-key=us-ms-regs-official--title-15--13#3.2.5}

“Sanitize” means adequate treatment for surfaces by a process that is effective in destroying vegetative cells of pathogenic bacteria and in substantially reducing other microorganisms. Such treatments shall not adversely affect the product and shall be safe for the consumer.

**History**
- *SOURCE: Miss. Code Ann.§ 75-29-19*

##### **15 Miss. Admin. Code Pt. 13, R. 3.2.6** “Stand-alone ice vending machine” means a free-standing, on-demand ice plant providing point of sale {#sec-13-3.2.6 omnilex-key=us-ms-regs-official--title-15--13#3.2.6}

Subchapter 3 Grounds Rule 3.3.1 The grounds around an ice plant under the control of the operator shall be free from conditions which may result in the contamination of ice including, but not limited to, the following:

**History**
- *SOURCE: Miss Code Ann. §75-29-19*
- *SOURCE: Miss. Code Ann.§ 75-29-19*

##### **15 Miss. Admin. Code Pt. 13, R. 3.3.2** Rule 3.3.2 {#sec-13-3.3.2 omnilex-key=us-ms-regs-official--title-15--13#3.3.2}

Improperly stored equipment, litter, waste, refuse, and uncut weeds or grass within the immediate vicinity of the plant buildings or structures that may constitute an attractant, breeding place, or harborage for rodents, insects, and other pests.

**History**
- *SOURCE: Miss. Code Ann.§ 75-29-19*

##### **15 Miss. Admin. Code Pt. 13, R. 3.3.3** Rule 3.3.3 {#sec-13-3.3.3 omnilex-key=us-ms-regs-official--title-15--13#3.3.3}

Excessively dusty roads, yards, or parking lots that may constitute a source of contamination in areas where ice is exposed.

**History**
- *SOURCE: Miss. Code Ann.§ 75-29-19*

##### **15 Miss. Admin. Code Pt. 13, R. 3.3.4** Rule 3.3.4 {#sec-13-3.3.4 omnilex-key=us-ms-regs-official--title-15--13#3.3.4}

Inadequately drained areas that may contribute contamination to ice products through seepage or foot-borne filth and by providing a breeding place for insects or microorganisms.

**History**
- *SOURCE: Miss. Code Ann.§ 75-29-19 Subchapter 4 Plant Construction and Design Rule 3.4.1 Plant buildings and structures shall be suitable in size, construction, and design to facilitate maintenance and sanitary operations. The plant and facilities shall:*
- *SOURCE: Miss. Code Ann.§ 75-29-19*

##### **15 Miss. Admin. Code Pt. 13, R. 3.4.2** Food Protection {#sec-13-3.4.2 omnilex-key=us-ms-regs-official--title-15--13#3.4.2}

Provide sufficient space for such placement of equipment and storage of materials as is necessary for sanitary operations and production of safe ice. Floors, walls, and ceilings in the plant shall be of such construction as to be adequately cleanable and shall be kept clean and in good repair. Fixtures, ducts, and pipes shall not be so suspended over working areas that drip or condensate may contaminate ice or ice contact surfaces. Aisles or working spaces between equipment and between equipment and walls shall be unobstructed and of sufficient width to permit employees to perform their duties without contamination of ice or ice contact surfaces with clothing or personal contact.

**History**
- *SOURCE: Miss. Code Ann.§ 75-29-19*

##### **15 Miss. Admin. Code Pt. 13, R. 3.4.3** Rule 3.4.3 {#sec-13-3.4.3 omnilex-key=us-ms-regs-official--title-15--13#3.4.3}

Provide separation by partition, location, or other effective means for those operations which may cause contamination of ice products with undesirable microorganisms, chemicals, filth, or other extraneous material.

**History**
- *SOURCE: Miss. Code Ann.§ 75-29-19*

##### **15 Miss. Admin. Code Pt. 13, R. 3.4.4** Provide adequate lighting to handwashing areas, dressing and locker rooms, and toilet rooms {#sec-13-3.4.4 omnilex-key=us-ms-regs-official--title-15--13#3.4.4}

Light bulbs, fixtures, skylights, or other glass suspended over exposed ice in any step of preparation shall be of the safety type or otherwise protected to prevent contamination in case of breakage.

**History**
- *SOURCE: Miss. Code Ann.§ 75-29-19*

##### **15 Miss. Admin. Code Pt. 13, R. 3.4.5** Provide adequate ventilation or control equipment to minimize odors and noxious fumes or vapors {#sec-13-3.4.5 omnilex-key=us-ms-regs-official--title-15--13#3.4.5}

Such ventilation or control equipment shall not create conditions that may contribute to contamination by airborne contaminants.

**History**
- *SOURCE: Miss. Code Ann.§ 75-29-19*

##### **15 Miss. Admin. Code Pt. 13, R. 3.4.6** Rule 3.4.6 {#sec-13-3.4.6 omnilex-key=us-ms-regs-official--title-15--13#3.4.6}

Provide, where necessary, effective screening or other protection against birds, animals, and vermin (including, but not limited to, insects and rodents).

**History**
- *SOURCE: Miss. Code Ann.§ 75-29-19 Subchapter 5 Water Supply*

##### **15 Miss. Admin. Code Pt. 13, R. 3.5.1** Food Protection {#sec-13-3.5.1 omnilex-key=us-ms-regs-official--title-15--13#3.5.1}

All water used in the manufacture of ice shall be of a quality meeting the standards of the State Board of Health for potable water, and the water supplies used by ice plants shall be subject to the approval of the State Department of Health. Samples for bacteriological analysis should be taken within each six (6) month period and samples for chemical analysis should be taken every two (2) years.

**History**
- *SOURCE: Miss. Code Ann.§ 75-29-19*

##### **15 Miss. Admin. Code Pt. 13, R. 3.5.2** Submerging or spraying of ice cakes shall be carried out only with water of sanitary quality {#sec-13-3.5.2 omnilex-key=us-ms-regs-official--title-15--13#3.5.2}

**History**
- *SOURCE: Miss. Code Ann.§ 75-29-19*

##### **15 Miss. Admin. Code Pt. 13, R. 3.5.3** Cross connections between water supplies of approved quality and unapproved water supplies shall be prohibited {#sec-13-3.5.3 omnilex-key=us-ms-regs-official--title-15--13#3.5.3}

Cross connections between private water supplies and municipal water supplies are not approved.

**History**
- *SOURCE: Miss. Code Ann.§ 75-29-19 Subchapter 6 Sewage Disposal Rule 3.6.1 Sewage disposal shall be made into an adequate sewage system or disposed of through other adequate means.*
- *SOURCE: Miss. Code Ann.§ 75-29-19 Subchapter 7 Plumbing Rule 3.7.1 Plumbing shall be of adequate size and design and adequately installed and maintained to:*
- *SOURCE: Miss. Code Ann.§ 75-29-19*

##### **15 Miss. Admin. Code Pt. 13, R. 3.7.2** Carry sufficient quantities of water to required locations throughout the plant {#sec-13-3.7.2 omnilex-key=us-ms-regs-official--title-15--13#3.7.2}

**History**
- *SOURCE: Miss. Code Ann.§ 75-29-19*

##### **15 Miss. Admin. Code Pt. 13, R. 3.7.3** Properly convey sewage and liquid disposable waste from the plant {#sec-13-3.7.3 omnilex-key=us-ms-regs-official--title-15--13#3.7.3}

**History**
- *SOURCE: Miss. Code Ann.§ 75-29-19*

##### **15 Miss. Admin. Code Pt. 13, R. 3.7.4** Not constitute a source of contamination {#sec-13-3.7.4 omnilex-key=us-ms-regs-official--title-15--13#3.7.4}

**History**
- *SOURCE: Miss. Code Ann.§ 75-29-19*

##### **15 Miss. Admin. Code Pt. 13, R. 3.7.5** Rule 3.7.5 {#sec-13-3.7.5 omnilex-key=us-ms-regs-official--title-15--13#3.7.5}

Provide adequate floor drainage in all areas where floors are subject to flooding type cleaning or where normal operations release or discharge water or other liquid waste on the floor.

Food Protection

**History**
- *SOURCE: Miss. Code Ann.§ 75-29-19 Subchapter 8 Toilet Facilities Rule 3.8.1 Each plant shall provide its employees with adequate toilet and associated hand- washing facilities within the plant. Toilet rooms shall be furnished with toilet tissue. The facilities shall be maintained in a sanitary condition and kept in good repair at all times. Doors to toilet rooms shall be self-closing and shall not open directly into areas where ice is exposed to airborne contamination, except where alternate means have been taken to prevent such contamination (such as double doors, positive air-flow systems, etc.). Signs shall be posted directing employees to wash their hands with cleaning soap or detergents after using toilet.*
- *SOURCE: Miss. Code Ann.§ 75-29-19 Subchapter 9 Hand-washing Facilities Rule 3.9.1 Adequate and convenient facilities for hand washing and, where appropriate, hand sanitizing shall be provided at each location in the plant where good sanitary practices require employees to wash or sanitize and dry their hands. Such facilities shall be furnished with running water at a suitable temperature for hand washing, effective hand-cleaning and sanitizing preparations, sanitary towel service or suitable drying devices, and, where appropriate, easily cleanable waste receptacles.*
- *SOURCE: Miss. Code Ann.§ 75-29-19 Subchapter 10 Rubbish and Offal Disposal Rule 3.10.1 Rubbish and any offal shall be so conveyed, stored, and disposed of as to minimize the development of odor, prevent waste from becoming an attractant and harborage or breeding place for vermin, and prevent contamination.*
- *SOURCE: Miss. Code Ann.§ 75-29-19 Subchapter 11 Equipment Rule 3.11.1 All plant equipment and utensils should be (1) suitable for their intended use, (2) so designed and of such material and workmanship as to be adequately cleanable, and (3) properly maintained. The design, construction and use of such equipment and utensils shall preclude the adulteration of ice with lubricants, fuel, metal fragments, contaminated water, or any other contaminants. All equipment should be so installed and maintained as to facilitate the cleaning of the equipment and of all adjacent spaces.*
- *SOURCE: Miss. Code Ann.§ 75-29-19 Subchapter 12 Personnel*

##### **15 Miss. Admin. Code Pt. 13, R. 3.12.1** Food Protection {#sec-13-3.12.1 omnilex-key=us-ms-regs-official--title-15--13#3.12.1}

No person affected by disease in a communicable form, or while a carrier of such disease, or while affected with boils, sores, infected wounds, or other abnormal sources of microbiological contamination, shall work in an ice plant in any capacity in which there is a reasonable possibility of ice becoming contaminated by such person, or of disease being transmitted by such person to other individuals.

**History**
- *SOURCE: Miss. Code Ann.§ 75-29-19*

##### **15 Miss. Admin. Code Pt. 13, R. 3.12.2** Rule 3.12.2 {#sec-13-3.12.2 omnilex-key=us-ms-regs-official--title-15--13#3.12.2}

**History**
- *SOURCE: Miss. Code Ann.§ 75-29-19*

##### **15 Miss. Admin. Code Pt. 13, R. 3.12.3** All persons while working in direct contact with ice shall {#sec-13-3.12.3 omnilex-key=us-ms-regs-official--title-15--13#3.12.3}

Wear clean outer garments, maintain a high degree of personal cleanliness, and conform to hygienic practices while on duty, to the extent necessary to prevent contamination of ice products.

**History**
- *SOURCE: Miss. Code Ann.§ 75-29-19*

##### **15 Miss. Admin. Code Pt. 13, R. 3.12.4** Rule 3.12.4 {#sec-13-3.12.4 omnilex-key=us-ms-regs-official--title-15--13#3.12.4}

Wash their hands thoroughly (and sanitize if necessary to prevent contamination by undesirable microorganisms) in an adequate hand-washing facility before starting work, after each absence from the work station and at any other time when the hands may have become soiled or contaminated.

**History**
- *SOURCE: Miss. Code Ann.§ 75-29-19*

##### **15 Miss. Admin. Code Pt. 13, R. 3.12.5** Rule 3.12.5 {#sec-13-3.12.5 omnilex-key=us-ms-regs-official--title-15--13#3.12.5}

Remove all insecure jewelry and, during periods where ice is manipulated by hand, remove from hands any jewelry that cannot be adequately sanitized.

**History**
- *SOURCE: Miss. Code Ann.§ 75-29-19*

##### **15 Miss. Admin. Code Pt. 13, R. 3.12.6** If gloves are used in ice handling, maintain them in an intact, clean and sanitary condition {#sec-13-3.12.6 omnilex-key=us-ms-regs-official--title-15--13#3.12.6}

Such gloves should be of an impermeable material except where their usage would be inappropriate or incompatible with the work involved.

**History**
- *SOURCE: Miss. Code Ann.§ 75-29-19*

##### **15 Miss. Admin. Code Pt. 13, R. 3.12.7** Wear hair nets, headbands, caps, or other effective hair restraints {#sec-13-3.12.7 omnilex-key=us-ms-regs-official--title-15--13#3.12.7}

**History**
- *SOURCE: Miss. Code Ann.§ 75-29-19*

##### **15 Miss. Admin. Code Pt. 13, R. 3.12.8** Rule 3.12.8 {#sec-13-3.12.8 omnilex-key=us-ms-regs-official--title-15--13#3.12.8}

Take any other necessary precautions to prevent contamination of foods with microorganisms or foreign substances including, but not limited to, perspiration, hair, cosmetics, tobacco, chemicals, and medicants.

Food Protection

Subchapter 13 Labeling Rule 3.13.1 All bags, boxes, or other containers of ice intended for human consumption must clearly state the plant number, name and location of the manufacturer with the exception of those provided by stand-alone ice vending machines.

**History**
- *SOURCE: Miss. Code Ann.§ 75-29-19*
- *SOURCE: Miss Code Ann. §75-29-19*

##### **15 Miss. Admin. Code Pt. 13, R. 3.13.2** Rule 3.13.2 {#sec-13-3.13.2 omnilex-key=us-ms-regs-official--title-15--13#3.13.2}

All stand-alone ice vending machines must clearly display the permit number, name, and physical location of the manufacturer, and the phone number of a responsible official.

Chapter 4 REGULATION GOVERNING MANUFACTURE AND SALE OF FOOD AND FOOD PRODUCTS Subchapter 1 Purpose Rule 4.1.1 This regulation prescribes requirements for the intrastate and interstate sale of food and food products, prevents the sale of adulterated or mislabeled food or food products, prescribes good manufacturing practices, adopts requirements for specific standardized foods, and provides for the issuing of permits to food manufacturers, processors, and warehouses. This regulation applies only to food and food products not otherwise regulated by existing state law.

**History**
- *SOURCE: Miss Code Ann. §75-29-19*
- *SOURCE: Miss. Code Ann.§ 75-29-19*

##### **15 Miss. Admin. Code Pt. 13, R. 4.1.2** Rule 4.1.2 {#sec-13-4.1.2 omnilex-key=us-ms-regs-official--title-15--13#4.1.2}

Authorization: The State Board of Hea1th is authorized to promulgate these regulations under and by virtue of Section 75-29-19, Mississippi Code of 1972, Annotated.

**History**
- *SOURCE: Miss. Code Ann.§ 75-29-19*

##### **15 Miss. Admin. Code Pt. 13, R. 4.1.3** Rule 4.1.3 {#sec-13-4.1.3 omnilex-key=us-ms-regs-official--title-15--13#4.1.3}

Adoption by Reference: This regulation adopts by reference specific parts of the Code of Federal Regulations, 21 CFR, ( Subchapter B ( Food for Human Consumption ), recommended by the U.S. Food and Drug Administration/U.S. Department of Health and Human Services, including, but not limited to, the following sections.

**History**
- *SOURCE: Miss. Code Ann.§ 75-29-19 Subchapter 2 Food for Human Consumption Rule 4.2.1 General requirements, including state and local requirements, misbranding for reasons other than labeling, and specific administrative rulings and decisions shall be regulated as set forth in 21 CFR Part 100.*
- *SOURCE: Miss. Code Ann.§ 75-29-19*

##### **15 Miss. Admin. Code Pt. 13, R. 4.2.2** Food labeling shall be regulated as set forth in 21 CFR Part 101 {#sec-13-4.2.2 omnilex-key=us-ms-regs-official--title-15--13#4.2.2}

**History**
- *SOURCE: Miss. Code Ann.§ 75-29-19*

##### **15 Miss. Admin. Code Pt. 13, R. 4.2.3** Common or usual name for nonstandardized foods shall be regulated as set forth in 21 CFR Part l02 {#sec-13-4.2.3 omnilex-key=us-ms-regs-official--title-15--13#4.2.3}

**History**
- *SOURCE: Miss. Code Ann.§ 75-29-19*

##### **15 Miss. Admin. Code Pt. 13, R. 4.2.4** Quality standards for food with no identity standards shall be regulated as set forth in 21 CFR Part -103 {#sec-13-4.2.4 omnilex-key=us-ms-regs-official--title-15--13#4.2.4}

**History**
- *SOURCE: Miss. Code Ann.§ 75-29-19*

##### **15 Miss. Admin. Code Pt. 13, R. 4.2.5** Nutritional quality guidelines for foods shall be regulated as set forth in 21 CFR Part 104 {#sec-13-4.2.5 omnilex-key=us-ms-regs-official--title-15--13#4.2.5}

**History**
- *SOURCE: Miss. Code Ann.§ 75-29-19*

##### **15 Miss. Admin. Code Pt. 13, R. 4.2.6** Foods for special dietary use shall be regulated as set forth in-21 CFR Part 105 {#sec-13-4.2.6 omnilex-key=us-ms-regs-official--title-15--13#4.2.6}

Infant formula quality control procedures shall be regulated as set forth in 21 CFR Part 106.

**History**
- *SOURCE: Miss. Code Ann.§ 75-29-19*

##### **15 Miss. Admin. Code Pt. 13, R. 4.2.7** Infant formula shall be regulated as set forth in 21 CFR Part 107 {#sec-13-4.2.7 omnilex-key=us-ms-regs-official--title-15--13#4.2.7}

**History**
- *SOURCE: Miss. Code Ann.§ 75-29-19*

##### **15 Miss. Admin. Code Pt. 13, R. 4.2.8** Rule 4.2.8 {#sec-13-4.2.8 omnilex-key=us-ms-regs-official--title-15--13#4.2.8}

Unavoidable contaminants in food for human consumption and food-packaging material shall be regulated as set forth in 21 CFR Part 109.

**History**
- *SOURCE: Miss. Code Ann.§ 75-29-19*

##### **15 Miss. Admin. Code Pt. 13, R. 4.2.9** Rule 4.2.9 {#sec-13-4.2.9 omnilex-key=us-ms-regs-official--title-15--13#4.2.9}

Current good manufacturing practice in manufacturing, packing, or holding human food shall be regulated as set forth in 21 CFR Part 117 Subpart A, Subpart B, and Subpart F.

**History**
- *SOURCE: Miss. Code Ann.§ 75-29-19*

##### **15 Miss. Admin. Code Pt. 13, R. 4.2.10** Rule 4.2.10 {#sec-13-4.2.10 omnilex-key=us-ms-regs-official--title-15--13#4.2.10}

Thermally processed low-acid foods packaged in hermetically sealed containers shall be regulated as set forth in 21 CFR Part 113.

**History**
- *SOURCE: Miss. Code Ann.§ 75-29-19*

##### **15 Miss. Admin. Code Pt. 13, R. 4.2.11** Acidified foods.sha1l be regulated as set forth in 21 CFR Part 114 {#sec-13-4.2.11 omnilex-key=us-ms-regs-official--title-15--13#4.2.11}

**History**
- *SOURCE: Miss. Code Ann.§ 75-29-19*

##### **15 Miss. Admin. Code Pt. 13, R. 4.2.12** Seafood HACCP shall be regulated as set forth in 21 CFR Part 123 {#sec-13-4.2.12 omnilex-key=us-ms-regs-official--title-15--13#4.2.12}

**History**
- *SOURCE: Miss. Code Ann.§ 75-29-19*

##### **15 Miss. Admin. Code Pt. 13, R. 4.2.13** Food standards: General shall be regulated as set forth in 21 CFR1 Part 130 {#sec-13-4.2.13 omnilex-key=us-ms-regs-official--title-15--13#4.2.13}

**History**
- *SOURCE: Miss. Code Ann.§ 75-29-19*

##### **15 Miss. Admin. Code Pt. 13, R. 4.2.14** Cheeses and related cheese products shall be regulated as set forth in 21 CFR Part 133 {#sec-13-4.2.14 omnilex-key=us-ms-regs-official--title-15--13#4.2.14}

**History**
- *SOURCE: Miss. Code Ann.§ 75-29-19*

##### **15 Miss. Admin. Code Pt. 13, R. 4.2.15** Bakery products shall be regulated as set forth in 21 CFR Part 136 {#sec-13-4.2.15 omnilex-key=us-ms-regs-official--title-15--13#4.2.15}

**History**
- *SOURCE: Miss. Code Ann.§ 75-29-19*

##### **15 Miss. Admin. Code Pt. 13, R. 4.2.16** Cereal flours and related products shall be regulated as set forth in 21 CFR Part 137 {#sec-13-4.2.16 omnilex-key=us-ms-regs-official--title-15--13#4.2.16}

**History**
- *SOURCE: Miss. Code Ann.§ 75-29-19*

##### **15 Miss. Admin. Code Pt. 13, R. 4.2.17** Macaroni and noodle products shall be regulated as set forth in 21 CFR Part 139 {#sec-13-4.2.17 omnilex-key=us-ms-regs-official--title-15--13#4.2.17}

**History**
- *SOURCE: Miss. Code Ann.§ 75-29-19*

##### **15 Miss. Admin. Code Pt. 13, R. 4.2.18** Canned fruits shall be regulated as set forth in 21 CFR Part 145 {#sec-13-4.2.18 omnilex-key=us-ms-regs-official--title-15--13#4.2.18}

**History**
- *SOURCE: Miss. Code Ann.§ 75-29-19*

##### **15 Miss. Admin. Code Pt. 13, R. 4.2.19** Canned fruit juices shall be regulated as set forth in 21 CFR Part 146 {#sec-13-4.2.19 omnilex-key=us-ms-regs-official--title-15--13#4.2.19}

**History**
- *SOURCE: Miss. Code Ann.§ 75-29-19*

##### **15 Miss. Admin. Code Pt. 13, R. 4.2.20** Fruit butters, jellies, preserves, and related products shall be regulated as set forth in 21 CFR Part 150 {#sec-13-4.2.20 omnilex-key=us-ms-regs-official--title-15--13#4.2.20}

**History**
- *SOURCE: Miss. Code Ann.§ 75-29-19*

##### **15 Miss. Admin. Code Pt. 13, R. 4.2.21** Fruit pies shall be regulated as set forth in 21 CFR Part 152 {#sec-13-4.2.21 omnilex-key=us-ms-regs-official--title-15--13#4.2.21}

**History**
- *SOURCE: Miss. Code Ann.§ 75-29-19*

##### **15 Miss. Admin. Code Pt. 13, R. 4.2.22** Canned vegetables shall be regulated as set forth in 21 CFR Part 155 {#sec-13-4.2.22 omnilex-key=us-ms-regs-official--title-15--13#4.2.22}

**History**
- *SOURCE: Miss. Code Ann.§ 75-29-19*

##### **15 Miss. Admin. Code Pt. 13, R. 4.2.23** Vegetable juices shall be regulated as set forth in 21 CFR Part 156 {#sec-13-4.2.23 omnilex-key=us-ms-regs-official--title-15--13#4.2.23}

**History**
- *SOURCE: Miss. Code Ann.§ 75-29-19*

##### **15 Miss. Admin. Code Pt. 13, R. 4.2.24** Frozen vegetables shall be regulated as set forth in 21 CFR Part 158 {#sec-13-4.2.24 omnilex-key=us-ms-regs-official--title-15--13#4.2.24}

**History**
- *SOURCE: Miss. Code Ann.§ 75-29-19*

##### **15 Miss. Admin. Code Pt. 13, R. 4.2.25** Eggs and egg products shall be regulated as set forth in 21 CFR Part 160 {#sec-13-4.2.25 omnilex-key=us-ms-regs-official--title-15--13#4.2.25}

**History**
- *SOURCE: Miss. Code Ann.§ 75-29-19*

##### **15 Miss. Admin. Code Pt. 13, R. 4.2.26** Cacao products shall be regulated as set forth in 21 CFR Part 163 {#sec-13-4.2.26 omnilex-key=us-ms-regs-official--title-15--13#4.2.26}

**History**
- *SOURCE: Miss. Code Ann.§ 75-29-19*

##### **15 Miss. Admin. Code Pt. 13, R. 4.2.27** Tree nut and peanut products shall be regulated as set forth in 21 CFR Part 164 {#sec-13-4.2.27 omnilex-key=us-ms-regs-official--title-15--13#4.2.27}

**History**
- *SOURCE: Miss. Code Ann.§ 75-29-19*

##### **15 Miss. Admin. Code Pt. 13, R. 4.2.28** Margarine shall be regulated as set forth in 21 CFR Part 166 {#sec-13-4.2.28 omnilex-key=us-ms-regs-official--title-15--13#4.2.28}

**History**
- *SOURCE: Miss. Code Ann.§ 75-29-19*

##### **15 Miss. Admin. Code Pt. 13, R. 4.2.29** Food dressings and flavorings shall be regulated as set forth in 21 CFR Part 169 {#sec-13-4.2.29 omnilex-key=us-ms-regs-official--title-15--13#4.2.29}

**History**
- *SOURCE: Miss. Code Ann.§ 75-29-19*

##### **15 Miss. Admin. Code Pt. 13, R. 4.2.30** Food additives shall be regulated as set forth in 21 CFR Part 170 {#sec-13-4.2.30 omnilex-key=us-ms-regs-official--title-15--13#4.2.30}

**History**
- *SOURCE: Miss. Code Ann.§ 75-29-19*

##### **15 Miss. Admin. Code Pt. 13, R. 4.2.31** Food additive petitions shall be regulated as set forth in 21 CFR Part 171 {#sec-13-4.2.31 omnilex-key=us-ms-regs-official--title-15--13#4.2.31}

**History**
- *SOURCE: Miss. Code Ann.§ 75-29-19*

##### **15 Miss. Admin. Code Pt. 13, R. 4.2.32** Rule 4.2.32 {#sec-13-4.2.32 omnilex-key=us-ms-regs-official--title-15--13#4.2.32}

Food additives permitted for direct addition to food for human consumption shall be regulated as set forth in 21 CFR Part 172.

**History**
- *SOURCE: Miss. Code Ann.§ 75-29-19*

##### **15 Miss. Admin. Code Pt. 13, R. 4.2.33** Rule 4.2.33 {#sec-13-4.2.33 omnilex-key=us-ms-regs-official--title-15--13#4.2.33}

Secondary direct food additives permitted in food for human consumption shall be regulated as set forth in 21 CFR Part 173.

**History**
- *SOURCE: Miss. Code Ann.§ 75-29-19*

##### **15 Miss. Admin. Code Pt. 13, R. 4.2.34** Indirect food additives: General shall be regulated as set forth in 21 CFR Part 174 {#sec-13-4.2.34 omnilex-key=us-ms-regs-official--title-15--13#4.2.34}

**History**
- *SOURCE: Miss. Code Ann.§ 75-29-19*

##### **15 Miss. Admin. Code Pt. 13, R. 4.2.35** Indirect food additives: Adhesives and components of coatings shall be regulated as set forth in 21 CFR Part 175 {#sec-13-4.2.35 omnilex-key=us-ms-regs-official--title-15--13#4.2.35}

**History**
- *SOURCE: Miss. Code Ann.§ 75-29-19*

##### **15 Miss. Admin. Code Pt. 13, R. 4.2.36** Indirect food additives: Paper and paperboard components shall be regulated as set forth in 21 CFR Part I76 {#sec-13-4.2.36 omnilex-key=us-ms-regs-official--title-15--13#4.2.36}

**History**
- *SOURCE: Miss. Code Ann.§ 75-29-19*

##### **15 Miss. Admin. Code Pt. 13, R. 4.2.37** Indirect food additives: Polymers shall be regulated as set forth in 21 CFR Part 177 {#sec-13-4.2.37 omnilex-key=us-ms-regs-official--title-15--13#4.2.37}

**History**
- *SOURCE: Miss. Code Ann.§ 75-29-19*

##### **15 Miss. Admin. Code Pt. 13, R. 4.2.38** Indirect food additives: Adjuvants, production aids, and sanitizers shall be regulated as set forth in 21 CFR Part 178 {#sec-13-4.2.38 omnilex-key=us-ms-regs-official--title-15--13#4.2.38}

**History**
- *SOURCE: Miss. Code Ann.§ 75-29-19*

##### **15 Miss. Admin. Code Pt. 13, R. 4.2.39** Irradiation in the production, processing and handling of food shall be regulated as set forth in 21 CFR Part 179 {#sec-13-4.2.39 omnilex-key=us-ms-regs-official--title-15--13#4.2.39}

**History**
- *SOURCE: Miss. Code Ann.§ 75-29-19*

##### **15 Miss. Admin. Code Pt. 13, R. 4.2.40** Rule 4.2.40 {#sec-13-4.2.40 omnilex-key=us-ms-regs-official--title-15--13#4.2.40}

Food additives permitted in food on an interim basis or in contact with food pending additional study shall be regulated as set forth in 21 CFR Part 180.

**History**
- *SOURCE: Miss. Code Ann.§ 75-29-19*

##### **15 Miss. Admin. Code Pt. 13, R. 4.2.41** Prior-sanctioned food ingredients shall be regulated as set forth in 21 CFR Part 181 {#sec-13-4.2.41 omnilex-key=us-ms-regs-official--title-15--13#4.2.41}

**History**
- *SOURCE: Miss. Code Ann.§ 75-29-19*

##### **15 Miss. Admin. Code Pt. 13, R. 4.2.42** Substances generally recognized as safe shall be regulated as set forth in 21 CFR Part 182 {#sec-13-4.2.42 omnilex-key=us-ms-regs-official--title-15--13#4.2.42}

**History**
- *SOURCE: Miss. Code Ann.§ 75-29-19*

##### **15 Miss. Admin. Code Pt. 13, R. 4.2.43** Direct food substances affirmed as generally recognized as safe shall be regulated as set forth in 21 CFR Part 184 {#sec-13-4.2.43 omnilex-key=us-ms-regs-official--title-15--13#4.2.43}

**History**
- *SOURCE: Miss. Code Ann.§ 75-29-19*

##### **15 Miss. Admin. Code Pt. 13, R. 4.2.44** Indirect food substances affirmed as generally recognized as safe shall be regulated as set forth in 21 CFR Part 186 {#sec-13-4.2.44 omnilex-key=us-ms-regs-official--title-15--13#4.2.44}

**History**
- *SOURCE: Miss. Code Ann.§ 75-29-19*

##### **15 Miss. Admin. Code Pt. 13, R. 4.2.45** Substances prohibited from use in human food, shall be regulated as set forth in 21 CFR Part 189 {#sec-13-4.2.45 omnilex-key=us-ms-regs-official--title-15--13#4.2.45}

**History**
- *SOURCE: Miss. Code Ann.§ 75-29-19 Subchapter 3 Definitions of Food Establishment Types Rule 4.3.1 Labeler/Relabeler. An establishment which affixes the original labe1ing to a food product or changes in any way the labeling on a food product without affecting the product: or its container.*
- *SOURCE: Miss. Code Ann.§ 75-29-19*

##### **15 Miss. Admin. Code Pt. 13, R. 4.3.2** Manufacturer {#sec-13-4.3.2 omnilex-key=us-ms-regs-official--title-15--13#4.3.2}

An establishment which makes a new or a changed food product from one or more ingredients.

**History**
- *SOURCE: Miss. Code Ann.§ 75-29-19*

##### **15 Miss. Admin. Code Pt. 13, R. 4.3.3** Own Label Distributor {#sec-13-4.3.3 omnilex-key=us-ms-regs-official--title-15--13#4.3.3}

An establishment which distributes a food product under a custom or own label. The product is manufactured and labeled by another establishment.

**History**
- *SOURCE: Miss. Code Ann.§ 75-29-19*

##### **15 Miss. Admin. Code Pt. 13, R. 4.3.4** Packer/Repacker {#sec-13-4.3.4 omnilex-key=us-ms-regs-official--title-15--13#4.3.4}

An establishment which packs a food product or products into different containers without making any change in the form of the product.

**History**
- *SOURCE: Miss. Code Ann.§ 75-29-19*

##### **15 Miss. Admin. Code Pt. 13, R. 4.3.5** Salvage Operation {#sec-13-4.3.5 omnilex-key=us-ms-regs-official--title-15--13#4.3.5}

A wholesaler or repacker who deals primarily in the resale and reconditioning of damaged food products.

**History**
- *SOURCE: Miss. Code Ann.§ 75-29-19*

##### **15 Miss. Admin. Code Pt. 13, R. 4.3.6** Warehouse {#sec-13-4.3.6 omnilex-key=us-ms-regs-official--title-15--13#4.3.6}

A facility for the storage of consumer food products or the reshipment of products from the producer or grower to the manufacturer or other consumer. This can be temporary storage such as cream stations, the traditional warehouse, or grain elevator storing human food.

An annual permit fee shall be paid as authorized in Sec. 41-3-18 Mississippi Code of 1972, Annotated, and as specified in Chapter 5 of this Subpart.

**History**
- *SOURCE: Miss. Code Ann.§ 75-29-19 Subchapter 4 Procedures for Permits Rule 4.4.1 General: From and after January 1, 1999, no person shall operate a food establishment without first obtaining a permit for the operation of that facility from the State Department of Health (hereafter referred to as Health Authority).*
- *SOURCE: Miss. Code Ann.§ 75-29-19*

##### **15 Miss. Admin. Code Pt. 13, R. 4.4.2** Rule 4.4.2 {#sec-13-4.4.2 omnilex-key=us-ms-regs-official--title-15--13#4.4.2}

Issuance of Permit: Any person desiring to operate a food establishment of a type required to have a permit or who is requesting a permit shall make written application for a permit on forms provided by the Health Authority.

**History**
- *SOURCE: Miss. Code Ann.§ 75-29-19*

##### **15 Miss. Admin. Code Pt. 13, R. 4.4.3** Rule 4.4.3 {#sec-13-4.4.3 omnilex-key=us-ms-regs-official--title-15--13#4.4.3}

Prior to approval of an application for a permit, the Health Authority shall inspect the proposed food establishment to determine compliance with the requirements of this regulation and applicable state law.

**History**
- *SOURCE: Miss. Code Ann.§ 75-29-19*

##### **15 Miss. Admin. Code Pt. 13, R. 4.4.4** Rule 4.4.4 {#sec-13-4.4.4 omnilex-key=us-ms-regs-official--title-15--13#4.4.4}

The Health Authority shall issue a permit if the inspection reveals that the proposed food establishment complies with the requirements of this regulation and applicable state law.

**History**
- *SOURCE: Miss. Code Ann.§ 75-29-19*

##### **15 Miss. Admin. Code Pt. 13, R. 4.4.5** Rule 4.4.5 {#sec-13-4.4.5 omnilex-key=us-ms-regs-official--title-15--13#4.4.5}

Each permit shall be issued only for the premises and owner named in the application, and shall not be transferable or assignable.

**History**
- *SOURCE: Miss. Code Ann.§ 75-29-19*

##### **15 Miss. Admin. Code Pt. 13, R. 4.4.6** Each permit shall be issued for a period of one year {#sec-13-4.4.6 omnilex-key=us-ms-regs-official--title-15--13#4.4.6}

**History**
- *SOURCE: Miss. Code Ann.§ 75-29-19*

##### **15 Miss. Admin. Code Pt. 13, R. 4.4.7** Rule 4.4.7 {#sec-13-4.4.7 omnilex-key=us-ms-regs-official--title-15--13#4.4.7}

Renewal of Permit: A permit issued under the provisions of this regulation shall be renewed annually upon determination by inspection that the facility complies with this regulation.

**History**
- *SOURCE: Miss. Code Ann.§ 75-29-19*

##### **15 Miss. Admin. Code Pt. 13, R. 4.4.8** Rule 4.4.8 {#sec-13-4.4.8 omnilex-key=us-ms-regs-official--title-15--13#4.4.8}

Emergency Suspension of Permit: Any permit issued pursuant to this regulation may be suspended prior to a hearing if the Health Authority has reasonable cause to suspect that the continued operation of the permitted establishment constitutes a substantial hazard to the public health.

**History**
- *SOURCE: Miss. Code Ann.§ 75-29-19*

##### **15 Miss. Admin. Code Pt. 13, R. 4.4.9** Rule 4.4.9 {#sec-13-4.4.9 omnilex-key=us-ms-regs-official--title-15--13#4.4.9}

Whenever a permit is suspended, the holder of the permit or person in charge shall be notified in writing that the permit is, upon service of the notice, immediately suspended and that an opportunity for hearing will be provided if

requested in writing within ten days of the receipt of the notice of suspension. If no written request for hearing is filed within ten days, the suspension is sustained.

**History**
- *SOURCE: Miss. Code Ann.§ 75-29-19*

##### **15 Miss. Admin. Code Pt. 13, R. 4.4.10** The Health Authority may relinquish the suspension at any time if reasons for suspension no longer exist {#sec-13-4.4.10 omnilex-key=us-ms-regs-official--title-15--13#4.4.10}

**History**
- *SOURCE: Miss. Code Ann.§ 75-29-19*

##### **15 Miss. Admin. Code Pt. 13, R. 4.4.11** Rule 4.4.11 {#sec-13-4.4.11 omnilex-key=us-ms-regs-official--title-15--13#4.4.11}

Denial or Revocation of Permit: Grounds for denial or revocation of a permit shall include but not be limited to: 1 Failure to complete the information requested on the application. 2 Falsification of information submitted on an application for a permit. 3 Refusal to allow inspections by the Health Authority, or other interference in the performance of duty. 4 Violation of the Regulation Governing Manufacture and Sale of Food and Food Products of the State Board of Health or violations of Sections 75-29-1 through 75-29-29, Mississippi Code of 1972, Annotated. 5 Failure to correct violations of inspection standards within the time specified following inspection. 6 Any circumstances where the operation of the food establishment constitutes a hazard to the public health.

**History**
- *SOURCE: Miss. Code Ann.§ 75-29-19*

##### **15 Miss. Admin. Code Pt. 13, R. 4.4.12** Rule 4.4.12 {#sec-13-4.4.12 omnilex-key=us-ms-regs-official--title-15--13#4.4.12}

Notice: Prior to revocation or denial of a permit, the owner of the food establishment shall be notified, in writing of the proposed action, together with the reasons for same. Said notice shall provide owners/applicants ten days in which to request a hearing.

**History**
- *SOURCE: Miss. Code Ann.§ 75-29-19*

##### **15 Miss. Admin. Code Pt. 13, R. 4.4.13** Rule 4.4.13 {#sec-13-4.4.13 omnilex-key=us-ms-regs-official--title-15--13#4.4.13}

Hearing: If requested in writing, a hearing shall be scheduled within the State Department of Health not less than ten days nor more than 30 days following receipt of the request. On the basis of such hearing, the State Department of Health shall make a decision with respect to proposed action. This decision, together, with the findings of the hearing officer, and reasons for the decision, shall be forwarded to the owner/applicant within 30 days of the hearing.

**History**
- *SOURCE: Miss. Code Ann.§ 75-29-19 Subchapter 5 Plan Review, Inspections, Sampling and Labeling*

##### **15 Miss. Admin. Code Pt. 13, R. 4.5.1** Rule 4.5.1 {#sec-13-4.5.1 omnilex-key=us-ms-regs-official--title-15--13#4.5.1}

Review of Plans and Specifications: Prior to the construction, remodeling or conversion for use as a food establishment plans and specifications shall be submitted to the Health Authority for review and approval. The plans and specifications shall include a description of the food processing; indicate the proposed layout, arrangement, and construction materials of work areas and the type and model of proposed fixed equipment and faci1ities to the extent necessary to determine whether the proposed facility will comply with the Regulation Governing Manufacture and Sale of Food and Food Products. A Plan Review fee must be submitted to the department in accordance with Chapter 5 of this Subpart.

**History**
- *SOURCE: Miss. Code Ann.§ 75-29-19*

##### **15 Miss. Admin. Code Pt. 13, R. 4.5.2** Rule 4.5.2 {#sec-13-4.5.2 omnilex-key=us-ms-regs-official--title-15--13#4.5.2}

Inspections: The Health Authority shall inspect each food establishment prior to issuing a permit, and shall make as many additional inspections as are necessary for the enforcement of this regulation. 1 Whenever an inspection is made of a food establishment, the findings shall be recorded on an official inspection form, and furnished to the person in charge of the food establishment at the time of the inspection, or posted in a conspicuous place. 2 If violations noted on the inspection form are not corrected within the period of time specified by the Health Authority, a permit may be denied, suspended or revoked in accordance with this regulation. 3 The Health Authority may enter any food establishment, during normal hours of operation, for the purpose of making inspections, or investigations to determine compliance with this regulation, or collecting necessary information or documents.

**History**
- *SOURCE: Miss. Code Ann.§ 75-29-19*

##### **15 Miss. Admin. Code Pt. 13, R. 4.5.3** Rule 4.5.3 {#sec-13-4.5.3 omnilex-key=us-ms-regs-official--title-15--13#4.5.3}

Examination or Sampling of Food: Food samples for laboratory analysis may be collected by the Health Authority as often as necessary for enforcement of the regulation.

**History**
- *SOURCE: Miss. Code Ann.§ 75-29-19*

##### **15 Miss. Admin. Code Pt. 13, R. 4.5.4** Rule 4.5.4 {#sec-13-4.5.4 omnilex-key=us-ms-regs-official--title-15--13#4.5.4}

Review of Labels: Labels of any food or food product regulated by the State Department of Health are subject to review and approval by the Health Authority.

repacker/packer, and/or salvage operation which is in a risk category 3 or 4 shall establish and operate under a HACCP plan / food safety plan, as approved by the Health Authority, and which shall contain as a minimum:

1. A hazard analysis for all types of potentially hazardous foods that are manufactured, packed/repacked, or salvaged.

2 A flow diagram by specific food or category type identifying critical control points and providing information on

a. ingredients, materials, and equipment, and b. formulations or recipes. c. A written HACCP plan / food safety plan which identifies: d. each critical control point, e. the critical limits for each critical control point, f. the method and frequency for monitoring and controlling each critical control point, g. corrective action to be taken if the critical limits for each critical control point are not met, h. written records to document that the HACCP plan / food safety plan is properly implemented, and i. written Standard Sanitation Operating Procedures (SSOP's) in place which insure compliance with the good manufacturing practices of 21 CFR Part 110; and additional scientific data or other information or training, as required by the Health Authority, supporting the determination that food safety is not compromised by the proposal.

Fee Description Fee Amount Frequency Bottled Water Plant Permit $264.50 Annually Water Vending Permit $39.68 Annually Plan Review Fee $224.25 With Application Re-inspection Fee $165.00 Upon Owner’s request

Certificate of Free Sale $10.00 per certificate Upon Owner’s request

**History**
- *SOURCE: Miss. Code Ann.§ 75-29-19 Subchapter 6 Hazard Analysis Critical Control Points (HACCP) Rule 4.6.1 Any permitted food establishment shall operate under a HACCP plan / food safety plan approved by the Health Authority, if required under Federal statutes. If not required under Federal statutes, any permitted food manufacturer,*
- *SOURCE: MS Code Ann.§ 75-29-19 Chapter 5 FEES Rule 5.1.1 Fees shall be collected by the Department for the following services:*
- *SOURCE: Miss. Code Ann. § 41-3-15*

##### **15 Miss. Admin. Code Pt. 13, R. 5.1.2** Rule 5.1.2 {#sec-13-5.1.2 omnilex-key=us-ms-regs-official--title-15--13#5.1.2}

Risk categorization allows establishments to be ranked by considering risk factors and creating a variable inspection frequency for each category. There shall be from one to four levels of risks established. The minimal frequency of inspection shall be as follows:

Risk Level

Fee

Risk Level Category Description Minimum number of inspections per year

$40.00  Pre-packaged non-time, temperature controlled for safety (TCS) food  Limited prep of non-TCS food  Two-three day events if TCS food limited to one- two items with no cooling or reheating

$132.25  Limited menu (one or two primary items)  Minimal food preparation  Products cooked, prepared, and served immediately  Hot or cold hold limited to single meal service  Raw ingredients requiring minimal preparation

$198.00  Handling of several TCS foods  Preparation including cooking, cooling, and reheating of TCS foods  Retail food operations including deli and seafood departments  Hot and cold holding of foods  Wholesale processing (non-TCS) foods

$264.50  Extensive handling of raw ingredients  Preparation processes include the cooking, cooling, and reheating of TCS foods  Processing requiring hot and cold holding of TCS foods  Food processes include advance preparation of TCS foods for next day service  Facilities whose primary service is to the immuno- compromised  Wholesale TCS foods  Extensive handling of raw potentially hazardous ingredients extended hours  Food processing of TCS foods (wholesale or retail)

**History**
- *SOURCE: Miss. Code Ann. § 41-3-15*

### **Part 14** General Sanitation

##### **15 Miss. Admin. Code Pt. 14, R. 2.1.2** Construction {#sec-14-2.1.2 omnilex-key=us-ms-regs-official--title-15--14#2.1.2}

All toilet rooms shall be constructed of sound material and kept clean and free of insects and rodents. Walls and ceiling shall be of light color. Floors shall be constructed of impervious material free from defects. Adequate light and ventilation shall be provided.

**History**
- *SOURCE: Miss. Code Ann.§ 41-25-1*

##### **15 Miss. Admin. Code Pt. 14, R. 2.1.3** Plumbing and Plumbing Fixtures {#sec-14-2.1.3 omnilex-key=us-ms-regs-official--title-15--14#2.1.3}

The plumbing and plumbing fixtures shall be installed in compliance with good plumbing practices, maintained in good repair and kept clean. Hand-washing facilities, provided with soap and individual towels, shall be provided in each toilet room. Wastes from public toilets shall be disposed of in compliance with the Regulation Governing Disposal of Human Excreta and Other Liquid Wastes. (Note: Superseded by the Regulation Governing Individual Onsite Wastewater Disposal Systems.)

**History**
- *SOURCE: Miss. Code Ann.§ 41-25-1*

##### **15 Miss. Admin. Code Pt. 14, R. 2.1.4** Responsibility {#sec-14-2.1.4 omnilex-key=us-ms-regs-official--title-15--14#2.1.4}

It shall be the duty of the owner, manager or custodian to see that this regulation is complied with.

**History**
- *SOURCE: Miss. Code Ann.§ 41-25-1*

##### **15 Miss. Admin. Code Pt. 14, R. 3.1.2** Rule 3.1.2 {#sec-14-3.1.2 omnilex-key=us-ms-regs-official--title-15--14#3.1.2}

Person shall mean an individual or a firm, partnership, company, corporation, trustee, association, or any public or private entity.

**History**
- *SOURCE: Miss. Code Ann.§ 45-21-11*

##### **15 Miss. Admin. Code Pt. 14, R. 3.1.3** Rule 3.1.3 {#sec-14-3.1.3 omnilex-key=us-ms-regs-official--title-15--14#3.1.3}

Health Officer shall mean an official representative of the Mississippi State Board of Health or any county health officer or his authorized representative.

**History**
- *SOURCE: Miss. Code Ann.§ 45-21-11*

##### **15 Miss. Admin. Code Pt. 14, R. 3.1.4** Refuse shall mean garbage, rubbish, and all other putrescible and non-putrescible waste, except sewage {#sec-14-3.1.4 omnilex-key=us-ms-regs-official--title-15--14#3.1.4}

**History**
- *SOURCE: Miss. Code Ann.§ 45-21-11 Subchapter 2 Plans and Specifications Rule 3.2.1 Any person desiring to hold, sponsor, or supervise a rock festival in the State of Mississippi shall submit plans and specifications for such event to the State Board of Health at least 18 days prior to the commencement of the festival. The plans and specifications shall ,contain complete information regarding location of the festival, water supply, toilet and handwashing facilities, sewage disposal system, drainage, refuse storage and disposal, food service, medical facilities, insect and noxious weed control, fire protection, and sleeping areas and facilities. Also, information shall be given as to the calendar dates of the festival, the maximum number of persons who will be permitted to attend the event, the maximum number of hours or days it will be held, the name and address of the person or persons requesting certification from the State Board of Health, and such other pertinent information as the Board shall find necessary.*
- *SOURCE: Miss. Code Ann.§ 45-21-11 Subchapter 3 Festival Area Rule 3.3.1 Premises. The premises where any rock festival is to be held shall be kept free of refuse, waste materials, rodent infestations, insect breeding places, noxious weeds, and other objectionable conditions.*

##### **15 Miss. Admin. Code Pt. 14, R. 3.3.2** Fences {#sec-14-3.3.2 omnilex-key=us-ms-regs-official--title-15--14#3.3.2}

Adequate fences shall be provided where necessary to prevent easy access to areas or conditions that may be hazardous to health and safety.

**History**
- *SOURCE: Miss. Code Ann.§ 45-21-11*

##### **15 Miss. Admin. Code Pt. 14, R. 3.3.3** Festival Site {#sec-14-3.3.3 omnilex-key=us-ms-regs-official--title-15--14#3.3.3}

The festival site shall be well drained and not immediately adjacent to any marshy area. No festival shall be held on a site located on the watershed of a domestic or public water supply so as to create a pollution hazard. The site shall provide adequate space commensurate with the purpose and number of people attending.

**History**
- *SOURCE: Miss. Code Ann.§ 45-21-11*

##### **15 Miss. Admin. Code Pt. 14, R. 3.3.4** Roads {#sec-14-3.3.4 omnilex-key=us-ms-regs-official--title-15--14#3.3.4}

The festival site shall be provided with a network of interior roads that are to be kept clear at all times for emergency vehicles and so that trucks and other vehicles can properly service all facilities and refuse pick-up stations. Provisions shall be made for adequate traffic control measures that will preclude hazards to both vehicular and pedestrian traffic.

**History**
- *SOURCE: Miss. Code Ann.§ 45-21-11*

##### **15 Miss. Admin. Code Pt. 14, R. 3.3.5** Parking Area {#sec-14-3.3.5 omnilex-key=us-ms-regs-official--title-15--14#3.3.5}

An adequate and properly designated parking area shall be provided for the parking of all vehicles. The parking area shall be well separated from the medical facilities, entertainment area, foodhandling facilities, and other designated areas.

**History**
- *SOURCE: Miss. Code Ann.§ 45-21-11*

##### **15 Miss. Admin. Code Pt. 14, R. 3.3.6** Sleeping Area {#sec-14-3.3.6 omnilex-key=us-ms-regs-official--title-15--14#3.3.6}

Adequate and clearly designated camping and sleeping areas that will not result in overcrowding shall be provided. The camping, pitching of a tent, or sleeping in the entertainment or medical treatment area shall not be permitted.

**History**
- *SOURCE: Miss. Code Ann.§ 45-21-11*

##### **15 Miss. Admin. Code Pt. 14, R. 3.3.7** Lighting {#sec-14-3.3.7 omnilex-key=us-ms-regs-official--title-15--14#3.3.7}

Adequate artificial light shall be provided for the medical facilities area, toilet areas, shower areas, service areas, walkways, and other areas where needed.

**History**
- *SOURCE: Miss. Code Ann.§ 45-21-11 Subchapter 4 Sanitary Facilities Rule 3.4.1 Water Supply. The water supply shall be adequate, of a safe and sanitary quality, and from an approved source. There shall be no physical connection*

##### **15 Miss. Admin. Code Pt. 14, R. 3.4.2** Sewage disposal {#sec-14-3.4.2 omnilex-key=us-ms-regs-official--title-15--14#3.4.2}

All sewage and liquid waste shall be disposed of in compliance with the Mississippi State Board of Health Regulation Governing Disposal of Human Excreta and Other Liquid Wastes. Any treatment facility or discharge therefrom shall be in compliance with all appropriate state laws.

**History**
- *SOURCE: Miss. Code Ann.§ 45-21-11*

##### **15 Miss. Admin. Code Pt. 14, R. 3.4.3** Toilet Facilities {#sec-14-3.4.3 omnilex-key=us-ms-regs-official--title-15--14#3.4.3}

There shall be provided at each rock festival adequate and conveniently located toilet facilities. Toilet rooms and toilet room fixtures shall be kept clean and in good repair. Toilet tissue shall be provided in all toilet rooms at all times. Separate toilet facilities shall be provided for each sex.

**History**
- *SOURCE: Miss. Code Ann.§ 45-21-11*

##### **15 Miss. Admin. Code Pt. 14, R. 3.4.4** Drinking Fountains {#sec-14-3.4.4 omnilex-key=us-ms-regs-official--title-15--14#3.4.4}

A common drinking utensil shall not be provided or allowed. Any drinking fountain shall be of approved sanitary design and construction.

**History**
- *SOURCE: Miss. Code Ann.§ 45-21-11*

##### **15 Miss. Admin. Code Pt. 14, R. 3.4.5** Handwashing Facilities {#sec-14-3.4.5 omnilex-key=us-ms-regs-official--title-15--14#3.4.5}

Adequate handwashing facilities, including lavatory equipped with running water, soap, and individual paper towels, shall be provided at all rock festivals. Such facilities shall be convenient to the foodhandling areas and toilet areas.

**History**
- *SOURCE: Miss. Code Ann.§ 45-21-11*

##### **15 Miss. Admin. Code Pt. 14, R. 3.4.6** Showers {#sec-14-3.4.6 omnilex-key=us-ms-regs-official--title-15--14#3.4.6}

Any festival that can be expected to continue for a period of more than 48 hours shall provide adequate showers that are conveniently located and separate for each sex. Showers shall be properly screened for privacy and supplied with potable water only.

**History**
- *SOURCE: Miss. Code Ann.§ 45-21-11*

##### **15 Miss. Admin. Code Pt. 14, R. 3.4.7** Refuse {#sec-14-3.4.7 omnilex-key=us-ms-regs-official--title-15--14#3.4.7}

Adequate garbage containers, conveniently located, shall be provided at all rock festivals, and the Mississippi State Board of Health Regulation Governing Disposal of Refuse shall be complied with at all times.

**History**
- *SOURCE: Miss. Code Ann.§ 45-21-11*

##### **15 Miss. Admin. Code Pt. 14, R. 3.4.8** Insect Control {#sec-14-3.4.8 omnilex-key=us-ms-regs-official--title-15--14#3.4.8}

Effective measures shall be utilized to properly control insects so that they will not become a nuisance or a public health hazard.

##### **15 Miss. Admin. Code Pt. 14, R. 3.5.2** Medical Facilities {#sec-14-3.5.2 omnilex-key=us-ms-regs-official--title-15--14#3.5.2}

Adequate medical treatment facilities shall be provided, with a complete inventory of emergency medical supplies on hand at all times. An ambulance shall be available for the transfer of patients to a hospital.

**History**
- *SOURCE: Miss. Code Ann.§ 45-21-11*

##### **15 Miss. Admin. Code Pt. 14, R. 3.5.3** Communicable Disease Control {#sec-14-3.5.3 omnilex-key=us-ms-regs-official--title-15--14#3.5.3}

The physician in charge shall immediately report to the county health officer any case or suspected case of communicable or reportable disease which he is attending, has examined, or of which he has knowledge. Such report shall include the patient's name, address, age, race, sex, the suspected disease, and the date of the onset of the disease. No person having or being suspected of having a communicable or infectious disease shall attend or be permitted to attend any rock festival or be allowed on the site where the festival is to be held.

**History**
- *SOURCE: Miss. Code Ann.§ 45-21-11 Subchapter 6 Food Service Rule 3.6.1 All food service equipment and foodhandling establishments shall comply with the Mississippi State Board of Health Regulation Governing Food and Foodhandling Establishments.*
- *SOURCE: Miss. Code Ann.§ 45-21-11 Subchapter 7 Fire Protection Rule 3.7.1 All areas and buildings on the festival site shall conform to the requirements established by the laws of Mississippi and the regulations and standards issued by the State Fire Marshal.*
- *SOURCE: Miss. Code Ann.§ 45-21-11 Subchapter 8 Maintenance of Site Rule 3.8.1 All sites where rock festivals are held and all facilities provided shall be maintained in a clean, safe, and sanitary condition. At the close of the festival, the sponsors or persons in charge shall have all rubbish removed from the premises and leave the site in a clean and sanitary condition.*

##### **15 Miss. Admin. Code Pt. 14, R. 4.4.2** Building Exterior {#sec-14-4.4.2 omnilex-key=us-ms-regs-official--title-15--14#4.4.2}

All roofs and outside walls, doors and windows shall be maintained in good repair.

**History**
- *SOURCE: Miss. Code Ann.§ 41-49-1*

##### **15 Miss. Admin. Code Pt. 14, R. 4.4.3** Heating and Cooling System {#sec-14-4.4.3 omnilex-key=us-ms-regs-official--title-15--14#4.4.3}

The heating system shall be properly installed and maintained in good repair and shall be capable of maintaining a temperature of at least 68 degrees Fahrenheit in each sleeping room whenever occupied. The cooling system, if any, shall be properly installed and maintained in good repair.

**History**
- *SOURCE: Miss. Code Ann.§ 41-49-1*

##### **15 Miss. Admin. Code Pt. 14, R. 4.4.4** Rule 4.4.4 {#sec-14-4.4.4 omnilex-key=us-ms-regs-official--title-15--14#4.4.4}

Ventilation 1 Sleeping and toilet rooms shall have sufficient ventilation to keep them free from steam condensation, excessive heat vapors, smoke, fumes or noxious odors. 2 Rooms or units without a mechanical cooling system shall have an operable screened window (sixteen mesh screen) for natural ventilation or a transom exhausting 20 cfm of air.

**History**
- *SOURCE: Miss. Code Ann.§ 41-49-1*

##### **15 Miss. Admin. Code Pt. 14, R. 4.4.5** Lighting {#sec-14-4.4.5 omnilex-key=us-ms-regs-official--title-15--14#4.4.5}

Natural and artificial lighting for general cleaning purposes and safety of guests shall be at least 10 footcandles in guest rooms, stairways, hallways, and storage areas. Lighting in reading areas of guest rooms shall be at least 30 footcandles.

**History**
- *SOURCE: Miss. Code Ann.§ 41-49-1*

##### **15 Miss. Admin. Code Pt. 14, R. 4.4.6** Rule 4.4.6 {#sec-14-4.4.6 omnilex-key=us-ms-regs-official--title-15--14#4.4.6}

Toilet and Bathing Facilities 1 Each hotel/motel shall be provided with adequate and conveniently located toilet and bathing facilities. Except for hotels constructed before the effective date of this regulation, toilet and bathing facilities shall be provided for each sleeping room. Toilets and bathing facilities, including rooms and fixtures, shall be of sanitary design, easily cleanable, kept in good repair, and shall be cleaned and disinfected daily. Toilet tissue shall be provided, and new soap shall be provided after each guest occupancy. Easily cleanable receptacles shall be provided for waste materials. 2 Anti-slip tubs, adequate slip strips, appliques, or slip-proof mats shall be provided in each bathing facility and shall be kept clean and in good repair. 3 Each hotel/motel shall provide adequate, conveniently located hand-washing facilities at each toilet and bathroom including a lavatory or lavatories equipped with hot and cold or tempered running water, hand-cleansing soap and towels. Individual single-service towels or a hot-air hand-drying device shall be provided in restrooms in public areas. Such facilities shall be kept clean and in good repair.

**History**
- *SOURCE: Miss. Code Ann.§ 41-49-1*

##### **15 Miss. Admin. Code Pt. 14, R. 4.8.2** Rule 4.8.2 {#sec-14-4.8.2 omnilex-key=us-ms-regs-official--title-15--14#4.8.2}

No person having open, oozing or weeping lesions of the skin on any exposed part of the body shall be employed unless such lesion(s) are completely covered by adequate bandages or other appropriate dressing(s). Employees shall wear clean outer garments and conform to good hygienic practices.

**History**
- *SOURCE: Miss. Code Ann.§ 41-49-1*

##### **15 Miss. Admin. Code Pt. 14, R. 4.8.3** Rooms {#sec-14-4.8.3 omnilex-key=us-ms-regs-official--title-15--14#4.8.3}

It shall be the duty of every person keeping, managing, or operating a hotel/motel to see that every room which has been occupied by any person known to the keeper, manager, or operator to have had communicable disease at the time of such occupancy, together with its contents, shall be thoroughly disinfected in a manner prescribed by the health officer before permitting such room to be occupied by any other person.

1 All outside premises shall be maintained free of litter and unnecessary articles, and shall be well drained. 2 Openings to the outside shall be effectively protected against the entrance of insects and rodents.

**History**
- *SOURCE: Miss. Code Ann.§ 41-49-1 Subchapter 9 Fire Escape Rule 4.9.1 Every hotel/motel shall comply with the requirements of the NFPA - Life Safety Code regarding fire exits and fire safety.*
- *SOURCE: Miss. Code Ann.§ 41-49-1 Subchapter 10 Refuse and Vector Control Rule 4.10.1 Refuse shall be stored, collected and disposed of in a manner which prevents the breeding of flies and other vermin. Containers shall be cleaned at such frequency as to prevent a nuisance or odor.*

##### **15 Miss. Admin. Code Pt. 14, R. 5.1.2** For lathering, a good mechanical latherizer or hand-applied shaving cream is recommended {#sec-14-5.1.2 omnilex-key=us-ms-regs-official--title-15--14#5.1.2}

If shaving brushes are used they must be thoroughly cleaned after each usage.

**History**
- *SOURCE: Miss. Code Ann.§ 41-3- 17*

##### **15 Miss. Admin. Code Pt. 14, R. 5.1.3** Rule 5.1.3 {#sec-14-5.1.3 omnilex-key=us-ms-regs-official--title-15--14#5.1.3}

Any styptic, caustic or other local medication used in stopping the flow of blood or for any other purpose must be used in powder or liquid form and should be applied with a portion of a clean towel or face cloth. Use of alum, pencils or any styptic in solid form is prohibited.

**History**
- *SOURCE: Miss. Code Ann.§ 41-3- 17*

##### **15 Miss. Admin. Code Pt. 14, R. 5.1.4** Rule 5.1.4 {#sec-14-5.1.4 omnilex-key=us-ms-regs-official--title-15--14#5.1.4}

No barber, barber apprentice, barber student, cashier, bootblack, manicurist or any person having gonorrhea, syphilis, tuberculosis, trench mouth, barber's itch, ringworm or any other communicable disease, or who has been recently exposed to a quarantinable disease, shall be permitted to practice barbering or perform any other labor or duties in any barber shop or barber school. To satisfy this section

##### **15 Miss. Admin. Code Pt. 14, R. 5.1.5** There shall be no direct connection between a sleeping room and a barber shop {#sec-14-5.1.5 omnilex-key=us-ms-regs-official--title-15--14#5.1.5}

**History**
- *SOURCE: Miss. Code Ann.§ 41-3- 17*

##### **15 Miss. Admin. Code Pt. 14, R. 5.1.6** Rule 5.1.6 {#sec-14-5.1.6 omnilex-key=us-ms-regs-official--title-15--14#5.1.6}

It shall be the duty of the head barber or manager of each barber shop or barber school to make certain that all employees know and observe these regulations.

**History**
- *SOURCE: Miss. Code Ann.§ 41-3- 17*

#### **Chapter 6** - REGULATIONS FOR TANNING FACILITIES

##### **15 Miss. Admin. Code Pt. 14, R. 6.1.1** Purpose and Scope {#sec-14-6.1.1 omnilex-key=us-ms-regs-official--title-15--14#6.1.1}

1. This Chapter provides for the registration of tanning equipment and tanning facilities and regulation of the maintenance and operation of tanning facilities. 2. In addition to the requirements of this Chapter, all registrants are subject to the applicable provision of other Chapters of these regulations. 3. Nothing in this Chapter shall be interpreted as limiting the intentional exposure of patients to ultraviolet radiation for the purpose of treatment or use commensurate with the licensed practitioner's use of a healing art.

**History**
- *Source: MS Code Ann. § 45-14-11*

##### **15 Miss. Admin. Code Pt. 14, R. 6.1.2** Definitions {#sec-14-6.1.2 omnilex-key=us-ms-regs-official--title-15--14#6.1.2}

The following terms are defined for purposes of this Chapter. 1. "Act" means the Mississippi Radiation Protection Law of 1976. 2. “Affected Party” means a tanning registrant whom an enforcement action has been taken by the Agency. 3. "Agency" means the Mississippi Department of Health. 4. "CFR" means Code of Federal Regulations. 5. “Complaint” is a written document submitted to the Agency addressing an existing or potential public health hazard.

##### **15 Miss. Admin. Code Pt. 14, R. 6.1.3** Exemptions {#sec-14-6.1.3 omnilex-key=us-ms-regs-official--title-15--14#6.1.3}

1. General: The Agency may, upon application therefore or upon its own initiative, grant such exemptions or exceptions from the requirements of these regulations as it determines are authorized by law and will not result in undue hazard to public health and safety. 2. Equipment intended for purposes other than the deliberate exposure of parts of the living body to ultraviolet radiation, and which produce or emit ultraviolet radiation incidental to its proper operation are exempt from the provisions of this Chapter. 3. Radiation machines while in transit or storage incidental thereto are exempt from the provisions of this Chapter.

##### **15 Miss. Admin. Code Pt. 14, R. 6.1.4** Application for Registration of Tanning Facilities {#sec-14-6.1.4 omnilex-key=us-ms-regs-official--title-15--14#6.1.4}

1. Each person having a tanning facility shall apply for registration of such facility with the Agency within thirty (30) days following the effective date of these regulations or thereafter prior to the operation of a tanning facility. Application for registration shall be completed on forms furnished by the Agency and shall contain all the information required by the form and the accompanying instructions. 2. The Agency shall require at least the following information on the Application for Registration of Tanning Facilities form: a. Name, address and telephone number of the following: i. the tanning facility; ii. the owner(s) of the tanning facility b. The manufacturer, model number, and type of each ultraviolet lamp or tanning equipment located within the facility. c. Name of the tanning equipment supplier, installer, and service agent. d. A signed and dated certification that the applicant has read and understands the requirements of these regulations. e. A copy of operating and safety procedures unique to facility operation. f. A copy of the certificate from a state approved training program showing satisfactory completion of Formal Operator Training. 3. Each applicant shall provide such additional information as the Agency may reasonably require.

**History**
- *Source: MS Code Ann. § 45-14-11*

##### **15 Miss. Admin. Code Pt. 14, R. 6.1.5** Issuance of Certificate of Registration {#sec-14-6.1.5 omnilex-key=us-ms-regs-official--title-15--14#6.1.5}

##### **15 Miss. Admin. Code Pt. 14, R. 6.1.6** Expiration of Certificate of Registration {#sec-14-6.1.6 omnilex-key=us-ms-regs-official--title-15--14#6.1.6}

Except as provided in 6.1.7 (2), each certificate of registration shall expire at the end of the specified day in the month and year stated therein.

**History**
- *Source: MS Code Ann. § 45-14-11*

##### **15 Miss. Admin. Code Pt. 14, R. 6.1.7** Renewal of Certificate of Registration {#sec-14-6.1.7 omnilex-key=us-ms-regs-official--title-15--14#6.1.7}

1. Application for renewal of registration shall be filed in accordance with 6.1.4. 2. In any case in which a registrant, not less than 30 days prior to the expiration of his existing certificate of registration, has filed an application in proper form for renewal, such existing certificate of registration shall not expire until the application status has been finally determined by the Agency.

**History**
- *Source: MS Code Ann. § 45-14-11*

##### **15 Miss. Admin. Code Pt. 14, R. 6.1.8** Report of Changes {#sec-14-6.1.8 omnilex-key=us-ms-regs-official--title-15--14#6.1.8}

The registrant shall notify the Agency in writing before making any change which would render the information reported pursuant to 6.1.4(2)(a), (b) and (c) contained in the application for registration and/or the certificate of registration, no longer accurate. This requirement shall not apply to changes involving replacement of designated original equipment lamp types with lamps which have been certified with the FDA as "equivalent” replacement of the lamps. The facility owner shall maintain manufacturer's literature demonstrating the equivalency of any replacement lamps.

**History**
- *Source: MS Code Ann. § 45-14-11*

##### **15 Miss. Admin. Code Pt. 14, R. 6.1.9** Transfer of Certificate of Registration {#sec-14-6.1.9 omnilex-key=us-ms-regs-official--title-15--14#6.1.9}

No certificate of registration shall be transferable from one person to another or from one tanning facility to another.

##### **15 Miss. Admin. Code Pt. 14, R. 6.1.10** Approval Not Implied {#sec-14-6.1.10 omnilex-key=us-ms-regs-official--title-15--14#6.1.10}

No person, in any advertisement, shall refer to the fact that their facility is registered with the Agency pursuant to the provisions of 1.4, and no person shall state or imply that any activity under such registration has been approved by the Agency.

**History**
- *Source: MS Code Ann. § 45-14-11*

##### **15 Miss. Admin. Code Pt. 14, R. 6.1.11** Denial, Suspension, or Revocation of Certificate of Registration {#sec-14-6.1.11 omnilex-key=us-ms-regs-official--title-15--14#6.1.11}

The Agency may, for good cause shown, deny, suspend or revoke a certificate of registration sought or issued pursuant to these regulations for any of the following reasons: 1. Failure of reports, plans or specifications to show that the tanning facility will be constructed, operated or maintained in accordance with the requirements of these regulations; 2. Submission of incorrect, false or misleading information in the application, reports, plans, or specifications; 3. Failure to construct, operate or maintain the tanning facility in accordance with the application, plans and specifications approved by the Agency except as such maintenance may involve the replacement of lamps by "equivalent" lamps which have been defined in 1.8; 4. Operation of the tanning facility in a way that causes or creates a nuisance or hazard to the public health or safety; 5. Violation of any rules, regulations, standards, or requirements adopted by the Agency; 6. Violation of any condition upon which the certificate of registration was issued; 7. Failure to allow duly authorized agents of the Agency to conduct inspections at reasonable hours and in a reasonable manner; 8. Failure to pay any registration or inspection fees within 30 days upon receipt of the invoice. 9. Failure of the tanning equipment to comply with the Federal Performance Standard for Sunlamp Products and Ultraviolet Lamps intended for use in Sunlamp Products 21 CFR 1040.20. Rule 6.1.12 Hearing: If any certificate of registration is denied, suspended, or revoked, the applicant or registrant may request a hearing in accordance with Chapter 45-14-21, Mississippi Code of 1972, Annotated.

**History**
- *Source: MS Code Ann. § 45-14-11*

##### **15 Miss. Admin. Code Pt. 14, R. 6.1.13** Construction and Operation of Tanning Facilities {#sec-14-6.1.13 omnilex-key=us-ms-regs-official--title-15--14#6.1.13}

Unless otherwise ordered or approved by the Agency, each tanning facility shall be constructed, operated, and maintained to meet the following minimum requirements: 1. Physical Facilities a. The following warning sign shall be posted in the immediate proximity (within 1 meter) of each piece of tanning equipment and it shall be readily legible, clearly visible, and not obstructed by any barrier, equipment, or other item present so that the user can easily view the warning sign before energizing the tanning equipment: DANGER - ULTRAVIOLET RADIATION b. Follow instructions. c. Avoid overexposure. As with natural sunlight, overexposure can cause eye and skin injury and allergic reactions. Repeated exposure may cause premature aging of the skin and skin cancer. d. Wear FDA compliant protective eyewear. e. FAILURE TO USE PROTECTIVE EYEWEAR MAY RESULT IN SEVERE BURNS OR LONG-TERM INJURY TO THE EYES. f. Medications or cosmetics may increase your sensitivity to the ultraviolet radiation. Consult a physician before using sunlamps, indoor tanning beds or booths if you are using medications or have a history of skin problems or believe yourself especially sensitive to sunlight. g. If you do not tan in the sun, you are unlikely to tan from the use of this product. h. The lettering on each warning sign shall be at least ten (10) millimeters high for all words showing in capital letters and at least five (5) millimeters high for all lowercase letters. A consumer notification providing the consumer the name and address of the Agency so that in case of an injury the consumer can contact the Agency. i. Only tanning equipment manufactured and certified to comply with 21 CFR Part 1040, Chapter 1040.20, "Sunlamp products and ultraviolet lamps intended for use in sunlamp products", shall be used in tanning facilities. Compliance shall be based on the standard in effect at the time of manufacture as shown on the device identification label required by 21 CFR Part 1010, Chapter 1010.3.

##### **15 Miss. Admin. Code Pt. 14, R. 6.1.14** Enforcement and Penalties {#sec-14-6.1.14 omnilex-key=us-ms-regs-official--title-15--14#6.1.14}

An injunction or other court order may be obtained prohibiting any violation of any provision of the Act or any regulation or order issued there under. Any person who willfully violates any provisions of the Act, or any regulation, or order issued there under, may be guilty of a misdemeanor and, upon conviction, may be punished by fine or imprisonment or both, as provided by Section 45-14-37 of the Act.

**History**
- *Source: MS Code Ann. § 45-14-11*

##### **15 Miss. Admin. Code Pt. 14, R. 6.1.15** Communications {#sec-14-6.1.15 omnilex-key=us-ms-regs-official--title-15--14#6.1.15}

All communications and reports concerning these regulations, and applications filed there under, should be addressed to the Office of Environmental Health at its office located at 570 East Woodrow Wilson Blvd., P. O. Box 1700, Jackson, Mississippi, 39215-1700.

**History**
- *Source: MS Code Ann. § 45-14-11*

##### **15 Miss. Admin. Code Pt. 14, R. 7.1.1** Fees necessary to support program functions shall be assessed as follows: {#sec-14-7.1.1 omnilex-key=us-ms-regs-official--title-15--14#7.1.1}

1. Correctional Facility Sanitation Inspection Fee ....................................$500.00

**History**
- *SOURCE: Miss. Code A nn. § 41-3- 15*

### **Part 16** Health Facilities Licensure and Certification

##### **15 Miss. Admin. Code Pt. 16, R. 1.1.1** Rule 1.1.1 {#sec-16-1.1.1 omnilex-key=us-ms-regs-official--title-15--16#1.1.1}

Every Hospice located inside the boundaries of a municipality shall comply with all local municipal codes and ordinances applicable thereto. In addition, each hospice shall comply with all applicable federal laws and state laws inclusive of Mississippi Code Annotated (41-85-1) through (41-85-25).

**History**
- *SOURCE: Miss. Code Ann. §41-85-7 Subchapter 2 LEGAL AUTHORITY*

##### **15 Miss. Admin. Code Pt. 16, R. 1.2.1** Rule 1.2.1 {#sec-16-1.2.1 omnilex-key=us-ms-regs-official--title-15--16#1.2.1}

Adoption of Rules, Regulations, and Minimum Standards – The Mississippi State Department of Health, Bureau of Health Facilities, Licensure and Certification adopts the following rule governing the licensing and regulation of hospices as authorized by the Mississippi Code Annotated Section 41-85-1 through 41-85-25 and in accordance with House Bill 379 enacted by the Regular 1995 Session of the Legislature of the State of Mississippi known as the “Mississippi Hospice Law of 1995”. The Bureau of Health Facilities, Licensure and Certification amends the following regulations which will govern the licensing of hospice agencies licensed on or after adoption of this rule.

**History**
- *SOURCE: Miss. Code Ann. §41-85-7*

##### **15 Miss. Admin. Code Pt. 16, R. 1.2.2** Rule 1.2.2 {#sec-16-1.2.2 omnilex-key=us-ms-regs-official--title-15--16#1.2.2}

Effective date of Rules, Regulations, and Minimum Standards for Hospice - This rule shall replace and supersede the rule adopted on August 21, 1995, except that the rule adopted on August 21, 1995 and reference in the Mississippi Register shall continue to regulate those hospice agencies licensed on or before adoption of this rule, and shall continue to regulate these agencies for 90 days from adoption of this rule. Effective 30 days from the adoption of this rule, the provisions of this rule shall govern all hospice agencies, regardless of the date of issuance of license.

**History**
- *SOURCE: Miss. Code Ann. §41-85-7*

##### **15 Miss. Admin. Code Pt. 16, R. 1.2.3** Rule 1.2.3 {#sec-16-1.2.3 omnilex-key=us-ms-regs-official--title-15--16#1.2.3}

Fire Safety – No freestanding hospice may be licensed until it shows conformance to the safety regulations providing minimum standards for prevention and detection of fire as well as for protection of life and property against fire.

**History**
- *SOURCE: Miss. Code Ann. §41-85-7 Subchapter 3 DEFINITIONS*

##### **15 Miss. Admin. Code Pt. 16, R. 1.3.1** Rule 1.3.1 {#sec-16-1.3.1 omnilex-key=us-ms-regs-official--title-15--16#1.3.1}

Unless a different meaning is required by the context, the following terms as used in these rules and regulations shall have the meaning hereinafter respectively ascribed to them:

1. Administrator - Means the person, designated by the governing body, who is responsible for the management of the overall operation of the hospice.

2. Advance Directives – Directive from the patient/family (see definition of family) such as a durable power of attorney for health care, a directive pursuant to patient self-determination initiatives, a living will, or an oral directive which either states a person’s choices for medical treatment or, in the event the person is unable to make treatment choices, designates who shall make those decisions.

3. Attending/Primary Physician – A doctor of medicine or osteopathy licensed to practice medicine in the State of Mississippi, who is designated by the patient or responsible party as the physician responsible for his/her medical care.

4. Bereavement Services – Organized services provided under the supervision of a qualified counselor (see definition) to help the family cope with death related grief and loss.

5. Autonomous – Means a separate and distinct operational entity which functions under its own administration and bylaws, either within or independently of a parent organization.

6. Bed Capacity – Means the largest number which can be installed or set up in the freestanding hospice at any given time for use of patients. The bed capacity shall be based upon space designed and/or specifically intended for such use whether or not the beds are actually installed or set up.

7. Bed Count – Means the number of beds that are actually installed or set for patients in freestanding hospice at a given time.

8. Branch Office/Alternate Site –A location or site from which a hospice agency provides services within a portion of the total geographic area served by the parent agency. The branch is a part of the parent hospice agency and is located within the 50 mile radius of the parent agency and shares administration and supervision. No branch office site shall be opened unless the parent office has had full licensure for the immediately preceding 12 months and has admitted 10 patients within the last twelve (12) months. A branch office does not extend the Geographic Service Area of the Parent Agency.

9. Bureau – Mississippi State Department of Health, Bureaus of Health Facilities, Licensure and Certification.

10. Care Giver – The person whom the patient designates to provide his/her emotional support and/or physical care.

11. Chaplain – Means an individual representative of a specific spiritual belief who is qualified by education received through accredited academic or theological institutions, and/or experience thereof, to provide counseling and who serves as a consultant for and/or core member of the hospice care team.

12. Change of Ownership – Means but is not limited to, intervivos, gifts, transfers, leases, cash and/or stock transactions or other comparable arrangements whenever the person or entity acquires a majority interest (fifty percent (50%) or more) of the facility or service. Changes of ownership from partnerships, single proprietorships or corporations to another form of ownership are specifically included. Provided, however, “Change of Ownership” shall not include any inherited interest acquired as a result of a testamentary instrument or under the laws of descent and distribution of the State of Mississippi. The change of IRS exemption status also constitutes a change of ownership.

13. Community – A group of individuals or a defined geographic area served by a hospice.

14. Continuous Home Care – Care provided by the hospice during a period of crisis as necessary to maintain the terminally ill individual at home. A minimum of eight hours of care must be furnished on a particular day to be considered continuous home care. Nursing care must be provided for more than one-half of the period of care and must be provided by either a registered nurse or licensed practical nurse. Services may be provided by a homemaker or hospice aide to supplement the nursing care. When determining the necessity for continuous home care, a registered nurse must complete/document a thorough assessment and plan of care that includes participation of all necessary disciplines to meet the patient’s identified needs, prior to assigning a licensed practical nurse, homemaker, or a hospice aide to a patient requiring continuous home care. This assignment must comply with accepted professional standards of practice.

15. Contracted Services – Services provided to a hospice provider or its patients by a third party under a legally binding agreement that defines the roles and responsibilities of the hospice and service provider.

16. Core Services – Nursing services, physician services, medical social services, and counseling services, including bereavement counseling, spiritual counseling, and any other counseling services provided to meet the needs of the individual and family. These services must be provided by employees of the hospice, except that physician services and counseling services may be provided through contract.

17. Counselor – Means an individual who has at least a bachelor’s degree in psychology, a master’s or bachelor’s degree from a school of social work accredited by the Council on Social Work Education, a bachelor’s degree in counseling; or the documented equivalent of any of the above in education, training in the spiritual care of the dying and end of life issues, and who is currently licensed in the state of Mississippi, if applicable. Verification of education and training must be maintained in the individual’s personnel file

18. Criminal History Record Check

a. Affidavit -For the purpose of fingerprinting and criminal background history checks, the term “affidavit” means the use of Mississippi State Department of Health (MDH) form #210, or a copy thereof, which shall be placed in the individual’s personal file.

b. Employee -For the purpose of fingerprinting and criminal background history checks, employee shall mean any individual employed by a covered entity. The term “employee” also includes any individual who by contract with a covered entity provides patient care in a patient’s, resident’s, or client’s room or in treatment rooms.

c. The term employee does not include healthcare professional/ technical students, as defined in Section 37-29-232, performing clinical training in a licensed entity under contracts between their schools and the licensed entity, and does not include students at high schools who observe the treatment and care of patients in a licensed entity as part of the requirements of an allied health course taught in the school if:

i. The student is under the supervision of a licensed healthcare provider; and

ii. The student has signed the affidavit that is on file at the student’s school stating that he or she has not been convicted of or plead guilty or nolo contendere to a felony of possession or sale of drugs, murder, manslaughter, armed robbery, rape, sexual battery, any sex offenses listed in section 45-33- 23 (g), child abuse, arson, grand larceny, burglary, gratification of lust, aggravated assault, or felonious abuse and/or battery of a vulnerable adult, or that any such conviction or plea was reversed on appeal or a pardon was granted for the conviction or plea.

iii. Further, applicants and employees of the University of Mississippi Medical Center for whom criminal history record checks and fingerprinting are obtained in accordance with Section 37-115-41 are exempt from application of the term employee under Section 43-11-13.

d. Covered Entity - For the purpose of criminal history record checks, “covered entity” means a licensed entity or a healthcare professional staffing agency.

e. Licensed Entity - For the purpose of criminal history record checks, the term “licensed entity” means a hospital, nursing home, personal care home, home health agency or hospice.

f. Health Care Professional/Vocational Technical Academic Program - For purpose of criminal history record checks, “health care professional/vocational technical academic program” means an academic program in medicine, nursing , dentistry, occupational therapy, physical therapy, social services, speech therapy, or other allied-health professional whose purpose is to prepare professionals to render patient care services.

g. Health Care Professional/Vocational Technical Student For purposes of criminal history record checks, the term means a student enrolled in a healthcare professional/vocational technical academic program.

h. Direct Patient Care or Services - For the purposes of fingerprinting and criminal background history checks, the term “direct patient care” means direct hands-on medical patient care and services provided by an individual in a patient, resident or client’s room, treatment room or recovery room. Individuals providing direct patient care may be directly employed by the facility or provides patient care on a contractual basis.

i. Documented disciplinary action - For the purpose of fingerprinting and criminal background history checks, the term “documented disciplinary action” means any action taken against an employee for abuse or neglect of a patient.

19. Department – Means the Mississippi State Department of Health (MDH).

20. Discharge – The point at which the patient’s active involvement with the hospice program is ended and the program no longer has active responsibility for the care of the patient.

21. Dietitian – Means a person who is registered by the Commission on Dietetic Registration of the American Dietetic Association or who has the documented equivalent in education, training and/or experience.

22. Do Not Resuscitate Orders (DNR) – Orders written by the patient’s physician which stipulate that in the event the patient has a cardiac or respiratory arrest, cardiopulmonary resuscitation will not be initiated or performed.

23. Emotional Support – Support provided to assist the person in coping with stress, grief and loss.

24. Family Unit – Means the terminally ill person and his or her family, which may include spouse, children, sibling, parents, and other with significant personal ties to the patient.

25. Freestanding Hospice– Freestanding Hospice means a hospice that is not a part of any other type of health care provider.

26. Geographic Service Area – Area around the Parent Office, which is within 50 miles radius of the Parent Office premises. Each hospice must designate the geographic service area in which the agency will provide services. Should any portion of a county fall within a 50 mile radius of the Parent, then the entire county may fall within the geographic service area of the Parent. Nothing herein is intended to automatically expand the service area of any existing Parent. A hospice shall seek approval of the Department for any expansion of their service area. The full range of hospice services, as specified, must be provided to the entire designated geographic services area.

27. Governing Body- A hospice program shall have a clearly defined organized governing body that has autonomous authority for the conduct of the hospice program. (Section: 41-85-19) This governing body is not required to meet more often than quarterly.

28. Hospice Aide-An individual who is currently qualified in the State of Mississippi to provide personal care services to hospice patients under the direction of a registered nurse of the hospice.

29. Hospice Inpatient Facility – Organized facilities where specific levels of care ranging from residential to acute, including respite, are provided on a 24-hour basis within the confines of a licensed hospital, nursing home, or freestanding hospice in order to meet the needs of the patient/family. A hospice inpatient facility shall meet the Condition of Participation for providing inpatient care directly as specified in Title 42, Section 418.100 of the Code of Federal Regulations.

30. Hospice – Means an autonomous, centrally administered, nonprofit or for profit medically directed, nurse-coordinated program providing a continuum of home, outpatient and homelike inpatient care for not less than four (4) terminally ill patients and their families. It employs a hospice care team (see definition of hospice care team) to assist in providing palliative and supportive care to meet the special needs arising out of the physical, emotional, spiritual, social and economic stresses which are experienced during the final stages of illness and during dying and bereavement. This care is available twenty-four (24) hours a day, seven (7) days a week, and is provided on the basis of need regardless of inability to pay. (Section 41-85-3)

31. Hospice Physician – A doctor of medicine or osteopathy who is currently and legally authorized to practice medicine in the State of Mississippi and is designated by the hospice to provide medical care to hospice patients, in coordination with the patient’s primary physician.

32. Hospice Premises – The physical site where the hospice maintains staff to perform administrative functions, maintains its personnel records, maintains its client service records, and holds itself out to the public as being a location for receipt of client referrals. A hospice must be physically located within the State of Mississippi. A license for a hospice program shall not be issued if the hospice is to be located in an area in violation of any local zoning ordinance or regulation\

33. Informed Consent – A documented process in which information regarding the potential and actual benefits and risks of a given procedure or program of care is exchanged between provider and patient.

34. Inpatient Services – Care available for General Inpatient Care or Respite Care that is provided in an Inpatient Hospice Facility, hospital, or SNF that meets the Condition of Participation for providing inpatient care directly as specified in Title 42, Section 418.100 of the Code of Federal Regulations.

35. Interdisciplinary Team (IDT) – An interdisciplinary team or group(s) designated by the hospice, composed of representatives from all the core services. The Interdisciplinary Team must include at least a doctor of medicine or osteopathy, a registered nurse, a social worker, and a pastoral or other counselor. The interdisciplinary team is responsible for participation in the establishment of the plan of care; provision or supervision of hospice care and services; periodic review and updating of the plan of care for each individual receiving hospice care, and establishment of policies governing the day-to-day provision of hospice care and services. If a hospice has more than one interdisciplinary team; it must designate, in advance, the team it chooses to execute the establishment of policies governing the day-to-day provision of hospice care and services.

36. Interdisciplinary Team Conferences – Regularly scheduled periodic meetings of specific members of the interdisciplinary team (see Rule 1.3.36) to review the most current patient/family assessment, evaluate care needs, and update the plan of care.

37. Level of Care – Hospice care is divided into four categories of care rendered to the hospice patient.

a. Routine home care

b. Continuous home care

c. Inpatient respite care

d. General inpatient care

38. License (Hospice) – A document permitting an organization to practice hospice care for a specific period of time under the rules and regulations set forth by the State of Mississippi.

39. Licensing Agency- Means the Mississippi State Department of Health.

40. Life-Threatening – Causes or has the potential to cause serious bodily harm or death of an individual.

41. Medically Directed – Means that the delivery of medical care is directed by a licensed physician who is employed by the hospice for the purpose of providing ongoing palliative care as a participating caregiver on the hospice care team.

42. Medical Social Services – Include a comprehensive psychosocial assessment; ongoing support for the patient and family; and assistance with coping skills, anticipatory grief, and grief reactions.

43. Non-Core Services- Services provided directly by hospice employees or under arrangement that are not considered Core Services. These services include, but are not limited to:

a. Hospice aide and homemaker

b. Physical therapy services

c. Occupational therapy services

d. Speech-language pathology services

e. General inpatient care

f. Respite care

g. Medical supplies and appliances including drugs and biologicals.

44. Nurse Practitioner/Physician Assistant – Shall mean a nurse who is currently licensed as such in the State of Mississippi and is performing duties in accordance with the Mississippi Nurse Practice Act or a physician assistant who is currently licensed as such in the State of Mississippi and is performing duties in accordance with the Mississippi Physician Assistants Act.

45. Occupational Therapist – Means a person licensed to practice Occupational Therapy in the State of Mississippi.

46. Outpatient Care- Means any care rendered or coordinated by the hospice care team that is not “home care” or “inpatient care”.

47. Palliative Care – Means the reduction or abatement of pain and other troubling symptoms by appropriate coordination of all elements of the hospice care team needed to achieve needed relief of distress.

48. Parent Office – The primary location or site from which a hospice agency provides services within a Geographic Service Area. The Parent Office is used to determine the base of the Geographic Service Area.

49. Patient – Shall mean the terminally ill individual who meets criteria as defined per State law.

50. Period of Crisis – A period in which a patient required predominately nursing care to achieve palliation or management of acute medical problems.

51. Physical Therapist – Means an individual who is currently licensed to practice physical therapy in the State of Mississippi.

52. Plan of Care (POC) – A written document established and maintained for each individual admitted to a hospice program. Care provided to an individual must be in accordance with the plan. The plan must include a comprehensive assessment of the individual’s needs and identification of the care/services including the management of discomfort and symptom relief.

53. Primary Care person – A person designated by the patient who agrees to give continuing support and/or care.

54. Registered Nurse – An individual who is currently licensed in the State of Mississippi or in accordance with criteria established per the Nurse Compact Act and is performing nursing duties in accordance with the Mississippi Nurse Practice Act.

55. Representative – An individual who has been authorized under State law to terminate medical care or to elect or revoke the election of hospice care on behalf of a terminally ill individual who is mentally or physically incapacitated.

56. Residential Care- Hospice care provided in a nursing facility or any residence or facility other than the patient’s private residence.

57. Respite Care- Short-term care provided in an Inpatient Hospice Facility, hospital, or SNF that meets the Condition of Participation for providing inpatient care directly as specified in Title 42, Section 418.100 of the Code of Federal

Regulations. Respite care is short-term inpatient care provided to the patient only when necessary to relieve the family members or other persons caring for the patient. Respite care may be provided only on an occasional basis and may not be reimbursed for more than five consecutive days at a time.

58. Social Worker – An individual who has a degree from a school of social work accredited by the Council on Social Work Education and is licensed by the State of Mississippi.

59. Speech Pathologist – Shall mean an individual who meets the educational and experience requirements for a Certificate of Clinical Competence granted by the American Speech and Hearing Association and is currently licensed as a Speech and Language Pathologist in the State of Mississippi.

60. Spiritual Services – Providing the availability of clergy, as needed, to address the patient’s/family’s spiritual needs and concerns.

61. Terminally Ill- A medical prognosis of limited expected survival of approximately six months or less, if the disease follows its normal course, of an individual who is experiencing an illness for which therapeutic strategies directed toward cure and control of the disease alone is no longer appropriate.

62. Volunteer – Means a trained individual who provides support and assistance to the patient, family or organization, without remuneration, in accord with the plan of care developed by the hospice core team and under the supervision of a member of the hospice staff appointed by the governing body or its designee.

63. Director of Volunteers - Means a person who directs the volunteer program in accordance with the acceptable standards of hospice practice.

**History**
- *SOURCE: Miss. Code Ann. §41-85-7 Subchapter 4 PROCEDURE GOVERNING ADOPTION AND AMENDEMENT*

##### **15 Miss. Admin. Code Pt. 16, R. 1.4.1** Rule 1.4.1 {#sec-16-1.4.1 omnilex-key=us-ms-regs-official--title-15--16#1.4.1}

Authority – The Mississippi State Department of Health shall have the power to adopt, amend, promulgate and enforce such minimum standards of operation as it deems appropriate, within the law.

**History**
- *SOURCE: Miss. Code Ann. §41-85-7*

##### **15 Miss. Admin. Code Pt. 16, R. 1.4.2** Rule 1.4.2 {#sec-16-1.4.2 omnilex-key=us-ms-regs-official--title-15--16#1.4.2}

Amendment – The Minimum Standards of Operation for Hospice may be amended by the Mississippi State Department of Health as necessary to promote the health, safety and welfare of persons receiving services.

**History**
- *SOURCE: Miss. Code Ann. §41-85-7*

##### **15 Miss. Admin. Code Pt. 16, R. 1.5.1** For the purpose of these rules, regulations, and minimum standards, hospice shall be classified as: {#sec-16-1.5.1 omnilex-key=us-ms-regs-official--title-15--16#1.5.1}

1. Freestanding Hospice 2. Hospital Hospice 3. Nursing Home Hospice 4. Home Health Agency Hospice

**History**
- *SOURCE: Miss. Code Ann. §41-85-7*

##### **15 Miss. Admin. Code Pt. 16, R. 1.5.2** Rule 1.5.2 {#sec-16-1.5.2 omnilex-key=us-ms-regs-official--title-15--16#1.5.2}

Hospice Core Service - To be classified as a Hospice these core services shall be provided but need not be limited to the following:

1. Physician Service

2. Nursing Service

3. Medical Social Service

4. Pastoral/Counseling Services

**History**
- *SOURCE: Miss. Code Ann. §41-85-7*

##### **15 Miss. Admin. Code Pt. 16, R. 1.5.3** Rule 1.5.3 {#sec-16-1.5.3 omnilex-key=us-ms-regs-official--title-15--16#1.5.3}

Inpatient Hospice - To be classified as an Inpatient Hospice that provides inpatient care, the core services (physician, nursing, medical, social and counseling) shall be provided on the premises. Inpatient Hospice must have a registered nurse on duty seven days a week, twenty-four hours a day to provide direct patient care. Other members and types of personnel sufficient to meet the total needs of the patient shall be provided.

**History**
- *SOURCE: Miss. Code Ann. §41-85-7 Subchapter 6 LICENSING*

##### **15 Miss. Admin. Code Pt. 16, R. 1.6.1** It shall be unlawful to operate or maintain a hospice without first obtaining a license from the department {#sec-16-1.6.1 omnilex-key=us-ms-regs-official--title-15--16#1.6.1}

The Mississippi State Department of Health is the licensing authority for hospice in the State of Mississippi.

**History**
- *SOURCE: Miss. Code Ann. §41-85-7 Subchapter 7 TYPES OF LICENSES*

##### **15 Miss. Admin. Code Pt. 16, R. 1.7.1** Rule 1.7.1 {#sec-16-1.7.1 omnilex-key=us-ms-regs-official--title-15--16#1.7.1}

Regular License – A license shall be issued to each hospice that meets the requirements as set forth in these regulations. The license shall show the classification Home Health, Nursing Home, Hospital or Freestanding.

**History**
- *SOURCE: Miss. Code Ann. §41-85-7*

##### **15 Miss. Admin. Code Pt. 16, R. 1.7.2** Rule 1.7.2 {#sec-16-1.7.2 omnilex-key=us-ms-regs-official--title-15--16#1.7.2}

Provisional License – Within its discretion, the Mississippi State Department of Health may issue a provisional license when a temporary condition of non- compliance with these regulations exists in one or more particulars. A provisional license shall be issued only if the Department of Health is satisfied that preparations are being made to qualify for a regular license and that the health and safety of patients will not be endangered. One condition on which a provisional license may be issued is as follows: A new hospice agency may be issued a provisional license prior to opening and subsequent to meeting the required minimum staffing personnel. The license issued under this condition shall be valid until the issuance of a regular license or June 30 following date of issuance whichever may be sooner. A provisional license may be reissued only if it is satisfactorily proven to the Department of Health that efforts are being made to fully comply with these regulations by a specified time.

**History**
- *SOURCE: Miss. Code Ann. §41-85-7*

##### **15 Miss. Admin. Code Pt. 16, R. 1.7.3** Rule 1.7.3 {#sec-16-1.7.3 omnilex-key=us-ms-regs-official--title-15--16#1.7.3}

A hospice program against which a revocation or suspension proceeding is pending at the time of licensure renewal may be issued a conditional license effective until final disposition by the department of such proceedings. If judicial relief is sought from the final disposition, the court having jurisdiction may issue a conditional permit for the duration of the judicial proceeding.

**History**
- *SOURCE: Miss. Code Ann. §41-85-7 Subchapter 8 APPLICATION FOR LICENSE*

##### **15 Miss. Admin. Code Pt. 16, R. 1.8.1** A Hospice shall not be operated in Mississippi without a valid license from Mississippi State Department of Health {#sec-16-1.8.1 omnilex-key=us-ms-regs-official--title-15--16#1.8.1}

**History**
- *SOURCE: Miss. Code Ann. §41-85-7*

##### **15 Miss. Admin. Code Pt. 16, R. 1.8.2** Any person or organization desiring to operate a hospice shall file with the Department of Health: {#sec-16-1.8.2 omnilex-key=us-ms-regs-official--title-15--16#1.8.2}

1. Application on a form prescribed and furnished by the Department of Health; and 2. Fees as applicable per State law

**History**
- *SOURCE: Miss. Code Ann. §41-85-7*

##### **15 Miss. Admin. Code Pt. 16, R. 1.8.3** Rule 1.8.3 {#sec-16-1.8.3 omnilex-key=us-ms-regs-official--title-15--16#1.8.3}

The application shall include complete information concerning the address of the applicant; the ownership of the hospice; if organized as a corporation, the names and addresses of each officer and director of the corporation; if organized as a partnership, the names and addresses of each partner; membership of the governing body; the identities of the medical director and administrator; and any other relevant information which the Mississippi State Department of Health may require.

**History**
- *SOURCE: Miss. Code Ann. §41-85-7*

##### **15 Miss. Admin. Code Pt. 16, R. 1.8.4** Ownership of the hospice shall be fully disclosed in the application {#sec-16-1.8.4 omnilex-key=us-ms-regs-official--title-15--16#1.8.4}

This disclosure shall include names and addresses of all corporate officers and any person(s) having a five percent (5%) financial interest.

**History**
- *SOURCE: Miss. Code Ann. §41-85-7*

##### **15 Miss. Admin. Code Pt. 16, R. 1.8.5** A license shall be issued to the person(s) named only for the premises listed on the application for licensure {#sec-16-1.8.5 omnilex-key=us-ms-regs-official--title-15--16#1.8.5}

Separate applications and licenses are required for hospices maintained separately, even if they are owned or operated by the same person(s), business or corporation, and may be doing business under the same trade name. No hospices shall establish a branch/satellite facility outside a 50 mile radius from the Parent facility. However, existing satellite branch offices operating outside the described 50 mile radius referenced in Rule 1.3.27 prior to the effective date of these regulations shall be permitted to remain satellite branch offices under their existing Parent facility.

**History**
- *SOURCE: Miss. Code Ann. §41-85-7*

##### **15 Miss. Admin. Code Pt. 16, R. 1.8.6** Licenses are not transferable or assignable {#sec-16-1.8.6 omnilex-key=us-ms-regs-official--title-15--16#1.8.6}

**History**
- *SOURCE: Miss. Code Ann. §41-85-7*

##### **15 Miss. Admin. Code Pt. 16, R. 1.8.7** Rule 1.8.7 {#sec-16-1.8.7 omnilex-key=us-ms-regs-official--title-15--16#1.8.7}

Each planned change of ownership or lease shall be reported to the Department at least thirty (30) days prior to such change along with an application from the proposed new owners/lessees for a new license.

**History**
- *SOURCE: Miss. Code Ann. §41-85-7*

##### **15 Miss. Admin. Code Pt. 16, R. 1.8.8** The application is considered a continuing application {#sec-16-1.8.8 omnilex-key=us-ms-regs-official--title-15--16#1.8.8}

A written amendment to the current application shall be filed when there is a change in any of the information reported in the application.

**History**
- *SOURCE: Miss. Code Ann. §41-85-7*

##### **15 Miss. Admin. Code Pt. 16, R. 1.8.9** Rule 1.8.9 {#sec-16-1.8.9 omnilex-key=us-ms-regs-official--title-15--16#1.8.9}

Fees: Prior to review for an initial license and prior to license renewal, the facility shall submit fees as established by the Mississippi State Board of Health, made

payable to the Mississippi State Department of Health, either by business check, money order, or electronic means.

**History**
- *SOURCE: Miss. Code Ann. §41-85-7*

##### **15 Miss. Admin. Code Pt. 16, R. 1.8.10** Rule 1.8.10 {#sec-16-1.8.10 omnilex-key=us-ms-regs-official--title-15--16#1.8.10}

Operational Requirements/Conditions of Operation – In order for a hospice program to be considered operational, the program must:

1. Have admitted at least ten patients since the last annual survey;

2. Be able to accept referrals at any time;

3. Have adequate staff to meet the needs of their current patients;

4. Have required designated staff on the premises at all times during business hours;

5. Be immediately available by telecommunications 24 hours per day. A registered nurse must answer calls from patients and other medical personnel after hours;

6. Be open for business of providing hospice services to those who need assistance.

**History**
- *SOURCE: Miss. Code Ann. §41-85-7*

##### **15 Miss. Admin. Code Pt. 16, R. 1.8.11** License Renewal Process {#sec-16-1.8.11 omnilex-key=us-ms-regs-official--title-15--16#1.8.11}

1. A license issued for the operation of a hospice program, unless sooner suspended or revoked, shall expire automatically on June 30 of each calendar year.

2. Renewal packet includes forms required for renewal of license.

3. An agency seeking a renewal of its hospice license shall:

a. Request a renewal packet from the bureau if one is not received at least 45 days prior to license expiration;

b. Complete all forms and return to bureau at least 30 days prior to license expiration;

c. Submit the current annual licensure fees with packet. An application is not considered to have been submitted unless the licensure fees are received.

**History**
- *SOURCE: Miss. Code Ann. §41-85-7 Subchapter 9 NOTIFICATION OF CHANGES*

##### **15 Miss. Admin. Code Pt. 16, R. 1.9.1** Rule 1.9.1 {#sec-16-1.9.1 omnilex-key=us-ms-regs-official--title-15--16#1.9.1}

Mississippi State Department of Health shall be notified, in writing, of any of the following within five working days following the occurrence:

1. Address/location (An Inpatient Hospice facility must notify and receive approval by Mississippi State Department of Health prior to a change of address/location);

2. Agency name; 3. Phone number; 4. Hours of operation/24 hour contact procedure; 5. Change in address or phone number of any branch office; 6. Administrator; 7. Director of nursing; and 8. Cessation of business.

**History**
- *SOURCE: Miss. Code Ann. §41-85-7*

##### **15 Miss. Admin. Code Pt. 16, R. 1.9.2** Rule 1.9.2 {#sec-16-1.9.2 omnilex-key=us-ms-regs-official--title-15--16#1.9.2}

Name of Institution – Every hospice shall be designated by a permanent and distinctive name which shall be used in applying for a license and shall not be changed without first notifying the licensing agency in writing and receiving written approval of the change from the licensing agency. Such notice shall specify the name to be discontinued as well as the new name proposed. Only the official name by which the institution is licensed shall be used in telephone listing, on stationery, in advertising, etc. Two or more facilities shall not be licensed under similar names in the same vicinity.

**History**
- *SOURCE: Miss. Code Ann. §41-85-7*

##### **15 Miss. Admin. Code Pt. 16, R. 1.9.3** Rule 1.9.3 {#sec-16-1.9.3 omnilex-key=us-ms-regs-official--title-15--16#1.9.3}

Number of Beds – Each application for license shall specify the maximum number of inpatient beds in the hospice as determined by these regulations. The maximum number of inpatient beds for which the facility is licensed shall not be exceeded.

**History**
- *SOURCE: Miss. Code Ann. §41-85-7*

##### **15 Miss. Admin. Code Pt. 16, R. 1.9.4** Rule 1.9.4 {#sec-16-1.9.4 omnilex-key=us-ms-regs-official--title-15--16#1.9.4}

A license for a hospice program shall not be issued if the hospice is to be located in an area in violation of any local zoning ordinances or regulations.

**History**
- *SOURCE: Miss. Code Ann. §41-85-7*

##### **15 Miss. Admin. Code Pt. 16, R. 1.9.5** Rule 1.9.5 {#sec-16-1.9.5 omnilex-key=us-ms-regs-official--title-15--16#1.9.5}

Following inspection and evidence of compliance with these regulations, the Mississippi State Department of Health may issue a license. Only licensed hospices shall be authorized to use the name “hospice.

**History**
- *SOURCE: Miss. Code Ann. §41-85-7*

##### **15 Miss. Admin. Code Pt. 16, R. 1.9.6** A license shall be displayed in a prominent place in the hospice’s administrative offices {#sec-16-1.9.6 omnilex-key=us-ms-regs-official--title-15--16#1.9.6}

**History**
- *SOURCE: Miss. Code Ann. §41-85-7*

##### **15 Miss. Admin. Code Pt. 16, R. 1.9.7** Inspections {#sec-16-1.9.7 omnilex-key=us-ms-regs-official--title-15--16#1.9.7}

1. Observation and examination of the hospice operation shall be available at all reasonable hours to properly identified representatives of the Department.

2. The Department shall conduct inspections of all Parent and Branch units annually.

3. Hospice inspections shall include personal contacts with recipients of the hospice service.

**History**
- *SOURCE: Miss. Code Ann. §41-85-7*

##### **15 Miss. Admin. Code Pt. 16, R. 1.9.8** Change of Ownership: Should a hospice program/facility wish to undergo a change of ownership, the facility must: {#sec-16-1.9.8 omnilex-key=us-ms-regs-official--title-15--16#1.9.8}

1. Submit a written request to Mississippi State Department of Health to obtain a Change of Ownership (CHOW) Package.

2. Submit the following with the request for CHOW within five (5) working days after the act of sale:

a. A new license application and the current licensing fee. The purchaser of the agency must meet all criteria required for initial licensure for hospice;

b. Any changes in the name and or address of the agency;

c. Any changes in administrative personnel;

d. Copy of the Bill of Sale and/or legal document reflecting change;

e. Copy of Articles of Incorporation.

**History**
- *SOURCE: Miss. Code Ann. §41-85-7 Subchapter 10 DENIAL, SUSPENSION, OR REVOCATION OF LICENSE*

##### **15 Miss. Admin. Code Pt. 16, R. 1.10.1** Rule 1.10.1 {#sec-16-1.10.1 omnilex-key=us-ms-regs-official--title-15--16#1.10.1}

Denial or Revocation of License: Hearing and Review – The licensing agency is authorized to deny, suspend, or revoke a license. Any of the following actions shall be grounds for action by the department against a hospice program:

1. A violation of the provisions of the Mississippi Hospice Law of 1995 or any standard or rule of these regulations, including but not limited to, in any case the Department finds that there has been substantial failure to comply with the requirements established under the law and these regulations. These are inclusive of the following:

a. Fraud on the part of the licensee in applying for license.

b. Willful or repeated violations by the licensee of any of the provisions of the Mississippi Law of 1995, as amended, and /or of the rules, regulations, and minimum standards established by the Department of Health.

c. Addiction to narcotic drug(s) by the licensee or the management staff of the hospice.

2. Use of alcoholic beverages by the licensee or other personnel of the hospice to the extent which threatens the well being or safety of the patient or resident.

3. Conviction of the licensee of a felony.

4. Publicly misrepresenting the hospice and/or its services.

5. Permitting, aiding, and abetting the commission of any unlawful act.

6. Misappropriation of the money or property of a patient or resident.

7. An intentional or negligent act materially affecting the health and safety of a patient. These acts include but are not necessarily limited to:

a. Cruelty to patient or resident or indifference to their needs which are essential to their general well-being and health.

b. Failure to provide food adequate for the needs of the patient or resident, when residing in an inpatient facility.

c. Inadequate staff to provide safe care and supervision of patient or resident.

d. Failure to call a physician when required by patient’s or resident’s condition.

e. Failure to notify next of kin or designated individual hen patient’s or resident’s conditions become critical.

f. Failure to provide appropriate level of care.

8. If, three (3) months after the date of obtaining a license, or at any time thereafter, a hospice does not have in operation the home-care component of hospice care, the department shall immediately revoke the license of such hospice.

9. If, twelve (12) months after the date of obtaining a license, or at any time thereafter, a hospice does not have in operation the outpatient and homelike inpatient components of hospice care, the department shall immediately revoke the license of such hospice.

**History**
- *SOURCE: Miss. Code Ann. §41-85-7 Subchapter 11 PROVISION OF HEARING AND APPEAL FOLLOWING DENIAL OR REVOCATION OF LICENSE; PENALTIES*

##### **15 Miss. Admin. Code Pt. 16, R. 1.11.1** Rule 1.11.1 {#sec-16-1.11.1 omnilex-key=us-ms-regs-official--title-15--16#1.11.1}

Administrative Decision – The Mississippi State Department of Health will provide an opportunity for a fair hearing to every applicant or licensee who is dissatisfied with administrative decisions made in the suspension, denial or revocation of license.

1. The licensing agency shall notify the applicant or licensee by registered mail or personal service the particular reasons for the suspension, denial or revocation of license. Upon written request of applicant or licensee within ten (10) days of the date of notification the licensing agency shall fix a date not less than thirty (30) days from the date of such service at which time the applicant or licensee shall be given an opportunity for a prompt and fair hearing.

2. On the basis of such hearing or upon default of the applicant or licensee, the licensing agency shall make a determination specifying its findings of fact and conclusions of law. A copy of such determination shall be sent by registered mail to the last known address of the applicant or licensee or served personally upon the applicant or licensee.

3. The decision revoking, suspending, or denying the application or license shall become final thirty (30) days after it is so mailed or served unless the applicant or licensee, within such thirty (30) day period, appeals the decision to the State court having jurisdiction and such court issues a conditional permit for the duration of the judicial proceedings. An additional period of time may be granted at the discretion of the licensing agency including a conditional license.

**History**
- *SOURCE: Miss. Code Ann. §41-85-7*

##### **15 Miss. Admin. Code Pt. 16, R. 1.11.2** Rule 1.11.2 {#sec-16-1.11.2 omnilex-key=us-ms-regs-official--title-15--16#1.11.2}

Penalties – Any person establishing, conducting, managing, or operating a hospice without a license shall be declared in violations of these regulations and State law. Penalties shall be assessed in accordance with §41-85-25 of the Mississippi Code of 1972.

**History**
- *SOURCE: Miss. Code Ann. §41-85-7*

##### **15 Miss. Admin. Code Pt. 16, R. 1.12.1** General – In the event that a Hospice ceases operation, voluntarily or otherwise, the agency shall: {#sec-16-1.12.1 omnilex-key=us-ms-regs-official--title-15--16#1.12.1}

1. Inform the attending physician, patient, and persons responsible for the patient’s care in ample time to provide for alternate methods of care;

2. Provide the receiving facility or agency with a complete copy of the clinical record;

3. Inform the community through public announcement of the termination;

4. Ensure the safekeeping, confidentiality, and storage of all clinical records for a period of five (5) years, following discharge, and notify Mississippi State Department of Health, in writing, the location of all records;

5. Return the license to the licensing agency.

**History**
- *SOURCE: Miss. Code Ann. §41-85-7 Subchapter 13 ADMINISTRATION*

##### **15 Miss. Admin. Code Pt. 16, R. 1.13.1** Rule 1.13.1 {#sec-16-1.13.1 omnilex-key=us-ms-regs-official--title-15--16#1.13.1}

Governing Body – A hospice shall have a governing body (See Definition ) that assumes full legal responsibility for compliance with these regulations and for setting policy, appointing persons to carry out such policies, and monitoring the hospice’s total operation.

**History**
- *SOURCE: Miss. Code Ann. §41-85-7*

##### **15 Miss. Admin. Code Pt. 16, R. 1.13.2** Medical Director {#sec-16-1.13.2 omnilex-key=us-ms-regs-official--title-15--16#1.13.2}

1. Each hospice shall have a Medical Director, who, on the basis of training, experience and interest, shall be knowledgeable about the psychosocial and medical aspects of hospice care.

2. The Medical Director shall be appointed by the governing body or its designee.

3. The Medical Director is expected to play an integral role in providing medical supervision to the hospice interdisciplinary group and in providing overall coordination of the patient’s plan of care. The Medical Director’s expertise in managing pain and symptoms associated with the patient’s terminal disease is necessary, regardless of the setting in which the patient is receiving services to assure that the hospice patient has access quality hospice care.

4. The duties of the Medical Director shall include, but not be limited to:

a. Determination of patient medical eligibility for hospice services in accordance with hospice program policy;

b. Collaboration with the individual’s attending physician to assure all aspects of medical care are taken into consideration in devising a palliative plan of care;

c. Review, revise and document the plan at intervals specified in the plan, but no less than every 14 calendar days;

d. Acting as a medical resource to the hospice care team and as a medical liaison with physicians in the community; and

e. Coordination of efforts with each attending physician to provide care in the event that the attending physician is unable to retain responsibility for patient care.

**History**
- *SOURCE: Miss. Code Ann. §41-85-7*

##### **15 Miss. Admin. Code Pt. 16, R. 1.13.3** Rule 1.13.3 {#sec-16-1.13.3 omnilex-key=us-ms-regs-official--title-15--16#1.13.3}

Administrator – A person shall be designated by the governing body or its designee to be responsible for the management of the hospice program in matters of overall operation. This person may be a member of the hospice care team.

**History**
- *SOURCE: Miss. Code Ann. §41-85-7*

##### **15 Miss. Admin. Code Pt. 16, R. 1.13.4** Rule 1.13.4 {#sec-16-1.13.4 omnilex-key=us-ms-regs-official--title-15--16#1.13.4}

Advertising – If a hospice advertises its services, such advertisement shall be factual and not contain any element which might be considered coercive or misleading. Any written advertising describing services offered by the hospice shall contain notification that services are available regardless of ability to pay.

**History**
- *SOURCE: Miss. Code Ann. §41-85-7*

##### **15 Miss. Admin. Code Pt. 16, R. 1.13.5** Annual Budget {#sec-16-1.13.5 omnilex-key=us-ms-regs-official--title-15--16#1.13.5}

1. The annual budget shall include income plus expenses related to overall cost of the program.

2. The overall plan and budget shall be reviewed and updated at least annually by the governing body.

3. The annual budget should reflect a comparative analysis of the cost savings of the volunteers.

**History**
- *SOURCE: Miss. Code Ann. §41-85-7 Subchapter 14 POLICIES AND PROCEDURES*

##### **15 Miss. Admin. Code Pt. 16, R. 1.14.1** The hospice shall maintain operational policies and procedures, which shall be kept current {#sec-16-1.14.1 omnilex-key=us-ms-regs-official--title-15--16#1.14.1}

**History**
- *SOURCE: Miss. Code Ann. §41-85-7*

##### **15 Miss. Admin. Code Pt. 16, R. 1.14.2** Rule 1.14.2 {#sec-16-1.14.2 omnilex-key=us-ms-regs-official--title-15--16#1.14.2}

Such policies and procedures shall accurately reflect a description of the hospice’s goals, methods by which these goals are sought, and mechanisms by which the basic hospice care services are delivered. The facility must follow all written policies developed by the licensed facility.

**History**
- *SOURCE: Miss. Code Ann. §41-85-7 Subchapter 15 PERSONNEL POLICIES*

##### **15 Miss. Admin. Code Pt. 16, R. 1.15.1** Rule 1.15.1 {#sec-16-1.15.1 omnilex-key=us-ms-regs-official--title-15--16#1.15.1}

Personnel Policies – Each licensed hospice agency shall adopt and enforce personnel policies applicable and available to all full and part time employees. These policies shall include but not be limited to the following: 1. Fringe benefits, hours of work and leave time; 2. Requirements for initial and periodic health examinations; 3. Orientation to the hospice and appropriate continuing education; 4. Job descriptions for all positions utilized by the agency; 5. Annual performance evaluations for all employees; 6. Compliance with all applicable requirements of the Civil Rights Act of 1964; 7. Provision for confidentiality of personnel records.

**History**
- *SOURCE: Miss. Code Ann. §41-85-7*

##### **15 Miss. Admin. Code Pt. 16, R. 1.15.2** Rule 1.15.2 {#sec-16-1.15.2 omnilex-key=us-ms-regs-official--title-15--16#1.15.2}

Personnel Records – Each licensed hospice shall maintain complete personnel records for all employees on file at each licensed site. Personnel records for all employees shall include and application for employment including name and address of the employee, social security number, date of birth, name and address of next of kin, evidence of qualifications, (including reference checks), current licensure and/or registration (if applicable), performance evaluation, evidence of health screening, evidence of orientation, and a contract (if applicable), date of employment and separation from the hospice and the reason for separation. A Hospice that provides other services under arrangement through a contractual purchase of services shall ensure that these services are provided by qualified personnel; currently licensed and/or registered if applicable, and are under the supervision of the agency.

**History**
- *SOURCE: Miss. Code Ann. §41-85-7*

##### **15 Miss. Admin. Code Pt. 16, R. 1.15.3** Criminal History Record Checks {#sec-16-1.15.3 omnilex-key=us-ms-regs-official--title-15--16#1.15.3}

9. Pursuant to Section 43-11-13, Mississippi Code of 1972, the covered entity shall require to be performed a disciplinary check with the professional licensing agency, if any, for each employee to determine if any disciplinary action has been taken against the employee by the agency, and a criminal history record check on:

A. Every new employee of a covered entity who provides direct patient care or services; and

B. Any individual seeking new employment with a covered entity whose initial criminal history record check is over two years.

**History**
- *SOURCE: Miss. Code Ann. §41-85-7*

##### **15 Miss. Admin. Code Pt. 16, R. 1.15.3** Rule 1.15.3 {#sec-16-1.15.3 omnilex-key=us-ms-regs-official--title-15--16#1.15.3}

Employee Health Screening – Every employee of a hospice who comes in contact with patients shall receive a health screening by a licensed physician, nurse practitioner/physician assistant or employee health nurse who conduct exams prior to employment. Facilities shall comply with recommendations from the Centers for Disease Control and/or the Mississippi State Department of Health regarding baseline employee TB testing and routine serial employee TB testing and education.

**History**
- *SOURCE: Miss. Code Ann. §41-85-7*

##### **15 Miss. Admin. Code Pt. 16, R. 1.15.4** Rule 1.15.4 {#sec-16-1.15.4 omnilex-key=us-ms-regs-official--title-15--16#1.15.4}

Staffing Schedule – Each hospice and alternate site shall maintain on site current staffing patterns for all health care personnel including full-time, part-time, contract staff and staff under arrangement. The staffing pattern shall be developed at least one week in advance, updated daily as needed, and kept on file for a period of one year. The staffing pattern shall indicate the following for each working day:

1. Name and position of each staff member. 2. Patients to be visited. 3. Scheduled on call after office hours.

**History**
- *SOURCE: Miss. Code Ann. §41-85-7 Subchapter 16 CONTRACT SERVICES*

##### **15 Miss. Admin. Code Pt. 16, R. 1.16.1** Rule 1.16.1 {#sec-16-1.16.1 omnilex-key=us-ms-regs-official--title-15--16#1.16.1}

Contract Services – Contract services may be provided when necessary to supplement hospice employees in order to meet the needs of patients during peak patient loads or under extraordinary circumstances. If contracting is used, the hospice must maintain professional, financial and administrative responsibility for

the services. The hospice must assure that the personnel contracted are legally and professionally qualified to perform the services.

**History**
- *SOURCE: Miss. Code Ann. §41-85-7*

##### **15 Miss. Admin. Code Pt. 16, R. 1.16.2** Rule 1.16.2 {#sec-16-1.16.2 omnilex-key=us-ms-regs-official--title-15--16#1.16.2}

The hospice must assure that contracted staff are providing care that is consistent with the Hospice philosophy and the patient’s plan of care.

**History**
- *SOURCE: Miss. Code Ann. §41-85-7 Subchapter 17 ORGANIZATION AND STAFFING PERSONNEL QUALIFICATIONS/RESPONSIBILITIES*

##### **15 Miss. Admin. Code Pt. 16, R. 1.17.1** Rule 1.17.1 {#sec-16-1.17.1 omnilex-key=us-ms-regs-official--title-15--16#1.17.1}

Administrator – A person who is designated, in writing, by the Governing Body as administratively responsible for all aspects of hospice operations. When the administrator serves more than one licensed agency, he/she shall designate, in writing, an alternate to serve as administrator for each site where he/she is not physically housed continuously. The alternate shall be a full-time, on-site employee of the hospice and shall meet the same qualifications as the administrator. The administrator and the Director of Nurses/Alternates may be the same individual if that individual is dually qualified.

1. Qualifications – Licensed physician, a licensed registered nurse, a social worker with a Bachelor’s degree, or a college graduate with a bachelor’s degree and two (2) years of health care management experience or an individual with one (1) year of healthcare management experience and three (3) years of healthcare service delivery experience that would be relevant to managing the day-to-day operations of a hospice. EXEMPTION: Any person who is employed by a licensed Mississippi hospice as the administrator, as of the effective date of these regulations, shall be exempt from these requirements as long as he/she remains employed by that hospice as the administrator. If the hospice is sold to, acquired by, or merged into another legal entity, such transaction shall have no effect on the exemption provided in the preceding sentence.

2. Responsibilities – The administrator shall be responsible for compliance with all regulations, laws, policies and procedures applicable to hospice specifically and to Medicare/Medicaid issues when applicable:

a. Ensure the hospice employs qualified individuals;

b. Be on-site during business hours or immediately available by ecommunications when working within the geographic service area;

3. Be responsible for and direct the day-to-day operations of the hospice; 4. Act as liaison among staff, patients, and governing board;

5. Designate, in writing, an individual who meets the administrator qualifications to assume the authority and the control of the hospice if the administrator is unavailable; and

6. Designate in advance the IDT he/she chooses to establish policies governing the day-to-day provisions of hospice care.

**History**
- *SOURCE: Miss. Code Ann. §41-85-7*

##### **15 Miss. Admin. Code Pt. 16, R. 1.17.2** Counselor – Bereavement {#sec-16-1.17.2 omnilex-key=us-ms-regs-official--title-15--16#1.17.2}

1. Qualifications – Documented evidence of appropriate training and experience in the care of the bereaved received under the supervision of a qualified professional.

2. Responsibilities – Under the supervision of a qualified professional, and as part of an organized program for the provision of bereavement services, the counselor shall implement bereavement counseling in a manner consistent with standards of practice. Services include, but are not limited to the following:

3. Assess grief counseling needs;

4. Provide bereavement information and referral services to the bereaved, as needed, in accordance with the POC;

5. Provide bereavement support to hospice staff as needed;

6. Attend hospice IDT meetings as needed; and

7. Document bereavement services provided and progress of bereaved on a clinical progress note to be incorporated in the clinical record.

**History**
- *SOURCE: Miss. Code Ann. §41-85-7*

##### **15 Miss. Admin. Code Pt. 16, R. 1.17.3** Counselor – Dietary {#sec-16-1.17.3 omnilex-key=us-ms-regs-official--title-15--16#1.17.3}

1. Qualifications – A registered dietician licensed in the State of Mississippi who meets the qualification standards of the Commission on Dietetic Registration of the American Dietetic Association.

2. Responsibilities – The dietitian shall implement dietary services based on initial and ongoing assessment of dietary needs in a manner consistent with standards of practice including, but not limited to, the following:

a. Evaluate outcomes of interventions and document findings on a clinical progress note which is to be incorporated into the clinical record within one week of the visit;

b. Collaborate with the patient/family, physician, registered nurse, and/or the IDT in providing dietary counseling to the patient/family;

c. Instruct patient/family and/or hospice staff as needed;

d. Evaluate patient socioeconomic factors to develop recommendations concerning food purchasing, preparation and storage;

e. Evaluate food preparation methods to ensure nutritive value is conserved, flavor, texture and temperature principles are adhered to in meeting the individual patient’s needs; and

f. Participate in IDT conference as needed.

**History**
- *SOURCE: Miss. Code Ann. §41-85-7*

##### **15 Miss. Admin. Code Pt. 16, R. 1.17.4** Counselor – Spiritual {#sec-16-1.17.4 omnilex-key=us-ms-regs-official--title-15--16#1.17.4}

1. Qualifications – Documented evidence of appropriate training and skills to provide spiritual counseling, such as Bachelor of Divinity, Master of Divinity or equivalent theological degree or training.

2. Responsibilities – The counselor shall provide spiritual counseling based on the initial and ongoing assessment of spiritual needs of the patient/family, in a manner consistent with standards of practice including, but not limited to, the following:

a. Serve as a liaison and support to community chaplains and/or spiritual counselors;

b. Provide consultation, support, and education to the IDT members on spiritual care;

c. Supervise spiritual care volunteers assigned to family/care givers; and

d. Attend IDT meetings.

**History**
- *SOURCE: Miss. Code Ann. §41-85-7*

##### **15 Miss. Admin. Code Pt. 16, R. 1.17.5** Director of Nurses (DON) {#sec-16-1.17.5 omnilex-key=us-ms-regs-official--title-15--16#1.17.5}

1. A person designated, in writing, by the Governing Body to supervise all aspects of patient care, all activities of professional staff and allied health personnel, and responsible for compliance with regulatory requirements. The DON or alternate, shall be on site or immediately available to be on site, at all times during

operating hours. If the DON is unavailable he/she shall designate a Registered Nurse to be responsible during his/her absence.

2. NOTE: The Director of Nurses is prohibited from simultaneous concurrent employment with any entity or any other licensed health care entity, unless such licensed healthcare agency is occupying the same physical office space as the hospice.

3. Qualifications – A registered nurse who is currently licensed to practice in the State of Mississippi.

4. With at least three years experience as a registered nurse. One of these years shall consist of full-time experience in:

a. Providing direct patient care in a hospice, home health, or oncology setting; or

b. The management of patient care staff in an acute care setting, hospice or home health; and

c. Be a full time employee of only the hospice agency.

5. Responsibilities – The DON shall supervise all patient care activities to assure compliance with current standards of accepted nursing and medical practice including, but not limited to, the following:

a. The POC;

b. Implement personnel and employment policies to assure that only qualified personnel are hired. verify licensure and/or certification (as required by law) prior to employment and annually thereafter;

c. maintain records to support competency of all allied health personnel;

d. Implement hospice policies and procedures that establish and support quality patient care, cost control, and mechanisms for disciplinary action for infractions;

e. Ensure clinical staff compliance with the employee health program; and

f. Ensure compliance with local, state, and federal laws to promote the health and safety of employees, patients and the community, using the following non- exclusive methods:

i. Resolve problems;

ii. Perform complaint investigations; iii. Refer impaired personnel to proper authorities;

iv. Ensure appropriate orientation and in-service training to employees;

v. Ensure the development and implementation of an orientation program for new direct health care personnel;

vi. Ensure the completion of timely annual performance evaluations of health care personnel or designate other supervisory personnel to perform such evaluations;

vii. Ensure participation in regularly scheduled appropriate continuing education for all health professionals, home health aides and homemakers;

viii. Ensure that the care provided by the health care personnel promotes effective hospice services and the safety of the patient; and

ix. Ensure that the hospice policies are enforced.

**History**
- *SOURCE: Miss. Code Ann. §41-85-7 Subchapter 18 GOVERNING BODY*

##### **15 Miss. Admin. Code Pt. 16, R. 1.18.1** Rule 1.18.1 {#sec-16-1.18.1 omnilex-key=us-ms-regs-official--title-15--16#1.18.1}

The hospice shall have a governing body that assumes full legal responsibility for determining, implementing and monitoring policies governing the hospice’s total operation. No contracts/arrangements or other agreements may limit or diminish the responsibility of the governing body. The governing body shall:

1. Designate an individual who is responsible for the day to day management of the hospice program;

2. Ensure that all services provided are consistent with accepted standards of practice;

3. Develop and approve policies and procedures which define and describe the scope of services offered;

4. Review policies and procedures at least annually revise them as necessary; and

5. Maintain an organizational chart that delineates lines of authority and responsibility for all hospice personnel.

**History**
- *SOURCE: Miss. Code Ann. §41-85-7*

##### **15 Miss. Admin. Code Pt. 16, R. 1.18.2** Rule 1.18.2 {#sec-16-1.18.2 omnilex-key=us-ms-regs-official--title-15--16#1.18.2}

Hospice Aide - A qualified person who provides direct patient care and/or housekeeping duties in the home or homelike setting under the direct supervision of a registered nurse. The facility shall ensure that each hospice aide is appropriately trained and competent to meet the needs of the patient per the plan

of care. Documentation must be maintained on-site of all training and competency in accordance with patient plan of care.

1. Responsibilities – The hospice aide shall provide services established and delegated in POC, record and notify the primary registered nurse of deviations according to standard of practice including, but not limited to, the following:

2. Provide assistance with mobility, transferring, walking, grooming, bathing, dressing or undressing, eating, toileting, and/or housekeeping needs.

3. Complete a clinical note for each visit, which must be incorporated into the record at least on a weekly basis.

4. Restrictions – The hospice aide shall not:

a. Perform any intravenous procedures, procedures involving the use of Levine tubes or Foley catheters, or any other sterile or invasive procedures.

b. Administer medications.

5. Initial Orientation – The content of the basic orientation provided to the hospice aides shall include the following:

a. Policies and objectives of the agency;

b. Duties and responsibilities of a hospice aide;

c. The role of the hospice aide as a member of the healthcare team;

6. Emotional problems associated with terminal illness;

7. The aging process;

8. Information on the process of aging and behavior of the aged;

9. Information on the emotional problems accompanying terminal illness;

10. Information on terminal care, stages of death and dying, and grief;

11. Principles and practices of maintaining a clean, healthy and safe environment;

12. Ethics; and

13. Confidentiality.

**History**
- *SOURCE: Miss. Code Ann. §41-85-7*

##### **15 Miss. Admin. Code Pt. 16, R. 1.18.3** Rule 1.18.3 {#sec-16-1.18.3 omnilex-key=us-ms-regs-official--title-15--16#1.18.3}

NOTE: The orientation and training curricula for hospice aides shall be detailed in a policies and procedures manual maintained by the hospice agency and provision of orientation and training shall be documented in the employee personnel record. Training shall include the following areas of instruction:

1. Assisting patients to achieve optimal activities of daily living;

2. Principles of nutrition and meal preparation;

3. Record keeping;

4. Procedures for maintaining a clean, healthful environment; and

5. Changes in the patients’ condition to be reported to the supervisor.

6. In-service Training – The hospice aide must have a minimum of 12 hours of appropriate in-service training annually. In-service training may be prorated for employees working a portion of the year. However, part-time employee who worked throughout the year must attend all twelve (12) hours of in-service training.

**History**
- *SOURCE: Miss. Code Ann. §41-85-7*

##### **15 Miss. Admin. Code Pt. 16, R. 1.18.4** Rule 1.18.4 {#sec-16-1.18.4 omnilex-key=us-ms-regs-official--title-15--16#1.18.4}

Licensed Practical Nurse (LPN) - The LPN must work under the direct supervision of a registered nurse and perform skilled services as delegated by the registered nurse.

1. Qualifications – A LPN must be currently licensed by the Mississippi State Board of Practical Nurse Examiners with no restrictions:

a. With at least one year full time experience as an LPN. Two years of full time experience is preferred; b. Be an employee of the hospice agency.

2. Responsibilities – The LPN shall perform skilled nursing services under the supervision of a registered nurse, in a manner consistent with standards of practice, including but not limited to, such duties as follows:

a. Observe, record, and report to the registered nurse or director of nurses on the general physical and mental conditions of the patient;

b. Administer prescribed medications and treatments as permitted by State regulations;

c. Assist the physician and/or registered nurse in performing procedures as per the patient’s plan of care.

d. Prepare equipment for treatments, including sterilization, and adherence to aseptic techniques;

e. Assist the patient with activities of daily living;

f. Prepare clinical and/or progress notes and incorporate them into the clinical record at least weekly;

g. Perform wound care and treatments as specified per nursing practice and if training competency is documented;

h. Accepts verbal/written orders from the physician or nurse practitioner or physician’s assistant in accordance with facility policies; and

i. Attend hospice IDT meetings.

3. Restrictions – An LPN shall not:

a. Access any intravenous appliance for any reason;

b. Perform supervisory aide visit;

c. Develop and/or alter the POC;

d. Make an assessment visit;

e. Evaluate recertification criteria;

f. Make aide assignments; or

g. Function as a supervisor of the nursing practice of any registered nurse.

**History**
- *SOURCE: Miss. Code Ann. §41-85-7*

##### **15 Miss. Admin. Code Pt. 16, R. 1.18.5** Rule 1.18.5 {#sec-16-1.18.5 omnilex-key=us-ms-regs-official--title-15--16#1.18.5}

Medical Director/Physician Designee - A physician, currently and legally authorized to practice medicine the State, and knowledgeable about the medical and psychosocial aspects of hospice care. The Medical Director reviews, coordinates, and is responsible for the management of clinical and medical care for all patients.

**History**
- *SOURCE: Miss. Code Ann. §41-85-7*

##### **15 Miss. Admin. Code Pt. 16, R. 1.18.6** NOTE: The Medical Director or Physician Designee may be an employee or a volunteer of the hospice agency {#sec-16-1.18.6 omnilex-key=us-ms-regs-official--title-15--16#1.18.6}

The hospice agency may also contract for the services of the Medical Director or Physician Designee.

1. Qualifications – A Doctor of Medicine or Osteopathy licensed to practice in the State of Mississippi.

2. Responsibilities – The Medical Director or Physician designee assumes overall responsibility for the medical component of the hospice’s patient care program and shall include, but not be limited to:

a. Serve as a consultant with the attending physician regarding pain and symptom control as needed;

b. Serve as the attending physician if designated by the patient/family unit;

c. Review patient eligibility for hospice services;

d. Participate in the review and update of the POC for each patient at a minimum of every 14 calendar days, unless the plan of care has been reviewed/updated by the attending physician who is not also the Medical Director or Physician Designee. These reviews must be documented.

e. Document the patient’s progress toward the outcomes specified in the plan of care.

f. Serve as a medical resource for the hospice interdisciplinary group and as a liaison to physicians in the community;

g. Develop and coordinate procedures for the provision of emergency care;

h. Provide a system to assure continuing education for hospice medical staff as needed.

**History**
- *SOURCE: Miss. Code Ann. §41-85-7*

##### **15 Miss. Admin. Code Pt. 16, R. 1.18.7** Occupational Therapist {#sec-16-1.18.7 omnilex-key=us-ms-regs-official--title-15--16#1.18.7}

1. Qualifications – An occupational therapist must be licensed by the State of Mississippi.

2. Responsibilities – The occupational therapist shall assist the physician in evaluating the patient’s level of functioning by applying diagnostic and prognostic procedures including, but not limited to, the following:

a. Provide occupational therapy in accordance with a physician’s orders and the POC;

b. Guide the patient in his/her use of therapeutic, creative and self-care activities for the purpose of improving function, in a manner consistent with accepted standards of practice;

c. Observe, record, and report to the physician and/or interdisciplinary group the patient’s reaction to treatment and any changes in the patient’s condition;

d. Instruct and inform other health team personnel, assist in the formation of the POC; including, when appropriate hospice aides and family members in certain phases of occupational therapy in which they may work with the patient;

e. Document each visit made to the patient and incorporate notes into the clinical record within one week of the visit;

f. Participate in IDT conference as needed with hospice staff; and

g. Prepare written discharge summary when applicable, with a copy retained in patient’s clinical record.

3. Supervision of an Occupational Therapy Assistant

a. The occupational therapist shall conduct the initial assessment and establish the goals and treatment plan before the licensed and certified occupational therapy assistant may treat the patients on site without the physical presence of the occupational therapist.

b. The occupational therapist and the occupational therapy assistant must schedule joint visits at least once every two weeks or every four to six treatment sessions.

c. The occupational therapist must review and countersign all progress notes written by the licensed and certified occupational therapy assistant.

d. The supervising occupational therapist is responsible for assessing the competency and experience of the occupational therapy assistant;

**History**
- *SOURCE: Miss. Code Ann. §41-85-7*

##### **15 Miss. Admin. Code Pt. 16, R. 1.18.8** Rule 1.18.8 {#sec-16-1.18.8 omnilex-key=us-ms-regs-official--title-15--16#1.18.8}

Occupational Therapy Assistant (OTA) Qualifications – The occupational therapist assistant must be licensed in the State of Mississippi to assist in the practice of occupational therapy under the supervision of a licensed Registered Occupational Therapist and have at least two years experience as a licensed OTA.

**History**
- *SOURCE: Miss. Code Ann. §41-85-7*

##### **15 Miss. Admin. Code Pt. 16, R. 1.18.9** Rule 1.18.9 {#sec-16-1.18.9 omnilex-key=us-ms-regs-official--title-15--16#1.18.9}

Physical Therapist (PT) - The physical therapist when provided must be available to perform in a manner consistent with accepted standards of practice.

1. Qualifications – The physical therapist must be currently licensed in the State of Mississippi.

2. Responsibilities – The physical therapist shall assist the physician in evaluating the patient’s functional status and physical therapy needs in a manner consistent with standards of practice to include, but is not limited to, the following:

a. Provide services within the scope of practice as defined by state law governing the practice of physical therapy, in accordance with the POC, and in coordination with the other members of the IDT:

b. Observe, and report to the physician and the IDT, the patient’s reaction to treatment and any changes in the patient’s condition;

c. Instruct and inform participating member of the IDT, the patient, family/care givers, regarding the POC, functional limitations and progress toward goals;

d. Prepare clinical and progress notes for each visit and incorporate them into the clinical record within one week of the visit;

e. Participate in IDT conference as needed with hospice staff

f. The physical therapist shall be readily accessible by telecommunications.

g. The physical therapist shall evaluate and establish a written treatment plan on the patient prior to implementation of any treatment program.

h. The physical therapist shall assess the final treatment rendered to the patient at discharge and write a discharge summary with a copy retained in the clinical record.

3. Supervision of Physical Therapy Assistant (PTA) - The physical therapist shall make the initial visit with the PTA and conduct supervisory visits no later than every sixth treatment day.

**History**
- *SOURCE: Miss. Code Ann. §41-85-7*

##### **15 Miss. Admin. Code Pt. 16, R. 1.18.10** Physical Therapy Assistant (PTA) {#sec-16-1.18.10 omnilex-key=us-ms-regs-official--title-15--16#1.18.10}

1. Qualifications – A physical therapy assistant must be licensed by the Physical Therapy Board of Mississippi and supervised by a Physical Therapist.

2. Responsibilities – The physical therapy assistant shall:

a. Provide therapy in accordance with the POC;

b. Document each visit made to the patient and incorporate notes into the clinical record at least weekly; and

c. Participates in IDT conference as needed with hospice staff.

**History**
- *SOURCE: Miss. Code Ann. §41-85-7*

##### **15 Miss. Admin. Code Pt. 16, R. 1.18.11** Rule 1.18.11 {#sec-16-1.18.11 omnilex-key=us-ms-regs-official--title-15--16#1.18.11}

Registered Nurse (RN) - The hospice must designate a registered nurse to coordinate the implementation of the POC for each patient.

1. Qualifications – A licensed registered nurse must be currently licensed to practice in the State of Mississippi with no restrictions:

a. Have at least one year full-time experience as a registered nurse or have been a licensed LPN employed for three years full-time working in a healthcare setting; and

b. Be an employee of the hospice.

2. Responsibilities – The registered nurse shall identify the patient/family’s physical, psychosocial, and environmental needs and reassess as needed but no less frequently than every 14-15 days:

a. Provide nursing services in accordance with the POC;

b. Document problems, appropriate goals, interventions, and patient/family response to hospice care;

c. Collaborate with the patient/family, attending physician and other members of the IDT in providing patient and family care;

d. Instruct patient/family in self-care techniques when appropriate;

e. Supervise ancillary personnel and delegate responsibilities when required;

f. Complete and submit accurate and relevant clinical notes regarding the patient’s condition into the clinical record within one week of the visit;

g. Provide direct supervision of the Licensed Practical Nurse (LPN) in the home of each patient seen by the LPN at least once a month;

h. Make supervisory visits to the patient’s residence at least every other week with the aide alternately present and absent, to provide direct supervision, to assess relationships and determine whether goals are being met. For the initial visit, the RN must accompany/assist the nurse aide; i. If a hospice aide is assigned to a patient by the RN, in accordance with the POC, specific written instructions for patient care are to be prepared by the RN. All personal care services are to be outlined for the patient, in writing, by the RN;

j. Document supervision, to include the hospice aide relationships, services provided and instructions and comments given as well as other requirements of the clinical note;

k. Document annual performance reviews for the hospice aide. This performance review must be maintained in the individual’s personnel record; and

l. Attend hospice IDT meetings.

**History**
- *SOURCE: Miss. Code Ann. §41-85-7*

##### **15 Miss. Admin. Code Pt. 16, R. 1.18.12** Social Worker {#sec-16-1.18.12 omnilex-key=us-ms-regs-official--title-15--16#1.18.12}

1. Qualifications – A minimum of a bachelor’s degree from a school of social work accredited by the Council of Social Work Education. This individual must be licensed in the State of Mississippi.

a. A minimum of one year documented clinical experience appropriate to the counseling and casework needs of the terminally ill.

b. Must be an employee of the hospice.

2. Responsibilities – The social worker shall assist the physician and other IDT members in understanding significant social and emotional factors related to the patient’s health status and shall include, but not be limited to:

a. Assessment of the social and emotional factors having an impact on the patient’s health status;

b. Assist in the formulation of the POC;

c. Provide services within the scope of practice as defined by state law and in accordance with the POC;

d. Coordination with other IDT members and participate in IDT conferences;

e. Prepare clinical and/or progress notes and incorporate them into the clinical record within one week of the visit;

f. Participate in discharge planning, and in-service programs related to the needs of the patient;

g. Acts as a consultant to other member of the IDT;

h. When medical social services are discontinued, submit a written summary of services provided, including an assessment of the patient’s current status, to be retained in the clinical record; and

i. Attend hospice IDT meetings.

**History**
- *SOURCE: Miss. Code Ann. §41-85-7*

##### **15 Miss. Admin. Code Pt. 16, R. 1.18.13** Speech Pathology Services {#sec-16-1.18.13 omnilex-key=us-ms-regs-official--title-15--16#1.18.13}

1. Qualifications – A speech pathologist must:

a. Be licensed by the State of Mississippi; or

b. Have completed the academic requirements and is in the process of accumulating the necessary supervised (as directed by the State Certifying body) work experience required for certification. Evidence of this supervision will be retained in the non-certified speech pathologist’s personnel folder.

2. Responsibilities – The speech pathologist shall assist the physician in evaluation of the patient to determine the type of speech or language disorder and the appropriate corrective therapy in a manner consistent with standards of practice to include, but is not limited to, the following:

a. Provide rehabilitative services for speech and language disorders;

b. Observe, record and report to the physician and the IDT the patient’s reaction to treatment and any changes in the patient’s condition;

c. Instruct other health personnel and family members in methods of assisting the patient to improve and correct speech disabilities;

d. Communicate with the registered nurse, director of nurses, and/or the IDT the need for continuation of speech pathology services for the patient;

e. Participate in hospice IDT meetings as needed;

f. Document each visit made to the patient and incorporate notes into the clinical record within one week of the visit; and

g. Prepare written discharge summary as indicated, with a copy retained in patient’s clinical record.

**History**
- *SOURCE: Miss. Code Ann. §41-85-7*

##### **15 Miss. Admin. Code Pt. 16, R. 1.18.14** Rule 1.18.14 {#sec-16-1.18.14 omnilex-key=us-ms-regs-official--title-15--16#1.18.14}

Volunteers - Volunteers that provide patient care and support services according to their experience and training must be in compliance with agency policies, and under the supervision of a designated hospice employee.

1. Qualifications – Volunteers who are qualified to provide professional services must meet all standards associated with their specialty area.

2. Responsibilities - The volunteer shall:

a. Provide assistance to the hospice program, and/or patient/family in accordance with designated assignments;

b. Provide input into the plan of care and interdisciplinary group meetings, as appropriate;

c. Document services provided as trained and instructed by the hospice agency;

d. Maintain strict patient/family confidentiality; and

e. Communicate any changes or observations to the assigned supervisor.

3. Training – The volunteers must receive appropriate documented training which shall include at a minimum:

a. An introduction to hospice;

b. The role of the volunteer in hospice;

c. Concepts of death and dying;

d. Communication skills;

e. Care and comfort measures;

f. Diseases and medical conditions;

g. Psychosocial and spiritual issues related to death and dying;

h. The concept of the hospice family;

i. Stress management;

j. Bereavement;

k. Infection control;

l. Safety;

m. Confidentiality;

n. Patient rights;

o. The role of the IDT; and

p. Additional supplemental training for volunteers working in specialized program (i.e. Nursing homes, AIDS facilities).

**History**
- *SOURCE: Miss. Code Ann. §41-85-7 Subchapter 19 PATIENT CARE SERVICES*

##### **15 Miss. Admin. Code Pt. 16, R. 1.19.1** Patient Care Standard {#sec-16-1.19.1 omnilex-key=us-ms-regs-official--title-15--16#1.19.1}

1. Patient Certification –To be eligible for hospice care, an individual, or his/her representative, must sign an election statement with a licensed hospice; the individual must have a certification of terminal illness and must have a plan of care (POC) which is established before services are provided.

2. Admission criteria – The hospice shall have written policies to be followed in making decisions regarding acceptance of patients for care. Decisions are based upon medical, physical, and psychosocial information provided by the patient’s attending physician, the patient/family and the interdisciplinary group. The admission criteria shall include:

a. The ability of the agency to provide core services on a 24-hour basis and provide for or arrange for non-core services on a 24-hour basis to the extent necessary to meet the needs of individuals for care that is reasonable and necessary for the palliation and management of terminal illness and related conditions;

b. Certification of terminal illness signed by the attending physician and the medical director of the agency upon admission and recertification;

c. A documented assessment of the patient/family needs and desires for hospice services;

d. Informed consent signed by patient or representative who is authorized in accordance with state law to elect the hospice care, which will include the purpose and scope of hospice services.

3. Admission Procedure – Patients are to be admitted only upon the order of the patient’s attending physician.

4. An assessment visit shall be made by a registered nurse, who will assess the patient’s needs with emphasis on pain and symptom control. This assessment shall occur within 48 hours of referral for admission, unless otherwise ordered by physician or unless a request for delay is made by patient/family.

5. Documentation at admission will be retained in the clinical record and shall include:

a. Signed consent forms;

b. Documented evidence that a patient’s rights statement has been given or explained to the patient and/or family;

c. Clinical data including physician’s order for care;

d. Patient Release of Information;

e. Orientation of the patient/care giver, which includes:

i. Advanced directives;

ii. Agency services;

iii. Patient’s rights; and

iv. agency contact procedures;

f. Certification of terminal illness signed by the medical director and attending physician.

**History**
- *SOURCE: Miss. Code Ann. §41-85-7*

##### **15 Miss. Admin. Code Pt. 16, R. 1.19.2** Rule 1.19.2 {#sec-16-1.19.2 omnilex-key=us-ms-regs-official--title-15--16#1.19.2}

Plan of Care (POC) - Within 48 hours of the admission, a written plan of care must be developed for each patient/family by a minimum of two IDT members and approved by the full IDT and the Medical Director at the next meeting. The care provided to an individual must be in accordance with the POC.

1. The IDT member who assesses the patient’s needs must meet or call at least one other IDT member before writing the IPOC. At least one of the persons involved in developing the IPOC must be a registered nurse or physician.

2. At a minimum the POC will include the following:

a. An assessment of the individual’s needs and identification of services, including the management of discomfort and symptom relief;

b. In detail, the scope and frequency of services needed to meet the patient’s and family’s needs. The frequency of services established in the POC will be sufficient to effectively manage the terminal diagnosis of the patient, provide appropriate amounts of counseling to the family, and meet or exceed nationally accepted hospice standards of practice;

c. Identification of problems with realistic and achievable goals and objectives;

d. Medical supplies and appliances including drugs and biologicals needed for the palliation and management of the terminal illness and related conditions;

e. Patient/family understanding, agreement and involvement with the POC; and

f. Recognition of the patient/family’s physiological, social, religious and cultural variables and values.

3. The POC must be maintained on file as part of the individual’s clinical record. Documentation of updates shall be maintained.

4. The hospice will designate a registered nurse to coordinate the implementation of the POC for each patient.

**History**
- *SOURCE: Miss. Code Ann. §41-85-7*

##### **15 Miss. Admin. Code Pt. 16, R. 1.19.3** Review and Update of the Plan of Care {#sec-16-1.19.3 omnilex-key=us-ms-regs-official--title-15--16#1.19.3}

1. The plan of care is reviewed and updated at intervals specified in the POC, when the patient’s condition changes and a minimum of every 14 days for home care and every 7 days for general inpatient care, collaboratively with the IDT and the attending physician.

2. Agency shall have policy and procedures for the following:

a. The attending physician’s participation in the development, revision, and approval of the POC is documented. This is evidenced by change in patient orders and documented communication between Hospice Staff and the attending physician;

b. Physician orders must be signed and dated in a timely manner, but must be received before billing is submitted for each patient.

3. The agency shall have documentation that the patient’s condition and POC is reviewed and the POC updated, even when the patient’s condition does not change.

**History**
- *SOURCE: Miss. Code Ann. §41-85-7*

##### **15 Miss. Admin. Code Pt. 16, R. 1.19.4** Rule 1.19.4 {#sec-16-1.19.4 omnilex-key=us-ms-regs-official--title-15--16#1.19.4}

Coordination and Continuity of Care: The hospice shall adhere to the following additional principles and responsibilities:

1. An assessment of the patient/family needs and desire for hospice services and a hospice program’s specific admission, transfer, and discharge criteria determine any changes in services;

2. Nursing services, physician services, and drugs and biologicals are routinely available to hospice patients on a 24 hour basis, seven days a week;

3. All other covered services are available on a 24 hour basis to the extent necessary to meet the needs of individuals for care that is reasonable and necessary for the palliation and management of terminal illness and related conditions;

4. Case-management is provided and an accurate and complete documented record of services and activities describing care of patient/family is maintained;

5. Collaboration with other providers to ensure coordination of services;

6. Maintenance of professional management responsibility and coordination of the patient/family care regardless of the setting;

7. Maintenance of contracts/agreements for the provision of services not directly provided by the hospice, including but not limited to:

a. Radiation therapy;

b. Infusion therapy;

c. Inpatient care;

d. Consulting physician.

8. Provision or access to emergency medical care;

9. When home care is no longer possible, assistance to the patient in transferring to an appropriate setting where hospice care can be delivered;

10. When the patient is admitted to a setting where hospice care cannot be delivered, hospice adheres to standards, policies and procedures on transfer and discharge and facilitates the patient’s transfer to another care provider;

11. Maintenance of appropriately qualified IDT health care professionals and volunteers to meet patients need;

12. Maintenance and documentation of a volunteer staff to provide administrative or direct patient care. The hospice must document a continuing level of volunteer activity

13. Coordination of the IDT, as well as of volunteers, by a qualified health care professional, to assure continuous assessment, continuity of care and implementation of the POC;

14. Supervision and professional consultation by qualified personnel, available to staff and volunteers during all hours of service;

15. Hospice care provided in accordance with accepted professional standards and accepted code of ethics;

16. The facility must proceed in accordance with written policy at the time of death of the patient.

**History**
- *SOURCE: Miss. Code Ann. §41-85-7*

##### **15 Miss. Admin. Code Pt. 16, R. 1.19.5** Pharmaceutical Services {#sec-16-1.19.5 omnilex-key=us-ms-regs-official--title-15--16#1.19.5}

1. Hospices must provide for the pharmaceutical needs of the patient as related to the terminal diagnosis.

2. The agency shall institute procedures which protect the patient from medication errors.

3. The Agency shall provide verbal and written instruction to patient and family regarding the administration of their medications, as indicated.

4. Drugs and treatments are administered by agency staff as ordered by the physician.

5. The hospice must ensure appropriate monitoring and supervision of pharmaceutical services and have written policies and procedures governing prescribing, dispensing, administering, controlling, storing and disposing of all biologicals and drugs in compliance with applicable laws and regulations.

6. The hospice must ensure timely pharmaceutical services on a 24 hour a day/seven day a week basis that include provision of drugs, biologicals and infusion services which are consistent with patient’s individual drug profile.

7. The hospice must provide the IDT and the patient/family with coordinated information and instructions about individual drug profiles.

**History**
- *SOURCE: Miss. Code Ann. §41-85-7*

##### **15 Miss. Admin. Code Pt. 16, R. 1.19.6** Rule 1.19.6 {#sec-16-1.19.6 omnilex-key=us-ms-regs-official--title-15--16#1.19.6}

Pathology and Laboratory Services - The hospice must provide or have access to pathology and laboratory services which comply with CLIA guidelines and that meets the patient’s plan of care.

**History**
- *SOURCE: Miss. Code Ann. §41-85-7*

##### **15 Miss. Admin. Code Pt. 16, R. 1.19.7** Radiology Services - The hospice must provide radiology services in accordance with the patient’s plan of care {#sec-16-1.19.7 omnilex-key=us-ms-regs-official--title-15--16#1.19.7}

**History**
- *SOURCE: Miss. Code Ann. §41-85-7*

##### **15 Miss. Admin. Code Pt. 16, R. 1.19.8** Rule 1.19.8 {#sec-16-1.19.8 omnilex-key=us-ms-regs-official--title-15--16#1.19.8}

Discharge/Revocation/Transfer - The hospice must provide adequate and appropriate patient/family information at discharge, revocation or transfer.

1. Discharge – The patient shall be discharged only in the following circumstances:

a. The patient is determined to no longer be terminally Ill with a life expectancy of six months or less;

b. Patient relocates from the hospice’s geographically defined service area;

c. If the safety of the patient or of the hospice staff is compromised. The hospice shall make every effort to resolve these problems satisfactorily before discharge. All efforts by the hospice to resolve the problem must be documented in detail in the patient’s clinical record; and

d. If the patient enters a non-contracted nursing home or hospital and all options have been exhausted (a contract is not attainable, the patient chooses not to transfer to a facility with which the hospice has a contract, or to a hospice with which the SNF has a contract), the hospice shall then discharge the patient.

e. The hospice must clearly document reasons for discharge.

2. Revocation – Occurs when the patient or representative makes a decision to discontinue receiving hospices services:

a. A recipient may revoke hospice care at any time;

b. If a patient or representative chooses to revoke from hospice care, the patient must sign a statement which states that he or she is aware of the revocation and stating why revocation is chosen. The effective date of discharge cannot be earlier than the signed revocation date.

3. Non compliance – When a patient is non-compliant, the hospice must counsel the patient/family on the option to revoke and any advantages or disadvantages of the decision that is made. A patient is considered non-compliant if:

a. The patient seeks or receives curative treatment for the illness;

b. The patient seeks treatment related to the terminal illness in a facility that does not have a contract with the hospice; or

c. The patient seeks treatment related to the terminal illness that is not in the POC, or is not pre-approved by the hospice.

4. Transfer – The hospice must document the reason for such transfer and an appropriate discharge plan/summary is to be written. Appropriate continuity of care is to be arranged prior to such transfer.

**History**
- *SOURCE: Miss. Code Ann. §41-85-7*

##### **15 Miss. Admin. Code Pt. 16, R. 1.19.9** Patient Rights and Responsibilities - The hospice shall insure that the patient has the right to: {#sec-16-1.19.9 omnilex-key=us-ms-regs-official--title-15--16#1.19.9}

1. Be cared for by a team of professionals who provide health quality comprehensive hospice services as needed and appropriate for patient/family;

2. Have a clear understanding of the availability of hospice services and the hospice team 24 hours a day, seven days a week;

3. Receive appropriate and compassionate care, regardless of diagnosis, race, age, gender, creed, disability, sexual orientation, place of residence, or the ability to pay for the services rendered;

4. Be fully informed regarding patient’s status in order to participate in the POC. The hospice professional team will assist patient/family in identifying which services and treatments will help attain these goals;

5. Be fully informed regarding the potential benefits and risks of all medical treatments or services suggested, and to accept or refuse those treatments and/or services as appropriate to patient/family personal wishes;

6. Refuse any treatment without severing his/her relationship with the hospice;

7. Choose his/her private physician as long as the attending physician agrees to abide by the policies of the hospice program;

8. Be treated with respect and dignity;

9. Confidentiality with regard to provision of services and all client records, including information concerning patient/family health status, as well as social, and/or financial circumstances. The patient information and/or records may be released only with patient/family’s written consent, and/or as required by law;

10. Voice grievances concerning patient care, treatment and/or respect for person or privacy without being subject to discrimination or reprisal, and have any such complaints investigated by the hospice; and

11. Be informed of any fees or charges in advance of services for which patient/family may be liable. Patient/family has the right to access any insurance or entitlement program for which patient may be eligible.

12. The patient has the responsibility to:

a. Participate in developing the POC and update as his or her condition/needs change;

b. Provide hospice with his/her accurate and complete health information;

c. Remain under a physician’s care while receiving hospice services; and

d. Assist hospice staff in developing and maintaining a safe environment in which patient care can be provided.

**History**
- *SOURCE: Miss. Code Ann. §41-85-7*

##### **15 Miss. Admin. Code Pt. 16, R. 1.19.10** Rule 1.19.10 {#sec-16-1.19.10 omnilex-key=us-ms-regs-official--title-15--16#1.19.10}

Clinical Records - In accordance with accepted principles of practice the hospice shall establish and maintain a clinical record for every individual receiving care and services. The record shall be complete, promptly and accurately documented, readily accessible and systematically organized to facilitate retrieval. The clinical record shall contain all pertinent past and current medical, nursing, social and other therapeutic information, including the current POC under which services are being delivered.

1. All clinical records shall be safeguarded against loss, destruction and unauthorized use and shall be maintained at the hospice site issued the license. (S.O.M. 208.1)

2. Hospice records must be maintained in a distinct location and not mingled with records of other types of health care related agencies.

3. Clinical records shall be kept in a safe and confidential area which provides convenient access to clinicians.

4. The agency shall have policies addressing who is permitted access to the clinical records. No unauthorized person shall be permitted access to the clinical records.

5. Records shall be maintained from the patient’s effective date of discharge, as per State law.

6. When applicable, the agency will obtain a signed “Release of Information” from the patient and /or the patient’s family. A copy will be retained in the record.

7. The clinical record shall contain a comprehensive compilation of information including, but not limited to, the following:

a. Initial and subsequent Plans of Care and initial assessment;

b. Certifications of terminal illness;

c. Written physician’s orders for admission and changes to the POC;

d. Current clinical notes (at least the past sixty (60) days;

e. Plan of Care;

f. Signed consent, authorization and election forms;

g. Pertinent medical history; and

h. Identifying data, including name, address, date of birth, sex, agency case number and next of kin.

8. Entries for all provided services must be documented in the clinical record and must be signed by the staff providing the service.

9. Complete documentation of all services and event (including evaluations, treatments, progress notes, etc.) are recorded whether furnished directly by hospice staff or by arrangement.

**History**
- *SOURCE: Miss. Code Ann. §41-85-7 Subchapter 20 ADMINISTRATION*

##### **15 Miss. Admin. Code Pt. 16, R. 1.20.1** Agency Operations {#sec-16-1.20.1 omnilex-key=us-ms-regs-official--title-15--16#1.20.1}

1. The hospice must have adequate space and resources for all operational and patient care needs.

2. The hospice shall not share office space with a non-healthcare related entity.

**History**
- *SOURCE: Miss. Code Ann. §41-85-7*

##### **15 Miss. Admin. Code Pt. 16, R. 1.20.2** Rule 1.20.2 {#sec-16-1.20.2 omnilex-key=us-ms-regs-official--title-15--16#1.20.2}

Hours of Operation - The hospice shall be required to have regular posted (in a prominent and easily accessible manner) business hours and be fully operational at least eight hours a day, five days a week between 7:00 a.m. and 6:00 p.m. Hospice services shall be available 24 hours per day, seven days a week, which include, at a minimum:

1. Professional registered nurse services;

2. Palliative medications;

3. Other services, equipment or supplies necessary to meet the patient’s immediate needs.

4. Hospice provides on-call medical and nursing services to assess and meet changing patient/family needs, provide instruction and support, and conduct additional on-site assessment or treatment, 24 hours a day, seven days per week.

**History**
- *SOURCE: Miss. Code Ann. §41-85-7*

##### **15 Miss. Admin. Code Pt. 16, R. 1.20.3** Policies and Procedures {#sec-16-1.20.3 omnilex-key=us-ms-regs-official--title-15--16#1.20.3}

1. Must be written, current, and reviewed annually by appropriate personnel.

2. Must contain policies and procedures specific to the agency addressing personnel standards and qualifications, agency operations, patient care standards, problem and complaint resolution, purpose and goals of operation, management/operation of the hospice’s defined service area and a formal disaster preparedness plan as referenced in Subchapter 47.

**History**
- *SOURCE: Miss. Code Ann. §41-85-7*

##### **15 Miss. Admin. Code Pt. 16, R. 1.20.4** Contract Services {#sec-16-1.20.4 omnilex-key=us-ms-regs-official--title-15--16#1.20.4}

1. When the hospice provides services on a contractual basis to a patient the hospice is responsible for all actions of the contract personnel.

2. The hospice shall not at any time use contract employees as administrator/alternate or for the provision of core services unless the facility provides documentation that a waiver has been granted in accordance with certification requirements.

3. Whenever services are provided by an organization or individual other than the hospice, a written agreement will delineate services available and procedures for accessing those services.

4. Whenever services are provided by an outside agency or individual, a legally binding written agreement must be effected. The legally binding written agreement shall include at least the following items:

a. Identification of the services to be provided;

b. A stipulation that services may be provided only with the express authorization of the hospice;

c. The manner in which the contracted services are coordinated, supervised, and evaluated by the hospice; d. The delineation of the role(s) of the hospice and the contractor in the admission process, patient/family assessment, and the IDT conferences;

e. Requirements for documenting that services are furnished in accordance with the agreement;

f. The qualifications of the personnel providing the services;

g. Assurance that the personnel contracted complete the clinical record in the same timely manner as required by the staff personnel of the hospice;

h. Payment fees and terms; and

i. Statement that the hospice retains responsibility for appropriate hospice care training of the personnel who provide care under the agreement.

5. The hospice shall document review of its contract on an annual basis.

6. The hospice is to coordinate services with contract personnel to assure continuity of patient care.

7. Hospice maintains professional management responsibilities for those services and ensures that they are furnished in a safe and effective manner by qualified persons and in accordance with the patient’s POC.

**History**
- *SOURCE: Miss. Code Ann. §41-85-7*

##### **15 Miss. Admin. Code Pt. 16, R. 1.20.5** Quality Assurance {#sec-16-1.20.5 omnilex-key=us-ms-regs-official--title-15--16#1.20.5}

1. The hospice shall conduct an ongoing, comprehensive integrated self-assessment quality improvement process (inclusive of inpatient care, home care and respite care) which evaluates not only the quality of care provided, but also the appropriateness care/services provided and evaluations of such services. Findings shall be documented and used by the hospice to correct identified problems and to revise hospice policies.

2. The hospice shall have written plans, policies and procedures addressing quality assurance.

3. The hospice shall designate, in writing, an individual responsible for the coordination of the quality improvement program.

4. The hospice shall conduct quality improvement meetings quarterly, at a minimum.

5. The Hospice’s written plan for continually assessing and improving all aspects of operations must include:

a. Goals and objectives;

b. A system to ensure systematic, objective quarterly reports. Documentation must be maintained to reflect that such reports were reviewed with the IDT, the Medical Director, the Governing Body and distributed to appropriate areas;

c. The method for evaluating the quality and the appropriateness of care;

d. A method for resolving identified problems; and

e. Application to improving the quality of patient care.

6. Quality assessment and improvement activities are based on the systematic collection, review, and evaluation of data which, at a minimum, includes:

a. Services provided by professional and volunteer staff;

b. Outcome audits of patient charts;

c. Reports from staff, volunteers, and clients about services;

d. Concerns or suggestion for improvement in services;

e. Organizational review of the hospice program;

f. Patient/family evaluations of care; and

g. High-risk, high-volume and problem-prone activities.

7. The quality improvement plan must be reviewed at least annually and revised as appropriate.

8. When problems are identified in the provision of hospice care, there shall be evidence of corrective actions, including ongoing monitoring, revisions of policies and procedures, educational intervention and changes in the provision of services.

9. The effectiveness of actions taken to improve services or correct identified problems must be evaluated/documented.

**History**
- *SOURCE: Miss. Code Ann. §41-85-7*

##### **15 Miss. Admin. Code Pt. 16, R. 1.20.6** Branch Offices {#sec-16-1.20.6 omnilex-key=us-ms-regs-official--title-15--16#1.20.6}

1. No Branch Office may be opened without written approval from Mississippi State Department of Health.

2. No Branch Office shall be opened unless the parent office has had full licensure for a full twelve(12) months preceding the request and has admitted at least ten (10) patients within the last annual renewal cycle.

3. Each Branch must serve the same or part of the geographic service area approved for the parent.

4. Each Branch Office shall be open for business the same hours as required for the parent office, must have a registered nurse immediately available to be on site, or on site in the branch office at all times during operating hours.

5. All hospice patient’s clinical records must be maintained at the hospice site issued the provider license (S.O.M. 208.1). Duplicate records may be maintained at the Branch Office.

6. Original personnel files are to be kept at the Parent office, but shall be made available, upon request, to federal/state surveyors during any review of the branch.

7. A statement of personnel policies is maintained in each Branch for staff usage.

8. Approval for Branch Offices will be issued, in writing, by Mississippi State Department of Health for one year and will be renewed at time of re-licensure, if the branch office meets the following criteria:

a. Is operational and providing hospice services;

b. Offer exact same services as the parent office; and

c. Parent office meets requirements for full licensure.

**History**
- *SOURCE: Miss. Code Ann. §41-85-7 Subchapter 21 BASIC HOSPICE CARE: CORE SERVICES*

##### **15 Miss. Admin. Code Pt. 16, R. 1.21.1** Hospice care shall be provided by a hospice care team {#sec-16-1.21.1 omnilex-key=us-ms-regs-official--title-15--16#1.21.1}

Medical, nursing and counseling services are basic to hospice care and shall be provided directly (Medical Director only may be contract). Hospice care will be available twenty- four (24) hours a day, seven (7) days a week.

1. Medical services shall be under the direction of the Medical Director.

2. Nursing services shall be under the direction of a registered nurse and shall include, but not be limited to: assessment, planning and delivery of nursing care;

carrying out physician’s orders; documentation; evaluation of nursing care; and direction of patient care provided by non-professionals.

3. Counseling services shall be provided in a manner which best assists the patient and family unit to cope with the stresses related to the patient’s condition. These services may be provided by a member of the clergy who is qualified through training and/or experience to provide such services, or by other qualified counselor(s). Such counselors shall be licensed, if applicable.

4. Social services shall be directed by a social worker, and shall consist primarily of assisting the patient and family unit to deal with problems of social functioning affecting the health or well-being of the patient.

**History**
- *SOURCE: Miss. Code Ann. §41-85-7 Subchapter 22 OTHER SERVICES*

##### **15 Miss. Admin. Code Pt. 16, R. 1.22.1** Coordination of patient care shall be the responsibility of a registered nurse of hospice care team {#sec-16-1.22.1 omnilex-key=us-ms-regs-official--title-15--16#1.22.1}

Duties include coordination of team meetings, care delivery, and evaluation of activities.

**History**
- *SOURCE: Miss. Code Ann. §41-85-7*

##### **15 Miss. Admin. Code Pt. 16, R. 1.22.2** Rule 1.22.2 {#sec-16-1.22.2 omnilex-key=us-ms-regs-official--title-15--16#1.22.2}

Spiritual services shall be available and offered to the patient and family unit; however, no value or belief system may be imposed.

**History**
- *SOURCE: Miss. Code Ann. §41-85-7*

##### **15 Miss. Admin. Code Pt. 16, R. 1.22.3** Volunteer services shall be provided by the hospice {#sec-16-1.22.3 omnilex-key=us-ms-regs-official--title-15--16#1.22.3}

These services shall be provided according to written policies and procedures. These policies and procedures shall address at a minimum:

1. Recruitment and retention; 2. Screening; 3. Orientation; 4. Scope of function; 5. Supervision; 6. Ongoing training and support; 7. Documentation of volunteer activities.

**History**
- *SOURCE: Miss. Code Ann. §41-85-7*

##### **15 Miss. Admin. Code Pt. 16, R. 1.22.4** Bereavement services shall be available for a period of at least one year following the patient’s death {#sec-16-1.22.4 omnilex-key=us-ms-regs-official--title-15--16#1.22.4}

Such services shall be defined by policy. Documentation of such services shall be maintained.

**History**
- *SOURCE: Miss. Code Ann. §41-85-7*

##### **15 Miss. Admin. Code Pt. 16, R. 1.22.5** Hospice aide services shall be available and adequate to meet the needs of the patient {#sec-16-1.22.5 omnilex-key=us-ms-regs-official--title-15--16#1.22.5}

The hospice aide shall meet the federal and state training requirements.

Subchapter 24 MEDICAL WASTE (Refer to Subchapter 43)

**History**
- *SOURCE: Miss. Code Ann. §41-85-7 Subchapter 23 DISASTER PREPAREDNESS PLAN (Refer to Subchapter 48)*

##### **15 Miss. Admin. Code Pt. 16, R. 1.25.1** Subchapter 25 RESPITE – INPATIENT CARE {#sec-16-1.25.1 omnilex-key=us-ms-regs-official--title-15--16#1.25.1}

If a hospice is not based in a licensed facility (hospital or nursing home); a contractual arrangement shall be made with one or more such facilities for provision of respite-inpatient services. Inpatient beds under such contract may be used by the hospice when needed or may remain otherwise available to the inpatient unit at other times without a change in licensing.

**History**
- *SOURCE: Miss. Code Ann. §41-85-7*

##### **15 Miss. Admin. Code Pt. 16, R. 1.25.2** Such contract shall be maintained with an inpatient provider who contractually agrees to support the policies of hospice {#sec-16-1.25.2 omnilex-key=us-ms-regs-official--title-15--16#1.25.2}

**History**
- *SOURCE: Miss. Code Ann. §41-85-7*

##### **15 Miss. Admin. Code Pt. 16, R. 1.25.3** The hospice care team shall retain the responsibility for coordinating the patient’s care during inpatient hospice care {#sec-16-1.25.3 omnilex-key=us-ms-regs-official--title-15--16#1.25.3}

**History**
- *SOURCE: Miss. Code Ann. §41-85-7*

##### **15 Miss. Admin. Code Pt. 16, R. 1.25.4** Rule 1.25.4 {#sec-16-1.25.4 omnilex-key=us-ms-regs-official--title-15--16#1.25.4}

The aggregate number of inpatient days provided by a hospice through all contractual arrangements between the hospice and licensed health care facilities providing inpatient hospice care may not exceed twenty percent (20%) of the aggregate total number of days of hospice care provided to all patients receiving hospice care from the hospice during a twelve (12) month period.

**History**
- *SOURCE: Miss. Code Ann. §41-85-7*

##### **15 Miss. Admin. Code Pt. 16, R. 1.25.5** Rule 1.25.5 {#sec-16-1.25.5 omnilex-key=us-ms-regs-official--title-15--16#1.25.5}

The designation of a specific room or rooms for inpatient hospice care shall not be required if beds are available through contract between an existing healthcare facility and a hospice.

**History**
- *SOURCE: Miss. Code Ann. §41-85-7*

##### **15 Miss. Admin. Code Pt. 16, R. 1.25.6** Rule 1.25.6 {#sec-16-1.25.6 omnilex-key=us-ms-regs-official--title-15--16#1.25.6}

Licensed beds designated for inpatient hospice care through contract between an existing health care facility and a hospice shall not be required to be de-licensed from one type of bed in order to enter into a contract with a hospice, nor shall the physical plant of any facility be required to be altered, except that a homelike atmosphere may be required.

**History**
- *SOURCE: Miss. Code Ann. §41-85-7*

##### **15 Miss. Admin. Code Pt. 16, R. 1.25.7** Rule 1.25.7 {#sec-16-1.25.7 omnilex-key=us-ms-regs-official--title-15--16#1.25.7}

Staffing standards for inpatient hospice care provided through a contract may not exceed the staffing standards required under the license held by the contractee.

**History**
- *SOURCE: Miss. Code Ann. §41-85-7*

##### **15 Miss. Admin. Code Pt. 16, R. 1.25.8** Rule 1.25.8 {#sec-16-1.25.8 omnilex-key=us-ms-regs-official--title-15--16#1.25.8}

Under no circumstance may a hospice contract for the use of a licensed bed in a health care facility or another hospice that has, or has had within the last eighteen (18) months, a suspended, revoked or conditional license, accreditation or rating.

**History**
- *SOURCE: Miss. Code Ann. §41-85-7 Subchapter 26 IN-SERVICE TRAINING*

##### **15 Miss. Admin. Code Pt. 16, R. 1.26.1** The hospice shall provide ongoing, relevant in-service training for all members of the hospice care team {#sec-16-1.26.1 omnilex-key=us-ms-regs-official--title-15--16#1.26.1}

(For hospice aide training, refer to section titled Personnel Qualification/Responsibility.)

**History**
- *SOURCE: Miss. Code Ann. §41-85-7*

##### **15 Miss. Admin. Code Pt. 16, R. 1.26.2** Rule 1.26.2 {#sec-16-1.26.2 omnilex-key=us-ms-regs-official--title-15--16#1.26.2}

For each direct-care employee, the hospice shall require training of twelve (12) hours inservice education, at a minimum annually. Documentation of such training shall be maintained.

**History**
- *SOURCE: Miss. Code Ann. §41-85-7*

##### **15 Miss. Admin. Code Pt. 16, R. 1.26.3** The hospice shall provide relevant inservice training on a quarterly basis for volunteers {#sec-16-1.26.3 omnilex-key=us-ms-regs-official--title-15--16#1.26.3}

Documentation of the offered inservices and attendees shall be maintained.

**History**
- *SOURCE: Miss. Code Ann. §41-85-7 Subchapter 27 RECORDS*

##### **15 Miss. Admin. Code Pt. 16, R. 1.27.1** Rule 1.27.1 {#sec-16-1.27.1 omnilex-key=us-ms-regs-official--title-15--16#1.27.1}

In accordance with acceptable principles of practice, the hospice shall establish and maintain a clinical record for every patient admitted for care and services. The records must be complete, promptly and accurately documented, readily accessible and systematically organized to facilitate retrieval.

**History**
- *SOURCE: Miss. Code Ann. §41-85-7*

##### **15 Miss. Admin. Code Pt. 16, R. 1.27.2** Content - Each clinical record shall be comprehensive compilation of information {#sec-16-1.27.2 omnilex-key=us-ms-regs-official--title-15--16#1.27.2}

Entries shall be made for all services provided and shall be signed and dated within 7 days by the individual providing the services. The record shall include all services whether furnished directly or under arrangements made by the hospice. Each patient’s record shall contain:

1. Identification data; 2. The initial and subsequent assessments; 3. The plan of care; 4. Consent and authorization forms; 5. Pertinent medical and psychosocial history; 6. Complete documentation of all services and events (including evaluations, treatments, progress notes, etc.)

**History**
- *SOURCE: Miss. Code Ann. §41-85-7*

##### **15 Miss. Admin. Code Pt. 16, R. 1.27.3** Protection of Information {#sec-16-1.27.3 omnilex-key=us-ms-regs-official--title-15--16#1.27.3}

The hospice shall safeguard the clinical record against loss, destruction and unauthorized use.

**History**
- *SOURCE: Miss. Code Ann. §41-85-7*

##### **15 Miss. Admin. Code Pt. 16, R. 1.27.4** Rule 1.27.4 {#sec-16-1.27.4 omnilex-key=us-ms-regs-official--title-15--16#1.27.4}

Retention of Records: Clinical records shall be preserved as original records, micro-films or other usable forms and shall be such as to afford a basis for complete audit of professional information. Complete clinical records shall be retained for a period after discharge of the patient of at least five (5) years. In the event the hospice shall cease operation, the Department shall be advised of the location of said records.

**History**
- *SOURCE: Miss. Code Ann. §41-85-7 Subchapter 28 SUPPLIES AND EQUIPMENT*

##### **15 Miss. Admin. Code Pt. 16, R. 1.28.1** The hospice shall provide supplies and equipment related to the terminal illness {#sec-16-1.28.1 omnilex-key=us-ms-regs-official--title-15--16#1.28.1}

**History**
- *SOURCE: Miss. Code Ann. §41-85-7*

##### **15 Miss. Admin. Code Pt. 16, R. 1.29.1** The hospice shall have a written policy for procurement, administration and destruction of drugs {#sec-16-1.29.1 omnilex-key=us-ms-regs-official--title-15--16#1.29.1}

**History**
- *SOURCE: Miss. Code Ann. §41-85-7*

##### **15 Miss. Admin. Code Pt. 16, R. 1.29.2** Drug administration shall be in compliance with all applicable state and federal laws {#sec-16-1.29.2 omnilex-key=us-ms-regs-official--title-15--16#1.29.2}

**History**
- *SOURCE: Miss. Code Ann. §41-85-7*

##### **15 Miss. Admin. Code Pt. 16, R. 1.29.3** Rule 1.29.3 {#sec-16-1.29.3 omnilex-key=us-ms-regs-official--title-15--16#1.29.3}

The hospice shall have a standardized mechanism to record scheduled medications written for patients and a standardized program for the collection and disposal of all medications upon a patient’s death.

**History**
- *SOURCE: Miss. Code Ann. §41-85-7*

##### **15 Miss. Admin. Code Pt. 16, R. 1.30.1** Each hospice office shall be commensurate in size for the volume of staff, patients, and services provided {#sec-16-1.30.1 omnilex-key=us-ms-regs-official--title-15--16#1.30.1}

Offices shall be well-lighted, heated and cooled. Offices shall be accessible to the individuals with disabilities.

**History**
- *SOURCE: Miss. Code Ann. §41-85-7 Subchapter 31 ADMINISTRATIVE OFFICES*

##### **15 Miss. Admin. Code Pt. 16, R. 1.31.1** Each hospice shall provide adequate office space and equipment for all administrative and health care staff {#sec-16-1.31.1 omnilex-key=us-ms-regs-official--title-15--16#1.31.1}

An adequate number of desks, chairs, filing cabinets, telephones, tables, etc., shall be available.

**History**
- *SOURCE: Miss. Code Ann. §41-85-7 Subchapter 32 STORAGE FACILITIES*

##### **15 Miss. Admin. Code Pt. 16, R. 1.32.1** Each Hospice shall provide sufficient areas for storage of: {#sec-16-1.32.1 omnilex-key=us-ms-regs-official--title-15--16#1.32.1}

1. Administrative records and supplies 2. Clinical Records 3. Medical equipment and supplies

**History**
- *SOURCE: Miss. Code Ann. §41-85-7 Subchapter 33 TOILET FACILITIES*

##### **15 Miss. Admin. Code Pt. 16, R. 1.33.1** Each hospice office shall be equipped with an adequate number of toilet rooms {#sec-16-1.33.1 omnilex-key=us-ms-regs-official--title-15--16#1.33.1}

Each toilet room shall include: lavatories, soap, towels, and water closets.

**History**
- *SOURCE: Miss. Code Ann. §41-85-7 Subchapter 34 COMMUNICATION FACILITIES*

##### **15 Miss. Admin. Code Pt. 16, R. 1.34.1** Rule 1.34.1 {#sec-16-1.34.1 omnilex-key=us-ms-regs-official--title-15--16#1.34.1}

Each Hospice Agency shall have an adequate number of telephones and extensions, located so as to be quickly accessible from all parts of the building. The telephone shall be listed under the official licensed name of the agency.

**History**
- *SOURCE: Miss. Code Ann. §41-85-7 Subchapter 35 INPATIENT FACILITY*

##### **15 Miss. Admin. Code Pt. 16, R. 1.35.1** Rule 1.35.1 {#sec-16-1.35.1 omnilex-key=us-ms-regs-official--title-15--16#1.35.1}

Inpatient hospice staffing – An inpatient hospice must maintain the coverage of a registered nurse twenty-four (24) hours a day. Other medical/nursing personnel must be available to meet the needs of the patients.

**History**
- *SOURCE: Miss. Code Ann. §41-85-7*

##### **15 Miss. Admin. Code Pt. 16, R. 1.35.2** Rule 1.35.2 {#sec-16-1.35.2 omnilex-key=us-ms-regs-official--title-15--16#1.35.2}

Medical Director-Inpatient Services-The hospice inpatient facility shall have a Medical Director who is a doctor of medicine or osteopathy and is currently licensed to practice medicine in Mississippi. The Medical Director must ensure and assume the overall responsibility for the medical component of the hospice’s inpatient care services

**History**
- *SOURCE: Miss. Code Ann. §41-85-7*

##### **15 Miss. Admin. Code Pt. 16, R. 1.35.3** Nursing Services-Inpatient Services- The inpatient hospice facility shall provide an organized 24-hour nursing service {#sec-16-1.35.3 omnilex-key=us-ms-regs-official--title-15--16#1.35.3}

**History**
- *SOURCE: Miss. Code Ann. §41-85-7*

##### **15 Miss. Admin. Code Pt. 16, R. 1.35.4** Rule 1.35.4 {#sec-16-1.35.4 omnilex-key=us-ms-regs-official--title-15--16#1.35.4}

The nursing service shall be under the direction of a Director of Nursing Services who is a registered nurse licensed to practice in Mississippi. The Director of Nurses is prohibited from simultaneous employment with more than one agency. Each facility shall provide a similarly qualified registered nurse available to act in the absence of the Director of Nursing Services. A registered nurse shall be responsible to assure the accurate assessment, development of a plan of care, implementation and evaluation of each patient’s plan of care. Nursing care is administered and delegated in accordance with acceptable standards of nursing practice and the Mississippi Nurse Practice Act. Nursing staff must be available on the premises

twenty-four hours a day, seven days a week. There shall be a registered nurse on duty at all times when there are patients in the facility. When there are no patients in the facility, the hospice shall have a registered nurse on call to be immediately available. The facility shall provide sufficient nursing personnel to meet each patient’s needs in accordance with the patient’s plan of care.

**History**
- *SOURCE: Miss. Code Ann. §41-85-7*

##### **15 Miss. Admin. Code Pt. 16, R. 1.35.5** Rule 1.35.5 {#sec-16-1.35.5 omnilex-key=us-ms-regs-official--title-15--16#1.35.5}

Pharmaceutical Services of Inpatient Hospice- The hospice shall provide pharmaceutical services in accordance with acceptable professional standards of nursing and pharmaceutical practice and State law. The hospice shall have policies and procedures that address receipt, storage, dispensing, labeling, medication administration, all aspects of controlled substance storage, usage, and disposal of controlled substances, the handling of medication errors and components for incorporating pharmacy practices into the facility’s overall quality improvement plan. Each inpatient pharmacy shall maintain a current pharmacy permit or registration, as applicable to the services offered.

**History**
- *SOURCE: Miss. Code Ann. §41-85-7 Subchapter 36 FOOD SERVICE IN INPATIENT HOSPICE*

##### **15 Miss. Admin. Code Pt. 16, R. 1.36.1** Rule 1.36.1 {#sec-16-1.36.1 omnilex-key=us-ms-regs-official--title-15--16#1.36.1}

Direction and Supervision – The inpatient hospice facility shall provide well- planned, attractive, and satisfying meals which will meet their nutritional, social, emotional, and therapeutic needs. The dietary department of a hospice shall be directed by a registered dietitian, certified dietary manager, or a qualified dietary manager. If a food service supervisor is the director, she must receive regularly scheduled consultation, at a minimum monthly, from a registered dietitian.

**History**
- *SOURCE: Miss. Code Ann. §41-85-7 Subchapter 37 FOOD HANDLING PROCEDURES*

##### **15 Miss. Admin. Code Pt. 16, R. 1.37.1** Rule 1.37.1 {#sec-16-1.37.1 omnilex-key=us-ms-regs-official--title-15--16#1.37.1}

Clean Rooms – Floors, walls, and ceilings of rooms in food service area shall be free of an accumulation of rubbish, dust, grease and dirt.

**History**
- *SOURCE: Miss. Code Ann. §41-85-7*

##### **15 Miss. Admin. Code Pt. 16, R. 1.37.2** Clean Equipment – Equipment within the food service area shall be clean and free of dust, grease, and dirt {#sec-16-1.37.2 omnilex-key=us-ms-regs-official--title-15--16#1.37.2}

**History**
- *SOURCE: Miss. Code Ann. §41-85-7*

##### **15 Miss. Admin. Code Pt. 16, R. 1.37.3** Tables and Counters – Tables and counters which are used for food service shall be kept clean {#sec-16-1.37.3 omnilex-key=us-ms-regs-official--title-15--16#1.37.3}

**History**
- *SOURCE: Miss. Code Ann. §41-85-7*

##### **15 Miss. Admin. Code Pt. 16, R. 1.37.4** Clean Utensils – Service utensils shall be cleaned after each use {#sec-16-1.37.4 omnilex-key=us-ms-regs-official--title-15--16#1.37.4}

Utensils used for food storage shall be kept clean.

**History**
- *SOURCE: Miss. Code Ann. §41-85-7*

##### **15 Miss. Admin. Code Pt. 16, R. 1.37.5** Rule 1.37.5 {#sec-16-1.37.5 omnilex-key=us-ms-regs-official--title-15--16#1.37.5}

Dish and Utensil Washing – Dishes and utensils used for eating, drinking, and in preparation or serving food and drink shall be cleaned after each use in accordance with the regulations of the Mississippi State Department of Health governing food handling establishments.

**History**
- *SOURCE: Miss. Code Ann. §41-85-7*

##### **15 Miss. Admin. Code Pt. 16, R. 1.37.6** Ice – Ice to be served shall be of sanitary quality {#sec-16-1.37.6 omnilex-key=us-ms-regs-official--title-15--16#1.37.6}

Ice shall be handled, crushed, and stored in clean equipment and shall not be served by direct contact of fingers or hands but only with spoons, scoops, or the like.

**History**
- *SOURCE: Miss. Code Ann. §41-85-7*

##### **15 Miss. Admin. Code Pt. 16, R. 1.37.7** Rule 1.37.7 {#sec-16-1.37.7 omnilex-key=us-ms-regs-official--title-15--16#1.37.7}

Protection from Contamination – All foods and food ingredients shall be so stored, handled, and served so as to be protected from dust, flies, roaches, rats, unsanitary handling, droplet infection, overhead leakage, sewage backflow and any other contamination. Sugar, syrup and condiment receptacles shall be provided with lids and shall be kept covered when not in use.

**History**
- *SOURCE: Miss. Code Ann. §41-85-7*

##### **15 Miss. Admin. Code Pt. 16, R. 1.37.8** Storage and Service of Milk and Ice Cream {#sec-16-1.37.8 omnilex-key=us-ms-regs-official--title-15--16#1.37.8}

1. All milk and fluid milk products shall be stored and served in accordance with regulations of the Department of Health governing the production and sale of milk and milk products.

2. All ice cream and other frozen desserts shall be from an approved source. Ice cream shall be stored in covered containers. No contaminating substance shall be stored with ice cream.

**History**
- *SOURCE: Miss. Code Ann. §41-85-7*

##### **15 Miss. Admin. Code Pt. 16, R. 1.37.9** Kitchen Garbage and Trash Handling {#sec-16-1.37.9 omnilex-key=us-ms-regs-official--title-15--16#1.37.9}

1. Kitchen garbage and trash shall be placed in suitable containers with tight-fitting lids and stored in a screened or refrigerated space pending removal. Kitchen garbage and trash shall not be allowed to accumulate in the kitchen and shall be removed from the premises at frequent intervals.

2. After being emptied, all garbage and trash cans shall be washed and dried before re-use.

**History**
- *SOURCE: Miss. Code Ann. §41-85-7*

##### **15 Miss. Admin. Code Pt. 16, R. 1.37.10** Employee Cleanliness {#sec-16-1.37.10 omnilex-key=us-ms-regs-official--title-15--16#1.37.10}

1. Employees engaged in handling, preparation, and/or serving of food shall wear clean clothing at all times. They shall wear hair nets, head bands, or caps to prevent the falling of hair.

2. Employee handling food shall wash their hands thoroughly before starting to work, immediately after contact with any soiled matter, and before returning to work after each visit to the toilet room.

3. Street clothing of employees shall be stored in lockers or dressing rooms.

**History**
- *SOURCE: Miss. Code Ann. §41-85-7*

##### **15 Miss. Admin. Code Pt. 16, R. 1.37.11** Smoking and Expectorating – Smoking or expectorating within the food service area shall not be permitted {#sec-16-1.37.11 omnilex-key=us-ms-regs-official--title-15--16#1.37.11}

**History**
- *SOURCE: Miss. Code Ann. §41-85-7*

##### **15 Miss. Admin. Code Pt. 16, R. 1.37.12** Dining in Kitchen – Eating or dining in the food preparation area or kitchen shall not be permitted {#sec-16-1.37.12 omnilex-key=us-ms-regs-official--title-15--16#1.37.12}

**History**
- *SOURCE: Miss. Code Ann. §41-85-7 Subchapter 38 MEAL SERVICE*

##### **15 Miss. Admin. Code Pt. 16, R. 1.38.1** Meals and Nutrition – At least three (3) meals in each twenty-four (24) hours shall be provided {#sec-16-1.38.1 omnilex-key=us-ms-regs-official--title-15--16#1.38.1}

The daily food allowance shall meet the current recommended dietary allowances of the Food and Nutrition Board of National Research Council adjusted for individual needs.

**History**
- *SOURCE: Miss. Code Ann. §41-85-7*

##### **15 Miss. Admin. Code Pt. 16, R. 1.38.2** Menu – The menu shall be planned and written at least one (1) week in advance {#sec-16-1.38.2 omnilex-key=us-ms-regs-official--title-15--16#1.38.2}

The current week’s menu shall be signed by the dietitian, dated, posted in the kitchen and followed as planned. Substitutions and changes on all diets shall be documented in writing. Copies of menus and substitutions shall be kept on file for at least thirty (30) days.

**History**
- *SOURCE: Miss. Code Ann. §41-85-7*

##### **15 Miss. Admin. Code Pt. 16, R. 1.38.3** Timing of Meals – A time schedule for serving meals to patients or residents and personnel shall be established {#sec-16-1.38.3 omnilex-key=us-ms-regs-official--title-15--16#1.38.3}

Meals shall be served approximately five (5) hours apart with no more than fourteen (14) hours between a substantial evening

meal and breakfast. The time schedule of meals shall be posted with the menu on the board. Bedtime/in between meal snacks of nourishing quality must be offered to patients not on diets prohibiting such nourishment.

**History**
- *SOURCE: Miss. Code Ann. §41-85-7*

##### **15 Miss. Admin. Code Pt. 16, R. 1.38.4** Rule 1.38.4 {#sec-16-1.38.4 omnilex-key=us-ms-regs-official--title-15--16#1.38.4}

Modification in Regular Diets – Modified diets which are a part of medical treatment shall be prescribed in written orders by the physician, for example; sodium restricted diets; bland-low residue diets; and modification in carbohydrates, protein, or fat. All modified diets shall be planned in writing and posted along with regular menus. A current diet manual shall be available to personnel. The registered dietitian shall approve all modified diet menus and diet manual used in the facility.

**History**
- *SOURCE: Miss. Code Ann. §41-85-7*

##### **15 Miss. Admin. Code Pt. 16, R. 1.38.5** Food Preparation – Foods shall be prepared by methods that conserve optimum nutritive value, flavor, and appearance {#sec-16-1.38.5 omnilex-key=us-ms-regs-official--title-15--16#1.38.5}

The food shall be acceptable to the individuals served.

**History**
- *SOURCE: Miss. Code Ann. §41-85-7*

##### **15 Miss. Admin. Code Pt. 16, R. 1.38.6** Rule 1.38.6 {#sec-16-1.38.6 omnilex-key=us-ms-regs-official--title-15--16#1.38.6}

Food Supply – Supplies of perishable foods for at least a twenty-four (24) hour period and or non-perishable foods for a three (3) day period shall be on the premises to meet the requirements of the planned menus. The non-perishable foods shall consist of commercial type processed foods.

**History**
- *SOURCE: Miss. Code Ann. §41-85-7*

##### **15 Miss. Admin. Code Pt. 16, R. 1.38.7** Serving of Meals {#sec-16-1.38.7 omnilex-key=us-ms-regs-official--title-15--16#1.38.7}

1. Tables should be made available for all patients. Patients who are not able to go to the dining room shall be provided sturdy tables (not TV trays) of proper heights. For those who are bedfast or infirm, tray service shall be provided in their rooms with the tray resting on a firm support.

2. Personnel eating meals or snacks on the premises shall be provided facilities separate from and outside of food preparation, tray service and dish washing areas.

3. Foods shall be attractively and neatly served. All foods shall be served at proper temperature. Effective equipment shall be provided and procedures established to maintain food at proper temperature during serving.

4. All trays, tables, utensils and supplies such as china, glassware, flatware, linens and paper placemats or tray covers used for meal service shall be appropriate, sufficient in quantity and in compliance with the applicable sanitation standard.

5. Food Service personnel- A competent person shall be designated by the administrator to be responsible for the total food service. Sufficient staff shall be employed to meet the established standards of food service. Provision should be made for adequate supervision and training of the employee.

**History**
- *SOURCE: Miss. Code Ann. §41-85-7 Subchapter 39 PHYSICAL PLANT FACILITIES*

##### **15 Miss. Admin. Code Pt. 16, R. 1.39.1** Rule 1.39.1 {#sec-16-1.39.1 omnilex-key=us-ms-regs-official--title-15--16#1.39.1}

Floors – Floors in food service areas shall be of such construction so as to be easily cleaned, sound, smooth, non-absorbent and without cracks or crevices. Floors shall be maintained in good repair.

**History**
- *SOURCE: Miss. Code Ann. §41-85-7*

##### **15 Miss. Admin. Code Pt. 16, R. 1.39.2** Rule 1.39.2 {#sec-16-1.39.2 omnilex-key=us-ms-regs-official--title-15--16#1.39.2}

Walls and Ceilings – Walls and ceilings of food service areas shall be tight and of substantial construction, smoothly finished and painted in a light color. The walls and ceilings shall be without horizontal ledges and shall be washable up to the highest level reached by splash and spray. Roofs and walls shall be maintained free of leaks. All openings to the exterior shall be provided with doors or windows that will prevent the entrance of rain or dust during inclement weather.

**History**
- *SOURCE: Miss. Code Ann. §41-85-7*

##### **15 Miss. Admin. Code Pt. 16, R. 1.39.3** Screens on Outside Openings – Openings to the outside shall be effectively screened {#sec-16-1.39.3 omnilex-key=us-ms-regs-official--title-15--16#1.39.3}

Screen doors shall open outward and be equipped with self-closing devices.

**History**
- *SOURCE: Miss. Code Ann. §41-85-7*

##### **15 Miss. Admin. Code Pt. 16, R. 1.39.4** Rule 1.39.4 {#sec-16-1.39.4 omnilex-key=us-ms-regs-official--title-15--16#1.39.4}

Lighting – The kitchen, dish washing area, and dining room shall be provided with well distributed and unobstructed natural light or openings. Artificial light properly distributed and of an intensity of not less than thirty (30) foot candles shall be provided.

**History**
- *SOURCE: Miss. Code Ann. §41-85-7*

##### **15 Miss. Admin. Code Pt. 16, R. 1.39.5** Rule 1.39.5 {#sec-16-1.39.5 omnilex-key=us-ms-regs-official--title-15--16#1.39.5}

Ventilation – The food service area shall be ventilated in a manner that will maintain comfortable working conditions, remove objectionable odors and fumes, and prevent excessive condensations.

**History**
- *SOURCE: Miss. Code Ann. §41-85-7*

##### **15 Miss. Admin. Code Pt. 16, R. 1.39.6** Employee Toilet Facilities – Toilet facilities shall be provided for employees {#sec-16-1.39.6 omnilex-key=us-ms-regs-official--title-15--16#1.39.6}

Toilet rooms shall not open directly into any room in which food is prepared, stored, displayed, or served, nor into any room in which utensils are washed or stored. Toilet rooms shall have a lavatory and shall be well lighted and ventilated.

**History**
- *SOURCE: Miss. Code Ann. §41-85-7*

##### **15 Miss. Admin. Code Pt. 16, R. 1.39.7** Rule 1.39.7 {#sec-16-1.39.7 omnilex-key=us-ms-regs-official--title-15--16#1.39.7}

Hand Washing Facilities – Hand washing facilities with hot and cold water, soap dispenser and a supply of soap and disposable towels shall be provided in all kitchens. The use of a common towel is prohibited. Hands shall not be washed in sinks where food is prepared or where utensils are cleaned.

**History**
- *SOURCE: Miss. Code Ann. §41-85-7*

##### **15 Miss. Admin. Code Pt. 16, R. 1.39.8** Rule 1.39.8 {#sec-16-1.39.8 omnilex-key=us-ms-regs-official--title-15--16#1.39.8}

Refrigeration Facilities – Adequate refrigeration facilities, automatic in operation, for the storage of perishable foods shall be provided. Where separate refrigeration can be provided, the recommended temperatures for storing perishable foods are thirty-two (32 degrees) to thirty-eight (38 degrees) Fahrenheit for meats, forty (40 degrees) Fahrenheit for dairy products, and forty- five (45 degrees) Fahrenheit for fruits and vegetables. All refrigerators shall be provided with thermometers. Facilities with more than twenty-four (24) beds shall have commercial or institutional type refrigeration.

**History**
- *SOURCE: Miss. Code Ann. §41-85-7*

##### **15 Miss. Admin. Code Pt. 16, R. 1.39.9** Rule 1.39.9 {#sec-16-1.39.9 omnilex-key=us-ms-regs-official--title-15--16#1.39.9}

Equipment or Utensil Construction – Equipment and utensils shall be constructed so as to be easily cleaned and shall be kept in good repair

**History**
- *SOURCE: Miss. Code Ann. §41-85-7*

##### **15 Miss. Admin. Code Pt. 16, R. 1.39.10** Rule 1.39.10 {#sec-16-1.39.10 omnilex-key=us-ms-regs-official--title-15--16#1.39.10}

Separation of Kitchen from Resident Rooms and Sleeping Quarters – Any room used for sleeping quarters shall be separated from the food service area by a solid wall. Sleeping accommodations such as a cot, bed, or couch shall not be permitted within the food service area

**History**
- *SOURCE: Miss. Code Ann. §41-85-7 Subchapter 40 AREAS AND EQUIPMENT*

##### **15 Miss. Admin. Code Pt. 16, R. 1.40.1** Rule 1.40.1 {#sec-16-1.40.1 omnilex-key=us-ms-regs-official--title-15--16#1.40.1}

Location and Space Requirements – Food service facilities shall be located in a specifically designated area and shall include the following rooms and/or spaces: kitchen, dishwashing, food storage, and dining room.

**History**
- *SOURCE: Miss. Code Ann. §41-85-7*

##### **15 Miss. Admin. Code Pt. 16, R. 1.40.2** Kitchen {#sec-16-1.40.2 omnilex-key=us-ms-regs-official--title-15--16#1.40.2}

1. Size and Dimensions – The minimum area of kitchen (food preparation only) for less than twenty-five (25) beds shall be two hundred (200) square feet. In facilities with twenty-five (25) to sixty (60) beds, a minimum area of ten (10) square feet per bed shall be provided. In facilities with sixty-on (61) to eighty (80) beds, a minimum of six (6) square feet per bed shall be provided for each bed over sixty (60). In facilities with eighty-one (81) to one hundred (100) beds, a minimum of five (5) square feet per bed shall be provided for each bed over eighty (80). In facilities with more than one hundred (100) beds, proportionate space as approved by the licensing agency shall be provided. The kitchen shall be of such size and dimensions in order to:

a. Permit orderly and sanitary handling and processing of food;

b. Avoid overcrowding and congestion of operations;

c. Provide at least three (3) feet between working areas and wider if space is used as a passageway;

d. Provide a ceiling height of at least eight (8) feet.

2. Minimum equipment in kitchen shall include:

a. Range and cooking equipment – Facility with more than twenty-four (24) beds shall have institutional type ranges, ovens, steam cookers, fryers, etc., in appropriate sizes and numbers to meet the food preparation needs of the facility. The cooking equipment shall be equipped with a hood vented to the outside as appropriate.

b. Refrigerator and freezers – Facilities with more than twenty-four (24) beds shall have sufficient commercial or institutional type refrigeration/freezer units to meet the storage needs of the facility.

c. Bulletin Board

d. Clock

e. Cook’s table

f. Counter or table for tray set-up

g. Cans, garbage (heavy plastic or galvanized)

h. Lavatories, hand washing; conveniently located throughout the department

i. Pot, pans, silverware, dishes, and glassware in sufficient numbers with storage space for each.

j. Pot and pan sink – A three compartment sink shall be provided for cleaning pots and pans. Each compartment shall be a minimum of twenty-four (24) inches by twenty-four (24) inches by sixteen (16) inches. A drain board of approximately thirty (30) inches shall be provided at each end of the sink, one to be used for stacking soiled utensils and the other for draining clean utensils. k. Food Preparation Sink – A double compartment food preparation sink shall be provided for washing vegetables and other foods. A drain board shall be provided at each end of the sink.

l. Fire extinguisher, 20 BC rated (sodium bicarbonate or potassium bicarbonate)

m. Ice machine – At least one ice machine shall be provided. If there is only one (1) ice machine in the facility, it shall be located adjacent to but not in the kitchen. If there is an ice machine located at nursing station, then the ice machine for dietary shall be located in the kitchen.

n. Office – An office shall be provided near the kitchen for the use of the food service supervisor. At a minimum, the space provided shall be adequate for a desk, two chairs and a filing cabinet.

o. Coffee, tea and milk dispenser – (Milk dispenser not required if milk is served in individual cartons.

p. Tray assembly line equipment with tables, hot food tables, tray slide, etc.

q. Ice Cream Storage

r. Tray cart – (Hot food carts are desirable but not specifically required.)

s. Mixer – Institutional type mixer of appropriate size for facility.

**History**
- *SOURCE: Miss. Code Ann. §41-85-7*

##### **15 Miss. Admin. Code Pt. 16, R. 1.40.3** Rule 1.40.3 {#sec-16-1.40.3 omnilex-key=us-ms-regs-official--title-15--16#1.40.3}

Dishwashing – Commercial or institutional type dishwashing equipment shall be provided in facilities with more than twenty- four (24) beds. The dishwashing area shall be separated from the food preparation area by a partition wall. If sanitizing is to be accomplished by hot water, a minimum temperature of one hundred eighty degrees (180o) Fahrenheit shall be maintained during the rinsing cycle. An alternate method of sanitizing through use of chemicals (chlorine) may be provided if sanitizing standards are observed in accordance with requirements as set forth by the Mississippi State Department of Health. Adequate counter space for stacking soiled dishes shall be provided in the dishwashing area at the most convenient place of entry from the dining room, followed by a disposer with can storage under the counter. There shall be a pre-rinse sink, then the dishwasher and finally a counteror drain for clean dishes. The dishwashing areas shall have a wall or partition separating soiled and clean dish areas.

**History**
- *SOURCE: Miss. Code Ann. §41-85-7*

##### **15 Miss. Admin. Code Pt. 16, R. 1.40.4** Food Storage – A food-storage room with cross-ventilation shall be provided {#sec-16-1.40.4 omnilex-key=us-ms-regs-official--title-15--16#1.40.4}

Adequate shelving, bins and heavy plastic or galvanized cans shall be provided. The storeroom shall be of such construction as to prevent the invasion of rodents and insects, the seepage of dust and water leakage, or any other source of contamination. The food-storage room should be adjacent to the kitchen and convenient to the receiving area. There shall be sufficient food storage area to meet need of the facility.

**History**
- *SOURCE: Miss. Code Ann. §41-85-7 Subchapter 41 SANITATION AND HOUSEKEEEPING IN PATIENT CARE*

##### **15 Miss. Admin. Code Pt. 16, R. 1.41.1** Water Supply {#sec-16-1.41.1 omnilex-key=us-ms-regs-official--title-15--16#1.41.1}

1. If at all possible, all water shall be obtained from a public water supply. If not possible to obtain water from a public water supply source, the private water supply shall meet the approval of the local county health department and/or the Department of Health.

2. Water under pressure sufficient to operate fixtures at the highest point during maximum periods shall be provided. Water under pressure of at least fifteen (15) pounds per square inch shall be piped to all sink, toilets, lavatories, tubs, showers, and other fixtures requiring water.

3. It is recommended that the water supply into the building can be obtained from two (2) separate water lines if possible.

4. A dual hot water supply shall be provided. The temperature of hot water to lavatories and bathing facilities shall not exceed one hundred ten degrees (110 degrees) Fahrenheit, nor shall hot water be less than one hundred degrees (100 degrees) Fahrenheit.

**History**
- *SOURCE: Miss. Code Ann. §41-85-7*

##### **15 Miss. Admin. Code Pt. 16, R. 1.41.2** Disposal of Liquid and Human Wastes {#sec-16-1.41.2 omnilex-key=us-ms-regs-official--title-15--16#1.41.2}

1. There shall be installed within the building a properly designed waste disposal system connecting to all fixtures to which water under pressure is piped.

2. All liquid and human waste, including floor-wash water and liquid waste from refrigerators, shall be disposed of through trapped drains into a public sewer system where such system is available.

3. In localities where a public sanitary sewer is not available, liquid and human waste shall be disposed of through trapped drains into a sewerage disposal system approved by the local county health department and/or the Department of Health. The sewerage disposal system shall be of a size and capacity based on the number of patients and personnel housed and employed in the facility. Where the sewerage disposal system is installed prior to the opening of the facility, it shall be assumed, unless proven otherwise, that the system was designed for ten (10) or fewer persons.

**History**
- *SOURCE: Miss. Code Ann. §41-85-7*

##### **15 Miss. Admin. Code Pt. 16, R. 1.41.3** Rule 1.41.3 {#sec-16-1.41.3 omnilex-key=us-ms-regs-official--title-15--16#1.41.3}

Premises –The premises shall be kept neat, clean, and free of an accumulation of rubbish, weeds, ponded water, or other conditions which would have a tendency to create a health hazard.

**History**
- *SOURCE: Miss. Code Ann. §41-85-7*

##### **15 Miss. Admin. Code Pt. 16, R. 1.41.4** Control of Insects, Rodents, Etc {#sec-16-1.41.4 omnilex-key=us-ms-regs-official--title-15--16#1.41.4}

– The institution shall be kept free of ants, flies, roaches, rodents, and other insects and vermin. Proper methods of eradication and control shall be utilized through contract with a reputable licensed pest control company.

**History**
- *SOURCE: Miss. Code Ann. §41-85-7*

##### **15 Miss. Admin. Code Pt. 16, R. 1.41.5** Rule 1.41.5 {#sec-16-1.41.5 omnilex-key=us-ms-regs-official--title-15--16#1.41.5}

Toilet Room Cleanliness – Floors, walls, ceilings and fixtures of all toilet rooms shall be kept clean and free of objectionable odors. These rooms shall be kept free of an accumulation of rubbish, cleaning supplies, toilet articles, etc.

**History**
- *SOURCE: Miss. Code Ann. §41-85-7*

##### **15 Miss. Admin. Code Pt. 16, R. 1.41.6** Garbage Disposal {#sec-16-1.41.6 omnilex-key=us-ms-regs-official--title-15--16#1.41.6}

1. Garbage must be kept in water-tight suitable containers with tight fitting covers. Garbage containers must be emptied at frequent intervals and cleaned before using again.

2. Proper disposition of infectious materials shall be observed.

**History**
- *SOURCE: Miss. Code Ann. §41-85-7 Subchapter 42 HOUSEKEEPING AND PHYSICAL PLANT MAINTENANCE*

##### **15 Miss. Admin. Code Pt. 16, R. 1.42.1** Housekeeping Facilities and Services {#sec-16-1.42.1 omnilex-key=us-ms-regs-official--title-15--16#1.42.1}

1. The physical plant shall be kept in good repair, neat and attractive. The safety and comfort of the patient shall be the first consideration.

2. Janitor closets shall be provided with a mop-cleaning sink and be large enough in area to store cleaning supplies and equipment. A separate janitor closet area and equipment shall be provided for the food service area.

**History**
- *SOURCE: Miss. Code Ann. §41-85-7*

##### **15 Miss. Admin. Code Pt. 16, R. 1.42.2** Bathtubs, Showers, and Lavatories – Bathtubs, showers, and lavatories shall be kept clean and in proper working order {#sec-16-1.42.2 omnilex-key=us-ms-regs-official--title-15--16#1.42.2}

They shall not be used for laundering or for storage of soiled materials. Neither shall these facilities be used for cleaning mops, brooms, etc.

**History**
- *SOURCE: Miss. Code Ann. §41-85-7*

##### **15 Miss. Admin. Code Pt. 16, R. 1.42.3** Rule 1.42.3 {#sec-16-1.42.3 omnilex-key=us-ms-regs-official--title-15--16#1.42.3}

Patient Bedrooms – Patient bedrooms shall be cleaned and dusted as often as necessary to maintain a clean, attractive appearance. All sweeping should be damp sweeping. All dusting should be damp dusting with a good germicide or detergent-germicide.

**History**
- *SOURCE: Miss. Code Ann. §41-85-7*

##### **15 Miss. Admin. Code Pt. 16, R. 1.42.4** Storage {#sec-16-1.42.4 omnilex-key=us-ms-regs-official--title-15--16#1.42.4}

1. Such items as beds, mattresses, mops, mop buckets, dust rags, etc. shall not be kept in hallways, corners, toilet or bathrooms, clothes closets, or patient bedrooms.

2. The use of attics for storage of combustible materials is prohibited.

3. If basements are used for storage, they shall meet acceptable standards for storage and for fire safety.

**History**
- *SOURCE: Miss. Code Ann. §41-85-7 Subchapter 43 MEDICAL WASTE*

##### **15 Miss. Admin. Code Pt. 16, R. 1.43.1** Rule 1.43.1 {#sec-16-1.43.1 omnilex-key=us-ms-regs-official--title-15--16#1.43.1}

Regulated Medical Waste - “Infectious Medical Wastes” includes solid or liquid wastes which may contain pathogens with sufficient virulence and quantity such that exposure to the waste by a susceptible host has been proven to result in an infectious disease. For purposes of this Regulation, the following wastes shall be considered to be infectious medical wastes:

1. Wastes resulting from the care of patients and animals who have Class I and/or II diseases that are transmitted by blood and body fluid as defined in the rules and regulations governing reportable diseases as defined by the Mississippi State Department of Health;

2. Cultures and stocks of infectious agents; including specimen cultures collected from medical and pathological laboratories, cultures and stocks of infectious agents from research and industrial laboratories, wastes from the production of biologicals, discarded live and attenuated vaccines, and culture dishes and devices used to transfer, inoculate, and mix cultures;

3. Blood and blood products such as serum, plasma, and other blood components;

4. Pathological wastes, such as tissues, organs, body parts, and body fluids that are removed during surgery and autopsy;

5. Contaminated carcasses, body parts, and bedding of animals that were exposed to pathogens in medical research;

6. All discarded sharps (e.g., hypodermic needles, syringes, Pasteur pipettes, broken glass, scalpel blades) which have come into contact with infectious agents;

7. Other wastes determined infectious by the generator or so classified by the Mississippi State Department of Health.

**History**
- *SOURCE: Miss. Code Ann. §41-85-7*

##### **15 Miss. Admin. Code Pt. 16, R. 1.43.2** Rule 1.43.2 {#sec-16-1.43.2 omnilex-key=us-ms-regs-official--title-15--16#1.43.2}

Medical Waste – Means all waste generated in direct patient care or in diagnostic or research areas that is non-infectious but aesthetically repugnant if found in the environment

**History**
- *SOURCE: Miss. Code Ann. §41-85-7*

##### **15 Miss. Admin. Code Pt. 16, R. 1.43.3** Rule 1.43.3 {#sec-16-1.43.3 omnilex-key=us-ms-regs-official--title-15--16#1.43.3}

Medical Waste Management Plan – All generators of infectious medical waste and medical waste shall have a medical waste management plan that shall include, but is not limited to, the following:

1. Storage and Containment of Infectious Medical Waste and Medical Waste

a. Containment of infectious medical waste and medical waste shall be in a manner and location which affords protection from animals, rain and wind, does not provide a breeding place or a food source for insects and rodents, and minimizes exposure to the public.

b. Infectious medical waste shall be segregated from other waste at the point of origin in the producing facility.

c. Unless approved by the Mississippi State Department of Health or treated and rendered non-infectious, infectious medical waste (except for sharps in approved containers) shall not be stored at a waste producing facility for more than seven

days above a temperature of 60 C (38 degrees F). Containment of infectious medical waste at the producing facility is permitted at or below a temperature of 0 degrees C (32 degrees F) for a period of not more than 90 days without specific approval of the Department of Health.

d. Containment of infectious medical waste shall be separate from other wastes. Enclosures or containers used for containment of infectious medical waste shall be so secured so as to discourage access by unauthorized persons and shall be marked with prominent warning signs on, or adjacent to, the exterior of entry doors, gates, or lids. Each container shall be prominently labeled with a sign using language to be determined by the Department and legible during daylight hours.

e. Infectious medical waste, except for sharps capable of puncturing or cutting, shall be contained in double disposable plastic bags or single bags (1.5 mills thick) which are impervious to moisture and have strength sufficient to preclude ripping, tearing, or bursting under normal conditions of usage. The bags shall be securely tied so as to prevent leakage or expulsion of solid or liquid waste during storage, handling or transport.

f. All sharps shall be contained for disposal in leak proof, rigid, puncture-resistant containers which are taped closed or tightly lidded to preclude loss of the contents.

g. All bags used for containment and disposal of infectious medical waste shall be of distinctive color or display the Universal Symbol for infectious waste. Rigid containers of all sharps waste shall be labeled.

h. Compactors or grinders shall not be used to process infectious medical waste unless the waste has been rendered non-infectious. Sharps containers shall not be subject to compaction by any compacting device except in the institution itself and shall not be placed for storage or transport in a portable or mobile trash compactor.

i. Infectious medical waste and medical waste contained in disposable containers, as prescribed above, shall be placed for storage, handling or transport in disposable or reusable pails, cartons, drums or portable bins. The containment system shall be leak proof, have tight-fitting covers and be kept clean and in good repair.

j. Reusable containers for infectious medical waste and medical waste shall be thoroughly washed and decontaminated each time they are emptied by a method specified by the Mississippi State Department of Health, unless the surfaces of the containers have been protected from contamination by disposable liners, bags, or other devices removed with the waste, as outlined in E.

k. Approved methods of decontamination include, but are not limited to, agitation to remove visible soil combined with one or more of the following procedures:

i. Exposure to hot water at least 180 F for a minimum of 15 seconds.

ii. Exposure to a chemical sanitizer by rinsing with or immersion in one of the following for a minimum of 3 minutes:

a. Hypochlorite solution (500 ppm available chlorine).

b. Phenolic solution (500 ppm active agent).

c. Iodoform solution (100 ppm available iodine).

d. Quaternary ammonium solution (400 ppm active agent).

l. Reusable pails, drums or bins used for containment of infectious waste shall not be used for containment of waste to be disposed of as non-infectious waste or for other purposes except after being decontaminated by procedures as described in part (J) of this section.

m. Trash chutes shall not be used to transfer infectious medical waste.

n. Once treated and rendered non-infectious, previously defined infectious medical waste will be classified as medical waste and may be landfilled in an approved landfill.

**History**
- *SOURCE: Miss. Code Ann. §41-85-7*

##### **15 Miss. Admin. Code Pt. 16, R. 1.43.4** Treatment Or Disposal Of Infectious Medical Waste Shall Be by One Of the Following Methods: {#sec-16-1.43.4 omnilex-key=us-ms-regs-official--title-15--16#1.43.4}

1. By incineration in an approved incinerator which provides combustion of the waste to carbonized or mineralized ash.

2. By sterilization by heating in a steam sterilizer, so as to render the waste non- infectious. Infectious medical waste so rendered non-infectious shall be disposable as medical waste. Operating procedures for steam sterilizers shall include, but not be limited to the following:

a. Adoption of standard written operating procedures or each steam sterilizer including time, temperature, pressure, type of waste, type of container(s), closure on container(s), pattern of loading, water content, and maximum load quantity;

b. Check or recording and/or indicating thermometers during each complete cycle to ensure the attainment of a temperature of 121 C (250 degrees F) for one-half hour or longer, depending on quantity and density of the load, in order to achieve sterilization of the entire load. Thermometers shall be checked for calibration at least annually;

c. Use of heat sensitive tape or other device for each container that is processed to indicate the attainment of adequate sterilization conditions;

d. Use of the biological indicator Bacillus stearothermophilus placed at the center of a load processed under standard operating conditions at least monthly to confirm the attainment of adequate sterilization conditions;

e. Maintenance of records of procedures specified in (a), (b), (c) and (d) above for period of not less than a year;

f. By discharge to the approved sewerage system if the waste is liquid or semi- liquid, except as prohibited by the Mississippi State Department of Health.

3. Recognizable human anatomical remains shall be disposed of by incineration or internment, unless burial at an approved landfill is specifically authorized by the Mississippi State Department of Health.

4. Chemical sterilization shall use only those chemical sterilants recognized by the U. S. Environmental Protection Agency, Office of Pesticides and Toxic Substances.

5. Ethylene oxide, glutaraldehyde, and hydrogen peroxide are examples of sterilants that, used in accordance with manufacturer recommendation, will render infectious waste non-infectious. Testing with Bacillus Subtilis Spores or other equivalent organisms shall be conducted quarterly to ensure the sterilization effectiveness of gas or steam treatment.

**History**
- *SOURCE: Miss. Code Ann. §41-85-7*

##### **15 Miss. Admin. Code Pt. 16, R. 1.43.5** Treatment and Disposal of Medical Waste Which Is Not Infectious Shall be By One Of The Following: {#sec-16-1.43.5 omnilex-key=us-ms-regs-official--title-15--16#1.43.5}

1. By incineration in an approved incinerator which provides combustion of the waste to a carbonized or mineralized ash; or

2. By sanitary landfill, in an approved landfill which shall mean a disposal facility or part of a facility where medical waste is placed in or on land and which is not a treatment facility. All the requirements of these standards shall apply, without regard to the quantity of medical waste generated per month, to any generator of medical waste.

**History**
- *SOURCE: Miss. Code Ann. §41-85-7 Subchapter 44 LAUNDRY- INPATIENT FACILITY*

##### **15 Miss. Admin. Code Pt. 16, R. 1.44.1** Direction and Supervision Responsibility for laundry services shall be delegated to a competent employee {#sec-16-1.44.1 omnilex-key=us-ms-regs-official--title-15--16#1.44.1}

**History**
- *SOURCE: Miss. Code Ann. §41-85-7 Subchapter 45 PHYSICAL FACILITY*

##### **15 Miss. Admin. Code Pt. 16, R. 1.45.1** Rule 1.45.1 {#sec-16-1.45.1 omnilex-key=us-ms-regs-official--title-15--16#1.45.1}

Location and Space Requirements Each inpatient hospice shall have laundry facilities unless commercial laundries are used. The laundry shall be located in specifically designated areas and there shall be adequate room and space for sorting, processing and storage of soiled material. There should be a separate storage area for provided for soiled linens apart from the clean linens laundry. Laundry rooms or soiled linen storage areas shall not open directly into a patient bedroom or food service area. Soiled materials shall not be transported through the food service area. If commercial laundry is used, separate satisfactory storage areas shall be provided for clean and soiled linens.

**History**
- *SOURCE: Miss. Code Ann. §41-85-7*

##### **15 Miss. Admin. Code Pt. 16, R. 1.45.2** Ventilation – Provisions shall be made to prevent the recirculation of air through the heating and air condition systems {#sec-16-1.45.2 omnilex-key=us-ms-regs-official--title-15--16#1.45.2}

**History**
- *SOURCE: Miss. Code Ann. §41-85-7*

##### **15 Miss. Admin. Code Pt. 16, R. 1.45.3** Lint Traps – Lint traps in driers shall be maintained free of lint and debris, {#sec-16-1.45.3 omnilex-key=us-ms-regs-official--title-15--16#1.45.3}

**History**
- *SOURCE: Miss. Code Ann. §41-85-7*

##### **15 Miss. Admin. Code Pt. 16, R. 1.45.4** Rule 1.45.4 {#sec-16-1.45.4 omnilex-key=us-ms-regs-official--title-15--16#1.45.4}

Laundry Chutes – When laundry chutes are provided they shall have a minimum diameter of two (2) feet; and they shall be installed with flushing ring, vent and drain.

1. An automatic sprinkler shall be provided at the top of the laundry chute and in any receiving room for a chute.

2. A self-closing door shall be provided at the bottom of the chute.

**History**
- *SOURCE: Miss. Code Ann. §41-85-7*

##### **15 Miss. Admin. Code Pt. 16, R. 1.45.5** Laundry Equipment –Laundry equipment shall be of the type to adequately perform the laundry needs of the facility {#sec-16-1.45.5 omnilex-key=us-ms-regs-official--title-15--16#1.45.5}

The equipment shall be installed to comply with all local and state codes.

**History**
- *SOURCE: Miss. Code Ann. §41-85-7 Subchapter 46 PHYSICAL FACILITIES: DESIGN AND CONSTRUCTION ELEMENTS*

##### **15 Miss. Admin. Code Pt. 16, R. 1.46.1** General {#sec-16-1.46.1 omnilex-key=us-ms-regs-official--title-15--16#1.46.1}

Every institution subject to these Minimum Standards shall be housed in a safe building which contains all the facilities required to render the services contemplated in the application for license.

**History**
- *SOURCE: Miss. Code Ann. §41-85-7*

##### **15 Miss. Admin. Code Pt. 16, R. 1.46.2** Codes {#sec-16-1.46.2 omnilex-key=us-ms-regs-official--title-15--16#1.46.2}

The term “safe” as used in Section Rule 1.46.1 hereof shall be interpreted in the light of compliance with the requirements of the codes recognized by this agency on date of construction which are incorporated by reference as a part of these Minimum Standards; included are the Life Safety Code of the National Fire Protection Association, American National Standards Institute, Standards Number A-17.1, and A-17.3, Safety Code for Elevators and Escalators, the American Institute of Architects (AIA), Guidelines for Design and Construction of Hospital and Health Care Facilities, and references incorporated as body of all afore mentioned standards. Life Safety Code compliance relative to construction date:

1. Buildings constructed after October 17, 2007 shall comply with the edition of the Life Safety Code (NFPA 101) recognized by this agency on the date of construction.

2. Building constructed prior to October 17, 2007 shall comply with existing chapter of the Life Safety Code recognized by this agency.

3. For minimum standards governing Heating, Ventilation, and Air Conditioning (HVAC), area design, space allocation, parking requirements, and other considerations not specifically addressed by local authority or standards referenced herein, compliance with the AIA guidelines will be deemed acceptable.

**History**
- *SOURCE: Miss. Code Ann. §41-85-7*

##### **15 Miss. Admin. Code Pt. 16, R. 1.46.3** Rule 1.46.3 {#sec-16-1.46.3 omnilex-key=us-ms-regs-official--title-15--16#1.46.3}

Location – All inpatient hospices established or constructed after the adoption of these regulations shall be located in an area free from undue noise, smoke, dust, or foul odors and shall not be located adjacent to disposal plants, cemeteries, etc.

**History**
- *SOURCE: Miss. Code Ann. §41-85-7*

##### **15 Miss. Admin. Code Pt. 16, R. 1.46.4** Site – The proposed site for an inpatient hospice must be approved by the Department of Health {#sec-16-1.46.4 omnilex-key=us-ms-regs-official--title-15--16#1.46.4}

Prior to construction/renovation, all proposed plans and sites must be submitted and approved by the Mississippi State Department of Health, Fire Safety and Construction Branch. Factors to be considered in approving a site may be convenience to medical and hospital services, approved

water supply and sewerage disposal, community services, services of a fire department, and availability to labor supply. Not more than 50% of a site shall be covered by a building(s) except by special approval of the Department of Health. One example whereby approval may be granted is where the structure is to be placed in a very desirable location where the grounds are limited and very expensive. Where such approval is granted, the structure will be required to have a living room, day room, sun room, and recreational areas adequate to compensate for lack of required outside area.

**History**
- *SOURCE: Miss. Code Ann. §41-85-7*

##### **15 Miss. Admin. Code Pt. 16, R. 1.46.5** Rule 1.46.5 {#sec-16-1.46.5 omnilex-key=us-ms-regs-official--title-15--16#1.46.5}

Local Restrictions – The site and structure of all facilities shall comply with local building, fire and zoning ordinances. Evidence to this effect signed by local building, fire, and zoning officials shall be presented, where applicable.

**History**
- *SOURCE: Miss. Code Ann. §41-85-7*

##### **15 Miss. Admin. Code Pt. 16, R. 1.46.6** Transportation – Facilities shall be located on streets or roads which are passable at all times {#sec-16-1.46.6 omnilex-key=us-ms-regs-official--title-15--16#1.46.6}

They should be located convenient to public transportation facilities, when applicable.

**History**
- *SOURCE: Miss. Code Ann. §41-85-7*

##### **15 Miss. Admin. Code Pt. 16, R. 1.46.7** Rule 1.46.7 {#sec-16-1.46.7 omnilex-key=us-ms-regs-official--title-15--16#1.46.7}

Communication – There shall be at least one electrically interconnected hardwire telephone in the facility and such additional telephones as are necessary to summon help in the event of a fire or other emergency. The telephone shall be listed under the official licensed name or title of the facility.

**History**
- *SOURCE: Miss. Code Ann. §41-85-7*

##### **15 Miss. Admin. Code Pt. 16, R. 1.46.8** Rule 1.46.8 {#sec-16-1.46.8 omnilex-key=us-ms-regs-official--title-15--16#1.46.8}

Occupancy – No part of the facility may be rented, leased, or used for any commercial purpose not related to the operation of the facility.

**History**
- *SOURCE: Miss. Code Ann. §41-85-7*

##### **15 Miss. Admin. Code Pt. 16, R. 1.46.9** Basement -No patient or resident shall be housed on any floor that is below ground level at any point {#sec-16-1.46.9 omnilex-key=us-ms-regs-official--title-15--16#1.46.9}

**History**
- *SOURCE: Miss. Code Ann. §41-85-7*

##### **15 Miss. Admin. Code Pt. 16, R. 1.46.10** Call System – Some type of signal for summoning aid shall be conveniently provided for each patient {#sec-16-1.46.10 omnilex-key=us-ms-regs-official--title-15--16#1.46.10}

**History**
- *SOURCE: Miss. Code Ann. §41-85-7 Subchapter 47 BUILDING REQUIREMENTS*

##### **15 Miss. Admin. Code Pt. 16, R. 1.47.1** One-Story Building Non-Combustible Construction {#sec-16-1.47.1 omnilex-key=us-ms-regs-official--title-15--16#1.47.1}

1. One-hour fire resistive rating generally. After adoption of these regulations, one- story buildings shall be of at least one-hour fire resistive rating throughout except as provided in subparagraph of this section (“hazardous areas and combustible storage”).

2. Hazardous areas and combustible storage. All areas used for storage of combustible materials shall be classified as hazardous areas and shall be separated from other areas by construction having a fire resistive rating of at least two (2) hours.

**History**
- *SOURCE: Miss. Code Ann. §41-85-7*

##### **15 Miss. Admin. Code Pt. 16, R. 1.47.2** Multi-Story Building {#sec-16-1.47.2 omnilex-key=us-ms-regs-official--title-15--16#1.47.2}

1. Fire resistive construction. After adoption of these regulations all institutions for the aged or infirm containing two (2) or more stories shall be of at least one-hour fire resistive construction throughout except as provided in 140.1 (2).

2. Elevator required. No patient shall be housed above the first floor unless the building is equipped with an elevator. The minimum cab size of the elevator shall be approximately five (5) feet four (4) inches by eight (8) feet no (0) inches and constructed of metal. The width of the shaft door shall be at least three (3) feet ten (10) inches. The load weight capacity shall be at least two thousand five hundred (2,500) pounds. The elevator shaft shall be enclosed in fire resistant construction of not less than two-hour fire resistive rating. Elevators shall not be counted as required exits. Elevators are subject to the requirements of the referenced standard listed in paragraph 139.2 of this chapter. Exceptions to sub- paragraphs 1 and 2 may be granted to existing facilities at the discretion of the licensing agency.

**History**
- *SOURCE: Miss. Code Ann. §41-85-7*

##### **15 Miss. Admin. Code Pt. 16, R. 1.47.3** Rule 1.47.3 {#sec-16-1.47.3 omnilex-key=us-ms-regs-official--title-15--16#1.47.3}

Building Codes – All construction shall be in accordance with applicable local building codes and regulations and with these regulations.

**History**
- *SOURCE: Miss. Code Ann. §41-85-7*

##### **15 Miss. Admin. Code Pt. 16, R. 1.47.4** Rule 1.47.4 {#sec-16-1.47.4 omnilex-key=us-ms-regs-official--title-15--16#1.47.4}

Structural Soundness and Repair; Fire Resistive Rating – The building shall be structurally sound, free from leaks and excessive moisture, in good repair, and painted at sufficient intervals to be reasonably attractive inside and out. One- story structures shall have a one-hour fire resistance rating except that walls and ceilings of high fire hazard areas shall be of two-hour fire resistance rating in accordance with NFPA #220. Multi-storied buildings shall be of fire resistive materials.

**History**
- *SOURCE: Miss. Code Ann. §41-85-7*

##### **15 Miss. Admin. Code Pt. 16, R. 1.47.5** Rule 1.47.5 {#sec-16-1.47.5 omnilex-key=us-ms-regs-official--title-15--16#1.47.5}

Temperature – Adequate heating and cooling shall be provided in all rooms used by patients so that a minimum temperature of seventy-five (75 degrees) to eighty (80 degrees) Fahrenheit may be maintained.

**History**
- *SOURCE: Miss. Code Ann. §41-85-7*

##### **15 Miss. Admin. Code Pt. 16, R. 1.47.6** Lighting – Each patient’s room shall have artificial light adequate for reading and other uses as needed {#sec-16-1.47.6 omnilex-key=us-ms-regs-official--title-15--16#1.47.6}

All entrances, corridors, stairways, ramps, cellars, attics, storerooms, kitchens, laundries, and service units shall have sufficient artificial lighting to prevent accidents and promote efficiency of service. Night lights shall be provided in all corridors, stairways, toilets, and bathing rooms.

**History**
- *SOURCE: Miss. Code Ann. §41-85-7*

##### **15 Miss. Admin. Code Pt. 16, R. 1.47.7** Rule 1.47.7 {#sec-16-1.47.7 omnilex-key=us-ms-regs-official--title-15--16#1.47.7}

Emergency power / Lighting – To provide electricity during an interruption of the normal electric supply that could affect the medical care, treatment and safety of the occupants, an emergency source of electricity shall be provided and connected to certain circuits for lighting and power. The source of the emergency electric service shall be an emergency generator, with a stand-by supply of fuel for 24 hours.

**History**
- *SOURCE: Miss. Code Ann. §41-85-7*

##### **15 Miss. Admin. Code Pt. 16, R. 1.47.8** Rule 1.47.8 {#sec-16-1.47.8 omnilex-key=us-ms-regs-official--title-15--16#1.47.8}

Screens – All screen doors and non-stationary windows shall be equipped with tight fitting, full length, sixteen (16) mesh screens. Screen doors shall swing out and shall be equipped with self-closing devices.

**History**
- *SOURCE: Miss. Code Ann. §41-85-7*

##### **15 Miss. Admin. Code Pt. 16, R. 1.47.9** Rule 1.47.9 {#sec-16-1.47.9 omnilex-key=us-ms-regs-official--title-15--16#1.47.9}

Floors – All floors shall be smooth and free from defects such as cracks and be finished so that they can be easily cleaned. Floors in corridors, patient bedrooms, toilets, bathing rooms, kitchens, utility rooms, and other areas where frequent cleaning is necessary should be covered wall-to-wall with inlaid linoleum, resilient tile, hard tile, or the equivalent.

**History**
- *SOURCE: Miss. Code Ann. §41-85-7*

##### **15 Miss. Admin. Code Pt. 16, R. 1.47.10** Rule 1.47.10 {#sec-16-1.47.10 omnilex-key=us-ms-regs-official--title-15--16#1.47.10}

Walls and Ceilings –All walls and ceilings shall be of sound construction with an acceptable surface and shall be maintained in good repair. Generally the walls and ceilings should be painted a light color.

**History**
- *SOURCE: Miss. Code Ann. §41-85-7*

##### **15 Miss. Admin. Code Pt. 16, R. 1.47.11** Rule 1.47.11 {#sec-16-1.47.11 omnilex-key=us-ms-regs-official--title-15--16#1.47.11}

Ceiling Height – All ceilings shall have a height of at least eight (8) feet except that a height of seven (7) feet six (6) inches may be approved for corridors or

toilets and bathing rooms where the lighting fixtures are recessed. Exception may be made for existing facilities.

**History**
- *SOURCE: Miss. Code Ann. §41-85-7*

##### **15 Miss. Admin. Code Pt. 16, R. 1.47.12** Handrails – Handrails shall be installed on both sides of all corridors and hallways used by patients {#sec-16-1.47.12 omnilex-key=us-ms-regs-official--title-15--16#1.47.12}

The handrails should be installed from thirty-two (32) inches to thirty-six (36) inches above the floor. The handrails should have a return to the wall at each rail ending.

**History**
- *SOURCE: Miss. Code Ann. §41-85-7*

##### **15 Miss. Admin. Code Pt. 16, R. 1.47.13** Rule 1.47.13 {#sec-16-1.47.13 omnilex-key=us-ms-regs-official--title-15--16#1.47.13}

Ramps and Inclines – Ramps and inclines, where installed for the use of patients, shall not exceed one (1) foot of rise in ten (10) feet of run, shall be furnished with a non-slip floor, and shall be provided with handrails on both sides.

**History**
- *SOURCE: Miss. Code Ann. §41-85-7*

##### **15 Miss. Admin. Code Pt. 16, R. 1.47.14** Rule 1.47.14 {#sec-16-1.47.14 omnilex-key=us-ms-regs-official--title-15--16#1.47.14}

Stairways - Stairways shall have a minimum width of forty-four (44) inches with risers not to exceed seven and three-fourths (7¾) inches and treads not less than nine (9) inches. Treads shall be of uniform width and risers of uniform height in any one flight of stairs. All stairways and stairway landings shall be equipped with handrails on both sides.

1. A landing with width not less than the width of the stairs shall be provided at the top and bottom of each flight of stairs.

2. Winding stairways or triangular treads are prohibited.

3. Stairways shall be enclosed with noncombustible materials of at least two-hour fire resistance rating.

4. Openings to stairways shall be equipped with doors with self-closing devices.

5. Doors to stairways shall open in the direction of exit travel and be equipped with a vision window of wired glass. The doors shall open on a landing of the same width as the stair width.

6. Stairways shall be individually enclosed and separated from any public hall.

**History**
- *SOURCE: Miss. Code Ann. §41-85-7*

##### **15 Miss. Admin. Code Pt. 16, R. 1.47.15** Corridors and Passageways {#sec-16-1.47.15 omnilex-key=us-ms-regs-official--title-15--16#1.47.15}

1. Corridors in patient areas shall be not less than eight (8) feet wide. Exception may be granted to existing structures where it is structurally or feasibly impossible to comply.

2. Exit Passageways other than corridors in patient areas shall be not less than four (4) feet wide between handrails.

3. Corridors and passageways shall be kept unobstructed.

4. Corridors and passageways which lead to the outside from any required stairway shall be enclosed as required for stairways.

**History**
- *SOURCE: Miss. Code Ann. §41-85-7*

##### **15 Miss. Admin. Code Pt. 16, R. 1.47.16** Doors General {#sec-16-1.47.16 omnilex-key=us-ms-regs-official--title-15--16#1.47.16}

1. All stairway doors; doors providing egress from corridors (other than to the exterior) and all doors to shafts, utility closets, boiler and incinerator rooms, in fire walls, and other spaces which are a possible source of fire shall be equal to Underwriters’ Laboratories “Class B-1 ½ hour” self-closing doors.

2. All corridor doors except doors to janitor closets, toilets, and bathrooms shall be 20 minute rated fire doors or solid wooden doors of the flush type of nominal thickness of at least one and three-fourths (1 3/4 inches)

3. Bedroom, patient bath, and toilet doors shall not be equipped with hardware that will allow a patient to lock himself within the room.

**History**
- *SOURCE: Miss. Code Ann. §41-85-7*

##### **15 Miss. Admin. Code Pt. 16, R. 1.47.17** Exit Doors – Exit doors shall meet the following: {#sec-16-1.47.17 omnilex-key=us-ms-regs-official--title-15--16#1.47.17}

1. They shall be of a fire resistive rating equal to the stairway or passage.

2. Doors leading to stairways shall be not less than forty-four (44) inches wide.

3. Doors to the exterior shall be not less than forty-four (44) inches wide except where the capacity of a first floor exceeds sixty (60) persons or a floor above the first floor exceeds thirty (30) persons in which case wider doors maybe required.

4. Exit doors shall swing in the direction of exit and shall not obstruct the travel along any required exit.

5. Revolving doors shall not be used as required exits.

**History**
- *SOURCE: Miss. Code Ann. §41-85-7*

##### **15 Miss. Admin. Code Pt. 16, R. 1.47.18** Door Widths – All exit doors shall be a minimum of forty-four (44) inches wide and open outward {#sec-16-1.47.18 omnilex-key=us-ms-regs-official--title-15--16#1.47.18}

Doors to patient bedrooms shall be a minimum of forty-four (44) inches wide. All other doors through which patients must pass (doors to living and day rooms, dining rooms, recreational areas, toilet and bathrooms, physical and occupational therapy rooms, etc.) shall be a minimum of thirty-six (36) inches wide. Doors to patient closets shall be not less than twenty (20) inches wide. Exception may be granted to existing facilities.

**History**
- *SOURCE: Miss. Code Ann. §41-85-7*

##### **15 Miss. Admin. Code Pt. 16, R. 1.47.19** Door Swing {#sec-16-1.47.19 omnilex-key=us-ms-regs-official--title-15--16#1.47.19}

1. Exit doors, other than from a living unit, shall swing in the direction of exit from the structure.

2. Patient bedroom doors. Patient bedroom doors opening from a corridor shall open to the inside of the room.

3. Toilet or bathroom doors. Doors to toilet and bathrooms accessible from the patient’s bedroom shall open into the room. Doors to toilet or bathroom accessible from a corridor shall open into the toilet or bathroom.

**History**
- *SOURCE: Miss. Code Ann. §41-85-7*

##### **15 Miss. Admin. Code Pt. 16, R. 1.47.20** Rule 1.47.20 {#sec-16-1.47.20 omnilex-key=us-ms-regs-official--title-15--16#1.47.20}

Floor levels – All differences in floor levels within the building shall be accomplished by stairs of not less than three (3) six-inch risers, ramps, or inclines; and they shall be equipped with handrails on both sides.

**History**
- *SOURCE: Miss. Code Ann. §41-85-7*

##### **15 Miss. Admin. Code Pt. 16, R. 1.47.21** Space Under Stairs – Space under stairs shall not be used for storage purposes {#sec-16-1.47.21 omnilex-key=us-ms-regs-official--title-15--16#1.47.21}

All walls and doors shall meet the same fire rating as the stairwell.

**History**
- *SOURCE: Miss. Code Ann. §41-85-7*

##### **15 Miss. Admin. Code Pt. 16, R. 1.47.22** Rule 1.47.22 {#sec-16-1.47.22 omnilex-key=us-ms-regs-official--title-15--16#1.47.22}

Interior Finish and Decorative Materials – All combustible, decorative, and acoustical material shall be rendered and maintained flame resistant. It is recommended that curtains be of fiberglass or other flame resistant material.

**History**
- *SOURCE: Miss. Code Ann. §41-85-7*

##### **15 Miss. Admin. Code Pt. 16, R. 1.47.23** Rule 1.47.23 {#sec-16-1.47.23 omnilex-key=us-ms-regs-official--title-15--16#1.47.23}

Fire Extinguishers- Fire extinguishers of number, type, and capacity appropriate to the need shall be provided for each floor and for special fire hazard areas such as kitchen, laundry, and mechanical room. All extinguishers shall be of a type approved by the licensing authority of the Department of Health. A vaporizing liquid extinguisher (such as carbon tetrachloride) will not be approved for use inside the building. Extinguishers shall be inspected and serviced periodically as

recommended by the manufacturer. The date of inspection shall be entered on a tag attached to the extinguisher and signed by a reliable inspector such as the local fire chief or representative of a fire extinguisher servicing company.

**History**
- *SOURCE: Miss. Code Ann. §41-85-7*

##### **15 Miss. Admin. Code Pt. 16, R. 1.47.24** Fire Detection and Fire Protection System {#sec-16-1.47.24 omnilex-key=us-ms-regs-official--title-15--16#1.47.24}

1. If an automatic sprinkler-alarm system is installed, it shall meet the requirements as a recommended by the National Fire Protection Association according to NFPA, No. 13.

2. If an automatic fire detection system is installed, it shall meet the following requirements:

3. It shall be an Underwriters’ Laboratories approved system.

4. A smoke detector unit shall be installed upon the ceiling or on the side walls near the ceiling throughout all parts of the premises including all rooms, halls, storage areas, basements, attics, and lofts and inside all closets, elevator shafts, enclosed stairways and dumbwaiter shafts, chutes, and other enclosures.

5. The system shall be electrically supervised so that the occurrence of a break or a ground fault of its installation writing circuits, which present the required operation of system or failure of its main power supply source, will be indicated by a distinctive trouble signal.

6. The conductors of the signaling system power supply circuit shall be connected on the line side of the main service of a commercial light or power supply circuit. A circuit disconnecting means shall be so installed that it will be accessible only by authorized personnel.

**History**
- *SOURCE: Miss. Code Ann. §41-85-7*

##### **15 Miss. Admin. Code Pt. 16, R. 1.47.25** Rule 1.47.25 {#sec-16-1.47.25 omnilex-key=us-ms-regs-official--title-15--16#1.47.25}

Smoke Barrier or Fire Retardant Walls- Each building shall be divided into areas not exceeding five thousand (5,000) square feet between exterior walls or smoke barrier walls. The barrier walls shall be constructed from floor to roof decking with no openings except in corridors or other areas specifically approved by the licensing agency. Self-closing “B” label fire doors with fusible linkage shall be installed in the barrier walls in corridors. All air spaces in the walls shall be filled with noncombustible material.

**History**
- *SOURCE: Miss. Code Ann. §41-85-7*

##### **15 Miss. Admin. Code Pt. 16, R. 1.47.26** Rule 1.47.26 {#sec-16-1.47.26 omnilex-key=us-ms-regs-official--title-15--16#1.47.26}

Exit Signs – Exits shall be marked with plainly lettered illuminated signs bearing the word “Exit” or “Fire Escape” in letters at least four and one-half (4 ½ ) inches high. Exit signs shall be illuminated at all times and wired in front of the

electrical panel with fuse control in a locked box. Additional signs shall be placed in corridors and passageways wherever necessary to indicate the direction of exit.

**History**
- *SOURCE: Miss. Code Ann. §41-85-7*

##### **15 Miss. Admin. Code Pt. 16, R. 1.47.27** Fire Escapes and Ladders {#sec-16-1.47.27 omnilex-key=us-ms-regs-official--title-15--16#1.47.27}

1. The use of ladders (metal or otherwise) in lieu of escapes or fire stairways shall not be permitted on any facility licensed under these regulations.

2. The use of open fire escapes shall not be permitted on facilities opened or established after the effective date of these regulations.

3. Open fire escapes will be permitted on existing institutions provided such fire escapes meet the following requirements:

a. They must be of non-combustible material.

b. They must have railing or guard at least four (4) feet high on each unenclosed side.

c. Wall openings adjacent to fire escapes shall be protected with fire resistive doors and windows.

d. Doors leading to fire escapes shall open in the direction of exit.

e. Fire escapes on facilities licensed after adoption of these regulations should generally meet requirements for stairways.

**History**
- *SOURCE: Miss. Code Ann. §41-85-7*

##### **15 Miss. Admin. Code Pt. 16, R. 1.47.28** Required Fire Exits {#sec-16-1.47.28 omnilex-key=us-ms-regs-official--title-15--16#1.47.28}

1. At least two (2) exits, remote from each other, shall be provided for each occupied story of the building. Dead-end corridors are undesirable and in no even shall exceed thirty (30) feet.

2. Exits shall be of such number and so located that the distance of travel from the door of any occupied room to an exit from that floor shall not exceed one hundred (100) feet. In buildings completely protected by a standard automatic sprinkler system, the distance may be one hundred fifty (150) feet.

3. Each occupied room shall have at least one (1) door opening directly to the outside or to a corridor, stairway, or ramp leading directly to the outside.

4. Doors on fire exits shall open to the outside.

5. Building Exits Code, NFPA, No. 101, shall be the governing code for exit items which are not covered in the regulations.

**History**
- *SOURCE: Miss. Code Ann. §41-85-7*

##### **15 Miss. Admin. Code Pt. 16, R. 1.47.29** Rule 1.47.29 {#sec-16-1.47.29 omnilex-key=us-ms-regs-official--title-15--16#1.47.29}

Mechanical and Electrical Systems- Mechanical, electrical, plumbing, heating, air-conditioning, and water systems installed shall meet the requirements of local codes and ordinances as well as the applicable regulation of the Department of Health. Where there are no local codes or ordinances, the following codes and recommendations shall govern:

1. National Electrical Code.

2. National Plumbing Code.

3. American Society of Heating, Refrigerating, and Air-Conditioning Engineers, Inc.

4. Recommendations of the American Society of Mechanical Engineers.

5. Recommendations of American Gas Association.

6. National Board of Fire Underwriters.

**History**
- *SOURCE: Miss. Code Ann. §41-85-7*

##### **15 Miss. Admin. Code Pt. 16, R. 1.47.30** Rule 1.47.30 {#sec-16-1.47.30 omnilex-key=us-ms-regs-official--title-15--16#1.47.30}

The heating of institutions for the aged or infirm licensed after adoption of these regulations shall be restricted to steam, hot water, or warm air systems employing central heating plants or Underwriters’ Laboratories approved electric heating. The use of portable heaters of any kind is prohibited with the following exceptions for existing homes:

1. Portable type gas heaters provided they meet all the following:

a. A circulating type with a recessed enclosed flame so designed that clothing or other flammable material cannot be ignited;

b. Equipped with a safety pilot light;

c. Properly vented to the outside;

d. Approved by American Gas Association or Underwriters’ Laboratories.

e. An approved type of electrical heater such as wall insert type.

f. Lighting (except for emergency lighting) shall be restricted to electricity. No open flame lighting such as by kerosene lamps, gas lamps, or candles shall be permitted.

g. The Department of Health may require, at its discretion, inspection of mechanical, plumbing and electrical systems installed prior to effective date of these regulations by building, electrical plumbing officials or other competent authorities, a certification of adequacy and safety presented to the Department of Health.

**History**
- *SOURCE: Miss. Code Ann. §41-85-7 Subchapter 48 EMERGENCY OPERATIONS PLAN (EOP)*

##### **15 Miss. Admin. Code Pt. 16, R. 1.48.1** Rule 1.48.1 {#sec-16-1.48.1 omnilex-key=us-ms-regs-official--title-15--16#1.48.1}

The licensed entity shall develop and maintain a written preparedness plan utilizing the “All Hazards” approach to emergency and disaster planning. The plan must include procedures to be followed in the event of any act of terrorism or man-made or natural disaster as appropriate for the specific geographical location. The final draft of the Emergency Operations Plan (EOP), will be reviewed by the Office of Emergency Preparedness and Response, Mississippi State Department of Health, or their designates, for conformance with the “All Hazards Emergency Preparedness and Response Plan.” Particular attention shall be given to critical areas of concern which may arise during any “all hazards” emergency whether required to evacuate or to sustain in place. Additional plan criteria or a specified EOP format may be required as deemed necessary by the Office of Emergency Preparedness and Response. The six (6) critical areas of consideration are:

1. Communications – Facility status reports shall be submitted in a format and a frequency as required by the Office of EOP.

2. Resources and Assets 3. Safety and Security 4. Staffing 5. Utilities 6. Clinical Activities.

**History**
- *SOURCE: Miss. Code Ann. §41-85-7*

##### **15 Miss. Admin. Code Pt. 16, R. 1.48.2** Rule 1.48.2 {#sec-16-1.48.2 omnilex-key=us-ms-regs-official--title-15--16#1.48.2}

Emergency Operations Plans (EOPs) must be exercised and reviewed annually or as directed by the Emergency Preparedness and Response. Written evidence of current approval or review of provider EOPs, by the Office of Emergency

Preparedness and Response, shall accompany all applications for facility license renewals.

**History**
- *SOURCE: Miss. Code Ann. §41-85-7 Subchapter 49 FACILITY FIRE PREPAREDNESS*

##### **15 Miss. Admin. Code Pt. 16, R. 1.49.1** Fire Drills {#sec-16-1.49.1 omnilex-key=us-ms-regs-official--title-15--16#1.49.1}

Fire drills shall be conducted one (1) per shift per quarter. Employees shall participate in a fire drill at least four (4) times per year.

**History**
- *SOURCE: Miss. Code Ann. §41-85-7*

##### **15 Miss. Admin. Code Pt. 16, R. 1.49.2** Written Records {#sec-16-1.49.2 omnilex-key=us-ms-regs-official--title-15--16#1.49.2}

Written records of all drills shall be maintained, indicating content of and attendance at each drill.

**History**
- *SOURCE: Miss. Code Ann. §41-85-7*

##### **15 Miss. Admin. Code Pt. 16, R. 1.49.3** A fire evacuation plan shall be posted in each facility in a conspicuous place and kept current {#sec-16-1.49.3 omnilex-key=us-ms-regs-official--title-15--16#1.49.3}

**History**
- *SOURCE: Miss. Code Ann. §41-85-7 Subchapter 50 NURSING UNIT*

##### **15 Miss. Admin. Code Pt. 16, R. 1.50.1** Rule 1.50.1 {#sec-16-1.50.1 omnilex-key=us-ms-regs-official--title-15--16#1.50.1}

Nursing Unit – Medical, nursing, and personal services shall be provided in a specifically designated area which shall include bedrooms, special care room(s), nurses’ station, utility room toilet and bathing facilities, linen and storage closets and wheelchair space.

**History**
- *SOURCE: Miss. Code Ann. §41-85-7*

##### **15 Miss. Admin. Code Pt. 16, R. 1.50.2** The maximum nursing unit shall be twenty-five (25) beds {#sec-16-1.50.2 omnilex-key=us-ms-regs-official--title-15--16#1.50.2}

**History**
- *SOURCE: Miss. Code Ann. §41-85-7*

##### **15 Miss. Admin. Code Pt. 16, R. 1.50.3** Bedrooms Location {#sec-16-1.50.3 omnilex-key=us-ms-regs-official--title-15--16#1.50.3}

1. All patient bedrooms shall have an outside exposure and shall not be below grade. Window area shall not be less than one-eighth (1/8) of the floor area. The window sill shall not be over thirty-six (36) inches from the floor.

2. Patient bedrooms shall be located so as to minimize the entrance of unpleasant odors, excessive noise and other nuisances.

3. Patient bedrooms shall be directly accessible from the main corridor of the nursing unit providing that accessibility from any public space other than the

dining room will be acceptable. In no case shall a patient bedroom be used for access to another patient bedroom.

4. All patient bedrooms shall be so located that the patient can travel from his/her bedroom to a living room, day room, dining room, or toilet or bathing facility without having to go through another patient bedroom.

a. Floor Area – Minimum usable floor area per bed shall be as follows:

i. Private room 100 square feet

ii. Multi-bed room 80 square feet

b. Provision for Privacy – Cubicle curtains, screens or other suitable provisions for privacy shall be provided in multi-bed patient bedrooms.

c. Accommodations for Patients – The minimum accommodations for each patient shall include:

i. Bed – The patient shall be provided with either an adjustable bed or a regular single bed, according to needs of the patient, with a good grade mattress atleast four (4) inches thick. Beds shall be single except in case of special approval of the licensing agency. Cots and roll-away beds are prohibited for patient use. Full and half bedrails shall be available to assist in safe care of patients.

ii. Pillows, linens, and necessary coverings.

iii. Chair.

iv. Bedside cabinet or table.

v. Storage space for clothing, toilet articles, and personal belongings including rod for clothes hanging.

vi. Means at bedside for signaling attendants.

vii. Bed pan and urinal for patients who need them.

viii. Over-bed tables as required.

d. Bed Maximum – Effective from the approval date of these regulations, each newly renovated or newly constructed hospice facility shall contain only private patient rooms. There shall be no multi-patient wards.

**History**
- *SOURCE: Miss. Code Ann. §41-85-7*

##### **15 Miss. Admin. Code Pt. 16, R. 1.50.4** Rule 1.50.4 {#sec-16-1.50.4 omnilex-key=us-ms-regs-official--title-15--16#1.50.4}

Isolation Room – Each hospice facility shall have one isolation room which shall be a single bedroom with at least a private half bath (lavatory and water closet).

**History**
- *SOURCE: Miss. Code Ann. §41-85-7*

##### **15 Miss. Admin. Code Pt. 16, R. 1.50.5** Nurses’ Station - Each inpatient hospice shall have a nurses’ station for each nursing unit {#sec-16-1.50.5 omnilex-key=us-ms-regs-official--title-15--16#1.50.5}

The nurses’ station shall include as a minimum the following:

a. Annunciator board or other equipment for patient’s call;

b. The minimum areas of the medicine storage/preparation room shall be seventy- five (75) feet;

c. Storage space for patients’ medical records and nurses’ charts.

d. Lavatory or sink with disposable towel dispenser;

e. Desk or counter top space adequate for recording and charting purposes by physicians and nurses.

f. The nurses’ station area shall be well-lighted.

g. It is recommended that nurses’ lounge with toilet be provided for nursing personnel adjacent to the station. A refrigerator for the storage of drugs shall be provided at each nurses’ station. Drugs, food and beverages may be stored together only if separate compartments or containers are provided for the storage of drugs.

**History**
- *SOURCE: Miss. Code Ann. §41-85-7*

##### **15 Miss. Admin. Code Pt. 16, R. 1.50.6** Rule 1.50.6 {#sec-16-1.50.6 omnilex-key=us-ms-regs-official--title-15--16#1.50.6}

Utility Room – Each inpatient hospice shall provide a separate utility room for soiled and clean patient care equipment such as bedpans, urinals, et cetera. The soiled utility room shall contain, as a minimum, the following equipment:

1. Provision for cleaning utensils such as bed pans, urinal,et cetera;

2. Utensil sterilizer;

3. Lavatory or sink and disposable towel dispenser;

4. The utility room for clean equipment shall have suitable storage.

**History**
- *SOURCE: Miss. Code Ann. §41-85-7*

##### **15 Miss. Admin. Code Pt. 16, R. 1.50.7** Rule 1.50.7 {#sec-16-1.50.7 omnilex-key=us-ms-regs-official--title-15--16#1.50.7}

Toilet and Bathing Facilities - Separate toilet and bathing facilities shall be provided on each floor for each sex in the following ratios as a minimum:

a. Bathtubs or showers1 per 12 beds or fraction thereof Lavatories1 per 8 beds or fraction thereof

b. Toilets1 per 8 beds or fraction thereof

c. As a minimum, showers shall be four (4) feet by four (4) feet without curbing.

d. Handrails shall be provided for all tubs, showers, and commodes.

e. A lavatory shall be provided in each patient bedroom or in a toilet room that is directly accessible from the bedroom.

f. A water closet shall be located in a room directly accessible from each patient bedroom. The minimum area for a room containing only a water closet shall be three (3) feet by six (6) feet.

**History**
- *SOURCE: Miss. Code Ann. §41-85-7*

##### **15 Miss. Admin. Code Pt. 16, R. 1.50.8** Rule 1.50.8 {#sec-16-1.50.8 omnilex-key=us-ms-regs-official--title-15--16#1.50.8}

Other Rooms and Areas – In addition to the above facilities, each nursing unit shall include the following rooms and areas: linen closet, storage closet and wheelchair space.

**History**
- *SOURCE: Miss. Code Ann. §41-85-7*

##### **15 Miss. Admin. Code Pt. 16, R. 1.50.9** Required Rooms and Areas {#sec-16-1.50.9 omnilex-key=us-ms-regs-official--title-15--16#1.50.9}

1. Clean linen storage – Adequate area shall be provided for storing clean linens which shall be separate from dirty linen storage.

2. Wheelchair area – Adequate area shall be provided for storage of wheelchairs.

3. Dining Room – The dining area shall be large enough to accommodate needs of the hospice patients/families.

4. Food Storage – A food storage room shall be provided convenient to the kitchen in all future licensed homes. It should have cross ventilation. All foods must be stored a minimum of twelve (12) inches above the floor.

5. Day Room or Living Room – Adequate day or living room area shall be provided for patients or residents and guests. These areas shall be designated exclusively for this purpose and shall not be used as sleeping area or otherwise. It is recommended that at least two (2) such areas be provided and more in larger facilities.

6. Counseling Room- The hospice shall provide a defined quiet room or place that will accommodate families and where consoling and/or counseling can be offered.

7. Janitor Closet – At least one (1) janitor’s closet shall be provided for each floor. The closet shall be equipped with a mop sink and be adequate in area to store cleaning supplies and equipment. A separate janitor’s closet shall be provided for the food service area.

8. Garbage – Garbage can cleaning and storage area.

9. General Storage – A minimum area equal to at least (5) square feet per bed shall be provided for general storage.

10. Laundry – If laundry is done in the institution, a laundry room shall be provided. The laundry shall be enclosed by two-hour fire resistive construction. Adequate equipment for the laundry load of the home shall be installed. The sorting, washing, and extracting process should be separated from the folding and ironing area – preferably in separate rooms.

11. A separate toilet room (lavatory and water closet) with lockers shall be provided for male and female employees.

12. A separate toilet room shall be provided for each sex of the public.

**History**
- *SOURCE: Miss. Code Ann. §41-85-7*

##### **15 Miss. Admin. Code Pt. 16, R. 1.51.1** Subchapter 51 CONCLUSION: GENERAL {#sec-16-1.51.1 omnilex-key=us-ms-regs-official--title-15--16#1.51.1}

Conditions which have not been covered in the Standards shall be enforced in accordance with the best practices as interpreted by the Licensing Agency. The Licensing Agency reserves the right to:

1. Visit hospice patients in their place of residence in order to evaluate the quality of care provided.

2. Review the payroll records of each hospice agency for the purpose of verifying staffing patterns.

3. Information obtained by the licensing agency through filed reports, inspection, or as otherwise authorized, shall not be disclosed publicly in such manner as to identify individuals or institutions, except in proceedings involving the question of licensure.

**History**
- *SOURCE: Miss. Code Ann. §41-85-7*

##### **15 Miss. Admin. Code Pt. 16, R. 1.51.2** VARIANCES AND WAIVERS {#sec-16-1.51.2 omnilex-key=us-ms-regs-official--title-15--16#1.51.2}

1. The Department, upon application, may grant variances or waivers of specific rules and regulations when it has been shown that the rule or regulation is not applicable or to allow experimentation and demonstration of new and innovative approaches to delivery of services.

2. The Department may exempt classes of facilities from regulation, as provided, when regulation would not permit the purpose intended or the class of facilities is subject to similar requirements under other rules and regulations.

**History**
- *SOURCE: Miss. Code Ann. §41-85-7 Chapter 2 Minimum Standards of Operation of Prescribed Pediatric Extended Care (PPEC) Centers Subchapter 1 General: Legal Authority*

##### **15 Miss. Admin. Code Pt. 16, R. 2.1.1** Authority {#sec-16-2.1.1 omnilex-key=us-ms-regs-official--title-15--16#2.1.1}

By virtue of authority vested in it by Mississippi Code Annotated, §41-125-1 through §41-125-23, or as otherwise amended, the Mississippi State Department of Health (MSDH, otherwise known as the licensing agency), has the authority and powers, as necessary, to promulgate and adopt the following rules, regulations and standards governing Prescribed Pediatric Extended Care (PPEC) centers and to license and regulate said centers in the State of Mississippi.

**History**
- *SOURCE: Mississippi Code Annotated §41-125-19*

##### **15 Miss. Admin. Code Pt. 16, R. 2.1.2** Procedures Governing Amendments {#sec-16-2.1.2 omnilex-key=us-ms-regs-official--title-15--16#2.1.2}

The rules, regulations and minimum standards for Prescribed Pediatric Extended Care centers may be amended by the licensing agency from time to time as necessary to promote the health, safety and welfare of the children being served and to assure that centers provide the necessary family-centered medical, developmental, psychological, nutritional, psychological and family training services.

**History**
- *SOURCE: Mississippi Code Annotated §41-125-19*

##### **15 Miss. Admin. Code Pt. 16, R. 2.1.3** Inspections Required {#sec-16-2.1.3 omnilex-key=us-ms-regs-official--title-15--16#2.1.3}

No PPEC center shall operate without a license. No PPEC center shall be licensed without being inspected and having achieved compliance with the rules, regulations and standards as set forth in this chapter. Each PPEC center for which a license has been issued shall be inspected by the Mississippi State Department of Health or by persons delegated with authority by said Mississippi State Department of Health at such interval that the Department may direct. Mississippi State Department of Health and/or its authorized representatives shall have the right to inspect construction work in progress. The PPEC center shall provide Mississippi State Department of Health unrestricted access to the center, children and clinical/medical records as necessary to verify compliance with said rules and regulations.

**History**
- *SOURCE: Mississippi Code Annotated §41-125-19*

##### **15 Miss. Admin. Code Pt. 16, R. 2.2.1** A listing of terms often used in connection with the rules and regulations and standards follows: {#sec-16-2.2.1 omnilex-key=us-ms-regs-official--title-15--16#2.2.1}

1. Administrator. For the purpose of this chapter, the PPEC Administrator shall mean an individual who is responsible and accountable for the implementation and supervision of all administrative and clinical policies as well as overall operations and management of the PPEC center.

2. Basic Services. Include, but are not limited to development, implementation and monitoring of a comprehensive protocol of care, developed in conjunction with the parent or guardian, which specifies the medical, nursing, psychosocial and developmental therapies required by the medically dependent or technologically dependent child served as well as the caregiver training needs of the child’s legal guardian.

3. Child Development Specialist. Shall mean an individual with a master’s degree in child development or a related field with at least one year of experience in trans-disciplinary evaluation and treatment planning for children who are at risk of experiencing developmental delay.

4. Child Life Specialist. Shall mean an individual with a baccalaureate degree in child life, early childhood education or a related field and at least one year of experience in planning and implementing developmental stimulation programs for children.

5. Criminal History Record Check. For purposes of the requirement for a criminal history record check:

a. Employee -For the purpose of fingerprinting and criminal background history checks, employee shall mean any individual employed by a covered entity. The term “employee” also includes any individual who by contract with a covered entity provides patient care in a patient’s, resident’s, or client’s room or in treatment rooms provides direct care/services for clients currently enrolled in the PPEC Center.

b. The term employee does not include healthcare professional/ technical students, as defined in Section 37-29-232, performing clinical training in a licensed entity under contracts between their schools and the licensed entity, and does not include students at high schools who observe the treatment and care of patients in a licensed entity as part of the requirements of an allied health course taught in the school if:

i. The student is under the supervision of a licensed healthcare provider; and

ii. The student has signed the affidavit that is on file at the student’s school stating that he or she has not been convicted of or plead guilty or nolo contendere to a felony of possession or sale of drugs, murder, manslaughter, armed robbery, rape, sexual battery, any sex offenses listed in section 45-33-23 (g), child abuse, arson, grand larceny, burglary, gratification of lust, aggravated assault, or felonious abuse and/or battery of a vulnerable adult, or that any such conviction or plea was reversed on appeal or a pardon was granted for the conviction or plea.

iii. Further, applicants and employees of the University of Mississippi Medical Center for whom criminal history record checks and fingerprinting are obtained in accordance with Section 37-115-41 are exempt from application of the term employee.

c. Covered Entity - For the purpose of criminal history record checks, “covered entity” means a licensed entity or a healthcare professional staffing agency.

d. Licensed Entity - For the purpose of criminal history record checks, the term “licensed entity” means a hospital, nursing home, personal care home, home health agency, hospice or PPEC center.

e. Health Care Professional/Vocational Technical Academic Program - For purpose of criminal history record checks, “health care professional/vocational technical academic program” means an academic program in medicine, nursing , dentistry, occupational therapy, physical therapy, social services, speech therapy, or other allied-health professional whose purpose is to prepare professionals to render patient care services.

f. Health Care Professional/Vocational Technical Student - For purposes of criminal history record checks, the term means a student enrolled in a healthcare professional/vocational technical academic program.

g. Direct Patient Care or Services - For the purposes of fingerprinting and criminal background history checks, the term “direct patient care” means direct hands-on medical patient care and services provided by an individual in a patient, resident or client’s room, treatment room, recovery room or PPEC center. Individuals providing direct patient care may be directly employed by the facility or provides patient care on a contractual basis.

h. Documented Disciplinary Action - For the purpose of fingerprinting and criminal background history checks, the term “documented disciplinary action” means any action taken against an employee for abuse or neglect of a patient.

6. Direct Care Staff. For the purposes of this chapter, direct care staff shall include certified nursing assistants, patient care technicians, medical assistants, emergency medical technician (EMT), play assistants or any individual with training and experience in child care related fields.

7. Functional Assessment. Refers to an evaluation of the child’s abilities and needs related to self-care, communication skills, social skills, motor skills, academic areas, play with toys or objects, growth and development appropriate for age.

8. License. Shall mean the document issued by the Mississippi State Department of Health and signed by the State Health Officer. Licensure shall constitute authority to receive patients and perform the services included within the scope of these rules, regulations and standards. A license shall be issued only for the location as addressed on the license and is not transferable.

9. Licensee. Shall mean the individual, firm, association, partnership or corporation to whom the license is issued and upon whom rests the responsibility for the operation and all aspects of administrative/regulatory compliance of the PPEC center.

10. Licensing Agency. Shall mean Mississippi State Department of Health.

11. Medical Director. Shall mean a physician, licensed to practice in the State of Mississippi, board certified by the American Board of Pediatrics or the American Osteopathic Board of Pediatrics, who serves as a liaison between the PPEC center and the medical community.

12. Medical Records. Shall mean medical records maintained in accordance with acceptable standards and practices as specified by the rules implementing this act.

13. Medically Dependent or Technologically Dependent Child. Shall mean a child, from birth up to 21 years of age who because of a medical condition/disability whether acute, chronic or intermittent in nature requires on- going physician prescribed, technologically-based skilled nursing supervision and/or requires the routine use of a medical device to compensate for the deficit of life-sustaining body function.

14. Nursing Director. Shall mean a licensed registered nurse, licensed in accordance with the Mississippi Nurse Practice Act, who maintains

responsibility for providing continuous supervision of the PPEC services and manages the day-to-day operations of the PPEC center.

15. Owner or Operator. Shall mean a licensee.

16. Physical Therapist. Shall mean, for purposes of this chapter, an individual, licensed in the State of Mississippi, who has at least one year’s experience in evaluating and designing therapeutic programs for children with developmental disabilities.

17. Premises. Shall mean those buildings, beds, facilities and fenced outdoor recreational/play area located at the main address of the licensee.

18. Prescribed Pediatric Extended Care Center or PPEC Center. Shall mean any building or buildings, or other place, whether operated for profit or not, which undertakes through its ownership or management to provide basic nonresidential services to three (3) or more medically dependent or technologically dependent children who are not related to the owner or operator by blood, marriage or adoption and who require such services. Infants and children considered for admission to a PPEC center must have complex medical conditions that require continual care. Prerequisites for admission are a prescription from the child’s physician and consent from a parent or guardian.

Exemption: A facility, institution or other place operated by the federal government or an agency of the federal government is exempt from the provisions of this chapter.

19. Prescribing Physician. Shall mean the physician, licensed to practice medicine in the State of Mississippi that signs the order admitting the child to the PPEC center.

20. Primary or Subspecialist Physician. Shall mean the physician, licensed to practice medicine in the State of Mississippi, who maintains overall responsibility for the medical management of the child and who is available for consultation and collaboration with the PPEC center staff.

21. Protocol of Care. The comprehensive plan for implementation of medical, nursing, psychosocial, developmental, and education therapies to be provided by the PPEC center.

22. Psychiatrist. Shall mean, for purposes of this chapter, a board-certified psychiatrist, licensed to practice in the State of Mississippi and who has at least two years of experience in child psychology.

23. Psychologist. Shall mean, for purposes of this chapter, a licensed individual in Mississippi with doctorial; preparation in child or developmental counseling

psychology, or a related field , and at least two years current experience in evaluation and management of children.

24. Quality Assurance (QA) Committee. A group of individuals, including the PPEC center Medical Director, Administrator, Director of Nursing, two other healthcare members and at least one consumer member with an interest in PPEC services who functions to conduct the duties, as outlined in Subchapter 18 of this chapter, which includes but is not limited to, review of medical records, review and approval of policies and procedures, treatment plans/procedures and to evaluate the quality of care provided to children enrolled in the PPEC center.

25. Social Worker. Shall mean, for purposes of this chapter, an individual, licensed to practice social work in the State of Mississippi, and who has at least one year of experience in assessing, counseling, and planning interventions for children and their families or guardians.

26. Speech Pathologist. Shall mean, for purposes of this chapter, an individual who attained a master’s degree in speech-language pathology from an educational institution accredited by the American Speech-Language, Hearing Association, licensed to practice speech-language pathology in the State of Mississippi, and who has at least one year of experience in evaluating and treating children at risk for, or experiencing problems with communication skills.

27. Supportive Services or Contracted Services. Includes but are not limited to speech therapy, occupational therapy, physical therapy, respiratory therapy, social work, developmental, educational services.

**History**
- *SOURCE: Mississippi Code Annotated §41-125-19*

##### **15 Miss. Admin. Code Pt. 16, R. 2.3.1** Authority {#sec-16-2.3.1 omnilex-key=us-ms-regs-official--title-15--16#2.3.1}

Except as provided in Mississippi Code §41-125-5, no individual, firm, association, partnership or corporation shall either directly or indirectly operate a PPEC center in this state without first applying for and receiving a license from the Mississippi State Department for Health.

**History**
- *SOURCE: Mississippi Code of 1972, Section §41-125-5*

##### **15 Miss. Admin. Code Pt. 16, R. 2.3.2** License {#sec-16-2.3.2 omnilex-key=us-ms-regs-official--title-15--16#2.3.2}

A license, from the Mississippi State Department of Health, is required to operate a Prescribed Pediatric Extended Care (PPEC) center prior to said entity providing services to three or more medically dependent or technologically dependent children who meet the definition of the above definitions unless such entity meets the definition/requirement for exemption which reads:

1. A PPEC center, institution or other place operated by the federal government or any agency of the federal government are exempt from the provisions of this chapter.

**History**
- *SOURCE: Mississippi Code of 1972, Section §41-125-5*

##### **15 Miss. Admin. Code Pt. 16, R. 2.3.3** Designation of License {#sec-16-2.3.3 omnilex-key=us-ms-regs-official--title-15--16#2.3.3}

Separate licenses are required for PPEC centers maintained on separate premises, even though such centers may be operated under the same management. A separate distinct license is required to distinguish entities providing twelve (12) hour care services verses twenty-four (24) hour services. No PPEC center shall co-locate with another facility licensed by the Department.

**History**
- *SOURCE: Mississippi Code Annotated §41-125-19*

##### **15 Miss. Admin. Code Pt. 16, R. 2.3.4** Rules and Regulations {#sec-16-2.3.4 omnilex-key=us-ms-regs-official--title-15--16#2.3.4}

Any individual, firm, association, partnership or corporation operating a PPEC center in this state is subject to the requirements of Section §41-125-19 and all requirements as outlined in the Minimum Standards of Operation for Prescribed Pediatric Extended Care Centers. The Mississippi State Department of Health has legal authority to promulgate rules and regulations.

**History**
- *SOURCE: Mississippi Code Annotated §41-125-19*

##### **15 Miss. Admin. Code Pt. 16, R. 2.3.5** Application {#sec-16-2.3.5 omnilex-key=us-ms-regs-official--title-15--16#2.3.5}

Application for a license or renewal shall be made on in writing to the licensing agency, on forms provided by the licensing agency, which shall contain information that the licensing agency may require.

**History**
- *SOURCE: Mississippi Code Annotated §41-125-19*

##### **15 Miss. Admin. Code Pt. 16, R. 2.3.6** Fees {#sec-16-2.3.6 omnilex-key=us-ms-regs-official--title-15--16#2.3.6}

1. Each initial and renewal licensure application, unless suspended or revoked shall be accompanied by a fee in an amount set by the Board and made payable to the Mississippi State Department of Health, either by business check, money order, or electronic means. Fees are non-refundable.

2. Applicants for initial licensure, or licensees, shall pay a user fee to the licensing agency for review of any construction proposal whether modification or new construction in a fee amount set by the Board and made payable to the Mississippi State Department of Health, either by business check, money order, or electronic means. The fees are non-refundable.

**History**
- *SOURCE: Mississippi Code Annotated §41-125-7*

##### **15 Miss. Admin. Code Pt. 16, R. 2.3.7** Name of Facility {#sec-16-2.3.7 omnilex-key=us-ms-regs-official--title-15--16#2.3.7}

Only the official name, as approved by the licensing agency and by which the center is licensed shall be used in telephone listings, on stationary, in advertising, etc.

**History**
- *SOURCE: Mississippi Code Annotated §41-125-19*

##### **15 Miss. Admin. Code Pt. 16, R. 2.3.8** Capacity {#sec-16-2.3.8 omnilex-key=us-ms-regs-official--title-15--16#2.3.8}

Licensees shall not operate at any given time with a capacity greater than the number of clients on the face of the license. The maximum number of beds shall be calculated based on the required staff to child ratio delineated in Rule 2.10.1, management team personnel, and additional ancillary staffing/support personnel not to exceed the maximum occupancy load of the building as defined in Rule 2.20.2.

**History**
- *SOURCE: Mississippi Code Annotated §41-125-19*

##### **15 Miss. Admin. Code Pt. 16, R. 2.3.9** Initial Licensure {#sec-16-2.3.9 omnilex-key=us-ms-regs-official--title-15--16#2.3.9}

For initial licensure, an applicant shall be in compliance with all requirements, as outlined in these regulations, and must submit documents, included but not limited to, those outlined:

1. A completed/signed application, on forms as designated by MSDH. All information submitted on the application forms, or by request for additional information, shall be accurate and current at the time of filing;

2. A non-refundable application/processing fee in an amount set by the Board. The fee shall be made payable to the Mississippi State Department of Health, either by business check, money order, or electronic means. The fee is non-refundable.

3. A licensing fee in an amount set by the Board. The licensing fee shall be made payable to the Mississippi State Department of Health, either by business check, money order or electronic means. The fee is non- refundable.

4. Certificates/letters of approval from the local zoning authority indicating that the location of the PPEC center conforms to local zoning ordinances, if applicable;

5. Certificates/letters of approval from the local/regional/state Fire Marshal that the PPEC center is in compliance with all applicable fire safety standards;

6. Evidence that the PPEC center’s water and sewer systems have been approved by the Mississippi State Department of Health;

7. A licensed facility shall obtain a Food Service Permit from the Mississippi State Department of Health Office of Environmental Health.

8. Certificate of Occupancy;

9. Clinical Laboratory Improvement Amendments (CLIA) certificate or CLIA certificate of waiver.

10. Proof of general and Professional Liability Insurance in the amount of at least $300,000.00 including Workman’s Compensation Insurance;

11. Articles of Incorporation, Disclosure of Ownership and Control Information;

12. Proof of financial viability/contingency plan demonstrating evidence that the applicant processes assets sufficient to establish and sustain all components of a PPEC center to meet the provisions as outlined in these regulations while operating and/or during extraordinary circumstances including but not limited to audited financial statements, an established line of credit issued from a federally insured institution in the amount of at least $100,000.00, a projected twelve (12) month statement of operations and a projected first twelve months statement of cash flow. The requesting PPEC center shall provide evidence of the referenced above review in the form of a certified affidavit or statement resultant of a review from an independent certified public accountant firm.

13. That the center is located within 20 miles or 30 minutes (whichever is greater) of an Emergency Department that has capabilities to handle pediatric emergencies;

14. The name of the PPEC center’s administrator, the name and license number of the Medical Director and Director of Nursing along with proof of available licensed and supportive personnel who will have responsibility for any part of the care given to PPEC center’s clients; as well as proof of ancillary support services such as dietary, housekeeping, maintenance and other personnel either directly or contractually secured to support the PPEC center on a daily basis;

15. The names and titles of personnel who have been affiliated, during the preceding five (5) years with any other PPEC center through ownership or employment, and the listing of names and addresses of the appropriate PPEC center for each. This information shall be provided for the applicant: administrator, and all licensed nurses; and

16. Floor sketch or drawing of premises to be licensed, letter of intent and a detailed functional plan which delineates the proposed use of space, that includes but is not limited to the programmatic design outlined in Rule 2.20.2, the purpose of the project, the key elements of the physical environment, functional requirements and other basic information related to the fulfillment of the services required in the Minimum Standards of Operation for a PPEC Center.

**History**
- *SOURCE: Mississippi Code Annotated §41-125-19*

##### **15 Miss. Admin. Code Pt. 16, R. 2.3.10** Approval of Building {#sec-16-2.3.10 omnilex-key=us-ms-regs-official--title-15--16#2.3.10}

Prior to the issuance of a license, the building must be inspected/approved by MSDH, Fire and Life Safety Code Division within Health Facilities Licensure and Certification and approved as being in compliance with all applicable National Fire Protection Association fire safety code standards, as appropriate to this type setting.

**History**
- *SOURCE: Mississippi Code Annotated §41-125-19*

##### **15 Miss. Admin. Code Pt. 16, R. 2.3.11** Licensure Term {#sec-16-2.3.11 omnilex-key=us-ms-regs-official--title-15--16#2.3.11}

Each license issued shall be valid for a period of twelve (12) months and shall be issued for the licensure period from January 1, of each year and shall expire December 31, of the that same year. Should an entity be approved for licensure after the January 1, date for licensure, the licensure date shall reflect the approved date of licensure for this center and will be valid until December 31, of that licensure year. As with all other centers, a renewal applications/documentation pertinent to renewal (see Rule 2.3.9) must be submitted to initiate the licensure process for the next January 1, thru December 31, licensure year.

**History**
- *SOURCE: Mississippi Code Annotated §41-125-19*

##### **15 Miss. Admin. Code Pt. 16, R. 2.3.12** Posting of License {#sec-16-2.3.12 omnilex-key=us-ms-regs-official--title-15--16#2.3.12}

The license shall be posted in a conspicuous place on the licensed premises and shall be available for review by in interested person.

**History**
- *SOURCE: Mississippi Code Annotated §41-125-19*

##### **15 Miss. Admin. Code Pt. 16, R. 2.3.13** License Not Transferable {#sec-16-2.3.13 omnilex-key=us-ms-regs-official--title-15--16#2.3.13}

A PPEC center license is for the stated licensee and location as reflected on the license and is not transferable.

**History**
- *SOURCE: Mississippi Code Annotated §41-125-19*

##### **15 Miss. Admin. Code Pt. 16, R. 2.3.14** License Renewal {#sec-16-2.3.14 omnilex-key=us-ms-regs-official--title-15--16#2.3.14}

For renewal, each licensed entity shall submit:

1. A completed and signed renewal application; received on or before 30 days prior to the date of expiration;

2. A renewal licensure fee in an amount set by the Board and made payable to the Mississippi State Department of Health, either by business check, money order, or electronic means. The fee is non-refundable.

3. In a format as requested by MSDH, information designed to capture the entity’s provision of services being provided, to include but not be limited to, number and acuity of infants/children served, number and types of treatments/specialized services provided, and other information that may be useful in determining that services, as outlined in these requirements are offered/met; and

4. Evidence of continued compliance with all building/fire codes as evidence by a copy of the annual inspection by the local Fire Marshall of the area/region where the center is located; and

5. Proof of General and Professional Liability Insurance in the amount of at least $300,000 including Workers Compensation Insurance.

**History**
- *SOURCE: Mississippi Code Annotated §41-125-19*

##### **15 Miss. Admin. Code Pt. 16, R. 2.3.15** Late Fees {#sec-16-2.3.15 omnilex-key=us-ms-regs-official--title-15--16#2.3.15}

Should all documentation appropriate for license renewal not be received by MSDH, Division of Health Facilities Licensure and Certification on or prior to the expiration date of the license, a late fee in an amount set by the Board will be assessed and must be submitted payable by business check, money order, or electronic means to the Mississippi State Department of Health prior to the issuance of a license. Should all paperwork necessary for renewal not be submitted within 30 days post-expiration of the license, the center shall be considered unlicensed and actions taken, as appropriate, to process termination of the license

**History**
- *SOURCE: Mississippi Code Annotated §41-125-19*

##### **15 Miss. Admin. Code Pt. 16, R. 2.3.16** Rule 2.3.16 {#sec-16-2.3.16 omnilex-key=us-ms-regs-official--title-15--16#2.3.16}

In the case of a change of ownership or a change in Proprietors that constitutes a sale or change of greater that 20% of the assets, the center shall notify the Department and submit all Legal documents/information, as requested, to document that change of ownership and to confirm/verify the operational sustainability of the center.

**History**
- *SOURCE: Mississippi Code Annotated §41-125-19*

##### **15 Miss. Admin. Code Pt. 16, R. 2.3.17** Required Reporting: {#sec-16-2.3.17 omnilex-key=us-ms-regs-official--title-15--16#2.3.17}

1. Within ten calendar days, the licensed entity shall submit, in writing, to MSDH, Division of Licensure and Certification, the following:

a. Change in the administrator, director of nursing services, or the medical director;

2. Within 24 hours of occurrence, the licensed entity shall submit in writing, to MSDH, Division of Licensure and Certification the following:

a. Any fire or incident of natural disaster whereas damage to the center was sustained;

b. Any incident whereas a child is left alone and unattended, either during the hours of operation of the PPEC center, after hours, while on a field trip or at an alternate location;

c. Any accident or injury sustained by a child, while the child was under the care of the PPEC center that required emergency medical intervention

**History**
- *SOURCE: Mississippi Code Annotated §41-125-19*

##### **15 Miss. Admin. Code Pt. 16, R. 2.3.18** Rule 2.3.18 {#sec-16-2.3.18 omnilex-key=us-ms-regs-official--title-15--16#2.3.18}

Such reports shall contain a clear description of each accident or incident, the names of the persons involved, a description of all medical or other services provided to those persons, specifying who provided such services, and the steps taken, if any, to prevent reoccurrence of such accident or incidents in the future.

**History**
- *SOURCE: Mississippi Code Annotated §41-125-19*

##### **15 Miss. Admin. Code Pt. 16, R. 2.3.19** Rule 2.3.19 {#sec-16-2.3.19 omnilex-key=us-ms-regs-official--title-15--16#2.3.19}

All applicants for a license to operate a PPEC center, whether for initial or for renewal, the administrator and the director of nursing services shall:

1. Be 21 years of age or older;

2. Be of good moral character; and

3. Have not been convicted or found guilty, regardless of adjudication, in any jurisdiction, of any felony involving fraud, embezzlement, fraudulent conversion, misappropriation of property, moral turpitude, violence against a person or persons, abuse of a vulnerable adult; or any act(s) of sexual abuse as outlined in Section 45-33-23(g), Mississippi Code of 1972, Annotated.

**History**
- *SOURCE: Mississippi Code Annotated §41-125-19*

##### **15 Miss. Admin. Code Pt. 16, R. 2.3.20** Rule 2.3.20 {#sec-16-2.3.20 omnilex-key=us-ms-regs-official--title-15--16#2.3.20}

As documentation for the Department, regarding the requirement for licensure, each applicant(s) for a license to operate a PPEC center, whether for initial or renewal, shall submit together, with their application:

1. Two (2) personal character references and two (2) professional character references for the administrator, of the PPEC center, except on renewal if previously provided to the Department;

2. The criminal record, if any, for the administrator and director of nursing services of the PPEC center, to include the court, date of conviction, the offense, penalties imposed by each conviction, regardless of adjudication;

3. Any injunctive or restrictive order or federal or state administrative order related to business activity or health care as a result of an action brought by a public agency or department;

4. A copy of current agreements entered into with third party providers; and

5. A copy of current agreements with each consultant employed by the center and documentation specifying frequency of consultative visits and required written, dated reports.

**History**
- *SOURCE: Mississippi Code Annotated §41-125-19*

##### **15 Miss. Admin. Code Pt. 16, R. 2.3.21** Liability Insurance {#sec-16-2.3.21 omnilex-key=us-ms-regs-official--title-15--16#2.3.21}

Facilities shall obtain and keep in force liability insurance. Proof of Professional and General Liability insurance including worker’s compensation insurance must be submitted at the time of application. Liability insurance must cover legal liability for death, injury, or disability of any human being, or for damage of property, with provision for medical, hospital and surgical benefits to the injured person, irrespective of the legal disability of the insured, when issued as a part of the liability insurance contract.

**History**
- *SOURCE: Mississippi Code Annotated §41-125-19*

##### **15 Miss. Admin. Code Pt. 16, R. 2.3.22** Denial, Suspension, Revocation of Licensure, Administrative Fines; Grounds {#sec-16-2.3.22 omnilex-key=us-ms-regs-official--title-15--16#2.3.22}

1. The licensing agency may deny, revoke, and suspend a license and impose an administrative fine as provided in section eight (8) of Section §41-125-19, Mississippi Code of 1972, Annotated, for violation of any provision of this act, or applicable rules.

2. Any of the following actions by the PPEC center or its employee is grounds for action by the licensing agency against the PPEC center or its employee:

a. An intentional or negligent act materially affecting the health and safety of children in the PPEC center.

b. A violation of the provisions of the act, or applicable rules.

c. Multiple or repeat violations of this act or of minimum standards or rules adopted under this act.

**History**
- *SOURCE: Mississippi Code Annotated §41-125-13*

##### **15 Miss. Admin. Code Pt. 16, R. 2.3.23** Immediate Revocation of License {#sec-16-2.3.23 omnilex-key=us-ms-regs-official--title-15--16#2.3.23}

Pursuant to Section 41-3-15, the State Department of Health is authorized and empowered, to revoke, immediately, the license and require closure of said healthcare center/institution, including any other remedy less than closure to protect the health and safety of the children

being provided care/services or the health and safety of the public.

**History**
- *SOURCE: Mississippi Code Annotated §41-125-19 and §41.3.15*

##### **15 Miss. Admin. Code Pt. 16, R. 2.3.24** Administrative Fines {#sec-16-2.3.24 omnilex-key=us-ms-regs-official--title-15--16#2.3.24}

If the licensing agency determines that a PPEC center is not in compliance with this act, or applicable rules, the licensing agency may require that the PPEC center submit a corrective action plan that demonstrates a good-faith effort to remedy each violation by a specific date, subject to the approval of the licensing agency. The licensing agency may fine a PPEC center or employee found in violation of this act, or applicable rules, in the amount not to exceed five thousand dollars ($5000.00) in the aggregate. Should the center not correct a violation by the date agreed upon by the licensing agency, or the failure to comply with an approved corrective action plan, is a separate violation for each day that the failure continues, unless the licensing agency approves an extension to the specific date.

**History**
- *SOURCE: Mississippi Code Annotated §41-125-15*

##### **15 Miss. Admin. Code Pt. 16, R. 2.3.25** Closing of a PPEC Center {#sec-16-2.3.25 omnilex-key=us-ms-regs-official--title-15--16#2.3.25}

Whenever a PPEC center voluntarily discontinues operation, it shall, at least thirty days before the discontinuance of operation, inform each child’s legal guardian of the fact and the proposed time of the discontinuance. The licensing agency shall also be notified of the same such fact, at least thirty days prior to the date of discontinuance of operation.

Subchapter 4 Provision For Hearing And Appeal Following Denial or Revocation of License.

**History**
- *SOURCE: Mississippi Code Annotated §41-125-17*

##### **15 Miss. Admin. Code Pt. 16, R. 2.4.1** Administrative Decision {#sec-16-2.4.1 omnilex-key=us-ms-regs-official--title-15--16#2.4.1}

The licensing agency shall provide an opportunity for a fair hearing to every applicant or licensee who is dissatisfied with administrative decisions made in regard to the denial or revocation of a license.

1. The licensing agency shall notify the applicant or licensee by registered mail or personal service the particular reasons for the proposed denial or revocation of a license. Upon written request of an applicant or licensee received within ten (10) days of the date of notification, the licensing agency shall fix a date for the hearing at which time the applicant or licensee shall have an opportunity for a prompt and fair hearing.

2. On the basis of such hearing or upon default of the applicant or licensee, the licensing agency shall make a determination specifying its findings of fact and conclusions of law. A copy of such determinations shall be sent by registered mail to the last known address of the applicant or licensee or served personally upon the applicant or licensee.

3. The decision revoking, suspending, or denying the applicant or license shall become final thirty (30) days after it is mailed or served unless the applicant or licensee, within a thirty (30) day period, appeals to the Chancery Court pursuant to Section 43-11-23 of the Mississippi Code of 1972. An additional period of time may be granted at the discretion of the licensing agency.

**History**
- *SOURCE: Mississippi Code Annotated §41-125-19*

##### **15 Miss. Admin. Code Pt. 16, R. 2.5.1** Rule 2.5.1 Licensee {#sec-16-2.5.1 omnilex-key=us-ms-regs-official--title-15--16#2.5.1}

The licensee of each PPEC center shall have full legal authority and responsibility for the operation of the center. The licensee shall assure that the PPEC center is administered on a sound financial basis consistent with good business practice. There shall be financial records and annual budget information including monthly statements of operation and Profit and Loss statements made available from the PPEC center.

**History**
- *SOURCE: Mississippi Code Annotated §41-125-19*

##### **15 Miss. Admin. Code Pt. 16, R. 2.5.2** Organizational Structure {#sec-16-2.5.2 omnilex-key=us-ms-regs-official--title-15--16#2.5.2}

Each PPEC center must be organized in accordance with a written table of organization, which describes the lines of authority and communication down to the child care level. The organization structure must be designed so as to ensure an integrated continuum of services to the children.

**History**
- *SOURCE: Mississippi Code Annotated §41-125-19*

##### **15 Miss. Admin. Code Pt. 16, R. 2.5.3** Rule 2.5.3 {#sec-16-2.5.3 omnilex-key=us-ms-regs-official--title-15--16#2.5.3}

The licensee of each PPEC center must designate, in writing, one person, as Administrator, who is responsible and accountable for the overall management of the center.

**History**
- *SOURCE: Mississippi Code Annotated §41-125-19*

##### **15 Miss. Admin. Code Pt. 16, R. 2.5.4** Administrator Qualifications: The Administrator shall have the following minimum qualifications: {#sec-16-2.5.4 omnilex-key=us-ms-regs-official--title-15--16#2.5.4}

1. Five years of experience in the delivery of health care services, with a minimum of two years administrative or supervisory experience and meet one of the following criteria:

a. A physician currently licensed in the state of Mississippi;

b. A registered nurse currently licensed in the state of Mississippi;

c. A qualified health professional licensed by the state of Mississippi when required such as but not limited to a physician assistant, pharmacist,

dietitian, respiratory care practitioner, social worker, physical therapist, occupational therapist or speech-language pathologist;

d. A college graduate with a bachelor’s degree or higher in a health related field.

**History**
- *SOURCE: Mississippi Code Annotated §41-125-19*

##### **15 Miss. Admin. Code Pt. 16, R. 2.5.5** Administrator Designee {#sec-16-2.5.5 omnilex-key=us-ms-regs-official--title-15--16#2.5.5}

The center administrator must designate, in writing, a person to be responsible for the center when the administrator is absent from or unavailable to the center for more than 24 hours.

**History**
- *SOURCE: Mississippi Code Annotated §41-125-19*

##### **15 Miss. Admin. Code Pt. 16, R. 2.5.6** Administrator Responsibilities: The center administrator shall: {#sec-16-2.5.6 omnilex-key=us-ms-regs-official--title-15--16#2.5.6}

1. Be located on site at the center and serve full time as the Administrator.

2. Maintain the following written records, and all other records as outlined under subchapter 13 of these rules. The records must be kept in a place, form, and system in accordance with medical and business practices and such records must be available in the center for inspection by the Department during normal business hours:

3. A daily census record, which must indicate the names/number of children currently receiving services in the center. Census records must be maintained and available for review, on the premises, for a period of three years.

4. A record of all accidents or unusual incidents involving any child or staff member that caused, or had the potential to cause, injury or harm to any person or property within the center, and ensures for timely reporting within 24 hours of discovery to the Mississippi Department of Human Services and the Mississippi State Department of Health, Bureau of Health Facilities Licensure and Certification for those incidents involving allegations of abuse and/or neglect of the minor child.

5. A copy of current agreements with third party providers;

6. A copy of current agreements with each consultant contracted by the PPEC center and documentation of each consultant’s visit and required written, dated reports;

7. A personnel record for each employee, which must include, at a minimum, a current copy and/or verification of the licensure status of professional discipline employed or on contract, the original employment application, references, employment history for the preceding five years, if applicable; a copy of the job

description (acknowledged by employee); and a copy of all job performance evaluations;

8. Develop and maintain a current job description for each employee;

9. Provide each employee access to written personnel policies governing conditions of employment;

10. Conduct annual written job performance reviews that note strengths and weaknesses and include plans to correct any job performance weaknesses. Performance evaluations must be reviewed with the employee;

11. Assign duties to employees that are consistent with their job descriptions and their levels of education, preparation and experience;

12. Provide necessary qualified personnel and ancillary services to ensure the health, safety, and proper care of the child;

13. Ensure the development and implementation of policies and procedures, including but not limited to infection control and quality assurance. These policies and procedure must be included in the PPEC center’s policy manual.

**History**
- *SOURCE: Mississippi Code Annotated §41-125-19*

##### **15 Miss. Admin. Code Pt. 16, R. 2.5.7** Organizational Responsibility {#sec-16-2.5.7 omnilex-key=us-ms-regs-official--title-15--16#2.5.7}

The administrative structure of the PPEC center shall include a policy and procedure manual to assure standards for medical and nursing care are met and to assure that the requirements as set forth in licensure and certification are maintained.

**History**
- *SOURCE: Mississippi Code Annotated §41-125-19*

##### **15 Miss. Admin. Code Pt. 16, R. 2.5.8** Resources {#sec-16-2.5.8 omnilex-key=us-ms-regs-official--title-15--16#2.5.8}

Each PPEC center shall have the following documents on the premises and available to staff: American Academy of Pediatrics Red Book, Minimum Standards of Operation for Prescribed Pediatric Extended Care, Policy and Procedure Manual and a Personnel Manual.

**History**
- *SOURCE: Mississippi Code Annotated §41-125-19*

##### **15 Miss. Admin. Code Pt. 16, R. 2.5.9** Rule 2.5.9 {#sec-16-2.5.9 omnilex-key=us-ms-regs-official--title-15--16#2.5.9}

Personnel Policies and Procedures shall include provisions for at least, a current personnel file, position descriptions, employee benefits, policy for attendance, overtime, compensatory time, performance evaluations, grievance procedures, and termination of employment. Personnel policies must also require that employees of the center are current in their immunizations and undergo a medical evaluation to rule out communicable diseases, including but not limited to, tuberculosis (TB). Facilities shall comply with recommendations from the Centers for Disease Control

and/or the Mississippi State Department of Health regarding baseline employee TB testing and routine serial employee TB testing and education.

**History**
- *SOURCE: Mississippi Code Annotated §41-125-19*

##### **15 Miss. Admin. Code Pt. 16, R. 2.5.10** Rule 2.5.10 {#sec-16-2.5.10 omnilex-key=us-ms-regs-official--title-15--16#2.5.10}

A formal orientation shall be required for all PPEC center employees; staff development programs for all categories of personnel shall be held quarterly and documented accordingly.

**History**
- *SOURCE: Mississippi Code Annotated §41-125-19*

##### **15 Miss. Admin. Code Pt. 16, R. 2.5.11** Rule 2.5.11 {#sec-16-2.5.11 omnilex-key=us-ms-regs-official--title-15--16#2.5.11}

Policy and procedure manuals including but not limited to specifications for therapeutic intervention shall be available for use by all staff involved in the care of children. Revisions of the policies and procedures are reviewed and approved quarterly during QA meetings. All forms, policies and procedures are reviewed and signed off as approved by the administrator, medical director and the director of nursing services, annually to assure that procedures conform to prevailing and acceptable treatment modalities.

**History**
- *SOURCE: Mississippi Code Annotated §41-125-19*

##### **15 Miss. Admin. Code Pt. 16, R. 2.5.12** Rule 2.5.12 {#sec-16-2.5.12 omnilex-key=us-ms-regs-official--title-15--16#2.5.12}

For each employee of the PPEC center (see definition of employee), the center shall submit fingerprints to MSDH for the purpose of processing a criminal history records check. The center shall develop policies and procedures consistent with this requirement.

**History**
- *SOURCE: Mississippi Code Annotated §41-125-11*

##### **15 Miss. Admin. Code Pt. 16, R. 2.5.13** Criminal History Record Checks {#sec-16-2.5.13 omnilex-key=us-ms-regs-official--title-15--16#2.5.13}

The covered entity shall require to be performed a disciplinary check with the professional licensing agency, if any, for each employee to determine if any disciplinary action has been taken against the employee by the agency, and a criminal history record check on:

1. Every new employee of a covered entity who provides direct patient care or services and who is employed after or on July 01, 2003.

2. Every employee of a covered entity employed prior to July 01, 2003, who has documented disciplinary action by his or her present employer.

3. Except as otherwise provided in this paragraph, no employee hired on or after July 01, 2003, shall be permitted to provide direct patient care until the results of the criminal history check have revealed no disqualifying record or the employee has been granted a waiver. Provided the covered entity has documented evidence of submission of fingerprints for the background check, any person may be employed and provide direct patient care on a temporary basis pending the results of the criminal history record check by any

employment offer, contract, or arrangement with the person shall be voidable, if he/she receives a disqualifying criminal record check.

4. If such criminal history record check discloses a criminal conviction; a guilty plea; and/or a plea of nolo contendere to a crime that is job-related which has not been reversed on appeal, or for which a pardon has not been granted, the applicant/employee may not be eligible to be employed at the licensed facility.

5. Documentation of verification of the employee’s disciplinary status, if any, with the employee’s professional licensing agency as applicable, and evidence of submission of the employee’s fingerprints to the licensing agency must be on file and maintained by the facility prior to the new employees first date of employment. The covered entity shall maintain on file evidence of verification of the employee’s disciplinary status from any applicable professional licensing agency and submission and/or completion of the criminal record check, the signed affidavit, if applicable, and/or a copy of the referenced notarized letter addressing the individual’s suitability for such employment.

6. The covered entity may, in its discretion, allow any employee applicant aggrieved by the employment decision under this subsection to appear before the licensed entity’s hiring officer, or his or her designee, to show mitigating circumstances that may exist and allow the employee or employee applicant to be employed at the covered entity. The covered entity, upon report and recommendation of the hiring officer, may grant waivers for those mitigating circumstances, which shall include, but not be limited to: (1) age at which the crime was committed; (2) circumstances surrounding the crime; (3) length of time since the conviction and criminal history since the conviction; (4) work history; (5) current employment and character references; and (6) other evidence demonstrating the ability of the individual does not pose a threat to the health or safety of the patients in the licensed facility.

7. The licensing agency may charge the covered entity submitting the fingerprints a fee not to exceed Fifty Dollars ($50.00).

8. Should results of an employee applicant’s criminal history record check reveal no disqualifying event, then the covered entity shall, within two (2) weeks of the notification of no disqualifying, event provide the employee applicant with a notarized letter signed by the chief executive officer of the covered entity, or his or her authorized designee, confirming the employee applicant’s suitability for employment based on his or her criminal history record check. An employee applicant may use that letter for a period of two (2) years from the date of the letter to seek employment at any covered entity licensed by the Mississippi Department of Health without the necessity of an additional criminal record check. Any covered entity presented with the letter may rely on the letter with respect to an employee applicant’s criminal background and is not required for

a period of two (2) years from the date of the letter to conduct or have conducted a criminal history record check as required in this subsection.

9. For individuals contracted through a third party who provide direct patient care as defined herein, the covered entity shall require proof of a criminal history record check.

10. The licensing agency, the covered entity, and their agents, officers, employees, attorneys and representatives, shall be presumed to be acting in good faith for any employment decision or action taken under this section. The presumption of good faith may be overcome by a preponderance of the evidence in any civil action. No licensing agency, covered entity, nor their agents, officers, employees, attorneys and representatives shall be held liable in any employment discrimination suit in which an allegation of discrimination is made regarding an employment decision authorized under this section.

Subchapter 6 Child/Parent’s Rights.

**History**
- *SOURCE: Mississippi Code Annotated §41-125-11*

##### **15 Miss. Admin. Code Pt. 16, R. 2.6.1** Every child shall be treated with consideration, respect, and full recognition of his/her dignity and individuality {#sec-16-2.6.1 omnilex-key=us-ms-regs-official--title-15--16#2.6.1}

**History**
- *SOURCE: Mississippi Code Annotated §41-125-19*

##### **15 Miss. Admin. Code Pt. 16, R. 2.6.2** Each child shall receive care, treatment and services which are adequate and appropriate for his/her therapeutic plan {#sec-16-2.6.2 omnilex-key=us-ms-regs-official--title-15--16#2.6.2}

**History**
- *SOURCE: Mississippi Code Annotated §41-125-19*

##### **15 Miss. Admin. Code Pt. 16, R. 2.6.3** Rule 2.6.3 {#sec-16-2.6.3 omnilex-key=us-ms-regs-official--title-15--16#2.6.3}

Parent(s) or legal guardian(s) shall, prior to and upon admission and during the period of service to his/her child, receive a written statement of the services provided by the PPEC center including those offered on an “as needed” basis. They shall also receive a statement of related charges including any charges for services not covered under the PPEC center’s basic per diem rate.

**History**
- *SOURCE: Mississippi Code Annotated §41-125-19*

##### **15 Miss. Admin. Code Pt. 16, R. 2.6.4** Rule 2.6.4 {#sec-16-2.6.4 omnilex-key=us-ms-regs-official--title-15--16#2.6.4}

Each child’s medical care program shall be conducted discreetly and in accordance with the parent’s/guardian’s need for privacy. Personal and medical records shall be treated confidentially and shall not be made public without written consent of parent(s) or legal guardian(s).

**History**
- *SOURCE: Mississippi Code Annotated §41-125-19*

##### **15 Miss. Admin. Code Pt. 16, R. 2.6.5** Each child shall be free from mental and physical abuse and also physical and {#sec-16-2.6.5 omnilex-key=us-ms-regs-official--title-15--16#2.6.5}

chemical restraints, unless authorized by a physician according to clear and indicated medical requirements. Justification for use, shall include but not be limited to, the risks verses benefits for use and shall be documented by the physician and maintained as part of the child’s medical record.

**History**
- *SOURCE: Mississippi Code Annotated §41-125-19*

##### **15 Miss. Admin. Code Pt. 16, R. 2.6.6** Rule 2.6.6 {#sec-16-2.6.6 omnilex-key=us-ms-regs-official--title-15--16#2.6.6}

Every parent or legal guardian has a right, personally or through others, to present grievances to state and local authorities without reprisal, interference, coercion or discrimination of the child as a result of the grievance or suggestion.

**History**
- *SOURCE: Mississippi Code Annotated §41-125-19*

##### **15 Miss. Admin. Code Pt. 16, R. 2.7.1** Each PPEC center shall have policies and procedures governing the admission, transfer, and discharge of children {#sec-16-2.7.1 omnilex-key=us-ms-regs-official--title-15--16#2.7.1}

The admission of each child to the PPEC center shall be under the supervision of the center administrator or his/her designee, and shall be in accordance with the center’s child care policies and procedures.

**History**
- *SOURCE: Mississippi Code Annotated §41-125-19*

##### **15 Miss. Admin. Code Pt. 16, R. 2.7.2** Hours of Service {#sec-16-2.7.2 omnilex-key=us-ms-regs-official--title-15--16#2.7.2}

The hours of operation of a PPEC center must be clearly posted. At no time shall a child remain at a PPEC center in excess of twelve (12) hours in any one twenty-four (24) hour period, unless such center is licensed for twenty-four hour (24) continued service.

RULE 2.7.3 Criteria for Admission. Infants and children considered for admission to the PPEC center shall be those who are medically or technologically dependent to include, but not be limited to, conditions such seizure disorder, chronic lung disorder, malignancy, and heart disease and/or complex medical problems requiring continual care, including but not limited to, ventilator dependence, supplemental oxygen, I.V therapy, nasogastric or gastrostomy feedings, tracheotomy, etc.

**History**
- *SOURCE: Mississippi Code Annotated §41-125-19*
- *SOURCE: Mississippi Code Annotated §41-125-19*

##### **15 Miss. Admin. Code Pt. 16, R. 2.7.4** Rule 2.7.4 {#sec-16-2.7.4 omnilex-key=us-ms-regs-official--title-15--16#2.7.4}

Each child admitted to the PPEC center shall be admitted under the prescription of the licensed prescribing physician and shall remain under the care of the primary care or subspecialist physician for the duration of his/her stay at the center. Each child placed in the PPEC center shall have documentation of the physician’s written order placed in the child’s medical record. A copy of the order shall be provided to the child’s parent(s) or guardian(s).

**History**
- *SOURCE: Mississippi Code Annotated §41-125-19*

##### **15 Miss. Admin. Code Pt. 16, R. 2.7.5** Rule 2.7.5 {#sec-16-2.7.5 omnilex-key=us-ms-regs-official--title-15--16#2.7.5}

Infants and children considered for admission to the PPEC center shall be stable for outpatient medical services and shall not, prior to admission, present a significant risk of infection to the other children or personnel. The medical and nursing directors shall review, on a case-by-case basis, any child with a suspected infection to determine appropriateness of admission.

**History**
- *SOURCE: Mississippi Code Annotated §41-125-19*

##### **15 Miss. Admin. Code Pt. 16, R. 2.7.6** Rule 2.7.6 {#sec-16-2.7.6 omnilex-key=us-ms-regs-official--title-15--16#2.7.6}

A consent form outlining the purpose of a PPEC center, family responsibilities, authorized treatments and appropriate liability release and emergency disposition plans shall be signed by the parent(s) and/or guardian(s) prior to admission to the PPEC center. The parents and guardians shall be provided a copy of the consent form. Confidentiality of PPEC center’s records shall be maintained in accordance with HIPPA requirements.

**History**
- *SOURCE: Mississippi Code Annotated §41-125-19*

##### **15 Miss. Admin. Code Pt. 16, R. 2.7.7** Rule 2.7.7 {#sec-16-2.7.7 omnilex-key=us-ms-regs-official--title-15--16#2.7.7}

The protocol for care shall be developed under the direction of the PPEC center nursing director and shall specify the treatment plan needed to accommodate the medical, nursing, psychosocial and educational needs of the child and family. Specific goals for care shall be identified. Plans for achieving the goals shall be determined and a schedule for evaluation of progress shall be established. The protocol shall include specific discharge criteria.

**History**
- *SOURCE: Mississippi Code Annotated §41-125-19*

##### **15 Miss. Admin. Code Pt. 16, R. 2.7.8** Rule 2.7.8 {#sec-16-2.7.8 omnilex-key=us-ms-regs-official--title-15--16#2.7.8}

The protocol must be signed by the physician, the authorized representative(s) of the PPEC center and the parent(s) or guardian(s) of the child with ten (10) days of initiation of the plan. Copies of the protocol shall be given to the parent(s), guardian(s) of the child, the child’s primary physician, PPEC center staff, and other agencies as appropriate.

**History**
- *SOURCE: Mississippi Code Annotated §41-125-19*

##### **15 Miss. Admin. Code Pt. 16, R. 2.7.9** Rule 2.7.9 {#sec-16-2.7.9 omnilex-key=us-ms-regs-official--title-15--16#2.7.9}

Communication with the child’s primary physician shall be provided by the nursing director or designee on a monthly or quarterly basis, as identified in the plan or at a minimum when there is a change in the child’s clinical condition.

**History**
- *SOURCE: Mississippi Code Annotated §41-125-19*

##### **15 Miss. Admin. Code Pt. 16, R. 2.7.10** Rule 2.7.10 {#sec-16-2.7.10 omnilex-key=us-ms-regs-official--title-15--16#2.7.10}

Prescribed therapies may be adjusted, in consultation with the child’s primary care or subspecialist physician, to accommodate the child’s condition.

**History**
- *SOURCE: Mississippi Code Annotated §41-125-19*

##### **15 Miss. Admin. Code Pt. 16, R. 2.7.11** Rule 2.7.11 {#sec-16-2.7.11 omnilex-key=us-ms-regs-official--title-15--16#2.7.11}

If a child is hospitalized at the time of referral, pre-admission planning will include the parents and guardians, relevant hospital medical, nursing, social services and developmental staff to assure that the hospital’s discharge plans will be implemented following placement in the PPEC center.

**History**
- *SOURCE: Mississippi Code Annotated §41-125-19*

##### **15 Miss. Admin. Code Pt. 16, R. 2.8.1** Qualifications of a Medical Director {#sec-16-2.8.1 omnilex-key=us-ms-regs-official--title-15--16#2.8.1}

A physician, licensed in accordance with the requirements of the Mississippi Board of Medical Licensure, and is board certified by the American Board of Pediatrics or the American Osteopathic Board of Pediatrics shall serve as medical director of the PPEC center.

**History**
- *SOURCE: Mississippi Code Annotated §41-125-19*

##### **15 Miss. Admin. Code Pt. 16, R. 2.8.2** Responsibilities of the Medical Director shall be: {#sec-16-2.8.2 omnilex-key=us-ms-regs-official--title-15--16#2.8.2}

1. Periodic review of services to assure acceptable levels of quality;

2. Maintenance of a liaison role with the medical community;

3. Advisement of the development of new programs and modifications of existing programs;

4. Assurance that medical consultation will be available in the medical director’s absence;

5. Serving on committees as defined and required by these rules and by the center’s policies;

6. Consultation with the center administrator on the health status of the center’s personnel;

7. Reviewing reports of all accidents and unusual incidents, to but not be limited to, medication errors, and identifying to the center administrator hazards to health and safety; and

8. Ensuring the development of policies and procedures for the delivery of emergency services and the delivery of regular physician services when the child’s attending physician or his designated alternate is not available.

**History**
- *SOURCE: Mississippi Code Annotated §41-125-19*

##### **15 Miss. Admin. Code Pt. 16, R. 2.9.1** Qualification of the Director of Nursing {#sec-16-2.9.1 omnilex-key=us-ms-regs-official--title-15--16#2.9.1}

A registered nurse shall serve full- time as the Director of Nursing. The Director of Nursing must have, at a minimum, the following qualifications:

1. Minimum of a baccalaureate degree in nursing;

2. Current unrestricted Mississippi nursing license;

3. Current certification in Cardio Pulmonary Resuscitation (CPR) or Basic Cardiac Life Support (BCLS); and

4. Current certification in Pediatric Advanced Life Support (PALS)

5. A minimum of five years of employment in a pediatric setting caring for medically and/or technologically dependent children with at least three years of experience in one of the following specialty settings: pediatric intensive care, neonatal intensive care, pediatric emergency care, PPEC center or comparable pediatric unit

**History**
- *SOURCE: Mississippi Code Annotated §41-125-19*

##### **15 Miss. Admin. Code Pt. 16, R. 2.9.2** Responsibilities {#sec-16-2.9.2 omnilex-key=us-ms-regs-official--title-15--16#2.9.2}

The Director of Nursing Services shall be responsible for the day-to-day operations of the PPEC center, to include but not be limited to, the development of and implementation of policies and procedures to facilitate effective and safe care and treatment modalities, scheduling of staff, coordination of employee and contracted specialized services in accordance with each child’s individualized plan of care, participating in pre-admission screening along with other appropriate nursing staff, participating on the interdisciplinary team (IDT) in the development of each child’s plan care, evaluation of all nursing services provided to each child; assuring that training and inservices are provided consistent with the treatments/care being provided and the identified weaknesses and/or needs of the employee.

**History**
- *SOURCE: Mississippi Code Annotated §41-125-19*

##### **15 Miss. Admin. Code Pt. 16, R. 2.9.3** Registered Nurse Qualifications {#sec-16-2.9.3 omnilex-key=us-ms-regs-official--title-15--16#2.9.3}

Each registered nurse employed by the PPEC center shall have a current unencumbered Mississippi nursing license, have at least two years of pediatric specialty care experience with emphasis on medically and technologically dependent children and maintain current certification in pediatric CPR, pediatric advance life support (PALS) and basic first aid.

**History**
- *SOURCE: Mississippi Code Annotated §41-125-19*

##### **15 Miss. Admin. Code Pt. 16, R. 2.9.4** Registered Nurse Responsibilities {#sec-16-2.9.4 omnilex-key=us-ms-regs-official--title-15--16#2.9.4}

The registered nurse shall be responsible for at least the following:

1. The provision of nursing intervention; educational services to increase the family’s confidence and competence in caring for the child with special needs; assistance to facilitate coping with the effects of chronic illness on the child and family and support effective relationships among siblings and the ill child; interventions to foster normal development and psychosocial adaptation;

2. Knowledge of the availability and access requirements to community resources;

3. Participation in the interdisciplinary teams (IDT), as necessary and in the interdisciplinary staff meetings regarding the child’s progress. Fostering and maintaining collaborative relationship with the interdisciplinary teams;

4. The administration of medication, intravenous infusions, parenteral feedings and other specialized treatments; monitoring and documenting the effects of medications, therapies and progress in accordance with accepted standards of practice; and

5. Knowledge of the competence and scope of practice of other licensed and unlicensed personnel and delegation of duties to such personnel within that level of competence and scope of practice.

**History**
- *SOURCE: Mississippi Code Annotated §41-125-19*

##### **15 Miss. Admin. Code Pt. 16, R. 2.9.5** Qualifications of Licensed Practical Nurse {#sec-16-2.9.5 omnilex-key=us-ms-regs-official--title-15--16#2.9.5}

Each licensed practical nurse employed by the PPEC center shall have a current unencumbered Mississippi nursing license, have at least two years of pediatric specialty care experience with emphasis on medically and technologically dependent children and current certification in pediatric CPR and basic first aid.

##### **15 Miss. Admin. Code Pt. 16, R. 2.9.6** Qualifications of Direct Care Staff {#sec-16-2.9.6 omnilex-key=us-ms-regs-official--title-15--16#2.9.6}

If direct care staff are utilized to augment licensed nurse staffing, the direct care staff shall have a minimum of the following qualifications:

1. Two years of experience in a healthcare setting providing care to infants and children who are medically or technologically dependent;

2. References documenting skill in the care of infants and children; and

3. Current certification in pediatric CPR and basic first aid.

**History**
- *SOURCE: Mississippi Code Annotated §41-125-19*

##### **15 Miss. Admin. Code Pt. 16, R. 2.9.7** Rule 2.9.7 {#sec-16-2.9.7 omnilex-key=us-ms-regs-official--title-15--16#2.9.7}

The Licensed Practical Nurse and Direct Care Staff shall work under the supervision of the registered nurse and is responsible to provide, within their level of competence and scope of practice, direct care to the PPEC center children.

**History**
- *SOURCE: Mississippi Code Annotated §41-125-19*

##### **15 Miss. Admin. Code Pt. 16, R. 2.10.1** Ratio {#sec-16-2.10.1 omnilex-key=us-ms-regs-official--title-15--16#2.10.1}

Total staffing for nursing services shall be, at a minimum, in the following ratios but at no time shall there be less than one (1) staff member of duty per three (3) children. If only one (1) staff member is on duty, that member must be a registered nurse.

Children Total Staff RN

RN or LPN Direct Care, or Licensed Nurse (RN, LPN or Respiratory Therapist) 1 1 1 2-6 2 1 1 7-9 3 1 1 1 10-12 4 2 1 1 13-15 5 3 1 1 16-18 6 3 1 2 19-21 7 4 1 2 22-24 8 4 1 3 25-27 9 4 1 4 28-30 11 5 1 5 31-33 12 5 1 6 34 -36 13 5 2 6 37- 39 14 5 3 6 40-42 15 5 3 7 43- 45 16 5 4 7

**History**
- *SOURCE: Mississippi Code Annotated §41-125-19*

##### **15 Miss. Admin. Code Pt. 16, R. 2.10.2** Rule 2.10.2 {#sec-16-2.10.2 omnilex-key=us-ms-regs-official--title-15--16#2.10.2}

If a PPEC center has more than 45 children, the staffing must increase by one staff for every three (3) children, alternating between a direct care staff and licensed nurse.

**History**
- *SOURCE: Mississippi Code Annotated §41-125-19*

##### **15 Miss. Admin. Code Pt. 16, R. 2.10.3** Ancillary Professional Staffing {#sec-16-2.10.3 omnilex-key=us-ms-regs-official--title-15--16#2.10.3}

Although the PPEC center is not required to have the following disciplines on staff, such services may be contractual, on a consultant basis, depending on the assessed need of the child.

1. Resource consultants:

a. A child development specialist available to serve as a resource for PPEC center staff and parents of children served who can be available to evaluate through use of standardized and non-standardized procedures the developmental status of children;

b. A child life specialist who can assist in planning and conducting individualized child development and play programs; and who can serve as a resource to the PPEC center staff and parents of children being served.

##### **15 Miss. Admin. Code Pt. 16, R. 2.10.4** The PPEC center shall have the following staff, either by employment or on a contractual as needed basis: {#sec-16-2.10.4 omnilex-key=us-ms-regs-official--title-15--16#2.10.4}

1. Occupational therapy is the provision of services that addresses the developmental or functional needs of a child related to the performance of self- help adaptive skills, adaptive behaviors, and sensory, motor and postural development. Occupational therapy includes the evaluation and treatment to prevent or correct physical and emotional deficits, minimize the disabling effects of these deficits, maintain a level of function, acquire a skill set or A child life specialist who shall be responsible for at least the following:

a. Evaluation of child following physician referral to include neuromuscular status, developmental level, perceptual motor functioning, need for adaptive equipment or appliances, self-care and play;

b. Designing and implementing therapeutic programs to meet the needs of the individual child;

c. Maintaining records documenting the therapy program and progress for each child as approved by the attending physician; and

d. Participating as part of the child’s IDT team if occupational therapies are a part of the child’s plan and serving as a resource for PPEC center staff and the parents being served.

2. Physical therapy services include the evaluation and treatment of range of motion, muscle strength, functional abilities and the use of adaptive and therapeutic equipment. The PPEC center shall assure the availability of, either by employment of contract, a physical therapist who is responsible for at least the following:

a. Evaluation of each child upon physician referral to include neuromuscular status, developmental level, gait, posture and adaptive equipment;

b. Designing and implementing therapeutic programs to meet the needs of each individual child;

c. Maintaining records documenting the therapy program and progress for each child as approved by the attending physician; and

d. Serving as a resource for PPEC center staff and parents of children served.

e. If physical therapy is an active component in the treatment of the child, the physical therapist shall participate as part of the child’s IDT.

3. Respiratory care services include evaluation and treatment related to pulmonary dysfunction. Examples are ventilator support, therapeutic and diagnostic use of medical gases, respiratory rehabilitation, management of life support systems and bronchopulmonary drainage, breathing exercises and chest physiotherapy. The PPEC center shall assure the availability of a licensed respiratory therapist when appropriate, to:

a. Evaluation of the respiratory function and needs of the child, make recommendations based upon that assessed need,

b. Provide therapies, as appropriate, per physician orders,

c. Maintain documentation of provided therapies, in accordance with physician’s orders and the child’s IDT plan, and the progress of the child and/or educational progress of the parents.

d. Serve as a resource to train staff and parents of the child on the physiology of the child’s disease processor respiratory dysfunction and on the modalities necessary for care and treatment of the child.

4. Speech language involves the evaluation and treatment of speech-language disorders, to include but not be limited to, the evaluation and treatments of verbal and written language, articulation, voice, fluency, phonology, mastication, deglutition, cognition, and communications. The PPEC center shall assure that a speech-language pathologist is available, either by employment or through a contractual basis on an as needed basis, for the:

a. Evaluation of children to include: ability to swallow and feeding, respirations, language, speech, communication and play using formal and informal test and observations;

b. Designing and implementing individualized therapeutic programs for each child, including recommendations for communication devices;

c. Speech-language encounters must be face-to-face and the speech-language pathologist must maintain, in the child’s record, documentation of each evaluation, documentation of therapies and progress; and

d. Serving as a resource for the PPEC center staff and parents of children being served.

e. Speech-language visits must be face-to-face encounters

5. A social worker who is responsible for at least the following:

a. Conducting family psychosocial assessments as requested by the medical or nursing director

b. Counseling, including emotional support and grief resolution as requested by the nursing and medical director, or family;

c. Family advocacy and coordination with community resources;

d. Maintaining records and documenting social work interventions;

e. Conducting home visits and home evaluations as requested by the medical director or nursing director; and

f. Serving as a resource for the PPEC center staff and parents of children served.

6. A dietician, who is licensed in the State of Mississippi and currently registered with the American Dietetic Association, will be available on a consultant basis.

**History**
- *SOURCE: Mississippi Code Annotated §41-125-19*

##### **15 Miss. Admin. Code Pt. 16, R. 2.11.1** Subchapter 11 Developmental Services {#sec-16-2.11.1 omnilex-key=us-ms-regs-official--title-15--16#2.11.1}

Each child shall have a functional assessment and an individualized family service plan (IFSP) to include developmentally appropriate areas.

**History**
- *SOURCE: Mississippi Code Annotated §41-125-19*

##### **15 Miss. Admin. Code Pt. 16, R. 2.11.2** Rule 2.11.2 {#sec-16-2.11.2 omnilex-key=us-ms-regs-official--title-15--16#2.11.2}

The child’s IFSP plan shall include specific programs and action steps to facilitate developmental progress and shall be reviewed and updated per early intervention/early step guidelines.

**History**
- *SOURCE: Mississippi Code Annotated §41-125-19*

##### **15 Miss. Admin. Code Pt. 16, R. 2.11.3** Developmental and educational needs shall be incorporated into each child’s protocol for care {#sec-16-2.11.3 omnilex-key=us-ms-regs-official--title-15--16#2.11.3}

**History**
- *SOURCE: Mississippi Code Annotated §41-125-19*

##### **15 Miss. Admin. Code Pt. 16, R. 2.11.4** Rule 2.11.4 {#sec-16-2.11.4 omnilex-key=us-ms-regs-official--title-15--16#2.11.4}

The PPEC center shall provide evidence of a good-faith effort in assuring the development of a comprehensive developmental program for each child birth 3 years old to meet the identified developmental needs of the child. The PPEC center may enter into a contractual relation with the local early intervention provider/early steps to assure that these services are met and provided accordingly. The child’s IFSP plan shall include:

1. Measurable goals in need areas and/or goals to enhance and normalize independent functioning in daily activities and to promote socialization in order to minimize difficulties in being assimilated into the home/community environment;

2. A description of the child’s strengths and present performance level with respect to each goal;

3. Skills areas in priority order;

4. Anticipatory planning for specific areas identified at risk for problems even though a specific delay or problem may not be demonstrable.

**History**
- *SOURCE: Mississippi Code Annotated §41-125-19*

##### **15 Miss. Admin. Code Pt. 16, R. 2.11.5** Rule 2.11.5 {#sec-16-2.11.5 omnilex-key=us-ms-regs-official--title-15--16#2.11.5}

The developmentalist and/or child life specialist shall participate in regularly scheduled interdisciplinary staff meetings as needed.

**History**
- *SOURCE: Mississippi Code Annotated §41-125-19*

##### **15 Miss. Admin. Code Pt. 16, R. 2.11.6** Rule 2.11.6 {#sec-16-2.11.6 omnilex-key=us-ms-regs-official--title-15--16#2.11.6}

A program for parent(s) and/or guardian(s) shall be provided to prepare parent(s) or guardian(s) to accommodate the child’s needs as needed.

**History**
- *SOURCE: Mississippi Code Annotated §41-125-19*

##### **15 Miss. Admin. Code Pt. 16, R. 2.11.7** Rule 2.11.7 {#sec-16-2.11.7 omnilex-key=us-ms-regs-official--title-15--16#2.11.7}

The PPEC center shall assist parent(s) and guardian(s) by including them in care- related conferences and teaching them how to perform necessary therapies and how to meet the developmental and psychosocial needs of the child at home.

**History**
- *SOURCE: Mississippi Code Annotated §41-125-19*

##### **15 Miss. Admin. Code Pt. 16, R. 2.11.8** Rule 2.11.8 {#sec-16-2.11.8 omnilex-key=us-ms-regs-official--title-15--16#2.11.8}

PPEC center staff shall make referrals to appropriate resources, facilitate access to community, social, educational and financial services, and shall provide assistance to enhance coping skills, interpersonal; relationships and family functioning.

**History**
- *SOURCE: Mississippi Code Annotated §41-125-19*

##### **15 Miss. Admin. Code Pt. 16, R. 2.12.1** Subchapter 12 Educational Services {#sec-16-2.12.1 omnilex-key=us-ms-regs-official--title-15--16#2.12.1}

The PPEC center shall provide evidence of a good-faith effort in assuring the development of a comprehensive educational program for each school-aged child to meet the identified educational needs of the child. The PPEC center may enter into a contractual relationship with the local school system to assure that these services are met and provided accordingly.

**History**
- *SOURCE: Mississippi Code Annotated §41-125-19*

##### **15 Miss. Admin. Code Pt. 16, R. 2.12.2** Rule 2.12.2 {#sec-16-2.12.2 omnilex-key=us-ms-regs-official--title-15--16#2.12.2}

Each child, after being determined appropriate for educational services based on a comprehensive assessment, shall have a comprehensive individualized educational plan (IEP). Such plan shall be based upon the assessed needs of the child and shall be developed in coordination with PPEC center staff. If a child is on an IEP, the educational teacher /instructor shall participate in the child’s overall IEP and review.

**History**
- *SOURCE: Mississippi Code Annotated §41-125-19*

##### **15 Miss. Admin. Code Pt. 16, R. 2.12.3** Rule 2.12.3 {#sec-16-2.12.3 omnilex-key=us-ms-regs-official--title-15--16#2.12.3}

The PPEC center shall provide a room, space or adequate workspace, well lighted and equipped with general supplies such as tables, desks, chalkboard/whiteboard, etc. to be conducive to such specialized educational learning. The PPEC center may request parent or the local school system participation in the purchase of books, routine schools supplies, etc., necessary for their child’s day-to-day school activities.

**History**
- *SOURCE: Mississippi Code Annotated §41-125-19*

##### **15 Miss. Admin. Code Pt. 16, R. 2.12.4** Rule 2.12.4 {#sec-16-2.12.4 omnilex-key=us-ms-regs-official--title-15--16#2.12.4}

For children needing or receiving educational instruction, the educational instructor/teacher shall participate as part of the interdisciplinary team to assure coordination of the child’s care and services with the scheduled educational component of activities. The PPEC center will provide an area to post the calendar and school related information bulletins. The instructor shall document

in the child’s school record the progress of the child. A duplicate copy shall be maintained o the PPEC center premises at all times.

**History**
- *SOURCE: Mississippi Code Annotated §41-125-19*

##### **15 Miss. Admin. Code Pt. 16, R. 2.13.1** Subchapter 13 Nutrition Services {#sec-16-2.13.1 omnilex-key=us-ms-regs-official--title-15--16#2.13.1}

A registered dietician shall be available for consultation regarding the nutritional needs and special diets of individual children.

**History**
- *SOURCE: Mississippi Code Annotated §41-125-19*

##### **15 Miss. Admin. Code Pt. 16, R. 2.13.2** Rule 2.13.2 {#sec-16-2.13.2 omnilex-key=us-ms-regs-official--title-15--16#2.13.2}

If the PPEC center serves food to the children, a Certified Food Service Manager, who works under the consulting registered dietician, shall be available and responsible for overseeing dietary services. All physician-prescribed meals, snacks, special diets and dietary supplements shall meet the daily nutritional requirements of the child as ordered.

**History**
- *SOURCE: Mississippi Code Annotated §41-125-19*

##### **15 Miss. Admin. Code Pt. 16, R. 2.13.3** Rule 2.13.3 {#sec-16-2.13.3 omnilex-key=us-ms-regs-official--title-15--16#2.13.3}

If a child has a specific allergy to foods or is on a special diet, PPEC center staff shall be notified and the such allergies notated as part of the child’s medical record.

**History**
- *SOURCE: Mississippi Code Annotated §41-125-19*

##### **15 Miss. Admin. Code Pt. 16, R. 2.13.4** Prepared foods shall be kept under refrigeration with identifying dates and the child’s name {#sec-16-2.13.4 omnilex-key=us-ms-regs-official--title-15--16#2.13.4}

**History**
- *SOURCE: Mississippi Code Annotated §41-125-19*

##### **15 Miss. Admin. Code Pt. 16, R. 2.13.5** Rule 2.13.5 {#sec-16-2.13.5 omnilex-key=us-ms-regs-official--title-15--16#2.13.5}

If the PPEC center prepares meals, per menu, for the children, a copy of the menus to include substitutions available must be posted in a place accessible to the parents and be made available for parental review.

**History**
- *SOURCE: Mississippi Code Annotated §41-125-19*

##### **15 Miss. Admin. Code Pt. 16, R. 2.14.1** Subchapter 14 Transportation Services {#sec-16-2.14.1 omnilex-key=us-ms-regs-official--title-15--16#2.14.1}

If transportation services are provided by a PPEC center and prescribed by the primary care or subspecialist physician, a procedure delineating personnel and equipment to accompany the child shall be included in the PPEC center procedure manual. PPEC center policy and procedure shall clearly state, regardless of the transportation provision, if the child is to be under the care of the PPEC center, the PPEC center is responsible for the safety of the children.

1. If the PPEC Center provides transportation of the child to and from the center; the PPEC center shall exercise best efforts to limit the time a child, regardless of his/her region of origin, may be in transport, not to exceed an average of one hour on any single trip.

**History**
- *SOURCE: Mississippi Code Annotated §41-125-19*

##### **15 Miss. Admin. Code Pt. 16, R. 2.14.2** All children shall be properly restrained whenever they are being transported in a motor vehicle {#sec-16-2.14.2 omnilex-key=us-ms-regs-official--title-15--16#2.14.2}

1. Every person transporting a child under the age of four (4) in a passenger motor vehicle and operated on a public roadway, street or highway, shall provide for the protection of the child by properly using a child passenger restraint device or system meeting applicable federal motor vehicle safety standards, i.e., child safety seat.

2. Every person transporting a child in a passenger motor vehicle operated on a public roadway, street or highway, shall provide for the protection of the child by using a belt positioned booster seat system meeting applicable federal motor vehicle safety standards if the child is at least four (4) years of age, but less than seven (7) years of age and measures less than four (4) feet nine (9) inches in height or weighs less than sixty-five pounds.

**History**
- *SOURCE: Mississippi Code Annotated §41-125-19*

##### **15 Miss. Admin. Code Pt. 16, R. 2.14.3** An individual seat restraint must be used for each child {#sec-16-2.14.3 omnilex-key=us-ms-regs-official--title-15--16#2.14.3}

The use of an individual seat restraint for two or more children is not allowed.

**History**
- *SOURCE: Mississippi Code Annotated §41-125-19*

##### **15 Miss. Admin. Code Pt. 16, R. 2.14.4** Should the PPEC center provide or contract for transportation, it is incumbent upon the center to assure that: {#sec-16-2.14.4 omnilex-key=us-ms-regs-official--title-15--16#2.14.4}

1. All drivers are appropriately licensed;

2. All vehicles used for the transportation of the PPEC center children have licenses (vehicle tag) and registration; and be registered in the name of the PPEC center and the county in Mississippi where operating and serving children;

3. Insurance adequately covers the transportation of children;

4. A daily sign-in sheet or log is maintained of the children being transported and include the to/from location;

5. A trained medical escort will accompany all children during transport. An additional medical escort shall be required for every six children. The driver of the bus/vehicle cannot serve as a medical escort;

6. Children board and leave from the curbside of the street and/or safely accompanied to the destinations;

7. Upon arrival via transportation to the child’s final destination care of child is relinquished to either a parent/guardian or designated caregiver as authorized by the parent or guardian.

**History**
- *SOURCE: Mississippi Code Annotated §41-125-19*

##### **15 Miss. Admin. Code Pt. 16, R. 2.15.1** Each PPEC center shall develop staff and parent/guardian orientation and training programs {#sec-16-2.15.1 omnilex-key=us-ms-regs-official--title-15--16#2.15.1}

These programs include but are limited to the following:

1. Quarterly staff development/inservice programs appropriate to the category of personnel will be conducted to maintain quality patient care; All staff development programs will be documented; to include date/time, trainer, listing of attendees and a summary of the program content/training. This documentation shall be maintained for a period of three years, unless pertinent to a specific child’s care; then reference to the training shall be maintained as part of the child’s record as long as the child receives the service of the center.

2. Annual pediatric cardiopulmonary resuscitation review and update;

3. New hire orientation to acquaint the employee with the philosophy, organization, program, practices and goals of the PPEC center;

4. Parent orientation to acquaint the parent/guardian to the PPEC center, including philosophy of the center, goals, expectations, not only of staff/caregivers but also of parents (such as expectation that parent and/or guardian participate in the IEP) and services that can be offered and/or expected;

5. Parent/guardian trainings shall be documented in the child’s medical record.

**History**
- *SOURCE: Mississippi Code Annotated §41-125-19*

##### **15 Miss. Admin. Code Pt. 16, R. 2.16.1** A medical record shall be maintained for each child {#sec-16-2.16.1 omnilex-key=us-ms-regs-official--title-15--16#2.16.1}

The medical record shall contain at least the following:

1. All details of the referral, admission, correspondence and papers concerning the child;

2. Entries in the medical record shall be in ink, shall be signed by the authorized personnel, to include name and title/discipline, and shall include at least the following:

a. Physician’s orders;

b. Flow charts of medications and treatments administered;

c. Concise accurate information and initialed case notes reflecting progress toward protocol of care goals achievement or reasons for lack of progress;

d. Documentation of nutritional management and special diets, as appropriate;

e. Documentation of nursing, physical, occupational, speech, respiratory and social service assessments, goals, treatment plans, documentation of each treatment, to include date, time and therapy/treatments provided and progress of the child;

f. An individualized protocol of care developed within ten (10) working days of admission and revised, as necessary, to include recommended changes in the therapeutic plan. The disposition to be followed in the event of emergency situations shall be specified in the plan of care;

g. Medical history to include allergies and special precautions;

h. Immunization record;

i. Quarterly reviews of the protocol of care to update the plan in consultation with other professionals involved in the child’s care;

j. A discharge order, written by the primary care or subspecialist physician, shall be documented and entered in the child’s record. A discharge summary, which includes the reason for discharge, shall also be included.

**History**
- *SOURCE: Mississippi Code Annotated §41-125-19*

##### **15 Miss. Admin. Code Pt. 16, R. 2.17.1** Infection Control Procedures {#sec-16-2.17.1 omnilex-key=us-ms-regs-official--title-15--16#2.17.1}

Each PPEC center shall have written infection control procedures to include at least the following:

1. The PPEC center shall contain an isolation room with one large glass area for observation of the child. Isolation procedures shall be used to prevent cross-

contamination. The room shall be equipped with emergency outlets and equipment as necessary to provide are to the child. A bathroom accessible to the isolation room but separate from the other PPEC center’s rooms is required. Procedures must address that all equipment must be thoroughly cleaned and sanitized when brought into the isolation room and upon removal from the room;

2. All cribs and beds shall be labeled with the individual child’s name. Linens are to be maintained clean and in good repair and shall be removed for laundering whenever soiled or needed; however, laundering of all linens shall occur, at a minimum, on a weekly basis;

3. Antibacterial soap and disposable paper towels shall maintained at each sink. Policy shall address that staff shall wash their hands between each treatment and care interaction with a child for which the hands may become contaminated/soiled;

4. Children suspected of having a communicable disease, which may be contacted through casual contact, as determined by the facility’s medical director, shall be isolated; the parent(s) shall be notified of the condition; and the child shall be removed from the PPEC center as soon as possible. When the communicable disease is no longer present; as written by a written physician’s statement, the child may return to the PPEC center; and

5. PPEC center staff suspected of having a communicable disease shall not return to the PPEC center until all signs and symptoms which relate to the communicable disease are no longer evident, as evidenced by a written physician’s statement.

**History**
- *SOURCE: Mississippi Code Annotated §41-125-19*

##### **15 Miss. Admin. Code Pt. 16, R. 2.18.1** Subchapter 18 Quality Assurance {#sec-16-2.18.1 omnilex-key=us-ms-regs-official--title-15--16#2.18.1}

The PPEC center shall have a quality assurance program and will conduct quarterly reviews of the PPEC center’s medical records for at least one-half (1/2) of the children served by the PPEC center at the time of the quality assurance review.

**History**
- *SOURCE: Mississippi Code Annotated §41-125-19*

##### **15 Miss. Admin. Code Pt. 16, R. 2.18.2** The quality assurance review will be conducted by, at a minimum, two members of the quality assurance committee {#sec-16-2.18.2 omnilex-key=us-ms-regs-official--title-15--16#2.18.2}

The quality assurance responsibilities shall rotate among the quality assurance committee at least on an annual basis.

**History**
- *SOURCE: Mississippi Code Annotated §41-125-19*

##### **15 Miss. Admin. Code Pt. 16, R. 2.18.3** Each quarterly quality assurance review shall include: {#sec-16-2.18.3 omnilex-key=us-ms-regs-official--title-15--16#2.18.3}

1. A review of the protocols in each child’s Protocol of Care to assure that it clearly reflects the assessed needs of the child, to include but not be limited to, the evaluation, goals/expectation, treatment modalities and care provided, by each professional discipline serving the child;

2. A review of the steps, process, and success in achieving the goals;

3. Identification of goals not being achieved as expected, reasons for lack of achievement and plans to promote goal achievement;

4. When a child’s clinical status changes, either improvement or decline, that the protocol of care is revised to accommodate the child’s change in status as evidence by revised professional assessments and re-formulation of goals;

5. Within ten days of the review, the quality assurance committee will meet, discuss and ratify the report. Within fifteen days of the review, the quality assurance committee shall furnish copies of its report to the PPEC center medical and nursing directors.

6. The PPEC center shall develop a corrective action plan for each area in which the center failed to meet the established expectations and goals and shall assure implementation of measures, as appropriate, for correction of any deficient area. PPEC center management, to include the medical director and the director of nursing, shall sign the quality assurance report indicating awareness of the deficient findings and shall insure that measures are put into place to correct any deficient practice and/or to prevent the reoccurrence of any such practice.

**History**
- *SOURCE: Mississippi Code Annotated §41-125-19*

##### **15 Miss. Admin. Code Pt. 16, R. 2.19.1** Subchapter 19 Equipment {#sec-16-2.19.1 omnilex-key=us-ms-regs-official--title-15--16#2.19.1}

Each PPEC center shall maintain an age and developmentally appropriate environment including but not limited to furnishings, equipment, adaptive devices and indoor/outdoor therapeutic play/educational equipment and supplies, etc. At the time of request for initial licensure, the PPEC center shall have the capability with regard to furnishings, equipment, adaptive devices and indoor/outdoor therapeutic play/educational equipment and supplies, etc to provide services to the children for the licensure capacity requested.

**History**
- *SOURCE: Mississippi Code Annotated §41-125-19*

##### **15 Miss. Admin. Code Pt. 16, R. 2.19.2** Each PPEC center shall provide safety, medical and emergency equipment as described below {#sec-16-2.19.2 omnilex-key=us-ms-regs-official--title-15--16#2.19.2}

All equipment shall be maintained in a safe, usable and sanitary condition.

**History**
- *SOURCE: Mississippi Code Annotated §41-125-19*

##### **15 Miss. Admin. Code Pt. 16, R. 2.19.3** Rule 2.19.3 {#sec-16-2.19.3 omnilex-key=us-ms-regs-official--title-15--16#2.19.3}

Each full size infant crib shall meet the construction standards as established in Federal Regulations 16 CFR 1219 or its successor regulation. Each non-full size infant crib shall meet the construction standards as established in Federal Regulations 16 CFR 1220 or its successor regulations. Pediatric hospital beds with rails, age appropriate elevated cots or toddler beds are permissible in the PPEC center. The PPEC center shall have documentation/specifications that cribs, beds and cots used in the center meets the stated federal construction and/or child safety standards as applicable. The use of stackable cribs and rest mats are prohibited.

**History**
- *SOURCE: Mississippi Code Annotated §41-125-19*

##### **15 Miss. Admin. Code Pt. 16, R. 2.19.4** Safety equipment {#sec-16-2.19.4 omnilex-key=us-ms-regs-official--title-15--16#2.19.4}

The following items of safety equipment shall be available on the premises:

1. Fire Code Items: extinguishers, alarms, smoke detectors as required by “Life Safety Code” (NFPA 2000 Edition, at a minimum) which references, but is not limited to:

a. Circuit interrupters;

b. Flush door openers;

c. Child proof latches on closets, cabinets;

d. Straps on all highchairs, swings, infant seats;

e. Locks on storage cabinets housing hazardous/poisonous materials;

f. Integral child proof safety outlets or electrical outlet covers.

**History**
- *SOURCE: Mississippi Code Annotated §41-125-19*

##### **15 Miss. Admin. Code Pt. 16, R. 2.19.5** Medical Equipment/Supplies {#sec-16-2.19.5 omnilex-key=us-ms-regs-official--title-15--16#2.19.5}

The following items at a minimum, shall be available on the premises:

1. Suction machines-one per child requiring daily suctioning plus one suctioning machine for emergency use;

2. Double lockable narcotic cabinet;

3. Mechanical percussors and hand percussors, as prescribed;

4. Oxygen-in two portable tanks in storage carts (one with low flow, one with high flow regulator), two Oxygen concentrators (one with low flow, one with high flow regulator) or piped in with the appropriate tubing, neonate/infant, pediatric and adult manual resuscitation devices with masks to accommodate faces and tracheotomies;

5. Ventilator with provisions for mixing of gases to prescribed oxygen concentration as specifically prescribed shall be available per child requiring mechanical ventilation in the PPEC center;

6. Pulse oximeter with supplies;

7. Electronice Blood Pressure machine (Dinamap);

8. First Aid supply kit;

9. Thermometers-excluding glass thermometers, manual sphygmomanometers, stethoscopes, otoscopes, and ophthalmoscopes;

10. Apnea monitoring supplies-belts, leads to apply to monitors brought from home; and

11. Disposable supplies, to include but not be limited to, gloves, scissors, and other disposable equipment needed by the child or by staff in the care of the child, shall be on hand at the PPEC center, as needed.

**History**
- *SOURCE: Mississippi Code Annotated §41-125-19*

##### **15 Miss. Admin. Code Pt. 16, R. 2.19.6** Emergency Equipment and Supplies {#sec-16-2.19.6 omnilex-key=us-ms-regs-official--title-15--16#2.19.6}

At least the following items of emergency equipment and supplies shall be available on the premises:

1. Centers shall equip the building with an emergency generating system; Level 1, Type 10 or equivalent in accordance with current NFPA 110 Standard for Emergency and Standby Power Systems; with adequate generating power to maintain full power to the building in the case of power failure;

2. Basic emergency equipment, including but not limit to:

a. Airways - in a range of sizes appropriate for the children served;

b. Suction catheters-in a range of sizes as necessary to meet the needs of each child served;

c. Pediatric manual resuscitators - self-inflating, with preemie, infant and pediatric mask (and adult resuscitators/mask available, if older, more developed children accepted);

d. Pediatric AED device;

e. Child oxygen mask;

f. Infant oxygen mask;

g. Oxygen regulator with mist bottle and heating element;

h. Flashlight with extra batteries;

i. Stethoscope;

j. Feeding tubes – in a range of appropriate sizes for the children being served;

k. Disposable syringes, needles with size needles appropriate for the pediatric population and other children being served;

l. Intravenous catheters, angio-catheters an scalp vein needles in a range of appropriate pediatric sizes (sizes as appropriate for each child being served);

m. Tourniquets; armboards for preemie, infant and children being served, IV starting supplies, various sizes of adhesive tape;

n. Two-way stopcocks;

o. Two electrical outlet adapters for three-prong outlets;

p. Betadine preps and alcohol supplies.

**History**
- *SOURCE: Mississippi Code Annotated §41-125-19*

##### **15 Miss. Admin. Code Pt. 16, R. 2.19.7** Fluids/Medications {#sec-16-2.19.7 omnilex-key=us-ms-regs-official--title-15--16#2.19.7}

Basic drugs and solutions shall be on-site, available and accessible to medical/nursing staff, at all times:

1. Epinephrine (ampules, vials, or syringes) - 2 each of 1:1000 and 1:10,000;

2. Dextrose (vials or syringes) 1 each of a) 25% solutions and b) 50% solutions;

3. Activated Charcoal (1);

4. Sterile Water (vials or syringes) – 2;

5. Normal Saline (vials or syringes) – 2;

6. Intravenous fluids of Dextrose 5% and 10% in water, Dextrose 5% in Lactated Ringers, Normal Saline---500 cc/bag (2 each);

7. Heparin 10 units – 2 (vials or syringes), Heparin 100unit – 2 (vials or syringes);

8. Diphenhydramine (Benadryl 50mg/ml) – 1 (vials or syringes).

**History**
- *SOURCE: Mississippi Code Annotated §41-125-19*

##### **15 Miss. Admin. Code Pt. 16, R. 2.20.1** Construction {#sec-16-2.20.1 omnilex-key=us-ms-regs-official--title-15--16#2.20.1}

For any existing construction, as of the date of this standard, shall meet, at a minimum, NFPA 101 Life Safety Code, current edition and the FGI (Facility Guidelines Institute) Guidelines for Design and Construction of Health Care Facilities. In the event of the construction of a new PPEC center or substantial modification of an existing facility, any subsequent edition of NFPA, Life Safety Code may be used, provided the licensing agency approve the use of such edition and that all construction and/or modifications meet the requirements of the approved edition.

1. The construction of the building should be a free-standing building.

2. Automatic Sprinklers Required. Facilities shall be protected throughout by a supervised automatic sprinkler system installed in accordance with the current edition of NFPA 13, Installation of Sprinkler Systems.

3. Fire Code Items:

a. Fire extinguishers in accordance with current edition NFPA 10, Standard for Portable Fire Extinguishers.

b. Fire alarms and smoke detectors in accordance with current edition of NFPA 72, National Fire Alarm Code

**History**
- *SOURCE: Mississippi Code Annotated §41-125-19*

##### **15 Miss. Admin. Code Pt. 16, R. 2.20.2** The PPEC center at a minimum shall include the following programmatic design elements: {#sec-16-2.20.2 omnilex-key=us-ms-regs-official--title-15--16#2.20.2}

1. Separate Quiet Rooms for each age group served. These rooms shall be separate and distinct from play areas and shall contain appropriate sleep furnishings that

are readily available. Quiet rooms should be equipped with blinds or other means of controlling the amount of light;

2. Nutritional and food prep area;

3. Age appropriate toileting facilities;

4. Indoor and outdoor recreational exercise play areas, with each exercise play area maintaining 35 square feet per licensed child. Outdoor play areas should be of appropriate surface and conform to the US Consumer Product Safety Commission Public Playground Safety Handbook. In addition, outdoor play areas should have covered areas for protection from sun;

5. Treatment room with med prep area, containing lockable storage;

6. Isolation room containing an observation window as well as a window to the outside, allowing for natural light, with a dedicated toilet room.

7. Clean and dirty storage rooms, separate and distinct;

8. Janitorial closet;

9. Biohazard closet;

10. Therapy/education/activity learning lab areas, separate and distinct;

11. Laundry room;

12. General storage rooms; for equipment, wheelchairs, etc.;

13. Staff area;

14. Reception area;

15. Administrative office;

16. Separate guest and child entrances. In addition, child vehicular drop off areas should be covered; and the size of the covering should be large enough to protect from inclement weather;

17. Maximum Occupant Load for the building shall be calculated based on 100 gross square feet per person to include staff and each child.

18. Milieu containing finishes and furnishings, in texture and color, which support child development, and the specific activities and services conducted in the PPEC center.

**History**
- *SOURCE: Mississippi Code Annotated §41-125-19*

##### **15 Miss. Admin. Code Pt. 16, R. 2.20.3** SUBMISSION OF PLANS AND SPECIFICATIONS {#sec-16-2.20.3 omnilex-key=us-ms-regs-official--title-15--16#2.20.3}

Construction shall not be started for any institution subject to these standards (whether new or remodeling or additions to an existing licensed PPEC) until the plans and specifications for such construction or remodeling have been submitted to the Licensing Agency in writing and its approval of the changes given in writing.

1. Exception: Foundation changes made necessary by unanticipated conditions, or any conditions which present a hazard to life or property if not immediately corrected.

**History**
- *SOURCE: Mississippi Code Annotated §41-125-19*

##### **15 Miss. Admin. Code Pt. 16, R. 2.20.4** Rule 2.20.4 {#sec-16-2.20.4 omnilex-key=us-ms-regs-official--title-15--16#2.20.4}

Plans and specifications for any substantial construction or remodeling shall be prepared by competent architects and engineers licensed to practice in the state and who assume responsibility for supervising the construction. The following plans shall be submitted to the Licensing Agency for review:

1. Preliminary Plans - To include schematics of buildings, plot plans showing size and shape of entire site, existing structures, if any, streets and location and characteristics of all needed utilities, floor plans of every floor dimensioned and with proposed use of each room or area shown and gross area calculations as defined by current edition NFPA 101 Life Safety Code. If for additions or remodeling, provide plan or of existing building showing all proposed alterations, outline specifications to include a general description of the construction, type of finishes, and type of heating, ventilating, plumbing and electrical systems proposed. 2. Final Working Drawings and Specifications - Complete and in sufficient detail to be the basis for the award of construction contracts.

**History**
- *SOURCE: Mississippi Code Annotated §41-125-19*

##### **15 Miss. Admin. Code Pt. 16, R. 2.20.5** Rule 2.20.5 {#sec-16-2.20.5 omnilex-key=us-ms-regs-official--title-15--16#2.20.5}

All plans submitted for review must be accompanied in their first submission by an order of the governing board indicating the type and scope of license to be applied for.

**History**
- *SOURCE: Mississippi Code Annotated §41-125-19*

##### **15 Miss. Admin. Code Pt. 16, R. 2.20.6** Rule 2.20.6 {#sec-16-2.20.6 omnilex-key=us-ms-regs-official--title-15--16#2.20.6}

Plans receiving approval of the Licensing Agency upon which construction has not begun within six (6) months following such approval must be resubmitted for approval.

**History**
- *SOURCE: Mississippi Code Annotated §41-125-19*

##### **15 Miss. Admin. Code Pt. 16, R. 2.20.7** Rule 2.20.7 {#sec-16-2.20.7 omnilex-key=us-ms-regs-official--title-15--16#2.20.7}

In all new facilities, plans must be submitted to all regulatory agencies, such as the County Health Department, etc., for approval assuring proper water/sewer connectivity/facilities prior to starting construction.

**History**
- *SOURCE: Mississippi Code Annotated §41-125-19*

##### **15 Miss. Admin. Code Pt. 16, R. 2.20.8** Rule 2.20.8 {#sec-16-2.20.8 omnilex-key=us-ms-regs-official--title-15--16#2.20.8}

Upon completion of construction, an inspection shall be made by the Licensing Agency and approval given prior to occupying the building or any part thereof. The state and county health departments shall have access to the job site during regular business hours and shall conduct construction progress inspections as deemed necessary by the agency.

**History**
- *SOURCE: Mississippi Code Annotated §41-125-19*

##### **15 Miss. Admin. Code Pt. 16, R. 2.20.9** Zoning Restrictions {#sec-16-2.20.9 omnilex-key=us-ms-regs-official--title-15--16#2.20.9}

The locations of a center shall comply with all local zoning ordinances.

**History**
- *SOURCE: Mississippi Code Annotated §41-125-19*

##### **15 Miss. Admin. Code Pt. 16, R. 2.20.10** Access {#sec-16-2.20.10 omnilex-key=us-ms-regs-official--title-15--16#2.20.10}

Institutions located in rural areas shall be served by good roads which can be kept passable at all times.

**History**
- *SOURCE: Mississippi Code Annotated §41-125-19*

##### **15 Miss. Admin. Code Pt. 16, R. 2.20.11** Elevators {#sec-16-2.20.11 omnilex-key=us-ms-regs-official--title-15--16#2.20.11}

One power driven elevator is required in all centers having children’s rooms, playrooms or classrooms above the first floor. Minimum cab dimensions required for elevators transporting children is 76" x 50" inside clear measurements; hatchway and cab doors 3'8" wide, minimum.

**History**
- *SOURCE: Mississippi Code Annotated §41-125-19*

##### **15 Miss. Admin. Code Pt. 16, R. 2.20.12** Heating and Ventilation {#sec-16-2.20.12 omnilex-key=us-ms-regs-official--title-15--16#2.20.12}

A draft free seasonally appropriate temperature of 65 degrees Fahrenheit to 78 degrees Fahrenheit shall be maintained.

**History**
- *SOURCE: Mississippi Code Annotated §41-125-19*

##### **15 Miss. Admin. Code Pt. 16, R. 2.21.1** Subchapter 21 Emergency Operations Plan {#sec-16-2.21.1 omnilex-key=us-ms-regs-official--title-15--16#2.21.1}

The PPEC center shall develop and maintain a written preparedness plan utilizing the “All Hazards” approach to emergency and disaster planning. The plan must include procedures to be flowed in the event of any act of terrorism or man-made or natural disaster as appropriate for the specific geological location. The final draft of the Emergency Operations Plan (EOP) will be reviewed by the Office of Emergency Preparedness and Response, Mississippi State Department of Health, or their designees, for conformance with the “All Hazards Emergency

Preparedness and Response Plan. Particular attention shall be given to critical areas of concern which may arise during any “all hazards” emergency whether required to evaluate or to sustain in place. Additional plan criteria or a specific ECP format may be required as deemed necessary by the Office of Emergency Preparedness and Response. The six critical areas of consideration are:

1. Communications - Facility status report shall be submitted in a format and a frequency as required by the Office of EOP;

2. Resources and Assets;

3. Safety and Security;

4. Staffing;

5. Utilities;

6. Clinical Activities.

**History**
- *SOURCE: Mississippi Code Annotated §41-125-19*

##### **15 Miss. Admin. Code Pt. 16, R. 2.21.2** Rule 2.21.2 {#sec-16-2.21.2 omnilex-key=us-ms-regs-official--title-15--16#2.21.2}

Emergency Operations Plans (EOPs) must be exercised and reviewed annually or as directed by the office of Emergency Preparedness and Response. Written evidence of current approval or review of provider EOPs, by the Office of Emergency Preparedness and Response, shall accompany all applications for facility license renewals.

**History**
- *SOURCE: Mississippi Code Annotated §41-125-19*

##### **15 Miss. Admin. Code Pt. 16, R. 2.22.1** Fire Drills {#sec-16-2.22.1 omnilex-key=us-ms-regs-official--title-15--16#2.22.1}

Fire drills shall be conducted one (1) per shift per quarter. Employees shall participate in a fire drill at least four time per year.

**History**
- *SOURCE: Mississippi Code Annotated §41-125-19*

##### **15 Miss. Admin. Code Pt. 16, R. 2.22.2** Written Records {#sec-16-2.22.2 omnilex-key=us-ms-regs-official--title-15--16#2.22.2}

Written records of all fire drills shall be maintained, indicating content of and attendance at each drill.

**History**
- *SOURCE: Mississippi Code Annotated §41-125-19*

##### **15 Miss. Admin. Code Pt. 16, R. 2.22.3** A fire evacuation plan shall be posted in each facility in a conspicuous place and kept current {#sec-16-2.22.3 omnilex-key=us-ms-regs-official--title-15--16#2.22.3}

Chapter 3 Minimum Standards of Operation of Pediatric Skilled Nursing Facilities Subchapter 1 General: Legal Authority

**History**
- *SOURCE: Mississippi Code Annotated §41-125-19*

##### **15 Miss. Admin. Code Pt. 16, R. 3.1.1** Authority {#sec-16-3.1.1 omnilex-key=us-ms-regs-official--title-15--16#3.1.1}

By virtue of authority vested in it by Mississippi Code Annotated, §43-13-117, or as otherwise amended, the Mississippi State Department of Health (MSDH, otherwise known as the licensing agency), has the authority and powers, as necessary, to promulgate and adopt the following rules, regulations and standards governing and to license and regulate Pediatric Skilled Nursing Facilities in the State of Mississippi.

**History**
- *SOURCE: Mississippi Code Annotated §43-13-117*

##### **15 Miss. Admin. Code Pt. 16, R. 3.1.2** Procedures Governing Amendments {#sec-16-3.1.2 omnilex-key=us-ms-regs-official--title-15--16#3.1.2}

The rules, regulations and minimum standards for Pediatric Skilled Nursing Facilities may be amended by the licensing agency from time to time as necessary to promote the health, safety and welfare of the children being served and to assure that centers provide the necessary family-centered medical, developmental, psychological, nutritional, psychological and family training services.

**History**
- *SOURCE: Mississippi Code Annotated §43-13-117*

##### **15 Miss. Admin. Code Pt. 16, R. 3.1.3** Inspections Required {#sec-16-3.1.3 omnilex-key=us-ms-regs-official--title-15--16#3.1.3}

No Pediatric Skilled Nursing Facility shall operate without a license. No Pediatric Skilled Nursing Facility shall be licensed without being inspected and having achieved compliance with the rules, regulations and standards as set forth in this minimum standard. Each Pediatric Skilled Nursing Facility for which a license has been issued shall be inspected by the Mississippi State Department of Health or by persons delegated with authority by said Mississippi State Department of Health at such interval that the Department may direct. Mississippi State Department of Health and/or its authorized representatives shall have the right to inspect construction work in progress. The Pediatric Skilled Nursing Facility shall provide Mississippi State Department of Health unrestricted access to the center, children and clinical/medical records as necessary to verify compliance with said rules and regulations.

**History**
- *SOURCE: Mississippi Code Annotated §43-13-117*

##### **15 Miss. Admin. Code Pt. 16, R. 3.2.1** General {#sec-16-3.2.1 omnilex-key=us-ms-regs-official--title-15--16#3.2.1}

A listing of terms often used in connection with the rules and regulations and standards follows:

1. Basic Services. Include, but are not limited to development, implementation and monitoring of a comprehensive protocol of care, developed in conjunction with the parent or guardian, which specifies the medical, nursing, psychosocial and developmental therapies required by the medically dependent or technologically

dependent child served as well as the caregiver training needs of the child’s legal guardian.

2. Child Development Specialist. Shall mean an individual with a master’s degree in child development or a related field with at least one year of experience in trans- disciplinary evaluation and treatment planning for children who are at risk of experiencing developmental delay.

3. Child Life Specialist. Shall mean an individual with a baccalaureate degree in child life, early childhood education or a related field and at least one year of experience in planning and implementing developmental stimulation programs for children.

4. Criminal History Record Check. For purposes of the requirement for a criminal history record check:

a. Employee -For the purpose of fingerprinting and criminal background history checks, employee shall mean any individual employed by a covered entity. The term “employee” also includes any individual who by contract with a covered entity provides patient care in a patient’s, resident’s, or client’s room or in treatment rooms provides direct care/services for clients currently enrolled in the Pediatric Skilled Nursing Facility.

b. The term employee does not include healthcare professional/ technical students, as defined in Section 37-29-232, performing clinical training in a licensed entity under contracts between their schools and the licensed entity, and does not include students at high schools who observe the treatment and care of patients in a licensed entity as part of the requirements of an allied health course taught in the school if:

i. The student is under the supervision of a licensed healthcare provider; and

ii. The student has signed the affidavit that is on file at the student’s school stating that he or she has not been convicted of or plead guilty or nolo contendere to a felony of possession or sale of drugs, murder, manslaughter, armed robbery, rape, sexual battery, any sex offenses listed in section 45-33-23 (g), child abuse, arson, grand larceny, burglary, gratification of lust, aggravated assault, or felonious abuse and/or battery of a vulnerable adult, or that any such conviction or plea was reversed on appeal or a pardon was granted for the conviction or plea.

iii. Further, applicants and employees of the University of Mississippi Medical Center for whom criminal history record checks and

fingerprinting are obtained in accordance with Section 37-115-41 are exempt from application of the term employee.

c. Covered Entity - For the purpose of criminal history record checks, “covered entity” means a licensed entity or a healthcare professional staffing agency.

d. Licensed Entity - For the purpose of criminal history record checks, the term “licensed entity” means a hospital, nursing home, personal care home, home health agency, hospice, PPEC or a Pediatric Skilled Nursing Facility.

e. Health Care Professional/Vocational Technical Academic Program - For purpose of criminal history record checks, “health care professional/vocational technical academic program” means an academic program in medicine, nursing, dentistry, occupational therapy, physical therapy, social services, speech therapy, or other allied-health professional whose purpose is to prepare professionals to render patient care services.

f. Health Care Professional/Vocational Technical Student - For purposes of criminal history record checks, the term means a student enrolled in a healthcare professional/vocational technical academic program.

g. Direct Patient Care or Services - For the purposes of fingerprinting and criminal background history checks, the term “direct patient care” means direct hands-on medical patient care and services provided by an individual in a patient, resident or client’s room, treatment room, recovery room or Pediatric Skilled Nursing Facility. Individuals providing direct patient care may be directly employed by the facility or provides patient care on a contractual basis.

h. Documented Disciplinary Action - For the purpose of fingerprinting and criminal background history checks, the term “documented disciplinary action” means any action taken against an employee for abuse or neglect of a patient.

5. Direct Care Staff. For the purposes of these minimum standards, direct care staff shall include certified nursing assistants, patient care technicians, medical assistants, emergency medical technician (EMT), play assistants or any individual with training and experience in child care related fields.

6. Functional Assessment. Refers to an evaluation of the child’s abilities and needs related to self-care, communication skills, social skills, motor skills, academic areas, play with toys or objects, growth and development appropriate for age.

7. License. Shall mean the document issued by the Mississippi State Department of Health and signed by the State Health Officer. Licensure shall constitute authority to receive patients and perform the services included within the scope of these rules, regulations and standards. A license shall be issued only for the location as addressed on the license and is not transferable.

8. Licensee. Shall mean the individual, firm, association, partnership or corporation to whom the license is issued and upon whom rests the responsibility for the operation and all aspects of administrative/regulatory compliance of the Pediatric Skilled Nursing Center.

9. Licensing Agency. Shall mean Mississippi State Department of Health.

10. Medical Director. Shall mean a physician, licensed to practice in the State of Mississippi, certified by the American Board of Pediatrics or the American Osteopathic Board of Pediatrics, who serves as a liaison between the Pediatric Skilled Nursing Facility and the medical community.

11. Medical Records. Shall mean medical records maintained in accordance with acceptable standards and practices as specified by the rules implementing this act.

12. Medically Dependent or Technologically Dependent Child. Shall mean a child, from birth up to 21 years of age who because of a medical condition/disability whether acute, chronic or intermittent in nature requires on-going physician prescribed, technologically-based skilled nursing supervision and/or requires the routine use of a medical device to compensate for the deficit of life-sustaining body function. (See Aging-in Place under admissions)

13. Nursing Director. Shall mean a licensed registered nurse, licensed in accordance with the Mississippi Nurse Practice Act, who maintains responsibility for providing continuous supervision of the Pediatric Skilled Nursing Facility services and manages the day-to-day operations of the Pediatric Skilled Nursing Facility.

14. Owner or Operator. Shall mean a licensee.

15. Physical Therapist. Shall mean, for purposes of these minimum standards, an individual, licensed in the State of Mississippi, who has at least one year’s experience in evaluating and designing therapeutic programs for children with developmental disabilities.

16. Premises. Shall mean those buildings, beds, facilities and fenced outdoor recreational/play area located at the main address of the licensee.

17. Pediatric Skilled Nursing Facility. Shall mean any building or buildings, or other place, whether operated for profit or not, which undertakes through its ownership or management to provide basic residential services to three (3) or more medically dependent or technologically dependent children who are not related to the owner or operator by blood, marriage or adoption and who require such services. Infants and children considered for admission to a Pediatric Skilled Nursing Facility must be ventilator dependent or otherwise medically dependant pediatric patients who require medical and nursing care or rehabilitative services;

thus, having complex medical conditions that require continual care. Prerequisites for admission are a prescription from the child’s physician and consent from a parent or guardian.

18. Prescribing Physician. Shall mean the physician, licensed to practice medicine in the State of Mississippi that signs the order admitting the child to the Pediatric Skilled Nursing Facility.

19. Primary or Subspecialist Physician. Shall mean the physician, licensed to practice medicine in the State of Mississippi, who maintains overall responsibility for the medical management of the child and who is available for consultation and collaboration with the Pediatric Skilled Nursing Facility.

20. Protocol of Care. The comprehensive plan for implementation of medical, nursing, psychosocial, developmental, and education therapies to be provided by the Prescribed Pediatric Skilled Nursing Facility.

21. Psychiatrist. Shall mean, for purposes of these minimum standards, a board- certified psychiatrist, licensed to practice in the State of Mississippi and who has at least two years of experience in child psychology.

22. Psychologist. Shall mean, for purposes of these minimum standards, a licensed individual in Mississippi with doctorial; preparation in child or developmental counseling psychology, or a related field, and at least two years current experience in evaluation and management of children.

23. Quality Assurance (QA) Committee. A group of individuals, including the Pediatric Skilled Nursing Facility Medical Director, Administrator, Director of Nursing, two other healthcare members and at least one consumer member with an interest in Pediatric Nursing Facility services who functions to conduct the duties, as outlined in Subchapter 18 of these minimum standards, which includes but is not limited to, review of medical records, review and approval of policies and procedures, treatment plans/procedures and to evaluate the quality of care provided to children enrolled in the Pediatric Skilled Nursing Facility.

24. Social Worker. Shall mean, for purposes of these minimum standards, an individual, licensed to practice social work in the State of Mississippi, and who has at least one year of experience in assessing, counseling, and planning interventions for children and their families or guardians.

25. Speech Pathologist. Shall mean, for purposes of these minimum standards, an individual who attained a master’s degree in speech-language pathology from an educational institution accredited by the American Speech-Language, Hearing Association, licensed to practice speech-language pathology in the State of Mississippi, and who has at least one year of experience in evaluating and treating children at risk for, or experiencing problems with communication skills.

26. Supportive Services or Contracted Services. Includes but are not limited to speech therapy, occupational therapy, physical therapy, respiratory therapy, social work, developmental, educational services.

**History**
- *SOURCE: Mississippi Code Annotated §43-13-117*

##### **15 Miss. Admin. Code Pt. 16, R. 3.3.1** Authority {#sec-16-3.3.1 omnilex-key=us-ms-regs-official--title-15--16#3.3.1}

Except as provided in Mississippi Code 43-13-117, Section 3 (2), no individual, firm, association, partnership or corporation shall either directly or indirectly operate a Pediatric Skilled Nursing Facility in this state without first applying for and receiving a license from the Mississippi State Department for Health.

**History**
- *SOURCE: Mississippi Code Annotated §43-13-117*

##### **15 Miss. Admin. Code Pt. 16, R. 3.3.2** License {#sec-16-3.3.2 omnilex-key=us-ms-regs-official--title-15--16#3.3.2}

A license, from the Mississippi State Department of Health, is required to operate a Pediatric Skilled Nursing Facility prior to said entity providing services to three or more medically dependent or technologically dependent children who meet the criteria for admissions as stated in the above definitions unless such entity meets the definition/requirement for exemption which reads:

1. A Pediatric Skilled Nursing Facility, institution or other place operated by the federal government or any agency of the federal government are exempt from the provisions of these minimum standards.

2. County-operated or municipally operated Pediatric Skilled Nursing Facility applying for a licensure under Section 43-13-117, Mississippi Code Annotated, are exempt from the payment of licensure fees. Such entities must comply with and meet all other requirements of these minimum standards.

3. Only the official name, as approved by the licensing agency and by which the facility is licensed, shall be used in telephone listings, on stationary, in advertisements, etc.

4. Licensee shall not operate at any given time with a capacity greater than the number of clients on the face of the license.

**History**
- *SOURCE: Mississippi Code Annotated §43-13-117*

##### **15 Miss. Admin. Code Pt. 16, R. 3.3.3** Designation of License {#sec-16-3.3.3 omnilex-key=us-ms-regs-official--title-15--16#3.3.3}

Separate licenses are required for Pediatric Skilled Nursing Facility maintained on separate premises, even though such centers may be operated under the same management. A separate distinct license is required to distinguish entities providing twelve (12) hour care services verses twenty-four

(24) hour services. No Pediatric Skilled Nursing Facility shall co-locate with another facility licensed by the Department.

**History**
- *SOURCE: Mississippi Code Annotated §43-13-117*

##### **15 Miss. Admin. Code Pt. 16, R. 3.3.4** Rules and Regulations {#sec-16-3.3.4 omnilex-key=us-ms-regs-official--title-15--16#3.3.4}

Any individual, firm, association, partnership or corporation operating a Pediatric Skilled Nursing Facility in this state is subject to the requirements of Section 43-13-117 and all requirements as outlined in the Minimum Standards of Operation for Pediatric Skilled Nursing Facilities. The Mississippi State Department of Health has legal authority to promulgate rules and regulations.

**History**
- *SOURCE: Mississippi Code Annotated §43-13-117*

##### **15 Miss. Admin. Code Pt. 16, R. 3.3.5** Application {#sec-16-3.3.5 omnilex-key=us-ms-regs-official--title-15--16#3.3.5}

Application for a license or renewal shall be made on in writing to the licensing agency, on forms provided by the licensing agency, which shall contain information that the licensing agency may require.

**History**
- *SOURCE: Mississippi Code Annotated §43-13-117*

##### **15 Miss. Admin. Code Pt. 16, R. 3.3.6** Fees {#sec-16-3.3.6 omnilex-key=us-ms-regs-official--title-15--16#3.3.6}

The following fees are applicable to Pediatric Skilled Nursing Facilities:

1. Each application for initial licensure or renewal licensure, unless suspended or revoked shall be accompanied by a fee in an amount set by the Board, made payable to the Mississippi State Department of Health by business check, money order, or by electronic means. The fees are not refundable.

2. Applicants for initial licensure, or licensees, shall pay a user fee in an amount set by the Board, and made payable to the Mississippi State Department of Health by business check, money order, or by electronic means. The fee is non- refundable.

**History**
- *SOURCE: Mississippi Code Annotated §43-13-117*

##### **15 Miss. Admin. Code Pt. 16, R. 3.3.7** Name of Facility {#sec-16-3.3.7 omnilex-key=us-ms-regs-official--title-15--16#3.3.7}

Only the official name, as approved by the licensing agency and by which the center is licensed shall be used in telephone listings, on stationary, in advertising, etc.

**History**
- *SOURCE: Mississippi Code Annotated §43-13-117*

##### **15 Miss. Admin. Code Pt. 16, R. 3.3.8** Capacity {#sec-16-3.3.8 omnilex-key=us-ms-regs-official--title-15--16#3.3.8}

Licensees shall not operate at any given time with a capacity greater than the number of clients on the face of the license.

**History**
- *SOURCE: Mississippi Code Annotated §43-13-117*

##### **15 Miss. Admin. Code Pt. 16, R. 3.3.9** Initial Licensure {#sec-16-3.3.9 omnilex-key=us-ms-regs-official--title-15--16#3.3.9}

For initial licensure, an applicant shall be in compliance with all requirements, as outlined in these regulations, and must submit documents, included but not limited to, those outlined below:

1. A completed/signed application, on forms as designated by MSDH. All information submitted on the application forms, or by request for additional information, shall be accurate and current at the time of filing;

2. A non-refundable application/processing fee in an amount set by the Board and made payable to the Mississippi State Department of Health, by business check, money order, or by electronic means. The fee is non-refundable.

3. A Licensing Fee in an amount set by the Board and made payable to the Mississippi State Department of Health by business check, money order, or by electronic means. The fee is non-refundable.

4. Certificates/letters of approval from the local zoning authority indicating that the location of the Pediatric Skilled Nursing Facility conforms to local zoning ordinances, if applicable;

5. Certificates/letters of approval from the local/regional/state Fire Marshal that the Pediatric Skilled Nursing Facility is in compliance with all applicable fire safety standards;

6. Evidence that the Pediatric Skilled Nursing Facility water and sewer systems have been approved by the Mississippi State Department of Health;

7. Copy of the Health Inspection report/approval from the MSDH, office of public health.

8. Certificate of Occupancy;

9. Clinical Laboratory Improvement Amendments (CLIA) certificate or CLIA certificate of waiver.

10. Proof of general and Professional Liability Insurance in the amount of at least $300,000.00 including Workman’s Compensation Insurance;

11. Articles of Incorporation, Disclosure of Ownership and Control Information;

12. Proof of financial viability/contingency plan demonstrating evidence that the applicant processes assets sufficient to establish and sustain all components of a Pediatric Skilled Nursing Facility to meet the provisions as outlined in these regulations while operating and/or during extraordinary circumstances including but not limited to audited financial statements, an established line of credit issued from a federally insured institution in the amount of at least

$100,000.00, a projected twelve (12) month statement of operations and a projected first twelve months statement of cash flow. The requesting Pediatric Skilled Nursing Facility shall provide evidence of the referenced above review in the form of a certified affidavit or statement resultant of a review from an independent certified public accountant firm.

13. That the center is located within 20 miles or 30 minutes (whichever is greater) of an Emergency Department that has capabilities to handle pediatric emergencies;

14. The name of the Pediatric Skilled Nursing Facility’s administrator, manager or supervisor, the name and license number of the Medical Director and Director of Nursing along with proof of available licensed and supportive personnel who will have responsibility for any part of the care given to Pediatric Skilled Nursing Facility’s clients; as well as proof of ancillary support services such as dietary, housekeeping, maintenance and other personnel either directly or contractually secured to support the Pediatric Skilled Nursing Facility on a daily basis;

15. The names and titles of personnel who have been affiliated, during the preceding five (5) years with any other Pediatric Skilled Nursing Facility, through ownership or employment, and the listing of names and addresses of the appropriate Pediatric Skilled Nursing Facility for each. This information shall be provided for the applicant: administrator, manager or supervisor, and all licensed nurses; and

16. Floor sketch or drawing of premises to be licensed, letter of intent and functional plan.

17. Lead Testing Reports. The exterior playground shall be soil tested for lead contamination; soil samples shall be taken from a minimum of four remote locations around the playground and submitted to a certified lead testing laboratory for analysis. If the building was constructed before 1965, a lead hazard screen or lead-based paint risk assessment shall be done by an individual or company certified as a Lead Risk Assessor by the Mississippi Department of Environmental Quality (MDEQ).

18. Asbestos Testing Report. An asbestos survey shall be performed on all existing structures to be converted into a Pediatric Skilled Nursing Facility to assure compliance with Air Emission Regulations for the Prevention, Abatement, and Control of Air Contaminates-APC S-1-Section 8 (state regulation) and National Emission Standards for Hazardous Air Pollutants (NESHAP) – 40CFR Part 62, Subpart M (federal regulation).

**History**
- *SOURCE: Mississippi Code Annotated §43-13-117*

##### **15 Miss. Admin. Code Pt. 16, R. 3.3.10** Approval of Building {#sec-16-3.3.10 omnilex-key=us-ms-regs-official--title-15--16#3.3.10}

Prior to the issuance of a license, the building must be inspected/approved by MSDH, Fire and Life Safety Code Division within Health Facilities Licensure and Certification and approved as being in compliance with all applicable National Fire Protection Association fire safety code standards, as appropriate to this type setting.

**History**
- *SOURCE: Mississippi Code Annotated §43-13-117*

##### **15 Miss. Admin. Code Pt. 16, R. 3.3.11** Licensure Term {#sec-16-3.3.11 omnilex-key=us-ms-regs-official--title-15--16#3.3.11}

Each license issued shall be valid for a period of twelve (12) months and shall be issued for the licensure period from January 1, of each year and shall expire December 31, of the that same year. Should an entity be approved for licensure after the January 1, date for licensure, the licensure date shall reflect the approved date of licensure for this center and will be valid until December 31, of that licensure year. As with all other centers, a renewal applications/documentation pertinent to renewal (see Rule 2.3.9) must be submitted to initiate the licensure process for the next January 1, thru December 31, licensure year.

**History**
- *SOURCE: Mississippi Code Annotated §43-13-117*

##### **15 Miss. Admin. Code Pt. 16, R. 3.3.12** Posting of License {#sec-16-3.3.12 omnilex-key=us-ms-regs-official--title-15--16#3.3.12}

The license shall be posted in a conspicuous place on the licensed premises and shall be available for review by in interested person.

**History**
- *SOURCE: Mississippi Code Annotated §43-13-117*

##### **15 Miss. Admin. Code Pt. 16, R. 3.3.13** License Not Transferable {#sec-16-3.3.13 omnilex-key=us-ms-regs-official--title-15--16#3.3.13}

A Pediatric Skilled Nursing Facility license is for the stated licensee and location as reflected on the license and is not transferable.

**History**
- *SOURCE: Mississippi Code Annotated §43-13-117*

##### **15 Miss. Admin. Code Pt. 16, R. 3.3.14** License Renewal {#sec-16-3.3.14 omnilex-key=us-ms-regs-official--title-15--16#3.3.14}

For renewal, each licensed entity shall submit:

1. A completed and signed renewal application; received on or before 30 days prior to the date of expiration;

2. A renewal licensure Fee in an amount set by the Board and made payable to the Mississippi State Department of Health (MSDH) by business check, money order, or by electronic means. The fee is non-refundable.

3. In a format as requested by MSDH, information designed to capture the entity’s provision of services being provided, to include but not be limited to, number and acuity of infants/children served, number and types of treatments/specialized services provided, and other information that may be useful in determining that services, as outlined in these requirements are offered/met; and

4. Evidence of continued compliance with all building/fire codes as evidence by a copy of the annual inspection by the local Fire Marshall of the area/region where the center is located; and

5. Proof of General and Professional Liability Insurance in the amount of at least $300,000 including Workers Compensation Insurance.

**History**
- *SOURCE: Mississippi Code Annotated §43-13-117*

##### **15 Miss. Admin. Code Pt. 16, R. 3.3.15** Late Fees {#sec-16-3.3.15 omnilex-key=us-ms-regs-official--title-15--16#3.3.15}

Should all documentation appropriate for license renewal not be received by MSDH, Division of Health Facilities Licensure and Certification on or prior to the expiration date of the license, a late fee in the amount set by the Board, will be assessed and must be submitted payable to Mississippi State Department of Health either by business check, money order, or by electronic means, prior to the issuance of a license. Should all paperwork necessary for renewal not be submitted within 30 days post-expiration of the license, the center shall be considered unlicensed and actions taken, as appropriate, to process termination of the license;

**History**
- *SOURCE: Mississippi Code Annotated §43-13-117*

##### **15 Miss. Admin. Code Pt. 16, R. 3.3.16** Rule 3.3.16 {#sec-16-3.3.16 omnilex-key=us-ms-regs-official--title-15--16#3.3.16}

In the case of a change of ownership or a change in Proprietors that constitutes a sale or change of greater that 20% of the assets, the center shall notify the Department and submit all Legal documents/information, as requested, to document that change of ownership and to confirm/verify the operational sustainability of the center.

**History**
- *SOURCE: Mississippi Code Annotated §43-13-117*

##### **15 Miss. Admin. Code Pt. 16, R. 3.3.17** Duty to Report {#sec-16-3.3.17 omnilex-key=us-ms-regs-official--title-15--16#3.3.17}

The licensed entity shall submit, in writing, to MSDH, Division of Licensure and Certification, the following:

1. Change in the administrator, manager/ supervisor, director of nursing services, or the medical director within ten calendar days of the occurrence;

2. All fires, explosions, natural disasters, as well as, avoidable deaths or avoidable, serious, or life-threatening injuries resultant of such fires, explosions or natural disasters shall be reported by telephone to the Life Safety Code and Construction Division of the licensing agency by the next working day of the occurrence. The licensing agency will provide the appropriate forms to the facility which shall be completed and returned within fifteen (15) calendar days of the occurrence. All reports shall be complete, thorough, and shall record at a minimum the causal factors, date and time of the occurrence, exact location of the occurrence, whether inside or outside of the facility, and attached thereto shall be all police, fire, and other official reports.

3. Any incident whereas a child is left alone and unattended, either during the hours of operation of the Pediatric Skilled Nursing Facility, while on a field trip or at an alternate location, by the next working day after the occurrence;

4. Any accident or injury sustained by a child, while the child was under the care of the Pediatric Skilled Nursing Facility that required emergency medical intervention by the next working day after the occurrence.

**History**
- *SOURCE: Mississippi Code Annotated §43-13-117*

##### **15 Miss. Admin. Code Pt. 16, R. 3.3.18** Rule 3.3.18 {#sec-16-3.3.18 omnilex-key=us-ms-regs-official--title-15--16#3.3.18}

Such reports shall contain a clear description of each accident or incident, the names of the persons involved, a description of all medical or other services provided to those persons, specifying who provided such services, and the steps taken, if any, to prevent reoccurrence of such accident or incidents in the future.

**History**
- *SOURCE: Mississippi Code Annotated §43-13-117*

##### **15 Miss. Admin. Code Pt. 16, R. 3.3.19** Management {#sec-16-3.3.19 omnilex-key=us-ms-regs-official--title-15--16#3.3.19}

All applicants for a license to operate a Pediatric Skilled Nursing Facility, whether for initial or for renewal, and the administrator, manager/supervisor and the director of nursing services shall:

1. Be twenty-one years of age or older;

2. Be of good moral character; and

3. Have not been convicted or found guilty, regardless of adjudication, in any jurisdiction, of any felony involving fraud, embezzlement, fraudulent conversion, misappropriation of property, moral turpitude, violence against a person or persons, abuse of a vulnerable adult and/or child; or any act(s) of sexual abuse as outlined in Section 45-33-23(g), Mississippi Code of 1972, Annotated.

**History**
- *SOURCE: Mississippi Code Annotated §43-13-117*

##### **15 Miss. Admin. Code Pt. 16, R. 3.3.20** Evidence of Character and Related History {#sec-16-3.3.20 omnilex-key=us-ms-regs-official--title-15--16#3.3.20}

As documentation for the Department, regarding the requirement for licensure, each applicant(s) for a license to operate a Pediatric Skilled Nursing Facility, whether for initial or renewal, shall submit together, with their application:

1. Two (2) personal character references and two (2) professional character references for the administrator, manager, or supervisor of the Pediatric Skilled Nursing Facility, except on renewal if previously provided to the Department;

2. The criminal record, if any, for himself and the manager, supervisor, director of nursing services of the Pediatric Skilled Nursing Facility, to include the court,

date of conviction, the offense, penalties imposed by each conviction, regardless of adjudication;

3. Any injunctive or restrictive order or federal or state administrative order related to business activity or health care as a result of an action brought by a public agency or department;

4. A copy of current agreements entered into with third party providers; and

5. A copy of current agreements with each consultant employed by the center and documentation specifying frequency of consultative visits and required written, dated reports.

**History**
- *SOURCE: Mississippi Code Annotated §43-13-117*

##### **15 Miss. Admin. Code Pt. 16, R. 3.3.21** Liability Insurance {#sec-16-3.3.21 omnilex-key=us-ms-regs-official--title-15--16#3.3.21}

Facilities shall obtain and keep in force liability insurance. Proof of Professional and General Liability insurance including worker’s compensation insurance must be submitted at the time of application. Liability insurance must cover legal liability for death, injury, or disability of any human being, or for damage of property, with provision for medical, hospital and surgical benefits to the injured person, irrespective of the legal disability of the insured, when issued as a part of the liability insurance contract.

**History**
- *SOURCE: Mississippi Code Annotated §43-13-117*

##### **15 Miss. Admin. Code Pt. 16, R. 3.3.22** Denial, Suspension, Revocation of Licensure, Administrative Fines; Grounds {#sec-16-3.3.22 omnilex-key=us-ms-regs-official--title-15--16#3.3.22}

1. The licensing agency may deny, revoke, and suspend a license and impose an administrative fine as provided in section eight (8) of Section 43-13-117, Mississippi Code of 1972, Annotated, for violation of any provision of this act, or applicable rules.

2. Any of the following actions by the Pediatric Skilled Nursing Facility or its employee is grounds for action by the licensing agency against the Pediatric Skilled Nursing Facility or its employee:

a. An intentional or negligent act materially affecting the health and safety of children in the Pediatric Skilled Nursing Facility.

b. A violation of the provisions of the act, or applicable rules.

c. Multiple or repeat violations of this act or of minimum standards or rules adopted under this act.

**History**
- *SOURCE: Mississippi Code Annotated §43-13-117*

##### **15 Miss. Admin. Code Pt. 16, R. 3.3.23** Immediate Revocation of License {#sec-16-3.3.23 omnilex-key=us-ms-regs-official--title-15--16#3.3.23}

Pursuant to Section 41-3-15, the State Department of Health is authorized and empowered, to revoke, immediately, the license and require closure of said healthcare center/institution, including any other remedy less than closure to protect the health and safety of the children being provided care/services or the health and safety of the public.

**History**
- *SOURCE: Mississippi Code Annotated §43-13-117and §41.3.15*

##### **15 Miss. Admin. Code Pt. 16, R. 3.3.24** Administrative Fines {#sec-16-3.3.24 omnilex-key=us-ms-regs-official--title-15--16#3.3.24}

If the licensing agency determines that a Pediatric Skilled Nursing Facility is not in compliance with this act, or applicable rules, the licensing agency may require that the Pediatric Skilled Nursing Facility submit a corrective action plan that demonstrates a good-faith effort to remedy each violation by a specific date, subject to the approval of the licensing agency. The licensing agency may fine a Pediatric Skilled Nursing Facility or employee found in violation of this act, or applicable rules, in the amount not to exceed five thousand dollars ($5000.00) in the aggregate. Should the facility not correct a violation by the date agreed upon by the licensing agency, or the failure to comply with an approved corrective action plan, is a separate violation for each day that the failure continues, unless the licensing agency approves an extension to the specific date.

**History**
- *SOURCE: Mississippi Code Annotated §43-13-117*

##### **15 Miss. Admin. Code Pt. 16, R. 3.3.25** Closing of a Pediatric Skilled Nursing Facility {#sec-16-3.3.25 omnilex-key=us-ms-regs-official--title-15--16#3.3.25}

Whenever a Pediatric Skilled Nursing Facility voluntarily discontinues operation, it shall, at least thirty days before the discontinuance of operation, inform each child’s legal guardian of the fact and the proposed time of the discontinuance. The licensing agency shall also be notified of the same such fact, at least thirty days prior to the date of discontinuance of operation.

Subchapter 4 Provision For Hearing And Appeal Following Denial or Revocation of License.

**History**
- *SOURCE: Mississippi Code Annotated §43-13-117*

##### **15 Miss. Admin. Code Pt. 16, R. 3.4.1** Administrative Decision {#sec-16-3.4.1 omnilex-key=us-ms-regs-official--title-15--16#3.4.1}

The licensing agency shall provide an opportunity for a fair hearing to every applicant or licensee who is dissatisfied with administrative decisions made in regard to the denial or revocation of a license.

1. The licensing agency shall notify the applicant or licensee by registered mail or personal service the particular reasons for the proposed denial or revocation of a license. Upon written request of an applicant or licensee received within ten (10) days of the date of notification, the licensing agency shall fix a date for the hearing at which time the applicant or licensee shall have an opportunity for a prompt and fair hearing.

2. On the basis of such hearing or upon default of the applicant or licensee, the licensing agency shall make a determination specifying its findings of fact and conclusions of law. A copy of such determinations shall be sent by registered mail to the last known address of the applicant or licensee or served personally upon the applicant or licensee.

3. The decision revoking, suspending, or denying the applicant or license shall become final thirty (30) days after it is mailed or served unless the applicant or licensee, within a thirty (30) day period, appeals to the Chancery Court pursuant to Section 43-11-23 of the Mississippi Code of 1972. An additional period of time may be granted at the discretion of the licensing agency.

**History**
- *SOURCE: Mississippi Code Annotated §43-13-117*

##### **15 Miss. Admin. Code Pt. 16, R. 3.5.1** Licensee {#sec-16-3.5.1 omnilex-key=us-ms-regs-official--title-15--16#3.5.1}

The licensee of each Pediatric Skilled Nursing Facility shall have full legal authority and responsibility for the operation of the facility.

**History**
- *SOURCE: Mississippi Code Annotated §43-13-117*

##### **15 Miss. Admin. Code Pt. 16, R. 3.5.2** Organizational Structure {#sec-16-3.5.2 omnilex-key=us-ms-regs-official--title-15--16#3.5.2}

Each Pediatric Skilled Nursing Facility must be organized in accordance with a written table of organization, which describes the lines of authority and communication down to the child care level. The organization structure must be designed so as to ensure an integrated continuum of services to the children.

**History**
- *SOURCE: Mississippi Code Annotated §43-13-117*

##### **15 Miss. Admin. Code Pt. 16, R. 3.5.3** Designation of Administrator {#sec-16-3.5.3 omnilex-key=us-ms-regs-official--title-15--16#3.5.3}

The licensee of each Pediatric Skilled Nursing Facility must designate, in writing, one person who is responsible and accountable for the overall management of the facility.

**History**
- *SOURCE: Mississippi Code Annotated §43-13-117*

##### **15 Miss. Admin. Code Pt. 16, R. 3.5.4** Administrator Designee in the Absence of Administrator {#sec-16-3.5.4 omnilex-key=us-ms-regs-official--title-15--16#3.5.4}

The facility administrator must designate, in writing, a person to be responsible for the facility when the administrator is absent from or unavailable to the center for more than 24 hours. Identification of the administrator’s proxy, as well as, the date and duration of substitution shall be entered into the Pediatric Skilled Nursing Facility’s administrative records.

**History**
- *SOURCE: Mississippi Code Annotated §43-13-117*

##### **15 Miss. Admin. Code Pt. 16, R. 3.5.5** Responsibilities of Administrator {#sec-16-3.5.5 omnilex-key=us-ms-regs-official--title-15--16#3.5.5}

The center administrator must:

1. Maintain the following written records, and all other records as outlined under Subchapter 16, Medical Record of these rules. The records must be kept in a place, form, and system in accordance with medical and business practices and such records must be available in the facility for inspection by the Department during normal business hours;

2. Assure that the Pediatric Skilled Nursing Facility is administered on a sound financial basis consistent with good business practice. There shall be financial records and annual budget information including monthly statements of operation and Profit and Loss statements made available for the Pediatric Skilled Nursing Facility;

3. Maintain a daily census record, which must indicate the names and number of children currently receiving services in the facility. Census records must be maintained and available for review, on the premises, for a period of three years;

4. Maintain a record of all accidents or unusual incidents involving any child or staff member that caused, or had the potential to cause, injury or harm to any person or property within the center. Such records shall be maintained on the premises of the facility and be available to the licensing agency upon request;

5. Maintain a copy of current agreements with third party providers;

6. Maintain a copy of current agreements with each consultant contracted by the Pediatric Skilled Nursing Facility and documentation of each consultant’s visit and required written, dated reports;

7. Assure the maintenance of a personnel record for each employee, which must include, at a minimum, a current copy and/or verification of the licensure status of professional discipline employed or on contract, the original employment application, references, employment history for the preceding five years, if applicable; a copy of the job description (acknowledged by employee); evidence of a completed criminal history records check (as referenced in these regulations) and a copy of all job performance evaluations;

8. Develop and maintain a current job description for each employee;

9. Provide each employee access to written personnel policies governing conditions of employment;

10. Conduct annual written job performance reviews that note strengths and weaknesses and include plans to correct any job performance weaknesses. Performance evaluations must be reviewed with the employee;

11. Assign duties to employees that are consistent with their job descriptions and their levels of education, preparation and experience;

12. Provide necessary qualified personnel and ancillary services to ensure the health, safety, and proper care of the child;

13. Develop and implement policies and procedures for infection control and quality assurance. These policies and procedure must be included in the Pediatric Skilled Nursing Facility policy manual.

**History**
- *SOURCE: Mississippi Code Annotated §43-13-117*

##### **15 Miss. Admin. Code Pt. 16, R. 3.5.6** Organizational Responsibility {#sec-16-3.5.6 omnilex-key=us-ms-regs-official--title-15--16#3.5.6}

The administrative structure of the Pediatric Skilled Nursing Facility shall include a policy and procedure manual to assure standards for medical and nursing care are met and to assure that the requirements as set forth in licensure and certification are maintained.

**History**
- *SOURCE: Mississippi Code Annotated §43-13-117*

##### **15 Miss. Admin. Code Pt. 16, R. 3.5.7** Resources {#sec-16-3.5.7 omnilex-key=us-ms-regs-official--title-15--16#3.5.7}

Each Pediatric Skilled Nursing Facility shall have the following documents on the premises and available to staff: American Academy of Pediatrics Red Book, Minimum Standards of Operation for Pediatric Skilled Nursing Facility, Policy and Procedure Manual and a Personnel Manual.

**History**
- *SOURCE: Mississippi Code Annotated §43-13-117*

##### **15 Miss. Admin. Code Pt. 16, R. 3.5.8** Rule 3.5.8 {#sec-16-3.5.8 omnilex-key=us-ms-regs-official--title-15--16#3.5.8}

Personnel Policies and Procedures shall include provisions for at least, a current personnel file, position descriptions, employee benefits, policy for attendance, overtime, compensatory time, performance evaluations, grievance procedures, and termination of employment. Personnel policies must also require that employees of the facility are current in their immunizations and undergo a medical evaluation to rule out communicable diseases, including but not limited to, tuberculosis (TB). Facilities shall comply with recommendations from the Centers for Disease Control and/or the Mississippi State Department of Health regarding baseline employee TB testing and routine serial employee TB testing and education.

**History**
- *SOURCE: Mississippi Code Annotated §43-13-117*

##### **15 Miss. Admin. Code Pt. 16, R. 3.5.9** Orientation of Staff {#sec-16-3.5.9 omnilex-key=us-ms-regs-official--title-15--16#3.5.9}

A formal orientation shall be required for all Pediatric Skilled Nursing Facility employees; staff development programs for all categories of personnel shall be held quarterly and documented accordingly.

**History**
- *SOURCE: Mississippi Code Annotated §43-13-117*

##### **15 Miss. Admin. Code Pt. 16, R. 3.5.10** Policies and Procedures {#sec-16-3.5.10 omnilex-key=us-ms-regs-official--title-15--16#3.5.10}

Policy and procedure manuals, including but not limited to, specifications for therapeutic intervention shall be available for use by all staff involved in the care of children. Revisions of the policies and procedures

are reviewed and approved quarterly during QA meetings. All forms, policies and procedures are reviewed and signed off as approved by the administrator, medical director and the director of nursing services, annually to assure that procedures conform to prevailing and acceptable treatment modalities.

**History**
- *SOURCE: Mississippi Code Annotated §43-13-117*

##### **15 Miss. Admin. Code Pt. 16, R. 3.5.11** Fingerprint Requirement {#sec-16-3.5.11 omnilex-key=us-ms-regs-official--title-15--16#3.5.11}

For each employee of the Pediatric Skilled Nursing Facility (see definition of employee), the facility shall submit fingerprints to MSDH for the purpose of processing a criminal history records check. The center shall develop policies and procedures consistent with this requirement.

**History**
- *SOURCE: Mississippi Code Annotated §43-13-117 and § 43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 3.5.12** Criminal History Record Checks {#sec-16-3.5.12 omnilex-key=us-ms-regs-official--title-15--16#3.5.12}

The covered entity shall be required to perform a disciplinary check with the professional licensing agency, if any, for each employee to determine if any disciplinary action has been taken against the employee by the agency, and a criminal history record check on:

1. Every new employee of a covered entity who provides direct patient care or Services;

2. Except as otherwise provided in this paragraph, no employee shall be permitted to provide direct patient care until the results of the criminal history check have revealed no disqualifying record or the employee has been granted a waiver. Provided the covered entity has documented evidence of submission of fingerprints for the background check, any person may be employed and provide direct patient care on a temporary basis pending the results of the criminal history record check by any employment offer, contract, or arrangement with the person shall be voidable, if he/she receives a disqualifying criminal record check.

3. If such criminal history record check discloses a felony conviction; a guilty plea; and/or a plea of nolo contendere to a felony for one (1) or more of the following crimes which has not been reversed on appeal, or for which a pardon has not been granted, the applicant/employee shall not be eligible to be employed at the licensed facility:

a. Possession or sale of drugs

b. Murder

c. Manslaughter

d. Armed robbery

e. Rape

f. Sexual battery

g. Sex offense listed in Section 45-33-23, Mississippi Code of 1972:

h. Child abuse

i. Arson

j. Grand larceny

k. Burglary

l. Gratification of lust

m. Aggravated assault

n. Felonious abuse and/or battery of vulnerable adult

4. Documentation of verification of the employee’s disciplinary status, if any, with the employee’s professional licensing agency as applicable, and evidence of submission of the employee’s fingerprints to the licensing agency must be on file and maintained by the facility prior to the new employees first date of employment. The covered entity shall maintain on file evidence of verification of the employee’s disciplinary status from any applicable professional licensing agency and submission and/or completion of the criminal record check, the signed affidavit, if applicable, and/or a copy of the referenced notarized letter addressing the individual’s suitability for such employment.

5. The covered entity may, in its discretion, allow any employee applicant aggrieved by the employment decision under this subsection to appear before the licensed entity’s hiring officer, or his or her designee, to show mitigating circumstances that may exist and allow the employee or employee applicant to be employed at the covered entity. The covered entity, upon report and recommendation of the hiring officer, may grant waivers for those mitigating circumstances, which shall include, but not be limited to: (1) age at which the crime was committed; (2) circumstances surrounding the crime; (3) length of time since the conviction and criminal history since the conviction; (4) work history; (5) current employment and character references; and (6) other evidence demonstrating that the individual does not pose a threat to the health or safety of the patients in the licensed facility.

6. The licensing agency may charge the covered entity submitting the fingerprints a fee not to exceed Fifty Dollars ($50.00).

7. Should results of an employee applicant’s criminal history record check reveal no disqualifying event, then the covered entity shall, within two (2) weeks of the notification of no disqualifying, event provide the employee applicant with a notarized letter signed by the chief executive officer of the covered entity, or his or her authorized designee, confirming the employee applicant’s suitability for employment based on his or her criminal history record check. An employee applicant may use that letter for a period of two (2) years from the date of the letter to seek employment at any covered entity licensed by the Mississippi Department of Health without the necessity of an additional criminal record check. Any covered entity presented with the letter may rely on the letter with respect to an employee applicant’s criminal background and is not required for a period of two (2) years from the date of the letter to conduct or have conducted a criminal history record check as required in this subsection.

8. For individuals contracted through a third party who provide direct patient care as defined herein, the covered entity shall require proof of a criminal history record check.

9. The licensing agency, the covered entity, and their agents, officers, employees, attorneys and representatives, shall be presumed to be acting in good faith for any employment decision or action taken under this section. The presumption of good faith may be overcome by a preponderance of the evidence in any civil action. No licensing agency, covered entity, nor their agents, officers, employees, attorneys and representatives shall be held liable in any employment discrimination suit in which an allegation of discrimination is made regarding an employment decision authorized under this section.

Subchapter 6 Child/Parent’s Rights.

**History**
- *SOURCE: Mississippi Code Annotated §43-13-117 and §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 3.6.1** Each child shall be treated with consideration, respect, and full recognition of his/her dignity and individuality {#sec-16-3.6.1 omnilex-key=us-ms-regs-official--title-15--16#3.6.1}

**History**
- *SOURCE: Mississippi Code Annotated §43-13-117*

##### **15 Miss. Admin. Code Pt. 16, R. 3.6.2** Each child shall receive care, treatment and services which are adequate and appropriate for his/her therapeutic plan {#sec-16-3.6.2 omnilex-key=us-ms-regs-official--title-15--16#3.6.2}

**History**
- *SOURCE: Mississippi Code Annotated §43-13-117*

##### **15 Miss. Admin. Code Pt. 16, R. 3.6.3** Rule 3.6.3 {#sec-16-3.6.3 omnilex-key=us-ms-regs-official--title-15--16#3.6.3}

Parent(s) or legal guardian(s) shall, prior to and upon admission and as needed during the period of service to his/her child, receive a written statement of the services provided by the Pediatric Skilled Nursing Facility including those offered on an “as needed” basis. They shall also receive a statement of related charges

including any charges for services not covered under the Pediatric Skilled Nursing Facility’s basic per diem rate.

**History**
- *SOURCE: Mississippi Code Annotated §43-13-117*

##### **15 Miss. Admin. Code Pt. 16, R. 3.6.4** Rule 3.6.4 {#sec-16-3.6.4 omnilex-key=us-ms-regs-official--title-15--16#3.6.4}

Each child’s medical care program shall be conducted discreetly and in accordance with the parent’s/guardian’s need for privacy. Personal and medical records shall be treated confidentially and shall not be made public without written consent of parent(s) or legal guardian(s).

**History**
- *SOURCE: Mississippi Code Annotated §43-13-117*

##### **15 Miss. Admin. Code Pt. 16, R. 3.6.5** Rule 3.6.5 {#sec-16-3.6.5 omnilex-key=us-ms-regs-official--title-15--16#3.6.5}

Each child shall be free from mental and physical abuse and also physical and chemical restraints, unless authorized by a physician according to clear and indicated medical requirements. Justification for use, shall include but not be limited to, the risks verses benefits for use and shall be documented by the physician and maintained as part of the child’s medical record.

**History**
- *SOURCE: Mississippi Code Annotated §43-13-117*

##### **15 Miss. Admin. Code Pt. 16, R. 3.6.6** Rule 3.6.6 {#sec-16-3.6.6 omnilex-key=us-ms-regs-official--title-15--16#3.6.6}

Each parent and/or legal guardian has a right, personally or through others, to present grievances to state and local authorities without reprisal, interference, coercion or discrimination of the child as a result of the grievance or suggestion.

**History**
- *SOURCE: Mississippi Code Annotated §43-13-117*

##### **15 Miss. Admin. Code Pt. 16, R. 3.7.1** Admission Procedures {#sec-16-3.7.1 omnilex-key=us-ms-regs-official--title-15--16#3.7.1}

Each Pediatric Skilled Nursing Facility shall have policies and procedures governing the admission, transfer, and discharge of children. The admission of each child into the Pediatric Nursing Facility shall be upon the written orders of the physician and shall be under the supervision of the facility administrator or his/her designee, and shall be in accordance with the facility's childcare policies and procedures.

1. Aging-in-Place- Considering the fact that an individual was admitted to a Pediatric Skilled Nursing Facility prior to his/her twenty-first (21) birth date, the facility may allow the individual to age-in-place past the twenty-first birth date, provided:

a. The facility may allow aging-in-place for established residents, not to exceed 15% of the facility's licensed capacity.

b. The individual continues to be ventilator or otherwise medically dependent; thus, requiring the services of the Pediatric Skilled Nursing Facility.

c. The facility is able to provide the needed medical, psychological, and safety needs of the resident; and

d. The resident does not present a threat for harm to himself or other children of the facility.

2. Transfer of Individuals over the age of twenty-one (21) - An individual(s) currently aging-in-place at a teaching hospital in the state may be admitted to a Pediatric Skilled Nursing Facility if said individual(s) was admitted to the teaching hospital prior to his/her twenty-first (21) birth date, provided subparts b, c, and d above are met. Additionally, any individual(s) that are currently aging in place in a Pediatric Skilled Nursing Facility out of state that was a citizen of the State of Mississippi at the time of transfer to the out of state facility could be transferred to a Pediatric Skilled Nursing Facility provided subparts b, c, and d above are met and a written justification, requesting approval, to the licensing agency be submitted along with any supporting documentation requested by the licensing agency.

**History**
- *SOURCE: Miss. Code. Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 3.7.2** Justification for Aging-in-Place {#sec-16-3.7.2 omnilex-key=us-ms-regs-official--title-15--16#3.7.2}

Should a facility choose to maintain a resident past the twenty-first birth date, the facility must submit a written justification, requesting approval, to the licensing agency. The written justification must be completed and signed by the Medical Director of the facility and must contain documentation reflective that the resident continues to meet the medical necessity requirements for such facility, that the facility can continue to meet the resident’s needs, as outlined above, and that the resident is not a danger to him/her self or others.

**History**
- *SOURCE: Mississippi Code Annotated §43-13-117*

##### **15 Miss. Admin. Code Pt. 16, R. 3.7.3** Hours of Service {#sec-16-3.7.3 omnilex-key=us-ms-regs-official--title-15--16#3.7.3}

The hours of operation of a Pediatric Skilled Nursing Facility shall be 24/7 and must be clearly posted.

**History**
- *SOURCE: Mississippi Code Annotated §43-13-117*

##### **15 Miss. Admin. Code Pt. 16, R. 3.7.4** Criteria for Admission {#sec-16-3.7.4 omnilex-key=us-ms-regs-official--title-15--16#3.7.4}

Infants and children considered for admission to the Pediatric Skilled Nursing Facility shall be:

1. A child who is less than twenty-one years of age and medically or technologically dependent to include, but not be limited to, conditions such seizure disorder, chronic lung disorder, malignancy, and heart disease and/or complex medical problems requiring continual care, including but not limited to, ventilator dependence, supplemental oxygen, I.V therapy, nasogastric or gastrostomy feedings, tracheotomy, etc.

2. Each child admitted to the Pediatric Skilled Nursing Facility shall be admitted under the prescription of the licensed prescribing physician and shall remain under the care of the primary care or subspecialist physician for the duration of his/her stay at the facility. Each child placed in the Pediatric Skilled Nursing Facility shall have documentation of the physician’s written order placed in the child’s medical record. A copy of the order shall be provided to the child’s parent(s) or guardian(s).

3. Infants and children considered for admission to the Pediatric Skilled Nursing Facility shall be stable for outpatient medical services and shall not, prior to admission, present a significant risk of infection to the other children or personnel. The medical and nursing directors shall review, on a case-by-case basis, any child with a suspected infection to determine appropriateness of admission.

**History**
- *SOURCE: Mississippi Code Annotated §43-13-117*

##### **15 Miss. Admin. Code Pt. 16, R. 3.7.5** Consents {#sec-16-3.7.5 omnilex-key=us-ms-regs-official--title-15--16#3.7.5}

A consent form outlining the purpose of a Pediatric Skilled Nursing Facility, family responsibilities, authorized treatments and appropriate liability release and emergency disposition plans shall be signed by the parent(s) and/or guardian(s) prior to admission to the Pediatric Skilled Nursing Facility. The parents and guardians shall be provided a copy of the consent form. Confidentiality of Pediatric Skilled Nursing Facility’s records shall be maintained in accordance with HIPPA requirements.

**History**
- *SOURCE: Mississippi Code Annotated §43-13-117*

##### **15 Miss. Admin. Code Pt. 16, R. 3.7.6** Protocol of Care {#sec-16-3.7.6 omnilex-key=us-ms-regs-official--title-15--16#3.7.6}

The protocol for care shall be developed under the direction of the Pediatric Skilled Nursing Facility nursing director and shall specify the treatment plan needed to accommodate the medical, nursing, psychosocial and educational needs of the child and family. Specific goals for care shall be identified. Plans for achieving the goals shall be determined and a schedule for evaluation of progress shall be established. When appropriate, the protocol shall include specific discharge criteria.

**History**
- *SOURCE: Mississippi Code Annotated §43-13-117*

##### **15 Miss. Admin. Code Pt. 16, R. 3.7.7** Protocol Authorization {#sec-16-3.7.7 omnilex-key=us-ms-regs-official--title-15--16#3.7.7}

The protocol must be signed by the physician, the authorized representative(s) of the Pediatric Skilled Nursing Facility and the parent(s) or guardian(s) of the child within ten (10) days of initiation of the plan. Copies of the protocol shall be given to the parent(s), guardian(s) of the child, the child’s primary physician, Pediatric Skilled Nursing Facility staff, and other agencies as appropriate.

**History**
- *SOURCE: Mississippi Code Annotated §43-13-117*

##### **15 Miss. Admin. Code Pt. 16, R. 3.7.8** Routine Communications {#sec-16-3.7.8 omnilex-key=us-ms-regs-official--title-15--16#3.7.8}

Communication with the child’s primary physician shall be provided by the nursing director or designee on a monthly or quarterly basis, as identified in the plan or at a minimum when there is a change in the child’s clinical condition.

**History**
- *SOURCE: Mississippi Code Annotated §43-13-117*

##### **15 Miss. Admin. Code Pt. 16, R. 3.7.9** Therapies {#sec-16-3.7.9 omnilex-key=us-ms-regs-official--title-15--16#3.7.9}

Prescribed therapies may be adjusted, in consultation with the child’s primary care or subspecialist physician, to accommodate the child’s condition.

**History**
- *SOURCE: Mississippi Code Annotated §43-13-117*

##### **15 Miss. Admin. Code Pt. 16, R. 3.7.10** Pre-admission Planning {#sec-16-3.7.10 omnilex-key=us-ms-regs-official--title-15--16#3.7.10}

If a child is hospitalized at the time of referral, pre- admission planning will include the parents and guardians, relevant hospital medical, nursing, social services and developmental staff to assure that the hospital’s discharge plans will be implemented following placement in the Pediatric Skilled Nursing Facility.

**History**
- *SOURCE: Mississippi Code Annotated §43-13-117*

##### **15 Miss. Admin. Code Pt. 16, R. 3.8.1** Qualifications of a Medical Director {#sec-16-3.8.1 omnilex-key=us-ms-regs-official--title-15--16#3.8.1}

A physician licensed in accordance with the requirements of the Mississippi Board of Medical Licensure, and certified by the American Board of Pediatrics or the American Osteopathic Board of Pediatrics shall serve as Medical Director of the Pediatric Skilled Nursing Facility.

**History**
- *SOURCE: Mississippi Code Annotated §43-13-117*

##### **15 Miss. Admin. Code Pt. 16, R. 3.8.2** Responsibilities of the Medical Director shall be: {#sec-16-3.8.2 omnilex-key=us-ms-regs-official--title-15--16#3.8.2}

1. Periodic review of services to assure acceptable levels of quality;

2. Maintenance of a liaison role with the medical community;

3. Advisement of the development of new programs and modifications of existing programs;

4. Assurance that medical consultation will be available in the Medical Director’s absence;

5. Serving on committees as defined and required by these rules and by the facility’s policies;

6. Consultation with the center administrator on the health status of the facility’s personnel;

7. Reviewing reports of all accidents and unusual incidents, to but not be limited to, medication errors, and identifying to the facility administrator hazards to health and safety; and

8. Ensuring the development of policies and procedures for the delivery of emergency services and the delivery of regular physician services when the child’s attending physician, or his designated alternate is not available.

**History**
- *SOURCE: Mississippi Code Annotated §43-13-117*

##### **15 Miss. Admin. Code Pt. 16, R. 3.9.1** Qualification of the Director of Nursing {#sec-16-3.9.1 omnilex-key=us-ms-regs-official--title-15--16#3.9.1}

A registered nurse shall serve full- time as the Director of Nursing. The Director of Nursing must have, at a minimum, the following qualifications:

1. Minimum of a baccalaureate degree in nursing;

2. Current unrestricted Mississippi nursing license;

3. Current certification in Cardio Pulmonary Resuscitation (CPR) or Basic Cardiac Life Support (BCLS); and

4. Current certification in Pediatric Advanced Life Support (PALS)

5. A minimum of five years of employment in a pediatric setting caring for medically and/or technologically dependent children or at least three years of experience in one of the following specialty settings: pediatric intensive care, neonatal intensive care, pediatric emergency care, Pediatric Skilled Nursing Facility or comparable pediatric unit.

**History**
- *SOURCE: Mississippi Code Annotated §43-13-117*

##### **15 Miss. Admin. Code Pt. 16, R. 3.9.2** Responsibilities {#sec-16-3.9.2 omnilex-key=us-ms-regs-official--title-15--16#3.9.2}

The Director of Nursing Services shall be responsible for the day-to-day operations of the Pediatric Skilled Nursing Facility, to include but not be limited to, the development of and implementation of policies and procedures to facilitate effective and safe care and treatment modalities, scheduling of staff, coordination of employee and contracted specialized services in accordance with each child’s individualized plan of care, participating in pre-admission screening along with other appropriate nursing staff, participating on the interdisciplinary team (IDT) in the development of each child’s plan care, evaluation of all nursing services provided to each child; assuring that training and inservices are provided

consistent with the treatments/care being provided and the identified weaknesses and/or needs of the employee.

**History**
- *SOURCE: Mississippi Code Annotated §43-13-117*

##### **15 Miss. Admin. Code Pt. 16, R. 3.9.3** Registered Nurse Qualifications {#sec-16-3.9.3 omnilex-key=us-ms-regs-official--title-15--16#3.9.3}

Each registered nurse employed by the Pediatric Skilled Nursing Facility shall have a current unencumbered Mississippi nursing license, have at least two years of pediatric specialty care experience with emphasis on medically and technologically dependent children and maintain current certification in pediatric CPR, pediatric advance life support (PALS) and basic first aid.

**History**
- *SOURCE: Mississippi Code Annotated §43-13-117*

##### **15 Miss. Admin. Code Pt. 16, R. 3.9.4** Registered Nurse Responsibilities {#sec-16-3.9.4 omnilex-key=us-ms-regs-official--title-15--16#3.9.4}

The registered nurse shall be responsible for at least the following:

1. The provision of nursing intervention; educational services to increase the family’s confidence and competence in caring for the child with special needs; assistance to facilitate coping with the effects of chronic illness on the child and family and support effective relationships among siblings and the ill child; interventions to foster normal development and psychosocial adaptation;

2. Knowledge of the availability and access requirements to community resources;

3. Participation in the interdisciplinary teams (IDT), as necessary and in the interdisciplinary staff meetings regarding the child’s progress. Fostering and maintaining collaborative relationship with the interdisciplinary teams;

4. The administration of medication, intravenous infusions, parenteral feedings and other specialized treatments; monitoring and documenting the effects of medications, therapies and progress in accordance with accepted standards of practice; and

5. Knowledge of the competence and scope of practice of other licensed and unlicensed personnel and delegation of duties to such personnel within that level of competence and scope of practice.

**History**
- *SOURCE: Mississippi Code Annotated §43-13-117*

##### **15 Miss. Admin. Code Pt. 16, R. 3.9.5** Qualifications of Licensed Practical Nurse {#sec-16-3.9.5 omnilex-key=us-ms-regs-official--title-15--16#3.9.5}

Each licensed practical nurse employed by the Pediatric Skilled Nursing Facility shall have a current unencumbered Mississippi nursing license, have at least two years of pediatric specialty care experience with emphasis on medically and technologically dependent children and current certification in pediatric CPR and basic first aid.

##### **15 Miss. Admin. Code Pt. 16, R. 3.9.6** Licensed Practical Nurse Responsibilities {#sec-16-3.9.6 omnilex-key=us-ms-regs-official--title-15--16#3.9.6}

The licensed practical nurse shall work under the supervision of the registered nurse and is responsible to provide, within their level of competence and scope of practice, direct care to the Pediatric Skilled Nursing Facility children.

##### **15 Miss. Admin. Code Pt. 16, R. 3.9.7** Qualifications of Direct Care Staff {#sec-16-3.9.7 omnilex-key=us-ms-regs-official--title-15--16#3.9.7}

Direct care staff shall work under the supervision of the licensed nurse. If direct care staff are utilized to augment licensed nurse staffing, the direct care staff shall have a minimum of the following qualifications:

1. Two years of experience in a healthcare setting providing care to infants and children who are medically or technologically dependent;

2. References documenting skill in the care of infants and children; and

3. Current certification in pediatric CPR and basic first aid.

**History**
- *SOURCE: Mississippi Code Annotated §43-13-117*

##### **15 Miss. Admin. Code Pt. 16, R. 3.10.1** Subchapter 10 Staffing {#sec-16-3.10.1 omnilex-key=us-ms-regs-official--title-15--16#3.10.1}

Ratio Total staffing for nursing services shall be, at a minimum, in the following ratios but at no time shall there be less than one (1) staff member of duty per three (3) children. If only one (1) staff member is on duty, that member must be a registered nurse.

Children Total Staff RN

RN or LPN Direct Care, or Licensed Nurse (RN, LPN or Respiratory Therapist) 1 1 1 2-6 2 1 1 1 7-9 3 1 1 1 10-12 4 2 1 1 13-15 5 3 1 1 16-18 6 3 1 2 19-21 7 4 1 2 22-24 8 4 1 3 25-27 9 4 1 4 28-30 11 5 1 5

**History**
- *SOURCE: Mississippi Code Annotated §43-13-117*

##### **15 Miss. Admin. Code Pt. 16, R. 3.10.2** 31-33 12 5 1 6 34 -36 13 5 2 6 37- 39 14 5 3 6 40-42 15 5 3 7 43- 45 16 5 4 7 {#sec-16-3.10.2 omnilex-key=us-ms-regs-official--title-15--16#3.10.2}

If a Pediatric Skilled Nursing Facility has more than 45 children, the staffing must increase by one staff for every three (3) children, alternating between a direct care staff and licensed nurse.

**History**
- *SOURCE: Mississippi Code Annotated §43-13-117*

##### **15 Miss. Admin. Code Pt. 16, R. 3.10.3** Ancillary Professional Staffing {#sec-16-3.10.3 omnilex-key=us-ms-regs-official--title-15--16#3.10.3}

Although the Pediatric Skilled Nursing Facility is not required to have the following disciplines on staff, such services may be contractual, on a consultant basis, depending on the assessed need of the child.

1. Resource consultants:

a. A child development specialist available to serve as a resource for Pediatric Skilled Nursing Facility staff and parents of children served who can be available to evaluate through use of standardized and non-standardized procedures the developmental status of children;

b. A child life specialist who can assist in planning and conducting individualized child development and play programs; and who can serve as a resource to the Pediatric Skilled Nursing Facility staff and parents of children being served.

**History**
- *SOURCE: Mississippi Code Annotated §43-13-117*

##### **15 Miss. Admin. Code Pt. 16, R. 3.10.4** Rule 3.10.4 {#sec-16-3.10.4 omnilex-key=us-ms-regs-official--title-15--16#3.10.4}

The Pediatric Skilled Nursing Facility shall have the following staff, either by employment or on a contractual as needed basis:

1. Occupational therapy is the provision of services that addresses the developmental or functional needs of a child related to the performance of self- help adaptive skills, adaptive behaviors, and sensory, motor and postural development. Occupational therapy includes the evaluation and treatment to prevent or correct physical and emotional deficits, minimize the disabling effects of these deficits, maintain a level of function, acquire a skill set or A child life specialist who shall be responsible for at least the following:

a. Evaluation of child following physician referral to include neuromuscular status, developmental level, perceptual motor functioning, need for adaptive equipment or appliances, self-care and play;

b. Designing and implementing therapeutic programs to meet the needs of the individual child;

c. Maintaining records documenting the therapy program and progress for each child as approved by the attending physician; and

d. Participating as part of the child’s IDT team if occupational therapies are a part of the child’s plan and serving as a resource for Pediatric Skilled Nursing Facility staff and the parents being served.

2. Physical therapy services include the evaluation and treatment of range of motion, muscle strength, functional abilities and the use of adaptive and therapeutic equipment. The Pediatric Skilled Nursing Facility shall assure the availability of, either by employment of contract, a physical therapist who is responsible for at least the following:

a. Evaluation of each child upon physician referral to include neuromuscular status, developmental level, gait, posture and adaptive equipment;

b. Designing and implementing therapeutic programs to meet the needs of each individual child;

c. Maintaining records documenting the therapy program and progress for each child as approved by the attending physician; and

d. Serving as a resource for Pediatric Skilled Nursing Facility staff and parents of children served.

e. If physical therapy is an active component in the treatment of the child, the physical therapist shall participate as part of the child’s IDT.

3. Respiratory care services include evaluation and treatment related to pulmonary dysfunction. Examples are ventilator support, therapeutic and diagnostic use of medical gases, respiratory rehabilitation, management of life support systems and bronchopulmonary drainage, breathing exercises and chest physiotherapy. The Pediatric Skilled Nursing Facility shall assure the availability of a licensed respiratory therapist when appropriate, to:

a. Evaluation of the respiratory function and needs of the child, make recommendations based upon that assessed need;

b. Provide therapies, as appropriate, per physician orders,

c. Maintain documentation of provided therapies, in accordance with physician’s orders and the child’s IDT plan, and the progress of the child and/or educational progress of the parents; and

d. Serve as a resource to train staff and parents of the child on the physiology of the child’s disease processor respiratory dysfunction and on the modalities necessary for care and treatment of the child.

4. Speech language involves the evaluation and treatment of speech-language disorders, to include but not be limited to, the evaluation and treatments of verbal and written language, articulation, voice, fluency, phonology, mastication, deglutition, cognition, and communications. The Pediatric Skilled Nursing Facility shall assure that a speech-language pathologist is available, either by employment or through a contractual basis on an as needed basis, for the:

a. Evaluation of children to include: ability to swallow and feeding, respirations, language, speech, communication and play using formal and informal test and observations;

b. Designing and implementing individualized therapeutic programs for each child, including recommendations for communication devices;

c. Speech-language encounters must be face-to-face, and the speech-language pathologist must maintain, in the child’s record, documentation of each evaluation, documentation of therapies and progress; and

d. Serving as a resource for the Pediatric Skilled Nursing Facility staff and parents of children being served.

e. Speech-language visits must be face-to-face encounters.

5. A social worker who is responsible for at least the following:

a. Conducting family psychosocial assessments as requested by the medical or nursing director;

b. Counseling, including emotional support and grief resolution as requested by the nursing and medical director, or family;

c. Family advocacy and coordination with community resources;

d. Maintaining records and documenting social work interventions;

e. Conducting home visits and home evaluations as requested by the medical director or nursing director; and

f. Serving as a resource for the Pediatric Skilled Nursing Facility staff and parents of children served.

6. A dietician, who is licensed in the State of Mississippi and currently registered with the American Dietetic Association, will be available, at a minimum on a consultant basis. The dietician shall:

a. Conduct a thorough evaluation of each child’s nutritional status, preferences, likes and dislikes, upon admission and as needed throughout the child’s stay; b. Develop and approve menus appropriate to the nutritional needs of the children. Assure that specialty feedings are prepared in accordance with physician’s orders, meet the nutritional needs of the child and make recommendations, as appropriate; c. Document in the clinical record, at least quarterly, an update of the child’s nutritional status to include, but not be limited to, weight, alteration in the diet, eating modalities, etc.; and d. Assure that dietary staff are trained and competent in the preparation and service delivery of meals/feedings related to each child’s diet.

**History**
- *SOURCE: Mississippi Code Annotated §43-13-117*

##### **15 Miss. Admin. Code Pt. 16, R. 3.11.1** Assessment and Plan {#sec-16-3.11.1 omnilex-key=us-ms-regs-official--title-15--16#3.11.1}

Each child shall have a functional assessment and an individualized family service plan (IFSP) to include developmentally appropriate areas.

**History**
- *SOURCE: Mississippi Code Annotated §43-13-117*

##### **15 Miss. Admin. Code Pt. 16, R. 3.11.2** Developmental Plan {#sec-16-3.11.2 omnilex-key=us-ms-regs-official--title-15--16#3.11.2}

The child’s IFSP plan shall include specific programs and action steps to facilitate developmental progress and shall be reviewed and updated per early intervention/early step guidelines.

**History**
- *SOURCE: Mississippi Code Annotated §43-13-117*

##### **15 Miss. Admin. Code Pt. 16, R. 3.11.3** Incorporation of Plan {#sec-16-3.11.3 omnilex-key=us-ms-regs-official--title-15--16#3.11.3}

Developmental and educational needs shall be incorporated into each child’s protocol for care.

**History**
- *SOURCE: Mississippi Code Annotated §43-13-117*

##### **15 Miss. Admin. Code Pt. 16, R. 3.11.4** Comprehensive Developmental Program {#sec-16-3.11.4 omnilex-key=us-ms-regs-official--title-15--16#3.11.4}

The Pediatric Skilled Nursing Facility shall provide evidence of a good-faith effort in assuring the development of a comprehensive developmental program for each child birth to 3 years old to meet the identified developmental needs of the child. The Pediatric Skilled Nursing Facility may enter into a contractual relation with the local early intervention provider/early steps to assure that these services are met and provided accordingly. The child’s IFSP plan shall include:

1. Measurable goals in need areas and/or goals to enhance and normalize independent functioning in daily activities and to promote socialization in order to minimize difficulties in being assimilated into the home/community environment;

2. A description of the child’s strengths and present performance level with respect to each goal;

3. Skills areas in priority order;

4. Anticipatory planning for specific areas identified at risk for problems even though a specific delay or problem may not be demonstrable.

**History**
- *SOURCE: Mississippi Code Annotated §43-13-117*

##### **15 Miss. Admin. Code Pt. 16, R. 3.11.5** Scheduled Meetings {#sec-16-3.11.5 omnilex-key=us-ms-regs-official--title-15--16#3.11.5}

The developmentalist and/or child life specialist shall participate in regularly scheduled interdisciplinary staff meetings as needed.

**History**
- *SOURCE: Mississippi Code Annotated §43-13-117*

##### **15 Miss. Admin. Code Pt. 16, R. 3.11.6** Involvement of Parent and/or Guardian {#sec-16-3.11.6 omnilex-key=us-ms-regs-official--title-15--16#3.11.6}

A program for parent(s) and/or guardian(s) shall be provided to prepare parent(s) or guardian(s) to accommodate the child’s needs as needed.

**History**
- *SOURCE: Mississippi Code Annotated §43-13-117*

##### **15 Miss. Admin. Code Pt. 16, R. 3.11.7** Parent/Guardian Education {#sec-16-3.11.7 omnilex-key=us-ms-regs-official--title-15--16#3.11.7}

The Pediatric Skilled Nursing Facility shall assist parent(s) and guardian(s) by including them in care-related conferences and teaching them how to perform necessary therapies and how to meet the developmental and psychosocial needs of the child at home.

**History**
- *SOURCE: Mississippi Code Annotated §43-13-117*

##### **15 Miss. Admin. Code Pt. 16, R. 3.11.8** Referrals {#sec-16-3.11.8 omnilex-key=us-ms-regs-official--title-15--16#3.11.8}

Pediatric Skilled Nursing Facility staff shall make referrals to appropriate resources, facilitate access to community, social, educational and financial services, and shall provide assistance to enhance coping skills, interpersonal; relationships and family functioning.

**History**
- *SOURCE: Mississippi Code Annotated §43-13-117*

##### **15 Miss. Admin. Code Pt. 16, R. 3.12.1** Comprehensive Educational Program {#sec-16-3.12.1 omnilex-key=us-ms-regs-official--title-15--16#3.12.1}

The Pediatric Skilled Nursing Facility shall provide evidence of a good-faith effort in assuring the development of a comprehensive educational program for each school-aged child to meet the identified educational needs of the child. The Pediatric Skilled Nursing Facility may enter into a contractual relationship with the local school system to assure that these services are met and provided accordingly.

**History**
- *SOURCE: Mississippi Code Annotated §43-13-117*

##### **15 Miss. Admin. Code Pt. 16, R. 3.12.2** Comprehensive Educational IEP Plan {#sec-16-3.12.2 omnilex-key=us-ms-regs-official--title-15--16#3.12.2}

Each child, after being determined appropriate for educational services based on a comprehensive assessment, shall have a comprehensive individualized educational plan (IEP). Such plan shall be based upon the assessed needs of the child and shall be developed in coordination with Pediatric Skilled Nursing Facility staff. If a child is on an IEP, the educational teacher /instructor shall participate in the child’s overall IEP and review.

**History**
- *SOURCE: Mississippi Code Annotated §43-13-117*

##### **15 Miss. Admin. Code Pt. 16, R. 3.12.3** Space/Supplies for Educational Needs {#sec-16-3.12.3 omnilex-key=us-ms-regs-official--title-15--16#3.12.3}

The Pediatric Skilled Nursing Facility shall provide a dedicated room, space or adequate workspace, well lighted and equipped with general supplies such as tables, desks, chalkboard/whiteboard, etc. to be conducive to such specialized educational learning. The Pediatric Skilled Nursing Facility may request parent or the local school system participation in the purchase of books, routine schools supplies, etc., necessary for their child’s day- to-day school activities.

**History**
- *SOURCE: Mississippi Code Annotated §43-13-117*

##### **15 Miss. Admin. Code Pt. 16, R. 3.12.4** Education Incorporated into Child’s Overall IED Plan {#sec-16-3.12.4 omnilex-key=us-ms-regs-official--title-15--16#3.12.4}

For children needing or receiving educational instruction, the educational instructor/teacher shall participate as part of the interdisciplinary team to assure coordination of the child’s care and services with the scheduled educational component of activities. The Pediatric Skilled Nursing Facility will provide an area to post the calendar and school related information bulletins. The instructor shall document in the child’s school record the progress of the child. A duplicate copy shall be maintained on the Pediatric Skilled Nursing Facility premises.

**History**
- *SOURCE: Mississippi Code Annotated §43-13-117*

##### **15 Miss. Admin. Code Pt. 16, R. 3.13.1** Nutritional Services {#sec-16-3.13.1 omnilex-key=us-ms-regs-official--title-15--16#3.13.1}

A registered dietician shall be available, either full time, part time or on a consultant basis, to evaluate the child’s nutritional needs and to assure that meal planning and dietary services are provided so as to meet the nutritional and dietary needs of each child.

**History**
- *SOURCE: Mississippi Code Annotated §43-13-117*

##### **15 Miss. Admin. Code Pt. 16, R. 3.13.2** Food Service on Location {#sec-16-3.13.2 omnilex-key=us-ms-regs-official--title-15--16#3.13.2}

If the Pediatric Skilled Nursing Facility serves food to the children:

a) A Certified Food Service Manager who works under the consulting Registered Dietitian shall be available and responsible for overseeing dietary services.

b) Menus shall be nutritionally adequate and consistent with the Dietary Guidelines for Americans. Foods shall be provided in quantities and meal patterns that balance energy and nutrients with the children’s ages, appetites, activity levels, special needs, and cultural and ethnic differences in food habits. All physician-prescribed meals, snacks, special diets and dietary supplements shall meet the daily nutritional requirements of the child as ordered. Substitution of foods/snacks, of the same nutritional value, shall be made available should a child dislike or refuse a food item.

c) Parents, when possible, shall be involved in the nutritional components of their child’s meal. Menus must be prepared for a minimum of one week in advance and shall be posted so that parents/child is aware of foods/snacks served. Food items, texture and consistency should be age and/or needs appropriate. Substitutions shall be offered if a child has a dislike of foods prepared. Menus shall be maintained on-site for a period of one (1) year.

**History**
- *SOURCE: Mississippi Code Annotated §43-13-117*

##### **15 Miss. Admin. Code Pt. 16, R. 3.13.3** Documentation of Allergies {#sec-16-3.13.3 omnilex-key=us-ms-regs-official--title-15--16#3.13.3}

If a child has a specific allergy to foods or is on a special diet, Pediatric Skilled Nursing Facility staff shall be notified, and such allergies notated as part of the child’s medical record.

**History**
- *SOURCE: Mississippi Code Annotated §43-13-117*

##### **15 Miss. Admin. Code Pt. 16, R. 3.13.4** Timing of Meals {#sec-16-3.13.4 omnilex-key=us-ms-regs-official--title-15--16#3.13.4}

For infants and toddlers, feedings and/or meals shall be in accordance with physician’s orders and/or the routine of the child (if orders related to timing are not available). At a minimum, for each twenty-four-hour day, three meals and three snacks must be offered.

**History**
- *SOURCE: Mississippi Code Annotated §43-13-117*

##### **15 Miss. Admin. Code Pt. 16, R. 3.13.5** Furniture/Utensils {#sec-16-3.13.5 omnilex-key=us-ms-regs-official--title-15--16#3.13.5}

Furniture and Utensils shall be age-appropriate and developmentally suitable to encourage children to accept and enjoy mealtime.

**History**
- *SOURCE: Mississippi Code Annotated §43-13-117*

##### **15 Miss. Admin. Code Pt. 16, R. 3.13.6** Dining Experience {#sec-16-3.13.6 omnilex-key=us-ms-regs-official--title-15--16#3.13.6}

The facility shall design the dining area so as to create a home-like environment for dining. Caregivers shall encourage positive experiences with food and eating. Caregivers are encouraged to eat with the children; however, shall not eat foods outside of the foods served in the facility in front of the children.

**History**
- *SOURCE: Mississippi Code Annotated §43-13-117*

##### **15 Miss. Admin. Code Pt. 16, R. 3.13.7** Refrigerated Individual Foods {#sec-16-3.13.7 omnilex-key=us-ms-regs-official--title-15--16#3.13.7}

Prepared foods shall be kept under refrigeration with identifying dates and the child’s name.

**History**
- *SOURCE: Mississippi Code Annotated §43-13-117*

##### **15 Miss. Admin. Code Pt. 16, R. 3.14.1** Transportation Services {#sec-16-3.14.1 omnilex-key=us-ms-regs-official--title-15--16#3.14.1}

If transportation services are provided by a Pediatric Skilled Nursing Facility and prescribed by the primary care or subspecialist physician, a procedure delineating personnel and equipment to accompany the child shall be included in the Pediatric Skilled Nursing Facility procedure manual. The Pediatric Skilled Nursing Facility policy and procedure shall clearly state, regardless of the transportation provision, if the child is to be under the care of the Pediatric Skilled Nursing Facility, the Pediatric Skilled Nursing Facility is responsible for the safety of the children.

**History**
- *SOURCE: Mississippi Code Annotated §43-13-117*

##### **15 Miss. Admin. Code Pt. 16, R. 3.14.2** Restraint During Transport {#sec-16-3.14.2 omnilex-key=us-ms-regs-official--title-15--16#3.14.2}

All children shall be properly restrained whenever they are being transported in a motor vehicle.

1. Every person transporting a child under the age of four (4) in a passenger motor vehicle and operated on a public roadway, street or highway, shall provide for the protection of the child by properly using a child passenger restraint device or system meeting applicable federal motor vehicle safety standards, i.e., child safety seat.

2. Every person transporting a child in a passenger motor vehicle operated on a public roadway, street or highway, shall provide for the protection of the child by using a belt positioned booster seat system meeting applicable federal motor vehicle safety standards if the child is at least four (4) years of age, but less than seven (7) years of age and measures less than four (4) feet nine (9) inches in height or weighs less than sixty-five pounds.

3. An individual seat restraint must be used for each child, regardless of age, height or weight and appropriate for the child’s condition. The use of an individual seat restraint for two or more children is not allowed.

**History**
- *SOURCE: Mississippi Code Annotated §43-13-117*

##### **15 Miss. Admin. Code Pt. 16, R. 3.14.3** Contract Transportation {#sec-16-3.14.3 omnilex-key=us-ms-regs-official--title-15--16#3.14.3}

Should the Pediatric Skilled Nursing Facility provide or contract for transportation, it is incumbent upon the center to assure that:

1. All drivers are appropriately licensed;

2. All vehicles used for the transportation of the Pediatric Skilled Nursing Facility children have current safety inspection stickers, licenses (vehicle tag) and registration;

3. Insurance adequately covers the transportation of children;

4. A daily sign-in sheet or log is maintained of the children being transported and include the to/from location;

5. A trained medical escort will accompany all children during transport. An additional medical escort shall be required for every six children. The driver of the bus/vehicle cannot serve as a medical escort;

6. Children board and leave from the curbside of the street and/or safely accompanied to the destinations;

7. Upon arrival via transportation to the child’s final destination care of child is relinquished to either a parent/guardian or designated caregiver as authorized by the parent or guardian.

**History**
- *SOURCE: Mississippi Code Annotated §43-13-117*

##### **15 Miss. Admin. Code Pt. 16, R. 3.15.1** Inservice Training {#sec-16-3.15.1 omnilex-key=us-ms-regs-official--title-15--16#3.15.1}

Each Pediatric Skilled Nursing Facility shall develop staff and parent/guardian orientation and training programs. These programs include but are limited to the following:

1. Quarterly staff development / inservice programs appropriate to the category of personnel will be conducted to maintain quality patient care; All staff development programs will be documented; to include date/time, trainer, listing of attendees and a summary of the program content/training. This documentation shall be maintained for a period of three years, unless pertinent to a specific child’s care; then reference to the training shall be maintained as part of the child’s record as long as the child receives the service of the facility.

2. Annual pediatric cardiopulmonary resuscitation review and update;

3. New hire orientation to acquaint the employee with the philosophy, organization, program, practices and goals of the Pediatric Skilled Nursing Facility;

4. Parent orientation to acquaint the parent/guardian to the Pediatric Skilled Nursing Facility, including philosophy of the center, goals, expectations, not only of staff/caregivers but also of parents (such as expectation that parent and/or guardian participate in the IEP) and services that can be offered and/or expected;

5. Parent/guardian trainings shall be documented in the child’s medical record.

**History**
- *SOURCE: Mississippi Code Annotated §43-13-117*

##### **15 Miss. Admin. Code Pt. 16, R. 3.16.1** Medical Records {#sec-16-3.16.1 omnilex-key=us-ms-regs-official--title-15--16#3.16.1}

A medical record shall be maintained for each child. The medical record shall contain at least the following:

1. All details of the referral, admission, correspondence and papers concerning the child;

2. Entries in the medical record shall be in ink, shall be signed by the authorized personnel, to include name and title/discipline, and shall include at least the following:

a. Physician’s orders;

b. Flow charts of medications and treatments administered;

c. Concise accurate information and initialed case notes reflecting progress toward protocol of care goals achievement or reasons for lack of progress;

d. Documentation of nutritional management and special diets, as appropriate;

e. Documentation of nursing, physical, occupational, speech, respiratory and social service assessments, goals, treatment plans, documentation of each treatment, to include date, time and therapy/treatments provided and progress of the child;

f. An individualized protocol of care developed within ten (10) working days of admission and revised, as necessary, to include recommended changes in

the therapeutic plan. The disposition to be followed in the event of emergency situations shall be specified in the plan of care;

g. Medical history to include allergies and special precautions;

h. Immunization record;

i. Quarterly reviews of the protocol of care to update the plan in consultation with other professionals involved in the child’s care;

j. A discharge order, written by the primary care or subspecialist physician, shall be documented and entered in the child’s record. A discharge summary, which includes the reason for discharge, shall also be included.

**History**
- *SOURCE: Mississippi Code Annotated §43-13-117*

##### **15 Miss. Admin. Code Pt. 16, R. 3.17.1** Infection Control Procedures {#sec-16-3.17.1 omnilex-key=us-ms-regs-official--title-15--16#3.17.1}

Each Pediatric Skilled Nursing Facility shall have written infection control procedures to include at least the following:

1. The Pediatric Skilled Nursing Facility shall contain an isolation room with one large glass area for observation of the child. Isolation procedures shall be used to prevent cross-contamination. The room shall be equipped with emergency outlets and equipment as necessary to provide care to the child. A bathroom accessible to the isolation room but separate from the other Pediatric Skilled Nursing Facility’s rooms is required. Procedures must address that all equipment must be thoroughly cleaned and sanitized when brought into the isolation room and upon removal from the room;

2. All cribs and beds shall be labeled with the individual child’s name. Linens are to be maintained clean and in good repair and shall be removed for laundering whenever soiled or needed; however, laundering of all linens shall occur, at a minimum, on a weekly basis;

3. Antibacterial soap and disposable paper towels shall be maintained at each sink and lavatory. Policy shall address that staff shall wash their hands between each treatment and care interaction with a child for which the hands may become contaminated/soiled;

4. Children suspected of having a communicable disease, which may be contacted through casual contact, as determined by the facility’s medical director, shall be isolated; the parent(s) shall be notified of the condition; and the child shall be removed from the Pediatric Skilled Nursing Facility as soon as possible. When the communicable disease is no longer present; as evidenced by a written

physician’s statement, the child may return to the Pediatric Skilled Nursing Facility; and

5. Pediatric Skilled Nursing Facility staff suspected of having a communicable disease shall not return to the Pediatric Skilled Nursing Facility until all signs and symptoms which relate to the communicable disease are no longer evident, as evidenced by a written physician’s statement.

**History**
- *SOURCE: Mississippi Code Annotated §43-13-117*

##### **15 Miss. Admin. Code Pt. 16, R. 3.18.1** Quality Assurance Program {#sec-16-3.18.1 omnilex-key=us-ms-regs-official--title-15--16#3.18.1}

The Pediatric Skilled Nursing Facility shall have:

1. A quality assurance program and will conduct quarterly reviews of The Pediatric Skilled Nursing Facility’s medical records for at least one-half (1/2) of the children served by The Pediatric Skilled Nursing Facility at the time of the quality assurance review.

2. The quality assurance review will be conducted by, at a minimum, two members of the quality assurance committee. The quality assurance responsibilities shall rotate among the quality assurance committee at least on an annual basis.

**History**
- *SOURCE: Mississippi Code Annotated §43-13-117*

##### **15 Miss. Admin. Code Pt. 16, R. 3.18.2** Quality Assurance Review {#sec-16-3.18.2 omnilex-key=us-ms-regs-official--title-15--16#3.18.2}

Each quarterly quality assurance review shall include:

1. A review of the protocols in each child’s Protocol of Care to assure that it clearly reflects the assessed needs of the child, to include but not be limited to, the evaluation, goals/expectation, treatment modalities and care provided, by each professional discipline serving the child;

2. A review of the steps, process, and success in achieving the goals;

3. Identification of goals not being achieved as expected, reasons for lack of achievement and plans to promote goal achievement;

4. When a child’s clinical status changes, either improvement or decline, that the protocol of care is revised to accommodate the child’s change in status as evidence by revised professional assessments and re-formulation of goals;

5. Within ten days of the review, the quality assurance committee will meet, discuss and ratify the report. Within fifteen days of the review, the quality

assurance committee shall furnish copies of its report to the Pediatric Skilled Nursing Facility medical and nursing directors.

6. The Pediatric Skilled Nursing Facility shall develop a corrective action plan for each area in which the facility failed to meet the established expectations and goals and shall assure implementation of measures, as appropriate, for correction of any deficient area. Pediatric Skilled Nursing Facility management, to include the medical director and the director of nursing, shall sign the quality assurance report indicating awareness of the deficient findings and shall insure that measures are put into place to correct any deficient practice and/or to prevent the reoccurrence of any such practice.

**History**
- *SOURCE: Mississippi Code Annotated §43-13-117*

##### **15 Miss. Admin. Code Pt. 16, R. 3.19.1** Equipment {#sec-16-3.19.1 omnilex-key=us-ms-regs-official--title-15--16#3.19.1}

Each Pediatric Skilled Nursing Facility shall maintain:

1. An age and developmentally appropriate environment including but not limited to furnishings, equipment, adaptive devices and indoor/outdoor therapeutic play/educational equipment and supplies, etc.;

2. Each Pediatric Skilled Nursing Facility shall provide safety, medical and emergency equipment as described below. All equipment shall be maintained in a safe, usable and sanitary condition.

**History**
- *SOURCE: Mississippi Code Annotated §43-13-117*

##### **15 Miss. Admin. Code Pt. 16, R. 3.19.2** Crib Standards {#sec-16-3.19.2 omnilex-key=us-ms-regs-official--title-15--16#3.19.2}

Each full-size infant crib shall meet the construction standards as established in Federal Regulations 16 CFR 1219 or its successor regulation. Each non-full-size infant crib shall meet the construction standards as established in Federal Regulations 16 CFR 1220 or its successor regulations. Pediatric hospital beds with rails, age appropriate elevated cots or toddler beds are permissible in the Pediatric Skilled Nursing Facility. The Pediatric Skilled Nursing Facility shall have documentation/specifications that cribs, beds and cots used in the facility meets the stated federal construction and/or child safety standards as applicable. The use of stackable cribs is prohibited.

**History**
- *SOURCE: Mississippi Code Annotated §43-13-117*

##### **15 Miss. Admin. Code Pt. 16, R. 3.19.3** Safety equipment {#sec-16-3.19.3 omnilex-key=us-ms-regs-official--title-15--16#3.19.3}

The following items of safety equipment shall be available on the premises:

1. Fire Code Items: extinguishers, alarms, smoke detectors as required by “Life Safety Code” (NFPA 2000 Edition, at a minimum) which references, but is not limited to:

a. Circuit interrupters;

b. Flush door openers;

c. Child proof latches on all closets, cabinets;

d. Straps on all highchairs, swings, infant seats;

e. Locks on storage cabinets housing hazardous/poisonous materials;

f. Integral child proof safety outlets or electrical outlet covers.

**History**
- *SOURCE: Mississippi Code Annotated §43-13-117*

##### **15 Miss. Admin. Code Pt. 16, R. 3.19.4** Medical Equipment/Supplies {#sec-16-3.19.4 omnilex-key=us-ms-regs-official--title-15--16#3.19.4}

The following items at a minimum, shall be available on the premises:

1. Suction machines-one per child requiring daily suctioning plus one suctioning machine for emergency use;

2. Double lockable narcotic cabinet;

3. Mechanical percussors and hand percussors, as prescribed;

4. Oxygen-in two portable tanks in storage carts (one with low flow, one with high flow regulator), two Oxygen concentrators (one with low flow, one with high flow regulator) or piped in with the appropriate tubing, neonate/infant, pediatric and adult manual resuscitation devices with masks to accommodate faces and tracheotomies;

5. Ventilator with provisions for mixing of gases to prescribed oxygen concentration as specifically prescribed shall be available per child requiring mechanical ventilation in the Pediatric Skilled Nursing Facility;

6. Pulse oximeter with supplies;

7. Electronic Blood Pressure machine (Dinamap);

8. First Aid supply kit;

9. Thermometers-excluding glass thermometers, manual sphygmomanometers, stethoscopes, otoscopes, and ophthalmoscopes;

10. Apnea monitoring supplies-belts, leads to apply to monitors brought from home; and

11. Disposable supplies, to include but not be limited to, gloves, scissors, and other disposable equipment needed by the child or by staff in the care of the child, shall be on hand at the Pediatric Skilled Nursing Facility, as needed.

**History**
- *SOURCE: Mississippi Code Annotated §43-13-117*

##### **15 Miss. Admin. Code Pt. 16, R. 3.19.5** Emergency Equipment and Supplies {#sec-16-3.19.5 omnilex-key=us-ms-regs-official--title-15--16#3.19.5}

At least the following items of emergency equipment and supplies shall be available on the premises:

1. An emergency generating system with adequate generating power to maintain medical equipment and adequate HVAC to operate the Pediatric Skilled Nursing Facility in the case of power failure;

2. Basic emergency equipment, including but not limit to:

a. Airways - in a range of sizes appropriate for the children served;

b. Suction catheters-in a range of sizes as necessary to meet the needs of each child served;

c. Pediatric manual resuscitators - self-inflating, with preemie, infant and pediatric mask (and adult resuscitators/mask available, if older, more developed children are accepted);

d. Pediatric AED device;

e. Child oxygen mask;

f. Infant oxygen mask;

g. Oxygen regulator with mist bottle and heating element;

h. Flashlight with extra batteries;

i. Stethoscope;

j. Feeding tubes – in a range of appropriate sizes for the children being served;

k. Disposable syringes, needles with size needles appropriate for the pediatric population and other children being served;

l. Intravenous catheters, angio-catheters and scalp vein needles in a range of appropriate pediatric sizes (sizes as appropriate for each child being served);

m. Tourniquets; armboards for preemie, infant and children being served, IV starting supplies, various sizes of adhesive tape;

n. Two-way stopcocks;

o. Two electrical outlet adapters for three-prong outlets;

p. Betadine preps and alcohol supplies.

**History**
- *SOURCE: Mississippi Code Annotated §43-13-117*

##### **15 Miss. Admin. Code Pt. 16, R. 3.19.6** Fluids/Medications {#sec-16-3.19.6 omnilex-key=us-ms-regs-official--title-15--16#3.19.6}

Basic drugs and solutions shall be on-site, available and accessible to medical/nursing staff, at all times:

1. Epinephrine ampule - 2 each of 1:1000 and 1:10,000;

2. Dextrose- 1 each of a) 25% solutions and b) 50% solutions

3. Activated Charcoal (1)

4. Sterile Water- 2 vials

5. Normal Saline- 2 vials

6. Intravenous fluids of Dextrose 5% and 10% in water, Dextrose 5% in Lactated Ringers, Normal Saline---500 cc/bag (2 each)

7. Heparin 10 units – 2 vials, Heparin 100unit – 2vials

8. Diphenhydramine (Benadryl 50mg/ml) – 1vial

**History**
- *SOURCE: Mississippi Code Annotated §43-13-117*

##### **15 Miss. Admin. Code Pt. 16, R. 3.20.1** General {#sec-16-3.20.1 omnilex-key=us-ms-regs-official--title-15--16#3.20.1}

Every facility/institution subject to these minimum standards shall be housed in a safe building which contains all the facility required to render the services contemplated on the application for license.

**History**
- *SOURCE: Mississippi Code Annotated §43-13-117*

##### **15 Miss. Admin. Code Pt. 16, R. 3.20.2** Codes {#sec-16-3.20.2 omnilex-key=us-ms-regs-official--title-15--16#3.20.2}

The term “safe”, in Rule 2.20.1 above, shall be interpreted to mean in compliance with the requirements of the codes, standards, and guidelines recognized by this agency at the time of construction, and are incorporated by reference to be part of these minimum standards.

1. For any existing construction, as of the date of this standard, shall meet, at a minimum, NFPA, Life Safety Code, 2000 Edition. In the event of the construction of a new Pediatric Skilled Nursing Facility or substantial modification of an existing facility, any subsequent edition of NFPA, Life Safety Code may be used, provided the licensing agency approve the use of such edition and that all construction and/or modifications meet the requirements of the approved edition.

2. Additional Codes. Regulations, Standards and Guidelines as required by the local authority having jurisdiction; should multiple documents have the same criterion, the most stringent will apply.

**History**
- *SOURCE: Mississippi Code Annotated §43-13-117*

##### **15 Miss. Admin. Code Pt. 16, R. 3.20.3** Site / Environment {#sec-16-3.20.3 omnilex-key=us-ms-regs-official--title-15--16#3.20.3}

For new construction, the proposed site of a facility must be approved by the licensing agency. Factors to be considered in approving a site, in addition to the above, may be convenience to medical and hospital services, approved water supply and sewage disposal, public transportation, community services, and the services of an organized fire department.

**History**
- *SOURCE: Mississippi Code Annotated §43-13-117*

##### **15 Miss. Admin. Code Pt. 16, R. 3.20.4** Location {#sec-16-3.20.4 omnilex-key=us-ms-regs-official--title-15--16#3.20.4}

All facilities established or constructed after the adoption of these regulations shall be located so that they are free of undue noise, smoke, dust, foul odors, etc.

**History**
- *SOURCE: Mississippi Code Annotated §43-13-117*

##### **15 Miss. Admin. Code Pt. 16, R. 3.20.5** Occupancy {#sec-16-3.20.5 omnilex-key=us-ms-regs-official--title-15--16#3.20.5}

No part of the facility may be leased, rented, or used for any other purpose not related to the operation of the Pediatric Skilled Nursing Facility.

**History**
- *SOURCE: Mississippi Code Annotated §43-13-117*

##### **15 Miss. Admin. Code Pt. 16, R. 3.20.6** Zoning Restrictions {#sec-16-3.20.6 omnilex-key=us-ms-regs-official--title-15--16#3.20.6}

The locations of a center shall comply with all local zoning ordinances.

**History**
- *SOURCE: Mississippi Code Annotated §43-13-117*

##### **15 Miss. Admin. Code Pt. 16, R. 3.20.7** Access {#sec-16-3.20.7 omnilex-key=us-ms-regs-official--title-15--16#3.20.7}

Institutions located in rural areas shall be served by good roads which can be kept passable at all times.

**History**
- *SOURCE: Mississippi Code Annotated §43-13-117*

##### **15 Miss. Admin. Code Pt. 16, R. 3.20.8** Building Classification {#sec-16-3.20.8 omnilex-key=us-ms-regs-official--title-15--16#3.20.8}

A Pediatric Skilled Nursing Facility building shall be constructed in accordance with NFPA 220, Standard on Types of Building

Construction.

**History**
- *SOURCE: Mississippi Code Annotated §43-13-117*

##### **15 Miss. Admin. Code Pt. 16, R. 3.20.9** Structural Soundness and Repair {#sec-16-3.20.9 omnilex-key=us-ms-regs-official--title-15--16#3.20.9}

The building shall be structurally sound, free of leaks and excessive moisture, in good repair, and painted at sufficient intervals to be reasonably attractive, inside and out.

**History**
- *SOURCE: Mississippi Code Annotated §43-13-117*

##### **15 Miss. Admin. Code Pt. 16, R. 3.20.10** Floors {#sec-16-3.20.10 omnilex-key=us-ms-regs-official--title-15--16#3.20.10}

All floors shall be smooth and free from defects such as cracks and be finished so that they can be easily cleaned.

**History**
- *SOURCE: Mississippi Code Annotated §43-13-117*

##### **15 Miss. Admin. Code Pt. 16, R. 3.20.11** Floor Levels {#sec-16-3.20.11 omnilex-key=us-ms-regs-official--title-15--16#3.20.11}

All differences in floor levels within the building shall be accomplished by stairs of not less than three (3) risers, ramps, or inclines, and shall be equipped with handrails on both sides.

**History**
- *SOURCE: Mississippi Code Annotated §43-13-117*

##### **15 Miss. Admin. Code Pt. 16, R. 3.20.12** Ramps and Inclines {#sec-16-3.20.12 omnilex-key=us-ms-regs-official--title-15--16#3.20.12}

Ramps and inclines shall not exceed one (1) foot of rise in twelve (12) feet of run, shall be furnished with a non-slip floor, and shall be provided with handrails on both sides.

**History**
- *SOURCE: Mississippi Code Annotated §43-13-117*

##### **15 Miss. Admin. Code Pt. 16, R. 3.20.13** Walls {#sec-16-3.20.13 omnilex-key=us-ms-regs-official--title-15--16#3.20.13}

All walls shall be of sound construction with an acceptable surface and shall be maintained in good repair. Generally, the walls should be painted a light color.

**History**
- *SOURCE: Mississippi Code Annotated §43-13-117*

##### **15 Miss. Admin. Code Pt. 16, R. 3.20.14** Handrails {#sec-16-3.20.14 omnilex-key=us-ms-regs-official--title-15--16#3.20.14}

Handrails shall be installed on both sides of the corridors and hallways used by residents, and shall be installed per current edition of the DOJ’s ADA Standards for Accessible Design.

**History**
- *SOURCE: Mississippi Code Annotated §43-13-117*

##### **15 Miss. Admin. Code Pt. 16, R. 3.20.15** Ceilings {#sec-16-3.20.15 omnilex-key=us-ms-regs-official--title-15--16#3.20.15}

1. All ceilings shall be of sound construction with an acceptable surface and shall be maintained in good repair. Generally, the ceilings should be painted a light color.

2. Ceiling Height. All ceilings shall have a height of at least eight (8) feet except that a height of seven (7) feet and six (6) inches may be approved for corridors or toilets and bathing rooms where the lighting fixtures are recessed. Exception may be made for existing facilities.

**History**
- *SOURCE: Mississippi Code Annotated §43-13-117*

##### **15 Miss. Admin. Code Pt. 16, R. 3.20.16** Windows {#sec-16-3.20.16 omnilex-key=us-ms-regs-official--title-15--16#3.20.16}

All areas where children are taught, or play shall have outside exposure by windows, clerestories, or skylights providing:

1. natural daylight;

2. a view of the exterior environment; and

3. shall not have any portion located below grade.

**History**
- *SOURCE: Mississippi Code Annotated §43-13-117*

##### **15 Miss. Admin. Code Pt. 16, R. 3.20.17** Fire Safety/Supervised Automatic Sprinkler System/Fire Alarm {#sec-16-3.20.17 omnilex-key=us-ms-regs-official--title-15--16#3.20.17}

All ediatric Skilled Nursing Facility shall be protected throughout by a supervised automatic Sprinkler system installed in accordance with the current edition of NFPA 13, Installation of Sprinkler Systems and a fire alarm system in accordance with the current edition of NFPA 72.

**History**
- *SOURCE: Mississippi Code Annotated §43-13-117*

##### **15 Miss. Admin. Code Pt. 16, R. 3.20.18** Fire Extinguishers {#sec-16-3.20.18 omnilex-key=us-ms-regs-official--title-15--16#3.20.18}

All Pediatric Skilled Nursing Facility shall be equipped with fire extinguishers in accordance with NFPA 10.

**History**
- *SOURCE: Mississippi Code Annotated §43-13-117*

##### **15 Miss. Admin. Code Pt. 16, R. 3.20.19** Smoke Detectors {#sec-16-3.20.19 omnilex-key=us-ms-regs-official--title-15--16#3.20.19}

All Pediatric Skilled Nursing Facility shall be equipped with and approved smoke detection system.

**History**
- *SOURCE: Mississippi Code Annotated §43-13-117*

##### **15 Miss. Admin. Code Pt. 16, R. 3.20.20** Water Supply, Plumbing and Sewerage {#sec-16-3.20.20 omnilex-key=us-ms-regs-official--title-15--16#3.20.20}

The water supply and sewerage disposal shall be approved by the local county health department and/or the Division of Environmental, Mississippi State Department of Health. No system of water supply, plumbing, sewerage, garbage, or refuse disposal shall be installed nor any such existing system materially altered or extended until complete plans and specifications for the installation, alteration, or extension have been so approved and submitted to the licensing agency for review and final determination.

**History**
- *SOURCE: Mississippi Code Annotated §43-13-117*

##### **15 Miss. Admin. Code Pt. 16, R. 3.20.21** Water Supply {#sec-16-3.20.21 omnilex-key=us-ms-regs-official--title-15--16#3.20.21}

1. All water shall be obtained from a public water supply.

2. Water under pressure sufficient to operate fixtures at the highest point during maximum demand periods shall be provided. Water under pressure of at least fifteen (15) pounds per square inch shall be piped to all sinks, toilets, lavatories, tubs, showers, and other fixtures requiring water.

3. It is recommended that the water supply into the facility be obtained from two (2) separate water lines, if possible.

4. A dual hot water supply shall be provided. The temperature of hot water to lavatories and bathing facilities shall not exceed one hundred fifteen (115) degrees Fahrenheit, nor shall hot water be less than one hundred (100) degrees Fahrenheit.

**History**
- *SOURCE: Mississippi Code Annotated §43-13-117*

##### **15 Miss. Admin. Code Pt. 16, R. 3.20.22** Supply Piping {#sec-16-3.20.22 omnilex-key=us-ms-regs-official--title-15--16#3.20.22}

Piping within the institution shall be in accordance with adopted local codes. Use of any device or installation configuration which could cause contamination of the supply through back siphonage or cross connections is strictly prohibited.

**History**
- *SOURCE: Mississippi Code Annotated §43-13-117*

##### **15 Miss. Admin. Code Pt. 16, R. 3.20.23** Sewerage Disposal {#sec-16-3.20.23 omnilex-key=us-ms-regs-official--title-15--16#3.20.23}

1. There shall be installed within the facility a properly designed waste disposal system connecting to all fixtures to which water under pressure is piped.

2. All liquid and human waste, including floor-wash water and liquid waste from refrigerators shall be disposed of through trapped drains into a public sewer system where such system is available.

3. In localities where a public sanitary sewer is not available, liquid and human waste shall be disposed of through trapped drains into sewerage disposal system approved by the local county health department and/or the Mississippi State Department of Health.

**History**
- *SOURCE: Mississippi Code Annotated §43-13-117*

##### **15 Miss. Admin. Code Pt. 16, R. 3.20.24** Plumbing Fixtures {#sec-16-3.20.24 omnilex-key=us-ms-regs-official--title-15--16#3.20.24}

For toddler toilet rooms, the fixtures shall be toddler- sized units;

**History**
- *SOURCE: Mississippi Code Annotated §43-13-117*

##### **15 Miss. Admin. Code Pt. 16, R. 3.20.25** Emergency Electrical Supply {#sec-16-3.20.25 omnilex-key=us-ms-regs-official--title-15--16#3.20.25}

The Pediatric Skilled Nursing Facility shall have a Level I EES (Essential Electrical System) in accordance with NFPA, Standard for Emergency and Standby Power Systems. The facility shall maintain an emergency electrical generator, of sufficient size and caliber, to make life- sustaining equipment operable in case of power failure and to support the daily function of the facility, to include but not be limited to, lighting, heating and air conditioning. Emergency outlets shall be made available in all rooms/areas, as appropriate, to assure uninterrupted operation of each child’s specialized equipment. The facility shall conduct and document operational testing of the equipment monthly. Documentation of such testing/maintenance shall be maintained on-site for a period of three years.

**History**
- *SOURCE: Mississippi Code Annotated §43-13-117*

##### **15 Miss. Admin. Code Pt. 16, R. 3.20.26** Emergency Lighting {#sec-16-3.20.26 omnilex-key=us-ms-regs-official--title-15--16#3.20.26}

Emergency Illumination Levels Shall Be Per Section 7.9 of NFPA 101, Life Safety Code.

**History**
- *SOURCE: Mississippi Code Annotated §43-13-117*

##### **15 Miss. Admin. Code Pt. 16, R. 3.20.27** Thermal Comfort/Temperature {#sec-16-3.20.27 omnilex-key=us-ms-regs-official--title-15--16#3.20.27}

A draft free seasonally appropriate temperature of 65 degrees Fahrenheit to 78 degrees Fahrenheit shall be maintained.

**History**
- *SOURCE: Mississippi Code Annotated §43-13-117*

##### **15 Miss. Admin. Code Pt. 16, R. 3.20.28** Telephone Communications {#sec-16-3.20.28 omnilex-key=us-ms-regs-official--title-15--16#3.20.28}

There shall be not less than one telephone in the Pediatric Skilled Nursing Facility and such additional telephones as necessary to summon help in the event of fire or other emergency. The telephone shall be listed under the official name of the facility.

**History**
- *SOURCE: Mississippi Code Annotated §43-13-117*

##### **15 Miss. Admin. Code Pt. 16, R. 3.20.29** Programmatic Design {#sec-16-3.20.29 omnilex-key=us-ms-regs-official--title-15--16#3.20.29}

The Pediatric Skilled Nursing Facility, at a minimum, shall include the following programmatic design elements:

1. Quiet rooms;

2. Nutritional and food prep area;

3. Age appropriate toileting facilities;

4. Indoor and outdoor recreational exercise play areas;

5. Treatment room(s)with adequate storage for needed supplies and a medication prep area;

6. Isolation room (s);

7. Clean and dirty storage areas;

8. Janitorial closet(s);

9. Biohazard closet;

10. Therapy/education/activity learning lab area;

11. Laundry area, to include but not be limited to, a separate area for clean and dirty laundry and adequate space for folding of clothes;

12. Staff area;

13. Reception area;

14. Administrative office(s);

15. Separate guest and child entrances;

16. Secured medication room / storage area;

17. A fully functional commercial-grade kitchen, dining room area; and

18. A designated secured area /room designated for medical records storage.

##### **15 Miss. Admin. Code Pt. 16, R. 3.20.30** Required Areas / Rooms {#sec-16-3.20.30 omnilex-key=us-ms-regs-official--title-15--16#3.20.30}

As a minimum, the Pediatric Skilled Nursing Facility shall include the following programmatic design areas sized as required to accommodate the Pediatric Skilled Nursing Facility census and all applicable codes/regulations, but in no instance shall they be less than indicated below:

1. Bedrooms. Facilities shall make efforts to design and decorate the bedrooms so as to create a home-like environment. Bedrooms of children shall be grouped in accordance with the child’s age group. Each child shall have a private room, unless such instances as siblings; whereas they wish to share a room. For single bedrooms, there shall be a minimum of 80 square feet and furniture shall be age-appropriate. In the case of a shared bedroom, as referenced herein, there shall be a minimum of 100 square feet. Each bedroom shall, at a minimum, contain a bed, (crib if appropriate), dresser, mirror, table and a chair. In the case of a shared room, privacy curtains or a mechanism to assure privacy must be provided;

2. The Pediatric Skilled Nursing Facility shall have age-appropriate toileting facilities with separate facilities for toddler and school-age children, as well as a shared tub (as a minimum);

3. The Pediatric Skilled Nursing Facility shall provide an indoor recreational/exercise/play area at the rate of 50 square feet minimum per licensed child;

4. The Pediatric Skilled Nursing Facility shall provide an outdoor Recreational / exercise / play area, directly adjoining the facility, that encompassing, at a minimum, 450 square feet, enclosed with a 6-foot privacy fence and that has a gate opening onto a non-hazardous exterior area. Playground play surface and equipment shall meet the standards and guidelines of the most current edition of the Public Playground Safety Handbook published by the U.S. Consumer Product Safety Commission.

5. Kitchen. The facility shall provide a commercial-grade kitchen that meets the standards of NFPA 96, with a food preparation area of not less than of not less than ten square feet per bed (for a 60 bed facility) that is designed to permit orderly and sanitary handling and processing of food; that avoids overcrowding and congestion of operations, provides at least three feet between work areas, and has a height of at least eight (8) feet. Commercial and/or institutional ranges, freezers units, dishwashers, ice machines, mixers, and other equipment as may be needed shall be present, as well as adequate numbers of pots, pans, silverware, glassware and dishes. Hand washing lavatories shall be conveniently located throughout the department, be equipped with hot and cold water, soap dispenser, a supply of soap, and disposable towels. The use of a common towel is prohibited. Hands shall not be washed in sinks where food is prepared or where utensils are cleaned.

a. Commercial of institutional dishwashing equipment shall be used. The dishwashing area shall be separated from the food preparation area. If sanitation is to be accomplished with hot water, a minimum temperature of one hundred eighty (180) degrees Fahrenheit shall be maintained during the rinse cycle. An alternate method of use of chemicals may be provided if sanitizing standards of the Mississippi State Department of Food Code Regulations are observed.

b. Adequate counter space for stacking soiled dishes shall be provided in the dishwashing area at the most convenient place of entry from the dining room, followed by a disposal with can storage under the counter. There shall be a pre-rinse sink, then the dishwasher and finally a counter or drain for clean dishes.

6. Commercial Laundry. The facility shall have laundry facilities unless commercial laundries are used. Laundry equipment shall be the type to

adequately perform the laundry needs of the facility. Provisions shall be made for proper mechanical ventilation of the laundry. Provisions shall be made to prevent the recirculation of air through the heating and air conditioning systems. Adequate lint traps shall be provided for driers. When laundry chutes are provided, they shall be a minimum of two (2) feet, and they shall be installed with flushing ring, vent, and drain.

7. Janitor closets. The facility shall provide janitor closets sufficient to meet the needs of the facility. Each shall contain a mop-cleaning sink and be large enough to store house cleaning supplies and equipment. A separate janitor closet area and equipment should be provided for the food service area. Each shall be kept clean and orderly.

8. Toilet Rooms. Adequate toileting facilities shall be provided to accommodate the needs of the residents and staff. Floors, ceilings, walls and fixtures of all toilet rooms shall be kept clean, in good repair and free of objectionable odors. The room shall be kept free of an accumulation of rubbish, cleaning supplies, toilet articles, etc.

9. Refrigeration Facilities. Adequate refrigeration facilities, automatic in operation, for the storage of perishable foods shall be provided. Where separate refrigeration can be provided, the recommended temperatures for storing perishable foods (32) to forty (40) degrees Fahrenheit for meat and dairy products, and forty (40) to forty-five (45) degrees Fahrenheit for fruit and vegetables. If it is impractical to provide separate refrigeration, the temperature shall be maintained at forty-one (41) degrees Fahrenheit. All refrigerators shall be provided with a thermometer. Facilities with more than twenty-four (24) beds shall have commercial or institutional type refrigeration.

10. Employee Toilet Facilities. Toilet facilities with lockers shall be provided for employees. Toilet rooms shall not open directly into any room in which food is prepared, stored, displayed or served, or into any room in which utensils are washed or stored. Toilet rooms shall be well lighted and ventilated. Each lavatory shall be equipped with hot and cold water, soap dispensers, a supply of soap, and disposable towels. The use of a common towel is prohibited.

**History**
- *SOURCE: Mississippi Code Annotated §43-13-117*

##### **15 Miss. Admin. Code Pt. 16, R. 3.20.31** Fire Safety {#sec-16-3.20.31 omnilex-key=us-ms-regs-official--title-15--16#3.20.31}

No facility shall be licensed until it conforms to the safety regulations providing minimum standards for prevention and protection of fire, as well as, for protection of life and property against fire.

Subchapter 21 Construction References

` Rule 3.21.1 Mandatory References. The Pediatric Skilled Nursing Facility shall comply with the requirements and guidelines of the following references:

1. Mississippi Code of 1972, Chapter 13 of Title 43 Public Health;

2. NFPA 101, Life Safety Code; National Fire Protection Association, Chapter 1 through 10 (General), AND Chapter 20, (New Ambulatory Health Care Occupancy), including all referenced standards and publications;

3. NFPA 220, Standard on types of Building Construction, National Fire Protection Association;

4. NFPA 241, Standard for Safeguarding Construction, Alteration, and Demolition Operations; National Fire Protection Association;

5. NFPA 72, National Fire Alarm and Signaling Code; National Fire Protection Association;

6. NFPA 70, National Electric Code, National Fire Protection Association;

7. NFPA 13, Standard for the Installation of Sprinkler Systems, National Fire Protection Association;

8. NFPA 10, Standards for Portable Fire Extinguishers; National Fire Protection Association;

9. NFPA 96, Standards for Ventilation, Control and Fire Protection of Commercial Cooking Operations, National Fire Protection Association;

10. ANSI/ASHRAE/ASHE Standard 170, Ventilation of Health Care Facilities, and its addenda; American National Standards Institute/American Society of Heating, Refrigeration and Air Conditioning Engineers/American Society for Healthcare Engineering; and the

11. ANSI A117.1, Accessible and Usable Buildings and Facilities; American National Standards Institute/American Society of Mechanical Engineers.

**History**
- *Source: Mississippi Code Annotated § 43-13-117*
- *SOURCE: Mississippi Code Annotated §43-13-117*

##### **15 Miss. Admin. Code Pt. 16, R. 3.22.1** Submission of Plans and Specifications {#sec-16-3.22.1 omnilex-key=us-ms-regs-official--title-15--16#3.22.1}

Construction shall not be started for any institution subject to these standards (whether new or remodeling/renovations or additions to an existing licensed hospital) until the plans and specifications for such construction or remodeling have been submitted to the Licensing Agency in

writing and its approval of the changes given in writing. Any contract modifications which affects or changes the function, design or purpose of the facility shall be submitted to and approved by the licensing agency prior to the beginning of work set forth in any contract modification.

1. Exception: Foundation changes made necessary by unanticipated conditions, or any conditions which present a hazard to life or property if not immediately corrected.

**History**
- *SOURCE: Mississippi Code Annotated §43-13-117*

##### **15 Miss. Admin. Code Pt. 16, R. 3.22.2** Plan Submissions {#sec-16-3.22.2 omnilex-key=us-ms-regs-official--title-15--16#3.22.2}

Plans and specifications for any substantial construction or remodeling should be prepared by competent architects and engineers licensed to practice in the state and who assume responsibility for supervising the construction. The following plans shall be submitted to the Licensing Agency for review:

1. Preliminary Plans - To include schematics of buildings, plot plans showing size and shape of entire site, existing structures, if any, streets and location and characteristics of all needed utilities, floor plans of every floor dimensioned and with proposed use of each room or area shown. If for additions or remodeling, provide plan or of existing building showing all proposed alterations, outline specifications to include a general description of the construction, type of finishes, and type of heating, ventilating, plumbing and electrical systems proposed. 2. Final Working Drawings and Specifications - Complete and in sufficient detail to be the basis for the award of construction contracts.

**History**
- *SOURCE: Mississippi Code Annotated §43-13-117*

##### **15 Miss. Admin. Code Pt. 16, R. 3.22.3** Governing Board Approval for Plans Submission {#sec-16-3.22.3 omnilex-key=us-ms-regs-official--title-15--16#3.22.3}

All plans submitted for review must be accompanied in their first submission by an order of the governing board indicating the type and scope of license to be applied for.

**History**
- *SOURCE: Mississippi Code Annotated §43-13-117*

##### **15 Miss. Admin. Code Pt. 16, R. 3.22.4** Time Limit of Plan Approval {#sec-16-3.22.4 omnilex-key=us-ms-regs-official--title-15--16#3.22.4}

Plans receiving approval of the Licensing Agency upon which construction has not begun within six (6) months following such approval must be resubmitted for approval.

**History**
- *SOURCE: Mississippi Code Annotated §43-13-117*

##### **15 Miss. Admin. Code Pt. 16, R. 3.22.5** Approval for Waste Water/Sewer Connectivity {#sec-16-3.22.5 omnilex-key=us-ms-regs-official--title-15--16#3.22.5}

In addition to submission to the licensing agency, plans must be submitted to other regulatory entities, such as the County Health Department, etc., for approval of proper water/sewer connectivity/facilities prior to starting construction.

**History**
- *SOURCE: Mississippi Code Annotated §43-13-117*

##### **15 Miss. Admin. Code Pt. 16, R. 3.22.6** Approval for Occupancy {#sec-16-3.22.6 omnilex-key=us-ms-regs-official--title-15--16#3.22.6}

Upon completion of construction, an inspection shall be made by the Licensing Agency and approval given prior to occupying the building or any part thereof. The state and county health departments shall have access to the job site during regular business hours and shall conduct construction progress inspections as deemed necessary by the agency.

**History**
- *SOURCE: Mississippi Code Annotated §43-13-117*

##### **15 Miss. Admin. Code Pt. 16, R. 3.22.7** Construction Close-Out Documents {#sec-16-3.22.7 omnilex-key=us-ms-regs-official--title-15--16#3.22.7}

At the time of the final inspection, the following documentation shall be provided to the State Agency:

1. A Letter from the Architect of Record attesting that he/she supervised or directed the supervision of all phases of the construction and that all work was performed in compliance with approved plans;

2. A copy of the Certificate of Occupancy or statement of approval from the local building official permitting occupancy of the facility for its intended use. In the absence of a local building authority, approval of a local fire authority having jurisdiction shall be provided. If the facility is owned by the State of Mississippi and subject to the State Bureau of Buildings Grounds and Real Estate Management, approval of occupancy shall be coordinated between the state agencies involved;

3. The Pediatric Skilled Nursing Facility, providing in-house dietary services shall provide a current copy of the Certificate or other Installer authority issued by the manufacture of the engineered automatic range exhaust hood and duct fire suppression system installed. The installer must verify, in writing, that the staff have been trained in its use or that such training will be provided, and that operation and service manuals have been provided to the owner;

4. A copy of the fire alarm systems operational test prepared by the installer/vendor. This test must be documented and equivalent to the acceptance test required by NFPA 72, the National Fire Alarm Code, Chapter 7, “Initial Acceptance Testing”. When the emergency forces notification requirement is provided by a private central station, a current copy of the provider’s listing (i.e. UL, FM, etc.) must be attached;

5. A copy of the automatic fire sprinkler installer’s Contractor’s Materials and Test Certificate, for part A (above ground piping) and/or Part U (underground piping);

6. Provide verification that all backflow prevention devices, required by local authority, serving sprinkled buildings are equipped with valve supervision (tamper switches) electronically interconnected to the fire alarm system;

7. Evidence that an installation acceptance test was performed on the emergency generator by qualified technicians in accordance with NPFA 110, Standards for Emergency and Standby Power Systems, Section 5-13, “Installation Acceptance”;

8. Evidence that the electrical grounding system and the power system performs within the limits described in NFPA 99, Health Care Facilities, Section 3-3-3, “Performance Criteria and Testing”;

9. Certification of the fire alarm equipment and installation to be in accordance with applicable section of NFPA 70, The National Electric Code, and NFPA 72, The National Fire Alarm Code; and

10. Test certificates for all interior combustible wall and ceiling finishes based on the test method described in NFPA 255, Standard Method of Testing Surface Burning Characteristics of Building Materials.

**History**
- *SOURCE: Mississippi Code Annotated §43-13-117*

##### **15 Miss. Admin. Code Pt. 16, R. 3.23.1** Elevators {#sec-16-3.23.1 omnilex-key=us-ms-regs-official--title-15--16#3.23.1}

One power driven elevator is required in all facilities having children’s rooms, playrooms or classrooms above the first floor. Minimum cab dimensions required for elevators transporting children is 76" x 50" inside clear measurements; hatchway and cab doors 3'8" wide, minimum.

**History**
- *SOURCE: Mississippi Code Annotated §43-13-117*

##### **15 Miss. Admin. Code Pt. 16, R. 3.23.2** Heating and Ventilation {#sec-16-3.23.2 omnilex-key=us-ms-regs-official--title-15--16#3.23.2}

Heating and air conditioning units/systems shall be provided to maintain comfortable temperatures throughout the facility. A draft free seasonally appropriate temperature of 65 degrees Fahrenheit to 78 degrees Fahrenheit shall be maintained.

**History**
- *SOURCE: Mississippi Code Annotated §43-13-117*

##### **15 Miss. Admin. Code Pt. 16, R. 3.24.1** Medical Waste {#sec-16-3.24.1 omnilex-key=us-ms-regs-official--title-15--16#3.24.1}

The facility shall have and abide by a medical waste management plan consistent with the “Adopted Standards for the Regulation of Medical Waste” in Health Care Facilities Licensed by the Mississippi State Department of Health. These standards can be located under Licensure and Regulations at www.msdh.state.ms.us.

**History**
- *SOURCE: Mississippi Code Annotated §43-13-117*

##### **15 Miss. Admin. Code Pt. 16, R. 3.25.1** Emergency Operations Plan {#sec-16-3.25.1 omnilex-key=us-ms-regs-official--title-15--16#3.25.1}

The Pediatric Skilled Nursing Facility shall develop and maintain a written preparedness plan utilizing the “All Hazards” approach to emergency and disaster planning. The plan must include procedures to be flowed in the event of any act of terrorism or man-made or natural disaster as appropriate for the specific geological location. The final draft of the Emergency Operations Plan (EOP) will be reviewed by the Office of Emergency Preparedness and Response (EOPR), Mississippi State Department of Health, or their designees, for conformance with the “All Hazards” Emergency Preparedness and Response Plan. Particular attention shall be given to critical areas of concern which may arise during any “All Hazards” emergency whether required to evaluate or to sustain in place. Additional plan criteria or a specific EOP format may be required as deemed necessary by the Office of Emergency Preparedness and Response. The six critical areas of consideration are:

1. Communications. Facility status report shall be submitted in a format and a frequency as required by the Office of EOPR;

2. Resources and Assets;

3. Safety and Security;

4. Staffing;

5. Utilities;

6. Clinical Activities.

**History**
- *SOURCE: Mississippi Code Annotated §43-13-117*

##### **15 Miss. Admin. Code Pt. 16, R. 3.25.2** Emergency Operations Plans {#sec-16-3.25.2 omnilex-key=us-ms-regs-official--title-15--16#3.25.2}

Emergency Operations Plans (EOPs) must be exercised and reviewed annually or as directed by the office of Emergency Preparedness and Response. Written evidence of current approval or review of provider EOPs, by the Office of Emergency Preparedness and Response, shall accompany all applications for facility license renewals.

**History**
- *SOURCE: Mississippi Code Annotated §43-13-117*

##### **15 Miss. Admin. Code Pt. 16, R. 3.26.1** Fire Drills {#sec-16-3.26.1 omnilex-key=us-ms-regs-official--title-15--16#3.26.1}

Fire drills shall be conducted one (1) per shift per quarter. Employees shall participate in a fire drill at least four time per year.

**History**
- *SOURCE: Mississippi Code Annotated §43-13-117*

##### **15 Miss. Admin. Code Pt. 16, R. 3.26.2** Written Records {#sec-16-3.26.2 omnilex-key=us-ms-regs-official--title-15--16#3.26.2}

Written records of all fire drills shall be maintained, indicating content of and attendance at each drill.

**History**
- *SOURCE: Mississippi Code Annotated §43-13-117*

##### **15 Miss. Admin. Code Pt. 16, R. 3.26.3** Evacuation Plan {#sec-16-3.26.3 omnilex-key=us-ms-regs-official--title-15--16#3.26.3}

A fire evacuation plan shall be posted in each facility in a conspicuous place and kept current.

CHAPTER 4 MINIMUM STANDARDS OF OPERATION FOR POST-ACUTE RESIDENTIAL BRAIN INJURY REHABILITATION FACILITIES (RBIR) CHAPTER 4 MINIMUM STANDARDS OF OPERATION FOR POST-ACUTE RESIDENTIA Subchapter 1 GENERAL: LEGAL AUTHORITY

**History**
- *SOURCE: Mississippi Code Annotated §43-13-117*

##### **15 Miss. Admin. Code Pt. 16, R. 4.1.1** Adoption of Rules, Regulations, and Minimum Standards {#sec-16-4.1.1 omnilex-key=us-ms-regs-official--title-15--16#4.1.1}

By virtue of authority vested in it by the Legislature of the State of Mississippi as per Section 41-75-13 of the Mississippi Code of 1972, as amended, the Mississippi State Department of Health does hereby adopt and promulgate the following Rules, Regulations, and Minimum Standards of Operation for RBIR. Upon adoption of these Rules, Regulations, and Minimum Standards, all former rules, regulations and minimum standards in conflict therewith, previously adopted by the licensing agency, are hereby repealed.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 4.1.2** Codes and Ordinances {#sec-16-4.1.2 omnilex-key=us-ms-regs-official--title-15--16#4.1.2}

Every licensed facility located inside the boundaries of a municipality shall comply with all local municipal codes and ordinances applicable thereto. In addition, each licensed facility shall comply with all applicable state and federal laws.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 4.1.3** Fire Safety {#sec-16-4.1.3 omnilex-key=us-ms-regs-official--title-15--16#4.1.3}

No RBIR shall be licensed until it shows conformance to the s a f e t y regulations providing minimum standards for prevention and detection of fire as well as for protection of life and property against fire.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 4.1.4** Duty to Report {#sec-16-4.1.4 omnilex-key=us-ms-regs-official--title-15--16#4.1.4}

All fires, explosions, natural disasters as well as avoidable deaths, or avoidable, serious, or life-threatening injuries to clients resulting from fires, explosions, and natural disasters shall be reported by telephone to the Life

Safety Code Division of the licensing agency by the next working day after the occurrence. The licensing agency will provide the appropriate forms to the RBIR which shall be completed and returned within fifteen (15) calendar days of the occurrence. All reports shall be complete and thorough and shall record, at a minimum the causal factors, date and time of occurrence, exact location of occurrence within or without the RBIR, and attached thereto shall be all police, fire, or other official reports.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 4.2.1** Abuse {#sec-16-4.2.1 omnilex-key=us-ms-regs-official--title-15--16#4.2.1}

The willful infliction of physical or mental injury on an individual by other parties, including but not limited to such means as sexual abuse, exploitation, or extortion of funds or other things of value, unreasonable confinement, and/or intimidation to emotional well-being is endangered.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 4.2.2** Activities of Daily Living (ADLs) {#sec-16-4.2.2 omnilex-key=us-ms-regs-official--title-15--16#4.2.2}

These are considered the basic, vital, daily activities for persons and are identified as bathing, grooming, dressing, dining, toileting, and ambulation/transfer.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 4.2.3** Brain Injury {#sec-16-4.2.3 omnilex-key=us-ms-regs-official--title-15--16#4.2.3}

The term “brain injury" is a traumatic or other insult to the brain and its related parts resulting in organic damage thereto that may cause physical, intellectual, emotional, social, and/or vocational changes in a person.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 4.2.4** Client {#sec-16-4.2.4 omnilex-key=us-ms-regs-official--title-15--16#4.2.4}

An individual receiving care from a RBIR and shall include only individuals who are medically stable.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 4.2.5** Community Integration {#sec-16-4.2.5 omnilex-key=us-ms-regs-official--title-15--16#4.2.5}

The participation in the mainstream of community life and maintaining social relationships with family members, peers, and others in the community who do not have brain injuries. Integration also means that clients have equal access to and full participation in community resources and activities available to the general public at the maximum amount of safety and independence as possible.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 4.2.6** Residential Brain Injury Rehabilitation Facility (RBIR) {#sec-16-4.2.6 omnilex-key=us-ms-regs-official--title-15--16#4.2.6}

A facility containing no more than twelve (12) beds providing medically directed long- term but non-acute rehabilitation to patients who have acquired brain injury. In order to be eligible for licensure, the post-acute residential brain injury rehabilitation facility shall be located at least twenty-five (25) miles from the nearest acute care rehabilitation hospital and at least five (5) miles from the boundaries of any municipality having a population of ten thousand (10,000) or more, according to the most recent federal decennial census, at the time that facility is established.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 4.2.7** Direct Care Staff {#sec-16-4.2.7 omnilex-key=us-ms-regs-official--title-15--16#4.2.7}

Employees of the facility that provide personal services to the clients.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 4.2.8** Director {#sec-16-4.2.8 omnilex-key=us-ms-regs-official--title-15--16#4.2.8}

The person designated by the owner or Governing Body as responsible for carrying on the day to day management, administration, supervision, and operation of the facility.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 4.2.9** Exploitation {#sec-16-4.2.9 omnilex-key=us-ms-regs-official--title-15--16#4.2.9}

The illegal or improper use of a vulnerable adult or his resources for another's profit or advantage, with or without the consent of the vulnerable adult, and includes acts committed pursuant to a power of attorney. "Exploitation" includes, but is not limited to, a single incident.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 4.2.10** Facility {#sec-16-4.2.10 omnilex-key=us-ms-regs-official--title-15--16#4.2.10}

The term "facility" shall mean any home or institution that has sought or is currently seeking designation as a "licensed facility" under the terms of these regulations.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 4.2.11** IGRA(s) (Interferon-Gamma Release Assay(s) {#sec-16-4.2.11 omnilex-key=us-ms-regs-official--title-15--16#4.2.11}

A whole blood test used to assist in diagnosing Mycobacterium Tuberculosis infection. The IGRA blood test used must be approved by the U.S. Food and Drug Administration (FDA).

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 4.2.12** Immediate Jeopardy (Serious and Immediate to Health and Safety) {#sec-16-4.2.12 omnilex-key=us-ms-regs-official--title-15--16#4.2.12}

A situation in which the licensed facility's failure to meet one or more regulatory requirements has caused, or is likely to cause, serious injury, harm, impairment, or death to a client.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 4.2.13** Instrumental Activities of Daily Living (IADLs) {#sec-16-4.2.13 omnilex-key=us-ms-regs-official--title-15--16#4.2.13}

These activities are considered to be instrumental, essential activities for persons, but are not usually considered as basic or vital activities of daily living, and may not be daily activities. Such activities would include, but are not limited to: socialization, managing personal affairs, financial management, shopping, housekeeping, appropriate transportation correspondence, behavior and health management, etc.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 4.2.14** License {#sec-16-4.2.14 omnilex-key=us-ms-regs-official--title-15--16#4.2.14}

The term "license" shall mean the document issued by the licensing agency of the Mississippi State Department of Health. Licensure shall constitute authority to receive clients and perform the services included within the scope of these rules, regulations, and minimum standards.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 4.2.15** Licensed Facility {#sec-16-4.2.15 omnilex-key=us-ms-regs-official--title-15--16#4.2.15}

The term "licensed facility" shall mean any business for RBIR which has been issued a license for operation by the licensing agency.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 4.2.16** Licensed Practical Nurse {#sec-16-4.2.16 omnilex-key=us-ms-regs-official--title-15--16#4.2.16}

The term "licensed practical nurse" shall mean a person who is currently licensed by the Mississippi Board of Nursing as a Licensed Practical Nurse.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 4.2.17** Licensee {#sec-16-4.2.17 omnilex-key=us-ms-regs-official--title-15--16#4.2.17}

The term "licensee" shall mean the person to which the license is issued and upon whom rests the responsibility for the operation of the institution.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 4.2.18** Licensing Agency {#sec-16-4.2.18 omnilex-key=us-ms-regs-official--title-15--16#4.2.18}

The term “licensing agency" shall mean the Mississippi State Department of Health.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 4.2.19** Licensure Violation {#sec-16-4.2.19 omnilex-key=us-ms-regs-official--title-15--16#4.2.19}

The failure of a RBIR to comply with the minimum standards or requirements contained within this Chapter 4.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 4.2.20** Mantoux Test {#sec-16-4.2.20 omnilex-key=us-ms-regs-official--title-15--16#4.2.20}

A method of skin testing that is performed by injecting one- tenth (0.1) milliliter of purified protein derivative-tuberculin containing five (5) tuberculin units into the dermis (i.e., the second layer of skin) of the forearm with a needle and syringe. The area is examined between forty-eight (48) and seventy-two (72) hours after the injection. A reaction is measured according to the size of the induration. The classification of a reaction as positive or negative depends on the patient’s medical history and various risk factors (see definition for “significant tuberculin skin test”). This test is used to evaluate the likelihood that a person is infected with M. tuberculosis. The Mantoux (TST) test should be administered only by persons certified in the intradermal technique.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 4.2.21** Medication Administration {#sec-16-4.2.21 omnilex-key=us-ms-regs-official--title-15--16#4.2.21}

For the purposes of these regulations, the term "medication administration" is limited to those decisions, made by a licensed nurse or physician, regarding (1) which medication is to be taken, (2) the dosage of the medication, or (3) the time at which the medication is to be taken.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 4.2.22** Medication Assistance {#sec-16-4.2.22 omnilex-key=us-ms-regs-official--title-15--16#4.2.22}

For the purposes of these regulations, the term "medication assistance" is the physical act of handing an oral prescription medication to the client along with liquids to assist the client in swallowing as deemed appropriate by the Medication Management Program.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 4.2.23** Medication Management Program {#sec-16-4.2.23 omnilex-key=us-ms-regs-official--title-15--16#4.2.23}

A systematic, functionally, oriented program formulated in consultation with the client’s primary provider, and implemented by staff. The program shall be based upon an assessment and understanding of the behaviors of the client and recognition of the unique medical and pharmacological needs of the client. It shall also mean an incorporation of the most appropriate level of assistance necessary to advance towards independence.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 4.2.24** Neglect {#sec-16-4.2.24 omnilex-key=us-ms-regs-official--title-15--16#4.2.24}

The failure to provide food, shelter, clothing, medical or other health services, appropriate security and supervision, or other personal services necessary for a client’s well-being.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 4.2.25** Nutritional Assessment {#sec-16-4.2.25 omnilex-key=us-ms-regs-official--title-15--16#4.2.25}

A nutritional assessment assesses nutritional status and

includes determination of appropriateness of diet, adequacy of total food intake and the skills associated with eating, including chewing, sucking and swallowing disorders, food service practices, and monitoring and supervision of one’s own nutritional status.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 4.2.26** Outpatient {#sec-16-4.2.26 omnilex-key=us-ms-regs-official--title-15--16#4.2.26}

Outpatient rehabilitative treatment services may be provided to a client of the RBIR at an outpatient facility if necessary to advance the individual’s independence for higher level of community or transition to a greater level of independence in community or vocational function.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 4.2.27** Personal Care {#sec-16-4.2.27 omnilex-key=us-ms-regs-official--title-15--16#4.2.27}

The term “personal care" shall mean the assistance rendered by personnel of the licensed facility to clients in performing one or more of the activities of daily living, including but not limited to bathing, hair care, skin care, shaving, nail care, oral hygiene, overall hygiene, walking, bowel and bladder management, eating, personal grooming, dressing, positioning, care of adaptive personal care devise and appropriate level of supervision.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 4.2.28** Pharmacist {#sec-16-4.2.28 omnilex-key=us-ms-regs-official--title-15--16#4.2.28}

The term "pharmacist" shall mean a person currently licensed to practice pharmacy in Mississippi by the State Board of Pharmacy.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 4.2.29** Plan of Correction {#sec-16-4.2.29 omnilex-key=us-ms-regs-official--title-15--16#4.2.29}

Plan of Correction shall mean a plan developed by the RBIR and approved by the licensure agency that describes the action the RBIR will take to correct the licensure violation(s) and specifies the date by which these licensure violation(s) will be corrected.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 4.2.30** Primary Provider {#sec-16-4.2.30 omnilex-key=us-ms-regs-official--title-15--16#4.2.30}

A physician provider board certified in his/her specialty who currently holds a valid license in Mississippi. The primary provider is responsible for overseeing the decision making process for admission and continued stay of clients.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 4.2.31** Rehabilitative Treatment Environment {#sec-16-4.2.31 omnilex-key=us-ms-regs-official--title-15--16#4.2.31}

A rehabilitation setting that provides for all of the following:

1. A provision of a range of choices, with personal preference, self-

determination, and dignity of risks receiving full respect and consideration.

2. A variety of social interactions that promote community integration.

3. An environment of peer support and mentorship.

4. Professional team involvement.

5. A physical environment conducive to enhancing the functional abilities of the client.

6. Necessary therapeutic services. These therapeutic services may include social work, behavioral services, speech therapy, physical therapy, occupational therapy, vocational services, and therapeutic recreational services. All therapeutic providers must be licensed under state and, if applicable, national boards.

7. A medication management program.

8. Cognitive rehabilitation activities.

9. The identification of functional limitations.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 4.2.32** Rehabilitation {#sec-16-4.2.32 omnilex-key=us-ms-regs-official--title-15--16#4.2.32}

The process of providing those comprehensive services deemed appropriate to the needs of a client in a coordinated manner in a program designed to achieve functional objectives of improved health, welfare, maximum physical, cognitive, social, psychological, and community functioning.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 4.2.33** Representative {#sec-16-4.2.33 omnilex-key=us-ms-regs-official--title-15--16#4.2.33}

A person who voluntarily, with the client’s written authorization, may act upon the client’s direction regarding matters concerning the health and welfare of the client, including having access to personal records contained in the client’s file and receiving information and notices about the client’s overall care and condition. No member of the Governing Body, administration, or staff of a brain injury facility or any member of their family may serve as the representative for a client unless they are related to the client by blood or marriage. In the case of an individual that has been interdicted, “representative” means the court- appointed curator or his designee.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 4.2.34** Therapeutic Recreational Services {#sec-16-4.2.34 omnilex-key=us-ms-regs-official--title-15--16#4.2.34}

Services that identify leisure activities and assistance in modifying and adapting identified leisure activities to allow safe

participation by the client as a means to improve quality of life and aid in integration into the community.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 4.2.35** Service Plan {#sec-16-4.2.35 omnilex-key=us-ms-regs-official--title-15--16#4.2.35}

Each client must have a service plan that is developed by an interdisciplinary team that represents the professions, disciplines or service areas relevant to identifying the client’s needs as described by the comprehensive functional assessments. This service plan shall be prepared within 14 days after admission.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 4.2.36** Significant Tuberculin Skin Test {#sec-16-4.2.36 omnilex-key=us-ms-regs-official--title-15--16#4.2.36}

An induration of five (5) millimeters or greater is significant (or positive) in the following:

10. Persons known to have or suspected of having human immunodeficiency virus (HIV).

11. Close contacts of a person with infectious tuberculosis.

12. Persons who have a chest radiograph suggestive of previous tuberculosis.

13. Persons who inject drugs (if HIV status is unknown). An induration of ten (10) millimeters or greater is significant (or positive) in all other persons tested in Mississippi. A tuberculin skin test is recorded in millimeters of induration. For accurate results, measure the widest diameter of the palpable induration transverse (across) the arm.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 4.2.37** Support {#sec-16-4.2.37 omnilex-key=us-ms-regs-official--title-15--16#4.2.37}

Activities, materials, equipment, or other services designed and implemented to assist the client with a brain injury. Examples include but are not limited to instruction, training, assistive technology, or removal of architectural barriers.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 4.2.38** Surveyor {#sec-16-4.2.38 omnilex-key=us-ms-regs-official--title-15--16#4.2.38}

The term “surveyor" shall mean an individual employed, or hired on a contractual basis, by the licensing agency for the purpose of conducting surveys, inspections, investigations, or other related functions as part of the licensing agency's responsibilities for licensure and regulation of RBIR.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 4.2.39** Two-step Testing {#sec-16-4.2.39 omnilex-key=us-ms-regs-official--title-15--16#4.2.39}

A procedure used for the baseline testing of person who will periodically receive tuberculin skin tests (e.g., health care workers) to reduce the likelihood of mistaking a boosted reaction for a new infection. If initial tuberculin-test result is classified as negative, a second test is repeated one (1) to three (3) weeks later. If reaction to the second test is positive, it probably represents a boosted reaction. If second test is also negative, the person is classified as not infected. A positive reaction to a subsequent test would indicate new infection (i.e., a skin-test conversion) in the person.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 4.2.40** Vocational Services {#sec-16-4.2.40 omnilex-key=us-ms-regs-official--title-15--16#4.2.40}

Services provided directly or through cooperating agencies to a client in accordance with his individualized plan and designed to improve or enhance skills and behaviors necessary for successful placement in a volunteer or work setting.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 4.2.41** The above definitions are not intended to be all-inclusive {#sec-16-4.2.41 omnilex-key=us-ms-regs-official--title-15--16#4.2.41}

Other definitions are included in the text as appropriate.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 4.3.1** Authority {#sec-16-4.3.1 omnilex-key=us-ms-regs-official--title-15--16#4.3.1}

The licensing agency shall have the power to adopt, amend, promulgate and enforce such rules, regulations and minimum standards as it deems appropriate, within the law.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 4.4.1** Inspections/Surveys Required {#sec-16-4.4.1 omnilex-key=us-ms-regs-official--title-15--16#4.4.1}

Each licensed facility shall be inspected by the licensing agency or by persons delegated with authority by said licensing agency annually or more frequently at such intervals as the licensing agency may direct. The licensing agency and/or its authorized representatives shall have the right to inspect construction work in progress. New facilities shall not be licensed without having first been inspected for compliance with these rules, regulations, and minimum standards.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 4.5.1** Regular License {#sec-16-4.5.1 omnilex-key=us-ms-regs-official--title-15--16#4.5.1}

A license shall be issued to each facility that meets

the requirements as set forth in these regulations.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 4.5.2** Provisional License {#sec-16-4.5.2 omnilex-key=us-ms-regs-official--title-15--16#4.5.2}

Within its discretion, the licensing agency may issue a provisional license only if the licensing agency is satisfied that preparations are being made to qualify for a regular license and that the health and safety of clients will not be endangered.

**History**
- *SOURCE: Miss. Code Ann. §41-75*

##### **15 Miss. Admin. Code Pt. 16, R. 4.6.1** Application {#sec-16-4.6.1 omnilex-key=us-ms-regs-official--title-15--16#4.6.1}

Application for a license or renewal of a license shall be made in writing to the licensing agency, on forms provided by the licensing agency, which shall contain such information as the licensing agency may require.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 4.6.2** Fees {#sec-16-4.6.2 omnilex-key=us-ms-regs-official--title-15--16#4.6.2}

1. Fees. Each application for licensure shall be accompanied by a fee of One Thousand Dollars ($1000.00) plus Twenty Dollars ($20.00) per bed, in check or money order made payable to Mississippi State Department of Health. The fees are not refundable.

2. Applicants for initial licensure, or licensees, shall pay a User Fee to the licensing agency when it is required to review and/or inspect the proposal of any licensed facility in which there are additions, renovations, modernizations, expansions, alterations, conversions, modifications, or replacements. Said fee shall be assessed at the rate of Fifty Dollars ($50.00) per hour or part thereof.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 4.6.3** Application for License {#sec-16-4.6.3 omnilex-key=us-ms-regs-official--title-15--16#4.6.3}

Applications should include:

1. Name of Facility. Every RBIR shall be designated by a permanent and distinctive name which shall be used in applying for a license and shall not be changed without first notifying the licensing agency in writing and receiving written approval of the change from the licensing agency. Such notice shall specify the name to be discontinued as well as the new name proposed. Only the official name, as approved by the licensing agency and by which the facility is licensed shall be used in telephone listing, on stationery, in advertising, etc. Two or more facilities shall not be licensed under a similar name.

2. Number of Beds. RBIR shall contain no more than 12 beds.

3. A copy of the on-site inspection report with approval for occupancy by the Office of the State Fire Marshal.

4. A copy of the health inspection report with approval of occupancy from the Mississippi State Department of Health.

5. Verification of a criminal history records check which was processed through the MSDH FingerPro system.

6. Proof of financial viability as evidenced by one of the following:

a. Verification of sufficient assets equal to one hundred thousand dollars or the cost of three months of operation, whichever is less; or

b. A letter of credit equal to one hundred thousand dollars or the cost of three months of operation, whichever is less.

7. Proof of worker’s compensation insurance.

8. Disclosure of ownership and control information.

9. A written statement that the facility will not at any time participate in the Medicaid program (Section 43-13-101 et.seq.) or admit or keep any patients in the facility who are participating in the Medicaid program.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 4.7.1** Issuance of License {#sec-16-4.7.1 omnilex-key=us-ms-regs-official--title-15--16#4.7.1}

All licenses issued by the licensing agency shall set forth the name of the facility, the location, the name of the licensee, the classification of the facility, the type of building, the bed capacity for which

the facility is licensed and the license number.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 4.7.2** Posting of License {#sec-16-4.7.2 omnilex-key=us-ms-regs-official--title-15--16#4.7.2}

The license shall be posted in a conspicuous place on the licensed premises and shall be available for review by interested persons.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 4.7.3** License Not Transferable {#sec-16-4.7.3 omnilex-key=us-ms-regs-official--title-15--16#4.7.3}

The license is not transferable or assignable to any other person except by written approval of the licensing agency.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 4.7.4** Expiration of License {#sec-16-4.7.4 omnilex-key=us-ms-regs-official--title-15--16#4.7.4}

Each license shall expire on March 31, following the date of issuance.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 4.7.5** Renewal of License {#sec-16-4.7.5 omnilex-key=us-ms-regs-official--title-15--16#4.7.5}

License shall be renewable annually upon:

1. Filing and approval of an application for renewal by the licensing agency.

2. Submission of appropriate licensure renewal fee of $20.00 per bed.

3. Maintenance by the licensed facility of minimum standards in its physical facility, staff, services, and operation as set forth in these regulations.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 4.8.1** Denial or Revocation of License {#sec-16-4.8.1 omnilex-key=us-ms-regs-official--title-15--16#4.8.1}

The licensing agency, after notice and opportunity for a hearing to the applicant or licensee, is authorized to deny, suspend, or revoke a license, or deny renewal of a license, in any case in which it finds that there has been a substantial failure to comply with the requirements established under the law and these regulations. Also, the following shall be grounds for denial or revocation of license:

1. Fraud on the part of the licensee in applying for a license, or renewal of

license.

2. Willful or repeated violations by the licensee of any of the provisions of Sections 43-11-1 et seq, of the Mississippi Code of 1972, as amended, and/or of the rules, regulations, and minimum standards established by the licensing agency.

3. Addiction to narcotic drug(s) by the licensee or other employees or personnel of the licensed facility.

4. Use of alcoholic beverages by the licensee or other personnel of the licensed facility to the extent which threatens the well-being or safety of the clients.

5. Conviction of the licensee of a felony.

6. Publicly misrepresenting the licensed facility and/or its services.

7. Permitting, aiding, or abetting the commission of any unlawful act.

8. Conduct or practices detrimental to the health or safety of clients and employees of said licensed facility. Detrimental practices include but are not limited to:

a. Cruelty or abuse of or to a client or indifference to the needs of the client which are essential to the general well-being and health.

b. Misappropriation of the money or property of a client.

c. Failure to provide food adequate for the needs of a client.

d. Inadequate staff to provide safe care and supervision of a client.

e. Failure to call a physician or nurse practitioner/physician assistant when required by a client's condition.

f. Failure to notify next of kin when a client's condition becomes critical.

g. Admission of a client whose condition demands care beyond the level of care provided by the licensed facility as determined by its classification.

9. A violation of 24-hour supervision requirement and/or the transfer of a client from the licensed facility to any unlicensed facility may result in the facility's license being made provisional for a period of 90 days. At the end of that 90-day period, if corrective actions have not been taken by the

licensed facility, that Provisional License may be revoked.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 4.8.2** Immediate Revocation of License {#sec-16-4.8.2 omnilex-key=us-ms-regs-official--title-15--16#4.8.2}

Pursuant to Section 41-3-15, the State Department of Health is authorized and empowered, to revoke, immediately, the license and require closure of any institution for the aged or infirm, including any other remedy less than closure to protect the health and safety of the clients of said institution or the health and safety of the general public.

Subchapter 9 FOR HEARING AND APPEAL FOLLOWING DENIAL OR REVOCATION OF LICENSE; PENALTIES

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 4.9.1** Administrative Decision {#sec-16-4.9.1 omnilex-key=us-ms-regs-official--title-15--16#4.9.1}

The licensing agency will provide an opportunity for a fair hearing to every applicant or licensee who is dissatisfied with administrative decisions made in the denial or revocation of license.

1. The licensing agency shall notify the applicant or licensee by registered mail or personal service the particular reasons for the proposed denial or revocation of license. Upon written request of applicant or licensee within ten (10) days of the date of notification, the licensing agency shall fix a date not less than thirty (30) days from the date of such service at which time the applicant or licensee shall be given an opportunity for a prompt and fair hearing.

2. On the basis of such hearing or upon default of the applicant or licensee, the licensing agency shall make a determination specifying its findings of fact and conclusions of law. A copy of such determination shall be sent by registered mail to the last known address of the applicant or licensee or served personally upon the applicant or licensee.

3. The decision revoking, suspending, or denying the application or license shall become final thirty (30) days after it is so mailed or served unless the applicant or licensee, within such thirty (30) day period, appeals the decision in Chancery Court pursuant to Section 43-11 -23 of the Mississippi Code of 1972. An additional period of time may be granted at the discretion of the licensing agency.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 4.9.2** Penalties {#sec-16-4.9.2 omnilex-key=us-ms-regs-official--title-15--16#4.9.2}

Any person establishing, conducting, managing, or operating facility without a license shall be declared in violation of these regulations and may be punished as set forth in the enabling statute. Further, any person who violates

any provision of the enabling statute or of these regulations promulgated t h e r e t o shall, upon conviction thereof, be guilty of a misdemeanor. Such misdemeanor shall, upon conviction, be as referenced in Section 43-1 1-25 of the Mississippi Code of 1972, Annotated.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 4.9.3** Ban on Admissions {#sec-16-4.9.3 omnilex-key=us-ms-regs-official--title-15--16#4.9.3}

If a condition of immediate jeopardy exists at a licensed facility, written notice of the determination of the condition shall be provided by the licensing agency to the licensed facility, along with the notification that a ban on all admissions is to be imposed within five (5) calendar days after the receipt of the notice by the licensed facility. If the licensing agency's determination of a condition of immediate jeopardy on the day of the licensure visit/survey is confirmed, a ban on all admissions shall be imposed until the licensed facility achieves compliance and such compliance is verified by the licensing agency. The licensing agency will verify the licensed facility's corrective actions as soon as possible after the licensing agency receives an acceptable plan of correction from the licensed facility.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 4.10.1** Governing Body {#sec-16-4.10.1 omnilex-key=us-ms-regs-official--title-15--16#4.10.1}

1. A facility shall have an identifiable Governing Body with responsibility and authority for the policies and activities of the program/agency. The governing authority, the owner, or the person(s) designated by the governing authority shall be the supreme authority in an RBIR responsible for the management, control, and operation of the institution, including the appointment of qualified staff.

a. The Governing Body shall be designated in writing.

b. When the Governing Body of a facility is comprised of more than one person, the Governing Body shall hold formal meetings at least quarterly. There shall be written bylaws specifying frequency of meetings and quorum requirements. There shall be written minutes of all meetings.

c. When the Governing Body is composed of only one person, this person shall assume all responsibilities of the Governing Body.

2. Responsibilities of the Governing Body. The Governing Body of a facility shall:

a. Ensure the facility’s compliance and conformity with the facility’s policies and procedures;

b. Ensure the facility’s continual compliance and conformity with all relevant federal, state, and local laws and regulations;

c. Ensure that the facility is adequately funded and fiscally sound;

d. Review and approve the facility’s annual budget;

e. Designate a person to act as Director and delegate sufficient authority to this person to manage the facility (a sole owner may be the director);

f. Formulate and annually review, in consultation with the Director, written policies concerning the facility’s philosophy, goals, current services, personnel practices, job descriptions and fiscal management; and

g. Annually evaluate the Director’s performance (if a sole owner is not acting as director).

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 4.10.2** Organization {#sec-16-4.10.2 omnilex-key=us-ms-regs-official--title-15--16#4.10.2}

Each RBIR shall establish a written organizational plan, which may be in the form of an organizational chart that clearly establishes a line of authority, responsibilities, and relationships. Written personnel policies and job descriptions shall be prepared and provided to each employee.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 4.10.3** Director {#sec-16-4.10.3 omnilex-key=us-ms-regs-official--title-15--16#4.10.3}

There shall be a full-time employee designated as Director of the licensed facility who shall be responsible for the management of the licensed facility, including day to day management, supervision, operation of the facility, and ensuring the individual service plan is implemented and carried out. The Director shall be at least twenty-one years of age and shall posses, at a minimum:

1. A Bachelor’s degree in a health care field, plus six (6) years of experience in the fields of health, social services, management or administration; or

2. A Master’s degree in a health care field, plus five (5) years of experience in the field of health, social services, management, or administration

3. The Director shall not be a client of the licensed facility. The Director shall have verification that he/she is not listed on the "Mississippi Nurses

Aide Abuse Registry." When the Director is not within the licensed facility, there shall be an individual onsite at the licensed facility who shall represent the Director, and be capable of assuming the responsibility of Director. Said person must be at least twenty-one years of age, possess a bachelor’s degree, and shall have verification that he/she is not listed on the "Mississippi Nurses Aide Abuse Registry."

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 4.10.4** Financial Financial {#sec-16-4.10.4 omnilex-key=us-ms-regs-official--title-15--16#4.10.4}

1. Accounting. Accounting methods and procedures should be carried out in accordance with a recognized system of good business practice. The m e t h o d and procedure used should be sufficient to permit annual audit, accurate determination of the cost of operation and the cost per client per day.

2. Financial Structure. All facilities shall have a financial plan which guarantees sufficient resources to meet operating cost at all times and to maintain standards required by these regulations.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 4.10.5** Personnel {#sec-16-4.10.5 omnilex-key=us-ms-regs-official--title-15--16#4.10.5}

There must be responsible trained staff on duty on a 24- hour basis to provide direct care services, respond to injuries and symptoms of illness, and to handle emergencies. All direct care employees shall be a minimum of 18 years of age, and shall have verification that they are not listed on the "Mississippi Nurses Aide Abuse Registry." The staff shall be knowledgeable of each client’s service plan. Personnel shall be employed and on duty, awake, and fully dressed to provide personal care to the clients. The facility shall be staffed to properly safeguard the health, safety and welfare of the clients, as required in these regulations. There shall be adequate staff to meet the needs of the clients as outlined in the individual service plans, but at a minimum, there shall be no fewer than one (1) direct care staff per four (4) or fewer clients at all times and a designated person in charge on each shift.

1. Personnel shall receive training annually on topics and issues related to the population being served in the licensed facility. Training shall be documented by a narrative of the content and signatures of those attending.

2. Direct Care Staff may include care assistants, nurses, social workers, activities personnel, or other staff who provide direct care services to clients on a regular basis. If employed at more than one facility, the facility must maintain a copy of each entities schedule and ensure that their schedule does not

overlap.

3. The Nursing Director or physician must be available by telecommunications or able to be available on-site as needed 24 hours/day.

4. Nursing Director

a. Qualifications: Each facility must have a Nursing Director who currently maintains an unrestricted license as a Registered Nurse in Mississippi.

b. Nursing activities must comply with Mississippi Board of Nursing Nurse Practice Law.

c. Responsibilities: The responsibilities of a Nursing Director are to advance community integration through:

i. Overseeing the medication management program, including staff training to implement the program;

ii. Assisting the client in the restoration and maintenance of maximal health;

iii. Consulting the primary physician to advance the client with their medication management program;

iv. Advancing understanding of their unique medical and pharmacological needs; and

v. Assuring that nursing care is provided in accordance with the client’s individual service plan;

d. The Nurse Director may be a contract employee.

5. LPN staff may administer medications in accordance with the Mississippi Board of Nursing requirements.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 4.10.6** Criminal History Record Checks {#sec-16-4.10.6 omnilex-key=us-ms-regs-official--title-15--16#4.10.6}

1. Definitions.

a. Affidavit. For the purpose of fingerprinting and criminal background history checks, the term "affidavit" means the use of Mississippi State Department of Health (MSDH) Form #210, or a copy thereof, which shall be placed in the individual’s personal file.

b. Employee. For the purpose of fingerprinting and criminal background history checks, employee shall mean any individual employed by a covered entity. The term "employee" also includes any individual who by contract with the covered entity provides direct client care in a client's room or in treatment rooms.

c. The term employee does not include healthcare professional/technical students, as defined in Section 37-29-232, performing clinical training in a licensed e n t i t y under contracts between their schools and the licensed entity, and does not include students at high schools who observe the treatment and care of clients in a licensed entity as part of the requirements of an allied health course taught in the school if:

i. The student is under the supervision of a licensed healthcare provider; and

ii. The student has signed the affidavit that is on file at the student's school stating that he or she has not been convicted of or plead guilty or nolo contendere to a felony of possession or sale of drugs, murder, manslaughter, armed robbery, rape, sexual battery, any sex offenses listed in section 45-33-23 (g), child abuse, arson, grand larceny, burglary, gratification of lust, aggravated assault, or felonious abuse and/or battery of a vulnerable adult, or that any such conviction or plea was reversed on appeal or a pardon was granted for the conviction or plea.

iii. Further, applicants and employees of the University of Mississippi Medical Center for whom criminal history record checks and fingerprinting are obtained in accordance with Section 37-115-41 are exempt from application of the term employee under Section 41-75-13.

d. Covered Entity. For the purpose of criminal history record checks, "covered entity" means a licensed entity or a healthcare professional staffing agency.

e. Licensed Entity. For the purpose of criminal history record checks, the term "licensed entity" means an RBIR.

f. Health Care Professional Vocational Technical Student. For purposes of criminal history record checks, the term means a student enrolled in a healthcare professional/vocational technical academic program.

g. Direct Client Care or Services. For the purposes of fingerprinting and

criminal background history checks, the term "direct client care" means direct hands-on medical client care and services provided by an individual to a client, in a client's room or treatment room. Individuals providing direct client care may be directly employed by the facility or provides client care on a contractual basis.

h. Documented Disciplinary Action. For the purpose of fingerprinting and criminal background history checks, the term "documented disciplinary action" means any action taken against an employee for abuse or neglect of a client.

2. Pursuant to Section 43-1 1-13, Mississippi Code of 1972, the covered entity shall require to be performed a disciplinary check with the professional licensing agency, if any, for each employee to determine if any disciplinary action has been taken against the employee by the agency, and a criminal history record check on:

a. Every new employee of a covered entity who provides direct client care or services; and

b. Every employee of a covered entity who has documented disciplinary action by his or her present employer.

3. Except as otherwise provided in this paragraph, no employee shall be permitted to provide direct client care until the results of the criminal history record check have revealed no disqualifying record or the employee has been granted a waiver. Provided the covered entity has documented evidence of submission of fingerprints for the background check, any person may be employed and provide direct client care on a temporary basis pending the results of the criminal history record check but any employment offer, contract, or arrangement with the person shall be voidable, if he/she receives a disqualifying criminal record check and no waiver is g r a n t e d.

4. If such criminal history record check discloses a criminal conviction; a guilty plea; and/or a plea of nolo contendere to a crime that is job-related which has not been reversed on appeal, or for which a pardon has not been granted, the applicant/employee may not be eligible to be employed at the licensed facility. Documentation of verification of the employee's disciplinary status, if any, with the employee's professional licensing agency as applicable, and evidence of submission of the employee's fingerprints to the licensing agency must be on file and maintained by the facility prior to the new employees first date of employment. The covered entity shall maintain on file evidence of verification of the employee's disciplinary status from any applicable professional licensing agency and of submission and/or completion of the criminal record check, a copy of

the referenced notarized letter addressing the individual’s suitability for such employment.

5. The licensing agency may charge the covered entity submitting the fingerprints a fee not to exceed Fifty Dollars ($50.00).

6. Should results of an employee applicant's criminal history record check reveal no disqualifying event, then the covered entity shall, within two (2) weeks of the notification of no disqualifying event, provide the employee applicant with a notarized letter signed by the chief executive officer of the covered entity, or his or her authorized designee, confirming the employee applicant's suitability for employment based on his or her criminal history record check. An employee applicant may use that letter for a period of two (2) years from the date of the letter to seek employment at any covered entity licensed by the Mississippi State Department of Health without the necessity of an additional criminal record check. Any covered entity presented with the letter may rely on the letter with respect to an employee applicant's criminal background and is not required for a period of two (2) years from the date of the letter to conduct or have conducted a criminal history record check as required in this subsection.

7. For individuals contracted through a third party who provide direct client care as defined herein, the covered entity shall require proof of a criminal history record check.

8. Pursuant to Section 41-75-13, Mississippi Code of 1972, the licensing agency, the covered entity, and their agents, officers, employees, attorneys and representatives, shall be presumed to be acting in good faith for any employment decision or action taken under this section. The presumption of good faith may be overcome by a preponderance of the evidence in any civil action. No licensing agency, covered entity, nor their agents, officers, employees, attorneys and representatives shall be held liable in any employment discrimination suit in which an allegation of discrimination is made regarding an employment decision authorized under this section.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 4.10.7** Employee's Health Status {#sec-16-4.10.7 omnilex-key=us-ms-regs-official--title-15--16#4.10.7}

All licensed facility personnel shall receive a health screening by a licensed physician, a nurse practitioner/physician assistant, or a registered nurse prior to employment and annually thereafter. Records of this health screening shall be kept on file in the licensed facility.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 4.10.8** Employee Testing for Tuberculosis {#sec-16-4.10.8 omnilex-key=us-ms-regs-official--title-15--16#4.10.8}

1. Each employee, upon employment of a licensed entity and prior to contact with any patient/client, shall be evaluated for tuberculosis by one of the following methods:

a. IGRA (blood test) and an evaluation of the individual for signs and symptoms of tuberculosis by medical personnel; or

b. A two-step Mantoux tuberculin skin test administered and read by a licensed medical/nursing person certified in the techniques of tuberculin testing and an evaluation of the individual for signs and symptoms of tuberculosis by a licensed Physician, Physician’s Assistant, Nurse Practitioner or a Registered Nurse.

2. The IGRA/Mantoux testing and the evaluation of signs/symptoms may be administered/conducted on the date of hire or administered/read no more than 30 days prior to the individual’s date of hire; however, the individual must not be allowed contact with a patient or work in areas of the RBIR where patients have access until receipt of the results of the IGRA/assessment or at least the first of the two-step Mantoux test has been administered/read and assessment for the signs and symptoms completed.

3. If the Mantoux test is administered, results must be documented in millimeters. Documentation of the IGRA/TB skin test results and assessment must be documented in accordance with accepted standards of medical/nursing practice and must be placed in the individual’s personnel file no later than 7 days of the individual’s date of employment. If an IGRA is performed, results and quantitative values must be documented.

4. Any employee noted to have a newly positive IGRA, a newly positive Mantoux skin test or signs/symptoms indicative of tuberculin disease (TB) that last longer than three weeks (regardless of the size of the skin test or results of the IGRA), shall have a chest x-ray interpreted by a board certified Radiologist and be evaluated for active tuberculosis by a licensed physician within 72 hours. The employee shall not be allowed to work in any area where clients have routine access until evaluated by a physician/nurse practitioner/physician assistant and approved to return. Exceptions to this requirement may be made if the employee is asymptomatic and:

a. The individual is currently receiving or can provide documentation of having received a course of tuberculosis prophylactic therapy approved by the Mississippi State Department of Health (MSDH) Tuberculosis Program for tuberculosis infection, or

b. The individual is currently receiving or can provide documentation of having received a course of multi-drug chemotherapy approved by the MSDH Tuberculosis Program; or

c. The individual has a documented previous significant tuberculin skin reaction or IGRA reaction.

5. For individuals noted to have a previous positive to either Mantoux testin g or the IGRA, annual re-evaluation for the signs and symptoms must be conducted and must be maintained as part of the employee’s annual health screening. A follow-up annual chest x-ray is NOT required unless symptoms of active tuberculosis develop.

6. If using the Mantoux method, employees with a negative tuberculin skin test and a negative symptom assessment shall have the second step of the two- step Mantoux tuberculin skin test performed and documented in the employees’ personal record within fourteen (14) days of employment.

7. The IGRA or the two-step protocol is to be used for each employee who has not been previously skin tested and/or for whom a negative test cannot be documented within the past 12 months. If the employer has documentation that the employee has had a negative TB skin test within the past 12 months, a single test performed thirty (30) days prior to employment or immediately upon hire will fulfill the two-step requirements. As above, the employee shall not have contact with clients or be allowed to work in areas of the RBIR to which clients have routine access prior to reading the skin test, completing a signs and symptoms assessment and documenting the results and findings.

8. Facilities shall comply with recommendations from the Centers for Disease Control and/or the Mississippi State Department of Health regarding baseline employee TB testing and routine serial employee TB testing and education. Staff exposed to an active infectious case of tuberculosis shall be treated as contacts and be managed appropriately. Individuals found to have a significant Mantoux tuberculin skin test reaction and a chest x-ray not suggestive of active tuberculosis, shall be evaluated by a physician or nurse practitioner/physician assistant for treatment of latent tuberculin infection.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 4.10.9** Orientation {#sec-16-4.10.9 omnilex-key=us-ms-regs-official--title-15--16#4.10.9}

Facilities shall have an orientation program upon hire and ongoing annual training thereafter.

1. A facility shall have an orientation program upon hire that shall include, but is not limited to, training in the following topics for all personnel:

a. The policies and procedures of the facility;

b. Emergency and evacuation procedures;

c. Client’s rights;

d. Abuse/neglect and exploitation prevention and requirements concerning the reporting of abuse and neglect of clients;

e. Procedures for reporting of incidents and accidents;

f. Instruction in the specific responsibilities of the employee’s job; and

g. Cultural competency.

2. Orientation for direct care staff shall include the following:

a. Training in Client Care Services (Activities of Daily Living and Instrumental Activities of Daily Living) provided by the facility;

b. Infection control to include Universal Precautions; and,

c. Any specialized training to meet clients’ needs.

3. A new employee shall not be given sole responsibility for the implementation of a client’s program plan until this training is completed.

4. All direct care staff shall receive and/or have documentation of certification in Basic Life Support and general first aid procedures within the first 30 days of employment.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 4.10.10** Annual Training {#sec-16-4.10.10 omnilex-key=us-ms-regs-official--title-15--16#4.10.10}

1. A facility shall ensure that each direct care staff participates in in-service training each year. Routine supervision of direct care staff shall not be considered as meeting this requirement.

2. The facility shall document that direct care staff receive training on an annual basis in:

a. Facility’s policies and procedures.

b. Emergency and evacuation procedures;

c. Client’s rights;

d. Abuse and neglect prevention and requirements concerning the reporting

of abuse and neglect and incidents and accidents;

e. Client care services (Activities of Daily Living and Instrumental Activities of Daily Living);

f. Infection control to include Universal Precautions;

g. Any specialized training to meet clients’ needs, and

h. Cultural competency.

3. All direct care staff shall have documentation of current certification in Basic Life Support.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 4.10.11** Personnel Files {#sec-16-4.10.11 omnilex-key=us-ms-regs-official--title-15--16#4.10.11}

1. A facility shall maintain a personnel record for each employee. At a minimum, this file shall contain the following:

a. The application for employment including the applicant’s education, training, and experience;

b. A criminal history check, prior to an offer of employment;

c. Evidence of applicable professional credentials;

d. Documentation of required health assessment as defined in the facility’s policy and procedure;

e. Annual performance evaluation;

f. Employee’s hire and termination dates;

g. Documentation of orientation and annual training; and

h. Documentation of a current, valid driver’s license (if driving or transporting clients).

2. A facility shall not release an employee’s personnel file without the employee’s written permission, except as required by state law.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 4.10.12** Evaluation {#sec-16-4.10.12 omnilex-key=us-ms-regs-official--title-15--16#4.10.12}

An employee’s Annual Performance Evaluation shall include an

evaluation of his/her interaction with clients, family, and other employees.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 4.11.1** Admission Criteria {#sec-16-4.11.1 omnilex-key=us-ms-regs-official--title-15--16#4.11.1}

1. The facility shall have a clear and specific written description of admission policies and procedures. This should include, but is not limited to, a) the application process and the criteria for the rejection of an application; b) types of clients suitable to the facility; c) services offered and allowed in the facility.

2. The following criteria must be applied and maintained for client placement in a licensed facility:

a. Only clients whose needs can be met by the licensed facility shall be admitted.

b. Clients are brain injury patients who require education and training for independent living with a focus on increasing independence; such care prepares clients for maximum independence, teaches necessary skills for community interaction, works with clients pre-vocational and vocational training and stresses cognitive, speech and behavioral therapies structured to the individual needs of patients who cannot live at home and who require on-going support and rehabilitation.

c. A person shall not be admitted or continue to reside in an licensed facility if the person:

i. Requires physical restraints;

ii. Poses a serious threat to himself or herself or others;

iii. Requires nasopharyngeal and/or tracheotomy suctioning;

iv. Requires intravenous fluids, medications, or feedings; or

d. Licensed facilities which are not accessible to individuals with disabilities through the A.N.S.I. Standards as they relate to facility accessibility may not accept wheelchair bound clients. Only those persons who, in an emergency, would be physically and mentally capable of traveling to safety may be accepted. For multilevel facilities, no clients that are unable to descend the stairs unassisted may be placed

above the ground floor level.

e. The licensed facility must be able to identify at the time of admission and during continued stay those clients whose needs for services are consistent with these rules and regulations, and those clients who should be transferred to an appropriate level of care.

f. Notwithstanding any determination by the licensing agency that the client no longer meets admission criteria, that client, the client's guardian, or the legally recognized responsible party for the client may consent in writing for the client to continue reside in the RBIR, if approved in writing by a licensed physician. Provided , however, that no RBIR shall allow more than two (2) clients, or ten percent (10%) of the number of clients in the facility, whichever is greater, to remain in the RBIR under the provisions herein. This consent shall be deemed to be appropriately informed consent as described by these regulations. After that written consent has been obtained, the client shall have the right to continue to reside in the RBIR for as long as the client meets the other conditions for residing in the RBIR. A copy of the written consent and the physician's approval shall be forwarded by the RBIR to the licensing agency within thirty (30) days of the issuance of the latter of the two (2) documents.

g. No licensee, owner, or administrator of a RBIR; a member of their family; an employee of the RBIR; or a person who has financial interest in the home shall act as the legal guardian for a client of the RBIR. This requirement shall not apply if the client is related within the third degree as computed by civil law.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 4.11.2** At the time of admission the facility shall: {#sec-16-4.11.2 omnilex-key=us-ms-regs-official--title-15--16#4.11.2}

1. Obtain from the client or the client’s family or representative, their plan for both routine and emergency medical care to include the name of physician(s) and provisions and authorization for emergency medical care;

2. Document that the client and/or representative was informed of the facility’s emergency and evacuation procedures;

3. Obtain a copy of any existing executed Medical Power of Attorney or a Living Will. The facility shall maintain a copy of such documents; and

4. Shall execute, in writing, an admission agreement, including a financial agreement. This agreement shall be prepared and signed by the Director and the client or the client’s responsible party, in two or more copies. One copy

shall be given to the client or his/her responsible party, and one copy placed on file in the licensed facility. As a minimum, this agreement shall contain specifically:

a. Clear and specific occupancy criteria and procedures (admission, transfer, and discharge);

b. Basic services to be made available;

c. Basic charges agreed upon;

d. Optional services which are available;

e. Statement of non-covered services;

f. Payor or funding source;

g. Period to be covered in the charges;

h. Services for which special charges are made;

i. Agreement regarding refunds for any payments made in advance.

j. Client’s Code of Conduct for participation in the program and client’s agreement to abide by the same;

k. A Notice that the MS State Department of Health has the authority to examine clients’ records as part of the evaluation of the facility;

l. Division of responsibility between the facility, client, family, or others (e.g., arranging for or overseeing medical care, purchase of essential or desired supplies, emergencies, monitoring of health, handling or finances);

m. Clients’ rights;

n. Explanation of the grievance procedure and appeals process;

o. The development of a service plan specific to the individual client, including participation of the client and/or representative in the development of the plan;

p. A statement that the Director shall make the client's responsible party aware, in a timely manner, of any changes in client's status, including those which require transfer and discharge; or Directors who have been designated as a client's responsible party shall ensure prompt and

efficient action to meet client's needs;

q. State that the client or his responsible party shall be furnished a receipt signed by the licensee of the licensed facility or his lawful agent, for all sums of money paid to the licensed facility; and

r. Evidence of written notification provided to the client/responsible party when basic charges and/or licensed facility policies change.

5. No agreement or contract shall be entered into between the licensee and the client or his responsible agent which will relieve the licensee of the responsibility for the protection of the person and personal property of the individual admitted to the licensed facility for care.

6. Within seven days of admission, the facility shall complete an assessment to determine the needs and preferences of the client. The assessment shall include but is not limited to:

a. Review of physical health, psycho-social status, and cognitive status and determination of services necessary to meet those needs;

b. A summary of the client’s health needs, if any, including medication, treatment and special diet orders obtained from professionals with responsibility for the client’s physical or emotional health;

c. A written description of the activities of daily living and instrumental activities of daily living for which the client requires assistance, if any, obtained from the client, the client’s physician, family, or representative;

d. The client’s interests, likes and dislikes;

e. Recreational and social activities which are suitable or desirable;

f. A plan for handling special emergency evacuation needs; and

g. Additional information or documents pertinent to the client’s service planning, such as guardianship papers, Power of Attorney, Living Wills, Do-Not-Resuscitate orders, or other relevant medical documents.

7. Within 14 days after admission, the facility, with input from the client and/or his/her representative, shall develop and implement a service plan using information from the assessment. The service plan shall include:

a. The client’s needs;

b. The scope, frequency, and duration of services and monitoring that will be provided to meet the client’s needs;

c. Staff responsible for providing the services inclusive of third party providers;

d. Current medication list from the client’s primary care physician; and

e. Identification of level of assistance client requires.

8. The facility shall have a reporting procedure in place for notifying appropriate individuals of observed or reported changes in a client’s condition.

9. The client’s service plan shall be revised when a client’s condition or preferences change. The revised service plan shall be signed by the client and the representative, if applicable, and the designated facility staff.

10. The service plan shall be monitored on an ongoing basis to determine its continued appropriateness and to identify when a client’s condition or preferences have changed. A documented review of the service plan shall be made at least every quarter.

11. All plans and reviews shall be signed by the client, facility staff, and the representative, if applicable.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 4.12.1** Subchapter 12 DISCHARGE CRITERIA OR TRANSFER {#sec-16-4.12.1 omnilex-key=us-ms-regs-official--title-15--16#4.12.1}

The Director shall, in consultation with the client and the representative, if applicable, assist in planning and implementing the transfer or discharge of the client when:

1. The client’s adjustment to the facility is not satisfactory as determined by the Director in consultation with the client or his or her representative. It is the responsibility of the Director to contact the client’s representative, if applicable, and request assistance to help the client in adjusting. This request is to be made at the first indication of an adjustment problem;

2. The client is in need of services that the facility cannot provide or obtain for the client; or

3. The client or representative has failed to pay all fees and costs stated in the admission agreement or otherwise materially breached the admission agreement.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 4.12.2** Rule 4.12.2 {#sec-16-4.12.2 omnilex-key=us-ms-regs-official--title-15--16#4.12.2}

When a discharge or transfer is initiated by the facility, the Director must provide the client, and his/her representative, if applicable, with thirty (30) days prior written notice citing the reason for the discharge or transfer, except shorter notice may be given in cases where the client is a danger to self or others.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 4.12.3** Rule 4.12.3 {#sec-16-4.12.3 omnilex-key=us-ms-regs-official--title-15--16#4.12.3}

At the request of the client or representative, copies of all pertinent information shall be given to the Director of the licensed facility to which the client is transferred.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 4.12.4** The following discharge information shall be recorded in the client’s record: {#sec-16-4.12.4 omnilex-key=us-ms-regs-official--title-15--16#4.12.4}

1. Date of discharge;

2. Transfer facility;

3. Reason(s) for discharge; and

4. Condition upon discharge.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 4.12.5** Discharge records shall be retained for at least six (6) years from the date of discharge {#sec-16-4.12.5 omnilex-key=us-ms-regs-official--title-15--16#4.12.5}

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 4.13.1** Subchapter 13 SERVICES {#sec-16-4.13.1 omnilex-key=us-ms-regs-official--title-15--16#4.13.1}

The facility shall provide adequate services and oversight/supervision including adequate security measures, twenty-four (24) hours per day.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 4.13.2** The facility shall provide or coordinate services, to the extent needed or desired by clients {#sec-16-4.13.2 omnilex-key=us-ms-regs-official--title-15--16#4.13.2}

The client may participate in these services as written in their service plan. The following services are required:

1. Assistance with all activities of daily living and instrumental activities of daily living;

2. At least three meals a day, seven days a week, that take into account client’s dietary requirements, preferences and needs in residential facilities;

3. Basic personal laundry services in residential facilities;

4. Opportunities for individual and group socialization and to utilize community resources to create a normal and realistic environment for community interaction within and outside the facility (i.e. barber/beauty services, social/recreational opportunities);

5. Services for client requiring occupational, physical and speech therapy, as outlined in their individual service plan;

6. Services for clients requiring social and emotional services;

7. Services for clients who have behavior problems requiring ongoing staff support, intervention, and supervision to ensure no danger or infringement of the rights of other clients or individuals;

8. Household services essential for the health and comfort of client (e.g. floor cleaning, dusting, bed making, etc) in residential facilities;

9. Assistance with self-administration of medications as needed and deemed appropriate by the Medication Management Program; and,

10. A program of recreational activities.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 4.13.3** Method of Medication Assistance {#sec-16-4.13.3 omnilex-key=us-ms-regs-official--title-15--16#4.13.3}

The method of providing medication shall be the use of a pre-prepared blister pack of medication prescribed to the client. Packaging of the blister pack must be by a licensed pharmacist who has filled the prescription following licensed primary care provider’s orders as to medication to be taken, dosage, and the time at which the medication is to be taken. The facility shall assess the skill level of the person assisting in delivering medication and provide training to assure competency.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 4.13.4** Nutritional Assessment {#sec-16-4.13.4 omnilex-key=us-ms-regs-official--title-15--16#4.13.4}

A Registered Dietician shall provide ongoing evaluation and assessment when individual needs are identified and, at minimum, on a quarterly basis and more often if indicated. The Registered Dietician shall be notified for intervention as appropriate when a change in nutritional status, weight loss or weight g a i n is noted. The initial nutritional assessment shall be completed within 14 days after admission.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 4.14.1** Conservatorship and Licensing Agency Records {#sec-16-4.14.1 omnilex-key=us-ms-regs-official--title-15--16#4.14.1}

The Director shall maintain:

2. A record of the clients for whom he or she serves as the conservator or a representative payee. This record shall include evidence of the means by which the conservatorship or representative payee relationship was established and evidence of separate accounts in a bank for each client whose conservator or representative payee is the Director of the licensed facility.

2. Inspection reports from the licensing agency, any branch or division thereof in the licensed facility, and submitted to the licensing agency as required, or when requested.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 4.14.2** Confidentiality and Security of Files {#sec-16-4.14.2 omnilex-key=us-ms-regs-official--title-15--16#4.14.2}

The facility shall ensure the confidentiality of client records, including information in a computerized medical record system, in accordance with the HIPAA Privacy Regulations (Title 45, Part 164, Subpart E of the Code of Federal Regulations) and any Mississippi state laws and regulations which provide a more stringent standard of confidentiality than the HIPAA Privacy Regulations. Information from or copies of records may be released only to authorized individuals, and the facility must ensure that unauthorized individuals cannot gain access to or alter client records. Original medical records shall not be released outside the facility unless under court order or subpoena or in order to safeguard the record in the event of a physical plant emergency or natural disaster.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 4.14.3** Client Records {#sec-16-4.14.3 omnilex-key=us-ms-regs-official--title-15--16#4.14.3}

The facility shall maintain a separate record for each client. Such record shall be current and complete and shall be maintained in the facility or in a central administrative location readily available to facility staff and to the licensing agency. All records shall be maintained in an accessible, standardized order and format and shall be retained and disposed of in accordance with state laws.

1. Client records shall contain the following:

a. General information form, including at a minimum: Identifying information to include at least client’s name, marital status, date of birth, and gender;

b. Dates of admission and discharge;

c. Client’s written authorization and contact information of the representative or responsible person;

d. Admission agreement(s) and financial statements;

e. Clients' rights and licensed facility's rules, signed, dated, and witnessed;

f. Medical referral from physician or nurse practitioner/physician assistant;

g. The admission assessment documenting the appropriateness of the client’s admission to facility;

h. Individual service plan, updates, and quarterly reviews;

i. Name and 24 hour contact information for the primary physician and any other physician involved in the client’s care;

j. Initial and annual health and physicals;

k. Current medication record, including any reactions to such medication;

l. Progress notes of care and services received and response to treatment;

m. Social services and activity contacts;

n. Record of all personal property and funds;

o. Representative payee statement, if applicable; and

p. Physician orders or nurse practitioner/physician assistant orders (including, but not limited to, therapies, diets, medications, etc.) and medication administration records.

2. The records, as described in this section, shall be made available to the client, the client's family, or other responsible party for the client upon reasonable request.

3. The facility shall report and comply with the annual MSDH TB Program surveillance procedures.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 4.14.4** Client Funds {#sec-16-4.14.4 omnilex-key=us-ms-regs-official--title-15--16#4.14.4}

1. If a facility offers the service of safekeeping and/or management of clients’ personal funds, the facility’s admission agreement shall include the client’s rights regarding personal funds and list the services offered and charges, if any. Any charges assessed shall not exceed the actual cost incurred by the facility for the provision of the services.

2. There is no obligation for a client to deposit funds with the facility or have the facility manage his/her funds, and the facility may not require the client to deposit his/her funds with the facility. If a facility offers the service of safekeeping and if a client wishes to entrust funds, the facility shall:

a. Obtain written authorization from the client and/or his/her representative to safekeeping of funds;

b. Provide each client with a receipt listing the amount of money the facility is holding in trust for the client;

c. Maintain a current balance sheet containing all financial transactions to include the signatures of staff and the client for each transaction; and

d. Not accept more than three hundred dollars ($300) of a client’s money.

3. If a facility offers the service of safekeeping and/or management of clients’ personal funds, the facility shall purchase a surety bond or otherwise provide assurance satisfactory to the Secretary to assure the security of all personal funds of clients deposited with the facility. In addition, if a client wishes the facility to assist with the management of all their funds, the facility:

a. Shall receive written authorization to manage the client’s funds from the client and the representative, if applicable;

b. Shall only manage a client’s money when such management is mandated by the client’s service plan; and

c. Shall keep funds received from the client for management in an individual account in the name of the client.

4. When a client is discharged, the facility shall refund the balance of the client’s personal funds to the client or representative, if applicable, on the date of discharge or no later than the last day of the month of the month of discharge.

5. In the event of the death of the client, the facility shall refund the balance of the client’s personal funds to the executor of the client’s estate. If there is no executor, the facility shall refund the balance to the representative or responsible party for the client. The refund shall be made within three months of the date of death.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 4.15.1** The facility shall have: {#sec-16-4.15.1 omnilex-key=us-ms-regs-official--title-15--16#4.15.1}

1. Written policies and procedures approved by the Governing Body that address the following:

a. Confidentiality of client information and security of client files;

b. Advertising;

c. Personnel issues including;

i. Orientation, ongoing training, development, supervision, and performance evaluation of personnel members;

ii. Written job descriptions for each position including volunteers;

iii. Requirements for a health assessment of personnel prior to employment. These policies shall, at a minimum, require that the individual has no evidence of active tuberculosis and is re-evaluated as recommended by the Mississippi State Department of Health;

iv. Abuse prevention and reporting procedures that include what constitutes abuse, how to prevent it and requirement that all personnel report any incident of abuse or mistreatment to the director or his/her designee, whether that abuse or neglect is done by another staff member, a family member, a client, or any other person; and

v. Criteria for determining employment based on the results of a criminal history check.

d. Client’s rights;

e. A grievance procedure to include documentation of grievances, investigation, resolution and response to complainant in a timely manner, time frame in which facility will respond, and an appeals process for grievances;

f. Safekeeping of personal possessions, if applicable;

g. Clients’ funds, if applicable;

h. Emergency and evacuation procedures;

i. Abuse and neglect, and documentation and reporting of same;

j. Incidents and accidents and documentation of same;

k. Admissions, transfers and discharge procedures;

l. Medication administration;

m. Minutes of formal Governing Body meetings;

n. Organizational chart of the facility; and

o. Written leases, contracts, and purchase-of-service agreements (including all appropriate credentials) to which the facility is a party.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 4.15.2** Organizational Communication {#sec-16-4.15.2 omnilex-key=us-ms-regs-official--title-15--16#4.15.2}

1. A facility shall establish procedures to assure written communication among personnel to provide continuity of services to all clients.

2. Direct care staff shall have access to information concerning clients that is necessary for effective performance of the employee’s assigned tasks.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 4.15.3** Incidents/Accident {#sec-16-4.15.3 omnilex-key=us-ms-regs-official--title-15--16#4.15.3}

1. The facility shall have written procedures for the reporting and documentation of unusual incidents and other situations or circumstances affecting the health, safety or well-being of a client or clients. (i.e. death of unnatural causes, injuries, fights or physical confrontations, situations requiring the use of passive physical restraints, suspected incidents of abuse or neglect).

a. Such procedures shall ensure timely verbal reporting to the Director or designee and a preliminary verbal report to the State Licensing agency within twenty-four (24) hours of the incident. A written report shall be submitted to the licensing agency within seventy-two (72) hours.

b. Incidents or accidents shall be documented in the client record. An incident report shall be maintained by the facility.

2. Incident/Accident Report. When and if an incident occurs, a detailed report of the incident shall be made. At a minimum, the incident report shall contain the following:

a. Circumstances under which the incident occurred; names of clients, staff and others involved;

b. Date and time the incident occurred;

c. Where the incident occurred (bathroom, bedroom, street, lawn, etc.);

d. Immediate treatment and follow-up care;

e. Name and address of witnesses and their statements;

f. Date and time family or representative was notified;

g. Symptoms of pain and injury discussed with the physician; to include date and time the physician was notified; and

h. Signatures of the staff completing the report, client, and Director.

3. When an incident results in death of a client or involves abuse, neglect, or exploitation of a client or entails any serious threat to the client’s health, safety or well-being, the facility shall:

a. Immediately report verbally to the Director and submit a preliminary written report within twenty-four (24) hours of the incident;

b. Within twenty-four hours of the suspected incident notify the MSDH, licensing agency, and the attorney general’s office, as well as local law enforcement in accordance with State law and the Vulnerable Persons Act, with written notification to the above agencies to follow within seventy- two hours of the suspected incident;

c. Immediately notify the family or representative of the client;

d. Provide follow-up written reports within 72 hours of the completed investigation to all the above persons and agencies;

e. Take appropriate corrective actions to prevent future incidents; and

f. Document compliance with the above procedures for each incident.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 4.15.4** Abuse, Neglect, and Exploitation {#sec-16-4.15.4 omnilex-key=us-ms-regs-official--title-15--16#4.15.4}

The facility shall have comprehensive written procedures concerning client abuse and neglect to include provisions for:

1. Training and maintaining staff awareness of abuse prevention, current definitions of abuse and neglect, reporting requirements and applicable laws;

2. Ensuring that procedures for reporting critical incidents involving abuse and neglect are followed;

3. Ensuring that the Director completes an investigation report within five (5) working days;

4. Ensuring that the client and/or reporter of the abuse is protected from potential harassment during the investigation; and

5. Protecting clients from abuse/neglect and/or injury inflicted by other clients, staff or third parties.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 4.15.5** Clients' Rights {#sec-16-4.15.5 omnilex-key=us-ms-regs-official--title-15--16#4.15.5}

Rights and licensed facility rules must be in writing and be made available to all clients, employees, responsible parties, and must be posted in the facility for public viewing. Each client shall:

1. Not be deprived of civil or legal rights;

2. Not be denied admission, segregated or otherwise subjected to discrimination on the basis of race, sex, handicap, creed, national background or ancestry; a facility that is a religious organization may limit admissions to its own adherents;

3. Live within the least restrictive environment possible in order to retain their individuality and personal freedom. Staff shall knock and request entrance before entering any bedroom;

4. Be treated as individuals and with dignity, be assured choice and privacy and the opportunity to act autonomously, take risks to enhance independence, and share responsibility for decisions;

5. Be allowed to participate and have family participate, if desired, in the planning of activities and services;

6. Receive or refuse care and services that are adequate, appropriate, and in compliance with conditions of residency, relevant federal and State laws and rules and regulations;

7. Be free from mental, emotional, and physical abuse and neglect and assured that no chemical restraints will be used;

8. Have records and other information kept confidential and released only with a client’s or legal guardian’s expressed written consent or in accordance with state law;

9. Have a service animal for medical reasons;

10. Have visitors of their choice, as long as such does not infringe upon the rights of others;

11. Have access to private telephone communications;

12. Send and receive mail promptly and unopened;

13. Furnish their own rooms, use and maintain personal clothing and possessions as space permits;

14. Have the right to manage his/her personal financial affairs, or is given at least a quarterly accounting of financial transactions made on his/her behalf should the facility accept the written delegation from the client or from his/her responsible party of this responsibility to the facility for any period of time in conformance with State Law.

15. Be free from restraint except by order of a physician or nurse practitioner/physician assistant, or unless it is determined that the client is a threat to himself or to others. Physical and chemical restraints shall be used for medical conditions that warrant the use of a restraint. Restraint is not to be used for discipline or staff convenience. The RBIR must have policies and procedures addressing the use of and monitoring of restraints. A physician’s order for restraint must be countersigned physician, nurse practitioner or physician assistant within 24 hours of the emergency application of the restraint;

16. Have freedom to participate in accessible community activities and in social, political, medical, and religious activities or to have freedom to refuse such participation;

17. Arrange for third-party services at their own expense should such not be available through the facility provided the client remains in compliance with the conditions of residency;

18. Be informed of grievance process and procedures and to receive response to grievances without fear of reprisal. To voice grievances and suggest changes in policies and services to either staff or outside representatives without fear of reprisal or other retaliation;

19. Be given written notice of not less than thirty (30) days prior to discharge from the facility, except in life-threatening emergencies and when the client is a danger to him/her self or to others;

20. Remain in the current facility, foregoing a recommended transfer to obtain additional services, if a mutually agreed upon risk agreement is signed by the client, the responsible representative (if any) and the facility provided such does not place the facility in conflict with these or other laws or regulations;

21. Receive at least a 24 hour notice prior to a change in room/unit. The client shall be informed of the reason for the move and/or shall be informed when their roommate is being changed;

22. Live in a physical environment which ensures their physical and emotional security and well-being;

23. Retain the services of his/her own personal physician, dentist or other health care facility;

24. Be provided confidentiality and privacy concerning his/her medical and dental condition and treatment;

25. Select the pharmacy or pharmacist of their choice;

26. Not be required to perform services for the RBIR that are not included for therapeutic purposes in their individual program plan; and

27. Have the right to associate and communicate privately with persons of his choice, may join with other clients or individuals within or outside of the RBIR to work for improvements in client care, unless medically contraindicated (as documented by his physician or nurse practitioner/physician assistant in his medical record).

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 4.15.6** Grievance Procedure {#sec-16-4.15.6 omnilex-key=us-ms-regs-official--title-15--16#4.15.6}

A facility shall establish and have written grievance procedures to include, but not limited to:

1. A formal process to present grievances;

2. A formal appeals process for grievances; and,

3. A process to respond to client requests and/or client grievances in a timely manner, and the time frames in which the facility will respond.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 4.15.7** Photographs {#sec-16-4.15.7 omnilex-key=us-ms-regs-official--title-15--16#4.15.7}

A facility shall have written policies and procedures regarding the photographing and audio or audiovisual recordings of clients for the purposes of advertising.

1. No client shall be photographed or recorded without the client’s or representative’s prior informed written consent. Such consent cannot be made a condition for admission into, remaining in, or participating fully in the activities of the facility. Consent agreements must clearly notify the client of his/her rights under this regulation and must specify precisely what use is to be made of the photograph or recordings. Consents are valid for a maximum of one year from the date of execution. Clients are free to revoke such agreements at any time, either orally or in writing.

2. All photographs and recordings shall be used in a way that respects the dignity and confidentiality of the client.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 4.16.1** Medical Evaluation {#sec-16-4.16.1 omnilex-key=us-ms-regs-official--title-15--16#4.16.1}

3. Each person admitted to a licensed facility shall have admission orders and a health and physical examination prescribed by a licensed physician or certified nurse practitioner/physician assistant within thirty (30) days prior to admission. The examination, which shall be reviewed by the Medical Director, shall include, at a minimum:

a. Review of physical health, psycho-social status, cognitive status, and determination of services necessary to meet those needs;

b. A summary of the client’s health needs, if any, including medication, treatment and special diet orders;

4. An annual health and physical update by a physician and/or nurse practitioner/physician assistant shall be completed.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 4.16.2** Tuberculosis (TB): Admission Requirements to Rule out Active Tuberculosis (TB) {#sec-16-4.16.2 omnilex-key=us-ms-regs-official--title-15--16#4.16.2}

1. The following are to be performed and documented within 30 days prior to the client's admission to the licensed facility:

a. TB signs and symptoms assessment by a licensed Physician, Physician's Assistant or a Licensed Nurse Practitioner, and

b. A chest x-ray taken and have a written interpretation.

2. Admission to the facility shall be based on the results of the required tests as follows:

a. Clients with an abnormal chest x-ray and/or signs and symptoms assessment shall have the first step of a two-step Mantoux tuberculin skin test (TST) placed and read by certified personnel OR an IGRA (blood test) drawn and results documented within 30 days prior to the client's admission to the licensed facility. Evaluation for active TB shall be at the recommendation of the MSDH and shall be prior to admission . If TB is ruled out and the first s t e p of the TST is negative, the second step of the two-step TST shall be completed and documented within 10-21 days of admission. TST administration and reading shall be done by certified personnel. If an IGRA (blood test) is done, TST (first and/or second step) is not done.

b. Clients with a normal chest x-ray and no signs or symptoms of TB shall have a baseline IGRA test (blood test) OR a TST performed with the initial step of a the two-step Mantoux TST placed on or within 30 days prior to the day of admission. IF TST is done, the second step shall be completed within 10-21 days of the first step. TST administration and reading shall be done by certified personnel. If an IGRA (blood test) is done, a TST is not done (first or second step).

c. Clients with a significant TST OR positive IGRA (blood test) upon baseline testing or who have documented prior significant TST shall be monitored regularly for signs and symptoms of active TB (cough, sputum production, chest pain, fever, weight loss, or night sweats, especially if the symptoms have lasted longer than three weeks) and if these symptoms develop, shall have an evaluation for TB per the recommendations of the MSDH within 72 hours.

d. Clients with a non significant TST or negative IGRA (blood test) upon baseline testing shall have an annual tuberculosis testing within thirty (30) days of the anniversary of their last test. Note: Once IGRA testing is used, IGRA testing should continue to be used rather than TST

testing.

e. Clients with a new significant TST or newly positive IGRA (blood test) on annual testing shall be evaluated for active TB by a nurse practitioner or physician or physician's assistant.

f. Active or suspected active TB Admission. If a client has or is suspected to have active TB, prior written approval for admission to the facility is required from the MSDH TB State Medical Consultant.

g. Exceptions to TST/ IGRA requirement may be made if:

i. Client has prior documentation of a significant TST/positive IGRA.

ii. Client has received or is receiving a MSDH approved treatment regimen for latent TB infection or for active TB disease.

iii. Client is excluded by a licensed physician or nurse practitioner/physician assistant due to medical contraindications.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 4.16.3** Rule 4.16.3 {#sec-16-4.16.3 omnilex-key=us-ms-regs-official--title-15--16#4.16.3}

Transfer to another facility or return of a client to respite care shall be based on the above tests (Rule 47.12.3) if done within the past 12 months and the client has no signs and symptoms of TB.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 4.16.4** Transfer to a Hospital or Visit to a Physician Office {#sec-16-4.16.4 omnilex-key=us-ms-regs-official--title-15--16#4.16.4}

If a client has signs or symptoms of active TB (i.e., is a TB suspect) the facility shall notify the MSDH, the hospital, transporting staff and the physician's office prior to transferring the client to a hospital. Appropriate isolation and evaluation shall be the responsibility of the hospital and physician. If a client has or is suspected to have active TB, prior written approval for admission or readmission to the facility is required from the MSDH TB State Consultant.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 4.16.5** Rehabilitative Services {#sec-16-4.16.5 omnilex-key=us-ms-regs-official--title-15--16#4.16.5}

Clients shall be provided rehabilitative services, as identified in the written individualized plan of care. Such rehabilitative services require the written orders of an attending physician or nurse practitioner/physician assistant.

1. The therapies shall be provided by a qualified therapist.

2. Appropriate equipment and supplies shall be provided.

3. Each client’s medical record shall contain written evidence that services are provided in accordance with the written orders of an attending physician or nurse practitioner/physician assistant.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 4.17.1** Meals {#sec-16-4.17.1 omnilex-key=us-ms-regs-official--title-15--16#4.17.1}

The licensed facility shall provide clients with well-planned, attractive, and satisfying meals at least three (3) times daily, seven (7) days a week, which will meet their nutritional, social, emotional and therapeutic needs. The daily food allowance shall meet the current recommended dietary allowances.

1. Meals shall be planned one (1) week in advance. Current menus must be posted and dated. A record of meals served shall be maintained for a one (1) month period.

2. A record of all food purchases shall be maintained in the licensed facility for a one (1) month period.

a. All meals for clients who require therapeutic diets shall be planned by a Licensed Dietitian. If a therapeutic diet is prescribed by the physician for the client, the licensed dietitian shall visit the licensed facility at a minimum of once every thirty (30) days, and shall file a consulting report with the licensed facility.

3. Meals should meet religious and ethnic preferences.

4. Meals should meet clients’ temporary schedule changes as well as clients’ preference (e.g. to skip a meal or prepare a simple late breakfast)

5. Facilities should make snacks, fruits, and beverages available to clients when requested.

6. Staff shall be available in the dining area to serve the food and to give individual attention as needed.

7. Written reports of inspection by the Mississippi State Department of Health shall be kept on file in the facility.

8. Specific times for serving meals shall be established and posted.

9. Meals shall be prepared and served in a manner that assures that they are

appetizing, attractive, and nutritional and that promotes socialization among the clients.

10. Food shall be prepared by methods that conserve the nutritive value, flavor, and appearance. It shall be palatable, properly prepared and sufficient in quantity and quality.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 4.17.2** Menus {#sec-16-4.17.2 omnilex-key=us-ms-regs-official--title-15--16#4.17.2}

1. Menus shall be planned and written at least one week in advance and dated as served. The current week’s menu shall be posted in a conspicuous place in the facility.

2. The facility shall furnish medically prescribed diets to clients in accordance with their service plan. These menus shall be planned or approved by a Registered licensed Dietician.

3. Records of all menus as served shall be kept on file for at least 30 days.

4. All substitutions made on the master menu shall be recorded in writing.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 4.17.3** Food Supplies {#sec-16-4.17.3 omnilex-key=us-ms-regs-official--title-15--16#4.17.3}

1. All food in the facility shall be safe for human consumption.

2. Grade “A” pasteurized fluid milk and fluid milk products shall be used or served. Dry milk products may not be used, except for cooking purposes.

3. Wild game or home canned foods shall not be served;

4. Other than fresh or frozen vegetables and fruit, all foods must be from commercial sources.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 4.17.4** Food Protection {#sec-16-4.17.4 omnilex-key=us-ms-regs-official--title-15--16#4.17.4}

1. If food is prepared in a central kitchen and delivered to separate facilities, provisions shall be made for proper maintenance of food temperatures and a sanitary mode of transportation.

2. Facility refrigerator(s) shall be maintained at a temperature of 45 degrees F or

below. Freezers shall be maintained at a temperature of 0 degrees F or below. Thermometers shall be provided for all refrigerators and freezers.

3. Food stored in the refrigerator shall be covered and dated.

4. Pets are not allowed in food preparation and services areas.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 4.17.5** Ice and Drinking Water {#sec-16-4.17.5 omnilex-key=us-ms-regs-official--title-15--16#4.17.5}

1. The water supply shall be adequate, of a safe sanitary quality and from an approved source. Clean sanitary drinking water shall be available and accessible in adequate amounts at all times.

2. The ice scoop shall be maintained in a sanitary manner. The handle of the ice scoop should not come into contact with the ice.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 4.17.6** Physical Facilities.hysical Facilities {#sec-16-4.17.6 omnilex-key=us-ms-regs-official--title-15--16#4.17.6}

1. A licensed facility with fifteen (15) or fewer clients shall meet the requirements as set forth in the facility Inspection Report issued by the Mississippi State Department of Health.

2. The facility shall have kitchens and dining rooms appropriately furnished and adequate to serve the number of clients residing in the facility in a comfortable environment. Dining room(s) may be sized to accommodate clients in either one or two sittings. Kitchens and dining facilities shall meet all applicable sanitation and safety standards.

3. The facility shall have a central or a warming kitchen that shall be well lighted and ventilated.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 4.17.7** Dietary Staffingietary Staffing {#sec-16-4.17.7 omnilex-key=us-ms-regs-official--title-15--16#4.17.7}

1. All employees engaged in handling, preparation and/or serving of food shall wear clean clothing at all times.

2. All employees engaged in handling and/or preparation of food shall wash their hands thoroughly before starting to work and immediately after contact with any soiled matter.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 4.18.1** Restrictions {#sec-16-4.18.1 omnilex-key=us-ms-regs-official--title-15--16#4.18.1}

Licensed facilities shall meet Mississippi State Board of Pharmacy requirements for the storage and dispensing of prescription medications. Schedule II Narcotics as defined in the Uniform Control Substances Law may only be allowed in a brain injury facility if they are administered or stored utilizing proper procedures under the direct supervision of a licensed physician or nurse.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 4.18.2** Labeling {#sec-16-4.18.2 omnilex-key=us-ms-regs-official--title-15--16#4.18.2}

The medications of all clients shall be clearly labeled.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 4.18.3** Storage of Prescription Medications {#sec-16-4.18.3 omnilex-key=us-ms-regs-official--title-15--16#4.18.3}

Proper storage of all prescription medications shall be provided.

1. All clients' prescription medications shall be stored in a secured area. The area shall be kept locked when not in use, with responsibility for the key designated in writing.

2. The prescription medication storage area shall be well-lighted, well- ventilated, and kept in a clean and orderly fashion. The temperature of the medication storage area should not exceed 85 degrees Fahrenheit at any time.

3. A refrigerator shall be provided for the storage of prescription medications requiring refrigeration. If the refrigerator houses food or beverages, the clients' prescription medications shall be stored in a covered container or separate compartment. All refrigerators shall be equipped with thermometers.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 4.18.4** Responsibility {#sec-16-4.18.4 omnilex-key=us-ms-regs-official--title-15--16#4.18.4}

A non-client employee, appointed by the Director, shall be responsible for the following:

1. Storage of prescription medications.

2. Keeping a current prescription medication list, including frequency and dosage, which shall be updated at least every thirty (30) days, or with any significant change.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 4.18.5** Disposal of Unused Prescription Medications {#sec-16-4.18.5 omnilex-key=us-ms-regs-official--title-15--16#4.18.5}

In the event any prescription medication is no longer in use for any reason, it shall be disposed of in accordance with the regulations of the Mississippi State Board of Pharmacy.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 4.19.1** Subchapter 19 SOCIAL SERVICES {#sec-16-4.19.1 omnilex-key=us-ms-regs-official--title-15--16#4.19.1}

The licensed facility shall make provisions for referring clients with social and emotional needs to an appropriate social services agency.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 4.20.1** Activities Program {#sec-16-4.20.1 omnilex-key=us-ms-regs-official--title-15--16#4.20.1}

An activities program shall be in effect which is appropriate to the needs and interests of each client.

1. The facility shall have a range of indoor and outdoor recreational and leisure opportunities to meet the needs and preferences of clients.

2. Adequate and activity-appropriate space shall be provided for the various client activities.

3. Activities shall be provided on a daily basis.

4. Available community resources shall be utilized in the activities program.

5. Supplies shall be available to implement an adequate activities program.

6. A non-client employee may be responsible for the activities program.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 4.21.1** General {#sec-16-4.21.1 omnilex-key=us-ms-regs-official--title-15--16#4.21.1}

1. The facility shall be designed throughout to meet the accessibility needs of the clients.

2. Handrails and sufficient lighting shall be integrated into public areas, as

appropriate, to assist clients in ambulation.

3. Sufficient lighting shall be provided for general lighting purposes and for reading in bedrooms and common areas.

4. Night lights for corridors, emergency situations and the exterior shall be provided as needed for security and safety.

5. Windows used for ventilation to the outside and exterior doors used for ventilation shall be screened and in good repair.

6. The facility shall be constructed, equipped, and maintained in good repair and kept free of hazards.

7. The facility shall have sufficient and separate storage space for administration records, cleaning supplies (janitorial), food service (supplies), lawn maintenance (equipment) and locked areas for medications. Poisonous and toxic materials shall be identified, and stored in a separate cabinet that is used for no other purpose.

8. There shall be evidence of routine maintenance and cleaning programs in all areas of the facility. The facility shall replace or repair broken, worn or defective furnishings and equipment promptly.

9. The facility shall be furnished according to the activities offered. Furniture shall be of good repair and appropriate for the functional program.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 4.21.2** Exterior Space {#sec-16-4.21.2 omnilex-key=us-ms-regs-official--title-15--16#4.21.2}

1. A facility shall ensure that the grounds and any structure thereon shall be maintained in good repair and free from any hazard to health and safety.

a. Garbage shall be stored securely in covered containers and shall be removed on a regular basis.

b. Trash collection receptacles and incinerators shall be separate from outdoor recreational space.

c. Areas determined to be unsafe, including but not limited to steep grades, cliffs, open pits, swimming pools, high voltage boosters or high speed roads shall be fenced off or have natural barriers to protect clients.

d. Fences shall be in good repair.

2. A facility shall provide clients access to outdoor space designated for recreational use. The parking lot shall not double as recreational space.

3. The facility’s address or name shall be displayed so as to be easily visible from the street.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 4.21.3** Required Areas/Rooms {#sec-16-4.21.3 omnilex-key=us-ms-regs-official--title-15--16#4.21.3}

The following areas/rooms are required to be provided in a licensed facility:

1. Bedrooms;

2. Living room;

3. Dining Area;

4. Toilet and bathing facilities;

5. Laundry; and

6. Kitchen.

**History**
- *SOURCE: Miss. Code Ann. §43-ll -13*

##### **15 Miss. Admin. Code Pt. 16, R. 4.21.4** Bedrooms {#sec-16-4.21.4 omnilex-key=us-ms-regs-official--title-15--16#4.21.4}

1. Location. All client bedrooms shall have an outside exposure and shall not be below grade. Window areas shall not be less than one-eighth (1/8) of the floor area. The window sill shall not be over thirty-six (36) inches from the floor. Windows shall be operable.

a. Client bedrooms shall be located so as to minimize the entrance of unpleasant odors, excessive noise, and other nuisances.

b. Client bedrooms shall be directly accessible from the main corridor. In no case shall a client bedroom be used for access to another client bedroom nor shall a client bedroom be used for access to a required outside exit.

c. All client bedrooms shall be so located that the client can travel from his/her bedroom to a living room, day room, dining room, or toilet or bathing facility without having to go through another client’s bedroom.

d. A facility shall ensure that each single occupancy bedroom has a floor

area of at least one hundred (100) net square feet, exclusive of bathrooms, closets or storage space; and that each multiple occupancy bedroom has a floor area of at least eighty (80) net square feet for each client. There shall be no more than two (2) clients per bedroom. The facility shall strive to maintain a homelike environment.

2. Furnishings.

a. Single beds shall be provided with good grade mattresses at least four (4) inches thick. Cots and roll-away beds shall not be used. Each client in the facility shall have his/her own bed. Cots, bunk beds or portable beds are not allowed.

b. Each bed shall be equipped with a pillow and clean linens to include sheets, pillow cases, spreads and blankets. An adequate supply of such linens shall be provided at all times to allow for a change of linen at least once a week.

c. Chest of drawers or similar adequate storage space shall be provided for the clothing, toilet articles, and personal belongings of each client.

d. Adequate closet space shall be provided for each client.

e. An adequate number of comfortable, sturdy chairs shall be provided.

f. The opportunity for personal expression shall be permitted.

g. A client shall be permitted to use personal furnishings in lieu of those provided by the licensed facility, when practical.

3. Common Space.

a. The facility shall provide common areas to allow clients the opportunity for socialization.

b. Common areas for leisure shall be at least sixty (60) square feet per person per licensed capacity.

c. Dining rooms and leisure areas shall be available for use by clients at appropriate times to provide periods of social and diversified individual and group activities.

d. The facility’s common areas shall be accessible and maintained to provide a clean, safe, and attractive environment for the clients.

e. Space used for administration, sleeping, or passage shall not be considered as dining or leisure space.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 4.21.5** Living Room {#sec-16-4.21.5 omnilex-key=us-ms-regs-official--title-15--16#4.21.5}

Living rooms, dayrooms, and/or recreation rooms shall be provided for clients and visitors. Each licensed facility shall provide at least two (2) areas for this purpose: one (1) for small groups such as a private visit with relatives and friends; and one (1) for larger group activities. The living room must be equipped with attractive, functional, and comfortable furniture in sufficient number to accommodate all clients. A minimum of 18 square feet per bed shall be provided.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 4.21.6** Dining Area {#sec-16-4.21.6 omnilex-key=us-ms-regs-official--title-15--16#4.21.6}

A dining area shall be provided which shall be adequate to seat all clients at the same meal seating. The dining area may also be used for social, recreational, and/or religious services when not in use as a dining facility. A minimum of 15 square feet per client shall be provided.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 4.21.7** Toilet and Bathing Facilities {#sec-16-4.21.7 omnilex-key=us-ms-regs-official--title-15--16#4.21.7}

1. There shall be adequate toilet, bathing and hand washing facilities in accordance with the current edition of the State Sanitary Code.

2. One bathroom shall serve no more than four beds.

3. Each bathroom shall contain wash basins with hot and cold water, flush toilets and bath or shower facilities with hot and cold water according to client care needs.

4. Bathrooms shall be located so that they open into a hallway, common area or directly into the bedroom. If the bathroom only opens directly into a bedroom, it shall be for the use of the occupants of that bedroom only.

5. Each bathroom shall be properly equipped with toilet paper, towels, soap, and other items required for personal hygiene, unless clients are individually given such items. Tubs and showers shall have slip-proof surfaces.

6. A facility shall provide toilets, baths and showers which allow for individual privacy, unless clients require assistance for care.

7. A facility’s bathrooms shall contain mirrors secured to the walls at convenient heights and other furnishings necessary to meet the client’s basic hygienic and grooming needs.

8. A facility’s bathrooms shall be equipped to facilitate maximum self-help by clients. Bathtubs and showers shall be equipped with grab bars, towel racks and non-glass shower enclosures. Commodes shall be equipped with grab bars.

9. Toilets, wash basins and other plumbing or sanitary areas in a facility shall be maintained in good operating condition at all times.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 4.21.8** Laundry {#sec-16-4.21.8 omnilex-key=us-ms-regs-official--title-15--16#4.21.8}

The facility shall have provisions to provide laundry services that are adequate to handle the needs of the clients, including those with incontinence.

1. The laundry shall be located in a specifically designated area and shall have adequate space for sorting, processing and storage of soiled material. Laundry rooms or soiled linen storage areas shall not open directly into a client's bedroom or food service area. Soiled materials shall not be transported through the food service area. The laundry area shall be kept clean and orderly.

2. If a commercial laundry is used, separate storage areas shall be provided for clean and soiled linens.

3. Adequate and effective lint traps shall be provided for dryers.

4. When laundry chutes are provided, they shall have a minimum diameter of two (2) feet; and shall be installed with flushing ring, vent, and drain.

5. A functional automatic sprinkler shall be provided at the top of the laundry chute and in any receiving room for a chute.

6. A self-closing door shall be provided at the bottom of the chute.

7. Laundry equipment shall be of the type to adequately perform the laundry needs of the facility. The equipment shall be installed to comply with all local and state codes.

8. There shall be a separate and designated area for the storage of clean linen.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 4.21.9** Kitchen {#sec-16-4.21.9 omnilex-key=us-ms-regs-official--title-15--16#4.21.9}

In facilities with 16 or more clients, commercial cooking equipment must comply with NFPA 96, "Standard for Ventilation Control and Protection of Commercial Cooking Operations".

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 4.22.1** Licensed Facility Classification {#sec-16-4.22.1 omnilex-key=us-ms-regs-official--title-15--16#4.22.1}

To qualify for a license, the facility shall be designed to serve the type of clients to be admitted and shall meet the requirements as set forth in these regulations.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 4.22.2** Location {#sec-16-4.22.2 omnilex-key=us-ms-regs-official--title-15--16#4.22.2}

Facilities shall be located so that they are free from undue noise, smoke, dust, or foul odors.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 4.22.3** Site {#sec-16-4.22.3 omnilex-key=us-ms-regs-official--title-15--16#4.22.3}

The proposed site for the facility must be approved by the licensing agency. Factors to be considered in approving a site shall be convenient to medical and hospital services, an approved water supply and sewage disposal, community services, services of an organized fire department, and the availability of labor supply. No more than one-third (1/3) of a site shall be covered by a building(s) except by special approval of the licensing agency. Where such approval is granted, the structure will be required to have a living room, day room, sun room, and recreational areas adequate to compensate for lack of required outside area.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 4.22.4** Local Restrictions {#sec-16-4.22.4 omnilex-key=us-ms-regs-official--title-15--16#4.22.4}

The site and structure of all licensed facilities shall comply with local building, fire, and zoning ordinances. Proof of compliance shall be submitted to the licensing agency.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 4.22.5** Transportation {#sec-16-4.22.5 omnilex-key=us-ms-regs-official--title-15--16#4.22.5}

Licensed facilities shall be located on streets or roads which are passable at all times.

1. The facility shall have the capacity to provide or to arrange transportation as necessary for the following:

a. Medical services, including ancillary services for medically related care (e.g., physician, pharmacist, therapist, podiatrist);

b. Personal services, including barber/beauty services;

c. Personal errands; and

d. Social/recreational opportunities.

2. All vehicles used to transport clients shall maintain current licenses/registrations.

3. When transportation services are provided by the facility, whether directly or by third party contract, the facility shall document and ensure that each driver has a valid driver’s license, that drivers have an insurable driving record, and that they are trained/experienced in assisting clients.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 4.22.6** Communications {#sec-16-4.22.6 omnilex-key=us-ms-regs-official--title-15--16#4.22.6}

There shall be not less than one telephone in the licensed facility and such additional telephones as are necessary to summon help in the event of fire or other emergency. The telephone shall be listed under the official licensed name of the facility.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 4.22.7** Occupancy {#sec-16-4.22.7 omnilex-key=us-ms-regs-official--title-15--16#4.22.7}

No part of the licensed facility may be rented, leased, or used for any purpose not related to the operation of the licensed facility.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 4.22.8** Basement {#sec-16-4.22.8 omnilex-key=us-ms-regs-official--title-15--16#4.22.8}

The basement shall be considered as a story if one-half (1/2) or more of its clear height is above the average elevation of the ground adjoining the building on all sides. No client shall be housed on any floor that is below ground level.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 4.23.1** Minor Alterations and Remodeling {#sec-16-4.23.1 omnilex-key=us-ms-regs-official--title-15--16#4.23.1}

It is not necessary for an entity to submit plans to Health Facilities provided such are just minor alterations and remodeling which do not affect the structural integrity of the building, change functional operation, affect fire safety, or affect the license bed capacity. A detailed explanation of the proposed alteration or remodeling must be submitted to and approved by the licensing agency prior to such renovation.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 4.23.2** First Stage Submission-Preliminary Plans {#sec-16-4.23.2 omnilex-key=us-ms-regs-official--title-15--16#4.23.2}

First stage or preliminary plans shall include:

1. Plot plan showing size and shape of entire site; location of proposed building and any existing structure(s); adjacent streets, highways, sidewalks, railroads, etc., all properly designated; and size, characteristics, and location of all existing public utilities.

2. Floor plan showing over-all dimensions of building(s); location, size, and purpose of all rooms; location and size of all doors, windows, and other openings with swing of doors properly indicated; dimensions of all corridors and hallways; and location of stairs, elevators, dumbwaiters, vertical shafts, and chimneys.

3. Outline specifications giving kinds and types of materials.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 4.23.3** Final Stage Submission-Working Drawings and Specifications {#sec-16-4.23.3 omnilex-key=us-ms-regs-official--title-15--16#4.23.3}

1. Final stage or working drawings and specifications shall include:

a. Architectural drawings

b. Structural drawings

c. Mechanical drawings to include plumbing, heat, and air-conditioning

d. Electrical drawings

e. Detailed specifications

2. Approval of working drawings and specifications shall be obtained from the licensing agency in writing prior to the beginning of actual construction.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 4.23.4** Preparation of Plans and Specifications {#sec-16-4.23.4 omnilex-key=us-ms-regs-official--title-15--16#4.23.4}

The preparation of drawings and specifications shall be executed by or under the immediate supervision of an architect who shall supervise construction and furnish a signed statement that construction was performed according to plans and specifications approved by the licensing agency.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 4.23.5** Contract Modifications {#sec-16-4.23.5 omnilex-key=us-ms-regs-official--title-15--16#4.23.5}

Any contract modification which affects or changes the function, design, or purpose of a facility shall be submitted to and approved by the licensing agency prior to the beginning of work set forth in any contract modification.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 4.23.6** Notification of Start of Construction {#sec-16-4.23.6 omnilex-key=us-ms-regs-official--title-15--16#4.23.6}

The licensing agency shall be informed in writing at the time construction is begun.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 4.23.7** Inspections {#sec-16-4.23.7 omnilex-key=us-ms-regs-official--title-15--16#4.23.7}

The licensing agency or its authorized representatives shall have access at all times to inspect work in progress and the owner shall ascertain that proper facilities are made available for such access and inspection.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 4.28.8** Limit of Approval {#sec-16-4.28.8 omnilex-key=us-ms-regs-official--title-15--16#4.28.8}

If construction is delayed for a period exceeding six (6) months from the time of approval of final working plans and specifications, a new evaluation and/or approval shall be obtained from the licensing agency.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 4.23.9** Water Supply, Plumbing, Sewerage Disposal {#sec-16-4.23.9 omnilex-key=us-ms-regs-official--title-15--16#4.23.9}

The water supply and sewerage disposal shall be approved by the local county health department or the appropriate division within the Mississippi State Department of Health. No system of water supply, plumbing, sewerage, garbage, or refuse disposal shall be installed nor any such existing system materially altered or extended until complete plans and specifications for the installation, alteration, or extension have been so approved and submitted to the licensing agency for review and final determination.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 4.24.1** Structural Soundness and Repair {#sec-16-4.24.1 omnilex-key=us-ms-regs-official--title-15--16#4.24.1}

The building shall be structurally sound, free from leaks and excessive moisture, in good repair, and painted at sufficient intervals to be reasonably attractive inside and out. Walls and ceilings of hazardous areas shall be one (1) hour fire resistance rating.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 4.24.2** Heating and Cooling Systems {#sec-16-4.24.2 omnilex-key=us-ms-regs-official--title-15--16#4.24.2}

Adequate heating and cooling systems shall be provided to maintain inside temperature between 68 degrees Fahrenheit and 78 degrees Fahrenheit depending on the season.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 4.24.3** Lighting {#sec-16-4.24.3 omnilex-key=us-ms-regs-official--title-15--16#4.24.3}

Each client's room shall have artificial light adequate for reading and other uses as needed. There should be a minimum brightness of ten (10) foot candles of lighting for general use in clients' rooms and a minimum brightness of thirty (30) foot candles of lighting for reading purposes. All entrances, hallways, stairways, ramps, cellars, attics, storerooms, kitchens, laundries, and service units shall have sufficient artificial lighting to prevent accidents and promote efficiency of service. Night lights shall be provided in all hallways, stairways, toilets, and bathing rooms.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 4.24.4** Emergency Lighting {#sec-16-4.24.4 omnilex-key=us-ms-regs-official--title-15--16#4.24.4}

At least one functioning, battery-operated emergency light shall be provided in each hallway.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 4.24.5** Screens {#sec-16-4.24.5 omnilex-key=us-ms-regs-official--title-15--16#4.24.5}

All screen doors and non-stationary windows shall be equipped with tight fitting, full length, sixteen (16) mesh screens. Screen doors shall swing out and shall be equipped with self-closing devices.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 4.24.6** Floors {#sec-16-4.24.6 omnilex-key=us-ms-regs-official--title-15--16#4.24.6}

All floors shall be smooth and free from defects such as cracks and shall be finished so that they can be easily cleaned.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 4.24.7** Walls and Ceilings {#sec-16-4.24.7 omnilex-key=us-ms-regs-official--title-15--16#4.24.7}

All walls and ceilings shall be of sound construction, with an acceptable surface, and shall be maintained in good repair.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 4.24.8** Ceiling Height {#sec-16-4.24.8 omnilex-key=us-ms-regs-official--title-15--16#4.24.8}

All ceilings shall have a height of at least seven (7) feet, except that a height of six (6) feet six (6) inches may be approved for hallways or toilets and bathing rooms where the lighting fixtures are recessed.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 4.24.9** Ramps and Inclines {#sec-16-4.24.9 omnilex-key=us-ms-regs-official--title-15--16#4.24.9}

Ramps and inclines, where installed for the use of clients, shall not exceed one (1) foot of rise in twelve (12) feet of run, shall be

furnished with a non-slip floor, and shall be provided with handrails on both sides.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 4.24.10** Door Swing {#sec-16-4.24.10 omnilex-key=us-ms-regs-official--title-15--16#4.24.10}

Exit doors, other than from a living unit, shall swing in the direction of exit from the structure.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 4.24.11** Floor Levels {#sec-16-4.24.11 omnilex-key=us-ms-regs-official--title-15--16#4.24.11}

All differences in floor levels within the building shall be accomplished by stairs of not less than three (3) six-inch risers, ramps, or inclines, and shall be equipped with handrails on both sides.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 4.24.12** Space Under Stairs {#sec-16-4.24.12 omnilex-key=us-ms-regs-official--title-15--16#4.24.12}

Space under stairs shall not be used for storage purposes. All walls and doors shall meet the same fire rating as the stairwell.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 4.24.13** Interior Finish and Floor Coverings {#sec-16-4.24.13 omnilex-key=us-ms-regs-official--title-15--16#4.24.13}

Interior finish and decorative material shall be not less than Class B and floor covering shall have a flame spread not to exceed 75.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 4.24.14** Fire Extinguishers {#sec-16-4.24.14 omnilex-key=us-ms-regs-official--title-15--16#4.24.14}

Fire extinguishers of number, type, and capacity appropriate to the need of the facility and shall be provided for each floor and for special fire hazard areas such as kitchen, laundry, and mechanical room. All extinguishers shall be of a type approved by the licensing agency. A vaporizing liquid extinguisher (such as carbon tetrachloride) will not be approved for use inside the building. Extinguishers shall be inspected and serviced periodically as recommended by the manufacturer. The date of inspection shall be entered on a tag attached to the extinguisher and signed by a reliable inspector such as the local fire marshal or representative of a fire extinguisher servicing company.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 4.24.15** Smoke Detectors {#sec-16-4.24.15 omnilex-key=us-ms-regs-official--title-15--16#4.24.15}

Smoke detectors shall be installed in each hallway no more than thirty (30) feet apart and in each bedroom and storage room.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 4.24.16** Trash Chutes {#sec-16-4.24.16 omnilex-key=us-ms-regs-official--title-15--16#4.24.16}

Trash chutes are prohibited.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 4.24.17** Housekeeping and Maintenance {#sec-16-4.24.17 omnilex-key=us-ms-regs-official--title-15--16#4.24.17}

The interior and exterior of the licensed facility shall be maintained in an attractive, safe and sanitary condition.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 4.24.18** Pest Control {#sec-16-4.24.18 omnilex-key=us-ms-regs-official--title-15--16#4.24.18}

Pest control inspections and, if necessary, treatments, shall be made to control pests, vermin, insects and rodents, at a minimum of once every ninety (90) days, by a company that is licensed by the State of Mississippi. The licensing agency may, in its discretion, require more frequent inspections and treatments. The inspection and treatment reports shall be maintained at the licensed facility.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 4.24.19** Water Temperature {#sec-16-4.24.19 omnilex-key=us-ms-regs-official--title-15--16#4.24.19}

The facility shall have a system in place to control water temperature to prevent burns and ensure client safety. The temperature of hot water at plumbing fixtures used by clients shall not exceed 115 degrees Fahrenheit and no less than 100 degrees Fahrenheit. Hot water temperature for each faucet shall be monitored on a weekly basis. Documentation shall be maintained in the facility for 12 months.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 4.24.20** Combustion Air {#sec-16-4.24.20 omnilex-key=us-ms-regs-official--title-15--16#4.24.20}

Combustion air to all equipment requiring such must come from the outside.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 4.24.21** Basement {#sec-16-4.24.21 omnilex-key=us-ms-regs-official--title-15--16#4.24.21}

The basement shall be considered as a story if one-half (1/2) or more of its clear height is above the average elevation of the ground adjoining the building on all sides. No client shall be housed on any floor that is below ground level.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 4.25.1** Building Protection {#sec-16-4.25.1 omnilex-key=us-ms-regs-official--title-15--16#4.25.1}

Facilities shall be constructed to have:

1. Automatic Sprinklers Required. Facilities licensed after the effective date of these regulations shall be protected throughout by a supervised automatic sprinkler system installed in accordance with the current

edition of NFPA 13, Installation of Sprinkler Systems.

2. One hour fire resistance rating as prescribed by the current edition of the National Fire Protection Association (NFPA) Standard 220, types of Building Construction. (Example: Type II (111), or Type V (l l l).

3. No mobile structures are acceptable for housing clients.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 4.25.2** Multi-story Building {#sec-16-4.25.2 omnilex-key=us-ms-regs-official--title-15--16#4.25.2}

Elevator Required. No client shall be housed in a building three stories and above unless the building is equipped with an elevator. The minimum cab size of the elevator shall be approximately six (6) feet eight (8) inches by five (5) feet and constructed of metal. The width of the shaft door shall be at least three (3) feet six (6) inches. The load weight capacity shall not be less than 2,500 pounds. The elevator shaft shall be enclosed by construction of not less than a two-hour fire resistive rating. Elevators shall not be counted as required exits.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 4.25.3** Hazardous Areas and Combustible Storage {#sec-16-4.25.3 omnilex-key=us-ms-regs-official--title-15--16#4.25.3}

Heating apparatus and boiler and furnace rooms, basements, or attics used for the storage of combustible m ater ial and workrooms shall be classified as hazardous areas and shall be separated from other areas by construction having a fire resistive rating of at least one (1) hour.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 4.25.4** Stairs {#sec-16-4.25.4 omnilex-key=us-ms-regs-official--title-15--16#4.25.4}

Stairs shall be enclosed with at least one-hour fire rated construction.

1. Handrails shall be provided on both sides of the stairs.

2. The width of the stairs shall not be less than forty-four (44) inches.

3. The stairs shall be well lighted at all times.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 4.25.5** Exit Doors {#sec-16-4.25.5 omnilex-key=us-ms-regs-official--title-15--16#4.25.5}

Exit doors shall meet the following:

1. At least two (2) remotely located exits shall be provided for each occupied story of a facility.

2. Dead end hallways in excess of twenty (20) feet are not allowed.

3. Doors to the exterior shall be not less than thirty-six (36) inches wide and egress shall not be impeded by being locked.

4. Exit doors shall swing in the direction of exit and shall not obstruct the travel along any required exit.

5. Doors leading to stairways shall be not less than thirty-six (36) inches wide.

6. Revolving doors shall not be used as required exits.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 4.25.6** Hallways and Passageways {#sec-16-4.25.6 omnilex-key=us-ms-regs-official--title-15--16#4.25.6}

1. Hallways and passageways shall be eight (8) feet wide and shall be kept unobstructed.

2. Hallways and passageways which lead to the outside from any required stairway shall be enclosed as required for stairways.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 4.25.7** Mechanical and Electric Systems {#sec-16-4.25.7 omnilex-key=us-ms-regs-official--title-15--16#4.25.7}

All mechanical, electrical, plumbing, heating, air-conditioning, and water systems shall meet the requirements of local codes and ordinances as well as the applicable regulation of the licensing agency. Where there are no local codes or ordinances, the most current versions of the following codes and recommendations shall govern:

1. National Electrical Code.

2. National Plumbing Code.

3. American Society of Heating, Refrigerating, and Air Conditioning Engineers, Inc.

4. Recommendations of the American Society of Mechanical Engineers.

5. Recommendations of American Gas Association.

6. National Fire Protection Association. The heating of licensed facilities shall be restricted to steam, hot water, or warm air systems employing central heating plants, or Underwriters Laboratories approved electric heating. The use of portable heaters of any kind is prohibited with the

following exceptions:

a. Gas heaters must meet all of the following:

i. A circulating type with a recessed enclosed flame so designed that clothing or other inflammable material cannot be ignited.

ii. Equipped with a safety pilot light.

iii. Properly vented to the outside.

iv. Approved by American Gas Association or Underwriters Laboratories.

b. An approved type of electrical heater such as wall insert type.

7. Lighting (except for battery-operated emergency lighting) shall be restricted to electricity.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 4.26.1** General {#sec-16-4.26.1 omnilex-key=us-ms-regs-official--title-15--16#4.26.1}

Each licensed entity shall develop and maintain a written preparedness plan utilizing the "All Hazards" approach to emergency and disaster planning. The plan must include procedures to be followed in the event of any act of terrorism or man-made or natural disaster as appropriate for the specific geographical location. The final draft of the Emergency Operations Plan (EOP) will be reviewed by the Office of Emergency Preparedness and Response, Mississippi State Department of Health, or their designates, for conformance with the "All Hazards Emergency Preparedness and Response Plan." Particular attention shall be given to critical areas of concern which may arise during any "all hazards" emergency, whether required to evacuate or to sustain in place. Additional plan criteria or a specified EOP format may be required as deemed necessary by the Office of Emergency Preparedness and Response. The six (6) critical areas of consideration are:

1. Communications - Facility status reports shall be submitted in a format and a frequency as required by the Office of Emergency Planning & Response.

2. Resources and Assets

3. Safety and Security

4. Staffing

5. Utilities

6. Clinical Activities

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 4.26.2** Plan Content {#sec-16-4.26.2 omnilex-key=us-ms-regs-official--title-15--16#4.26.2}

Emergency Operations Plans (EOPs) must be exercised and reviewed annually or as directed by the Office of Emergency Preparedness and Response. Written evidence of current approval or review of provider EOPs, by the Office of Emergency Preparedness and Response, shall accompany all applications for facility license renewals.

1. Emergency plans should include, at a minimum:

a. The facility shall have telephone service on a twenty-four hour basis.

b. The facility shall either post telephone numbers of emergency services, including the fire department, police department, medical services, poison control and ambulance, or else show evidence of an alternate means of immediate access to these services.

c. The facility shall have a detailed written plan and procedures including the evacuation of residences or sheltering in place as appropriate to meet all potential emergencies and disasters such as fire, severe weather, and missing clients. The facility shall implement this plan in the event that an emergency or disaster occurs. These emergency and evacuation procedures shall include:

i. An agreement with a host or receiving facility for transportation, medications, food, and necessary items to be evacuated with clients to safe or sheltered areas. Plans that family may evacuate the client when possible;

ii. Means for an ongoing safety program including continuous inspection of the facility for possible hazards, continuous monitoring of safety equipment and investigation of all accidents or emergencies;

iii. The resources to shelter in place, when appropriate;

iv. Transportation arrangements for hospitalization or any other services which are appropriate; and

v. Maintenance of a first aid kit for emergencies.

d. The facility shall train all employees in emergency and evacuation

procedures in orientation when they begin to work in the facility and annually thereafter.

e. The facility shall immediately notify the department and other appropriate agencies of any fire, disaster or other emergency that may present a danger to clients or require evacuation from the facility.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 4.27.1** RBIR Fire Preparedness.Fire Preparedness {#sec-16-4.27.1 omnilex-key=us-ms-regs-official--title-15--16#4.27.1}

1. Fire Drills. Fire drills shall be conducted one (1) per shift per quarter. Employees shall participate in a fire drill at least four (4) times per year.

2. Written Records. Written records of all drills shall be maintained, indicating content of and attendance at each drill.

3. A fire evacuation plan shall be posted in a conspicuous place and kept current.

CHAPTER 5 MISSISSIPPI POISON CONTROL CENTER ACCREDITATION STANDARDS Subchapter 1 AUTHORITY Rule 5.1.1 Adoption of Regulation and Standards. By virtue of authority vested in it by the Mississippi Code Annotated Section 41-3-15(5)(a), or as otherwise amended, the Mississippi State Department of Health does hereby adopt and promulgate the following standards and regulations governing accreditation of Mississippi Poison Control Center(s).

**History**
- *SOURCE: Miss. Code Ann. §43-11-1*
- *Source: Miss. Code Ann. §41-3-15*

##### **15 Miss. Admin. Code Pt. 16, R. 5.2.1** Poison Control Centers {#sec-16-5.2.1 omnilex-key=us-ms-regs-official--title-15--16#5.2.1}

The poison control center is a specialized unit providing information on poisoning, in principle to the whole community. The primary functions of a poison control center are 1) to enhance the health of the lay public by assessing exposures and providing timely information, including referral to health care facilities when indicated; 2) to enhance the care of poisoned patients by providing timely information on diagnosis and treatment to health care professionals and 3) to provide information on potential poisons and

chemical hazards to citizens and governmental agencies. In fulfilling its function, poison control centers provide the provision of toxicological information and advice, management of poisoning cases, information on the provision of laboratory analytical services, toxicovigilance activities, research, and education and training in the prevention and treatment of poisoning. As part of its role in toxicovigilance, the center advises on and is actively involved in the development, implementation, and evaluation of measures for the prevention of poisoning. In association with other responsible bodies, it also plays an important role in developing contingency plans for, and responding to, chemical disasters, in monitoring the adverse effects of drugs, and in handling problems of substance abuse. In fulfilling its role and functions, the Mississippi Poison Control Center needs to cooperate not only with similar organizations, but also with other institutions concerned with prevention of and response to poisons center is a specialized unit that advises on, and assists with, the prevention, diagnosis and management of poisoning. A poison center answers inquiries about exposure to chemical agents, including products, pharmaceuticals, natural toxins, pesticides and industrial chemicals. It provides an assessment of whether a particular exposure is hazardous, and information on the need for treatment and the kind of treatment that should be given. The goal of the poison control center for the State of Mississippi is to promote evidence-based, cost-effective management of poisoning and to ensure that unnecessary or ineffective treatment is minimized.

**History**
- *Source: Miss. Code Ann. §41-3-15*

##### **15 Miss. Admin. Code Pt. 16, R. 5.2.2** Accreditation {#sec-16-5.2.2 omnilex-key=us-ms-regs-official--title-15--16#5.2.2}

The process by which an organization is deemed to meet certain standards, as designated appropriate by the Legislature or a governing body.

##### **15 Miss. Admin. Code Pt. 16, R. 5.2.3** Rule 5.2.3 {#sec-16-5.2.3 omnilex-key=us-ms-regs-official--title-15--16#5.2.3}

American Association of Poison Control Centers (AAPCC) The national organization for poison control centers and for certification of Specialist in Poison Information.

**History**
- *Source: Miss. Code Ann. §41-3-15*

##### **15 Miss. Admin. Code Pt. 16, R. 5.2.4** Rule 5.2.4 {#sec-16-5.2.4 omnilex-key=us-ms-regs-official--title-15--16#5.2.4}

Bureau means the Bureau of Health Facilities Licensure and Certification within the Mississippi State Department of Health.

**History**
- *Source: Miss. Code Ann. §41-3-15*

##### **15 Miss. Admin. Code Pt. 16, R. 5.2.5** Agency means Mississippi State Department of Health {#sec-16-5.2.5 omnilex-key=us-ms-regs-official--title-15--16#5.2.5}

**History**
- *Source: Miss. Code Ann. §41-3-15*

##### **15 Miss. Admin. Code Pt. 16, R. 5.2.6** Certified Specialist in Poison Control {#sec-16-5.2.6 omnilex-key=us-ms-regs-official--title-15--16#5.2.6}

Specialist in Poison Control who has passed the AAPCC Certified Poison Control exam.

**History**
- *Source: Miss. Code Ann. §41-3-15*

##### **15 Miss. Admin. Code Pt. 16, R. 5.2.7** Clinical Toxicologist {#sec-16-5.2.7 omnilex-key=us-ms-regs-official--title-15--16#5.2.7}

Diplomats of the American Board of Applied Toxicology (DABAT) or individual with appropriate training as referenced in Rule 5.10.6 that has been approved by the Medical Director to function in this role.

**History**
- *Source: Miss. Code Ann. §41-3-15*

##### **15 Miss. Admin. Code Pt. 16, R. 5.2.8** Electronic Linkage {#sec-16-5.2.8 omnilex-key=us-ms-regs-official--title-15--16#5.2.8}

Real-time technology that enables medical record system accessibility by another poison center when needed to provide coverage for a call region. Also applies to real-time technology to enable medical record accessibility for personnel or consultants utilizing remote access.

**History**
- *Source: Miss. Code Ann. §41-3-15*

##### **15 Miss. Admin. Code Pt. 16, R. 5.2.9** Health Care Provider Education {#sec-16-5.2.9 omnilex-key=us-ms-regs-official--title-15--16#5.2.9}

Professional education to healthcare providers in a poison center service area for the purpose of improving the quality, effectiveness, and efficiency of medical treatment provided to poisoned patients and enhancing awareness of poison control center services.

**History**
- *Source: Miss. Code Ann. §41-3-15*

##### **15 Miss. Admin. Code Pt. 16, R. 5.2.10** Functional Linkage {#sec-16-5.2.10 omnilex-key=us-ms-regs-official--title-15--16#5.2.10}

A cooperative working relationship with another poison center to ensure services are provided in a seamless manner to the designated population. Coordinated patient care guidelines, databases, and other reference material must be available to enable remote agents to provide a single standard of information and care across the designated region.

##### **15 Miss. Admin. Code Pt. 16, R. 5.2.11** Medical Director {#sec-16-5.2.11 omnilex-key=us-ms-regs-official--title-15--16#5.2.11}

The Medical Director is a doctor of medicine or osteopathy currently licensed in the appropriate state(s). The Medical Director is board certified in medical toxicology through the American Board of Medical Specialties. A physician who is not board certified as listed above may submit evidence of equivalent expertise demonstrated by training and certification:

1. Board-eligible physicians trained in a fellowship in medical toxicology approved by the Accreditation Council for Graduate Medical Education (AGCME) must become board certified within two consecutive examination cycles.

2. Doctors of osteopathy who have completed an Accreditation Council Graduate Medical Education approved fellowship and who have passed the American Osteopathic Board of Emergency Medicine examination for Certification of Added Qualification in Medical Toxicology will be considered qualified.

**History**
- *Source: Miss. Code Ann. §41-3-15*

##### **15 Miss. Admin. Code Pt. 16, R. 5.2.12** Rule 5.2.12 {#sec-16-5.2.12 omnilex-key=us-ms-regs-official--title-15--16#5.2.12}

Medical Toxicologist Physicians who are board certified in medical toxicology through the American Board of Medical Specialties or physicians who have completed an accredited fellowship in medical toxicology and in the process of taking the certification examination.

**History**
- *Source: Miss. Code Ann. §41-3-15*

##### **15 Miss. Admin. Code Pt. 16, R. 5.2.13** National Poison Data System (NPDS) {#sec-16-5.2.13 omnilex-key=us-ms-regs-official--title-15--16#5.2.13}

Refers to a national database utilized by poison control centers for entry of all human exposure data.

**History**
- *Source: Miss. Code Ann. §41-3-15*

##### **15 Miss. Admin. Code Pt. 16, R. 5.2.14** Partnership {#sec-16-5.2.14 omnilex-key=us-ms-regs-official--title-15--16#5.2.14}

Any organized group where poison center education staff is in regular attendance or plays a significant role. Examples include committees, subcommittees, taskforces, workgroups, coalitions, and councils.

**History**
- *Source: Miss. Code Ann. §41-3-15*

##### **15 Miss. Admin. Code Pt. 16, R. 5.2.15** Poison Information Provider (PIP) {#sec-16-5.2.15 omnilex-key=us-ms-regs-official--title-15--16#5.2.15}

An individual who answers calls for a poison control center and does not meet the eligibility criteria for the CSPI examination or has failed the CSPI examination two or more consecutive times. Individuals in professional training programs on educational rotations in a poison control center are not considered PIPs. The title and availability of the “PIP” position may differ at poison control center host institutions.

**History**
- *Source: Miss. Code Ann. §41-3-15*

##### **15 Miss. Admin. Code Pt. 16, R. 5.2.16** Public Education {#sec-16-5.2.16 omnilex-key=us-ms-regs-official--title-15--16#5.2.16}

Public information shall be provided that raises awareness of poisoning, poison prevention, and poison control center services based on regional and community needs. Educational programs, materials, and messages are under the direction of the poison control center staff or through collaborative partnerships such as public health organizations, poison prevention education centers, state and local agencies, schools, and other community organizations.

**History**
- *Source: Miss. Code Ann. §41-3-15*

##### **15 Miss. Admin. Code Pt. 16, R. 5.2.17** Quality Management {#sec-16-5.2.17 omnilex-key=us-ms-regs-official--title-15--16#5.2.17}

A quality management and improvement program is an ongoing systematic, coordinated, and continuous approach to assessing and improving the delivery, quality, efficiency, and outcome of poison control center services. This is accomplished through ongoing quality improvement and quality assurance activities.The quality management program must include tools for chart review (ensuring accurate information and documentation), measuring customer and employee satisfaction, monitoring work flow and output, and improving the overall quality of services. Thisincludes ongoing collection, monitoring, and analysis of data and the conduct of quality improvement

initiatives while taking action where indicated for the purpose of reducing errors and improve performance.

**History**
- *Source: Miss. Code Ann. §41-3-15*

##### **15 Miss. Admin. Code Pt. 16, R. 5.2.18** Specialist in Poison Control {#sec-16-5.2.18 omnilex-key=us-ms-regs-official--title-15--16#5.2.18}

A specialist in poison information (SPI) is a licensed registered nurse, pharmacist, physician, or physician assistant (PA), current or previously certified specialist in poison information as defined by AAPCC Certified Specialist in Poison Control Exam Criteria for Specialists in Poison Information or an individual who has completed job training as directed by the medical director.

**History**
- *Source: Miss. Code Ann. §41-3-15*

##### **15 Miss. Admin. Code Pt. 16, R. 5.2.19** Teleworking {#sec-16-5.2.19 omnilex-key=us-ms-regs-official--title-15--16#5.2.19}

Refers to any arrangement in which a poison control center employee is working at an off-site environment on a regular, recurring, or occasional basis or as an element of a disaster plan.

**History**
- *Source: Miss. Code Ann. §41-3-15*

##### **15 Miss. Admin. Code Pt. 16, R. 5.3.1** Accreditation {#sec-16-5.3.1 omnilex-key=us-ms-regs-official--title-15--16#5.3.1}

An entity shall not operate a poison control center within the State of Mississippi without first obtaining accreditation from the Mississippi State Department of Health. Substantial compliance with all requirements, as outlined in this Chapter, must be achieved in order for a Poison Control Center to become accredited.

**History**
- *Source: Miss. Code Ann. §41-3-15*

##### **15 Miss. Admin. Code Pt. 16, R. 5.3.2** Application for Accreditation {#sec-16-5.3.2 omnilex-key=us-ms-regs-official--title-15--16#5.3.2}

Upon request for accreditation, the entity shall submit an application and required documentation, on Forms and in a manner as prescribed by Mississippi State Department of Health.

**History**
- *Source: Miss. Code Ann. §41-3-15*

##### **15 Miss. Admin. Code Pt. 16, R. 5.3.3** Fees {#sec-16-5.3.3 omnilex-key=us-ms-regs-official--title-15--16#5.3.3}

Accreditation and re-accreditation renewal fees shall be established by the Mississippi Board of Health. The applicant shall bear the expense of all compliance reviews and inspection, to include but not be limited to, the cost of contracted services, transportation, lodging, and related per- diem expenses for specialist, as necessary, to conduct the initial certification compliance review and annual recertification reviews, plus the cost of administrative review, and monitoring.

**History**
- *Source: Miss. Code Ann. §41-3-15*

##### **15 Miss. Admin. Code Pt. 16, R. 5.3.4** Name of Institution {#sec-16-5.3.4 omnilex-key=us-ms-regs-official--title-15--16#5.3.4}

The institutional name will be specific to the institution but shall contain the words “poison control center”.

**History**
- *Source: Miss. Code Ann. §41-3-15*

##### **15 Miss. Admin. Code Pt. 16, R. 5.3.5** Foundation for Services {#sec-16-5.3.5 omnilex-key=us-ms-regs-official--title-15--16#5.3.5}

The Mississippi Poison Control Center shall operate under the auspices of a tertiary care center that is associated with a medical and pharmacy school. The Medical Director of the poison control center shall assume overall responsibility to assure compliance with the regulations, for setting policy, appointing medical and other persons to carry out such policies and for monitoring the poison control center’s total operation. Collaboration of services with a medical center/school is important due to expertise and resources of that entity in the management of poisonings and its function as an educational institution for medical and other health related professions.

**History**
- *Source: Miss. Code Ann. §41-3-15*

##### **15 Miss. Admin. Code Pt. 16, R. 5.3.6** Operational Requirements {#sec-16-5.3.6 omnilex-key=us-ms-regs-official--title-15--16#5.3.6}

In order for a poison control center to be considered operational, the center must:

1. Have telecommunications and data resources to assure accessibility 24/7/365;

2. Utilize the national PCC hotline number of 1-800-222- 1222;

3. Have availability of medical and assistive staff to meet the needs of the call volume, educational and training productions and related services;

4. Routinely upload exposure data into the National Poison Control Database.

**History**
- *Source: Miss. Code Ann. §41-3-15*

##### **15 Miss. Admin. Code Pt. 16, R. 5.3.7** Accreditation Renewal Cycle {#sec-16-5.3.7 omnilex-key=us-ms-regs-official--title-15--16#5.3.7}

The accreditation issued for the operation of a poison control program, unless sooner suspended or revoked, shall expire automatically on June 30 of each third calendar year. Should initial accreditation occur prior to the June 30 date, the initial accreditation period shall run from the date of determination of compliance with all rules and regulations through June 30 of the following year post June 30. For example, if compliance is determined and initial accreditation is granted on February 28, 2015, the initial licensure period shall run from February 28, 2015 thru June 30, 2018. June 30, 2016, then shall be established on an every three calendar year cycle.

**History**
- *Source: Miss. Code Ann. §41-3-15*

##### **15 Miss. Admin. Code Pt. 16, R. 5.3.8** Accreditation Renewal Process {#sec-16-5.3.8 omnilex-key=us-ms-regs-official--title-15--16#5.3.8}

The poison control center seeking renewal of its accreditation shall:

1. Request a renewal packet from the Bureau if one is not received within 45 days prior to the expiration of the accreditation date;

2. Complete all forms and return to the Bureau within 30 days prior to the expiration of the renewal;

3. Submit the required accreditation renewal fees with the packet. A renewal packet is not considered complete until the completed packet and all pertinent fees are submitted.

**History**
- *Source: Miss. Code Ann. §41-3-15*

##### **15 Miss. Admin. Code Pt. 16, R. 5.3.9** Notification of Changes {#sec-16-5.3.9 omnilex-key=us-ms-regs-official--title-15--16#5.3.9}

Mississippi State Department of Health shall be notified, in writing, of any of the following within 5 business days following the occurrence:

1. Address/Location

2. Phone Number (or change in national hotline number)

3. Hours of Operation/24 hour Contact Procedure

4. Medical Director

5. Poison Control Manager

6. Cessation of Business

**History**
- *Source: Miss. Code Ann. §41-3-15*

##### **15 Miss. Admin. Code Pt. 16, R. 5.3.10** Posting of Accreditation Status {#sec-16-5.3.10 omnilex-key=us-ms-regs-official--title-15--16#5.3.10}

The accreditation notice shall be displayed in a prominent place within the office of the poison control command center.

**History**
- *Source: Miss. Code Ann. §41-3-15*

##### **15 Miss. Admin. Code Pt. 16, R. 5.3.11** Inspections {#sec-16-5.3.11 omnilex-key=us-ms-regs-official--title-15--16#5.3.11}

Observation and inspection of the poison control center, to include but not be limited to, review of staffing, procedures, processes, cases, logs, reports, quality assurance/improvement reviews shall be available at all reasonable hours to properly identified representatives of the Department.

**History**
- *Source: Miss. Code Ann. §41-3-15*

##### **15 Miss. Admin. Code Pt. 16, R. 5.3.12** Denial, Suspension or Revocation of Accreditation {#sec-16-5.3.12 omnilex-key=us-ms-regs-official--title-15--16#5.3.12}

Under the Agency’s authority to promote and protect public health, the accrediting Agency will hold authority to deny, suspend or revocate the accreditation of an accredited poison

control center. Any of the following actions may be grounds for action by the Agency:

1. Noncompliance with provisions of the accreditation regulations as written in this chapter;

2. Failure to assure qualified medical oversight and adequately qualified trained staff;

3. Failure to maintain telecommunications on a 24 hour basis;

4. Addiction to narcotics by any member of the medical or management staff of the center;

5. Conviction of a felony by any member of the medical or management staff of the center;

6. Publicly misrepresenting the poison control center or its services;

7. Permitting, aiding or abetting the commission of an unlawful act;

8. Misappropriating monies or properties of the center;

9. Failure to promptly notify the appropriate authorities upon receipt of a call or information indicative of imminent danger to the calling party, their family or others.

**History**
- *Source: Miss. Code Ann. §41-3-15*

##### **15 Miss. Admin. Code Pt. 16, R. 5.3.13** Termination of Operation {#sec-16-5.3.13 omnilex-key=us-ms-regs-official--title-15--16#5.3.13}

Thirty days prior to discontinuation or determination of operation, management within the poison control center shall notify, in writing, the Governor and Lieutenant Governor of the State of Mississippi, Legislative Speakers of the House, both Senate and House of Representatives, the State Health Officer, and all other individuals, as deemed appropriate. The poison control center shall take steps, as necessary, to assure notification of the citizens of the State of Mississippi.

**History**
- *Source: Miss. Code Ann. §41-3-15*

##### **15 Miss. Admin. Code Pt. 16, R. 5.4.1** Communications and Infrastructure {#sec-16-5.4.1 omnilex-key=us-ms-regs-official--title-15--16#5.4.1}

The poison control center maintains the infrastructure and resources necessary to respond to calls from its designated service region 24 hours per day, 365 days a year. The center demonstrates its commitment to high standards of patient care and safety by providing sufficient human, physical, and financial resources to support its mission. All activities of

the poison control center are conducted at all times with sound ethical principles and in compliance with applicable federal and state laws.

**History**
- *Source: Miss. Code Ann. §41-3-15*

##### **15 Miss. Admin. Code Pt. 16, R. 5.4.2** Access {#sec-16-5.4.2 omnilex-key=us-ms-regs-official--title-15--16#5.4.2}

The poison control call center shall maintain a communications infrastructure to ensure timely and uninterrupted access to call center staff 24 hours a day, 7 days a week, and 365 days a year.

1. The poison control center shall maintain a communications infrastructure that ensures timely and unrestricted access to its trained staff without interruption. 2. The poison control center shall ensure a communications infrastructure sufficient to respond to demands for services within its designated region, the State of Mississippi.

3. The poison center shall monitor to ensure that all counties within its designated region, the State of Mississippi are served.

4. The poison control center shall use and promote the nationwide toll-free number, 1-800-222-1222.

5. The poison control center shall not impose a direct fee to individual members of the lay public (either by direct billing or pay-forcall services) for poison exposure emergency calls received from the public within its region.

6. The poison control center shall respond to inquiries in languages other than English as appropriate to the region, using language translation services, interpreters, and/or bilingual staff.

7. The poison control center shall provide access for hearing- impaired individuals.

8. The poison control center shall document and upload to the National Poison Data System (NPDS) all human exposure and information cases received by any communication method (e.g., email, text, chat).

**History**
- *Source: Miss. Code Ann. §41-3-15*

##### **15 Miss. Admin. Code Pt. 16, R. 5.4.3** Service Coverage {#sec-16-5.4.3 omnilex-key=us-ms-regs-official--title-15--16#5.4.3}

The poison control center shall have systems in place to monitor and assure that poison control education and services are available and provided to all parts of the State of Mississippi. The center shall use NPDS data to monitor county utilization annually and will utilize quality improvement measures to improve utilization in underserved areas.

**History**
- *Source: Miss. Code Ann. §41-3-15*

##### **15 Miss. Admin. Code Pt. 16, R. 5.4.4** Policies and Procedures {#sec-16-5.4.4 omnilex-key=us-ms-regs-official--title-15--16#5.4.4}

The poison control center must establish and comply with policies and procedures that ensure poisoning exposures and/or situations threatening human health are responded to and handled appropriately.

**History**
- *Source: Miss. Code Ann. §41-3-15*

##### **15 Miss. Admin. Code Pt. 16, R. 5.4.5** Additional Information Services {#sec-16-5.4.5 omnilex-key=us-ms-regs-official--title-15--16#5.4.5}

The poison control center may provide additional information services for public health, private industry, or other entities but must ensure adequate staffing is provided for poison-related calls.

**History**
- *Source: Miss. Code Ann. §41-3-15*

##### **15 Miss. Admin. Code Pt. 16, R. 5.4.6** Reference Materials {#sec-16-5.4.6 omnilex-key=us-ms-regs-official--title-15--16#5.4.6}

The poison control center shall establish patient care guidelines, databases, and other reference materials that ensure a single standard of information and care across the state.

**History**
- *Source: Miss. Code Ann. §41-3-15*

##### **15 Miss. Admin. Code Pt. 16, R. 5.4.7** Triage of Calls {#sec-16-5.4.7 omnilex-key=us-ms-regs-official--title-15--16#5.4.7}

The poison control center provides effective triage of emergent calls.

**History**
- *Source: Miss. Code Ann. §41-3-15*

##### **15 Miss. Admin. Code Pt. 16, R. 5.4.8** Diversion of Calls {#sec-16-5.4.8 omnilex-key=us-ms-regs-official--title-15--16#5.4.8}

If the poison control center routinely diverts calls, it must have the technology in place to allow real-time computer-networked access through a shared or replicated database to patient records with the capability to retrieve records for patient care and to have charting entries made in real time, following the standard practices for the poison center. This excludes brief periods such as coverage for staff meetings, telephony updates and disaster situations.

The poison control center may divert calls only to an accredited poison control center. Both centers must ensure that continuity of clinical care is achieved when diverting calls or sharing call responsibilities. Medical direction shall be maintained at all times during the process. A system must be put into place to replicate records into the home poison control database in a timely manner.

**History**
- *Source: Miss. Code Ann. §41-3-15*

##### **15 Miss. Admin. Code Pt. 16, R. 5.4.9** Internal Emergency Operations Plan {#sec-16-5.4.9 omnilex-key=us-ms-regs-official--title-15--16#5.4.9}

The poison control center shall have a written internal emergency operations plan designed to coordinate its communications, resources, staff responsibilities, and clinical and support

activities during an internal emergency, to ensure that services can be provided continuously to its designated service region.

1. The poison control center shall develop response and contingency plans for natural and technological disasters that may affect its facility, operations, and/or staff.

2. The poison control center shall develop a policy for business continuity in the event of a communications failure.

**History**
- *Source: Miss. Code Ann. §41-3-15*

##### **15 Miss. Admin. Code Pt. 16, R. 5.4.10** External Emergency Operations Plan {#sec-16-5.4.10 omnilex-key=us-ms-regs-official--title-15--16#5.4.10}

The poison control center must have a written external emergency operations plan for assisting local, state, and federal authorities respond to emergencies occurring within its designated service region.

1. The poison control center shall assists in local, regional, and/or national emergency preparedness planning activities.

2. The poison control center shall develop and maintain a plan for capacity to respond to mass poisoning exposures or public health events. The written plan must cover surge capacity to respond to mass poisoning exposure or public health events.

3. The poison control center shall develop response and contingency plans for natural and technological disasters that may affect its facility, operations, and/or staff.

4. The poison control center shall develop a policy for business continuity in the event of a communications failure.

**History**
- *Source: Miss. Code Ann. §41-3-15*

##### **15 Miss. Admin. Code Pt. 16, R. 5.5.1** Qualified Staff {#sec-16-5.5.1 omnilex-key=us-ms-regs-official--title-15--16#5.5.1}

The poison control center’s telephone consultation personnel possess the appropriate combination of educational credential(s), specialized training and/or certification, work experience, and demonstrated skills to qualify them for the tasks they are performing.

1. Telephone consultation staff members must be qualified, experienced, trained, and competent to deliver quality patient care.

2. Telephone consultation staff shall receive ongoing continuing education related to toxicology.

**History**
- *Source: Miss. Code Ann. §41-3-15*

##### **15 Miss. Admin. Code Pt. 16, R. 5.5.2** Staffing for PCC {#sec-16-5.5.2 omnilex-key=us-ms-regs-official--title-15--16#5.5.2}

The poison control center must ensure that telephone consultation staff members are adequately qualified. The center shall be staffed with medical toxicologist, clinical toxicologist, certified poison information specialist (CSPI), specialist in poison information (SPI), poison information providers (PIP), and other personnel, as needed, based on the volume of calls.

1. A Specialist in Poison Information (SPI) or a Certified Specialist in Poison Information (CSPI) may work part time or full time in the poison control center, but when scheduled to work on the poison center hotline, 100% of his or her time must be dedicated to poison control center activities.

2. A Certified Specialist in Poison Information (CSPI) may work as a sole individual providing service in handling human exposure calls if the medical director and the Poison Control Manager (if a clinical toxicologist) have evaluated the CSPI’s performance and have deemed the CSPI appropriate to work alone with access to clinical supervision at all times.

3. A non-certified Specialist in Poison Information (SPI) may work as a sole individual providing service in handling human exposure calls if the SPI is in the process of meeting the Certified Specialist in Poison Information (CSPI) examination eligibility requirements, has handled a minimum of 2,000 human exposure cases, and the medical director and poison control manager have evaluated the SPIs performance and have deemed the SPI appropriate to work alone with access to clinical supervision at all times.

4. Specialist in Poison Information (SPI) who are not Clinical Toxicologists (see Rule 5.2.7) or Medical Toxicologists (see Rule 5.2.12) shall be certified by the American Association of Poison Control Centers within three consecutive certification examinations. Initial eligibility for certification is met when the candidate meets criteria for call volume and hours worked and poison control center leadership has verified the candidate’s eligibility.

5. A Certified Specialist in Poison Information (CSPI) who fails the re- certification exam or does not retake it before the expiration date of the certification reverts to a Specialist in Poison Information (SPI) but remains eligible to retake the examination. This SPI must recertify within three consecutive administrations of the certification exam.

6. A Specialist in Poison Information (SPI) or Certified Specialist in Poison Information (CSPI) who has failed the examination three times may not work independently and must follow the scheduling and supervision requirements of a Poison Information Provider (PIP) (refer to items 8-10, as listed below) but remains eligible to retake the certification examination. Any change in employment status must follow host institution policy.

7. A Poison Information Provider may work part time or full time in the poison control center, but when scheduled to work on the poison center hotline, 100% of his or her time must be dedicated to poison control center activities.

8. Poison Information Providers may not be the sole individual scheduled to work on the poison center hotline.

9. At all times, Poison Information Providers must be under the oversight/direction of a certified Specialist in Poison Control, a qualified person providing medical direction, or a Clinical Toxicologist and/or Medical Toxicologist.

10. Qualified individuals – (an individual as defined in Rule 5.5.2(2) The center must provide 1:2 (supervisor to PIP) oversight of PIPs who manage exposure calls.

11. Supervising individuals, as listed in Rule 5.5.2 (2) shall provide the following types of oversight to a Poison Information Provider: direct oversight, on-site oversight, or general oversight. Direct oversight means the individual is within technologically unassisted audible and visible reach of the Poison Information Provider. On-site oversight means the individual must be in the Poison Control Center and quickly available to the Poison Information Provider. General oversight means accepting responsibility for and overseeing the services of a Poison Information Provider by telephone, by videoconferencing, or in person as frequently as necessary considering the location, nature of practice, and experience of the Poison Information Provider.

**History**
- *Source: Miss. Code Ann. §41-3-15*

##### **15 Miss. Admin. Code Pt. 16, R. 5.5.3** Staff Experience/Expertise {#sec-16-5.5.3 omnilex-key=us-ms-regs-official--title-15--16#5.5.3}

The poison control center must ensure that telephone consultation staff have the appropriate experience and level of expertise to achieve and maintain a high standard of practice.

1. To maintain experience, expertise, and quality, call center personnel at a poison control center must handle, on average, at least 2,000 and not more than 5,500 human exposures per Certified Specialist in Poison

Control/Specialist in Poison Control/ Poison Information Provider full- time equivalent (FTE) per year.

2. The Mississippi Poison Control Center will strive to maintain 100% of Specialist in Poison Control’s FTEs by certified specialist in poison control; however, in times of high turnover, the Mississippi Poison Control Center will make every effort to assure that at least 50% of the specialists functioning in the poison control center will be certified specialist in poison control. Should the number of certified specialist in poison control information drop below the 50% , the Mississippi Poison Control Unit will notify the accrediting agency and provide to the accrediting agency a detailed action plan for assuring adequate coverage of the center with qualified staff during this period and which shall address recruitment and training efforts. The minimum number of Certified Specialist in Poison Information (CSPI) for certification shall be no less than 40%.

3. Specialists in Poison Control (SPI) not currently certified by AAPCC must spend a minimum of 800 hours per year (15 hours/week average) and manage 1,000 human exposure cases per year working as a SPI.

4. Certified Specialists in Poison Information (CSPIs) must spend a minimum of 400 hours per year (8 hours/week average) and manage 500 human exposure cases per year or equivalent of an equal number of hours in providing professional education, clinical, or case management activities.

**History**
- *Source: Miss. Code Ann. §41-3-15*

##### **15 Miss. Admin. Code Pt. 16, R. 5.5.4** Training and Orientation {#sec-16-5.5.4 omnilex-key=us-ms-regs-official--title-15--16#5.5.4}

The poison control center must demonstrate that telephone consultation staff are trained appropriately and assessed on an ongoing basis to maintain competency.

1. The Medical Director is responsible for content oversight of staff toxicology education and training.

2. The poison control center must have an orientation/training program for new staff providing toxicologic information, including training manuals, written learning objectives, regular evaluation of progress, and competency evaluation.

3. The poison control center must have an ongoing education program in place to update and increase the knowledge base and competency of staff.

4. A regular evaluation process must be in place for telephone consultation

staff, involving review of both communication skills and case management.

a. All telephone personnel must complete the Poison Control Center Collaborative Communications Training Module on an annual basis.

**History**
- *Source: Miss. Code Ann. §41-3-15*

##### **15 Miss. Admin. Code Pt. 16, R. 5.5.5** Resources {#sec-16-5.5.5 omnilex-key=us-ms-regs-official--title-15--16#5.5.5}

The poison control center must ensure that medical toxicologists, clinical toxicologists, and telephone consultation staff have access to resources needed to ensure learning and the delivery of competent care.

1. Comprehensive product information resources shall be immediately available to the clinical staff at all times.

2. Clinical staff members shall be timely informed of current toxicology matters and trends (e.g., current drug trends, recalls).

**History**
- *Source: Miss. Code Ann. §41-3-15*

##### **15 Miss. Admin. Code Pt. 16, R. 5.5.6** Teleworking {#sec-16-5.5.6 omnilex-key=us-ms-regs-official--title-15--16#5.5.6}

If the poison control center’s leadership determines that teleworking is an appropriate alternative work arrangement to meet the needs of the populations it serves, the center must ensure that its services provided by teleworkers meet all requisite standards.

1. Employee eligibility for teleworking is determined at the sole discretion of the poison control center clinical/medical director leadership.

2. At least one Specialist in Poison Information (SPI) must be onsite for each shift during business and peak call volume hours, unless there is a disaster that requires closure of the facility.

3. The poison control center has a teleworking agreement or policy to establish eligibility guidelines, usage policies, work hours, employee availability, IT support processes, and data security, demonstrating a clear understanding of the expectations of teleworkers.

4. The poison control center has a well-defined emergency service continuity plan, including a policy for business continuity in the event of a telecommunication failure at the remote site (refer to Emergency Operations Plan).

5. Teleworkers must have immediate access to a clinical or medical toxicologist at all times commensurate with on-site staff designated to answer poison control center calls.

6. Teleworkers must have access to key information resources at all times commensurate with onsite staff designated to answer poison control center calls.

7. The poison control center ensures proper review of patient management by teleworkers. This includes immediate access to teleworker case and voice recordings for review by medical director and/or clinical supervisor.

8. The poison control center has a plan to provide and document staff development activities for teleworkers.

**History**
- *Source: Miss. Code Ann. §41-3-15*

##### **15 Miss. Admin. Code Pt. 16, R. 5.5.6** (9) The poison control center may utilize teleworking to support call delivery {#sec-16-5.5.6 omnilex-key=us-ms-regs-official--title-15--16#5.5.6}

In addition, the poison control center may enter into an agreement with another poison control center to provide call management services via teleworking during low volume times in which it is not financially feasible to maintain a full-time SPI at the home poison control center.

a. The poison control center supplying the teleworking services must be accredited.

b. Teleworking calls will be answered as “Thank you for calling the Mississippi Poison Control Center”.

c. The home poison control center will supply medical direction and medical toxicologists from the home poison control center and will communicate with physicians requiring assistance during these hours.

d. All teleworking SPIs must meet the minimum eligibility requirements of the home poison center.

e. This will be a Functional linkage as defined under 5.2.10. Coordinated patient care guidelines, databases, and other reference material must be available to enable remote agents to provide a single standard of information and care across the Mississippi. This process is not call diversion.

f. All call records will be routinely uploaded to the NPDS at a frequency equal to or shorter than that used by the home poison control center. These call records must be identified as Mississippi calls and the home center must be listed as the primary center. The teleworking poison control center will

provide full electronic copies of all cases to the home poison control center. A written procedure will be followed for full electronic call records of teleworking calls to be replicated in the home poison control center database within 10 hours of the call.

g. The home poison control center will have immediate access to a shared/replicated database maintained by the teleworking poison control center.

h. A written plan will be maintained and followed for the home poison control center to resume call management in the case of a disaster at the teleworking poison control center.

**History**
- *Source: Miss. Code Ann. §41-3-15*

##### **15 Miss. Admin. Code Pt. 16, R. 5.6.1** Patient Management {#sec-16-5.6.1 omnilex-key=us-ms-regs-official--title-15--16#5.6.1}

Poison control centers shall provide information to the public and to health care providers regarding human exposures, including assessment of the type and severity of poisoning, suggestions for on-site management when appropriate, reassurance to the caller, and referral to a health care facility when necessary.

**History**
- *Source: Miss. Code Ann. §41-3-15*

##### **15 Miss. Admin. Code Pt. 16, R. 5.6.2** Systems for Care {#sec-16-5.6.2 omnilex-key=us-ms-regs-official--title-15--16#5.6.2}

The poison control center shall have systems in place to provide safe and appropriate exposure management recommendations and to help the public and care providers avoid unnecessary utilization of health care resources. When referral to a health care facility is necessary, the facility will be notified of information regarding the case and the relevant toxicology of the poison involved.

**History**
- *Source: Miss. Code Ann. §41-3-15*

##### **15 Miss. Admin. Code Pt. 16, R. 5.6.3** Informational Source {#sec-16-5.6.3 omnilex-key=us-ms-regs-official--title-15--16#5.6.3}

The poison control center will provide health care providers with information on treatment, differential diagnosis, and interpretation of clinical signs and laboratory values and facilitate access to specialized toxicology services and follow- up.

**History**
- *Source: Miss. Code Ann. §41-3-15*

##### **15 Miss. Admin. Code Pt. 16, R. 5.6.4** Availability of Medical Consultation {#sec-16-5.6.4 omnilex-key=us-ms-regs-official--title-15--16#5.6.4}

Clinical or medical toxicologists shall be available at all times for consultation. The poison control center medical director or designee shall be available for medical back-up at all times. Consultations to healthcare facilities shall be conducted by the Medical Toxicologist or his/her designee.

**History**
- *Source: Miss. Code Ann. §41-3-15*

##### **15 Miss. Admin. Code Pt. 16, R. 5.6.5** Patient Management Guidelines {#sec-16-5.6.5 omnilex-key=us-ms-regs-official--title-15--16#5.6.5}

The poison control center must utilize patient management guidelines for the assessment, triage, management, and follow-up of poisoning exposures. Those guidelines must clearly define parameters for patients managed on- site and health care facility (HCF) management and appropriate follow-up.

1. The poison control center provides clinical guidelines that include but are not limited to the evaluation and follow-up of potentially toxic exposures and appropriate criteria for patient disposition.

2. The poison control center regularly uses a process for the establishment of guidelines, including time lines for review and update.

3. The poison control center ensures that guidelines are available to all staff at all times.

**History**
- *Source: Miss. Code Ann. §41-3-15*

##### **15 Miss. Admin. Code Pt. 16, R. 5.6.6** Follow-up of Cases {#sec-16-5.6.6 omnilex-key=us-ms-regs-official--title-15--16#5.6.6}

The poison control center shall provide timely and appropriate follow-up (internally defined). Follow-up calls from the poison control center are used to ascertain patient status, symptom resolution, compliance with or modification of recommended therapy, and, when appropriate, status after discharge.

1. At least 75% of human exposure cases managed at a Health Care Facility (HCF) (already in or en route to HCF) are followed to a known outcome (excluding not followed, judged as nontoxic; lost to follow-up/left AMA, refused referral/did not arrive at HCF).

**History**
- *Source: Miss. Code Ann. §41-3-15*

##### **15 Miss. Admin. Code Pt. 16, R. 5.6.7** External Resources {#sec-16-5.6.7 omnilex-key=us-ms-regs-official--title-15--16#5.6.7}

The poison control center must identify and have access to pertinent external resources at all times to assist with unique poisonings encountered in the region.

**History**
- *Source: Miss. Code Ann. §41-3-15*

##### **15 Miss. Admin. Code Pt. 16, R. 5.6.8** Antidotes {#sec-16-5.6.8 omnilex-key=us-ms-regs-official--title-15--16#5.6.8}

The poison control center must maintain a process to locate critical antidotes and assist with the transfer of the patient or the antidote when necessary.

**History**
- *Source: Miss. Code Ann. §41-3-15*

##### **15 Miss. Admin. Code Pt. 16, R. 5.7.1** Quality Assurance Program {#sec-16-5.7.1 omnilex-key=us-ms-regs-official--title-15--16#5.7.1}

The poison control center shall develop and utilize an on-going quality management and improvement program. This quality management and improvement program and activities shall be the framework within which the poison control center improves the quality of information and service delivery to callers. 1. The quality management program must include tools for chart review (ensuring accurate information and documentation), measuring customer and employee satisfaction, monitoring work flow and output, and improving the overall quality of services.

2. The poison control center shall demonstrate the use of a comprehensive, written, quality management program that describes the center’s methods of conducting quality improvement and quality assurance.

3. The poison control center shall apply the results of quality management to update its policies and procedures, reduce errors, and improve performance.

4. The quality assurance and quality improvement program shall be managed by the medical or clinical toxicologist or designee and overseen by the Medical Director. These activities are conducted in accordance with the policies and procedures of the poison control center, reviewed by the Medical Director and action taken as appropriate. Documentation of the quality assurance processes, findings, outcome and all corrective actions taken shall be documented and maintained as evidence of the poison control center’s quality assurance/improvement process.

5. The poison control center shall conduct at least one unique quality management initiative every 12 months, at a minimum, exclusive of regular audits.

6. The poison control center shall incorporate an internal or external benchmarking into its quality management program. Proposed Outcomes include: a. Improve quality of patient care and information services; b. Organizational efficiency and performance; c. Therapeutic and coding error reduction; d. Optimization of caller satisfaction; e. Optimization of employee satisfaction; and f. Fulfillment of the center’s mission.

**History**
- *Source: Miss. Code Ann. §41-3-15*

##### **15 Miss. Admin. Code Pt. 16, R. 5.7.2** Case Review {#sec-16-5.7.2 omnilex-key=us-ms-regs-official--title-15--16#5.7.2}

The poison control center shall regularly review its medical records for, at a minimum, the quality of poison information provided and the quality of documentation, including accuracy and completeness.

1. The Medical Director shall be responsible for the accuracy of toxicologic recommendations made by clinical staff, including specialists in poison information, poison information providers, students, residents, and fellows. A program for the review of medical records shall be in place for improved management and documentation of cases.

2. A selection of high-risk or problem-prone cases and those managed in a health care facility shall be reviewed internally on an ongoing basis under the direction of a medical or clinical toxicologist.

3. A selection of cases managed on-site (non-health care facility) shall be reviewed internally on an ongoing basis by a medical or clinical toxicologist or individual designated by the medical or clinical toxicologist.

**History**
- *Source: Miss. Code Ann. §41-3-15*

##### **15 Miss. Admin. Code Pt. 16, R. 5.7.3** Policy/Procedural Reviews {#sec-16-5.7.3 omnilex-key=us-ms-regs-official--title-15--16#5.7.3}

The poison control center shall, on a regular basis, examine all of its guidelines, policies, and procedures to ensure that they drive optimal performance.

1. The poison control center shall regularly examine the compliance of its employees in adhering to its clinical guidelines, policies, and procedures.

2. The Medical Director shall review and approve all clinical guidelines at least every 24 months and ensure that the number and content of the center’s policies are adequate to direct the provision of state-of-the-art toxicologic advice.

**History**
- *Source: Miss. Code Ann. §41-3-15*

##### **15 Miss. Admin. Code Pt. 16, R. 5.7.4** Customer Satisfaction {#sec-16-5.7.4 omnilex-key=us-ms-regs-official--title-15--16#5.7.4}

The poison control center shall measure the satisfaction of its customers (general public and health care providers) on an ongoing basis (minimum of once per year).

**History**
- *Source: Miss. Code Ann. §41-3-15*

##### **15 Miss. Admin. Code Pt. 16, R. 5.7.5** Medical/Case Records {#sec-16-5.7.5 omnilex-key=us-ms-regs-official--title-15--16#5.7.5}

The poison control center shall keep records of all cases for which it was consulted or provided information in a format that is acceptable as a medical record.

1. The medical/case record shall be used to facilitate communication among poison control center staff members to ensure a clear, consistent, and cohesive set of recommendations regarding diagnosis, treatment, and other clinical advice.

2. The medical record of the poison control center shall contain data elements and sufficient narrative to allow peer review and medical audit.

3. The poison control center shall follow applicable institutional, state, and federal laws and regulations regarding patient confidentiality. Its medical record system shall be indexed for easy retrieval, either hardcopy or electronic and maintained in a secure location.

4. The poison control center shall develop, in writing, and abide by a record retention policy.

**History**
- *Source: Miss. Code Ann. §41-3-15*

##### **15 Miss. Admin. Code Pt. 16, R. 5.8.1** Public Education Program {#sec-16-5.8.1 omnilex-key=us-ms-regs-official--title-15--16#5.8.1}

The control center will provide or participate in poisoning prevention, awareness, and education throughout its designated region, the state of Mississippi. Public education will incorporate a combination of public health strategies, including but not limited to direct outreach, marketing, public relations, collaborative relationships with community groups and other agencies, and mass media, to increase awareness of poisoning, poison prevention, and poison center services, tailored to regional community needs and the population served. Effective public education is based on a solid understanding of the impact of poisonings, the groups at risk, and the use of appropriate educational strategies. Public education efforts provided through collaborative partnerships shall be vetted by the poison control center to meet the identified needs of the designated populations.

1. The poison control center shall utilize internal or external individual(s) or organization(s) that are qualified/ trained to plan, design, and implement coordinated public education activities throughout the designated region.

2. The poison control center will provide poison prevention and awareness education. Collaboration and partnerships may enhance the ability to provide effective public education and awareness programs.

3. The educator(s) with oversight of content and quality of public education activities at the poison control center must be a health professional or have

a degree in health education, public health, or an education-related discipline or relevant work-related experience.

4. The educator(s) must demonstrate ongoing efforts in continuing education related to his or her current job function and accreditation standards.

5. The poison control center will periodically assess community needs for public education. Target populations throughout Mississippi will be identified.

6. The poison center shall ensure planning and implementation of a comprehensive public education program to reach the target populations. The poison center adapts or develops public education strategies that are appropriate for the intended target populations.

7. The public education programs conducted by the poison control center shall include ongoing evaluations and apply the results to improve and advance public education programs.

**History**
- *Source: Miss. Code Ann. §41-3-15*

##### **15 Miss. Admin. Code Pt. 16, R. 5.8.2** Healthcare Provider Education Program {#sec-16-5.8.2 omnilex-key=us-ms-regs-official--title-15--16#5.8.2}

The poison control center provides education to health care providers (HCPs) in their designated region for the purpose of improving awareness of poison center services and the quality, effectiveness, and efficiency of medical treatment for the poisoned patient.

1. The poison control center must employ or utilize individual(s) that are qualified/trained to plan, design, and implement coordinated health care provider education activities at the poison control center and throughout the designated region. Content oversight will be provided by the Medical Director or a clinical or medical toxicologist as his designee.

2. New and important advances in poisoning management will be provided to health care providers throughout the designated service region.

3. The accredited poison control center may offer educational activities for students in health care disciplines and residents in training.

4. The curricula and program formats shall be developed around learning objectives consistent with the interests and level of expertise of the targeted professional audience. The poison center will apply evaluation results to improve the provider education program.

**History**
- *Source: Miss. Code Ann. §41-3-15*

##### **15 Miss. Admin. Code Pt. 16, R. 5.8.3** Educational Information {#sec-16-5.8.3 omnilex-key=us-ms-regs-official--title-15--16#5.8.3}

The poison control center shall provide public education information and materials (developed internally or externally) that are clinically accurate and designed for the specific target population.

1. All information and materials shall be easy to read, simple to understand by the targeted population, and developed applying health literacy principles.

2. Public education program materials developed by the poison control center or by an American Association for Poison Prevention Center must be reviewed for clinical accuracy by the Clinical and/ or Medical Toxicologist of the poison control center.

**History**
- *Source: Miss. Code Ann. §41-3-15*

##### **15 Miss. Admin. Code Pt. 16, R. 5.8.3** Collaborative Relationships {#sec-16-5.8.3 omnilex-key=us-ms-regs-official--title-15--16#5.8.3}

The poison control center shall develop collaborative relationships with entities such as public health organizations, other poison prevention centers, state and local agencies, private-sector businesses, schools, and community organizations in support of poison prevention efforts and poison center services.

1. The poison control center shall maintain documentation of said activities.

**History**
- *Source: Miss. Code Ann. §41-3-15*

##### **15 Miss. Admin. Code Pt. 16, R. 5.9.1** Data and Surveillance {#sec-16-5.9.1 omnilex-key=us-ms-regs-official--title-15--16#5.9.1}

The poison control center shall collaborate with local, state, and federal public health entities for the surveillance of poisonings.

1. Surveillance data shall be used for:

a. The detection and monitoring of, and response to, public health and environmental emergencies involving toxic exposures, pandemics, as well as the contamination of the air, water, pharmaceutical or food supply;

b. Implementing and evaluating prevention and control measures;

c. Planning and managing resources and establishing priorities; and

d. Identifying emerging trends and/or public health threats.

**History**
- *Source: Miss. Code Ann. §41-3-15*

##### **15 Miss. Admin. Code Pt. 16, R. 5.9.2** Record/Case Retention {#sec-16-5.9.2 omnilex-key=us-ms-regs-official--title-15--16#5.9.2}

The poison control center shall generate and keep a permanent confidential record of each exposure case handled by the center in a form generally accepted as a medical record for a period of time consistent with institutional, state, and federal regulations on the retention of general medical records.

**History**
- *Source: Miss. Code Ann. §41-3-15*

##### **15 Miss. Admin. Code Pt. 16, R. 5.9.3** Record Documentation {#sec-16-5.9.3 omnilex-key=us-ms-regs-official--title-15--16#5.9.3}

The poison control center shall facilitate communication among staff to ensure clear, consistent, and cohesive documentation using the medical record.

**History**
- *Source: Miss. Code Ann. §41-3-15*

##### **15 Miss. Admin. Code Pt. 16, R. 5.9.4** Retrieval of Records {#sec-16-5.9.4 omnilex-key=us-ms-regs-official--title-15--16#5.9.4}

The poison control center’s medical records (paper or electronic) shall be stored appropriately and easily retrievable.

**History**
- *Source: Miss. Code Ann. §41-3-15*

##### **15 Miss. Admin. Code Pt. 16, R. 5.9.5** System for Disaster Recovery {#sec-16-5.9.5 omnilex-key=us-ms-regs-official--title-15--16#5.9.5}

The poison control center maintains a disaster recovery system for patient records.

**History**
- *Source: Miss. Code Ann. §41-3-15*

##### **15 Miss. Admin. Code Pt. 16, R. 5.9.6** Submissions to National Poison Data System (NPDS) {#sec-16-5.9.6 omnilex-key=us-ms-regs-official--title-15--16#5.9.6}

The poison control center shall submit all of its human exposure data to the NPDS in the format and time-frame, as prescribed by the NPDS.

**History**
- *Source: Miss. Code Ann. §41-3-15*

##### **15 Miss. Admin. Code Pt. 16, R. 5.9.7** NPDS Entries {#sec-16-5.9.7 omnilex-key=us-ms-regs-official--title-15--16#5.9.7}

The poison control center shall have an ongoing process to ensure that consistent, complete, and accurate data are entered and submitted to the National Poison Data System.

1. The poison control center shall have a process in place to minimize data coding errors.

**History**
- *Source: Miss. Code Ann. §41-3-15*

##### **15 Miss. Admin. Code Pt. 16, R. 5.9.8** Public Health Monitoring {#sec-16-5.9.8 omnilex-key=us-ms-regs-official--title-15--16#5.9.8}

The poison control center will monitor for the emergence of poisoning hazards and take specific actions to eliminate them. Those actions include, but are not limited to, notification of the appropriate public health officials regarding hazards, public and professional education efforts, press releases, and poison prevention efforts.

1. The poison control center has a process for sharing information to meet the needs of local, state, and federal public health entities.

2. The poison control center has a process of communicating hazards to local, state, and federal authorities and other agencies in real time and maintains communication with those entities as needed.

**History**
- *Source: Miss. Code Ann. §41-3-15*

##### **15 Miss. Admin. Code Pt. 16, R. 5.10.1** Leadership and Management {#sec-16-5.10.1 omnilex-key=us-ms-regs-official--title-15--16#5.10.1}

The poison control center shall employ individuals who collectively provide expertise in clinical toxicology. The poison control center shall also employ or utilize leaders and managers to perform the functions necessary to support the expert staff, including experts in human resource management, budgetary and financial management, education, regulatory compliance, emergency preparedness and response, facilities management, and information technology.

**History**
- *Source: Miss. Code Ann. §41-3-15*

##### **15 Miss. Admin. Code Pt. 16, R. 5.10.2** Qualified Leadership {#sec-16-5.10.2 omnilex-key=us-ms-regs-official--title-15--16#5.10.2}

The poison control center shall be staffed by leadership personnel who are qualified to perform their designated duties.

**History**
- *Source: Miss. Code Ann. §41-3-15*

##### **15 Miss. Admin. Code Pt. 16, R. 5.10.3** Functions of Leadership {#sec-16-5.10.3 omnilex-key=us-ms-regs-official--title-15--16#5.10.3}

The poison center’s leaders shall have the following duties and responsibilities:

1. Ensure that information provided to the public and health care professionals is of the highest possible quality;

2. Optimize the poison control center’s stability through astute financial management;

3. Hire, train, mentor, and manage a team of experts in toxicology, using policies and procedures designed to facilitate optimal output (timely flow of quality information);

4. Oversee the quality of information collected and recorded for descriptive epidemiology purposes;

5. Ensure that the center has planned for continued provision of poison control center services during emergencies;

6. Establish and maintain partnerships with public health and other stakeholders; and

7. Ensure that meaningful surveillance links exist to transmit poison control center hazard observations to appropriate public health officials.

**History**
- *Source: Miss. Code Ann. §41-3-15*

##### **15 Miss. Admin. Code Pt. 16, R. 5.10.4** Medical Leadership {#sec-16-5.10.4 omnilex-key=us-ms-regs-official--title-15--16#5.10.4}

The individual or individuals providing medical direction shall individually or collectively devote a minimum of 20 hours per week to the center to conduct the required Medical Director duties. Additional medical direction may be desirable and may be necessary.

1. One or more individuals may function as administrative director(s) and shall be accountable for all operations of the poison control center.

2. These individuals are accountable for all operations of the poison control center shall ensure that all other staff members meet qualifications for their designated duties.

3. An individual may be qualified to perform more than one leadership function.

4. Poisoning information and treatment advice shall be provided by staff under the direction of adequately qualified clinical toxicologists, at least one of which must be a qualified medical toxicologist designated to serve as the Medical Director.

**History**
- *Source: Miss. Code Ann. §41-3-15*

##### **15 Miss. Admin. Code Pt. 16, R. 5.10.5** Credentials and Qualifications {#sec-16-5.10.5 omnilex-key=us-ms-regs-official--title-15--16#5.10.5}

The poison control center shall employ or use toxicologists who are appropriately qualified and approved by the Medical Director to perform clinical supervision. Qualified toxicologists may be either Clinical Toxicologists or Medical Toxicologists.

**History**
- *Source: Miss. Code Ann. §41-3-15*

##### **15 Miss. Admin. Code Pt. 16, R. 5.10.6** Credentials of Clinical Toxicologist {#sec-16-5.10.6 omnilex-key=us-ms-regs-official--title-15--16#5.10.6}

The poison control center may employ or use Clinical Toxicologists, defined as follows:

1. Clinical Toxicologists may be diplomats of the American Board of Applied Toxicology (DABAT).

2. Health care providers without ABAT certification will be considered qualified to provide clinical supervision for the purpose of determining compliance with current criteria if:

a. The healthcare provider has met the following criteria:

i. A minimum of a baccalaureate degree in nursing, pharmaceutical services, or a doctorate in medicine; and

ii. A minimum of a baccalaureate degree in toxicology related field, such as toxicology, chemistry, biochemistry, or environmental science; and

iii. A certification by a national toxicology board such as the American Board of Applied Toxicology, the American Association of Poison Control Centers, or the American Board of Toxicology; and

iv. Post graduate education/certificate in clinical toxicology.

**History**
- *Source: Miss. Code Ann. §41-3-15*

##### **15 Miss. Admin. Code Pt. 16, R. 5.10.7** Qualifications of Medical Toxicologist {#sec-16-5.10.7 omnilex-key=us-ms-regs-official--title-15--16#5.10.7}

The poison control center shall employ or use one or more medical toxicologists who meet the following:

1. Medical toxicologists associated with the poison control center shall be physicians (MD, DO) who are board-eligible or board-certified in medical toxicology through the American Board of Medical Specialties or the American Board of Osteopathic Medicine;

2. Have a current and unrestricted license from the Mississippi State Board of Medical Licensure; and

3. Participate in consultations with the poison control center staff and perform consultations with other health care providers.

**History**
- *Source: Miss. Code Ann. §41-3-15*

##### **15 Miss. Admin. Code Pt. 16, R. 5.10.8** Medical Director Qualifications {#sec-16-5.10.8 omnilex-key=us-ms-regs-official--title-15--16#5.10.8}

One or more medical toxicologists may share the duties of the Medical Director, provided that all meet the qualifications.

1. If more than one individual performs the duties of a Medical Director, one individual shall serve as the designated Medical Director for the center.

2. The Medical Director shall be a doctor of medicine or osteopathy with a current and unrestricted license from the Mississippi State Board of Medical Licensure.

3. The Medical Director shall be board certified in medical toxicology through the American Board of Medical Specialties subspecialty examination in Medical Toxicology (after 1994). A physician who is not board certified as listed above may submit evidence of equivalent expertise demonstrated by training and certification:

a. Board-eligible physicians trained in a fellowship in medical toxicology approved by the Accreditation Council for Graduate Medical Education (AGCME) must become board certified within two consecutive examination cycles.

b. Doctors of Osteopathy who have completed an ACGME- approved fellowship and who have passed the American Osteopathic Board of Emergency Medicine examination for Certification of Added Qualification in Medical Toxicology will be considered qualified.

4. The Medical Director and all other individuals designated as providers of medical direction must have active staff appointments at an inpatient treatment facility and must be involved in the bedside clinical management of poisoned patients.

**History**
- *Source: Miss. Code Ann. §41-3-15*

##### **15 Miss. Admin. Code Pt. 16, R. 5.10.9** Readily Available Evidence of Qualifications {#sec-16-5.10.9 omnilex-key=us-ms-regs-official--title-15--16#5.10.9}

The poison control center shall maintain and have readily accessible for review an individual file for each employee which shall contain, but not be limited to the following:

1. Signed acknowledgement of the duties and responsibilities of their job description, to include a copy of said job description;

2. A biographical sketch for each physician and/or toxicologists (clinical and medical);

3. Documentation of the Medical Director’s approval of all toxicologists operating within the poison control center;

4. Verification of current medical, nursing and/or other professional licensure, as applicable;

5. Documented evidence that the Medical Director and all other individuals designated as providers of medical direction have active medical staff privileges at an inpatient treatment facility (e.g., letters of appointment).

6. Verification of clinical and/or medical toxicology board certification (or alternative proof of qualification).

**History**
- *Source: Miss. Code Ann. §41-3-15*

##### **15 Miss. Admin. Code Pt. 16, R. 5.10.10** Required Expertise {#sec-16-5.10.10 omnilex-key=us-ms-regs-official--title-15--16#5.10.10}

In an effort to assure quality poison control services, the poison control center shall assure clinical and medical toxicology expertise for all Medical and Clinical Toxicologist working as part of or in conjunction with the center.

1. A poison control center shall provide full-time toxicological supervision. This must include at least one full-time equivalent on-site toxicologic supervision provided by a qualified Clinical or Medical Toxicologist (or a combination) and appropriate qualified back-up.

2. The Medical Director may designate other toxicologists (e.g., clinical toxicologist, fellows in training) to provide immediate consultation, (either within the center or by taking call) to the clinical staff as long as a qualified medical toxicologist is immediately available 24/7.

3. The Medical Director shall be responsible for information and recommendations related to patient care.

**History**
- *Source: Miss. Code Ann. §41-3-15*

##### **15 Miss. Admin. Code Pt. 16, R. 5.10.11** Appropriate Medical Direction {#sec-16-5.10.11 omnilex-key=us-ms-regs-official--title-15--16#5.10.11}

The poison control center shall have appropriate medical direction. The following shall represent the minimum time commitment for medical direction. Additional medical direction is highly desirable and may be necessary. 1. The Medical Director must spend a minimum of 20 hours per week dedicated to the poison control center. At least 15 hours must be on- site. Five (5) hours a week may be off-site if directed to activities of the poison control center.

2. If the call volume for human exposures for the state of Mississippi exceeds 24,999/year, the following schedule will be used to determine the required Medical Director hours per week.

Human exposures per year Off-site* hours/week On-site hours/week PCC total

hours/wee k 0–24,999 5 15 20 25,000–37,499 10 15 25 37,500–49,999 10 20 30 50,000–74,999 10 30 40 75,000–99,999 10 40 50

3. For poison control centers in transition with medical direction or other special circumstances (e.g., loss of Medical Director or other circumstances deemed appropriate by the certifying Agency, up to 50% of Medical Director on-site time may be accomplished through direct continuous video conferencing with poison control center clinical staff. Availability by phone or beeper alone is not sufficient.

4. Time applied to medical direction must be 100% engaged in poison control center activities.

**History**
- *Source: Miss. Code Ann. §41-3-15*

##### **15 Miss. Admin. Code Pt. 16, R. 5.10.12** Support Systems {#sec-16-5.10.12 omnilex-key=us-ms-regs-official--title-15--16#5.10.12}

The poison control center shall have access to or supports additional functions, including human resources, budgetary and financial management, employee education, training and staff development, information technology, external relations, and other administrative functions. These roles may be fulfilled by the certified poison control center director or other designated individual(s).

1. The person(s) responsible for human resources shall ensure that all managerial and staff actions considered to be human resource functions are carried out according to the poison center’s policies and in accordance with applicable local, state, and federal laws.

2. The person(s) responsible for the budgetary and financial management shall develop, balance, and reconcile budgets; identify, manage, and generate revenue streams; ensures the appropriate accounting procedures are used, manages grants and contracts; procures equipment, supplies, software, hardware, and licenses; and oversees business and financial development.

3. The person(s) responsible for compliance with accreditation of this poison control center shall assure the development of internal processes for monitoring said poison control center’s compliance with the requirements as addressed in the Regulations Governing Accreditation of Poison Control Centers in Mississippi and ensures adherence to federal, state, and local laws; regulations, and institutional policies.

4. The person(s) responsible for employee education, training, and staff development shall train and maintain documentation of said training for new employees, provide updated new information in a clear and consistent manner, and encourage and participate in the professional development of the center’s employees.

5. The person(s) responsible for information technology shall provide information technology support, including maintaining the center’s hardware and software, information transmission to the National Poison Data System, maintenance of confidentiality, and emergency backup.

6. The person(s) responsible for the operations and infrastructure of the poison control center shall be available, or have an assigned designee who has decision making authority available, at all times to ensure the continuous provision of accredited poison control center services.

**History**
- *Source: Miss. Code Ann. §41-3-15*

##### **15 Miss. Admin. Code Pt. 16, R. 5.10.13** Documentation of Compliance {#sec-16-5.10.13 omnilex-key=us-ms-regs-official--title-15--16#5.10.13}

The poison control center shall document ongoing compliance with the requirement for assuring medical direction and services. Documentation to reflect compliance shall be submitted as outlined in the Mississippi Poison Control Center Accreditation Standards, Appendix A and Appendix B.

Mississippi Poison Control Center Accreditation Standards Appendix A Documentation of Compliance

1. Call center communications and infrastructure

a. Describe the poison control center’s designated service region.

b. Provide written documentation of state designation of the poison control center by the state public health authority and clearly delineate the region served.

c. Submit Table1, Appendix B of the call volume and population by county. c.1. Provide documentation that adequately explains the reasons for an unusually low county utilization rate (counties with more than 2 standard deviation rates below the state mean for the most recent available year). Submit a documented improvement plan that describes timelines, goals, and objectives for improving utilization of PCC services in underserved counties or equivalent regions.

d. Provide a map of the designated service region.

e. Describe current methods by which the center can be accessed by the public and health care professionals including, but not limited to, telephone, videoconferencing, and web access.

e.1. Describe access for hearing-impaired individuals.

e.2. Describe the poison control center’s capabilities to respond to inquiries in languages other than English.

e.3. Describe how the poison control center interfaces with 911 and other emergency operators.

f. Submit call center metrics for 3 recent consecutive months for any/all local and national phone lines used to respond to poison control calls. f.1. Total number of inbound calls.

f.2. Rate (%) of calls abandoned. This is defined as the number of abandoned calls divided by total incoming calls. Exclude calls with abandoned times of less than or equal to 12 seconds.

f.3. Average abandonment time. This is defined as the average time calls were waiting in queue before abandonment. f.4. Average time to answer a call. This is defined as the average time a call was waiting in queue before being answered by an agent.

f.5. Submit a detailed explanation for metrics that exceed defined acceptable service levels by the approved benchmark. If necessary, submit a documented improvement plan that describes timelines, goals, and objectives to maintain metrics within acceptable range.

g. Describe how the poison control center uses and promotes the nationwide toll-free number, 1-800-222-1222.

h. Provide the following documentation for all communications modalities:

h.1. all applicable triage and communication policies and procedures that were developed specifically for each communication modality;

h.2. a detailed description of the process for training and monitoring the quality and effectiveness of communication modalities.

i. Describe the telephone system (e.g. call flow, interactive voice response [IVR], call routing, priority queue, remote locations).

j. List and describe all types of communications methods, such as telephone, chat, and text, and information services (e.g., on topics such as flu or rabies offered by the center, including the annual volume of calls for each service and the presence or absence of separate staffing for each service).

k. Provide policies and procedures that ensure poisoning calls threatening human health are responded to and handled appropriately.

l. If call diversion is used, describe the process for call diversion and ensuring access to case information.

m. If call diversion is used, provide evidence of coordinated patient care guidelines, databases and other reference material that ensures a single standard of care.

n. If call diversion is used, describe how continuity of clinical care is achieved when routinely diverting calls to another poison control center.

o. Provide response plan for natural and technological disasters to ensure business continuity in the event of a communications failure.

p. Provide a plan for surge capacity to respond to mass poisoning exposures or public health events.

2. Call center staffing

a. Submit a listing (Table 2, Appendix B) of SPIs/CSPIs, their background and their work effort.

a.1. Provide a copy of the job description for a SPI/CSPI.

a.2. Submit the total number of candidates who have taken the CSPI examination over the past 7 years and note the pass/fail status.

a.3. Submit an explanation for any instance where a SPI has worked alone and has not met criteria as mentioned above. For any instance where a SPI has worked alone and has not met the criteria, a time-limited waiver may be granted upon the provision of an explanation, a time line for correction, and explanation of the methodology used by the medical director and managing director in assessing and verifying the competency of the specialist working alone. Submit the explanation/verification required for waiver.

b. Submit (Table 3, Appendix B), a listing of PIPs, their background and their work effort. (Do not include rotating residents, students or fellows.) b.b.1. Provide a copy of the job description for a PIP.

b.2. Provide internal policy statements or other documents which guarantee that, while answering exposure calls, PIPs are always under the oversight of a CSPI, medical director or clinical toxicologist.

b.3. Submit Table 4, Appendix B, summarizing all poison information staff. Provide a copy of the SPI staffing schedule for the most recent 3 months.

c. c.1. Identify each entry as per job function.

c.2. Designate every shift that is completely or partially covered by one staff member alone and teleworking staff.

c.3. For non-certified SPIs working alone, submit documentation verifying that the individual is in process of meeting CSPI examination eligibility requirement and has handled 2,000 human exposure cases.

d. Document total call volume and human exposure calls per SPI FTE (calls documented in database).

d.1. Provide an explanation for any discrepancy between call volume that drops below 2,000 human exposures or exceeds 5,500 human exposure for CSPI/SPI/PIP.

e. Describe supervisor or case management activities for certified SPIs not working 400 hours per year and managing 500 human exposure cases per year.

f. Describe the poison control center’s programs for initial orientation training, continuing education, and team efforts to increase the knowledge base and skill of the clinical staff.

g. Provide a list of activities and sample of training materials for SPIs/PIPs.

h. Describe evidence of staff competency assessment.

i. Describe the toxicology references, including website links and list of online resources that are most often utilized by the staff.

j. Describe the method of access for staff, including remote agents, if applicable.

k. Describe the method of keeping staff aware of current trends and toxicology matters.

l. Provide a copy of currently teleworking policy and procedures.

m. Describe the technology of teleworkers for communication with the main site and record continuity. n. Provide staffing patterns for teleworkers (clearly mark teleworking staff on 3 month schedule), include provisions for the training of students or residents rotating through the poison control center if all SPIs are off-site.

o. Describe the specific procedure to be implemented if technical difficulties impede the flow of work at the remote site. p. Describe how the teleworker is able to access the information resources deemed necessary for case management. q. Demonstrate that clinical supervision and quality management of remote staff are equivalent to those for on-site staff (this includes communication with the clinical and/or medical toxicologist, chart review, voice recording, evaluation of staff performance, and staff productivity). r. Describe the special circumstances justifying individual SPIs teleworking over 50% and describe how they participate in staff development activities.

3. Patient management

a. Provide a list, signed and dated by the Medical Director, of all clinical guidelines.

b. Describe the process for establishing and reviewing patient management guidelines including guidelines as to when to consult clinical and/or medical toxicologist and guidelines for life threatening exposures.

c. Provide explanation if less than 75% of human exposure cases with symptoms managed at a HCF are followed to a known outcome.

d. Describe the procedure that is followed if external resources/experts are required.

e. Describe the process for locating critical antidotes and assisting with their acquisition throughout the designated service region.

4. Quality assurance

a. Submit and describe the quality management and improvement program. Describe the quality management initiatives since the center’s last successful accreditation.

b. Describe the procedure for internal chart audits performed.

c. Submit a list of all clinical guidelines, including review dates and describe the process of review.

d. Submit the center’s satisfaction survey tool and recent caller satisfaction survey results.

e. Describe how the center uses customer complaints to drive its quality initiatives.

f. Describe the center’s record retention policy.

5. Public education

a. Describe how public education is accomplished. Include goals and objectives, programs and activities for target populations.

b. Describe how the public education is accomplished including a biographical sketch of the individual(s) involved and a job description and any continuing education.

c. Describe efforts for identifying target populations. c.1. Provide a description of the region and populations, including the geographic and age distributions. c.2. Describe data-gathering methods used to assess gaps (deficiencies/discrepancies) in the designated service region. This needs assessment may include primary data sources, such as surveys, focus group findings, or key informant interviews, or secondary data sources, such as NPDS data, community health assessments, or census data. c.3. Summarize your priority populations and why they were selected.

d. Submit a list of public education materials and provide a summary of mass media activities.

e. Provide a list of collaborations with other agencies or poison control centers.

f. Submit a list of Collaborative Partnerships.

g. Describe how education programs are impacting your service area. Examples may include: g.1. Describe and provide examples of indicators used to measure increased awareness (e.g., change in call volume, survey results, increased website traffic, measured behavior changes).

g.2. Describe and provide examples of an evaluation tool(s) or method(s) used to assess the impact and effectiveness of your education program(s). g.3. Describe and provide examples of process evaluations used to identify potential or actual improvements or modifications in project/program/product improvement.

6. Healthcare provider education a. The individual providing the healthcare provider education must be approved by the Medical Director. b. Provide a biographical sketch of the healthcare provider education staff. c. Describe the healthcare provider education program methods and activities. d. Describe the evaluation process and how the results are used to improve programs. 7. Data and surveillance a. Describe communication mechanisms used to ensure up-to-date and consistent documentation. b. Describe the computerized data collection/medical record program and verify it is the most current version. c. Described the manner in which patient case records are stored and retrieved. d. Summarize the disaster recovery/back-up procedure for poison center records. e. If the center withholds industry-derived human exposure data, indicate the number of industry-derived human exposures that were withheld during the most recent year. f. Submit an annual report or the following NPDS reports: f.1. Call type distribution f.2 Distribution of reasons f.3. Distribution of outcomes f.4. Management site by referral patterns

g. Submit NPDS Fatality Status Report(s). h. Describe efforts to ensure that consistent, complete, and accurate data are entered and submitted to the NPDS. i. Describe how your center shares information to meet the needs of local, state, and federal public health entities. j. Describe how the center routinely monitors the emergence of poisoning hazards and takes specific action to address them. Cite examples. k. Describe collaboration with local, state, and federal public health entities.

8. Leadership and management a. Submit a current PCC organization chart. b. Provide a description of the leadership and administrative structure of the center. c. Provide job description of all toxicologists (clinical and medical) providing toxicology services. d. Provide biographical sketch of all toxicologists (clinical and medical). e. Provide Medical Director’s approval of all toxicologists operating within the PCC. f. Provide verification of current medical licensure. g. Provide evidence that the Medical Director and all other individuals designated as providers of medical direction have active medical staff privileges at an inpatient facility. h. Provide verification of clinical and/or medical toxicology board certification for the medical director and any of his/her designee(s). i. Provide evidence that medical toxicologist(s) or other health care provider(s) are (a) involved in the treatment of poisoned patients and (b) regularly consult with specialists in poison information. j. Describe how the roles and activities are divided between medical toxicologists and clinical toxicologists. k. Provide copies of the toxicologist(s) on-call schedule for the most recent 3 months, indicating all persons taking call and designating their qualifications. l. Provide a copy of the time the medical toxicologist(s) and clinical toxicologist(s) provide clinical supervision at the PCC. m. Provide a copy of the poison control center’s policy regarding conditions under which clinical staff should contact the toxicologist on call to seek assistance with a case or to provide notification of a particular situation or patient, and submit a log of time spent for medical direction (on-site and off-site). n. Submit log(s) of time spent meeting required hours for medical direction (on-site and off-site). o. Describe the purpose of a transition plan and/or special circumstances justifying video conferencing or other remote electronic means and demonstrate how the Medical Director interacts and participates in clinic staff activities. p. Describe the role of individual(s) performing the duties and fulfilling those responsibilities of human resources, budgetary and financial management, accreditation and compliance, employee education, training and staff development, information technology, external relations and other administrative functions.

Appendix B attached and authorized under:

Appendix B Table 1 Call Center County Data

CHAPTER 6 MINIMUM STANDARDS OF OPERATION RELATIVE TO THE PRACTICE OF TELEMEDICINE

**History**
- *Source: Miss. Code Ann. §41-3-15*
- *Source: Miss. Code Ann. §41-3-15*
- *Source: Miss. Code Ann. §41-3-15*
- *Source: Miss. Code Ann. §41-3-15*
- *Source: Miss. Code Ann. §41-3-15*
- *Source: Miss. Code Ann. §41-3-15*

##### **15 Miss. Admin. Code Pt. 16, R. 6.1.1** Authority {#sec-16-6.1.1 omnilex-key=us-ms-regs-official--title-15--16#6.1.1}

By virtue of authority vested in it by Mississippi Code Annotated, §41-3-15 (4) (j), or as otherwise amended, the Mississippi State Department of Health (MSDH), otherwise known as the licensing agency, has the authority and powers, as necessary, to promulgate and adopt the following rules/ regulations, relative to the practice of telehealth in the State of Mississippi.

**History**
- *Source: Mississippi Code Annotated §41-3-15*

##### **15 Miss. Admin. Code Pt. 16, R. 6.1.2** Regulatory Standards {#sec-16-6.1.2 omnilex-key=us-ms-regs-official--title-15--16#6.1.2}

Providers/organizations that practice telehealth in the State of Mississippi shall comply with standards as outlined in this Chapter.

**History**
- *Source: Mississippi Code Annotated §41-3-15*

##### **15 Miss. Admin. Code Pt. 16, R. 6.2.1** Health Professional(s) {#sec-16-6.2.1 omnilex-key=us-ms-regs-official--title-15--16#6.2.1}

Refers to individual(s).

##### **15 Miss. Admin. Code Pt. 16, R. 6.2.2** Provider Entity/Organization {#sec-16-6.2.2 omnilex-key=us-ms-regs-official--title-15--16#6.2.2}

Includes organizations, institutions, and business entities, including online service entities.

##### **15 Miss. Admin. Code Pt. 16, R. 6.2.3** Telehealth {#sec-16-6.2.3 omnilex-key=us-ms-regs-official--title-15--16#6.2.3}

The use of technology to deliver healthcare. Telehealth includes telemedicine, mHealth, eHealth, and Tele-Education.

##### **15 Miss. Admin. Code Pt. 16, R. 6.2.4** Telemedicine {#sec-16-6.2.4 omnilex-key=us-ms-regs-official--title-15--16#6.2.4}

As defined in Section 25-15-9 (1) (c) of the Mississippi Code of 1972, Annotated, “telemedicine means the delivery of healthcare services such as diagnosis, consultation, and treatment through the use of interactive audio, video or other electronic media.

**History**
- *Source: Mississippi Code Annotated §41-3-15 and § 25-15-9*

##### **15 Miss. Admin. Code Pt. 16, R. 6.3.1** Standard of Care {#sec-16-6.3.1 omnilex-key=us-ms-regs-official--title-15--16#6.3.1}

Practitioners and/or organizations providing medical/health services via telehealth shall ensure that the standard of care is maintained for a telehealth encounter consistent with the expectation of in-person care.

**History**
- *Source: Mississippi Code Annotated §41-3-15*

##### **15 Miss. Admin. Code Pt. 16, R. 6.3.2** Technology {#sec-16-6.3.2 omnilex-key=us-ms-regs-official--title-15--16#6.3.2}

Practitioners and/or organizations providing medical/health services via telehealth shall ensure equipment and technology be adequate to provide information necessary to meet the in-person standard of care.

**History**
- *Source: Mississippi Code Annotated §41-3-15*

##### **15 Miss. Admin. Code Pt. 16, R. 6.4.1** Registration {#sec-16-6.4.1 omnilex-key=us-ms-regs-official--title-15--16#6.4.1}

Pursuant to Mississippi Code Annotated §41-3-15, each provider entity/organization offering telehealth services in the State of Mississippi shall register with the Mississippi State Department of Health, Office of Licensure, hereafter referred to as the Department. An applicant shall not provide telehealth services in the State of Mississippi without first registering with the Department.

1. Each provider entity/organization conducting telehealth services in Mississippi shall submit an application for registration including information about the type of telehealth services offered as well as the providers that will be performing services. Proprietary information may be asked but will not be required for approval.

**History**
- *Source: Mississippi Code Annotated §41-3-15*

##### **15 Miss. Admin. Code Pt. 16, R. 6.4.2** Documents {#sec-16-6.4.2 omnilex-key=us-ms-regs-official--title-15--16#6.4.2}

In addition to the registration application as referenced above, the registering entity shall submit at the time of registration:

1. A copy of the Mississippi Secretary of State Business Services Form as evidence of the entity’s registration with the Mississippi Secretary of State to conduct business in the State of Mississippi.

2. Proof of Professional and General Liability Insurance.

**History**
- *Source: Mississippi Code Annotated §41-3-15*

##### **15 Miss. Admin. Code Pt. 16, R. 6.4.3** Registration Term {#sec-16-6.4.3 omnilex-key=us-ms-regs-official--title-15--16#6.4.3}

Each registration issued shall be valid for a period of twenty-four (24) months and shall be issued for the registration period of July 1 of the registration year and shall expire on June 30 two calendar years later. Should an entity be approved for registration after the July 1 date for registration, the registration date shall reflect the approval date of registration for that entity and will be valid until June 30 of the registration year.

**History**
- *Source: Mississippi Code Annotated §41-3-15*

##### **15 Miss. Admin. Code Pt. 16, R. 6.4.4** Registration Not Transferable {#sec-16-6.4.4 omnilex-key=us-ms-regs-official--title-15--16#6.4.4}

A Registration Certificate for a telehealth provider is for the stated entity as listed on the registration application and is not transferable. Should a change of location (address only) occur without change of ownership, the entity shall notify the Department, in writing, within 10 calendar

days of the change of address. Should a Change of Ownership occur (a sale or transfer of 51% or more of stock), the new ownership of the company/organization shall notify the Department and submit a new application.

**History**
- *Source: Mississippi Code Annotated §41-3-15*

##### **15 Miss. Admin. Code Pt. 16, R. 6.4.5** Registration Renewal {#sec-16-6.4.5 omnilex-key=us-ms-regs-official--title-15--16#6.4.5}

For renewal, each registered entity shall submit:

1. A completed and signed renewal registration application to be received by the Department at least 30 days prior to the date of expiration; and

2. Proof of General and Professional Liability Insurance.

##### **15 Miss. Admin. Code Pt. 16, R. 6.4.6** Fees {#sec-16-6.4.6 omnilex-key=us-ms-regs-official--title-15--16#6.4.6}

The following fees are established for registration for businesses performing telemedicine services in this state; (1) initial registration fee, $50; (2) fee to report changes in the information on the initial registration, $50.

**History**
- *Source: Mississippi Code Annotated §41-3-15*

##### **15 Miss. Admin. Code Pt. 16, R. 6.5.1** Complaints {#sec-16-6.5.1 omnilex-key=us-ms-regs-official--title-15--16#6.5.1}

Complaints received by the Department relative to telehealth services which indicate a potential violation of medical and/or nursing practice shall be logged and forwarded to the appropriate professional licensing agency.

CHAPTER 40 MINIMUM STANDARDS OF OPERATION FOR PSYCHIATRIC HOSPITALS Subchapter 1 LEGISLATIVE AUTHORITY Rule 40.1.1 Mississippi State Department of Health Law of 1979, Mississippi Code Annotated, 43-11-1 through 43-11-27 (Supplemented 1986) The Mississippi Health Care Commission adopted additional regulations for Psychiatric Hospitals on November 17, 1983. The regulations became effective December 22, 1983. The Mississippi State Department of Health took over the licensing duties of the Mississippi Health Care Commission on July 1, 1986. 1. Psychiatric Hospitals are free-standing facilities established to offer facilities, beds and services over a continuous period exceeding 24 hours to individuals requiring diagnosis and intensive and continued clinical therapy for mental illness. Distinct parts of General Acute Hospitals may be designated as Psychiatric. This unit is organized, staffed and equipped to render psychiatric services.

2. These standards are to be applied in conjunction with the Minimum Standards of Operation for Mississippi Hospitals where applicable. 3. These standards are written so that they closely parallel the Standards for Accreditation of Psychiatric Facilities established by the Joint Commission on Accreditation of Hospitals. By basing these standards on the Joint Commission's standards, we have developed standards which have the input of a national panel of knowledgeable experts and skilled people on psychiatric treatment.

1. A public facility shall have a written description of the administrative organization of the government agency within which it operates. 2. A public facility shall also have a written description of how the lines of authority within the government agency relate to the governing body of the facility. 3. A private facility shall have a charter, constitution or bylaws.

**History**
- *Source: Mississippi Code Annotated §41-3-15*
- *SOURCE: Miss. Code Ann. §41-9-17 Subchapter 2 FACILITY MANAGEMENT GOVERNING BODY Rule 40.2.1 Every facility shall have a governing body that has overall responsibility for the operation of the facility.*
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.2.2** Rule 40.2.2 {#sec-16-40.2.2 omnilex-key=us-ms-regs-official--title-15--16#40.2.2}

The names and addresses of all owners or controlling parties of the facility (whether they are individuals; partnerships; corporate bodies; or subdivisions of other bodies, such as public agencies or religious, fraternal or other charitable organizations) shall be fully disclosed. In case of corporations, the names and addresses of all officers, directors and principal stockholders either beneficial, or of record, shall be disclosed.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.2.3** The governing body shall meet at least quarterly {#sec-16-40.2.3 omnilex-key=us-ms-regs-official--title-15--16#40.2.3}

1. Minutes of these meetings shall be kept and shall include at least the following: a. The date of the meeting; b. The names of members who attended; c. The topics discussed; d. The decisions reached and actions taken; e. The dates for implementation of recommendations; and

f. The reports of the Chief Executive Officer and others.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.2.4** Rule 40.2.4 {#sec-16-40.2.4 omnilex-key=us-ms-regs-official--title-15--16#40.2.4}

The governing body shall establish a committee structure to fulfill its responsibilities and to assess the results of the facility's activities.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.2.5** Rule 40.2.5 {#sec-16-40.2.5 omnilex-key=us-ms-regs-official--title-15--16#40.2.5}

The governing body, through the Chief Executive Officer, shall have a written statement of the facility's goals and objectives, as well as, written procedures for implementing these goals and objectives. 1. There shall be documentation that the statement and procedures are based upon a planning process, and that the facility's goals and objectives are approved by the governing body. 2. The governing body, through the Chief Executive Officer, shall have a written plan for obtaining financial resources that are consonant with the facility's goals and objectives.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.2.6** Rule 40.2.6 {#sec-16-40.2.6 omnilex-key=us-ms-regs-official--title-15--16#40.2.6}

When a categorical program (for example, a child, adolescent, or adult psychiatric program) is a component of a larger facility, the staff of the categorical program, subject to the overall responsibility of the governing body, shall be given the authority necessary to plan, organize and operate the program. The categorical program shall hire and assign its own staff. The categorical program shall employ a sufficient number of qualified and appropriately trained staff.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.2.7** Rule 40.2.7 {#sec-16-40.2.7 omnilex-key=us-ms-regs-official--title-15--16#40.2.7}

The governing body, through its Chief Executive Officer, shall develop policies and shall make sufficient resources available (for example, funds, staff, equipment, supplies and facilities) to assure that the program is capable of providing appropriate and adequate services to patients.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.2.8** The facility's physical and financial resources shall be adequately insured {#sec-16-40.2.8 omnilex-key=us-ms-regs-official--title-15--16#40.2.8}

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.2.9** Rule 40.2.9 {#sec-16-40.2.9 omnilex-key=us-ms-regs-official--title-15--16#40.2.9}

The governing body shall establish bylaws, rules and regulations, and a table of organization to guide relationships between itself and the responsible administration and professional staffs and the community.

1. The governing body may establish one set of bylaws, rules and regulations that clearly delineates the responsibilities and authority of the governing body and the administrative and professional staff. 2. Administrative and professional staffs may establish separate bylaws, rules and regulations that are consistent with policies established by the governing body.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.2.10** Rule 40.2.10 {#sec-16-40.2.10 omnilex-key=us-ms-regs-official--title-15--16#40.2.10}

All bylaws, rules and regulations shall comply with legal requirements, be designed to encourage high quality patient care, and be consistent with the facility's community responsibility.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.2.11** Rule 40.2.11 {#sec-16-40.2.11 omnilex-key=us-ms-regs-official--title-15--16#40.2.11}

Such bylaws, rules and regulations shall describe the powers and duties of the governing body and its officers and committees; or the authority and responsibilities of any person legally designed to function as the governing body, as well as, the authority and responsibility delegated to the responsible administrative and professional staffs.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.2.12** Rule 40.2.12 {#sec-16-40.2.12 omnilex-key=us-ms-regs-official--title-15--16#40.2.12}

Such bylaws, rules and regulations shall state the eligibility criteria for governing body membership; the types of membership and the method of selecting members; frequency of governing body meetings; the number of members necessary for a quorum and other attendance requirements for governing body meetings; the requirement that meetings be documented in the form of written minutes and the duration of appointment or election for governing body members, officers and committed chairpersons.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.2.13** Rule 40.2.13 {#sec-16-40.2.13 omnilex-key=us-ms-regs-official--title-15--16#40.2.13}

Such bylaws, rules and regulations shall describe the qualifications, authority and responsibilities of the Chief Executive Officer.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.2.14** Such bylaws, rules and regulations shall specify the method for appointing the Chief Executive Officer {#sec-16-40.2.14 omnilex-key=us-ms-regs-official--title-15--16#40.2.14}

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.2.15** Rule 40.2.15 {#sec-16-40.2.15 omnilex-key=us-ms-regs-official--title-15--16#40.2.15}

Such bylaws, rules and regulations shall provide the administrative and professional staffs with the authority and freedom necessary to carry out their responsibilities within the organizational framework of the facility.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.2.16** Rule 40.2.16 {#sec-16-40.2.16 omnilex-key=us-ms-regs-official--title-15--16#40.2.16}

Such bylaws, rules and regulations shall provide the professional staff with the authority necessary to encourage high quality patient care.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.2.17** Rule 40.2.17 {#sec-16-40.2.17 omnilex-key=us-ms-regs-official--title-15--16#40.2.17}

Such bylaws, rules and regulations shall state the procedures under which the administrative and professional staff cooperatively function.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.2.18** Rule 40.2.18 {#sec-16-40.2.18 omnilex-key=us-ms-regs-official--title-15--16#40.2.18}

Such bylaws, rules and regulations shall require the establishment of controls designed to encourage each member of the professional staff to observe the standards of the profession and assume and carry out functions in accordance with local, state and federal laws and rules and regulations.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.2.19** Rule 40.2.19 {#sec-16-40.2.19 omnilex-key=us-ms-regs-official--title-15--16#40.2.19}

Such bylaws, rules and regulations shall require the professional staff bylaws, rules and regulations to be subject to governing body approval.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.2.20** Rule 40.2.20 {#sec-16-40.2.20 omnilex-key=us-ms-regs-official--title-15--16#40.2.20}

Such bylaws, rules and regulations shall specify procedures for selecting professional staff officers, directors and department or service chiefs.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.2.21** Rule 40.2.21 {#sec-16-40.2.21 omnilex-key=us-ms-regs-official--title-15--16#40.2.21}

Such bylaws, rules and regulations shall require that physicians with appropriate qualifications, licenses and clinical privileges evaluate and authenticate medical histories and physical examinations and prescribe medications.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.2.22** Rule 40.2.22 {#sec-16-40.2.22 omnilex-key=us-ms-regs-official--title-15--16#40.2.22}

Such bylaws, rules and regulations may also allow dentists with appropriate qualifications, licenses and clinical privileges to prescribe medications.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.2.23** Rule 40.2.23 {#sec-16-40.2.23 omnilex-key=us-ms-regs-official--title-15--16#40.2.23}

Such bylaws, rules and regulations shall describe the procedure for conferring clinical privileges on all professional staff.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.2.24** Rule 40.2.24 {#sec-16-40.2.24 omnilex-key=us-ms-regs-official--title-15--16#40.2.24}

Such bylaws, rules and regulations shall define the responsibilities of physicians in relation to non-physician members of the professional staff.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.2.25** Rule 40.2.25 {#sec-16-40.2.25 omnilex-key=us-ms-regs-official--title-15--16#40.2.25}

Such bylaws, rules and regulations shall provide a mechanism through which the administrative and professional staffs report to the governing body. Such bylaws, rules and regulations shall define the means by which the administrative and professional staffs participate in the development of facility and program policies concerning program management and patient care.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.2.26** Rule 40.2.26 {#sec-16-40.2.26 omnilex-key=us-ms-regs-official--title-15--16#40.2.26}

Such bylaws, rules and regulations shall require an orientation program for new governing body members and a continuing education program for all members of the governing body.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.2.27** Rule 40.2.27 {#sec-16-40.2.27 omnilex-key=us-ms-regs-official--title-15--16#40.2.27}

Such bylaws, rules and regulations shall require that the bylaws, rules and regulations be reviewed at least every two years, revised as necessary, and signed and dated to indicate the time of last review.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17 Subchapter 3 CHIEF EXECUTIVE OFFICER Rule 40.3.1 The governing body shall appoint a Chief Executive Officer who shall be employed on a full-time basis.*
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.3.2** Rule 40.3.2 {#sec-16-40.3.2 omnilex-key=us-ms-regs-official--title-15--16#40.3.2}

The qualifications, authority and duties of the Chief Executive Officer shall be stated in the governing body's bylaws, rules and regulations.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.3.3** Rule 40.3.3 {#sec-16-40.3.3 omnilex-key=us-ms-regs-official--title-15--16#40.3.3}

The Chief Executive Officer shall be a health professional with appropriate professional qualifications and experience, including previous administrative responsibility in a health facility.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.3.4** Rule 40.3.4 {#sec-16-40.3.4 omnilex-key=us-ms-regs-official--title-15--16#40.3.4}

The Chief Executive Officer shall have a medical degree or at least a master's degree in administration, psychology, social work, education or nursing; and, when required, should have appropriate licenses. Experience may be substituted for a professional degree when it is carefully evaluated, justified and documented by the governing body.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.3.5** Rule 40.3.5 {#sec-16-40.3.5 omnilex-key=us-ms-regs-official--title-15--16#40.3.5}

In facilities primarily serving children or adolescents, the Chief Executive Officer shall have appropriate professional qualifications and experience, including previous administrative responsibility in a facility for children or adolescents.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.3.6** Rule 40.3.6 {#sec-16-40.3.6 omnilex-key=us-ms-regs-official--title-15--16#40.3.6}

In accordance with the facility's bylaws, rules and regulations, the Chief Executive Officer shall be responsible to the governing body for the overall operation of the facility, including the control, utilization and conservation of its physical and financial assets and the recruitment and direction of staff.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.3.7** Rule 40.3.7 {#sec-16-40.3.7 omnilex-key=us-ms-regs-official--title-15--16#40.3.7}

The Chief Executive Officer shall assist the governing body in formulating policy by preparing the following items and presenting them to and reviewing them with the governing body: 1. Long-term and short-term plans of the facility. 2. Reports on the nature and extent of funding and other available resources. 3. Reports describing the facility's operations. 4. Reports evaluating the efficiency and effectiveness of facility or program activity; and 5. Budgets and financial statements.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.3.8** Rule 40.3.8 {#sec-16-40.3.8 omnilex-key=us-ms-regs-official--title-15--16#40.3.8}

The Chief Executive Officer shall be responsible for the preparation of a written manual that defines the facility policies and procedures and that is regularly revised and updated.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.3.9** There shall be documentation that the Chief Executive Officer attends and participates in continuing education programs {#sec-16-40.3.9 omnilex-key=us-ms-regs-official--title-15--16#40.3.9}

the facility is located. The professional staff bylaws, rules and regulations, and the rules and regulations of the governing authority shall require that a qualified physician be responsible for diagnosis and all care and treatment. The organization of the professional staff and its bylaws, rules and regulations, shall be approved by the facility's governing body.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17 Subchapter 4 PROFESSIONAL STAFF ORGANIZATION Rule 40.4.1 There shall be a single organized professional staff that has the overall responsibility for the quality of all clinical care provided to patients, and for the ethical conduct and professional practices of its members, as well as, for accounting therefore to the governing body. The manner in which the professional staff is organized shall be consistent with the facility's documented staff organization and bylaws, rules and regulations, and pertain to the setting where*
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.4.2** Rule 40.4.2 {#sec-16-40.4.2 omnilex-key=us-ms-regs-official--title-15--16#40.4.2}

There professional staff shall strive to assure that each member is qualified for membership and shall encourage the optimal level of professional performance of its members through the appointment/reappointment procedure, the specific delineation of clinical privileges, and the periodic reappraisal of each staff member according to the provisions.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17 Subchapter 5 QUALIFICATIONS Rule 40.5.1 The appointment and reappointment of professional staff member shall be based upon well defined, written criteria that are related to the goals and objectives of the facility as stated in the bylaws, rules and regulations of the professional staff and of the governing body.*
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.5.2** Rule 40.5.2 {#sec-16-40.5.2 omnilex-key=us-ms-regs-official--title-15--16#40.5.2}

Upon application or appointment to the professional staff, each individual must sign a statement to the effect that he or she has read and agrees to be bound by the professional staff and governing body bylaws, rules and regulations.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.5.3** Rule 40.5.3 {#sec-16-40.5.3 omnilex-key=us-ms-regs-official--title-15--16#40.5.3}

The initial appointment and continued professional staff membership shall be dependent upon professional competence and ethical practice in keeping with the qualifications, standards and requirements set forth in the professional staff and governing body bylaws, rules and regulations.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.5.4** Rule 40.5.4 {#sec-16-40.5.4 omnilex-key=us-ms-regs-official--title-15--16#40.5.4}

Unless otherwise provided by law, only those practitioners who are licensed, certified, or registered, or who have demonstrated competence and experience, shall be eligible for professional staff membership.

appropriately licensed, certified, registered, or experienced, and qualified for the privileges and responsibilities he or she seeks.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17 Subchapter 6 METHOD OF SELECTION Rule 40.6.1 Each facility is responsible for developing a process of appointment to the professional staff whereby it can satisfactorily determine that the person is*
- *SOURCE: Miss. Code Ann. §41-9-17 Subchapter 7 PRIVILEGE DELINEATION Rule 40.7.1 Privileges shall be delineated for each member of the professional staff, regardless of the type and size of the facility and the age and disability group served.*
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.7.2** Rule 40.7.2 {#sec-16-40.7.2 omnilex-key=us-ms-regs-official--title-15--16#40.7.2}

The delineation of privileges shall be based on all verified information available in the applicant's or staff member's credentials file.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.7.3** Clinical privileges shall be facility-specific {#sec-16-40.7.3 omnilex-key=us-ms-regs-official--title-15--16#40.7.3}

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.7.4** Rule 40.7.4 {#sec-16-40.7.4 omnilex-key=us-ms-regs-official--title-15--16#40.7.4}

The professional staff shall delineate in its bylaws, rules and regulations the qualifications, status, clinical duties, and responsibilities of clinical practitioners who are not members of the professional staff but whose services require that they be processed through the usual professional staff channels.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.7.5** Rule 40.7.5 {#sec-16-40.7.5 omnilex-key=us-ms-regs-official--title-15--16#40.7.5}

The training, experience and demonstrated competence of individuals in such categories shall be sufficient to permit their performing their assigned functions.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.7.6** Rule 40.7.6 {#sec-16-40.7.6 omnilex-key=us-ms-regs-official--title-15--16#40.7.6}

There shall be provisions for individuals in such categories to receive professional supervision, when indicated, from their professional counterparts.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17 Subchapter 8 REAPPOINTMENT Rule 40.8.1 The facility's professional staff bylaws, rules and regulations shall provide for review and reappointment of each professional staff member at least once every two years.*
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.8.2** Rule 40.8.2 {#sec-16-40.8.2 omnilex-key=us-ms-regs-official--title-15--16#40.8.2}

The reappointment process should include a review of the individual's status by a designated professional staff committee, such as the credentials committee.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.8.3** Rule 40.8.3 {#sec-16-40.8.3 omnilex-key=us-ms-regs-official--title-15--16#40.8.3}

When indicated, the credentials committee shall require the individual to submit evidence of his or her current health status that verifies the individual's ability to discharge his or her responsibilities.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.8.4** Rule 40.8.4 {#sec-16-40.8.4 omnilex-key=us-ms-regs-official--title-15--16#40.8.4}

The committee's review of the clinical privileges of a staff member for reappointment should include the individual's past and current professional performance, as well as, his or her adherence to the governing body and professional staff bylaws, rules and regulations.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.8.5** Rule 40.8.5 {#sec-16-40.8.5 omnilex-key=us-ms-regs-official--title-15--16#40.8.5}

The professional staff bylaws, rules and regulations shall limit the time within which the professional staff reappointment and privilege delineation processes must be completed.

(Although not all members of professional health care disciplines need to be members of the professional staff, membership may include active staff, consulting staff, affiliate staff, associate staff and others according to the needs of the facility.)

**History**
- *SOURCE: Miss. Code Ann. §41-9-17 Subchapter 9 ORGANIZATION Rule 40.9.1 The professional staff shall be organized to accomplish its required functions. The professional staff organization must provide a framework in which the staff can carry out its duties and functions effectively. The complexity of the organization shall be consonant with the size of the facility and the scope of its activities.*
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.9.2** Rule 40.9.2 {#sec-16-40.9.2 omnilex-key=us-ms-regs-official--title-15--16#40.9.2}

The professional staff bylaws, rules and regulations shall provide for the selection of officers for an executive committee, and, when appropriate, for other organizational components of the facility.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.9.3** Rule 40.9.3 {#sec-16-40.9.3 omnilex-key=us-ms-regs-official--title-15--16#40.9.3}

The professional staff bylaws, rules and regulations should specify the organization needed to provide effective governance of the professional staff.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17 Subchapter 10 EXECUTIVE COMMITTEE*

##### **15 Miss. Admin. Code Pt. 16, R. 40.10.1** The executive committee shall be empowered to act for the professional staff in the intervals between the staff meetings {#sec-16-40.10.1 omnilex-key=us-ms-regs-official--title-15--16#40.10.1}

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.10.2** The committee shall serve as a liaison mechanism between the professional staff and the administration {#sec-16-40.10.2 omnilex-key=us-ms-regs-official--title-15--16#40.10.2}

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.10.3** There shall be a mechanism that assures medical participation in the deliberations of the executive committee {#sec-16-40.10.3 omnilex-key=us-ms-regs-official--title-15--16#40.10.3}

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.10.4** Rule 40.10.4 {#sec-16-40.10.4 omnilex-key=us-ms-regs-official--title-15--16#40.10.4}

The professional staff bylaws, rules and regulations shall define the size, composition, method of selecting members and frequency of meetings of the executive committee.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.10.5** The executive committee shall maintain a permanent record of its proceedings and actions {#sec-16-40.10.5 omnilex-key=us-ms-regs-official--title-15--16#40.10.5}

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.10.6** The functions and responsibilities of the executive committee shall include at least the following: 1 {#sec-16-40.10.6 omnilex-key=us-ms-regs-official--title-15--16#40.10.6}

Receiving and acting upon reports and recommendations from a professional staff committees, departments and services. 2. Implementing the approved policies of the professional staff. 3. Recommending to the governing body all matters relating to appointments and reappointments, staff categorization and assignments, clinical privileges, and except when such is a function of the professional staff or one of its committees, corrective action. 4. Fulfilling the professional staff's accountability to the governing body for the quality of the overall clinical care rendered to the patients in the facility; and 5. Initiating and pursuing corrective action when warranted, in accordance with the provisions of the professional staff bylaws, rules and regulations.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17 Subchapter 11 PROFESSIONAL STAFF BYLAWS*

##### **15 Miss. Admin. Code Pt. 16, R. 40.11.1** Rule 40.11.1 {#sec-16-40.11.1 omnilex-key=us-ms-regs-official--title-15--16#40.11.1}

The professional staff shall develop and adopt bylaws, rules and regulations to establish a framework of self-government and a means of accountability to the governing body. 1. The bylaws, rules and regulations shall be subject to the approval of the governing body. 2. The professional staff shall regulate itself by its bylaws, rules and regulations. 3. The professional staff bylaws, rules and regulations shall reflect current staff practices, shall be enforced and shall be periodically reviewed and revised as necessary. 4. The professional staff bylaws, rules and regulations shall include a requirement for an ethical pledge from each practitioner. 5. The professional staff bylaws, rules and regulations shall describe the specific role of each discipline represented on the professional staff or exercising clinical privileges in the care of patients.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.11.2** The professional staff bylaws, rules and regulations shall include the following patient record requirements: 1 {#sec-16-40.11.2 omnilex-key=us-ms-regs-official--title-15--16#40.11.2}

Symbols and abbreviations shall be used only when they have been approved by the professional staff and when there is an explanatory legend; 2. The categories of personnel who are qualified to accept and transcribe verbal orders, regardless of the mode of transmission of the orders, shall be specifically identified; 3. The period of time following admission to the facility within which a history and physical examination must be entered in the patient record shall be specified; 4. The time period in which patient records must be completed following discharge shall be specified and shall not exceed fourteen (14) days; and 5. The entries in patient records that must be dated and authenticated by the responsible practitioner shall be specified.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.11.3** Rule 40.11.3 {#sec-16-40.11.3 omnilex-key=us-ms-regs-official--title-15--16#40.11.3}

The professional staff bylaws, rules and regulations shall specify mechanisms for the regular review, evaluation and monitoring of professional staff practices.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.11.4** Rule 40.11.4 {#sec-16-40.11.4 omnilex-key=us-ms-regs-official--title-15--16#40.11.4}

The professional staff bylaws, rules and regulations shall provide a procedure relative to denial of staff appointments and reappointments, as well as, for denial, curtailment, suspension, or revocation of clinical privileges. When appropriate, this procedure shall provide for a practitioner to be heard, upon request, at some stage of the process.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17 Subchapter 12 WRITTEN PLAN FOR PROFESSIONAL SERVICES Rule 40.12.1 The facility shall formulate and specify in a written plan for professional services its goals, objectives, policies and programs so that its performance can be measured.*
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.12.2** Rule 40.12.2 {#sec-16-40.12.2 omnilex-key=us-ms-regs-official--title-15--16#40.12.2}

The plan shall describe the services offered by the facility so that a frame of reference for judging the various aspects of the facility's operation is available.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.12.3** The written plan for professional services shall describe the following: 1 {#sec-16-40.12.3 omnilex-key=us-ms-regs-official--title-15--16#40.12.3}

The population served, including age groups and other relevant characteristics of the patient population; 2. The hours and days the facility operates; 3. The methods used to carry out initial screening and/or triage; 4. The intake or admission process; including how the initial contact is made with the patient and the family or significant others; 5. The assessment and evaluation procedures provided by the facility; 6. The methods used to deliver services to meet the identified clinical needs of patients served; 7. The basic therapeutic programs offered by the facility; 8. The treatment planning process and the periodic review of therapy; 9. The discharge and post-therapy planning processes; 10. The organizational relationships of each of the facility's therapeutic programs, including channels of staff communication, responsibility and authority, as well as, supervisory relationships; and

11. The means by which the facility provides, or makes arrangements for the provision of the following: a. Other medical, special assessments and therapeutic services; b. Patient education services, whether provided from within or outside the facility; c. Emergency services and crisis intervention; and d. Discharge and aftercare, including post-therapy planning and follow-up evaluation.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.12.4** Rule 40.12.4 {#sec-16-40.12.4 omnilex-key=us-ms-regs-official--title-15--16#40.12.4}

When the facility is organized by departments or services, the written plan for professional services shall describe how each department or service relates to the goals and other programs of the facility, specify lines of responsibility within each department of service and define the roles of department or service personnel and the methods for interdisciplinary collaboration.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.12.5** Rule 40.12.5 {#sec-16-40.12.5 omnilex-key=us-ms-regs-official--title-15--16#40.12.5}

When a facility is organized on a team or unit basis, either totally or in part, the written plan for professional services shall delineate the roles and responsibilities of team members in meeting the identified clinical needs of patients and in relation to the goals and programs of the facility.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.12.6** Rule 40.12.6 {#sec-16-40.12.6 omnilex-key=us-ms-regs-official--title-15--16#40.12.6}

The written plan for professional services shall be made known and available to all professional personnel and to the Chief Executive Officer.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.12.7** Rule 40.12.7 {#sec-16-40.12.7 omnilex-key=us-ms-regs-official--title-15--16#40.12.7}

The plan shall be reviewed at least annually, and revised as necessary, in relation to the changing needs of the patients, the community, and the overall objectives and goals of the facility, and it shall be signed and dated by the reviewers.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.12.8** Rule 40.12.8 {#sec-16-40.12.8 omnilex-key=us-ms-regs-official--title-15--16#40.12.8}

Within the scope of its activities, the facility shall have enough appropriately qualified health care professional, administrative and support staff available to adequately assess and address the identified clinical needs of patients. Appropriately qualified professional staff may include qualified psychiatrists and other physicians, clinical psychologists, social workers, psychiatric nurses and other health care professionals in numbers and variety appropriate to the services offered by the facility.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.12.9** Rule 40.12.9 {#sec-16-40.12.9 omnilex-key=us-ms-regs-official--title-15--16#40.12.9}

When appropriate qualified professional staff members are not available or needed on a full-time basis, arrangements shall be made to obtain sufficient services on an attending continuing consultation, or part-time basis.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.12.10** Rule 40.12.10 {#sec-16-40.12.10 omnilex-key=us-ms-regs-official--title-15--16#40.12.10}

Facilities providing child and adolescent psychiatric services shall have available appropriately qualified mental health professionals and paraprofessionals including, but not limited to, the following: 1. Child psychiatrists; 2. Child psychologists; 3. Social workers; 4. Psychiatric nurses; 5. Child care workers; 6. Educators; 7. Speech, hearing and language specialists; 8. Activity and recreation specialists; and 9. Vocational counselors.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.12.11** The staff shall be assigned full-time to the child/adolescent program and not shared with other programs {#sec-16-40.12.11 omnilex-key=us-ms-regs-official--title-15--16#40.12.11}

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.12.12** The staff shall be specially trained to meet the needs of adolescents and children {#sec-16-40.12.12 omnilex-key=us-ms-regs-official--title-15--16#40.12.12}

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.12.13** Rule 40.12.13 {#sec-16-40.12.13 omnilex-key=us-ms-regs-official--title-15--16#40.12.13}

There shall be documentation to verify that health care professional staff meets all federal, state and local requirements for licensing, registration or certification.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17 Subchapter 13 STAFF COMPOSITION: PSYCHIATRIC SERVICES*

##### **15 Miss. Admin. Code Pt. 16, R. 40.13.1** Rule 40.13.1 {#sec-16-40.13.1 omnilex-key=us-ms-regs-official--title-15--16#40.13.1}

Psychiatric services are under the supervision of a clinical director, service chief or equivalent, who is qualified to provide the leadership required for an intensive treatment program.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.13.2** Rule 40.13.2 {#sec-16-40.13.2 omnilex-key=us-ms-regs-official--title-15--16#40.13.2}

The director shall be certified by the American Board of Psychiatry and Neurology, or meet the training and experience requirements for examination by the Board (Board eligible). In the even the psychiatrist in charge of the clinical program is Board eligible, there is evidence of consultation given to the clinical program on a continuing basis from a psychiatrist certified by the American Board of Psychiatry and neurology.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.13.3** The number of psychiatrists is commensurate with the size and scope of the treatment program {#sec-16-40.13.3 omnilex-key=us-ms-regs-official--title-15--16#40.13.3}

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.13.4** All psychiatrists shall be licensed by the State of Mississippi {#sec-16-40.13.4 omnilex-key=us-ms-regs-official--title-15--16#40.13.4}

**History**
- *SOURCE: Miss. Code Ann. §41-9-17 Subchapter 14 MEDICAL SERVICES Rule 40.14.1 Physicians shall be available at all times to provide necessary medical and surgical diagnostic and treatment services, including specialized services.*
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.14.2** Rule 40.14.2 {#sec-16-40.14.2 omnilex-key=us-ms-regs-official--title-15--16#40.14.2}

If medical and surgical diagnosis and treatment services are not available within the institution, qualified consultants or attending physicians are immediately available or arrangements are made to transfer patients to a general hospital.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17 Subchapter 15 NURSING SERVICES Rule 40.15.1 Nursing services shall be under the direct supervision of a registered nurse who has had at least two (2) years of experience in psychiatric or mental health nursing and at least one (1) year of experience in a supervisory position.*
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.15.2** Rule 40.15.2 {#sec-16-40.15.2 omnilex-key=us-ms-regs-official--title-15--16#40.15.2}

The number of registered professional nurses, licensed practical nurses, and other nursing personnel shall be adequate to formulate and carry out the nursing components of the individual treatment plan for each patient.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.15.3** Rule 40.15.3 {#sec-16-40.15.3 omnilex-key=us-ms-regs-official--title-15--16#40.15.3}

There shall be a registered professional nurse on duty 24 hours a day, seven days a week, to plan, assign, supervise and evaluate nursing care and to provide for the delivery of nursing care to patients.

1. Services to patients include evaluations, consultations, therapy and program development. 2. A qualified psychologist is an individual by the State Board of Psychological Examiners with a specialty area in Clinical or Counseling Psychology (refer to Mississippi Code of 1972, annotated and amended. Section 73-31-10).

**History**
- *SOURCE: Miss. Code Ann. §41-9-17 Subchapter 16 PSYCHOLOGICAL SERVICES Rule 40.16.1 Patients shall be provided psychological services, in accordance with their needs by a qualified psychologist.*
- *SOURCE: Miss. Code Ann. §41-9-17 Subchapter 17 SOCIAL SERVICES Rule 40.17.1 Social work services are under the supervision of a qualified social worker. The director of the service or department shall have a master's degree from an accredited school of social work, or have been certified by the Academy of Certified Social Workers.*
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.17.2** Social work staff is qualified and numerically adequate to provide the following services: 1 {#sec-16-40.17.2 omnilex-key=us-ms-regs-official--title-15--16#40.17.2}

Psychosocial data for diagnosis and treatment planning. 2. Direct therapeutic services to individual patients, patient groups or families. 3. Develop community resources. 4. Participate in interdisciplinary conferences and meetings concerning treatment planning, including identification and utilization of other facilities and alternative forms of care and treatment.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17 Subchapter 18 REHABILITATIVE SERVICES*

##### **15 Miss. Admin. Code Pt. 16, R. 40.18.1** Rule 40.18.1 {#sec-16-40.18.1 omnilex-key=us-ms-regs-official--title-15--16#40.18.1}

Qualified therapists, consultants, assistants or aides are sufficient in number to provide comprehensive therapeutic activities, including at least occupational, recreational and physical therapy as needed to assure that appropriate treatment is rendered for each patient and to establish a therapeutic milieu. 1. Occupational therapy services are prescribed by a physician and provided to a patient by or under the direction of a qualified occupational therapist. 2. A qualified occupational therapist is an individual who is registered by the American Occupational Therapy Association; or is a graduate of a program in occupational therapy approved by the Council on medical Education of the American Medical Association and engaged in the supplemental clinical experience required before registration by the American Occupational Therapy Association. 3. Physical therapy services are prescribed by a physician and provided to a patient by or under the direction of a qualified therapist. 4. A qualified physical therapist is an individual who is a graduate of a program of physical therapy approved by both the Council on Medical Education of the American Medical Association and the American Physical Therapy Association; and who is licensed by the State. 5. Recreation services shall be supervised by a qualified recreation therapist. The qualified recreation therapist shall meet one of the following definitions: a. A qualified therapeutic recreation specialist; or b. A bachelor's degree in recreation and one (1) year of recreational experience in a health care setting; or c. An associate degree in recreation or in a specialty area such as art or music plus completion of comprehensive in-service training in recreation.

1. All personnel policies shall be reviewed and approved on an annual basis by the governing body. 2. There shall be documentation to verify that the written personnel policies and procedures are explained and made available to each employee.

3. The policies and procedures shall include a mechanism for determining that all personnel are medically and emotionally capable of performing assigned tasks and are free of communicable and infectious diseases.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17 Subchapter 19 PERSONNEL POLICIES AND PROCEDURES Rule 40.19.1 Personnel policies and procedures shall be developed in writing, adopted and maintained to promote the objectives of the facility and to provide for an adequate number of qualified personnel during all hours of operation to support the functions of the facility and the provision of high quality care.*
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.19.2** There shall be written policies and procedures for handling cases of patient neglect and abuse {#sec-16-40.19.2 omnilex-key=us-ms-regs-official--title-15--16#40.19.2}

The policies and procedures on patient neglect or abuse shall be given to all personnel. Any alleged violations of these policies and procedures shall be investigated, and the results of such investigation shall be reviewed and approved by the director and reported to the governing body.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.19.3** A personnel record shall be kept on each staff member and shall contain the following items, as appropriate: 1 {#sec-16-40.19.3 omnilex-key=us-ms-regs-official--title-15--16#40.19.3}

Application for employment; 2. Written references and a record of verbal references; 3. Verification of all training and experience, licensure, certification, registration and/or renewals. 4. Wage and salary information; 5. Performance appraisals; 6. Initial and subsequent health clearances; 7. Disciplinary and counseling actions; 8. Commendations; 9. Employee incident reports; 10. Record of orientation to the facility, its policies and procedures and the employee's position.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.19.4** Rule 40.19.4 {#sec-16-40.19.4 omnilex-key=us-ms-regs-official--title-15--16#40.19.4}

For each position in the facility, there shall be a written job description that specifies the duties and responsibilities of the position and the minimum level of education, training and/or related work experience required or needed to fulfill it.

Subchapter 20 STAFF DEVELOPMENT Rule 40.20.1 The facility shall have a written plan of evidence of implementation of a program of staff development and in-service training that is consonant with the basic goals and objectives of the program.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.20.2** Staff development shall be under the supervision and direction of a committee or qualified person {#sec-16-40.20.2 omnilex-key=us-ms-regs-official--title-15--16#40.20.2}

This person or committee may delegate responsibility for any part of the program to appropriately qualified individuals.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.20.3** Rule 40.20.3 {#sec-16-40.20.3 omnilex-key=us-ms-regs-official--title-15--16#40.20.3}

The staff development plan shall include plans for orientation of new employees and shall specify subject areas to be covered in the orientation process.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.20.4** Rule 40.20.4 {#sec-16-40.20.4 omnilex-key=us-ms-regs-official--title-15--16#40.20.4}

Staff development program shall reflect all administrative and service changes in the facility and shall prepare personnel for promotions and responsibilities.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.20.5** Rule 40.20.5 {#sec-16-40.20.5 omnilex-key=us-ms-regs-official--title-15--16#40.20.5}

A continuous professional education program shall be provided to keep the professional staff informed of significant clinical and administrative developments and skills.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.20.6** Rule 40.20.6 {#sec-16-40.20.6 omnilex-key=us-ms-regs-official--title-15--16#40.20.6}

The facility shall provide continuing training for all staff and specific orientation for all new personnel in the principles of confidentiality, privacy, patients' rights, infection control, fire prevention, disaster preparedness, accident prevention and patient safety.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.20.7** Specialized training shall be provided for staff working with children and adolescents {#sec-16-40.20.7 omnilex-key=us-ms-regs-official--title-15--16#40.20.7}

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.20.8** Rule 40.20.8 {#sec-16-40.20.8 omnilex-key=us-ms-regs-official--title-15--16#40.20.8}

The facility shall have documentation of the staff development, in-service training and orientation activities of all employees.

Subchapter 21 PATIENT RIGHTS Rule 40.21.1 The facility shall support and protect the fundamental human, civil, constitutional and statutory rights of each patient.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.21.2** Rule 40.21.2 {#sec-16-40.21.2 omnilex-key=us-ms-regs-official--title-15--16#40.21.2}

The facility shall have written policies and procedures that describe the rights of patients and the means by which these rights are protected and exercised. These rights shall include the following: 1. Each patient shall have impartial access to treatment, regardless of race, religion, sex, ethnicity, age or disabilities. 2. Each patient's personal dignity shall be recognized and respected in the provision of all care and treatment. 3. Each patient shall receive individualized treatment, which shall include at least the following: a. The provision of adequate and human services regardless of source(s) of financial support; b. The provision of services within the least restrictive environment possible; c. The provision of an individual treatment plan; d. The periodic review of the patient's treatment plan; e. The active participation of patients over twelve (12) years of age and their responsible parent, relative, or guardian in planning for treatment; and f. The provision of an adequate number of competent, qualified and experienced professional clinical staff to supervise and implement the treatment plan. 4. Each patient's personal privacy shall be assured and protected within the constraints of the individual treatment plan. a. The patient's family and significant others, regardless of their age, shall be allowed to visit the patient, unless such visits are clinically contraindicated. b. Suitable areas shall be provided for patients to visit in private, unless such privacy is contraindicated by the patient's treatment plan. c. Patients shall be allowed to send and receive mail without hindrance. d. Patients shall be allowed to conduct private telephone conversations with family and friends, unless clinically contraindicated.

e. If therapeutic indications necessitate restrictions on visitors, telephone calls, or other communications, those restrictions shall be evaluated for therapeutic effectiveness by the clinically responsible staff at least every seven days. f. If limitations on visitors, telephone calls or other communications are indicated for practical reasons (for example, expense of travel or phone calls) such limitations shall be determined with the participation of the patient and the patient's family. All such restrictions shall be fully explained to the patient and the patient's family. 5. Each patient has the right to request the opinion of a consultant at his or her expense or to request an in-house review of the individual treatment plan, as provided in specific procedures of the facility.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.21.3** Each patient shall be informed of his or her rights in a language the patient understands {#sec-16-40.21.3 omnilex-key=us-ms-regs-official--title-15--16#40.21.3}

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.21.4** Rule 40.21.4 {#sec-16-40.21.4 omnilex-key=us-ms-regs-official--title-15--16#40.21.4}

Each patient shall receive a written statement of patient rights and a copy of this statement shall be posted in various areas of the facility.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.21.5** Rule 40.21.5 {#sec-16-40.21.5 omnilex-key=us-ms-regs-official--title-15--16#40.21.5}

As appropriate, the patient, the patient's family or the patient's legal guardian shall be fully informed about the following items: 1. The rights of patients; 2. The professional staff members responsible for his or her care, their professional status and their staff relationship; 3. The nature of the care, procedures and treatment that he or she will receive; 4. The current and future use and disposition of products of special observation and audiovisual techniques, such as one-way vision mirrors, tape recorders, television, movies or photographs; 5. The risks, side effects and benefits of all medications and treatment procedures used, especially those that are unusual or experimental; 6. The alternate treatment procedures that are available; 7. The right to refuse to participate in any research project without compromising his or her access to facility services;

8. The right to the extent permitted by law, to refuse specific medications or treatment procedures; 9. The responsibility of the facility when the patient refuse treatment, to seek appropriate legal alternatives or orders of involuntary treatment, or, in accordance with professional standards, to terminate the relationship with the patient upon reasonable notice; 10. As appropriate, the cost, itemized when possible, of services rendered; 11. The source of the facility's reimbursement and any limitations placed on duration of services; 12. The reasons for any proposed change in the professional staff responsible for the patient, or for any transfer of the patient either within or outside of the facility. 13. The rules and regulations of the facility applicable to his or her conduct; 14. The right to initiate a complaint or grievance procedure and the appropriate means of requesting a hearing or review of the complaint; 15. The discharge plans; and 16. The plans for meeting continuing mental and physical health requirements following discharge.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.21.6** Rule 40.21.6 {#sec-16-40.21.6 omnilex-key=us-ms-regs-official--title-15--16#40.21.6}

In accordance with the requirements of any applicable law or any other applicable standard in this manual, a written, dated and signed informed consent form shall be obtained from the patient, the patient's family or the patient's legal guardian, as appropriate, for participation in any research project and for use or performance of the following: 1. Surgical procedures; 2. Electroconvulsive therapy; 3. Unusual medications; 4. Hazardous assessment procedures; 5. Audiovisual equipment; and 6. Other procedures where consent is required by law.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.21.7** Rule 40.21.7 {#sec-16-40.21.7 omnilex-key=us-ms-regs-official--title-15--16#40.21.7}

The maintenance of confidentiality of communications between patients and staff and of all information recorded in patient records shall be the responsibility of all staff. (Refer to the patient records section of this manual.) The facility shall provide continuing training for all staff and specific orientation for all new personnel in the principles of confidentiality and privacy.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.21.8** The patient shall be allowed to work for the service provider only under the following conditions: 1 {#sec-16-40.21.8 omnilex-key=us-ms-regs-official--title-15--16#40.21.8}

The work is part of the individual treatment plan; 2. The work is performed voluntarily; 3. The patient receives wages commensurate with the economic value of the work; and 4. The work project complies with local, state and federal laws and regulations.

2. The use of seclusion; 3. The use of electroconvulsive therapy and other forms of convulsive therapy; 4. The performance of psychosurgery of other surgical procedures for the intervention in, or alteration of, a mental, emotional or behavioral disorder; 5. The use of behavior modification procedures that use painful stimuli; 6. The use of unusual medications and investigational and experimental drugs; 7. The prescribing and administering of drugs for maintenance use that have abuse potential (usually considered to be Schedule II drugs), and drugs that are known to involve substantial risk or to be associated with undesirable side effects; and 8. The use of research projects that involve inconvenience or risk to the patient.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17 Subchapter 22 SPECIAL TREATMENT PROCEDURES Rule 40.22.1 Treatment procedures that require special justification shall include, but not necessarily be limited to the following: 1. The use of restraint;*
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.22.2** The rationale for using special treatment procedures shall be clearly stated in the patient's record {#sec-16-40.22.2 omnilex-key=us-ms-regs-official--title-15--16#40.22.2}

1. When appropriate, there shall be evidence in the patient's record that proposed special treatment procedures have been reviewed before implementation by the head of the professional staff and/or his or her designee. 2. The plan for using special treatment procedures shall be consistent with the patient's rights and the facility's policies governing the use of such procedures. 3. The clinical indications for the use of special treatment procedures shall be documented in the patient's record. 4. The clinical indications for the use of special treatment procedures shall outweigh the known contraindications.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.22.3** The facility shall have written policies and procedures that govern the use of restraint or seclusion {#sec-16-40.22.3 omnilex-key=us-ms-regs-official--title-15--16#40.22.3}

1. The use of restraint or seclusion shall require clinical justification and shall be employed only to prevent a patient from injuring himself or others, or to prevent serious disruption of the therapeutic environment. Restraint or seclusion shall not be employed as punishment or for the convenience of staff. 2. The rationale for the use of restraint or seclusion shall address the inadequacy of less restrictive intervention techniques. 3. To ascertain that the procedure is justified, a physician shall conduct a clinical assessment of the patient before writing an order for the use of restraint or seclusion. 4. A written order from a physician shall be required for the use of restraint. 5. A written order from a physician shall be required for the use of seclusion for longer than one (1) hour. 6. Written orders for the use of restraint or seclusion shall be time-limited. 7. The written approval of the head of the professional staff and/or his or her designee shall be required when restraint or seclusion is utilized for longer than 24 hours. 8. PRN orders shall not be used to authorize the use of restraint or seclusion. 9. All uses of restraint or seclusion shall be reported daily to the head of the professional staff and/or his or her designee.

10. The head of the professional staff and/or his or her designee shall review daily all uses of restraint or seclusion and investigate unusual or possibly unwarranted patterns of utilization. 11. Staff, who implement written orders for restraint and seclusion, shall have documented training in the proper use of the procedure for which the order was written. 12. Restraint or seclusion shall not be used in a manner that causes undue physical discomfort, harm or pain to the patient. 13. Appropriate attention shall be paid every 15 minutes to a patient in restraint or seclusion, especially in regard to regular meals, bathing and use of the toilet. 14. There shall be documentation in the patient's record that such attention was given to the patient. 15. Under the following conditions, restraint or seclusion may be employed in an emergency without a written order from a physician: a. the written order for restraint or seclusion is given by a member of the professional staff who is qualified by experience and training in the proper use of the procedure for which the order is written; b. the professional staff member writing the order has observed and assessed the patient before writing the order; and c. the written order of the physician who is responsible for the patient's medical care is obtained within not more than eight (8) hours after initial employment of the restraint or seclusion.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.22.4** Rule 40.22.4 {#sec-16-40.22.4 omnilex-key=us-ms-regs-official--title-15--16#40.22.4}

The facility shall have written policies and procedures that govern the use of electroconvulsive therapy and other forms of convulsive therapy. 1. The written informed consent of the patient for the use of electroconvulsive therapy or other forms of convulsive therapy shall be obtained and made part of the patient's record. The patient may withdraw consent at any time. 2. When required, the written informed consent of the family and/or legal guardian for the use of electroconvulsive therapy or other forms of convulsive therapy shall be obtained and made part of the patient's record. The family and/or guardian may withdraw consent at any time. 3. In cases dealing with children or adolescents, the responsible parent(s), relative or guardian, and, when appropriate, the patient shall give written, dated and signed informed consent for the use of electroconvulsive therapy or other forms of

convulsive therapy. The family and/or guardian and, when appropriate, the child or adolescent patient may withdraw consent at any time.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.22.5** Rule 40.22.5 {#sec-16-40.22.5 omnilex-key=us-ms-regs-official--title-15--16#40.22.5}

Electroconvulsive therapy or other forms of convulsive therapy shall not be administered to children or adolescents unless, prior to the initiation of treatment, two (2) qualified psychiatrists who have training or experience in the treatment of children and adolescents and who are not affiliated with the treating program have examined the patient, have consulted with the responsible psychiatrist, and have written and signed reports in the patient's record that concur with the decision to administer such therapy. The record of patients under the age of thirteen (13) shall contain documentation that such examinations and consultations were carried out by qualified child psychiatrists.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.22.6** Rule 40.22.6 {#sec-16-40.22.6 omnilex-key=us-ms-regs-official--title-15--16#40.22.6}

The facility shall have written policies and procedures that govern the performance of psychosurgery or other surgical procedures for the intervention in, or alteration of, a mental, emotional or behavioral disorder in an adult patient. 1. Psychosurgery shall not be performed on any adult patient unless, prior to the initiation of such treatment, a qualified psychiatrist and a neurosurgeon who are not affiliated with the treating program have examined the patient, have consulted with the responsible psychiatrist and have written and signed reports in the patient's record that concur with the decision to perform psychosurgery. 2. The patient's record shall contain documentation of such examinations and consultations.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.22.7** Rule 40.22.7 {#sec-16-40.22.7 omnilex-key=us-ms-regs-official--title-15--16#40.22.7}

The written informed consent of the adult patient for the performance of psychosurgery or other surgical procedures for the intervention in, or alteration of, a mental, emotional, or behavioral disorder shall be obtained and made part of the patient's record. The patient may withdraw consent at any time. When required, the written informed consent of the family and/or legal guardian for the performance of psychosurgery or other surgical procedures for the intervention in, or alteration of, a mental, emotional or behavioral disorder in an adult patient shall be obtained and made part of the patient's record. The family and/or guardian may withdraw consent at any time.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.22.8** Rule 40.22.8 {#sec-16-40.22.8 omnilex-key=us-ms-regs-official--title-15--16#40.22.8}

The facility shall have policies that prohibit the performance of psychosurgery or other surgical procedures for the intervention in, or alteration of a mental, emotional or behavioral disorder in children or adolescents.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.22.9** Rule 40.22.9 {#sec-16-40.22.9 omnilex-key=us-ms-regs-official--title-15--16#40.22.9}

Behavior modification procedures that use painful stimuli shall be documented in the patient's record.Such documentation shall include the rationale or justification for the use of the procedure, the required authorization, a description of the procedures employed to protect the patient's safety and rights, and a description of the behavior modification procedures to be used.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.22.10** Rule 40.22.10 {#sec-16-40.22.10 omnilex-key=us-ms-regs-official--title-15--16#40.22.10}

The written informed consent of the patient for the use of behavior modification procedures that use painful stimuli shall be obtained and made part of the patient's record. The patient may withdraw consent at any time. 1. When required, the written informed consent of the family and/or legal guardian shall be obtained and made part of the patient's record. The family and/or guardian may withdraw consent at any time. 2. In cases dealing with children or adolescents, the responsible parent(s), relative or guardian and, when appropriate, the patient shall given written, dated and signed informed consent. The family and/or guardian and, when appropriate, the child or adolescent patient may withdraw consent at any time.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.22.11** Rule 40.22.11 {#sec-16-40.22.11 omnilex-key=us-ms-regs-official--title-15--16#40.22.11}

The facility shall have written policies and procedures that govern the use of unusual medications and investigational and experimental drugs. 1. Unusual or experimental drugs shall be reviewed before use by the research review committee, the patient rights' review committee, or another appropriate peer review committee. 2. Investigational drugs shall be used only under the direct supervision of the principal investigator and with the approval of the physician members of the professional staff or an appropriate committee of the professional staff, the research review committee and appropriate federal, state and local agencies.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.22.12** Rule 40.22.12 {#sec-16-40.22.12 omnilex-key=us-ms-regs-official--title-15--16#40.22.12}

A central unit shall be established to maintain essential information on investigational drugs, such as drug dosage form, dosage range, storage requirements, adverse reactions, usage and contraindications.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.22.13** Investigational drugs shall be properly labeled {#sec-16-40.22.13 omnilex-key=us-ms-regs-official--title-15--16#40.22.13}

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.22.14** Nurses may administer investigational drugs only after receiving basic pharmacologic information about the drugs {#sec-16-40.22.14 omnilex-key=us-ms-regs-official--title-15--16#40.22.14}

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.22.15** Rule 40.22.15 {#sec-16-40.22.15 omnilex-key=us-ms-regs-official--title-15--16#40.22.15}

The written informed consent of the patient for the use of unusual medications or investigational or experimental drugs shall be obtained and made part of the patient's record. The patient may withdraw consent at any time. 1. When required, the written informed consent of the family and/or legal guardian for the use of unusual medication or investigational or experimental drugs shall be obtained and made part of the patient record. The family and/or guardian may withdraw consent at any time. 2. In cases dealing with children and adolescents, the responsible parent(s), relative, or guardian and, when appropriate, the patient shall give written, dated and signed informed consent, unless prohibited by law. The family an/or guardian and, when appropriate, the child or adolescent patient may withdraw consent at any time. 3. The denial of consent to take unusual medications of investigational or experimental drugs shall not be cause for denying or altering services indicated for the patient.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.22.16** Rule 40.22.16 {#sec-16-40.22.16 omnilex-key=us-ms-regs-official--title-15--16#40.22.16}

The facility shall have written policies and procedures that govern the prescribing and administering of drugs for maintenance use that have abuse potential (usually considered to be Schedule II drugs), and drugs that are known to involve a substantial risk or be associated with undesirable side effects. 1. Drugs that have abuse potential shall be prescribed and administered for maintenance use only when the following criteria are met: a. A physician member of the professional staff has reviewed the patient's record and has recorded the reasons for prescribing the drug(s) in the patient's record; b. The prescribed drug is listed in the facility's formulary; and c. Prior to the administration of the drug, the patient and, when required by law, the patient's parent(s) or guardian are informed orally and in writing, and, if possible, in the patient's native language, of the benefits and hazards of the drug.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.22.17** Rule 40.22.17 {#sec-16-40.22.17 omnilex-key=us-ms-regs-official--title-15--16#40.22.17}

The facility shall have written policies and procedures that protect the rights of patients involved in research projects that involve inconvenience or risk to the patient. The policies and procedures shall require a statement of the rationale for

a patient's participation in any research project that involves inconvenience to risk to the patient.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17 Subchapter 23 PATIENT RECORDS Rule 40.23.1 A patient record shall be maintained, in accordance with accepted professional principles, for each patient admitted for care in the facility.*
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.23.2** Such records shall be kept confidential and only authorized personnel shall have access to the record {#sec-16-40.23.2 omnilex-key=us-ms-regs-official--title-15--16#40.23.2}

Staff members and other persons having access to patient records shall be required to abide by the written policies confidentiality of patient records and disclosure of information in the record, as well as, all applicable federal, state and local laws, rules and regulations.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.23.3** Rule 40.23.3 {#sec-16-40.23.3 omnilex-key=us-ms-regs-official--title-15--16#40.23.3}

The facility shall have written policies and procedures that protect the confidentiality of patient records and govern the disclosure of information in the records. The policies and procedures shall specify the conditions under which information on applicants or patients may be disclosed and the procedures for releasing such information.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.23.4** Rule 40.23.4 {#sec-16-40.23.4 omnilex-key=us-ms-regs-official--title-15--16#40.23.4}

A patient or his or her authorized representative may consent to the release of information provided that written consent is given on a form containing the following information: 1. Name of patient; 2. Name of program; 3. The name of the person, agency or organization to which the information is to be disclosed; 4. The specific information to be disclosed; 5. The purpose for the disclosure; 6. The date the consent was signed and the signature of the individual witnessing the consent; 7. The signature of the patient, parent, guardian or authorized representative; and 8. A notice that the consent is valid only for a specified period of time.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.23.5** Rule 40.23.5 {#sec-16-40.23.5 omnilex-key=us-ms-regs-official--title-15--16#40.23.5}

The written consent of a patient, or his or her authorized representative, to the disclosure of information shall be considered valid only if the following conditions have been met: 1. The patient or the representative shall be informed, in a manner calculated to assure his or her understanding, of the specific type of information that has been requested and, if known, the benefits and disadvantages of releasing the information; 2. The patient or the representative shall give consent voluntarily; 3. The patient or the representative shall be informed that the provision of services is not contingent upon his or her decision concerning the release of information; and 4. The patient's consent shall be acquired in accordance with all applicable federal, state and local laws, rules and regulations.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.23.6** Rule 40.23.6 {#sec-16-40.23.6 omnilex-key=us-ms-regs-official--title-15--16#40.23.6}

Every consent for release of information, the actual date the information was released, the specific information released, and the signature of the staff member who released the information shall be made a part of the patient record.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.23.7** Rule 40.23.7 {#sec-16-40.23.7 omnilex-key=us-ms-regs-official--title-15--16#40.23.7}

In a life-threatening situation or when an individual's condition or situation precludes the possibility of obtaining written consent, the facility may release pertinent medical information to the medical personnel responsible for the individual's care without the individual's consent and without the authorization of the Chief Executive Officer or a designee, if obtaining such authorization would cause an excessive delay in delivering treatment to the individual. 1. When information has been released under emergency conditions, the staff member responsible for the release of information shall enter all pertinent details of the transaction into the individual's record including at least the following items: a. The date the information was released; b. The person to whom the information was released; c. The reason the information was released; d. The reason written consent could not be obtained; and e. The specific information released. 2. The patient or applicant shall be informed that the information was released as soon as possible after the release of information.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.23.8** Patient records shall not be removed from the facility except upon subpoena and court order {#sec-16-40.23.8 omnilex-key=us-ms-regs-official--title-15--16#40.23.8}

**History**
- *SOURCE: Miss. Code Ann. §41-9-17 Subchapter 24 PRESERVATION AND STORAGE Rule 40.24.1 Records shall be preserved, either in the original or by microfilm, for a period of time not less than that determined by the statute of limitations in the State of Mississippi.*
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.24.2** Rule 40.24.2 {#sec-16-40.24.2 omnilex-key=us-ms-regs-official--title-15--16#40.24.2}

Written policies and procedures shall govern the compilation, storage, dissemination and accessibility of patient records. The policies and procedures shall be designed to assure that the facility fulfills its responsibility to safeguard and protect the patient record against loss, unauthorized alteration, or disclosure of information; to assure that each patient record contains all required information; to uniformity in the format and forms in use in patient records; to require entries in patient records to be dated and signed.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.24.3** Rule 40.24.3 {#sec-16-40.24.3 omnilex-key=us-ms-regs-official--title-15--16#40.24.3}

The facility shall provide facilities for the storage, processing and handling of patient records, including suitably locked and secured rooms and files. When a facility stores patient data on magnetic tape, computer files, or other types of automated information systems, adequate security measures shall prevent inadvertent or unauthorized access to such data. A written policy shall govern the disposal of patient records. Methods of disposal shall be designed to assure the confidentiality of information in the records.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17 Subchapter 25 PERSONNEL Rule 40.25.1 The patient records department shall maintain, control and supervise the patient records, and shall be responsible for maintaining the quality.*
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.25.2** Rule 40.25.2 {#sec-16-40.25.2 omnilex-key=us-ms-regs-official--title-15--16#40.25.2}

A qualified medical record individual who is employed on at least a part-time basis, consistent with the needs of the facility and the professional staff, shall be responsible for the patient records department. This individual shall be a registered record administrator or an accredited record technician.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.25.3** Rule 40.25.3 {#sec-16-40.25.3 omnilex-key=us-ms-regs-official--title-15--16#40.25.3}

When it can be demonstrated that the size, location or needs of the facility do not justify employment of a qualified individual, the facility must secure the consultative assistance of a registered record administrator at least twice a year to assure that the patient record department is adequate to meet the needs of the facility.

1. The original or all reports originating in the facility shall be filed in the medical record. 2. Appropriate patient records shall be kept on the unit where the patient is being treated and shall be directly accessible to the clinician caring for the patient.

2. Home address; 3. Home telephone number; 4. Date of birth; 5. Sex;

6. Race or ethnic origin; 7. Next of kin; 8. Education; 9. Marital status; 10. Type and place of employment; 11. Date of initial contact or admission to the facility; 12. Legal status, including relevant legal documents; 13. Other identifying data as indicated; 14. Date the information was gathered; and 15. Signature of the staff member gathering the information.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17 Subchapter 26 CENTRALIZATION OF REPORTS Rule 40.26.1 All clinical information pertaining to a patient's stay shall be centralized in the patient's record.*
- *SOURCE: Miss. Code Ann. §41-9-17 Subchapter 27 CONTENT OF RECORDS Rule 40.27.1 The medical record shall contain sufficient information to justify the diagnosis and warrant the treatment and end results. The patient record shall describe the patient's health status at the time of admission, the services provided and the patient's progress in the facility, and the patient's health status at the time of discharge. The patient record shall provide information for the review and evaluation of the treatment provided to the patient. When appropriate, data in the patient record shall be used in training, research, evaluation and quality assurance programs. When indicated, the patient record shall contain documentation that the rights of the patient and of the patient's family are protected. The patient record shall contain documentation of the patient's and, as appropriate, family members' involvement in the patient's treatment program. When appropriate, a separate record may need to be maintained on each family member involved in the patient's treatment program. The patient record shall contain identifying data that is recorded on standardized forms. This identifying data shall include the following: 1. Full name;*
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.27.2** The patient record shall contain information on any unusual occurrences such as the following: 1 {#sec-16-40.27.2 omnilex-key=us-ms-regs-official--title-15--16#40.27.2}

Treatment complications; 2. Accidents or injuries to the patient; 3. Morbidity; 4. Death of a patient; and 5. Procedures that place the patient at risk or that cause unusual pain.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.27.3** Rule 40.27.3 {#sec-16-40.27.3 omnilex-key=us-ms-regs-official--title-15--16#40.27.3}

As necessary, the patient record shall contain documentation of the consent of the patient, appropriate family members or guardians for admission, treatment, evaluation, aftercare or research.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.27.4** Rule 40.27.4 {#sec-16-40.27.4 omnilex-key=us-ms-regs-official--title-15--16#40.27.4}

The patient record shall contain both physical and psychiatric diagnoses that have been made using a recognized diagnostic system.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.27.5** Rule 40.27.5 {#sec-16-40.27.5 omnilex-key=us-ms-regs-official--title-15--16#40.27.5}

The patient record shall contain reports of laboratory, roentgenographic, or other diagnostic procedures and reports of medical/surgical services when performed.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.27.6** Rule 40.27.6 {#sec-16-40.27.6 omnilex-key=us-ms-regs-official--title-15--16#40.27.6}

The patient record shall contain correspondence concerning the patient's treatment, and signed and dated notations of telephone calls concerning the patient's treatment.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.27.7** Rule 40.27.7 {#sec-16-40.27.7 omnilex-key=us-ms-regs-official--title-15--16#40.27.7}

A discharge summary shall be entered in the patient's record within a reasonable period of time (not to exceed 14 days) following discharge as determined by the professional staff bylaws, rules and regulations.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.27.8** The patient record shall contain a plan for aftercare {#sec-16-40.27.8 omnilex-key=us-ms-regs-official--title-15--16#40.27.8}

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.27.9** All entries in the patient record shall be signed and dated {#sec-16-40.27.9 omnilex-key=us-ms-regs-official--title-15--16#40.27.9}

Symbols and abbreviations shall be used only if they have been approved by the professional staff, and only when there is an explanatory legend. Symbols and abbreviations shall not be used in the recording of diagnoses.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.27.10** When a patient dies, a summation statement shall be entered in the record in the form of a discharge summary {#sec-16-40.27.10 omnilex-key=us-ms-regs-official--title-15--16#40.27.10}

The summation statement shall include the circumstances leading to death and shall be signed by a physician. An autopsy shall be performed whenever possible. When an autopsy is performed, a provisional anatomic diagnosis shall be recorded in the patient's record within 72 hours. The complete protocol shall be made part of the record within three (3) months.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17 Subchapter 28 PROMPTNESS OF RECORD COMPLETION Rule 40.28.1 Current records shall be completed promptly upon admission. Records of patients discharged shall be completed within 14 days following discharge. The staff regulations of the facility shall provide for the suspension or termination of staff privileges of physicians who are persistently delinquent in completing records.*
- *SOURCE: Miss. Code Ann. §41-9-17 Subchapter 29 IDENTIFICATION, FILING AND INDEXING*

##### **15 Miss. Admin. Code Pt. 16, R. 40.29.1** A system of identification and filing to ensure the prompt location of a patient's medical record shall be maintained {#sec-16-40.29.1 omnilex-key=us-ms-regs-official--title-15--16#40.29.1}

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.29.2** Rule 40.29.2 {#sec-16-40.29.2 omnilex-key=us-ms-regs-official--title-15--16#40.29.2}

The patient index cards shall bear at least the full name of the patient, the address, the birth date and the medical record number.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.29.3** Records shall be indexed according to disease and physician, and shall be kept up to date {#sec-16-40.29.3 omnilex-key=us-ms-regs-official--title-15--16#40.29.3}

For indexing, any recognized system may be used.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.29.4** Indexing shall be current within six (6) months following discharge of the patient {#sec-16-40.29.4 omnilex-key=us-ms-regs-official--title-15--16#40.29.4}

**History**
- *SOURCE: Miss. Code Ann. §41-9-17 Subchapter 30 FACILITY AND PROGRAM EVALUATION Rule 40.30.1 Program evaluation is a management tool primarily utilized by the facility's administration to assess and monitoring, on a priority bases, a variety of facility, service and programmatic activities.*
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.30.2** The facility shall have a written statement of goals and objectives {#sec-16-40.30.2 omnilex-key=us-ms-regs-official--title-15--16#40.30.2}

1. The goals and objectives shall result from a planning process. 2. The goals and objectives shall be related to the needs of the population served.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.30.3** Rule 40.30.3 {#sec-16-40.30.3 omnilex-key=us-ms-regs-official--title-15--16#40.30.3}

The written statement of the goals and objectives of the facility service and programmatic activities shall be provided to the governing body and facility administration and shall be made available to staff.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.30.4** The facility shall have a written plan for evaluating its progress in attaining its goals and objectives {#sec-16-40.30.4 omnilex-key=us-ms-regs-official--title-15--16#40.30.4}

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.30.5** Rule 40.30.5 {#sec-16-40.30.5 omnilex-key=us-ms-regs-official--title-15--16#40.30.5}

The written plan shall specify the information to be collected and the methods to be used in retrieving and analyzing this information.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.30.6** Rule 40.30.6 {#sec-16-40.30.6 omnilex-key=us-ms-regs-official--title-15--16#40.30.6}

The written plan shall specify methods for assessing the utilization of staff and other resources to meet facility goals and objectives.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.30.7** The written plan shall specify when evaluations shall be conducted {#sec-16-40.30.7 omnilex-key=us-ms-regs-official--title-15--16#40.30.7}

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.30.8** Rule 40.30.8 {#sec-16-40.30.8 omnilex-key=us-ms-regs-official--title-15--16#40.30.8}

The written plan shall specify the criteria to be used in assessing the facility's progress in attaining its goals and objectives.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.30.9** The written plan shall require an explanation of any failure to achieve facility goals and objectives {#sec-16-40.30.9 omnilex-key=us-ms-regs-official--title-15--16#40.30.9}

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.30.10** Rule 40.30.10 {#sec-16-40.30.10 omnilex-key=us-ms-regs-official--title-15--16#40.30.10}

There shall be documentation that the goals and objectives of facility, service and programmatic activities shall be evaluated at least annually and revised as necessary.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.30.11** Rule 40.30.11 {#sec-16-40.30.11 omnilex-key=us-ms-regs-official--title-15--16#40.30.11}

There shall be documentation that the results of the evaluation shall be provided to the governing body and facility administration and shall be made available to staff.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.30.12** There shall be documentation that the findings of the evaluation have influenced facility and program planning {#sec-16-40.30.12 omnilex-key=us-ms-regs-official--title-15--16#40.30.12}

**History**
- *SOURCE: Miss. Code Ann. §41-9-17 Subchapter 31 FISCAL MANAGEMENT Rule 40.31.1 The facility shall annually prepare a formal, written budget of expected revenues and expenses.*
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.31.2** The budget shall categorize revenues for the facility by source {#sec-16-40.31.2 omnilex-key=us-ms-regs-official--title-15--16#40.31.2}

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.31.3** The budget shall categorize expenses by the types of services of programs provided {#sec-16-40.31.3 omnilex-key=us-ms-regs-official--title-15--16#40.31.3}

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.31.4** The budget shall be reviewed and approved by the governing body prior to the beginning of the fiscal year {#sec-16-40.31.4 omnilex-key=us-ms-regs-official--title-15--16#40.31.4}

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.31.5** Revisions made in the budget during the fiscal year shall be reviewed and approved by the governing body {#sec-16-40.31.5 omnilex-key=us-ms-regs-official--title-15--16#40.31.5}

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.31.6** The fiscal management system shall include a fee schedule {#sec-16-40.31.6 omnilex-key=us-ms-regs-official--title-15--16#40.31.6}

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.31.7** Rule 40.31.7 {#sec-16-40.31.7 omnilex-key=us-ms-regs-official--title-15--16#40.31.7}

The facility shall maintain current, written schedules of rate and charge policies that have been approved by the governing body.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.31.8** The fee schedule shall be accessible to personnel and to individuals served by the facility {#sec-16-40.31.8 omnilex-key=us-ms-regs-official--title-15--16#40.31.8}

**History**
- *SOURCE: Miss. Code Ann. §41-9-17 Subchapter 32 UTILIZATION REVIEW Rule 40.32.1 The facility shall demonstrate appropriate allocation of its resources by conducting a utilization review program. The program shall address underutilization, over-utilization and inefficient scheduling of the facility's resources.*
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.32.2** The facility shall implement a written plan that describes the utilization review program and governs its operations {#sec-16-40.32.2 omnilex-key=us-ms-regs-official--title-15--16#40.32.2}

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.32.3** The written plan shall include at least the following: 1 {#sec-16-40.32.3 omnilex-key=us-ms-regs-official--title-15--16#40.32.3}

a delineation of the responsibilities and authority of those involved in utilization review activities, including members of the professional staff, the utilization review committees, the administration, and when applicable, any qualified outside organization contracted to perform review activities;

2. a conflict of interest policy applicable to everyone involved in utilization review activities; 3. a confidentiality policy applicable to all utilization review activities and to resultant findings and recommendations; 4. a description of the method(s) used to identify utilization-related problems; 5. the procedures for conducting concurrent review; and 6. a mechanism for initiating discharge planning.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.32.4** The written plan shall be approved by the professional staff, the administration, and the governing body {#sec-16-40.32.4 omnilex-key=us-ms-regs-official--title-15--16#40.32.4}

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.32.5** Rule 40.32.5 {#sec-16-40.32.5 omnilex-key=us-ms-regs-official--title-15--16#40.32.5}

The methods for identifying utilization-related problems shall include analysis of the appropriateness and clinical necessity of admission, continued stays, and supportive services; analysis of delays in the provision of supportive services; and examination of the findings of related quality assurance activities and other current relevant documentation.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.32.6** Rule 40.32.6 {#sec-16-40.32.6 omnilex-key=us-ms-regs-official--title-15--16#40.32.6}

Such documentation may include, but is not limited to, profile analyses; the results of patient care evaluation studies, medication usage reviews, and infection control activities; and reimbursement agency utilization reports that are program/service-specific.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.32.7** Rule 40.32.7 {#sec-16-40.32.7 omnilex-key=us-ms-regs-official--title-15--16#40.32.7}

To identify problems and document the impact of corrective actions taken, retrospective monitoring of the facility's utilization of resources shall be ongoing.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.32.8** Rule 40.32.8 {#sec-16-40.32.8 omnilex-key=us-ms-regs-official--title-15--16#40.32.8}

The procedures for conducting concurrent review shall specify the time period following admission within which the review is to be initiated and the length-of- stay norms and percentiles to be used in assigning continued stay review dates.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.32.9** Sources of payment shall not be the sole basis for determining which patients are to be reviewed concurrently {#sec-16-40.32.9 omnilex-key=us-ms-regs-official--title-15--16#40.32.9}

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.32.10** Rule 40.32.10 {#sec-16-40.32.10 omnilex-key=us-ms-regs-official--title-15--16#40.32.10}

Written measurable criteria and length-of-stay norms that have been approved by the professional staff shall be utilized in performing concurrent review and shall be included in, or appended to, the facility's utilization review plan.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.32.11** Length-of-stay norms must be specific to diagnoses, problems, or procedures {#sec-16-40.32.11 omnilex-key=us-ms-regs-official--title-15--16#40.32.11}

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.32.12** Rule 40.32.12 {#sec-16-40.32.12 omnilex-key=us-ms-regs-official--title-15--16#40.32.12}

To facilitate discharge when care is no longer required, discharge planning shall be initiated as soon as the need for it can be determined.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.32.13** Rule 40.32.13 {#sec-16-40.32.13 omnilex-key=us-ms-regs-official--title-15--16#40.32.13}

Criteria for initiating discharge planning may be developed to identify those patients whose diagnoses, problems or psychosocial circumstances usually require discharge planning.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.32.14** Rule 40.32.14 {#sec-16-40.32.14 omnilex-key=us-ms-regs-official--title-15--16#40.32.14}

Discharge planning shall not be limited to placement in long term facilities, but shall also include provision for, or referral to, services that the patient may require to improve or maintain his or her mental health status.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.32.15** Rule 40.32.15 {#sec-16-40.32.15 omnilex-key=us-ms-regs-official--title-15--16#40.32.15}

The facility's utilization review program, including the written plan, criteria, and length-of-stay norms, shall be reviewed and evaluated at least annually and revised as necessary to reflect the findings of the program's activities.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.32.16** A record shall be maintained or reviews of, and revisions to, the utilization review program {#sec-16-40.32.16 omnilex-key=us-ms-regs-official--title-15--16#40.32.16}

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.32.17** Rule 40.32.17 {#sec-16-40.32.17 omnilex-key=us-ms-regs-official--title-15--16#40.32.17}

The findings of such reviews shall be reported to the appropriate committee of the professional staff and to the governing body.

kept on the intake process; and d. the procedures to be followed when an applicant or a referral is found ineligible for admission.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17 Subchapter 33 INDIVIDUALIZED COMPREHENSIVE TREATMENT PLANNING: INTAKES Rule 40.33.1 Written policies and procedures governing the intake process shall specify the following: a. the information to be obtained on all applicants or referrals for admission; b. the records to be kept on all applicants; c. the statistical data to be*
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.33.2** Criteria for determining the eligibility of individuals for admission shall be clearly stated in writing {#sec-16-40.33.2 omnilex-key=us-ms-regs-official--title-15--16#40.33.2}

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.33.3** The intake procedure shall include an initial assessment of the patient {#sec-16-40.33.3 omnilex-key=us-ms-regs-official--title-15--16#40.33.3}

1. The intake assessment shall be done by professional staff. The results of the intake assessment shall be clearly explained to the patient. 2. The results of the intake assessment shall be clearly explained to the patient's family when appropriate.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.33.4** Acceptance of a patient for treatment shall be based on an intake procedure that results in the following conclusions: a {#sec-16-40.33.4 omnilex-key=us-ms-regs-official--title-15--16#40.33.4}

the treatment required by the patient is appropriate to the intensity and restrictions of care provided by the facility or program component; and/or b. the treatment required can be appropriately provided by the facility or program component; and c. the alternatives for less intensive and restrictive treatment are not available. The patient record shall contain the source of any referral.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.33.5** During the intake process, every effort shall be made to assure that applicants understand the following: a {#sec-16-40.33.5 omnilex-key=us-ms-regs-official--title-15--16#40.33.5}

the nature and goals of the treatment program; b. the treatment costs to be borne by the patient, if any; and c. the rights and responsibilities of patients, including the rules governing patient conduct and the types of infractions that can result in disciplinary action or discharge from the facility or program component.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.33.6** Facilities shall have policies and procedures that adequately address the following items for each patient: a {#sec-16-40.33.6 omnilex-key=us-ms-regs-official--title-15--16#40.33.6}

responsibility for medical and dental care, including consents for medical or surgical care and treatment; b. when appropriate, arrangements for family participation in the treatment program; c. arrangements for clothing, allowances, and gifts; d. arrangements regarding the patient's departure from the facility or program; and e. arrangements regarding the patient's departure from the facility or program against clinical advice.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.33.7** Rule 40.33.7 {#sec-16-40.33.7 omnilex-key=us-ms-regs-official--title-15--16#40.33.7}

When a patient is admitted on court order, the rights and responsibilities of the patient and the patient's family shall be explained to them.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.33.8** Rule 40.33.8 {#sec-16-40.33.8 omnilex-key=us-ms-regs-official--title-15--16#40.33.8}

This explanation of the rights and responsibilities of the patient and the patient's family shall be documented in the patient's record.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.33.9** Sufficient information shall be collected during the intake process to develop a preliminary treatment plan {#sec-16-40.33.9 omnilex-key=us-ms-regs-official--title-15--16#40.33.9}

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.33.10** Rule 40.33.10 {#sec-16-40.33.10 omnilex-key=us-ms-regs-official--title-15--16#40.33.10}

Staff members who will be working with the patient but who did not participate in the initial assessment shall be informed about the patient prior to meeting him or her.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17 Subchapter 34 ASSESSMENTS Rule 40.34.1 Within 72 hours of admission, the staff shall conduct a complete assessment of each patient's needs. The assessment shall include, but shall not necessarily be limited to physical, emotional, behavioral, social, recreational, nutritional, and when appropriate, legal and vocational.*
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.34.2** A licensed physician shall be responsible for assessing each patient's physical health {#sec-16-40.34.2 omnilex-key=us-ms-regs-official--title-15--16#40.34.2}

The health assessment shall include a medical history; a physical examination; and neurological examination when indicated and a laboratory workup. The physical examination shall be completed within 24 hours after admission.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.34.3** Rule 40.34.3 {#sec-16-40.34.3 omnilex-key=us-ms-regs-official--title-15--16#40.34.3}

In facilities serving children and adolescents, each patient's physical health assessment shall also include evaluations of the following: motor development and functioning; sensorimotor functioning; speech, hearing, and language functioning, visual functioning; and immunization status. Facilities serving children and adolescents shall have all necessary diagnostic tools and personnel available to perform physical health assessments.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.34.4** A registered nurse shall be responsible for obtaining a nursing history and assessment at the time of admission {#sec-16-40.34.4 omnilex-key=us-ms-regs-official--title-15--16#40.34.4}

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.34.5** A psychiatric evaluation of each patient shall be completed and entered in the patient's record {#sec-16-40.34.5 omnilex-key=us-ms-regs-official--title-15--16#40.34.5}

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.34.6** The evaluation shall include, but not be limited to, the following items: a {#sec-16-40.34.6 omnilex-key=us-ms-regs-official--title-15--16#40.34.6}

a history of previous emotional, behavioral, and psychiatric problems and treatment; b. the patient's current emotional and behavioral functioning; c. when indicated, psychological assessments, including intellectual and personality testing.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.34.7** Rule 40.34.7 {#sec-16-40.34.7 omnilex-key=us-ms-regs-official--title-15--16#40.34.7}

A social assessment of each patient shall be completed by the qualified social worker and entered in the patient's record. The assessment shall include information relating to the following areas, as necessary: 1. environment and home 2. religion 3. childhood history 4. military service history 5. financial status 6. the social, peer-group, and environmental setting from which the patient comes; and g. the patient's family circumstances, including the constellation of the family group, the current living situation, and social, ethnic, cultural, emotional, and health factors.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.34.8** Rule 40.34.8 {#sec-16-40.34.8 omnilex-key=us-ms-regs-official--title-15--16#40.34.8}

A recreational assessment of each patient shall be completed by the qualified recreational director and shall include information relating to the individual's current skills, talents, aptitudes, and interests.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.34.9** Rule 40.34.9 {#sec-16-40.34.9 omnilex-key=us-ms-regs-official--title-15--16#40.34.9}

A nutritional assessment shall be conducted by the food service supervisor or registered dietitian and shall be documented in the patient's record.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.34.10** Rule 40.34.10 {#sec-16-40.34.10 omnilex-key=us-ms-regs-official--title-15--16#40.34.10}

When appropriate, a vocational assessment of the patient shall be undertaken and shall include, but not be limited to, the following areas: a. vocational therapy b. educational history, including academic and vocational training, and c. a preliminary discussion between the individual and the staff member doing the assessment concerning the individual's past experiences with, and attitudes toward work, present motivations or areas of interest, and possibilities for future education, training, and employment.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.34.11** Rule 40.34.11 {#sec-16-40.34.11 omnilex-key=us-ms-regs-official--title-15--16#40.34.11}

When appropriate, a legal assessment of the patient shall be undertaken and shall include, but not be limited to, the following areas: 1. A legal history; and 2. A preliminary discussion to determine the extent to which the individual's legal situation will influence his or her progress in treatment and the urgency of the legal situation.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17 Subchapter 35 TREATMENT PLANS Rule 40.35.1 Each patient shall have a written individual treatment plan that is based on assessments of his or her clinical needs.*
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.35.2** Rule 40.35.2 {#sec-16-40.35.2 omnilex-key=us-ms-regs-official--title-15--16#40.35.2}

Overall development and implementation of the treatment plan shall be assigned to an appropriate member of the professional staff.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.35.3** The treatment plan shall be developed as soon as possible after the patient's admission {#sec-16-40.35.3 omnilex-key=us-ms-regs-official--title-15--16#40.35.3}

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.35.4** Appropriate therapeutic efforts may begin before a fully developed treatment plan is finalized {#sec-16-40.35.4 omnilex-key=us-ms-regs-official--title-15--16#40.35.4}

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.35.5** Upon admission, a preliminary treatment plan shall be formulated on the basis of the intake assessment {#sec-16-40.35.5 omnilex-key=us-ms-regs-official--title-15--16#40.35.5}

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.35.6** Rule 40.35.6 {#sec-16-40.35.6 omnilex-key=us-ms-regs-official--title-15--16#40.35.6}

Within 72 hours following admission a designated member of the treatment team shall develop an initial treatment plan that is based on at least an assessment of the patient's presenting problems, physical health, emotional status, and behavioral status. This initial treatment plan shall be utilized to implement immediate treatment objectives.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.35.7** Rule 40.35.7 {#sec-16-40.35.7 omnilex-key=us-ms-regs-official--title-15--16#40.35.7}

If a patient's stay in a facility is ten days or less, only a discharge summary will be required in addition to the initial treatment plan.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.35.8** Rule 40.35.8 {#sec-16-40.35.8 omnilex-key=us-ms-regs-official--title-15--16#40.35.8}

If a patient's stay in a facility exceeds ten days, the interdisciplinary team shall develop a master treatment plan that is based on a comprehensive assessment of the patient's needs.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.35.9** The master treatment plan shall contain objectives and methods for achieving them {#sec-16-40.35.9 omnilex-key=us-ms-regs-official--title-15--16#40.35.9}

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.35.10** Rule 40.35.10 {#sec-16-40.35.10 omnilex-key=us-ms-regs-official--title-15--16#40.35.10}

The treatment plan shall reflect the facility's philosophy of treatment and the participation of staff from appropriate disciplines.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.35.11** The treatment plan shall reflect consideration of the patient's clinical needs {#sec-16-40.35.11 omnilex-key=us-ms-regs-official--title-15--16#40.35.11}

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.35.12** The treatment plan shall specify the services necessary to meet the patient's needs {#sec-16-40.35.12 omnilex-key=us-ms-regs-official--title-15--16#40.35.12}

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.35.13** The treatment plan shall include referrals for needed services that are not provided directly by the facility {#sec-16-40.35.13 omnilex-key=us-ms-regs-official--title-15--16#40.35.13}

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.35.14** Rule 40.35.14 {#sec-16-40.35.14 omnilex-key=us-ms-regs-official--title-15--16#40.35.14}

The treatment plan shall contain specific goals that the patient must achieve to attain, maintain, and/or reestablish emotional and/or physical health as well as maximum growth and adaptive capabilities. These goals shall be based on assessments of the patient and, as appropriate, the patient's family.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.35.15** Rule 40.35.15 {#sec-16-40.35.15 omnilex-key=us-ms-regs-official--title-15--16#40.35.15}

The treatment plan shall contain specific objectives that relate to the goals, are written in measurable terms, and include expected achievement dates.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.35.16** Rule 40.35.16 {#sec-16-40.35.16 omnilex-key=us-ms-regs-official--title-15--16#40.35.16}

The treatment plan shall describe the services, activities, and programs planned for the patient, and shall specify the staff members assigned to work with the patient.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.35.17** The treatment plan shall specify the frequency of treatment procedures {#sec-16-40.35.17 omnilex-key=us-ms-regs-official--title-15--16#40.35.17}

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.35.18** The treatment plan shall delineate the specific criteria to be met for termination of treatment {#sec-16-40.35.18 omnilex-key=us-ms-regs-official--title-15--16#40.35.18}

Such criteria shall be a part of the initial treatment plan.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.35.19** Rule 40.35.19 {#sec-16-40.35.19 omnilex-key=us-ms-regs-official--title-15--16#40.35.19}

When appropriate, the patient shall participate in the development of his or her treatment plan, and such participation shall be documented in the patient's record.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.35.20** A specific plan for involving the family or significant others shall be included in the treatment plan when indicated {#sec-16-40.35.20 omnilex-key=us-ms-regs-official--title-15--16#40.35.20}

**History**
- *SOURCE: Miss. Code Ann. §41-9-17 Subchapter 36 PROGRESS NOTES Rule 40.36.1 Progress notes shall be recorded by the physician, nurse, social worker and, when appropriate, others significantly involved in treatment. The frequency of progress notes is determined by the condition of the patient but should be recorded at least weekly for the first two (2) months and at least monthly thereafter.*
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.36.2** Progress notes shall be entered in the patient's record and shall include the following: a {#sec-16-40.36.2 omnilex-key=us-ms-regs-official--title-15--16#40.36.2}

documentation of implementation of the treatment plan b. documentation of all treatment rendered to the patient c. description of change in the patient's condition; and d. descriptions of the response of the patient to treatment, the outcome of treatment, and the response of significant others to important intercurrent events.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.36.3** Progress notes shall be dated and signed by the individual making the entry {#sec-16-40.36.3 omnilex-key=us-ms-regs-official--title-15--16#40.36.3}

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.36.4** Rule 40.36.4 {#sec-16-40.36.4 omnilex-key=us-ms-regs-official--title-15--16#40.36.4}

All entries involving subjective interpretation of the patient's progress should be supplemented with a description of the actual behavior observed.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17 Subchapter 37 TREATMENT PLAN REVIEW Rule 40.37.1 Interdisciplinary case conferences shall be regularly conducted to review and evaluate each patient's treatment plan and his or her progress in attaining the stated treatment goals and objectives.*
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.37.2** Rule 40.37.2 {#sec-16-40.37.2 omnilex-key=us-ms-regs-official--title-15--16#40.37.2}

Interdisciplinary case conferences shall be documented, and the results of the review and evaluation shall be recorded in the patient's record. The review and update shall be completed no later than thirty (30) days following the first 10 days of treatment and at least every 60 days thereafter.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17 Subchapter 38 DISCHARGE PLANNING/AFTERCARE Rule 40.38.1 The facility maintains a centralized coordinated program to ensure that each patient has a planned program of continuing care which meets his post-discharge needs.*
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.38.2** Each patient shall have an individualized discharge plan which reflects input from all disciplines involved in his care {#sec-16-40.38.2 omnilex-key=us-ms-regs-official--title-15--16#40.38.2}

The patient, patient's family, and/or significant others shall be involved in the discharge planning process.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.38.3** Discharge planning data shall be collected at the time of admission or within seven (7) days thereafter {#sec-16-40.38.3 omnilex-key=us-ms-regs-official--title-15--16#40.38.3}

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.38.4** Rule 40.38.4 {#sec-16-40.38.4 omnilex-key=us-ms-regs-official--title-15--16#40.38.4}

The Chief Executive Officer shall delegate the responsibility for discharge planning, in writing, to one or more staff members.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.38.5** The facility shall maintain written discharge planning policies and procedures which describe: {#sec-16-40.38.5 omnilex-key=us-ms-regs-official--title-15--16#40.38.5}

1. How the discharge coordinator will function, and his authority and relationships with the facility's staff; 2. The time period in which each patient's need for discharge planning is determined (within seven days after admission). 3. The maximum time period after which re-evaluation of each patient's discharge plan is made. 4. Local resources available to the facility and the patient to assist in developing and implementing individual discharge plan; and e. Provisions for periodic review and re-evaluation of the facility's discharge planning program (at least annually).

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.38.6** An interdisciplinary case conference shall be held prior to the patient's discharge {#sec-16-40.38.6 omnilex-key=us-ms-regs-official--title-15--16#40.38.6}

The discharge/aftercare plan shall be reviewed with the patient, patient's family and/or significant others.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.38.7** Rule 40.38.7 {#sec-16-40.38.7 omnilex-key=us-ms-regs-official--title-15--16#40.38.7}

The facility shall have documentation that the aftercare plan has been implemented and shall have documentation of follow-ups to assure referrals to appropriate community agencies.

Recommendations and arrangements for further treatment, including prescribed medications and aftercare.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17 Subchapter 39 DISCHARGE SUMMARY Rule 40.39.1 A discharge summary shall be entered in the patient's record within fourteen (14) days following discharge. The discharge summary shall include but not be limited to: a. reason for admission b. brief summary of treatment c. reason for discharge d. assessment of treatment plan goals and objectives.*
- *SOURCE: Miss. Code Ann. §41-9-17 Subchapter 40 SUPPORT SERVICES: PHARMACY Rule 40.40.1 Direction and Supervision: The hospital shall have a pharmacy directed by a registered pharmacist, who has had, by education or experience, training in the specialized area of hospital pharmacy. The pharmacy or drug room shall be administered in accordance with accepted professional principles. The pharmacist shall be assisted, as needed, by additional qualified pharmacists and ancillary personnel.*
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.40.2** Rule 40.40.2 {#sec-16-40.40.2 omnilex-key=us-ms-regs-official--title-15--16#40.40.2}

Pharmacy assistants shall work under the supervision of a pharmacist and shall not be assigned duties that are required to be performed only by registered pharmacists.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.40.3** Provision shall be made for emergency pharmaceutical services {#sec-16-40.40.3 omnilex-key=us-ms-regs-official--title-15--16#40.40.3}

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.40.4** Rule 40.40.4 {#sec-16-40.40.4 omnilex-key=us-ms-regs-official--title-15--16#40.40.4}

If the hospital has 50 beds or less, and if no full-time pharmacists are employed by the hospital; and if medications administered to patients in the hospital are dispensed by pharmacist(s) elsewhere (i.e. outside the hospital)...then the hospital must have arrangements with a consultant pharmacist who shall supervise all matters pertaining to medication handling in the hospital. The hospital must have a written agreement with the consultant pharmacist to provide services on a routine basis to the hospital. The consultant pharmacist must make regular visits to the hospital to ensure the proper procurement, storage, recordkeeping, administration, and disposal of medications within the hospital. The consultant pharmacist must submit a written report, at least monthly, to the administrator upon the status of the performance of nursing personnel in the areas of drug handling as mentioned above. The report shall include any discrepancies in recordkeeping the consultant pharmacist finds during his/her inspection of the hospital. The consultant pharmacist shall meet all other requirements for Pharmacist as outlined under the other Subchapters 40 through 50.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17 Subchapter 41 RECORDS Rule 40.41.1 Records shall be kept of the transactions of the pharmacy (or drug room) and correlated with other hospital records where indicated. Such special records shall be kept as required by law.*
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.41.2** Rule 40.41.2 {#sec-16-40.41.2 omnilex-key=us-ms-regs-official--title-15--16#40.41.2}

The pharmacy shall establish and maintain a satisfactory system of records and accountability in accordance with the policies of the hospital for maintaining adequate control over the requisitioning and dispensing of all drugs and pharmaceutical supplies.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.41.3** Rule 40.41.3 {#sec-16-40.41.3 omnilex-key=us-ms-regs-official--title-15--16#40.41.3}

A record of the stock on hand and of the dispensing of all narcotic drugs shall be maintained in such a manner that the disposition of any particular item may be readily traced.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.41.4** Rule 40.41.4 {#sec-16-40.41.4 omnilex-key=us-ms-regs-official--title-15--16#40.41.4}

Where possible, the label of each outpatient's individual prescription medication container shall bear the lot and control number of the drug, the name of the manufacturer (or trademark) and, unless the physician directs otherwise, the name of the medication dispensed.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17 Subchapter 42 CONTROL OF TOXIC OR DANGEROUS DRUGS Rule 40.42.1 Policies shall be established to control the administration of toxic or dangerous drugs with specific reference to the duration of the order and the dosage. The facility shall establish a written policy that all toxic or dangerous medications, not specifically prescribed as to time or number of doses, shall be automatically stopped after a reasonable time limit. The classification ordinarily thought of as toxic, dangerous or abuse drugs shall be varcotics, sedatives, anticoagulants, antibiotics, oxytocics and cortisone products, and shall include other categories so established by federal, state or local laws.*
- *SOURCE: Miss. Code Ann. §41-9-17 Subchapter 43 DRUGS TO BE DISPENSED Rule 40.43.1 The pharmacist, with the advice and guidance of the pharmacy and therapeutics committee, shall be responsible for specifications as to quality, quantity, and source of supply of all drugs.*
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.43.2** Rule 40.43.2 {#sec-16-40.43.2 omnilex-key=us-ms-regs-official--title-15--16#40.43.2}

There shall be available a formulary or list of drugs accepted for use in the facility which is developed and amended at regular intervals by the pharmacy and therapeutics committee (or equivalent committee) with the cooperation of the pharmacist and the administration.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.43.3** The pharmacy of drug room shall be adequately supplied with preparations as approved {#sec-16-40.43.3 omnilex-key=us-ms-regs-official--title-15--16#40.43.3}

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.43.4** Committee {#sec-16-40.43.4 omnilex-key=us-ms-regs-official--title-15--16#40.43.4}

There shall be a pharmacy and therapeutics committee (or equivalent committee), composed of physicians and pharmacists, and registered professional nurses, established in the facility.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.43.5** Rule 40.43.5 {#sec-16-40.43.5 omnilex-key=us-ms-regs-official--title-15--16#40.43.5}

It shall represent the organization line of communication and the liaison between the professional staff and the pharmacist.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.43.6** Rule 40.43.6 {#sec-16-40.43.6 omnilex-key=us-ms-regs-official--title-15--16#40.43.6}

The committee shall assist in the formulation of board professional policies regarding the evaluation, appraisal, selection, procurement, storage, distribution, use, and safety procedures, and all other matters relating to drugs in hospitals.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.43.7** The committee shall perform the following specific functions: a {#sec-16-40.43.7 omnilex-key=us-ms-regs-official--title-15--16#40.43.7}

Serve as an advisory group to the professional staff and the pharmacist on matters pertaining to the choice of drugs; b. develop and review periodically a formulary or drug list for use in the facility; c. establish standards concerning the use and control of investigational drugs and research in the use of recognized drugs; d. evaluate clinical data concerning new drugs or preparations requested for use in the facility; e. make recommendations concerning drugs to be stocked on the nursing unit floors and by other services; and f. prevent unnecessary duplication in stocking drugs and drugs in combination having identical amounts of the same therapeutic ingredients.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.43.8** The committee shall meet at least quarterly and report to the professional staff {#sec-16-40.43.8 omnilex-key=us-ms-regs-official--title-15--16#40.43.8}

**History**
- *SOURCE: Miss. Code Ann. §41-9-17 Subchapter 44 MEDICATION CONTROL Rule 40.44.1 The facility shall have written policies and procedures designed to ensure that all medications are dispensed and administered safely and properly in accordance with the applicable federal, state, and local laws and regulations.*
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.44.2** Medication orders shall be written only by authorized prescribers {#sec-16-40.44.2 omnilex-key=us-ms-regs-official--title-15--16#40.44.2}

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.44.3** An up-to-date list of authorized prescribers shall be available in all areas where medication is dispensed {#sec-16-40.44.3 omnilex-key=us-ms-regs-official--title-15--16#40.44.3}

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.44.4** Telephone orders shall be accepted only from individuals on the list of authorized prescribers {#sec-16-40.44.4 omnilex-key=us-ms-regs-official--title-15--16#40.44.4}

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.44.5** Rule 40.44.5 {#sec-16-40.44.5 omnilex-key=us-ms-regs-official--title-15--16#40.44.5}

Telephone orders shall be limited to emergency situations that have been defined in writing in the facility's policies and procedures manual.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.44.6** Telephone orders shall be accepted and written in the patient's record only by staff authorized to administer medication {#sec-16-40.44.6 omnilex-key=us-ms-regs-official--title-15--16#40.44.6}

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.44.7** Rule 40.44.7 {#sec-16-40.44.7 omnilex-key=us-ms-regs-official--title-15--16#40.44.7}

Telephone orders shall be signed by an authorized prescriber on the next regular working day, but in all events within 72 hours.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.44.8** A written order signed by the authorized prescriber shall be include in patient's record {#sec-16-40.44.8 omnilex-key=us-ms-regs-official--title-15--16#40.44.8}

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.44.9** Rule 40.44.9 {#sec-16-40.44.9 omnilex-key=us-ms-regs-official--title-15--16#40.44.9}

Medication orders that contain abbreviations and chemical symbols shall be carried out only if the abbreviations and symbols are on a standard list approved by the physician members of the professional staff.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.44.10** There shall be automatic stop orders on specified medications {#sec-16-40.44.10 omnilex-key=us-ms-regs-official--title-15--16#40.44.10}

Refer to Rule 40.34. 1.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.44.11** There shall be a specific routine of drug administration, indicating dose schedules and standardization of abbreviations {#sec-16-40.44.11 omnilex-key=us-ms-regs-official--title-15--16#40.44.11}

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.44.12** Only pharmacists, physicians, registered nurses, or licensed practical nurses shall administer medications {#sec-16-40.44.12 omnilex-key=us-ms-regs-official--title-15--16#40.44.12}

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.44.13** Self administration of medication shall be permitted only when specifically ordered by the responsible physician {#sec-16-40.44.13 omnilex-key=us-ms-regs-official--title-15--16#40.44.13}

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.44.14** Rule 40.44.14 {#sec-16-40.44.14 omnilex-key=us-ms-regs-official--title-15--16#40.44.14}

Drugs brought into the facility by patients shall not be administered unless they can be absolutely identified, and unless written orders to administer these specific drugs are given by the responsible physician. If the drugs that the patient brings to the facility are not to be used, they shall be packaged, sealed, and stored, and, if approved by the responsible physician, they shall be returned to the patient, family, or significant others at the time of discharge.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.44.15** Rule 40.44.15 {#sec-16-40.44.15 omnilex-key=us-ms-regs-official--title-15--16#40.44.15}

The patient and, when appropriate, the family shall be instructed about which medications, if any, are to be administered at home.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.44.16** Medications administered, medication errors, and adverse drug reactions shall be documented in the patient's record {#sec-16-40.44.16 omnilex-key=us-ms-regs-official--title-15--16#40.44.16}

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.44.17** Rule 40.44.17 {#sec-16-40.44.17 omnilex-key=us-ms-regs-official--title-15--16#40.44.17}

Facilities should implement a reporting system under which the reporting program of the federal Food and Drug Administration and the drug manufacturer are advised of unexpected adverse drug reactions.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.44.18** There shall be methods of detecting drug side effects or toxic reactions {#sec-16-40.44.18 omnilex-key=us-ms-regs-official--title-15--16#40.44.18}

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.44.19** Rule 40.44.19 {#sec-16-40.44.19 omnilex-key=us-ms-regs-official--title-15--16#40.44.19}

Investigational drugs shall be used only under the direct supervision of the principal investigator and with the approval of research review committee and either the physician members of the professional staff or an appropriate committee of the professional staff.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.44.20** Rule 40.44.20 {#sec-16-40.44.20 omnilex-key=us-ms-regs-official--title-15--16#40.44.20}

A central unit shall be established where essential information on investigational drugs, such as dosage form, dosage range, storage requirements, adverse reactions, usage, and contraindications, is maintained.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.44.21** Investigational drugs shall be properly labeled {#sec-16-40.44.21 omnilex-key=us-ms-regs-official--title-15--16#40.44.21}

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.44.22** Nurses may administer investigational drugs only after receiving basic pharmacologic information about the drugs {#sec-16-40.44.22 omnilex-key=us-ms-regs-official--title-15--16#40.44.22}

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.44.23** The facility shall have specific methods for controlling and accounting for drug products {#sec-16-40.44.23 omnilex-key=us-ms-regs-official--title-15--16#40.44.23}

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.44.24** Rule 40.44.24 {#sec-16-40.44.24 omnilex-key=us-ms-regs-official--title-15--16#40.44.24}

The pharmacy service shall maintain records of its transactions as required by law and as necessary to maintain adequate control of, and accountability for, all drugs. These records shall document all supplies issued to units, departments, or services of the facility, as well as all prescription drugs dispensed.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.44.25** Rule 40.44.25 {#sec-16-40.44.25 omnilex-key=us-ms-regs-official--title-15--16#40.44.25}

Records and inventories of the drugs listed in the current Comprehensive Drug Abuse Prevention and Control Act shall be maintained as required by the act and regulations.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.44.26** Rule 40.44.26 {#sec-16-40.44.26 omnilex-key=us-ms-regs-official--title-15--16#40.44.26}

Distribution and administration of controlled drugs are adequately documented, and inspections of these records by the pharmacist is documented.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17 Subchapter 45 EMERGENCY MEDICATION KIT Rule 40.45.1 There is an emergency kit that is: a. made up under the supervision and responsibility of the pharmacist, and approved by the Pharmacy and Therapeutic Committee; b. readily available to staff yet not accessible to patients; c. constituted so as to be appropriate to the needs of the patients; and d. inspected monthly to remove deteriorated and outdated drugs and to ensure completeness of content.*
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.45.2** Rule 40.45.2 {#sec-16-40.45.2 omnilex-key=us-ms-regs-official--title-15--16#40.45.2}

The pharmacist responsible for the emergency kit shall provide a list of its contents and appropriate instructions, and shall authenticate this list with his signature.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17 Subchapter 46 STORAGE OF DRUGS Rule 40.46.1 Drug storage shall be maintained in accordance with the security requirements of federal, state, and local laws. Drug preparation areas and drug storage areas shall be well-lighted and shall be so located that personnel will not be interrupted when handling drugs.*
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.46.2** All drugs shall be kept in locked storage {#sec-16-40.46.2 omnilex-key=us-ms-regs-official--title-15--16#40.46.2}

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.46.3** Poisons, external drugs, and internal drugs shall be stored on separate shelves or in separate cabinets {#sec-16-40.46.3 omnilex-key=us-ms-regs-official--title-15--16#40.46.3}

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.46.4** Rule 40.46.4 {#sec-16-40.46.4 omnilex-key=us-ms-regs-official--title-15--16#40.46.4}

Medications that are stored in a refrigerator containing items other than drugs shall be kept in a separate compartment or container with proper security.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.46.5** Rule 40.46.5 {#sec-16-40.46.5 omnilex-key=us-ms-regs-official--title-15--16#40.46.5}

Antidote charts and the telephone number of the Regional Poison Control Center shall be kept in all drug storage and preparation areas.

Adequate space is defined on a minimum of 350 square feed for 50 beds or less; 500 sq. feet for 75 beds or less; 750 sq. ft. for 100 beds of less, and 1000 sq. ft. for 100 beds or more.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17 Subchapter 47 SPACE FOR STORAGE OF DRUGS Rule 40.47.1 Adequate space shall be provided in the Pharmacy for storage of drugs and for keeping of necessary records. The pharmacy shall be capable of being securely locked in accordance with regulations regarding storage of dangerous drugs.*
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.47.2** Rule 40.47.2 {#sec-16-40.47.2 omnilex-key=us-ms-regs-official--title-15--16#40.47.2}

If the hospital has 50 beds or less, and if no full-time pharmacists are employed by the hospital, and if medications administered to patients in the hospital are dispensed by pharmacist(s) elsewhere (i.e. outside the hospital)...then only the storage of pre-dispensed, individual medications (either medication containers or unit-dose medications) shall be allowed in the hospital. The exception is for the allowance for Emergency Medications as outlined in Rule 40.45.1

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.47.3** Rule 40.47.3 {#sec-16-40.47.3 omnilex-key=us-ms-regs-official--title-15--16#40.47.3}

Storage of medications, as outlined directly above, in the hospital shall be in an area to measure not less than 100 square feet of space. This storage area is to be designated as the Medication Preparation Area/Room, and is to have the following personality: 1. Medication Refrigerator (for storage or drugs and biologicals); 2. Handwashing lavatory with hot water capability, and paper towel dispenser. 3. Medication Preparation Area/Room to have self-closing self-locking door(s); 4. Medication Preparation Area/Room to have its own environment control, i.e., its own thermostats and regulator of heating and air-conditioning. The air temperature in the Medication Preparation Area/Room is not to exceed 85 degrees Fahrenheit or fall below 50 degrees Fahrenheit.

5. Medication Preparation Area/Room to have counter-top space provided for medication preparation adequate to meet the needs of the hospital, but not less than 18 square feet of space (the hospital may ask for a variance of this requirement if medication carts are utilized with a unit-dose drug delivery system). 6. Medication Preparation Area/Room to have special, securely constructed cabinet(s) or area, adequate in size, for the storage of controlled substances in the hospital (the hospital may ask for a variance of this requirement if medication carts are utilized which are equipped with securely constructed controlled substance cabinets(s).

**History**
- *SOURCE: Miss. Code Ann. §41-9-17 Subchapter 48 QUALITY ASSURANCE ACTIVITIES Rule 40.48.1 A pharmacist shall regularly review the medication records of patients.*
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.48.2** All medication orders shall be reviewed monthly by the responsible physician {#sec-16-40.48.2 omnilex-key=us-ms-regs-official--title-15--16#40.48.2}

Adverse drug reactions and medication errors shall be reported to the physician responsible for the patient, and shall be documented in the patient's record.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.48.3** Rule 40.48.3 {#sec-16-40.48.3 omnilex-key=us-ms-regs-official--title-15--16#40.48.3}

The pharmacist in charge of dispensing medications shall provide for monthly inspection of all storage units including emergency boxes and emergency carts.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.48.4** A record of these inspections shall be maintained in order to verify the following: 1 {#sec-16-40.48.4 omnilex-key=us-ms-regs-official--title-15--16#40.48.4}

Disinfectants and drugs for external use are stored separately from internal and injectable medications. 2. Drugs requiring special conditions for storage to ensure stability are properly stored.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17 Subchapter 49 FUNCTIONAL SAFETY AND SANITATION Rule 40.49.1 Adequate precautions shall be taken to store medications under proper conditions of sanitation, temperature, light, moisture, ventilation, segregation, and security.*
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.49.2** All drugs shall be kept in locked storage {#sec-16-40.49.2 omnilex-key=us-ms-regs-official--title-15--16#40.49.2}

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.49.3** Security shall be maintained in accordance with local and state laws {#sec-16-40.49.3 omnilex-key=us-ms-regs-official--title-15--16#40.49.3}

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.49.4** Poisons, external drugs, and internal drugs shall be stored on separate shelves or in separate containers {#sec-16-40.49.4 omnilex-key=us-ms-regs-official--title-15--16#40.49.4}

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.49.5** Rule 40.49.5 {#sec-16-40.49.5 omnilex-key=us-ms-regs-official--title-15--16#40.49.5}

Drugs preparation and storage areas shall be well lighted and shall be located where personnel will not be interrupted when handling drugs.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.49.6** Rule 40.49.6 {#sec-16-40.49.6 omnilex-key=us-ms-regs-official--title-15--16#40.49.6}

Metric-apothecaries' weight and measure conversion charts shall be posted in each drug preparation area and wherever else they are needed.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17 Subchapter 50 CONTINUING EDUCATION Rule 40.50.1 The director of the pharmacy service shall receive orientation in the specialization functions of the facility.*
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.50.2** A pharmacist should participate in staff development programs for the clinical staff {#sec-16-40.50.2 omnilex-key=us-ms-regs-official--title-15--16#40.50.2}

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.50.3** Rule 40.50.3 {#sec-16-40.50.3 omnilex-key=us-ms-regs-official--title-15--16#40.50.3}

As appropriate, a pharmacist should participate in public education and information programs relative to the services of the facility.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.50.4** Rule 40.50.4 {#sec-16-40.50.4 omnilex-key=us-ms-regs-official--title-15--16#40.50.4}

Up-to-date pharmaceutical reference material shall be provided so that appropriate staff will have adequate information concerning drugs.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.50.5** Rule 40.50.5 {#sec-16-40.50.5 omnilex-key=us-ms-regs-official--title-15--16#40.50.5}

Current editions of text and reference books covering the following topics shall be provided; theoretical and practical pharmacy; general, organic, pharmaceutical, and biological chemistry; toxicology; pharmacology; bacteriology; sterilization and disinfection; and other subjects important to good patient care.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17 Subchapter 51 DIETARY: ORGANIZATION*

##### **15 Miss. Admin. Code Pt. 16, R. 40.51.1** Rule 40.51.1 {#sec-16-40.51.1 omnilex-key=us-ms-regs-official--title-15--16#40.51.1}

The facility shall have an organized dietary department directed by a qualified food service supervisor, with services of a registered dietitian on at least a consultant basis. However, a facility which has a contract with an outside food management company may be found to meet this requirement if the company has a therapeutic dietitian who serves, as required by scope and complexity of the services, on a full-time, part-time, or consultant basis to the facility. If the dietitian is not employed full-time a certified food service supervisor should direct the dietary department.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.51.2** The qualified dietitian shall be registered or eligible for registration by the Commission on Dietetic Registration {#sec-16-40.51.2 omnilex-key=us-ms-regs-official--title-15--16#40.51.2}

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.51.3** Rule 40.51.3 {#sec-16-40.51.3 omnilex-key=us-ms-regs-official--title-15--16#40.51.3}

When a qualified dietitian is employed on a part-time or consultative basis, the dietitian shall devote enough time to accomplish the following tasks: 1. Assure continuity of services; 2. Direct the nutritional aspects of patient care; 3. Assure that dietetic instructions are carried out; 4. On occasion, supervise the serving of meals; and assist in the evaluation of the dietetic services.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.51.4** Rule 40.51.4 {#sec-16-40.51.4 omnilex-key=us-ms-regs-official--title-15--16#40.51.4}

Regular written reports shall be submitted to the Chief Executive Officer on the extent of services provided by the dietitian.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.51.5** Rule 40.51.5 {#sec-16-40.51.5 omnilex-key=us-ms-regs-official--title-15--16#40.51.5}

There shall be written policies and procedures for food storage, preparation, and service developed by a registered dietitian.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.51.6** Rule 40.51.6 {#sec-16-40.51.6 omnilex-key=us-ms-regs-official--title-15--16#40.51.6}

The dietetic service shall have an adequate number of appropriately qualified individual to meet the dietetic needs of the facility's patients. Dietetic service personnel shall assist patients when necessary in making appropriate food choices from the planned daily menu. Dietetic services personnel shall be made aware that emotional factors may cause patients to change their food habits. Dietetic service personnel shall inform appropriate members of the professional staff of any change in a patient's food habits.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.51.7** Written job descriptions of all dietary employees shall be available {#sec-16-40.51.7 omnilex-key=us-ms-regs-official--title-15--16#40.51.7}

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.51.8** There shall be procedures to control dietary employees with infectious and open lesions {#sec-16-40.51.8 omnilex-key=us-ms-regs-official--title-15--16#40.51.8}

Routine health examinations shall meet local and state codes for food service personnel.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.51.9** Rule 40.51.9 {#sec-16-40.51.9 omnilex-key=us-ms-regs-official--title-15--16#40.51.9}

There shall be an on-going planned in-service training program for dietary employees which includes the proper handling of food and personal grooming, safety, sanitation, behavioral and therapeutic needs of patients.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17 Subchapter 52 FACILITIES Rule 40.52.1 Adequate space, equipment, ventilation and supplies as well as any necessary written procedure and precautions, shall be provided for the safe and sanitary operation of the dietetic service and the safe and sanitary handling and distribution of food.*
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.52.2** The food service area should be appropriately located {#sec-16-40.52.2 omnilex-key=us-ms-regs-official--title-15--16#40.52.2}

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.52.3** The dietitian's office should be easily accessible to all who require consultation services {#sec-16-40.52.3 omnilex-key=us-ms-regs-official--title-15--16#40.52.3}

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.52.4** Sufficient space shall be provided for support personnel to perform their duties {#sec-16-40.52.4 omnilex-key=us-ms-regs-official--title-15--16#40.52.4}

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.52.5** Rule 40.52.5 {#sec-16-40.52.5 omnilex-key=us-ms-regs-official--title-15--16#40.52.5}

The layout of the department and the type, amount, size, and placement of equipment shall make possible the efficient and sanitary preparation and distribution of food.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.52.6** Rule 40.52.6 {#sec-16-40.52.6 omnilex-key=us-ms-regs-official--title-15--16#40.52.6}

Lavatories with wrist action blades, soap dispenser and disposable towel dispenser shall be located throughout the dietary department.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.52.7** Rule 40.52.7 {#sec-16-40.52.7 omnilex-key=us-ms-regs-official--title-15--16#40.52.7}

Dry or staple food items shall be stored in a ventilation room which is not subject to sewage or waste water backflow, or contamination by condensation, leakage, rodents or vermin.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.52.8** All perishable foods shall be refrigerated at the appropriate temperature and in an orderly and sanitary manner {#sec-16-40.52.8 omnilex-key=us-ms-regs-official--title-15--16#40.52.8}

Each refrigerator shall contain a thermometer in good working order.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.52.9** Foods being displayed or transported shall be protected from contamination {#sec-16-40.52.9 omnilex-key=us-ms-regs-official--title-15--16#40.52.9}

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.52.10** Rule 40.52.10 {#sec-16-40.52.10 omnilex-key=us-ms-regs-official--title-15--16#40.52.10}

Dishwashing procedures and techniques shall be developed and carried out in compliance with the state and local health codes.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.52.11** Rule 40.52.11 {#sec-16-40.52.11 omnilex-key=us-ms-regs-official--title-15--16#40.52.11}

All garbage and kitchen refuse which is not disposed of mechanically shall be kept in leak-proof non-absorbent containers with close fitting covers and be disposed of routinely in manner that will not permit transmission of disease, a nuisance, or a breeding place for flies.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.52.12** All garbage containers are to be thoroughly cleaned inside and outside each time emptied {#sec-16-40.52.12 omnilex-key=us-ms-regs-official--title-15--16#40.52.12}

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.52.13** Rule 40.52.13 {#sec-16-40.52.13 omnilex-key=us-ms-regs-official--title-15--16#40.52.13}

All dietary areas, equipment, walls, floors, etc., shall be kept maintained in good working condition and sanitary at all times.

1. The dietitian shall have available an up-to-date manual or regimens for all therapeutic diets, approved jointly by the dietitian and medical staff, which is available to dietary supervisory personnel. Diets serviced to patients shall be in compliance with these established diet principles:

a. The diet manual shall be reviewed annually and revised as necessary by a qualified dietitian, and shall be dated to identify the time of the review. b. Revisions to the diet manual shall be approved by the facility's physician. c. The diet manual should be used to standardize the ordering of diets. d. The policies and procedures shall provide for dietetic counseling. e. The nutritional deficiencies of any diet in the manual shall be indicated. f. The policies and procedures shall require the recording of dietetic orders in the patient's record. g. The policies and procedures shall require the recording of all observations and information pertinent to dietetic treatment in the patient's record by the food service supervisor or dietitian. h. The policies and procedures shall require the use of standards for nutritional care in evaluating the nutritional adequacy of the patient's diet and in ordering diet supplements. The current Recommended Dietary Allowances of the Food and Nutrition Board of the National Research Council of the National Academy of Science is suggested as a guide in developing these standards. i. The policies and procedures shall describe the methods for assuring that each patient on a special diet receives the prescribed diet regimen. j. The policies and procedures shall provide for altering diets or diet schedules as well as for discontinuing diets. k. Dietetic service personnel shall conduct periodic food acceptance studies among the patients and should encourage them to participate in menu planning. l. The results of food acceptance studies should be reflected in revised menus. m. All menus shall be approved by a qualified dietitian.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17 Subchapter 53 DIETS Rule 40.53.1 There shall be a systematic record of diets, correlated when appropriate, with the medical records.*
- *SOURCE: Miss. Code Ann. §41-9-17 Subchapter 54 FOOD SERVICE AND DINING Rule 40.54.1 Food shall be served in an appetizing and attractive manner, at planned and realistic mealtimes, and in a congenial and relaxed atmosphere.*
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.54.2** Dining areas should be attractive and maintained at appropriate temperatures {#sec-16-40.54.2 omnilex-key=us-ms-regs-official--title-15--16#40.54.2}

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.54.3** Rule 40.54.3 {#sec-16-40.54.3 omnilex-key=us-ms-regs-official--title-15--16#40.54.3}

The dietetic services shall be patient-oriented and should take into account the many factors that contribute to the wide variations in patient eating habits, including cultural, religious, and ethnic factors.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.54.4** Snacks shall be available as appropriate to the nutritional needs of the patient and the needs of the facility {#sec-16-40.54.4 omnilex-key=us-ms-regs-official--title-15--16#40.54.4}

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.54.5** The dietetic service shall be prepared to give extra food to individual patients {#sec-16-40.54.5 omnilex-key=us-ms-regs-official--title-15--16#40.54.5}

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.54.6** Appropriate food should be available for patients with special or limited dietary needs {#sec-16-40.54.6 omnilex-key=us-ms-regs-official--title-15--16#40.54.6}

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.54.7** There shall be adequate equipment provided for tray assembly and tray delivery {#sec-16-40.54.7 omnilex-key=us-ms-regs-official--title-15--16#40.54.7}

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.54.8** Facilities or arrangement shall be available family and friends to eat with patients when possible {#sec-16-40.54.8 omnilex-key=us-ms-regs-official--title-15--16#40.54.8}

**History**
- *SOURCE: Miss. Code Ann. §41-9-17 Subchapter 55 RECREATION Rule 40.55.1 The facility shall provide or make arrangements for the provision of recreation services to all patients in accordance with their needs and interests and as appropriate within the scope of the facility's program.*
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.55.2** Rule 40.55.2 {#sec-16-40.55.2 omnilex-key=us-ms-regs-official--title-15--16#40.55.2}

The facility shall have a written plan that describes the organization of their recreation services or the arrangements made for the provision of recreation services. The recreation services shall have a well-organized plan for using community resources. The goals and objectives of the facility's recreation services shall be stated in writing.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.55.3** Rule 40.55.3 {#sec-16-40.55.3 omnilex-key=us-ms-regs-official--title-15--16#40.55.3}

The facility shall have written policies and procedures for the recreation services which are made available to recreation services and other appropriate personnel. The policies and procedures shall be reviewed and revised at least annually.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.55.4** Recreational activities shall be provided to all patients during the day, in the evening, and on weekends {#sec-16-40.55.4 omnilex-key=us-ms-regs-official--title-15--16#40.55.4}

The daily recreation program shall be planned to provide a consistent and well-structured yet flexible framework for daily living. Whenever possible, patients should participate in planning recreational services.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.55.5** Recreation schedules shall be posted in places accessible to patients and staff {#sec-16-40.55.5 omnilex-key=us-ms-regs-official--title-15--16#40.55.5}

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.55.6** The recreation program shall be reviewed and revised according to the changing needs of the patients {#sec-16-40.55.6 omnilex-key=us-ms-regs-official--title-15--16#40.55.6}

1. When indicated, recreation services shall be incorporated in the patient's treatment plan. 2. Recreation services that are included in a patient's treatment plan shall reflect an assessment of the patient's needs interests, life experiences, capacities, and deficiencies. Recreation services staff shall collaborate with other professional staff in delineating goals for patient's treatment, health maintenance, and vocational adjustments.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.55.7** Rule 40.55.7 {#sec-16-40.55.7 omnilex-key=us-ms-regs-official--title-15--16#40.55.7}

The patient's record shall contain progress notes that describe the patient's response to recreation services and other pertinent observations.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.55.8** Vehicles used for transportation shall not be labeled in a manner that calls unnecessary attention to the patient {#sec-16-40.55.8 omnilex-key=us-ms-regs-official--title-15--16#40.55.8}

**History**
- *SOURCE: Miss. Code Ann. §41-9-17 Subchapter 56 QUALITY ASSURANCE ACTIVITIES Rule 40.56.1 The recreation services shall have written procedures for ongoing review and revision of its goals, objectives, and role within the facility.*
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.56.2** The recreation service shall maintain statistical and other records on the functioning and utilization {#sec-16-40.56.2 omnilex-key=us-ms-regs-official--title-15--16#40.56.2}

Subchapter 57 CONTINUING EDUCATION Rule 40.57.1 The facility service shall maintain ongoing staff development programs. Recreation service staff shall participate in appropriate clinical and administrative committees and conferences. Recreation services staff shall receive training and demonstrate competence in handling medical and psychiatric emergencies. The recreation service shall encourage extramural studies and evaluations of recreation services and extramural research in recreation services.

1. Facilities and equipment designated for recreation services shall be constructed or modified in such a manner as to provide, insofar as possible, pleasant and functional areas that are accessible to all patients regardless of their disabilities. 2. Space for offices, storage, and supplies shall be adequate and accessible. 3. When indicated, equipment and supplies that enable the activity to be brought to the patient should be used. 4. Space, equipment and facilities utilized both inside and outside the facility shall meet federal, state, and local requirements for safety, fire prevention, health, and sanitation.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17 Subchapter 58 FUNCTIONAL SAFETY AND SANITATION Rule 40.58.1 Appropriate space, equipment, and facilities shall be provided to meet the needs of patients for recreation services.*
- *SOURCE: Miss. Code Ann. §41-9-17 Subchapter 59 PHYSICAL AND OCCUPATIONAL THERAPY Rule 40.59.1 The facility shall provide, or arrange for, under written agreement, physical and occupational therapy services as needed by patients to improve and maintain functioning.*
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.59.2** Rule 40.59.2 {#sec-16-40.59.2 omnilex-key=us-ms-regs-official--title-15--16#40.59.2}

Qualified therapists, consultants, volunteers, assistants, or aides, are sufficient in number to provide comprehensive occupation and physical therapy services, as needed, to assure that appropriate treatment is rendered for each patient in accordance with stated goals and objectives.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.59.3** Services are provided only upon the written order of a licensed physician {#sec-16-40.59.3 omnilex-key=us-ms-regs-official--title-15--16#40.59.3}

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.59.4** The therapist must: 1 {#sec-16-40.59.4 omnilex-key=us-ms-regs-official--title-15--16#40.59.4}

Record regularly and evaluate periodically the treatment training progress. 2. Use the treatment training progress as the basis for continuation or change in the program.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.59.5** Treatment training programs shall be designed to: a {#sec-16-40.59.5 omnilex-key=us-ms-regs-official--title-15--16#40.59.5}

Preserve and improve abilities for independent function, such as range of motion, strength, tolerance, coordination, and activities of daily living. b. Prevent, insofar as possible, irreducible disabilities through means such as the use of orthotic and prosthetic appliances, assistive and adaptive devices, positioning, behavior adoptions, and sensory stimulation.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.59.6** Rule 40.59.6 {#sec-16-40.59.6 omnilex-key=us-ms-regs-official--title-15--16#40.59.6}

Evaluation results, treatment objectives, plans and procedures and progress notes shall be recorded in the patient's record.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.59.7** Rule 40.59.7 {#sec-16-40.59.7 omnilex-key=us-ms-regs-official--title-15--16#40.59.7}

For effective and efficient physical and occupational therapy services, the facility shall provide sufficient space, equipment and supplies.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.59.8** Physical and occupational therapists shall meet the qualifications of Subchapters 13 through 16 {#sec-16-40.59.8 omnilex-key=us-ms-regs-official--title-15--16#40.59.8}

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.59.9** Therapy assistants must work under the supervision of the qualified therapist {#sec-16-40.59.9 omnilex-key=us-ms-regs-official--title-15--16#40.59.9}

**History**
- *SOURCE: Miss. Code Ann. §41-9-17 Subchapter 60 EDUCATION Rule 40.60.1 The facility shall provide, or make arrangements for the provision of, education services to meet the needs of all patients.*
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.60.2** Rule 40.60.2 {#sec-16-40.60.2 omnilex-key=us-ms-regs-official--title-15--16#40.60.2}

Special education services shall be provided for patients whose emotional disturbances make it difficult for them to learn.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.60.3** Rule 40.60.3 {#sec-16-40.60.3 omnilex-key=us-ms-regs-official--title-15--16#40.60.3}

Education services shall provide opportunities for patients who have fallen behind because of their disorder, to correct deficiencies in their education.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.60.4** Rule 40.60.4 {#sec-16-40.60.4 omnilex-key=us-ms-regs-official--title-15--16#40.60.4}

Facilities that operate their own education service shall have adequate staff and space to meet the educational needs of patients.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.60.5** Rule 40.60.5 {#sec-16-40.60.5 omnilex-key=us-ms-regs-official--title-15--16#40.60.5}

An education director and staff who meet state and/or local certification requirements for education and/or special education shall be provided.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.60.6** Special education teachers shall be certified for individuals with emotional disabilities {#sec-16-40.60.6 omnilex-key=us-ms-regs-official--title-15--16#40.60.6}

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.60.7** Rule 40.60.7 {#sec-16-40.60.7 omnilex-key=us-ms-regs-official--title-15--16#40.60.7}

An appropriate ratio of teachers to students shall be provided so teachers can give special attention to students or to groups of students who are at difference stages of treatment and education.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.60.8** Rule 40.60.8 {#sec-16-40.60.8 omnilex-key=us-ms-regs-official--title-15--16#40.60.8}

The education service shall have space and materials commensurate with the scope of its activities, including an adequate number of classrooms.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.60.9** When indicated, patients shall participate in education programs in the community {#sec-16-40.60.9 omnilex-key=us-ms-regs-official--title-15--16#40.60.9}

Teachers in the community shall be given the information necessary to work effectively with the patient.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.60.10** Clinicians shall periodically confer with teachers or principals on the progress of each patient {#sec-16-40.60.10 omnilex-key=us-ms-regs-official--title-15--16#40.60.10}

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.60.11** When appropriate, patients shall be encouraged to take part in extra curricular school activities {#sec-16-40.60.11 omnilex-key=us-ms-regs-official--title-15--16#40.60.11}

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.60.12** Rule 40.60.12 {#sec-16-40.60.12 omnilex-key=us-ms-regs-official--title-15--16#40.60.12}

There shall be documentation in each patient's record of periodic evaluations of educational achievement in relation to development level, chronological age, sex, individuals with disabilities, medications, and psychotherapeutic needs.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17 Subchapter 61 VOCATIONAL REHABILITATION: POLICIES AND PROCEDURES Rule 40.61.1 Patients shall receive counseling on their specific vocational needs, for example, their vocational strengths and weaknesses, the demands of their current and future jobs, the responsibilities of holding a job, and the problems related to vocational training, placement, and employment.*
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.61.2** A facility may delegate vocational rehabilitation responsibilities to an outside vocational rehabilitation agency {#sec-16-40.61.2 omnilex-key=us-ms-regs-official--title-15--16#40.61.2}

However, the agency must assign an individual approved by the facility to serve as the facility's coordinator of vocational rehabilitation and agree to comply with the standards in this section.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.61.3** Rule 40.61.3 {#sec-16-40.61.3 omnilex-key=us-ms-regs-official--title-15--16#40.61.3}

Facilities that have a vocational rehabilitation service shall have written policies and procedures to govern the operation of the service.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.61.4** The vocational rehabilitation service shall assess the patients vocational needs with regard to the following: 1 {#sec-16-40.61.4 omnilex-key=us-ms-regs-official--title-15--16#40.61.4}

Current work skills and potential for improving skills or developing new ones; 2. Educational background; 3. Aptitudes, interests, and motivations for getting involved in various job-related activities; 4. Physical abilities; 5. Skills and experiences in seeking jobs; 6. Work habits related to tardiness, absenteeism, dependability, honesty, and relations with co-workers and supervisor; 7. Personal grooming and appearance; 8. Expectations regarding the personal, financial, and social benefits to be derived from working; and

9. Amenability to vocational counseling.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.61.5** Vocational services shall be provided according to an individualized treatment plan {#sec-16-40.61.5 omnilex-key=us-ms-regs-official--title-15--16#40.61.5}

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.61.6** The criteria for determining a patient's job-readiness shall be stated in the patient's treatment plan {#sec-16-40.61.6 omnilex-key=us-ms-regs-official--title-15--16#40.61.6}

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.61.7** Rule 40.61.7 {#sec-16-40.61.7 omnilex-key=us-ms-regs-official--title-15--16#40.61.7}

A record shall be kept of vocational rehabilitation activities, including the date and a description of the activity, participants, and results.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.61.8** All work programs must conform to federal, state, and local rules and regulations {#sec-16-40.61.8 omnilex-key=us-ms-regs-official--title-15--16#40.61.8}

**History**
- *SOURCE: Miss. Code Ann. §41-9-17 Subchapter 62 STAFF COMPOSITION AND SUPERVISION Rule 40.62.1 The facility's vocational rehabilitation service shall have a sufficient number of appropriately qualified staff and support personnel.*
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.62.2** A person or team shall be assigned responsibility for the implementation of vocational rehabilitation services {#sec-16-40.62.2 omnilex-key=us-ms-regs-official--title-15--16#40.62.2}

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.62.3** Rule 40.62.3 {#sec-16-40.62.3 omnilex-key=us-ms-regs-official--title-15--16#40.62.3}

The facility shall have at least one qualified vocational rehabilitation counselor or qualified occupational therapist available who is responsible for the professional standards, coordination, and delivery of vocational rehabilitation services.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.62.4** Rule 40.62.4 {#sec-16-40.62.4 omnilex-key=us-ms-regs-official--title-15--16#40.62.4}

All personnel providing vocational rehabilitation services shall have training, experience, and competence consistent with acceptable standards of their specialty field.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.62.5** Rule 40.62.5 {#sec-16-40.62.5 omnilex-key=us-ms-regs-official--title-15--16#40.62.5}

Enough qualified vocational rehabilitation counselors and support personnel shall be available to meet the needs of patients.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17 Subchapter 63 SPEECH, LANGUAGE, AND HEARING: POLICIES AND PROCEDURES Rule 40.63.1 Speech, language, and hearing services shall be available, either within the facility or by written arrangement with another facility or a qualified clinician, to provide assessments of speech, language, or hearing when indicated, and to provide counseling, treatment, and rehabilitation when needed.*
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.63.2** Rule 40.63.2 {#sec-16-40.63.2 omnilex-key=us-ms-regs-official--title-15--16#40.63.2}

Facilities that have a speech, language, and hearing service shall have written policies and procedures to govern the operation of the service.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.63.3** The speech, language, and hearing service shall provide the following services: 1 {#sec-16-40.63.3 omnilex-key=us-ms-regs-official--title-15--16#40.63.3}

Speech and language screening of patients when deemed necessary by members of the treatment team, the family, or significant others; 2. Comprehensive speech and language evaluation of patients when indicated by screening results; 3. Comprehensive audiological assessment of patients when indicated; 4. Procurement, maintenance, or replacement of hearing aids when specified by a qualified audiologist; and 5. Rehabilitation programs, when appropriate, to establish the speech skills necessary for comprehensive and expression.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.63.4** Rule 40.63.4 {#sec-16-40.63.4 omnilex-key=us-ms-regs-official--title-15--16#40.63.4}

Assessment and treatment results shall be reported accurately and systematically and in manner that accomplishes the following: 1. Defines the problem; 2. Provides a basis for formulating a plan that contains treatment objectives and procedures; 3. Provides information of staff working with the patient; and 4. Provides evaluations and summary reports for inclusion in the patient's record.

Subchapter 64 STAFF COMPOSITION AND SUPERVISION Rule 40.64.1 The speech, language, and hearing service shall be administered and supervised by qualified speech-language and hearing clinicians.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.64.2** Rule 40.64.2 {#sec-16-40.64.2 omnilex-key=us-ms-regs-official--title-15--16#40.64.2}

All staff with independent responsibilities shall have a Certificate of Clinical Competence or a Statement of Equivalence in either speech pathology or audiology from the American Speech-Language-Hearing Association, or have documented equivalent training and experience; and shall meet current legal requirements of licensure or registration.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.64.3** Rule 40.64.3 {#sec-16-40.64.3 omnilex-key=us-ms-regs-official--title-15--16#40.64.3}

Support personnel, such as speech pathology assistants and communication aides, shall be qualified by training and/or experience for the level of work they perform and shall be appropriately supervised by a staff speech-language pathologist or audiologist.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17 Subchapter 65 QUALITY ASSURANCE ACTIVITIES Rule 40.65.1 Equipment shall meet the standards of the American Board of Examiners in Speech Pathology and Audiology of the American Speech-Language-Hearing Association, including the standards concerning the location, calibration, and maintenance of equipment; or equipment shall meet equivalent standards.*
- *SOURCE: Miss. Code Ann. §41-9-17 Subchapter 66 DENTAL: POLICIES AND PROCEDURES Rule 40.66.1 The facility shall have a written plan that outlines the procedures used to assess and treat the dental health care needs of patients.*
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.66.2** The written dental health care plan shall describe the following: 1 {#sec-16-40.66.2 omnilex-key=us-ms-regs-official--title-15--16#40.66.2}

Mechanisms for evaluating each patient's need for dental treatment; 2. Provisions for emergency dental services; 3. Policies on oral hygiene and preventive dentistry; 4. Provisions for coordinating dental services with other services provided by the facility; and

5. A mechanism for the referral of patients for services not provided by the facility.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.66.3** Rule 40.66.3 {#sec-16-40.66.3 omnilex-key=us-ms-regs-official--title-15--16#40.66.3}

When a facility provides dental services, a written policy shall delineate the functions of the service and the specific services provided.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.66.4** Reports of all dental services provided shall be made a part of the patient's record {#sec-16-40.66.4 omnilex-key=us-ms-regs-official--title-15--16#40.66.4}

**History**
- *SOURCE: Miss. Code Ann. §41-9-17 Subchapter 67 STAFF COMPOSITION AND SUPERVISION Rule 40.67.1 A dental service provided by the facility shall be directed by a fully licensed dentist who is a member of the professional staff and qualified to assume management and administrative responsibility for the dental service.*
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.67.2** Rule 40.67.2 {#sec-16-40.67.2 omnilex-key=us-ms-regs-official--title-15--16#40.67.2}

A dental service provided by the facility shall have a sufficient number of adequately trained personnel to meet the needs of patients.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17 Subchapter 68 FUNCTIONAL SAFETY AND SANITATION Rule 40.68.1 A dental service provided by the facility shall have adequate space, equipment, instruments, and supplies to meet the needs of patients.*
- *SOURCE: Miss. Code Ann. §41-9-17 Subchapter 69 REFERRALS Rule 40.69.1 The facility shall have written policies and procedures that facilitate the referrals of patients and the provision of consultation between the facility's program components and between the facility and other service providers in the community. The written policies and procedures shall describe the conditions under which referrals can be made and consultations provided. These conditions shall provide for the examinations, assessment, or consultations that are not within the professional domain or expertise of the staff; special treatment services; and assistance from providers who can contribute to the patient's well- being.*
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.69.2** The written policies and procedures shall describe the methods by which continuity of care is assured for the patient {#sec-16-40.69.2 omnilex-key=us-ms-regs-official--title-15--16#40.69.2}

These methods shall include, but not

be limited to, providing the facility, program component, or other service provider to which the patient is referred with the following: 1. Background information on the referral; 2. Information on the patient's treatment, for example, current treatment, diagnostic assessments, and special requirements; 3. Treatment objectives desired; 4. Suggestions for continued coordination between the referring and the receiving resource; 5. Special clinical management requirements; and 6. Information on how the patient can be returned to the referring facility or program component.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.69.3** Rule 40.69.3 {#sec-16-40.69.3 omnilex-key=us-ms-regs-official--title-15--16#40.69.3}

The facility shall ask the facility, program component, or other service provider to which the patient is referred to submit a follow-up report within a designated time period.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.69.4** The written policies and procedures shall describe the mechanism by which a patient may request a referral {#sec-16-40.69.4 omnilex-key=us-ms-regs-official--title-15--16#40.69.4}

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.69.5** Rule 40.69.5 {#sec-16-40.69.5 omnilex-key=us-ms-regs-official--title-15--16#40.69.5}

The written policies and procedures shall describe the means by which the facility assists in the referral of individuals who are seeking services that the facility does not provide.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.69.6** Rule 40.69.6 {#sec-16-40.69.6 omnilex-key=us-ms-regs-official--title-15--16#40.69.6}

The written policies and procedures shall be reviewed and approved annually by the director and appropriate administrative and professional staff members. The annual review and approval shall be documented.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.69.7** Rule 40.69.7 {#sec-16-40.69.7 omnilex-key=us-ms-regs-official--title-15--16#40.69.7}

Each community service provider to which patients are referred shall express in writing its willingness to abide by federal and state standards concerning confidentiality of patient information.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.69.8** The facility shall have a letter of agreement and/or contract with community service providers that it uses repeatedly {#sec-16-40.69.8 omnilex-key=us-ms-regs-official--title-15--16#40.69.8}

Emergency services shall be provided by the facility or through clearly defined arrangements with another facility.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17 Subchapter 70 EMERGENCY Rule 40.70.1 The facility shall have written procedures for taking care of emergencies.*
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.70.2** Rule 40.70.2 {#sec-16-40.70.2 omnilex-key=us-ms-regs-official--title-15--16#40.70.2}

When emergency services are provided by an outside facility, a written plan shall delineate the type of emergency services available and the arrangements for referring or transferring patients to another facility. The written plan shall be available to all professional staff and shall clearly specify the following: 1. The staff of the facility who are available and authorized to provide necessary emergency evaluations; 2. The staff of the facility who are authorized to arrange for patients to be referred or transferred to another facility when necessary; 3. The arrangements the facility has made for exchanging records with the outside facility when it is necessary for the care of the patient; 4. The location of the outside facility and the names of the appropriate personnel to contact; 5. The method of communication between the two facilities; 6. The arrangements the facility has made to assure that when a patient requiring emergency care is transferred to an non-psychiatric or substance abuse service or facility, he or she will receive further evaluation and/or treatment of his or her psychiatric or substance abuse problem, as needed; 7. The arrangements the facility has made for transporting patients, when necessary, from the facility to the facility providing emergency services; 8. The policy for referring patients needing continued care after emergency services back to the referring facility; and 9. Policies concerning notification of the patient's family of emergencies and of arrangements that have been made for referring or transferring the patient to another facility.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.70.3** Rule 40.70.3 {#sec-16-40.70.3 omnilex-key=us-ms-regs-official--title-15--16#40.70.3}

When an emergency service is provided by the facility, the service shall be well organized, properly directed, and integrated with other services of the facility and shall comply with Part IV, Chapter 7, Section 701-705.6 of the Minimum Standards of Operations of Mississippi Hospitals.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17 Subchapter 71 LIBRARY Rule 40.71.1 Library services shall be made available to meet the professional and technical needs of the facility's staff.*
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.71.2** Rule 40.71.2 {#sec-16-40.71.2 omnilex-key=us-ms-regs-official--title-15--16#40.71.2}

Facilities that do not maintain a professional library shall have an arrangement with a nearby facility or institution to use its professional library.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.71.3** Current reference material, books, and basic health care journals shall be available in each facility {#sec-16-40.71.3 omnilex-key=us-ms-regs-official--title-15--16#40.71.3}

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.71.4** Rule 40.71.4 {#sec-16-40.71.4 omnilex-key=us-ms-regs-official--title-15--16#40.71.4}

The library shall establish regular and convenient hours of service so that staff may have prompt access to current materials.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.71.5** Rule 40.71.5 {#sec-16-40.71.5 omnilex-key=us-ms-regs-official--title-15--16#40.71.5}

When a facility operates its own library, the professional library service shall provide pertinent, current and useful medical, psychiatric, psychological, alcohol, drug, educational, and related materials.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.71.6** A facility providing extensive library services should utilize the services of a professional librarian {#sec-16-40.71.6 omnilex-key=us-ms-regs-official--title-15--16#40.71.6}

**History**
- *SOURCE: Miss. Code Ann. §41-9-17 Subchapter 72 LABORATORY/RADIOLOGY Rule 40.72.1 The facility shall have provisions for promptly obtaining required laboratory, x- ray, and other diagnostic services.*
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.72.2** Rule 40.72.2 {#sec-16-40.72.2 omnilex-key=us-ms-regs-official--title-15--16#40.72.2}

If the facility provides its own laboratory and x-ray services, these shall meet the applicable standards established for hospital licensure. Refer to Subchapter 21,

Subchapters 57-61 & Subchapters 70-73 of the Minimum Standards of Operation for Mississippi Hospitals.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.72.3** Rule 40.72.3 {#sec-16-40.72.3 omnilex-key=us-ms-regs-official--title-15--16#40.72.3}

If the facility itself does not provide such services, arrangements shall be made for obtaining these services from a licensed and certified laboratory.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.72.4** All laboratory and x-ray services shall be provided only on the orders of the attending physician {#sec-16-40.72.4 omnilex-key=us-ms-regs-official--title-15--16#40.72.4}

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.72.5** The facility shall assist the patient, if necessary, in arranging for transportation to and from the source of service {#sec-16-40.72.5 omnilex-key=us-ms-regs-official--title-15--16#40.72.5}

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.72.6** Rule 40.72.6 {#sec-16-40.72.6 omnilex-key=us-ms-regs-official--title-15--16#40.72.6}

All signed and dated reports of laboratory, x-ray, and other diagnostic services shall be filed with the patient's medical record.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17 Subchapter 73 VOLUNTEER Rule 40.73.1 In facilities where volunteer services are utilized, the objectives and scope of the volunteer service shall be clearly stated in writing.*
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.73.2** Rule 40.73.2 {#sec-16-40.73.2 omnilex-key=us-ms-regs-official--title-15--16#40.73.2}

An appropriately qualified and experienced staff member shall be assigned to select and evaluate volunteers and to coordinate volunteer activities.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.73.3** The authority and responsibilities of the volunteer coordinator shall be clearly stated in writing {#sec-16-40.73.3 omnilex-key=us-ms-regs-official--title-15--16#40.73.3}

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.73.4** The volunteer coordinator shall perform the following functions: 1 {#sec-16-40.73.4 omnilex-key=us-ms-regs-official--title-15--16#40.73.4}

Assist staff in determining the need for volunteer services and in developing assignments; 2. Plan and implement the program for recruiting volunteers;

3. Coordinate efforts to recruit, select, and train volunteers, and to place volunteers in appropriate services or units; 4. Instruct staff on the proper, effective, and creative use of volunteers; 5. Keep staff and the community informed about volunteer services and activities; 6. Provide opportunities for volunteers to acquire the qualifications for certification when applicable; and 7. Assign an appropriate staff member to provide ongoing supervision, in-service training, and evaluation of volunteers.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.73.5** Rule 40.73.5 {#sec-16-40.73.5 omnilex-key=us-ms-regs-official--title-15--16#40.73.5}

An orientation program shall be conducted to familiarize volunteers with the facility's goals and services and to provide appropriate clinical orientation regarding the facility's patients.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.73.6** The orientation program shall include explanations of at least the following: 1 {#sec-16-40.73.6 omnilex-key=us-ms-regs-official--title-15--16#40.73.6}

The importance of maintaining confidentiality and protecting patients' rights. 2. The procedures for responding to unusual events and incidents; and 3. The program's channels of communication and the distinctions between administrative and clinical authority and responsibility.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.73.7** Rule 40.73.7 {#sec-16-40.73.7 omnilex-key=us-ms-regs-official--title-15--16#40.73.7}

Volunteers shall be under the direct supervision of the staff of the service or unit utilizing their services, and shall receive general direction and guidance from the volunteer coordinator.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.73.8** Rule 40.73.8 {#sec-16-40.73.8 omnilex-key=us-ms-regs-official--title-15--16#40.73.8}

The use of volunteers as members of treatment teams to supplement the total treatment program shall be done only in collaboration with appropriate professional staff members and after consideration of the patients' needs for continuity.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.73.9** Rule 40.73.9 {#sec-16-40.73.9 omnilex-key=us-ms-regs-official--title-15--16#40.73.9}

Supervisory professional staff shall be available to help volunteers establish the most effective relationship with patients.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.73.10** Rule 40.73.10 {#sec-16-40.73.10 omnilex-key=us-ms-regs-official--title-15--16#40.73.10}

Procedures shall be established to assure that the observations of volunteers are reported to the professional staff members responsible for the patient. These observations may be recorded in the patient's record.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.73.11** Volunteers may be utilized to help meet patients' basic needs for social interaction, self-esteem, and self-fulfillment {#sec-16-40.73.11 omnilex-key=us-ms-regs-official--title-15--16#40.73.11}

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.73.12** Rule 40.73.12 {#sec-16-40.73.12 omnilex-key=us-ms-regs-official--title-15--16#40.73.12}

Volunteer activity records and reports shall contain information that can be used to evaluate the effectiveness of the volunteer services.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.73.13** At least the following records shall be maintained by the volunteer service: 1 {#sec-16-40.73.13 omnilex-key=us-ms-regs-official--title-15--16#40.73.13}

A personnel record that includes the volunteer's application, record of assignments, and progress reports; 2. A master assignment schedule for all volunteers, including times and units of assignment; and 3. A current job description for each volunteer.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17 Subchapter 74 RESEARCH OPTIONAL Rule 40.74.1 When a facility or program conducts or participants in research with human subjects, policies shall be designed and written to assure that rigorous review is made of the merits of each research project and of the potential effects of the research procedures on the participants.*
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.74.2** An interdisciplinary research committee shall review all research projects utilizing human subjects {#sec-16-40.74.2 omnilex-key=us-ms-regs-official--title-15--16#40.74.2}

The committee shall be either a permanent standing committee or a committee convened on an as-needed basis.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.74.3** Members of the research review committee shall be qualified by training and experience to serve on the committee {#sec-16-40.74.3 omnilex-key=us-ms-regs-official--title-15--16#40.74.3}

Individuals who have appropriate experience in the research areas being reviewed shall be included on the committee.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.74.4** Rule 40.74.4 {#sec-16-40.74.4 omnilex-key=us-ms-regs-official--title-15--16#40.74.4}

A majority of the committee member should be individuals who are not directly associated with the research project under consideration.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.74.5** Some committee members should be individuals who are not formally associated with the facility {#sec-16-40.74.5 omnilex-key=us-ms-regs-official--title-15--16#40.74.5}

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.74.6** Rule 40.74.6 {#sec-16-40.74.6 omnilex-key=us-ms-regs-official--title-15--16#40.74.6}

Prior to the authorization and initiation of each research project, the research committee shall conduct a detailed review of the project. This review shall include the following: 1. The adequacy of the research design; 2. The qualifications of the individuals responsible for coordinating the project; 3. The benefits of the research in general; 4. The benefits and risks to the participants; 5. The benefits to the facility; 6. The possible disruptive effects of the project on facility operations; 7. The compliance of the research design with accepted ethical standards; 8. The process to be used to obtain informed consent from participants; and 9. The procedures for dealing with any.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.74.7** Rule 40.74.7 {#sec-16-40.74.7 omnilex-key=us-ms-regs-official--title-15--16#40.74.7}

This initial review shall form the basis for a written report that shall be submitted by the committee to the Chief Executive Officer.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.74.8** Rule 40.74.8 {#sec-16-40.74.8 omnilex-key=us-ms-regs-official--title-15--16#40.74.8}

All individuals asked to participate in a research project shall be given the following information before being asked to give their consent: 1. A description of the benefits to be expected; 2. A description of the potential discomforts and risks; 3. A description of alternative services that might prove equally advantageous to them; and

4. A full explanation of the procedures to be followed, especially those that are experimental in nature.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.74.9** Rule 40.74.9 {#sec-16-40.74.9 omnilex-key=us-ms-regs-official--title-15--16#40.74.9}

If the investigator does not wish to fully disclose the purpose, nature, expected outcome, and implications of the research to the participants before it begins, the investigator shall clearly and rigorously justify to the research review committee that such disclosure is inadvisable and that failure to give full disclosure is not detrimental to the participants. Under such conditions, disclosure may be deferred until the research project is completed.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.74.10** Rule 40.74.10 {#sec-16-40.74.10 omnilex-key=us-ms-regs-official--title-15--16#40.74.10}

All research project participants shall sign a consent form that indicates their willingness to participate in the project.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.74.11** Rule 40.74.11 {#sec-16-40.74.11 omnilex-key=us-ms-regs-official--title-15--16#40.74.11}

All consent forms, except as provided in Rule 40.74.9 shall address all of the information specified in Rule 40.74.8 and shall indicate the name of the person who supplied the participant with the information and the date the form was signed.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.74.12** The informed consent document shall address the participant's right to privacy and confidentiality {#sec-16-40.74.12 omnilex-key=us-ms-regs-official--title-15--16#40.74.12}

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.74.13** Rule 40.74.13 {#sec-16-40.74.13 omnilex-key=us-ms-regs-official--title-15--16#40.74.13}

Neither the consent form nor any written or oral agreement entered into by the participant shall include any language that releases the facility, its agents, or those responsible for conducting the research from liability for negligence.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.74.14** Rule 40.74.14 {#sec-16-40.74.14 omnilex-key=us-ms-regs-official--title-15--16#40.74.14}

All prospective participants over the age of 12 and all parents or guardians of participants under the age of 18 shall sign a written consent form that indicates willingness to participate in the project.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.74.15** Rule 40.74.15 {#sec-16-40.74.15 omnilex-key=us-ms-regs-official--title-15--16#40.74.15}

The consent form shall address all of the information specified in Standard 2914.10 and shall indicate the name of the individual who supplied the participant with the information and the date the consent form was signed.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.74.16** Rule 40.74.16 {#sec-16-40.74.16 omnilex-key=us-ms-regs-official--title-15--16#40.74.16}

Prospective participants under the age of 18, and all prospective participants who are legally or functionally incompetent to provide informed consent, shall participate only when and if consent has been given by a person legally empowered to consent, shall participate only when and if consent has been given by a person legally empowered to consent, and such consent has been reviewed by an independent advocacy group, if available.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.74.17** Rule 40.74.17 {#sec-16-40.74.17 omnilex-key=us-ms-regs-official--title-15--16#40.74.17}

Such legal guardian and/or advocate shall receive the same information as required in Rule 40.74.8 and shall sign the consent form.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.74.18** Rule 40.74.18 {#sec-16-40.74.18 omnilex-key=us-ms-regs-official--title-15--16#40.74.18}

A patient's refusal to participate in a research project shall not be a cause for denying or altering the provision of indicated services to that patient.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.74.19** Rule 40.74.19 {#sec-16-40.74.19 omnilex-key=us-ms-regs-official--title-15--16#40.74.19}

Participants shall be allowed to withdraw consent and discontinue participation in a research project at any time without affecting their status in the program.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.74.20** Privacy and confidentiality should be strictly maintained at all times {#sec-16-40.74.20 omnilex-key=us-ms-regs-official--title-15--16#40.74.20}

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.74.21** Rule 40.74.21 {#sec-16-40.74.21 omnilex-key=us-ms-regs-official--title-15--16#40.74.21}

Upon completion of the research procedures, the principal investigator shall attempt to remove any confusion, misinformation, stress, physical discomfort, or other harmful consequences that may have arisen with respect to the participants as a result of the procedures.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.74.22** Rule 40.74.22 {#sec-16-40.74.22 omnilex-key=us-ms-regs-official--title-15--16#40.74.22}

Investigators and other directly involved in research shall, both in obtaining consent and in conducting research, adhere to the ethical standards of their respective professions concerning the conduct of research and should be guided by the regulations of the US Department of Health and Human Services and other federal, state, and local statues and regulations concerning the protection of human subjects.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.74.23** Rule 40.74.23 {#sec-16-40.74.23 omnilex-key=us-ms-regs-official--title-15--16#40.74.23}

Upon completion of the research, the principal investigator, whether a member of the facility's staff or an outside researcher, shall be responsible for communicating the purpose, nature, outcome, and possible practical or

theoretical implications of the research to the staff of the program in a manner which they can understand.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 40.74.24** Rule 40.74.24 {#sec-16-40.74.24 omnilex-key=us-ms-regs-official--title-15--16#40.74.24}

Reports of all research projects shall be submitted to the Chief Executive Officer and the research committee and shall be maintained by the facility.

Provisional License. Within its discretion, the Mississippi State Department of Health may issue a provisional license when a temporary condition of non- compliance with these regulations exists in one or more particulars. A provisional license shall be issued only if the Department of Health is satisfied that preparations are being made to qualify for a regular license and that the health and safety of patients will not be endangered. The license issued under this condition shall be valid until the issuance of a regular license but shall not exceed five months following date of issuance whichever may be sooner.

Rule 41.2.9. Renewal of License. A license, unless suspended or revoked, shall be renewable annually, upon filing by the licensee, and approval by the licensing agency of an annual report upon such uniform dates and containing such information as the licensing agency requires and upon paying the annual fee for such license.

Rule 41.2.12. Trauma Registry. Collection of data on patients who receive hospital care for certain types of injuries. Such data are primarily designed to ensure quality of trauma care and outcomes in individual institutions and trauma systems but have the secondary purpose of providing useful data for the surveillance of injury, morbidity, and mortality.

Rule 41.3.1. The licensing agency, after notice and opportunity for hearing to the applicant or licensee, is authorized to deny, suspend, or revoke a license in any case in which it finds that there has been a substantial failure to comply with the requirements established in these regulations and standards.

2. The name, address, and capacity of each officer and each member of the governing body, as well as the individual(s) directly responsible for the operation of the hospital. 3. Owner's proof of financial ability for continuous operation. 4. The name and address of the resident agent for service of process within the State of Mississippi if the owner shall not reside or be domiciled in the State of Mississippi.

1. The name and address of the operator. 2. The name, address and capacity of each officer and each member of the governing body, as well as the individual(s) responsible for the operation of the hospital. Rule 41.4.3. When any changes shall be made in the constituency of the governing body, the officers, or the individual(s) directly responsible for the operation of the hospital, the hospital shall notify the licensing agency in writing within 15 days of such changes and shall also furnish to it a certified copy of that portion of the minutes of the governing body dealing with such changes.

conduct of the hospital in a manner consistent with the objective of making available high quality patient care. The governing body shall be the supreme authority in the hospital, responsible for the management of the hospital and appointment of the medical staff. The governing body shall adopt bylaws in accordance with legal requirements and with its community responsibility, identifying the purposes of the hospital and the means of fulfilling them, and shall at least: 1. Be in writing available to all members of the governing body. 2. Contain the name of the governing body. 3. State the manner in which the members of the governing body, the officers and the administrative personnel are selected, the terms for which they are elected or appointed, and their duties and responsibilities. 4. Specify to whom authority for operation and maintenance of the hospital, including evaluation of hospital practices, may be delegated; and the methods established by the governing body for holding such individuals responsible. 5. Provide a schedule of meetings of the governing body at sufficiently frequent intervals to permit it an evaluation of the performance of the hospital as an institution and to carry on necessary planning for the proper developments and growth of the hospital, with written minutes to be kept of all such meetings. 6. Provide the method of appointment, re-appointment, and removal of members of the medical staff. 7. Provide mechanisms for the formal approval of the organization, bylaws, and rules and regulations of the medical staff and its department in the hospital. Facility Discontinuation/Closure of Service: 1. Discontinuation of Service: Facilities proposing the closure/discontinuation of patient medical care services that are listed on the facility’s hospital licensure application and/or a Certificate of Need (CON) regulated service, shall notify the Department in writing a minimum of 30 days prior to closure and include the effective closure date. The notification to the Department shall include, but is not limited to:

A. The type of services that will no longer be provided due to closure; B. The reason for closure; C. The location where the patients have been/will be transferred; D. The plan for storage of patient medical records; and E. Plan for notifying the public. 2. Closure: Facilities proposing the permanent closure of a hospital shall notify the Department in writing at of the intent to close a minimum of 30 days in advance of the closure date. The notice of closure shall include, but is not limited to: A. Effective date of permanent closure; B. The number of beds eliminated; C. Summary of services being eliminated; D. A description of the nearest available comparable services in the community; E. The Plan for the maintenance and retention of the patient medical records; and F. On the date of closure, the license shall be returned to Department.

Rule 41.6.3. The governing body, through the administrator, shall provide appropriate physical resources and personnel required to meet the needs of the patients, and shall participate in planning to meet the health needs of the community.

Rule 41.6.8. Appointment, reappointment, and removal of the members of the medical staff and other practitioners with clinical privileges shall be based upon well-defined written criteria set forth in the bylaws.

Rule 41.6.9. The governing body shall utilize the advice of the medical staff in granting and defining the scope of clinical privileges to individual physicians, dentists and other practitioners requesting clinical privileges. If the medical staff does not include a physician or

practitioner of the same specialty, the medical staff shall consult with the appropriate licensure boards regarding scope of practice before making recommendations to the governing body regarding clinical privileges.

Rule 41.6.10. No applicant shall be denied medical staff privileges in any publicly owned hospital on the basis of any criteria lacking professional justification.

Rule 41.6.11. A mechanism shall be established in the bylaws for review by a joint committee when the governing body disagrees with the recommendations of the medical staff.

Rule 41.6.12. All physicians, dentists and other practitioners applying for medical staff membership and/or clinical privileges must sign an agreement to abide by the medical staff by-laws and rules and regulations.

Rule 41.6.13. The governing body shall inform applicants for medical staff membership and/or clinical privileges of the disposition of their application in a reasonable time.

Rule 41.6.14. The medical staff bylaws and rules and regulations shall be subject to governing body approval, which shall not be unreasonably withheld. These shall include an effective formal means for the medical staff to participate in the development of hospital policy relative to patient care.

Rule 41.6.15. The governing body shall require that the medical staff establish controls that are designed to insure the achievement and maintenance of high standards of professional ethical practices, and shall:

1. Establish policies that ensure that only members of the medical staff dental staff or other practitioners designated by the governing body admit patients to the hospital.

2. Ensure that a physician member of the medical staff is responsible for the care of each patient with respect to any medical or psychiatric problem that is present on admission or develops during hospitalization and is not specifically within the scope of practice of other practitioners with clinical privileges as defined by State law.

3. Each individual hospital in the state shall decide by its "credentialing committee", or by whatever name it uses for the functions of credentialing, whether or not it chooses to abide by the amendments as set out in Chapters 1, 2, 3, and 4 hereof, as pertaining to dental staff.

Rule 41.6.16. If it shall be the policy of the hospital for physicians rendering consecutive services under contract with the hospital to bill hospital patients separately for their services, all hospital patients shall be advised, upon entering or prior to leaving the hospital, that they may expect a separate and additional bill for any such services as may have been rendered them.

Rule 41.6.17. Criminal History Record Checks.

1. Employee. For the purpose of fingerprinting and criminal background history checks, employee shall mean any individual employed by a covered entity. The term employee”, also includes any individual who by contract with the covered entity provides direct patient care in a patient’s, resident’s, or client’s room or in treatment rooms.

The term employee does not include healthcare professional/technical students, as defined in Section 37-29-232, performing clinical training in a licensed entity under contracts between their schools and the licensed entity, and does not include students at high schools who observe the treatment and care of patients in a licensed entity as part of the requirements of an allied health course taught in the school if:

A. The student is under the supervision of a licensed healthcare provider; and B. The student has signed the affidavit that is on file at the student’s school stating that he or she has not been convicted of or plead guilty or nolo contendere to a felony of possession or sale of drugs, murder, manslaughter, armed robbery, rape, sexual battery, any sex offenses listed in section 45-33-23 (g), child abuse, arson, grand larceny, burglary, gratification of lust, aggravated assault, or felonious abuse and/or battery of a vulnerable adult, or that any such conviction or plea was reversed on appeal or a pardon was granted for the conviction or plea. C. Further, applicants and employees of the University of Mississippi Medical Center for whom criminal history record checks and fingerprinting are obtained in accordance with Section 37-115-41 are exempt from application of the term employee under Section 43-11- 13.

2. Covered Entity. For the purpose of criminal history record checks, “covered entity” means a licensed entity or a healthcare professional staffing agency.

3. Licensed Entity. For the purpose of criminal history record checks, the term “licensed entity” means a hospital, nursing home, personal care home, home health agency or hospice.

4. Health Care Professional/Vocational Technical Academic Program. For the purpose of criminal history record checks, “health care professional/vocational technical academic program” means an academic program in

medicine, nursing, dentistry, occupational therapy, physical therapy, social services, speech therapy, or other allied-health professional whose purpose is to prepare professionals to render patient care services.

5. Health Care Professional/Vocational Technical Student. For purposes of criminal history record checks, the term means a student enrolled in a healthcare professional/vocational technical academic program.

6. Direct Patient Care or Services. For purposes of fingerprinting and criminal background history checks, the term “direct patient care” means direct hands- on medical patient care and services provided by an individual in a patient, resident or client’s room treatment room or recovery room. Individuals providing direct patient care may be directly employed by the facility or provides patient care on a contractual basis. 7. Documented Disciplinary Action. For the purpose of fingerprinting and criminal background history checks, the term “documented disciplinary action” means any action taken against an employee for abuse or neglect of a patient.

Rule 41.6.18. Criminal History Record Checks.

1. Pursuant to Section 43-11-13, Mississippi Code of 1972, the covered entity shall require to be performed a disciplinary check with the professional licensing agency, if any, for each employee to determine if any disciplinary action has been taken against the employee by the agency, and a criminal history record check on:

A. Every new employee of a covered entity who provides direct patient care or services; and

B. Any individual seeking new employment with a covered entity whose initial criminal history record check is over two years old.

2. Except as otherwise provided in this paragraph, no employee hired on or after July 01, 2003, shall be permitted to provide direct patient care until the results of the criminal history record check revealed no disqualifying record or the employee has been granted a waiver. Provided the covered entity has documented evidence of submission of fingerprints for the background check, any person may be employed and provide direct patient care on a temporary basis pending the results of the criminal history record check but any employment offer, contract, or arrangement with the person shall be voidable, if he/she receives a disqualifying criminal record check, and no waiver is granted.

3. If such criminal history record check discloses a felony conviction; a guilty plea; and/or a plea of nolo contendere to a felony for one (1) or more of the following crimes which has not been reversed on appeal, or for which a pardon has not been granted, the applicant/employee shall not be eligible to be employed at the licensed facility:

A. possession or sale of drugs

B. murder

C. manslaughter

D. armed robbery

E. rape

F. sexual battery G. sex offense listed in Section 45-33-23(g), Mississippi Code of 1972

H. child abuse

I. arson

J. grand larceny

K. burglary

L. gratification of lust

M. aggravated assault

N. felonious abuse and/or battery of vulnerable adult

4. Documentation of verification of the employee’s disciplinary status, if any, with the employee’s professional licensing agency as applicable, and evidence of submission of the employee’s fingerprints to the licensing agency must be on file and maintained by the facility prior to the new employees first date of employment. The covered entity shall maintain on file evidence of verification of the employee’s disciplinary status from any applicable professional licensing agency and of submission and/or completion of the criminal record check, the signed affidavit, if applicable, and/or a copy of the referenced notarized letter addressing the individual’s suitability for such employment.

5. Pursuant to Section 43-11-13, Mississippi Code of 1972, the licensing agency shall require every employee of a covered entity employed prior to July 01, 2003, to sign an affidavit stating that he or she does not have a criminal history as outlined in paragraph (c) above.

6. From and after December 31, 2003, no employee of a covered entity hired before July 01, 2003, shall be permitted to provide direct patient care unless the employee has signed an affidavit as required by this section. The covered entity shall place the affidavit in the employee’s personnel file as proof of compliance with this section.

7. If a person signs the affidavit required by this section, and it is later determined that the person actually had been convicted of or pleaded guilty or nolo contendere to any of the offenses listed herein, and the conviction or pleas has not been reversed on appeal or a pardon has not been granted for the conviction or plea, the person is guilty of perjury as set out in Section 43-11-13,

Mississippi Code of 1972. The covered entity shall immediately institute termination proceedings against the employee pursuant to the facility’s policies and procedures. 8. The covered entity may, in its discretion, allow any employee unable to sign the affidavit required by paragraph (g) of this subsection or any employee applicant aggrieved by the employment decision under this subsection to appear before the covered entity’s hiring officer, or his or her designee, to show mitigating circumstances that may exist and allow the employee or employee applicant to be employed at the covered entity. The covered entity, upon report and recommendation of the hiring officer, may grant waivers for those mitigating circumstances, which shall include, but not be limited to: (1) age at which the crime was committed; (2) circumstances surrounding the crime; (3) length of time since the conviction and criminal history since the conviction; (4) work history; (5) current employment and character references; and (6) other evidence demonstrating the ability of the individual does not pose a threat to the health or safety of the patients in the licensed facility. 9. The licensing agency may charge the covered entity submitting the fingerprints a fee not to exceed Fifty Dollars ($50.00). 10. Should results of an employee applicant’s criminal history record check reveal no disqualifying event, then the covered entity shall, within two (2) weeks of the notification of no disqualifying event, provide the employee applicant with a notarized letter signed by the chief executive officer of the covered entity, or his or her authorized designee, confirming the employee applicant’s suitability for employment based on his or her criminal history record check. An employee applicant may use that letter for a period of two (2) years from the date of the letter to seek employment at any covered entity licensed by the Mississippi Department of Health without the necessity of an additional criminal record check. Any covered entity presented with the letter may rely on the letter with respect to an employee applicant’s criminal background and is not required for a period of two (2) years from the date of the letter to conduct or have conducted a criminal history check as required in this subsection. 11. For individuals contacted through a third party who provide direct patient care as defined herein, the covered entity shall require proof of a criminal history record check. 12. Pursuant to Section 43-11-13, Mississippi Code of 1972, the

licensing agency, the covered entity, and their agents, officer, employees, attorneys, and representatives, shall be presumed to be acting in good faith for any employment decision or action taken under this section. The presumption of good faith may be overcome by a preponderance of the evidence in any civil action. No licensing agency, covered entity, nor their agents, officers, employees, attorneys, and representatives shall be held liable in any employment discrimination suit in which an allegation of discrimination is made regarding an employment decision authorized under this section.

Subchapter 7 THE MEDICAL STAFF

Rule 41.7.1. The hospital shall have an organized medical staff that has the overall responsibility for the quality of all medical care provided to patients, and for the ethical conduct and professional practices of its members as well as for accounting therefore to the governing body. Each member of the medical staff shall be qualified for staff membership and for the exercise of the clinical privileges granted to him.

Rule 41.7.2. The medical staff shall be limited to individuals who are licensed to practice medicine, osteopathy, or dentistry in the State of Mississippi, and such other practitioners as determined by the governing body. Such members must be appropriately licensed or certified and shall be professionally and ethically qualified for the positions to which they are appointed.

Rule 41.7.3. Clinical privileges granted to dentists shall be based on their training, experience, demonstrated competence and judgment.

1. The scope and extent of surgical procedures that each dentist may perform must be specifically defined and recommended in the same manner as surgical privileges for physicians.

2. Surgical procedures performed by dentists shall be under the overall supervision of the Chief of Surgery. In hospitals where a Chief of Surgery is not designated, they shall be under the overall supervision of a competent surgeon approved by the Chief of Staff or president of the medical staff. 3. All dental patients must receive the same basis medical appraisal by a physician as patients admitted for other services except patients admitted by a qualified oral surgeon. An oral surgeon who admits a patient without medical problems may complete an admission history and a physical examination and assess the medical risks of the procedure to the patient if qualified to do so. Criteria to be used in identifying such a qualified oral surgeon shall include, but shall not necessarily be limited to, the following: successful completion of a postgraduate program in oral surgery accredited by a nationally recognized accrediting body approved by the United States Office of Education; and, as determined by the medical staff, evidence that the oral surgeon who admitted the patient is currently competent to conduct a complete history and physical examination to determine the patient's ability to undergo the oral surgical procedure the oral surgeon proposes to perform.

4. Patients with medical problems admitted to the hospital by qualified oral surgeons and patients admitted for dental care by individuals who are not qualified oral surgeons shall receive the same basic medical appraisal as patients admitted for other services. This includes having a physician who either is a member of the medical staff or is approved by the medical staff perform an admission history, a physical examination, and an evaluation of the overall medical risk and record the findings in the medical record. The responsible dentist shall take into account their commendations of this consultation in the overall assessment of the specific procedure proposed and the effect of the procedure on the patient. When significant medical abnormality is present, the final decision must be a joint responsibility of the dentist and the medical consultant. The dentist shall be responsible for that part of the history and physical examination related to dentistry. A physician member of the medical staff shall be responsible for the care of any medical problem that may be present on admission or that may arise during hospitalization of dental patients.

5. A physician member of the medical staff must be responsible for the care of any medical problem that may be present or that may arise during the hospitalization of dental patients.

Rule 41.7.4. All clinical privileges shall be based on training, experience, demonstrated competence, and judgment.

Rule 41.7.5. The medical staff shall be organized to accomplish its required functions; it shall provide for selection or appointment of its officers, executive committee, department head or service chiefs.

Rule 41.7.6. The medical staff must provide a framework in which the duties, functions, and responsibilities of the medical staff can be carried out. The complexity of the organization will depend on the size of the hospital and the scope of the activities of the medical staff.

Rule 41.7.7. There shall be such officers of the medical staff as to provide effective governing of the medical staff and to provide effective medical care. There should be at least a president, vice-president, and secretary-treasurer of the medical staff, or other similar titles.

Rule 41.7.8. The medical staff shall participate in the maintenance of high professional standards by representation on committees concerned with patient care.

should include participation in the development of hospital policies and procedures in-so-far as they affect patient care.

Rule 41.7.10. The development and surveillance of pharmacy and therapeutic practices in relation to drug utilization must be performed by the medical staff in cooperation with the pharmacist.

Rule 41.7.11. The medical staff shall see that there is adequate documentation of medical events by a review of discharged patients that shall insure those medical records meet the required standards of completeness, clinical pertinence, and promptness or completion of following discharge.

Rule 41.7.12. The medical staff shall actively participate in the study of hospital- associated infections, and infection potentials, and must promote a preventive and corrective program designed to minimize their hazards.

Rule 41.7.13. The medical staff and the hospital’s administration must evaluate their ability to manage internal and external disasters and other emergency situations. Medical staff responsibilities shall be clearly outlined.

Rule 41.7.14. There shall be regular medical staff meetings to review the clinical work of members and to complete medical staff administrative duties.

Rule 41.7.15. The medical staff shall provide a continuing program of professional education or give evidence of participation in such a program.

Rule 41.7.16. The medical staff shall develop and adopt bylaws and rules and regulations to establish a framework for self-government and a means of accountability to the governing body, such bylaws and rules and regulations to be approved by the governing body.

Rule 41.7.17. The medical staff bylaws and rules and regulations, as a minimum, shall: 1. Contain the name of the organization. 2. Delineate the organizational structure of the medical staff. 3. Specify the qualifications and procedures for admission to and retention of staff membership, including the delineation, assignment, reduction, and withdrawal of clinical privileges. 4. Specify the method of reviewing the qualifications of staff members.

5. Provide an appeal mechanism relative to medical staff recommendations for denial, curtailment, suspension, or revocation of clinical privileges in any hospital having an open staff. This mechanism shall provide for review of decisions including the right to be heard at each step of the process when requested by the practitioner.

6. Delineate clinical privileges of non-physician practitioners, as well as responsibilities of the physician members of the medical staff in relation to non- physician practitioners. A non-physician practitioner is a health professional licensed or otherwise authorized by the state to provide a range of independent or interdependent health services. Such providers include but are not limited to chiropractors, licensed professional counselors, licensed social workers, nurse practitioners/physician assistants (including nurse anesthetists), psychologists, podiatrists, and optometrists.

7. Require a pledge that each practitioner will conduct his

practice in accordance with high ethical traditions and will refrain from:

A. Rebating a portion of a fee or receiving other inducements in exchange for a patient referral.

B. Deceiving a patient as to the identity of an operating surgeon or any other medical practitioner providing services.

C. Delegating the responsibility of hospitalized patients to another medical practitioner who is not qualified to undertake this responsibility.

8. Provide for methods of selection of officers and clinical department or service chairmen.

9. Outline the responsibilities of the medical staff officers and clinical department or service chairmen.

10. Specify composition and functions of standing committees or standing committee functions as required by the complexity of the hospital.

11. Establish requirements regarding the frequency of and attendance at general and departmental meetings of the medical staff.

12. Require that the evaluation of the significance of medical histories, the authentication of medical histories, and the performance and recording of physical examinations and prescribing of treatment be carried out by those with appropriate licenses and clinical privileges within their sphere of authorization.

13. Establish requirements regarding the completion of medical records.

14. Provide for a mechanism by which the medical staff consults with and reports to the governing body.

15. Adopt rules and regulations that contain specific statements covering procedures that foster optimal achievable patient care, including the care provided in the emergency service area.

16. Provide that each practitioner shall on application for clinical privileges sign an agreement to abide by the current medical staff bylaws and rules and regulations and the hospital bylaws.

17. Provide for records of attendance and minutes that adequately reflect the transactions, conclusions, and recommendations of the medical staff.

18. Require and include procedures for evaluation of medical care.

Subchapter 8 DESIGN AND CONSTRUCTION ELEMENTS: PHYSICAL PLANT

Rule 41.8.1. General. Every institution subject to these Minimum Standards shall be housed in a safe building which contains all the facilities required to render the services contemplated in the application for license.

Rule 41.8.2. Codes. The term “safe” as used in Rule 41.8.1 hereof shall be interpreted in the light of compliance with the requirements of the codes recognized by this agency on date of construction which are incorporated by reference as a part of these Minimum Standards; included are the Life Safety Code of the National Fire Protection Association, American National Standards Institute, Standards Number A-17.1, and A-17.3, Safety Code for Elevators and Escalators, the American Institute of Architects (AIA), Guidelines for Design and Construction of Hospital and Health Care Facilities, and references incorporated as body of all afore mentioned standards.

1. Life Safety Code compliance relative to construction date:

A. Buildings constructed after February 14, 2005, shall comply with the edition of the Life Safety Code (NFPA 101) recognized by this agency on the date of construction. B. Building constructed prior to February 14, 2005, shall comply with existing chapter of the Life Safety Code recognized by this agency.

2. For minimum standards governing Heating, Ventilation, and Air Conditioning (HVAC), area design, space allocation, parking requirements, and other considerations not specifically addressed by local authority or standards referenced herein, compliance with the AIA guidelines will be deemed acceptable.

Subchapter 9 SUBMISSION OF PLANS AND SPECIFICATIONS

Rule 41.9.1. Construction shall not be started for any institution subject to these standards (whether new or remodeling or additions to an existing licensed hospital) until the plans and specifications for such construction or remodeling have been submitted to the Licensing Agency in writing and its approval of the changes given in writing.

1. Exception: Foundation changes made necessary by unanticipated conditions, or any conditions which present a hazard to life or property if not immediately corrected.

Rule 41.9.2. Plans and specifications for any substantial hospital construction or remodeling should be prepared by competent architects and engineers licensed to practice in the state and who assume responsibility for supervising the construction. The following plans shall be submitted to the Licensing Agency for review:

1. Preliminary Plans - To include schematics of buildings, plot plans showing size and shape of entire site, existing structures, if any, streets and location and characteristics of all needed utilities, floor plans of every floor dimensioned and with proposed use of each

room or area shown. If for additions or remodeling, provide plan or of existing building showing all proposed alterations, outline specifications to include a general description of the construction, type of finishes, and type of heating, ventilating, plumbing, and electrical systems proposed.

2. Final Working Drawings and Specifications - Complete and in sufficient detail to be the basis for the award of construction contracts.

Rule 41.9.3. All plans submitted for review must be accompanied in their first submission by an order of the governing board indicating the type and scope of license to be applied for or a Certificate of Need.

Rule 41.9.4. Plans receiving approval of the Licensing Agency upon which construction has not begun within six (6) months following such approval must be resubmitted for approval.

Rule 41.9.5. In all new facilities, plans must be submitted to all regulatory agencies, such as the County Health Department, etc., for approval prior to starting construction.

Rule 41.9.6. Upon completion of construction an inspection shall be made by the Licensing Agency and approval given prior to occupying the building or any part thereof. The state and county health departments shall have access to the job site during regular business hours and shall conduct construction progress inspections as deemed necessary by the agency.

Rule 41.9.7. Environment. All hospitals shall be so located that they are reasonably free from undue noises, smoke, dust, or foul odors, and should not be located adjacent to railroads, freight yards, schools, children's playgrounds, airports, industrial plants or disposal plants. The proposed site for new hospitals shall be approved by the department. No new

facilities shall be located nearer than 1000 ft. to a cross- country petroleum or gas pipeline.

Rule 41.9.8. Zoning Restrictions. The locations of an institution shall comply with all local zoning ordinances.

Rule 41.9.9. Access. Institutions located in rural areas must be served by good roads which can be kept passable at all times.

Rule 41.9.10. Elevators. One power driven elevator is required in all hospitals having patient rooms, operating suite, or delivery suite above the first floor. Two or more elevators are required if 60 or more patients are housed above the ground floor. Minimum cab dimensions required for elevators transporting patients is 76" x 50" inside clear measurements: hatchway and cab doors 3'8" wide, minimum. Elevators are subject to the requirements of referenced standard listed in paragraph 602, Codes, of this regulation.

Subchapter 10 FIRE REPORTING AND PROTECTION

Rule 41.10.1. Duty to report all fires, explosions, natural disasters, avoidable deaths or avoidable serious or life-threatening injuries to patients shall be reported by telephone to the department by the next working day after the occurrence. The licensing agency will provide the appropriate forms to the facility which shall be completed and returned within fifteen (15) calendar days of the occurrence. All reports shall be complete, thorough, and shall record at a minimum the casual factors, date, time of occurrence, and exact location of occurrence whether inside or outside of the facility. Attached thereto shall be all police, fire, and/or other official reports. There must be a telephone in the building to summon help in case of fire.

approval date on or after February 14, 2005, shall be protected throughout by a sprinkler system.

Electrical heating will be approved provided a standby electrical generator is provided of capacity to furnish 80% of the maximum heating load in addition to other power and lighting loads that maybe connected to it, or the hospital is supplied by two electric service lines connected to separate transformers at the sub-station so arranged that electric service can be maintained in case of failure of one line or transformer.

Subchapter 11 PLUMBING

Rule 41.11.1. All institutions subject to these standards shall be connected to an approved municipal water system or to a private supply whose purity has been certified by the laboratory of the Department of Health. Private supplies must be sampled, tested, and its purity certified at least twice annually and immediately following any repair or modification to the underground lines, the elevated tank, or to the well or pump. Supply must be adequate, both as to volume and pressure for firefighting purposes. Deficiencies in either must be remedied by the provision of auxiliary pumps, pressure tanks or elevated tanks as may be required.

Rule 41.11.2. An approved method of supplying hot water for all hospital uses must be provided. Water to lavatories and scrub sinks must be 100 degrees-115ºF. Water to mechanical dishwashers must be delivered at 180 degrees F for rinsing.

Rule 41.11.3. Supply piping within the building shall be in accordance with the local code.

Special care must be taken to avoid use of any device or installation which might cause contamination of the supply through back-siphonage or cross connections.

Subchapter 12 SEWAGE DISPOSAL

Rule 41.12.1. All institutions subject to these standards shall dispose of all sanitary wastes through connection to a suitable municipal sewerage system or through a private sewerage system that has been approved in writing by the Division of Environmental Services, Onsite Wastewater of the Department of Health.

Rule 41.12.2. All fixtures located in the kitchen, including the dishwasher, shall be installed so as to empty into a drain which is not directly connected to the sanitary house drain. Kitchen drain may empty into a manhole or catch basin having a perforated cover with an elevation of at least 24" below the kitchen floor evaluation, and hence to the sewer. Exceptions: existing licensed institutions which have no plumbing fixtures installed on floors which are above the floor on which the kitchen is located.

Subchapter 13 EQUIPMENT

Rule 41.13.1. Medical Equipment Management. In order to ensure safe and reliable operation of medical equipment, qualified personnel shall maintain all medical equipment, regardless of ownership. Such maintenance shall be based upon criteria such as manufacturer’s recommendations, common industry practices and current hospital experience and shall include the following:

1. Current equipment inventory.

2. Periodic electrical safety inspections and preventive maintenance.

3. Documentation of all testing and maintenance activities, inclusive of any repairs.

4. Reporting and investigating equipment problems, failures, and user errors that may have an adverse effect on patient safety or the quality of care. 5. Monitoring and acting on equipment hazard notice and recalls.

6. Monitoring and reporting incidents in which a medical device is suspected or attributed to the death, serious injury, or serious illness of any individual, as required by the Safe Medical Devices Act of 1990.

7. The facility shall maintain life support equipment utilizing maintenance strategies designed to minimize clinical and physical risks inherent in use of such equipment.

Rule 41.13.2. Electric Nurse Call. There shall be installed a low voltage nurse call system for every bed and such other areas as deemed necessary, with annunciator at nurses’ station and nurses work area.

Subchapter 14 EMERGENCY ELECTRIC SERVICE

Rule 41.14.1. General. To provide electricity during an interruption of the normal electric supply that could affect the medical care, treatment, or safety of the occupants, an emergency source of electricity shall be provided and connected to certain circuits for lighting and power.

Rule 41.14.2. Source. The source of this emergency electric service shall be an emergency generator, with a stand-by supply of fuel for 24 hours.

Rule 41.14.3. Patient Rooms: Each patient room shall meet the following requirements:

1. Area. Shall provide 120 sq. ft. of floor area for a single bedroom and 100 sq. ft. per bed in multi-bedrooms with new construction or renovation approved by the licensing agency on or after February 14, 2005.

2. Ceiling Height. Shall be 8'0" minimum.

3. Windows. All rooms housing patients shall be outside rooms and shall have window area equal to 1/8th of the floor area. The sill shall not be higher than 36inches above the floor and shall be above grade. Windows shall not have any obstruction to vision (wall, cooling tower, etc.) within 50 feet as measured perpendicular to the plane of the window.

4. Storage. Each patient shall be provided with a hanging storage space of not less than 16" x 24" x 52" for personal belongings.

Rule 41.14.4. Furnishings:

1. Bed. Each patient room shall be equipped with an adjustable bed.

2. Bedside Cabinet. A bedside cabinet shall be provided for each patient. It should contain a water service, bedpan, urinal, emesis basin, and bath basin. (These may be disposable.)

Rule 41.14.5. Rooms shall be equipped with curtains or blinds at windows. All curtains shall have a flame spread of 25 or less.

Rule 41.14.6. Cubicle curtains or equivalent built-in devices for privacy in all multi- bedrooms shall be provided. They shall have a flame spread of 25 or less. Cubicle curtains shall encircle the bed on three sides. Must comply with mesh webbing for sprinkler systems.

Rule 41.14.7. A lavatory equipped with wrist action handles, shall be located in the room or in a private toilet room. (If a water closet is provided, a bedpan washer is recommended.)

Rule 41.14.8. Patient bed light shall be provided which shall be capable of control by the patient. Provide a night light bright enough for the staff to perform routine duties but dim enough so as not to disturb the patient.

Rule 41.14.9. Service Areas. The size of each service area will depend on the number and type beds within the unit and shall include the following:

1. Nurse Station. For nurses charting, doctors charting, communication and storage for supplies and nurses’ personal effects.

2. Staff Toilet with Lavatory. Convenient to nurse’s station.

3. Clean Work Room. For storage and assembly of supplies for nursing procedures. Shall contain cabinets or storage carts, work counter and sink.

4. Soiled Utility. Shall contain deep sink, work counter, waste receptacle, soiled linen receptacle, and provision for washing bedpans if not provided elsewhere. 5. Medicine Station. Adjacent to nurses’ station, with sink, small refrigerator, locked storage, narcotic locker with a light in the nurse’s station that indicates when the door is open and work counter. (May be in clean work room in self-contained cabinet.)

6. Clean Linen Storage. A closet large enough to hold an adequate supply of clean linen.

7. Provision for between-meal nourishments.

8. Patient Bath. At least one tub or shower-stall for each 18 patients not served by private bath.

9. Stretcher and Wheelchair Storage Area.

10. Fire Extinguisher. One (1) approved Class ABC unit for each 3000 sq. ft.

11. Janitor's Closet. Closet large enough to contain floor receptor with plumbing and space for some supplies and mop buckets.

Rule 41.14.10. Isolation Room: (At least one per hospital). It shall contain:

1. One patient bed per room.

2. Private lavatory and toilet.

3. View window 10" x 10" in door.

4. Anteroom with door to corridor and door into patient room. This anteroom shall have a lavatory, shelving, space for linen hamper, and hanging space adequate for isolation techniques. Supply and exhaust are to be separate from the patient room supply and exhaust.

A. An alternative design that omits the anteroom may be approved if the facility demonstrates that its alternative design meets all required safety outcomes, specifically air pressure differentials, in accordance with the current edition of the Guidelines for Design and Construction of Hospitals Facility Guidelines Institute (FGI). Facilities utilizing this performance-based design must maintain engineering documentation, which shall mean a written report or certification, signed by a Professional Engineer (PE) licensed in the State of Mississippi, that verifies the alternative design has been tested and meets the specific air pressure differential, air exchange rate, and other relevant safety outcome standards set forth in the applicable edition of the FGI Guidelines. This documentation must be provided to the licensing agency upon request.

Rule 41.14.11. Detention Room. If a detention room is provided, it shall be provided with key- only lock on all doors operated from both sides and security screen on the window for disturbed or confused patients. The isolation room may be modified for this purpose.

Subchapter 15 SPECIAL CARE

Rule 41.15.1. In addition to the requirements for patient rooms and service areas, a special care area, where provided, shall meet fire safety standards and electrical hazard standards applicable to intensive care units, cardiac units, and other such areas.

Rule 41.15.2. A waiting room shall be provided in this area and shall contain 10 sq. ft. per bed.

Rule 41.15.3. Newborn Nursery shall have:

1. Lavatory with wrist action blade handles.

2. Emergency nurses call.

3. Oxygen, with equipment for measuring oxygen content.

4. Facilities for viewing the babies.

Rule 41.15.4. Each full-term nursery shall contain no more than 12 bassinets with a minimum area of 24 sq. ft. for each bassinet. An examination and work room shall be provided. One work room may serve more than one nursery. The nursery is to be entered only through the work room. There shall be a separate bassinet for each infant consisting of stand, removable basket, cabinet, or table for storage of individual utensils and supplies.

Rule 41.15.5. Janitor's closet shall be provided. (See Rule 41.14.9(11)).

Rule 41.15.6. Specific provisions shall be made to take care of premature babies. Incubators suitable for the care of premature infants shall be provided.

Rule 41.15.7. Nursery heating shall be variable from 75 degrees - 80 degrees, with provisions for maintaining a relative humidity above 50%.

Rule 41.15.8. All electric receptacles in each nursery shall be on the emergency circuit.

Rule 41.15.9. Pediatric Unit (if provided as a separate unit) shall contain:

1. Patient room as described in Rule 41.14.3. 2. 50 sq. ft. per crib, with adequate space provided for person in attendance.

3. Service areas, in addition to those described in Rule 41.14.9, shall include a treatment room with lavatory with wrist action blade handles.

Rule 41.15.10. Psychiatric Unit, if provided, shall contain rooms and service areas as described in Rule 41.14.3 and Rule 41.14.9. In addition, there shall be physician’s office, examining room, conference room, dining room and day room.

Subchapter 16 SURGICAL SUITE

Rule 41.16.1. This area shall be located so as to prevent through traffic and shall contain:

1. At least one operating room, with adequate sterile storage cabinets, for the first 50beds and thereafter the number of rooms should be based on the expected surgical workload.

2. Recovery room with charting space, medication storage and preparation and sink are required. Oxygen, suction, and other life supporting equipment must be immediately available to the patient and shall meet the requirements of National Fire Protection Association NFPA 99.

3. A service area which shall include: A. Surgical supervisor's station. B. Provision for high-speed sterilization of dropped instruments readily available to operating room. C. Medicine preparation and storage area. D. Scrub station for two persons to scrub simultaneously. E. Clean up room with a two-compartment sink and drain board and space for a dirty linen hamper. F. Anesthesia storage in compliance with National Fire Protection Association NFPA 99. G. Oxygen and nitrous oxide storage in compliance with National Fire Protection Association NFPA (99). H. Janitors closet (See Rule 41.14.9). I. Physicians’ locker room containing toilet and shower with entry from non-sterile area and exit into sub- sterile area. J. Nurses' locker room containing toilet and shower with entry from non-sterile area and exit into sub-sterile area. K. Storage for transport beds.

2. Pack Make Up. Shall have autoclaves, work counter and unsterile storage. 3. Sterile Storage Area. Should have pass-through to corridor.

Rule 41.18.2. A labor room shall be provided with necessary equipment, a lavatory with wrist action blade handles, and shall be acoustically treated.

2. Waiting room with public telephone, drinking fountain, and toilet. 3. Admission and record area. 4. Examination and treatment rooms containing lavatory with wrist action blade handles and nurse call station. These rooms shall be so arranged that stretcher patients can be examined and treated. 5. Trauma room adequate for cast work and with sufficient lighting for detailed examinations.

6. Storage for sterile supplies.

7. Medicine preparation and storage area that can be locked.

8. Transport bed and wheelchair storage.

9. Janitor’s closet (See Rule 41.14.9).

10. Dirty Utility area.

Rule 41.19.2. The walls and floors shall be capable of repeated washings in all areas except trauma area which shall have floors, walls, and ceilings capable of repeated washings.

Subchapter 20 RADIOLOGY SUITE

Rule 41.20.1. This area should be as close to outpatient area as practical. It shall contain:

1. Radiographic room or rooms.

2. Film processing room. 3. Film filing room.

4. Toilet available to each fluoroscopy room.

5. Dressing room (at least two per radiographic room).

6. Patient waiting area.

7. Administrative area, including space for film viewing.

Subchapter 21 LABORATORY

Rule 41.21.1. Adequate space for the following services shall be provided: chemistry, bacteriology, serology, pathology, and hematology. Provision shall be made for:

1. Glass washing and sterilizing.

2. Administrative area, to include space for records and files.

3. Blood storage.

4. Specimen collection toilet (This may be primarily for other use).

Subchapter 22 DRUG ROOM

Rule 41.22.1. Adequate space shall be provided for storage of drugs and for keeping of necessary records. The room shall be capable of being

securely locked in accordance with regulations regarding storage of dangerous drugs.

Subchapter 23 DIETARY

Rule 41.23.1. Construction and equipment shall comply with Department of Health regulations, and shall include:

1. Food preparation center. Provide lavatory (without mirror) with wrist action blades, soap dispenser and disposable towel dispenser. All cooking appliances to have ventilating hood.

2. Food serving facilities. If dining space is provided, it shall contain a minimum of15 sq. ft. per person seated.

3. Dishwashing room. Provide commercial type dishwashing equipment. 4. Pot washing facilities.

5. Refrigerated storage (three-day supply).

6. Day storage (three-day supply).

7. Cart cleaning facilities (can be in dishwashing room).

8. Can wash and storage (must be fly-tight).

9. Cart storage.

10. Dietitian's office.

11. Janitor’s closet (See Rule 41.14.9(11)).

12. Personnel toilets and lockers convenient to, but not in, the kitchen proper.

13. Approved automatic fire extinguisher system in range hood. In addition, Class K extinguisher to be installed in the kitchen.

2. Administrator's office.

3. Admitting area.

4. Lobby or foyer, with public toilets.

5. Medical Library (This area should be as close to medical records as possible).

6. Space for conferences and in-service training.

7. Medical records - office and storage.

8. Director of Nurses' office.

9. Fire Extinguisher. An approved Class 2A unit shall be provided.

Rule 41.24.2. Housekeeping Area. To include:

1. Housekeeper's office. 2. Storage space for staff carts, if used.

Rule 41.24.3. Laundry. To include:

1. Soiled linen room with lavatory with wrist action blades.

2. Clean linen and mending area. (To include space for storage of clean linen carts).

3. Laundry process room. Commercial type equipment sufficient for the needs of the hospital unless contract service is used.

4. Janitor’s closet (See Rule 41.14.9(11)).

Rule 41.24.4. General Storage. There shall be a one-hour fire rated lockable room, or separate building provided, which contains at least 18 sq. ft. per licensed bed.

Rule 41.24.5. Boiler Room. Space shall be adequate for the installation and maintenance of the required machinery.

Rule 41.24.6. Maintenance Area. Sufficient area for performing routine maintenance activities shall be provided and shall include office for maintenance engineer.

Subchapter 25 NURSING SERVICES EMERGENCY

Rule 41.25.1. General. The hospital shall have a procedure for taking care of emergency cases. Participation shall not be limited to hospitals which have organized emergency services or departments. There shall be effective policies and procedures relating to the staff, functions of the service, and emergency room medical records and adequate facilities in order to assure the health and safety of the patients.

Subchapter 26 ORGANIZATION AND DIRECTION

Rule 41.26.1. The department or service shall be organized, directed by qualified personnel, and integrated with other departments of the hospital.

Rule 41.26.3. The policies and procedures governing medical care provided in the emergency service or department shall be established by and shall be a continuing responsibility of the medical staff. The Emergency Department shall have written policies and procedures governing the receipt of patients from emergency medical services and the transfer of patients to a receiving facility. The policies must comply with Mississippi Emergency Medical Services Rules and Regulations.

Rule 41.26.4. The emergency service shall be supervised by a qualified member of the medical staff, and nursing functions shall be the responsibility of a registered professional nurse.

Rule 41.26.5. The administrative functions shall be the responsibility of a member of the hospital administration.

Subchapter 27 FACILITIES

Rule 41.27.1. Facilities shall be provided to assure prompt diagnosis and emergency treatment.

Rule 41.27.2. Facilities shall be separate and independent of the operating room.

Rule 41.27.3. Freestanding Emergency Room (FER). Means a facility open twenty- four hours a day for the treatment of urgent and emergent medical conditions which is not located on a hospital campus. In order to be eligible for licensure under this chapter, the freestanding emergency room shall be located at least fifteen (15) miles from the nearest hospital- based emergency room in any rural community where the federal Centers for Medicaid & Medicare Services (CMS) had previously designated a rural hospital as a critical access hospital and that designation has been revoked. A FER shall not retain any patient beyond 23 hours and 59 minutes under normal operations and shall not hold itself out as an emergency hospital.

Rule 41.27.4. Diagnostic and treatment equipment, drugs, supplies, and space, including a sufficient number of treatment rooms, shall be adequate in terms of the size and scope of services provided.

Subchapter 28 MEDICAL AND NURSING PERSONNEL Rule 41.28.1. There shall be adequate medical and nursing personnel available at all times.

Rule 41.28.2. The medical staff shall be responsible for insuring adequate medical coverage for emergency services.

Rule 41.28.3. Qualified physicians shall be regularly available at all times for the emergency service, either on duty or on call.

Rule 41.28.4. Qualified nurses shall be available at all times and in sufficient number to deal with the number and extent of emergency services.

Subchapter 29 MEDICAL RECORDS

Rule 41.29.1. Adequate medical records on each patient shall be kept. The emergency medical record shall contain:

1. Patient identification.

2. History of disease or injury.

3. Physical findings.

4. Laboratory and x-ray reports, if any.

5. Diagnosis.

6. Record of treatment.

7. Disposition of the case.

8. Signature of a physician.

Rule 41.29.2. Medical records for patients treated in the emergency service shall be maintained and correlated with other hospital records in accordance with Medical Records section.

Rule 41.29.3. Where appropriate, medical records of emergency services shall be integrated with those of the inpatient and outpatient services.

Rule 41.29.4. An emergency service register shall be maintained and shall contain at least: date and time, patient identification, injury or disease, treatment, and the name of the doctor.

Subchapter 30 NURSING

Rule 41.30.1. The hospital shall maintain an organized nursing staff to provide high quality nursing care for the needs of the patients and to be responsible to the hospital for the professional performance of its members. The nursing service shall be under the direction of a legally and professionally qualified registered nurse. There shall also be a sufficient number of duly licensed registered nurses on duty at all times to plan, assign, supervise, and evaluate nursing care, as well as to give patients the nursing care that requires judgment and specialized skills of a registered nurse.

Rule 41.30.2. The director of nursing service shall be qualified by education, experience, and demonstrated ability to organize, coordinate, and evaluate the work of the service. He or she shall be qualified in the fields of nursing and administration consistent with the complexity and scope of operation of the hospital and shall be responsible to the administrator for developing and implementing policies and procedures of the service in the hospital.

Rule 41.30.3. Individual staffing patterns shall be developed for each nursing care unit, including the surgical and obstetrical suites, each special care unit, and outpatient services. The staffing patterns shall provide for sufficient nursing personnel and for adequate supervision and direction by registered nurses consistent with the size and complexity of the hospital.

Rule 41.30.4. There shall be an adequate number of registered nurses readily available to patients requiring their services. A registered nurse must plan, supervise, and evaluate the nursing care of each patient.

Rule 41.30.6. To develop better patterns of utilization of nursing personnel, periodic evaluation of the activities and effectiveness of the nursing staff should be conducted

Rule 41.30.7. The nursing service shall have a current written organizational plan that delineates its functional structure and its mechanisms for cooperative planning and decision making. This plan shall be an integral part of the overall hospital plan and its shall:

1. Be made available to all nursing personnel.

2. Be reviewed periodically and revised as necessary.

3. Reflect the staffing pattern for nursing personnel throughout the hospital.

4. Delineate the functions for which nursing service is responsible.

5. Indicate all positions required to carry out such functions.

6. Contain job descriptions for each position classification in nursing service that delineate the functions, responsibilities, and desired qualifications of each classification, and should be made available to nursing personnel at the time of employment.

7. Indicate the lines of communication within nursing service.

8. Define the relationships of nursing service to all other services and departments in the hospital.

Rule 41.30.8. If the hospital provides clinical facilities for the education and training of nursing students, licensed practical nurses, nurses’ aides, or other categories of nursing personnel, there shall be a written agreement that defines the role and responsibility of both the nursing service and the education program.

Rule 41.30.9. In the planning, decision making, and formulation of policies that affect the operation of nursing service, the nursing care of patients, or the patients' environment, the recommendations of representatives of nursing service should be considered.

Rule 41.30.10. In hospitals where the size of the nursing staff permits, nursing committees should be formally organized to facilitate the establishment and attainment of goals and objectives of the nursing service.

Rule 41.30.11. Written nursing care and administrative policies and procedures shall be developed to provide the nursing staff with acceptable methods of meeting its responsibilities and achieving projected goals through realistic and attainable goals.

Rule 41.30.12. Nursing care policies and procedures shall be consistent with professionally recognized standards of nursing practice and shall be in accordance with Nurse Practice Act of the State of Mississippi. They should take into account new equipment and current practice.

Rule 41.30.13. Policies shall be developed to address the following:

1. Noting diagnostic and therapeutic orders.

2. Assignment of nursing care to patients.

3. Administration of medications.

4. Charting by nursing personnel.

5. Infection control.

6. Patient and personnel safety.

7. Prevention of pressure sores.

8. Prevention of medication errors.

9. Reporting of adverse drug reactions.

10. Comprehensive assessment.

11. Pain Management.

Rule 41.30.14. All nursing personnel, including non-employee licensed nurses who are working in the hospital, must adhere to the hospital’s policies and procedures.

Rule 41.30.15. Policies and procedures shall be developed to include plans for orientation for all newly employed and non-employee nursing personnel. The policies and procedures shall specify specific subjects and topics to be covered in the orientation process. The facility shall maintain documented evidence of orientation of all nursing personnel.

Rule 41.30.16. Written copies of the procedure manual shall be available to the nursing staff in every nursing care unit and service area and to other services and departments in the hospital. The nursing procedure manual should be used to:

1. Provide a basis for training programs to enable new nursing personnel to acquire local knowledge and current skills.

2. Provide a ready reference on procedures for all nursing personnel.

3. Standardize procedures and equipment.

4. Provide a basis for evaluation and study to insure

continued improvements in techniques.

Rule 41.30.17. The nursing policies and procedures shall be developed, periodically reviewed, and revised as necessary by nursing representatives in cooperation with administration, the medical staff, and other hospital services and departments concerned. All revisions shall be dated to indicate the date of the latest review.

Rule 41.30.18. There shall be evidence established that the nursing service provides safe, efficient, and therapeutically effective nursing care through the planning of each patient's care and the effective implementation of the plans.

Rule 41.30.19. A brief and pertinent written nursing care plan should be developed for each patient. It should include:

1. Medication, treatment, and other items ordered by individuals granted clinical privileges and by authorized house staff members.

2. Nursing care needed.

3. Long-term goals and short-term goals.

4. Patient and family teaching and instructional programs.

5. The socio-psychological needs of the patient.

6. Preventative nursing care.

Rule 41.30.20. The nursing care plan should be initiated upon admission of the patient and, as a part of the long-term goal, should include discharge plans.

Nursing records and reports that reflect the patient's progress and the nursing care planned should be maintained.

Rule 41.30.21. Meetings of the nursing staff shall be held at least monthly in order to discuss nursing service problems and policies. Minutes of these meetings shall be kept.

Rule 41.30.22. An in-service education program shall be provided for the improvement of nursing care and service through increased proficiency and knowledge of nursing personnel. The in-service program shall be planned, scheduled, documented, and held on a continuing basis.

Rule 41.30.23. All nursing personnel shall have training and a program of in- service and continuing education commensurate with the duties and responsibilities of the individual. All training shall be documented for each individual so employed.

Rule 41.30.24. The in-service should include but not limit topics to pressure sore prevention, prevention of medication errors, pain management, patient’s rights, and dignity.

Rule 41.30.25. In hospitals where cardiac monitors are used on the nursing unit, rather than in a separate and distinct "Special Care Unit" as described in Subchapter 36 of these standards, special training, protocols, and staffing are required. Initial coronary care course that has been approved by the Mississippi State Board of Nursing that will include as a minimum the basic Cardiac Life Support Course is required for all Registered Nurses and Licensed Practical Nurses who have responsibilities for caring for cardiac monitored patients. A program of in-service and continuing education commensurate with the duties and responsibilities of the individual shall be established and documented for each individual so employed.

Rule 41.30.26. Protocols. Protocols shall be established and approved for response of trained, experienced Registered Professional Nurses to codes or cardiac emergencies that deal with lethal arrhythmias, hypotension, defibrillation, heart block and respiratory arrest by the nursing service and medical staff of each hospital.

Rule 41.30.27. Staffing. Nurse staffing will be evaluated on an individual basis for compliance. Factors to be considered are number of patients on monitors, layout of facility and proximity of emergency room to nursing unit, volume of services in the OB and Nursery and the emergency room, the number of patients on the medical/surgical floor and other responsibilities that the RN may have other than the ones described above. A sufficient number of RNs shall be available to meet the needs of the patients served. In the event that a hospital has patients on cardiac monitors in use in one area of the hospital and an emergency room in another area, the facility must have more than one RN in house to care for the patient.

Subchapter 31 OBSTETRICS AND NEWBORN NURSERY ORGANIZATION

Rule 41.31.1. Obstetrics and newborn nursery services shall be under the direction of a member of the staff of physicians who has been duly appointed for this service and who has experience in maternity and newborn care.

Rule 41.31.2. There shall be a qualified professional registered nurse responsible at all times for the nursing care of maternity patients and newborn infants.

Rule 41.31.3. Provisions shall be made for pre-employment and annual health examinations for all personnel on this service.

Rule 41.31.4. Physical facilities for perinatal care in hospitals shall be conducive to care that meets the normal physiologic and psychosocial needs of mothers, neonates, and their families. The facilities provide for deviations from the norm consistent with professionally recognized standards/guidelines.

Rule 41.31.5. The obstetrical service should have facilities for the following components:

1. Antepartum care and testing.

2. Fetal diagnostic services.

3. Admission/observation/waiting.

4. Labor.

5. Delivery/cesarean birth.

6. Newborn nursery.

7. Newborn Intensive Care (Levels II and III only).

8. Recovery and postpartum care.

9. Visitation.

Rule 41.31.6. Any facility providing obstetric care shall have at least the following services available:

1. Identification of high-risk mothers and fetuses.

2. Equipment for continuous fetal heart rate monitoring or capability of following auscultation guidelines.

3. Capabilities to begin a cesarean delivery within 30 minutes of a decision to do so.

4. Blood and fresh-frozen plasma for transfusion.

5. Anesthesia on a 24-hour basis.

6. Radiology and ultrasound examination.

7. Neonatal resuscitation, including equipment and trained personnel.

8. Laboratory testing on a 24-hour basis.

9. Consultation and transfer agreement.

10. Nursery.

11. Data collection and retrieval.

12. Patient education. Rule 41.31.7. Staffing. The facility is staffed to meet its patient care commitments consistent with professionally recognized guidelines. There must be a registered nurse immediately available for direct patient care.

Rule 41.31.8. Level I.

1. Surveillance and care of all patients admitted to the obstetric service, with an established triage system for identifying high- risk mothers who should be transferred to a facility that provides level II and III care prior to delivery.

2. Proper detection and supportive care of unanticipated maternal-fetal problems that occur during labor and delivery.

3. Performance of cesarean delivery.

4. Care of postpartum conditions.

5. Personnel trained in neonatal resuscitation in the hospital at all times.

6. Stabilization of unexpectedly small or sick neonates before transfer to a facility that provides level II or III care.

7. Evaluation of the condition of healthy neonates and continuing care of these neonates until their discharge.

8. Patient education.

Rule 41.31.9. Level II. 1. Performance of level I services.

2. Management of high-risk mothers and neonates admitted and evaluated for continued management and/or appropriate transfer.

Rule 41.31.10. Level III.

1. Provision of full range of perinatal care services for all mothers and neonates. 2. Research support. 3. Completion, analysis, and evaluation of regional data. Rule 41.31.11. Antepartum Care. There should be policies for the care of pregnant patients with obstetric, medical, or surgical complications and for maternal transfer.

Rule 41.31.12. Intra-partum Services: Labor and Delivery. Intra-partum care should be both personalized and comprehensive with continuous surveillance of the mother and fetus. There should be written policies and procedures in regard to:

1. Assessment.

2. Admission.

3. Medical records (including complete prenatal history and physical).

4. Consent forms.

5. Management of labor including assessment of fetal well-being.

6. Term patients.

7. Preterm patients.

8. Premature rupture of membranes.

9. Preeclampsia/eclampsia.

10. Third trimester hemorrhage.

11. Pregnancy Induced Hypertension (PIH).

12. Patients receiving oxytoxics or tocolytics.

13. Patients with stillbirths and miscarriages.

14. Pain control during Labor and Delivery.

15. Management of Delivery.

16. Emergency cesarean delivery (capability within 30 minutes).

17. Assessment of fetal maturity prior to repeat cesarean delivery or induction of labor.

18. Vaginal birth after cesarean delivery.

19. Assessment and care of neonate in the delivery room.

20. Infection control in the Obstetric and newborn areas. 21. A delivery room record shall be kept that will indicate:

A. The name of the patient.

B. Date of delivery.

C. Sex of Infant.

D. Apgar.

E. Weight.

F. Name of physician.

G. Name of persons assisting.

H. What complications, if any, occurred.

I. Type of anesthesia used.

J. Name of person administering anesthesia.

22. Maternal transfer.

23. Immediate postpartum/recovery care.

24. Housekeeping.

Rule 41.31.13. Newborn Care. There shall be policies and procedures for providing care of the neonate including:

1. Immediate stabilization period. 2. Neonate identification and security. 3. Assessment of neonatal risks. 4. Cord blood, Combs, and serology testing. 5. Eye care. 6. Subsequent care. 7. Administration of Vitamin K. 8. Neonatal screening. 9. Circumcision.

10. Parent education.

11. Visitation.

12. Admission of neonates born outside of facility.

13. Housekeeping.

14. Care of or stabilization and transfer of high-risk neonates.

15. Postpartum. There shall be policies and procedures for postpartum care of mother.

16. Assessment.

17. Subsequent care (bed rest, ambulation, diet, care of the vulva, care of the bowel and bladder functions, bathing, care of the breasts, temperature elevation).

18. Postpartum sterilization.

19. Immunization. RHIG and Rubella.

20. Discharge Planning.

Subchapter 32 OUTPATIENT

Rule 41.32.1. Hospitals rendering outpatient services shall have effective policies and procedures relating to the staff, functions of the service, and outpatient medical records and adequate facilities in order to assure the health and safety of the patients.

Subchapter 33 ORGANIZATION

Rule 41.33.1. The outpatient department shall be organized into sections according to medical specialties (clinics), the number of which depends on the size and the degree of departmentalization of the medical staff, available facilities,

and the needs of the patients for whom it accepts responsibility.

Rule 41.33.2. The outpatient department shall have appropriate cooperative arrangements and communications with the community agencies such as other outpatient departments, public health nursing agencies, the department of health, and welfare agencies.

Rule 41.33.3. Clinics shall be integrated with corresponding inpatient services.

Rule 41.33.4. Clinics shall be maintained for the following purposes:

1. Care of ambulatory patient unrelated to inpatient admission or discharge.

2. Study of preadmission patients.

3. Follow-up of discharge hospital patients.

Rule 41.33.5. Patients, on their initial visit to the department, shall receive a general medical evaluation and patients under continuous care shall receive an adequate periodic re-evaluation.

Rule 41.33.6. Established medical screening procedures shall be employed routinely.

Subchapter 34 PERSONNEL

Rule 41.34.1. There shall be such professional and non-professional personnel as are required for efficient operation.

Rule 41.34.2. The outpatient service shall be supervised by a qualified member of the medical staff. Either this physician or a qualified administrator shall be responsible for administrative services.

Rule 41.34.3. A registered professional nurse shall be responsible for the nursing services of the department.

Rule 41.34.4. The number and type of other personnel employed shall reflect the volume and type of work carried out and the type of patient served in the outpatient department.

Subchapter 35 FACILITIES

Rule 41.35.1. Facilities shall be provided to assure the efficient operation of the department.

Rule 41.35.2. The number of examination and treatment rooms shall be adequate in relation to the volume and nature of work performed.

Rule 41.35.3. Suitable facilities for necessary diagnostic tests shall be available either through the hospital or some other facility approved to provide these services.

Rule 41.35.4. Medical Records. Shall be maintained and correlated with other hospital records in accordance with Subchapter 48, Medical Records.

Rule 41.35.5. Liaison Conferences. Conference, both departmental and inter- departmental, shall be conducted to maintain close liaison between the various sections within the department and with other hospital services, and minutes shall be kept.

Subchapter 36 SPECIAL CARE UNIT

Rule 41.36.1. Special care units, if provided, shall be properly organized, directed, and integrated with other departments or services of the hospital.

Rule 41.36.2. The hospital organizational plan shall provide for the identification of each special care unit and delineate appropriate relationships with other clinical areas of the hospital. Each such unit shall be under the direction of a qualified physician who has a special interest in, and preferable additional experience in providing, this type of care. This physician shall also be one who is readily available - The director of the special care unit should be responsible for the implementation of established policy, which should include at least:

1. Rules for proper utilization of the services.

2. Provision for participation in appropriate training programs for the safe and effective use of diagnostic and therapeutic equipment for cardiopulmonary resuscitation and for other aspects of intensive care. 3. Plans for supervision of the collection and analysis of clinical data needed for the retrospective evaluation of the care provided in the unit.

Rule 41.36.3. The activities within a multipurpose special care unit should be guided by a multi- disciplinary committee, with one member serving as director of the unit.

Rule 41.36.4. Special care unit personnel shall be prepared for their responsibilities through appropriate training and educational programs.

Rule 41.36.5. All nursing personnel assigned to a special care unit must have completed an educational course specifically oriented to their level of participation in the care of seriously ill patients.

Rule 41.36.6. A continuing education program developed specifically for the personnel in the unit must be provided in order to enable them to maintain and improve their skills, as well as to learn new techniques.

Rule 41.36.7. Registered nurses and health care personnel may serve as assistant or backup personnel under the direct supervision of a qualified special care unit nurse. All nurses with patient care responsibility in the unit must have the ability to recognize clinical signs and symptoms that require notification of a physician.

Rule 41.36.8. Whatever the design or purpose of the unit, enough space shall be provided around each bed to make it easily accessible for routine and emergency care of the patients and also to accommodate bulky equipment that may be needed.

Rule 41.36.9. Oxygen and suction and properly grounded electrical outlets shall be readily available to every patient. Each bed shall be readily adjustable to various therapeutic positions, easily moved for transport, shall have a locking mechanism for a secure stationary position and, where feasible a removable headboard.

Rule 41.36.10. Direct visual observation of all patients should be possible from a central vantage point, yet patients should have a reasonable amount of privacy. They should be sheltered as much as possible from the activity and noise of the unit by partitions, drapes, and acoustic ceilings, but caution should be exercised in the use of carpeting and under carpet padding both as to fire resistance and potential production of toxic fumes in case of fire.

Rule 41.36.11. There shall be an alarm system for special care unit personnel to summon additional personnel in an emergency. The alarm should be connected to any area where unit personnel might be, such as physician's sleeping rooms, consultation rooms, nurse’s lounges, and nurses' stations.

Rule 41.36.12. The kind and quality of equipment in the special care unit shall depend upon the needs of the patients treated. Diagnostic monitoring and resuscitative equipment, such as respiratory assist apparatus, defibrillators, pacemakers, phlebotomy and tracheostomy sets, endotracheal tubes, laryngoscopes, and other such devices should be easily available within the unit, and in good working order. There shall be a written preventive maintenance program that includes techniques for cleaning and for contamination control, as well as for the periodic testing of all equipment.

Rule 41.36.13. When any electronic devices are used on patients, especially patients who have intravenous catheters or wires leading to the heart, special safety precautions related to proper grounding, current leakage and device-safety must be observed. Electrically operated beds are a potential electrical hazard where the patient is physically connected to any other electrical device.

Rule 41.36.14. Expert advice concerning the safe use of, and preventive maintenance for, all biomedical devices and electrical installations shall be readily available at all times. Documentation of safety testing should be provided on a regular basis to the unit director.

Rule 41.36.15. There shall be specific written policies and procedures for each special care unit, which supplement the basic hospital policies and procedures.

Rule 41.36.16. Because of the intensity of care given within the unit, and of the critical nature of the illnesses of patients cared for in it, written policies, and procedures additional to basic hospital policies should be developed to guide personnel in the management of the unique situations within the unit. These policies and procedures should be developed and approved by the medical staff, in cooperation with the nursing staff and with other hospital departments and services and the hospital administration as necessary. They should be periodically reviewed and revised as indicated.

Subchapter 37 SURGERY AND ANESTHESIA

Rule 41.37.1. General. Surgical services are optional, but if this service is provided, there shall be effective policies and procedures regarding surgical privileges, maintenance of the operating rooms, and evaluation of the surgical patient.

Subchapter 38 SURGERY

Rule 41.38.1. Surgical privileges shall be delineated for all physicians doing surgery in accordance with the competencies of each physician. A roster of surgeons specifying the surgical privileges of each shall be kept in the confidential files of the operation room supervisor and in the files of the administrator.

Rule 41.38.2. In any procedure with unusual hazard to life, there shall be present and scrubbed as first assistant a physician designated by the credentials committee as being qualified to assist in major surgery.

Rule 41.38.3. The operating room register shall be complete and up to date.

Rule 41.38.4. There shall be a complete history and physical work-up in the chart of every patient prior to surgery (whether the surgery is major or minor).

Rule 41.38.5. A properly executed consent form for operation shall be in the patient's chart prior to surgery.

Rule 41.38.6. There shall be adequate provision for immediate post-operative care.

Rule 41.38.7. An operative report describing techniques and findings shall be written or dictated immediately following surgery and signed by the surgeon.

Rule 41.38.8. All infections of clean surgical cases shall be recorded and reported to the administration. A procedure shall exist for the investigation of such cases.

Rule 41.38.9. The operating rooms shall be supervised by an experienced registered professional nurse.

Rule 41.38.10. The following equipment shall be available to the operating suites: Call-in system, resuscitator, defibrillator, aspirator, thoracotomy set, and tracheotomy set.

Rule 41.38.11. The operating room suite and accessory services shall be so located that traffic in and out can be controlled and there is no through traffic.

Rule 41.38.12. Precautions shall be taken to eliminate hazards of explosions, including use of shoes with conductive soles and prohibition of nylon garments.

Rule 41.38.13. Rules and regulations or policies related to the operating room shall be available and posted.

Subchapter 39 ANESTHESIA

Rule 41.39.1. The Department of Anesthesia shall have effective policies and procedures regarding staff privileges, the administration of anesthetics, and the maintenance of strict safety controls.

Rule 41.39.2. The Department of Anesthesia shall be responsible for all anesthetics administered in the hospital.

Rule 41.39.3. In hospitals where there is no Department of Anesthesia, the Department of Surgery shall assume the responsibility for establishing general policies for the administration of anesthetics.

Rule 41.39.4. Safety precautions shall be accordance with NFPA Bulletin 56A.

Subchapter 40 GENERAL SERVICES: DIETARY ORGANIZATION

Rule 41.40.1. The hospital shall have an organized dietary department directed by qualified personnel. However, a hospital which has a contract with an outside food management company may be found to meet this requirement if the company has a therapeutic dietitian who serves, as required by scope and complexity of the service, on a full-time, part- time, or consultant basis to the hospital.

Rule 41.40.2. There shall be written policies and procedures for food storage, preparation, and service developed by a qualified dietitian (preferably meeting the American Dietetic Association's standards for qualification).

Rule 41.40.3. The number of personnel, such as cooks, bakers, dishwashers, and clerks shall be adequate to perform effectively all defined functions.

Rule 41.40.4. Written job descriptions of all dietary employees shall be available.

Rule 41.40.5. There shall be procedures to control dietary employees with infectious and open lesions. Routine health examinations shall meet local and state codes for food service personnel.

Rule 41.40.6. There shall be an in-service training program for dietary employees which includes the proper handling of food and personal grooming.

Subchapter 41 FACILITIES Rule 41.41.1. Written reports of inspections by the Department of Health of action taken to comply with recommendations are to be kept on file at the hospital with notation made by the hospital.

Rule 41.41.2. Dry or staple food items shall be stored at least 12 inches off the floor in a ventilated room which is not subject to sewage or wastewater back-flow, or contamination by condensation, leakage, rodents, or vermin.

Rule 41.41.3. All perishable foods shall be refrigerated at the appropriate temperature and in an orderly and sanitary manner. Each refrigerator shall contain a thermometer in good working order.

Rule 41.41.4. Foods being displayed or transported shall be protected from contamination.

Rule 41.41.5. Dishwashing procedures and techniques shall be developed and carried out in compliance with the state and local health codes.

Rule 41.41.6. All garbage and kitchen refuse which is not disposed of mechanically shall be kept in leak proof non-absorbent containers with close fitting covers and be disposed or routinely in a manner that will not permit transmission of disease, a nuisance, or a breeding place for flies. All garbage containers are to be thoroughly cleaned inside and outside each time emptied. No garbage or kitchen refuse may be used as feed for swine.

Rule 41.41.7. Diets. There shall be a systematic record of diets, correlated when appropriate, with the medical records. The dietitian shall have available an up-to-date manual or regimens for all therapeutic diets, approved jointly by the dietitian and medical staff, which is available to dietary supervisory personnel. Diets served to patients shall be in compliance with these established diet principles.

Subchapter 42 ENVIRONMENT AND SAFETY: FIRE CONTROL AND INTERNAL DISASTER Rule 41.42.1. The hospital shall provide fire protection by the elimination of fire hazards the installation of necessary safeguards such as extinguishers, sprinkling devices, fire barriers to insure rapid and effective fire control and the adoption of written fire control and evacuation plans rehearsed at least three times a year by key personnel.

Rule 41.42.2. Written fire control plans shall contain provisions for prompt reporting of all fires extinguishing fires; protection of patients, personnel, and guests’ evacuation; training of personnel in use of first aid firefighting equipment; and cooperation with firefighting authorities.

Rule 41.42.3. There shall be rigidly enforced written rules and regulations governing proper routine methods of handling and storing of flammable and explosive agents, particularly in operating rooms and laboratories, and governing the provision of oxygen therapy.

Rule 41.42.4. The hospital shall have:

1. Written evidence of regular inspection and approval by state or local fire control agencies.

2. Stairwells kept closed by fire doors or equipped with unimpaired automatic closing devices.

3. Fire extinguishers refilled when necessary and kept in condition for instant use. There shall be an annual inspection of each fire extinguisher which shall include a tag showing the month and year of the inspection and the initials of the inspector.

4. Conductive floors with the required equipment and ungrounded

electrical circuits in areas subject to explosion hazards.

5. Proper routine storage and prompt disposal of trash.

6. "No Smoking" signs prominently displayed where appropriate, with rules governing the ban on smoking in designated areas of the hospital enforced and obeyed by all personnel.

7. Fire regulations easily available to all personnel and all fire codes rigidly observed and carried out.

8. Corridors and exits clear of all obstructions except for permanently mounted handrails.

9. Holiday decorations consisting of natural foliage or plant material are not permitted.

Subchapter 43 EMERGENCY OPERATIONS PLAN (EOP)

Rule 41.43.1. The hospital shall develop and maintain a comprehensive emergency preparedness program that includes an emergency plan. The emergency plan must be based on a documented, facility-based and community- based risk assessment utilizing an "all-hazards" approach. The program and its plan must be reviewed and updated at least annually by the hospital.

1. A hospital subject to 42 CFR Part 482 shall comply with the requirements of 42 CFR § 482.15, "Condition of participation: Emergency preparedness."

2. A Critical Access Hospital (CAH) subject to 42 CFR Part 485 shall comply with the requirements of 42 CFR § 485.625, "Condition of participation: Emergency preparedness."

3. Communications and Facility Status Reporting. The hospital shall submit facility status reports, including but not limited to, bed availability and operational status, in a format and at a frequency determined by the Department.

Subchapter 44 FACILITY FIRE PREPAREDNESS

Rule 41.44.1. Fire Drills. Fire drills shall be conducted one (1) per shift per quarter. Employees shall participate in a fire drill at least four (4) times per year. 1. Written Records. Written records of all drills shall be maintained, indicating content of and attendance at each drill. 2. A fire evacuation plan shall be posted in each facility in a conspicuous place and kept current.

Subchapter 45 SANITARY ENVIRONMENT

Rule 41.45.1. The hospital shall provide a sanitary environment to avoid sources and transmission of infections.

Rule 41.45.2. An infection committee, composed of members of the medical and nursing staffs and administration, shall be established and shall be responsible for investigating, controlling, and preventing infections in the hospital.

Rule 41.45.3. There shall be written procedures to govern the use of aseptic techniques and procedures in all areas of the hospital.

Rule 41.45.4. To keep infections at a minimum, such procedures and techniques shall be regularly reviewed by the infection committee.

Rule 41.45.5. There shall be a method of control used in relation to the sterilization and water and a written policy requiring sterile supplies to be re-processed at specified time periods.

Rule 41.45.6. Continuing education shall be provided to all hospital personnel on the cause, effect, transmission, prevention, and elimination of infections.

Rule 41.45.7. A continuing process shall be enforced for inspection and reporting of any hospital employee with an infection who may be in contact with patients, their food or laundry.

Rule 41.45.8. Regulated Medical Waste. "Infectious medical wastes" includes solid or liquid wastes which may contain pathogens with sufficient virulence and quantity such that exposure to the waste by a susceptible host has been proven to result in an infectious disease. For purposes of this Regulation, the following wastes shall be considered to be infectious medical wastes:

1. Wastes resulting from the care of patients and animals who have Class I and (or) II diseases that are transmitted by blood and body fluid as defined in the rules and regulations governing reportable diseases as defined by the Mississippi Department of Health;

2. Cultures and stocks of infectious agents; including specimen cultures collected from medical and pathological laboratories, cultures and stocks of infectious agents from research and industrial laboratories, wastes from the production of biologicals, discarded live and attenuated vaccines, and culture dishes and devices used to transfer, inoculate, and mix cultures;

3. Blood and blood products such as serum, plasma, and other blood components;

4. Pathological wastes, such as tissues, organs, body parts, and body fluids that are removed during surgery and autopsy;

5. Contaminated carcasses, body parts, and bedding of animals that were exposed to pathogens in medical research;

6. All discarded sharps (e.g., hypodermic needles, syringes, Pasteur

pipettes, broken glass, scalpel blades) which have come into contact with infectious agents;

7. Other wastes determined infectious by the generator or so classified by the Department of Health.

Rule 41.45.9. "Medical Waste" means all waste generated in direct patient care or in diagnostic or research areas that is non-infectious but aesthetically repugnant if found in the environment.

Rule 41.45.10. Medical Waste Management Plan. All generators of infectious medical waste and medical waste shall have a medical waste management plan in accordance with Adopted Standards for the Regulation of Medical Waste.

Subchapter 46 HOUSEKEEPING

Rule 41.46.1. The housekeeping functions of the hospital shall be under the direction of a certified executive housekeeper, or other person knowledgeable about and capable of maintaining the aseptic conditions required in the various departments of the hospital.

Rule 41.46.2. There shall be adequate space provided for the storage of housekeeping equipment and supplies and for the housekeeper to maintain adequate records of the housekeeping operations.

Rule 41.46.3. Separate janitor’s closets and separate cleaning equipment and supplies shall be maintained for the following areas and shall not be used for cleaning in any other location:

1. Surgical Suites.

2. Delivery Suites.

3. Newborn Nursery.

4. Dietary Department

5. Emergency Service Area.

6. Patient Areas.

Rule 41.46.4. Additional janitor’s closets, equipment and supplies should be provided for laboratories, radiology, offices, locker rooms and other areas of the hospital. Housekeeping equipment or supplies used for cleaning in isolation or contaminated areas shall not be used in any other area of the hospital before it has been properly cleaned and sterilized.

Rule 41.46.5. All areas of the hospital, including the building and grounds, shall be kept clean and orderly.

Rule 41.46.6. There shall be frequent cleaning of floors, walls, woodwork, and windows.

Rule 41.46.7. The premises must be kept free of rodent and insect infestations.

Rule 41.46.8. Accumulated waste material and rubbish must be removed at frequent intervals.

Rule 41.46.9. No flammable cleaning agents or other flammable liquids or gases shall be stored in any janitor’s closet or other area of the hospital except in a properly fire rated, and properly ventilated storage area specifically designed for such storage.

Subchapter 47 LAUNDRY & LINEN

Rule 41.47.1. Laundry and linen service shall be under the direction of a person knowledgeable about the capable of maintaining the sanitary requirements of the hospital in the care of both clean and soiled linens. This person shall report directly to the administrator of the hospital.

Rule 41.47.2. If the hospital maintains its own laundry, it shall have separate areas for:

1. Collection of soiled linens.

2. Washing, drying, and ironing.

3. Clean linen storage.

Rule 41.47.3. The laundry design and operation shall comply with all appropriate codes and regulations to assure that it will not be a health or safety hazard to hospital patients and personnel.

Rule 41.47.4. If the hospital uses a laundry not controlled by the hospital, that laundry must maintain the sanitary requirements of hospitals regarding the processing of its linens and must maintain a satisfactory schedule of pick-up and delivery. Sanitary practices shall be checked by periodic laboratory tests.

Rule 41.47.5. Hospitals shall maintain an adequate supply of clean linens at all times.

Rule 41.47.6. Adequate clean linen storage shall be readily accessible to nurses’ stations.

Rule 41.47.7. Dirty linen storage shall be well ventilated and shall be located convenient to the laundry or service entrance of the hospital. The storage of appreciable quantities of soiled linens is discouraged.

Subchapter 48 MEDICAL RECORDS – ORGANIZATION

Rule 41.48.1. The hospital shall have a medical record department with administrative responsibility for medical records. A medical record shall be maintained, in accordance with accepted professional principles, for each patient receiving care in the hospital.

Rule 41.48.2. Such records shall be kept confidential and only authorized personnel shall have access to the records.

Rule 41.48.3. Written consent of the patient or the patient’s legal representative shall be presented as authority for release of medical information and this release shall become part of the medical record.

Rule 41.48.4. Medical records shall not be removed from the hospital environment except upon subpoena.

Rule 41.48.5. Preservation. Records shall be preserved, either in the original or by reproduction, for a period of time not less than that set forth in Title 41, Chapter 9 of the Mississippi Code of 1972.

Subchapter 49 PERSONNEL

Rule 41.49.1. Qualified personnel adequate to supervise and conduct the department shall be provided.

Rule 41.49.2. Preferably a Registered Health Information Administrator or Registered Health Information Technician shall head the department. If such a professionally qualified person is not in charge of medical records, one shall be employed either on a part-time or consultative basis to organize the department, train the regular personnel, and make periodic visits to the hospital to evaluate the records and the operation of the department.

Subchapter 50 IDENTIFICATION AND FILING

Rule 41.50.1. A system of identification and filing to ensure the prompt location of a patient's medical record shall be maintained.

Rule 41.50.2. A master patient index shall be maintained and shall bear at least the full name of the patient, the address, the birth date, and the medical record number.

Rule 41.50.3. Filing equipment and space shall be adequate to house the records and facilitate retrieval.

Rule 41.50.4. A unit record should be maintained so that both inpatient and outpatient treatment are in one folder.

Subchapter 51 CENTRALIZATION OF REPORTS

Rule 41.51.1. All clinical information pertaining to a patient's stay shall be centralized in the patient's record.

Rule 41.51.2. The original of all reports originating in the hospital shall be filed in the medical records.

Rule 41.51.3. All reports or records shall be completed and filed within a period consistent with good medical practice and not longer than 30 days following discharge.

Rule 41.51.4. INDEXES - RESERVED

Rule 41.51.5. Records shall be indexed according to disease, operation, and physician and shall be kept up to date. For indexing, any recognized system may be used.

Rule 41.51.6. Diagnoses and Operations. shall be expressed in terminology which describes the morbid condition both as to site and ethological factors or the method or procedure.

Rule 41.51.7. Indexing shall be current within six months following discharge of the patient.

Rule 41.51.8. Content. The medical record shall contain sufficient information to justify the diagnosis and warrant the treatment and end results. The medical record shall contain the following information: Identification date, chief complaint, present illness, physician's orders, past history, family history, physical examination, provisional diagnosis, clinical laboratory reports, x- ray reports, consultations, treatment medical and surgical, tissue report, progress notes, final diagnosis, discharge summary, autopsy findings.

Rule 41.51.9. Authorship. Only practitioners authorized by the governing body to perform medical histories and physical examinations shall be permitted to write or dictate medical histories and physical examinations.

Subchapter 52 ENTRIES

Rule 41.52.1. All entries must be legible and complete and must be authenticated and dated promptly by the person (identified by name and discipline) responsible for ordering, providing, or evaluating the service furnished. All orders/entries must be dated, timed, and authenticated promptly by the prescribing physician or another physician responsible for the care of the patient, even if the order did not originate with him or her. Authentication may include signatures, written initials, or computer entry.

Rule 41.52.2. Entries in the medical records may be made only by individuals as specified in hospital and medical staff policies. All entries in the medical record must be dated and authenticated, and a method established to identify the authors of entries. Such identification may include written signatures initials or computer key. When rubber stamp signatures are authorized, the individual whose signature the stamp represents shall place in the administrative offices of the hospital, a signed statement to the effect that he/she is the only one who has the stamp and uses it. There shall be no delegation to another individual. A list of computer codes and written signatures must be readily available and maintained under adequate safeguards. There shall be sanctions established for improper or unauthorized use of stamp and computer key signatures.

Rule 41.52.4. In hospitals with house staff, the attending physician shall countersign at least the history and physical examination and summary written by the house staff.

Subchapter 53 PROMPTNESS OF RECORD COMPLETION

Rule 41.53.1. Current records shall be completed within 24 to 48 hours following admission. Verbal orders shall be authenticated in accordance with facility policy and, in the absence of a facility policy, no later than 30 days after discharge.

Rule 41.53.2. Records of patients discharged shall be completed within 30 days following discharge. The staff regulations of the hospital shall provide for the suspension or termination of staff membership and/or clinical privileges of practitioners who are persistently delinquent in completing records.

Rule 41.53.3. If a patient is readmitted within a month for the same condition, reference to the previous history with an interval note and physical examination shall suffice.

Rule 41.53.4. Medical Library. The medical library shall have modern textbooks and current periodicals relative to the clinical services offered.

Subchapter 54 ANCILLARY SERVICES: DENTAL, REHABILITATION, PHYSICAL THERAPY, OCCUPATIONAL THERAPY & SPEECHPATHOLOGY

Rule 41.54.1. General. Dental and rehabilitation departments are optional, but if these optional services are present, there shall be effective policies and procedures relating to the staff and the functions of the services in order to assure the health and safety of the patients.

Subchapter 55 DEPARTMENT OF DENTISTRY AND DENTAL STAFF

Rule 41.55.1. According to the procedure established for the appointment of the medical staff, one or more dentists may be appointed to the dental staff. If the dental service is organized, its organization shall be comparable to that of other services or departments. Whether or not the dental service is organized as a department, the following requirements shall be met:

1. Members of the dental staff shall be qualified legally, professionally, and ethically for the positions to which they are appointed.

2. Patients admitted for dental services shall be admitted by the dentist either to the department of dentistry, or, if there is no department, to an organized clinical service.

3. There shall be a physician in attendance who is responsible for the medical care of the patient throughout the hospital stay. A medical survey shall be done and recorded by a member of the medical staff before dental surgery is performed. A medical survey may be done by an oral surgeon as outlined in Rule 41.7.3.

4. There shall be specific bylaws concerning the dental staff written as combined medical - dental staff bylaws or separate or adjunct dental bylaws.

5. The staff bylaws and rules and regulations shall specifically delineate the rights and privileges of the dentists.

6. Complete records, both medical and dental, shall be required

on each dental patient and shall be a part of the hospital records.

Subchapter 56 REHABILITATION, PHYSICAL THERAPY, OCCUPATIONAL THERAPY, AND SPEECH PATHOLOGY DEPARTMENTS Rule 41.56.1. These services may be provided. If provided, they shall have effective policies and procedures relating to the organization and functions of the services and be staffed by qualified therapists.

Rule 41.56.2. The department head shall have the necessary knowledge, experience, and capabilities to properly supervise and administer the department. A rehabilitation department head shall be a psychiatrist or other physician with pertinent experience. If separate therapy departments are maintained, the department head shall be a qualified therapist (as is appropriate) or a physician with pertinent experience.

Rule 41.56.4. If occupational therapy services are offered, the services shall be given by or under the supervision of a professional licensed occupational therapist and hold a current Mississippi license. Other properly trained and supervised personnel, such as licensed occupational therapy assistants and aides, shall be sufficient to meet the needs of the department.

Rule 41.56.5. If speech pathology services are offered, the service shall be given by a qualified speech pathologist and hold a current Mississippi license.

Rule 41.56.6. Facilities and equipment for physical and occupational therapy shall be adequate to meet the needs of the services and shall be in good condition.

Rule 41.56.7. Physical therapy, occupational therapy, and speech pathology shall be given in accordance with a physician's orders.

Rule 41.56.8. Complete records shall be maintained for each patient receiving therapy services and are to include evaluations and clinical notes.

Subchapter 57 LABORATORY - ORGANIZATION

Rule 41.57.1. The hospital shall have a well-organized, adequately supervised and staffed clinical laboratory with the necessary space, facilities, and equipment to perform those services commensurate with the hospital's needs for its patients. Anatomical pathology services and transfusion services shall be available either in the hospital or by arrangement with other facilities.

Subchapter 58 CLINICAL LABORATORY EXAMINATIONS

Rule 41.58.1. Provision shall be made to carry out adequate clinical laboratory examinations including chemistry, microbiology, hematology, coagulation, general immunology, and clinical microscopy either in the hospital or an approved outside laboratory.

Rule 41.58.2. In the case of work performed by an outside laboratory, the original report from such laboratory shall be contained in the medical record. For results received directly from the testing laboratory’s computer, there may not be a paper copy, which is acceptable.

Subchapter 59 AVAILABILITY OF FACILITIES AND SERVICES

Rule 41.59.1. Adequate provision shall be made for assuring the availability of emergency laboratory services, either in the hospital or under arrangements with an approved outside laboratory. Such services shall be available 24 hours a day, seven days a week, including holidays.

Rule 41.59.2. Where services are provided by an outside laboratory, the conditions, procedures, and availability of services offered shall be in writing and available in the hospital.

Subchapter 60 PERSONNEL

Rule 41.60.1. Services shall be under the technical supervision of a physician with training and experience in clinical laboratory services.

Rule 41.60.2. All personnel in the laboratory must meet the qualification and training requirements specified in the federal Clinical Laboratory Improvement Amendments of 1988 (CLIA).

Subchapter 61 LABORATORY REPORT

Rule 41.61.1. Reports shall be filed with the patient’s medical record and duplicate copies kept in the department. For data filed electronically, it is not necessary to retain paper copies in the laboratory. The laboratory must be able to identify the analyst and date completed for all procedures and tests.

Rule 41.61.2. The laboratory director shall be responsible for the laboratory report.

Rule 41.61.3. There shall be a procedure for assuring that all tests are ordered by a physician.

Subchapter 62 PATHOLOGIST SERVICES

Rule 41.62.1. Services shall be under the direct supervision of a pathologist on a full- time, regular part-time, or regular consultative basis. If the latter pertains, the hospital shall provide for, as a minimum, quarterly consultative visits by a pathologist.

Rule 41.62.2. The pathologist should participate in staff, departmental and clinical- pathologic conferences.

Rule 41.62.3. The pathologist shall be responsible for assuring the qualifications of his staff meet CLIA’88 requirements. The pathologist must provide for in-service and continuing education for the staff.

Subchapter 63 TISSUE EXAMINATIONS

Rule 41.63.1. All tissues removed during surgery, shall be examined. The extent of

examination shall be determined by the pathology department.

Rule 41.63.2. All tissues removed from patients during surgery shall be macroscopically, and if necessary, microscopically examined by the pathologist.

Rule 41.63.4. A tissue file shall be maintained in the hospital.

Rule 41.63.5. In the absence of a pathologist or suitable physician substituted, there shall be an established plan for sending to a pathologist outside the hospital all tissues requiring examination.

Subchapter 64 REPORTS OF TISSUE EXAMINATION

Rule 41.64.1. Signed reports of tissue examinations shall be filed within the patient’s medical record and duplicate copies kept in the department.

Rule 41.64.2. All reports of macro and microscopic examinations performed shall be signed by the pathologist or designated physician.

Rule 41.64.3. Provision shall be made for the prompt filing of examination results in the patient’s medical record and notification of the physician requesting the examination.

Rule 41.64.4. Duplicate copies of the examination reports shall be filed in the laboratory in a manner which permits ready identification and accessibility.

Subchapter 65 BLOOD AND BLOOD PRODUCTS

Rule 41.65.1. Facilities for procurement, safekeeping and transfusion of blood products shall be provided or readily available consistent with the size and scope of operation of the hospital.

Rule 41.65.2. The hospital shall maintain, as a minimum, proper blood storage facilities under adequate control and supervision of the pathologist or other authorized physician.

Rule 41.65.3. For emergency situations the hospital shall maintain at least a minimum blood supply in the hospital at all times or be able to obtain blood quickly from community blood banks or institutions.

Rule 41.65.4. Where the hospital depends on outside blood banks, there shall be an agreement governing the procurement, transfer and availability of blood which is reviewed and approved by the medical staff, administration, and governing body.

Rule 41.65.5. There shall be provision for prompt blood typing and compatibility testing, and for laboratory investigation of transfusion reactions, either through the hospital or by arrangement with others on a continuous basis, under the supervision of a physician.

Rule 41.65.6. Blood storage facilities in the hospital shall have an adequate temperature

alarm system that is regularly inspected. The alarm system must be audible and monitor proper blood storage temperature over a 24-hour period. If blood is stored or maintained for transfusion outside of a monitored refrigerator, the laboratory must ensure and document that the storage conditions (including temperature) are appropriate to prevent deterioration of the blood or blood product.

Rule 41.65.7. Records shall be kept on file indicating the receipt and disposition of all blood products that are received into the hospital.

Rule 41.65.8. Samples of each unit of blood transfused at the hospital shall be retained according to the instructions of the committee indicated in Rule 41.65.9 for further retesting in the event of reactions.

Rule 41.65.9. A committee of the medical staff or its equivalent shall review all transfusions of blood or blood products and make recommendations concerning policies governing such practices.

Subchapter 66 PHARMACY OR DRUG ROOM ORGANIZATION

Rule 41.66.1. The hospital shall have a pharmacy directed by a registered pharmacist, or a drug room under competent supervision. The pharmacy or drug room shall be administered in accordance with accepted professional principles.

Rule 41.66.2. Provision shall be made for emergency pharmaceutical services.

Rule 41.66.3. If the hospital does not have a staff pharmacist, a consulting pharmacist shall have overall responsibility for control and distribution of drugs and a designated individual or individuals shall have responsibility for day-to- day operation of the pharmacy.

Rule 41.66.4. Outdated, mislabeled, or otherwise unusable drugs and biologicals shall not be available for patient use.

Subchapter 67 RECORDS

Rule 41.67.1. Records shall be kept of the transactions of the pharmacy (or drug room) and correlated with other hospital records where indicated. Such special records shall be kept as required by law.

Rule 41.67.2. The pharmacy shall establish and maintain a satisfactory system of records and accountability in accordance with the policies of the hospital for maintaining adequate control over the requisitioning and dispensing of all drugs and pharmaceutical supplies.

Rule 41.67.3. A record of the stock on hand and of the dispensing of all narcotic drugs shall be maintained in such a manner that the disposition of any particular item may be readily traced.

Rule 41.67.4. Records for prescription drugs dispensed to each patient (inpatients and outpatients) shall be maintained which contain the full name of the patient and the prescribing physician, the prescription number, the name, and strength of the drug, the date of issue, the expiration date for all time-dated medications, the lot and control

number of the drug, and the name of the manufacturer (or trademark) dispensed.

Rule 41.67.5. The label of each individual prescription medication container shall bear the lot and control number of the drug, the name of the manufacturer (or trademark) and, unless the physician directs otherwise, the name of the medication dispensed.

Subchapter 68 CONTROL OF TOXIC OR DANGEROUS DRUGS

Rule 41.68.1. Policies shall be established to control the administration of toxic or dangerous drugs with specific reference to the duration of the order and the dosage.

Rule 41.68.2. The medical staff shall establish a written policy that all toxic or dangerous medications, not specifically prescribed as to time or number of doses, will be automatically stopped after a reasonable time limit set by the staff.

Rule 41.68.3. The classification ordinarily thought of as toxic, dangerous or abuse drugs shall be narcotics sedatives, anticoagulants, antibiotics, oxytocic and cortisone products, antineoplastic agents and shall include other categories so established by federal, state, or local laws.

Rule 41.68.4. Drugs to be Dispensed. Therapeutic ingredients of medications dispensed shall be those included (or approved for inclusion) in the United States Pharmacopoeia, National Formulary, United State Homeopathic Pharmacopoeia, New Drugs, or Accepted Dental Premedies (except for any drugs unfavorably evaluated therein), or those approved for use by the pharmacy and drug therapeutics committee. There shall be available a formulary or list of drugs accepted for use in the hospital which is developed and amended at regular intervals by the pharmacy

and therapeutics committee (or equivalent committee) with the cooperation of the pharmacist (consulting or otherwise) and the administration.

Subchapter 69 REGULATION CONTROLLED SUBSTANCES IN ANESTHETIZING AREAS

Rule 41.69.1. Dispensing Controlled Substances. All controlled substances shall be dispensed to the responsible person (Supervisor, CRNA, Anesthesiologist, etc.) designated to handle controlled substances in the operating room by a Registered Pharmacist in the hospital. When the controlled substance is dispensed, the following information shall be recorded into the controlled substance (proof-of-use) record.

1. Signature of pharmacist dispensing the controlled substance.

2. Signature of designated licensed person receiving the controlled substance.

3. The date and time-controlled substance is dispensed.

4. The name, the strength, and quantity of controlled substance dispensed.

5. The serial number assigned to that particular record, which corresponds to same number recorded in the pharmacy’s dispensing record.

Rule 41.69.2. Security/Storage of Controlled Substances. When not in use, all controlled substances shall be maintained in a securely locked, substantially constructed cabinet or area. All controlled substance storage cabinets shall be permanently affixed. Controlled substances removed from the controlled substance cabinet shall not be left unattended.

Rule 41.69.3. Controlled Substance Administration Accountability. The administration of all controlled substances to patients shall be carefully recorded into the anesthesia record. The following information shall be transferred from the anesthesia record to the controlled substance record by the administering practitioner during the shift in which the controlled substance was administered.

1. The patient’s name.

2. The name of the controlled substance and the dosage administered.

3. The date and time the controlled substance is administered.

4. The signature of the practitioner administering the controlled substance.

5. The wastage of any controlled substance.

6. The balance of controlled substances remaining after the administration of any quantity of the controlled substance.

7. Day-ending or shift-evening verification of count of balances of controlled substances remaining and controlling substances administered shall be accomplished by two (2) designated licensed persons whose signatures shall be affixed to a permanent record.

Rule 41.69.4. Waste of Controlled Substances

1. All partially used quantities of controlled substances shall be wasted at the end of each case by the practitioner, in the presence of a licensed person. The quantity, expressed in milligrams, shall be recorded by the wasting practitioner into the anesthesia record and into the controlled substance record followed by his or her

signature. The licensed person witnessing this wastage of controlled substances shall co-sign the controlled substance record.

2. All unused and unopened quantities of controlled substances which have been removed from the controlled substance cabinet shall be returned to the cabinet by the practitioner at the end of each shift.

3. Any return of controlled substances to the pharmacy in the hospital must be documented by a registered pharmacist responsible for controlled substance handing in the hospital.

Rule 41.69.5. Verification of Controlled Substances Administration. The hospital shall implement procedures whereby, on a periodic basis, a registered pharmacist shall reconcile quantities of controlled substances dispensed in the hospital to the anesthetizing area against the controlled substance record in said area. Any discrepancies shall be reported to the Director of Nursing and to the Chief Executive Officer of the hospital. Upon completion, all controlled substance records shall be returned from the anesthetizing area to the hospital’s pharmacy by the designated responsible person in the anesthetizing area.

Subchapter 70 RADIOLOGY

Rule 41.70.1. Radiological Services. The hospital shall maintain or have available radiological services according to needs of the hospital, either in the hospital building proper or in an adjacent clinic or medical facility that is readily accessible to the hospital patients, physicians, and personnel. If therapeutic x-ray services are also provided, they, as well as the diagnostic services, shall meet professionally approved standards for safety and personnel qualifications.

Subchapter 71 HAZARDS TO PATIENTS AND PERSONNEL

Rule 41.71.1. The radiology department shall be free of hazards to patients and personnel.

Rule 41.71.2. Proper safety precautions shall be maintained against fire and explosion hazards, electrical hazards, and radiation hazards.

Rule 41.71.3. Periodic inspection shall be made by Department of Health or a radiation physicist, and hazards so identified shall be promptly corrected.

Rule 41.71.4. Radiation workers shall be checked periodically for amount of radiation exposure by the use of exposure meters or badge tests.

Rule 41.71.5. With fluoroscopes, attention shall be paid to modern safety design and operating procedures; records shall be maintained of the output of all fluoroscopes.

Rule 41.71.6. Regulations based on medical staff recommendations shall be established as to the administration of the application and removal of radium element, its disintegration products, and other radioactive isotopes.

Subchapter 72 PERSONNEL

Rule 41.72.1. Personnel adequate to supervise and conduct the services shall be provided, and the interpretation of radiological examinations shall be made by physicians competent in the field.

Rule 41.72.2. The hospital shall have a qualified radiologist, either full-time or part- time, on a consulting basis, both to give direction to the department and to interpret films that require specialized knowledge for accurate reading. If the hospital is small and a radiologist cannot come to the hospital regularly, selected x-ray films shall be sent to a radiologist for interpretation.

Rule 41.72.3. If the activities of the radiology department extend to radiotherapy, the physician in charge shall be appropriately qualified.

Rule 41.72.4. The amount of qualified radiologist's and technologist's time shall be sufficient to meet the hospital's requirement. A technologist shall be on duty or on call at all times.

Rule 41.72.5. The use of all x-ray apparatus shall be limited to personnel designated as qualified by the radiologist or by an appropriately constituted committee of the medical staff. The same limitation shall apply to personnel applying and removing radium element, its disintegration products, and radioactive isotopes. The use of fluoroscopes shall be limited to physicians or technologist under the direction of a physician.

Subchapter 73 SIGNED REPORTS

Rule 41.73.1. Signed reports shall be filed with the patient's medical record.

Rule 41.73.2. Requests by the attending physician for x-ray examination shall contain a concise statement of reason for the examination.

Rule 41.73.3. Reports of interpretations shall be written or dictated and signed by the radiologist.

Rule 41.73.4. X-ray reports and roentgenographies shall be preserved according to statute.

Subchapter 74 SOCIAL WORK

Rule 41.74.1. Hospitals without an organized Social Work Department may provide this service. If such department is provided, there shall be effective policies and procedures relating to the staff and the functions of the service.

Rule 41.74.2. If the facility offers social services, a member of the staff of the facility shall be responsible for social services. If the designated person is not a qualified social worker, the facility has a written agreement with a qualified social worker, or recognized social agency for consultation and assistance on a regularly scheduled basis.

Rule 41.74.3. A qualified social worker is an individual who is currently licensed by the State of Mississippi and has one (1) year of experience in a health care setting.

Subchapter 75 UTILIZATION REVIEW PLAN

Rule 41.75.1. The hospital must have in effect a utilization review (UR) plan that provides for review of services furnished by the institution and by members of the medical staff to patients.

1. The UR plan must provide for review for patients with respect to the medical necessity of:

A. Admissions to the institution;

B. The duration of stays; and

C. Professional services furnished including drugs and biologicals.

2. Review of admissions may be performed before, at, or after hospital admission.

3. Reviews may be conducted on a sample basis.

Subchapter 76 UTILIZATION REVIEW COMMITTEE

Rule 41.76.1. A UR committee consisting of two or more practitioners must carry out the UR function. At least two of the members of the committee must be Doctor of Medicine or osteopathy. The other members may be any of the other types of practitioners.

Rule 41.76.2. The committee must review professional services provided to determine medical necessity and to promote the most efficient use of available health facilities and services.

Subchapter 77 QUALITY ASSESSMENT AND PERFORMANCE IMPROVEMENT (QAPI PROGRAM)

Rule 41.77.1. The hospital must develop, implement, and maintain an effective, ongoing, hospital-wide, data-driven quality assessment and performance improvement program.

Rule 41.77.2. The hospital’s governing body must ensure that the program reflects the complexity of the hospital’s organization and services; involves all hospital departments and services (including those services furnished

under contract or arrangement); and focuses on indicators related to improved health outcomes and the prevention and reduction of medical errors.

Subchapter 78 QAPI PROGRAM SCOPE

Rule 41.78.1. The program must include, but not be limited to, an ongoing program that shows measurable improvement in indicators for which there is evidence that it will improve health outcomes and will identify and reduce medical errors.

Rule 41.78.2. The hospital must measure, analyze, and track quality indicators, including adverse patient events, and other aspects of performance that assess processes of care, hospital service and operations.

Subchapter 79 QAPI PROGRAM DATA

Rule 41.79.1. The hospital must use the data collected to:

1. Monitor the effectiveness and safety of services and quality of care; and

2. to identify opportunities for improvement and changes that will lead to improvement.

Rule 41.79.2. The frequency and detail of data collection must be specified by the hospital’s governing body.

Subchapter 80 QAPI PROGRAM ACTIVITIES

Rule 41.80.1. The hospital must set priorities for its performance improvement activities that:

1. Focus on high-risk, high-volume, or problem-prone areas;

2. Consider the incidence, prevalence, and severity of problems in those areas;

3. Affect health outcomes and quality of care; and

4. Affect patient safety.

Rule 41.80.2. Performance improvement activities must track medical errors and adverse patient events, analyze their causes, and implement preventive actions and mechanisms that include feedback and learning throughout the hospital.

Rule 41.80.3. The hospital must take actions aimed at performance improvement and, after implementing those actions, the hospital must measure its success, and track performance to ensure that improvements are sustained.

Subchapter 81 PERFORMANCE IMPROVEMENT PROJECTS

Rule 41.81.1. As part of its quality assessment and performance improvement program, the hospital must conduct performance improvement projects.

Rule 41.81.2. The number and scope of distinct improvement projects conducted

annually must be proportional to the scope and complexity of the hospital’s services and operations.

Rule 41.81.3. The hospital must document what quality improvement projects are being conducted, the reasons for conducting these projects, and the measurable progress achieved on these projects.

Subchapter 82 TRAUMA REGISTRY

Rule 41.82.1. All licensed hospitals which have organized emergency services or departments must participate in the statewide trauma registry for the purpose of supporting peer review and performance improvement activities at the local, regional and state levels. Since this data relates to specific trauma patients and is used to evaluate and improve the quality of health care services, this data is confidential and will be governed by Miss. Code Ann. §41-59-77 (as amended). Compliance with the above will be evidenced by:

1. Documentation of utilization of the Trauma Registry data in the trauma performance improvement process and 2. Timely submission of Trauma Registry Data to the Bureau of EMS at least monthly.

Rule 41.82.2. Data Submission Requirements: Patients to be included in the trauma registry are defined in “Mississippi Trauma Care System: Rules and Regulations (as amended).”

Subchapter 83 FREESTANDING EMERGENCY DEPARTMENTS

Rule 41.83.1. Adoption of Regulations and Minimum Standards. By virtue of authority vested in it by the Mississippi Code Annotated Sections 41-75- 1 through 41-75- 13, or as otherwise amended, the Mississippi Department of Health does hereby adopt and promulgate the following regulations and standards for Freestanding Emergency Departments (FED).

**History**
- *SOURCE: Miss. Code Ann. §41-9-17 CHAPTER 41 MINIMUM STANDARDS OF OPERATION FOR MISSISSIPPI HOSPITALS Subchapter 1 AUTHORITY AND LICENSE Rule 41.1.1. Adoption of Regulations and Minimum Standards. By virtue of authority vested in it by the Mississippi Code Annotated Sections 41-9-1 through 41-9- 35, or as otherwise amended, the Mississippi Department of Health does hereby adopt and promulgate the following regulations and standards for hospitals.*
- *SOURCE: Miss. Code Ann. §41-9-17 Subchapter 2 DEFINITIONS Rule 41.2.1. Hospital. “Hospital” means a place devoted primarily to the maintenance and operation of facilities for the diagnosis, treatment and care of individuals suffering from physical or mental infirmity, illness, disease, injury or deformity, or a place devoted primarily to providing obstetrical or other medical, surgical, or nursing care of individuals, whether any such place be organized or operated for profit and whether any such place be publicly or privately owned. The term “hospital” does not include convalescent or boarding homes, children’s homes, homes for the aged or other like establishments where room and board only are provided, nor does it include offices or clinics where patients are not regularly kept as bed patients.*
- *SOURCE: Miss. Code Ann. §41-9-17 Rule 41.2.2. Person. “Person” means any individual, firm, partnership, corporation, company, association or joint stock association, and the legal successor thereof.*
- *SOURCE: Miss. Code Ann. §41-9-17 Rule 41.2.3. Governmental Unit. “Governmental Unit” means the state, or any county, municipality or other political subdivision or any department, division, board, or other agency of any of the foregoing, excluding all federal establishments.*
- *SOURCE: Miss. Code Ann. §41-9-17 Rule 41.2.4. Licensing Agency. “Licensing agency” means the Mississippi Department of Health.*
- *SOURCE: Miss. Code Ann. §41-9-17 Rule 41.2.5. License. No person or governmental unit shall establish, conduct, or maintain a hospital in this state without a license.*
- *SOURCE: Miss. Code Ann. §41-9-17 Rule 41.2.6. Application for License. An application for a license shall be made to the licensing agency upon forms provided by the licensing agency and shall contain such information as the licensing agency reasonably requires.*
- *SOURCE: Miss. Code Ann. §41-9-17 Rule 41.2.7. Licensure Fees. Each initial and renewal licensure application, unless suspended or revoked, shall be accompanied by a fee as set by the Board, made payable to the Mississippi State Department of Health, either by business check, money order, or electronic means. Renewal of licenses shall occur on an annual basis. Fees are non-refundable.*
- *SOURCE: Miss. Code Ann. §41-9-17 Rule 41.2.8. User Fee. A “user fee” in an amount set by the Board, shall be assessed by the licensing agency for the purpose of the required reviewing and inspections of the proposal of any hospital in which there are additions, renovations, modernizations, expansion, alterations, conversions, modifications or replacement of the entire facility involved in the proposal. This fee includes the reviewing of architectural plans in all required steps. Fees are to be made payable to the Mississippi State Department of Health, and paid by either a business check, money order, or electronic means.*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17 Rule 41.2.10. Issuance of License. Each license shall be issued only for the premises and persons or governmental units names in the application and shall not be transferable or assignable except with the written approval of the licensing agency.*
- *SOURCE: Miss. Code Ann. §41-9-17 Rule 41.2.11. Posting of License. Licenses shall be posted in a conspicuous place on the licensed premises.*
- *SOURCE: Miss. Code Ann. §41-9-17 Subchapter 3 DENIAL OR REVOCATION OF LICENSE.*
- *SOURCE: Miss. Code Ann. §41-9-17 Subchapter 4 ADMINISTRATION: OWNERSHIP Rule 41.4.1. There shall be full disclosure of hospital ownership and control. In its Initial Application for Hospital License the hospital shall disclose: 1. The ownership of the hospital, including the names and addresses of the following: all stockholders, if the owner is a corporation; the partners, if the owner is a partnership; or the owner(s), if individually owned.*
- *SOURCE: Miss. Code Ann. §41-9-17 Rule 41.4.2. Annually in its Application for Renewal of Hospital License the hospital shall report: The name and address of the owner.*
- *SOURCE: Miss. Code Ann. §41-9-17 Rule 41.4.4. When change of ownership of a hospital is contemplated, the hospital shall notify the licensing agency in writing at least 30 days prior to the proposed date of change of ownership, giving the name and address of the proposed new owner.*
- *SOURCE: Miss. Code Ann. §41-9-17 Rule 41.4.5. The hospital shall notify the licensing agency in writing within 24 hours after any change of ownership and shall surrender its license there with.*
- *SOURCE: Miss. Code Ann. §41-9-17 Subchapter 5 GOVERNING AUTHORITY Rule 41.5.1. The hospital shall have an organized governing body, or designated person(s) so functioning, that has overall responsibility for the*
- *SOURCE: Miss. Code Ann. §41-9-17 Subchapter 6 MANAGEMENT Rule 41.6.1. The governing body shall appoint an administrator whose, authority, and duties shall be defined in a written statement adopted by the governing body, the medical staff and all other branches and departments of the hospital. An administrator appointed on or after February 14, 2005, shall have at least a bachelor’s degree and one (1) year experience in a health-related field.*
- *SOURCE: Miss. Code Ann. §41-9-17 Rule 41.6.2. The administrator shall be vested with sufficient authority to adequately perform all of the duties and responsibilities of his position, both written and implied.*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17 Rule 41.6.4. The governing body, through its administrator, shall take all reasonable steps to comply with all applicable federal, state, and local laws and regulations.*
- *SOURCE: Miss. Code Ann. §41-9-17 Rule 41.6.5. The governing body, through its administrator, shall provide for the control and use of the physical and financial resources of the hospital.*
- *SOURCE: Miss. Code Ann. §41-9-17 Rule 41.6.6. The governing body shall delegate to the medical staff the authority to evaluate the professional competence of staff members and applicants for medical staff membership and/or clinical privileges. It shall hold the medical staff responsible for making recommendations to the governing body concerning initial staff appointments, re- appointments, removals and/or assignment or curtailment of clinical privileges.*
- *SOURCE: Miss. Code Ann. §41-9-17 Rule 41.6.7. The governing body shall have the authority and responsibility for the appointment, reappointment, and removal of the members of the medical staff and other practitioners who have been granted clinical privileges.*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *Source: Miss. Code Ann. §41-9-13*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17 Rule 41.7.9. The medical staff should participate in continuous study and evaluation of factors relating to patient care in the hospital's internal environment. This*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17 Rule 41.10.2. All new construction or renovation with the licensing agency’s*
- *SOURCE: Miss. Code Ann. §41-9-17 Rule 41.10.3. Heating and Ventilating. Suitable artificial heat shall be furnished to maintain75 degrees F inside temperature with 10 degrees F outside temperature. Circulating hot water from a remote boiler or vapor steam with circulating pump sand controls on emergency electrical service to provide heating in case of power failures are the preferred methods of heating.*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17 Rule 41.16.2. All finishes shall be capable of repeated scrubbings.*
- *SOURCE: Miss. Code Ann. §41-9-17 Rule 41.16.3. Heating and cooling in accordance with AIA guidelines.*
- *SOURCE: Miss. Code Ann. §41-9-17 Rule 41.16.4. Special lighting shall be supplied that eliminated shadows in the operating field with enough background illumination to avoid excessive contrast. Emergency lighting shall comply with Subchapter 14.*
- *SOURCE: Miss. Code Ann. §41-9-17 Rule 41.16.5. Fire extinguishers shall be provided and distributed in accordance with NFPA10.*
- *SOURCE: Miss. Code Ann. §41-9-17 Subchapter 17 CENTRAL STERILE SUPPLY Rule 41.17.1. The following areas shall be separate: 1. Receiving and Clean-Up Area. To contain a two-compartment sink with two drain boards.*
- *SOURCE: Miss. Code Ann. §41-9-17 Subchapter 18 OBSTETRICAL SUITE Rule 41.18.1. The requirements of this area are the same as Rule 41.17.1 except for Rule 41.17.1(2) & (3).*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17 Subchapter 19 OUTPATIENT AND TRAUMA AREA Rule 41.19.1. This area shall be located to prevent outpatient from traversing inpatient areas and shall include: 1. A well-marked and sheltered entry with nearby parking and access for ambulance.*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17 Subchapter 24 ADMINISTRATIVE AREA Rule 41.24.1. Administrative Area. To include: 1. Business office with information desk cashier's station and personnel toilets.*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17 Rule 41.26.2. There shall be written policies which shall be enforced to control emergency room procedures.*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-75-13*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17 Rule 41.30.5. Licensed practical nurses currently licensed to practice within the state, as well as other ancillary nursing personnel, may be used to give nursing care that does not require the skill and judgment of a registered nurse. Their performance shall be supervised by one or more registered nurses.*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17 Rule 41.31.9.*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17 Rule 41.52.3. A single signature on the face sheet of the record shall not suffice to authenticate the entire record.*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17 Rule 41.56.3. If physical therapy services are offered, the services shall be given by or under the supervision of a qualified physical therapist. A qualified physical therapist shall be a graduate of a program in physical therapy approved by the Council on Medical Education of the American Medical Association (in collaboration with the American Physical Therapy Association) or its equivalent and hold a current Mississippi license. Additional properly trained and supervised personnel shall be sufficient to meet the needs of the department.*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17 Rule 41.57.2. All equipment shall be in good working order, routinely quality controlled, and precise in terms of calibration. The laboratory shall be in compliance with all applicable federal requirements for clinical laboratories. (Clinical Laboratory Improvement Amendments of 1988 at 42 CFR Part 493)*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17 Rule 41.63.3. A list of tissues which routinely require microscopic examination shall be developed in writing by the pathologist or designated physician with the approval of the medical staff.*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17 Rule 41.65.10. The review committee shall investigate all transfusion reactions occurring in the hospital and make recommendations to the medical staff regarding improvements in transfusion procedures.*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17 Rule 41.77.3. The hospital must maintain and demonstrate evidence of its QAPI program for review by the Department.*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 41.83.2** Compliance with Rules, Regulations and Standards {#sec-16-41.83.2 omnilex-key=us-ms-regs-official--title-15--16#41.83.2}

The FED shall:

1. Comply with all applicable Medicare provider-based regulations. The FED shall comply with all regulations that apply to clinical services and staffing for emergency departments, as set forth in the MSDH Minimum Standards of Operation for Mississippi Hospitals.

2. Provide data to their Trauma Region and the department’s Trauma Registry through participation in the Mississippi Trauma Care System (MTS).

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 41.83.3** Definitions {#sec-16-41.83.3 omnilex-key=us-ms-regs-official--title-15--16#41.83.3}

The definitions specific to the FED are:

1. Freestanding Emergency Room. “Freestanding Emergency Room” is a facility open twenty-four hours a day for the treatment of urgent and emergent medical conditions which is not located on a hospital campus. In order to eligible for licensure under this chapter, the freestanding emergency room shall be located at least fifteen (15) miles from the nearest hospital- based emergency room in any rural community where the federal Centers for Medicaid & Medicare Services (CMS) had previously designated a rural hospital as a critical access hospital and that designation has been revoked.

2. Licensing Agency. “Licensing agency” means the Mississippi State Department of Health.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 41.83.4** License {#sec-16-41.83.4 omnilex-key=us-ms-regs-official--title-15--16#41.83.4}

No person or governmental unit shall establish, conduct, or maintain a Freestanding Emergency Department in this state without a license.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 41.83.5** Application for License {#sec-16-41.83.5 omnilex-key=us-ms-regs-official--title-15--16#41.83.5}

An application for a license shall be made to the licensing agency upon forms provided by the licensing agency and shall contain such information as the licensing agency reasonably requires.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 41.83.6** Licensure and User Fees {#sec-16-41.83.6 omnilex-key=us-ms-regs-official--title-15--16#41.83.6}

Such fees shall be paid to the licensing agency by electronic payment, business check, certified check, or money order. A license shall not be issued to any FED until such fee is received by the licensing agency.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 41.83.7** User Fee {#sec-16-41.83.7 omnilex-key=us-ms-regs-official--title-15--16#41.83.7}

A “user fee” shall be assessed by the licensing agency for the purpose of the required reviewing and inspections of the proposal of any FED in which there are additions, renovations, modernizations, expansion, alterations, conversions, modifications, or replacement of the entire facility involved in the proposal. This fee includes the reviewing of architectural plans in all required steps.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 41.83.8** Renewal of License {#sec-16-41.83.8 omnilex-key=us-ms-regs-official--title-15--16#41.83.8}

A license, unless suspended or revoked, shall be renewable annually by submitting an application, paying an annual fee and submitting such reports as required by the licensing agency, including annual information reports.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 41.83.9** Issuance of License {#sec-16-41.83.9 omnilex-key=us-ms-regs-official--title-15--16#41.83.9}

Each license shall be issued only for the premises and persons or governmental units names in the application and shall not be transferable or assignable except with the written approval of the licensing agency.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 41.83.10** Denial or Revocation of a License {#sec-16-41.83.10 omnilex-key=us-ms-regs-official--title-15--16#41.83.10}

The licensing agency, after notice and opportunity for hearing to the applicant or licensee, is authorized to deny, suspend, or revoke a license in any case in which it finds that there has been a substantial failure to comply with the requirements established in these regulations and standards.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 41.83.11** Ownership {#sec-16-41.83.11 omnilex-key=us-ms-regs-official--title-15--16#41.83.11}

There shall be full disclosure of FED ownership and control. Annually, in its application for renewal of an FED License, the facility shall report the name and address of the owner and the name and address of the individual(s) responsible for operation of the FED.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 41.83.12** Change of Ownership {#sec-16-41.83.12 omnilex-key=us-ms-regs-official--title-15--16#41.83.12}

When change of ownership of a FED is contemplated, the FED shall notify the licensing agency, in writing, at least 30 days prior to the proposed date of change of ownership, giving the name and address of the proposed new owner and all other documents as required by the licensing agency.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 41.83.13** Governing Authority {#sec-16-41.83.13 omnilex-key=us-ms-regs-official--title-15--16#41.83.13}

The FED shall have an organized governing body, or designated person(s):

1. That has overall responsibility for the conduct of the FED in a manner consistent with the objective of making available high quality patient care.

2. That shall be the authority in the FED, responsible for the management of the FED and appointment of the medical staff.

3. That shall adopt bylaws in accordance with legal requirements and with its community responsibility, identifying the purposes of the FED and the means of fulfilling them,

4. That shall take all reasonable steps to comply with all applicable federal, state, and local laws and regulations.

Rule 41.83.14. Staffing and Treatment. The FED must possess the staff and resources necessary to evaluate all individuals presenting to the emergency department. The FED must follow all requirements of EMTALA in regard to assuring the medical evaluation, stabilization and transfer of a patient found to have an emergency condition. Because of the unscheduled and episodic nature of health emergencies and acute illness, the FED must be staffed with experienced American Board of Medical Specialties (ABMS) or American Osteopathic Association (AOA) board certified or board eligible physicians, nursing and ancillary personnel who must be available 24 hours a day. The FED will also provide treatment for individuals whose health needs are not of an emergent nature, but for whom the FED may be the only accessible or timely entry point into the broader health care system.

1. Each FED shall have patient transfer agreements with an EMS service and with an acute care or trauma hospital with the capability of handling such emergencies and to assure provisions for patient admissions, continued emergency, and diagnostic services beyond the capability of the FED, and the safe emergency transport of the patient, when needed.

2. As stated by the American College of Emergency Physicians (ACEP):

A. Emergency medical care must be available to all members of the public.

B. Access to appropriate emergency medical and nursing care must be unrestricted.

C. A smooth continuum should exist among pre-hospital providers, emergency department (ED) providers, and providers of definitive follow- up care.

D. Evaluation, management, and treatment of patient must be appropriate and expedient.

E. Resources should exist in the ED to accommodate each patient from the time of arrival through evaluation, medical decision making, treatment and disposition.

F. FEDs should have policies and plans to provide effective administration, staffing, facility design, equipment, medication, and ancillary services.

G. The emergency physician, emergency nurse, and additional medical team members must establish effective working relationships with other health care providers and entities with whom they must interact. These include emergency medical services (EMS) providers, ancillary hospital personnel, other physicians, and other health care and social services resources.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 41.83.15** Required Policies {#sec-16-41.83.15 omnilex-key=us-ms-regs-official--title-15--16#41.83.15}

The FED Emergency Department Policy Sections shall include:

1. Resources and Planning

A. Necessary Elements

i. Administration

ii. Staffing

iii. Facility

iv. Equipment and Supplies

v. Pharmacologic/Therapeutic Drugs and Agents

vi. Safety

vii. Ancillary Services

viii. Transfer policies and procedures for critical patients

ix. Electronic Medical Record

x. Relationships and Responsibilities

2. Core Measures

A. Measure Groups

i. Median Time from FED Arrival to ED Departure for Discharged Patients

ii. Median Time from FED Arrival to Decision to Transfer

iii. Median Time from Decision to Transfer to arrival at receiving facility

iv. Total lengths of stay and door-to-doctor times

B. Quality/Safety Metrics

i. FED will be responsible for reporting all categories required

ii. Case analysis of EMS patient outliers.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 41.83.16** FED Equipment, Instruments, and Supplies {#sec-16-41.83.16 omnilex-key=us-ms-regs-official--title-15--16#41.83.16}

The equipment, instruments, and supplies listed below are required in the FED and each of the items should be located in or immediately available to the area noted. This list does not include routine medical/surgical supplies such as adhesive bandages, gauze pads, and suture material, nor does it include routine office items such as paper, desks, paper clips, and chairs.

Rule 41.83.17. Entire FED Department shall include:

1. Central station monitoring capability

2. Physiological monitors

3. Blood flow detectors

4. Defibrillator with monitor and battery

5. Thermometers

6. Pulse oximetry

7. Nurse-call system for patient use

8. Portable suction regulator

9. Infusion pumps to include blood pumps

10. IV poles

11. Bag-valve-mask respiratory and adult and pediatric size mask

12. Portable oxygen tanks

13. Blood/fluid warmer and tubing

14. Nasogastric suction supplies

15. Nebulizer

16. Gastric lavage supplies, including large-lumen tubes and bite blocks

17. Urinary catheters, including straight catheters, Foley catheters, Coude catheters, filiforms and followers, and appropriate collection equipment

18. Intraosseous needles

19. Lumbar puncture sets (adult and pediatric) 20. Blanket warmer

21. Tonometer

22. Slit lamp

23. Wheelchairs

24. Medication dispensing system with locking capabilities

25. Separately wrapped instruments (specifics will vary by department)

26. Availability of light microscopy for emergency procedures

27. Weight scales (adult and infant)

28. Tape measure

29. Ear irrigation and cerumen removal equipment

30. Vascular Doppler

31. Anoscope

32. Adult and Pediatric "code" cart

33. Suture or minor surgical procedure sets (generic)

34. Portable sonogram equipment

35. EKG machine

36. Point of care testing

37. X-ray view box and hot light

38. Film boxes for holding x-rays

39. Chart Rack

40. Computer system

41. Internet capabilities

42. Patient tracking system

43. Radio or other device for communication with ambulances

44. Patient discharge instruction system

45. Patient registration system/ Information services

46. Intradepartmental staff communication system- pagers, mobile phones

47. ED charting system for physician, nursing, and attending physician documentation equipment

48. Reference materials including toxicology resource information

49. Personal protective equipment- gloves, eye goggles, face mask, gowns, head, and foot covers

50. Linen (pillows, towels, wash cloths, gowns, blankets)

51. Patient belongings or clothing bag

52. Security needs -including restraints and wand-type or free-standing metal

53. detectors as indicated

54. Equipment for adequate housekeeping

Rule 41.83.18. FED General Examination Rooms shall include:

1. Examination tables or stretchers appropriate to the area.

2. For any area in which seriously ill patients are managed, a stretcher with capability for changes in position, attached IV poles, and a holder for portable oxygen tank should be used.

3. Pelvic tables for GYN examinations.

4. Step stool

5. Chair/stool for emergency staff

6. Seating for family members or visitors

7. Adequate lighting, including procedure lights as indicated

8. Cabinets

9. Adequate sinks for handwashing, including dispensers for germicidal soap and paper towels.

10. Wall mounted oxygen supplies and equipment, including nasal cannulas, facemasks, and venturi masks.

11. Wall mounted suction capability, including both tracheal cannulas and larger cannulas.

12. Wall-mounted or portable otoscope/ophthalmoscope

13. Sphygmomanometer/stethoscope

14. Oral and nasal airways

15. Biohazard-disposal receptacles, including for sharps

16. Garbage receptacles for non-contaminated materials

Rule 41.83.19. FED Resuscitation Room. All items listed for general examination rooms plus:

1. Adult and Pediatric "code cart" to include appropriate medication charts

2. Capability for direct communication with nursing station, preferably hands free

3. Radiography equipment

4. Radiographic view boxes and hot light

5. Airways needs

A. Big-valve-mask respirator (adult, pediatric, and infant) Cricothyroidotomy instruments and supplies

B. Endotracheal tubes, size 2.5 to 8.5 mm

C. Fiberoptic laryngoscope

D. Laryngoscopes, straight and curved blades and stylets

E. Laryngoscope mirror and supplies

F. Laryngeal Mask Airway (LMA)

G. Oral and nasal airways

H. Tracheostomy instrument and supplies

6. Breathing A. BiPAP Ventilation System

B. Closed-chest drainage device

C. Chest tube instruments and supplies

D. Emergency thoracotomy instruments and supplies

E. End-tidal C02 monitor18

F. Nebulizer

G. Peak flow meter

H. Pulse oximetry

I. Volume cycle ventilator

7. Circulation

A. Automatic physiological monitor, noninvasive

B. Blood/fluid infusion pumps and tubing

C. Blood/fluid warmers

D. Cardiac compression board

E. Central venous catheter setups/kits

F. Central venous pressure monitoring equipment

G. Cutdown instruments and supplies

H. Intraosseous needles

I. IV catheters, sets, tubing, poles

J. Monitor/defibrillator with pediatric paddles, internal paddles, appropriate pads, and other supplies Pericardiocentesis instruments

K. Temporary external pacemaker

L. Transvenous and/or transthoracic pacemaker setup and supplies

M. 12-Lead ECG machine

Rule 41.83.20. Trauma and miscellaneous resuscitation shall include:

1. Blood salvage/autotransfusion device

2. Emergency obstetric instruments and supplies

3. Hypothermia thermometer

4. Infant warming equipment

5. Peritoneal lavage instruments and supplies

6. Pneumatic antishock garment, as indicated

7. Spine stabilization equipment to include cervical collars, short and long boards

8. Warming/cooling blanket

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*
- *SOURCE: Miss. Code Ann. §41-75-13*
- *SOURCE: Miss. Code Ann. §41-75-13*
- *SOURCE: Miss. Code Ann. §41-75-13*
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 41.83.21** Other Special Rooms {#sec-16-41.83.21 omnilex-key=us-ms-regs-official--title-15--16#41.83.21}

All items listed for general examination rooms plus:

1. Orthopedic

A. Cast cutter

B. Cast and splint application supplies and equipment Cast spreader

C. Crutches

D. Extremity-splinting devices including traction splinting and fixation pins/wires and corresponding instruments and supplies

E. Halo traction or Gardner-Wells/Trippe-Wells traction Radiograph view and hot light

F. Suture instrument and supplies

G. Traction equipment, including hanging weights and finger traps

2. Eye/ENT

A. Eye chart

B. Ophthalmic tonometry device (applanation, Schiotz, or other)

C. Other ophthalmic supplies as indicated, including eye spud, rust ring remover, cobalt blue light

D. Slit lamp

E. Ear irrigation and cerumen removal equipment

F. Epistaxis instrument and supplies, including balloon posterior packs Frazier suction tips

G. Headlight

H. Laryngoscope mirror

I. Plastic suture instruments and supplies

3. OB-GYN

A. Fetal Doppler and ultrasound equipment

B. Obstetrics/Gynecology examination light

C. Vaginal specula in pediatric through adult sizes

D. Sexual assault evidence-collection kits (as appropriate)

E. Suture material

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 41.83.22** Required Pharmacological/Therapeutic drugs for FED {#sec-16-41.83.22 omnilex-key=us-ms-regs-official--title-15--16#41.83.22}

These classes of drugs and agents are required. The medical director of the FED, representatives of the medical staff, and the director of the pharmacy shall develop a formulary of specific agents for use in the FED. 1. Analgesics A. narcotic and non-narcotic 2. Anesthetics A. topical, infiltrative, general 3. Anticonvulsants 4. Antidiabetic agents 5. Antidotes

6. Antihistamines 7. Anti-infective agents A. systemic/topical 8. Anti-inflammatories A. steroidal/non-steroidal 9. Anti-platelets 10. Aspirin 11. Plavix 12. Heparin 13. Bicarbonates 14. Blood Modifiers 15. Anticoagulants to include thrombolytics 16. Anticoagulants 17. Hemostatic agents A. systemic B. topical C. plasma expanders/ extenders 18. Burn Preparations 19. Cardiovascular agents A. Ace inhibitors B. Adrenergic blockers C. Adrenergic stimulants D. Alpha/Beta blockers E. Antiarrhythmic agents F. Calcium channel blockers

G. Digoxin antagonist H. Diuretics I. Vasodilators J. Vasopressors 20. Cholinesterase Inhibitors 21. Diagnostic agents A. Blood contents B. tool contents C. Testing for myasthenia gravis D. Urine contents 22. Electrolytes A. Cation exchange resin B. Electrolyte replacements, parenteral and oral C. Fluid replacement solutions 23. Gastrointestinal agents A. Antacids B. Anti-diarrheals C. Emetics and Anti-emetics D. Anti-flatulent E. Anti-spasmodics F. Bowel evacuants/laxatives G. Histamine receptor antagonists H. Proton pump inhibitors 24. Glucose elevating agents 25. Hormonal agents

26. Hypocalcemia and hypercalcemia management agents 27. Lubricants 28. Migraine preparations 29. Muscle relaxants 30. Narcotic antagonist 31. Nasal preparation 32. Ophthalmologic preparations 33. Otic preparations 34. Oxytocics 35. Pain Medications 36. Psychotherapeutic agents 37. Respiratory agents A. Antitussives B. Bronchodilators C. Decongestants D. Leukotriene antagonist 38. Rho(D) immune globulin 39. Salicylates 40. Sedatives and Hypnotics 41. Thrombolytics 42. Vaccinations 43. Vitamins and minerals

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 41.83.23** Radiologic, Imaging, and Other Diagnostic Services {#sec-16-41.83.23 omnilex-key=us-ms-regs-official--title-15--16#41.83.23}

The specific services available and the timeliness of availability of these services

for emergency patients in FED should be determined by the medical director of the FED in collaboration with the directors of the diagnostic services and other appropriate individuals. 1. The following should be readily available 24 hours a day for emergency patients:

A. Standard radiologic studies of bony and soft-tissue structures including, but not limited to:

i. Cross-table lateral views of spine with full series to follow

ii. Portable chest radiographs for acutely ill patients and for verification of placement of endotracheal tube, central line, or chest tube

iii. Soft-tissue views of the neck

iv. Soft-tissue views of subcutaneous tissues to rule out the presence of foreign body

v. Standard chest radiographs, abdominal series, etc.

B. Pulmonary services

i. Arterial blood gas determination

ii. Peak flow determination

iii. Pulse oximetry

C. Fetal monitoring (nonstress test)/uterine monitoring

D. Cardiovascular services

i. Doppler studies

ii. 12-Lead ECGs and rhythm strips

E. Emergency ultrasound services for the diagnosis of obstetric/gynecologic, cardiac, and hemodynamic problems and other urgent conditions.

2. The following services shall be available on an urgent basis. Such may be provided by on duty staff or on call staff available to respond within a reasonable period of time:

A. Nuclear medicine

i. Ventilation-perfusion lungs scans

ii. Other scintigraphy for trauma and other conditions B. Radiographic

i. Arteriography/venography

ii. Computed tomography

iii. Dye-contrast studies (intravenous pyelography, gastrointestinal contrast, etc.)

C. Vascular/flow studies including impedance plethysmography

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 41.83.24** Required Laboratory Capabilities {#sec-16-41.83.24 omnilex-key=us-ms-regs-official--title-15--16#41.83.24}

The medical director of the FED and the director of laboratory services shall develop guidelines for availability and timeliness of services for the FED. The following laboratory capabilities are required for the FED. This list may not be comprehensive or complete.

1. Blood bank

A. Bank products availability

B. Type and cross-matching capabilities

2. Chemistry

A. Ammonia

B. Amylase

C. Anticonvulsant and other therapeutic drug levels

D. Arterial blood gases

E. Bilirubin (total and direct)

F. Calcium

G. Carboxyhemoglobin

H. Cardiac isoenzymes (including creatine kinase- MB)

I. Chloride (blood and cerebrospinal fluid [CSF])

J. Creatinine

K. Electrolytes

L. Ethanol M. Glucose (blood and CSF)

N. Liver-function enzymes (ALT, AST, alkaline phosphatase)

O. Methemoglobin

P. Osmolality

Q. Protein (CSF)

R. Serum magnesium

S. Urea nitrogen

3. Hematology

A. Cell count and differential (blood, CSF, and joint fluid analysis)

B. Coagulation studies

C. Erythrocyte sedimentation rate

D. Platelet count

E. Reticulocyte count

F. Sickle cell prep

4. Microbiology

A. Acid fast smear/staining

B. Chlamydia testing

C. Counter immune electrophoresis for bacterial identification

D. Gram staining and culture/sensitivities

E. Herpes testing

F. Strep screening

G. Viral culture

H. Wright stain

5. Other

A. Hepatitis screening B. HIV screening

C. Prothrombin Time (PT)/International Normalized Ratio (INR), Partial Thromboplastin Time (PTT)

i. D-dimer

D. Joint fluid and CSF analysis

E. Toxicology screening and drug levels

F. Urinalysis

G. Mononucleosis spot

H. Serology (syphilis, recombinant, immunoassay)

I. Pregnancy testing (qualitative and quantitative)

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 41.83.25** Transfer of Unstable Patients from FED to Acute Care Hospital {#sec-16-41.83.25 omnilex-key=us-ms-regs-official--title-15--16#41.83.25}

Once the patient is determined to require a higher level of care than can be provided at the FED, the physician shall immediately contact the designated EMS for transport. If the EMS is based on site, the transport team will be notified immediately. The physician will stabilize the emergency medical condition and determine the transfer destination based on the specialized capabilities of facilities that are offered at local hospitals. The FED facility will implement all procedures and protocols for acutely ill patients before departure from the FED. Such conditions would include, but not be limited to, STEMI, acute ischemic stroke, and cardiac arrests. All electronic medical records and any diagnostic test results will be transported with the patient to the receiving facility. Should a patient meeting trauma system activation requirements arrive at the FED, the FED will transfer the patient in accordance with the federal EMTALA regulations and the MS State Board of Health approved System of Care Plans.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 41.83.26** Medical records/organization {#sec-16-41.83.26 omnilex-key=us-ms-regs-official--title-15--16#41.83.26}

The FED shall have a medical record department with administrative responsibility for medical records. A medical record shall be maintained, in accordance with accepted professional principles, for each patient receiving care in the FED.

**History**
- *SOURCE: Miss. Code Ann. 41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 41.83.27** Confidentiality {#sec-16-41.83.27 omnilex-key=us-ms-regs-official--title-15--16#41.83.27}

Medical records shall be kept confidential and only authorized personnel shall have access to the records.

**History**
- *SOURCE: Miss. Code Ann. 41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 41.83.28** Consent {#sec-16-41.83.28 omnilex-key=us-ms-regs-official--title-15--16#41.83.28}

Written consent of the patient or the patient’s legal representative shall be presented as authority for release of medical information and this release shall become part of the medical record.

**History**
- *SOURCE: Miss. Code Ann. 41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 41.83.29** Access to records {#sec-16-41.83.29 omnilex-key=us-ms-regs-official--title-15--16#41.83.29}

Medical records shall not be removed from the

FED environment except upon subpoena or patient’s written consent.

**History**
- *SOURCE: Miss. Code Ann. 41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 41.83.30** Preservation {#sec-16-41.83.30 omnilex-key=us-ms-regs-official--title-15--16#41.83.30}

Medical records shall be preserved, either in the original or by reproduction, for a period of time not less than that set forth in Title 41, Chapter 9 of the Mississippi Code of 1972.

SUBCHAPTER 84 MINIMUM STANDARDS OF OPERATION FOR MISSISSIPPI PILOT FREESTANDING EMERGENCY ROOMS

Rule 41.84.1. Adoption of Regulations and Minimum Standards. By virtue of authority vested in it by the Mississippi Code Annotated Sections 41- 75-1 through 41-75- 13, or as otherwise amended, the Mississippi Department of Health does hereby adopt and promulgate the following regulations and standards for Pilot Freestanding Emergency Rooms (PFER).

**History**
- *SOURCE: Miss. Code Ann. 41-75-13*
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 41.84.2** Compliance with Rules, Regulations and Standards {#sec-16-41.84.2 omnilex-key=us-ms-regs-official--title-15--16#41.84.2}

The PFER shall report to the licensing agency all required data as specified by the licensing agency at a frequency required by the licensing agency. Must include but not limited to trauma, hospital discharge data, etc.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 41.84.3** Definitions {#sec-16-41.84.3 omnilex-key=us-ms-regs-official--title-15--16#41.84.3}

The definitions specific to the PFER are:

1. Licensing Agency. “Licensing agency” means the Mississippi State Department of Health.

2. Pilot Freestanding Emergency Room (PFER). "Pilot freestanding emergency room" is a facility open twenty- four (24) hours a day for the treatment of urgent and

emergent medical conditions that is not located on a hospital campus. In order to be eligible for licensure under this chapter, the pilot freestanding emergency room shall be located at least fifteen (15) miles from the nearest hospital- based emergency room in a county without emergency hospital care that is open twenty-four (24) hours a day. A PFER shall not retain any patient beyond 23 hours and 59 minutes under normal operations and shall not hold itself out as an emergency hospital.

**History**
- *SOURCE: Miss. Code Ann. §41-75-1*

##### **15 Miss. Admin. Code Pt. 16, R. 41.84.4** License {#sec-16-41.84.4 omnilex-key=us-ms-regs-official--title-15--16#41.84.4}

No person or governmental unit shall establish, conduct, or maintain a Pilot Freestanding Emergency Room in this state without a license. The licensing agency shall not issue licenses for more than five (5) pilot freestanding emergency rooms. Licensing fees will be set by the board.

Provisional License. Within its discretion, the Mississippi State Department of Health may issue a provisional license when a temporary condition of non- compliance with these regulations exists in one or more particulars. A provisional license shall be issued only if the Department of Health is satisfied that preparations are being made to qualify for a regular license and that the health and safety of patients will not be endangered. One condition on which a provisional license may be issued is as follows: A new pilot freestanding emergency room may be issued a provisional license prior to opening and subsequent to meeting the required minimum staffing personnel. The license issued under this condition shall be valid until the issuance of a regular license but shall not exceed five months following date of issuance whichever may be sooner.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 41.84.5** Application for License {#sec-16-41.84.5 omnilex-key=us-ms-regs-official--title-15--16#41.84.5}

An application for a license shall be made to the licensing agency by a licensed Mississippi hospital upon forms provided by the licensing agency and shall contain such information as the licensing agency reasonably requires.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 41.84.6** Licensure and User Fees {#sec-16-41.84.6 omnilex-key=us-ms-regs-official--title-15--16#41.84.6}

Such fees shall be paid to the licensing

agency by electronic payment, business check, certified check, or money order. A license shall not be issued to any PFER until such fee is received by the licensing agency.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 41.84.7** User Fee {#sec-16-41.84.7 omnilex-key=us-ms-regs-official--title-15--16#41.84.7}

A “user fee” shall be assessed by the licensing agency for the purpose of the required reviewing and inspections of the proposal of any PFER in which there are additions, renovations, modernizations, expansion, alterations, conversions, modifications, or replacement of the entire facility involved in the proposal. This fee includes the reviewing of architectural plans in all required steps.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 41.84.8** Renewal of License {#sec-16-41.84.8 omnilex-key=us-ms-regs-official--title-15--16#41.84.8}

A license, unless suspended or revoked, shall be renewable annually by submitting an application, paying an annual fee and submitting such reports as required by the licensing agency, including annual information reports.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 41.84.9** Issuance of License {#sec-16-41.84.9 omnilex-key=us-ms-regs-official--title-15--16#41.84.9}

Each license shall be issued only for the premises and persons or governmental units names in the application and shall not be transferable or assignable except with the written approval of the licensing agency.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 41.84.10** Denial or Revocation of a License {#sec-16-41.84.10 omnilex-key=us-ms-regs-official--title-15--16#41.84.10}

The licensing agency, after notice and opportunity for hearing to the applicant or licensee, is authorized to deny, suspend, or revoke a license in any case in which it finds that there has been a substantial failure to comply with the requirements established in these regulations and standards.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 41.84.11** Ownership {#sec-16-41.84.11 omnilex-key=us-ms-regs-official--title-15--16#41.84.11}

There shall be full disclosure of PFER ownership and control.

Annually, in its application for renewal of an PFER License, the facility shall report the name and address of the owner and the name and address of the individual(s) responsible for operation of the PFER. All PFERs must be affiliated with a MS licensed hospital.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 41.84.12** Change of Ownership {#sec-16-41.84.12 omnilex-key=us-ms-regs-official--title-15--16#41.84.12}

When change of ownership of a PFER is contemplated, the PFER shall notify the licensing agency, in writing, at least 30 days prior to the proposed date of change of ownership, giving the name and address of the proposed new owner and all other documents as required by the licensing agency.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 41.84.13** Governing Authority {#sec-16-41.84.13 omnilex-key=us-ms-regs-official--title-15--16#41.84.13}

The PFER shall have an organized governing body, or designated person(s):

1. That has overall responsibility for the conduct of the PFER in a manner consistent with the objective of making available high quality patient care. 2. That shall be the authority in the PFER, responsible for the management of the PFER and appointment of the medical staff. 3. That shall adopt bylaws in accordance with legal requirements and with its community responsibility, identifying the purposes of the PFER and the means of fulfilling them. 4. That shall take all reasonable steps to comply with all applicable federal, state, and local laws and regulations.

Rule 41.84.14. Staffing and Treatment. The PFER must possess the staff and resources necessary to evaluate all individuals presenting to the emergency department. The PFER must follow all requirements of EMTALA in regard to assuring the medical evaluation, stabilization and transfer of a patient found to have an emergency condition. The

PFER must follow all Board approved System of Care Plans. Because of the unscheduled and episodic nature of health emergencies and acute illness, the PFER must be staffed with experienced American Board of Medical Specialties (ABMS) or American Osteopathic Association (AOA) board certified or board eligible medical director, physicians, nursing, and ancillary personnel who must be available 24 hours a day. The PFER will also provide treatment for individuals whose health needs are not of an emergent nature, but for whom the PFER may be the only accessible or timely entry point into the broader health care system.

1. Staffing that must be available 24 hours a day on site include:

A. At-least one physician on site Certified or Board Eligible by the American Board of Emergency Medicine or the American Board of Osteopathic Emergency Medicine; or Certified or Board Eligible to sit for the examination of one of the following boards: Internal Medicine, Family Medicine, or Surgery; and shall hold a certificate from the following approved programs: Advanced Coronary Life Support; Advanced Trauma Life Support; Advanced Pediatric Life Support; and shall have three years of full- time clinical experience in emergency medicine within the past five years.

B. At-least one registered nurse on site with training in emergency care. Registered nurse shall hold a current certification in both Advanced Cardiac Life Support and Advanced Pediatric Life Support, or two registered nurses on site at all times, one having current certification in Advanced Cardiac Life Support and one with current certification in Advanced Pediatric Life Support.

C. At-least one certified and registered radiology technologist shall be on site at the PFER at all times.

D. At-least one person qualified to perform laboratory testing at the level of laboratory services provided on site by the PFER shall be on duty at all times.

E. Each PFER shall have a full-time administrative

director who directors the daily administrative operations of the PFER, ensures the employees and staff are adequately trained, and provides oversight of the maintenance of the PFER, coordination of patient safety and quality improvement programs and activities.

F. Compliance with the above will be evidenced by:

i. Published on-call list of practitioners to the Emergency Department; and

ii. Documentation of nursing staffing patterns to assure 24- hour coverage.

2. Each PFER shall have patient transfer agreements with an EMS service and with an affiliated acute care or trauma hospital with the capability of handling such emergencies or has State Board of Health approved system of care plan to assure provisions for patient admissions, continued emergency, and diagnostic services beyond the capability of the PFER, and the safe emergency transport of the patient, when needed.

3. Once the decision for transfer has been made, it is the responsibility of the referring physician to initiate resuscitation measures within the capabilities of the local hospital. The referring provider shall select a mode of transport according to the patient’s needs so that the level of care is appropriate during transport.

4. As stated by the American College of Emergency Physicians (ACEP):

A. Emergency medical care shall be available to all members of the public 24 hours a day.

B. Access to appropriate emergency medical and nursing care shall be unrestricted.

C. A smooth continuum should exist among pre-hospital

providers, emergency room (ER) providers, and providers of definitive follow-up care.

D. Evaluation, management, and treatment of patient shall be appropriate and expedient.

E. Resources should exist in the ER to accommodate each patient from the time of arrival through evaluation, medical decision making, treatment and disposition.

F. PFERs should have policies and plans to provide effective administration, staffing, training, facility design, equipment, medication, and ancillary services.

G. The emergency physician, emergency nurse, and additional medical team members should establish effective working relationships with other healthcare providers and entities with whom they must interact. These include emergency medical services (EMS) providers, ancillary hospital personnel, other physicians, and other health care and social services resources.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 41.84.15** Criminal History Record Checks {#sec-16-41.84.15 omnilex-key=us-ms-regs-official--title-15--16#41.84.15}

1. Employee. For the purpose of fingerprinting and criminal background history checks, employee shall mean any individual employed by a covered entity. The term employee”, also includes any individual who by contract with the covered entity provides direct patient care in a patient’s, resident’s, or client’s room or in treatment rooms.

The term employee does not include healthcare professional/technical students, as defined in Section 37-29-232, performing clinical training in a licensed entity under contracts between their schools and the licensed entity, and does not

include students at high schools who observe the treatment and care of patients in a licensed entity as part of the requirements of an allied health course taught in the school if:

A. The student is under the supervision of a licensed healthcare provider; and

B. The student has signed the affidavit that is on file at the student’s school stating that he or she has not been convicted of or plead guilty or nolo contendere to a felony of possession or sale of drugs, murder, manslaughter, armed robbery, rape, sexual battery, any sex offenses listed in section 45-33-23 (g), child abuse, arson, grand larceny, burglary, gratification of lust, aggravated assault, or felonious abuse and/or battery of a vulnerable adult, or that any such conviction or plea was reversed on appeal or a pardon was granted for the conviction or plea.

C. Further, applicants and employees of the University of Mississippi Medical Center for whom criminal history record checks and fingerprinting are obtained in accordance with Section 37-115-41 are exempt from application of the term employee under Section 43-11- 13. 2. Covered Entity. For the purpose of criminal history record checks, “covered entity” means a licensed entity or a healthcare professional staffing agency.

3. Licensed Entity. For the purpose of criminal history record checks, the term “licensed entity” means a hospital, nursing home, personal care home, home health agency or hospice.

4. Health Care Professional/Vocational Technical Academic Program. For the purpose of criminal history record checks, “health care professional/vocational technical academic program” means an academic program in medicine, nursing, dentistry, occupational therapy, physical therapy, social services, speech therapy, or other allied-health professional whose purpose is to prepare professionals to render patient care services.

5. Health Care Professional/Vocational Technical Student. For purposes of criminal history record checks, the term means a student enrolled in a healthcare professional/vocational technical academic program.

6. Direct Patient Care or Services. For purposes of fingerprinting and criminal background history checks, the term “direct patient care” means direct hands-on medical patient care and services provided by an individual in a patient, resident or client’s room treatment room or recovery room. Individuals providing direct patient care may be directly employed by the facility or provides patient care on a contractual basis.

7. Documented Disciplinary Action. For the purpose of fingerprinting and criminal background history checks, the term “documented disciplinary action” means any action taken against an employee for abuse or neglect of a patient.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 41.84.16** Criminal History Record Checks {#sec-16-41.84.16 omnilex-key=us-ms-regs-official--title-15--16#41.84.16}

1. Pursuant to Section 43-11-13, Mississippi Code of 1972, the covered entity shall require to be performed a disciplinary check with the professional licensing agency, if any, for each employee to determine if any disciplinary action has been taken against the employee by the agency, and a criminal history record check on:

A. Every new employee of a covered entity who provides direct patient care or services; and

B. Any individual seeking new employment with a covered entity whose initial criminal history record check is over two years old. 2. Except as otherwise provided in this paragraph, no employee hired on or after July 01, 2003, shall be permitted to provide direct patient care until the results of the criminal history record check revealed no disqualifying record, or the employee has been granted a waiver. Provided the covered entity has documented evidence of submission of fingerprints for the background check, any

person may be employed and provide direct patient care on a temporary basis pending the results of the criminal history record check but any employment offer, contract, or arrangement with the person shall be voidable, if he/she receives a disqualifying criminal record check and no waiver is granted.

3. If such criminal history record check discloses a felony conviction; a guilty plea; and/or a plea of nolo contendere to a felony for one (1) or more of the following crimes which has not been reversed on appeal, or for which a pardon has not been granted, the applicant/employee shall not be eligible to be employed at the licensed facility:

A. possession or sale of drugs B. murder C. manslaughter D. armed robbery E. rape F. sexual battery G. sex offense listed in Section 45-33-23(g), Mississippi Code of

H. child abuse I. arson J. grand larceny K. burglary L. gratification of lust M. aggravated assault N. felonious abuse and/or battery of vulnerable adult 4. Documentation of verification of the employee’s disciplinary status, if any, with the employee’s professional licensing agency

as applicable, and evidence of submission of the employee’s fingerprints to the licensing agency must be on file and maintained by the facility prior to the new employees first date of employment. The covered entity shall maintain on file evidence of verification of the employee’s disciplinary status from any applicable professional licensing agency and of submission and/or completion of the criminal record check, the signed affidavit, if applicable, and/or a copy of the referenced notarized letter addressing the individual’s suitability for such employment.

5. Pursuant to Section 43-11-13, Mississippi Code of 1972, the licensing agency shall require every employee of a covered entity employed prior to July 01, 2003, to sign an affidavit stating that he or she does not have a criminal history as outlined in paragraph (c) above.

6. From and after December 31, 2003, no employee of a covered entity hired before July 01, 2003, shall be permitted to provide direct patient care unless the employee has signed an affidavit as required by this section. The covered entity shall place the affidavit in the employee’s personnel file as proof of compliance with this section.

7. If a person signs the affidavit required by this section, and it is later determined that the person actually had been convicted of or pleaded guilty or nolo contendere to any of the offenses listed herein, and the conviction or pleas has not been reversed on appeal or a pardon has not been granted for the conviction or plea, the person is guilty of perjury as set out in Section 43-11-13, Mississippi Code of 1972. The covered entity shall immediately institute termination proceedings against the employee pursuant to the facility’s policies and procedures.

8. The covered entity may, in its discretion, allow any employee unable to sign the affidavit required by paragraph (g) of this subsection or any employee applicant aggrieved by the employment decision under this subsection to appear before the covered entity’s hiring officer, or his or her designee, to show mitigating circumstances that may exist and allow the employee or employee applicant to be employed at the covered entity. The covered entity, upon report and recommendation of the hiring officer, may grant waivers for those mitigating circumstances, which shall include, but not be limited to:

(1) age at which the crime was committed; (2) circumstances surrounding the crime; (3) length of time since the conviction and criminal history since the conviction; (4) work history; (5) current employment and character references; and (6) other evidence demonstrating the ability of the individual does not pose a threat to the health or safety of the patients in the licensed facility.

9. The licensing agency may charge the covered entity submitting the fingerprints a fee not to exceed Fifty Dollars ($50.00).

10. Should results of an employee applicant’s criminal history record check reveal no disqualifying event, then the covered entity shall, within two (2) weeks two (2) weeks of the notification of no disqualifying event, provide the employee applicant with a notarized letter signed by the chief executive officer of the covered entity, or his or her authorized designee, confirming the employee applicant’s suitability for employment based on his or her criminal history record check. An employee applicant may use that letter for a period of two (2) years from the date of the letter to seek employment at any covered entity licensed by the Mississippi Department of Health without the necessity of an additional criminal record check. Any covered entity presented with the letter may rely on the letter with respect to an employee applicant’s criminal background and is not required for a period of two (2) years from the date of the letter to conduct or have conducted a criminal history check as required in this subsection.

11. For individuals contacted through a third party who provide direct patient care as defined herein, the covered entity shall require proof of a criminal history record check.

12. Pursuant to Section 43-11-13, Mississippi Code of 1972, the licensing agency, the covered entity, and their agents, officer, employees, attorneys, and representatives, shall be presumed to be acting in good faith for any employment decision or action taken under this section. The presumption of good faith may be overcome by a preponderance of the evidence in any civil action. No licensing agency, covered entity, nor their agents, officers, employees, attorneys, and representatives shall be held liable in any employment discrimination suit in which an allegation of discrimination is made regarding an employment decision authorized under this section.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 41.84.17** Required Policies {#sec-16-41.84.17 omnilex-key=us-ms-regs-official--title-15--16#41.84.17}

The PFER Emergency Department Policy Sections shall include:

1. Resources and Planning A. Necessary Elements B. Administration C. Staffing D. Facility E. Equipment and Supplies F. Pharmacologic/Therapeutic Drugs and Agents G. Safety H. Ancillary Services I. Transfer policies and procedures for critical patients J. Electronic Medical Record K. Relationships and Responsibilities L. The policies and procedures governing medical care provided in the emergency service or department shall be established by and shall be a continuing responsibility of the medical staff. The PFER shall have written policies and procedures governing the receipt of patients from emergency medical services and the transfer of patients to a receiving facility. The policies must comply with Mississippi Emergency Medical Services Rules and Regulations. 2. Core Measures A. Measure Groups i. Median Time from PFER Arrival to Departure for Discharged Patients

ii. Median Time from PFER Arrival to Decision to Transfer iii. Median Time from Decision to Transfer to arrival at receiving facility iv. Total lengths of stay and door-to-doctor times B. Quality/Safety Metrics i. PFER will be responsible for reporting all categories required ii. Case analysis of EMS patient outliers.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 41.84.18** Design and Construction Elements: Physical Plant {#sec-16-41.84.18 omnilex-key=us-ms-regs-official--title-15--16#41.84.18}

1. General. Every institution subject to these Minimum Standards shall be housed in a safe building which contains all the facilities required to render the services contemplated in the application for license.

2. Codes. The term “safe” shall be interpreted in the light of compliance with the requirements of the codes recognized by this agency on date of construction which are incorporated by reference as a part of these Minimum Standards; included are the Life Safety Code of the National Fire Protection Association, American National Standards Institute, Standards Number A- 17.1, and A- 17.3, Safety Code for Elevators and Escalators, the American Institute of Architects (AIA), Guidelines for Design and Construction of Hospital and Health Care Facilities, and references incorporated as body of all afore mentioned standards.

A. Life Safety Code compliance relative to construction date:

i. Buildings constructed after February 14, 2005, shall comply with the edition of the Life Safety Code (NFPA 101) recognized by this agency on the date of construction.

ii. Building constructed prior to February 14, 2005, shall comply with existing chapter of the Life Safety Code recognized by this agency.

B. For minimum standards governing Heating, Ventilation, and Air Conditioning (HVAC), area design, space allocation, parking requirements, and other considerations not specifically addressed by local authority or standards referenced herein, compliance with the AIA guidelines will be deemed acceptable.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 41.84.19** Submission of Plans and Specifications {#sec-16-41.84.19 omnilex-key=us-ms-regs-official--title-15--16#41.84.19}

1. Construction shall not be started for any institution subject to these standards (whether new or remodeling or additions to an existing licensed hospital) until the plans and specifications for such construction or remodeling have been submitted to the Licensing Agency in writing and its approval of the changes given in writing.

A. Exception: Foundation changes made necessary by unanticipated conditions, or any conditions which present a hazard to life or property if not immediately corrected.

2. Plans and specifications for any substantial hospital construction or remodeling should be prepared by competent architects and engineers licensed to practice in the state and who assume responsibility for supervising the construction. The following plans shall be submitted to the Licensing Agency for review:

A. Preliminary Plans - To include schematics of buildings, plot plans showing size and shape of entire site, existing structures, if any, streets and location and characteristics of all needed utilities, floor plans of every floor dimensioned and with proposed use of each room or area shown. If for additions or remodeling, provide plan or of

existing building showing all proposed alterations, outline specifications to include a general description of the construction, type of finishes, and type of heating, ventilating, plumbing, and electrical systems proposed. B. Final Working Drawings and Specifications - Complete and in sufficient detail to be the basis for the award of construction contracts.

3. All plans submitted for review must be accompanied in their first submission by an order of the governing board indicating the type and scope of license to be applied for or a Certificate of Need. Plans receiving approval of the Licensing Agency upon which construction has not begun within six (6) months following such approval must be resubmitted for approval.

A. In all new facilities, plans must be submitted to all regulatory agencies, such as the County Health Department, etc., for approval prior to starting construction.

B. Upon completion of construction an inspection shall be made by the Licensing Agency and approval given prior to occupying the building or any part thereof. The state and county health departments shall have access to the job site during regular business hours and shall conduct construction progress inspections as deemed necessary by the agency.

4. Environment. All hospitals shall be so located that they are reasonably free from undue noises, smoke, dust, or foul odors, and should not be located adjacent to railroads, freight yards, schools, children's playgrounds, airports, industrial plants, or disposal plants. The proposed site for new hospitals shall be approved by the department. No new facilities shall be located nearer than 1000 ft. to a cross- country petroleum or gas pipeline.

5. Zoning Restrictions. The locations of an institution shall comply with all local zoning ordinances.

6. Access. Institutions located in rural areas must be served by good roads which can be kept passable at all times.

7. Elevators. One power driven elevator is required in all hospitals having patient rooms, operating suite, or delivery suite above the first floor. Two or more elevators are required if 60 or more patients are housed above the ground floor. Minimum cab dimensions required for elevators transporting patients is 76" x 50"inside clear measurements: hatchway and cab doors 3'8" wide, minimum. Elevators are subject to the requirements of referenced standard listed in paragraph 602, Codes, of this regulation.

8. Signage. To post conspicuously in any emergency room or in a place or places likely to be noticed by all individuals entering the emergency room, as well as those individuals waiting for examination and treatment in areas other than traditional emergency room (that is, entrance, admitting area, waiting room, treatment area) to notify individuals they are in an emergency room and not in a clinic. A. Patient must be notified verbally or in writing of their location on arrival at the PFER.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 41.84.20** Fire Reporting and Protection {#sec-16-41.84.20 omnilex-key=us-ms-regs-official--title-15--16#41.84.20}

1. Duty to report all fires, explosions, natural disasters, avoidable deaths or avoidable serious or life-threatening injuries to patients shall be reported by telephone to the department by the next working day after the occurrence. The licensing agency will provide the appropriate forms to the facility which shall be completed and returned within fifteen (15) calendar days of the occurrence. All reports shall be complete, thorough, and shall record at a minimum the casual factors, date, time of occurrence, and exact location of occurrence whether inside or outside of the facility. Attached thereto shall be all police, fire, and/or other official reports. There must be a telephone in the building to summon help in case of fire.

2. All new construction or renovation with the licensing agency’s approval date on or after February 14, 2005, shall be protected

throughout by a sprinkler system.

3. Heating and Ventilating. Suitable artificial heat shall be furnished to maintain75 degrees F inside temperature with 10 degrees F outside temperature. Circulating hot water from a remote boiler or vapor steam with circulating pump sand controls on emergency electrical service to provide heating in case of power failures are the preferred methods of heating. Electrical heating will be approved provided a standby electrical generator is provided of capacity to furnish 80% of the maximum heating load in addition to other power and lighting loads that maybe connected to it, or the hospital is supplied by two electric service lines connected to separate transformers at the sub-station so arranged that electric service can be maintained in case of failure of one line or transformer.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 41.84.21** Plumbing {#sec-16-41.84.21 omnilex-key=us-ms-regs-official--title-15--16#41.84.21}

All institutions subject to these standards shall be connected to an approved municipal water system or to a private supply whose purity has been certified by the laboratory of the Department of Health. Private supplies must be sampled, tested, and its purity certified at least twice annually and immediately following any repair or modification to the underground lines, the elevated tank, or to the well or pump. Supply must be adequate, both as to volume and pressure for firefighting purposes. Deficiencies in either must be remedied by the provision of auxiliary pumps, pressure tanks or elevated tanks as may be required.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 41.84.22** Emergency Electric Service {#sec-16-41.84.22 omnilex-key=us-ms-regs-official--title-15--16#41.84.22}

1. General. To provide electricity during an interruption of the normal electric supply that could affect the medical care, treatment, or safety of the occupants, an emergency source of electricity shall be provided and connected to certain circuits for lighting and power.

2. Source. The source of this emergency electric service shall be an emergency generator, with a stand-by supply of fuel for 24 hours.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 41.84.23** PFER Equipment, Instruments, and Supplies 1 {#sec-16-41.84.23 omnilex-key=us-ms-regs-official--title-15--16#41.84.23}

The equipment, instruments, and supplies listed below are required in the PFER and each of the items should be located in or immediately available to the area noted. This list does not include routine medical/surgical supplies such as adhesive bandages, gauze pads, and suture material, nor does it include routine office items such as paper, desks, paper clips, and chairs.

2. Electric Nurse Call. There shall be installed a low voltage nurse call system for every bed and such other areas as deemed necessary, with annunciator at nurses’ station and nurses work area.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 41.84.24** Entire PFER shall include: {#sec-16-41.84.24 omnilex-key=us-ms-regs-official--title-15--16#41.84.24}

1. Central station monitoring capability

2. Physiological monitors

3. Blood flow detectors

4. Defibrillator with monitor and battery

5. Thermometers

6. Pulse oximetry

7. Nurse-call system for patient use

8. Portable suction regulator 9. Infusion pumps to include blood pumps

10. IV poles

11. Bag-valve-mask respiratory and adult and pediatric size mask

12. Portable oxygen tanks

13. Blood/fluid warmer and tubing

14. Nasogastric suction supplies

15. Nebulizer

16. Gastric lavage supplies, including large-lumen tubes and bite blocks

17. Urinary catheters, including straight catheters, Foley catheters, Coude catheters, filiforms and followers, and appropriate collection equipment

18. Intraosseous needles

19. Lumbar puncture sets (adult and pediatric)

20. Blanket warmer

21. Tonometer

22. Slit lamp

23. Wheelchairs

24. Medication dispensing system with locking capabilities

25. Separately wrapped instruments (specifics will vary by department)

26. Availability of light microscopy for emergency procedures

27. Weight scales (adult and infant)

28. Tape measure

29. Ear irrigation and cerumen removal equipment

30. Vascular Doppler

31. Anoscope

32. Adult and Pediatric "code" cart

33. Suture or minor surgical procedure sets (generic)

34. Portable sonogram equipment

35. EKG machine

36. Point of care testing

37. X-ray view box and hot light

38. Film boxes for holding x-rays

39. Chart Rack

40. Computer system

41. Internet capabilities

42. Patient tracking system

43. Radio or other device for communication with ambulances

44. Patient discharge instruction system

45. Patient registration system/ Information services

46. Intradepartmental staff communication system- pagers, mobile phones

47. charting system for physician, nursing, and attending physician documentation equipment

48. Reference materials including toxicology resource information

49. Personal protective equipment- gloves, eye goggles, face mask, gowns, head, and foot covers

50. Linen (pillows, towels, wash cloths, gowns, blankets)

51. Patient belongings or clothing bag

52. Security needs -including restraints and wand-type or free-standing metal

53. detectors as indicated 54. Equipment for adequate housekeeping

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 41.84.25** PFER General Examination Rooms shall include: {#sec-16-41.84.25 omnilex-key=us-ms-regs-official--title-15--16#41.84.25}

1. Examination tables or stretchers appropriate to the area.

2. For any area in which seriously ill patients are managed, a stretcher with capability for changes in position, attached IV poles, and a holder for portable oxygen tank should be used.

3. Pelvic tables for GYN examinations.

4. Step stool

5. Chair/stool for emergency staff

6. Seating for family members or visitors

7. Adequate lighting, including procedure lights as indicated

8. Cabinets

9. Adequate sinks for handwashing, including dispensers for germicidal soap and paper towels.

10. Wall mounted oxygen supplies and equipment, including nasal cannulas, facemasks, and venturi masks.

11. Wall mounted suction capability, including both tracheal cannulas and larger cannulas.

12. Wall-mounted or portable otoscope/ophthalmoscope

13. Sphygmomanometer/stethoscope

14. Oral and nasal airways

15. Biohazard-disposal receptacles, including for sharps

16. Garbage receptacles for non-contaminated materials

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 41.84.26** PFER Resuscitation Room {#sec-16-41.84.26 omnilex-key=us-ms-regs-official--title-15--16#41.84.26}

All items listed for general examination rooms plus: 1. Adult and Pediatric "code cart" to include appropriate medication charts

2. Capability for direct communication with nursing station, preferably hands free

3. Radiography equipment

4. Radiographic view boxes and hot light

5. Airways needs

A. Big-valve-mask respirator (adult, pediatric, and infant) Cricothyroidotomy instruments and supplies

B. Endotracheal tubes, size 2.5 to 8.5 mm

C. Fiberoptic laryngoscope

D. Laryngoscopes, straight and curved blades and stylets

E. Laryngoscope mirror and supplies

F. Laryngeal Mask Airway (LMA)

G. Oral and nasal airways

H. Tracheostomy instrument and supplies

6. Breathing

A. BiPAP Ventilation System

B. Closed-chest drainage device

C. Chest tube instruments and supplies

D. Emergency thoracotomy instruments and supplies

E. End-tidal C02 monitor18

F. Nebulizer

G. Peak flow meter

H. Pulse oximetry

I. Volume cycle ventilator 7. Circulation

A. Automatic physiological monitor, noninvasive

B. Blood/fluid infusion pumps and tubing

C. Blood/fluid warmers

D. Cardiac compression board

E. Central venous catheter setups/kits

F. Central venous pressure monitoring equipment

G. Cutdown instruments and supplies

H. Intraosseous needles

I. IV catheters, sets, tubing, poles

J. Monitor/defibrillator with pediatric paddles, internal paddles, appropriate pads, and other supplies Pericardiocentesis instruments

K. Temporary external pacemaker

L. Transvenous and/or transthoracic pacemaker setup and supplies

M. 12-Lead ECG machine

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 41.84.27** Trauma and miscellaneous resuscitation shall include: {#sec-16-41.84.27 omnilex-key=us-ms-regs-official--title-15--16#41.84.27}

1. Blood salvage/autotransfusion device

2. Emergency obstetric instruments and supplies

3. Hypothermia thermometer

4. Infant warming equipment

5. Peritoneal lavage instruments and supplies

6. Pneumatic antishock garment, as indicated

7. Spine stabilization equipment to include cervical collars, short and long boards 8. Warming/cooling blanket

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 41.84.28** Other Special Rooms {#sec-16-41.84.28 omnilex-key=us-ms-regs-official--title-15--16#41.84.28}

All items listed for general examination rooms plus:

1. Orthopedic A. Cast cutter B. Cast and splint application supplies and equipment Cast spreader C. Crutches D. Extremity-splinting devices including traction splinting and fixation pins/wires and corresponding instruments and supplies E. Halo traction or Gardner-Wells/Trippe- Wells traction Radiograph view and hot light F. Suture instrument and supplies G. Traction equipment, including hanging weights and finger traps 2. Eye/ENT A. Eye chart B. Ophthalmic tonometry device (applanation, Schiotz, or other) C. Other ophthalmic supplies as indicated, including

eye spud, rust ring remover, cobalt blue light D. Slit lamp E. Ear irrigation and cerumen removal equipment F. Epistaxis instrument and supplies, including balloon posterior packs Frazier suction tips G. Headlight H. Laryngoscope mirror I. Plastic suture instruments and supplies 3. OB-GYN A. Fetal Doppler and ultrasound equipment B. Obstetrics/Gynecology examination light C. Vaginal specula in pediatric through adult sizes D. Sexual assault evidence-collection kits (as appropriate) E. Suture material

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 41.84.29** Required Pharmacological/Therapeutic drugs for PFER {#sec-16-41.84.29 omnilex-key=us-ms-regs-official--title-15--16#41.84.29}

These classes of drugs and agents are required. The medical director of the PFER, representatives of the medical staff, and the director of the pharmacy shall develop a formulary of specific agents for use in the PFER.

1. Analgesics a. narcotic and non-narcotic 2. Anesthetics a. topical, infiltrative, general 3. Anticonvulsants 4. Antidiabetic agents

5. Antidotes 6. Antihistamines 7. Anti-infective agents a. systemic/topical 8. Anti-inflammatories a. steroidal/non-steroidal 9. Anti-platelets 10. Aspirin 11. Plavix 12. Heparin 13. Bicarbonates 14. Blood Modifiers 15. Anticoagulants to include thrombolytics 16. Anticoagulants 17. Hemostatic agents a. systemic b. topical c. plasma expanders/extenders 18. Burn Preparations 19. Cardiovascular agents a. Ace inhibitors b. Adrenergic blockers c. Adrenergic stimulants d. Alpha/Beta blockers e. Antiarrhythmic agents

f. Calcium channel blockers g. Digoxin antagonist h. Diuretics i. Vasodilators j. Vasopressors 20. Cholinesterase Inhibitors 21. Diagnostic agents a. Blood contents b. Stool contents c. Testing for myasthenia gravis d. Urine contents 22. Electrolytes a. Cation exchange resin b. Electrolyte replacements, parenteral and oral c. Fluid replacement solutions 23. Gastrointestinal agents a. Antacids b. Anti-diarrheal c. Emetics and Anti-emetics d. Anti-flatulent e. Anti-spasmodic f. Bowel evacuants/laxatives g. Histamine receptor antagonists h. Proton pump inhibitors 24. Glucose elevating agents

25. Hormonal agents 26. Hypocalcemia and hypercalcemia management agents 27. Lubricants 28. Migraine preparations 29. Muscle relaxants 30. Narcotic antagonist 31. Nasal preparation 32. Ophthalmologic preparations 33. Otic preparations 34. Oxytocics 35. Pain Medications 36. Psychotherapeutic agents 37. Respiratory agents a. Antitussives b. Bronchodilators c. Decongestants d. Leukotriene antagonist 38. Rho(D) immune globulin 39. Salicylates 40. Sedatives and Hypnotics 41. Thrombolytics 42. Vaccinations 43. Vitamins and minerals

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 41.84.30** Radiologic, Imaging, and Other Diagnostic Services {#sec-16-41.84.30 omnilex-key=us-ms-regs-official--title-15--16#41.84.30}

The specific services available and the timeliness of availability of these services for emergency patients in PFER should be determined by the medical director of the PFER in collaboration with the directors of the diagnostic services and other appropriate individuals.

1. The following should be readily available 24 hours a day for Emergency patients: A. Standard radiologic studies of bony and soft-tissue structures including, but not limited to: i. Cross-table lateral views of spine with full series to follow ii. Portable chest radiographs for acutely ill patients and for verification of placement of endotracheal tube, central line, or chest tube iii. Soft-tissue views of the neck iv. Soft-tissue views of subcutaneous tissues to rule out the presence of foreign body v. Standard chest radiographs, abdominal series, etc. B. Pulmonary services i. Arterial blood gas determination ii. Peak flow determination iii. Pulse oximetry C. Fetal monitoring (nonstress test)/uterine monitoring D. Cardiovascular services i. Doppler studies ii. 12-Lead ECGs and rhythm strips

E. Emergency ultrasound services for the diagnosis of obstetric/gynecologic, cardiac, and hemodynamic problems and other urgent conditions.

2. The following services shall be available on an urgent basis. All equipment listed below must be available if service is provided by the facility. Such may be provided by on duty staff or on call staff available to respond within a reasonable period of time:

A. Nuclear medicine i. Ventilation-perfusion lungs scans ii. Other scintigraphy for trauma and other conditions B. Radiographic i. Arteriography/venography ii. Computed tomography preferred iii. Dye-contrast studies (intravenous pyelography, gastrointestinal contrast, etc.) C. Vascular/flow studies including impedance plethysmography

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 41.84.31** Required Laboratory Capabilities {#sec-16-41.84.31 omnilex-key=us-ms-regs-official--title-15--16#41.84.31}

The medical director of the PFER and the director of laboratory services shall develop guidelines for availability and timeliness of services for the PFER. The following laboratory capabilities are required for the PFER. This list may not be comprehensive or complete.

1. Blood bank A. Bank products availability B. Type and cross-matching capabilities 2. Chemistry A. Ammonia B. Amylase

C. Anticonvulsant and other therapeutic drug levels D. Arterial blood gases E. Bilirubin (total and direct) F. Calcium G. Carboxyhemoglobin H. Cardiac isoenzymes (including creatine kinase- MB) I. Chloride (blood and cerebrospinal fluid [CSF]) J. Creatinine K. Electrolytes L. Ethanol M. Glucose (blood and CSF) N. Liver-function enzymes (ALT, AST, alkaline phosphatase) O. Methemoglobin P. Osmolality Q. Protein (CSF) R. Serum magnesium S. Urea nitrogen 3. Hematology A. Cell count and differential (blood, CSF, and joint fluid analysis) B. Coagulation studies C. Erythrocyte sedimentation rate D. Platelet count E. Reticulocyte count F. Sickle cell prep 4. Microbiology

A. Acid fast smear/staining B. Chlamydia testing C. Counter immune electrophoresis for bacterial identification D. Gram staining and culture/sensitivities E. Herpes testing F. Strep screening G. Viral culture H. Wright stain 5. Other A. Hepatitis screening B. HIV screening C. Prothrombin Time (PT)/International Normalized Ratio (INR), Partial Thromboplastin Time (PTT) i. D-dimer D. Joint fluid and CSF analysis E. Toxicology screening and drug levels F. Urinalysis G. Mononucleosis spot H. Serology (syphilis, recombinant, immunoassay) I. Pregnancy testing (qualitative and quantitative)

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 41.84.32** Infection Control {#sec-16-41.84.32 omnilex-key=us-ms-regs-official--title-15--16#41.84.32}

The PFER shall provide a sanitary environment to avoid sources and transmission of infections and communicable diseases. There shall be an active program for the prevention, control, and investigation of infections and communicable diseases.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 41.84.33** Medical Waste Management Plan {#sec-16-41.84.33 omnilex-key=us-ms-regs-official--title-15--16#41.84.33}

All generators of infectious medical waste and medical waste shall have a medical waste management plan in accordance with Adopted Standards for the Regulation for Medical Waste.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 41.84.34** Food and Dietetic Services {#sec-16-41.84.34 omnilex-key=us-ms-regs-official--title-15--16#41.84.34}

The PFER shall have appropriate food and beverages available for the patients. The PFER shall be responsible for meeting the nutritional needs of patients.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 41.84.35** Transfer of Unstable Patients from PFER to Acute Care Hospital {#sec-16-41.84.35 omnilex-key=us-ms-regs-official--title-15--16#41.84.35}

Once the patient is determined to require a higher level of care than can be provided at the PFER, the physician shall immediately contact the designated EMS for transport. If the EMS is based on site, the transport team will be notified immediately. The physician will stabilize the emergency medical condition and determine the transfer destination based on the specialized capabilities of facilities that are offered at local hospitals. The PFER facility will implement all procedures and protocols for acutely ill patients before departure from the PFER. Such conditions would include, but not be limited to, STEMI, acute ischemic stroke, and cardiac arrests. All electronic medical records and any diagnostic test results will be transported with the patient to the receiving facility. Should a patient meeting trauma system activation arrive at the PFER, the PFER will transfer the patient in accordance with the federal EMTALA regulations and MS State Board of Health approved System of Care Plans.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 41.84.36** Discharge Planning {#sec-16-41.84.36 omnilex-key=us-ms-regs-official--title-15--16#41.84.36}

The patient or their representative shall be provided written discharge instructions regarding follow up referrals/appointments, medication management and procurement, durable medical equipment, availability of community resources and other identified needs at the time of discharge.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 41.84.37** Medical Records {#sec-16-41.84.37 omnilex-key=us-ms-regs-official--title-15--16#41.84.37}

The facility shall have a medical record department with administrative responsibility for medical records. A medical record shall be maintained, in accordance with accepted professional principles, for each patient receiving care in the hospital. such records shall be kept confidential and only authorized personnel shall have access to the records.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 41.84.38** Written Consent {#sec-16-41.84.38 omnilex-key=us-ms-regs-official--title-15--16#41.84.38}

Written consent of the patient or the patient’s legal representative shall be presented as authority for release of medical information and this release shall become part of the medical record.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 41.84.39** Medical Records {#sec-16-41.84.39 omnilex-key=us-ms-regs-official--title-15--16#41.84.39}

Medical records shall not be removed from the hospital environment except upon subpoena.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 41.84.40** Preservation {#sec-16-41.84.40 omnilex-key=us-ms-regs-official--title-15--16#41.84.40}

Records shall be preserved, either in the original or by reproduction, for a period of time not less than that set forth in Title 41, Chapter 9 of the Mississippi Code of 1972.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 41.84.41** Confidentiality {#sec-16-41.84.41 omnilex-key=us-ms-regs-official--title-15--16#41.84.41}

Medical records shall be kept confidential and only authorized personnel shall have access to the records.

**History**
- *SOURCE: Miss. Code Ann. 41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 41.84.42** Emergency Operations Plan (EOP) {#sec-16-41.84.42 omnilex-key=us-ms-regs-official--title-15--16#41.84.42}

The licensed entity shall develop and maintain a written preparedness plan utilizing the Emergency Operations Plan (EOP) Template developed by the MSDH Office of Emergency Planning and Response. “All Hazards” and “Whole Community” approach to emergency and disaster planning. The plan must include procedures to be followed in the event of any pandemic, act of terrorism or man-made or natural disaster as appropriate for the specific geographical location. The final draft of the Emergency Operations Plan (EOP), will be reviewed by the Office of Emergency Planning and Response, Mississippi State

Department of Health, or their designates, for conformance with the “All Hazards Emergency Planning and Response Plan.” Particular attention shall be given to critical areas of concern which may arise during any “all hazards” emergency whether required to evacuate or to sustain in place. Additional plan criteria or a specified EOP format may be required as deemed necessary by the Office of Emergency Planning and Response. The eight (8) critical areas of consideration are:

1. Communications – Facility status reports shall be submitted in a format and a frequency as required by the Office of Emergency Planning and Response 2. Resources and Assets 3. Safety and Security 4. Smoke Detectors/Extinguishers (refer to NFPA 10) 5. Staffing 6. Infrastructure (Water, sewer, electricity, data systems, etc.) 7. Clinical Activities and 8. Continuity of Operations Planning (COOP) to include surge and alternate care sites.

**History**
- *SOURCE: Miss. Code Ann. 41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 41.84.43** Rule 41.84.43 {#sec-16-41.84.43 omnilex-key=us-ms-regs-official--title-15--16#41.84.43}

Emergency Operations Plans (EOPs) must be exercised and reviewed annually or as directed by the Office of Emergency Planning and Response. Written evidence of current verification or review of provider EOPs, by the Office of Emergency Planning and Response, shall accompany all applications for facility license renewals.

**History**
- *SOURCE: Miss. Code Ann. 41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 41.84.44** Facility Fire Preparedness {#sec-16-41.84.44 omnilex-key=us-ms-regs-official--title-15--16#41.84.44}

1. Fire Drills. Fire drills shall be conducted one (1) per shift per quarter. Employees shall participate in a fire drill at least four (4) times per year. A. Written Records. Written records of all drills

shall be maintained, indicating content of and attendance at each drill. B. A fire evacuation plan shall be posted in each facility in a conspicuous place and kept current.

**History**
- *SOURCE: Miss. Code Ann. 41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 41.84.45** Emergency Electric Services {#sec-16-41.84.45 omnilex-key=us-ms-regs-official--title-15--16#41.84.45}

(Refer to Subchapter 14).

Subchapter 85 MINIMUM STANDARDS OF OPERATION FOR MISSISSIPPI RURAL EMERGENCY HOSPITALS

**History**
- *SOURCE: Miss. Code Ann. 41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 41.85.1** Adoption of Regulations and Minimum Standards {#sec-16-41.85.1 omnilex-key=us-ms-regs-official--title-15--16#41.85.1}

This Subchapter provides the specific state licensure requirements for Rural Emergency Hospitals (REHs). The provisions contained within this Subchapter, in conjunction with the federal Medicare Conditions of Participation (CoPs) for REHs, constitute the complete set of standards for REH licensure. Sections within this Subchapter designated as 'Reserved' indicate topics for which the adopted federal Conditions of Participation shall serve as the governing standard. Other Subchapters of the Minimum Standards of Operation for Mississippi Hospitals shall not apply to licensed REHs, unless expressly provided otherwise by a specific cross-reference herein. By virtue of authority vested in it by the Mississippi Code Annotated, the Mississippi State Department of Health does hereby adopt the federal Medicare Conditions of Participation (CoPs) for Rural Emergency Hospitals (REH) as found in 42 CFR Part 485, Subpart E, as may be amended. These federal regulations shall serve as the primary operational and quality standards for an REH. 1. The Medicare and Medicaid Programs; Conditions of Participation (CoPs) for Rural Emergency Hospitals (REH) and Critical Access Hospital CoP Updates as found in 42 CFR Parts 485 and 489 [CMS–3419–P] RIN 0938– AU92/ Rural Emergency Hospital Conditions for Participation Part 485, Subpart E are hereby adopted.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 41.85.2** Compliance with Rules, Regulations and Standards {#sec-16-41.85.2 omnilex-key=us-ms-regs-official--title-15--16#41.85.2}

The REH shall report to the licensing agency all required data as specified by the licensing agency at a frequency required by the licensing agency. This includes but is not to trauma data, hospital discharge data, and other data points deemed necessary by the licensing agency.

**History**
- *SOURCE: Miss. Code Ann. 41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 41.85.3** Definitions {#sec-16-41.85.3 omnilex-key=us-ms-regs-official--title-15--16#41.85.3}

The definitions specific to the REH are:

1. Licensing Agency. “Licensing agency” means the Mississippi State Department of Health. 2. Rural Emergency Hospital (REH). A rural emergency hospital (REH) is a new Medicare provider designation established by Congress through the Consolidated Appropriations Act of 2021, Section 125. The REH designation allows Critical Access Hospitals (CAHs) and rural hospitals with no more than 50 beds to avert potential closure and continue to provide essential services for the communities they serve. REH’s provide emergency services and outpatient services. REH’s do not provide acute care inpatient services, with the exception of post- hospital extended care services furnished in a distinct part unit licensed as a skilled-nursing facility. Pilot Freestanding Emergency Rooms and Freestanding Emergency Departments are not eligible to convert to a Rural Emergency Hospital. 3. Certificate of Need (CON) Exemption. The conversion of an existing, eligible hospital to a Rural Emergency Hospital (REH) does not require a Certificate of Need or a Determination of Reviewability from the Mississippi State Department of Health.

**History**
- *SOURCE: Miss. Code Ann. 41-75-1*

##### **15 Miss. Admin. Code Pt. 16, R. 41.85.4** License {#sec-16-41.85.4 omnilex-key=us-ms-regs-official--title-15--16#41.85.4}

No person or governmental unit shall establish, conduct, or maintain a Rural Emergency Hospital in this state without a license issued by the licensing agency. Each license shall be issued only for the premises and persons or governmental units named in the application and shall not be transferable or assignable.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 41.85.5** Application for License {#sec-16-41.85.5 omnilex-key=us-ms-regs-official--title-15--16#41.85.5}

An application for a license shall be made to the licensing agency upon forms provided by the licensing agency and shall contain such information as the licensing agency reasonably requires, including: 1. Documentation of eligibility for the REH designation. 2. Proof of financial viability sufficient to ensure continuous operation for a period of not less than 24 months, which shall include, at a minimum, a business plan with pro forma financial statements.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 41.85.6** Licensure and User Fees {#sec-16-41.85.6 omnilex-key=us-ms-regs-official--title-15--16#41.85.6}

Each initial and renewal licensure application shall be accompanied by a fee as set by the Board. A license, unless suspended or revoked, shall be renewable annually. Such fees shall be paid to the licensing agency by electronic payment, business check, certified check, or money order. A license shall not be issued until such fee is received by the licensing agency. Fees are non-refundable. 1. User Fee. A “user fee” in an amount set by the Board, shall be assessed by the licensing agency for the purpose of the required reviewing and inspections of the proposal of any REH in which there are additions, renovations, modernizations, expansion, alterations, conversions, modifications or replacement of the entire facility involved in the proposal. This fee includes the reviewing of architectural plans in all required steps. 2. Provisional License. Within its discretion, the Mississippi State Department of Health may issue a provisional license when a facility is found to be in substantial compliance with these regulations but has minor, correctable deficiencies. A provisional license shall be issued only if the Department of Health is satisfied that preparations are being made to qualify for a regular license and that the health and safety of patients will not be endangered. The provisional license shall be valid until the issuance of a regular license but shall not exceed five months following the date of issuance. 3. .Denial, Revocation, or Suspension of License. The licensing agency, after notice and opportunity for a hearing to the applicant or licensee, is authorized to deny, suspend, or revoke a license in any case in which it finds that there has been a substantial failure to comply with the requirements established in these regulations and standards. 4. Posting of License. The license issued by the licensing agency shall be posted in a conspicuous place on the licensed premises, accessible to public view.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 41.85.7** User Fee {#sec-16-41.85.7 omnilex-key=us-ms-regs-official--title-15--16#41.85.7}

A “user fee” in an amount set by the Board, shall be assessed by the licensing agency for the purpose of the required reviewing and inspections of the proposal of any hospital in which there are additions, renovations, modernizations, expansion, alterations, conversions, modifications or replacement of the entire facility involved in the proposal. This fee includes the reviewing of architectural plans in all required steps. Fees are to be made

payable to the Mississippi State Department of Health, and paid by either a business check, money order, or electronic means.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 41.85.8** Renewal of License {#sec-16-41.85.8 omnilex-key=us-ms-regs-official--title-15--16#41.85.8}

A license, unless suspended or revoked, shall be renewable annually, upon filing by the licensee, and approval by the licensing agency of an annual report upon such uniform dates and containing such information as the licensing agency requires and upon paying the annual fee for such license.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 41.85.9** Issuance of License {#sec-16-41.85.9 omnilex-key=us-ms-regs-official--title-15--16#41.85.9}

Each license shall be issued only for the premises and persons or governmental units names in the application and shall not be transferable or assignable except with the written approval of the licensing agency.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 41.85.10** Denial or Revocation of a License {#sec-16-41.85.10 omnilex-key=us-ms-regs-official--title-15--16#41.85.10}

The licensing agency, after notice and opportunity for hearing to the applicant or licensee, is authorized to deny, suspend, or revoke a license in any case in which it finds that there has been a substantial failure to comply with the requirements established in these regulations and standards.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 41.85.11** Ownership {#sec-16-41.85.11 omnilex-key=us-ms-regs-official--title-15--16#41.85.11}

There shall be full and transparent disclosure of REH ownership and control. The application for licensure shall identify all persons and entities with a direct or indirect ownership or controlling interest of five percent (5%) or more in the REH, including the ultimate beneficial ownership. 1. Refer to Rules 41.4.1; 41.4.2; 41.4.3; 41.4.4; 41.4.5

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 41.85.12** Change of Ownership {#sec-16-41.85.12 omnilex-key=us-ms-regs-official--title-15--16#41.85.12}

A change of ownership requires prior notification to the licensing agency and approval for a new license before the change is

effective. When a change of ownership of an REH is contemplated, the REH and the proposed new owner shall notify the licensing agency, in writing, at least 30 days prior to the proposed date of change. The notification shall include a full disclosure of the proposed new ownership structure, identifying all persons and entities with a direct or indirect ownership or controlling interest of five percent (5%) or more, including the ultimate beneficial ownership, and all other documents as required by the licensing agency. A new license is required upon a change of ownership.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 41.85.13** Governing Authority {#sec-16-41.85.13 omnilex-key=us-ms-regs-official--title-15--16#41.85.13}

The REH shall have an organized governing body, or designated person(s), that has overall responsibility for the conduct of the REH, is responsible for the management of the facility and appointment of the medical staff, and ensures compliance with all applicable federal, state, and local laws and regulations. The governing body shall adopt bylaws in accordance with legal requirements and with its community responsibility, identifying the purposes of the hospital and the means of fulfilling them, and shall at least: 1. Be in writing available to all members of the governing body. 2. Contain the name of the governing body. 3. State the manner in which the members of the governing body, the officers and the administrative personnel are selected, the terms for which they are elected or appointed, and their duties and responsibilities. 4. Specify to whom authority for operation and maintenance of the hospital, including evaluation of hospital practices, may be delegated; and the methods established by the governing body for holding such individuals responsible. 5. Provide a schedule of meetings of the governing body at sufficiently frequent intervals to permit it an evaluation of the performance of the hospital as an institution and to carry on necessary planning for the proper developments and growth of the hospital, with written minutes to be kept of all such meetings. 6. Provide the method of appointment, re-appointment, and removal of members of the medical staff. 7. Provide mechanisms for the formal approval of the organization,

bylaws, and rules and regulations of the medical staff and its department in the hospital. Facility Discontinuation/Closure of Service: Discontinuation of Service: Facilities proposing the closure/discontinuation of patient medical care services that are listed on the facility’s hospital licensure application shall notify the Department in writing a minimum of 30 days prior to closure and include the effective closure date. The notification to the Department shall include, but is not limited to: A. The type of services that will no longer be provided due to closure; B. The reason for closure; C. The location where the patients have been/will be transferred; D. The plan for storage of patient medical records; and E. Plan for notifying the public.

Closure: Facilities proposing the permanent closure of a hospital shall notify the Department in writing at of the intent to close a minimum of 30 days in advance of the closure date. The notice of closure shall include, but is not limited to:

G. Effective date of permanent closure; H. The number of Emergency Department beds eliminated; I. Summary of services being eliminated. J. A description of the nearest available comparable services in the community; K. The Plan for the maintenance and retention of the patient medical records; and L. On the date of closure, the license shall be returned to Department.

Rule 41.85.16. Criminal History Record Checks. The REH shall conduct criminal history record checks in accordance with the requirements set forth in Subchapter 6 of these regulations.

Rule 41.85.19. Patient Rights. The REH shall develop and implement policies to protect and promote each patient's rights in accordance with the requirements of the adopted federal Conditions of Participation at 42 CFR § 485.534. Rule 41.85.20. Physical Plant and Environment. The REH shall be housed in a safe building that complies with the requirements of the Life Safety Code (NFPA 101) and any other applicable physical environment standards outlined in the adopted federal Conditions of Participation at 42 CFR §485.544.

Rule 41.85.23. Nursing Services. Reserved. This topic is governed by the adopted federal Conditions of Participation at 42 CFR § 485.530. Rule 41.85.24. Laboratory Services. Reserved. This topic is governed by the adopted federal Conditions of Participation at 42 CFR § 485.518. Rule 41.85.25. Radiology Services. Reserved. This topic is governed by the adopted federal Conditions of Participation at 42 CFR § 485.520. Rule 41.85.26. Pharmacy/Pharmaceutical Services. Reserved. This topic is governed by the adopted federal Conditions of Participation at 42 CFR § 485.522. Rule 41.85.27. Nutritional Services. The REH shall have written policies and procedures for the provision of food and nutritional services to patients as appropriate to the services provided and the patient's clinical needs. This shall include, at a minimum, the capability to provide nourishment and therapeutic diets as ordered by a practitioner, particularly for patients held in observation. All food and beverage storage and preparation shall be in accordance with public health standards. Rule 41.85.28. Outpatient Services. Reserved. This topic is governed by the adopted federal Conditions of Participation at 42 CFR § 485.524 Additional outpatient medical and health services.. Rule 41.85.29. Surgical Services. Reserved. This topic is governed by the adopted federal Conditions of Participation at 42 CFR § 485.524 Additional outpatient medical and health services. . Rule 41.85.30. Anesthesia Services. Reserved. This topic is governed by the adopted federal Conditions of Participation at 42 CFR § 485.524 Additional outpatient medical and health services.. Rule 41.85.31. Quality Assessment and Performance Improvement (QAPI).

The REH shall develop, implement, and maintain an effective, ongoing, REH- wide, data-driven quality assessment and performance improvement program in accordance with the requirements of the adopted federal Conditions of Participation at 42 CFR § 485.536.

1. When a patient requires services beyond the capability of the REH, the REH must stabilize the patient within its capability and arrange for a safe, timely transfer to an appropriate facility in accordance with federal EMTALA regulations, including the provisions at 42 CFR § 489.24, and the facility's transfer agreements.

Rule 41.85.37. Adverse Incident Reporting. The REH shall report to the licensing agency any of the following adverse incidents within 24 hours of the incident's occurrence or the facility's awareness of the incident: 1. The death of a patient. 2. Any incident, whether or not it results in death, that is a sentinel event as defined by the facility's accrediting organization, or that results in serious physical or psychological injury to a patient. The REH shall conduct a thorough investigation of any such incident and, upon request, provide a copy of the investigation report to the licensing agency.

1. The REH shall comply with the requirements of 42 CFR § 485.542, "Condition of participation: Emergency preparedness." 2. Communications and Facility Status Reporting. The REH shall submit facility status reports, including but not limited to, bed availability and operational status, in a format and at a frequency determined by the Department.

1. REH Status: The facility must have a process for notifying patients and the public that the facility is a Rural Emergency Hospital and that it does not provide acute care inpatient services. This process shall include, at a minimum, clear signage at public entrances and a method for informing patients at the time of registration.

2. EMTALA Signage: The REH shall post signage in accordance with federal EMTALA requirements at 42 CFR § 489.20(q), which specifies the posting of signs in the emergency department that conspicuously inform individuals of their right to a medical screening examination and any rights they may have under EMTALA.

CHAPTER 42 MINIMUM STANDARDS OF OPERATION FOR AMBULATORY SURGICAL FACILITIES Subchapter 1 GENERAL: LEGAL AUTHORITY Rule 42.1.1 Adoption of Regulations. Under and by virtue of authority vested in it by Mississippi Code Annotated § 41-75-1 thru § 41-75-25 (Supplement 1986), the Mississippi State Department of Health, as licensing agency, does hereby adopt and promulgate the following rules, regulations, and standards governing ambulatory surgical facilities licensed to operate in the State of Mississippi.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13 Rule 41.85.14. Administrator and Changes in Key Leadership. The governing body shall appoint a qualified administrator who is responsible for the overall management of the REH, in accordance with federal standards at 42 CFR § 485.510. This appointment shall be documented in the minutes of the governing body. The REH shall notify the licensing agency in writing within 15 days of any change in the facility’s administrator/chief executive officer or in the constituency of its governing body.*
- *SOURCE: Miss. Code Ann. §41-9-17; 42 CFR § 485.510 Rule 41.85.15. Staffing and Treatment. The REH must be staffed and equipped to provide emergency medical care to all individuals who present to the facility. Staffing, including medical, nursing, and ancillary personnel, must be sufficient in number and qualifications to meet the requirements of the adopted federal Conditions of Participation at 42 CFR §485, Subpart E.*
- *SOURCE: Miss. Code Ann. §41-9-17; 42 CFR §485 Subpart E.*
- *SOURCE: Miss. Code Ann. §41-9-13 Rule 41.85.17. Abuse and Neglect Reporting. The REH shall ensure the protection of all patients from abuse, neglect, and exploitation. The facility shall develop and implement written policies and procedures to ensure that all staff are aware of and comply with their reporting duties in accordance with the Mississippi Vulnerable Persons Act and any other applicable state laws regarding the reporting of suspected abuse or neglect of children and vulnerable adults. Such policies shall include, at a minimum, provisions for staff training on identifying and reporting suspected incidents to the appropriate state agencies.*
- *SOURCE: Miss. Code Ann. §41-9-17; Miss. Code Ann. Title 43, Chapter 47 Rule 41.85.18. Policies and Procedures. The REH shall develop, implement, and maintain written policies and procedures as necessary to ensure the health and safety of patients and to comply with all requirements of this Subchapter and the adopted federal Conditions of Participation (42 CFR Part 485, Subpart E).*
- *SOURCE: Miss. Code Ann. §41-9-17; 42 CFR §485 Subpart E.*
- *SOURCE: Miss. Code Ann. §41-9-17; 42 CFR §485.544 Rule 41.85.21. Patient Call System. The REH shall ensure each patient has a means to request immediate assistance from staff, in accordance with the patient rights and physical environment standards set forth in the adopted federal Conditions of Participation.*
- *SOURCE: Miss. Code Ann. §41-9-1t7; 42 CFR §485.534; 42 CFR §485.544 Rule 41.85.22. Medical Staff. Reserved. This topic is governed by the adopted federal Conditions of Participation at 42 CFR § 485.512.*
- *SOURCE: Miss. Code Ann. §41-9-17; 42 CFR § 485.536 Rule 41.85.32. Infection Control. The REH shall meet the requirements for an infection prevention and control program as set forth in the adopted federal Conditions of Participation at 42 CFR §485.526.*
- *SOURCE: Miss. Code Ann. §41-9-17; 42 CFR §485.526 Rule 41.85.33. Medical Waste Management Plan. All generators of infectious medical waste and medical waste shall develop and maintain a medical waste management plan in accordance with the Mississippi State Department of Health's "Regulations Governing Medical Waste."*
- *SOURCE: Miss. Code Ann. §41-9-17 Rule 41.85.34. Transfer of Patients. The REH must have in effect a written transfer agreement with at least one certified hospital that is a Level I or Level II trauma center for the referral and transfer of patients requiring emergency medical care beyond the capabilities of the REH, in accordance with 42 CFR § 485.538.*
- *SOURCE: Miss. Code Ann. §41-9-17; 42 CFR §485.538 Rule 41.85.35. Discharge Planning. The REH shall comply with the requirements of 42 CFR § 485.532.*
- *SOURCE: Miss. Code Ann. §41-9-17; 42 CFR § 485.532 Rule 41.85.36. Medical Records. The REH shall maintain a medical record for each patient in accordance with accepted professional principles and the requirements of the adopted federal Conditions of Participation at 42 CFR § 485.540. Records shall be confidential, safely stored, and preserved for a period of time not less than that set forth in Title 41, Chapter 9 of the Mississippi Code of 1972.*
- *SOURCE: Miss. Code Ann. §41-9-61 et seq.*
- *SOURCE: Miss. Code Ann. §41-9-17 Rule 41.85.38. Emergency Operations Plan (EOP). The REH shall develop and maintain a comprehensive emergency preparedness program that includes an emergency plan. The emergency plan must be based on a documented, facility-based and community-based risk assessment utilizing an "all-hazards" approach. The program and its plan must be reviewed and updated at least annually by the REH.*
- *SOURCE: Miss. Code Ann. §41-9-17; 42 CFR §485.542 Rule 41.85.39. Public Notification and Signage. The REH shall ensure the public is clearly informed of its status, scope of services, and patient rights through clear and conspicuous signage.*
- *SOURCE: Miss. Code Ann. §41-9-17; 42 CFR § 489.20(q)*
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 42.1.2** Procedures Governing Amendments {#sec-16-42.1.2 omnilex-key=us-ms-regs-official--title-15--16#42.1.2}

The rules, regulations, and minimum standards for ambulatory surgical facilities may be amended by the licensing agency from time to time as necessary to promote the health, safety, and welfare of persons receiving services in such institutions

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 42.1.3** Inspections Required {#sec-16-42.1.3 omnilex-key=us-ms-regs-official--title-15--16#42.1.3}

Each ambulatory surgical facility for which a license has been issued shall be inspected by the Mississippi State Department of Health or by persons delegated with authority by said Mississippi State Department of Health at such intervals as the Department may direct. Mississippi State Department of Health and/or its authorized representatives shall have the right to inspect construction work in progress. New ambulatory surgical facilities shall not be licensed without having first been inspected for compliance with these rules, regulations, and minimum standards.

responsibility for the establishment of safe and effective administrative management, control and operation of the services provided. This definition applies to a person designated as Chief Executive Officer or other similar title. 2. Ambulatory Surgery. Shall mean surgical procedures that are more complex than office procedures performed under local anesthesia, but less complex than major procedures requiring prolonged postoperative monitoring and hospital care to ensure safe recovery and desirable results. General anesthesia is used in most cases. The patient must arrive at the facility and expect to be discharged on the same day. Ambulatory surgery shall only be performed by physicians or dentists licensed to practice in the State of Mississippi. 3. Ambulatory Surgical Facility. Shall mean a publicly or privately owned institution which is primarily organized, constructed, renovated or otherwise established for the purpose of providing elective surgical treatment of outpatients whose recovery, under normal and routine circumstances, will not require inpatient care. Such facility as herein defined does not include the offices of private physicians or dentists whether practicing individually or in groups, but does include organizations or facilities primarily engaged in such outpatient surgery whether using the name "ambulatory surgical facility" or a similar or different name. Such organization or facility, if in any manner considered to be operated or owned by a hospital or a hospital holding, leasing or management company, either for profit or not for profit, is required to comply with all Mississippi State Department of Health ambulatory surgical licensure standards governing a hospital affiliated facility as adopted under Section 41-91-1 et seq, Mississippi Code of 1972; provided that such organization or facility does not intend to seek federal certification as an ambulatory surgical facility as provided for at 42 CFR, Parts 405 and 416. Further, if such organization or facility is to be operated or owned by a hospital or a hospital holding, leasing or management company and intends to seek federal certification as an ambulatory facility, then such facility is considered to be freestanding and must comply with all Mississippi State Department of Health ambulatory surgical licensure standards governing a freestanding facility. If such organization or facility is to be owned or operated by an entity or person other than a hospital or hospital holding, leasing or management company, then such organization or facility must comply with all Mississippi State Department of Health ambulatory surgical facility standards governing a freestanding facility. 4. Hospital Affiliated Ambulatory Surgical Facility. Shall mean a separate and distinct organized unit of a hospital or a building owned, leased, rented or utilized by a hospital and located in the same county in which the hospital is located for the primary purpose of performing ambulatory surgery procedures. Such facility is not required to be separately licensed under the statute and may operate under the hospital's license in compliance with all applicable requirements of Section 41-9-1 et seq. 5. Freestanding Ambulatory Surgical Facility. Shall mean a separate and distinct facility or a separate and distinct organized unit of a hospital owned, leased, rented

or utilized by a hospital or other persons for the primary purpose of performing ambulatory surgery procedures. Such facility must be separately licensed as herein defined and must comply with all licensing standards promulgated by the Mississippi State Department of Health under this statute regarding freestanding ambulatory surgical facility. Further, such facility must be a separate, identifiable entity and must be physically, administratively and financially independent and distinct from other operations of any other health facility, and shall maintain a separate organized medical and administrative staff. Furthermore, once licensed as a freestanding ambulatory surgical facility, such facility shall not become a component of any other health facility without securing a certificate of need to do such. 6. Anesthesiologist. A physician whose specialized training and experience qualify him/her to administer anesthetic agents and to monitor the patient under the influence of these agents. 7. Anesthetist. A physician or dentist qualified and trained to administer anesthetic agents or a certified registered nurse qualified to administer anesthetic agents. 8. Change of Ownership. The term "change of ownership" includes, but is not limited to, intervivos gifts, purchases, transfers, leases, cash and/or stock transaction or other comparable arrangements whenever the person or entity acquires an interest of fifty percent (50%) or more of the facility or services. Changes of ownership from partnerships, single proprietorships or corporations to another form of ownership are specifically included, provided, however, "change of ownership" shall not include any inherited interest acquired as a result of a testamentary instrument or under the laws of descent and distribution of the State of Mississippi. 9. Dentist. A person who holds a valid license issued by the Mississippi State Board of Dental Examiners to practice dentistry. 10. Director of Nursing. The term "director of nursing" means a registered nurse with supervisory and administrative ability who is responsible to the chief executive officer for supervision of nursing service for entire facility at all times. Qualifications of directory of nursing: a. Shall be a graduate of a professional school of nursing. b. Shall currently be licensed by the Mississippi Board of Nursing. c. Shall have at least one year of experience in medical surgical nursing and one year of surgical nursing and one year of surgical environment nursing. d. Shall have good mental and physical health. 11. Governing Authority. The term "governing authority" shall mean owner(s) associations, county board of supervisors, board of trustees, or any other

comparable designation of an individual or group of individuals who have the purpose of owning, acquiring, constructing, equipping, operating, and/or maintaining ambulatory surgical facilities and exercising control over the affairs and in which the ultimate responsibility and authority of the facility is vested. 12. Licensed Practical Nurse. "Licensed practical nurse" (LPN) means any person licensed as such by the Mississippi State Board of Nursing. 13. License. The term "license" shall mean the document issued by the Mississippi State Department of Health and signed by the Executive Director of the Mississippi State Department of Health. Licensure shall constitute authority to receive patients and perform the services included within the scope of these rules, regulations, and minimum standards. 14. Licensee. The term "licensee" shall mean the individual to whom the license is issued and upon whom rests the responsibility for the operation of the ambulatory surgical facility in compliance with these rules, regulations, and minimum standards. 15. Licensing Agency. The term "licensing agency" shall mean the Mississippi State Department of Health. 16. Local Hospital. As referenced in Rule 42.10.1(1), local hospital means that the ASC is to consider the most appropriate facility in which the ASC will transport its patients in the event of an emergency. 17. Nursing Personnel. The term "nursing personnel" shall mean registered nurses, graduate nurses, licensed practical nurses, nurses' aides, orderlies, attendants, and other rendering patient care. 18. Patient. The term "patient" shall mean a person admitted to the ambulatory surgical facility by and upon the recommendation of a physician and who is to receive medical care recommended by the physician. 19. Pharmacy. The term "pharmacy" shall mean a place licensed by the Mississippi State Department of Pharmacy where prescriptions, drugs, medicines and chemicals are offered for sale, compounded or dispensed, and shall include all places whose titles may imply the sale, offering for sale, compounding or dispensing of prescriptions, drugs, medicines or chemicals. 20. Pharmacist. The term "pharmacist" shall mean a person currently licensed by the Mississippi State Board of Pharmacy to practice pharmacy in Mississippi under the provisions contained in current state statutes. 21. Physician. The term "physician" shall mean a person currently licensed by the Mississippi State Board of Medical Licensure to practice medicine and surgery in Mississippi under provisions contained in current state statutes.

22. Registered Nurse. The term "registered nurse" (R.N.) shall mean a professional registered nurse currently licensed by the Mississippi Board of Nursing in accordance with the provisions contained in current state statutes. 23. Person. The term "person" means any individual, firm, partnership, corporation, company, association, or joint stock association, or any licensee herein or the legal successor thereof. 24. May. The term "may" indicates permission. 25. Shall. The term "shall" indicates mandatory requirement(s). 26. Should. The term "should" indicates recommendation(s).

**History**
- *SOURCE: Miss. Code Ann. §41-75-13 Subchapter 2 DEFINITIONS Rule 42.2.1 A list of selected terms often used in connection with these rules, regulations, and standards follows: 1. Administrator. The term "administrator" shall mean a person who is delegated the responsibility for the implementation and proper application of policies and programs established by the governing authority of the facility and is delegated*
- *SOURCE: Miss. Code Ann. §41-75-13 Subchapter 3 TYPE OF LICENSE Rule 42.3.1 Regular License. A license shall be issued to each ambulatory surgical facility that meets the requirements as set forth in these regulations. In addition, no ambulatory surgical facility may be licensed until it shows conformance to the regulations establishing minimum standards for prevention and detection of fire, as well as for protection of life and property against fire. Compliance with the N.F.P.A. Life Safety Code 101 for doctors' offices and clinics shall be required.*
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 42.3.2** Provisional License {#sec-16-42.3.2 omnilex-key=us-ms-regs-official--title-15--16#42.3.2}

Within its discretion, the Mississippi State Department of Health may issue a provisional license when a temporary condition of noncompliance with these regulations exists in one or more particulars. A provisional license shall be issued only if the Mississippi State Department of Health is satisfied that preparations are being made to qualify for a regular license and that the health and safety of patients will not be endangered meanwhile. A new ambulatory surgical facility may be issued a provision license prior to opening and subsequent to meeting the required minimum staffing personnel. The provisional license issued under this condition shall be valid until the issuance of a regular license, or June 30, following date of issuance of the provisional license, issued for any reason, shall not exceed 12 months and cannot be reissued.

reasonable, affirmative evidence of ability to comply with these rules, regulations, and minimum standards.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13 Subchapter 4 LICENSING Rule 42.4.1 Application and Annual Report. Application for a license or renewal of a license shall be made in writing to the Mississippi State Department of Health on forms provided by the Department which shall contain such information as the Mississippi State Department of Health may require. The application shall require*
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 42.4.2** Fees {#sec-16-42.4.2 omnilex-key=us-ms-regs-official--title-15--16#42.4.2}

Each initial and renewal licensure application, unless suspended or revoked, shall be accompanied by a fee as set by the Board, made payable to the Mississippi State Department of Health, either by business check, money order, or electronic means. Renewal of licenses shall occur on an annual basis. Fees are non-refundable.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 42.4.3** Annual Reports and Posting of License {#sec-16-42.4.3 omnilex-key=us-ms-regs-official--title-15--16#42.4.3}

The licensee shall submit an annual report in a format as established by the licensing agency. Licenses are issued only for the premises and person or persons named in the application and shall not be transferable or assignable. Licenses shall be posted in a conspicuous place on the licensed premises.

**History**
- *SOURCE: Miss. Code Ann. §41-75-1*

##### **15 Miss. Admin. Code Pt. 16, R. 42.4.4** Name {#sec-16-42.4.4 omnilex-key=us-ms-regs-official--title-15--16#42.4.4}

Every ambulatory surgical facility designated by a permanent and distinctive name which shall be used in applying for a license and shall not be changed without first notifying the licensing agency in writing and receiving written approval of the change from the licensing agency. Such notice shall specify the name to be discontinued as well as the new name proposed. Only the official name by which the ambulatory surgical facility is licensed shall be used in telephone listings, on stationery, in advertising, etc. Two or more ambulatory surgical facilities shall not be licensed under similar names in the same vicinity. No freestanding ambulatory surgical facility shall include the word "hospital" in its name.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 42.4.5** Issuance of License {#sec-16-42.4.5 omnilex-key=us-ms-regs-official--title-15--16#42.4.5}

All licenses issued by the Mississippi State Department of Health shall set forth the name of the ambulatory surgical facility, the location, the name of the licensee, and the license number.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 42.4.6** Separate License {#sec-16-42.4.6 omnilex-key=us-ms-regs-official--title-15--16#42.4.6}

A separate license shall be required for ambulatory surgical facilities maintained on separate premises even though under the same management. However, separate licenses are not required for buildings on the same ground which are under the same management.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 42.4.7** Expiration of License {#sec-16-42.4.7 omnilex-key=us-ms-regs-official--title-15--16#42.4.7}

Each license shall expire on June 30, following the date of issuance.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 42.4.8** Denial or Revocation of License: Hearings and Review {#sec-16-42.4.8 omnilex-key=us-ms-regs-official--title-15--16#42.4.8}

The Mississippi State Department of Health after notice and opportunity for a hearing to the applicant or licensee, is authorized to deny, suspend, or revoke a license in any case in which it finds that there has been a substantial failure to comply with the requirements established under the law and these regulations.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13 Subchapter 5 RIGHT OF APPEAL Rule 42.5.1 Provision for hearing and appeal following denial or revocation of license is as follows:*
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 42.5.2** Administrative Decision {#sec-16-42.5.2 omnilex-key=us-ms-regs-official--title-15--16#42.5.2}

The Mississippi State Department of Health will provide an opportunity for a fair hearing to every applicant or licensee who is dissatisfied with administrative decisions made in the denial or revocation of license. 1. The licensing agency shall notify the applicant or licensee by registered mail or personal service the particular reasons for the proposed denial or revocation of license. Upon written request of applicant or licensee within ten (10) days of the date of such service at which agency shall fix a date not less than thirty (30) days from the date of such service at which time the applicant or licensee shall be given an opportunity for a prompt and fair hearing. 2. On the basis of such hearing or upon default of the applicant or licensee, the licensing agency shall make a determination specifying its findings of fact and conclusions of law. A copy of such determination shall be sent by registered mail to the last known address of applicant or licensee or served personally upon the applicant or licensee. 3. The decision revoking, suspending, or denying the application or license shall become final thirty (30) days after it is so mailed or served unless the applicant or licensee, within such thirty (30) day period, appeals the decision to the Chancery Court in the county in which the facility is located, in the manner prescribed in Section 43-11-23, Mississippi Code of 1972, as amended. An additional period of time may be granted at the discretion of the licensing agency.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 42.5.3** Penalties {#sec-16-42.5.3 omnilex-key=us-ms-regs-official--title-15--16#42.5.3}

Any person or persons or other entity or entities establishing, managing or operating an ambulatory surgical facility or conducting the business of an ambulatory surgical facility without the required license, or which otherwise violate any of the provisions of this act or the Mississippi State Department of Health, as amended, or the rules, regulations or standards promulgated in furtherance of any law in which the Mississippi State Department of Health has authority therefore shall be subject to the penalties and sanctions of Section 41-7- 209, Mississippi Code of 1972.

2. Provide for at least annual meetings of the governing authority if the governing authority consists of two or more individuals. Minutes shall be maintained of such meetings. 3. Require policies and procedures which includes provisions for administration and use of the facility, compliance, personnel, quality assurance, procurement of outside services and consultations, patient care policies and services offered. 4. Provide for annual reviews and evaluations of the facility's policies, management, and operation. a. When services such as dietary, laundry, or therapy services are purchased from other the governing authority shall be responsible to assure the supplier(s) meets the same local and state standards the facility would have to meet if it were providing those services itself using its own staff. b. The governing authority shall provide for the selection and appointment of the medicaid and dental staff and the granting of clinical privileges and shall be responsible for the professional conduct of these persons.

1. The governing authority shall appoint a qualified person as chief executive officer of the facility to represent the governing authority and shall define his/her

authority and duties in writing. He/she shall be responsible for the management of the facility, implementation of the policies of the governing authority and authorized and empowered to carry out the provisions of these regulations. 2. The chief executive officer shall designate, in writing, a qualified person to act in his/her behalf during his/her absence. In the absence of the chief executive officer, the person on the grounds of the facility who is designated by the chief executive officer to be in charge of the facility shall have reasonable access to all areas in the facility related to patient care and to the operation of the physical plant. 3. When there is a planned change in ownership or in the chief executive officer, the governing authority of the facility shall notify the Mississippi State Department of Health. The chief executive officer shall be responsible for the preparation of written facility policies and procedures.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13 Subchapter 6 ADMINISTRATION: GOVERNING AUTHORITY Rule 42.6.1 Each facility shall be under the ultimate responsibility and control of an identifiable governing body, person, or persons. The facility's governing authority shall adopt bylaws, rules and regulations which shall: 1. Specify by name the person to whom responsibility for operation and maintenance of the facility is delegated and methods established by the governing authority for holding such individuals responsible.*
- *SOURCE: Miss. Code Ann. §41-75-13 Subchapter 7 ORGANIZATION AND STAFF Rule 42.7.1 Chief Executive Officer or Administrator.*
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 42.7.2** Administrative Records {#sec-16-42.7.2 omnilex-key=us-ms-regs-official--title-15--16#42.7.2}

The following essential documents and references shall be on file in the administrative office of the facility: 1. Appropriate documents evidencing control and ownerships, such as deeds, leases, or corporation or partnerships papers. 2. Bylaws and policies and procedures of the governing authority and professional staff. 3. Minutes of the governing authority meetings. 4. Minutes of the facility's professional and administrative staff meetings. 5. A current copy of the ambulatory surgical facility regulations. 6. Reports of inspections, reviews, and corrective actions taken related to licensure. 7. Contracts and agreements for all services not provided directly by the facility. 8. All permits and certificates shall be appropriately displayed.

2. Written references and/or a record of verbal references. 3. Verification of all training and experience, and licensure, certification, registration and/or renewals.

4. Performance appraisals. 5. Initial and subsequent health clearances. 6. Disciplinary and counseling actions. 7. Commendations. 8. Employee incident reports. 9. Record of orientation to the facility, its policies and procedures and the employee's position. Personnel records shall be confidential. Representatives of the licensing agency conducting an inspection of the facility shall have the right to inspect personnel records.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13 Subchapter 8 PERSONNEL POLICIES AND PROCEDURES Rule 42.8.1 Personnel Records. A record of each employee should be maintained which includes the following to help provide quality assurance in the facility: 1. Application for employment.*
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 42.8.2** Job Descriptions {#sec-16-42.8.2 omnilex-key=us-ms-regs-official--title-15--16#42.8.2}

1. Every position shall have a written description which adequately describes the duties of the position. 2. Each job description shall include position title, authority, specific responsibilities and minimum qualifications. Qualifications shall include education, training, experience, special abilities and license or certification required. 3. Job descriptions shall be kept current and given to each employee when assigned to the position and whenever the job description is changed.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 42.8.3** Health Examination {#sec-16-42.8.3 omnilex-key=us-ms-regs-official--title-15--16#42.8.3}

As a minimum, each employee shall have a pre-employment health examination by a physician. The examination is to be repeated annually and more frequently if indicated to ascertain freedom from communicable diseases. The extent of the annual examinations shall be determined by a committee consisting of the medical director, administrator and director of nursing, and documentation of the health examination shall be included in the employee’s personnel folder.

regulations, and pertain to the setting where the facility is located. The medical staff bylaws, rules and regulations, and the rules and regulations of the governing authority shall require that patients are admitted to the facility only upon the recommendation of a licensed physician and that a licensed physician be responsible for diagnosis and all medical care and treatment. The organization of the medical staff, and its bylaws, rules and regulations, shall be approved by the facility's governing authority. The medical staff shall strive to assure that each member is qualified for membership and shall encourage the optimal level of professional performance of its members through the appointment/reappointment procedure, the specific delineation of clinical privileges, and the periodic reappraisal of each staff member according to the established provisions.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13 Subchapter 9 MEDICAL STAFF ORGANIZATION Rule 42.9.1 There shall be a single organized medical staff that has the overall responsibility for the quality of all clinical care provided to patients, and for the ethical conduct and professional practices of its members, as well as for accounting therefore to the governing authority. The manner in which the medical staff is organized shall be consistent with the facility's documented staff organization bylaws, rules and*
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 42.9.2** Qualifications {#sec-16-42.9.2 omnilex-key=us-ms-regs-official--title-15--16#42.9.2}

The appointment and reappointment of medical staff members shall be based upon well-defined, written criteria that are related to the goals and objectives of the facility as stated in the bylaws, rules and regulations of the medical staff of the governing authority., Upon application or appointment to the medical staff, each individual must sign a statement to the effect that he/she has read and agrees to be bound by the medical staff and governing authority bylaws, rules and regulations. The initial appointment and continued medical staff membership shall be dependent upon professional competence and ethical practice in keeping with the qualifications, standards, and requirements set forth in the professional staff and governing authority bylaws, rules and regulations.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 42.9.3** Method of Selection {#sec-16-42.9.3 omnilex-key=us-ms-regs-official--title-15--16#42.9.3}

Each facility is responsible for developing a process of appointment to the medical staff whereby it can satisfactorily determine that the person is appropriately licensed and qualified for the privileges and responsibilities he/she seeks.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 42.9.4** Privilege Delineation {#sec-16-42.9.4 omnilex-key=us-ms-regs-official--title-15--16#42.9.4}

Privileges shall be delineated for each member of the medical staff, regardless of the type and size of the facility. The delineation of privileges shall be based on all verified information available in the applicant's or staff member's credentials file. Whatever method is used to delineate clinical privileges for each medical staff applicant, there must be evidence that the granting of such privileges is based on the member's demonstrated current competence.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 42.9.5** Clinical Privileges Shall Be Facility-Specific {#sec-16-42.9.5 omnilex-key=us-ms-regs-official--title-15--16#42.9.5}

The medical staff shall delineate in its bylaws, rules and regulations, the qualifications, status, clinical duties, and responsibilities of consultant physicians who are not members of the medical and

dental staff but whose services require that they be processed through the usual medical staff channels. The training, experience, and demonstrated competence of individuals in such categories shall be sufficient to permit their performing their assigned functions.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 42.9.6** Reappointment {#sec-16-42.9.6 omnilex-key=us-ms-regs-official--title-15--16#42.9.6}

The facility's medical staff bylaws, rules and regulations shall provide for review and reappointment of each medical staff member at least once every three years. The reappointment process should include a review of the individual's status by a designated medical staff committee, such as the credentials committee. When indicated, the credentials committee shall require the individual to submit evidence of his/her current health status that verifies the individual's ability to discharge his/her responsibility. The committee's review of the clinical privileges of a staff member for reappointment should include the individual's past and current professional performance as well as his/her adherence to the governing authority and professional staff bylaws, rules and regulations. The medical staff bylaws, rules and regulations shall limit the time within which the medical staff reappointment and privilege delineation processes must be completed.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 42.9.7** Professional Staff {#sec-16-42.9.7 omnilex-key=us-ms-regs-official--title-15--16#42.9.7}

Each facility shall have at all times a designated medical director who shall be a physician and who shall be responsible for the direction and coordination of all medical aspects of facility programs. Each members of the medical staff shall have like privileges in at least one local hospital. In the case of an abortion facility, the facility must comply with all state and federal laws and regulations, including , but not limited to, provisions of MS. Code Ann. §41-75- 1. There shall be a minimum of one licensed registered nurse per six patients (at any one time) at the clinic when patients are present, excluding the director of nursing. All facility personnel, medical and others, shall be licensed to perform the services they render when such services require licensure under the laws of the State of Mississippi. Anesthetic agents shall be administered by an anesthesiologist, a physician, or a certified registered nurse anesthetist under the supervision of a board-qualified or certified anesthesiologist or operating physician, who is actually on the premises. After the administration of an anesthetic, patients shall be constantly attended by an M.D., D.O., R.N., or a L.P.N. supervised directly by an R.N., until reacted and able to summon aid. All employees of the facility providing direct patient care shall be trained in emergency resuscitation at least annually. [Section 41-75-1(f)].

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 42.9.8** Reporting Requirements {#sec-16-42.9.8 omnilex-key=us-ms-regs-official--title-15--16#42.9.8}

Each abortion facility shall report monthly to the Mississippi State Department of Health such information as may be required by

the department in its rules and regulations for each abortion performed by such facility.

1. The ASC must have an effective procedure for the immediate transfer, to a hospital, of patients requiring medical care beyond the capabilities of the ASC. The hospital must be a local, Medicare participating hospital or a local non-participating hospital that meets the requirements for payment of emergency services. See Rule 42.2.1 (16) for definition of “local hospital”. a. The ASC must have a transfer agreement with a hospital that meets the requirements, as stated above, or b. Ensure that all physicians performing surgery in the ASC have admitting privileges at a hospital that meets the regulatory requirements of above. 2. If the ASC does not have a transfer agreement, then the ASC must maintain documentation of the current admitting privileges of all physicians who perform surgery at the ASC at local hospitals that will satisfy the regulatory requirements of Rule 42.10.1 (1).SOURCE: Miss. Code Ann. §41-75-13 Subchapter 11 SAFETY Rule 42.11.1 The governing authority shall develop written policies and procedures designed to enhance safety within the facility and on its grounds and minimize hazards to patients, staff and visitors.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13 Subchapter 10 PATIENT TRANSFER Rule 42.10.1 Transfer Agreement.*
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 42.11.2** The policies and procedures shall include establishment of the following: 1 {#sec-16-42.11.2 omnilex-key=us-ms-regs-official--title-15--16#42.11.2}

Safety rules and practices pertaining to personnel, equipment, gases, liquids, drugs; 2. Provisions for reporting and the investigation of accidental events regarding patients, visitors and personnel (incidents) and corrective action taken; 3. Provision for dissemination of safety-related information to employees and users of the facility; and 4. Provision for syringe and needle storage, handling and disposal.

Subchapter 12 HOUSEKEEPING Rule 42.12.1 Operating rooms shall be appropriately cleaned in accordance with established written procedures after each operation. Recovery rooms shall be maintained in a clean condition. Adequate housekeeping staff shall be employed to fulfill the above requirement.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*
- *SOURCE: Miss. Code Ann. §41-75-13 Subchapter 13 LINEN AND LAUNDRY Rule 42.13.1 An adequate supply of clean linen or disposable materials shall be maintained.*
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 42.13.2** Provisions for proper laundering of linen and washable goods shall be made {#sec-16-42.13.2 omnilex-key=us-ms-regs-official--title-15--16#42.13.2}

Soiled and clean linen shall be handled and stored separately.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 42.13.3** Rule 42.13.3 {#sec-16-42.13.3 omnilex-key=us-ms-regs-official--title-15--16#42.13.3}

Sufficient supply of cloth or disposable towels shall be available so that a fresh towel can be used after each hand washing. Towels shall not be shared.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13 Subchapter 14 SANITATION Rule 42.14.1 All parts of the facility, the premises and equipment shall be kept clean and free of insects, rodents, litter and rubbish.*
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 42.14.2** Rule 42.14.2 {#sec-16-42.14.2 omnilex-key=us-ms-regs-official--title-15--16#42.14.2}

All garbage and waste shall be collected, stored and disposed of in a manner designed to prevent the transmission of disease. Containers shall be washed and sanitized before being returned to work areas. Disposable type containers shall not be reused.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13 Subchapter 15 PREVENTIVE MAINTENANCE Rule 42.15.1 A schedule of preventive maintenance shall be developed for all of the surgical equipment in the surgical suite to assure satisfactory operation when needed.*
- *SOURCE: Miss. Code Ann. §41-75-13 Subchapter 16 DISASTER PREPAREDNESS Rule 42.16.1 The facility shall have a posted plan for evacuation of patients, staff, and visitors in case of fire or other emergency.*
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 42.16.2** Fire drills: 1 {#sec-16-42.16.2 omnilex-key=us-ms-regs-official--title-15--16#42.16.2}

At least one drill shall be held every three months for every employee to familiarize employees with the drill procedure. Reports of the drills shall be maintained with records of attendance. 2. Upon identification of procedural problems with regard to the drills, records shall show that corrective action has been taken. 3. There shall be an ongoing training program for all personnel concerning aspects of fire safety and the disaster plan.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13 Subchapter 17 MEDICAL RECORD SERVICES Rule 42.17.1 Medical Record System. A medical record is maintained in accordance with accepted professional principles for every patient admitted and treated in the facility. The medical record system shall be under the supervision of a designated person who has demonstrated through relevant experience the ability to perform the required functions.*
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 42.17.2** Facilities {#sec-16-42.17.2 omnilex-key=us-ms-regs-official--title-15--16#42.17.2}

A room or area shall be designated within the facility for medical records. The area shall be sufficiently large and adequately equipped to permit the proper processing and storing of records. All medical records must be accessible and easily retrieved.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 42.17.3** Ownership {#sec-16-42.17.3 omnilex-key=us-ms-regs-official--title-15--16#42.17.3}

Medical records shall be the property of the facility and shall not be removed except by subpoena or court order. These records shall be protected against loss, destruction and unauthorized use.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 42.17.4** Preservation of Records {#sec-16-42.17.4 omnilex-key=us-ms-regs-official--title-15--16#42.17.4}

Medical records shall be preserved either in the original form or by microfilm for a period of not less than ten years. In the case of minor the record is to be retained until the patient becomes of age, plus seven years.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 42.17.5** Individual Patient Records {#sec-16-42.17.5 omnilex-key=us-ms-regs-official--title-15--16#42.17.5}

Each patient's medical record shall include at least the following information:

1. Patient identification, including the patient's full name, sex, address, date of birth, next of kin and patient number. 2. Admitting diagnosis. 3. Preoperative history and physical examination pertaining to the procedure to be performed. 4. Anesthesia reports. 5. Operative report. 6. Pertinent laboratory, pathology and X-ray reports. 7. Preoperative and postoperative orders. 8. Discharge note and discharge diagnosis. 9. Informed consent. 10. Nurses' notes: a. Admission and preoperative. b. Recovery and discharge.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 42.17.6** Completion of Medical Records {#sec-16-42.17.6 omnilex-key=us-ms-regs-official--title-15--16#42.17.6}

All medical records shall be completed promptly.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 42.17.7** Indexes {#sec-16-42.17.7 omnilex-key=us-ms-regs-official--title-15--16#42.17.7}

All medical records should be indexed according to disease, operation, physician, and patient name.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13 Subchapter 18 Patient Care: Nursing Service Rule 42.18.1 Nursing Staff. The ambulatory surgical facility shall maintain an organized nursing staff to provide high quality nursing care for the needs of the patients and be responsible to the ambulatory surgical facility for the professional performance of its members. The ambulatory surgical facility nursing service shall be under the direction of a legally and professionally qualified registered nurse. There shall be a sufficient number of duly licensed registered nurses on duty at all times to plan, assign, supervise, and evaluate nursing care, as well as to give patients the nursing care that requires the judgment and specialized skills of a registered nurse.*
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 42.18.2** Director of Nursing Service {#sec-16-42.18.2 omnilex-key=us-ms-regs-official--title-15--16#42.18.2}

The director of nursing service shall be qualified by education, medical-surgical nursing and surgery experience of one year each, and demonstrated ability to organize, coordinate, and evaluate the work of the service. He/she shall be qualified in the fields of nursing and administration consistent with the complexity and scope of operation of the ambulatory surgical facility and shall be responsible to the administrator for the developing and implementing policies and procedures of the service in the ambulatory surgical facility.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 42.18.3** Staffing Pattern {#sec-16-42.18.3 omnilex-key=us-ms-regs-official--title-15--16#42.18.3}

A staffing pattern shall be developed for each nursing care unit (preoperative unit, surgical suite, recovery and postoperative unit). The staffing pattern shall provide for sufficient nursing personnel and for adequate supervision and direction by registered nurses consistent with the size and complexity of the ambulatory surgical facility.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 42.18.4** Nursing Care Plan {#sec-16-42.18.4 omnilex-key=us-ms-regs-official--title-15--16#42.18.4}

There shall be evidence established that the ambulatory surgical facility nursing service provides safe, efficient and therapeutically effective nursing care through the planning of each patient's preoperative, operative, recovery and postoperative care and the effective implementation of the plans. A registered nurse must plan, supervise and evaluate the nursing care of each patient from admission to discharge.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 42.18.5** Licensed Practical Nurse {#sec-16-42.18.5 omnilex-key=us-ms-regs-official--title-15--16#42.18.5}

Licensed practical nurses who are currently licensed to practice within the state, as well as other ancillary nursing personnel, may be used to give nursing care that does not require the skill and judgment of a registered nurse. Their performance shall be supervised by one or more registered nurses.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 42.18.6** Nursing Service Evaluation {#sec-16-42.18.6 omnilex-key=us-ms-regs-official--title-15--16#42.18.6}

To develop better patterns of utilization of nursing personnel, periodic evaluation of the activities and effectiveness of the nursing staff should be conducted as a part of quality assurance. Evaluations should be done after the first 90-day probationary period, then annually thereafter.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 42.18.7** Nursing Service Organization {#sec-16-42.18.7 omnilex-key=us-ms-regs-official--title-15--16#42.18.7}

The ambulatory surgical facility nursing service shall have a current written organization plan that delineates its functional structure and its mechanisms for cooperative planning and decision making. This plan shall be an integral part of the overall ambulatory surgical facility plan and shall:

1. Be made available to all nursing personnel. 2. Be reviewed periodically (yearly) and revised as necessary. 3. Reflect the staffing pattern for nursing personnel throughout the ambulatory surgical facility. 4. Delineate the functions for which nursing service is responsible. 5. Indicate all positions required to carry out such functions. 6. Contain job descriptions for each position classification in nursing service that delineates the functions, responsibilities, and desired qualifications of each classification, and should be made available to nursing personnel at the time of employment. 7. Indicate the lines of communication within nursing service. 8. Define the relationships of nursing service to all other services and departments in the ambulatory surgical facility. 9. In ambulatory surgical facilities where the size of the nursing staff permits, nursing committees shall be formally organized to facilitate the establishment and attainment of goals and objectives of the nursing service.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 42.18.8** Policies and Procedures {#sec-16-42.18.8 omnilex-key=us-ms-regs-official--title-15--16#42.18.8}

Written nursing care and administrative policies and procedures shall be developed to provide the nursing staff with acceptable methods of meeting its responsibilities and achieving projected goals through realistic, attainable goals. In planning, decision making, and formulation of policies that affect the operation of nursing service, the nursing care of patients, or the patient's environment, the recommendations of representatives of nursing service shall be considered. Nursing care policies and procedures shall be consistent with professionally recognized standards of nursing practice and shall be in accordance with Nurse Practice Act of the State of Mississippi and AORN Standards of Practice. Policies shall include statements relating to at least the following: 1. Noting diagnostic and therapeutic orders. 2. Assignment of preoperative and postoperative care of patients. 3. Administration of medications. 4. Charting of nursing personnel. 5. Infection control.

6. Patient and personnel safety.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 42.18.9** Rule 42.18.9 {#sec-16-42.18.9 omnilex-key=us-ms-regs-official--title-15--16#42.18.9}

Written copies of the procedure manual shall be available to the nursing staff in every nursing care unit and service area and to other services and departments in the ambulatory surgical facility. The nursing procedure manual should be used to: 1. Provide a basis for staff development to enable new nursing personnel to acquire local knowledge and current skills through established orientation programs. 2. Provide a ready reference or procedures for all nursing personnel. 3. Standardize procedures and equipment. 4. Provide a basis for evaluation and study to ensure continued improvements in techniques.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 42.18.10** Rule 42.18.10 {#sec-16-42.18.10 omnilex-key=us-ms-regs-official--title-15--16#42.18.10}

The ambulatory surgical facility nursing policies and procedures shall be developed, periodically reviewed, and revised as necessary by nursing representatives in cooperation with administration, the medical staff, and other facility services and departments concerned. All revisions shall be dated to indicate the date of the latest review.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 42.18.11** In-Service Education and Meetings {#sec-16-42.18.11 omnilex-key=us-ms-regs-official--title-15--16#42.18.11}

An in-service education programs and meetings of the nursing staff shall be provided for the improvement of existing aseptic and nursing practices; obtaining new knowledge and skills applicable to operating room nursing; keep personnel informed of changes in policies and procedures and discuss nursing service problems in the ambulatory surgical facility. The in-service program shall be planned, scheduled, documented and held on a continuing or monthly basis. There should be provisions for participation in appropriate training programs for the safe and effective use of diagnostic and therapeutic equipment for CPR and for other aspects of critical care.

1. Surgical privileges according to covered surgical procedures shall be delineated for all physicians doing surgery in accordance with the competencies of each physician. A roster shall be kept in the confidential files of the operating room supervisor and in the files of the administrator. 2. The operating room register shall be complete and up-to-date. 3. There shall be a complete history and physical work-up in the chart of every patient prior to surgery plus documentation of a properly executed informed patient consent. 4. There shall be adequate provision for immediate postoperative care. 5. An operative report describing techniques and findings shall be written or dictated immediately following surgery and signed by the surgeon. 6. A procedure shall exist in establishing a program for identifying and preventing infections, maintaining a sanitary environment, and reporting results to appropriate authorities. The operating surgeon shall be required to report back to the facility an infection for infection control follow-up. 7. The operating rooms shall be supervised by an experienced registered professional nurse. 8. The following equipment shall be available to the operating suite: emergency call system, oxygen, mechanical ventilatory assistance equipment, including airways and manual breathing bag, cardiac defibrillator, cardiac monitoring equipment, thoracotomy set, tracheotomy set, laryngoscopes and endotracheal tubes, suction equipment, emergency drugs and supplies specified by the medical staff. Personnel trained in the use of emergency equipment and in cardiopulmonary resuscitation must be available whenever there is a patient in the ambulatory surgical facility. 9. Precautions shall be taken to eliminate shock hazards, including use of shoe covers. 10. Rules and regulations or policies related to the operating room shall be available for ambulatory surgical facility personnel and physicians.

1. A preoperative evaluation of the patient within 24 hours of surgery shall be done by a physician to determine the risk or anesthesia and of the procedure to be performed. 2. Before discharge from the ambulatory surgical facility, each patient shall be evaluated by an anesthesiologist or certified registered nurse anesthetist for proper anesthesia recovery and discharged in the company of a responsible adult unless otherwise specified by the physician. 3. Anesthetic agents shall be administered by only a qualified anesthesiologist, a physician qualified to administer anesthetic agents or a certified registered nurse anesthetist. 4. The department of anesthesia shall be responsible for all anesthetic agents administered in the ambulatory surgical facility. 5. In the ambulatory surgical facility where there is no department of anesthesia, the department of surgery shall assume the responsibility of establishing general policies and supervising the administration of anesthetic agents. 6. Safety precautions shall be in accordance with N.F.P.A. Bulletin 56-A, 1981.

1. The above members shall be qualified legally, professionally, and ethically for the positions to which they are appointed. 2. Patients admitted for the above services shall be admitted by a physician. 3. There shall be medical history done and recorded by a member of the medical staff before surgery is done and a physician in attendance who is responsible for the medical care of the patient. 4. There shall be specific bylaws concerning dentists and combined with the medical staff by-laws. 5. The staff bylaws and regulations shall specifically delineate the rights and privileges of the dentists. 6. Complete records, both medical and surgical, shall be required on each patient and shall be a part of the ambulatory surgical facility records.

1. An infection committee, or comparable arrangement, composed or members of the medical staff, nursing staff, administration and other services of the ambulatory surgical facility, shall be established and shall be responsible for investigating, controlling and preventing infections, documentation of such meetings and an attendance roster. 2. There shall be written procedures to govern the use of aseptic techniques and procedures in all areas of the ambulatory surgical facility. 3. To keep infections at a minimum, such procedures and techniques shall be regularly by the infection committee annually. 4. Continuing education shall be provided to all ambulatory surgical facility personnel on causes, effects, transmission, prevention, and elimination of infection on an annual basis. 5. A continuing process shall be enforced for inspection and reporting of any ambulatory surgical facility employee with an infection who may be in contact with patients on the patient's environment.

2. Pack make-up shall have autoclaves, work counter and unsterile storage. 3. Sterile storage area should have pass-through to corridor.

drugs. Such orders shall be in writing and signed personally by the physician who prescribes the drug or medicine.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13 Subchapter 19 SURGERY Rule 42.19.1 The ambulatory surgical facility shall have effective policies and procedures regarding surgical privileges, maintenance of the operating rooms and evaluation of the surgical patient.*
- *SOURCE: Miss. Code Ann. §41-75-13 Subchapter 20 ANESTHESIA Rule 42.20.1 The department of anesthesia shall have effective policies and procedures regarding staff privileges, the administration of anesthetics, and the maintenance of strict safety control.*
- *SOURCE: Miss. Code Ann. §41-75-13 Subchapter 21 DEPARTMENT OF DENTISTRY Rule 42.21.1 According to the procedure established for the appointment of the medical staff, one or more licensed dentists may be appointed to the staff. If this service is organized, its organization is comparable to that of other services or departments.*
- *SOURCE: Miss. Code Ann. §41-75-13 Subchapter 22 SANITARY ENVIRONMENT Rule 42.22.1 The ambulatory surgical facility shall provide a safe and sanitary environment, properly constructed, equipped, and maintained to protect the health and safety of patients.*
- *SOURCE: Miss. Code Ann. §41-75-13 Subchapter 23 CENTRAL STERILE SUPPLY Rule 42.23.1 Policies and procedures shall be maintained for method of control used in relation to the sterilization of supplies and water and a written policy requiring sterile supplies to be reprocessed at specific time periods. These areas shall be separated: 1. Receiving and clean-up area, to contain a two-compartment sink with two drain- boards.*
- *SOURCE: Miss. Code Ann. §41-75-13 Subchapter 24 PHARMACEUTICAL SERVICES Rule 42.24.1 Administering Drugs and Medicines. Drugs and medicines shall not be administered to patients unless ordered by a physician duly licensed to prescribe*
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 42.24.2** Medicine Storage {#sec-16-42.24.2 omnilex-key=us-ms-regs-official--title-15--16#42.24.2}

Medicines and drugs maintained on the nursing unit for daily administration shall be properly stored and safe-guarded in enclosures of sufficient size, and which are not accessible to unauthorized persons. Only authorized personnel shall have access to storage enclosures.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 42.24.3** Safety {#sec-16-42.24.3 omnilex-key=us-ms-regs-official--title-15--16#42.24.3}

Pharmacies and drug rooms shall be provided with safeguards to prevent entrance of unauthorized persons, including bars on accessible windows and locks on doors. Controlled drugs shall be stored in a securely constructed room or cabinet, in accordance with applicable federal and state laws.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 42.24.4** Narcotic Permit {#sec-16-42.24.4 omnilex-key=us-ms-regs-official--title-15--16#42.24.4}

An in-house pharmacy shall procure a state controlled drug permit if a stock of controlled drugs is to be maintained. The permit shall be displayed in a prominent location.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 42.24.5** Records {#sec-16-42.24.5 omnilex-key=us-ms-regs-official--title-15--16#42.24.5}

Records shall be kept of all stock supplies of controlled substances giving an accounting of all items received and/or administered.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 42.24.6** Medication Orders {#sec-16-42.24.6 omnilex-key=us-ms-regs-official--title-15--16#42.24.6}

All oral or telephone orders for medications shall be received by a registered nurse, a physician or registered pharmacist and shall be reduced to writing on the physician's order record reflecting the prescribing physician and the name and title of the person who wrote the order. Telephone or oral orders shall be signed by the prescribing physician within 48 hours. The use of standing orders will be according to written policy.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 42.24.7** Pharmacy Permits {#sec-16-42.24.7 omnilex-key=us-ms-regs-official--title-15--16#42.24.7}

1. In circumstances where the facility employs a full-time or part-time pharmacist, the facility shall have obtained the appropriate pharmacy permit from the Mississippi State Board of Pharmacy. The facility shall not dispense medications to outpatients without the pharmacy permit. 2. The facility may procure medications for its patients through community pharmacists. Individual medication containers shall be properly labeled, and shall be properly stored in individual patient medication bins/trays within a lockable area, room or cabinet.

3. The facility may procure medications via the facility's physician's registration. Physicians shall administer or shall order medications to be administered to patients while in the facility attending physician. The only exception is in cases of A. above. In any case where medication controlled substances are stocked within the facility, a designated individual shall be responsible for the overall supervision of the handling, administration, storage, record keeping and final dispensation of medication.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 42.24.8** Controlled Substances -- Anesthetizing Areas: Dispensing Controlled Substances {#sec-16-42.24.8 omnilex-key=us-ms-regs-official--title-15--16#42.24.8}

All controlled substances shall be dispensed to the responsible person (OR Supervisor, SRNA, CRNA, Anesthesiologist, etc.) designated to handle controlled substances in the operating room by a registered pharmacist in the Ambulatory Surgical Facility. When the controlled substance is dispensed, the following information shall be recorded into the Controlled Substance (proof-of- use) Record. 1. Signature of pharmacist dispensing the controlled substance. 2. Signature of designated licensed person receiving the controlled substance. 3. The date and time controlled substance is dispensed. 4. The name, the strength, and quantity of controlled substance dispensed. 5. The serial number assigned to that particular record, which corresponds to same number recorded in the pharmacy's dispensing record.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 42.24.9** Security/Storage of Controlled Substances {#sec-16-42.24.9 omnilex-key=us-ms-regs-official--title-15--16#42.24.9}

When not in use, all controlled substances shall be maintained in a securely locked, substantially constructed cabinet or area. All controlled substance storage cabinets shall be permanently affixed. Controlled substances removed from the controlled substance cabinet shall not be left unattended.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 42.24.10** Controlled Substance Administration Accountability {#sec-16-42.24.10 omnilex-key=us-ms-regs-official--title-15--16#42.24.10}

The administration of all controlled substances to patients shall be carefully recorded into the anesthesia record. The following information shall be transferred from the anesthesia record to the controlled substance record by the administering practitioner during the shift in which the controlled substance was administered. 1. The patient's name. 2. The name of the controlled substance and the dosage administered.

3. The date and time the controlled substance is administered. 4. The signature of the practitioner administering the controlled substance. 5. The wastage of any controlled substance. 6. The balance of controlled substances remaining after the administration of any quantity of the controlled substance. 7. Day-ending or shift-ending verification of count of balances of controlled substances remaining, and controlled substances administered shall be accomplished by two (2) designated licensed persons whose signatures shall be affixed to a permanent record.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 42.24.11** Waste of Controlled Substances {#sec-16-42.24.11 omnilex-key=us-ms-regs-official--title-15--16#42.24.11}

1. All partially used quantities of controlled substances shall be wasted at the end of each case by the practitioner, in the presence of a licensed person. The quantity, expressed in milligrams, shall be recorded by the wasting practitioner into the anesthesia record and into the controlled substance record followed by his or her signature. The licensed record witnessing the wastage of controlled substances shall co-sign the controlled substance record. 2. All unused and unopened quantities of controlled substances which have been removed from the controlled substance cabinet shall be returned to the cabinet by the practitioner at the end of each shift. 3. Any return of controlled substances to the pharmacy in the Ambulatory Surgical Facility must be documented by a registered pharmacist responsible for controlled substance handling in the Ambulatory Surgical Facility.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 42.24.12** Verification of Controlled Substances Administration {#sec-16-42.24.12 omnilex-key=us-ms-regs-official--title-15--16#42.24.12}

The Ambulatory Surgical Facility shall implement procedures whereby, on a periodic basis, a registered pharmacist shall reconcile quantities of controlled substances dispensed in the Ambulatory Surgical Facility to the anesthetizing area against the controlled substance record in said area. Any discrepancies shall be reported to the Director of Nursing and to the Chief Executive Officer of the Ambulatory Surgical Facility. Upon completion, all Controlled Substance Records shall be returned from the anesthetizing area to the Ambulatory Surgical Facility's pharmacy by the designated responsible person in the anesthetizing area.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13 Subchapter 25 RADIOLOGY SERVICES*

##### **15 Miss. Admin. Code Pt. 16, R. 42.25.1** Personnel {#sec-16-42.25.1 omnilex-key=us-ms-regs-official--title-15--16#42.25.1}

When the facility provides in-house radiological services a qualified technician shall be employed.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 42.25.2** Reports {#sec-16-42.25.2 omnilex-key=us-ms-regs-official--title-15--16#42.25.2}

All X-rays shall be interpreted by a physician or a dentist when oral surgery is conducted and a written report of findings shall be made a part of the patient's record.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 42.25.3** Policies and Procedures {#sec-16-42.25.3 omnilex-key=us-ms-regs-official--title-15--16#42.25.3}

When X-ray is provided by the facility, written policies and procedures shall be developed for all services provided by the radiology department.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 42.25.4** Physical Environment {#sec-16-42.25.4 omnilex-key=us-ms-regs-official--title-15--16#42.25.4}

If in-house capabilities are provided, the area shall be of sufficient size and arrangement to provide for personnel and patient needs.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 42.25.5** Safety {#sec-16-42.25.5 omnilex-key=us-ms-regs-official--title-15--16#42.25.5}

Staff personnel exposed to radiation must be checked periodically for amount of radiation exposure by the use of exposure meters or badges. The radiological equipment shall be appropriately shielded to conform to state law. It shall be regularly checked by state health authorities and any hazards promptly corrected.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13 Subchapter 26 LABORATORY SERVICES Rule 42.26.1 The facility may either provide a clinical laboratory or make contractual arrangements with an approved outside laboratory to perform services commensurate with the needs of the facility.*
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 42.26.2** Qualifications of Outside Laboratory {#sec-16-42.26.2 omnilex-key=us-ms-regs-official--title-15--16#42.26.2}

An approved outside laboratory may be defined as a free-standing independent laboratory or a hospital-based laboratory which in either case has been appropriately certified or meets equivalent standards as a provider under the prevailing regulations of P.L. 89-97, Titles XVIII and XIX (Medicare/Medicaid).

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 42.26.3** Agreements {#sec-16-42.26.3 omnilex-key=us-ms-regs-official--title-15--16#42.26.3}

Such contractual arrangements shall be deemed as meeting the requirements of this section so long as those arrangements contain written policies, procedures and individual chart documentation to disclose that the

policies of the facility are met and the needs of the patients are being provided. Written original reports shall be a part of the patient's chart.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 42.26.4** In-House Laboratories {#sec-16-42.26.4 omnilex-key=us-ms-regs-official--title-15--16#42.26.4}

1. In-house laboratories shall be well-organized and properly supervised by qualified personnel. 2. The laboratory will be of sufficient size and adequately equipped to perform the necessary services of the facility. 3. Provisions shall be made for preventive maintenance and an acceptable quality control program covering all types of analyses performed by the laboratory. Documentation will be maintained. 4. Written policies and procedures shall be developed and approved for all services provided by the laboratory. 5. When tissue removed in surgery is examined by a pathologist, either macroscopically or microscopically, as determined by the treating physician and the pathologist, the pathology report shall be made a part of the patient's record. 6. Arrangements shall be made for immediate pathological examinations, when appropriate. 7. The laboratory must provide pathologists' services, as necessary.

2. Ceiling height of patients' rooms shall be 8'0" minimum. 3. Storage. Each patient shall be provided with secured hanging storage space for their personal belongings. 4. Furnishing: a. Bed. Each patient room or area shall be equipped with a hospital type bed with an adjustable spring.

b. Bedside cabinet. It shall contain water service, bedpan, urinal and emesis basin (these may be disposable). 5. Cubicle for privacy in all multi-bedrooms shall be provided. They shall have a flame spread of 25 or less. 6. All walls shall be suitable for washing. 7. A lavatory, equipped with wrist-action handles, shall be located in the room or in an adjacent private toilet room. (A bedpan washer is recommended.) 8. Patient bed light shall be provided. 9. Electric nurse call for every bed and other access shall be provided with annunciator at nurses station and nurses work area.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13 Subchapter 27 Environment: Patient Areas Rule 42.27.1 Patient Rooms (if provided): 1. Shall contain 100 square feet of floor space for one bedroom and 80 square feet per bed for each multi-bedroom.*
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 42.27.2** Service Areas {#sec-16-42.27.2 omnilex-key=us-ms-regs-official--title-15--16#42.27.2}

1. Nurses station for nurses charting, doctors charting, communication and storage for supplies and nurses personal effects. The station should accommodate at least three (3) persons. 2. Nurses toilet with lavatory, convenient to nurses station. 3. Clean work room for storage and assembly of supplies for nursing procedures shall contain storage cabinets or storage carts, work counter and sink. 4. Soiled utility shall contain deep sink, work counter, waste receptacle, soiled linen receptacle, and provision for washing bedpans if not provided elsewhere. 5. Medicine station, adjacent to nurses' station, with sink, small refrigerator, locked storage, narcotic locker and work counter. 6. Clean linen storage. A closet large enough to hold adequate supply of clean linen. 7. Provision for preoperative or postoperative nourishments. 8. Stretcher and wheelchair storage area. 9. Janitor’s closet, only large enough to contain floor receptor with plumbing and space for some supplies and mop buckets.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 42.27.3** Surgical Suite {#sec-16-42.27.3 omnilex-key=us-ms-regs-official--title-15--16#42.27.3}

1. This area shall be located so as to prevent through traffic and shall contain: At least one operating room with adequate sterile storage cabinets or number of operating rooms shall be based on the expected surgical workload. 2. A service area shall include: a. Surgical supervisor's station. b. Provision will be made for high speed sterilization of dropped instruments or pre-package instruments readily available for the operating room, if more than 50 feet from central supply. c. Scrub station for two persons to scrub simultaneously. d. Clean-up room with two-compartment sink and drain-board and space for a dirty linen hamper. e. Oxygen and nitrous oxide storage in compliance with National Fire Protection Association Bulletin 56-A. f. Janitor’s closet only large enough to contain floor receptor with plumbing and space for some supplies and mop buckets. g. Doctor’s locker room containing toilet and shower with entry from non-sterile area and exit into sub-sterile area. h. Nurses locker room containing toilet and shower with entry from non-sterile area and exit into sub-sterile area. i. Stretcher storage. 3. All finishes shall be capable of repeated scrubbings. 4. The use of flammable anesthetic gases is prohibited. 5. The temperature shall be maintained a 70-76 degrees Fahrenheit with a humidity level 50% to 60% and a 90% filter. 6. Special lighting shall be supplied that eliminates shadows in the operating field with enough background illumination to avoid excessive contrast. Isolated power system is required. Emergency lighting shall comply with Standards of Emergency Electrical Service. 7. Appropriate fire extinguisher shall be provided in the surgical suite.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 42.27.4** Recovery Room Suite {#sec-16-42.27.4 omnilex-key=us-ms-regs-official--title-15--16#42.27.4}

1. Recovery room shall contain charting space, medication storage and preparation and sink required. 2. Each patient shall have readily available oxygen, suction and properly grounded outlets. Each bed shall be readily adjustable to various therapeutic positions, easily moved for transport, shall have a locking mechanism for a secure stationary position and a removable headboard. 3. Direct visual observation of all patients shall be possible from a central vantage point, yet from the activity and noise of the unit by partitions, drapes and acoustic ceilings. 4. Eighty (80) square feet shall be provided each bed or stretcher to make easily accessible for routine and emergency care of the patients and also to accommodate bulky equipment that may be needed. 5. There shall be an alarm system for unit personnel to summon additional personnel in an emergency. The alarm shall be connected to any area where unit personnel might be, physician lounges, nurses lounges or stations. 6. The kind and quality of equipment shall depend upon the needs of the patients treated. Diagnostic monitoring and resuscitative equipment, such as respiratory assist apparatus, defibrillators, pacemakers, phlebotomy and tracheostomy sets, endotracheal tubes, laryngoscopes and other such devices shall be easily available within the units, and in good working order. There shall be a written preventive maintenance program that includes techniques for cleaning and for contamination control, as well as for the periodic testing of all equipment. 7. Expert advice concerning the safe use of, and preventive maintenance for all biomedical devices and electrical installations shall be readily available at all times. Documentation of safety testing shall be provided on a regular basis to unit supervisors. 8. There shall be written policies and procedures for the recovery room suite, which supplements the basic ambulatory surgical facility policies and procedures shall be developed and approved by the medical staff, in cooperation with the nursing staff.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13 Subchapter 28 GENERAL SERVICE FACILITIES Rule 42.28.1 Admission Office. There shall be a room designated as the admission office where patients may discuss personal matters in private. The admission office may be combined with the business office and medical record room if privacy can be maintained when confidential matters are being discussed. This space shall be separated from the treatment area by walls and partitions.*
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 42.28.2** Waiting Room {#sec-16-42.28.2 omnilex-key=us-ms-regs-official--title-15--16#42.28.2}

A waiting room in the administrative section shall be provided with sufficient seating for the maximum number of persons that may be waiting at any time. Public toilets/public telephones and drinking fountains, accessible to individuals with disabilities shall be available.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 42.28.3** Administrative Area Nursing {#sec-16-42.28.3 omnilex-key=us-ms-regs-official--title-15--16#42.28.3}

1. Space for conference and in-service training. 2. Director of Nurses office.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13 Subchapter 29 PLANS AND SPECIFICATIONS Rule 42.29.1 New Construction, Additions, and Major Alterations. When construction is contemplated, either for new buildings, conversions, additions, or major alterations to existing buildings, or portions of buildings coming within the scope of these rules, plans and specifications shall be submitted for review and approval to the Mississippi State Department of Health.*
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 42.29.2** Minor Alterations and Remodeling {#sec-16-42.29.2 omnilex-key=us-ms-regs-official--title-15--16#42.29.2}

Minor alterations and remodeling which do not affect the structural integrity of the building, which do not change functional operation, which do not affect fire safety, and which do not add beds or facilities over those for which the surgical facility is licensed need not be submitted for approval.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 42.29.3** Water Supply, Plumbing and Drainage {#sec-16-42.29.3 omnilex-key=us-ms-regs-official--title-15--16#42.29.3}

No system of water supply, plumbing, sewerage, garbage or refuse disposal shall be installed, nor any such existing system materially altered or extended until complete plans and specifications for the installation, alteration or extension have been submitted to the Mississippi State Department of Health for review and approval.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 42.29.4** First Stage Submission - Preliminary Plans {#sec-16-42.29.4 omnilex-key=us-ms-regs-official--title-15--16#42.29.4}

1. First stage or preliminary plans shall include the following: a. Plot plans showing size and shape of entire site, location of proposed building and any existing structures, adjacent streets, highways, sidewalks, railroad, etc.,

all properly designated; size, characteristics, and location of all existing public utilities. b. Floor plans showing overall dimensions of buildings; location, size and purpose of all rooms; location and size of all doors, windows, and other openings with swing of doors properly indicated; and location of stairs, elevators, dumbwaiters, vertical shafts, and chimneys. c. Outline specifications listing the kind and type of materials. 2. Approval of preliminary plans and specifications shall be obtained from the Mississippi State Department of Health prior to starting final working drawings and specifications.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 42.29.5** Final Stage Submission - Working Drawings and Specifications {#sec-16-42.29.5 omnilex-key=us-ms-regs-official--title-15--16#42.29.5}

1. Final stage or working drawings and specifications shall include the following: a. Architectural drawings. b. Structural drawings. c. Mechanical drawings to include plumbing, heating and air conditioning. d. Electrical drawings. e. Detailed specifications. 2. Approval of working drawings and specifications shall be obtained from the Mississippi State Department of Health prior to beginning actual construction.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 42.29.6** Preparation of Plans and Specifications {#sec-16-42.29.6 omnilex-key=us-ms-regs-official--title-15--16#42.29.6}

The preparation of drawings and specifications shall be executed by or be under the immediate supervision of an architect registered in the State of Mississippi.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 42.29.7** Contract Modifications {#sec-16-42.29.7 omnilex-key=us-ms-regs-official--title-15--16#42.29.7}

Any contract modification which affects or changes the function, design or purpose of a facility shall be submitted to and approved by the Mississippi State Department of Health prior to beginning work set forth in any contract modification.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 42.29.8** Inspections {#sec-16-42.29.8 omnilex-key=us-ms-regs-official--title-15--16#42.29.8}

The Mississippi State Department of Health and its authorized representative shall have access to the work for inspection whenever it is in preparation or progress.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13 Subchapter 30 GENERAL Rule 42.30.1 Location. The ambulatory surgical facility shall be located in an attractive setting with sufficient parking space provided, with provisions for meeting the needs of the individuals with disabilities. Also, the facility shall be located within 15 minutes travel time from a hospital which has an emergency room staffed by an in-house physician during the hours the ambulatory surgical facility is open. Site approval by the licensing agency must be secured before construction begins.*
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 42.30.2** Local Restriction {#sec-16-42.30.2 omnilex-key=us-ms-regs-official--title-15--16#42.30.2}

The ambulatory surgical facility shall comply with local zoning, building, and fire ordinances. In additional, ambulatory surgical facilities shall comply with all applicable state and federal laws.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 42.30.3** Structural Soundness {#sec-16-42.30.3 omnilex-key=us-ms-regs-official--title-15--16#42.30.3}

The building shall be structurally sound, free from leaks and excessive moisture, in good repair, and painted at intervals to be reasonably attractive inside and out.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 42.30.4** Fire Extinguisher {#sec-16-42.30.4 omnilex-key=us-ms-regs-official--title-15--16#42.30.4}

An all purpose fire extinguisher shall be provided at each exit and special hazard areas, and located so a person would not have to travel more than 75 feet to reach an extinguisher. Fire extinguishers shall be of a type approved by the local fire department or State Fire Marshall and shall be inspected at least annually. An attached tag shall bear the initials or name of the inspector and the date inspected.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 42.30.5** Ventilation {#sec-16-42.30.5 omnilex-key=us-ms-regs-official--title-15--16#42.30.5}

The building shall be properly ventilated at all times with a comfortable temperature maintained and 30% filters in all areas except surgery.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 42.30.6** Garbage Disposal {#sec-16-42.30.6 omnilex-key=us-ms-regs-official--title-15--16#42.30.6}

Space and facilities shall be provided for the sanitary storage and disposal of waste by incineration, containerization, removal, or by a combination of these techniques. Infectious waste materials shall be rendered noninfectious on the premises by appropriate measures.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 42.30.7** Elevators {#sec-16-42.30.7 omnilex-key=us-ms-regs-official--title-15--16#42.30.7}

Multi-story facilities shall be equipped with at least one automatic elevator of a size sufficient to carry a patient on a stretcher.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 42.30.8** Multi-Story Building {#sec-16-42.30.8 omnilex-key=us-ms-regs-official--title-15--16#42.30.8}

All multi-story facilities shall be of fire resistive construction in accordance with N.F.P.A. 220, Standards Types of Building Construction. If the facility is part of a series of buildings, it shall be separated by fire walls.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 42.30.9** Doors {#sec-16-42.30.9 omnilex-key=us-ms-regs-official--title-15--16#42.30.9}

Minimum width of doors to all rooms needing access for stretchers shall be 3 feet 8 inches wide and doors shall swing into rooms.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 42.30.10** Corridors {#sec-16-42.30.10 omnilex-key=us-ms-regs-official--title-15--16#42.30.10}

Corridors shall comply with the following: 1. Corridors used by patients shall be as a minimum six feet wide. 2. Service corridors may be as a minimum four feet wide.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 42.30.11** Occupancy {#sec-16-42.30.11 omnilex-key=us-ms-regs-official--title-15--16#42.30.11}

No part of an ambulatory surgical facility may be rented, leased or used for any commercial purpose, or for any purpose not necessary or in conjunction with the operation of the facility. Food and drink machines may be maintained or a diet kitchen provided.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 42.30.12** Lighting {#sec-16-42.30.12 omnilex-key=us-ms-regs-official--title-15--16#42.30.12}

All areas of the facility shall have sufficient artificial lighting to prevent accidents and provide proper illumination for all services.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 42.30.13** Emergency Lighting {#sec-16-42.30.13 omnilex-key=us-ms-regs-official--title-15--16#42.30.13}

Emergency lighting systems shall be provided to adequately light corridors, operating rooms, exit signs, stairways, and lights on each exit sign at each exit in case of electrical power failure.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 42.30.14** Emergency Power {#sec-16-42.30.14 omnilex-key=us-ms-regs-official--title-15--16#42.30.14}

Emergency generator shall be provided to make life sustaining equipment operable in case of power failure. Emergency failure outlets shall be provided in all patient care areas.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 42.30.15** Exits {#sec-16-42.30.15 omnilex-key=us-ms-regs-official--title-15--16#42.30.15}

Each floor of a facility shall have two or more exit ways remote from each other, leading directly to the outside or to a two-hour fire resistive passage to the outside. Exits shall be so located that the maximum distance from any point in a floor area, room or space to an exit doorway shall not exceed 100 feet except that

when a sprinkler system is installed the distance of travel shall not exceed 150 feet.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 42.30.16** Exit Doors {#sec-16-42.30.16 omnilex-key=us-ms-regs-official--title-15--16#42.30.16}

Exit doors shall meet the following criteria: 1. Shall be no less than 44 inches wide. 2. Shall swing in the direction of exit and shall not obstruct the travel along any required fire exit.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 42.30.17** Exit Signs {#sec-16-42.30.17 omnilex-key=us-ms-regs-official--title-15--16#42.30.17}

Exits shall be equipped with approved illuminated signs bearing the word "Exit" in letters at least 4 1/2 inches high. Exit signs shall be placed in corridors and passageways to indicate the direction of exit.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 42.30.18** Interior Finish and Decorative Materials {#sec-16-42.30.18 omnilex-key=us-ms-regs-official--title-15--16#42.30.18}

All combustible decorative and acoustical material to include wall paneling shall be as follows: 1. Materials on wall and ceiling in corridors and rooms occupied by four or more persons shall carry a flame spread rating of 25 or less and a smoke density rating of 450 or less in accordance with ASTM E-84. 2. Rooms occupied by less than four persons shall have a flame spread rating of 75 or less and a smoke density rating of 450 or less in accordance with ASTM E-84.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 42.30.19** Floors {#sec-16-42.30.19 omnilex-key=us-ms-regs-official--title-15--16#42.30.19}

All floors in operating and recovery areas shall be smooth resilient tile and be free from cracks and finished so that they can be easily cleaned. All other floors shall be covered with hard tile resilient tile or carpet or the equivalent. Carpeting is prohibited as floor covering in operating and recovery areas.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 42.30.20** Carpet {#sec-16-42.30.20 omnilex-key=us-ms-regs-official--title-15--16#42.30.20}

Carpet assemblies (carpet and/or carpet and pad) shall carry a flame spread rating of 75 or less and smoke density rating of 450 or less in accordance with ASTM E-84, or shall conform with paragraph 6-5, N.F.P.A. 101, Life Safety Code, 1981.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 42.30.21** Curtains {#sec-16-42.30.21 omnilex-key=us-ms-regs-official--title-15--16#42.30.21}

All draperies and cubicle curtains shall be rendered and maintained flame retardant.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 42.30.22** Facilities for Individuals with Disabilities {#sec-16-42.30.22 omnilex-key=us-ms-regs-official--title-15--16#42.30.22}

The facility shall be accessible to individuals with disabilities and shall comply with A.N.S.I. 117.1, "Making Buildings and Facilities Accessible and Usable by Individuals with Disabilities".

2. Description of the facility’s chain of command during emergency management, including 24-hour contact information and the facility’s primary mode of emergency communication system; 3. Written and signed agreements that describe how essential goods and services, such as water, electricity, fuel for generators, laundry, medications, medical equipment, and supplies, will be provided; 4. Shelter or relocation arrangements, including transportation arrangements, in the event of evacuation; and 5. Description of recovery, i.e., return of operations following an emergency.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13 Subchapter 31 DISASTER PREPAREDNESS PLAN Rule 42.31.1 The facility shall maintain a written disaster preparedness plan that includes procedures to be followed in the event of fire, train derailment, explosions, severe weather, and other possible disasters as appropriate for the specific geographic location. The plan shall include: 1. Written evidence that the plan has been reviewed and coordinated with the licensing agency’s local emergency response coordinator and the local emergency manager;*
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 42.31.2** The disaster preparedness plan shall be reviewed with new employees during orientation and at least annually {#sec-16-42.31.2 omnilex-key=us-ms-regs-official--title-15--16#42.31.2}

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 42.31.3** Fire drills shall be conducted quarterly {#sec-16-42.31.3 omnilex-key=us-ms-regs-official--title-15--16#42.31.3}

Disaster drills shall be conducted at least annually.

2. Grant variances as it deems necessary for facilities existing prior to July 1, 1983. 3. Information obtained by the licensing agency through filed reports, inspection, or as otherwise authorized, shall not be disclosed publicly in such manner as to identify individuals or institutions, except in proceedings involving the questions of licensure. 4. The licensing agency shall reserve the right to review any and all records and reports of any ambulatory surgical facility, as deemed necessary to determine compliance with these minimum standards of operation.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13 Subchapter 32 Conclusion Rule 42.32.1 Conditions which have not been covered in the standards shall be enforced in accordance with the best practices as interpreted by the licensing agency. The licensing agency reserves the right to: 1. Review the payroll records of each ambulatory surgical facility for the purpose of verifying staffing patterns.*
- *SOURCE: Miss. Code Ann. §41-75-13*

#### **Chapter 43** MINIMUM STANDARDS OF OPERATION FOR BIRTHING CENTERS Subchapter 1 INTRODUCTION Rule 43.1.1 On April 12, 1985, the Mississippi Legislature passed an Act to provide for the licensing of birthing centers by the department or its successor; to provide for license fees; to provide for hearings prior to the denial, suspension or revocation of a license; to provide for appeals from the decision at any such hearing; to provide penalties for violations of this act, and for related purposes.

##### **15 Miss. Admin. Code Pt. 16, R. 43.1.2** Rule 43.1.2 {#sec-16-43.1.2 omnilex-key=us-ms-regs-official--title-15--16#43.1.2}

The purpose of this act is to protect and promote the public welfare by providing for the development, establishment and enforcement of certain standards in the maintenance and operation of "birthing centers" which will ensure safe, sanitary and nationally recognized best practice standards adequate care of individuals in such institutions.

**History**
- *SOURCE: Miss. Code Ann. §41-77-3 and §41-77-11*

##### **15 Miss. Admin. Code Pt. 16, R. 43.1.3** Rule 43.1.3 {#sec-16-43.1.3 omnilex-key=us-ms-regs-official--title-15--16#43.1.3}

A "birthing center" is a home-like facility where low risk births are planned to occur following a normal, uncomplicated pregnancy. A "birthing center" has sufficient space to accommodate participating family members and support people of the woman's choice. A "birthing center" provides midwifery practice to childbearing women during pregnancy, birth, and puerperium and to the infant during the immediate newborn period by certified nurse-midwives or by an obstetrician or family physician or osteopathic physician. A "birthing center" has specified access to acute care obstetric and newborn services.

**History**
- *SOURCE: Miss. Code Ann. §41-77-1 and §41-77-11*

##### **15 Miss. Admin. Code Pt. 16, R. 43.2.1** Adoption of Regulations {#sec-16-43.2.1 omnilex-key=us-ms-regs-official--title-15--16#43.2.1}

Under and by virtue of the authority vested in it by Chapter 503 of the Laws of Mississippi, 1985, Regular Legislative Session, the department, as licensing agency, does hereby adopt and promulgate the following rules, regulations, and standards governing birthing centers licensed to operate in the State of Mississippi. The American Association of Birth Centers (AABC) Standards for Birth Centers are hereby incorporated by reference. In order to be licensed by the Mississippi State Department of Health, each birth center shall be in compliance with the AABC Standards for Birth Centers.

**History**
- *SOURCE: Miss. Code Ann. §41-77-11*

##### **15 Miss. Admin. Code Pt. 16, R. 43.2.2** Procedures Governing Amendments {#sec-16-43.2.2 omnilex-key=us-ms-regs-official--title-15--16#43.2.2}

The rules, regulations, and minimum standards for birthing center facilities may be amended by the licensing agency from time to time as necessary to promote the health, safety, and welfare of persons receiving services in such institutions.

**History**
- *SOURCE: Miss. Code Ann. §41-77-11*

##### **15 Miss. Admin. Code Pt. 16, R. 43.2.3** Inspections Required {#sec-16-43.2.3 omnilex-key=us-ms-regs-official--title-15--16#43.2.3}

The department shall inspect each birthing center for which a license has been issued or by persons, delegated authority by said Department on an annual basis at such intervals as the Department may direct. The department and/or its authorized representatives shall have the right to inspect construction work in progress. New birthing center facilities shall not be licensed without having first been inspected for compliance with these rules, regulations, and minimum standards.

**History**
- *SOURCE: Miss. Code Ann. §41-77-11 and §41-77-17*

##### **15 Miss. Admin. Code Pt. 16, R. 43.2.4** Definitions: A list of selected terms often used in connection with these rules, regulations, and standards follows {#sec-16-43.2.4 omnilex-key=us-ms-regs-official--title-15--16#43.2.4}

1. Administrator. The term "administrator" shall mean a person who is delegated the responsibility for the implementation and proper application of policies and programs established by the governing authority of the facility and is delegated responsibility for the establishment of safe and effective administrative management, control, and operation of the services provided.

2. Birthing Center. A "Birthing Center" shall mean a publicly or privately owned facility, place or institution constructed, renovated, leased, or otherwise established where non-emergency births are planned to occur away from the mother's usual residence following a documented period of prenatal care for a normal uncomplicated pregnancy which has been determined to be a low risk through a formal risk scoring examination. A licensed physician, or certified nurse midwife and a registered nurse

shall provide care in a birthing center. Services provided in a birthing center shall be limited in the following manner:

**History**
- *SOURCE: Miss. Code Ann. §41-77-1 and §41-77-11*

##### **15 Miss. Admin. Code Pt. 16, R. 43.3.2** Criminal History Record Checks {#sec-16-43.3.2 omnilex-key=us-ms-regs-official--title-15--16#43.3.2}

Definitions: A list of selected terms often used in connection with these rules, regulations and standards follows.

1. Employee. For the purpose of fingerprinting and criminal background history checks, employee shall mean any individual employed by a covered entity. The term “employee" also includes any individual who by contract with the covered entity provides direct client care in a client's room or in treatment rooms.

2. The term employee does not include healthcare professional/technical students, as defined in Section 37-29-232, performing clinical training in a licensed e n t i t y under contracts between their schools and the licensed entity, and does not include students at high schools who observe the treatment and care of clients in a licensed entity as part of the requirements of an allied health course taught in the school if:

A. The student is under the supervision of a licensed healthcare provider; and

B. The student has signed the affidavit that is on file at the student's school stating that he or she has not been convicted of or plead guilty or nolo contendere to a felony of possession or sale of drugs, murder, manslaughter, armed robbery, rape, sexual battery, any sex offenses listed in section 45-33-23 (g), child abuse, arson, grand larceny, burglary, gratification of lust, aggravated assault, or felonious abuse and/or battery of a vulnerable adult, or that any such conviction or plea was reversed on appeal or a pardon was granted for the conviction or plea; and

C. Further, applicants and employees of the University of Mississippi Medical Center for whom criminal history record checks and fingerprinting are obtained in accordance with Section 37-115-41 are exempt from application of the term employee under Section 41-75- 13.

3. Covered Entity. For the purpose of criminal history record checks, "covered entity" means a licensed entity or a healthcare professional staffing agency.

4. Licensed Entity. For the purpose of criminal history record checks, the term "licensed entity" means a Birthing Center.

5. Health Care Professional Vocational Technical Student. For purposes of criminal history record checks, the term means a student enrolled in a healthcare professional/vocational technical academic program.

6. Direct Client Care or Services. For the purposes of fingerprinting and criminal background history checks, the term "direct client care" means direct hands-on medical client care and services provided by an individual to a client, in a client's room or treatment room. Individuals providing direct client care may be directly employed by the facility or provides client care on a contractual basis.

7. Documented Disciplinary Action. For the purpose of fingerprinting and criminal background history checks, the term "documented disciplinary action" means any action taken against an employee for abuse or neglect of a client.

8. Pursuant to Section 43-11-13, Mississippi Code of 1972, the covered entity shall require to be performed a disciplinary check with the professional licensing agency, if any, for each employee to determine if any disciplinary action has been taken against the employee by the agency, and a criminal history record check on:

A. Every new employee of a covered entity who provides direct client care or services; and

B. Any individual seeking new employment with a covered entity whose initial criminal history record check is over two years.

9. Except as otherwise provided in this paragraph, no employee shall be permitted to provide direct client care until the results of the criminal history record check have revealed no disqualifying record or the employee has been granted a waiver. Provided the covered entity has documented evidence of submission of fingerprints for the background check, any person may be employed and provide direct client care on a temporary basis pending the results of the criminal history record check but any employment offer, contract, or arrangement with the person shall be voidable, if he/she receives a disqualifying criminal record check and no waiver is g r a n t e d .

10. If such criminal history record check discloses a conviction; a guilty plea; and/or a plea of nolo contendere to a felony for one (1) or more of the following crimes that is job-related which has not been reversed on

appeal, or for which a pardon has not been granted, the applicant/employee may not be eligible to be employed at the licensed facility:

A. Possession or sale of drugs;

B. Murder;

C. Manslaughter;

D. Armed robbery;

E. Rape; or

F. Sexual battery.

11. Sex offense listed in Section 45-33-23 (g), Mississippi Code of 1972:

A. Child abuse;

B. Arson;

C. Grand larceny;

D. Burglary;

E. Gratification of lust;

F. Aggravated assault;

G. Felonious abuse and/or battery of vulnerable adult;

H. Any felony; or

I. Identity theft. 12. Documentation of verification of the employee's disciplinary status, if any, with the employee's professional licensing agency as applicable, and evidence of submission of the employee's fingerprints to the licensing agency must be on file and maintained by the facility prior to the new employees first date of employment. The covered entity shall maintain on file evidence of verification of the employee's disciplinary status from any applicable professional licensing agency and of submission and/or completion of the criminal record check, a copy of the referenced notarized letter addressing the individual’s suitability for such employment.

13. Pursuant to Section §43-11-13, Mississippi Code of 1972, the licensing agency shall require every employee of a covered entity employed prior to July 01, 2003, to sign an affidavit stating that he or she does not have a criminal history as outlined in paragraph (3) above.

14. From and after December 31, 2003, no employee of a covered entity hired before July 01, 2003, shall be permitted to provide direct patient care unless the employee has signed an affidavit as required by this section. The covered entity shall place the affidavit in the employee’s personnel file as proof of compliance with this section.

15. If a person signs the affidavit required by this section, and it is later determined that the person actually had been convicted of or pleaded guilty or nolo contendere to any of the offenses listed herein, and the conviction or pleas has not been reversed on appeal or a pardon has not been granted for the conviction or plea, the person is guilty of perjury as set out in Section §43-11-13, Mississippi Code of 1972. The covered entity shall immediately institute termination proceedings against the employee pursuant to the facility’s policies and procedures.

16. The covered entity may, in its discretion, allow any employee unable to sign the affidavit required by paragraph (7) of this subsection or any employee applicant aggrieved by the employment decision under this subsection to appear before the covered entity’s hiring officer, or his or her designee, to show mitigating circumstances that may exist and allow the employee or employee applicant to be employed at the covered entity. The covered entity, upon report and recommendation of the hiring officer, may grant waivers for those mitigating circumstances, which shall include, but not be limited to: (1) age at which the crime was committed; (2) circumstances surrounding the crime; (3) length of time since the conviction and criminal history since the conviction; (4) work history; (5) current employment and character references; and (6) other evidence demonstrating the ability of the individual does not pose a threat to the health or safety of the patients in the licensed facility.

17. The licensing agency may charge the covered entity submitting the fingerprints a fee not to exceed Fifty Dollars ($50.00).

18. Should results of an employee applicant's criminal history record check reveal no disqualifying event, then the covered entity shall, within two (2) weeks of the notification of no disqualifying event, provide the employee applicant with a notarized letter signed by the chief executive officer of the covered, or his or her authorized designee, confirming the employee applicant's suitability for employment based on his or her criminal history record check. An employee applicant may use that letter for a period of two (2) years from the date of the

letter to seek employment at any covered entity licensed by the Mississippi State Department of Health without the necessity of an additional criminal record check. Any covered entity presented with the letter may rely on the letter with respect to an employee applicant's criminal background and is not required for a period of two (2) years from the date of the letter to conduct or have conducted a criminal history record check as required in this subsection.

19. For individuals contracted through a third party who provide direct client care as defined herein, the covered entity shall require proof of a criminal history record check.

20. Pursuant to Section 41-75-13, Mississippi Code of 1972, the licensing agency, the covered entity, and their agents, officers, employees, attorneys, and representatives shall be presumed to be acting in good faith for any employment decision or action taken under this section. The presumption of good faith may be overcome by a preponderance of the evidence in any civil action. No licensing agency, covered entity, nor their agents, officers, employees, attorneys, or representatives shall be held liable in any employment discrimination suit in which an allegation of discrimination is made regarding an employment decision authorized under this section.

**History**
- *SOURCE: Miss. Code Ann. §41-77-11*

##### **15 Miss. Admin. Code Pt. 16, R. 43.3.1** Employee Health Screening {#sec-16-43.3.1 omnilex-key=us-ms-regs-official--title-15--16#43.3.1}

Every employee of a birthing center who comes in contact with patients shall receive a health screening by a licensed physician, nurse practitioner/physician assistant or employee health nurse who conduct exams prior to employment. Facilities shall comply with recommendations from the Centers for Disease control and/or the Mississippi State Department of Health regarding baseline employee TB testing and routine serial employee TB testing and education.

**History**
- *SOURCE: Miss. Code Ann. §41-77-11*

##### **15 Miss. Admin. Code Pt. 16, R. 43.3.2** Criminal History Record Checks {#sec-16-43.3.2 omnilex-key=us-ms-regs-official--title-15--16#43.3.2}

Definitions: A list of selected terms often used in connection with these rules, regulations and standards follows.

1. Affidavit. For the purpose of fingerprinting and criminal background history checks, the term "affidavit" means the use of Mississippi State Department of Health (MSDH) Form #210, or a copy thereof, which shall be placed in the individual’s personal file.

2. Employee. For the purpose of fingerprinting and criminal background history checks, employee shall mean any individual employed by a covered entity. The term “employee" also includes any individual who by contract with the covered entity provides direct client care in a client's room or in treatment rooms.

The term employee does not include healthcare professional/technical students, as defined in Section 37-29-232, performing clinical training in a licensed e n t i t y under contracts between their schools and the licensed entity, and does not include students at high schools who observe the treatment and care of clients in a licensed entity as part of the requirements of an allied health course taught in the school if: a. The student is under the supervision of a licensed healthcare provider; and

b. The student has signed the affidavit that is on file at the student's school stating that he or she has not been convicted of or plead guilty or nolo contendere to a felony of possession or sale of drugs, murder, manslaughter, armed robbery, rape, sexual battery, any sex offenses listed in section 45-33-23 (g), child abuse, arson, grand larceny, burglary, gratification of lust, aggravated assault, or felonious abuse and/or battery of a vulnerable adult, or that any such conviction or plea was reversed on appeal or a pardon was granted for the conviction or plea.

c. Further, applicants and employees of the University of Mississippi Medical Center for whom criminal history record checks and fingerprinting are obtained in accordance with Section 37-115-41 are exempt from application of the term employee under Section 41-75-13.

3. Covered Entity. For the purpose of criminal history record checks, "covered entity" means a licensed entity or a healthcare professional staffing agency.

4. Licensed Entity. For the purpose of criminal history record checks, the term "licensed entity" means a Birthing Center.

5. Health Care Professional Vocational Technical Student. For purposes of criminal history record checks, the term means a student enrolled in a healthcare professional/vocational technical academic program.

6. Direct Client Care or Services. For the purposes of fingerprinting and criminal background history checks, the term "direct client care" means direct hands-on medical client care and services provided by an individual to a client, in a client's room or treatment room. Individuals providing direct client care may be directly employed by the facility or provides client care

on a contractual basis.

7. Documented Disciplinary Action. For the purpose of fingerprinting and criminal background history checks, the term "documented disciplinary action" means any action taken against an employee for abuse or neglect of a client.

Pursuant to Section 43-11-13, Mississippi Code of 1972, the covered entity shall require to be performed a disciplinary check with the professional licensing agency, if any, for each employee to determine if any disciplinary action has been taken against the employee by the agency, and a criminal history record check on:

a. Every new employee of a covered entity who provides direct client care or services; and

b. Every employee of a covered entity who has documented disciplinary action by his or her present employer.

Except as otherwise provided in this paragraph, no employee shall be permitted to provide direct client care until the results of the criminal history record check have revealed no disqualifying record or the employee has been granted a waiver. Provided the covered entity has documented evidence of submission of fingerprints for the background check, any person may be employed and provide direct client care on a temporary basis pending the results of the criminal history record check but any employment offer, contract, or arrangement with the person shall be voidable, if he/she receives a disqualifying criminal record check and no waiver is g r a n t e d.

a. If such criminal history record check discloses a conviction; a guilty plea; and/or a plea of nolo contendere to a crime that is job- related which has not been reversed on appeal, or for which a pardon has not been granted, the applicant/employee may not be eligible to be employed at the licensed facility. Documentation of verification of the employee's disciplinary status, if any, with the employee's professional licensing agency as applicable, and evidence of submission of the employee's fingerprints to the licensing agency must be on file and maintained by the facility prior to the new employees first date of employment.

b. The covered entity shall maintain on file evidence of verification of the employee's disciplinary status from any applicable professional licensing agency and of submission and/or completion of the criminal record check, a copy of the referenced notarized letter addressing the individual’s suitability for such employment.

The licensing agency may charge the covered entity submitting the fingerprints a fee not to exceed Fifty Dollars ($50.00).

Should results of an employee applicant's criminal history record check reveal no disqualifying event, then the covered entity shall, within two (2) weeks of the notification of no disqualifying event, provide the employee applicant with a notarized letter signed by the chief executive officer of the covered, or his or her authorized designee, confirming the employee applicant's suitability for employment based on his or her criminal history record check. An employee applicant may use that letter for a period of two (2) years from the date of the letter to seek employment at any covered entity licensed by the Mississippi State Department of Health without the necessity of an additional criminal record check. Any covered entity presented with the letter may rely on the letter with respect to an employee applicant's criminal background and is not required for a period of two (2) years from the date of the letter to conduct or have conducted a criminal history record check as required in this subsection.

For individuals contracted through a third party who provide direct client care as defined herein, the covered entity shall require proof of a criminal history record check.

Pursuant to Section 41-75-13, Mississippi Code of 1972, the licensing agency, the covered entity, and their agents, officers, employees, attorneys and representatives shall be presumed to be acting in good faith for any employment decision or action taken under this section. The presumption of good faith may be overcome by a preponderance of the evidence in any civil action. No licensing agency, covered entity, nor their agents, officers, employees, attorneys or representatives shall be held liable in any employment discrimination suit in which an allegation of discrimination is made regarding an employment decision authorized under this section.

**History**
- *SOURCE: Miss. Code Ann. §41-77-11*

##### **15 Miss. Admin. Code Pt. 16, R. 43.4.1** License {#sec-16-43.4.1 omnilex-key=us-ms-regs-official--title-15--16#43.4.1}

No license shall be issued to any facility, which fails to limit the clinical practice in the following manner: 1. Surgical services shall be limited to those normally performed during uncomplicated childbirth, such as episiotomy and repair, and shall not include operative obstetrics or Caesarean sections

2. Labor shall not be inhibited, stimulated or augmented with chemical agents during the first or second stage of labor

3. Systemic analgesia may be administered and local anesthesia for pudendal block and episiotomy repair may be performed. General and conductive anesthesia shall not be administered at birthing centers

4. Patients shall not remain in the facility in excess of twenty-four (24) hours.

**History**
- *SOURCE: Miss. Code Ann. §41-77-11*

##### **15 Miss. Admin. Code Pt. 16, R. 43.4.2** Regular License {#sec-16-43.4.2 omnilex-key=us-ms-regs-official--title-15--16#43.4.2}

A license shall be issued to each birthing center that meets the requirements as set forth in these regulations. In addition, no birthing center facility may be licensed until it shows conformance to the regulations establishing minimum standards for prevention and detection of fire, as well as for protection of life and property against fire.

Each initial and renewal licensure application, unless suspended or revoked, shall be accompanied by a fee as set by the Board, made payable to the Mississippi State Department of Health. Renewal of licenses shall occur on an annual basis. Fees are not refundable.

**History**
- *SOURCE: Miss. Code Ann. §41-77-11 Subchapter 5 LICENSING Rule 43.5.1 Application and Annual Report & Fees- Application for a license or renewal of a license shall be made in writing to the department on forms provided by the department, which shall contain such information as the department may require. The application shall require reasonable, affirmative evidence of ability to comply with these rules, regulations, and minimum standards. Each initial and renewal licensure application, unless suspended or revoked, shall be accompanied by a fee as set by the legislation according to sections MS Code § 41-77-9 & MS Code § 41-77- 25.*
- *SOURCE: Miss. Code Ann. §41-77-11*

##### **15 Miss. Admin. Code Pt. 16, R. 43.5.2** Rule 43.5.2 {#sec-16-43.5.2 omnilex-key=us-ms-regs-official--title-15--16#43.5.2}

To be eligible for licensure in MS under this section, a birth center must be accredited by the Commission for Accreditation for Birthing Centers (CABC) or must obtain accreditation within six months of the date of the application for licensure. If the birth center loses its accreditation, the center must immediately notify the department.

**History**
- *SOURCE: Miss. Code Ann. §41-77-11*

##### **15 Miss. Admin. Code Pt. 16, R. 43.5.3** Issuance of License {#sec-16-43.5.3 omnilex-key=us-ms-regs-official--title-15--16#43.5.3}

All licenses issued by the department shall set forth the name of the birthing center, the location, the name of the licensee, and the license number.

**History**
- *SOURCE: Miss. Code Ann. §41-77-11*

##### **15 Miss. Admin. Code Pt. 16, R. 43.5.4** Expiration of License {#sec-16-43.5.4 omnilex-key=us-ms-regs-official--title-15--16#43.5.4}

Each license shall expire on June 30 following the date of issuance.

**History**
- *SOURCE: Miss. Code Ann. §41-77-11*

##### **15 Miss. Admin. Code Pt. 16, R. 43.5.5** Denial or Revocation of License: Hearings and Review {#sec-16-43.5.5 omnilex-key=us-ms-regs-official--title-15--16#43.5.5}

The department of Health, after notice and opportunity for a hearing to the applicant or licensee, is authorized to deny, suspend, or revoke a license in any case in which it finds that there has been a substantial failure to comply with the requirements established under the law and these regulations. A facility that has had its license revoked may not apply for a license for five years after the revocation has occurred.

Also, the following shall be grounds for denial or revocation of license: 1. Fraud on the part of the licensee in applying for a license or renewal of license. 2. Willful or repeated violations by the licensee of any of the provisions of Miss. Code Ann. §41-77-1 et seq. and/or of the rules, regulations, and minimum standards established by the licensing agency. 3. Use of a controlled substance not prescribed by a licensed healthcare professional. 4. Use of alcoholic beverages by the licensee or other personnel of the licensed facility to the extent which threatens the well-being or safety of the residents. 5. Conviction of the licensee of a job-related felony and misdemeanor. 6. Publicly misrepresenting the licensed facility and/or its services. 7. Permitting, aiding, or abetting the commission of any unlawful act. 8. Conduct or practices detrimental to the health or safety of patients and employees of said licensed facility. Detrimental practices include but are not limited to: a. Cruelty to a patient or indifference to the needs which are essential to their general well-being and health. b. Misappropriation of the money or property of a patient.

c. Inadequate staff to provide safe care of a patient. Failure to transfer a patient whose condition demands care beyond the level of care provided by the licensed facility as determined by its classification.

**History**
- *SOURCE: Miss. Code Ann. §41-77-11and §41-77-19*

##### **15 Miss. Admin. Code Pt. 16, R. 43.5.6** Rule 43.5.6 {#sec-16-43.5.6 omnilex-key=us-ms-regs-official--title-15--16#43.5.6}

Mississippi State Department of Health shall be notified, in writing, of any of the following within 30 days prior the occurrence. 1. Address/location, 2. Facility name, 3. Phone number; 4. Hours of operation/24-hour contact procedure, 5. Change in address or phone number, 6. Administrator, 7. Director of nursing, and 8. Cessation of business.

**History**
- *SOURCE: Miss. Code Ann. §41-77-11and §41-77-19*

##### **15 Miss. Admin. Code Pt. 16, R. 43.6.1** Provision for hearing and appeal following denial or revocation of license is as follows: {#sec-16-43.6.1 omnilex-key=us-ms-regs-official--title-15--16#43.6.1}

1. Administrative Decision. The department will provide an opportunity for a fair hearing to every applicant or licensee who is dissatisfied with administrative decisions made in the denial or revocation of license.

2. The licensing agency shall notify the applicant or licensee by registered mail or personal service the particular reasons for the proposed denial or revocation of license. Upon written request of applicant or licensee within ten (10) days of the date of notification the licensing agency shall fix a date not less than thirty (30) days from the date of such service at which time the applicant or licensee shall be given an opportunity for a prompt and fair hearing.

3. On the basis of such hearing or upon default of the applicant or licensee, the licensing agency shall make a determination specifying its findings of

fact and conclusions of law. A copy of such determination shall be sent by registered mail to the last known address of the applicant or licensee or served personally upon the applicant or licensee.

4. The decision revoking, suspending, or denying the application or license shall become final thirty (30) days after it is so mailed or served unless the applicant or licensee, within such thirty (30) day period, appeals the decision to the Chancery Court in the county in which the facility is located, in the manner prescribed in Section 43-11-23, Mississippi Code of 1972, as amended. An additional period may be granted at the discretion of the licensing agency.

**History**
- *SOURCE: Miss. Code Ann. §41-77-11and §41-77-21*

##### **15 Miss. Admin. Code Pt. 16, R. 43.6.2** Penalties for Violations {#sec-16-43.6.2 omnilex-key=us-ms-regs-official--title-15--16#43.6.2}

Any person or persons or other entity or entities establishing, managing or operating a birthing center or conducting the business of a birthing center without the required license, or which otherwise violate any of the provisions of the Minimum Standards promulgated by the Mississippi State Department of Health as amended, or the rules, regulations or standards promulgated in furtherance of any law in which the department has authority therefore shall be subject to the penalties and sanctions of Section 41-7-209.

**History**
- *SOURCE: Miss. Code Ann. §41-77-11and §41-77-23*

##### **15 Miss. Admin. Code Pt. 16, R. 43.7.1** Subchapter 7 PATIENT TRANSFER {#sec-16-43.7.1 omnilex-key=us-ms-regs-official--title-15--16#43.7.1}

The patient shall be transferred when necessary to a hospital which shall have an organized obstetrical and newborn service which shall provide for an obstetrician and pediatrician on staff, 24-hour emergency care, and caesarean section capability within thirty (30) minutes of leaving the birthing center and shall provide skilled nursing care and facilities and equipment appropriate for the patient being transferred, having been notified on initiation of transfer. Facilities shall have a written policy that addresses the procedure for transfer.

**History**
- *SOURCE: Miss. Code Ann. §41-77-11*

##### **15 Miss. Admin. Code Pt. 16, R. 43.7.2** Written Agreement {#sec-16-43.7.2 omnilex-key=us-ms-regs-official--title-15--16#43.7.2}

The written agreement shall state that no license shall be issued to a “birthing center” until such “birthing center” shall have obtained a written agreement with a hospital, which has organized obstetrical service and provides such service on a continuing basis. The written agreement shall state that the hospital agrees to accept from the birthing center such cases as need to be referred for whatever reason from the birthing center, and for phone consultation for problems that arise in the birthing center. [Appropriate transfer criteria for agreement with hospital.] The facility must follow all

written policies developed by the licensed facility.

Subchapter 8 DISASTER PREPAREDNESS Rule 43.8.1 The Licensed Entity shall develop and maintain a written preparedness plan utilizing the Emergency Operations Plan (EOP) Template developed by the MSDH Office of Emergency Planning and Response. “All Hazards” and “Whole Community” approach to emergency and disaster planning. The plan must include procedures to be followed in the event of any pandemic, act of terrorism, or man-made or natural disaster as appropriate for the specific geographical location. The final draft of the Emergency Operations Plan (EOP), will be reviewed by the Office of Emergency Planning and Response, Mississippi State Department of Health, or their designates, for conformance with the “All Hazards Emergency Preparedness and Response Plan.” Particular attention shall be given to critical areas of concern which may arise during any “all hazards” emergency whether required to evacuate or to sustain in place. Additional plan criteria or a specified EOP format may be required as deemed necessary by the Office of Emergency Planning and Response. The nine (9) critical areas of consideration are:

1. Communications - Facility status reports shall be submitted in a format and a frequency as required by the Office of EOP;

2. Resources and Assets;

3. Safety and Security;

4. Staffing;

5. Infrastructure (Water, sewer, electricity, data systems, etc.);

6. Clinical Activities;

7. Exercises - Exercises shall be conducted a minimum of (2) times per year;

8. Smoke Detectors/Extinguishers (refer to NFPA 10 and NFPA 72); and

9. Continuity of Operations Planning (COOP) to include surge and alternate care sites.

**History**
- *SOURCE: Miss. Code Ann. §41-77-7 and §41-77-11*
- *SOURCE: Miss. Code Ann. §41-77-11*

##### **15 Miss. Admin. Code Pt. 16, R. 43.8.2** Emergency Operations Plans {#sec-16-43.8.2 omnilex-key=us-ms-regs-official--title-15--16#43.8.2}

Emergency Operations Plans (EOPs) must be exercised and reviewed annually or as directed by the Office of Emergency

Planning and Response. Written evidence of current approval or review of provider EOPs, by the Office of Emergency Planning and Response, shall accompany all applications for facility license renewals.

**History**
- *SOURCE: Miss. Code Ann. §41-77-11*

##### **15 Miss. Admin. Code Pt. 16, R. 43.8.3** Fire Drills {#sec-16-43.8.3 omnilex-key=us-ms-regs-official--title-15--16#43.8.3}

Fire drills shall be conducted one (1) per shift per quarter. Employees shall participate in a fire drill at least four (4) times per year. Written records of all drills shall be maintained, indicating content of and attendance at each drill. A fire evacuation plan shall be posted in each facility in a conspicuous place and kept current. The facility shall have a posted plan for evacuation of patients, staff and visitors in case of fire or another emergency. The birth center maintains functioning smoke alarms, appropriately placed fire extinguisher to control limited fires and emergency-powered lighting; identifies exits; protects stairwells with fire doors.

**History**
- *SOURCE: Miss. Code Ann. §41-77-11*

##### **15 Miss. Admin. Code Pt. 16, R. 43.9.1** Inspections {#sec-16-43.9.1 omnilex-key=us-ms-regs-official--title-15--16#43.9.1}

The department shall inspect each birthing center for which a license has been issued or by persons, delegated authority by said department on an annual basis at such intervals as the department may direct. The department and/or its authorized representatives shall have the right to inspect construction work in progress. New birthing center facilities shall not be licensed without having first been inspected for compliance with these rules, regulations, and minimum standards.

1. Construction shall not be started for any institution subject to these standards (whether new or remodeling or additions to an existing licensed birthing center) until the plans and specifications for such construction or remodeling have been submitted to the Licensing Agency in writing and its approval of the changes given in writing.

A. Exception: Foundation changes made necessary by unanticipated conditions, or any conditions which present a hazard to life or property if not immediately corrected.

B. New Construction, Additions, and Major Alterations. When construction is contemplated for new buildings, conversions, or additions to existing building coming within the scope of rules, plans, and specifications shall be submitted for review by the Department.

C. Minor Alterations and Remodeling. Minor alterations and remodeling which do not affect the structural integrity of the building, change functional operation, affect fire safety, and add services to those for which the birthing center is licensed need not

be submitted for review.

D. Local Requirements. The birthing center shall comply with all local zoning, building, and fire ordinances. A birthing center may not be operated in a private residence.

**History**
- *SOURCE: Miss. Code Ann. §41-77-11*

##### **15 Miss. Admin. Code Pt. 16, R. 43.9.2** Life Safety Codes {#sec-16-43.9.2 omnilex-key=us-ms-regs-official--title-15--16#43.9.2}

Physical Plant and Operational Standards. The following minimum physical plant and operational standards shall be met:

1. Construction. For any existing construction, as of the date of this standard, shall meet, at a minimum, NFPA 101 Life Safety Code, current edition and the FGI (Facility Guidelines Institute) Guidelines for Design and Construction of Health Care Facilities. In the event of the construction of a new birthing center or substantial modification of an existing facility, any subsequent edition of NFPA, Life Safety Code may be used, provided the licensing agency approve the use of such edition and that all construction and/or modifications meet the requirements of the approved edition.

A. The construction of the building should be a free-standing building.

B. Automatic Sprinklers Required. Facilities shall be protected throughout by a supervised automatic sprinkler system installed in accordance with the current edition of NFPA 13, Installation of Sprinkler Systems.

C. Fire Code Items:

i. Fire extinguishers in accordance with current edition NFPA 10, Standard for Portable Fire Extinguishers.

ii. Fire alarms and smoke detectors in accordance with current edition of NFPA 72, National Fire Alarm Code.

2. The center shall provide sufficient space and equipment for patient and visitor waiting area, examination and treatment rooms, birth rooms, special care capability, and for staff and administrative areas. Birth rooms shall each have at least 200 square feet of area, must include bathroom, toilet, or entry way, and be designed and located to prevent traffic through them to any other part of the center (Facility Guidelines Institute).

3. The licensing agency may deny the center a license if it does not comply with Federal, State, and local laws, codes, ordinances, and regulations which apply to its location, construction, maintenance, and operation.

4. It shall be the responsibility of the governing body to assure that the center is in a safe condition at all times, and that a fire inspection record is maintained on equipment, systems, and areas that may present a hazard to occupants.

5. In addition to requirements specified herein, and those required by local ordinances or regulations, the construction of a birth center shall meet the requirements of the current version National Fire Protection Association (NFPA) 101 shall be accompanied by written evidence that these requirements have been met.

6. Entrances for patients shall be connected to the public right-of-way by a hard-surfaced, unobstructed walkway in good repair. Access for handicapped individuals shall be provided at a minimum of one entrance. A hard-surfaced, unobstructed road or driveway for use by ambulances or other emergency vehicles shall run from at least one entrance of the building to the public right-of-way. The doorway of such entrance shall be immediately adjacent to the road or driveway. If such doorway is not on the same level as the road, a ramp shall provide a continuous, unobstructed plane to the entrance.

7. Services provided in multi-story buildings shall be accessible by an elevator of adequate size to accommodate a standard wheeled litter patient and two attendants. Multi-story buildings will be considered to have met this requirement when patients are located only on ground level floors with outside exits. A stairway or ramp of adequate dimensions shall be available for transfer of patients in case of power failure.

8. The birth center shall be constructed, equipped, and maintained to assure the safety of patients and personnel. The following requirements shall apply within the center:

A. Birth rooms shall be designed and located to prevent traffic through them to any other part of the center.

B. The walls and floors of birth rooms, examination rooms and staff dressing, and scrub areas shall be of material that will permit frequent washing and cleaning.

C. Staff dressing rooms and scrub facilities shall be

convenient to the birth rooms, and shall include a knee, elbow, wrist or foot operated sink soap dispenser and brushes.

D. Toilet and handwashing facilities shall be accessible to patients from the birth rooms. Bathrooms shall be equipped with handrails for toilets and showers. Convenient handwashing facilities shall be provided for both staff and patient and shall be provided with soap dispenser and individual or disposable towels. The use of common towels is prohibited.

E. The center shall be arranged and organized in such a manner as to ensure the comfort, safety, hygiene, privacy, and dignity of patients treated therein.

F. A clean up room for equipment shall be provided.

G. The center shall have an audible nurse call system with control switches in all birth rooms and bathrooms which can be activated during an emergency.

H. The center shall have special care capability which includes but is not necessarily limited to the following, for both adults and infants: resuscitation equipment, intravenous solutions, drugs, oxygen, suction, infant stethoscope, and transfer isolette. Such emergency equipment shall be provided on each floor on which patients are served.

I. Each birth room shall have an infant resuscitation tray with a laryngoscope, positive pressure bag and mask and endotracheal tubes.

9. The center shall provide space and facilities for administrative activities, including offices, medical records and other files and storage of supplies.

10. A waiting room and patient admissions area(s) shall be provided. There shall also be space for storage of personal belongings of staff, patients, and visitors.

11. The center shall have adequate and conveniently located toilets and handwashing facilities for its staff, employees, patients, and visitors.

Housekeeping, Laundry, Maintenance and Sterile Supplies:

1. The center shall ensure that housekeeping and maintenance is adequate to maintain the center and equipment in a clean condition and state of good repair. An equipment clean-up area with adequate plumbing, including a sink with counter, shall be provided within the center.

2. Laundry service shall be provided either in house or by contractual arrangement. Separate space and facilities shall be provided for receiving, sorting, and storing soiled laundry and for the sorting, storing, and issuing of clean laundry, if reusable items are utilized. Linens used for draping must be sterilized. All reusable linens, including those used as sterilizing wrappers, must be laundered before reuse. Linens shall be handled, stored, processed, and transported in such a manner as to prevent the spread of infection. Soiled and clean linen must be handled and stored separately.

3. There shall be adequate space and facilities for receiving packaging and proper sterilization end storage of supplies and equipment consistent with the services to be provided.

4. Special precaution shall be taken to ensure that sterile instruments and supplies are kept separate from nonsterile instruments and supplies. Equipment for sterilization of instruments and supplies shall be conveniently located and of adequate capacity for the workload. Records shall be maintained to assure quality control, including, date, time, and temperature of each batch of sterilized supplies and equipment. Sterilization performance shall be checked, and records shall be kept. Sterile items shall be dated and utilized, based on established procedures.

Electrical Power:

1. All electrical work and equipment shall be designed and installed in accordance with State and local laws and ordinances.

2. All areas of the center shall have sufficient artificial lighting for designated purposes.

3. All centers shall have an alternative lighting source for emergency use in the event of a power failure.

4. Centers shall equip the building with an emergency generating system;

Level 1, Type 10 or equivalent in accordance with current NFPA

Standard for Emergency and Standby Power Systems; with adequate generating power to maintain full power to the building in the case of power failure.

**History**
- *SOURCE: Miss. Code Ann. §41-77-11*

##### **15 Miss. Admin. Code Pt. 16, R. 43.10.1** Subchapter 10 WASTE MANAGEMENT {#sec-16-43.10.1 omnilex-key=us-ms-regs-official--title-15--16#43.10.1}

All facilities must comply with the Adopted Standards for the Regulation of Medical Waste in Health Care Facilities licensed by the Mississippi State Department of Health. These Standards are published on the MSDH website.

**History**
- *SOURCE: Miss. Code Ann. §41-77-11 Subchapter 11 INFECTION CONTROL*

##### **15 Miss. Admin. Code Pt. 16, R. 43.11.1** The following infection control standards shall be met: {#sec-16-43.11.1 omnilex-key=us-ms-regs-official--title-15--16#43.11.1}

1. The birthing center must maintain and document an effective infection control program that protects patients, families, visitors, and birthing center personnel by preventing and controlling infections and communicable diseases.

2. The birthing center inpatient facility must have an active surveillance program that includes specific measures for prevention, early detection, control, education, and investigation of infections and communicable diseases in the birthing center. There must be a mechanism to evaluate the effectiveness of the program(s) and take corrective action when necessary. The program must include implementation of nationally recognized systems of infection control guidelines to avoid sources and transmission of infections and communicable diseases

3. The birthing center must follow accepted standards of practice to prevent the transmission of infections and communicable diseases, including the use of standard precautions.

**History**
- *SOURCE: Miss. Code Ann. §41-77-11 CHAPTER 44 MINIMUM STANDARDS OF OPERATION FOR ABORTION FACILITIES Subchapter 1 INTRODUCTION*

##### **15 Miss. Admin. Code Pt. 16, R. 44.1.1** Adoption of Regulations {#sec-16-44.1.1 omnilex-key=us-ms-regs-official--title-15--16#44.1.1}

Under and by virtue of authority vested in it by Mississippi Code Annotated ', the Mississippi Department of Health, as licensing agency, does hereby adopt and promulgate the following rules, regulations and standards governing abortion facilities licensed to operate in the State of Mississippi.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 44.1.2** Procedures Governing Amendments {#sec-16-44.1.2 omnilex-key=us-ms-regs-official--title-15--16#44.1.2}

The rules, regulations, and minimum standards for abortion facilities may be amended by the licensing agency from time to time as necessary to promote the health, safety, and welfare of persons receiving services in such institutions.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 44.1.3** Inspections Required {#sec-16-44.1.3 omnilex-key=us-ms-regs-official--title-15--16#44.1.3}

Each abortion facility for which a license has been issued shall be inspected by the Mississippi Department of Health or by persons delegated with authority by said Mississippi Department of Health at such intervals as the Department may direct. The Mississippi Department of Health and/or its authorized representatives shall have the right to inspect construction work in progress. New abortion facilities shall not be licensed without having first been inspected for compliance with these rules, regulations, and minimum standards.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 44.1.4** Provisions {#sec-16-44.1.4 omnilex-key=us-ms-regs-official--title-15--16#44.1.4}

The provisions of this act shall not be constructed to repeal or modify any provision of Mississippi law not expressly altered by this act, and furthermore does not establish a state policy that condones abortion.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 44.1.5** DEFINITIONS A list of selected terms often used in connection with these rules, regulations, and standards follows: 1 {#sec-16-44.1.5 omnilex-key=us-ms-regs-official--title-15--16#44.1.5}

Abortion. For the purpose of these regulations, "Abortion" means the use or prescription of any instrument, medicine, drug or any other substances or device to terminate the pregnancy of a woman known to be pregnant with any intention other than to increase the probability of a live birth to preserve the life or health of the child after live birth or to remove a dead fetus. 2. Administrator. The term "administrator" shall mean a person who is delegated the responsibility for the implementation and proper application of policies and programs established by the governing authority of the facility and is delegated responsibility for the establishment of safe and effective administrative management, control, and operation of the services provided. This definition applies to a person designated as Chief Executive Officer or other similar title.

3. Abortion Facility. The term "abortion facility" means a facility operating substantially for the purpose of performing abortions for outpatients and is a separate identifiable legal entity from any other health care facility. Abortions shall only be performed by physicians licensed to practice in the State of Mississippi. The term "abortion facility" term includes physicians' offices which are used substantially for the purpose of performing abortions. An abortion facility operates substantially for the purpose of performing abortions if any of the following conditions are met: a. The abortion facility is a provider for performing ten (10) or more abortions procedures per calendar month during any month of a calendar year, or one hundred (100) or more in a calendar year. b. The abortion facility, if operating less than twenty (20) days per calendar month, is a provider for performing ten (10) or more abortion procedures, or performing a number of abortion procedures which would be equivalent to ten (10) procedures per month, if the facility were operating twenty (20) or more days per calendar month, in any month of a calendar year. c. The facility applies to the licensing agency for licensure as a Level I or Level II abortion facility. 4. Anesthetist. A physician qualified and trained to administer anesthetic agents or a certified registered nurse qualified to administer anesthetic agents. 5. Change of Ownership. The term "change of ownership" includes, but is not limited to, intervivos gifts, purchases, transfers, leases, can an/or stock transactions or other comparable arrangements whenever the person or entity acquires an interest of fifty percent (50%) or more of the facility or services. Changes of ownership from partnerships, single proprietorships, or corporations to another form of ownership are specifically included, provided, however, "change of ownership" shall not include any inherited interest acquired as a result of a testamentary instrument or under the laws of descent and distribution of the State of Mississippi. 6. Abortion Facility Charge Nurse. The "charge nurse" means a Registered Nurse, who is currently licensed by the Mississippi Board of Nursing, with supervisory and administrative ability who is responsible to the Governing Authority of the facility. 7. Dismemberment Abortion. The term dismemberment abortion means, with the purpose of causing the death of an unborn child, purposely to dismember a living unborn child and extract him or her one piece at a time from the uterus through use of clamps, grasping forceps, tongs, scissors or similar instruments that, through the convergence of two rigid levers, slice, crush and/or grasp a portion of the unborn child’s body to cut or rip it off. The term dismemberment abortion does not include an abortion that uses suction to dismember the body of the unborn child by sucking fetal parts into a collection chamber, although it does include an abortion in which a dismembership abortion is used to cause the death of an unborn child but suction is subsequently used to extract fetal parts after the death of the unborn child.

8. Governing Authority. The term "governing authority" shall mean owner(s) associations, public bodies, board of trustees, or any other comparable designation of an individual or group of individuals who have the purpose of owning, acquiring, constructing, equipping, operating and/or maintaining abortion facilities and exercising control over the affairs, and in which the ultimate responsibility and authority of the facility is vested. 9. Level I. In accordance with Section 41-75-1, Mississippi Code of 1972, effective August 15, 2005, a Level I abortion facility shall be required to meet minimum standards for Level II abortion facilities and Minimum Standards of Operation For Ambulatory Surgical Facilities as established by the licensing agency. 10. Level II. In accordance with Section 41-75-1, Mississippi Code of 1972, effective August 15, 2005, a Level II abortion facility shall be required to meet the minimum standards for Level II abortion facilities as established by the licensing agency. 11. Licensed Practical Nurse. "Licensed practical nurse" (LPN) means any person licensed as such by the Mississippi State Board of Nursing. 12. License. The term "license" shall mean the document issued by the Mississippi Department of Health and signed by the Executive Director of the Mississippi Department of Health. 13. Licensure shall constitute authority to receive patients and perform the services included within the scope of these rules, regulations, and minimum standards. 14. Licensee. The term "licensee" shall mean the individual to whom the license is issued and upon whom rests the responsibility for the operation of the abortion facility in compliance with these rules, regulations and minimum standards. 15. Licensing Agency. The term "licensing agency" shall mean the Mississippi Department of Health. 16. Medical Treatment. Means, but is not limited to, hospitalization, laboratory tests, surgery, or prescription of drugs. 17. Nursing Personnel. The term "nursing personnel" shall mean registered nurses, graduate nurses, licensed practical nurses, nurses' aides, orderlies, attendants and others rendering patient care. 18. Operating. "Operating" an abortion facility means that the facility is open for any period of time during a day and has on site at the facility or on call, a physician licensed to practice in the State of Mississippi available to provide abortions. 19. Patient. The term "patient" shall mean a person admitted to the abortion facility by and upon the recommendation of a physician and who is to receive medical care recommended by the physician.

20. Performance By Physician Required. No termination of pregnancy shall be performed at any time except by a physician. 21. Person. The term "person" means any individual, firm, partnership, corporation, company, association, or joint stock association, or any licensee herein or the legal successor thereof. 22. Pharmacy. The term "pharmacy" shall mean a place licensed by the Mississippi Board of Pharmacy where prescriptions, drugs, medicines and chemicals are offered for sale, compounded or dispensed, and shall include all places whose titles may imply the sale, offering for sale, compounding or dispensing of prescriptions, drugs, medicines or chemicals. 23. Pharmacist. The term "pharmacist" shall mean a person currently licensed by the Mississippi Board of Pharmacy to practice pharmacy in Mississippi under the provisions contained in current state statutes. 24. Physician. The term physician shall mean a person fully licensed by the Mississippi State Board of Medical Licensure to practice medicine and surgery in Mississippi under provisions contained in current state statutes, including but not limited to, Miss. Code Ann. §41-75-1: a. He or she must have completed a residency in family medicine, with strong rotation through OB/GYN, in a residency program approved by the accreditation counsel for graduate medical education. b. He or she must have completed a residency in obstetrics and gynecology in a residency program approved by the accreditation counsel for graduate medical education. c. He or she must have an M.D. or O.D. degree and at least one year of postgraduate training in a training facility with an approved residency program and an additional year of obstetrics/gynecology residency. 25. Purposely. The term “ purposely” means that a person acts purposely with respect to a material element of an offense when: a. If the element involves the nature of his conduct or a result there of, it is his conscious object to engage in conduct of that nature or to cause such a result; and b. If the element involves the attendant circumstances, he is aware of the existence of those circumstances or he believes or hopes that they exist. 26. Registered Nurse. The term "registered nurse" (R.N.) shall mean a professional registered nurse currently licensed by the Mississippi Board of Nursing in accordance with the provisions contained in current state statutes. 27. May. The term "may" indicates permission.

28. Serious health risk to the unborn child’s mother. This term means that in reasonable medical judgment, she has a condition that so complicates her medical condition that it necessitates the abortion of her pregnancy to avert her death or to avert serious risk of substantial and irreversible physical impairment of a major bodily function, not including psychological or emotional conditions. No such condition may be determined to exist if it is based on a claim or diagnosis that the women will engage in conduct that she intends to result in her death or in substantial or irreversible physical impairment of a major bodily function. 29. Shall. The term "shall" indicates mandatory requirement(s). 30. Should. The term "should" indicates recommendation(s). 31. Termination of Pregnancy. Abortion procedures after the first trimester shall only be performed at a Level I abortion facility or an ambulatory surgical facility or hospital licensed to perform that service.

**History**
- *SOURCE: Miss. Code Ann. §41-75-138 Subchapter 2 TYPE OF LICENSE Rule 44.2.1 Regular License. A license shall be issued to each abortion facility that meets the requirements as set forth in these regulations. In addition, no abortion facility may be licensed until it shows conformance to the regulations establishing minimum standards for prevention and detection of fire, as well as, for protection of life and property against fire. Compliance with the N.F.P.A. Life Safety Code 101 for doctors' office and clinics shall be required.*
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 44.2.2** Provisional License {#sec-16-44.2.2 omnilex-key=us-ms-regs-official--title-15--16#44.2.2}

Within its discretion, the Mississippi Department of Health may issue a provisional license when a temporary condition of noncompliance with these regulations exists in one or more particulars. A provisional license shall be issued only if the Mississippi Department of Health is satisfied that preparations are being made to qualify for a regular license and that the health and safety of patients will not be endangered meanwhile.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 44.2.3** Level I Abortion Facility {#sec-16-44.2.3 omnilex-key=us-ms-regs-official--title-15--16#44.2.3}

Level I abortion facilities shall be required to meet minimum standards for abortion facilities and The Minimum Standards of Operation For Ambulatory Surgical Facilities as established by this agency.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 44.2.4** Level II Abortion Facility {#sec-16-44.2.4 omnilex-key=us-ms-regs-official--title-15--16#44.2.4}

Level II abortion facilities shall be required to meet minimum standards for abortion facilities as established by this agency.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 44.2.5** The following shall be codified as Section 41-75-16, Mississippi Code of 1972: 41-75-16 {#sec-16-44.2.5 omnilex-key=us-ms-regs-official--title-15--16#44.2.5}

Any abortion facility which is in operation at the time of promulgation of any applicable rules or regulations or minimum standards under this chapter shall be given a reasonable time, under the particular circumstances not to exceed six (6) months from the date such are duly adopted, within which to comply with such rules and regulations and minimal standards.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13 Subchapter 3 LICENSING Rule 44.3.1 Application and Annual Report. Application for a license or renewal of a license shall be made in writing to the Mississippi Department of Health on forms provided by the Department which shall contain such information as the Mississippi Department of Health may require. The application shall require reasonable, affirmative evidence of ability to comply with these rules, regulations, and minimum standards.*
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 44.3.2** Fee {#sec-16-44.3.2 omnilex-key=us-ms-regs-official--title-15--16#44.3.2}

In accordance with Section 41-7-209 Mississippi Code of 1972, as amended, each application for initial licensure shall be accompanied by a fee as set by the Mississippi State Board of Health, made payable to the Mississippi Department of Health, either by business check, money order, or electronic means. The fee shall not be refundable after a license has been issued.

**History**
- *SOURCE: Miss. Code Ann. § 41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 44.3.3** Renewal {#sec-16-44.3.3 omnilex-key=us-ms-regs-official--title-15--16#44.3.3}

A license, unless suspended or revoked, shall be renewable annually upon payment of a renewal fee as set by the board which shall be paid to the Mississippi Department of Health, either by business check, money order, or electronic means, and upon filing by the licensee and approval by the Mississippi Department of Health of an annual report upon such uniform dates and containing such information in such form as the licensing agency requires. Each license shall be issued only for the premises and person or persons named in the application and shall not be transferable or assignable. Licenses shall be posted in a conspicuous place on the licensed premises. The fee shall not be refundable.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 44.3.4** Name {#sec-16-44.3.4 omnilex-key=us-ms-regs-official--title-15--16#44.3.4}

Every abortion facility designated by a permanent and distinctive name which shall be used in applying for a license and shall not be changes without first notifying the licensing agency in writing and receiving written approval of the change from the licensing agency. Such notice shall specify the name to be discontinued, as well as, the new name proposed. Only the official name by which the abortion facility is licensed shall be used in telephone listings, on

stationery, in advertising, etc. Two or more abortion facilities shall not be licensed under similar names in the same vicinity. No freestanding abortion facility shall include the word "hospital" in its name.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 44.3.5** Issuance of License {#sec-16-44.3.5 omnilex-key=us-ms-regs-official--title-15--16#44.3.5}

All licenses issued by the Mississippi Department of Health shall set forth the name of the abortion facility, the location, the name of the licensee and the license number.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 44.3.6** Separate License {#sec-16-44.3.6 omnilex-key=us-ms-regs-official--title-15--16#44.3.6}

A separate license shall be required for abortion facilities maintained on separate premises even though under the same management. However, separate licenses are not required for buildings, on the same ground, which are under the same management.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 44.3.7** Expiration of License {#sec-16-44.3.7 omnilex-key=us-ms-regs-official--title-15--16#44.3.7}

Each license shall expire on June 30, following the date of issuance.

**History**
- *SOURCE: Miss. Code Ann. § 41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 44.3.8** Denial or Revocation of License: Hearings and Review {#sec-16-44.3.8 omnilex-key=us-ms-regs-official--title-15--16#44.3.8}

The Mississippi Department of Health after notice and opportunity for a hearing to the applicant or licensee is authorized to deny, suspend, or revoke a license in any case in which it finds that there has been a substantial failure to comply with the requirements established under the law and these regulations. Section 6; 41-75-26.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 44.3.9** The following shall be codified as Section 41-75-26, Mississippi Code of 1972: 1 {#sec-16-44.3.9 omnilex-key=us-ms-regs-official--title-15--16#44.3.9}

Any person or persons or other entity or entities establishing, managing or operating an abortion facility or conducting the business of an abortion facility without the required license, or which otherwise violate any provision of this chapter regarding abortion facilities or the rules, regulations and standards promulgated in furtherance thereof shall be subject to revocation of the license of the abortion facility or non-licensure of the abortion facility. In addition, any violation of any provision of this chapter regarding abortion facilities or of the rules, regulations and standards promulgated in furtherance thereof by intent, fraud, deceit, unlawful design, willful and/or deliberate misrepresentation, or by careless, negligent or incautious disregard for such statutes or rules, regulations and standards, either by persons acting individually or in concert with others, shall constitute a misdemeanor and shall be punishable by a fine not to exceed One Thousand Dollars ($1,000) for each such offense. Each day of continuing

violation shall be considered a separate offense. The venue of persecution of any such violation shall be in any county of the state wherein any such violation, or portion thereof, occurred. 2. The Attorney General, upon certification by the executive director of the licensing agency, shall seek injunctive relief in a court of proper jurisdiction to prevent violations of the provisions of this chapter regarding abortion facilities or the rules, regulations and standards promulgated in furtherance thereof in cases where other administrative penalties and legal sanctions imposed have failed to prevent or cause a discontinuance of any such violation.

Subchapter 4 RIGHT OF APPEAL Rule 44.4.1 Provision for hearing and appeal following denial or revocation of license is as follows. 1. Administrative Decision. The Mississippi Department of Health will provide an opportunity for a fair hearing to every applicant or licensee who is dissatisfied with administrative decisions made in the denial or revocation of license. a. The licensing agency shall notify the applicant or licensee by registered mail or personal service the particular reasons for the proposed denial or revocation of license. Upon written request of applicant or licensee within ten (10) days of the date of notification, the licensing agency shall fix a date not less than thirty (30) days from the date of such service at which time the applicant or licensee shall be given an opportunity for a prompt and fair hearing. b. On the basis of such hearing or upon default of the applicant or licensee, the licensing agency shall make a determination specifying its findings of fact and conclusions of law. A copy of such determination shall be sent by registered mail to the last known address of applicant or licensee or served personally upon the applicant or licensee. c. The decision revoking, suspending, or denying the application or license shall become final thirty (30) days after it is so mailed or served unless the applicant or licensee, within such thirty (30) day period, appeals the decision to the Chancery Court in the county in which the facility is located, in the manner prescribed in SB2884, as amended. An additional period of time may be granted at the discretion of the licensing agency.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 44.4.2** Penalties {#sec-16-44.4.2 omnilex-key=us-ms-regs-official--title-15--16#44.4.2}

Any person or persons or other entity or entities establishing managing or operating an abortion facility or conducting the business of an abortion facility without the required license, or which otherwise violate any of the provisions of

this act or the Mississippi Department of Health, as amended, or the rules, regulations or standards promulgated in furtherance of any law in which the Mississippi Department of Health has authority therefore shall be subject to the penalties and sanctions of Section 41-7-209, Mississippi Code of 1972.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13 Subchapter 5 REPORTING REQUIREMENTS Rule 44.5.1 Reporting. Each abortion facility shall report monthly to the Mississippi Department of Health such information as may be required by the department in its rules and regulations for each abortion performed by such facility.*
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 44.5.2** Rule 44.5.2 {#sec-16-44.5.2 omnilex-key=us-ms-regs-official--title-15--16#44.5.2}

Abortion Complication Reporting A physician shall file a written report with the State Department of Health regarding each patient who comes under the physician's professional care and requires medical treatment or suffers death that the attending physician has a reasonable basis to believe is a primary, secondary, or tertiary result of an induced abortion. These reports shall be submitted within thirty (30) days of the discharge or death of the patient treated for the complication.

b. The particular medical risks associated with the particular abortion procedure to be employed including, when medically accurate the risks of infection, hemorrhage and breast cancer and the danger to subsequent pregnancies and infertility; c. The probable gestational age of the unborn fetus at the time the abortion is to be performed or induced; and d. The medical risks associated with carrying her fetus to term.

2. The woman is informed, by the physician of his agent orally and in person, at least twenty-four (24) hours before the abortion: a. That medical assistance benefits may be available for prenatal care, childbirth and neonatal care; b. That the father is liable to assist in the support of her child, even in instances which the father has offered to pay for the abortion; c. That there are available services provided by public and private agencies which provide pregnancy prevention counseling and medical referrals for obtaining pregnancy prevention medications or devices; and d. That she has the right to review the Informed Consent Information & Resources booklet. The physician or his agent shall orally inform the woman that these materials have been provided by the State of Mississippi and that they describe the unborn fetus and list agencies that offer alternatives to abortion. If the woman chooses to view the booklet, copies of them shall be furnished to her. The physician or his agent may disassociate himself or themselves from those materials, and may comment or refrain from comment on them as he chooses. The physician or his agency shall provide the woman with the "Informed Consent Information & Resource Booklet.” 3. The woman certifies in writing before the abortion that the information described in paragraphs (a) and (b) above has been furnished to her, and that she has been informed of her opportunity to review the Informed Consent Information and Resource booklet. Before the abortion is performed or induced, the physician who is to perform or induce the abortion receives a copy of the written certification prescribed by this section.

1. Before the performance of an abortion, as defined in Paragraph 105.01, the physician who is to perform the abortion, or a qualified person assisting the physician, shall: a. Perform fetal ultrasound imaging and auscultation of fetal heart tone services on the patient undergoing the abortion; b. Offer to provide the patient with an opportunity to view the active ultrasound image of the unborn child and hear the heartbeat of the unborn child if the heartbeat is audible; c. Offer to provide the patient with a physical picture of the ultrasound image of the unborn child;

d. Obtain the patient's signature on a certification form stating that the patient has been given the opportunity to view the active ultrasound image and hear the heartbeat of the unborn child if the heartbeat is audible, and that she has been offered a physical picture of the ultrasound image; and

2. Retain a copy of the signed certification form in the patient's medical record.

3. An ultrasound image must be of a quality consistent with standard medical practice in the community, shall contain the dimensions of the unborn child and shall accurately portray the presence of external members and internal organs, if present or viewable, of the unborn child.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13 Subchapter 6 CONSENTS REQUIRED Rule 44.6.1 Consents Required. No abortion shall be performed or induced except with the voluntary and informed consent of the woman upon whom the abortion is to be performed or induced. Except in the case of a medical emergency, consent to an abortion is voluntary and informed if and only if: 1. The woman is told the following by the physician who is to perform or induce the abortion or by the referring physician, orally and in person at least twenty-four (24) hours before the abortion: a. The name of the physician who will perform or induce the abortion;*
- *SOURCE: Miss. Code Ann. §41-75-13 Subchapter 7 PROCEDURES REQUIRED Rule 44.7.1 Procedures Required.*
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 44.7.2** Rule 44.7.2 Procedures Prohibited {#sec-16-44.7.2 omnilex-key=us-ms-regs-official--title-15--16#44.7.2}

It shall be unlawful for any person to purposely perform or attempt to perform a dismemberment abortion and thereby kill an unborn child unless necessary to prevent serious health risk to the unborn child’s mother.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 44.8.1** Subchapter 8 LEVEL II ABORTION FACILITY ADMINISTRATION: GOVERNING AUTHORITY {#sec-16-44.8.1 omnilex-key=us-ms-regs-official--title-15--16#44.8.1}

Each facility shall be under the ultimate responsibility and control of an identifiable governing body, person, or persons. 1. The facility's governing authority shall adopt bylaws, rules and regulations which shall: a. Specify by name the person to whom responsibility for operation and maintenance of the facility is delegated and methods established by the governing authority for holding such individuals responsible. b. Provide for at least annual meetings of the governing authority if the governing authority consists of two or more individuals. Minutes shall be maintained of such meetings. c. Require policies and procedures which includes provisions for administration and use of the facility, compliance, personnel, quality assurance, procurement of outside services and consultations, patient care policies and services offered. 2. When services such as dietary, laundry or therapy services are purchased from other the governing authority shall be responsible to assure the supplier(s) meets the same local and state standards the facility would have to meet if it were providing those services itself using its own staff.

3. The governing authority shall provide for the selection and appointment of the Medicaid and dental staff and the granting of clinical privileges and shall be responsible for the professional conduct of these persons.

1. The governing authority shall appoint a qualified person as chief executive officer or administrator of the facility to represent the governing authority and shall define his/her authority and duties in writing. He/she shall be responsible for the management of the facility, implementation of the policies of the governing authority and authorized and empowered to carry out the provisions of these regulations. 2. When there is a planned change in ownership or in the chief executive officer, the governing authority of the facility shall notify the Mississippi Department of Health. The chief executive officer shall be responsible for the preparation of written facility policies and procedures.

2. Written references and/or a record of verbal references. 3. Verification of all training and experience, and licensure, certification, registration, and/or renewals. 4. Initial and subsequent health clearances. 5. Record of orientation to the facility, its policies and procedures and the employee's position. 6. Personnel records shall be confidential. Representatives of the licensing agency conducting an inspection of the facility shall have the right to inspect personnel records.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13 Subchapter 9 ORGANIZATION AND STAFF Rule 44.9.1 Officer or Administrator.*
- *SOURCE: Miss. Code Ann. §41-75-13 Subchapter 10 PERSONNEL POLICIES AND PROCEDURES Rule 44.10.1 Personnel Records. A record of each employee should be maintained which includes the following to help provide quality assurance in the facility: 1. Application for employment.*
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 44.10.2** Health Examination {#sec-16-44.10.2 omnilex-key=us-ms-regs-official--title-15--16#44.10.2}

As a minimum, each employee shall have a pre- employment health examination by a physician. The examination is to be

repeated annually and more frequently if indicated to ascertain freedom from communicable diseases. The extent of the annual examinations shall be determined by a committee consisting of the medical director, administrator and director of nursing, and documentation of the health examination shall be included in the employee's personnel folder.

The medical staff bylaws, rules and regulations, and the rules and regulations of the governing authority shall require that patients are admitted to the facility only upon the recommendation of a licensed physician and that a licensed physician be responsible for diagnosis and all medical care and treatment. Physicians performing procedures in the licensed abortion facility must meet the requirements set forth in Rule 44.1.5.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13 Subchapter 11 MEDICAL STAFF ORGANIZATION Rule 44.11.1 Medical Staff. There shall be a single organized medical staff that has the overall responsibility for the quality of all clinical care provided to patients, and for the ethical conduct and professional practices of its members, as well as for accounting therefore to the governing authority. The manner in which the medical staff is organized shall be consistent with the facility's documented staff organization bylaws, rules and regulations, and pertain to the setting where the facility is located. The facility must comply with all state and federal laws and regulations, including, but not limited to, provisions of MS. Code Ann. §41-75-1.*
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 44.11.2** Professional Staff {#sec-16-44.11.2 omnilex-key=us-ms-regs-official--title-15--16#44.11.2}

Each facility shall have at all times a designated medical director who shall be a physician who shall be responsible for the direction and coordination of all medical aspects of facility programs. 1. There shall be a minimum of one licensed registered nurse per six patients (at any one time) at the clinic when patients are present. During times when procedures are actually being performed, there shall be a physician and a registered nurse present on the premises. 2. All facility personnel, medical and others, shall be licensed to perform the services they render when such services require licensure under the laws of the State of Mississippi. 3. Anesthetic agents shall be administered by an anesthesiologist, a physician, or a certified registered nurse anesthetist under the supervision of a board-qualified or certified anesthesiologist or operating physician, who is actually on the premises. After the administration of an anesthetic, patients shall be constantly attended by a M.D., D.O., R.N., or a L.P.N. supervised directly by a R.N., until reacted and able to summon aid.

4. All employees of the facility providing direct patient care shall be trained in emergency resuscitation at least annually.

2. Maintain his or her primary office location within 30 minutes travel time of the abortion facility. 3. Have full credentials to handle complications of abortions with the acute general hospital(s). 4. This transfer agreement is to be kept on site at the abortion facility subject to verification on demand by the Mississippi State Board of Health. The transfer agreement as well as the parties to the agreement or any information regarding the parties will be kept confidential by the Mississippi State Board of Health.

1. The governing authority shall develop written policies and procedures designed to enhance safety within the facility and on its grounds and minimize hazards to patients, staff, and visitors. 2. The policies and procedures shall include establishment of the following: a. Safety rules and practices pertaining to personnel, equipment, gases, liquids, drugs; b. Provisions for reporting and the investigation of accidental events regarding patients, visitors and personnel (incidents) and corrective action taken; c. Provision for dissemination of safety-related information to employees and users of the facility; and d. Provision for syringe and needle storage, handling and disposal.

Adequate housekeeping staff shall be employed to fulfill the above requirement.

1. An adequate supply of clean linen or disposable materials shall be maintained. 2. Provisions for proper laundering of linen and washable goods shall be made. Soiled and clean linen shall be handled and stored separately. 3. Sufficient supply of cloth or disposable towels shall be available so that a fresh towel can be used after each hand washing. Towels shall not be shared.

1. All parts of the facility, the premises, and equipment shall be kept clean and free of insects, rodents, litter, and rubbish. 2. All garbage and waste shall be collected, stored, and disposed of in a manner designed to prevent the transmission of disease. Containers shall be washed and sanitized before being returned to work areas. Disposable type containers shall not be reused. 3. Disposal of medical waste. “Infectious medical wastes” includes solid or liquid wastes which may contain pathogens with sufficient virulence and quantity such that exposure to the waste by a susceptible host has been proven to result in an infectious disease. For purposes of this Regulation, the following wastes shall be considered to be infectious medical wastes: a. Wastes resulting from the care of patients and animals who have Class I and/or II diseases that are transmitted by blood and body fluid as defined in the rules and regulations governing reportable diseases as defined in Rules 44.16.2 & 44.16.3.

b. Cultures and stocks of infectious agents: including specimen cultures collected from medical and pathological laboratories, cultures and stocks of infectious agents from research and industrial laboratories, wastes from biologicals, discarded live and attenuated vaccines, and culture dishes and devices used to transfer, inoculate and mix cultures; c. Blood and blood products such as serum, plasma and other blood components; d. Pathological wastes, such as tissues, organs, body parts and body fluids that are removed during surgery and autopsy; e. Contaminated carcasses, body parts and bedding of animals that were exposed to pathogens in medical research; f. All discarded sharps (e.g., hypodermic needles, syringes, Pasteur pipettes, broken glass, scalpel blades) which have come into contact with infectious agents; g. Other wastes determined infectious by the generator or so classified by the Department of Health. h. “Medical Waste” means all waste generated in direct patient care or in diagnostic or research areas that is non-infectious but aesthetically repugnant if found in the environment.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13 Subchapter 12 PATIENT TRANSFER Rule 44.12.1 Transfer Agreement. The abortion facility shall have a written agreement with one or more physicians for the express purpose of ensuring that patients who have complications will be immediately transferred to the physician’s care. The physician who enters the written agreement with the abortion facility shall: 1. Have full admitting privileges with one or more acute general hospitals that shall be located within 30 minutes travel time of the abortion facility.*
- *SOURCE: Miss. Code Ann. §41-75-13 Subchapter 13 SAFETY Rule 44.13.1 Written Policies and Procedures.*
- *SOURCE: Miss. Code Ann. §41-75-13 Subchapter 14 HOUSEKEEPING Rule 44.14.1 Cleaning. The abortion suite shall be appropriately cleaned in accordance with established written procedures after each operation. Holding rooms shall be maintained in a clean condition.*
- *SOURCE: Miss. Code Ann. §41-75-13 Subchapter 15 LINEN AND LAUNDRY Rule 44.15.1 Linen and Laundry Supply.*
- *SOURCE: Miss. Code Ann. §41-75-13 Subchapter 16 SANITATION Rule 44.16.1 Facility Sanitation.*
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 44.16.2** Class I Diseases - Immediate Report: 1 {#sec-16-44.16.2 omnilex-key=us-ms-regs-official--title-15--16#44.16.2}

Any suspected outbreak (including food borne outbreaks) 2. Anthrax (in man) Plague Botulism Poliomyelitis Cholera Rabies (human or animal) Dengue Syphilis Diphtheria Trichinosis Encephalitis Tuberculosis (active) Hepatitis A Typhoid HIV infection, including AIDS Yellow Fever Measles Meningitis or other Invasive Disease due to: Any case of rare or exotic Neisseria meningitides communicable disease Hemophilus influenza

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 44.16.3** Class II Diseases - Report within one Week: 1 {#sec-16-44.16.3 omnilex-key=us-ms-regs-official--title-15--16#44.16.3}

Actinomycosis 2. Acute Rheumatic Fever 3. Amebiasis 4. Ascariasis

5. Blastomycosis 6. Brucellosis 7. Coccidioidomycosis 8. Congenital Rubella Syndrome 9. Cryptococcoses 10. Gonorrhea 11. Hansen's Disease (Leprosy) 12. Helicobacter (Campylobacter) Infection 13. Hepatitis B 14. Hepatitis non-A, non-B 15. Hepatitis, unspecified 16. Histoplasmosis 17. HookwormHydatidosis 18. Legionellosis 19. Leptospirosis 20. Lyme Borreliosis 21. Malaria 22. Meningitis other than 23. Meningococcal or 24. Hemophilus influenza 25. Mumps 26. Pertussis 27. Poisoning 28. Psittacosis 29. Q Fever

30. Relapsing Fever 31. Reye Syndrome 32. Rocky Mountain Spotted Fever 33. Salmonellosis 34. Shigellosis 35. Taeniasis 36. Tetanus 37. Toxoplasmosis 38. Tularemia 39. Typhus Fever 40. Vibrio Infection other than 41. Cholera 42. Viral Encephalitis in Horses

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 44.16.4** Rule 44.16.4 {#sec-16-44.16.4 omnilex-key=us-ms-regs-official--title-15--16#44.16.4}

Medical Waste Management Plan All generators of infectious medical waste and medical waste shall have a medical waste management plan that shall include, but is not limited to the following: 1. Storage and Containment of Infectious Medical Waste and Medical Waste a. Containment of infectious medical waste and medical waste shall be in a manner and location which affords protection from animals, rain and wind, does not provide a breeding place or a food source for insects and rodents, and minimizes exposure to the public. b. Infectious medical waste shall be segregated from other waste at the point of origin in the producing facility. c. Unless approved by the Mississippi Department of Health or treated and rendered non-infectious, infectious medical waste (except for sharps in approved containers) shall not be stored at a waste producing facility for more than seven (7) days above a temperature of 6º C (38º F). Containment of infectious medical waste at the producing facility is permitted at or below a temperature of 0º C (32º F) for a period of not more than ninety (90) days without specific approval of the Department of Health.

d. Containment of infectious medical waste shall be separate from other wastes. Enclosures or containers used for containment of infectious medical waste shall be so secured so as to discourage access by unauthorized persons and shall be marked with prominent warning signs on, or adjacent to, the exterior of entry doors, gates, or lids. Each container shall be prominently labeled with a sign using language to be determined by the Department and legible during daylight hours. e. Infectious medical waste, except for sharps capable of puncturing or cutting, shall be contained in double disposable plastic bags or single bags (1.5 mills thick) which are impervious to moisture and have strength sufficient to preclude ripping, tearing, or bursting under normal conditions of usage. The bags shall be securely tied so as to prevent leakage or expulsion of solid or liquid wasted during storage, handling, or transport. f. All sharps shall be contained for disposal in leak proof, rigid, puncture-resistant containers which are taped closed or tightly lidded to preclude loss of the contents. g. All bags used for containment and disposal of infectious medical waste shall be of a distinctive color or display the Universal Symbol for infectious waste. Rigid containers of all sharps waste shall be labeled. h. Compactors or grinders shall not be used to process infectious medical waste unless the waste has been rendered non-infectious. Sharps containers shall not be subject to compaction by any compacting device except in the institution itself and shall not be placed for storage or transport in a portable or mobile trash compactor. i. Infectious medical waste and medical waste contained in disposable containers as prescribed above shall be placed for storage, handling, or transport in disposable or reusable pails, cartons, drums, or portable bins. The containment system shall be leak proof, have tight-fitting covers and be kept clean and in good repair. j. Reusable containers for infectious medical waste and medical waste shall be thoroughly washed and decontaminated each time they are emptied by a method specified by the Mississippi Department of Health, unless the surfaces of the containers have been protected from contamination by disposable liners, bags, or other devices removed with the waste, as outlined in I.E. 2. Approved methods of decontamination include, but are not limited to, agitation to remove visible soil combined with one or more of the following procedures: a. Exposure to hot water at least 180º F for a minimum of 15 seconds. b. Exposure to a chemical sanitizer by rinsing with or immersion in one of the following for a minimum of 3 minutes:

i. Hypochlorite solution (500-ppm available chlorine). ii. Phenolic solution (500-ppm active agent). iii. Iodoform solution (100-ppm available iodine). iv. Quaternary ammonium solution (400-ppm active agent). 3. Reusable pails, drums, or bins used for containment of infectious waste shall not be used for containment of waste to be disposed of as non-infectious waste or for other purposes except after being decontaminated by procedures as described in part (j) of this section. a. Trash chutes shall not be used to transfer infectious medical waste. b. Once treated and rendered non-infectious, previously defined infectious medical waste shall be classified as medical waste and may be landfilled in an approved landfill. 4. Treatment or disposal of infectious medical waste shall be by one of the following methods: a. By incineration in an approved incinerator which provides combustion of the waste to carbonized or mineralized ash. b. By sterilization by heating in a steam sterilizer, so as to render the waste noninfectious. Infectious medical waste so rendered non-infectious shall be disposable as medical waste. Operating procedures for steam sterilizers shall include, but not be limited to the following: i. Adoption of standard written operating procedures for each steam sterilizer including time, temperature, pressure, type of waste, type of container(s), closure on container(s), pattern of loading, water content, and maximum load quantity. ii. Check or recording and/or indicating thermometers during each complete cycle to ensure the attainment of a temperature of 121º C (250º F) for one half hour or longer, depending on quantity and density of the load, in order to achieve sterilization of the entire load. Thermometers shall be checked for calibration at least annually. iii. Use of heat sensitive tape or other device for each container that is processed to indicate the attainment of adequate sterilization conditions. iv. Use of the biological indicator Bacillus stearothermophilus placed at the center of a load processed under standard operating conditions at least monthly to confirm the attainment of adequate sterilization conditions.

v. Maintenance of records of procedures specified in (1), (2), (3) and (4) above for period of not less than a year. c. By discharge to the approved sewerage system if the waste is liquid or semi- liquid, except as prohibited by the Department of Health. d. Recognizable human anatomical remains shall be deposed of by incineration or internment, unless burial at an approved landfilled is specifically authorized by the Mississippi Department of Health. e. Chemical sterilization shall use only those chemical sterilants recognized by the U.S. Environmental Protection Agency, Office of Pesticides and Toxic Substances. Ethylene oxide, glutaraldehyde, and hydrogen peroxide are examples of sterilants that, used in accordance with manufacturer recommendation, will render infectious waste non-infectious. Testing with Bacillus subtilis spores or other equivalent organisms shall be conducted quarterly to ensure the sterilization effectiveness of gas or steam treatment. 5. Treatment and disposal of medical waste which is not infectious shall be by one of the following methods: a. By incineration in an approved incinerator which provides combustion of the waste to carbonized or mineralized ash. b. By sanitary landfill, in an approved landfill which shall mean a disposal facility or part of a facility where medical waste is placed in or on land and which is not a treatment facility. c. All the requirements of these standards shall apply, without regard to the quantity of medical waste generated per month, to any generator of medical waste.

1. The facility shall have a posted plan for evacuation of patients, staff, and visitors in case of fire or other emergency.

2. Fire drills: a. At least one drill shall be held every three months for every employee to familiarize employees with the drill procedure. Reports of the drills shall be maintained with records of attendance. b. Upon identification of procedural problems with regard to the drills, records shall show that corrective action has been taken. c. There shall be an ongoing training program for all personnel concerning aspects of fire safety and the disaster plan.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13 Subchapter 17 PREVENTIVE MAINTENANCE Rule 44.17.1 Preventive Maintenance. A schedule of preventive maintenance shall be developed for all of the surgical equipment in the surgical suite to assure satisfactory operation when needed.*
- *SOURCE: Miss. Code Ann. §41-75-13 Subchapter 18 DISASTER PREPAREDNESS Rule 44.18.1 Evacuation.*
- *SOURCE: Miss. Code Ann. §41-75-13 Subchapter 19 MEDICAL RECORD SERVICES Rule 44.19.1 Medical Record System. A medical record is maintained in accordance with accepted professional principles for every patient admitted and treated in the facility.*
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 44.19.2** Facilities {#sec-16-44.19.2 omnilex-key=us-ms-regs-official--title-15--16#44.19.2}

A room or area shall be designated within the facility for medical records.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 44.19.3** Ownership {#sec-16-44.19.3 omnilex-key=us-ms-regs-official--title-15--16#44.19.3}

Medical records shall be the property of the facility and shall not be removed except by subpoena or court order. These records shall be protected against loss, destruction and unauthorized use.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 44.19.4** Preservation of Records {#sec-16-44.19.4 omnilex-key=us-ms-regs-official--title-15--16#44.19.4}

Each patient's medical record shall include at least the following information: 1. Patient identification, including the patient's full name, sex, address, date of birth, next of kin, and patient number. 2. Admitting diagnosis. 3. Preoperative history and physical examination pertaining to the procedure to be performed. 4. Anesthesia reports. 5. Procedure report.

6. Pertinent laboratory and pathology reports as indicated and tests for RH Negative factor. A pregnancy test or pathological exam of tissue shall be recorded to verify pregnancy. 7. Preoperative and postoperative orders. 8. Discharge note and discharge diagnosis. 9. Informed consent. 10. Nurses' notes: a. Admission and preoperative. b. Recovery and discharge.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 44.19.5** Completion of Medical Records {#sec-16-44.19.5 omnilex-key=us-ms-regs-official--title-15--16#44.19.5}

All medical records shall be completed promptly. Indexes. All medical records should be properly indexed.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13 Subchapter 20 LEVEL II ABORTION FACILITY PATIENT CARE : NURSING SERVICE Rule 44.20.1 Nursing Staff. The abortion facility shall maintain an organized nursing staff to provide high quality nursing care for the needs of the patients and be responsible to the ambulatory surgical facility for the professional performance of its members. The abortion facility nursing service shall be under the direction of a legally and professionally qualified registered nurse. There shall be a sufficient number of duly licensed nurses on duty at all times to plan, and provide nursing care for the patient.*
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 44.20.2** The Nursing Supervisor {#sec-16-44.20.2 omnilex-key=us-ms-regs-official--title-15--16#44.20.2}

The nursing supervisor shall be a currently licensed Registered Professional Nurse.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 44.20.3** Staffing Pattern {#sec-16-44.20.3 omnilex-key=us-ms-regs-official--title-15--16#44.20.3}

The staffing pattern shall provide for sufficient nursing personnel and for adequate supervision and direction by a registered nurse(s) consistent with the size and complexity of the abortion facility.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 44.20.4** Nursing Care {#sec-16-44.20.4 omnilex-key=us-ms-regs-official--title-15--16#44.20.4}

A registered nurse must plan, supervise, and evaluate the nursing care of each patient from admission to discharge.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 44.20.5** Licensed Practical Nurse {#sec-16-44.20.5 omnilex-key=us-ms-regs-official--title-15--16#44.20.5}

Licensed practical nurses, who are currently licensed to practice within the state, as well as other ancillary nursing personnel, may be used to give nursing care that does not require the skill and judgment of a registered nurse. Their performance shall be supervised by one or more registered nurses.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 44.20.6** Policies and Procedures {#sec-16-44.20.6 omnilex-key=us-ms-regs-official--title-15--16#44.20.6}

Written nursing care and administrative policies and procedures shall be developed to provide the nursing staff with acceptable methods of meeting its responsibilities and achieving projected goals through realistic, attainable goals. 1. In planning, decision-making, and formulation of policies that affect the operation of nursing service, the nursing care of patients, or the patient's environment, the recommendations of representatives of nursing service shall be considered. 2. Nursing care policies and procedures shall be consistent with professionally recognized standards of nursing practice and shall be in accordance with Nurse Practice Act of the State of Mississippi and the Association of PeriOperative Registered Nurses (AORN) Standards of Practice. 3. Policies shall include statements relating to at least the following: a. Noting diagnostic and therapeutic orders. b. Assignment of preoperative and postoperative care of patients. c. Administration of medications. d. Charting of nursing personnel. e. Infection control. f. Patient and personnel safety. 4. Written copies of the procedure manual shall be available to the nursing staff in every nursing care unit and service area and to other services and departments in the ambulatory surgical facility. 5. The abortion facility nursing policies and procedures shall be developed, periodically reviewed, and revised as necessary.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13 Subchapter 21 SURGERY*

##### **15 Miss. Admin. Code Pt. 16, R. 44.21.1** Policies and Procedures {#sec-16-44.21.1 omnilex-key=us-ms-regs-official--title-15--16#44.21.1}

The abortion facility shall have effective policies and procedures regarding surgical privileges, maintenance of the operating rooms and evaluation of the clinic patient. 1. The abortion room register shall be complete and up-to-date. 2. There shall be a minor history and physical work-up in the chart of every patient prior to surgery plus documentation of a properly executed informed patient consent (by law). 3. There shall be adequate provision for immediate postoperative care. 4. An operative report describing techniques and findings shall be written or dictated immediately following surgery and signed by the surgeon. 5. A procedure shall exist in establishing a program for identifying and preventing infections, maintaining a sanitary environment, and reporting results to appropriate authorities. The operating surgeon shall be required to report back to the facility an infection for infection control follow-up. 6. The abortion rooms shall be supervised by an experienced registered professional nurse. 7. The following equipment shall be available to the abortion suite: emergency call system, oxygen, assistance equipment, including airways and manual breathing bag, sonography, emergency drugs and supplies specified by the medical staff. Personnel trained in the use of emergency equipment and in cardiopulmonary resuscitation must be available whenever there is a patient in the abortion facility. 8. Appropriate surgical attire will be worn in the abortion room. 9. Rules and regulations or policies related to the abortion room shall be available for abortion facility personnel and physicians.

1. A preoperative evaluation of the patient within 24 hours of surgery shall be done by a physician to determine the risk or anesthesia and of the procedure to be performed.

2. Before discharge from the abortion facility, each patient shall be evaluated by the physician for proper anesthesia recovery and discharged in the company of a responsible adult unless otherwise specified by the physician. 3. Anesthetic agents shall be administered by only a physician qualified to administer anesthetic agents or a Certified Registered Nurse Anesthetist (CRNA). 4. The operating physician shall be responsible for all anesthetic agents administered in the abortion facility. 5. The professional staff shall assume the responsibility of establishing general policies and supervising the administration of anesthetic agents. 6. Safety precautions shall be in accordance with N.F.P.A. Bulletin 56-A, 1981.

1. An infection committee, or comparable arrangement, composed of physician, Registered Nurse and Administrator, shall be established and shall be responsible for investigating, controlling, and preventing infections in the abortion facility. 2. There shall be written procedures to govern the use of aseptic techniques and procedures in all areas of the abortion facility. 3. Continuing education shall be provided to all abortion facility personnel on causes, effects, transmission, prevention, and elimination of infection on an annual basis.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13 Subchapter 22 ANESTHESIA Rule 44.22.1 Policies and Procedures. The clinic shall have effective policies and procedures regarding staff privileges, the administration of anesthetics, and the maintenance of strict safety control.*
- *SOURCE: Miss. Code Ann. §41-75-13 Subchapter 23 SANITARY ENVIRONMENT Rule 44.23.1 Environment. The abortion facility shall provide a safe and sanitary environment, properly constructed, equipped, and maintained to protect the health and safety of patients.*
- *SOURCE: Miss. Code Ann. §41-75-13 Subchapter 24 CENTRAL STERILE SUPPLY Rule 44.24.1 Sterilization. Policies and procedures shall be maintained for method of control used in relation to the sterilization of supplies and water and a written policy requiring sterile supplies to be reprocessed at specific time periods.*
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 44.25.1** Administering Drugs and Medicines {#sec-16-44.25.1 omnilex-key=us-ms-regs-official--title-15--16#44.25.1}

Drugs and medicines shall not be administered to patients unless ordered by a physician duly licensed to prescribe drugs. Such orders shall be in writing and signed personally by the physician who prescribes the drug or medicine.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 44.25.2** Medicine Storage {#sec-16-44.25.2 omnilex-key=us-ms-regs-official--title-15--16#44.25.2}

Medicines and drugs maintained on the nursing unit for daily administration shall be properly stored and safeguarded in enclosures of sufficient size, and which are not accessible to unauthorized persons. Only authorized personnel shall have access to storage enclosures.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 44.25.3** Safety {#sec-16-44.25.3 omnilex-key=us-ms-regs-official--title-15--16#44.25.3}

Pharmacies and drug rooms shall be provided with safeguards to prevent entrance of unauthorized persons, including bars on accessible windows and locks on doors. Controlled drugs shall be stored in a securely constructed room or cabinet, in accordance with applicable federal and state laws.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 44.25.4** Narcotic Permit {#sec-16-44.25.4 omnilex-key=us-ms-regs-official--title-15--16#44.25.4}

An in-house pharmacy shall procure a state controlled drug permit if a stock of controlled drugs is to be maintained. The permit shall be displayed in a prominent location.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 44.25.5** Records {#sec-16-44.25.5 omnilex-key=us-ms-regs-official--title-15--16#44.25.5}

Records shall be kept of all stock supplies of controlled substances giving an accounting of all items received and/or administered.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 44.25.6** Medication Orders {#sec-16-44.25.6 omnilex-key=us-ms-regs-official--title-15--16#44.25.6}

All oral or telephone orders for medications shall be received by a registered nurse, a physician or registered pharmacist and shall be reduced to writing on the physician's order record reflecting the prescribing physician and the name and title of the person who wrote the order. Telephone or oral orders shall be signed by the prescribing physician within 48 hours. The use of standing orders will be according to written policy.

When the controlled substance is dispensed, the following information shall be recorded into the Controlled Substance (proof-of-use) Record. 1. Signature of pharmacist dispensing the controlled substance. 2. Signature of designated licensed person receiving the controlled substance. 3. The date and time controlled substance is dispensed. 4. The name, the strength, and quantity of controlled substance dispensed. 5. The serial number assigned to that particular record, which corresponds to same number recorded in the pharmacy's dispensing record.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13 Subchapter 26 CONTROLLED SUBSTANCES: ANESTHETIZING AREAS: Rule 44.26.1 Dispensing Controlled Substances. All controlled substances shall be dispensed to the responsible person (nursing supervisor), designated to handle controlled substances in the abortion room by a registered pharmacist in the abortion facility.*
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 44.26.2** Security/Storage of Controlled Substances {#sec-16-44.26.2 omnilex-key=us-ms-regs-official--title-15--16#44.26.2}

When not in use, all controlled substances shall be maintained in a securely locked, substantially constructed cabinet or area. All controlled substance storage cabinets shall be permanently affixed. Controlled substances removed from the controlled substance cabinet shall not be left unattended.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 44.26.3** Controlled Substance Administration Accountability {#sec-16-44.26.3 omnilex-key=us-ms-regs-official--title-15--16#44.26.3}

The administration of all controlled substances to patients shall be carefully recorded into the anesthesia record. The following information shall be transferred from the anesthesia record to the controlled substance record by the administering practitioner during the shift in which the controlled substance was administered. 1. The patient's name. 2. The name of the controlled substance and the dosage administered. 3. The date and time the controlled substance is administered. 4. The signature of the practitioner administering the controlled substance. 5. The wastage of any controlled substance. 6. The balance of controlled substances remaining after the administration of any quantity of the controlled substance. 7. Day-ending or shift-ending verification of count of balances of controlled substances remaining, and controlled substances administered shall be accomplished by two (2) designated licensed persons whose signatures shall be affixed to a permanent record.

Subchapter 27 LABORATORY SERVICES Rule 44.27.1 Laboratory Services. The facility may either provide a clinical laboratory or make contractual arrangements with an approved outside laboratory to perform services commensurate with the needs of the facility.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 44.27.2** Qualifications of Outside Laboratory {#sec-16-44.27.2 omnilex-key=us-ms-regs-official--title-15--16#44.27.2}

An approved outside laboratory may be defined as a freestanding independent laboratory or a hospital-based laboratory which in either case has been appropriately certified or meets equivalent standards as a provider under the prevailing regulations of 42 CFR Part 493, Clinical Laboratory Improvement Amendment, 1988.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 44.27.3** Agreements {#sec-16-44.27.3 omnilex-key=us-ms-regs-official--title-15--16#44.27.3}

Such contractual arrangements shall be deemed as meeting the requirements of this section so long as those arrangements contain written policies, procedures and individual chart documentation to disclose that the policies of the facility are met and the needs of the patients are being provided. Written original reports shall be a part of the patient's chart.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 44.27.4** In-House Laboratories {#sec-16-44.27.4 omnilex-key=us-ms-regs-official--title-15--16#44.27.4}

1. In-house laboratories shall be well organized and properly supervised by qualified personnel. 2. The laboratory will be of sufficient size and adequately equipped to perform the necessary services of the facility. 3. Provisions shall be made for preventive maintenance and an acceptable quality control program covering all types of analyses performed by the laboratory. Documentation will be maintained. 4. Written policies and procedures shall be developed and approved for all services provided by the laboratory. 5. When tissue removed in surgery is examined by a pathologist, either macroscopically or microscopically, as determined by the treating physician and the pathologist, the pathology report shall be made a part of the patient's record. 6. Arrangements shall be made for immediate pathological examinations, when appropriate. 7. The laboratory must provide pathologists' services, as necessary.

1. Examination Room(s). Rooms for examination shall have a minimum floor area of 80 square feet, excluding vestibules, toilets, and closets. Room arrangement should permit at least 2 feet 8 inches clearance at each side and at the foot of the examination table. A hand-washing fixture shall be provided. 2. Procedure Room. Procedure rooms shall have a minimum floor area of 120 square feet, excluding vestibule, toilet, and closets. The minimum room dimension shall be 10 feet. A scrub sink with knee, elbow, wrist, or foot control, soap dispenser, and single service towel dispenser will be available. All finishes shall be capable of repeated cleaning. 3. Recovery Room. One or more recovery rooms containing sufficient beds for recovering patient shall be provided. Reclining type vinyl upholstered chairs may be substituted in lieu of beds. Direct visual observation of the patients shall be possible from a central vantage point, yet patients shall have a reasonable amount of privacy. 4. Clean Workroom. A clean workroom shall be provided sufficient in size to process and store clean and sterile supply material and equipment, and must contain a work counter and sink. A system for sterilizing equipment shall be provided. Sterilizing procedures may be done on or off site, or disposables may be used to satisfy functional needs. 5. Soiled Workroom. A separate soiled workroom is not required; however, facilities shall be provided for closed clean storage which prevents contamination by soiled materials and for storage and handling of soiled linens and other soiled materials. 6. Toilets. At least one toilet and lavatory with soap dispenser and towel dispenser shall be provided in the recovery room area. Recovering patients shall have easy access to toilet facilities. Toilet facilities shall be provided at no less than one water closet and lavatory per ten recovery beds. 7. Housekeeping Room. At least one housekeeping room or closet shall be provided. It shall contain a service sink and storage for housekeeping supplies and equipment. 8. The examination room, procedure room, and recovery room may be combined, provided that the combined room meets the requirements of Paragraphs 1, 2 and 3.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13 Subchapter 28 LEVEL II ABORTION FACILITY ENVIRONMENT : PATIENT AREAS Rule 44.28.1 Treatment Facilities.*
- *SOURCE: Miss. Code Ann. §41-75-13 Subchapter 29 General Service Facilities Rule 44.29.1 Admission Office. There shall be a room designated as the admission office where patients may discuss personal matters in private. The admission office may be combined with the business office and medical record room if privacy can be maintained when confidential matters are being discussed. This space shall be separated from the treatment area by walls and partitions.*
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 44.29.2** Waiting Room {#sec-16-44.29.2 omnilex-key=us-ms-regs-official--title-15--16#44.29.2}

A waiting room in the administrative section shall be provided with sufficient seating for the maximum number of persons that may be waiting at any time. Public toilets/public telephones and drinking fountains, accessible to individuals with disabilities shall be available.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13 Subchapter 30 Plan And Specifications Rule 44.30.1 New Construction, Additions, and Major Alterations. When construction is contemplated, either for new buildings, conversions, additions, or major alterations to existing buildings, or portions of buildings coming within the scope of these rules, plans and specifications shall be submitted for review and approval to the Mississippi Department of Health.*
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 44.30.2** Minor Alterations and Remodeling {#sec-16-44.30.2 omnilex-key=us-ms-regs-official--title-15--16#44.30.2}

Minor alterations and remodeling which do not affect the structural integrity of the building, which do not change functional operation, which do not affect fire safety, and which do not add beds or facilities over those for which the surgical facility is licensed need not be submitted for approval.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 44.30.3** Water Supply, Plumbing, and Drainage {#sec-16-44.30.3 omnilex-key=us-ms-regs-official--title-15--16#44.30.3}

No system of water supply, plumbing, sewerage, garbage, or refuse disposal shall be installed, nor any such existing system materially altered or extended until complete plans and specifications for the installation, alteration, or extension have been submitted to the Mississippi Department of Health for review and approval.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 44.30.4** First Stage Submission - Preliminary Plans {#sec-16-44.30.4 omnilex-key=us-ms-regs-official--title-15--16#44.30.4}

1. First stage or preliminary plans shall include the following:

a. Plot plans showing size and shape of entire site, location of proposed building and any existing structures, adjacent streets, highways, sidewalks, railroad, etc., all properly designated; size, characteristics, and location of all existing public utilities. b. Floor plans showing overall dimensions of buildings; location, size and purpose of all rooms; location and size of all doors, windows, and other openings with swing of doors properly indicated; and location of stairs, elevators, dumbwaiters, vertical shafts, and chimneys. c. Outline specifications listing the kind and type of materials. 2. Approval of preliminary plans and specifications shall be obtained from the Mississippi Department of Health prior to starting final working drawings and specifications.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 44.30.5** Final Stage Submission - Working Drawings and Specifications {#sec-16-44.30.5 omnilex-key=us-ms-regs-official--title-15--16#44.30.5}

1. Final stage or working drawings and specifications shall include the following: a. Architectural drawings. b. Structural drawings. c. Mechanical drawings to include plumbing, heating, and air conditioning. d. Electrical drawings. e. Detailed specifications. 2. Approval of working drawings and specifications shall be obtained from the Mississippi Department of Health prior to beginning actual construction.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 44.30.6** Preparation of Plans and Specifications {#sec-16-44.30.6 omnilex-key=us-ms-regs-official--title-15--16#44.30.6}

The preparation of drawings and specifications shall be executed by or be under the immediate supervision of an architect registered in the State of Mississippi.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 44.30.7** Contract Modifications {#sec-16-44.30.7 omnilex-key=us-ms-regs-official--title-15--16#44.30.7}

Any contract modification which affects or changes the function, design, or purpose of a facility shall be submitted to and approved by the Mississippi Department of Health prior to beginning work set forth in any contract modification.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 44.30.8** Inspections {#sec-16-44.30.8 omnilex-key=us-ms-regs-official--title-15--16#44.30.8}

The Mississippi Department of Health and its authorized representative shall have access to the work for inspection whenever it is in preparation or progress.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13 Subchapter 31 GENERAL Rule 44.31.1 Location. The abortion facility shall be located in an attractive setting with sufficient parking space provided, with provisions for meeting the needs of the individuals with disabilities. The facility shall be located within 30 minutes travel time from a hospital which has an emergency room and shall not be located within one thousand five hundred (1,500) feet from the property on which any church, school or kindergarten is located. Site approval by the licensing agency must be secured before construction begins.*
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 44.31.2** Local Restriction {#sec-16-44.31.2 omnilex-key=us-ms-regs-official--title-15--16#44.31.2}

The abortion facility shall comply with local zoning, building, and fire ordinances. In additional, ambulatory surgical facilities shall comply with all applicable state and federal laws.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 44.31.3** Structural Soundness {#sec-16-44.31.3 omnilex-key=us-ms-regs-official--title-15--16#44.31.3}

The building shall be structurally sound, free from leaks and excessive moisture, in good repair, and painted at intervals to be reasonably attractive inside and out.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 44.31.4** Fire Extinguisher {#sec-16-44.31.4 omnilex-key=us-ms-regs-official--title-15--16#44.31.4}

An all purpose fire extinguisher shall be provided at each exit and special hazard areas, and located so a person would not have to travel more than 75 feet to reach an extinguisher.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 44.31.5** Rule 44.31.5 {#sec-16-44.31.5 omnilex-key=us-ms-regs-official--title-15--16#44.31.5}

Fire extinguishers shall be of a type approved by the local fire department or State Fire Marshall and shall be inspected at least annually. An attached tag shall bear the initials or name of the inspector and the date inspected.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 44.31.6** Ventilation {#sec-16-44.31.6 omnilex-key=us-ms-regs-official--title-15--16#44.31.6}

The building shall be properly ventilated at all times with a comfortable temperature maintained.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 44.31.7** Garbage Disposal {#sec-16-44.31.7 omnilex-key=us-ms-regs-official--title-15--16#44.31.7}

Space and facilities shall be provided for the sanitary storage and disposal of waste by incineration, containerization, removal, or by a combination of these techniques. Infectious waste materials shall be rendered noninfectious on the premises by appropriate measures.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 44.31.8** Elevators {#sec-16-44.31.8 omnilex-key=us-ms-regs-official--title-15--16#44.31.8}

Multi-story facilities shall be equipped with at least one automatic elevator of a size sufficient to carry a patient on a stretcher.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 44.31.9** Multi-Story Building {#sec-16-44.31.9 omnilex-key=us-ms-regs-official--title-15--16#44.31.9}

All multi-story facilities shall be of fire resistive construction in accordance with N.F.P.A. 220, Standards Types of Building Construction. If the facility is part of a series of buildings, it shall be separated by firewalls.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 44.31.10** Doors {#sec-16-44.31.10 omnilex-key=us-ms-regs-official--title-15--16#44.31.10}

Minimum width of all doors shall be 3 feet.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 44.31.11** Corridors {#sec-16-44.31.11 omnilex-key=us-ms-regs-official--title-15--16#44.31.11}

Minimum public corridor with shall be 5 feet. Work corridors less than 6 feet in length may be 4 feet wide. Source:

**History**
- *SOURCE: Miss. Code Ann. § 41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 44.31.12** Occupancy {#sec-16-44.31.12 omnilex-key=us-ms-regs-official--title-15--16#44.31.12}

No part of an abortion facility may be rented, leased, or used for any commercial purpose, or for any purpose not necessary or in conjunction with the operation of the facility. Food and drink machines may be maintained or a diet kitchen provided.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 44.31.13** Lighting {#sec-16-44.31.13 omnilex-key=us-ms-regs-official--title-15--16#44.31.13}

All areas of the facility shall have sufficient artificial lighting to prevent accidents and provide proper illumination for all services.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 44.31.14** Emergency Lighting {#sec-16-44.31.14 omnilex-key=us-ms-regs-official--title-15--16#44.31.14}

Emergency lighting systems shall be provided to adequately light corridors, operating rooms, exit signs, stairways, and lights on each exit sign at each exit in case of electrical power failure.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 44.31.15** Exits {#sec-16-44.31.15 omnilex-key=us-ms-regs-official--title-15--16#44.31.15}

Each floor of a facility shall have two or more exit ways remote from each other, leading directly to the outside or to a two-hour fire resistive passage to the outside. Exits shall be so located that the maximum distance from any point in a

floor area, room, or space to an exit doorway shall not exceed 100 feet except that when a sprinkler system is installed the distance of travel shall not exceed 150 feet.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 44.31.16** Exit Doors {#sec-16-44.31.16 omnilex-key=us-ms-regs-official--title-15--16#44.31.16}

Exit doors shall be a minimum of 3 feet wide, shall swing in the direction of egress, and shall not obstruct the travel along any required fire exit.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 44.31.17** Exit Signs {#sec-16-44.31.17 omnilex-key=us-ms-regs-official--title-15--16#44.31.17}

Exits shall be equipped with approved illuminated signs bearing the word "Exit" in letters at least 42 inches high. Exit signs shall be placed in corridors and passageways to indicate the direction of exit.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 44.31.18** Interior Finish and Decorative Materials {#sec-16-44.31.18 omnilex-key=us-ms-regs-official--title-15--16#44.31.18}

All combustible decorative and acoustical material to include wall paneling shall be as follows: 1. Materials on wall and ceiling in corridors and rooms occupied by four or more persons shall carry a flame spread rating of 25 or less and a smoke density rating of 450 or less in accordance with ASTM E-84. 2. Rooms occupied by less than four persons shall have a flame spread rating of 75 or less and a smoke density rating of 450 or less in accordance with ASTM E-84.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 44.31.19** Floors {#sec-16-44.31.19 omnilex-key=us-ms-regs-official--title-15--16#44.31.19}

All floors in abortion suite and holding areas shall be smooth resilient tile and be free from cracks and finished so that they can be easily cleaned. All other floors shall be covered with hard tile resilient tile or carpet or the equivalent. Carpeting is prohibited as floor covering in abortion and holding areas.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 44.31.20** Carpet {#sec-16-44.31.20 omnilex-key=us-ms-regs-official--title-15--16#44.31.20}

Carpet assemblies (carpet and/or carpet and pad) shall carry a flame spread rating of 75 or less and smoke density rating of 450 or less in accordance with ASTM E-84, or shall conform with paragraph 6-5, N.F.P.A. 101, Life Safety Code, 1981.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 44.31.21** Curtains {#sec-16-44.31.21 omnilex-key=us-ms-regs-official--title-15--16#44.31.21}

All draperies and cubicle curtains shall be rendered and maintained flame retardant.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 44.31.22** Facilities for Individuals with Disabilities {#sec-16-44.31.22 omnilex-key=us-ms-regs-official--title-15--16#44.31.22}

The facility shall be accessible to individuals with disabilities and shall comply with A.N.S.I. 117.1, "Making Buildings and Facilities Accessible and Usable by Individuals with Disabilities.”

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 44.31.23** Smoke Free Environment {#sec-16-44.31.23 omnilex-key=us-ms-regs-official--title-15--16#44.31.23}

NO SMOKING of tobacco products will be allowed within the abortion facility.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 44.31.24** Ceiling {#sec-16-44.31.24 omnilex-key=us-ms-regs-official--title-15--16#44.31.24}

The minimum ceiling height shall be 7 feet 8 inches.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 44.31.25** Facilities for Individuals with Disabilities {#sec-16-44.31.25 omnilex-key=us-ms-regs-official--title-15--16#44.31.25}

The facility shall comply with the Americans with Disabilities Act Accessibility Guidelines.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 44.31.26** Wheelchair Storage {#sec-16-44.31.26 omnilex-key=us-ms-regs-official--title-15--16#44.31.26}

The facility shall provide space for the storage of wheelchairs and such storage space shall be out of the direct line of traffic.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13*

##### **15 Miss. Admin. Code Pt. 16, R. 44.31.27** Disaster Preparedness Plan 1 {#sec-16-44.31.27 omnilex-key=us-ms-regs-official--title-15--16#44.31.27}

The facility shall maintain a written disaster preparedness plan that includes procedures to be followed in the event of fire, train derailment, explosions, severe weather, and other possible disasters as appropriate for the specific geographic location. The plan shall include: a. Written evidence that the plan has been reviewed and coordinated with the licensing agency’s local emergency response coordinator and the local emergency manager; b. Description of the facility’s chain of command during emergency management, including 24-hour contact information and the facility’s primary mode of emergency communication system; c. Written and signed agreements that describe how essential goods and services, such as water, electricity, fuel for generators, laundry, medications, medical equipment, and supplies, will be provided; d. Shelter or relocation arrangements, including transportation arrangements, in the event of evacuation; and e. Description of recovery, i.e., return of operations following an emergency.

2. The disaster preparedness plan shall be reviewed with new employees during orientation and at least annually. 3. Fire drills shall be conducted quarterly. Disaster drills shall be conducted at least annually.

2. Grant variances as it deems necessary for facilities existing prior to July 1, 1997. 3. Information obtained by the licensing agency through filed reports, inspection or as otherwise authorized, shall not be disclosed publicly in such a manner as to identify individuals or institutions, except in proceedings involving the questions of licensure. In proceedings involving questions of licensure, confidentiality of patient identifying information shall be maintained through redaction of any identifying information from records and the use of AJohn Doe@ or AJane Doe, @ etc., in the proceeding, the use of protective orders or placing appropriate parts of the file or any transcript of the proceeding under seal, or all of the above as may be appropriate, unless a written consent in waiver of confidentiality is executed. 4. The licensing agency shall reserve the right to review any and all records and reports of any abortion facility, as deemed necessary to determine compliance with these minimum standards of operation.

Aged or Infirm (hereinafter referred to as facility/ies). Upon adoption of these Rules, Regulations, and Minimum Standards for Institutions for the Aged or Infirm, any former rules, regulations and minimum standards, in conflict therewith, previously adopted by the licensing agency are hereby repealed.

**History**
- *SOURCE: Miss. Code Ann. §41-75-13 Subchapter 32 LEVEL II ABORTION FACILITY LICENSING AGENCY CONDITIONS Rule 44.32.2 Conditions which have not been covered in the standards shall be enforced in accordance with the best practices as interpreted by the licensing agency. The licensing agency reserves the right to: 1. Review the payroll records of each abortion facility for the purpose of verifying staffing patterns.*
- *SOURCE: Miss. Code Ann. §41-75-13 CHAPTER 45 MINIMUM STANDARDS FOR INSTITUTIONS FOR THE AGED OR INFIRM Subchapter 1 GENERAL NURSING HOMES: LEGAL AUTHORITY Rule 45.1.1 Adoption of Rules, Regulations, and Minimum Standards. By virtue of authority vested in it by Mississippi Code Annotated §43-11-1 through §43-11- 17, or as otherwise amended, the Mississippi State Department of Health (otherwise known as the licensing agency), does hereby adopt and promulgate the following Rules, Regulations, and Minimum Standards for Institutions for the*
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 45.1.2** Codes and Ordinances {#sec-16-45.1.2 omnilex-key=us-ms-regs-official--title-15--16#45.1.2}

Every facility located inside the boundaries of a municipality shall comply with all local municipal codes and ordinances applicable thereto. In addition, each facility shall comply with all applicable state and federal laws.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 45.1.3** Fire Safety {#sec-16-45.1.3 omnilex-key=us-ms-regs-official--title-15--16#45.1.3}

No facility may be licensed until it shows conformance to the safety regulations providing minimum standards for prevention and detection of fire as well as for protection of life and property against fire.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 45.1.4** Duty to Report {#sec-16-45.1.4 omnilex-key=us-ms-regs-official--title-15--16#45.1.4}

All fires, explosions, natural disasters as well as avoidable deaths or avoidable, serious, or life-threatening injuries to residents resulting from fires, explosions, and natural disasters shall be reported by telephone to the Life Safety Code Division of the licensing agency by the next working day after the occurrence. The licensing agency will provide the appropriate forms to the facility which shall be completed and returned within fifteen (15) calendar days of the occurrence. All reports shall be complete and thorough and shall record, at a minimum the causal factors, date and time of occurrence, exact location of occurrence within or without the facility, and attached thereto shall be all police, fire, or other official reports.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13 Subchapter 2 Definitions Rule 45.2.1 Administrator. The term "administrator" shall mean a person who is delegated the responsibility for the interpretation, implementation, and proper application of policies and programs established by the governing authority and are delegated responsibility for the establishment of safe and effective administrative management, control, and operation of the services provided. The administrator may be titled manager, superintendent, director, or otherwise. The administrator shall be duly licensed by the Mississippi State Board of Nursing Home Administrators.*
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 45.2.2** Bed Capacity {#sec-16-45.2.2 omnilex-key=us-ms-regs-official--title-15--16#45.2.2}

The term "bed capacity" shall mean the largest number which can be installed or set up in a facility at any given time for use of residents, as printed

on the certificate of licensure. The bed capacity shall be based upon space designed and/or specifically intended for such use whether or not the beds are actually installed or set up.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 45.2.3** Bed Count {#sec-16-45.2.3 omnilex-key=us-ms-regs-official--title-15--16#45.2.3}

The term "bed count" shall mean the number of beds that are actually installed or set up for residents in a facility at a given time.

**History**
- *SOURCE: Miss. Code Ann. §43-11-1*

##### **15 Miss. Admin. Code Pt. 16, R. 45.2.4** Change of Ownership {#sec-16-45.2.4 omnilex-key=us-ms-regs-official--title-15--16#45.2.4}

The term "change of ownership" includes, but is not limited to, intervivos gifts, purchases, transfers, leases, cash and/or stock transactions or other comparable arrangements whenever the person or entity acquires a majority interest (Fifty percent [50%] or more) of the facility or services. Changes of ownership from partnerships, single proprietorships or corporations to another form of ownership are specifically included. Provided, however, "Change of Ownership" shall not include inherited interest acquired as a result of a testamentary instrument or under the laws of descent and distribution of the State of Mississippi

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 45.2.5** Criminal History Record Checks {#sec-16-45.2.5 omnilex-key=us-ms-regs-official--title-15--16#45.2.5}

REPEALED. Effective 01.13.2023 Rule 45.2.6 Day Shift. The term “day shift” shall mean a minimum eight (8) hour period between 6:00 a.m. and 6:00 p.m.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 45.2.7** Dentist {#sec-16-45.2.7 omnilex-key=us-ms-regs-official--title-15--16#45.2.7}

The term "dentist" shall mean a person currently licensed to practice dentistry in Mississippi by the State Board of Dental Examiners.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 45.2.8** Dietitian {#sec-16-45.2.8 omnilex-key=us-ms-regs-official--title-15--16#45.2.8}

The term “dietitian” shall mean a person who is licensed as a dietitian in the State of Mississippi, or a Registered Dietitian exempted from licensure by statute.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 45.2.9** Existing Facility {#sec-16-45.2.9 omnilex-key=us-ms-regs-official--title-15--16#45.2.9}

The term "existing facility" shall mean a facility that has obtained licensure prior to the adoption of these regulations.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 45.2.10** Governing Authority {#sec-16-45.2.10 omnilex-key=us-ms-regs-official--title-15--16#45.2.10}

The term "governing authority" shall mean owner(s), Board of Governors, Board of Trustees, or any other comparable body duly

organized and constituted for the purpose of owning, acquiring, constructing, equipping, operating and/or maintaining a facility, and exercising control over the internal affairs of said facility.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 45.2.11** Infectious Medical Waste {#sec-16-45.2.11 omnilex-key=us-ms-regs-official--title-15--16#45.2.11}

The term "infectious medical waste" includes solid or liquid wastes which may contain pathogens with sufficient virulence and quantity such that exposure to the waste by a susceptible host has been proven to result in an infectious disease. For purposes of this regulation, the following wastes shall be considered to be infectious medical wastes: 1. Wastes resulting from the care of residents and animals who have Class I and (or) II diseases that are transmitted by blood and body fluid as defined in the rules and regulations governing reportable diseases as defined by the Mississippi State Department of Health; 2. Cultures and stocks of infectious agents; including specimen cultures collected from medical and pathological laboratories, cultures and stocks of infectious agents from research and industrial laboratories, wastes from the production of biological, discarded lie and attenuated vaccines, and culture dishes and devices used to transfer, inoculate, and mix cultures; 3. Blood and blood products such as serum, plasma, and other blood components. 4. All discarded sharps (e.g., hypodermic needles, syringes, Pasteur pipettes, broken glass, scalpel blades) which have come into contact with infectious agents; 5. Other wastes determined infectious by the generator or so classified by the Mississippi State Department of Health.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 45.2.12** Institutions for the Aged or Infirm (Facility/ies) {#sec-16-45.2.12 omnilex-key=us-ms-regs-official--title-15--16#45.2.12}

The term "institution for the aged or infirm" (hereinafter referred to as facility or facilities) shall mean a place either governmental or private which provides group living arrangements for four (4) or more persons who are unrelated to the operator and who are being provided food, shelter, and personal care whether any such place be organized or operated for profit or not. The term "institution for the aged or infirm" includes nursing homes, pediatric skilled nursing facilities, psychiatric residential treatment facilities, convalescent homes and homes for the aged, provided that these institutions fall within the scope of the definition set forth above. The term “institutions for the aged or infirm" does not include hospitals, clinics, or mental institutions devoted primarily to providing medical service.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 45.2.13** License {#sec-16-45.2.13 omnilex-key=us-ms-regs-official--title-15--16#45.2.13}

The term "license" shall mean the document issued by the licensing agency and signed by the State Health Officer of the Mississippi State Department of Health. Licensure shall constitute authority to receive residents and perform the services included within the scope of these rules, regulations, and minimum standards.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 45.2.14** Rule 45.2.14 {#sec-16-45.2.14 omnilex-key=us-ms-regs-official--title-15--16#45.2.14}

Licensed Facility Representative: For the purposes of regulations governing informal dispute resolutions, the term “licensed facility representative” shall mean an employee of the licensed facility (i.e., including, but not limited to, administrator, assistant administrator, director of nursing, director of social services, and others), as designated by the administrator of the licensed facility.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 45.2.15** Licensed Practical Nurse {#sec-16-45.2.15 omnilex-key=us-ms-regs-official--title-15--16#45.2.15}

The term "licensed practical nurse" shall mean a person who is currently licensed by the Mississippi Board of Nursing as a Licensed Practical Nurse.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 45.2.16** Licensee {#sec-16-45.2.16 omnilex-key=us-ms-regs-official--title-15--16#45.2.16}

The term "licensee" shall mean the person to which the license is issued and upon whom rests the responsibility for the operation of the institution in compliance with these rules, regulations, and minimum standards. Rule 45.2.17 IGRA(s) (Interferon-Gamma Release Assay(s). A whole blood test used in to assist in diagnosing Mycobacterium Tuberculosis infection. The IGRA blood test used must be approved by the U.S. Food and Drug Administration (FDA).

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 45.2.18** Licensing Agency {#sec-16-45.2.18 omnilex-key=us-ms-regs-official--title-15--16#45.2.18}

The term “licensing agency” shall mean the Mississippi State Department of Health.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 45.2.19** Mantoux Test {#sec-16-45.2.19 omnilex-key=us-ms-regs-official--title-15--16#45.2.19}

A method of skin testing that is performed by injecting one-tenth (0.1) milliliter of purified protein derivative-tuberculin containing five (5) tuberculin units into the dermis (i.e., the second layer of skin) of the forearm with a needle and syringe. The area is examined between forty-eight (48) and seventy- two (72) hours after the injection. A reaction is measured according to the size of the induration. The classification of a reaction as positive or negative depends on the patient’s medical history and various risk factors (see definition for “significant tuberculin skin test”). This test is used to evaluate the likelihood that a person is infected with M. tuberculosis. The Mantoux (TST) test should be administered only by persons certified in the intradermal technique.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 45.2.20** Medical Waste {#sec-16-45.2.20 omnilex-key=us-ms-regs-official--title-15--16#45.2.20}

The term "medical waste" means all waste generated in direct resident care or in diagnostic or research areas that is non-infectious but aesthetically repugnant if found in the environment.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 45.2.21** New Facility {#sec-16-45.2.21 omnilex-key=us-ms-regs-official--title-15--16#45.2.21}

The term "new facility" shall mean a facility that applies for licensure after the adoption of these regulations.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 45.2.22** Nurse Practitioner/Physician Assistant {#sec-16-45.2.22 omnilex-key=us-ms-regs-official--title-15--16#45.2.22}

The term “nurse practitioner” shall mean a person who is currently licensed by the Mississippi Board of Nursing as a nurse practitioner. The term “physician assistant” shall mean a physician assistant who is currently licensed as such by the Mississippi Board of Medical Licensure.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 45.2.23** Nursing Facility {#sec-16-45.2.23 omnilex-key=us-ms-regs-official--title-15--16#45.2.23}

The term "nursing facility" shall mean a facility in which nursing care is under the supervision of a registered nurse. Either a registered nurse or a licensed practical nurse shall be on active duty at all times.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 45.2.24** Nursing Unit {#sec-16-45.2.24 omnilex-key=us-ms-regs-official--title-15--16#45.2.24}

The maximum nursing unit shall be sixty (60) beds.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 45.2.25** Patient {#sec-16-45.2.25 omnilex-key=us-ms-regs-official--title-15--16#45.2.25}

The term "patient" shall mean any person admitted to a facility for care.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 45.2.26** Person {#sec-16-45.2.26 omnilex-key=us-ms-regs-official--title-15--16#45.2.26}

The term "person" shall mean any individual, firm, partnership, corporation, company, association, or joint stock association, or any licensee herein or the legal successor thereof.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 45.2.27** Personal Care {#sec-16-45.2.27 omnilex-key=us-ms-regs-official--title-15--16#45.2.27}

The term “personal care” shall mean assistance rendered by personnel of the facility for residents in performing one or more of the activities of daily living which includes, but is not limited to, the bathing, walking, excretory functions, feeding, personal grooming, and dressing of such residents.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 45.2.28** Pharmacist {#sec-16-45.2.28 omnilex-key=us-ms-regs-official--title-15--16#45.2.28}

The term "pharmacist" shall mean a person currently licensed to practice pharmacy in Mississippi by the State Board of Pharmacy.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 45.2.29** Physician {#sec-16-45.2.29 omnilex-key=us-ms-regs-official--title-15--16#45.2.29}

The term "physician" shall mean any person currently licensed in Mississippi by the Mississippi State Board of Medical Licensure.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 45.2.30** Qualified Dietary Manager {#sec-16-45.2.30 omnilex-key=us-ms-regs-official--title-15--16#45.2.30}

1. A Dietetic Technician who has successfully graduated from a Dietetic Technician program accredited by the American Dietetic Association Commission on Accreditation and Approval of Dietetic Education and earns 15 hours of continuing education units every year approved by the Dietary Manager's Association or the American Dietetic Association. 2. A person who has successfully graduated from a didactic program in Dietetics approved by the American Dietetic Association Commission on Accreditation and Approval of Dietetic Education and earns 15 hours of continuing education units every year approved by the Dietary Manager's Association or the American Dietetic Association. 3. A person who has successfully completed a Dietary Manager's Course approved by the Dietary Manager's Association and who passes the credentialing examination and earns 15 hours of continuing education units every year approved by the Dietary Manager's Association or the American Dietetic Association. 4. A person who has successfully completed a Dietary Manager's Course approved by the Dietary Manager's Association and earns 15 hours of continuing education units every year approved by the Dietary Manager's Association or the American Dietetic Association

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 45.2.31** Registered Nurse {#sec-16-45.2.31 omnilex-key=us-ms-regs-official--title-15--16#45.2.31}

The term "registered nurse" shall mean a person who is currently licensed by the Nurses' Board of Examination and Registration of Mississippi Board of Nursing as a registered nurse.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 45.2.32** Resident {#sec-16-45.2.32 omnilex-key=us-ms-regs-official--title-15--16#45.2.32}

The term "resident" is synonymous with patient.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 45.2.33** Restraint {#sec-16-45.2.33 omnilex-key=us-ms-regs-official--title-15--16#45.2.33}

The term "restraint" shall include any means, physical or chemical, which is intentionally used to restrict the freedom of movement of a person.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 45.2.34** Surveyor {#sec-16-45.2.34 omnilex-key=us-ms-regs-official--title-15--16#45.2.34}

The term "surveyor" shall mean an individual employed, or hired on a contractual basis, by the licensing agency for the purpose of conducting surveys, inspections, investigations, or other related functions as part of the licensing agency’s responsibilities for licensure and regulation of institutions for the aged and infirm.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 45.2.35** Significant Tuberculin Skin Test {#sec-16-45.2.35 omnilex-key=us-ms-regs-official--title-15--16#45.2.35}

An induration of five (5) millimeters or greater is significant (or positive) in the following: 1. Persons known to have or suspected of having human immunodeficiency virus (HIV). 2. Close contacts of a person with infectious tuberculosis. 3. Persons who have a chest radiograph suggestive of previous tuberculosis. 4. Persons who inject drugs (if HIV status is unknown). 5. An induration of ten (10) millimeters or greater is significant (or positive) in all other persons tested in Mississippi. A tuberculin skin test is recorded in millimeters of induration. For accurate results, measure the widest diameter of the palpable induration transverse (across) the arm.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 45.2.36** Two-step Testing {#sec-16-45.2.36 omnilex-key=us-ms-regs-official--title-15--16#45.2.36}

A procedure used for the baseline testing of person who will periodically receive tuberculin skin tests (e.g., health care workers) to reduce the likelihood of mistaking a boosted reaction for a new infection. If the initial tuberculin-test result is classified as negative, a second test is repeated one (1) to three (3) weeks later. If the reaction to the second test is positive, it probably represents a boosted reaction. If the second test is also negative, the person is classified as not infected. A positive reaction to a subsequent test would indicate new infection (i.e., a skin-test conversion) in the person.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 45.2.37** Ventilator Dependent Patient {#sec-16-45.2.37 omnilex-key=us-ms-regs-official--title-15--16#45.2.37}

A patient who is dependent upon mechanical life support because of inability to breathe effectively. A ventilator is used when the patient cannot breathe well enough to maintain normal levels of oxygen and carbon dioxide in the blood.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13 Subchapter 3 INSPECTION*

##### **15 Miss. Admin. Code Pt. 16, R. 45.3.1** Inspections Required {#sec-16-45.3.1 omnilex-key=us-ms-regs-official--title-15--16#45.3.1}

Each facility for which a license has been issued shall be inspected by the licensing agency by persons delegated with authority by the licensing agency at such intervals as the licensing agency may direct. The licensing agency and/or its authorized representatives shall have the right to inspect construction work in progress. New institutions shall not be licensed without having first been inspected for compliance with these rules, regulations, and minimum standards.

2. Each facility shall have the following licensed personnel as a minimum: a. Seven (7) day coverage on the day shift by a registered nurse. b. A registered nurse designated as the Director of Nursing Services, who shall be employed on a full time (five [5] days per week) basis on the day shift and be responsible for all nursing services in the facility. c. Facilities of one-hundred eighty (180) beds or more shall have an assistant director of nursing services, who shall be a registered nurse. d. A registered nurse or licensed practical nurse shall serve as a charge nurse and be responsible for supervision of the total nursing activities in the facility during the 7:00 a.m. to 3:00 p.m. and 3:00 p.m. to 11:00 p.m. shift. The nurse assigned to the unit for the 11:00 p.m. to 7:00 a.m. shift may serve as both the charge nurse and medication/treatment nurse. A medication/treatment nurse for each nurses' station shall be required on all shifts. This shall be a registered nurse or licensed practical nurse. e. In facilities with sixty (60) beds or less, the director of nursing services may serve as charge nurse. f. In facilities with more than sixty (60) beds, the charge nurse may not be the director of nursing services or the medication/treatment nurse.

g. For facilities providing care to ventilator dependent patients/residents, the facility shall provide, on a twenty-four hour basis, an adequate number of registered nurses and respiratory therapist(s) who are trained and competent to take care of a ventilator dependent patient. Such training and the competency evaluation must be conducted by a respiratory therapist or a pulmonologist and records of said training maintained by the facility. 3. Non-Licensed Staff. The non-licensed staff shall be added to the total licensed staff, to complete the required staffing requirements. 4. There shall be at least two (2) employees in the facility at all times in the event of an emergency.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13 Subchapter 4 CLASSIFICATION OF INSTITUTIONS FOR THE AGED OR INFIRM AS NURSING FACILITY: NURSING FACILITY Rule 45.4.1 Nursing Facility. To be classified as a facility, the institution shall comply with the following staffing requirements: 1. Minimum requirements for nursing staff shall be based on the ratio of two and eight-tenths (2.80) hours of direct nursing care per resident per twenty-four (24) hours. Staffing requirements are based upon resident census. Based upon the physical layout of the nursing facility, the licensing agency may increase the nursing care per resident ratio.*
- *SOURCE: Miss. Code Ann. §43-11-13*
- *SOURCE: Miss. Code Ann. §43-11-13 Subchapter 5 THE LICENSE Rule 45.5.1 License. A license shall be issued to each facility that meets the requirements as set forth in these regulations.*
- *SOURCE: Miss. Code Ann. §43-11-13 Subchapter 6 APPLICATION FOR LICENSE Rule 45.6.1 Application. Application for a license or renewal of a license shall be made in writing to the licensing agency on forms provided by the licensing agency which shall contain such information as the licensing agency may require. The application shall require reasonable, affirmative evidence of ability to comply with these rules, regulations, and minimum standards.*
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 45.6.2** Fees {#sec-16-45.6.2 omnilex-key=us-ms-regs-official--title-15--16#45.6.2}

Each initial and renewal licensure application, unless suspended or revoked, shall be accompanied by a fee as set by the Board, made payable to the Mississippi State Department of Health, either by business check, money order, or electronic means. Renewal of licenses shall occur on an annual basis. Fees are non-refundable.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 45.6.3** Name of Institution {#sec-16-45.6.3 omnilex-key=us-ms-regs-official--title-15--16#45.6.3}

Every facility or infirm shall be designated by a permanent and distinctive name which shall be used in applying for a license and shall not be changed without first notifying the licensing agency in writing and receiving written approval of the change from the licensing agency. Such notice shall specify the name to be discontinued as well as the new name proposed. The words

“hospital”, “sanitarium”, “sanatorium”, “clinic” or any other word which would reflect a different type of facility shall not appear in the title of a facility.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 45.6.4** Number of Beds {#sec-16-45.6.4 omnilex-key=us-ms-regs-official--title-15--16#45.6.4}

Each application for license shall specify the maximum number of beds in the facility as determined by Rule 45.19.2 of these regulations. The maximum number of beds for which the facility is licensed shall not be exceeded.

Subchapter 7 LICENSING Rule 45.7.1 Issuance of License. All licenses issued by the licensing agency shall set forth the name of the facility, the location, the name of the licensee, the classification of the institution, the type of building, the bed capacity for which the institution is licensed, and the license number.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 45.7.2** Separate License {#sec-16-45.7.2 omnilex-key=us-ms-regs-official--title-15--16#45.7.2}

Separate license shall be required for institutions maintained on separate premises even though under the same management. However, separate license are not required for buildings on the same grounds which are under the same management.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 45.7.3** Posting of License {#sec-16-45.7.3 omnilex-key=us-ms-regs-official--title-15--16#45.7.3}

The license shall be posted in a conspicuous place on the license premises and shall be available for review by an interested person.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 45.7.4** License Not Transferable {#sec-16-45.7.4 omnilex-key=us-ms-regs-official--title-15--16#45.7.4}

The license for a facility is not transferable or assignable to any other person except by written approval of the licensing agency and shall be issued only for the premises named in the application. The license shall be surrendered to the licensing agency on change of ownership, licensee, name or location of the institution, or in the event that the institution ceases to be operated as a facility. In event of change of ownership, licensee, name or location of the facility, a new application shall be filed.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 45.7.5** Expiration of License {#sec-16-45.7.5 omnilex-key=us-ms-regs-official--title-15--16#45.7.5}

Each license shall expire on March 31 following the date of issuance.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 45.7.6** Renewal of License {#sec-16-45.7.6 omnilex-key=us-ms-regs-official--title-15--16#45.7.6}

License shall be renewable by the licensee. 1. Filing of an application for renewal of licensee. 2. Submission of appropriate licensure renewal fee as mandated in Rule 45.6.2. 3. Approval of an annual report by the licensing agency. 4. Maintenance by the institution of minimum standards in its physical facility, staff, services and operation as set forth in these regulations.

1. Fraud on the part of the licensee in applying for a license. 2. A willful or repeated violation by the licensee of any of the provisions of §43-11-1 et seq., of the Mississippi Code of 1972, as amended, and/or of the rules, regulations, and minimum standards established by the licensing agency. 3. Use of alcoholic beverages or narcotic drugs by the licensee or other personnel of the home, to the extent which threatens the well-being or safety of the resident. 4. Conviction of the licensee of a felony. 5. Publicly misrepresenting the home and/or its services. 6. Permitting, aiding, abetting the commission of any unlawful act. 7. Conduct or practices detrimental to the health or safety of residents and employees of said facilities provided that this provision shall not be construed to have any reference to healing practices authorized by law. Detrimental practices include but are not necessarily limited to: a. Cruelty to residents or indifference of their needs which are essential to their general well being and health. b. Misappropriation of the money or property of a resident. c. Failure to provide food adequate for the needs of the resident.

d. Inadequate staff to provide safe care and supervision of a resident. e. Failure to call a physician or nurse practitioner/physician assistant when required by the resident's condition. f. Failure to notify next of kin when a resident's conditions become critical. g. Admission of a resident whose condition demands care beyond the level of care provided by the facility as determined by its classification.

1. The licensing agency shall notify the applicant or licensee by certified mail or personal service the particular reasons for the proposed denial or revocation of license, or of the findings in the informal dispute resolution proceeding. Upon written request of applicant or licensee within ten (10) days of the date of notification the licensing agency shall fix a date not less than thirty (30) days from the date of such service at which time the applicant or licensee shall be given an opportunity for a prompt and fair hearing. 2. On the basis of such hearing or upon default of the applicant or licensee, the licensing agency shall make a determination specifying its findings of fact and conclusions of law. A copy of such determination shall be sent by registered mail to the last known address of the applicant or licensee or served personally upon the applicant or licensee. 3. The decision revoking, suspending, denying the application or license, or upholding the findings of the informal dispute resolution proceeding shall become final thirty (30) days after it is so mailed or served upon the applicant or licensee; however in matters involving the revocation, suspension, or denial of an application or license, or an enforcement action, the applicant or licensee may within such thirty (30) day period, appeal the decision to the Chancery Court pursuant to §43-11-23 of the Mississippi Code of 1972, as amended. An additional period of time may be granted at the discretion of the licensing agency.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13 Subchapter 8 DENIAL, SUSPENSION, OR REVOCATION OF LICENSE Rule 45.8.1 Denial or Revocation of License: Hearing and Review. The licensing agency after notice and opportunity for a hearing to the applicant or licensee is authorized to deny, suspend, or revoke a license in any case in which it finds that there has been a substantial failure to comply with the requirements established under the law and these regulations. Also, the following shall be grounds for denial or revocation of license.*
- *SOURCE: Miss. Code Ann. §43-11-13 Subchapter 9 PROVISION FOR HEARING AND APPEAL FOLLOWING DENIAL OR REVOCATION OF LICENSE; PENALTIES Rule 45.9.1 Administrative Decision. The licensing agency will provide an opportunity for a fair hearing to every applicant or licensee who is dissatisfied with administrative decisions made in the denial or revocation of a license, or who qualifies pursuant to Subchapter 8 to appeal from an adverse determination in an informal dispute resolution proceeding.*
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 45.9.2** Penalties {#sec-16-45.9.2 omnilex-key=us-ms-regs-official--title-15--16#45.9.2}

Any person establishing, conducting, managing, or operating a facility without a license shall be declared in violations of these regulations and Chapter

##### **15 Miss. Admin. Code Pt. 16, R. 451** Rule 451 {#sec-16-451 omnilex-key=us-ms-regs-official--title-15--16#451}

of the Laws of Mississippi of the Regular Legislative Session of 1979 and subject to the penalties specified in §18 thereof.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13 Subchapter 10 ADMINISTRATION: THE AUTHORITY FOR ADMINISTRATION FOR INSTITUTION FOR THE AGED OR INFIRM Rule 45.10.1 Responsibility. The governing authority, the owner, or the person(s) designated by the governing authority or the owner shall be the supreme authority in a facility responsible for the management, control, and operation of the institution including the appointment of a qualified staff.*
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 45.10.2** Organization {#sec-16-45.10.2 omnilex-key=us-ms-regs-official--title-15--16#45.10.2}

Each facility should establish a written organizational plan, which may be an organizational chart that clearly establishes a line of authority, responsibilities, and relationships. Written personnel policies and job descriptions shall be prepared and given to each employee.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 45.10.3** Relationship of staff to Governing Authority {#sec-16-45.10.3 omnilex-key=us-ms-regs-official--title-15--16#45.10.3}

The administrator, personnel, and all auxiliary organizations shall be directly or indirectly responsible to the governing authority.

1. Initial Application. The licensee shall submit the following with his initial application: a. References in regard to this character, temperament, and experience background from three (3) responsible persons not related to him. The licensing agency reserves the right to make investigations from its own source regarding the character of the applicant. b. Whether the governing body will be a private proprietary, partnership, corporation, governmental, or other (non-profit, church, etc.). If a partnership,

the full name and address of each partner. If a corporation or other, the name, address, and title of each officer. If governmental, the unit of government. 2. Application for License. Application for license or relicense shall be submitted in form and content pursuant to the instructions of the licensing agency.

1. There shall be a licensed administrator with authority and responsibility for the operation of the facility in all its administrative and professional functions subject only to the policies enacted by the governing authority and to such orders as it may issue. The administrator shall be the direct representative of the governing authority in the management of the facility and shall be responsible to said governing authority for the proper performance of duties. 2. There shall be a qualified individual present in the facility responsible to the administrator in matters of administration who shall represent him during the absence. The persons shall not be a resident of the facility.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13 Subchapter 11 THE LICENSEE Rule 45.11.1 Responsibility. The licensee shall be the person who the licensing agency will hold responsible for the operation of the home in compliance with these regulations. The licensee may serve as the administrator or may appoint someone to be the administrator. The licensee shall be responsible for submitting to the licensing agency the plans and specifications for the building, the applications for license, and such reports as are required.*
- *SOURCE: Miss. Code Ann. §43-11-13 Subchapter 12 ADMINISTRATOR Rule 45.12.1 Responsibility.*
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 45.12.2** Qualifications {#sec-16-45.12.2 omnilex-key=us-ms-regs-official--title-15--16#45.12.2}

The administrator shall be chosen primarily for his administrative ability to establish proper working relationship with physicians, nurse practitioners, and employees of the facility.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13 Subchapter 13 FINANCIAL Rule 45.13.1 Accounting. Accounting methods and procedures should be carried out in accordance with a recognized system of good business practice. The method and procedure used should be sufficient to permit annual audit, accurate determination of the cost of operation and the cost per resident per day.*
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 45.13.2** Financial Structure {#sec-16-45.13.2 omnilex-key=us-ms-regs-official--title-15--16#45.13.2}

All facilities shall have a financial plan which guarantees sufficient resources to meet operating cost at all times and to maintain standards required by these regulations.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 45.13.3** Admission Agreement {#sec-16-45.13.3 omnilex-key=us-ms-regs-official--title-15--16#45.13.3}

Prior to or at the time of admission, the administrator and the resident or the resident's responsible party shall execute in writing a

financial agreement. This agreement shall be prepared and signed in two or more copies, one copy given to the resident or his sponsor, and one copy placed on file in the license facility.As a minimum this agreement shall contain: 1. Basic charges agreed upon (room, board, laundry, nursing, and/or personal care). 2. Period to be covered in the charges. 3. Services for which special charges are made. 4. Agreement regarding refund for any payments made in advance.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 45.13.4** Rule 45.13.4 {#sec-16-45.13.4 omnilex-key=us-ms-regs-official--title-15--16#45.13.4}

No agreement or contract shall be entered into between the licensee and the resident or his responsible party which will relieve the licensee of responsibility for the protection of the person and of the rights of the individual admitted to the facility for care, as set forth in these regulations.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 45.13.5** A record of all sums of money received from each resident shall be kept up-to- date and available for inspection {#sec-16-45.13.5 omnilex-key=us-ms-regs-official--title-15--16#45.13.5}

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 45.13.6** Rule 45.13.6 {#sec-16-45.13.6 omnilex-key=us-ms-regs-official--title-15--16#45.13.6}

The resident or his lawful agent shall be furnished a receipt signed by the lawful agent of the institution for all sums paid over to the facility.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 45.13.7** Rule 45.13.7 {#sec-16-45.13.7 omnilex-key=us-ms-regs-official--title-15--16#45.13.7}

Neither the licensee or any employee shall misuse or misappropriate any property real or personal, belonging to a resident of the facility.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 45.13.8** Rule 45.13.8 {#sec-16-45.13.8 omnilex-key=us-ms-regs-official--title-15--16#45.13.8}

Undue influence or coercion shall not be used in procuring a transfer of funds or property or in procuring a contract or agreement providing for payment of funds or delivery of property belonging to a resident of the facility.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 45.13.9** Rule 45.13.9 {#sec-16-45.13.9 omnilex-key=us-ms-regs-official--title-15--16#45.13.9}

Agreements between a facility and a resident relative to cost of care shall include adequate arrangements for such emergency medical or hospital care as may be required by the resident.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 45.13.10** Rule 45.13.10 {#sec-16-45.13.10 omnilex-key=us-ms-regs-official--title-15--16#45.13.10}

No licensee, owner, or administrator of a facility; a member of their family; an employee of the facility; or a person who has financial interest in the home shall act as the legal guardian for a resident of the facility. This requirement shall not apply if the resident is related within the third degree as computed by civil law.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 45.13.11** Resident Admission {#sec-16-45.13.11 omnilex-key=us-ms-regs-official--title-15--16#45.13.11}

Prior to initial licensure of each facility, a written schedule for resident admission shall be developed and submitted to the licensing agency.

1. Communications - Facility status reports shall be submitted in a format and a frequency as required by the Office of Emergency Planning and Response;

2. Resources and Assets;

3. Safety and Security;

4. Staffing;

5. Utilities;

6. Clinical Activities;

7. Exercises - Exercises shall be conducted a minimum of two (2) times per year;

8. Smoke Detectors/Extinguishers (refer to NFPA 10 and NFPA 72); and

9. Continuity of Operations Planning (COOP) to include surge and alternate care sites.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13 Subchapter 14 EMERGENCY OPERATIONS PLAN (EOP) The licensed entity shall develop and maintain a written preparedness plan utilizing theEmergency Operations Plan (EOP) Template developed by the Mississippi State Department of Health, Office of Emergency Planning and Response. “All Hazards” and “Whole Community” approach to emergency and disaster planning. The plan must include procedures to be followed in the event of any pandemic, act of terrorism, or man-made or natural disaster as appropriate for the specific geographical location. The final draft of the Emergency Operations Plan (EOP), will be reviewed by the Office of Emergency Planning and Response, Mississippi State Department of Health, or their designees, for conformance with the “All Hazards Emergency Preparedness and Response Plan.” Particular attention shall be given to critical areas of concern which may arise during any “All Hazards” emergency whether required to evacuate or to sustain in place. Additional plan criteria or a specified EOP format may be required as deemed necessary by the Office of Emergency Planning and Response. The nine (9) critical areas of consideration are: (disaster drills)*

##### **15 Miss. Admin. Code Pt. 16, R. 45.14.1** Rule 45.14.1 {#sec-16-45.14.1 omnilex-key=us-ms-regs-official--title-15--16#45.14.1}

Emergency Operations Plans (EOPs) must be exercised and reviewed annually or as directed by the Office of Emergency Planning and Response. Written evidence of current verification or review of provider EOPs, by the Office of Emergency Planning and Response, shall accompany all applications for facility license renewals

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 45.14.2** Facility Fire Preparedness 1 {#sec-16-45.14.2 omnilex-key=us-ms-regs-official--title-15--16#45.14.2}

Fire Drills. Fire drills shall be conducted one (1) per shift per quarter. Employees shall participate in a fire drill at least four (4) times per year. 2. Written Records. Written records of all drills shall be maintained, indicating content of and attendance at each drill. 3. A fire evacuation plan for the facility shall be posted in each facility in a conspicuous place and kept current.

1. As a minimum, the office space and/or administrative office(s) shall be provided with a desk, file drawer or cabinet, and related office equipment and supplies. 2. Facilities caring for twenty-five (25) or more residents should provide a separate room(s) for these facilities. 3. Each facility should provide a waiting room or space for the public.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13 Subchapter 15 PHYSICAL FACILITIES Rule 45.15.1 Administration Facilities. Each facility shall provide an office space and/or administrative office(s).*
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 45.15.2** Communication Facilities {#sec-16-45.15.2 omnilex-key=us-ms-regs-official--title-15--16#45.15.2}

Each facility shall have an adequate number of telephones and extensions to summon help in case of fire or other emergency, and

these shall be located so as to be quickly accessible from all parts of the building. The telephone shall be listed under the official licensed name of the facility.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13 Subchapter 16 RECORDS AND REPORTS Rule 45.16.1 General. Each facility shall submit such records and reports as the licensing agency may request.*
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 45.16.2** Annual Report {#sec-16-45.16.2 omnilex-key=us-ms-regs-official--title-15--16#45.16.2}

An annual report shall be submitted to the licensing agency by each facility upon such uniform dates and shall contain such information in such form as the licensing agency prescribes.

A. The student is under the supervision of a licensed healthcare provider;

B. The student has signed the affidavit that is on file at the student’s school stating that he or she has not been convicted of or plead guilty or nolo contendere to a felony of possession or sale of drugs, murder, manslaughter, armed robbery, rape, sexual battery, any sex offenses listed in section 45-33-23 (g), child abuse, arson, grand larceny, burglary, gratification of lust, aggravated assault, or felonious abuse and/or battery of a vulnerable adult, or that any such conviction or plea was reversed on appeal or a pardon was granted for the conviction or plea; and

C. Further, applicants and employees of the University of Mississippi Medical Center for whom criminal history record checks and fingerprinting are obtained in accordance with Section 37-115-41 are exempt from application of the term employee under Section 43-11-13.

2. Covered Entity. For the purpose of criminal history record checks, “covered entity” means a licensed entity or a healthcare professional staffing agency.

3. Licensed Entity. For the purpose of criminal history record checks, the term “licensed entity” means a hospital, nursing home, personal care home, home health agency or hospice.

4. Health Care Professional/Vocational Technical Academic Program. For the purpose of criminal history record checks, “health care professional/vocational technical academic program” means an academic program in medicine, nursing, dentistry, occupational therapy, physical therapy, social services, speech therapy, or other allied-health professional whose purpose is to prepare professionals to render patient care services.

5. Health Care Professional/Vocational Technical Student. For purposes of criminal history record checks, the term means a student enrolled in a healthcare professional/vocational technical academic program.

6. Direct Patient Care or Services. For purposes of fingerprinting and criminal background history checks, the term “direct patient care” means direct hands-on medical patient care and services provided by an individual in a patient’s, resident’s or client’s room, treatment room or recovery room. Individuals providing direct patient care may be directly employed by the facility or provides patient care on a contractual basis.

7. Documented Disciplinary Action. For the purpose of fingerprinting and criminal background history checks, the term “documented disciplinary action” means any action taken against an employee for abuse or neglect of a patient.

8. Pursuant to Section 43-11-13, Mississippi Code of 1972, the covered entity shall require to be performed a disciplinary check with the professional

licensing agency, if any, for each employee to determine if any disciplinary action has been taken against the employee by the agency, and a criminal history record check on:

A. Every new employee of a covered entity who provides direct patient care or services; and

B. Any individual seeking new employment with a covered entity whose initial criminal history record check is over two years.

9. Except as otherwise provided in this paragraph, no employee hired on or after July 01, 2003, shall be permitted to provide direct patient care until the results of the criminal history record check revealed no disqualifying record or the employee has been granted a waiver. Provided the covered entity has documented evidence of submission of fingerprints for the background check, any person may be employed and provide direct patient care on a temporary basis pending the results of the criminal history record check but any employment offer, contract, or arrangement with the person shall be voidable, if he/she receives a disqualifying criminal record check and no waiver is granted.

10. If such criminal history record check discloses a felony conviction; a guilty plea; and/or a plea of nolo contendere to a felony for one (1) or more of the following crimes which has not been reversed on appeal, or for which a pardon has not been granted, the applicant/employee shall not be eligible to be employed at the licensed facility:

A. possession or sale of drugs

B. murder

C. manslaughter

D. armed robbery

E. rape

F. sexual battery

G. sex offense listed in Section 45-33-23(g), Mississippi Code of 1972

H. child abuse

I. arson

J. grand larceny

K. burglary

L. gratification of lust

M. aggravated assault

N. felonious abuse and/or battery of vulnerable adult

11. Documentation of verification of the employee’s disciplinary status, if any, with the employee’s professional licensing agency as applicable, and evidence of submission of the employee’s fingerprints to the licensing agency must be on file and maintained by the facility prior to the new employees first date of employment. The covered entity shall maintain on file evidence of verification of the employee’s disciplinary status from any applicable professional licensing agency and of submission and/or completion of the criminal record check, the signed affidavit, if applicable, and/or a copy of the referenced notarized letter addressing the individual’s suitability for such employment.

12. Pursuant to Section 43-11-13, Mississippi Code of 1972, the licensing agency shall require every employee of a covered entity employed prior to July 01, 2003, to sign an affidavit stating that he or she does not have a criminal history as outlined in paragraph (3) above.

13. From and after December 31, 2003, no employee of a covered entity hired before July 01, 2003, shall be permitted to provide direct patient care unless the employee has signed an affidavit as required by this section. The covered entity shall place the affidavit in the employee’s personnel

file as proof of compliance with this section.

14. If a person signs the affidavit required by this section, and it is later determined that the person actually had been convicted of or pleaded guilty or nolo contendere to any of the offenses listed herein, and the conviction or pleas has not been reversed on appeal or a pardon has not been granted for the conviction or plea, the person is guilty of perjury as set out in Section 43-11-13, Mississippi Code of 1972. The covered entity shall immediately institute termination proceedings against the employee pursuant to the facility’s policies and procedures.

15. The covered entity may, in its discretion, allow any employee unable to sign the affidavit required by paragraph (7) of this subsection or any employee applicant aggrieved by the employment decision under this subsection to appear before the covered entity’s hiring officer, or his or her designee, to show mitigating circumstances that may exist and allow the employee or employee applicant to be employed at the covered entity. The covered entity, upon report and recommendation of the hiring officer, may grant waivers for those mitigating circumstances, which shall include, but not be limited to: (1) age at which the crime was committed; (2) circumstances surrounding the crime; (3) length of time since the conviction and criminal history since the conviction; (4) work history; (5) current employment and character references; and (6) other evidence demonstrating the ability of the individual does not pose a threat to the health or safety of the patients in the licensed facility.

16. The licensing agency may charge the covered entity submitting the fingerprints a fee not to exceed Fifty Dollars ($50.00).

17. Should results of an employee applicant’s criminal history record check reveal no disqualifying event, then the covered entity shall, within two (2) weeks of the notification of no disqualifying event, provide the employee applicant with a notarized letter signed by the chief executive officer of the covered entity, or his or her authorized designee, confirming the employee applicant’s suitability for employment based on his or her criminal history record check. An employee applicant may use that letter for a period of two (2) years from the date of the letter to seek employment at any covered entity licensed by the Mississippi State Department of Health without the necessity of an additional criminal record check. Any covered entity presented with the letter may rely on the letter with respect to an employee applicant’s criminal background and is not required for a period of two (2)

years from the date of the letter to conduct or have conducted a criminal history check as required in this subsection.

18. For individuals contacted through a third party who provide direct patient care as defined herein, the covered entity shall require proof of a criminal history record check.

19. Pursuant to Section 43-11-13, Mississippi Code of 1972, the licensing agency, the covered entity, and their agents, officer, employees, attorneys, and representatives, shall be presumed to be acting in good faith for any employment decision or action taken under this section. The presumption of good faith may be overcome by a preponderance of the evidence in any civil action. No licensing agency, covered entity, nor their agents, officers, employees, attorneys, and representatives shall be held liable in any employment discrimination suit in which an allegation of discrimination is made regarding an employment decision authorized under this section.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13 Rule 45.16.3 1. Employee. For the purpose of fingerprinting and criminal background history checks, employee shall mean any individual employed by a covered entity. The term employee”, also includes any individual who by contract with the covered entity provides direct patient care in a patient’s, resident’s, or client’s room or in treatment rooms. The term “employee” does not include healthcare professional/technical students, as defined in Section 37-29-232, performing clinical training in a licensed entity under contracts between their schools and the licensed entity, and does not include students at high schools who observe the treatment and care of patients in a licensed entity as part of the requirements of an allied health course taught in the school if:*
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 45.16.4** Employee Health Screening {#sec-16-45.16.4 omnilex-key=us-ms-regs-official--title-15--16#45.16.4}

All staff of a facility shall receive a health screening by a licensed physician, registered nurse, or nurse practitioner/physician assistant prior to employment and annually thereafter. The extent of the screening shall be determined by committee consisting of at least a licensed physician, nurse practitioner/physician assistant or a registered nurse, and the facility's administrator.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 45.16.5** Testing for Tuberculosis 1 {#sec-16-45.16.5 omnilex-key=us-ms-regs-official--title-15--16#45.16.5}

Each employee, upon employment of a licensed entity and prior to contact with any patient/client, shall be evaluated for tuberculosis by one of the following methods:

a. IGRA (blood test) and an evaluation of the individual for signs and symptoms of tuberculosis by medical personnel; or

b. A two-step Mantoux tuberculin skin test administered and read by a licensed medical/nursing person certified in the techniques of tuberculin testing and an evaluation of the individual for signs and symptoms of tuberculosis by a licensed Physician, Physician’s Assistant, Nurse Practitioner or a Registered Nurse.

2. The IGRA/Mantoux testing and the evaluation of signs/symptoms may be

administered/conducted on the date of hire or administered/read no more than 30 days prior to the individual’s date of hire; however, the individual must not be allowed contact with a patient or work in areas of the RBIR where patients have access until receipt of the results of the IGRA/assessment or at least the first of the two-step Mantoux test has been administered/read and assessment for the signs and symptoms completed.

3. If the Mantoux test is administered, results must be documented in millimeters. Documentation of the IGRA/TB skin test results and assessment must be documented in accordance with accepted standards of medical/nursing practice and must be placed in the individual’s personnel file no later than 7 days of the individual’s date of employment. If an IGRA is performed, results and quantitative values must be documented.

4. Any employee noted to have a newly positive IGRA, a newly positive Mantoux skin test or signs/symptoms indicative of tuberculin disease (TB) that last longer than three weeks (regardless of the size of the skin test or results of the IGRA), shall have a chest x-ray interpreted by a board certified Radiologist and be evaluated for active tuberculosis by a licensed physician within 72 hours. The employee shall not be allowed to work in any area where clients have routine access until evaluated by a physician/nurse practitioner/physician assistant and approved to return. Exceptions to this requirement may be made if the employee is asymptomatic and:

a. The individual is currently receiving or can provide documentation of having received a course of tuberculosis prophylactic therapy approved by the Mississippi State Department of Health (MSDH) Tuberculosis Program for tuberculosis infection, or

b. The individual is currently receiving or can provide documentation of having received a course of multi-drug chemotherapy approved by the MSDH Tuberculosis Program; or

c. The individual has a documented previous significant tuberculin skin reaction or IGRA reaction.

5. For individuals noted to have a previous positive to either Mantoux testin g or the IGRA, annual re-evaluation for the signs and symptoms must be conducted and must be maintained as part of the employee’s annual health screening. A follow-up annual chest x-ray is NOT required unless symptoms of active tuberculosis develop.

6. If using the Mantoux method, employees with a negative tuberculin skin test and a negative symptom assessment shall have the second step of the two- step Mantoux tuberculin skin test performed and documented in the

employees’ personal record within fourteen (14) days of employment.

7. The IGRA or the two-step protocol is to be used for each employee who has not been previously skin tested and/or for whom a negative test cannot be documented within the past 12 months. If the employer has documentation that the employee has had a negative TB skin test within the past 12 months, a single test performed thirty (30) days prior to employment or immediately upon hire will fulfill the two-step requirements. As above, the employee shall not have contact with clients or be allowed to work in areas of the RBIR to which clients have routine access prior to reading the skin test, completing a signs and symptoms assessment and documenting the results and findings.

8. Facilities shall comply with recommendations from the Centers for Disease Control and/or the Mississippi State Department of Health regarding baseline employee TB testing and routine serial employee TB testing and education. Staff exposed to an active infectious case of tuberculosis shall be treated as contacts and be managed appropriately. Individuals found to have a significant Mantoux tuberculin skin test reaction and a chest x- ray not suggestive of active tuberculosis, shall be evaluated by a physician or nurse practitioner/physician assistant for treatment of latent tuberculin infection.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 45.16.6** Admission Record-Personal Information {#sec-16-45.16.6 omnilex-key=us-ms-regs-official--title-15--16#45.16.6}

Each facility shall prepare a record on each resident at the time of admission on which the following minimum information shall be recorded: name; date of admittance; address at the time of admittance; race; sex; marital status; religious preference; date of birth; name; address, and telephone number of person responsible for resident and his/her relationship to him/her; and name and telephone number of physician or nurse practitioner/physician assistant. The date and reason for discharge shall be entered upon discharge of a resident.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 45.16.7** Reporting of Tuberculosis Testing {#sec-16-45.16.7 omnilex-key=us-ms-regs-official--title-15--16#45.16.7}

The facility shall report and comply with the annual MSDH TB Program surveillance procedures.

policies and procedures regarding residents' rights shall be made available to residents or their guardian, next of kin, sponsoring agency or agencies, or lawful representative and to the public. There shall be documented evidence that the staff of the facility is trained and involved in the implementation of these policies and procedures. In-service on residents' rights and responsibilities shall be conducted annually. These rights and responsibilities shall be posted throughout the facility for the benefit of all staff and residents.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13 Subchapter 17 RESIDENTS RIGHTS Rule 45.17.1 General. The facility shall maintain written policies and procedures regarding the rights and responsibilities of residents. These written policies and procedures shall be established in consultation with residents or responsible parties. Written*
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 45.17.2** Residents' Rights {#sec-16-45.17.2 omnilex-key=us-ms-regs-official--title-15--16#45.17.2}

The residents' rights policies and procedures ensure that each resident admitted to the facility: 1. is fully informed, as evidenced by the resident's written acknowledgment, prior to or at the time of admission and during stay, of these rights and is given a statement of the facility's rules and regulations and an explanation of the resident's responsibility to obey all reasonable regulations of the facility and to respect the personal rights and private property of other residents; 2. is fully informed, and is given a written statement prior to or at time of admission and during stay, of services available in the facility, and of related charges including any charges for services covered by the facility's basic per diem rate; 3. is assured of adequate and appropriate medical care, is fully informed by a physician or nurse practitioner/physician assistant of his medical conditions unless medically contraindicated (as documented by a physician or nurse practitioner/physician assistant in his medical record), is afforded the opportunity to participate in the planning of his medical treatment, to not be limited in his/her choice of a pharmacy or pharmacist provider in accordance with state law, as referenced in House Bill 1439, which states that the facility shall not limit a resident’s choice of pharmacy or pharmacy provider if that provider meets the same standards of dispensing guidelines required of long term care facilities, to refuse to participate in experimental research, and to refuse medication and treatment after fully informed of and understanding the consequences of such action; 4. is transferred or discharged only for medical reasons, or for his welfare or that of other residents, or for nonpayment for his stay (except as prohibited by sources of third-party payment), and is given a two weeks advance notice in writing to ensure orderly transfer or discharge. A copy of this notice is maintained in his medical record; 5. is encouraged and assisted, throughout his period of stay, to exercise his rights as a resident and as a citizen, and to this end may voice grievances, has a right of action for damages or other relief for deprivations or infringements of his right to adequate and proper treatment and care established by an applicable statute, rule, regulation or contract, and to recommend changes in policies and services to

facility staff and/or to outside representatives of his choice, free from restraint, interference, coercion, discrimination, or reprisal; 6. may manage his personal financial affairs, or is given at least a quarterly accounting of financial transactions made on his behalf should the facility accept his written delegation of this responsibility to the facility for any period of time in conformance with State law; 7. is free from mental and physical abuse; 8. is free from restraint except by order of a physician or nurse practitioner/physician assistant, or unless it is determined that the resident is a threat to himself or to others. Physical and chemical restraints shall be used for medical conditions that warrant the use of a restraint. Restraint is not to be used for discipline or staff convenience. The facility must have policies and procedures addressing the use and monitoring of restraint. A physician order for restraint must be countersigned within 24 hours of the emergency application of the restraint; 9. is assured security in storing personal possessions and confidential treatment of his personal and medical records, and may approve or refuse their release to any individual outside the facility, except, in the case of his transfer to another health care institution, or as required by law of third-party payment contract; 10. is treated with consideration, respect, and full recognition of his dignity and individuality, including privacy in treatment and in care for his personal needs; 11. is not required to perform services for the facility that are not included for therapeutic purposes in his plan of care; 12. may associate and communicate privately with persons of his choice, may join with other residents or individuals within or outside of the facility to work for improvements in resident care, and send and receive his personal mail unopened, unless medically contraindicated (as documented by his physician or nurse practitioner/physician assistant in his medical record); 13. may meet with, and participate in activities of, social, religious and community groups at his discretion, unless medically contraindicated (as documented by his physician or nurse practitioner/physician assistant in his medical record); 14. may retain and use his personal clothing and possessions as space permits, unless to do so would infringe upon rights of other residents, unless medically contraindicated (as documented by his physician or nurse practitioner/physician assistant in his medical record); 15. if married, is assured privacy for visits by his/her spouse; if both are inpatients in the facility, they are permitted to share a room, unless medically contraindicated (as documented by the attending physician or nurse practitioner/physician assistant in the medical record); and

16. is assured of exercising his civil and religious liberties including the right to independent personal decisions and knowledge of available choice. The facility shall encourage and assist in the fullest exercise of these rights.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 45.17.3** Rule 45.17.3 {#sec-16-45.17.3 omnilex-key=us-ms-regs-official--title-15--16#45.17.3}

All rights and responsibilities specified in paragraph (1) through (16) of Section Rule 45.17.2, as they pertain to (1) a resident adjudicated incompetent in accordance with State law, (2) a resident who is found by his physician or nurse practitioner/physician assistant to be medically incapable of understanding these rights, or (3) a resident who exhibits a communication barrier, devolve to and shall be exercised by the resident's guardian, next of kin, sponsoring agencies, or representative payee (except when the facility is representative payee).

**History**
- *SOURCE: Miss. Code Ann. §43-11-13 Subchapter 18 STAFF DEVELOPMENT Rule 45.18.1 Orientation. Each employee shall receive thorough orientation to the position, the facility, and its policies.*
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 45.18.2** In-service Training {#sec-16-45.18.2 omnilex-key=us-ms-regs-official--title-15--16#45.18.2}

Appropriate in-service education programs shall be provided to all employees on an on-going basis.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 45.18.3** Training Records {#sec-16-45.18.3 omnilex-key=us-ms-regs-official--title-15--16#45.18.3}

A written record shall be maintained of all orientation and in- service training sessions.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 45.18.4** Administrator Mentoring {#sec-16-45.18.4 omnilex-key=us-ms-regs-official--title-15--16#45.18.4}

Administrators shall be scheduled to spend two (2) concurrent days with the licensing agency for the purpose of training and mentoring. Placement of an administrator with the licensing agency may include, but not be limited to, assignments within the licensing agency’s central offices or placement with a survey team. Any costs associated with placements for the purposes of this section shall be borne by the licensed facility at which the administrator is employed. The administrator shall keep confidential and not disclose to any other persons any identifying information about any person or entity that he/she learned while observing operations as required by this section, except as otherwise mandated by law. 1. This section shall apply to administrators who: a. received their license from the Mississippi Board of Nursing Home Administrators on or after January 1, 2002; and

b. have been employed by a licensed facility for less than six (6) months, during which time the placement must be completed. 2. This section shall not apply to administrators who: a. received a license from the Mississippi Board of Nursing Home Administrators on or prior to December 31, 2001; or b. who were previously employed by the licensing agency in a surveyor capacity. 3. Failure to successfully complete the placement required under this section shall disqualify the administrator from serving in such capacity for a licensed facility until a placement is completed. 4. This section shall go into effect January 1, 2002 and thereafter.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 45.18.5** Surveyor Mentoring {#sec-16-45.18.5 omnilex-key=us-ms-regs-official--title-15--16#45.18.5}

Surveyors shall be scheduled to spend two (2) concurrent days with a licensed facility for the purpose of training and mentoring. Selection of a licensed facility for placement of the surveyor shall be done at the discretion of the licensing agency, except no licensed facility shall be required to accept more than two (2) placements in any calendar year. Upon completion of said training, the surveyor shall not participate in a survey of the same licensed facility for a period not to exceed one year from the date of training placement. Any costs associated with the placement of a surveyor for the purposes of this section shall be borne by the licensing agency. The surveyor shall keep confidential and not disclose to any other persons any identifying information about any person or entity that the surveyor learned while observing operations as required by this section, except as otherwise mandated by law. 1. This section shall apply to surveyors who have been employed by the licensing agency in a surveyor capacity for less than six (6) months, during which time the placement must be completed. 2. This section shall not apply to surveyors who were previously employed by a licensed facility. 3. Failure to successfully complete the placement required under this section shall disqualify the surveyor from serving in such capacity for the licensing agency until a placement is completed.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13 Subchapter 19 MEDICAL, NURSING, AND PERSONAL SERVICES: PHYSICAL FACILITIES*

##### **15 Miss. Admin. Code Pt. 16, R. 45.19.1** Nursing Unit {#sec-16-45.19.1 omnilex-key=us-ms-regs-official--title-15--16#45.19.1}

Medical, nursing, and personal service shall be provided in a specifically designated area which shall include bedrooms, special care room(s), nurses' station, utility room, toilet and bathing facilities, linen and storage closets, and wheelchair space. The maximum nursing unit shall be sixty (60) beds.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 45.19.2** Bedrooms {#sec-16-45.19.2 omnilex-key=us-ms-regs-official--title-15--16#45.19.2}

1. Location. a. All resident bedrooms shall have an outside exposure and shall not be below grade. Window area shall not be less than one-eighth (1/8) of the required floor area. The window sill shall not be over thirty-six (36) inches from the floor. b. Resident bedrooms shall be located so as to minimize the entrance of unpleasant odors, excessive noise, and other nuisances. c. Resident bedrooms shall be directly accessible from the main corridor of the nursing unit providing that accessibility from any public space other than the dining room will be acceptable. In no case shall a resident bedroom be used for access to another resident bedroom. d. All resident bedrooms shall be so located that the resident can travel from his/her bedroom to a living room, day room, dining room, or toilet or bathing facility without having to go through another resident bedroom. 2. Floor Area. Minimum usable floor area per bed shall be as follows: Private room one-hundred (100) square feet, Multi-bed room eighty (80) square feet, per resident. This provision shall apply only to initial licensure, new construction, additions, and renovations. 3. Provisions for Privacy. a. Existing Facilities. Cubicle curtains, screening, or other suitable provisions for privacy shall be provided in multi-bed resident bedrooms. b. Initial Licensure, New Construction, Additions and Renovations. Cubicle curtains, screening, or other suitable provisions for privacy shall be provided in multi-bed resident bedrooms. Cubicle curtains shall completely enclose the bed from three (3) sides. 4. Accommodations for Residents. The minimum accommodations for each resident shall include: a. Bed. The resident shall be provided with either an adjustable bed or a regular single bed, according to needs of the resident, with a good grade mattress at least four (4) inches thick. Beds shall be single except in case of special

approval of the licensing agency. Cots and roll-a-way beds are prohibited for resident use. Full and half bed rails shall be available to assist in safe care of residents. b. Pillows, linens, and necessary coverings. c. Chair. d. Bedside cabinet or table. e. Storage space for clothing, toilet articles, and personal belongings including rod for clothes hanging. f. Means at bedside for signaling attendants. g. Bed pans or urinals for residents who need them. h. Over-bed tables as required. 5. Bed Maximum. Bedrooms in new facilities shall be limited to two (2) beds.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 45.19.3** Special Care Room {#sec-16-45.19.3 omnilex-key=us-ms-regs-official--title-15--16#45.19.3}

Each facility shall have a special care room which shall be a single bedroom with at least a private half bath (lavatory and water closet). There shall be a special care room for each thirty (30) beds or major fraction thereof. A special care room shall meet the requirements of Rule 45.20.2(3) and may be located anywhere in the building rather than a certain number per station.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 45.19.4** Nurses' Station {#sec-16-45.19.4 omnilex-key=us-ms-regs-official--title-15--16#45.19.4}

1. Each facility shall have a nurses' station for each nursing unit. The nurses' station includes as minimum the following: a. Annunciator board or other equipment for resident's call. b. The minimum areas of the medicine storage/preparation room shall be seventy- five (75) square feet. c. Storage space for residents' medical records and nurses' charts. d. Lavatory or sink with disposable towel dispenser. e. Desk or counter top space adequate for recording and charting purposes by physicians, nurse practitioners/physician assistants, and nurses. 2. The nurses' station area shall be well lighted.

3. It is recommended that a nurses' lounge with toilet be provided for nursing personnel adjacent to the station. A refrigerator for the storage of drugs shall be provided at each nurses’ station. Drugs and food for beverages may be stored together only if separate compartments or containers are provided for the storage of drugs.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 45.19.5** Utility Room {#sec-16-45.19.5 omnilex-key=us-ms-regs-official--title-15--16#45.19.5}

Each facility shall provide a separate utility room for soiled and clean resident care equipment, such as bed pans, urinals, etc. The soiled utility room shall contain, as a minimum, the following equipment. 1. Provision for cleaning utensils such as bed pans, urinals, et cetera. 2. Lavatory or sink and disposable towel dispenser. The utility room for clean equipment shall have suitable storage.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 45.19.6** Toilet and Bathing Facilities {#sec-16-45.19.6 omnilex-key=us-ms-regs-official--title-15--16#45.19.6}

1. Lavatory, toilet and bathing facilities shall be provided in each nursing unit as follows: a. Bathing Facilities 2 per nursing unit b. Combination toilet and lavatory 2 per nursing unit 2. As a minimum, showers shall be thirty (30) inches by sixty (60) inches without curbing. 3. Handrails shall be provided for all tubs, showers, and commodes. 4. In addition to the requirements set forth above, a lavatory shall be provided in each resident bedroom or in a toilet room that is directly accessible from the bedroom. 5. In addition to the requirements set forth above, a toilet shall be located in a room directly accessible from each resident bedroom. The minimum area for a room containing only a toilet shall be three (3) feet by six (6) feet.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 45.19.7** Other rooms and areas {#sec-16-45.19.7 omnilex-key=us-ms-regs-official--title-15--16#45.19.7}

In addition to the above facilities, each nursing unit shall include the following rooms and areas: 1. linen closet; 2. wheelchair space.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13 Subchapter 20 REQUIREMENTS FOR ADMISSION Rule 45.20.1 Physical Examination Required. Each resident shall be given a complete physical examination 30 days prior to admission and annually thereafter, including a history of tuberculosis exposure and an assessment for signs and symptoms of tuberculosis, by a licensed physician or nurse practitioner/physician assistant. The findings shall be entered as part of the Admission Record. The report of the examination shall include: 1. Orders, dated and signed, by a physician or nurse practitioner/physician assistant for the immediate care of the resident to include medication treatment, activities, and diet.*
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 45.20.2** Tuberculosis (TB) {#sec-16-45.20.2 omnilex-key=us-ms-regs-official--title-15--16#45.20.2}

Admission Requirements to Rule Out Active Tuberculosis (TB) 1. The following are to be performed and documented within 30 days prior to the resident’s admission to the “Licensed facility”: a. TB signs and symptoms assessment by a licensed Physician, Physician’s Assistant or a Licensed Nurse Practitioner, and b. A chest x-ray taken and a written interpretation. 2. Admission to the facility shall be based on the results of the required tests as follows: a. Residents with an abnormal chest x-ray and/or signs and symptoms assessment shall have the first step of a two-step Mantoux tuberculin skin test (TST) placed and read by certified personnel OR an IGRA (blood test) drawn and results documented within 30 days prior to the patient’s admission to the “Licensed facility”. Evaluation for active TB shall be at the recommendation of the MSDH and shall be prior to admission. If TB is ruled out and the first step of the TST is negative, the second step of the two-step TST shall be completed and documented within 10-21 days of admission. TST administration and reading shall be done by certified personnel. If an IGRA (blood test) is done, TST (first and/or second step) is not done. b. Residents with a normal chest x-ray and no signs or symptoms of TB shall have a baseline IGRA test (blood test) OR a TST performed with the initial step of a the two-step Mantoux TST placed on or within 30 days prior to the

day of admission. IF TST is done, the second step shall be completed within 10-21 days of the first step. TST administration and reading shall be done by certified personnel. If an IGRA (blood test) is done, a TST is not done (first or second step). c. Residents with a significant TST OR positive IGRA (blood test) upon baseline testing or who have documented prior significant TST shall be monitored regularly for signs and symptoms of active TB (cough, sputum production, chest pain, fever, weight loss, or night sweats, especially if the symptoms have lasted longer than three weeks) and if these symptoms develop, shall have an evaluation for TB per the recommendations of the MSDH within 72 hours. d. Residents with a non significant TST or negative IGRA (blood test) upon baseline testing shall have an annual tuberculosis testing within thirty (30) days of the anniversary of their last test. Note: Once IGRA testing is used, IGRA testing should continue to be used rather than TST testing. e. Residents with a new significant TST or newly positive IGRA (blood test) on annual testing shall be evaluated for active TB by a nurse practitioner or physician or physician’s assistant. f. Active or suspected Active TB Admission. If a resident has or is suspected to have active TB, prior written approval for admission to the facility is required from the MSDH TB State Medical Consultant. g. Exceptions to TST/ IGRA requirement may be made if: i. Resident has prior documentation of a significant TST/ positive IGRA. ii. Resident has received or is receiving a MSDH approved treatment regimen for latent TB infection or for active TB disease. iii. Resident is excluded by a physician, nurse practitioner/physician assistant due to medical contraindications.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 45.20.3** Rule 45.20.3 {#sec-16-45.20.3 omnilex-key=us-ms-regs-official--title-15--16#45.20.3}

Transfer to another facility or return of a resident to respite care shall be based on the above tests (Rule 47.12.3) if done within the past 12 months and the patient has no signs and symptoms of TB.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 45.20.4** Transfer to a Hospital or Visit to a Physician Office {#sec-16-45.20.4 omnilex-key=us-ms-regs-official--title-15--16#45.20.4}

If a resident has signs or symptoms of active TB (i.e., is a TB suspect) the licensed facility shall notify the MSDH, the hospital, transporting staff and the physician’s office prior to transferring the resident to a hospital. Appropriate isolation and evaluation shall be the responsibility of the hospital and physician. If a resident has or is suspected to have active TB, prior written approval for admission or readmission to the facility is required from the MSDH TB State Consultant.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13 Subchapter 21 RESIDENT CARE Rule 45.21.1 Service Beyond Capability of the Home. Whenever a resident requires hospitalization or medical, nursing, or other care beyond the capabilities and facilities of the home, prompt effort shall be made to transfer the patient/resident to a hospital or other appropriate medical facility. In regard to the transfer of a ventilator dependent patient to another hospital or other location, the facility shall assure that equipment as necessary and a trained and competent registered nurse, respiratory therapist, nurse practitioner, physician’s assistant or a physician accompany the patient/resident to the receiving hospital/location.*
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 45.21.2** Activities of Daily Living {#sec-16-45.21.2 omnilex-key=us-ms-regs-official--title-15--16#45.21.2}

Each resident shall receive assistance as needed with activities of daily living to maintain the highest practicable well-being. These shall include, but not be limited to:

1. Bath, dressing and grooming;

2. Transfer and ambulate;

3. Good nutrition, personal and oral hygiene; and

4. Toileting.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 45.21.3** Pressure Sores {#sec-16-45.21.3 omnilex-key=us-ms-regs-official--title-15--16#45.21.3}

Residents with a pressure sore shall receive necessary treatment and service to promote healing and prevent the development of new pressure sores. Residents without pressure sores will not develop pressure sores unless the residents' clinical condition indicates they were unavoidable.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 45.21.4** Urinary Incontinence {#sec-16-45.21.4 omnilex-key=us-ms-regs-official--title-15--16#45.21.4}

Residents with urinary incontinence shall be assessed for need of bladder retraining program. An indwelling catheter will not be used unless the resident’s clinical condition indicates that catheterization is necessary. These residents shall receive treatment and services to prevent urinary tract infections.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 45.21.5** Range of Motion {#sec-16-45.21.5 omnilex-key=us-ms-regs-official--title-15--16#45.21.5}

Residents with limited range of motion shall receive treatment and services to increase range of motion or prevent further decline in range of motion.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 45.21.6** Mental and Psychosocial {#sec-16-45.21.6 omnilex-key=us-ms-regs-official--title-15--16#45.21.6}

A resident who displays adjustment difficulty receives appropriate treatment and services to address the assessed problem.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 45.21.7** Gastric Feeding {#sec-16-45.21.7 omnilex-key=us-ms-regs-official--title-15--16#45.21.7}

Residents who are eating alone or with assistance are not fed by a gastric tube unless their clinical condition indicates that the use of a gastric feeding tube is unavoidable. The residents who are fed by a gastric tube receive the treatment and services to prevent complications or to restore, if possible, normal eating skills.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 45.21.8** Accidents {#sec-16-45.21.8 omnilex-key=us-ms-regs-official--title-15--16#45.21.8}

The facility shall ensure that the residents’ environment remains as free of accident hazards as possible, and adequate supervision shall be provided to prevent accidents. If an unexplained accident occurs, this injury must be investigated and reported to appropriate state agencies.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 45.21.9** Nutrition {#sec-16-45.21.9 omnilex-key=us-ms-regs-official--title-15--16#45.21.9}

Residents shall maintain acceptable parameters of nutritional status, such as body weight and protein levels, unless residents’ clinical condition indicates that this is unavoidable. All residents shall receive diets as orders by their physician or nurse practitioner/physician assistant. Residents identified with significant nutritional problems shall receive appropriate medical nutrition therapy based on current professional standards.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 45.21.10** Hydration {#sec-16-45.21.10 omnilex-key=us-ms-regs-official--title-15--16#45.21.10}

Each resident shall be provided sufficient fluid intake to maintain proper hydration and health.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 45.21.11** Special Needs {#sec-16-45.21.11 omnilex-key=us-ms-regs-official--title-15--16#45.21.11}

Each resident with special needs shall receive proper treatment and care. These special needs shall include but are not limited to injections; parenteral and enteral fluids; colostomy, ureterostomy, ileostomy care; tracheostomy care; tracheal suction; respiratory care; foot care; and prostheses.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13 Subchapter 22 PHYSICIAN SERVICES Rule 45.22.1 General. A physician shall personally approve in writing a recommendation that an individual be admitted to a facility.*
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 45.22.2** Designated physician {#sec-16-45.22.2 omnilex-key=us-ms-regs-official--title-15--16#45.22.2}

Each resident shall have a designated physician or nurse practitioner/physician assistant who is responsible for their care. In the absence of the designated physician or nurse practitioner/physician assistant, another physician or nurse practitioner/physician assistant shall be designated to supervise the resident medical care.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 45.22.3** Emergency physician {#sec-16-45.22.3 omnilex-key=us-ms-regs-official--title-15--16#45.22.3}

The facility shall arrange for the provision of physician or nurse practitioner/physician assistant services twenty-four (24) hours a day in case of an emergency.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 45.22.4** Physician visit {#sec-16-45.22.4 omnilex-key=us-ms-regs-official--title-15--16#45.22.4}

The resident shall be seen by a physician or nurse practitioner every sixty (60) days.

1. The therapies shall be provided by a qualified therapist. 2. Appropriate equipment and supplies shall be provided. 3. Each resident’s medical record shall contain written evidence that services are provided in accordance with the written orders of an attending physician or nurse practitioner/physician assistant.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13 Subchapter 23 REHABILITATIVE SERVICES Rule 45.23.1 Rehabilitative services. Residents shall be provided rehabilitative services as needed upon the written orders of an attending physician or nurse practitioner.*
- *SOURCE: Miss. Code Ann. §43-11-13 Subchapter 24 PHARMACY SERVICES*

##### **15 Miss. Admin. Code Pt. 16, R. 45.24.1** General {#sec-16-45.24.1 omnilex-key=us-ms-regs-official--title-15--16#45.24.1}

The facility shall provide routine drugs, emergency drugs and biologicals to its residents or obtain them by agreement.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 45.24.2** Policies and procedures {#sec-16-45.24.2 omnilex-key=us-ms-regs-official--title-15--16#45.24.2}

Each facility shall have policies and procedures to assure the following: 1. Accurate acquiring; 2. Receiving; 3. Dispensing; 4. Storage; and 5. Administration of all drugs and biologicals.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 45.24.3** Consultation {#sec-16-45.24.3 omnilex-key=us-ms-regs-official--title-15--16#45.24.3}

Each facility shall obtain the services of a licensed pharmacist who will be responsible for: 1. Establishing a system of records of receipt and disposition of all controlled drugs and to determine that drug records are in order and that an account of all controlled drugs are maintained and reconciled; 2. Provide drugs regimen review in the facility on each resident every thirty (30) days by a licensed pharmacist; 3. Report any irregularities to the attending physician or nurse practitioner/physician assistant and the director or nursing; and 4. Records must reflect that the consultation pharmacist monthly report is acted upon.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 45.24.4** Labeling of drugs {#sec-16-45.24.4 omnilex-key=us-ms-regs-official--title-15--16#45.24.4}

Each facility shall follow the Mississippi State Board of Pharmacy labeling requirements.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 45.24.5** Disposal of drugs {#sec-16-45.24.5 omnilex-key=us-ms-regs-official--title-15--16#45.24.5}

1. Unused portions of medicine may be given to a discharged resident or the responsible party upon orders of the prescribing physician or nurse practitioner/physician assistant.

2. Drugs and pharmaceuticals discontinued by the written orders of an attending physician or nurse practitioner/physician assistant or left in the facility on discharge or death of the resident will be disposed of according to the Mississippi State Board of Pharmacy disposal requirements.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 45.24.6** Poisonous Substances {#sec-16-45.24.6 omnilex-key=us-ms-regs-official--title-15--16#45.24.6}

All poisonous substances such as insecticides, caustic cleaning agents, rodenticide, and other such agents must be plainly labeled and kept in locked cabinet or closet. No substances of this type shall be kept in the following areas: kitchen, dining area, food storage room or pantry, medicine cabinet or drug room, resident's bedroom or toilet, public rooms, or spaces.

2. A sufficient number of personnel, competent to carry out the functions of the medical record service, shall be employed. 3. The facility shall safeguard medical record information against loss, destruction, or unauthorized use. 4. All medical records shall maintain the following information: identification data and consent form; assessments of the resident's needs by all disciplines involved in the care of the resident; medical history and admission physical exam; annual physical exams; physician or nurse practitioner/physician assistant orders; observation, report of treatment, clinical findings and progress notes; and discharge summary, including the final diagnosis. 5. All entries in the medical record shall be signed and dated by the person making the entry. Authentication may include signatures, written initials, or computer entry. A list of computer codes and written signatures must be readily available and maintained under adequate safeguards. 6. All clinical information pertaining to the residents stay shall be centralized in the resident's medical records. 7. Medical records of discharged residents shall be completed within sixty (60) days following discharge.

8. Medical records are to be retained for five (5) years from the date of discharge or, in the case of a minor, until the resident reaches the age of twenty-one (21), plus an additional three (3) years. 9. A resident index, including the resident's full name and birth date, shall be maintained.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13 Subchapter 25 MEDICAL RECORDS SERVICES Rule 45.25.1 1. A medical record shall be maintained in accordance with accepted professional standards and practices on all residents admitted to the facility. The medical records shall be completely and accurately documented, readily accessible, and systematically organized to facilitate retrieving and compiling information.*
- *SOURCE: Miss. Code Ann. §43-11-13 Subchapter 26 SOCIAL SERVICES AND RESIDENT ACTIVITIES Rule 45.26.1 Program. Each facility shall provide services to assist all residents in dealing with social and related problems through one or more case workers on the staff of the facility or through arrangements with an appropriate outside agency.*
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 45.26.2** Records {#sec-16-45.26.2 omnilex-key=us-ms-regs-official--title-15--16#45.26.2}

Social services information concerning each resident shall be obtained and kept. This information shall cover social and emotional factors related to the resident's condition and information concerning his home situation, financial resources and relationships with other people.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 45.26.3** Training {#sec-16-45.26.3 omnilex-key=us-ms-regs-official--title-15--16#45.26.3}

All nursing personnel and employees having contact with resident shall receive social service orientation and in-service training toward understanding emotional problems and social needs of residents.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 45.26.4** Personnel {#sec-16-45.26.4 omnilex-key=us-ms-regs-official--title-15--16#45.26.4}

At least one person in each facility shall be designated as being responsible for the social services aspect for care in the facility.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 45.26.5** Office Space {#sec-16-45.26.5 omnilex-key=us-ms-regs-official--title-15--16#45.26.5}

Office space shall be provided for social service personnel. The office shall be accessible to residents and ensure privacy for interviews.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13 Subchapter 27 RESIDENT ACTIVITIES Rule 45.27.1 Activity Coordinator. An individual shall be designated as being in charge of resident activities. This individual shall have experience and/or training in group activities, or shall have consultation made available from a qualified recreational therapist or group activity leader.*
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 45.27.2** Activity Program {#sec-16-45.27.2 omnilex-key=us-ms-regs-official--title-15--16#45.27.2}

Provisions shall be made for suitable recreational and entertainment activities for resident according to their needs and interests. These activities are an important adjunct to daily living and are to encourage restoration to self-care and resumption of normal activities. Variety in planning shall include some outdoor activities in suitable weather.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 45.27.3** Supplies and Equipment {#sec-16-45.27.3 omnilex-key=us-ms-regs-official--title-15--16#45.27.3}

The facility shall make available a variety of supplies and equipment adequate to satisfy the individual interests of residents.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 45.27.4** Living and/or Recreational Room(s) {#sec-16-45.27.4 omnilex-key=us-ms-regs-official--title-15--16#45.27.4}

1. Each facility shall provide adequate living room(s), day room(s) and/or recreational room(s) for residents and visitors. Each home should provide at least two areas for this purpose-one for small groups such as private visit with relatives and friends and one for larger group activities. A minimum of eighteen (18) square feet per bed shall be provided. 2. Dining area. A dining area shall be provided in facilities adequate to set at least three-fourths of the maximum capacity of the facility. The dining area may also be used for social, recreational, and/or religious services when not in use as a dining facility. A minimum of fifteen (15) square feet per person for three-fourths (3/4) of the capacity of the facility shall be provided.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 45.27.5** Special Activities Area {#sec-16-45.27.5 omnilex-key=us-ms-regs-official--title-15--16#45.27.5}

Each facility should provide space for hobbies and activities that cannot be included in a day room, living room, or recreational room.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 45.27.6** Outside Area {#sec-16-45.27.6 omnilex-key=us-ms-regs-official--title-15--16#45.27.6}

Adequate outside space should be provided for the use of residents in favorable weather.

therapeutic needs. The dietary department of a facility shall be directed by a Registered Dietitian, a certified dietary manager, or a qualified dietary manager. If a qualified dietary manager is the director, he/she must receive frequent, regularly scheduled consultation from a licensed dietitian, or a registered dietitian exempted from licensure by statute.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13 Subchapter 28 FOOD SERVICES: GENERAL Rule 45.28.1 Direction and Supervision. Food service is one of the basic services provided by the facility to its residents. Careful attention to adequate nutrition and prescribed modified diets contribute appreciably to the health and comfort to the resident and stimulate his desire to achieve and maintain a higher level of self- care. The facility shall provide residents with well-planned, attractive, and satisfying meals which will meet their nutritional, social, emotional, and*
- *SOURCE: Miss. Code Ann. §43-11-13 Subchapter 29 FOOD HANDLING PROCEDURES Rule 45.29.1 Safe Food Handling Procedures. Food shall be prepared, held, and served according to current Mississippi State Department of Health Food Code Regulations.*
- *SOURCE: Miss. Code Ann. §43-11-13 Subchapter 30 MEAL SERVICE Rule 45.30.1 Meal and Nutrition. At least three (3) meals in each twenty-four (24) hours shall be provided. The daily food allowance shall meet the current recommended dietary allowance of the Food and Nutrition Board of the National Research Council of the National Academy of Science adjusted for individual needs. A standard food planning guide (e.g., food pyramid) or Nutrient Based Menu (determined by nutritional analysis) shall be used for planning and food purchasing. It is not intended to meet the nutritional needs of all residents. This guide must be adjusted to consider individual differences. Some residents will need more or less due to age, size, gender, physical activity, or state of health.*
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 45.30.2** Meal Planning Guidelines {#sec-16-45.30.2 omnilex-key=us-ms-regs-official--title-15--16#45.30.2}

Daily Food Guide. The daily food allowance for each resident shall include: 1. Protein food. A minimum of 2-3 servings of meat, poultry, fish, dried beans, eggs, or meats. (4-6 oz daily). 2. Milk, yogurt, and cheese group: A minimum of 2 servings daily. 3. Vegetables and fruits: A minimum of 5 servings daily of fruits and vegetables. This shall include a Vitamin C source daily and a Vitamin A source 3-4 times weekly. 4. Breads, cereals, and pastas: A minimum of 6 servings daily. 5. Fat, oil, and sweets: As needed for additional calories and flavor.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 45.30.3** Nutrient-Based Menu may be used in lieu of using a standard food planning guide {#sec-16-45.30.3 omnilex-key=us-ms-regs-official--title-15--16#45.30.3}

Nutritional analysis of menus shall meet current recommended dietary allowances of the Food and Nutrition Board of the National Research Council of the national Academy of Science for age and gender.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 45.30.4** Menu {#sec-16-45.30.4 omnilex-key=us-ms-regs-official--title-15--16#45.30.4}

The menu shall be planned and written at least one week in advance. The current week's menu shall be approved by the dietitian, dated, posted in the kitchen and followed as planned. Substitutions and changes on all diets shall be documented in writing. Copies of menus and substitutions shall be kept on file for at least thirty (30) days.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 45.30.5** Timing of Meals {#sec-16-45.30.5 omnilex-key=us-ms-regs-official--title-15--16#45.30.5}

A time schedule for serving meals to residents shall be established. Meals shall be served during customarily-accepted timeframes. There shall be no more than fourteen (14) hours between evening meal and breakfast meal. There may be 16 hours between the evening meal and breakfast meal if approved by the resident involved and a substantial snack (including protein) is served before bedtime.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 45.30.6** Modified Diets {#sec-16-45.30.6 omnilex-key=us-ms-regs-official--title-15--16#45.30.6}

Modified diets which are a part of medical treatment shall be prescribed in written orders by the physician or nurse practitioner/physician assistant. All modified diets shall be planned in writing and posted along with regular menus. Liberalized Geriatric Diets are encouraged for elderly residents when there is a need for moderate diet therapy. A current diet manual shall be available to personnel. The dietitian shall approve all modified diet menus and the diet manual used in the nursing home.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 45.30.7** Food Preparation {#sec-16-45.30.7 omnilex-key=us-ms-regs-official--title-15--16#45.30.7}

Foods shall be prepared by methods that conserve optimum nutritive value, flavor, and appearance. Also, the food shall be acceptable to the individuals served. A file of tested recipes shall be maintained to assure uniform quantity and quality of products.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 45.30.8** Food Supply {#sec-16-45.30.8 omnilex-key=us-ms-regs-official--title-15--16#45.30.8}

Supplies of perishable foods for at least a twenty-four (24) hour period and or non-perishable foods for a three (3) day period shall be on the premises to meet the requirements of the planned menus. The non-perishable foods shall consist of commercial type processed foods.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 45.30.9** Serving of Meals {#sec-16-45.30.9 omnilex-key=us-ms-regs-official--title-15--16#45.30.9}

1. Table should be of a type to seat not more than four (4) or six (6) residents. Residents who are not able to go to the dining room shall be provided sturdy tables (not TV trays) of proper heights. For those who are bedfast or infirm tray service shall be provided in their rooms with the tray resting on a firm support. 2. Personnel eating meals or snacks on the premises shall be provided facilities separate from and outside of food preparation, tray service, and dishwashing areas. 3. Foods shall be attractively and neatly served. All foods shall be served at proper temperature. Effective equipment shall be provided and procedures established to maintain food at proper temperature during serving. 4. All trays, tables, utensils and supplies such as china, glassware, flatware, linens and paper placemats, or tray covers used for meal service shall be appropriate, sufficient in quantity and in compliance with the applicable sanitation standard. 5. Food Service personnel. A competent person shall be designated by the administrator to be responsible for the total food service of the home. Sufficient staff shall be employed to meet the established standards of food service. Provisions should be made for adequate supervision and training of the employees.

Also, floors shall be kept in good repair.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13 Subchapter 31 PHYSICAL FACILITIES Rule 45.31.1 Floors. Floors in food service areas shall be of such construction so as to be easily cleaned, sound, smooth, non-absorbent, and without cracks or crevices.*
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 45.31.2** Walls and Ceilings {#sec-16-45.31.2 omnilex-key=us-ms-regs-official--title-15--16#45.31.2}

Walls and ceilings of food service areas shall be of tight and substantial construction, smoothly finished, and painted in a light color. The walls and ceilings shall be without horizontal ledges and shall be washable up to the highest level reached by splash and spray. Roofs and walls shall be maintained free of leaks. All openings to the exterior shall be provided with doors or windows that will prevent the entrance of rain or dust during inclement weather.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 45.31.3** Screens and Outside Openings {#sec-16-45.31.3 omnilex-key=us-ms-regs-official--title-15--16#45.31.3}

Openings to the outside shall be effectively screened. Screen doors shall open outward and be equipped with self-closing devices.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 45.31.4** Lighting {#sec-16-45.31.4 omnilex-key=us-ms-regs-official--title-15--16#45.31.4}

The kitchen, dishwashing area, and dining room shall be provided with well distributed and unobstructed natural light or openings. Artificial light properly distributed and of an intensity of not less than thirty (30) foot candles shall be provided.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 45.31.5** Ventilation {#sec-16-45.31.5 omnilex-key=us-ms-regs-official--title-15--16#45.31.5}

The food service area shall be ventilated in a manner that will maintain comfortable working conditions, remove objectionable odors and fumes, and prevent excessive condensations.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 45.31.6** Employee Toilet Facilities {#sec-16-45.31.6 omnilex-key=us-ms-regs-official--title-15--16#45.31.6}

Toilet facilities with lockers shall be provided for employees. Toilet rooms shall not open directly into any room in which food is prepared, stored, displayed or served, nor into any room in which utensils are washed or stored. Toilet rooms shall have a lavatory and shall be well lighted and ventilated.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 45.31.7** Hand washing Facilities {#sec-16-45.31.7 omnilex-key=us-ms-regs-official--title-15--16#45.31.7}

Hand washing facilities with hot and cold water, soap dispenser and a supply of soap, and disposable towels shall be provided in all kitchens. The use of a common towel is prohibited. Hands shall not be washed in sinks where food is prepared or where utensils are cleaned.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 45.31.8** Refrigeration Facilities {#sec-16-45.31.8 omnilex-key=us-ms-regs-official--title-15--16#45.31.8}

Adequate refrigeration facilities, automatic in operation, for the storage of perishable foods shall be provided. Where separate refrigeration can be provided, the recommended temperatures for storing perishable foods are thirty-two (32) to forty (40) degrees Fahrenheit for meats and dairy products, and forty (40) degrees Fahrenheit to forty-five (45)for fruits and vegetables. If it is impractical to provide separate refrigeration, the temperature shall be maintained at forty-one (41) degrees Fahrenheit. Freezers shall be maintained at zero (0) degrees Fahrenheit or below. All refrigerators shall be provided with a thermometer. Homes with more than twenty-four (24) beds shall have commercial or institutional type refrigeration.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 45.31.9** Equipment and Utensil Construction {#sec-16-45.31.9 omnilex-key=us-ms-regs-official--title-15--16#45.31.9}

Equipment and utensils shall be constructed so as to be easily cleaned and shall be kept in good repair.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 45.31.10** Separation of Kitchen from Resident Rooms and Sleeping Quarters {#sec-16-45.31.10 omnilex-key=us-ms-regs-official--title-15--16#45.31.10}

Any room used for sleeping quarters shall be separated from the food service area by a solid wall. Sleeping accommodations such as a cot, bed, or couch shall not be permitted within the food service area.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13 Subchapter 32 AREAS AND EQUIPMENT Rule 45.32.1 Location and Space Requirements. Food service facilities shall be located in a specifically designated area and shall include the following rooms and/or spaces: kitchen, dishwashing, food storage, and dining room.*
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 45.32.2** Kitchen {#sec-16-45.32.2 omnilex-key=us-ms-regs-official--title-15--16#45.32.2}

1. Size and Dimensions. The minimum area of kitchen (food preparation only) for less than twenty-five (25) beds shall be a minimum area of two hundred (200) square feet. In facilities with twenty five (25) beds to sixty (60) beds, a minimum of ten (10) square feet per bed shall be provided. In facilities with sixty-one (61) to eighty (80) beds, a minimum of six (6) square feet per bed shall be provided for each bed over sixty (60) in the home. In facilities with eighty-one (81) to one hundred (100) beds, a minimum of five (5) square feet per bed shall be provided for each bed over eighty (80). In facilities with more than one hundred (100) beds proportionate space approved by the licensing agency shall be provided. Also, the kitchen shall be of such size and dimensions in order to: a. Permit orderly and sanitary handling and processing of food. b. Avoid overcrowding and congestion of operations. c. Provide at least three (3) feet between working areas and wider if space is used as a passageway. d. Provide a ceiling height of at least eight (8) feet. 2. Equipment. Minimum equipment in kitchen shall include: a. Range and cooking equipment. Facilities with more than twenty-four (24) beds shall have institutional type ranges, ovens, steam cookers, fryers, etc., in appropriate sizes and number to meet the food preparation needs of the facility. The cooking equipment shall be equipped with a hood vented to the outside as appropriate. b. Refrigerator and Freezers. Facilities with more than twenty-four (24) beds shall have sufficient commercial or institutional type refrigeration/freezer units to meet the storage needs of the facility.

c. Bulletin Board. d. Clock. e. Cook's table. f. Counter or table for tray set-up. g. Cans garbage (heavy plastic or galvanized). h. Lavatories, hand washing; conveniently located throughout the department. i. Pots, pans, silverware, dishes, and glassware in sufficient numbers with storage space for each. j. Pot and Pan Sink. A three compartment sink shall be provided for cleaning pots and pans. Each compartment shall be a minimum of twenty-four (24) inches by twenty (24) inches by sixteen (16) inches. A drain board of approximately thirty (30) inches shall be provided at each end of the sink, one to be used for stacking soiled utensils and the other for draining clean utensils. k. Food Preparation Sink. A double compartment food preparation sink shall provide for washing vegetables and other foods. A drain board shall be provided at each end of the sink. l. Ice Machine. At least one ice machine shall be provided. If there is only one (1) ice machine in the facility it shall be located adjacent to but not in the kitchen. If there is an ice machine located at nursing station, then ice machine for dietary shall be located in the kitchen. m. Office. An office shall be provided near the kitchen for the use of the food service supervisor. As a minimum, the space provided shall be adequate for a desk, two chairs and a filing cabinet. n. Coffee Tea and Milk Dispenser. (Milk dispenser not required if milk is served in individual cartons). o. Tray assembly line equipment with tables, hot food tables, tray slide, etc. p. Ice Cream Storage. q. Mixer. Institutional type mixer of appropriate size for facility. r. Food Processor.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 45.32.3** Dishwashing {#sec-16-45.32.3 omnilex-key=us-ms-regs-official--title-15--16#45.32.3}

Commercial or institutional type dishwashing equipment shall be provided in homes with more than twenty-four (24) beds. The dishwashing area

shall be separated from the food preparation area. If sanitizing is to be accomplished by hot water, a minimum temperature of one hundred eighty (180) degrees Fahrenheit shall be maintained during the rinsing cycle. An alternate method of sanitizing through use of chemicals may be provided if sanitizing standards of the Mississippi State Department of Health Food Code Regulations are observed. Adequate counter-space for stacking soiled dishes shall be provided in the dishwashing area at the most convenient place of entry from the dining room, followed by a disposer with can storage under the counter. There shall be a pre-rinse sink, then the dishwasher and finally a counter or drain for clean dishes.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 45.32.4** Food Storage {#sec-16-45.32.4 omnilex-key=us-ms-regs-official--title-15--16#45.32.4}

A food-storage room with cross ventilation shall be provided. Adequate shelving, bins, and heavy plastic or galvanized cans shall be provided. The storeroom shall be of such construction as to prevent the invasion of rodents and insects, the seepage of dust and water leakage, or any other source of contamination. The food-storage room should be adjacent to the kitchen and convenient to the receiving area. The minimum area for a food-storage room shall equal two and one-half (2 1/2) square feet per bed and the width of the aisle shall be a minimum of three (3) feet.

1. If at all possible, all water shall be obtained from a public water supply. If not possible to obtain water from a public water supply source, the private water supply shall meet the approval of the local county health department and/or the Mississippi State Department of Health. 2. Water under pressure sufficient to operate fixtures at the highest point during maximum demand periods shall be provided. Water under pressure of at least fifteen (15) pounds per square inch shall be piped to all sinks, toilets, lavatories, tubs, showers, and other fixtures requiring water. 3. It is recommended that the water supply into the facility can be obtained from two (2) separate water lines if possible. 4. A dual hot water supply shall be provided. The temperature of hot water to lavatories and bathing facilities shall not exceed one hundred fifteen (115) degrees Fahrenheit, nor shall hot water be less than one hundred (100) degrees Fahrenheit. 5. Each facility shall have a written agreement for an alternate source of potable water in the event of a disruption of the normal water supply.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13 Subchapter 33 SANITATION AND MEDICAL WASTE: SANITATION Rule 45.33.1 Water Supply.*
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 45.33.2** Disposal of Liquid and Human Wastes {#sec-16-45.33.2 omnilex-key=us-ms-regs-official--title-15--16#45.33.2}

1. There shall be installed within the facility a properly designed waste disposal system connecting to all fixtures to which water under pressure is piped. 2. All liquid and human waste, including floor-wash water and liquid waste from refrigerators, shall be disposed of through trapped drains into a public sewer system where such system is available. 3. In localities where a public sanitary sewer is not available, liquid and human waste shall be disposed of through trapped drains into sewerage disposal system approved by the local county health department and/or the Mississippi State Department of Health. The sewerage disposal system shall be of a size and capacity based on the number of residents and personnel housed and employed in the facility. Where the sewerage disposal system is installed prior to the opening of the facility, it shall be assumed, unless proven otherwise, that the system was designed for ten (10) or fewer persons.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 45.33.3** Premises {#sec-16-45.33.3 omnilex-key=us-ms-regs-official--title-15--16#45.33.3}

The premises shall be kept neat, clean, and free of an accumulation of rubbish, weeds, ponded water, or other conditions which would have a tendency to create a health hazard.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 45.33.4** Control of insects, rodents, etc {#sec-16-45.33.4 omnilex-key=us-ms-regs-official--title-15--16#45.33.4}

The facility shall be kept free of ants, flies, roaches, rodents, and other insects and vermin. Proper methods for their eradication and control shall be utilized.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 45.33.5** Toilet Room Cleanliness {#sec-16-45.33.5 omnilex-key=us-ms-regs-official--title-15--16#45.33.5}

Floors, walls, ceilings, and fixtures of all toilet rooms shall be kept clean and free of objectionable odors. These rooms shall be kept free of an accumulation of rubbish, cleaning supplies, toilet articles, etc.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 45.33.6** Garbage Disposal {#sec-16-45.33.6 omnilex-key=us-ms-regs-official--title-15--16#45.33.6}

1. Garbage must be kept in water-tight suitable containers with tight fitting covers. Garbage containers must be emptied at frequent intervals and cleaned before using again. 2. Proper disposition of infectious materials shall be observed.

Subchapter 34 REGULATED MEDICAL WASTE Rule 45.34.1 Standards and Requirements. REPEALED. Effective 01.13.2023

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 45.34.2** Medical Waste {#sec-16-45.34.2 omnilex-key=us-ms-regs-official--title-15--16#45.34.2}

REPEALED. Effective 01.13.2023

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 45.34.3** Medical Waste Management Plan {#sec-16-45.34.3 omnilex-key=us-ms-regs-official--title-15--16#45.34.3}

All generators of infectious medical waste and medical waste shall have a medical waste management plan in accordance with Adopted Standards for the Regulation of Medical Waste located on the Mississippi State Department of Health’s website.

1. The physical plant shall be kept in good repair, neat, and attractive. The safety and comfort of the resident shall be the first consideration. 2. Janitor closets shall be provided with a mop-cleaning sink and be large enough in area to store house cleaning supplies and equipment. A separate janitor closet area and equipment should be provided for the food service area.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13 Subchapter 34 HOUSEKEEPING AND PHYSICAL PLANT Rule 45.34.1 Housekeeping Facilities and Services.*
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 45.35.2** Bathtubs, Showers, and Lavatories {#sec-16-45.35.2 omnilex-key=us-ms-regs-official--title-15--16#45.35.2}

Bathtubs, showers, and lavatories shall be kept clean and in proper working order. They shall not be used for laundering or for storage of soiled materials. Neither shall these facilities be used for cleaning mops, brooms, etc.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 45.35.3** Resident Bedrooms {#sec-16-45.35.3 omnilex-key=us-ms-regs-official--title-15--16#45.35.3}

Resident bedrooms shall be cleaned and dusted as often as necessary to maintain a clean, attractive appearance. All sweeping should be damp sweeping, all dusting should be damp dusting with a good detergent or germicide.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 45.35.4** Storage {#sec-16-45.35.4 omnilex-key=us-ms-regs-official--title-15--16#45.35.4}

1. Such items as beds, mattresses, mops, mop buckets, dust rags, etc. shall not be kept in hallways, corners, toilet or bathrooms, clothes closets, or resident bedrooms. 2. The use of attics for storage of combustible materials is prohibited. 3. If basements are used for storage, they shall meet acceptable standards for storage and for fire safety.

Soiled materials shall not be transported through the food service area. If commercial laundry is used, separate satisfactory storage areas shall be provided for clean and soiled linens. There shall be provided a clean linen storage area separate from the laundry area.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13 Subchapter 36 LAUNDRY: GENERAL Rule 45.36.1 Commercial Laundry. Facilities may use commercial laundries or they may provide a laundry within the institution.*
- *SOURCE: Miss. Code Ann. §43-11-13 Subchapter 37 PHYSICAL FACILITIES Rule 45.37.1 Location and Space Requirements. Each facility shall have laundry facilities unless commercial laundries are used. The laundry shall be located in a specifically designated area, and there shall be adequate room and space for sorting, processing, and storage of soiled material. Laundry rooms or soiled linen storage areas shall not open directly into a resident bedroom or food service area.*
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 45.37.2** Ventilation {#sec-16-45.37.2 omnilex-key=us-ms-regs-official--title-15--16#45.37.2}

Provisions shall be made for proper mechanical ventilation of the laundry. Provisions shall be made to prevent the recirculation of air through the heating and air condition systems.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 45.37.3** Lint Traps {#sec-16-45.37.3 omnilex-key=us-ms-regs-official--title-15--16#45.37.3}

Adequate and effective lint traps shall be provided for driers.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 45.37.4** Laundry Chutes {#sec-16-45.37.4 omnilex-key=us-ms-regs-official--title-15--16#45.37.4}

When laundry chutes are provided they shall have a minimum diameter of two (2) feet; and they shall be installed with flushing ring, vent, and drain.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 45.37.5** Laundry Equipment {#sec-16-45.37.5 omnilex-key=us-ms-regs-official--title-15--16#45.37.5}

Laundry equipment shall be of the type to adequately perform the laundry needs of the institution. The equipment shall be installed to comply with all local and state codes.

1. To qualify for a license, the facility shall be planned to serve the type of patients to be admitted and shall comply with the following: a. All facilities constructed after the effective date of these regulations shall comply with the building requirements set forth in the regulations. b. After the effective date of these regulations, all additions to facilities shall comply with the building requirements for a license. Approval shall not be granted for an addition to an existing building which will increase the bed capacity unless the existing structure is basically sound and is to be brought into a condition of acceptable conformity with the current regulations. c. Authority to Waiver. The licensing agency may waive certain requirements in the regulations at its discretion for facilities licensed as a facility in a state- owned and state-operated mental institution provided the health and safety of residents will not be endangered. 2. Renovations within the exterior walls of a facility shall in no case be of such nature as to lower the character of the structure below the applicable building requirements for the type of license held by the facility.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13 Subchapter 38 PHYSICAL PLANT: GENERAL Rule 45.38.1 Building Classification.*
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 45.38.2** Location {#sec-16-45.38.2 omnilex-key=us-ms-regs-official--title-15--16#45.38.2}

All facilities established or constructed after the adoption of these regulations shall be located so that they are free from undue noise, smoke, dust, or foul odors and shall not be located adjacent to disposal plants, cemeteries, main line railroads, funeral home, airport, etc.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 45.38.3** Site {#sec-16-45.38.3 omnilex-key=us-ms-regs-official--title-15--16#45.38.3}

The proposed site for a facility must be approved by the licensing agency. Factors to be considered in approving a site in addition to the above may be convenience to medical and hospital services, approved water supply and sewerage disposal, public transportation, community services, services of an organized fire department, an availability to labor supply. Not more than one- third (1/3) of a site shall be covered by a building(s) except by special approval of the licensing agency. One example whereby approval may be granted is where the structure is to be placed in a very desirable location where the grounds are

limited and very expensive. Where such approval is granted, the structure will be required to have a living room, day room, sun room, and recreational areas adequate to compensate for lack of required outside area.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 45.38.4** Local Restrictions {#sec-16-45.38.4 omnilex-key=us-ms-regs-official--title-15--16#45.38.4}

The site and structure of all facilities shall comply with local building, fire and zoning ordinances. Evidence to this effect signed by local building, fire, and zoning officials shall be presented.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 45.38.5** Transportation {#sec-16-45.38.5 omnilex-key=us-ms-regs-official--title-15--16#45.38.5}

Facilities shall be located on streets or roads which have all weather surface. They should be located convenient to public transportation facilities.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 45.38.6** Communication {#sec-16-45.38.6 omnilex-key=us-ms-regs-official--title-15--16#45.38.6}

There shall be not less than one telephone in the home and such additional telephones as are necessary to summon help in event of fire or other emergency. The telephone shall be listed under the official licensed name or title of the home.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 45.38.7** Occupancy {#sec-16-45.38.7 omnilex-key=us-ms-regs-official--title-15--16#45.38.7}

No part of the facility may be rented, leased, or used for any commercial purpose not related to the operation of the home.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 45.38.8** Basement {#sec-16-45.38.8 omnilex-key=us-ms-regs-official--title-15--16#45.38.8}

1. The basement shall be considered as a story if one-half (1/2) or more of its clear height is above the average elevation of the ground adjoining the building on all sides. 2. No resident shall be housed on any floor that is below ground level.

one-eight (1/8) inch to equal one (1) foot or one-fourth (1/4) inch to equal one (1) foot.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13 Subchapter 39 SUBMISSION OF PLANS AND SPECIFICATIONS Rule 45.39.1 New Construction, Additions, and Renovations. When construction is contemplated either for new buildings, conversions, additions, or alterations to existing buildings, one set of plans and specifications shall be submitted to the licensing agency for review and approval. The submission shall be made in not less than two stages preliminary and final. Floor plans shall be drawn to scale of*
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 45.39.2** Minor Alterations and Remodeling {#sec-16-45.39.2 omnilex-key=us-ms-regs-official--title-15--16#45.39.2}

Minor alterations and remodeling which do not affect the structural integrity of the building, change functional operation, affect fire safety, or add beds or facilities or those for which the facility is licensed do not need to have plans submitted for review provided that a detailed explanation of the proposed alteration or remodeling is submitted to and approved by the licensing agency.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 45.39.3** First Stage Submission-Preliminary Plans.: First stage or preliminary plans shall include: 1 {#sec-16-45.39.3 omnilex-key=us-ms-regs-official--title-15--16#45.39.3}

Plot plant showing size and shape of entire site; location of proposed building and any existing structure(s); adjacent streets, highways, sidewalks, railroads, etc., all properly designated; and size, characteristics, and location of all existing public utilities. 2. Floor plan showing over-all dimensions of building(s); location, size, and purpose of all rooms; location and size of all doors, windows, and other openings with swing of doors properly indicated; dimensions of all corridors and hallways; and location of stairs, elevators, dumbwaiters, vertical shafts, and chimneys. a. Outline specifications giving kinds and types of materials. b. A scaled drawing of one-fourth (1/4) inch to one (1) foot shall be submitted for the following areas: Kitchen, dishwashing area, nurses' station and utility room(s).

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 45.39.4** Rule 45.39.4 {#sec-16-45.39.4 omnilex-key=us-ms-regs-official--title-15--16#45.39.4}

Final Stage Submission-Working Drawings and Specifications.: Final stage or working drawings and specifications shall include: 1. Architectural drawings 2. Structural drawings 3. Mechanical drawings to include plumbing, heat, and air-conditioning 4. Electrical drawings 5. Detailed specifications

6. Approval of working drawings and specifications shall be obtained from the licensing agency in writing prior to the beginning of actual construction.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 45.39.5** Preparation of Plans and Specifications {#sec-16-45.39.5 omnilex-key=us-ms-regs-official--title-15--16#45.39.5}

The preparation of drawings and specifications shall be executed by or under the immediate supervision of an architect who shall supervise construction and furnish a signed statement that construction was performed according to plans and specifications approved by the licensing agency.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 45.39.6** Contract Modifications {#sec-16-45.39.6 omnilex-key=us-ms-regs-official--title-15--16#45.39.6}

Any contract modification which affects or changes the function, design, or purpose of a facility shall be submitted to and approved by the licensing agency prior to the beginning of work set forth in any contract modification.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 45.39.7** Notification of Start of Construction {#sec-16-45.39.7 omnilex-key=us-ms-regs-official--title-15--16#45.39.7}

The licensing agency shall be informed in writing at the time construction is begun.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 45.39.8** Inspections {#sec-16-45.39.8 omnilex-key=us-ms-regs-official--title-15--16#45.39.8}

The licensing agency or its authorized representatives shall have access at all times to the work for inspection whenever it is in preparation or progress, and the owner shall ascertain that proper facilities are made available for such access and inspection.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 45.39.9** Limit of Approval {#sec-16-45.39.9 omnilex-key=us-ms-regs-official--title-15--16#45.39.9}

In construction delayed for a period of exceeding six (6) months from the time of approval of final working plans and specifications, a new evaluation and/or approval shall be obtained from the licensing agency.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 45.39.10** Water Supply, Plumbing, Sewerage Disposal {#sec-16-45.39.10 omnilex-key=us-ms-regs-official--title-15--16#45.39.10}

The water supply and sewerage disposal shall be approved by the local county health department and/or the Division of Sanitary Engineering, Mississippi State Department of Health. No system of water supply, plumbing, sewerage, garbage, or refuse disposal shall be installed nor any such existing system materially altered or extended until complete plans and specifications for the installation, alteration, or extension have been so approved and submitted to the licensing agency for review and final determination.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 45.39.11** Rule 45.39.11 {#sec-16-45.39.11 omnilex-key=us-ms-regs-official--title-15--16#45.39.11}

Availability of Approved Plans: Every licensed facility shall maintain, on the premises and available for inspection, a copy of current approved architectural plans and specifications.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13 Subchapter 40 GENERAL BUILDING REQUIREMENTS Rule 45.40.1 Scope. The provision of this section shall apply to all facilities except for those sections or paragraphs where a specific exception is granted for existing facilities.*
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 45.40.2** Structural Soundness and Repair; Fire Resistive Rating {#sec-16-45.40.2 omnilex-key=us-ms-regs-official--title-15--16#45.40.2}

The building shall be structurally sound, free from leaks and excessive moisture, in good repair, and painted at sufficient intervals to be reasonably attractive inside and out.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 45.40.3** Temperature {#sec-16-45.40.3 omnilex-key=us-ms-regs-official--title-15--16#45.40.3}

Adequate heating and cooling shall be provided in all rooms used by residents so that a minimum temperature of seventy-five (75) to eighty (80) degrees Fahrenheit may be maintained.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 45.40.4** Lighting {#sec-16-45.40.4 omnilex-key=us-ms-regs-official--title-15--16#45.40.4}

Each resident's room shall have artificial light adequate for reading and other uses as needed. There should be a minimum of ten (10) foot-candles of lighting for general use in resident's room and a minimum of thirty (30) foot- candles of lighting for reading purposes. All entrances, corridors, stairways, ramps, cellars, attics, storerooms, kitchens, laundries, and service units shall have sufficient artificial lighting to prevent accidents and promote efficiency of service. Night lights shall be provided in all corridors, stairways, toilets, and bathing rooms.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 45.40.5** Screens {#sec-16-45.40.5 omnilex-key=us-ms-regs-official--title-15--16#45.40.5}

All screen doors and non-stationary windows shall be equipped with tight fitting full length, sixteen (16) mesh screens. Screen doors shall swing out and shall be equipped with self-closing devices.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 45.40.6** Floors {#sec-16-45.40.6 omnilex-key=us-ms-regs-official--title-15--16#45.40.6}

All floors shall be smooth and free from defects such as cracks and be finished so that they can be easily cleaned.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 45.40.7** Walls and Ceilings {#sec-16-45.40.7 omnilex-key=us-ms-regs-official--title-15--16#45.40.7}

All walls and ceilings shall be of sound construction with an acceptable surface and shall be maintained in good repair. Generally the walls and ceilings should be painted a light color.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 45.40.8** Ceiling Height {#sec-16-45.40.8 omnilex-key=us-ms-regs-official--title-15--16#45.40.8}

All ceilings shall have a height of at least eight (8) feet except that a height of seven (7) feet and six (6) inches may be approved for corridors or toilets and bathing rooms where the lighting fixtures are recessed. Exception may be made for existing facilities.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 45.40.9** Handrails {#sec-16-45.40.9 omnilex-key=us-ms-regs-official--title-15--16#45.40.9}

Handrails shall be installed on both sides of all corridors and hallways used by residents. The handrails should be installed from thirty-two (32) inches to thirty-six (36) inches above the floors. The handrails should have a return to the wall at each rail ending. Exception may be made for existing facilities.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 45.40.10** Ramps and Inclines {#sec-16-45.40.10 omnilex-key=us-ms-regs-official--title-15--16#45.40.10}

Ramps and inclines, where installed for the use of residents, shall not exceed one (1) foot of rise in twelve (12) feet of run, shall be furnished with a non-slip floor, and shall be provided with handrails on both sides. Exception may be granted for existing ramps and inclines on existing facilities.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 45.40.11** Call System {#sec-16-45.40.11 omnilex-key=us-ms-regs-official--title-15--16#45.40.11}

A call system shall be in place at the nurses' station to receive resident calls through a communication system to include audible and visual signals from bedrooms, toilets, and bathing facilities.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 45.40.12** Trash Chutes {#sec-16-45.40.12 omnilex-key=us-ms-regs-official--title-15--16#45.40.12}

The installation and/or use of trash chutes is prohibited.

1. Buildings constructed after the effective date of these regulations shall comply with the edition of the Life Safety Code (NFPA 101) effective on the date of construction.

2. Buildings constructed prior to the effective date of these regulations shall comply with Chapter 19 of the Life Safety Code (NFPA 101), 2012 edition.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13 Subchapter 41 FIRE SAFETY AND CONSTRUCTION Rule 45.41.1 Date of Construction and Life Safety Code Compliance.*
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 45.41.2** Required Rooms and Areas {#sec-16-45.41.2 omnilex-key=us-ms-regs-official--title-15--16#45.41.2}

1. Resident bedroom. (See Rule 45.20.2) 2. Special care room. (See Rule 45.20.3) 3. Nurses' Station. (See Rule 45.20.4) 4. Utility room. (See Rule 45.20.5) 5. Toilet and bathing facilities. (See Rule 40.20.6) 6. Clean linen storage. Adequate areas shall be provided for storing clean linens which shall be separate from dirty linen storage. 7. Wheelchair area. Adequate area shall be provided for storage of wheelchairs. 8. Kitchen. (See Rule 45.33.2-45.33.4) 9. Dining room. The dining area shall be large enough to seat three-fourth (3/4) of the maximum capacity of nursing home. The dining area can also be used for social, recreational, or religious activities. It is recommended that a separate dining area be provided for personnel. 10. Food storage. A food storage room shall be provided convenient to the kitchen in all future licensed homes. It should have cross ventilation. All foods must be stored a minimum of twelve (12) inches above the floor. 11. Day room or living room. Adequate day or living room area shall be provided for residents or residents and guests. These areas shall be designated exclusively for this purpose and shall not be used as sleeping area or otherwise. It is recommended that at least two (2) such areas be provided and more in larger homes. 12. Janitor closet. At least one (1) janitor's closet shall be provided for each floor. The closet shall be equipped with a mop sink and be adequate in area to store cleaning supplies and equipment. A separate janitor's closet shall be provided for the food service area. 13. Garbage can cleaning and storage area. 14. General storage. A minimum area equal to at least five (5) square feet per bed shall be provided for general storage.

15. Laundry. If laundry is done in the institution, a laundry room shall be provided. Adequate equipment for the laundry load of the home shall be installed. The sorting, washing, and extracting process should be separated from the folding and ironing area-preferably in separate rooms. 16. Separate toilet room (lavatory and water closet) shall be provided for male and female employees. 17. A separate toilet room with a door that can be locked shall be provided for the public. 18. Food Service Supervisors Office. 19. Social Services Office.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13 Subchapter 42 ENFORCEMENT: DEFINITIONS FOR LICENSURE-ONLY NURSING FACILITIES Rule 45.42.1 Substandard Quality of Care. One or more deficiencies related to the regulatory requirements in Rule 45.1.3, 45.18.1 and Subchapter 22, which constitute either immediate jeopardy to resident health or safety, or a pattern or widespread deficiencies at a Level 3 severity, or widespread deficiencies at a Level 2 severity.*
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 45.42.2** Substandard Facility {#sec-16-45.42.2 omnilex-key=us-ms-regs-official--title-15--16#45.42.2}

A facility which is found to be in violation of any of the regulations in Rule 45.1.3, 45.18.1 and Subchapter 22, on the current licensure visit and has been found to be in violation of any of the afore cited regulations during the previous regular re-licensure visit, or any intervening revisit or complaint investigation.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 45.42.3** Ban on All Admissions {#sec-16-45.42.3 omnilex-key=us-ms-regs-official--title-15--16#45.42.3}

A ban on all admissions to a facility may be imposed by the licensing agency when it has been determined by the licensing agency that the facility is providing substandard quality of care as defined in Rule 45.9.2 above.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 45.42.4** Division Director {#sec-16-45.42.4 omnilex-key=us-ms-regs-official--title-15--16#45.42.4}

The Division Director is the Director of the Mississippi State Department of Health (otherwise known as the licensing agency), Division of Health Facilities Licensure and Certification.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 45.42.5** Informal Dispute Resolution {#sec-16-45.42.5 omnilex-key=us-ms-regs-official--title-15--16#45.42.5}

Procedures set forth in Rule 45.24.1 provide facilities with one opportunity to dispute findings of licensure violations.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 45.42.6** Temporary Manager {#sec-16-45.42.6 omnilex-key=us-ms-regs-official--title-15--16#45.42.6}

If a facility is designated as a substandard facility, the licensing agency may select a temporary manager in order to oversee correction of deficient practices cited as violations by the agency and assure the health and safety of the facility’s residents while corrections are being made. A temporary manager may also be appointed to oversee the orderly closure of a facility. No temporary manager shall be appointed pursuant to these regulations unless the licensing agency finds Widespread Level-3 Severity deficiency or deficiencies pursuant to Rule 45.9.11 and Rule 45.9.12 or Isolated, Pattern, or Widespread Level-4 deficiency or deficiencies pursuant to Rule 45.9.10, Rule 45.9.11 and Rule 45.9.12. Temporary management shall not be imposed unless other less intrusive remedies will not result in compliance, or have failed to cause the facility to achieve compliance.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 45.42.7** State Monitor {#sec-16-45.42.7 omnilex-key=us-ms-regs-official--title-15--16#45.42.7}

In lieu of a temporary manager, the licensing agency may appoint a state monitor to oversee the correction of cited deficiencies in a facility as a safeguard against further harm to residents, or when the potential for harm exists as a result of cited licensure violations at any level of severity or scope.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 45.42.8** Directed Plan of Correction {#sec-16-45.42.8 omnilex-key=us-ms-regs-official--title-15--16#45.42.8}

A Directed Plan of Correction is a plan which the licensing agency, or the temporary manager, develops to require a facility to take action within specified time frames.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 45.42.9** Substantial Compliance {#sec-16-45.42.9 omnilex-key=us-ms-regs-official--title-15--16#45.42.9}

A level of compliance which does not entail the imposition of an enforcement remedy.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 45.42.10** Pattern {#sec-16-45.42.10 omnilex-key=us-ms-regs-official--title-15--16#45.42.10}

Pattern is the scope of licensure violations when more than a limited number of residents are affected, and/or more than a limited number of staff are involved, and/or the situation has occurred in several locations, and/or the same resident(s) have been affected by repeated occurrences of the same deficient practice. The effect of the deficient practice is not found to be pervasive through the facility.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 45.42.11** Widespread {#sec-16-45.42.11 omnilex-key=us-ms-regs-official--title-15--16#45.42.11}

Widespread is the scope of licensure violations when the problems causing the violations are pervasive in the facility and/or represent systemic failure that affected or has the potential to affect a large portion or all of the facility’s residents.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 45.42.12** Severity {#sec-16-45.42.12 omnilex-key=us-ms-regs-official--title-15--16#45.42.12}

1. Level 1 - Potential for causing no more than a minor negative impact on the resident(s). 2. Level 2 - Noncompliance that results in minimal physical, mental, and/or psycho- social discomfort to the resident and/or has the potential (not yet realized) to compromise the resident’s ability to maintain and/or reach his/her highest practicable physical, mental and/or psycho-social well-being as defined by an accurate and comprehensive resident assessment, plan of care, and provision of services. 3. Level 3 - Noncompliance that results in a negative outcome that has compromised the resident’s ability to maintain his/her highest practicable physical, mental and psycho-social well-being as defined by an accurate and comprehensive resident assessment, plan of care, and provision of services. 4. Level 4 - Immediate jeopardy, a situation in which immediate corrective action is necessary because the facility’s noncompliance with one or more requirements of participation has caused, or is likely to cause, serious injury, harm, impairment, or death to a resident receiving care in a facility.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 45.42.13** Directed In-Service Training {#sec-16-45.42.13 omnilex-key=us-ms-regs-official--title-15--16#45.42.13}

The purpose of directed in-service training is to provide basic knowledge to achieve compliance and remain in compliance with the requirements of these regulations.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 45.42.14** Bureau Director {#sec-16-45.42.14 omnilex-key=us-ms-regs-official--title-15--16#45.42.14}

The Bureau Director is the Director of the Mississippi State Department of Health (otherwise known as the licensing agency), Bureau of Health Facilities Licensure and Certification.

healthcare facilities for participation in the Medicare and Medicaid programs, pursuant to the Social Security Act at 42.U.S.C. Sections 1819(h)(2), 1819(g)(2), 1919 (g)(2), 1919(h), and 42 CFR. 488.415, 488.425, 488.310, 488.331, and 488.417(a).

**History**
- *SOURCE: Miss. Code Ann. §43-11-13 Subchapter 43 DEFINITIONS FOR LICENSED AND CERTIFIED NURSING FACILITIES Rule 45.43.1 General. The Mississippi State Department of Health (otherwise known as the licensing agency), Bureau of Licensure and Certification is authorized to certify*
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 45.43.2** Substandard Quality of Care {#sec-16-45.43.2 omnilex-key=us-ms-regs-official--title-15--16#45.43.2}

One or more deficiencies related to participation requirements under 42 CFR 483.13, Resident Behavior and Facility Practices, 42 CFR 483.15, Quality of Life, or 42 CFR 483.25, Quality of Care which, constitute either immediate jeopardy to resident health or safety, or a pattern or widespread deficiencies at a Level 3 severity, or widespread deficiencies at Level 2 severity.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 45.43.3** Poor Performing Facility {#sec-16-45.43.3 omnilex-key=us-ms-regs-official--title-15--16#45.43.3}

If a facility is found noncompliant with any deficiency with a scope and severity at the level of actual harm or higher on the current survey and the facility had a deficiency at the level of actual harm or higher on any intervening survey (i.e., any survey between the last standard survey and the current one), the facility will be considered a poor performing facility.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 45.43.4** Immediate Jeopardy (Serious and Immediate to Health and Safety) {#sec-16-45.43.4 omnilex-key=us-ms-regs-official--title-15--16#45.43.4}

A situation in which the facility’s failure to meet one or more requirements of participation in the Medicare/Medicaid program has caused, or is likely to cause, serious injury, harm, impairment, or death to a resident.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 45.43.5** Rule 45.43.5 {#sec-16-45.43.5 omnilex-key=us-ms-regs-official--title-15--16#45.43.5}

Ban on all Admissions A ban on all admissions to a facility shall be imposed by the licensing agency when it has been determined by the licensing agency that the facility is not in compliance with a Level 2, widespread deficiency or Level 3, pattern or widespread deficiency, or any deficiency cited as a Level 4, immediate jeopardy. These deficiencies must be determined as Substandard Quality of Care as defined under Rule 45.9.1 or Immediate Jeopardy as defined under Rule 45.24.1. The licensing agency will also recommend to the state Medicaid agency denial of payment for new admissions.

Subchapter 45 TEMPORARY MANAGER Rule 45.45.1. Temporary Manager. A temporary manager may be selected as a remedy when a facility has been determined as having immediate jeopardy or widespread actual harm that does not constitute immediate jeopardy in order to oversee the correction of deficient practices cited by the licensing agency and assure the health and safety of the facility’s residents while the corrections are being made. A temporary manager may also be imposed to oversee orderly closure of a facility. Temporary management shall not be imposed unless other less intrusive remedies will not result in compliance, or have failed to cause the facility to achieve compliance.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13 Subchapter 44 INFORMAL DISPUTE RESOLUTION Rue 45.44.1 Informal Dispute Resolution. Procedures set forth in Rule 45.24.1 provide facilities with one opportunity to dispute survey findings.*
- *SOURCE: Miss. Code Ann. §43-11-13*
- *SOURCE: Miss. Code Ann. §43-11-13 Subchapter 46 STATE MONITORING Rule 45.46.1 State Monitoring. A State Monitor oversees the correction of cited deficiencies in a facility as a safeguard against further harm to residents when harm or a situation with a potential for harm has occurred.*
- *SOURCE: Miss. Code Ann. §43-11-13 Subchapter 47 DIRECTED PLAN OF CORRECTION Rule 45.47.1 A Directed Plan of Correction is a plan which the licensing agency, or the temporary manager, develops to require a facility to take action within specified time frames.*
- *SOURCE: Miss. Code Ann. §43-11-13 Subchapter 48 SUBSTANTIAL COMPLIANCE Rule 45.48.1 A level of compliance which does not entail the imposition of an enforcement remedy.*
- *SOURCE: Miss. Code Ann. §43-11-13 Subchapter 49 PATTERN Rule 45.49.1 Pattern is the scope of deficiencies when more than a limited number of residents are affected, and/or more than a limited number of staff are involved, and/or the situation has occurred in several locations, and/or the same resident(s) have been affected by repeated occurrences of the same deficient practice. The effect of the deficient practice is not found to be pervasive through the facility.*
- *SOURCE: Miss. Code Ann. §43-11-13 Subchapter 50 WIDESPREAD*

##### **15 Miss. Admin. Code Pt. 16, R. 45.50.1** Rule 45.50.1 {#sec-16-45.50.1 omnilex-key=us-ms-regs-official--title-15--16#45.50.1}

Widespread is the scope of deficiencies when the problems causing the deficiencies are pervasive in the facility and/or represent systemic failure that affected or has the potential to affect a large portion or all of the facility’s residents.

2. Level 2 - Noncompliance that results in minimal physical, mental, and/or psycho- social discomfort to the resident and/or has the potential (not yet realized) to compromise the resident’s ability to maintain and/or reach his/her highest practicable physical, mental and/or psycho-social well-being as defined by an accurate and comprehensive resident assessment, plan of care, and provision of services. 3. Level 3 - Noncompliance that results in a negative outcome that has compromised the resident’s ability to maintain his/her highest practicable physical, mental and psycho-social well-being as defined by an accurate and comprehensive resident assessment, plan of care, and provision of services. 4. Level 4 - Immediate jeopardy, a situation in which immediate corrective action is necessary because the facility’s noncompliance with one or more requirements of participation has caused, or is likely to cause, serious injury, harm, impairment, or death to a resident receiving care in a facility.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13 Subchapter 51 SEVERITY 1. Level 1 - Potential for causing no more than a minor negative impact on the resident(s).*
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 45.51.2** Directed In-Service Training {#sec-16-45.51.2 omnilex-key=us-ms-regs-official--title-15--16#45.51.2}

The purpose of directed in-service training is to provide basic knowledge to achieve compliance and remain in compliance with requirements of federal guidelines and state regulations, when applicable.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 45.51.3** Bureau Director {#sec-16-45.51.3 omnilex-key=us-ms-regs-official--title-15--16#45.51.3}

The Bureau Director is the Director of the Mississippi State Department of Health (otherwise known as the licensing agency), Bureau of Health Facilities Licensure and Certification.

the notification that a ban on all admissions is to be imposed five calendar (5) days after the receipt of the notice by the facility unless a hearing is requested within that five (5) calendar day period. If a hearing is requested by the facility, the informal dispute resolution procedures established under Rule 45.24.1 shall be applied. 1. If the licensing agency’s determination of noncompliance with Substandard Quality of Care or Immediate Jeopardy on the day of the licensure visit/ survey is confirmed, a ban on all admissions shall be imposed until the facility achieves compliance and such compliance is verified by the licensing agency. The licensing agency will verify the facility’s corrective actions as soon as possible after the licensing agency receives an allegation of compliance from the facility but no later than fifteen (15) days after the receipt of said notice. If the hearing determines that the facility was not providing Substandard Quality of Care or that Immediate Jeopardy did not exist, as applicable, on the day of the licensure/survey visit, no ban on all admissions will be imposed.

2. The monitor has no financial interest or any ownership interest in the facility. 3. The monitor has no immediate family member who has a relationship with the facility to be monitored. 4. The monitor has no immediate family member who is a resident in the facility. If a facility has not achieved substantial compliance within five (5) months of the annual licensure visit/standard survey date, the remedy of state monitoring will be imposed as determined by the licensing agency.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13 Subchapter 52 BAN ON ADMISSIONS PROCEDURE Rule 45.52.1 Ban on Admissions. If a facility is found to be providing substandard quality of care or immediate jeopardy exists at a facility, as applicable, written notice of the determination shall be provided by the licensing agency to the facility, along with*
- *SOURCE: Miss. Code Ann. §43-11-13 Subchapter 53 STATE MONITORING Rule 45.53.1 State Monitoring. Monitors are identified by the licensing agency as appropriate professionals to monitor cited deficiencies. A monitor shall meet the guidelines regarding conflicts of interests as follows: 1. The monitor does not currently work, or, within the past two (2) years, has worked as an employee, as employment agency staff at the facility, or as an officer, consultant, or agent for the facility to be monitored.*
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 45.53.2** Compensation and Per Diem Costs {#sec-16-45.53.2 omnilex-key=us-ms-regs-official--title-15--16#45.53.2}

All compensation and per diem costs of the State Monitor shall be paid by the facility. The licensing agency shall bill the facility for the costs of the State Monitor after termination of the monitoring services. The costs of the State Monitor for any weekly forty (40) hour period (forty [40] hours per week) shall not exceed the maximum allowable owner/administrator salary of a like sized facility as described in the Mississippi State Medicaid Plan. Within fifteen (15) days of receipt of the bill, the facility

shall pay the bill or request an informal dispute resolution procedure to contest the costs for which it was billed.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 45.53.3** Recommendation {#sec-16-45.53.3 omnilex-key=us-ms-regs-official--title-15--16#45.53.3}

If the facility has not achieved substantial compliance within six (6) months from the annual survey date, the licensing agency shall revoke the license of the facility and if applicable shall recommend to the State Medicaid Agency termination of participation in the Medicare/Medicaid programs.

2. Corporate facilities and consultant firms may use staff/consultants from other nursing homes of the corporation if that person has not been directly involved in routine in-services of the facility in question. Also, the staff/consultant is and has no history of involvement with a Substandard or Poor Performing Facility. 3. If hospital-owned facilities use hospital staff to conduct the in-service, the staff must not have been involved in the routine in-services and/or care of the residents. 4. All other facilities may use staff or consultants from other facilities if the other facility’s staff/consultant is not/has not been involved in a facility that is a Substandard Facility or Poor Performer. 5. Nursing homes with individual private consultants may not use the contracted consultant when directed In-Service is imposed.

correction, the licensing agency may impose one or more of the following remedies: a. Directed Plan of Correction; b. Revocation of State License; and/or c. Recommend termination of participation in the Medicaid/Medicare programs if applicable.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13 Subchapter 54 DIRECTED IN-SERVICE TRAINING Rule 45.54.1 Directed In-Service Training. If the remedy of Directed In-Service Training is imposed by the licensing agency for a facility to achieve substantial compliance, guidelines for accepting Plans of Correction to the Statement of Deficiencies shall be as follows: 1. Corporate facilities and consultant firms may only use staff to conduct the directed in-service training when the staff person has not had a direct or indirect involvement in the deficient practice and does not conduct in-services on a routine basis.*
- *SOURCE: Miss. Code Ann. §43-11-13 Subchapter 55 DIRECTED PLAN OF CORRECTION Rule 45.55.1 Directed Plan of Correction. Directed Plan of Correction as defined under Rule 45.14.1 may be imposed as follows: 1. The facility will be provided one (1) opportunity to submit an acceptable Plan of Correction. If the licensing agency does not receive an acceptable plan of*
- *SOURCE: Miss. Code Ann. §43-11-13 Subchapter 56 TEMPORARY MANAGEMENT Rule 45.56.1 Recommendation for Appointment of Temporary Management. If the licensing agency recommends the appointment of a temporary manager, the recommendation shall specify the grounds upon which such recommendation is based, including an assessment of the capability of the facility’s current management to achieve and maintain compliance with all Licensure and/or Certification requirements.*
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 45.56.2** Notice of Imposition of Temporary Management {#sec-16-45.56.2 omnilex-key=us-ms-regs-official--title-15--16#45.56.2}

A temporary manager may be imposed fifteen (15) days after the facility receives notice of the recommendation from the licensing agency and two (2) days after a facility which is licensed and certified receives notice where a determination that immediate jeopardy exists has been made.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 45.56.3** Conditions of Temporary Management {#sec-16-45.56.3 omnilex-key=us-ms-regs-official--title-15--16#45.56.3}

The facility’s management must agree to relinquish control to the temporary manager and to pay his/her salary before the temporary manager can be installed in the facility. 1. The facility cannot retain final authority to approve changes of personnel or expenditures of facility funds and be considered to have relinquished control to the temporary manager. 2. The temporary manager must be given access to all facility bank accounts. 3. In certified facilities, where immediate jeopardy exists, if a facility refuses to relinquish control to the temporary manager, the facility will be terminated from participation in medicare/medicaid within twenty-three (23) calendar days of the last day of the survey visit if the immediate jeopardy is not removed. 4. The temporary manager’s salary must be at least equivalent to the prevailing annual salary of nursing home administrators in the facility’s geographic area, plus the

additional costs that would have reasonably been incurred by the provider if the temporary manager had been in an employment relationship (e.g., the cost of a benefits package, prorated for the amount of time that the temporary manager spends in the facility). The licensing agency is responsible for determining what a facility’s geographic area is. 5. All compensation and per diem costs of the temporary manager shall be paid by the facility. The licensing agency shall bill the facility for the costs of the temporary manager after termination of temporary management. The costs of the temporary manager for any thirty (30) day period shall not exceed the maximum allowable owner/administrator salary of a like size facility as described in the Mississippi State Medicaid State Plan. Within fifteen (15) days of receipt of the bill, the facility shall pay the bill or request an informal dispute resolution procedure to contest the costs for which it was billed.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 45.56.4** Selection of Temporary Manager {#sec-16-45.56.4 omnilex-key=us-ms-regs-official--title-15--16#45.56.4}

The licensing agency shall compile and maintain a list of individuals eligible to serve as temporary managers. The temporary manager must possess a Mississippi nursing home administrator’s license. A contractual agreement will be executed between the temporary manager and the licensing agency.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 45.56.5** Eligibility of Temporary Manager {#sec-16-45.56.5 omnilex-key=us-ms-regs-official--title-15--16#45.56.5}

The following individuals are not eligible to serve as temporary managers: 1. Any individual who has been found guilty of misconduct by any licensing board or professional society in any State; or a. Any individual who has, or whose immediate family members have, any financial interest in or pre-existing fiduciary duty to the facility to be managed. Indirect ownership interest, such as through a mutual fund, does not constitute financial interest for the purpose of this restriction; or b. Any individual who currently serves or, within the past two (2) years, has served as a member of the staff of the facility or has a pre-existing fiduciary duty to the facility; or c. Any individual who does not possess sufficient training, expertise, and experience in the operation of a nursing facility as would be necessary to achieve the objectives of temporary management; or d. Any individual who at the time of the imposition of temporary management could stand to gain an unfair competitive advantage by being appointed as temporary manager of the facility.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 45.56.6** Condition of Appointment {#sec-16-45.56.6 omnilex-key=us-ms-regs-official--title-15--16#45.56.6}

As a condition of appointment, the temporary manager must agree not to purchase, lease, or manage the facility for a period of two (2) years following the end of the temporary management period.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 45.56.7** No Limitation {#sec-16-45.56.7 omnilex-key=us-ms-regs-official--title-15--16#45.56.7}

Nothing contained in these sections shall limit the right of any facility owner to sell, lease, mortgage, or close any facility in accordance with all applicable laws.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 45.56.8** Authority and Powers Of the Temporary Manager {#sec-16-45.56.8 omnilex-key=us-ms-regs-official--title-15--16#45.56.8}

1. A temporary manager has the authority to direct and oversee the correction of the deficiencies/licensure violations; to oversee and direct the management, hiring, reassignment and/or discharge of any consultant or employee, including the administrator of the facility; to direct the expenditure of or obligate facility funds in a reasonable and prudent manner; to oversee the continuation of the business and the care of the residents; to oversee and direct those acts necessary to accomplish the goals of the licensure and/or certification requirements; to alter facility procedures; and to direct and oversee regular accountings and the provision of periodic reports to the licensing agency. 2. A temporary manager shall provide reports to the licensing agency by the fifteenth (15th) day of each month showing the facility’s compliance status. 3. A temporary manager shall observe the confidentiality of the operating policies, procedures, employment practices, financial information, and all similar business information of the facility, except that the temporary manager shall make reports to the licensing agency as provided for in this section. 4. The temporary manager shall be liable for gross, willful or wanton negligence, intentional acts or omissions, unexplained shortfalls in the facility’s funds, and breaches of fiduciary duty. The temporary manager shall be bonded in an amount equal to the facility’s total revenues for the month preceding the appointment of the temporary manager.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 45.56.9** Authority of Temporary Manager {#sec-16-45.56.9 omnilex-key=us-ms-regs-official--title-15--16#45.56.9}

The temporary manager shall not have the authority to do the following: 1. To cause or direct the facility or its owner to incur debt or to enter into any contract with a duration beyond the term of the temporary management of the facility;

2. To cause or direct the facility to encumber its assets or receivables, or the premises on which it is located, with any lien or other encumbrances; 3. To cause or direct the sale of the facility, its assets, or the premises on which it is located; 4. To cause or direct the facility to cancel or reduce its liability or casualty insurance coverage; 5. To cause or direct the facility to default upon any valid obligations previously undertaken by the owners or operators of the facility, including but not limited to, leases, mortgages, and security interests; and 6. To incur capital expenditures in excess of two-thousand dollars ($2,000.00) without the permission of the owner of the facility and the licensing agency.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 45.56.10** Duration of Temporary Manager {#sec-16-45.56.10 omnilex-key=us-ms-regs-official--title-15--16#45.56.10}

Temporary management shall continue until a license is revoked and or the facility is terminated from participation in the Medicare or Medicaid programs, or the facility achieves substantial compliance and is capable of remaining in substantial compliance. The licensing agency may replace any temporary manager whose performance, in the discretion of the licensing agency, is deemed unsatisfactory. No formal procedure is required for such removal or replacement but written notice of any action shall be given to the facility, including the name of any replacement manager. 1. A facility subject to temporary management may petition the licensing agency for replacement of a temporary whose performance it considers unsatisfactory. The licensing agency shall respond to a petition for replacement within three (3) business days after receipt of said petition. 2. Otherwise, the licensing agency shall not terminate temporary management until it has determined that the facility has the management capability to ensure continued compliance with all licensure and/or certification requirements or until the facilities license is revoked or the facility’s participation in the medicare/medicaid program is terminated.

1. The purpose of the informal dispute resolution (IDR) process is to comply with 42 CFR 488.331 by giving licensed facilities an additional opportunity to refute cited deficiencies/licensure violations after any survey, or after notification of billing issues in situations involving state monitors or temporary managers. The IDR is

not intended to be an evidentiary hearing since licensed facilities are afforded such at the federal level. Licensed facilities may not use the IDR to delay the formal imposition of remedies or to challenge any other aspect of the survey process, including: a. The scope and severity assessments of deficiencies with the exception of scope and severity assessments that constitute substandard quality of care or immediate jeopardy; b. Remedies imposed by the licensing agency; c. Alleged failure of the survey team to comply with a requirement of the survey process; d. Alleged inconsistency of the survey team in citing deficiencies among facilities; and e. Alleged inadequacy or inaccuracy of the informal dispute resolution process. 2. All requests for an IDR must follow the procedures set forth herein. 3. All official statements of deficiencies/licensure violations requiring a response from the licensed facility, and billing statements for state monitors or temporary managers, shall be mailed by the licensing agency via certified mail, return receipt requested. Each official statement of deficiencies/licensure violations shall be accompanied by a copy of these Informal Dispute Resolution Procedure Regulations. 4. The licensed facility shall notify the Division Director that it requests an IDR. The request shall be in writing and must be received in the office of the licensing agency no later than ten (10) calendar days after the licensed facility’s receipt of the official statement of deficiencies/licensure violations or billing statement. The request shall specify which deficiencies/licensure violations or charges are disputed. The request shall also specify whether the licensed facility requests that the IDR be (1) in person; (2) via a telephone conference or by other electronic means (i.e., via video teleconference, if such service is available to all parties); or (3) by means of a written response to the official statements of deficiencies/licensure violations. The request must also designate a licensed facility representative for purposes of further communications regarding the IDR. 5. Every IDR shall be conducted by the licensing agency. If the IDR will be conducted in person, it shall be conducted at offices designated by the licensing agency. 6. The licensing agency shall notify the licensed facility representative by telephone or facsimile of the date, time, location, and format of the IDR. The IDR shall be held within ten (10) working days after the receipt by the licensing agency of the request. The IDR shall be conducted by a three (3) person panel, known as the

IDR Panel, consisting of a provider representative of the long term care community, a member of the medical community (physician or nurse practitioner/physician assistant), and a member of the Licensure staff who is SMQT qualified and who does not survey nor have supervisory capacity over the district of the related survey. In the event of a position vacancy, an alternate member may serve on the IDR panel as directed by the State Health Officer. 7. At the IDR, the licensed facility representative shall present any additional documentation or statements in support of its contention that a cited deficiency/licensure violation or billing charge may be incorrect. Additional employees of the licensed facility may participate in the IDR, including consultants utilized by the licensed facility as may be required by the regulations (i.e., dietary consultant, social work consultant, and others). Because the IDR is intended to be informal (1) IDR participants should be able to speak freely concerning deficiencies/licensure violations; (2) cross-examination of the IDR participants is not allowed, and (3) legal counsel for the licensed facility is not allowed to participate in the IDR. 8. The Bureau Director shall designate staff members from the survey/licensure visit team which performed the survey/licensure visit in question to attend the IDR and present any additional documentation or statements in support of the cited deficiency/licensure violation. In the case of billing disputes, the staff members who prepared the bill will present the any additional documentation or statements in support of the charges. Any other staff members as required and designated by the Bureau Director may attend the IDR. 9. At the conclusion of the IDR, a written report shall be prepared and forwarded to the Bureau Director, indicating the final determination regarding the validity of any disputed deficiencies/licensure violations. The decision of the IDR Panel regarding the disputed deficiencies/licensure violations shall be mailed, via certified mail, to the licensed facility representative within ten (10) calendar days of the conclusion of the IDR. Facilities which are licensed but not certified may appeal the decision of the IDR Panel regarding the disputed licensure violations if the violations are at a scope and severity level of G or above and enforcement remedies have been imposed by the licensing agency. The decision of the ICR Panel regarding the disputed deficiencies/licensure violations may be appealed pursuant to the administrative procedures outlined in Rule 45.10.1 of these regulations. 10. If the IDR Panel determines that a deficiency/licensure violation should not have been cited, the following steps shall be taken: a. The official statement of deficiencies/licensure violations shall be marked “deleted,” signed, and dated by the branch manager for the district where the facility is located.

b. A revised copy of the official survey/licensure violation form shall be issued to the licensed facility which shows the adjusted scope and severity assessment to reflect the outcome of the IDR. c. Any enforcement action imposed solely on an incorrect deficiency/licensure violation citation shall be rescinded. 11. If the IDR Panel determines that any charges for state monitoring or temporary management are inaccurate or disallowed, a revised copy of the bill will be issued to the licensed facility.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13 Subchapter 57 INFORMAL DISPUTE RESOLUTION Rule 45.57.1 Informal Dispute Resolution.*
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 45.57.2** Effect of Informal Dispute Resolution Procedures on Corrective Plans and Enforcement Actions {#sec-16-45.57.2 omnilex-key=us-ms-regs-official--title-15--16#45.57.2}

A request for an IDR does not stay the obligation of the licensed facility to submit an acceptable Plan of Correction to the licensing agency within ten (10) calendar days of the licensed facility’s receipt of the official statement of deficiencies. The licensing agency’s failure to complete the IDR timely will not delay the effective date of any enforcement action against a licensed facility. A licensed facility may not seek a delay of any enforcement action against it on the grounds that an IDR has not been completed before the effective date of the enforcement. A licensed facility may not use this procedure to challenge any other aspect of the survey/licensure process, including but not limited to: 1. Classification of deficiencies (i.e., scope and severity of harm assessments); 2. Remedy imposed or recommended by the licensing agency; 3. Failure of the survey/licensure team to comply with the survey/licensure process; 4. Inconsistency of the survey/licensure team in citing deficiencies/licensure violations among facilities; or 5. Inadequacy or inaccuracy of the informal dispute resolution process.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 45.57.3** Post Informal Dispute Resolution Survey Procedures {#sec-16-45.57.3 omnilex-key=us-ms-regs-official--title-15--16#45.57.3}

If a follow up survey/licensure visit is conducted regarding deficiencies/licensure violations which have been the subject of an informal dispute resolution procedure, and the follow-up survey/licensure visit indicates that the facility has not corrected the deficiencies/licensure violation which was the subject of the informal dispute resolution procedure, the facility shall not be entitled to another informal dispute resolution procedure hearing. However, if a follow-up survey is conducted and deficiencies are discovered which were not cited on the original official statement of deficiencies/licensure violations the facility is entitled to utilize the informal dispute resolution procedure with regard to any previously uncited deficiencies.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 45.58.1** The following infection control standards shall be met: {#sec-16-45.58.1 omnilex-key=us-ms-regs-official--title-15--16#45.58.1}

1. The facility must maintain and document an effective infection control program that protects patients, families, visitors, and facility personnel by preventing and controlling infections and communicable diseases.

2. The facility must have an active surveillance program that includes specific measures for prevention, early detection, control, education, and investigation of infections and communicable diseases in the facility. There must be a mechanism to evaluate the effectiveness of the program(s) and take corrective action when necessary. The program must include implementation of nationally recognized systems of infection control guidelines to avoid sources and transmission of infections and communicable diseases

3. The facility must follow accepted standards of practice to prevent the transmission of infections and communicable diseases, including the use of standard precautions.

CHAPTER 46 MINIMUM STANDARDS OF OPERATION FOR HOME HEALTH AGENCIES Subchapter 1 GENERAL Rule 46.1.1 HOME HEALTH AGENCIES. The following minimum standards of operation for home health agencies have been promulgated pursuant to Mississippi Code Annotated §41-71-1 through §41-71-19 (Supplement 1986), and are to be followed by persons operating a home health agency. They are minimum requirements that home health agencies will adopt new and improved methods and practices as they develop without waiting for improvements in the Standards. Regulatory in nature by necessity, they are designed to be educational in character and are intended to be reasonable and practicable. Laws and Standards are limited in what they can do in meeting the manifold health needs of individuals. Each home health agency bears a strong moral responsibility for providing the best possible care for the patients it serves.

by the Regular 1981 Session of the Legislature of the State of Mississippi, as amended in 1986, the Mississippi Department of Health does hereby adopt and promulgate the following Minimum Standards of Operation for Home Health Agencies.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*
- *SOURCE: Miss. Code Ann. §41-71-13 Subchapter 2 LEGAL AUTHORITY Rule 46.2.1 Adoption of Minimum Standards of Operation. By virtue of authority vested in it by the Legislature of the State of Mississippi as per House bill #427 enacted*
- *SOURCE: Miss. Code Ann. §41-71-13*

##### **15 Miss. Admin. Code Pt. 16, R. 46.2.2** Effective date of Minimum Standards of Operation for Home Health Agencies {#sec-16-46.2.2 omnilex-key=us-ms-regs-official--title-15--16#46.2.2}

The Mississippi Department of Health does hereby adopt these Minimum Standards of Operation for Home Health Services. These Minimum Standards of Operation are effective as of September 21, 1981. Any home health agency which is in operation on July 1, 1981, shall be given a reasonable time under the particular circumstances, not to exceed one (1) year from July 1, 1981, within which to comply with the provisions of the Mississippi Department of Health Act of 1979, as amended, and these Minimum Standards of Operation for Mississippi Home Health Agencies.

2. An incumbent administrator as of July 1, 1981; 3. An individual with a minimum of three (3) years of administrative experience in a health related field, one year of which shall be full-time in a home health setting, occurring within the last three (3) years.

**History**
- *SOURCE: Miss. Code Ann. §41-71-13 Subchapter 3 DEFINITIONS. As used in these minimum standards, the words and terms hereinafter set forth, shall be defined as follows: Rule 46.3.1 Administrator shall mean an individual who is delegated the responsibility for the interpretation, implementation, and proper application of policies and programs established by the governing authority and is delegated responsibility for the establishment of safe and effective administrative management, control, and operation of the services provided. This individual shall be one of the following: 1. An individual with a baccalaureate degree and at least one year of administrative experience in home health care or in a related health provider program, occurring within the last three (3) years;*
- *SOURCE: Miss. Code Ann. §41-71-13*

##### **15 Miss. Admin. Code Pt. 16, R. 46.3.2** Rule 46.3.2 {#sec-16-46.3.2 omnilex-key=us-ms-regs-official--title-15--16#46.3.2}

Audiologist shall mean an individual who meets the educational and experience requirements for a Certificate of Clinical Competence granted by the American Speech and Hearing Association and is currently licensed as an audiologist in the State of Mississippi.

**History**
- *SOURCE: Miss. Code Ann. §41-71-13*

##### **15 Miss. Admin. Code Pt. 16, R. 46.3.3** Rule 46.3.3 {#sec-16-46.3.3 omnilex-key=us-ms-regs-official--title-15--16#46.3.3}

Branch Office shall mean a location or site from which a home health agency provides services within a portion of the total geographic area served by the parent agency. The branch office is part of the home health agency and is located sufficiently close to share administration, supervision and services in a manner that renders it unnecessary to obtain a separate license as a home health agency. A branch office shall be staffed with at least one (1) registered nurse on a full- time basis.

**History**
- *SOURCE: Miss. Code Ann. §41-71-13*

##### **15 Miss. Admin. Code Pt. 16, R. 46.3.4** Care Team shall mean a group of individuals responsible for the development of each patient's care plan {#sec-16-46.3.4 omnilex-key=us-ms-regs-official--title-15--16#46.3.4}

The care team shall consist of, but not be limited to, the physician, podiatrist, nurse practitioners, physician assistants, clinical nurse specialists, and pertinent members of the agency staff, the patient and member of his/her family.

**History**
- *SOURCE: Miss. Code Ann. §41-71-13*

##### **15 Miss. Admin. Code Pt. 16, R. 46.3.5** Rule 46.3.5 {#sec-16-46.3.5 omnilex-key=us-ms-regs-official--title-15--16#46.3.5}

Certified Respiratory Therapy Technician shall mean an individual who has passed the National Board of Respiratory Therapy certification examination and renders services under consultation from a registered respiratory therapist.

**History**
- *SOURCE: Miss. Code Ann. §41-71-13*

##### **15 Miss. Admin. Code Pt. 16, R. 46.3.6** Rule 46.3.6 {#sec-16-46.3.6 omnilex-key=us-ms-regs-official--title-15--16#46.3.6}

Change of Ownership means but is not limited to, intervivos gifts, purchases transfers, leases, cash and/or stock transactions or other comparable arrangements whenever the person or entity acquires a majority interest (fifty percent (50%) or more) of the facility or service. Changes of ownership from partnerships, single proprietorships or corporations to another form of ownership are specifically included. Provided, however, "Change of Ownership" shall not include any inherited interest acquired as a result of a testamentary instrument or under the laws of descent and distribution of the State of Mississippi. The change of IRS exemption status also constitutes a change of ownership.

**History**
- *SOURCE: Miss. Code Ann. §41-71-13*

##### **15 Miss. Admin. Code Pt. 16, R. 46.3.7** Rule 46.3.7 {#sec-16-46.3.7 omnilex-key=us-ms-regs-official--title-15--16#46.3.7}

Clinical Note shall mean a written notation, dated and signed by the appropriate member of the health team, of a contact with a patient, containing a description of signs and symptoms, treatment and/or drugs given, the patient's reaction and any changes in physical or emotional condition. Clinical notes are written on the day service is rendered and incorporated into the patient's clinical records at least weekly.

**History**
- *SOURCE: Miss. Code Ann. §41-71-13*

##### **15 Miss. Admin. Code Pt. 16, R. 46.3.8** Rule 46.3.8 {#sec-16-46.3.8 omnilex-key=us-ms-regs-official--title-15--16#46.3.8}

Clinical Record shall mean a legal document containing all pertinent information relating to the care of an individual patient.

**History**
- *SOURCE: Miss. Code Ann. §41-71-13*

##### **15 Miss. Admin. Code Pt. 16, R. 46.3.9** Consumer shall mean a person who is neither an owner nor employee of the agency {#sec-16-46.3.9 omnilex-key=us-ms-regs-official--title-15--16#46.3.9}

**History**
- *SOURCE: Miss. Code Ann. §41-71-13*

##### **15 Miss. Admin. Code Pt. 16, R. 46.3.10** Rule 46.3.10 {#sec-16-46.3.10 omnilex-key=us-ms-regs-official--title-15--16#46.3.10}

Coordinated when used in conjunction with the phrase, Home Health Services, shall mean the integration of the multidisciplinary services provided by patient care team members directed toward meeting the home health needs of the patient.

**History**
- *SOURCE: Miss. Code Ann. §41-71-13*

##### **15 Miss. Admin. Code Pt. 16, R. 46.3.11** Rule 46.3.11 {#sec-16-46.3.11 omnilex-key=us-ms-regs-official--title-15--16#46.3.11}

REPEALED Effective 07/01/2022 Rule 46.3.12 Director of Nursing shall mean the individual responsible for the coordination of all patient services rendered by parent, sub-unit and branches as applicable. He/she shall be currently licensed in Mississippi with: 1. A baccalaureate degree in nursing and two (2) years of registered nursing experience, or 2. A graduate of a diploma school of nursing with two (2) years of registered nursing experience, or 3. An associate degree of nursing with four (4) years of registered nursing experience, or 4. An incumbent Director of Nursing as of July 1, 1981.

**History**
- *SOURCE: Miss. Code Ann. §41-71-13*

##### **15 Miss. Admin. Code Pt. 16, R. 46.3.13** Rule 46.3.13 {#sec-16-46.3.13 omnilex-key=us-ms-regs-official--title-15--16#46.3.13}

Directly shall mean providing home health services through salaried employees of the home health agency or through personnel under hourly or per visit contracts or the equivalent. Where an hourly or per visit contract is made, Subchapter 28 must be followed to ensure adequate control and supervision by the home health agency.

**History**
- *SOURCE: Miss. Code Ann. §41-71-13*

##### **15 Miss. Admin. Code Pt. 16, R. 46.3.14** Rule 46.3.14 {#sec-16-46.3.14 omnilex-key=us-ms-regs-official--title-15--16#46.3.14}

Direct Supervision shall mean that a registered nurse or appropriate health professional is physically present in the immediate area where the patient is being provided services.

**History**
- *SOURCE: Miss. Code Ann. §41-71-13*

##### **15 Miss. Admin. Code Pt. 16, R. 46.3.15** Rule 46.3.15 {#sec-16-46.3.15 omnilex-key=us-ms-regs-official--title-15--16#46.3.15}

Discharge Summary shall mean the written report of condition of patient, services rendered, pertinent goals achieved during the entire service provided and final disposition at the time of discharge from the service.

**History**
- *SOURCE: Miss. Code Ann. §41-71-13*

##### **15 Miss. Admin. Code Pt. 16, R. 46.3.16** Geographic Area shall mean the land area, for which the agency shall be licensed {#sec-16-46.3.16 omnilex-key=us-ms-regs-official--title-15--16#46.3.16}

The geographic area shall be expressed in Mississippi counties.

**History**
- *SOURCE: Miss. Code Ann. §41-71-13*

##### **15 Miss. Admin. Code Pt. 16, R. 46.3.17** Rule 46.3.17 {#sec-16-46.3.17 omnilex-key=us-ms-regs-official--title-15--16#46.3.17}

Governmental Agency for licensure purposes shall mean an agency operated by a federal, state or local government and is not connected to a hospital.

**History**
- *SOURCE: Miss. Code Ann. §41-71-13*

##### **15 Miss. Admin. Code Pt. 16, R. 46.3.18** Rule 46.3.18 {#sec-16-46.3.18 omnilex-key=us-ms-regs-official--title-15--16#46.3.18}

Governing Authority means the organization, person or persons designated to assume full legal and financial responsibility for the policy determination, management, operation, and financial viability of the home health agency.

**History**
- *SOURCE: Miss. Code Ann. §41-71-13*

##### **15 Miss. Admin. Code Pt. 16, R. 46.3.19** Rule 46.3.19 {#sec-16-46.3.19 omnilex-key=us-ms-regs-official--title-15--16#46.3.19}

Governing Body Bylaws shall mean a set of rules adopted by the governing body of the home health agency for governing the agency's operation.

**History**
- *SOURCE: Miss. Code Ann. §41-71-13*

##### **15 Miss. Admin. Code Pt. 16, R. 46.3.20** Rule 46.3.20 {#sec-16-46.3.20 omnilex-key=us-ms-regs-official--title-15--16#46.3.20}

Home Health Agency shall mean a public or privately owned agency or organization or a subdivision of such an agency or organization, properly authorized to conduct business in Mississippi, which is primarily engaged in providing to individuals, at the written direction of a licensed physician, podiatrist, nurse practitioners, physician assistants, and clinical nurse specialists in the individual's place of resident, skilled nursing services provided by or under the supervision of a registered nurse licensed to practice in Mississippi and one or more of the following part-time intermittent services or items: 1. Physical, occupational, or speech therapy; 2. Medical Social Services; 3. Home Health aide services; 4. Other services as approved by the licensing agency; 5. Medical supplies, other than drugs and biologicals, and the use of medical appliances; 6. Medical services provided by a resident in training at a hospital under a teaching program of such hospital. 7. Drugs and Biologicals as allowed by Mississippi Board of Pharmacy permit for home health. (Refer to Home Health and Hospice Permits - MS Board of Pharmacy.)

**History**
- *SOURCE: Miss. Code Ann. §41-71-13*

##### **15 Miss. Admin. Code Pt. 16, R. 46.3.21** Rule 46.3.21 {#sec-16-46.3.21 omnilex-key=us-ms-regs-official--title-15--16#46.3.21}

Home Health Aide shall mean a non-professional individual who has completed a home health aide training program meeting requirements as specified in Subchapter 29. The home health aide provides personal care services for a person in the home, under the supervision of a registered nurse or therapist of the agency. The care must relate to the type of supervision.

**History**
- *SOURCE: Miss. Code Ann. §41-71-13*

##### **15 Miss. Admin. Code Pt. 16, R. 46.3.22** Hospital Based Agency {#sec-16-46.3.22 omnilex-key=us-ms-regs-official--title-15--16#46.3.22}

To be classified as a hospital based agency, the agency must be a clearly definable separate department of a hospital.

**History**
- *SOURCE: Miss. Code Ann. §41-71-13*

##### **15 Miss. Admin. Code Pt. 16, R. 46.3.23** Rule 46.3.23 {#sec-16-46.3.23 omnilex-key=us-ms-regs-official--title-15--16#46.3.23}

License of Home Health Agency shall mean the document issued by the Mississippi Department of Health and signed by the Executive Director of the Mississippi Department of Health and the Chief of the Division of Licensure and Certification. Licensure shall constitute authority to perform the services included within the scope of these minimum standards of operation.

**History**
- *SOURCE: Miss. Code Ann. §41-71-13*

##### **15 Miss. Admin. Code Pt. 16, R. 46.3.24** Rule 46.3.24 {#sec-16-46.3.24 omnilex-key=us-ms-regs-official--title-15--16#46.3.24}

Licensed Practical Nurse shall mean an individual who is currently licensed as such in the State of Mississippi and is a graduate of an approved school of practical nursing, performing selected acts, as defined in the Mississippi Nurse Practice Act under the supervision of a registered nurse.

**History**
- *SOURCE: Miss. Code Ann. §41-71-13*

##### **15 Miss. Admin. Code Pt. 16, R. 46.3.25** Rule 46.3.25 {#sec-16-46.3.25 omnilex-key=us-ms-regs-official--title-15--16#46.3.25}

Licensee shall mean the defined persons to whom the license is issued and upon whom rests the responsibility for the operation of the agency in compliance with these minimum standards of operation.

**History**
- *SOURCE: Miss. Code Ann. §41-71-13*

##### **15 Miss. Admin. Code Pt. 16, R. 46.3.26** Licensing Agency shall mean the Mississippi Department of Health {#sec-16-46.3.26 omnilex-key=us-ms-regs-official--title-15--16#46.3.26}

**History**
- *SOURCE: Miss. Code Ann. §41-71-13*

##### **15 Miss. Admin. Code Pt. 16, R. 46.3.27** May shall mean permission {#sec-16-46.3.27 omnilex-key=us-ms-regs-official--title-15--16#46.3.27}

**History**
- *SOURCE: Miss. Code Ann. §41-71-13*

##### **15 Miss. Admin. Code Pt. 16, R. 46.3.28** Rule 46.3.28 {#sec-16-46.3.28 omnilex-key=us-ms-regs-official--title-15--16#46.3.28}

Medical Equipment and Supplies shall mean items which, due to their therapeutic or diagnostic characteristics, are essential in enabling a home health agency to carry out patient care.

**History**
- *SOURCE: Miss. Code Ann. §41-71-13*

##### **15 Miss. Admin. Code Pt. 16, R. 46.3.29** Rule 46.3.29 {#sec-16-46.3.29 omnilex-key=us-ms-regs-official--title-15--16#46.3.29}

Medical Social Worker shall mean a person who has a master's degree or bachelor's degree from a school of social work accredited by the Council on Social Work Education or Southern Association of Colleges and Schools and is licensed by the State of Mississippi as such and who has one year of social work experience in a health care setting. Nurse Practitioner shall mean an individual who is currently licensed as an Advanced Practice Registered Nurse in the State of Mississippi and is performing nurse practitioner duties in accordance with the Mississippi Nursing Practice Act.

**History**
- *SOURCE: Miss. Code Ann. §41-71-13*

##### **15 Miss. Admin. Code Pt. 16, R. 46.3.30** Rule 46.3.30 {#sec-16-46.3.30 omnilex-key=us-ms-regs-official--title-15--16#46.3.30}

Occupational Therapist shall mean a person who is currently licensed as such by the State of Mississippi and is performing therapy duties in accordance with the Mississippi Occupational Therapy Practice Act.

**History**
- *SOURCE: Miss. Code Ann. §41-71-13*

##### **15 Miss. Admin. Code Pt. 16, R. 46.3.31** Rule 46.3.31 {#sec-16-46.3.31 omnilex-key=us-ms-regs-official--title-15--16#46.3.31}

Occupational Therapy Assistant shall mean a person who is currently licensed as such by the State of Mississippi and is performing therapy duties in accordance with the Mississippi Occupational Therapy Practice Act.

**History**
- *SOURCE: Miss. Code Ann. §41-71-13*

##### **15 Miss. Admin. Code Pt. 16, R. 46.3.32** Owner shall mean a person who owns five percent (5%) or more of the interest in the agency {#sec-16-46.3.32 omnilex-key=us-ms-regs-official--title-15--16#46.3.32}

**History**
- *SOURCE: Miss. Code Ann. §41-71-13*

##### **15 Miss. Admin. Code Pt. 16, R. 46.3.33** Rule 46.3.33 {#sec-16-46.3.33 omnilex-key=us-ms-regs-official--title-15--16#46.3.33}

Parent Home Health Agency shall mean the agency that develops and maintains administrative control of sub-units and/or branches.

**History**
- *SOURCE: Miss. Code Ann. §41-71-13*

##### **15 Miss. Admin. Code Pt. 16, R. 46.3.34** Rule 46.3.34 {#sec-16-46.3.34 omnilex-key=us-ms-regs-official--title-15--16#46.3.34}

Part-time or Intermittent Care shall mean home health services given to a patient at least once every sixty (60) days or as frequently as a few hours a day, several times a week. This does not mean eight (8) hour shifts in the home.

**History**
- *SOURCE: Miss. Code Ann. §41-71-13*

##### **15 Miss. Admin. Code Pt. 16, R. 46.3.35** Rule 46.3.35 {#sec-16-46.3.35 omnilex-key=us-ms-regs-official--title-15--16#46.3.35}

Patient shall mean any individual whose condition is of such severity that the individual should be confined to his/her place of residence because of acute or chronic illness or injury or individuals with disabilities, convalescent or infirm, or who is in need of rehabilitative, obstetrical, surgical, medical, nursing, or supervisory care in their place of residence and under the care of a physician, podiatrist, nurse practitioners, physician assistants, and clinical nurse specialists.

**History**
- *SOURCE: Miss. Code Ann. §41-71-13*

##### **15 Miss. Admin. Code Pt. 16, R. 46.3.36** Rule 46.3.36 {#sec-16-46.3.36 omnilex-key=us-ms-regs-official--title-15--16#46.3.36}

Patient Care Plan shall mean a written coordinated plan of rendering care to the patient prepared by the combined as appropriate with each discipline providing service and the patient and/or family.

**History**
- *SOURCE: Miss. Code Ann. §41-71-13*

##### **15 Miss. Admin. Code Pt. 16, R. 46.3.37** Rule 46.3.37 {#sec-16-46.3.37 omnilex-key=us-ms-regs-official--title-15--16#46.3.37}

Patient's Residence shall mean the place where the patient makes his home, such as his own apartment or house, a relative's home but shall not include a hospital, nursing home or other extended care facility with the exception of services provided through outpatient therapy in a nursing home.

**History**
- *SOURCE: Miss. Code Ann. §41-71-13*

##### **15 Miss. Admin. Code Pt. 16, R. 46.3.38** Rule 46.3.38 {#sec-16-46.3.38 omnilex-key=us-ms-regs-official--title-15--16#46.3.38}

Person shall mean an individual, firm, partnership, corporation, company, association, or joint stock association, or any licensee herein or the legal successor thereof.

**History**
- *SOURCE: Miss. Code Ann. §41-71-13*

##### **15 Miss. Admin. Code Pt. 16, R. 46.3.39** Rule 46.3.39 {#sec-16-46.3.39 omnilex-key=us-ms-regs-official--title-15--16#46.3.39}

Physical Therapist shall mean an individual who is currently licensed to practice physical therapy in the State of Mississippi.

**History**
- *SOURCE: Miss. Code Ann. §41-71-13*

##### **15 Miss. Admin. Code Pt. 16, R. 46.3.40** Rule 46.3.40 {#sec-16-46.3.40 omnilex-key=us-ms-regs-official--title-15--16#46.3.40}

Physical Therapist Assistant shall mean an individual who is currently licensed to practice as such in the State of Mississippi under the supervision of a Licensed Physical Therapist.

**History**
- *SOURCE: Miss. Code Ann. §41-71-13*

##### **15 Miss. Admin. Code Pt. 16, R. 46.3.41** Rule 46.3.41 {#sec-16-46.3.41 omnilex-key=us-ms-regs-official--title-15--16#46.3.41}

Physician shall mean an individual currently licensed by the proper authority in his state to practice medicine or osteopathy.

**History**
- *SOURCE: Miss. Code Ann. §41-71-13*

##### **15 Miss. Admin. Code Pt. 16, R. 46.3.42** Rule 46.3.42 {#sec-16-46.3.42 omnilex-key=us-ms-regs-official--title-15--16#46.3.42}

Podiatrist shall mean an individual currently licensed by the proper authority in the state of Mississippi to practice podiatry.

**History**
- *SOURCE: Miss. Code Ann. §41-71-13*

##### **15 Miss. Admin. Code Pt. 16, R. 46.3.43** REPEALED {#sec-16-46.3.43 omnilex-key=us-ms-regs-official--title-15--16#46.3.43}

Effective 07/01/2022

**History**
- *SOURCE: Miss. Code Ann. §41-71-13*

##### **15 Miss. Admin. Code Pt. 16, R. 46.3.44** Rule 46.3.44 {#sec-16-46.3.44 omnilex-key=us-ms-regs-official--title-15--16#46.3.44}

Plan of Treatment shall mean the written instructions, signed and reviewed at least every 60 days or more often if the patient's condition so warrants, by the

physician, podiatrist, nurse practitioners, physician assistants, and clinical nurse specialists for the provision of services.

**History**
- *SOURCE: Miss. Code Ann. §41-71-13*

##### **15 Miss. Admin. Code Pt. 16, R. 46.3.45** Rule 46.3.45 {#sec-16-46.3.45 omnilex-key=us-ms-regs-official--title-15--16#46.3.45}

Private Non-Profit Agency means agency that is exempt from federal income taxation under Section 501 of the Internal Revenue Code of 1954.

**History**
- *SOURCE: Miss. Code Ann. §41-71-13*

##### **15 Miss. Admin. Code Pt. 16, R. 46.3.46** REPEALED {#sec-16-46.3.46 omnilex-key=us-ms-regs-official--title-15--16#46.3.46}

Effective 07/01/2022

**History**
- *SOURCE: Miss. Code Ann. §41-71-13*

##### **15 Miss. Admin. Code Pt. 16, R. 46.3.47** Rule 46.3.47 {#sec-16-46.3.47 omnilex-key=us-ms-regs-official--title-15--16#46.3.47}

Progress Note shall mean a written, signed and dated notation by the profession providing care, summarizing the information about the care provided by all the disciplines and the patient's response to the care during a given period of time.

**History**
- *SOURCE: Miss. Code Ann. §41-71-13*

##### **15 Miss. Admin. Code Pt. 16, R. 46.3.48** REPEALED {#sec-16-46.3.48 omnilex-key=us-ms-regs-official--title-15--16#46.3.48}

Effective 07/01/2022

**History**
- *SOURCE: Miss. Code Ann. §41-71-13*

##### **15 Miss. Admin. Code Pt. 16, R. 46.3.49** Rule 46.3.49 {#sec-16-46.3.49 omnilex-key=us-ms-regs-official--title-15--16#46.3.49}

Proprietary Agency shall mean a private organization not exempt from federal ncome taxation under Section 501 of the Internal Revenue Code of 1954.

**History**
- *SOURCE: Miss. Code Ann. §41-71-13*

##### **15 Miss. Admin. Code Pt. 16, R. 46.3.50** Rule 46.3.50 {#sec-16-46.3.50 omnilex-key=us-ms-regs-official--title-15--16#46.3.50}

Registered Dietitian shall mean a person who has successfully completed the national examination for dietitians and maintains their registration by meeting continuing education requirements.

**History**
- *SOURCE: Miss. Code Ann. §41-71-13*

##### **15 Miss. Admin. Code Pt. 16, R. 46.3.51** Rule 46.3.51 {#sec-16-46.3.51 omnilex-key=us-ms-regs-official--title-15--16#46.3.51}

Registered Nurse shall mean an individual who is currently licensed as such in the State of Mississippi and is performing nursing duties in accordance with the Mississippi Nurse Practice Act.

**History**
- *SOURCE: Miss. Code Ann. §41-71-13*

##### **15 Miss. Admin. Code Pt. 16, R. 46.3.52** Rule 46.3.52 {#sec-16-46.3.52 omnilex-key=us-ms-regs-official--title-15--16#46.3.52}

Registered Respiratory Therapist shall mean an individual who has passed the National Board of Respiratory Therapy Examination.

**History**
- *SOURCE: Miss. Code Ann. §41-71-13*

##### **15 Miss. Admin. Code Pt. 16, R. 46.3.53** Shall shall mean mandatory requirement(s) {#sec-16-46.3.53 omnilex-key=us-ms-regs-official--title-15--16#46.3.53}

**History**
- *SOURCE: Miss. Code Ann. §41-71-13*

##### **15 Miss. Admin. Code Pt. 16, R. 46.3.54** Should shall mean recommendation(s) {#sec-16-46.3.54 omnilex-key=us-ms-regs-official--title-15--16#46.3.54}

**History**
- *SOURCE: Miss. Code Ann. §41-71-13*

##### **15 Miss. Admin. Code Pt. 16, R. 46.3.55** Rule 46.3.55 {#sec-16-46.3.55 omnilex-key=us-ms-regs-official--title-15--16#46.3.55}

Skilled Nursing Services shall mean patient care services pertaining to the curative, restorative, and preventive aspects of nursing performed by or under the supervision of a registered nurse pursuant to the plan of treatment established in consultation with appropriate members of the care team. Skilled nursing service is nursing care emphasizing a high level of nursing direction, observation and skill.

**History**
- *SOURCE: Miss. Code Ann. §41-71-13*

##### **15 Miss. Admin. Code Pt. 16, R. 46.3.56** Rule 46.3.56 {#sec-16-46.3.56 omnilex-key=us-ms-regs-official--title-15--16#46.3.56}

Speech Pathologist shall mean an individual who meets the educational and experience requirements for a Certificate of Clinical Competence granted by the American Speech and Hearing Association or is fulfilling the Supervised Professional Employment requirements for a Certificate of Clinical Competence as dictated by the American Speech and Hearing Association and is currently licensed as such by the State of Mississippi.

**History**
- *SOURCE: Miss. Code Ann. §41-71-13*

##### **15 Miss. Admin. Code Pt. 16, R. 46.3.57** Rule 46.3.57 {#sec-16-46.3.57 omnilex-key=us-ms-regs-official--title-15--16#46.3.57}

Subdivision shall mean a component of a multi-functional health facility, such as the home health department of a hospital or a health department, which independently meets the licensure standards for home health agencies.

**History**
- *SOURCE: Miss. Code Ann. §41-71-13*

##### **15 Miss. Admin. Code Pt. 16, R. 46.3.58** Rule 46.3.58 {#sec-16-46.3.58 omnilex-key=us-ms-regs-official--title-15--16#46.3.58}

Sub-Unit shall mean a component of a multi-functional health facility, such as the home health department of a hospital or a health department, which independently meets the licensure standards for home health agencies.

**History**
- *SOURCE: Miss. Code Ann. §41-71-13*

##### **15 Miss. Admin. Code Pt. 16, R. 46.3.59** Supervising Nurse shall mean a registered nurse currently licensed in Mississippi, with: 1 {#sec-16-46.3.59 omnilex-key=us-ms-regs-official--title-15--16#46.3.59}

A baccalaureate degree in nursing and one (1) year of registered nursing experience, or 2. A graduate of a diploma school of nursing with one (1) year of registered nursing experience, or 3. An associate degree of nursing with three (3) years of registered nursing experience, or 4. An incumbent supervising nurse as of July 1, 1981.

**History**
- *SOURCE: Miss. Code Ann. §41-71-13*

##### **15 Miss. Admin. Code Pt. 16, R. 46.3.60** Rule 46.3.60 {#sec-16-46.3.60 omnilex-key=us-ms-regs-official--title-15--16#46.3.60}

Supervision shall mean authoritative procedural guidance by a qualified person of the appropriate discipline on a timely basis.

**History**
- *SOURCE: Miss. Code Ann. §41-71-13*

##### **15 Miss. Admin. Code Pt. 16, R. 46.3.61** Rule 46.3.61 {#sec-16-46.3.61 omnilex-key=us-ms-regs-official--title-15--16#46.3.61}

Utilization Review shall mean systematic evaluation of clinical records to determine the appropriateness and timeliness of services rendered as they relate to the plan of treatment and the person's needs.

**History**
- *SOURCE: Miss. Code Ann. §41-71-13*

##### **15 Miss. Admin. Code Pt. 16, R. 46.3.62** Rule 46.3.62 {#sec-16-46.3.62 omnilex-key=us-ms-regs-official--title-15--16#46.3.62}

Under Arrangement shall mean the procedure enabling public and nonprofit home health agencies to provide services through contractual arrangements with other agencies or organizations, including proprietary agencies or organizations. (Part V, Section H).

**History**
- *SOURCE: Miss. Code Ann. §41-71-13*

##### **15 Miss. Admin. Code Pt. 16, R. 46.3.63** Under Contract shall mean the provision of services through a written contract with an individual {#sec-16-46.3.63 omnilex-key=us-ms-regs-official--title-15--16#46.3.63}

**History**
- *SOURCE: Miss. Code Ann. §41-71-13 Subchapter 4 PROCEDURE GOVERNING ADOPTION AND AMENDMENT Rule 46.4.1 Authority. The Mississippi Department of Health shall have the power to adopt, amend, promulgate and enforce such minimum standards of operation as it deems appropriate, within the law.*
- *SOURCE: Miss. Code Ann. §41-71-13*

##### **15 Miss. Admin. Code Pt. 16, R. 46.4.2** Amendments {#sec-16-46.4.2 omnilex-key=us-ms-regs-official--title-15--16#46.4.2}

The minimum standards of operation for home health agencies may be amended by the licensing agency from time to time as necessary to promote the health, safety, and welfare of persons receiving services in compliance with the Administrative Procedures Act of the State.

Subchapter 6 CLASSIFICATION OF HOME HEALTH AGENCIES Rule 46.6.1 General. For the purposes of these minimum standards of operation, home health agencies shall be classified as: 1. Private non-profit agency 2. Proprietary agency 3. Hospital based agency 4. Governmental agency

**History**
- *SOURCE: Miss. Code Ann. §41-71-13 Subchapter 5 INSPECTION Rule 46.5.1 Inspections Required. Each home health agency shall be inspected by the State Department of Health delegated with authority by said Department of Health at such intervals as the Department of Health may direct. New agencies shall not be licensed without first having been inspected for compliance with these minimum standards.*
- *SOURCE: Miss. Code Ann. §41-71-13*
- *SOURCE: Miss. Code Ann. §41-71-13: Subchapter 7 THE LICENSE Rule 46.7.1 Regular License. A regular license shall be issued to each home health agency that meets the requirements as set forth in these minimum standards. The license shall show the classification of the agency (private non-profit, proprietary, hospital based or governmental agency).*
- *SOURCE: Miss. Code Ann. §41-71-13*

##### **15 Miss. Admin. Code Pt. 16, R. 46.7.2** Provisional License {#sec-16-46.7.2 omnilex-key=us-ms-regs-official--title-15--16#46.7.2}

Within its discretion, the Mississippi Department of Health may issue a provisional license when a temporary condition of non-compliance with these minimum standards exists in one particular. A provisional license shall be issued only if the Department of Health is satisfied that preparations are being made to qualify for a regular license and that the health and safety of patients will not be endangered meanwhile. A provisional license may be reissued only if it is satisfactorily proven to the Department of Health that efforts are been made to fully comply with these minimum standards by a specified time.

The application shall require reasonable affirmative evidence of ability to comply with these minimum standards. Each application for licensure and relicensure shall contain but not be limited to the following: 1. Complete ownership information 2. Geographic area to which services are provided. 3. Services to be provided directly or through arrangement

4. Information on numbers and types of personnel employed 5. Utilization statistics (renewal applications only) 6. Name of licensee 7. Evidence of Certificate of Need 8. Location of branch offices and/or sub-units 9. Location and name of parent agency (if a sub-unit)

**History**
- *SOURCE: Miss. Code Ann. §41-71-13 Subchapter 8 APPLICATION FOR LICENSE Rule 46.8.1 Application. Application for a license or renewal of license shall be made in writing to the licensing agency on forms provided by the Department of Health which shall contain such information as the Department of Health may require.*
- *SOURCE: Miss. Code Ann. §41-71-13*

##### **15 Miss. Admin. Code Pt. 16, R. 46.8.2** Fee {#sec-16-46.8.2 omnilex-key=us-ms-regs-official--title-15--16#46.8.2}

Each initial and renewal licensure application, unless suspended or revoked, shall be accompanied by a fee as set by the Board, made payable to the Mississippi State Department of Health either by business check, money order or electronic means. Renewal of licenses shall occur on an annual basis. Fees are non-refundable.

**History**
- *SOURCE: Miss. Code Ann. §41-71-13 Subchapter 9 THE LICENSEE Rule 46.9.1 Responsibility. The Licensee shall be the individual, firm, partnership, corporation, company, association, or joint stock association responsible for the operation of the home health agency. The licensee shall designate, in writing, one (1) individual as the responsible party for the conducting of the business of the home health agency in accordance with these Minimum Standards of Operation and for the conducting of the business of the home health agency with the licensing agency.*
- *SOURCE: Miss. Code Ann. §41-71-13*

##### **15 Miss. Admin. Code Pt. 16, R. 46.9.2** Name of Institution {#sec-16-46.9.2 omnilex-key=us-ms-regs-official--title-15--16#46.9.2}

Every Home Health agency shall be designated by a permanent and distinctive name which shall be used in applying for a license and shall not be changed without first notifying the licensing agency in writing and receiving written approval of the change from the licensing agency. Such notice shall specify the name to be discontinued as well as the new name proposed. Only the official name by which the agency is licensed shall be used in telephone listing, on stationery, in advertising, etc. Two or more agencies shall not be licensed under similar names.

**History**
- *SOURCE: Miss. Code Ann. §41-71-13 Subchapter 10 LICENSURE*

##### **15 Miss. Admin. Code Pt. 16, R. 46.10.1** Issuance of License {#sec-16-46.10.1 omnilex-key=us-ms-regs-official--title-15--16#46.10.1}

All licenses issued by the Department of Health shall set forth the name of the agency, the location, the name of the licensee, the classification of the agency, the geographic area served, the license number, services provided, and the name of the responsible party.

**History**
- *SOURCE: Miss. Code Ann. §41-71-13*

##### **15 Miss. Admin. Code Pt. 16, R. 46.10.2** Geographic Area {#sec-16-46.10.2 omnilex-key=us-ms-regs-official--title-15--16#46.10.2}

The service area of each home health agency shall consist of the counties listed on the agency's license. Should a home health agency desire to render services outside this service area, a Certificate of Need shall be obtained and a sub-unit established.

**History**
- *SOURCE: Miss. Code Ann. §41-71-13*

##### **15 Miss. Admin. Code Pt. 16, R. 46.10.3** Separate License {#sec-16-46.10.3 omnilex-key=us-ms-regs-official--title-15--16#46.10.3}

Separate licenses shall be required for each agency and each sub-unit. However, separate licenses are not required for branch offices. Sub- units shall not operate branch offices.

**History**
- *SOURCE: Miss. Code Ann. §41-71-13*

##### **15 Miss. Admin. Code Pt. 16, R. 46.10.4** Posting of License {#sec-16-46.10.4 omnilex-key=us-ms-regs-official--title-15--16#46.10.4}

The license shall be posted in a conspicuous place on the licensed premises and shall be available for review by any and all interested individuals.

**History**
- *SOURCE: Miss. Code Ann. §41-71-13*

##### **15 Miss. Admin. Code Pt. 16, R. 46.10.5** License Not Transferable {#sec-16-46.10.5 omnilex-key=us-ms-regs-official--title-15--16#46.10.5}

The license for a home health agency is not transferable or assignable to any other person except by written approval of the licensing agency and shall be issued only for the person and location named in the application. The license shall be surrendered to the Department of Health on change of ownership, name or location of the agency or in the event that the agency ceases to be operated as a home health agency. In event of a change of ownership, name or location of the agency, or change in services, a new application shall be filed at least thirty (30) days prior to the effective date of the change.

**History**
- *SOURCE: Miss. Code Ann. §41-71-13*

##### **15 Miss. Admin. Code Pt. 16, R. 46.10.6** Expiration of License {#sec-16-46.10.6 omnilex-key=us-ms-regs-official--title-15--16#46.10.6}

Each license shall expire on June 30 following the date of issuance.

**History**
- *SOURCE: Miss. Code Ann. §41-71-13*

##### **15 Miss. Admin. Code Pt. 16, R. 46.10.7** Renewal of License {#sec-16-46.10.7 omnilex-key=us-ms-regs-official--title-15--16#46.10.7}

License shall be renewable annually upon: 1. Filing of an application for renewal by the licensee. 2. Submission of appropriate licensure renewal fee as mandated in Section B.

3. Approval of an annual report by the licensing agency. 4. Maintenance by the agency of minimum standards in its staff, services, and operation as set forth in these minimum standards. 5. Evidence of Certificate of Need, when applicable.

**History**
- *SOURCE: Miss. Code Ann. §41-71-13 Subchapter 11 RECORDS AND REPORTS Rule 46.11.1 General. Each home health agency shall submit such records and reports as the Department of Health may request.*
- *SOURCE: Miss. Code Ann. §41-71-13*

##### **15 Miss. Admin. Code Pt. 16, R. 46.11.2** Daily Patient Census {#sec-16-46.11.2 omnilex-key=us-ms-regs-official--title-15--16#46.11.2}

Each agency shall maintain on a daily basis a current patient census log that accurately reflects admissions and discharges.

**History**
- *SOURCE: Miss. Code Ann. §41-71-13*

##### **15 Miss. Admin. Code Pt. 16, R. 46.11.3** Annual Report {#sec-16-46.11.3 omnilex-key=us-ms-regs-official--title-15--16#46.11.3}

Prior to relicensure, each agency shall submit to the licensing agency an annual report for the previous calendar year period, which shall include statistics as the Department of Health may direct.

2. Violations by the licensee of the minimum standards established by the Department of Health. 3. Publicly misrepresenting the agency and/or its services. 4. Conduct or practices detrimental to the Health or safety of patients and employees of said agency provided that this provision shall not be construed to have any reference to healing practices authorized by law. Detrimental practices include but are not necessarily limited to:

a. Cruelty to patients or indifference to their needs which are essential to their general well-being and health. b. Misappropriations of the money or property of a patient. c. Inadequate staff to provide safe care and supervision of any patient. d. Failure to call a physician or podiatrist when required by patient's condition. 5. Failure to comply with the requirements of the Mississippi Commission Act of 1979, amended.

**History**
- *SOURCE: Miss. Code Ann. §41-71-13 Subchapter 12 DENIAL, SUSPENSION, OR REVOCATION OF LICENSE Rule 46.12.1 Denial or Revocation of License. Hearings and Review. The licensing agency after notice and opportunity for a hearing to the applicant or licensee is authorized to deny, suspend, or revoke a license in any case in which it finds that there has been a failure to comply with the requirements established under the law and these minimum standards. Also, the following may be grounds for denial or revocation of license: 1. Fraud on the part of the licensee in applying for a license.*
- *SOURCE: Miss. Code Ann. §41-71-13 Subchapter 13 PROVISION FOR HEARING AND APPEAL Rule 46.13.1 Administrative Decision. The Mississippi Department of Health will provide an opportunity for a hearing to every applicant or licensee who is dissatisfied with administrative decisions made in the denial or revocation of license. The licensing agency, after notice and opportunity for a hearing to the applicant or licensee, is authorized to deny, suspend or revoke a license in any case in which it finds that the applicant or licensee has failed to comply with the requirements established by this act or the rules, regulations or standards promulgated in furtherance of this act. Such notice shall be given by registered mail, or by personal service, setting forth the particular reasons for the proposed action and fixing a date of not less than thirty (30) days from the date of such mailing or such personal service, at which times the applicant or licensee shall be given an opportunity for a prompt and fair hearing. On the basis of any such hearing, or upon default of the applicant or licensee, the licensing agency shall make a determination specifying its findings of fact and conclusions of law. A copy of such determination shall be sent by registered mail or served personally upon the applicant or licensee. The decision revoking, suspending or denying the license or application shall be come final thirty (30) days after it is so mailed or served, unless the applicant or licensee, within such thirty (30) day period, appeals the decision to the chancery court pursuant to Section 6 of House Bill #427 of the 1981 Legislative Session. The procedure governing hearings shall be in accordance with rules and regulations promulgated by the licensing agency.*
- *SOURCE: Miss. Code Ann. §41-71-13*

##### **15 Miss. Admin. Code Pt. 16, R. 46.13.2** Penalties {#sec-16-46.13.2 omnilex-key=us-ms-regs-official--title-15--16#46.13.2}

Any person or persons or other entity or entities establishing, managing or operating a home health agency or conducting the business of a home health agency without the required license, or which otherwise violates any of the provisions of this act or the rules, regulations or standards promulgated and established in furtherance of this act, shall be guilty of a misdemeanor and, upon conviction thereof, shall be fined not more than five hundred dollars ($500.00) for each offense. Each day of a continuing violation shall be considered a separate

offense. The licensing agency may seek injunctive relief in the event it deems such action necessary after consulting with the State Attorney General.

2. Provide the receiving facility or agency with a complete copy of the clinical record. 3. Inform the community through public announcement of the termination. 4. Ensure the safekeeping, confidentiality, and storage of all clinical records for a period of seven (7) years, following discharge. 5. Return the license to the licensing agency.

Rule 46.15.1 Physical Facilities. Each Home Health office shall be commensurate in size for the volume of staff, patients, and services provided. Offices shall be well lighted, heated, and cooled. Offices should be accessible to individuals with disabilities.

**History**
- *SOURCE: Miss. Code Ann. §41-71-13 Subchapter 14 TERMINATION OF OPERATION Rule 46.14.1 General. In the event that Home Health Agency ceases operation, voluntarily or otherwise, the agency shall: 1. Inform the attending physician or podiatrist, patient, and persons responsible for the patient's care in ample time to provide for alternate methods of care.*
- *SOURCE: Miss. Code Ann. §41-71-13 Subchapter 15 PHYSICAL FACILITIES: ADMINISTRATIVE OFFICES.*
- *SOURCE: Miss. Code Ann. §41-71-13*

##### **15 Miss. Admin. Code Pt. 16, R. 46.15.2** Administrative Offices {#sec-16-46.15.2 omnilex-key=us-ms-regs-official--title-15--16#46.15.2}

Each Home Health Agency shall provide adequate office space and equipment for all administrative and health care staff. An adequate number of desks, chairs, filing cabinets, telephones, tables, etc., shall be available.

Rule 46.16.1 Storage. Each Home Health Agency shall provide sufficient areas for the storage of: 1. Administrative records and supplies 2. Clinical Records 3. Medical equipment and supplies.

Rule 46.17.1 Toilet Rooms. Each Home Health office shall be equipped with an adequate number of toilet rooms. Each toilet room shall include: lavatories, soap, towels, and water closets.

Rule 46.18.1 Communication. Each Home Health Agency shall have an adequate number of telephones and extensions, located so as to be quickly accessible from all parts of the building. The telephone shall be listed under the official licensed name of the agency.

2. Cultures and stocks of infectious agents; including specimen cultures collected from medical and pathological laboratories, cultures and stocks of infectious agents from research and industrial laboratories, wastes from the production of biologicals, discarded live and attenuated vaccines, and culture dishes and devices used to transfer, inoculate, and mix cultures; 3. Blood and blood products such as serum, plasma, and other blood components; 4. Pathological wastes, such as tissues, organs, body parts, and body fluids that are removed during surgery and autopsy; 5. Contaminated carcasses, body parts, and bedding of animals that were exposed to pathogens in medical research; 6. All discarded sharps (e.g., hypodermic needles, syringes, Pasteur pipettes, broken glass, scalpel blades) which have come into contact with infectious agents;

7. Other wastes determined infectious by the generator or so classified by the State Department of Health. 8. "Medical Waste" means all waste generated in direct patient care or in diagnostic or research areas that is non-infectious but aesthetically repugnant if found in the environment.

**History**
- *SOURCE: Miss. Code Ann. §41-71-13 Subchapter 16 STORAGE FACILITIES.*
- *SOURCE: Miss. Code Ann. §41-71-13 Subchapter 17 TOILET FACILITIES.*
- *SOURCE: Miss. Code Ann. §41-71-13 Subchapter 18 COMMUNICATION FACILITIES.*
- *SOURCE: Miss. Code Ann. §41-71-13 Subchapter 19 REGULATED MEDICAL WASTE Rule 46.19.1 Infectious medical wastes includes solid or liquid wastes which may contain pathogens with sufficient virulence and quantity such that exposure to the waste by a susceptible host has been proven to result in an infectious disease. For purposes of this Regulation, the following wastes shall be considered to be infectious medical wastes: 1. Wastes resulting from the care of patients and animals who have Class I and/or II diseases that are transmitted by blood and body fluid as defined in the rules and regulations governing reportable diseases as defined by the Mississippi Department of Health;*
- *SOURCE: Miss. Code Ann. §41-71-13*

##### **15 Miss. Admin. Code Pt. 16, R. 46.19.2** Medical Waste Management Plan {#sec-16-46.19.2 omnilex-key=us-ms-regs-official--title-15--16#46.19.2}

All generators of infectious medical waste and medical waste shall have a medical waste management plan that shall include, but is not limited to, the following: 1. Storage and Containment of Infectious Medical Waste and Medical Waste a. Containment of infectious medical waste and medical waste shall be in a manner and location which affords protection from animals, rain and wind, does not provide breeding place or a food source for insects and rodents, and minimizes exposure to the public. b. Infectious medical waste shall be segregated from other waste at the point of origin in the producing facility. c. Unless approved by the Mississippi Department of Health or treated and rendered non-infectious, infectious medical waste (except for sharps in approved containers) shall not be stored at a waste producing facility for more than seven (7) days above a temperature of 6 C (38F). Containment of infectious medical waste at the producing facility is permitted at or below a temperature of 0 C (32F) for a period of not more than ninety (90) days without specific approval of the Department of Health. d. Containment of infectious medical waste shall be separated from other wastes. Enclosures or containers used for containment of infectious medical waste shall be so secured so as to discourage access by unauthorized persons and shall be marked with prominent warning signs on, or adjacent to, the exterior of entry doors, gates, or lids. Each container shall be prominently labeled with a sign using language to be determined by the Department and legible during daylight hours. e. Infectious medical waste, except for sharps capable of puncturing or cutting, shall be contained in double disposable plastic bags or single bags (1.5 mills thick) which are impervious to moisture and have a strength sufficient to preclude ripping, tearing, or bursting under normal conditions of usage. The bags shall be securely tied so as to prevent leakage or expulsion of solid or liquid wastes during storage, handling, or transport.

f. All sharps shall be contained for disposal in leakproof, rigid, puncture-resistant containers which are taped closed or tightly lidded to preclude loss of the contents. g. All bags used for containment and disposal of infectious medical waste shall be a distinctive color or display the Universal Symbol for infections waste. Rigid containers of all sharps waste shall be labeled. h. Compactors or grinders shall not be used to process infectious medical waste unless the waste has been rendered non-infectious. Sharps containers shall not be subject to compaction by any compacting device except in the institution itself and shall not be placed for storage or transport in a portable or mobile trash compactor. i. Infectious medical waste and medical waste contained in disposable containers as prescribed above, shall be placed for storage, handling, or transport in disposable or reusable pails, cartons, drums, or portable bins. The containment system shall be leak-proof, have tight-fitting covers and be kept clean and in good repair. j. Reusable containers for infectious medical waste and medical waste shall be thoroughly washed and decontaminated each time they are emptied by a method specified by the Mississippi Department of Health, unless the surfaces of the containers have been protected from contamination by disposable liners, bags, or other devices removed with the waste, as outlined in I. E. 2. Approved methods of decontamination include, but are not limited to, agitation to remove visible soil combined with one or more of the following procedures: a. Exposure to hot water at least 180 F for a minimum of 15 seconds. b. Exposure to a chemical sanitizer by rinsing with a immersion in one of the following for a minimum of three (3) minutes: i. Hypochlorite solution (500 ppm available chlorine). ii. Phenolic solution (500 ppm active agent). iii. Iodoform solution (100 ppm available iodine). iv. Quaternary ammonium solution (400 ppm active agent). 3. Reusable pails, drums, or bins used for containment of infections waste shall not be used for containment of waste to be disposed of as non-infectious waste or for other purposes except after being decontaminated by procedures as described in part (J) of this section. a. Trash chutes shall not be used to transfer infectious medical waste.

b. Once treated and rendered non-infectious, previously defined infectious medical waste will be classified as medical waste and may be landfilled in an approved landfill. 4. Treatment or disposal of infectious medical waste shall be by one of the following methods: a. By incineration in an approved incinerator which provides combustion of the waste carbonized or mineralized ash. b. By sterilization by heating in a steam sterilizer, so as to render the waste non- infectious. Infectious medical waste so rendered non-infectious shall be disposable as medical waste. Operating procedures for steam sterilizers shall include, but not be limited to, the following: i. Adoption of standard written operating procedures for each steam sterilizer including time, temperature, pressure, type of waste, type of container(s), closure on container(s), pattern of loading, water content, and maximum load quantity. ii. Check or recording and/or indicating thermometers during each complete cycle to ensure the attainment of a temperature of 121 C (250 F) for one-half hour or longer, depending on quantity and density of the load, in order to achieve sterilization of the entire load. Thermometers shall be checked for calibration at least annually. iii. Use of heat sensitive tape or other device for each container that is processed to indicate the attainment of adequate sterilization conditions. iv. Use of the biological indicator Bacillus stearothermophilus placed at the center of a load processed under standard operating conditions at least monthly to confirm the attainment of adequate sterilization conditions. v. Maintenance of records of procedures specified in (1), (2), (3), and (4) above for period of not less than a year. c. By discharge of the approved sewerage system if the waste is liquid or semi- liquid, except as prohibited by the State Department of Health. d. Recognizable human anatomical remains shall be disposed of by incineration or internment, unless burial at an approved landfill is specifically authorized by the Mississippi Department of Health. e. Chemical sterilization shall use only those chemical sterilants recognized by the U. S. Environmental Protection Agency, Office of Pesticides and Toxic Substances. Ethylene oxide, glutaraldehyde, and hydrogen peroxide are examples of sterilants that, used in accordance with manufacturer recommendation, will render infections waste non-infectious. Testing with

spores or other equivalent organisms shall be conducted quarterly to ensure the sterilization effectiveness of gas or steam treatment. 5. Treatment and disposal of medical waste which is not infectious shall be by one of the following methods: a. By incineration in an approved incinerator which provides combustion of the waste to carbonized or mineralized ash. b. By sanitary landfill, in an approved landfill which shall mean a disposal facility or part of a facility where medical waste is placed in or on land, and which is not a treatment facility. c. All the requirements of these standards shall apply, without regard to the quantity of medical waste generated per month, to any generator of medical waste.

The final draft of the Emergency Operations Plan (EOP), will be reviewed by the Office of Emergency Preparedness and Response, Mississippi State Department of Health, or their designates, for conformance with the “All Hazards Emergency Preparedness and Response Plan.” Particular attention shall be given to critical areas of concern which may arise during any “all hazards” emergency whether required to evacuate or to sustain in place. Additional plan criteria or a specified EOP format may be required as deemed necessary by the Office of Emergency Preparedness and Response. The six (6) critical areas of consideration are: 1. Communications - Facility status reports shall be submitted in a format and a frequency as required by the Office of EOP a. Resources and Assets b. Safety and Security c. Staffing d. Utilities e. Clinical Activities

2. Emergency Operations Plans (EOPs) must be exercised and reviewed annually or as directed by the Emergency Preparedness and Response. Written evidence of current approval or review of provider EOPs, by the Office of Emergency Preparedness and Response, shall accompany all applications for facility license renewals.

2. A provision specifying to whom responsibilities for administration and supervision of the program and evaluation of practices may be delegated and the methods established by the governing body for holding such individuals responsible. 3. A provision specifying the frequency of board meetings and requiring that minutes be taken at each meeting. 4. A provision requiring the establishment of personnel policies and an organizational chart, clearly establishing lines of authority and relationships. 5. The agency's statement of objectives. 6. Provisions for appointment of an advisory committee.

**History**
- *SOURCE: Miss. Code Ann. §41-71-13 Subchapter 20 GOVERNING BODY AND ADMINISTRATION: EMERGENCY OPERATIONS PLAN Rule 46.20.1 The licensed entity shall develop and maintain a written preparedness plan utilizing the “All Hazards” approach to emergency and disaster planning. The plan must include procedures to be followed in the event of any act of terrorism or man-made or natural disaster as appropriate for the specific geographical location.*
- *SOURCE: Miss. Code Ann. §41-71-13 Subchapter 21 GOVERNING BODY Rule 46.21.1 General. The Home Health Agency shall have an organized governing body so functioning which is legally responsible for the conduct of the agency. The administrator and all personnel shall be directly or indirectly responsible to this governing body. The ownership of the home health agency shall be fully disclosed to the State licensure authority. The governing body shall ensure that the agency complies with all applicable local, state and federal laws and regulations and similar requirements. Staff of the Agency shall be currently licensed or registered in accordance with applicable laws of the State of Mississippi. The governing body shall be responsible for periodic administrative and professional evaluations of the agency. The governing body shall receive, review and take action on recommendations made by the evaluating groups and so document the governing body shall adopt and enforce bylaws, or an acceptable equivalent thereof, in accordance with legal requirements. The bylaws, shall be written, revised as needed, and made available to all members of the governing body, the State licensure authority, and the advisory group. The terms of the bylaws shall cover at least the following: 1. The basis upon which members of the governing body are selected, their terms of office, and their duties and responsibilities.*
- *SOURCE: Miss. Code Ann. §41-71-13*

##### **15 Miss. Admin. Code Pt. 16, R. 46.21.2** Agency Policies {#sec-16-46.21.2 omnilex-key=us-ms-regs-official--title-15--16#46.21.2}

The governing body shall adopt agency policies, including admission, discharge, and care of patients.

2. Organizing and coordinating the administrative functions of the services, including implementing adequate budgeting and accounting procedures; 3. Maintaining an ongoing liaison with the professional advisory committee and the agency staff; 4. Coordinating service components to be provided by contractual agreement; and 5. Arranging employee orientation, continuing education and in-service training programs.

**History**
- *SOURCE: Miss. Code Ann. §41-71-13 Subchapter 22 ADMINISTRATOR Rule 46.22.1 Administrator. The governing body shall be legally responsible for the appointment of a qualified administrator and the delegation of responsibility and authority. The governing body shall assure that the administrator has sufficient freedom from other responsibilities to permit adequate attention to the overall direction and management of the agency. When there is a change of the administrator, the governing authority shall immediately notify the licensing agency in writing of the change. The duties and responsibilities of the agency administrator shall include at least the following: 1. Implementing the policies approved and/or developed by the governing body;*
- *SOURCE: Miss. Code Ann. §41-71-13*

##### **15 Miss. Admin. Code Pt. 16, R. 46.22.2** Designee {#sec-16-46.22.2 omnilex-key=us-ms-regs-official--title-15--16#46.22.2}

In order to provide administrative direction at all times, the agency's governing body or administrator shall designate in writing an individual to act for the administrator in his absence.

2. Be given the authority and responsibility to:

a. Develop and revise written patient care objectives policies, and procedure manuals; b. Assist in development of job description; c. Assist in recruitment and selection of personnel; d. Recommend to administrator number of levels of agency staff; e. Plan and conduct orientation and continuing education for agency staff engaged in patient care; f. Evaluate agency staff performance; g. Assist in planning and budgeting for provision of services; h. Assist in establishing agency criteria for admission and discharge of patients.

**History**
- *SOURCE: Miss. Code Ann. §41-71-13 Subchapter 23 SUPERVISING NURSE Rule 46.23.1 Qualified Supervising Nurse. Each Home Health Agency shall employ a qualified supervising nurse on a full-time basis. The supervising nurse shall be a registered nurse licensed to practice in Mississippi, who shall be readily available through the agency office to advise the professional and patient care staff. The supervising nurse shall be employed full-time in home health activities. A qualified alternate is designated in writing to serve in his/her absence. The supervising nurse shall: 1. Direct, supervise and coordinate the skilled nursing services and other therapeutic services provided by the agency.*
- *SOURCE: Miss. Code Ann. §41-71-13*

##### **15 Miss. Admin. Code Pt. 16, R. 46.23.2** Director of Nursing Services {#sec-16-46.23.2 omnilex-key=us-ms-regs-official--title-15--16#46.23.2}

Larger agencies should employ a Director of Nursing Services on a full-time basis to assume the duties of the supervising nurse listed above.

**History**
- *SOURCE: Miss. Code Ann. §41-71-13*

##### **15 Miss. Admin. Code Pt. 16, R. 46.23.3** Ratio of Patients {#sec-16-46.23.3 omnilex-key=us-ms-regs-official--title-15--16#46.23.3}

The following criteria should be used as a minimum standard in developing the ratio of patients to a supervising nurse: 1. The supervising nurse may serve both as the administrator and the supervising nurse until the patient census reaches 25 patients, then 2. The supervising nurse may have a regularly scheduled patient load until the patient census reaches 50, then 3. The supervising nurse may not render regularly scheduled patient services when the patient census is over 50, but shall devote full-time to supervisory duties. Those duties may include admission and discharge of patients as well as PRN visits and to fill in when another employee is absent.

and annually reviewed. Membership on the professional advisory committee shall include but not be limited to the following: 1. A licensed practicing physician; 2. A registered nurse; 3. Preferably, an appropriate number of members from other professional disciplines, who are representative of the scope of services offered; 4. A consumer; and 5. A professional who is neither an owner nor employee of the agency.

**History**
- *SOURCE: Miss. Code Ann. §41-71-13 Subchapter 24 PROFESSIONAL ADVISORY COMMITTEE Rule 46.24.1 General. The governing body shall appoint a multidisciplinary advisory committee to perform a systematic professional and administrative review and program evaluation of the services. Licensed hospitals may establish a committee specifically for this purpose or they may assign the responsibility to an existing committee. Bylaws or the equivalent for this committee shall be initially adopted*
- *SOURCE: Miss. Code Ann. §41-71-13*

##### **15 Miss. Admin. Code Pt. 16, R. 46.24.2** Meetings {#sec-16-46.24.2 omnilex-key=us-ms-regs-official--title-15--16#46.24.2}

The professional advisory committee shall meet at regular intervals, but not less than every six months. 1. Dated written minutes of each committee meeting shall be maintained and made available to the licensing agency upon request; and 2. The agency administrator or his designee shall attend all meetings of the committee.

**History**
- *SOURCE: Miss. Code Ann. §41-71-13*

##### **15 Miss. Admin. Code Pt. 16, R. 46.24.3** Duties {#sec-16-46.24.3 omnilex-key=us-ms-regs-official--title-15--16#46.24.3}

The duties and responsibilities of the professional advisory committee shall include but not be limited to the following: 1. Annual review and reevaluation for the program objectives as required; 2. Annual evaluation of the appropriateness of the scope of services offered; 3. Annual review of admission, discharge and patient care policies and procedures; 4. Annual review of the findings of a random sample of medical records (performed by in-house staff members of professional advisory committee) and written evaluation on quality of services provided; 5. Annual review of staffing qualifications, responsibilities and needs; 6. Annual review of survey findings; 7. Review of quarterly utilization statistics and findings of quarterly clinical record review, and 8. Written recommendations to the governing body and the agency administrator for any revisions in policies and procedures and changes in delivery of care; and

written recommendations on items such as methods for and participation in a continuing public education program to acquaint the community, the health care professions and public and private community resources on the scope, availability and appropriate utilization of home health services.

1. The home health agency administrator with advice from the professional advisory committee and the director of nursing/supervising nurse shall develop a policy and procedure manual. 2. Written policies and procedures shall include provisions covering at least the following: a. Definition of the scope of services offered; b. Admission and discharge policies; c. Medical direction and supervision; d. Plans of treatment; e. Staff qualifications, assignments and responsibilities; f. Medication administration; g. Medical records; h. Patient safety and emergency care; i. Administrative records; j. Agency evaluation; k. Provisions for after hours emergency care (on call); l. Patients rights policies and procedures; and m. Provisions for the proper collection, storage and submission of all referral laboratory samples collected on home health patients. 3. Patient admission and discharge policies shall include but not be limited to the following:

a. Patient shall be accepted for health service on a part-time or intermittent basis upon a plan of treatment established by the patient's physician or podiatrist. Patients accepted for admission should be essentially home bound and in need of skilled services. b. Patients are accepted for treatment on the basis of a reasonable expectation that the patient's medical, nursing, and social needs can be met adequately by the agency in the patient's place of residence. c. When services are to be terminated by the home health agency, the patient and the physician or podiatrist are to be notified in advance of the date of termination stating the reason and a plan shall be developed or a referral made for any continuing care. d. Services shall not be terminated without an order by the physician or podiatrist in consultation with the registered nurse and/or the appropriate therapist. Except in cases of non-payment, where the specific and approved plan of care has been documented as completed, where the patient refuses treatment, in the event of an unsafe environment, or should the patient require the services beyond the capability of the agency. In any event, the physician or podiatrist shall be notified of the termination of services. Arrangements shall be made for continuing care when deemed appropriate.

**History**
- *SOURCE: Miss. Code Ann. §41-71-13 Subchapter 25 POLICY AND PROCEDURE MANUAL Rule 46.25.1 Manual.*
- *SOURCE: Miss. Code Ann. §41-71-13 Subchapter 26 FINANCIAL Rule 46.26.1 Accounting. Accounting methods and procedures shall be carried out in accordance with a recognized system of good business practice. The method and procedure used should be sufficient to permit annual audit, accurate determination for the cost of operation, and the cost per patient visit.*
- *SOURCE: Miss. Code Ann. §41-71-13*

##### **15 Miss. Admin. Code Pt. 16, R. 46.26.2** Financial Structure {#sec-16-46.26.2 omnilex-key=us-ms-regs-official--title-15--16#46.26.2}

All home health agencies shall have an annual operating budget which assures sufficient resources to meet operating cost at all times and to maintain standards required by these regulations.

**History**
- *SOURCE: Miss. Code Ann. §41-71-13*

##### **15 Miss. Admin. Code Pt. 16, R. 46.26.3** Annual Budget {#sec-16-46.26.3 omnilex-key=us-ms-regs-official--title-15--16#46.26.3}

1. The annual operating budget shall include all anticipated income and expenses related to the overall operation of the program. 2. The overall plan and budget shall be reviewed and updated at least annually by the governing body.

3. A budget committee consisting of, but not limited to, the following members shall meet and document in minutes the planning of a yearly budget: a. Representative of the governing body. b. Representative of the administrative staff.

2. Requirements for initial and periodic health examinations; 3. Orientation to the home health agency and appropriate continuing education; 4. Job descriptions for all positions utilized by the agency; 5. Annual performance evaluations for all employees; 6. Compliance with all applicable requirements of the Civil Rights Act of 1964; 7. Provision for confidentiality of personnel records.

**History**
- *SOURCE: Miss. Code Ann. §41-71-13 Subchapter 27 PERSONNEL POLICIES Rule 46.27.1 Personnel Policies. Each home health agency shall adopt and enforce personnel policies applicable requirements of the Civil Rights Act of 1964: 1. Fringe benefits, hours of work and leave time;*
- *SOURCE: Miss. Code Ann. §41-71-13*

##### **15 Miss. Admin. Code Pt. 16, R. 46.27.2** Personnel Records {#sec-16-46.27.2 omnilex-key=us-ms-regs-official--title-15--16#46.27.2}

Each licensed agency shall maintain complete personnel records for all employees on file at each licensed site. Personnel records for all employees shall include an application for employment including name and address of the employee, social security number, date of birth, name and address of next of kin, evidence of qualifications, (including reference checks), current licensure and/or registration (if applicable), performance evaluation, evidence of health screening, evidence of orientation, and a contract (if applicable), date of employment and separation from the agency and the reason for separation. Home Health agencies that provide other home health services under arrangement through a contractual purchase of services shall ensure that these services are provided by qualified personnel; currently licensed and\or registered if applicable, under the supervision of the agency.

**History**
- *SOURCE: Miss. Code Ann. §41-71-13*

##### **15 Miss. Admin. Code Pt. 16, R. 46.27.3** Criminal History Record Checks {#sec-16-46.27.3 omnilex-key=us-ms-regs-official--title-15--16#46.27.3}

Rule 46.27.3 Criminal History Record Checks.

1. Pursuant to Section 43-11-13, Mississippi Code of 1972, the covered entity shall require to be performed a disciplinary check with the professional licensing agency, if any, for each employee to determine if any disciplinary action has been taken against the employee by the agency, and a criminal history record check on: A. Every new employee of a covered entity who provides direct patient care or services; and B. Any individual seeking new employment with a covered entity whose initial criminal history record check is over two years.

**History**
- *SOURCE: Miss. Code Ann. §41-71-13*

##### **15 Miss. Admin. Code Pt. 16, R. 46.27.4** Insurance Coverage {#sec-16-46.27.4 omnilex-key=us-ms-regs-official--title-15--16#46.27.4}

For the protection of owner, administrator, and the patients served, it is strongly recommended that every home health agency carry liability insurance coverage.

**History**
- *SOURCE: Miss. Code Ann. §41-71-13*

##### **15 Miss. Admin. Code Pt. 16, R. 46.27.5** Employee Health Screening {#sec-16-46.27.5 omnilex-key=us-ms-regs-official--title-15--16#46.27.5}

Every employee of a home health agency who comes in contact with patients shall receive a health screening by a licensed physician or nurse practitioner/physician assistant prior to employment and annually thereafter.

**History**
- *SOURCE: Miss. Code Ann. §41-71-13*

##### **15 Miss. Admin. Code Pt. 16, R. 46.27.6** Staffing Pattern {#sec-16-46.27.6 omnilex-key=us-ms-regs-official--title-15--16#46.27.6}

Each home health agency sub-unit, and branch shall maintain on site current staffing patterns for all health care personnel including full-time, part-time, contract staff and staff under arrangement. The staffing pattern shall be developed at least one week in advance, updated as needed, and kept on file for a period of one year. The staffing pattern shall indicate the following for each working day: 1. Name and position of each staff member. 2. Patients to be visited. 3. Scheduled supervisory visits. 4. Staff on call after office hours. The staffing pattern shall be updated daily by each home health agency in order to reflect actual staff activities on the previous day.

**History**
- *SOURCE: Miss. Code Ann. §41-71-13 Subchapter 28 CONTRACT SERVICES FOR PART-TIME, HOURLY OR PER VISIT PERSONNEL-SERVICES BY ARRANGEMENT*

##### **15 Miss. Admin. Code Pt. 16, R. 46.28.1** Contract Services {#sec-16-46.28.1 omnilex-key=us-ms-regs-official--title-15--16#46.28.1}

Services provided to the agency by contract shall be documented by means of a written contract with the individual or organization providing the service. The written contract shall include provisions covering at least the following: 1. Specification of services covered by the agreement or contract; 2. Effective date and length of the contract and terms of reimbursement; 3. Statement that patients will be accepted for care only by the home health agency; 4. Statement that services are to be provided only in accordance with the patient's plan of treatment and that the patient's plan for treatment will not be altered by the contracted individual or agency; 5. Statement that the quality of services provided and the qualifications of personnel who will provide services shall be consistent with the agency's applicable personnel and program policies and procedures; 6. Identification of parties responsible for supervision of personnel covered by the agreement or contract; and 7. Specification for procedures for, and frequency of, exchanging patient care information between parties to the contract and their agents, including submitting clinical notes, progress notes, scheduling of visits, periodic patient evaluation and participating in developing patient care plans.

**History**
- *SOURCE: Miss. Code Ann. §41-71-13 Subchapter 29 STAFF DEVELOPMENT Rule 46.29.1 Orientation. Upon employment each employee of the home health agency shall receive thorough orientation to his position; the agency’s organization, policies and objectives; the functions of other agency health personnel and how they relate to each other in caring for the patient; relationship of the home health agency to other community agencies; standards of ethical practice; confidentiality; and patient’s rights. Facilities shall comply with recommendations from the Centers for Disease Control and/or the Mississippi State Department of Health regarding baseline employee TB testing and routine serial employee TB testing and education.*
- *SOURCE: Miss. Code Ann. §41-71-13*

##### **15 Miss. Admin. Code Pt. 16, R. 46.29.2** Home Health Aide Training Program {#sec-16-46.29.2 omnilex-key=us-ms-regs-official--title-15--16#46.29.2}

Home Health aides, employed by the home health agency shall have previous work experience as a nurses aide or home health aide and/or have completed a special program for home health aides. As a part of the orientation for home health aides, each home health agency employing unqualified home health aides shall develop and implement a training program for

newly employed home health aides or require that the aide complete a program outside the agency that meet Medicare requirements regarding duration and subject matter. The aide training program shall be approved by the Department of Health. Each home health aide shall complete the basic training program prior to the provision of services in the home. Faculty for the training program shall consist of: A registered nurse to provide training in personal care services, and, as appropriate, physicians, dietitians, physical therapists, medical social workers, and other health personnel to provide training in the appropriate areas of health care. The following topics shall be included in the home health aide training program: 1. The role of the home health aide as a member of the health services team; 2. Instruction and supervised practice in personal care services of the sick at home, including personal hygiene and activities of daily living; 3. Principles of good nutrition and nutritional problems of the sick and elderly; 4. Preparation of meals including special diets; 5. Information on the process of aging and behavior of the aged; 6. Information on the emotional problems accompanying illness; 7. Principles and practices of maintaining a clean, healthy and safe environment; 8. What to report to the supervisor, and 9. Record keeping.

**History**
- *SOURCE: Miss. Code Ann. §41-71-13*

##### **15 Miss. Admin. Code Pt. 16, R. 46.29.3** In-Service Training {#sec-16-46.29.3 omnilex-key=us-ms-regs-official--title-15--16#46.29.3}

The home health agency shall provide an on-going in- service education program, which should be directly related to home health care and which shall be designed to improve the level of skills of all staff members involved in direct patient care. Full-time and part-time nurses and home health aides shall participate in a minimum of twelve (12) hours of pertinent continuing education programs per year.

**History**
- *SOURCE: Miss. Code Ann. §41-71-13*

##### **15 Miss. Admin. Code Pt. 16, R. 46.29.4** Documentation of Training {#sec-16-46.29.4 omnilex-key=us-ms-regs-official--title-15--16#46.29.4}

A written record of all orientation, basic training, and in-service education programs shall be maintained. Records shall reflect content of and attendance at all programs, as well as beginning and ending times.

**History**
- *SOURCE: Miss. Code Ann. §41-71-13 Subchapter 30 STANDARDS OF ETHICAL PRACTICE*

##### **15 Miss. Admin. Code Pt. 16, R. 46.30.1** General {#sec-16-46.30.1 omnilex-key=us-ms-regs-official--title-15--16#46.30.1}

Each home health agency shall maintain the highest level of ethical standards in its business practices. The governing body of each home health agency shall adopt written standards of ethical practice, which shall be strictly adhered to by all employees and owners of the agency. These standards shall be posted in each agency office in order to facilitate review by any interested individual. At a minimum, every home health agency shall include the following items in the agency's standards of ethical practice: 1. Neither the owner nor any home health agency employee shall knowingly mislead a patient, family member or caretaker concerning services, charges, or use of equipment. 2. Neither the owner nor any home health agency employee shall misuse or misappropriate any property-real or personal-belonging to any patient, family member or caretaker. 3. Neither the owner nor any home health agency employee shall knowingly and actively recruit a patient under the care of another home health agency. 4. No employee or patient of a home health agency shall be coerced into participating in agency fund raising activities. 5. The home health agency shall accept patient referrals in a professional manner with no remuneration provided to the referring party. 6. Patient clinical records, administrative records, and financial records shall not be falsified by any individual for any reason.

Written policies regarding patients' rights shall be made available to patients and/or their guardian, next of kin, sponsoring agency or agencies, or lawful representative and to the public. There shall be documented evidence that the staff of the agency is trained and involved in the implementation of these policies and procedures. In-service on patient's rights and responsibilities shall be conducted annually. The patients' rights policies and procedures ensure that each patient admitted to the agency: 1. Is fully informed, as evidenced by the patient's written acknowledgment, prior to or at the time of admission, of these rights and of all rules and regulations governing patient conduct and responsibilities;

2. Is fully informed prior to or at the time of admission and during the course of treatment of services available through the agency, and of related charges including any charges for services not covered under titles XVIII or XIX of the Social Security Act, or any other third party. 3. Is afforded the opportunity to participate in the planning of his medical treatment and to refuse to participate in experimental research; 4. Is transferred or discharged only for medical reasons, or for his welfare, or for non- payment (except as prohibited by Titles XVIII or XIX of the Social Security Act), or on the event of an unsafe environment, or should the patient refuse treatment, and is given advance notice to ensure orderly transfer to discharge, and such actions are documented in his clinical record; 5. May voice grievances and recommend changes in policies and services to agency staff and/or to outside representatives of his choice, free from restraint, interference, coercion, discrimination, or reprisal; 6. Is assured confidential treatment of his personal and clinical records, and may approve or refuse their release to any individual outside the agency, except, in case of his transfer to another health care institution or agency or as required by law or third-party payment contract; 7. Is treated with consideration, respect, and full recognition of his dignity and individuality, including privacy in treatment and in care of his personal needs; 8. No person shall be refused service because of age, race, religious preference, sex, marital status or national origin.

The total plan is reviewed by the attending physician or podiatrist, in consultation with agency professional personnel at such intervals as the severity of the patient's illness requires but in any instance, at least once every two (2) months. The registered nurse, and other health professional shall bring to the attention of the physician or podiatrist changes in the patient's condition which indicate the need for altering the treatment plan or for terminating services. No medication,

treatment or services shall be given except on signed order of a person lawfully authorized to give such an order.

**History**
- *SOURCE: Miss. Code Ann. §41-71-13 Subchapter 31 PATIENTS' RIGHTS Rule 46.31.1 General. The agency shall maintain written policies and procedures regarding the rights and responsibilities of patients. These written policies and procedures shall be established in consultation with the Professional Advisory Committee.*
- *SOURCE: Miss. Code Ann. §41-71-13 Subchapter 32 PLANNING FOR PATIENT TREATMENT: PLAN OF TREATMENT Rule 46.32.1 Development of Plan of Treatment. Each home health agency shall establish policies and procedures for assuring that services and items to be provided are specified under a plan of treatment established and regularly reviewed by the physician or podiatrist who is responsible for the care of the patient. Other agency personnel shall have input into the development of the plan of treatment as deemed appropriate by the physician or podiatrist. The original plan of treatment shall be signed by the physician or podiatrist who is responsible for the care of the patient and incorporated in the record maintained by the agency for the patient.*
- *SOURCE: Miss. Code Ann. §41-71-13*

##### **15 Miss. Admin. Code Pt. 16, R. 46.32.2** Plan of Treatment Content {#sec-16-46.32.2 omnilex-key=us-ms-regs-official--title-15--16#46.32.2}

The plan of treatment shall include: 1. Diagnoses relevant to the provision of home health services; 2. Functional limitations and rehabilitation potential; 3. Prognosis; 4. Services authorized by the physician or podiatrist, including frequency and duration; 5. Medications ordered by the physician or podiatrist to include dosage, route of administration and frequency; 6. Treatment, if applicable, including modality, frequency and duration; drug and food allergies; 7. Activities permitted; 8. Diet; 9. Specific procedures deemed essential for the health and safety of the patient; 10. The attending physician or podiatrist's signature; 11. Long term goals and discharge plans; 12. Mental status; and 13. Equipment required.

**History**
- *SOURCE: Miss. Code Ann. §41-71-13*

##### **15 Miss. Admin. Code Pt. 16, R. 46.32.3** Periodic Review of the Plan of Treatment {#sec-16-46.32.3 omnilex-key=us-ms-regs-official--title-15--16#46.32.3}

The professional person responsible for any specific treatment shall notify the attending physician or podiatrist, other professional persons, and responsible agency staff of significant changes in the patient's condition. The plan shall be reviewed by the agency care team at least every sixty (60) days and a written summary report sent to the attending physician or podiatrist containing home health services provided, the patient status, recommendations for revision of the plan of treatment, and the need for continuation or termination of services. The attending physician or podiatrist shall be consulted to approve additions or modifications to the original plan. When a patient is transferred to a hospital and readmitted to the agency, the plan of treatment shall be reviewed by the physician or podiatrist. If the diagnosis of

the patient has not changed (as documented in the agency's discharge/transfer summary, the hospital's discharge summary and reassessment of the patient), a statement to continue previous orders will suffice. At the end of the sixty (60) day period, new orders shall be written.

Assessments by other care team members shall be made on orders of the physician or podiatrist. The patient care plan shall be updated as often as the patient's condition indicates at least every sixty (60) days and shall be maintained as a permanent part of the patient's record.

**History**
- *SOURCE: Miss. Code Ann. §41-71-13 Subchapter 33 PATIENT PLAN Rule 46.33.1 General. A patient care plan shall be written for each patient by the registered nurse or other disciplines as needed based upon an assessment of the patient's significant clinical findings, resources, and environment. The initial assessment for patients requiring skilled nursing services is to be made by a registered nurse.*
- *SOURCE: Miss. Code Ann. §41-71-13*

##### **15 Miss. Admin. Code Pt. 16, R. 46.33.2** Content of Patient Care Plan {#sec-16-46.33.2 omnilex-key=us-ms-regs-official--title-15--16#46.33.2}

The patient care plan shall include: 1. Patient problems; 2. Anticipated goals and time frames; 3. Approaches; and 4. The discipline responsible for a given element of service.

**History**
- *SOURCE: Miss. Code Ann. §41-71-13 Subchapter 34 SERVICES PROVIDED: GENERAL Rule 46.34.1 Each agency shall provide skilled nursing service and at least one other home health service on a part-time or intermittent basis. The skilled nursing service shall be provided directly by agency staff. Other home health services may be provided by agency staff directly or provided under arrangement through a contractual purchase of services. All services shall be provided in accordance with order of the patient's physician or podiatrist and under a plan of treatment established by such physician or podiatrist.*
- *SOURCE: Miss. Code Ann. §41-71-13 Subchapter 35 SKILLED NURSING Rule 46.35.1 General. Skilled nursing services shall be provided by or under the supervision of registered nurses currently licensed in the State of Mississippi.*
- *SOURCE: Miss. Code Ann. §41-71-13*

##### **15 Miss. Admin. Code Pt. 16, R. 46.35.2** Duties of the Registered Nurse {#sec-16-46.35.2 omnilex-key=us-ms-regs-official--title-15--16#46.35.2}

The duties of the Registered Nurse shall include, but not be limited to the performance and documentation of the following: 1. Evaluate and regularly reevaluate the nursing needs of the patient; 2. Develop and implement the nursing component of the patient care plan; 3. Provide nursing services, treatments, and diagnostic and preventive procedures requiring substantial specialized skill; 4. Initiate preventive and rehabilitative nursing procedures as appropriate for the patient's care and safety; 5. Observe and report to the physician or podiatrist when appropriate, signs and symptoms, reaction to treatments and changes in the patient's physical or emotional condition; 6. Teach, supervise, and counsel the patient and family members regarding the nursing care needs and other related problems of the patient at home; check all medications to identify ineffective drug therapies, adverse reactions, significant side effects, drug allergies and/or contraindicated medications. Promptly report any problems to the physician or podiatrist. 7. Provide supervision and training to other nursing service personnel; 8. Provide supervision of the Licensed Practical Nurse in the home of each patient seen by the LPN at least once a month. It is not a requirement for the licensed practical nurse to be present at the supervisory visit by the RN; however, it does not preclude the licensed practical nurse from being present. In addition, the supervising RN must be accessible by telecommunications to the LPN at all times while the LPN is treating patients. 9. Make supervisory visits to the patient's residence at least every other week with the aide alternately present and absent, to provide direct supervision and to assess relationships and determine whether goals are being met; and 10. Ensures that the patient's nursing care and progress is recorded in the clinical record.

duties of the Licensed Practical Nurse shall include, but not limited to the following: 1. Observe, record and report to supervisor on the general physical and mental conditions of the patient; 2. Administer prescribed medications and treatments in accordance with the plan of treatment; 3. Assist the physician or podiatrist and/or registered nurse in performing specialized procedures; 4. Assist the patient with activities of daily living and encourage appropriate self-care; and 5. Prepare progress notes and clinical notes.

**History**
- *SOURCE: Miss. Code Ann. §41-71-13 Subchapter 36 LICENSED PRACTICAL NURSING SERVICES Rule 46.36.1 General. Licensed Practical Nursing Services shall be provided by a trained licensed practical nurse working under the supervision of a registered nurse. The*
- *SOURCE: Miss. Code Ann. §41-71-13 Subchapter 37 STUDENT NURSE Rule 46.37.1 General. When an agency elects to participate with an educational institution to provide clinical community health nursing experience for students as part of their nursing curriculum, the student nurse shall perform skilled nursing functions in the patient's home only under the direct supervision of a registered nurse.*
- *SOURCE: Miss. Code Ann. §41-71-13*

##### **15 Miss. Admin. Code Pt. 16, R. 46.37.2** Written Agreement {#sec-16-46.37.2 omnilex-key=us-ms-regs-official--title-15--16#46.37.2}

There shall be a written agreement between the agency and each educational institution. The agreement specifies the responsibilities of the agency and the educational institution. The agreement includes, at minimum the following: 1. The agency retains the responsibility for patient care. 2. The educational institution retains the responsibility for student education. 3. The student and facility performance expectations. 4. Faculty supervision of undergraduate students in the field. 5. Ratio of faculty to students. 6. Confidentiality regarding patient information. 7. Required insurance coverage. 8. Provisions for joint agency/facility student program evaluation.

**History**
- *SOURCE: Miss. Code Ann. §41-71-13 Subchapter 38 HOME HEALTH AIDE SERVICES Rule 46.38.1 General. When an agency provides or arranges for home health aide services, the aides shall be assigned because the patient needs personal care. The services shall be given under a physician or podiatrist's order and shall be supervised by a registered nurse. When appropriate, supervision may be given by a physical, speech, or occupational therapist.*
- *SOURCE: Miss. Code Ann. §41-71-13*

##### **15 Miss. Admin. Code Pt. 16, R. 46.38.2** Responsibilities of the Home Health Aide {#sec-16-46.38.2 omnilex-key=us-ms-regs-official--title-15--16#46.38.2}

Responsibilities of the home health aide shall include but not be limited to the following: 1. The home health aide shall perform only those personal care activities contained in written assignment by a health professional employee which include assisting the patient with personal hygiene, ambulation, eating, dressing and shaving. 2. The home health aide may perform other activities as taught by a health professional employee for a specific patient. These include, but are not limited to: shampoo, reinforcement of a dressing, assisting with the use of devices for aide to daily living (walker, wheelchair), assisting with prescribed range of motion exercises which the home health aide and the patient have been taught by a health professional employee, doing simple urine tests for sugar, acetone or albumin, measuring and preparing special diets, intake an output. 3. The home health aide shall not be allowed to perform the following and other procedures requiring skilled services: Change sterile dressings, irrigate body cavities such as a colostomy or wound, perform a gastric lavage or gavage, decubitus care, catheterize a patient, administer medications, apply heat by any method, care for a tracheotomy tube, or any personal health service which has not been included by the professional nurse in the aide assignment sheet. 4. The home health aide shall keep records of personal health care activities. 5. The home health aide shall observe appearance and behavioral changes in the patient and report to the professional nurse. 6. The home health aide patient services shall be evaluated by a health professional at least every other week, with the aide alternately present and absent, in the home for those patients receiving skilled services. When only home health aide services are being furnished to a patient, a registered nurse must make a supervisory visit to the patient's residence at least once every 60 days. This supervisory visit must occur while the aide is furnishing patient care.

Subchapter 39 PHYSICAL THERAPY SERVICE Rule 46.39.1 General. Physical therapy services shall be given in accordance with the responsible physician’s or podiatrist’s written order by a physical therapist or physical therapy assistant currently licensed in the State of Mississippi to practice as a physical therapist or physical therapist assistant. The physician’s or podiatrist’s order shall be specific as to modalities to be utilized and frequency of therapy.

**History**
- *SOURCE: Miss. Code Ann. §41-71-13*
- *SOURCE: Miss. Code Ann. §41-71-13*

##### **15 Miss. Admin. Code Pt. 16, R. 46.39.2** Duties of the Physical Therapist {#sec-16-46.39.2 omnilex-key=us-ms-regs-official--title-15--16#46.39.2}

The duties of the physical therapist shall include, but not be limited to the following: 1. Assisting the physician or podiatrist in the functional evaluation of the patient and development of the individual plan of treatment; 2. Developing and implementing a physical therapy component of the patient care plan; 3. Rendering treatments to relieve pain, develop or restore function, and maintain maximum performance; directing and aiding the patient in active and passive exercise, muscle reeducation, and engaging in functional training activities in daily living; 4. Observing and reporting to the responsible physician or podiatrist the patient's reactions to treatments and any changes in the patient's conditions; 5. Instructing the patient and family on the patient's total physical therapy program and in which they may work with the patient; 6. Instructing the patient and family on the patient's total physical therapy program and in the care and use of appliances, prosthetic and other orthopedic devices; 7. Preparing clinical notes, progress notes, and discharge summaries; 8. Participating in agency in-service training programs; 9. Acting as a consultant to other agency personnel; 10. Developing written policies and procedures for the physical therapy services of the home health agency; 11. Make the initial visit for evaluation of the patient and establishment of a plan of care; 12. The supervising physical therapist must have a case conference with the physical therapy assistant to discuss the evaluation, review the established plan of care, and

provide the physical therapy assistant with instructions needed for the safe and effective treatment of the patient before the physical therapy assistant begins providing services to the patient; 13. The supervising physical therapist must visit and personally render treatment and reassess each patient who is provided services by the physical therapist assistant no later than every sixth treatment day or thirtieth calendar day, whichever occurs first. It is not a requirement for the physical therapist assistant to be present at this visit; however, it does not preclude the physical therapist assistant from being present. In addition, the supervising physical therapist must be accessible by telecommunications to the physical therapist assistant at all times while the physical therapist assistant is treating patients. 14. Make the final visit to terminate the plan of care; and 15. Provide supervision for no more than four (4) physical therapy assistants.

**History**
- *SOURCE: Miss. Code Ann. §41-71-13*

##### **15 Miss. Admin. Code Pt. 16, R. 46.39.3** Duties of the Physical Therapy Assistant {#sec-16-46.39.3 omnilex-key=us-ms-regs-official--title-15--16#46.39.3}

The duties of the physical therapist assistant shall be limited to the following: 1. Perform physical therapy procedures and related tasks that have been selected and delegated by the supervising physical therapist with the exception of interpretation of referrals; identification, determination or modification of plans of care (including goals and treatment programs); final discharge assessment/evaluation or establishment of the discharge plan; or establishment of the discharge plan; or therapeutic techniques beyond the skill and knowledge of the physical therapist assistant. 2. Notify the supervising physical therapist of changes in the patient's status, including all untoward patient responses. 3. Discontinue immediately any treatment procedures which in their judgment appear to be harmful to the patient. 4. Preparing clinical notes and progress notes. 5. Participation in staff in-service programs.

licensed speech pathologist or a licensed audiologist. The frequency of service shall be specified in the physician's order.

**History**
- *SOURCE: Miss. Code Ann. §41-71-13 Subchapter 40 SPEECH PATHOLOGY AND AUDIOLOGY SERVICES Rule 46.40.1 General. The speech pathologist shall be currently licensed by the Mississippi Department of Health. The audiologist shall be currently licensed by the Mississippi Department of Health. Speech pathology and audiology services shall be given in accordance with the responsible physician's written order by a*
- *SOURCE: Miss. Code Ann. §41-71-13*

##### **15 Miss. Admin. Code Pt. 16, R. 46.40.2** Duties of the Speech Pathologist and/or Audiologist {#sec-16-46.40.2 omnilex-key=us-ms-regs-official--title-15--16#46.40.2}

The duties of the speech pathologist and/or audiologist shall include, but not be limited to: 1. Assisting the physician in the evaluation of the patient with speech, hearing, or language disorders; and development of the individual plan of treatment; 2. Developing and implementing a Speech Pathology and/or Audiology Component of the patient care plan; 3. Providing rehabilitative services for speech, hearing, and language disorders; 4. Observing and reporting to the responsible physician the patient's reaction to treatment and any changes in the patient's condition. 5. Instructing other agency personnel, the patient and family members in methods to improve and correct speech, hearing, and language disabilities; 6. Preparing clinical notes, progress notes, and discharge summaries; 7. Participating in agency in-service training programs; 8. Acting as a consultant to other agency personnel; and 9. Developing written policies and procedures for the Speech Pathology/Audiology Services of the Home Health Agency.

Subchapter 41 OCCUPATIONAL THERAPY SERVICES Rule 46.41.1 General. When an agency provides or arranges for occupational therapy, services shall be given in accordance with a physician's or podiatrist’s written order by a licensed occupational therapist or a licensed occupational therapy assistant under the supervision of a licensed occupational therapist.

**History**
- *SOURCE: Miss. Code Ann. §41-71-13*
- *SOURCE: Miss. Code Ann. §41-71-13*

##### **15 Miss. Admin. Code Pt. 16, R. 46.41.2** Duties of the Occupational Therapist {#sec-16-46.41.2 omnilex-key=us-ms-regs-official--title-15--16#46.41.2}

Duties of the occupational therapist shall include, but not be limited to, the following: 1. Assisting the physician or podiatrist in the evaluation of patients by applying diagnostic and prognostic tests and by reporting the findings in terms of problems

and abilities of the patient; identifying patients' therapy needs and development of the individual plan of treatment; 2. Developing and implementing an occupational therapy component of the patient care plan. 3. Treating patients for the purpose of attaining maximum functional performance through use of such procedures as: a. Task orientation therapeutic activities; b. Activities of daily living; c. Perceptual motor training and sensory integrative treatment; d. Orthotics and splinting; e. Use of adaptive equipment; f. Prosthetic training; g. Homemaking training. 6. Observing, recording and reporting to the physician or podiatrist and agency personnel the patient's reaction to treatment and any changes in the patient's condition; 7. Counseling with regard to levels of functional performance and the availability of community resources; 8. Instructing other health team personnel, patients, and family members; 9. Preparing clinical notes, progress notes, and discharge summaries; 10. Participating in staff in-service educational programs; 11. Developing written policies and procedures for the occupational therapy services of the home health agency; 12. Acting as a consultant to other agency personnel; and 13. Make supervisory visits to the patient's residence with the Occupational Therapy Assistant at least once every three (3) weeks or every five (5) to seven (7) treatment sessions to provide direct supervision and to assess the adherence to the plan of treatment and progress toward established goals. 14. Conduct all initial assessments and establish the goals and plans of treatment before the treatments are provided to the patient by an Occupational Therapy Assistant.

15. Prepare discharge summaries, interim assessments, and initiate any changes in the plan of care for patients treated by Occupational Therapy Assistants.

**History**
- *SOURCE: Miss. Code Ann. §41-71-13*

##### **15 Miss. Admin. Code Pt. 16, R. 46.41.3** Duties of the Occupational Therapy Assistant {#sec-16-46.41.3 omnilex-key=us-ms-regs-official--title-15--16#46.41.3}

The responsibilities of the therapy assistant shall be limited to the following: 1. Treating patients for the purpose of attaining maximum functional performance through the use of procedures as: a. Task oriented therapeutic activities; b. Activities of daily living; c. Perceptual motor training and sensory integrative treatment; d. Orthotics and splinting; e. Use of adaptive equipment; f. Prosthetic training; g. Homemaking training; h. Patient and family member education. 2. Observing, recording and reporting to the Supervising Therapist, any reaction to treatment and any changes in the patient's condition. 3. Preparation of clinical or treatment notes. 4. Participation in staff education programs.

worker shall review and evaluate the performance of the bachelor's degree social worker on a monthly basis.

**History**
- *SOURCE: Miss. Code Ann. §41-71-13 Subchapter 42 MEDICAL SOCIAL SERVICES Rule 46.42.1 General. Medical social services shall be provided by a social worker who has a masters degree from a school of social work accredited by the Council on Social Work Education and is licensed as such by the State of Mississippi and has one year of social work experience in a health care setting or by a licensed social worker who has a bachelor's degree from a school of social work accredited by the Council of Social Work Education or Southern Association of Colleges and Schools and has one year of social work experience in a health care setting and who is supervised by a licensed social worker with a masters degree. Medical social services shall be given in accordance with the responsible physician or podiatrist's written order by a medical social worker. Master's degree social*
- *SOURCE: Miss. Code Ann. §41-71-13*

##### **15 Miss. Admin. Code Pt. 16, R. 46.42.2** Duties of the Medical Social Worker {#sec-16-46.42.2 omnilex-key=us-ms-regs-official--title-15--16#46.42.2}

The duties of the medical social worker include, but are not limited to the following: 1. Assisting the responsible physician or podiatrist and other members of the agency team in understanding the significant social and emotional factors related to patient health problems; 2. Assessing the social and emotional factors in order to estimate the patient's capacity and potential to cope with problems of daily living; and assisting in the development of an individual plan of treatment; 3. Developing and implementing a social work component of the patient care plan; 4. Helping the patient and his/her family to understand, accept, and follow medical recommendations and provide services planned to restore the patient to optimum social and health adjustment within his/her capacity; 5. Assisting patients and their families with personal and environmental difficulties which predispose towards illness or interfere with obtaining maximum benefits from medical care; 6. Utilizing resources such as family and community agencies to assist the patient in resuming life in the community or to learn to live with his/her disability; 7. Preparing clinical notes, progress notes, and discharge summaries; 8. Participating in agency in-service training programs; 9. Acting as a consultant to other agency personnel; 10. Development of written policies and procedures for medical social services of the home health agency; and 11. Review and evaluate the work of a bachelor's degree licensed social worker on a monthly basis.

elects to provide nutrition services, these services shall include an evaluation of the nutritional status of the patient, the results of which shall be included in the patient care plan. Nutritional services shall be provided by or under the supervision of a registered dietitian.

**History**
- *SOURCE: Miss. Code Ann. §41-71-13 Subchapter 43 NUTRITIONAL SERVICES Rule 46.43.1 General. Nutrition is recognized as an important component of the total health status of all persons. Because state and community health agencies are concerned with the total health care of all, nutrition services must be considered a vital element in all home health agencies' programs. When a home health agency*
- *SOURCE: Miss. Code Ann. §41-71-13*

##### **15 Miss. Admin. Code Pt. 16, R. 46.43.2** Duties of the Dietitian {#sec-16-46.43.2 omnilex-key=us-ms-regs-official--title-15--16#46.43.2}

The responsibilities of the Dietitian shall include but not be limited to, the following: 1. Assisting the physician or podiatrist in the evaluation of the patient's nutritional status and development of the individual plan of treatment; 2. Developing and implementing a nutritional component of the patient care plan; 3. Selecting, preparing and evaluating teaching materials and aids for patient counseling and education and furnishing direct nutritional counseling services to the patient; 4. Observing and reporting to the physician or podiatrist the patient's reaction and adherence to the diet and change in the patient's nutritional status; 5. Preparing clinical notes, progress, and discharge summaries; 6. Participating in agency in-service training programs; 7. Acting as a consultant to other agency personnel; and 8. Developing written policies and procedures for the nutritional services of the home health agency.

Subchapter 44 RESPIRATORY THERAPY SERVICES Rule 46.44.1 General. Respiratory care services shall be provided only by a registered respiratory therapist or a certified respiratory therapy technician upon the written order of a physician. The physician's order shall specify the modality to be utilized and the frequency of services.

**History**
- *SOURCE: Miss. Code Ann. §41-71-13*
- *SOURCE: Miss. Code Ann. §41-71-13*

##### **15 Miss. Admin. Code Pt. 16, R. 46.44.2** Duties of the Respiratory Therapist or Technician {#sec-16-46.44.2 omnilex-key=us-ms-regs-official--title-15--16#46.44.2}

The duties of the registered respiratory therapist or certified respiratory therapy technician shall include, but not be limited to, the following:

1. Assisting the physician in the evaluation of patients; respiratory disorders, and development of individual plan of treatment; 2. Developing and implementing a respiratory therapy component of the patient care plan; 3. Providing rehabilitative services for respiratory disorders; 4. Observing and reporting to the responsible physician the patient's reaction to treatment and any changes in the patient's condition; and 5. Instructing other agency personnel, the patient, and family member in methods to improve and correct respiratory disabilities; 6. Preparing clinical notes, progress notes, and discharge summaries; 7. Participating in agency in-service training programs; 8. Acting as a consultant to other agency personnel; and 9. Developing written policies and procedures for the respiratory therapy services of the home health agency.

Symbols or abbreviations used in the clinical records shall be approved by the staff and a current copy of abbreviations shall be maintained in the agency office. Clinical records shall be readily accessible at all times.

2. A plan of treatment; 3. Initial and periodic patient assessments by the professional discipline responsible performed in the home; 4. Patient care plan; 5. Clinical notes signed and dated by all disciplines rendering service to the patient for each contact, written the day of service and incorporated into the patient's clinical record at least weekly; 6. Reports of case conferences including staff contacts with physicians or podiatrists and other members of the health care pertaining to the patients. Case conferences shall be conducted and documented at least every sixty (60) days or more often as required by the patient's condition; 7. Written summary reports to the physician or podiatrist every sixty (60) days; 8. Progress notes written at least every sixty (60) days or more frequently as warranted by the patient's conditions; 9. Documentation of supervisory visits by a registered nurse or other applicable supervisory personnel; 10. A discharge summary;

11. A copy of the patient transfer information sheet if patient is admitted to another health care facility; 12. Home health aide written instructions; 13. Verbal orders shall be taken only by registered nurses or health care professionals, and immediately recorded in the patient's clinical record with the date. These orders shall be countersigned by the physician or podiatrist; and 14. Duplicate copies of all laboratory results as reported by the referral laboratory.

consists of an overall policy and administrative review and a clinical record review. The evaluation shall assess the extent to which the agency's program is appropriate, adequate, effective, and efficient. Results of the evaluation shall be reported to and acted upon by those responsible for the operation of the agency and maintained separately as administrative records. The facility must follow all written policies developed by the licensed facility.

Mechanisms are established in writing for the collection of pertinent data to assist in evaluation. The data to be considered may include but are not limited to: number of patients receiving each service offered, number of patient visits, reasons for discharge, breakdown by diagnosis, sources of referral, number of patients not accepted with reasons, and total staff days for each service offered.

2. If the frequency of visits was consistent with plan of treatment; 3. If the services could have been provided in a shorter span of time.

**History**
- *SOURCE: Miss. Code Ann. §41-71-13 Subchapter 45 OUTPATIENT SERVICES IN LONG TERM CARE FACILITIES Rule 46.45.1 General. Any services provided by a home health agency on an outpatient basis to long term care facilities shall be provided under the terms of a written agreement signed by representatives of the home health agency and the long term care facility. The agreement shall contain: responsibilities of both parties, functions, objectives and terms of the agreement, including financial agreements and charges. The services shall be provided in accordance with all applicable laws, rules, and regulations. Clinical records for patients receiving the service shall be maintained with the original clinical record on file in the home health agency office and a copy provided the long term care facility.*
- *SOURCE: Miss. Code Ann. §41-71-13 Subchapter 46 APPLIANCE AND EQUIPMENT SERVICE Rule 46.46.1 General. Appliance and equipment services may be provided to patients by the home health agency only upon the written order of a physician or podiatrist. A home health agency may elect to provide the service directly or indirectly through a supplier. Policies and procedures shall be developed for the appliance and equipment services. All appliances and equipment provided for patients shall be maintained in good condition.*
- *SOURCE: Miss. Code Ann. §41-71-13 Subchapter 47 CLINICAL RECORDS: GENERAL Rule 46.47.1 General. Clinical records shall be under the direction of a designated person with adequate staff and facilities to perform required functions. The agency shall maintain a medical record for each patient covering those services provided directly by the agency and those provided by another agency or individual.*
- *SOURCE: Miss. Code Ann. §41-71-13 Subchapter 48 CLINICAL RECORD Rule 46.48.1 Clinical Record Content. A clinical record shall be established and maintained for every person admitted to home health services. The original or signed copy of clinical reports shall be filed in the clinical record. Clinical records shall contain: 1. Appropriate identifying information for the patient, household members and caretakers, pertinent diagnoses, medical history, and current findings;*
- *SOURCE: Miss. Code Ann. §41-71-13 Subchapter 49 CONFIDENTIALITY Rule 46.49.1 Patient Confidentiality. The agency shall insure confidentiality of patient information in accordance with written policies and procedures. Records shall be stored in a locked area and only authorized personnel shall have access to the records. Clinical records are the property of the home health agency and may be released only with the written consent of the patient, the legal guardian, or in accordance with the law.*
- *SOURCE: Miss. Code Ann. §41-71-13 Subchapter 50 RETENTION OF RECORDS Rule 46.50.1 Clinical Records. Clinical records shall be preserved for a period of not less than five (5) years following discharge. These records may be reproduced on film (microfilmed) or other form of medium acceptable to the licensing agency and, after the discharge of the patient involved, retire the original record so reproduced. If a facility ceases operation, arrangements shall be made for the preservation of records to ensure compliance with these regulations. The licensing agency shall be notified, in writing, concerning the arrangements.*
- *SOURCE: Miss. Code Ann. §41-71-13 Subchapter 51 AUTHORSHIP Rule 46.51.1 Authorship. Entries in the record shall be dated and signed by the person making the entry.*
- *SOURCE: Miss. Code Ann. §41-71-13 Subchapter 52 EVALUATION: GENERAL Rule 46.52.1 General. The home health agency shall have written policies requiring an overall General. The home health agency shall have written policies requiring an overall evaluation of the agency's total program at least once a year. The evaluation*
- *SOURCE: Miss. Code Ann. §41-71-13 Subchapter 53 POLICY AND ADMINISTRATIVE REVIEW Rule 46.53.1 Evaluation Process. As a part of the evaluation process, the policies and administrative practices of the agency are reviewed to determine the extent to which they promote appropriate, adequate, effective and efficient patient care.*
- *SOURCE: Miss. Code Ann. §41-71-13 Subchapter 54 CLINICAL RECORD REVIEW (54) Rule 46.54.1 Clinical Records. In addition to the annual clinical record review by the in-house staff members on the Professional Advisory Committee, members of professional disciplines representing at least the scope of the agency's programs shall at least quarterly review a sample of both active and closed clinical records to assure that established policies are followed in providing services (direct as well as those under arrangement). The clinical records of at least 10% of the total patient census are to be reviewed; however, at no time shall the review consist of less than ten (10) or more than fifty (50) records. The records reviewed shall be representative of the services rendered and include records of patients served by branch offices, if applicable. This review shall include, but not be limited to the following: 1. If the patient care plan was directly related to the stated diagnosis and plan of treatment;*
- *SOURCE: Miss. Code Ann. §41-71-13*

##### **15 Miss. Admin. Code Pt. 16, R. 46.54.2** Continuing Review {#sec-16-46.54.2 omnilex-key=us-ms-regs-official--title-15--16#46.54.2}

There shall be a continuing review of clinical records for each sixty (60) day period that a patient received home health services to

determine adequacy of the plan of treatment and appropriateness of continuation of care.

2. Visit home health patients in their place of residence in order to evaluate the quality of care provided; 3. Grant variances as it deems necessary for agencies existing prior to July 1, 1981; 4. Information obtained by the licensing agency through filed reports, inspection, or as otherwise authorized, shall not be disclosed publicly in such manner as to identify individuals or institutions, except in proceedings involving the questions of Licensure; and 5. The Licensing Agency shall reserve the right to review any and all records and reports of any home health agency, as deemed necessary to determine compliance with these Minimum Standards of Operation.

Upon adoption of these Rules, Regulations, and Minimum Standards, all former rules, regulations and minimum standards in conflict therewith, previously adopted by the licensing agency, are hereby repealed.

**History**
- *SOURCE: Miss. Code Ann. §41-71-13 Subchapter 55 CONCLUSION: GENERAL Rule 46.55.1 Conclusion. Conditions which have not been covered in the Standards shall be enforced in accordance with the best practices as interpreted by the Licensing Agency. The Licensing Agency reserves the right to: 1. Review the payroll records of each home health agency for the purpose of verifying staffing patterns;*
- *SOURCE: Miss. Code Ann. §41-71-13 CHAPTER 47 MINIMUM STANDARDS FOR PERSONAL CARE HOMES ASSISTED LIVING SUBCHAPTER 1 GENERAL: LEGAL AUTHORITY Rule 47.1.1 Adoption of Rules, Regulations, and Minimum Standards. By virtue of authority vested in it by the Legislature of the State of Mississippi as per Section 43-11-13 of the Mississippi Code of 1972, as amended, the Mississippi State Department of Health does hereby adopt and promulgate the following Rules, Regulations, and Minimum Standards for Personal Care Homes - Assisted Living.*
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 47.1.2** Codes and Ordinances {#sec-16-47.1.2 omnilex-key=us-ms-regs-official--title-15--16#47.1.2}

Every licensed facility located inside the boundaries of a municipality shall comply with all local municipal codes and ordinances

applicable thereto. In addition, each licensed facility shall comply with all applicable state and federal laws.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 47.1.3** Fire Safety {#sec-16-47.1.3 omnilex-key=us-ms-regs-official--title-15--16#47.1.3}

No facility may be licensed until it shows conformance to the safety regulations providing minimum standards for prevention and detection of fire as well as for protection of life and property against fire.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 47.1.4** Duty to Report {#sec-16-47.1.4 omnilex-key=us-ms-regs-official--title-15--16#47.1.4}

All fires, explosions, natural disasters as well as avoidable deaths, or avoidable, serious, or life-threatening injuries to residents resulting from fires, explosions, and natural disasters shall be reported by telephone to the Life Safety Code Division of the licensing agency by the next working day after the occurrence.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13 Subchapter 2 DEFINITIONS Rule 47.2.1 Assisted Living. The term “assisted living” shall mean the provision of personal care and the addition of supplemental services to include, but not be limited to, the provision of medical services (i.e., medication procedures and medication administration), and emergency response services.*
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 47.2.2** Ambulation {#sec-16-47.2.2 omnilex-key=us-ms-regs-official--title-15--16#47.2.2}

The terms “ambulation” or “ambulatory” shall mean the resident’s ability to bear weight, pivot, and safely walk independently or with the use of a cane, walker, or other mechanical supportive device (i.e., including, but not limited to, a wheelchair). A resident who requires a wheelchair must be capable of transferring to and propelling the wheelchair independently or with prompting. No more than ten percent (10%) of the resident census shall require assistance during any staffing shift as described and required herein.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 47.2.3** Criminal History Record Checks {#sec-16-47.2.3 omnilex-key=us-ms-regs-official--title-15--16#47.2.3}

1. Affidavit. For the purpose of fingerprinting and criminal background history checks, the term “affidavit” means the use of Mississippi State Department of Health (MSDH) Form #210, or a copy thereof, which shall be placed in the individual’s personal file. 2. Employee. For the purpose of fingerprinting and criminal background history checks, employee shall mean any individual employed by a covered entity. The term “employee”, also includes any individual who by contract with the covered

entity provides direct patient care in a patient’s, resident’s, or client’s room or in treatment rooms. 3. The term employee does not include healthcare professional/technical students, as defined in Section 37-29-232, performing clinical training in a licensed entity under contracts between their schools and the licensed entity, and does not include students at high schools who observe the treatment and care of patients in a licensed entity as part of the requirements of an allied health course taught in the school if: a. The student is under the supervision of a licensed healthcare provider; and b. The student has signed the affidavit that is on file at the student’s school stating that he or she has not been convicted of or plead guilty or nolo contendere to a felony of possession or sale of drugs, murder, manslaughter, armed robbery, rape, sexual battery, any sex offenses listed in section 45-33-23 (g),child abuse, arson, grand larceny, burglary, gratification of lust, aggravated assault, or felonious abuse and/or battery of a vulnerable adult, or that any such conviction or plea was reversed on appeal or a pardon was granted for the conviction or plea. c. Further, applicants and employees of the University of Mississippi Medical Center for whom criminal history record checks and fingerprinting are obtained in accordance with Section 37-115-41 are exempt from application of the term employee under Section 43-11-13. 4. Covered Entity. For the purpose of criminal history record checks, “covered entity” means a licensed entity or a healthcare professional staffing agency. 5. Licensed Entity. For the purpose of criminal history record checks, the term “licensed entity” means a hospital, nursing home, personal care home, home health agency or hospice. 6. Health Care Professional/Vocational Technical Academic Program. For the purpose of criminal history record checks, “health care professional/vocational technical academic program” means an academic program in medicine, nursing, dentistry, occupational therapy, physical therapy, social services, speech therapy, or other allied-health professional whose purpose is to prepare professionals to render patient care services. 7. Health Care Professional/Vocational Technical Student. For purposes of criminal history record checks, the term means a student enrolled in a healthcare professional/vocational technical academic program. 8. Direct Patient Care or Services. For the purposes of fingerprinting and criminal background history checks, the term “direct patient care” means direct hands-on medical patient care and services provided by an individual in a patient, resident or client’s room, treatment room or recovery room. Individuals providing direct

patient care may be directly employed by the facility or provides patient care on a contractual basis. 9. Documented Disciplinary Action. For the purpose of fingerprinting and criminal background history checks, the term “documented disciplinary action” means any action taken against an employee for abuse or neglect of a patient.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 47.2.4** Facility {#sec-16-47.2.4 omnilex-key=us-ms-regs-official--title-15--16#47.2.4}

The term “facility” shall mean any home or institution that (1) has sought or is currently seeking designation as a “licensed facility” under the terms of these regulations; or (2) is operating a home or institution unlawfully which, by its nature and operational intent, is required to be a licensed facility under the terms of these regulations.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 47.2.5** Immediate Jeopardy (Serious and Immediate to Health and Safety) {#sec-16-47.2.5 omnilex-key=us-ms-regs-official--title-15--16#47.2.5}

A situation in which the licensed facility’s failure to meet one or more regulatory requirements has caused, or is likely to cause, serious injury, harm, impairment, or death to a resident.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 47.2.6** IGRA(s) (Interferon-Gamma Release Assay(s) {#sec-16-47.2.6 omnilex-key=us-ms-regs-official--title-15--16#47.2.6}

A whole blood test used in to assist in diagnosing Mycobacterium Tuberculosis infection. The IGRA blood test used must be approved by the U.S. Food and Drug Administration (FDA).

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 47.2.7** Licensing Agency {#sec-16-47.2.7 omnilex-key=us-ms-regs-official--title-15--16#47.2.7}

The term "licensing agency" shall mean the Mississippi State Department of Health.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 47.2.8** Licensed Facility {#sec-16-47.2.8 omnilex-key=us-ms-regs-official--title-15--16#47.2.8}

The term “licensed facility” shall mean any personal care home for assisted living which has been issued a license for operation by the licensing agency.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 47.2.9** Mantoux Test {#sec-16-47.2.9 omnilex-key=us-ms-regs-official--title-15--16#47.2.9}

A method of skin testing that is performed by injecting one-tenth (0.1) milliliter of purified protein derivative-tuberculin containing five (5) tuberculin units into the dermis (i.e., the second layer of skin) of the forearm with a needle and syringe. The area is examined between forty-eight (48) and seventy- two (72) hours after the injection. A reaction is measured according to the size of the induration. The classification of a reaction as positive or negative depends on the patient’s medical history and various risk factors (see definition for

“significant tuberculin skin test”). This test is used to evaluate the likelihood that a person is infected with M. tuberculosis. It is the most reliable and standardized technique for tuberculin testing. It should be administered only by persons certified in the intradermal technique.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 47.2.10** Medication Administration {#sec-16-47.2.10 omnilex-key=us-ms-regs-official--title-15--16#47.2.10}

For the purposes of these regulations, the term “medication administration” is limited to these decisions, made by someone other than the person for whom the medication has been prescribed, regarding (1) which medication is to be taken, (2) the dosage of the medication, or (3) the time at which the medication is to be taken.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 47.2.11** Medication Assistance {#sec-16-47.2.11 omnilex-key=us-ms-regs-official--title-15--16#47.2.11}

For the purposes of these regulations, the term “medication assistance” is any form of delivering medication which has been prescribed which is not defined as “medication administration”, including, but not limited to, the physical act of handing an oral prescription medication to the patient along with liquids to assist the patient in swallowing.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 47.2.12** Personal Care {#sec-16-47.2.12 omnilex-key=us-ms-regs-official--title-15--16#47.2.12}

The term "personal care" shall mean the assistance rendered by personnel of the licensed facility to residents in performing one or more of the activities of daily living, including but not limited to bathing, walking, excretory functions, feeding, personal grooming, and dressing.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 47.2.13** Significant Tuberculin Skin Test {#sec-16-47.2.13 omnilex-key=us-ms-regs-official--title-15--16#47.2.13}

An induration of five (5) millimeters or greater is significant (or positive) in the following: 1. Persons known to have or suspected of having human immunodeficiency virus (HIV). 2. Close contacts of a person with infectious tuberculosis. 3. Persons who have a chest radiograph suggestive of previous tuberculosis. 4. Persons who inject drugs (if HIV status is unknown). An induration of ten (10) millimeters or greater is significant (or positive) in all other persons tested in Mississippi. A tuberculin skin test is recorded in millimeters of induration. For accurate results, measure the widest diameter of the palpable induration transverse (across) the arm.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 47.2.14** Surveyor {#sec-16-47.2.14 omnilex-key=us-ms-regs-official--title-15--16#47.2.14}

The term "surveyor" shall mean an individual employed, or hired on a contractual basis, by the licensing agency for the purpose of conducting surveys, inspections, investigations, or other related functions as part of the licensing agency’s responsibilities for licensure and regulation of institutions for the aged and infirm.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 47.2.15** Two-step Testing {#sec-16-47.2.15 omnilex-key=us-ms-regs-official--title-15--16#47.2.15}

A procedure used for the baseline testing of person who will periodically receive tuberculin skin tests (e.g., health care workers) to reduce the likelihood of mistaking a boosted reaction for a new infection. If the initial tuberculin-test result is classified as negative, a second test is repeated one (1) to three (3) weeks later. If the reaction to the second test is positive, it probably represents a boosted reaction. If the second test is also negative, the person is classified as not infected. A positive reaction to a subsequent test would indicate new infection (i.e., a skin-test conversion) in the person.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13 Subchapter 3 PROCEDURE GOVERNING ADOPTION AND AMENDMENT Rule 47.3.1 Authority. The licensing agency shall have the power to adopt, amend, promulgate and enforce such rules, regulations and minimum standards as it deems appropriate, within the law.*
- *SOURCE: Miss. Code Ann. §43-11-13 Subchapter 4 INSPECTION Rule 47.4.1 Inspections Required. Each licensed facility shall be inspected by the licensing agency or by persons delegated with authority by said licensing agency at such intervals as the licensing agency may direct. The licensing agency and/or its authorized representatives shall have the right to inspect construction work in progress. New facilities shall not be licensed without having first been inspected for compliance with these rules, regulations, and minimum standards.*
- *SOURCE: Miss. Code Ann. §43-11-13 Subchapter 5 CLASSIFICATION Rule 47.5.1 Personal Care Home - Residential Living. The terms “Personal Care Home - Residential” and “Residential Personal Care Home” shall mean any place or facility operating 24 hours a day, seven (7) days a week, accepting individuals who require personal care services or individuals, who due to functional impairments, may require mental health services to compensate for activities of daily living. Regulation by the licensing agency for such facilities are governed by the “Regulations Governing Licensure of Personal Care Homes - Residential”.*
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 47.5.2** Personal Care Home - Assisted Living {#sec-16-47.5.2 omnilex-key=us-ms-regs-official--title-15--16#47.5.2}

The terms “Personal Care Home - Assisted Living” and “Assisted Living Personal Care Home” shall mean any place or facility operating 24 hours a day, seven (7) days a week, accepting individuals who require assisted living services as governed by the regulations herein.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13 Subchapter 6 TYPES OF LICENSE Rule 47.6.1 Regular License. A license shall be issued to each facility that meets the requirements as set forth in these regulations.*
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 47.6.2** Provisional License {#sec-16-47.6.2 omnilex-key=us-ms-regs-official--title-15--16#47.6.2}

Within its discretion, the licensing agency may issue a provisional license only if the licensing agency is satisfied that preparations are being made to qualify for a regular license and that the health and safety of residents will not be endangered.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13 Subchapter 7 APPLICATION OR RENEWAL OF LICENSE Rule 47.7.1 Application. Application for a license or renewal of a license shall be made in writing to the licensing agency, on forms provided by the licensing agency, which shall contain such information as the licensing agency may require.*
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 47.7.2** Fees {#sec-16-47.7.2 omnilex-key=us-ms-regs-official--title-15--16#47.7.2}

1. Each initial and renewal licensure application, unless suspended or revoked, shall be accompanied by a fee in an amount set by the Board, made payable to the Mississippi State Department of Health, either by check, money order, or electronic means. Renewal of licenses shall occur on an annual basis. Fees are non-refundable. 2. Applicants for initial licensure, or licensees, shall pay a user fee, in an amount set by the Board, and shall be made payable, either by check, money order, or electronic means, to the Mississippi State Department of Health, when it is required to review and/or inspect the proposal of any licensed facility in which there are additions, renovations, modernizations, expansions, alterations, conversions, modifications, or replacements. Fees are non-refundable. 3. Should all documentation appropriate for license renewal not be received by Mississippi State Department of Health, Division of Health Facilities Licensure

and Certification on or prior to the expiration date of the license, a late fee in an amount set by the Board, will be assessed and must be submitted payable by business check, money order, or electronic means, to the Mississippi State Department of Health prior to the issuance of a license. Should all paperwork necessary for renewal not be submitted within 30 days post-expiration of the license, the facility shall be considered unlicensed and actions taken, as appropriate to process termination of the license.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 47.7.3** Name of Facility {#sec-16-47.7.3 omnilex-key=us-ms-regs-official--title-15--16#47.7.3}

Only the official name, as approved by the licensing agency and by which the facility is licensed shall be used in telephone listing, on stationery, in advertising, etc.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 47.7.4** Number of Beds {#sec-16-47.7.4 omnilex-key=us-ms-regs-official--title-15--16#47.7.4}

The maximum number of beds for which the facility is licensed shall not be exceeded.

Subchapter 8 LICENSING Rule 47.8.1 Issuance of License. All licenses issued by the licensing agency shall set forth the name of the facility, the location, the name of the licensee, the classification of the facility, the type of building, the bed capacity for which the facility is licensed and the licensed number.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 47.8.2** Posting of License {#sec-16-47.8.2 omnilex-key=us-ms-regs-official--title-15--16#47.8.2}

The license shall be posted in a conspicuous place on the licensed premises and shall be available for review by an interested person.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 47.8.3** License Not Transferable {#sec-16-47.8.3 omnilex-key=us-ms-regs-official--title-15--16#47.8.3}

The license is not transferable or assignable to any other person except by written approval of the licensing agency.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 47.8.4** Expiration of License {#sec-16-47.8.4 omnilex-key=us-ms-regs-official--title-15--16#47.8.4}

Each license shall expire on March 31, following the date of issuance.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 47.8.5** Renewal of License {#sec-16-47.8.5 omnilex-key=us-ms-regs-official--title-15--16#47.8.5}

License shall be renewable annually upon: 1. Filing and approval of an application for renewal by the licensee.

2. Submission of appropriate licensure renewal fee. 3. Maintenance by the licensed facility of minimum standards in its physical facility, staff, services, and operation as set forth in these regulations.

2. Willful or repeated violations by the licensee of any of the provisions of Sections 43-11-1 et seq, of the Mississippi Code of 1972, as amended, and/or of the rules, regulations, and minimum standards established by the licensing agency. 3. Addiction to narcotic drug(s) by the licensee or other employees or personnel of the licensed facility. 4. Use of alcoholic beverages by the licensee or other personnel of the licensed facility to the extent which threatens the well-being or safety of the residents. 5. Conviction of the licensee of a felony. 6. Publicly misrepresenting the licensed facility and/or its services. 7. Permitting, aiding, or abetting the commission of any unlawful act. 8. Conduct or practices detrimental to the health or safety of residents and employees of said licensed facility. Detrimental practices include but are not limited to: a. Cruelty to a resident or indifference to the needs which are essential to the general well-being and health. b. Misappropriation of the money or property of a resident. c. Failure to provide food adequate for the needs of a resident. d. Inadequate staff to provide safe care and supervision of a resident. e. Failure to call a physician or nurse practitioner/physician assistant when required by a resident's condition.

f. Failure to notify next of kin when a resident's condition becomes critical. g. Admission of a resident whose condition demands care beyond the level of care provided by the licensed facility as determined by its classification. 9. A violation of 24-hour supervision requirement and/or the transfer of a resident from the licensed facility to any unlicensed facility may result in the facility’s license being made provisional for a period of 90 days. At the end of that 90-day period, if corrective actions have not been taken by the licensed facility, that Provisional License may be revoked.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13 Subchapter 9 DENIAL, SUSPENSION, OR REVOCATION OF LICENSE Rule 47.9.1 Denial or Revocation of License: Hearings and Review. The licensing agency, after notice and opportunity for a hearing to the applicant or licensee, is authorized to deny, suspend, or revoke a license, or deny renewal of a license, in any case in which it finds that there has been a substantial failure to comply with the requirements established under the law and these regulations. Also, the following shall be grounds for denial or revocation of license: 1. Fraud on the part of the licensee in applying for a license, or renewal of license.*
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 47.9.2** Rule 47.9.2 {#sec-16-47.9.2 omnilex-key=us-ms-regs-official--title-15--16#47.9.2}

Immediate Revocation of License: Pursuant to Section 41-3-15, the State Department of Health is authorized and empowered, to revoke, immediately, the license and require closure of any institution for the aged or infirm, including any other remedy less than closure to protect the health and safety of the residents of said institution or the health and safety of the general public.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13 Subchapter 10 PROVISION FOR HEARING AND APPEAL FOLLOWING DENIAL OR REVOCATION OF LICENSE; PENALTIES*
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 47.10.1** Administrative Decision {#sec-16-47.10.1 omnilex-key=us-ms-regs-official--title-15--16#47.10.1}

The licensing agency will provide an opportunity for a fair hearing to every applicant or licensee who is dissatisfied with administrative decisions made in the denial or revocation of license. 1. The licensing agency shall notify the applicant or licensee by registered mail or personal service the particular reasons for the proposed denial or revocation of license. Upon written request of applicant or licensee within ten (10) days of the date of notification, the licensing agency shall fix a date not less than thirty (30) days from the date of such service at which time the applicant or licensee shall be given an opportunity for a prompt and fair hearing. 2. On the basis of such hearing or upon default of the applicant or licensee, the licensing agency shall make a determination specifying its findings of fact and conclusions of law. A copy of such determination shall be sent by registered mail to the last known address of the applicant or licensee or served personally upon the applicant or licensee. 3. The decision revoking, suspending, or denying the application or license shall become final thirty (30) days after it is so mailed or served unless the applicant or licensee, within such thirty (30) day period, appeals the decision in Chancery Court pursuant to Section 43-11-23 of the Mississippi Code of 1972. An additional period of time may be granted at the discretion of the licensing agency.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 47.10.2** Penalties {#sec-16-47.10.2 omnilex-key=us-ms-regs-official--title-15--16#47.10.2}

Any person establishing, conducting, managing, or operating facility without a license shall be declared in violation of these regulations and may be punished as set forth in the enabling statute. Further, any person who violates any provision of the enabling statute, or of these regulations promulgated thereto shall, upon conviction thereof, be guilty of a misdemeanor. Such misdemeanor shall, upon conviction, be as referenced in Section 43-11-25 of the Mississippi Code of 1972, Annotated.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 47.10.3** Ban on Admissions {#sec-16-47.10.3 omnilex-key=us-ms-regs-official--title-15--16#47.10.3}

If a condition of immediate jeopardy exists at a licensed facility, written notice of the determination of the condition shall be provided by the licensing agency to the licensed facility, along with the notification that a ban on all admissions is to be imposed five (5) calendar days after the receipt of the notice by the licensed facility. If the licensing agency’s determination of a condition of immediate jeopardy on the day of the licensure visit/survey is confirmed, a ban on all admissions shall be imposed until the licensed facility achieves compliance and such compliance is verified by the licensing agency. The licensing agency will verify the licensed facility’s corrective actions as soon as possible after the licensing agency receives a plan of correction from the licensed facility.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13 Subchapter 11 ADMINISTRATION Rule 47.11.1 Operator. There shall be a full-time employee designated as operator of the licensed facility who shall be responsible for the management of the licensed facility. The operator shall be at least twenty-one years of age and shall be a high school graduate, or have passed the GED, and shall not be a resident of the licensed facility. The operator shall have verification that he is not listed on the "Mississippi Nurses Aide Abuse Registry." When the operator is not within the licensed facility, there shall be an individual onsite at the licensed facility who shall represent the operator, and be capable of assuming the responsibility of operator. Said person must be at least twenty-one years or age and shall be a high school graduate, or have passed the GED, and shall have verification that he is not listed on the "Mississippi Nurses Aide Abuse Registry."*
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 47.11.2** Operator Mentoring {#sec-16-47.11.2 omnilex-key=us-ms-regs-official--title-15--16#47.11.2}

Operators shall be scheduled to spend two (2) concurrent days with the licensing agency for the purpose of training and mentoring. Placement of an operator with the licensing agency may include, but not be limited to, assignments within the licensing agency’s central offices or placement with a survey team. Any costs associated with placements for the purposes of this section shall be borne by the licensed facility at which the operator is employed.

The operator shall keep confidential and not disclose to any other persons any identifying information about any person or entity that he/she learned while observing operations as required by this section, except as otherwise mandated by law. 1. This section shall apply to operators who: have been employed by a licensed facility for less than six (6) months, during which time the placement must be completed. 2. This section shall not apply to operators who: a. have previously participated in a placement as required by this section; or b. who were previously employed by the licensing agency in a surveyor capacity. c. Failure to successfully complete the placement required under this section shall disqualify the operator from serving in such capacity of a licensed facility until a placement is completed. d. This section shall go into effect January 1, 2002 and thereafter.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 47.11.3** Surveyor Mentoring {#sec-16-47.11.3 omnilex-key=us-ms-regs-official--title-15--16#47.11.3}

Surveyors shall be scheduled to spend two (2) concurrent days with a licensed facility for the purpose of training and mentoring. Selection of a licensed facility for placement of the surveyor shall be done at the discretion of the licensing agency, except no licensed facility shall be required to accept more than two (2) placements in any calendar year. Upon completion of said training, the surveyor shall not participate in a survey of the same licensed facility for a period not to exceed one year from the date of training placement. Any costs associated with the placement of a surveyor for the purposes of this section shall be borne by the licensing agency. The surveyor shall keep confidential and not disclose to any other persons any identifying information about any person or entity that the surveyor learned while observing operations as required by this section, except as otherwise mandated by law. 1. This section shall apply to surveyors who have been employed by the licensing agency in a surveyor capacity for less than six (6) months, during which time the placement must be completed. 2. This section shall not apply to surveyors who were previously employed by a licensed facility. 3. Failure to successfully complete the placement required under this section shall disqualify the surveyor from serving in such capacity for the licensing agency until a placement is completed.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 47.11.4** Other Personnel {#sec-16-47.11.4 omnilex-key=us-ms-regs-official--title-15--16#47.11.4}

All direct care employees shall be a minimum of 18 years of age, and shall have verification that they are not listed on the "Mississippi Nurses Aide Abuse Registry." Personnel shall receive training on a quarterly basis on topics and issues related to the population being served in the licensed facility. Training shall be documented by a narrative of the content and signatures of those attending. Personnel shall be employed and on duty, awake, and fully dressed to provide personal care to the residents. The following staffing ratio shall apply: 1. One (1) resident attendant per fifteen (15) or fewer residents for the hours of 7:00 a.m. until 7:00 p.m. 2. One (1) resident attendant per twenty-five (25) or fewer residents for the hours of 7:00 p.m. until 7:00 a.m. There shall be designated, in writing and posted in a conspicuous place, on-call personnel in the event of an emergency, during this shift. 3. Shall have a licensed nurse on the premises for eight (8) hours a day. Licensed nurses, as required by this section, shall not be included in the resident attendant ratio. 4. For instances where a resident is unable to self-administer prescription medication, a licensed nurse must be present to administer the prescription medication. 5. Nursing activities must comply with Mississippi Board of Nursing regulations.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 47.11.5** Criminal History Record Checks {#sec-16-47.11.5 omnilex-key=us-ms-regs-official--title-15--16#47.11.5}

1. Pursuant to Section 43-11-13, Mississippi Code of 1972, the covered entity shall require to be preformed a disciplinary check with the professional licensing agency, if any, for each employee to determine if any disciplinary action has been taken against the employee by the agency, and a criminal history record check on: a. Every new employee of a covered entity who provides direct patient care or services and who is employed on or after July 01, 2003, and b. Every employee of a covered entity employed prior to July 01, 2003, who has documented disciplinary action by his or her present employer. 2. Except as otherwise provided in this paragraph, no employee hired on or after July 01, 2003, shall be permitted to provide direct patient care until the results of the criminal history record check have revealed no disqualifying record or the employee has been granted a waiver. Provided the covered entity has documented evidence of submission of fingerprints for the background check, any person may be employed and provide direct patient care on a temporary basis pending the results of the criminal history record check but any employment

offer, contract, or arrangement with the person shall be voidable, if he/she receives a disqualifying criminal record check and no waiver is granted. 3. If such criminal history record check discloses a felony conviction; a guilty plea; and/or a plea of nolo contendere to a felony for one (1) or more of the following crimes which has not been reversed on appeal, or for which a pardon has not been granted, the applicant/employee shall not be eligible to be employed at the licensed facility: a. possession or sale of drugs b. murder c. manslaughter d. armed robbery e. rape f. sexual battery g. sex offense listed in Section 45-33-23 (g), Mississippi Code of 1972 h. child abuse i. arson j. grand larceny k. burglary l. gratification of lust m. aggravated assault n. felonious abuse and/or battery of vulnerable adult o. Documentation of verification of the employee’s disciplinary status, if any, with the employee’s professional licensing agency as applicable, and evidence of submission of the employee’s fingerprints to the licensing agency must be on file and maintained by the facility prior to the new employees first date of employment. The covered entity shall maintain on file evidence of verification of the employee’s disciplinary status from any applicable professional licensing agency and of submission and/or completion of the criminal record check, the signed affidavit, if applicable, and/or a copy of the referenced notarized letter addressing the individual’s suitability for such employment. 4. Pursuant to Section §43-11-13, Mississippi Code of 1972, the licensing agency shall require every employee of a covered entity employed prior to July 01, 2003,

to sign an affidavit stating that he or she does not have a criminal history as outlined in paragraph (3) above. 5. From and after December 31, 2003, no employee of a covered entity hired before July 01, 2003, shall be permitted to provide direct patient care unless the employee has signed an affidavit as required by this section. The covered entity shall place the affidavit in the employee’s personnel file as proof of compliance with this section. 6. If a person signs the affidavit required by this section, and it is later determined that the person actually had been convicted of or pleaded guilty or nolo contendere to any of the offenses listed herein, and the conviction or pleas has not been reversed on appeal or a pardon has not been granted for the conviction or plea, the person is guilty of perjury as set out in Section §43-11-13, Mississippi Code of 1972. The covered entity shall immediately institute termination proceedings against the employee pursuant to the facility’s policies and procedures. 7. The covered entity may, in its discretion, allow any employee unable to sign the affidavit required by paragraph (7) of this subsection or any employee applicant aggrieved by the employment decision under this subsection to appear before the covered entity’s hiring officer, or his or her designee, to show mitigating circumstances that may exist and allow the employee or employee applicant to be employed at the covered entity. The covered entity, upon report and recommendation of the hiring officer, may grant waivers for those mitigating circumstances, which shall include, but not be limited to: (1) age at which the crime was committed; (2) circumstances surrounding the crime; (3) length of time since the conviction and criminal history since the conviction; (4) work history; (5) current employment and character references; and (6) other evidence demonstrating the ability of the individual does not pose a threat to the health or safety of the patients in the licensed facility. 8. The licensing agency may charge the covered entity submitting the fingerprints a fee not to exceed Fifty Dollars ($50.00). 9. Should results of an employee applicant’s criminal history record check reveal no disqualifying event, then the covered entity shall, within two (2) weeks of the notification of no disqualifying event, provide the employee applicant with a notarized letter signed by the chief executive officer of the covered, or his or her authorized designee, confirming the employee applicant’s suitability for employment based on his or her criminal history record check. An employee applicant may use that letter for a period of two (2) years from the date of the letter to seek employment at any covered entity licensed by the Mississippi State Department of Health without the necessity of an additional criminal record check. Any covered entity presented with the letter may rely on the letter with respect to an employee applicant’s criminal background and is not required for a period of two (2) years from the date of the letter to conduct or have conducted a criminal history record check as required in this subsection.

10. For individuals contracted through a third party who provide direct patient care as defined herein, the covered entity shall require proof of a criminal history record check. 11. Pursuant to Section §43-11-13, Mississippi Code of 1972, the licensing agency, the covered entity, and their agents, officers, employees, attorneys and representatives, shall be presumed to be acting in good faith for any employment decision or action taken under this section. The presumption of good faith may be overcome by a preponderance of the evidence in any civil action. No licensing agency, covered entity, nor their agents, officers, employees, attorneys and representatives shall be held liable in any employment discrimination suit in which an allegation of discrimination is made regarding an employment decision authorized under this section.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 47.11.6** Employee's Health Status {#sec-16-47.11.6 omnilex-key=us-ms-regs-official--title-15--16#47.11.6}

All licensed facility personnel shall receive a health screening by a licensed physician, a nurse practitioner/physician assistant, or a registered nurse prior to employment and annually thereafter. Records of this health screening shall be kept on file in the licensed facility.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 47.11.7** Employee Testing for Tuberculosis 1 {#sec-16-47.11.7 omnilex-key=us-ms-regs-official--title-15--16#47.11.7}

Each employee, upon employment of a licensed entity and prior to contact with any patient/client, shall be evaluated for tuberculosis by one of the following methods:

a. IGRA (blood test) and an evaluation of the individual for signs and symptoms of tuberculosis by medical personnel; or

b. A two-step Mantoux tuberculin skin test administered and read by a licensed medical/nursing person certified in the techniques of tuberculin testing and an evaluation of the individual for signs and symptoms of tuberculosis by a licensed Physician, Physician’s Assistant, Nurse Practitioner or a Registered Nurse.

2. The IGRA/Mantoux testing and the evaluation of signs/symptoms may be administered/conducted on the date of hire or administered/read no more than 30 days prior to the individual’s date of hire; however, the individual must not be allowed contact with a patient or work in areas of the RBIR where patients have access until receipt of the results of the IGRA/assessment or at least the first of the two-step Mantoux test has been administered/read and assessment for the signs and symptoms completed.

3. If the Mantoux test is administered, results must be documented in millimeters.

Documentation of the IGRA/TB skin test results and assessment must be documented in accordance with accepted standards of medical/nursing practice and must be placed in the individual’s personnel file no later than 7 days of the individual’s date of employment. If an IGRA is performed, results and quantitative values must be documented.

4. Any employee noted to have a newly positive IGRA, a newly positive Mantoux skin test or signs/symptoms indicative of tuberculin disease (TB) that last longer than three weeks (regardless of the size of the skin test or results of the IGRA), shall have a chest x-ray interpreted by a board certified Radiologist and be evaluated for active tuberculosis by a licensed physician within 72 hours. The employee shall not be allowed to work in any area where clients have routine access until evaluated by a physician/nurse practitioner/physician assistant and approved to return. Exceptions to this requirement may be made if the employee is asymptomatic and:

a. The individual is currently receiving or can provide documentation of having received a course of tuberculosis prophylactic therapy approved by the Mississippi State Department of Health (MSDH) Tuberculosis Program for tuberculosis infection, or

b. The individual is currently receiving or can provide documentation of having received a course of multi-drug chemotherapy approved by the MSDH Tuberculosis Program; or

c. The individual has a documented previous significant tuberculin skin reaction or IGRA reaction.

5. For individuals noted to have a previous positive to either Mantoux testin g or the IGRA, annual re-evaluation for the signs and symptoms must be conducted and must be maintained as part of the employee’s annual health screening. A follow-up annual chest x-ray is NOT required unless symptoms of active tuberculosis develop.

6. If using the Mantoux method, employees with a negative tuberculin skin test and a negative symptom assessment shall have the second step of the two- step Mantoux tuberculin skin test performed and documented in the employees’ personal record within fourteen (14) days of employment.

7. The IGRA or the two-step protocol is to be used for each employee who has not been previously skin tested and/or for whom a negative test cannot be documented within the past 12 months. If the employer has documentation that the employee has had a negative TB skin test within the past 12 months, a single test performed thirty (30) days prior to employment or immediately upon hire will fulfill the two-step requirements. As above, the employee shall not have contact with clients or be allowed to work in areas of the RBIR to which

clients have routine access prior to reading the skin test, completing a signs and symptoms assessment and documenting the results and findings.

8. Facilities shall comply with recommendations from the Centers for Disease Control and/or the Mississippi State Department of Health regarding baseline employee TB testing and routine serial employee TB testing and education. Staff exposed to an active infectious case of tuberculosis shall be treated as contacts and be managed appropriately. Individuals found to have a significant Mantoux tuberculin skin test reaction and a chest x-ray not suggestive of active tuberculosis, shall be evaluated by a physician or nurse practitioner/physician assistant for treatment of latent tuberculin infection.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 47.11.8** Admission Agreement {#sec-16-47.11.8 omnilex-key=us-ms-regs-official--title-15--16#47.11.8}

Prior to, or at the time of admission, the operator and the resident or the resident's responsible party shall execute in writing a financial agreement. This agreement shall be prepared and signed in two or more copies, one copy given to the resident or his/her responsible party, and one copy placed on file in the licensed facility. 1. As a minimum, this agreement shall contain specifically: a. Basic charges agreed upon (room, board, laundry, and personal care). b. Period to be covered in the charges. c. Services for which special charges are made. d. Agreement regarding refunds for any payments made in advance. e. A statement that the operator shall make the resident's responsible party aware, in a timely manner, of any changes in resident's status, including those which require transfer and discharge; or operators who have been designated as a resident's responsible party shall ensure prompt and efficient action to meet resident's needs. 2. No agreement or contract shall be entered into between the licensee and the resident or his responsible agent which will relieve the licensee of the responsibility for the protection of the person and personal property of the individual admitted to the licensed facility for care. 3. Any funds given or provided for the purpose of supplying services to any patient in any licensed facility, and any funds otherwise received and held from, for or on behalf of any such resident, shall be deposited by the director or other proper officer of the licensed facility to the credit of that patient in an account which shall be known as the Resident's Personal Deposit Fund. No more than one (1) month charge for the care, support, maintenance, and medical attention of the

patient shall be applied from such account at any one (1) time. After the death, discharge, or transfer of any resident for whose benefit any such fund has been provided, any unexpended balance remaining in his personal deposit fund shall be applied for the payment of care, cost of support, maintenance, and medical attention which is accrued. In the event any unexpended balance remains in that resident's personal deposit fund after complete reimbursement has been made for payment of care, support, maintenance, and medical attention, and the director or other proper officer of the licensed facility has been or shall be unable to locate the person or persons entitled to such unexpended balance, the director or other proper officer may, after the lapse of one (1) year from the date of such death, discharge, or transfer, deposit the unexpended balance to the credit of the licensed facility's operating fund. 4. The resident or his responsible party shall be furnished a receipt signed by the licensee of the licensed facility or his lawful agent, for all sums of money paid to the licensed facility. 5. Written notification shall be given to the resident/responsible party when basic charges and/or licensed facility policies change.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 47.11.9** Rule 47.11.9 {#sec-16-47.11.9 omnilex-key=us-ms-regs-official--title-15--16#47.11.9}

Records and Reports.The operator shall maintain a record of the residents for whom he or she serves as the conservator or a representative payee. This record shall include evidence of the means by which the conservatorship or representative payee relationship was established and evidence of separate accounts in a bank for each resident whose conservator or representative payee is the operator of the licensed facility. 1. Inspection reports from the licensing agency, any branch or division thereof by the operator in the licensed facility, and submitted to the licensing agency as required, or when requested. 2. Resident records shall contain the following: a. Admission agreement(s) and financial statements. b. Residents' rights and licensed facility’s rules, signed, dated, and witnessed. c. Medical evaluation and referral from physician or nurse practitioner/physician assistant. d. Current medication record, including any reactions to such medication. e. Social services and activity contacts. f. General information form.

g. Representative payee statement, if applicable. h. Physician orders or nurse practitioner/physician assistant orders (including, but not limited to, therapies, diets, medications, etc.) and medication administration records. 3. The records as described in this section shall be made available to the resident, the resident’s family, or other responsible party for the resident upon reasonable request. 4. The facility shall report and comply with the annual MDH TB Program surveillance procedures.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 47.11.10** Licensed Facility Policies {#sec-16-47.11.10 omnilex-key=us-ms-regs-official--title-15--16#47.11.10}

Written policies shall be available which indicate services to be provided, and which include policies regarding admission, transfer and discharge of residents.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 47.11.11** Residents' Rights {#sec-16-47.11.11 omnilex-key=us-ms-regs-official--title-15--16#47.11.11}

These rights and licensed facility rules must be in writing and be made available to all residents, employees, sponsors, and posted for public viewing. Each resident shall: 1. Have the right to attend religious and other activities of his/her choice. 2. Have the right to manage his/her personal financial affairs, or is given at least a quarterly accounting of financial transactions made on his/her behalf should the facility accept the written delegation from the resident or from his/her responsible party of this responsibility to the facility for any period of time in conformance with State law. 3. Not be required to perform services for the licensed facility. 4. Have the right to communicate with persons of his/her choice, and may receive mail unopened or in compliance with the policies of the home. 5. Be treated with consideration, kindness, respect, and full recognition of his/her dignity and individually. 6. May retain and use personal clothing and possessions as space permits. 7. May voice grievances and recommend changes in licensed facility policies and services.

8. Shall not be confined to the licensed facility against his/her will, and shall be allowed to move about in the community at liberty. Physical and/or chemical restraints are prohibited. 9. Not be limited in his/her choice of a pharmacy or pharmacist provider in accordance with State law.

An appropriate resident is primarily an aged ambulatory person who requires domiciliary care and who may require non-medical services, medical services such as medication assistance, emergency response services, and home health services as prescribed by a physician’s order and as allowed by law. 2. A person shall not be admitted or continue to reside in an licensed facility if the person: a. Requires physical restraints; b. Poses a serious threat to himself or herself or others; c. Requires nasopharyngeal and/or tracheotomy suctioning; d. Requires gastric feedings; e. Requires intravenous fluids, medications, or feedings; f. Requires a indwelling urinary catheter; g. Requires sterile wound care; or h. Requires treatment of decubitus ulcer or exfoliative dermatitis. 3. Licensed facilities which are not accessible to individuals with disabilities through the A.N.S.I. Standards as they relate to facility accessibility may not accept wheelchair bound residents. Only those persons who, in an emergency, would be physically and mentally capable of traveling to safety may be accepted. For multilevel facilities, no residents may be placed above the ground floor level that are unable to descend the stairs unassisted. 4. The licensed facility must be able to identify at the time of admission and during continued stay those residents whose needs for services are consistent with these

rules and regulations, and those residents who should be transferred to an appropriate level of care. 5. Notwithstanding any determination by the licensing agency that skilled nursing services would be appropriate for a resident of a personal care home, that resident, the resident’s guardian, or the legally recognized responsible party for the resident may consent in writing for the resident to continue to reside in the personal care home, if approved in writing by a licensed physician. Provided, however, that no personal care home shall allow more than two (2) residents, or ten percent (10%) of number of residents in the facility, whichever is greater, to remain in the personal care home under the provisions herein. This consent shall be deemed to be appropriately informed consent as described by these regulations. After that written consent has been obtained, the resident shall have the right to continue to reside in the personal care home for as long as the resident meets the other conditions for residing in the personal care home. A copy of the written consent and the physician’s approval shall be forwarded by the personal care home to the licensing agency within thirty (30) days of the issuance of the latter of the two (2) documents. 6. The licensed facility which accepts and admits residents requiring mental health services shall help arrange transportation to mental health appointments and cooperate with the community mental health center or other provider of mental health care, as necessary, to ensure access to and the coordination of care, within limits of the confidentiality and privacy rights of the individual receiving services.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13 Subchapter 12 MEDICAL AND PERSONAL CARE SERVICES Rule 47.12.1 Admission and Discharge Criteria. The following criteria must be applied and maintained for resident placement in a licensed facility: 1. Only residents whose needs can be met by the licensed facility shall be admitted.*
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 47.12.2** Medical Evaluation {#sec-16-47.12.2 omnilex-key=us-ms-regs-official--title-15--16#47.12.2}

Each person applying for admission to a licensed facility shall be given a thorough examination by a licensed physician or certified nurse practitioner/physician assistant within thirty (30) days prior to admission. The examination shall indicate the appropriateness of admission, according to the above criteria, to a licensed facility with an annual update by a physician and/or nurse practitioner/physician assistant.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 47.12.3** Tuberculosis (TB): Admission Requirements to Rule out Active Tuberculosis (TB) 1 {#sec-16-47.12.3 omnilex-key=us-ms-regs-official--title-15--16#47.12.3}

The following are to be performed and documented within 30 days prior to the resident’s admission to the licensed facility: a. TB signs and symptoms assessment by a licensed Physician, Physician’s Assistant or a Licensed Nurse Practitioner, and b. A chest x-ray taken and have a written interpretation.

2. Admission to the facility shall be based on the results of the required tests as follows: a. Residents with an abnormal chest x-ray and/or signs and symptoms assessment shall have the first step of a two-step Mantoux tuberculin skin test (TST) placed and read by certified personnel OR an IGRA (blood test) drawn and results documented within 30 days prior to the patient’s admission to the licensed facility. Evaluation for active TB shall be at the recommendation of the MSDH and shall be prior to admission. If TB is ruled out and the first step of the TST is negative, the second step of the two-step TST shall be completed and documented within 10-21 days of admission. TST administration and reading shall be done by certified personnel. If an IGRA (blood test) is done, TST (first and/or second step) is not done. b. Residents with a normal chest x-ray and no signs or symptoms of TB shall have a baseline IGRA test (blood test) OR a TST performed with the initial step of a the two-step Mantoux TST placed on or within 30 days prior to the day of admission. IF TST is done, the second step shall be completed within 10-21 days of the first step. TST administration and reading shall be done by certified personnel. If an IGRA (blood test) is done, a TST is not done (first or second step). c. Residents with a significant TST OR positive IGRA (blood test) upon baseline testing or who have documented prior significant TST shall be monitored regularly for signs and symptoms of active TB (cough, sputum production, chest pain, fever, weight loss, or night sweats, especially if the symptoms have lasted longer than three weeks) and if these symptoms develop, shall have an evaluation for TB per the recommendations of the MSDH within 72 hours. d. Residents with a non significant TST or negative IGRA (blood test) upon baseline testing shall have an annual tuberculosis testing within thirty (30) days of the anniversary of their last test. Note: Once IGRA testing is used, IGRA testing should continue to be used rather than TST testing. e. Residents with a new significant TST or newly positive IGRA (blood test) on annual testing shall be evaluated for active TB by a nurse practitioner or physician or physician’s assistant. g. Active or suspected Active TB Admission. If a resident has or is suspected to have active TB, prior written approval for admission to the facility is required from the MSDH TB State Medical Consultant. h. Exceptions to TST/ IGRA requirement may be made if: i. Resident has prior documentation of a significant TST/positive IGRA.

ii. Resident has received or is receiving a MSDH approved treatment regimen for latent TB infection or for active TB disease. iii. Resident is excluded by a licensed physician or nurse practitioner/physician assistant due to medical contraindications.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 47.12.4** Rule 47.12.4 {#sec-16-47.12.4 omnilex-key=us-ms-regs-official--title-15--16#47.12.4}

Transfer to another facility or return of a resident to respite care shall be based on the above tests (Rule 47.12.3) if done within the past 12 months and the patient has no signs and symptoms of TB.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 47.12.5** Disease Prevention {#sec-16-47.12.5 omnilex-key=us-ms-regs-official--title-15--16#47.12.5}

By September 1 st of each year and in accordance with the latest recommendations of the Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention, each Personal Care Home, both Assisted Living and Residential, shall provide residents educational information on Influenza disease. This educational information shall include, but need not be limited to, the risks associated with influenza disease, the availability, effectiveness and known contraindications of the influenza immunization, causes and symptoms of influenza and the means by which influenza is spread. (All information is free and available from the CDC website). Nothing in this provision shall require any Residential or Assisted Living Facility to provide or pay for any vaccination against influenza

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 47.12.6** Transfer to a Hospital or Visit to a Physician Office {#sec-16-47.12.6 omnilex-key=us-ms-regs-official--title-15--16#47.12.6}

If a resident has signs or symptoms of active TB (i.e., is a TB suspect) the facility shall notify the MSDH, the hospital, transporting staff and the physician’s office prior to transferring the resident to a hospital. Appropriate isolation and evaluation shall be the responsibility of the hospital and physician. If a resident has or is suspected to have active TB, prior written approval for admission or readmission to the facility is required from the MSDH TB State Consultant.

1. Meals shall be planned one (1) week in advance. A record of meals served shall be maintained for a one (1) month period. Current menus must be posted and dated.

2. A record of all food purchases shall be maintained in the licensed facility for a one (1) month period. 3. All food served in licensed facilities shall comply with the following: a. No game or home canned foods shall be served; b. Other than fresh or frozen vegetables and fruit, all foods must be from commercial sources. c. All meals for residents who require therapeutic diets shall be planned by a Licensed Dietitian. If a therapeutic diet is prescribed by the physician for the resident, the licensed dietitian shall visit the licensed facility at a minimum of once every thirty (30) days, and shall file a consulting report with the licensed facility.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13 Subchapter 13 FOOD SERVICE Rule 47.13.1 Meals. The licensed facility shall provide residents with well-planned, attractive, and satisfying meals at least three (3) times daily, seven (7) days a week, which will meet their nutritional, social, emotional and therapeutic needs. The daily food allowance shall meet the current recommended dietary allowances.*
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 47.13.2** Physical Facilities {#sec-16-47.13.2 omnilex-key=us-ms-regs-official--title-15--16#47.13.2}

1. A licensed facility with sixteen (16) or more residents shall obtain a Food Service Permit from the Mississippi State Department of Health. 2. A licensed facility with fifteen (15) or fewer residents shall meet the requirements as set forth in the Facility Inspection Report issued by the Mississippi State Department of Health.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 47.13.3** Dietary Staffing {#sec-16-47.13.3 omnilex-key=us-ms-regs-official--title-15--16#47.13.3}

1. Licensed facilities shall have an employee dedicated to meal preparation and food service. 2. All employees engaged in handling, preparation and/or serving of food shall wear clean clothing at all times. 3. All employees engaged in handling and/or preparation of food shall wear hair nets, head bands, or caps to prevent the falling of hair. 4. All employees engaged in handling and/or preparation of food shall wash their hands thoroughly before starting to work and immediately after contact with any soiled matter.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13 Subchapter 14 DRUG HANDLING*

##### **15 Miss. Admin. Code Pt. 16, R. 47.14.1** Restrictions {#sec-16-47.14.1 omnilex-key=us-ms-regs-official--title-15--16#47.14.1}

Licensed facilities shall meet Mississippi State Board of Pharmacy requirements for the storage and dispensing of prescription medications, whenever applicable. Resident requiring administration of Schedule II Narcotics as defined in the Uniform Controlled Substances Law may be admitted to a personal care home. Schedule drugs may only be allowed in a personal care home if they are administered or stored utilizing proper procedures under the direct supervision of a licensed physician or nurse.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 47.14.2** Labeling {#sec-16-47.14.2 omnilex-key=us-ms-regs-official--title-15--16#47.14.2}

The medications of all residents shall be clearly labeled.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 47.14.3** Storage of Prescription Medications {#sec-16-47.14.3 omnilex-key=us-ms-regs-official--title-15--16#47.14.3}

Proper storage of all prescription medications shall be provided. 1. All residents' prescription medications shall be stored in a secured area. The area shall be kept locked when not in use, with responsibility for the key designated in writing. 2. The prescription medication storage area shall be well-lighted, well-ventilated, and kept in a clean and orderly fashion. The temperature of the medication storage area should not exceed 85 degrees Fahrenheit at any time. 3. A refrigerator shall be provided for the storage of prescription medications requiring refrigeration. If the refrigerator houses food or beverages, the residents’ prescription medications shall be stored in a covered container or separate compartment. All refrigerators shall be equipped with thermometers.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 47.14.4** Responsibility {#sec-16-47.14.4 omnilex-key=us-ms-regs-official--title-15--16#47.14.4}

A non-resident employee, appointed by the operator, shall be responsible for the following: 1. Storage of prescription medications. 2. Keeping a current prescription medication list, including frequency and dosage, which shall be updated at least every thirty (30) days, or with any significant change.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 47.14.5** Disposal of Unused Prescription Medications {#sec-16-47.14.5 omnilex-key=us-ms-regs-official--title-15--16#47.14.5}

In the event any prescription medication is no longer in use for any reason, it shall be disposed of in accordance with the regulations of the Mississippi State Board of Pharmacy.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 47.14.6** Rule 47.14.6 {#sec-16-47.14.6 omnilex-key=us-ms-regs-official--title-15--16#47.14.6}

SOCIAL SERVICES: The licensed facility shall make provisions for referring residents with social and emotional needs to an appropriate social services agency.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13 Subchapter 15 RESIDENT ACTIVITIES Rule 47.15.1 Activities Program. An activities program shall be in effect which is appropriate to the needs and interests of each resident.*
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 47.15.2** Adequate and activity-appropriate space shall be provided for the various resident activities {#sec-16-47.15.2 omnilex-key=us-ms-regs-official--title-15--16#47.15.2}

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 47.15.3** Activities shall be provided on daily basis {#sec-16-47.15.3 omnilex-key=us-ms-regs-official--title-15--16#47.15.3}

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 47.15.4** Available community resources shall be utilized in the activities program {#sec-16-47.15.4 omnilex-key=us-ms-regs-official--title-15--16#47.15.4}

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 47.15.5** Supplies shall be available to implement an adequate activities program {#sec-16-47.15.5 omnilex-key=us-ms-regs-official--title-15--16#47.15.5}

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 47.15.6** A non-resident employee shall be responsible for the activities program {#sec-16-47.15.6 omnilex-key=us-ms-regs-official--title-15--16#47.15.6}

2. Living room; 3. Dining Area; 4. Toilet and bathing facilities: 5. Laundry; and

6. Kitchen.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13 Subchapter 16 PHYSICAL ENVIRONMENT Rule 47.16.1 Required Areas/Rooms. The following areas/rooms are required to be provided in a licensed facility: 1. Bedrooms;*
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 47.16.2** Bedrooms {#sec-16-47.16.2 omnilex-key=us-ms-regs-official--title-15--16#47.16.2}

1. Location.: All resident bedrooms shall have an outside exposure and shall not be below grade. Window areas shall not be less than one-eighth (1/8) of the floor area. The window sill shall not be over thirty-six (36) inches from the floor. Windows shall be operable. a. Resident bedrooms shall be located so as to minimize the entrance of unpleasant odors, excessive noise, and other nuisances. b. Resident bedrooms shall be directly accessible from the main corridor. In no case shall a resident bedroom be used for access to another resident bedroom nor shall a resident bedroom be used for access to a required outside exit. c. All resident bedrooms shall be so located that the resident can travel from his/her bedroom to a living room, day room, dining room, or toilet or bathing facility without having to go through another resident bedroom. d. Resident bedrooms shall house no more than four (4) persons each. 2. Furnishings. a. Single beds shall be provided with good grade mattresses at least four (4) inches thick. Cots and roll-away beds shall not be used. b. Each bed shall be equipped with a pillow and clean linens to include sheets, pillow cases, spreads and blankets. An adequate supply of such linens shall be provided at all times to allow for a change of linen at least once a week. c. Chest of drawers or similar adequate storage space shall be provided for the clothing, toilet articles, and personal belongings of each resident. d. Adequate closet space shall be provided for each resident. e. An adequate number of comfortable, sturdy chairs shall be provided. f. At least one (1) mirror, a minimum of 18" x 24", shall be provided in each bedroom. g. The opportunity for personal expression shall be permitted. h. A resident shall be permitted to use personal furnishings in lieu of those provided by the licensed facility, when practical. 3. Floor Area. Minimum usable floor area per bed shall be 80 square feet.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 47.16.3** Living Room {#sec-16-47.16.3 omnilex-key=us-ms-regs-official--title-15--16#47.16.3}

Living rooms, daybooks, and/or recreation rooms shall be provided for resident and visitors. Each licensed facility shall provide at least two (2) areas for this purpose: one (1) for small groups such as a private visit with relatives and friends; and one (1) for larger group activities. The living room must be equipped with attractive, functional, and comfortable furniture in sufficient number to accommodate all residents. A minimum of 18 square feet per bed shall be provided.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 47.16.4** Dining Area {#sec-16-47.16.4 omnilex-key=us-ms-regs-official--title-15--16#47.16.4}

A dining area shall be provided which shall be adequate to seat all residents at the same meal seating. The dining area may also be used for social, recreational, and/or religious services when not in use as a dining facility. A minimum of 15 square feet per bed shall be provided.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 47.16.5** Toilet and Bathing Facilities {#sec-16-47.16.5 omnilex-key=us-ms-regs-official--title-15--16#47.16.5}

1. Separate toilet and bathing facilities shall be provided, on each floor, for each sex in the following ratios as a minimum. a. Bathtubs/showers 1 per 12 or fraction thereof for each sex b. Lavatories 1 per 6 or fraction thereof c. Toilets 1 per 6 or fraction thereof 2. A lavatory with mirror shall be provided in each toilet room or bedroom. 3. Bathtubs and showers shall be equipped with grab bars, towel racks and non-glass shower enclosures. Commodes shall be equipped with grab bars.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 47.16.6** Laundry {#sec-16-47.16.6 omnilex-key=us-ms-regs-official--title-15--16#47.16.6}

Laundry facilities shall be provided unless commercial laundries are used. 1. The laundry shall be located in a specifically designated area, and there shall be adequate room and space for sorting, processing and storage of soiled material. Laundry rooms or soiled linen storage areas shall not open directly into a resident's bedroom or food service area. Soiled materials shall not be transported through the food service area. The laundry area shall be kept clean and orderly. 2. If commercial laundry is used, separate satisfactory storage areas shall be provided for clean and soiled linens.

3. Provisions shall be made for proper mechanical ventilation of the laundry. 4. Provisions shall also be made to prevent the recirculation of air through the heating and air-conditioning systems. 5. Adequate and effective lint traps shall be provided for dryers. 6. When laundry chutes are provided, they shall have a minimum diameter of two (2) feet; and they shall be installed with flushing ring, vent, and drain. 7. An automatic sprinkler shall be provided at the top of the laundry chute and in any receiving room for a chute. 8. A self-closing door shall be provided at the bottom of the chute. 9. Laundry equipment shall be of the type to adequately perform the laundry needs of the facility. The equipment shall be installed to comply with all local and state codes. 10. There shall be a separate and designated area for the storage of clean linen.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 47.16.7** Kitchen {#sec-16-47.16.7 omnilex-key=us-ms-regs-official--title-15--16#47.16.7}

In facilities with 16 or more residents, commercial cooking equipment must comply with NFPA 96, “Standard for Ventilation Control and Protection of Commercial Cooking Operations”. Licensed existing facilities shall be permitted to maintain and utilize existing equipment that is in service.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13 Subchapter 17 PHYSICAL PLANT: GENERAL Rule 47.17.1 Licensed Facility Classification.: To qualify for a license, the facility shall be planned to serve the type of residents to be admitted and shall meet the requirements as set forth in these regulations.*
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 47.17.2** Location {#sec-16-47.17.2 omnilex-key=us-ms-regs-official--title-15--16#47.17.2}

All facilities and licensed facilities shall be located so that they are free from undue noise, smoke, dust, or foul odors and shall not be located adjacent to disposal plants, railroad tracks, etc.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 47.17.3** Site {#sec-16-47.17.3 omnilex-key=us-ms-regs-official--title-15--16#47.17.3}

The proposed site for facility must be approved by the licensing agency. Factors to be considered in approving a site shall be convenient to medical and hospital services, approved water supply and sewage disposal, public transportation, community services, services of an organized fire department, and availability to labor supply. Not more than one-third (1/3) of a site shall be

covered by a building(s) except by special approval of the licensing agency. One example whereby approval may be granted is where the structure is to be placed in a very desirable location where the grounds are limited and very expensive. Where such approval is granted, the structure will be required to have a living room, day room, sun room, and recreational areas adequate to compensate for lack of required outside area.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 47.17.4** Local Restrictions {#sec-16-47.17.4 omnilex-key=us-ms-regs-official--title-15--16#47.17.4}

The site and structure of all licensed facilities shall comply with local building, fire, and zoning ordinances. Proof of compliance shall be submitted to the licensing agency.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 47.17.5** Transportation {#sec-16-47.17.5 omnilex-key=us-ms-regs-official--title-15--16#47.17.5}

Licensed facilities shall be located on streets or roads which are passable at all times. They should be located convenient to public transportation facilities.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 47.17.6** Communications {#sec-16-47.17.6 omnilex-key=us-ms-regs-official--title-15--16#47.17.6}

There shall be not less than one telephone in the licensed facility and such additional telephones as are necessary to summon help in the event of fire or other emergency. The telephone shall be listed under the official licensed name or title of the licensed facility.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 47.17.7** Occupancy {#sec-16-47.17.7 omnilex-key=us-ms-regs-official--title-15--16#47.17.7}

No part of the licensed facility may be rented, leased, or used for any purpose not related to the operation of the licensed facility.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 47.17.8** Rule 47.17.8 {#sec-16-47.17.8 omnilex-key=us-ms-regs-official--title-15--16#47.17.8}

Basement.: The basement shall be considered as a story if one-half (1/2) or more of its clear height is above the average elevation of the ground adjoining the building on all sides. No resident shall be housed on any floor that is below ground level.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13 Subchapter 18 SUBMISSIONS OF PLANS AND SPECIFICATIONS, EFFECTIVE AUGUST 13, 2005 Rule 47.18.1 Minor Alterations and Remodeling. Minor alterations and remodeling which do not affect the structural integrity of the building, change functional operation, affect fire safety, or affect the license bed capacity, do not need to have plans submitted for review provided that a detailed explanation of the proposed alteration or remodeling is submitted to and approved by the licensing agency.*
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 47.18.2** First Stage Submission-Preliminary Plans {#sec-16-47.18.2 omnilex-key=us-ms-regs-official--title-15--16#47.18.2}

First stage or preliminary plans shall include: 1. Plot plan showing size and shape of entire site; location of proposed building and any existing structure(s); adjacent streets, highways, sidewalks, railroads, etc., all properly designated; and size, characteristics, and location of all existing public utilities. 2. Floor plan showing over-all dimensions of building(s); location, size, and purpose of all rooms; location and size of all doors, windows, and other openings with swing of doors properly indicated; dimensions of all corridors and hallways; and location of stairs, elevators, dumbwaiters, vertical shafts, and chimneys. 3. Outline specifications giving kinds and types of materials.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 47.18.3** Final Stage Submission-Working Drawings and Specifications {#sec-16-47.18.3 omnilex-key=us-ms-regs-official--title-15--16#47.18.3}

1. Final stage or working drawings and specifications shall include: a. Architectural drawings b. Structural drawings c. Mechanical drawings to include plumbing, heat, and air-conditioning d. Electrical drawings e. Detailed specifications 2. Approval of working drawings and specifications shall be obtained from the licensing agency in writing prior to the beginning of actual construction.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 47.18.4** Preparation of Plans and Specifications {#sec-16-47.18.4 omnilex-key=us-ms-regs-official--title-15--16#47.18.4}

The preparation of drawings and specifications shall be executed by or under the immediate supervision of an architect who shall supervise construction and furnish a signed statement that construction was performed according to plans and specifications approved by the licensing agency.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 47.18.5** Contract Modifications {#sec-16-47.18.5 omnilex-key=us-ms-regs-official--title-15--16#47.18.5}

Any contract modification which affects or changes the function, design, or purpose of a facility shall be submitted to and approved by the

licensing agency prior to the beginning of work set forth in any contract modification.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 47.18.6** Notification of Start of Construction {#sec-16-47.18.6 omnilex-key=us-ms-regs-official--title-15--16#47.18.6}

The licensing agency shall be informed in writing at the time construction is begun.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 47.18.7** Inspections {#sec-16-47.18.7 omnilex-key=us-ms-regs-official--title-15--16#47.18.7}

The licensing agency or its authorized representatives shall have access at all times to the work for inspection whenever it is in preparation or progress, and the owner shall ascertain that proper facilities are made available for such access and inspection.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 47.18.8** Limit of Approval {#sec-16-47.18.8 omnilex-key=us-ms-regs-official--title-15--16#47.18.8}

In construction delayed for a period of exceeding six (6) months from the time of approval of final working plans and specifications, a new evaluation and/or approval shall be obtained from the licensing agency.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 47.18.9** Water Supply, Plumbing, Sewerage Disposal {#sec-16-47.18.9 omnilex-key=us-ms-regs-official--title-15--16#47.18.9}

The water supply and sewerage disposal shall be approved by the local county health department and/or the Division of Sanitary Engineering, Mississippi State Department of Health. No system of water supply, plumbing, sewerage, garbage, or refuse disposal shall be installed nor any such existing system materially altered or extended until complete plans and specifications for the installation, alteration, or extension have been so approved and submitted to the licensing agency for review and final determination.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13 Subchapter 19 GENERAL BUILDING REQUIREMENTS Rule 47.19.1 Structural Soundness and Repair. The building shall be structurally sound, free from leaks and excessive moisture, in good repair, and painted at sufficient intervals to be reasonably attractive inside and out. Walls and ceilings of hazardous areas shall be one (1) hour fire resistance rating.*
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 47.19.2** Heating and Cooling Systems {#sec-16-47.19.2 omnilex-key=us-ms-regs-official--title-15--16#47.19.2}

Adequate heating and cooling systems shall be provided to maintain inside temperature between 68 degrees Fahrenheit and 78 degrees Fahrenheit depending on the season.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 47.19.3** Lighting {#sec-16-47.19.3 omnilex-key=us-ms-regs-official--title-15--16#47.19.3}

Each resident's room shall have artificial light adequate for reading and other uses as needed. There should be a minimum brightness of ten (10) foot candles of lighting for general use in residents' rooms and a minimum brightness of thirty (30) foot candles of lighting for reading purposes. All entrances, hallways, stairways, ramps, cellars, attics, storerooms, kitchens, laundries, and service units shall have sufficient artificial lighting to prevent accidents and promote efficiency of service. Night lights shall be provided in all hallways, stairways, toilets, and bathing rooms.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 47.19.4** Emergency Lighting {#sec-16-47.19.4 omnilex-key=us-ms-regs-official--title-15--16#47.19.4}

At least one functioning, battery-operated emergency light shall be provided in each hallway.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 47.19.5** Screens {#sec-16-47.19.5 omnilex-key=us-ms-regs-official--title-15--16#47.19.5}

All screen doors and non-stationary windows shall be equipped with tight fitting, full length, sixteen (16) mesh screens. Screen doors shall swing out and shall be equipped with self-closing devices.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 47.19.6** Floors {#sec-16-47.19.6 omnilex-key=us-ms-regs-official--title-15--16#47.19.6}

All floors shall be smooth and free from defects such as cracks, and shall be finished so that they can be easily cleaned.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 47.19.7** Walls and Ceilings {#sec-16-47.19.7 omnilex-key=us-ms-regs-official--title-15--16#47.19.7}

All walls and ceilings shall be of sound construction, with an acceptable surface, and shall be maintained in good repair.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 47.19.8** Ceiling Height {#sec-16-47.19.8 omnilex-key=us-ms-regs-official--title-15--16#47.19.8}

All ceilings shall have a height of at least seven (7) feet, except that a height of six (6) feet six (6) inches may be approved for hallways or toilets and bathing rooms where the lighting fixtures are recessed.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 47.19.9** Ramps and Inclines {#sec-16-47.19.9 omnilex-key=us-ms-regs-official--title-15--16#47.19.9}

Ramps and inclines, where installed for the use of residents, shall not exceed one (1) foot of rise in ten (10) feet of run, shall be furnished with a non-slip floor, and shall be provided with handrails on both sides.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 47.19.10** Door Swing {#sec-16-47.19.10 omnilex-key=us-ms-regs-official--title-15--16#47.19.10}

Exit doors, other than from a living unit, shall swing in the director of exit from the structure.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 47.19.11** Floor Levels {#sec-16-47.19.11 omnilex-key=us-ms-regs-official--title-15--16#47.19.11}

All differences in floor levels within the building shall be accomplished by stairs of not less than three (3) six-inch risers, ramps, or inclines, and shall be equipped with handrails on both sides.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 47.19.12** Space Under Stairs {#sec-16-47.19.12 omnilex-key=us-ms-regs-official--title-15--16#47.19.12}

Space under stairs shall not be used for storage purposes. All walls and doors shall meet the same fire rating as the stairwell.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 47.19.13** Interior Finish and Floor Coverings {#sec-16-47.19.13 omnilex-key=us-ms-regs-official--title-15--16#47.19.13}

Interior finish and decorative material shall be not less than Class B and floor covering shall have a flame spread not to exceed 75.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 47.19.14** Fire Extinguishers {#sec-16-47.19.14 omnilex-key=us-ms-regs-official--title-15--16#47.19.14}

Fire extinguishers of number, type, and capacity appropriate to the need shall be provided for each floor and for special fire hazard areas such as kitchen, laundry, and mechanical room. All extinguishers shall be of a type approved by the licensing agency. A vaporizing liquid extinguisher (such as carbon tetrachloride) will not be approved for use inside the building. Extinguishers shall be inspected and serviced periodically as recommended by the manufacturer. The date of inspection shall be entered on a tag attached to the extinguisher and signed by a reliable inspector such as the local fire chief or representative of a fire extinguisher servicing company.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 47.19.15** Smoke Detectors {#sec-16-47.19.15 omnilex-key=us-ms-regs-official--title-15--16#47.19.15}

Smoke detectors shall be installed in each hallway no more than thirty (30) feet apart, in all bedrooms and in all storage rooms.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 47.19.16** Trash Chutes {#sec-16-47.19.16 omnilex-key=us-ms-regs-official--title-15--16#47.19.16}

Trash chutes are prohibited.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 47.19.17** Housekeeping and Maintenance {#sec-16-47.19.17 omnilex-key=us-ms-regs-official--title-15--16#47.19.17}

The interior and exterior of the licensed facility shall be maintained in an attractive, safe and sanitary condition.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 47.19.18** Pest Control {#sec-16-47.19.18 omnilex-key=us-ms-regs-official--title-15--16#47.19.18}

Pest control inspections and, if necessary, treatments, shall be made to control pests, vermin, insects and rodents, at a minimum of once every thirty (30) days, by a company that is licensed by the State of Mississippi. The licensing agency may, in its discretion, require more frequent inspections and

treatments. The inspection and treatment reports shall be maintained at the licensed facility.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 47.19.19** Water Temperature {#sec-16-47.19.19 omnilex-key=us-ms-regs-official--title-15--16#47.19.19}

The temperature of hot water at plumbing fixtures used by residents shall not exceed 115 degrees Fahrenheit and no less than 100 degrees Fahrenheit.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 47.19.20** Combustion Air {#sec-16-47.19.20 omnilex-key=us-ms-regs-official--title-15--16#47.19.20}

Combustion air to all equipment requiring it must come from the outside.

Subchapter 20 BUILDING REQUIREMENTS Rule 47.20.1 Building Protection. Facilities licensed after August 13, 2005 shall be constructed to have: 1. Building Protection a. Automatic Sprinklers Required. Facilities licensed after the effective date of these regulations shall be protected throughout by a supervised automatic sprinkler system installed in accordance with the current edition of NFPA 13, Installation of Sprinkler Systems. b. In facilities licensed for sixteen (16) or fewer residents and where the characteristics of occupancy are comparable with one (1) and two (2) family residential fire potentials, an NFPA 13D-styled sprinkler system may be installed. 2. Building Construction. a. Single story. No requirements b. Multi-story (less than four floors). One hour fire resistance rating as prescribed by the current edition of the National Fire Protection Association (NFPA) Standard 220, types of Building Construction. (Example: Type II (111), or Type V (111). c. Mobile structures. No mobile structures are acceptable for housing residents.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 47.20.2** Multi-story Building {#sec-16-47.20.2 omnilex-key=us-ms-regs-official--title-15--16#47.20.2}

Elevator Required. No resident shall be housed in a building three stories and above unless the building is equipped with an elevator. The minimum cab size of the elevator shall be approximately six (6) feet eight (8) inches by five (5) feet and constructed of metal. The width of the shaft door shall be at least three (3) feet six (6) inches. The load weight capacity shall not be less than 2,500 pounds. The elevator shaft shall be enclosed by construction of not less than a two-hour fire resistive rating. Elevators shall not be counted as required exits.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 47.20.3** Hazardous Areas and Combustible Storage {#sec-16-47.20.3 omnilex-key=us-ms-regs-official--title-15--16#47.20.3}

Heating apparatus and boiler and furnace rooms, basements, or attics used for the storage of combustible material and workrooms, shall be classified as hazardous areas and shall be separated from other areas by construction having a fire resistive rating of at least one (1) hour.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 47.20.4** Stairs {#sec-16-47.20.4 omnilex-key=us-ms-regs-official--title-15--16#47.20.4}

Stairs shall be enclosed with at least one-hour fire rated construction. 1. Handrails shall be provided on both sides of the stairs. 2. The width of the stairs shall not be less than forty-four (44) inches. 3. The stairs shall be well lighted at all times.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 47.20.5** Exit Doors {#sec-16-47.20.5 omnilex-key=us-ms-regs-official--title-15--16#47.20.5}

Exit doors shall meet the following: 1. At least two (2) remotely located exits shall be provided for each occupied story of a facility. 2. Dead end hallways in excess of twenty (20) feet are not allowed. 3. Doors to the exterior shall be not less than thirty-six (36) inches wide and egress shall not be impeded by being locked. 4. Exit doors shall swing in the direction of exit and shall not obstruct the travel along any required exit. 5. Doors leading to stairways shall be not less than thirty-six (36) inches wide. 6. Revolving doors shall not be used as required exits.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 47.20.6** Hallways and Passageways {#sec-16-47.20.6 omnilex-key=us-ms-regs-official--title-15--16#47.20.6}

1. Hallways and passageways shall be kept unobstructed. 2. Hallways and passageways which lead to the outside from any required stairway shall be enclosed as required for stairways.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 47.20.7** Mechanical and Electric Systems {#sec-16-47.20.7 omnilex-key=us-ms-regs-official--title-15--16#47.20.7}

Mechanical, electrical, plumbing, heating, air-conditioning, and water systems installed shall meet the requirements of local codes and ordinances as well as the applicable regulation of the licensing agency. Where there are no local codes or ordinances, the following codes and recommendations shall govern: 1. National Electrical Code. 2. National Plumbing Code. 3. American Society of Heating, Refrigerating, and Air Conditioning Engineers, Inc. 4. Recommendations of the American Society of Mechanical Engineers. 5. Recommendations of American Gas Association. 6. National Fire Protection Association. The heating of licensed facilities shall be restricted to steam, hot water, or warm air systems employing central heating plants, or Underwriters Laboratories approved electric heating. The use of portable heaters of any kind is prohibited with the following exceptions: 7. Gas heaters provided they meet all of the following: a. A circulating type with a recessed enclosed flame so designed that clothing or other inflammable material cannot be ignited. b. Equipped with a safety pilot light. c. Properly vented to the outside. d. Approved by American Gas Association or Underwriters Laboratories. 8. An approved type of electrical heater such as wall insert type. 9. Lighting (except for battery-operated emergency lighting) shall be restricted to electricity.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13 Subchapter 21 EMERGENCY OPERATIONS PLAN (EOP)*

##### **15 Miss. Admin. Code Pt. 16, R. 47.21.1** Rule 47.21.1 {#sec-16-47.21.1 omnilex-key=us-ms-regs-official--title-15--16#47.21.1}

The Licensed Entity shall develop and maintain a written preparedness plan utilizing the “All Hazards” approach to emergency and disaster planning. The plan must include procedures to be followed in the event of any act of terrorism or man-made or natural disaster as appropriate for the specific geographical location. The final draft of the Emergency Operations Plan (EOP), will be reviewed by the Office of Emergency Preparedness and Response, Mississippi State Department of Health, or their designates, for conformance with the “All Hazards Emergency Preparedness and Response Plan.” Particular attention shall be given to critical areas of concern which may arise during any “all hazards” emergency whether required to evacuate or to sustain in place. Additional plan criteria or a specified EOP format may be required as deemed necessary by the Office of Emergency Preparedness and Response. The six (6) critical areas of consideration are: 1. Communications - Facility status reports shall be submitted in a format and a frequency as required by the Office of EOP. 2. Resources and Assets 3. Safety and Security 4. Staffing 5. Utilities 6. Clinical Activities

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 47.21.2** Rule 47.21.2 {#sec-16-47.21.2 omnilex-key=us-ms-regs-official--title-15--16#47.21.2}

Emergency Operations Plans (EOPs) must be exercised and reviewed annually or as directed by the Office of Emergency Preparedness and Response. Written evidence of current approval or review of provider EOPs, by the Office of Emergency Preparedness and Response, shall accompany all applications for facility license renewals.

Written records of all drills shall be maintained, indicating content of and attendance at each drill. A fire evacuation plan shall be posted in each facility in a conspicuous place and kept current.

Subchapter 1 GENERAL: LEGAL AUTHORITY Rule 48.1.1. Adoption of Rules, Regulations, and Minimum Standards. By virtue of authority vested in it by the Legislature of the State of Mississippi as per Section 43-11-13 of the Mississippi Code of 1972, as amended, the Mississippi State Department of Health does hereby adopt and promulgate the following Rules, Regulations, and Minimum Standards for Personal Care Homes - Residential Living. Upon adoption of these Rules, Regulations, and Minimum Standards, all former rules, regulations and minimum standards in conflict therewith, previously adopted by the licensing agency, are hereby repealed.

1. Affidavit. For the purpose of fingerprinting and criminal background history checks, the term “affidavit” means the use of Mississippi State Department of Health (MSDH) Form #210, or a copy thereof, which shall be placed in the individual’s personal file. 2. Employee. For the purpose of fingerprinting and criminal background history checks, employee shall mean any individual employed by a licensed entity. The term “employee”, also includes any individual who by contract with the facility provides patient care in a patient’s, resident’s, or client’s room or in treatment rooms. a. The term employee does not include healthcare professional/technical students, as defined in Section 37-29-232 of the Miss. Code of 1972, performing clinical training in a licensed entity under contracts between their schools and the licensed entity, and does not include students at high schools who observe the treatment and care of patients in a licensed entity as part of the requirements of an allied health course taught in the school if: i. The student is under the supervision of a licensed healthcare provider; and ii. The student has signed the affidavit that is on file at the student’s school stating that he or she has been convicted of or plead guilty or nolo contendere to a felony of possession or sale of drugs, murder, manslaughter, armed robbery, rape, sexual battery, any sexual offenses listed in section 45-33-23 (g) of the Miss. Code of 1972, child abuse, arson, grand larceny, burglary, gratification of lust, aggravated assault, or felonious abuse and/or battery of a vulnerable adult, or that any such conviction or plea was reversed on appeal or a pardon was granted for the conviction or plea. iii. Further, applicants and employees of the University of Mississippi Medical Center for whom criminal history record checks and fingerprinting are obtained in accordance with Section 37-115-41 of the Miss. Code of 1972 are exempt from application of the term employee under Section 43-11-13 of the Miss. Code of 1972. 3. Covered Entity. For the purpose of criminal history record checks, “covered entity” means a licensed entity or a healthcare professional staffing agency. 4. Licensed Entity. For the purpose of criminal history record checks, the term “licensed entity” means a hospital, nursing home, personal care home, home health agency or hospice.

5. Health Care Professional/Vocational Technical Academic Program. For the purpose of criminal history record checks, “health care professional/vocational technical academic program” means an academic program in medicine, nursing, dentistry, occupational therapy, physical therapy, social services, speech therapy, or other allied-health professional whose purpose is to prepare professionals to render patient care services. 6. Health Care Professional/Vocational Technical Student. For purposes of criminal history record checks, the term means a student enrolled in a healthcare professional/vocational technical academic program. 7. Direct Patient Care or Services. For the purposes of fingerprinting and criminal background history checks, the term “direct patient care” means direct hands-on medical patient care and services provided by an individual in a patient, resident or client’s room, treatment room or recovery room. Individuals providing direct patient care may be directly employed by the facility or employed on a contractual basis. 8. Documented Disciplinary Action. For the purpose of fingerprinting and criminal background history checks, the term “documented disciplinary action” means any action taken against an employee for abuse or neglect of a patient.

2. Close contacts of a person with infectious tuberculosis. 3. Persons who have a chest radiograph suggestive of previous tuberculosis. 4. Persons who inject drugs (if HIV status is unknown).

5. An induration of ten (10) millimeters or greater is significant (or positive) in all other persons tested in Mississippi. A tuberculin skin test is recorded in millimeters of induration. For accurate results, measure the widest diameter of the palpable induration transverse (across) the arm.

electronic means. Renewal of licenses shall occur on an annual basis. Fees are non-refundable. 2. Applicants for initial licensure, or licensees, shall pay a user fee, in an amount set by the Board, and shall be made payable, either by check, money order, or electronic means, to the Mississippi State Department of Health, when it is required to review and/or inspect the proposal of any licensed facility in which there are additions, renovations, modernizations, expansions, alterations, conversions, modifications, or replacements. Fees are non-refundable. 3. Should all documentation appropriate for license renewal not be received by Mississippi State Department of Health, Division of Health Facilities Licensure and Certification on or prior to the expiration date of the license, a late fee in an amount set by the Board, will be assessed and must be submitted payable by business check, money order, or electronic means, to the Mississippi State Department of Health prior to the issuance of a license. Should all paperwork necessary for renewal not be submitted within 30 days post-expiration of the license, the facility shall be considered unlicensed and actions taken, as appropriate to process termination of the license.

Subchapter 8 LICENSING Rule 48.8.1. Issuance of License. All licenses issued by the licensing agency shall set forth the name of the facility, the location, the name of the licensee, the classification of the facility, the type of building, the bed capacity for which the facility is licensed and the licensed number.

Rule 48.8.3. License Not Transferable. The license is not transferable or assignable to any other person except by written approval of the licensing agency.

2. Submission of appropriate licensure renewal fee. 3. Maintenance by the licensed facility of minimum standards in its physical facility, staff, services, and operation as set forth in these regulations.

2. Willful or repeated violations by the licensee of any of the provisions of Sections 43-11-1 et seq, of the Mississippi Code of 1972, as amended, and/or of the rules, regulations, and minimum standards established by the licensing agency. 3. Addiction to narcotic drug(s) by the licensee or other employees or personnel of the licensed facility. 4. Use of alcoholic beverages by the licensee or other personnel of the licensed facility to the extent which threatens the well-being or safety of the residents. 5. Conviction of the licensee of a felony. 6. Publicly misrepresenting the licensed facility and/or its services. 7. Permitting, aiding, or abetting the commission of any unlawful act.

8. Conduct or practices detrimental to the health or safety of residents and employees of said licensed facility. Detrimental practices include but are not limited to: a. Cruelty to a resident or indifference to the needs which are essential to the general well-being and health. b. Misappropriation of the money or property of a resident. c. Failure to provide food adequate for the needs of a resident. d. Inadequate staff to provide safe care and supervision of a resident. e. Failure to call a physician or nurse practitioner/physician assistant when required by a resident's condition. f. Failure to notify next of kin when a resident's condition becomes critical. g. Admission of a resident whose condition demands care beyond the level of care provided by the licensed facility as determined by its classification. 9. A violation of 24-hour supervision requirement and/or the transfer of a residents from the licensed facility to any unlicensed facility may result in the facility’s license being made provisional for a period of 90 days. At the end of that 90-day period, if corrective actions have not been taken by the licensed facility, that Provisional License may be revoked.

1. The licensing agency shall notify the applicant or licensee by registered mail or personal service the particular reasons for the proposed denial or revocation of license. Upon written request of applicant or licensee within ten (10) days of the date of notification, the licensing agency shall fix a date within thirty (30) days

from the date of such service at which time the applicant or licensee shall be given an opportunity for a prompt and fair hearing. 2. On the basis of such hearing or upon default of the applicant or licensee, the licensing agency shall make a determination specifying its findings of fact and conclusions of law. A copy of such determination shall be sent by registered mail to the last known address of the applicant or licensee or served personally upon the applicant or licensee. 3. The decision revoking, suspending, or denying the application or license shall become final thirty (30) days after it is so mailed or served unless the applicant or licensee, within such thirty (30) day period, appeals the decision in Chancery Court pursuant to Section 43-11-23 of the Mississippi Code of 1972. An additional period of time may be granted at the discretion of the licensing agency.

The licensing agency will verify the licensed facility’s corrective actions as soon as possible after the licensing agency receives a plan of correction from the licensed facility.

"Mississippi Nurses Aide Abuse Registry." When the operator is not within the licensed facility, there shall be an individual onsite at the licensed facility who shall represent the operator, and be capable of assuming the responsibility of operator. Said person must be at least twenty-one years or age and shall be a high school graduate, or have passed the GED, and shall have verification that he is not listed on the "Mississippi Nurses Aide Abuse Registry."

Placement of an operator with the licensing agency may include, but not be limited to, assignments within the licensing agency’s central offices or placement with a survey team. Any costs associated with placements for the purposes of this section shall be borne by the licensed facility at which the operator is employed. The operator shall keep confidential and not disclose to any other persons any identifying information about any person or entity that he/she learned while observing operations as required by this section, except as otherwise mandated by law. 1. This section shall apply to operators who: 2. have been employed by a licensed facility for less than six (6) months, during which time the placement must be completed. 3. This section shall not apply to operators who: 4. have previously participated in a placement as required by this section or 5. who were previously employed by the licensing agency in a surveyor capacity. 6. Failure to successfully complete the placement required under this section shall disqualify the operator from serving in such capacity of a licensed facility until a placement is completed. 7. This section shall go into effect January 1, 2002, and thereafter.

not disclose to any other persons any identifying information about any person or entity that the surveyor learned while observing operations as required by this section, except as otherwise mandated by law. This section shall apply to surveyors who have been employed by the licensing agency in a surveyor capacity for less than six (6) months, during which time the placement must be completed. 1. This section shall not apply to surveyors who were previously employed by a licensed facility. 2. Failure to successfully complete the placement required under this section shall disqualify the surveyor from serving in such capacity for the licensing agency until a placement is completed.

Training shall be documented by a narrative of the content and signatures of those attending. Personnel shall be employed and on duty, awake, and fully dressed to provide personal care to the residents. The following staffing ratio shall apply: 1. one (1) resident attendant per fifteen (15) or fewer residents for the hours of 7:00 a.m. until 7:00 p.m. 2. one (1) resident attendant per twenty-five (25) or fewer residents for the hours of 7:00 p.m. until 7:00 a.m.

1. Pursuant to Section §43-11-13, Mississippi Code of 1972, the covered entity shall require to be performed a disciplinary check with the professional licensing agency, if any, for each employee to determine if any disciplinary action has been taken against the employee by the agency, and a criminal history check on: a. Every new employee of a covered entity who provides direct patient care or services and who is employed after or on July 01, 2003, and b. Every employee of a covered entity employed prior to July 01, 2003, who has documented disciplinary action by his or her present employer. 2. Except as otherwise provided in this paragraph, no employee hired on or after July 1, 2003, shall be permitted to provide direct patient care until the results of the criminal history record check revealed no disqualifying record or the

employee has been granted a waiver. Provide the covered entity has documented evidence of submission of fingerprints for the background check, any person may be employed and provide direct patient care on a temporary basis pending the results of the criminal history record check buy any employment offer, contract, or arrangement with the person shall be voidable if he/she receives a disqualifying criminal record check and no waiver is granted. 3. If such criminal history record check discloses a felony conviction; a guilty plea; and/or a plea of nolo contendere to a felony for one (1) or more of the following crimes which has not been reversed on appeal, or for which a pardon has not been granted, the applicant/employee shall not be eligible to be employed at the license facility: a. possession or sale of drugs b. murder c. manslaughter d. armed robbery e. rape f. sexual battery g. sex offense listed in Section 45-33-23, Mississippi Code of 1972 h. child abuse i. arson j. grand larceny k. burglary l. gratification of lust m. aggravated assault n. felonious abuse and/or battery of vulnerable adult 4. Documentation of verification of the employee’s disciplinary status, if any, with the employee’s professional licensing agency as applicable, and evidence of submission of the employee’s fingerprints to the licensing agency must be on file and maintained by the facility prior to the new employees first date of employment. The covered entity shall maintain on file evidence of verification of the employee’s disciplinary status from any applicable professional licensing agency and of submission and/or completion of the criminal record check, the

signed affidavit, if applicable, and/or a copy of the referenced notarized letter addressing the individual’s suitability for such employment. 5. Pursuant to Section §43-11-13, Mississippi Code of 1972, the licensing agency shall require every employee of a covered entity employed prior to July 01, 2003, to sign an affidavit stating that he or she does not have a criminal history as outlined in paragraph (c) above. 6. From and after December 31, 2003, no employee of a covered entity hired before July 01, 2003, shall be permitted to provide direct patient care unless the employee has signed an affidavit as required by this section. The covered entity shall place the affidavit in the employee’s personnel file as proof of compliance with this section. 7. If a person signs the affidavit required by this section, and it is later determined that the person actually had been convicted of or pleaded guilty or nolo contendere to any of the offenses listed herein, and the conviction or pleas has not been reversed on appeal or a pardon has not been granted for the conviction or plea, the person is guilty of perjury as set out in Section 43-11-13, Mississippi Code of 1972. The covered entity shall immediately institute termination proceedings against the employee pursuant to the facility’s policies and procedures. 8. The covered entity may, in its discretion, allow any employee unable to sign the affidavit required by paragraph (g) of this subsection or any employee applicant aggrieved by the employment decision under this subsection to appear before the covered entity’s hiring officer, or his or her designee, to show mitigating circumstances that may exist and allow the employee or employee applicant to be employed at the covered entity. The covered entity, upon report and recommendation of the hiring officer, may grant waivers for those mitigating circumstances, which shall include, but not be limited to: (1) age at which the crime was committed; (2) circumstances surrounding the crime; (3) length of time since the conviction and criminal history since the conviction; (4) work history; (5) current employment and character references; and (6) other evidence demonstrating the ability of the individual does not pose a threat to the health or safety of the patients in the licensed facility. 9. The licensing agency may charge the licensed entity submitting the fingerprints a fee not to exceed Fifty Dollars ($50.00). 10. Should results of an employee applicant’s criminal history record check reveal no disqualifying event, then the covered entity shall, within two (2) weeks of the notification of no disqualifying event, provide the employee applicant with a notarized letter signed by the chief executive officer of the covered entity, or his or her authorized designee, confirming the employee applicant’s suitability for employment based on his or her criminal history record check. An employee applicant may use that letter for a period of two (2) years from the date of the

letter to seek employment at any covered entity licensed by the Mississippi State Department of Health without the necessity of an additional criminal record check. Any covered entity presented with the letter may rely on the letter with respect to an employee applicant’s criminal background and is not required for a period of two (2) years from the date of the letter to conduct or have conducted a criminal history record check as required in this subsection. 11. For individuals contracted through a third party who provide direct patient care as defined herein, the covered entity shall require proof of a criminal history record check. 12. Pursuant to Section 43-11-13, Mississippi Code of 1972, the licensing agency, the covered entity, and their agents, officers, employees, attorneys and representatives, shall be presumed to be acting in good faith for any employment decision or action taken under this section. The presumption of good faith may be overcome by a preponderance of the evidence in any civil action. No licensing agency, covered entity, nor their agents, officers, employees, attorneys and representatives shall be held liable in any employment discrimination suit in which an allegation of discrimination is made regarding an employment decision authorized under this section.

a. IGRA (blood test) and an evaluation of the individual for signs and symptoms of tuberculosis by medical personnel; or

b. A two-step Mantoux tuberculin skin test administered and read by a licensed medical/nursing person certified in the techniques of tuberculin testing and an evaluation of the individual for signs and symptoms of tuberculosis by a licensed Physician, Physician’s Assistant, Nurse Practitioner or a Registered Nurse.

2. The IGRA/Mantoux testing and the evaluation of signs/symptoms may be administered/conducted on the date of hire or administered/read no more

than 30 days prior to the individual’s date of hire; however, the individual must not be allowed contact with a patient or work in areas of the RBIR where patients have access until receipt of the results of the IGRA/assessment or at least the first of the two-step Mantoux test has been administered/read and assessment for the signs and symptoms completed.

3. If the Mantoux test is administered, results must be documented in millimeters. Documentation of the IGRA/TB skin test results and assessment must be documented in accordance with accepted standards of medical/nursing practice and must be placed in the individual’s personnel file no later than 7 days of the individual’s date of employment. If an IGRA is performed, results and quantitative values must be documented.

4. Any employee noted to have a newly positive IGRA, a newly positive Mantoux skin test or signs/symptoms indicative of tuberculin disease (TB) that last longer than three weeks (regardless of the size of the skin test or results of the IGRA), shall have a chest x-ray interpreted by a board certified Radiologist and be evaluated for active tuberculosis by a licensed physician within 72 hours. The employee shall not be allowed to work in any area where clients have routine access until evaluated by a physician/nurse practitioner/physician assistant and approved to return. Exceptions to this requirement may be made if the employee is asymptomatic and:

a. The individual is currently receiving or can provide documentation of having received a course of tuberculosis prophylactic therapy approved by the Mississippi State Department of Health (MSDH) Tuberculosis Program for tuberculosis infection, or

b. The individual is currently receiving or can provide documentation of having received a course of multi-drug chemotherapy approved by the MSDH Tuberculosis Program; or

c. The individual has a documented previous significant tuberculin skin reaction or IGRA reaction.

5. For individuals noted to have a previous positive to either Mantoux testin g or the IGRA, annual re-evaluation for the signs and symptoms must be conducted and must be maintained as part of the employee’s annual health screening. A follow-up annual chest x-ray is NOT required unless symptoms of active tuberculosis develop.

6. If using the Mantoux method, employees with a negative tuberculin skin test and a negative symptom assessment shall have the second step of the two- step Mantoux tuberculin skin test performed and documented in the employees’ personal record within fourteen (14) days of employment.

7. The IGRA or the two-step protocol is to be used for each employee who has not been previously skin tested and/or for whom a negative test cannot be documented within the past 12 months. If the employer has documentation that the employee has had a negative TB skin test within the past 12 months, a single test performed thirty (30) days prior to employment or immediately upon hire will fulfill the two-step requirements. As above, the employee shall not have contact with clients or be allowed to work in areas of the RBIR to which clients have routine access prior to reading the skin test, completing a signs and symptoms assessment and documenting the results and findings.

8. Facilities shall comply with recommendations from the Centers for Disease Control and/or the Mississippi State Department of Health regarding baseline employee TB testing and routine serial employee TB testing and education. Staff exposed to an active infectious case of tuberculosis shall be treated as contacts and be managed appropriately. Individuals found to have a significant Mantoux tuberculin skin test reaction and a chest x- ray not suggestive of active tuberculosis, shall be evaluated by a physician or nurse practitioner/physician assistant for treatment of latent tuberculin infection.

1. As a minimum, this agreement shall contain specifically: a. Basic charges agreed upon (room, board, laundry, and personal care). b. Period to be covered in the charges. c. Services for which special charges are made. d. Agreement regarding refunds for any payments made in advance. e. A statement that the operator shall make the resident's responsible party aware, in a timely manner, of any changes in resident's status, including those which require transfer and discharge; or operators who have been designated as a resident's responsible party shall ensure prompt and efficient action to meet resident's needs. 2. No agreement or contract shall be entered into between the licensee and the resident or his responsible agent which will relieve the licensee of the

responsibility for the protection of the person and personal property of the individual admitted to the licensed facility for care. 3. Any funds given or provided for the purpose of supplying services to any patient in any licensed facility, and any funds otherwise received and held from, for or on behalf of any such resident, shall be deposited by the director or other proper officer of the licensed facility to the credit of that patient in an account which shall be known as the Resident's Personal Deposit Fund. No more than one (1) month charge for the care, support, maintenance, and medical attention of the patient shall be applied from such account at any one (1) time. After the death, discharge, or transfer of any resident for whose benefit any such fund has been provided, any unexpended balance remaining in his personal deposit fund shall be applied for the payment of care, cost of support, maintenance, and medical attention which is accrued. In the event any unexpended balance remains in that resident's personal deposit fund after complete reimbursement has been made for payment of care, support, maintenance, and medical attention, and the director or other proper officer of the licensed facility has been or shall be unable to locate the person or persons entitled to such unexpended balance, the director or other proper officer may, after the lapse of one (1) year from the date of such death, discharge, or transfer, deposit the unexpended balance to the credit of the licensed facility's operating fund. 4. The resident or his responsible party shall be furnished a receipt signed by the licensee of the licensed facility or his lawful agent, for all sums of money paid to the licensed facility. 5. Written notification shall be given to the resident/responsible party when basic charges and/or licensed facility policies change.

1. The operator shall maintain a record of the residents for whom he or she serves as the conservator or a representative payee. This record shall include evidence of the means by which the conservatorship or representative payee relationship was established and evidence of separate accounts in a bank for each resident whose conservator or representative payee is the operator of the licensed facility. 2. Inspection reports from the licensing agency, any branch or division thereof by the operator in the licensed facility, and submitted to the licensing agency as required, or when requested. 3. Resident records shall contain the following: a. Admission agreement(s) and financial statements. b. Residents' rights and licensed facility’s rules, signed, dated, and witnessed.

c. Medical evaluation and referral from physician or nurse practitioner/physician assistant. d. Current medication record, including any reactions to such medication. e. Social services and activity contacts. f. General information form. g. Representative payee statement, if applicable. h. Physician orders or nurse practitioner/physician assistant orders (including, but not limited to, therapies, diets, medications, etc.) and medication administration records. 4. The records as described in this section shall be made available to the resident, the resident’s family, or other responsible party for the resident upon reasonable request. 5. Reporting of Tuberculosis Testing. The facility shall report and comply with the annual MDH TB Program surveillance procedures.

2. Have the right to manage his/her personal financial affairs, or is given at least a quarterly accounting of financial transactions made on his/her behalf should the facility accept the written delegation from the resident or from his/her responsible party of this responsibility to the facility for any period of time in conformance with State law. 3. Not be required to perform services for the licensed facility. 4. Have the right to communicate with persons of his/her choice, and may receive mail unopened or in compliance with the policies of the home. 5. Be treated with consideration, kindness, respect, and full recognition of his/her dignity and individually.

6. May retain and use personal clothing and possessions as space permits. 7. May voice grievances and recommend changes in licensed facility policies and services. 8. Shall not be confined to the licensed facility against his/her will, and shall be allowed to move about in the community at liberty. Physical and/or chemical restraints are prohibited. 9. Not be limited in his/her choice of a pharmacy or pharmacist provider in accordance with State law.

1. A person shall not be admitted or continue to reside in a licensed facility if the person: a. Is not ambulatory; b. Requires physical restraints; c. Poses a serious threat to himself or herself or others; d. Requires nasopharyngeal and/or tracheotomy suctioning; e. Requires gastric feedings; f. Requires intravenous fluids, medications, or feedings; g. Requires a indwelling urinary catheter; h. Requires sterile wound care; or i. Requires treatment of decubitus ulcer or exfoliative dermatitis. 2. Licensed facilities which are not accessible to individuals with disabilities through the A.N.S.I. Standards as they relate to facility accessibility may not accept wheelchair bound residents. Only those persons who, in an emergency, would be physically and mentally capable of traveling to safety may be accepted. For multilevel facilities, no residents may be placed above the ground floor level that are unable to descend the stairs unassisted. 3. The licensed facility must be able to identify at the time of admission and during continued stay those residents whose needs for services are consistent with these

rules and regulations, and those residents who should be transferred to an appropriate level of care. 4. Notwithstanding any determination by the licensing agency that skilled nursing services would be appropriate for a resident of a personal care home, that resident, the resident’s guardian, or the legally recognized responsible party for the resident may consent in writing for the resident to continue to reside in the personal care home, if approved in writing by a licensed physician. Provided, however, that no personal care home shall allow more than two (2) residents, or ten percent (10%) of number of residents in the facility, whichever is greater, to remain in the personal care home under the provisions herein. This consent shall be deemed to be appropriately informed consent as described by these regulations. After that written consent has been obtained, the resident shall have the right to continue to reside in the personal care home for as long as the resident meets the other conditions for residing in the personal care home. A copy of the written consent and the physician’s approval shall be forwarded by the personal care home to the licensing agency within thirty (30) days of the issuance of the latter of the two (2) documents. 5. The licensed facility which accepts and admits residents requiring mental health services shall help arrange transportation to mental health appointments and cooperate with the community mental health center or other provider of mental health care, as necessary, to ensure access to and the coordination of care, within limits of the confidentiality and privacy rights of the individual receiving services.

2. Admission to the facility shall be based on the results of the required tests as follows:

a. Residents with an abnormal chest x-ray and/or signs and symptoms assessment shall have the first step of a two-step Mantoux tuberculin skin test (TST) placed and read by certified personnel OR an IGRA (blood test) drawn and results documented within 30 days prior to the patient’s admission to the “Licensed facility”. Evaluation for active TB shall be at the recommendation of the MSDH and shall be prior to admission. If TB is ruled out and the first step of the TST is negative, the second step of the two-step TST shall be completed and documented within 10-21 days of admission. TST administration and reading shall be done by certified personnel. If an IGRA (blood test) is done, TST (first and/or second step) is not done. b. Residents with a normal chest x-ray and no signs or symptoms of TB shall have a baseline IGRA test (blood test) OR a TST performed with the initial step of the two-step Mantoux TST placed on or within 30 days prior to the day of admission. IF TST is done, the second step shall be completed within 10-21 days of the first step. TST administration and reading shall be done by certified personnel. If an IGRA (blood test) is done, a TST is not done (first or second step). c. Residents with a significant TST OR positive IGRA (blood test) upon baseline testing or who have documented prior significant TST shall be monitored regularly for signs and symptoms of active TB (cough, sputum production, chest pain, fever, weight loss, or night sweats, especially if the symptoms have lasted longer than three weeks) and if these symptoms develop, shall have an evaluation for TB per the recommendations of the MSDH within 72 hours. d. Residents with a non significant TST or negative IGRA (blood test) upon baseline testing shall have an annual tuberculosis testing within thirty (30) days of the anniversary of their last test. Note: Once IGRA testing is used, IGRA testing should continue to be used rather than TST testing. e. Residents with a new significant TST or newly positive IGRA (blood test) on annual testing shall be evaluated for active TB by a nurse practitioner or physician or physician’s assistant. f. Active or suspected Active TB Admission. If a resident has or is suspected to have active TB, prior written approval for admission to the facility is required from the MSDH TB State Medical Consultant. g. Exceptions to TST/ IGRA requirement may be made if: i. Resident has prior documentation of a significant TST/positive IGRA. ii. Resident has received or is receiving a MSDH approved treatment regimen for latent TB infection or for active TB disease. iii. Resident is excluded by a licensed physician or nurse

practitioner/physician assistant due to medical contraindications.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13 Subchapter 22 FACILITY FIRE PREPAREDNESS Rule 47.22.1 Fire Drills. Fire drills shall be conducted one (1) per shift per quarter. Employees shall participate in a fire drill at least four (4) times per year. Written Records.*
- *SOURCE: Miss. Code Ann. §43-11-13 CHAPTER 48 MINIMUM STANDARDS FOR PERSONAL CARE HOMES RESIDENTIAL LIVING*
- *SOURCE: Miss. Code Ann. §43-11-13 Rule 48.1.2. Codes and Ordinances. Every licensed facility located inside the boundaries of a municipality shall comply with all local municipal codes and ordinances applicable thereto. In addition, each licensed facility shall comply with all applicable state and federal laws.*
- *SOURCE: Miss. Code Ann. §43-11-13 Rule 48.1.3. Fire Safety. No facility may be licensed until it shows conformance to the safety regulations providing minimum standards for prevention and detection of fire as well as for protection of life and property against fire.*
- *SOURCE: Miss. Code Ann. §43-11-13 Rule 48.1.4. Duty to Report. All fires, explosions, natural disasters as well as avoidable deaths, or avoidable, serious, or life-threatening injuries to residents resulting from fires, explosions, and natural disasters shall be reported by telephone to the Life Safety Code Division of the licensing agency by the next working day after the occurrence.*
- *SOURCE: Miss. Code Ann. §43-11-13 Subchapter 2 DEFINITIONS Rule 48.2.1. Ambulation. The terms “ambulation” or “ambulatory” shall mean the resident’s ability to bear weight, pivot, and safely walk independently or with the use of a cane, walker, or other mechanical supportive device (i.e., including, but not limited to, a wheelchair). A resident who requires a wheelchair must be capable of transferring to and propelling the wheelchair independently or with prompting.*
- *SOURCE: Miss. Code Ann. §43-11-13 Rule 48.2.2. Assisted Living. The term “assisted living” shall mean the provision of personal care and the addition of supplemental services to include, but not be limited to, the provision of medical services (i.e., medication procedures and medication administration), and emergency response services.*
- *SOURCE: Miss. Code Ann. §43-11-13 Rule 48.2.3. Criminal History Record Checks.*
- *SOURCE: Miss. Code Ann. §43-11-13 Rule 48.2.4. Facility. The term “facility” shall mean any home or institution that (1) has sought or is currently seeking designation as a “licensed facility” under the terms of these regulations; or (2) is operating a home or institution unlawfully which, by its nature and operational intent, is required to be a licensed facility under the terms of these regulations.*
- *SOURCE: Miss. Code Ann. §43-11-13 Rule 48.2.5. Immediate Jeopardy (Serious and Immediate to Health and Safety). A situation in which the licensed facility’s failure to meet one or more regulatory requirements has caused, or is likely to cause, serious injury, harm, impairment, or death to a resident.*
- *SOURCE: Miss. Code Ann. §43-11-13 Rule 48.2.6. IGRA(s) (Interferon-Gamma Release Assay(s). A whole blood test used in to assist in diagnosing Mycobacterium Tuberculosis infection. The IGRA blood test used must be approved by the U.S. Food and Drug Administration (FDA).*
- *SOURCE: Miss. Code Ann. §43-11-13 Rule 48.2.7. Licensing Agency. The term "licensing agency" shall mean the Mississippi State Department of Health.*
- *SOURCE: Miss. Code Ann. §43-11-13 Rule 48.2.8. Licensed Facility. The term “licensed facility” shall mean any personal care home for residential living which has been issued a license for operation by the licensing agency.*
- *SOURCE: Miss. Code Ann. §43-11-13 Rule 48.2.9. Mantoux Test. A method of skin testing that is performed by injecting one-tenth (0.1) milliliter of purified protein derivative-tuberculin containing five (5) tuberculin units into the dermis (i.e., the second layer of skin) of the forearm with a needle and syringe. The area is examined between forty-eight (48) and seventy- two (72) hours after the injection. A reaction is measured according to the size of the induration. The classification of a reaction as positive or negative depends on the patient’s medical history and various risk factors (see definition for significant tuberculin skin test. This test is used to evaluate the likelihood that a person is infected with M. tuberculosis. It is the most reliable and standardized technique for tuberculin testing. It should be administered only by persons certified in the intradermal technique.*
- *SOURCE: Miss. Code Ann. §43-11-13 Rule 48.2.10. Medication Assistance. For the purposes of these regulations, the term “medication assistance” is any form of delivering medication which has been prescribed which is not defined as “medication administration” including, but not limited to, the physical act of handing an oral prescription medication to the patient along with liquids to assist the patient in swallowing.*
- *SOURCE: Miss. Code Ann. §43-11-13 Rule 48.2.11. Personal Care. The term "personal care" shall mean the assistance rendered by personnel of the licensed facility to residents in performing one or more of the activities of daily living, including but not limited to bathing, walking, excretory functions, feeding, personal grooming, and dressing.*
- *SOURCE: Miss. Code Ann. §43-11-13 Rule 48.2.12. Significant Tuberculin Skin Test. An induration of five (5) millimeters or greater is significant (or positive) in the following: 1. Persons known to have or suspected of having human immunodeficiency virus (HIV).*
- *SOURCE: Miss. Code Ann. §43-11-13 Rule 48.2.13. Residential Living. The term “residential living” shall mean the provision of services to individuals who require personal care services or individuals, who due to functional impairments, may require mental health services.*
- *SOURCE: Miss. Code Ann. §43-11-13 Rule 48.2.14. Surveyor. The term "surveyor" shall mean an individual employed, or hired on a contractual basis, by the licensing agency for the purpose of conducting surveys, inspections, investigations, or other related functions as part of the licensing agency’s responsibilities for licensure and regulation of institutions for the aged and infirm.*
- *SOURCE: Miss. Code Ann. §43-11-13 Rule 48.2.15. Two-step Testing. A procedure used for the baseline testing of person who will periodically receive tuberculin skin tests (e.g., health care workers) to reduce the likelihood of mistaking a boosted reaction for a new infection. If the initial tuberculin-test result is classified as negative, a second test is repeated one (1) to three (3) weeks later. If the reaction to the second test is positive, it probably represents a boosted reaction. If the second test is also negative, the person is classified as not infected. A positive reaction to a subsequent test would indicate new infection (i.e., a skin-test conversion) in the person.*
- *SOURCE: Miss. Code Ann. §43-11-13 Subchapter 3 PROCEDURE GOVERNING ADOPTION AND AMENDMENT Rule 48.3.1. Authority. The licensing agency shall have the power to adopt, amend, promulgate and enforce such rules, regulations and minimum standards as it deems appropriate, within the law.*
- *SOURCE: Miss. Code Ann. §43-11-13 Subchapter 4 INSPECTION Rule 48.4.1. Inspections Required. Each licensed facility shall be inspected by the licensing agency or by persons delegated with authority by said licensing agency at such intervals as the licensing agency may direct. The licensing agency and/or its authorized representatives shall have the right to inspect construction work in progress. New facilities shall not be licensed without having first been inspected for compliance with these rules, regulations, and minimum standards.*
- *SOURCE: Miss. Code Ann. §43-11-13 Subchapter 5 CLASSIFICATION Rule 48.5.1. Personal Care Home - Residential Living. The terms “Personal Care Home - Residential Living” and “Residential Personal Care Home” shall mean any place or facility operating 24 hours a day, seven (7) days a week, accepting individuals who require personal care services or individuals, who due to functional impairments, may require mental health services to compensate for activities of daily living.*
- *SOURCE: Miss. Code Ann. §43-11-13 Rule 48.5.2. Personal Care Home - Assisted Living. The terms “Personal Care Home - Assisted Living” and “Assisted Living Personal Care Home” shall mean any place or facility operating 24 hours a day, seven (7) days a week, accepting individuals who require assisted living services as governed by the regulations herein.*
- *SOURCE: Miss. Code Ann. §43-11-13 Subchapter 6 TYPES OF LICENSE Rule 48.6.1. Regular License. A license shall be issued to each facility that meets the requirements as set forth in these regulations.*
- *SOURCE: Miss. Code Ann. §43-11-13 Rule 48.6.2. Provisional License. Within its discretion, the licensing agency may be issued only if the licensing agency is satisfied that preparations are being made to qualify for regular license and that the health and safety of residents will not be endangered.*
- *SOURCE: Miss. Code Ann. §43-11-13 Subchapter 7 APPLICATION OR RENEWAL OF LICENSE Rule 48.7.1. Application. Application for a license or renewal of a license shall be made in writing to the licensing agency, on forms provided by the licensing agency, which shall contain such information as the licensing agency may require.*
- *SOURCE: Miss. Code Ann. §43-11-13 Rule 48.7.2. Fees 1. Each initial and renewal licensure application, unless suspended or revoked, shall be accompanied by a fee in an amount set by the Board, made payable to the Mississippi State Department of Health, either by check, money order, or*
- *SOURCE: Miss. Code Ann. §43-11-13 Rule 48.7.3. Name of Facility. Only the official name, as approved by the licensing agency and by which the facility is licensed shall be used in telephone listing, on stationery, in advertising, etc.*
- *SOURCE: Miss. Code Ann. §43-11-13 Rule 48.7.4. Number of Beds. The maximum number of beds for which the facility is licensed shall not be exceeded.*
- *SOURCE: Miss. Code Ann. §43-11-13*
- *SOURCE: Miss. Code Ann. §43-11-13 Rule 48.8.2. Posting of License. The license shall be posted in a conspicuous place on the licensed premises and shall be available for review by an interested person.*
- *SOURCE: Miss. Code Ann. §43-11-13*
- *SOURCE: Miss. Code Ann. §43-11-13 Rule 48.8.4. Expiration of License. Each license shall expire on March 31, following the date of issuance.*
- *SOURCE: Miss. Code Ann. §43-11-13 Rule 48.8.5. Renewal of License. License shall be renewable annually upon: 1. Filing and approval of an application for renewal by the licensee.*
- *SOURCE: Miss. Code Ann. §43-11-13 Subchapter 9 DENIAL, SUSPENSION, OR REVOCATION OF LICENSE Rule 48.9.1. Denial or Revocation of License: Hearings and Review. The licensing agency, after notice and opportunity for a hearing to the applicant or licensee, is authorized to deny, suspend, or revoke a license, or deny renewal of a license, in any case in which it finds that there has been a substantial failure to comply with the requirements established under the law and these regulations. Also, the following shall be grounds for denial or revocation of license: 1. Fraud on the part of the licensee in applying for a license, or renewal of license.*
- *SOURCE: Miss. Code Ann. §43-11-13 RULE 48.9.2. Immediate Revocation of License: Pursuant to Section 41-3-15, the State Department of Health is authorized and empowered, to revoke, immediately, the license and require closure of any institution for the aged or infirm, including any other remedy less than closure to protect the health and safety of the residents of said institution or the health and safety of the general public.*
- *SOURCE: Miss. Code Ann. §43-11-13 Subchapter 10 PROVISION FOR HEARING AND APPEAL FOLLOWING DENIAL OR REVOCATION OF LICENSE; PENALTIES Rule 48.10.1. Administrative Decision. The licensing agency will provide an opportunity for a fair hearing to every applicant or licensee who is dissatisfied with administrative decisions made in the denial or revocation of license.*
- *SOURCE: Miss. Code Ann. §43-11-13 Rule 48.10.2. Penalties. Any person establishing, conducting, managing, or operating facility without a license shall be declared in violation of these regulations and may be punished as set forth in the enabling statute. Further, any person who violates any provision of the enabling statute, or of these regulations promulgated thereto shall, upon conviction thereof, be guilty of a misdemeanor. Such misdemeanor shall, upon conviction, be punishable as referenced in Section 43-11-25 of the Mississippi Code of 1972, Annotated.*
- *SOURCE: Miss. Code Ann. §43-11-13 Rule 48.10.3. Ban on Admissions. If a condition of immediate jeopardy exists at a licensed facility, written notice of the determination of the condition shall be provided by the licensing agency to the licensed facility, along with the notification that a ban on all admissions is to be imposed five (5) calendar days after the receipt of the notice by the licensed facility. If the licensing agency’s determination of a condition of immediate jeopardy on the day of the licensure visit/survey is confirmed, a ban on all admissions shall be imposed until the licensed facility achieves compliance and such compliance is verified by the licensing agency.*
- *SOURCE: Miss. Code Ann. §43-11-13 Subchapter 11 ADMINISTRATION Rule 48.11.1. Operator. There shall be a full-time employee designated as operator of the licensed facility who shall be responsible for the management of the licensed facility. The operator shall be at least twenty-one years of age and shall be a high school graduate, or have passed the GED, and shall not be a resident of the licensed facility. The operator shall have verification that he is not listed on the*
- *SOURCE: Miss. Code Ann. §43-11-13 Rule 48.11.2. Operator Mentoring. Operators shall be scheduled to spend two (2) concurrent days with the licensing agency for the purpose of training and mentoring.*
- *SOURCE: Miss. Code Ann. §43-11-13 Rule 48.11.3. Surveyor Mentoring. Surveyors shall be scheduled to spend two (2) concurrent days with a licensed facility for the purpose of training and mentoring. Selection of a licensed facility for placement of the surveyor shall be done at the discretion of the licensing agency, except no licensed facility shall be required to accept more than two (2) placements in any calendar year. Upon completion of said training, the surveyor shall not participate in a survey of the same licensed facility for a period not to exceed one year from the date of training placement. Any costs associated with the placement of a surveyor for the purposes of this section shall be borne by the licensing agency. The surveyor shall keep confidential and*
- *SOURCE: Miss. Code Ann. §43-11-13 Rule 48.11.4. Other Personnel. All direct care employees shall be a minimum of 18 years of age, and shall have verification that they are not listed on the "Mississippi Nurses Aide Abuse Registry." Personnel shall receive training on a quarterly basis on topics and issues related to the population being served in the licensed facility.*
- *SOURCE: Miss. Code Ann. §43-11-13 Rule 48.11.5. Criminal History Record Checks.*
- *SOURCE: Miss. Code Ann. §43-11-13 Rule 48.11.6. Employee's Health Status. All licensed facility personnel shall receive a health screening by a licensed physician, a nurse practitioner/physician assistant, or a registered nurse prior to employment and annually thereafter. Records of this health screening shall be kept on file in the licensed facility.*
- *SOURCE: Miss. Code Ann. §43-11-13 Rule 48.11.7. Employee Testing for Tuberculosis 1. Each employee, upon employment of a licensed entity and prior to contact with any patient/client, shall be evaluated for tuberculosis by one of the following methods:*
- *SOURCE: Miss. Code Ann. §43-11-13 Rule 48.11.8. Admission Agreement. Prior to, or at the time of admission, the operator and the resident or the resident's responsible party shall execute in writing a financial agreement. This agreement shall be prepared and signed in two or more copies, one copy given to the resident or his/her responsible party, and one copy placed on file in the licensed facility.*
- *SOURCE: Miss. Code Ann. §43-11-13 Rule 48.11.9. Records and Reports.*
- *SOURCE: Miss. Code Ann. §43-11-13 Rule 48.11.10. Licensed Facility Policies. Written policies shall be available which indicate services to be provided, and which include policies regarding admission, transfer and discharge of residents.*
- *SOURCE: Miss. Code Ann. §43-11-13 Rule 48.11.11. Residents' Rights. These rights and licensed facility rules must be in writing and be made available to all residents, employees, sponsors, and posted for public viewing. Each resident shall: 1. Have the right to attend religious and other activities of his/her choice.*
- *SOURCE: Miss. Code Ann. §43-11-13 Subchapter 12 MEDICAL AND PERSONAL CARE SERVICES Rule 48.12.1. Admission and Discharge. The following criteria must be applied and maintained for resident placement in a licensed facility.*
- *SOURCE: Miss. Code Ann. §43-11-13 Rule 48.12.2. Medical Evaluation. Each person applying for admission to a licensed facility shall be given a thorough examination by a licensed physician or certified nurse practitioner/physician assistant within thirty (30) days prior to admission. The examination shall indicate the appropriateness of admission, according to the above criteria, to a licensed facility with an annual update by a physician and/or nurse practitioner/physician assistant.*
- *SOURCE: Miss. Code Ann. §43-11-13 Rule 48.12.3. Admission Requirements to Rule Out Active Tuberculosis (TB) 1. The following are to be performed and documented within 30 days prior to the resident’s admission to the licensed facility: a. A TB signs and symptoms assessment by a licensed physician, physician assistant or nurse practitioner; and b. A chest x-ray taken and have a written interpretation.*
- *SOURCE: Miss. Code Ann. §43-11-13 Rule 48.12.4. Transfer to another facility or return of resident to respite care shall be based on the above tests (Rule 48.12.3) if done within the past 12 months and the patient has no signs and symptoms of TB.*
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 48.12.5** Disease Prevention {#sec-16-48.12.5 omnilex-key=us-ms-regs-official--title-15--16#48.12.5}

By September 1 st of each year and in accordance with the latest recommendations of the Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention, each Personal Care Home, both Assisted Living and Residential, shall provide residents educational information on Influenza disease. This educational information shall include, but need not be limited to, the risks associated with influenza disease, the availability, effectiveness and known contraindications of the influenza immunization, causes and symptoms of influenza and the means by which influenza is spread. (All information is free and available from the CDC website). Nothing in this provision shall require any Residential or Assisted Living Facility to provide or pay for any vaccination against influenza.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 48.12.6** Transfer to a Hospital or Visit to a Physician Office {#sec-16-48.12.6 omnilex-key=us-ms-regs-official--title-15--16#48.12.6}

If a resident has signs or symptoms of active TB (i.e., is a TB suspect) the facility shall notify the MDH, the hospital, transporting staff, and physician’s office prior to transferring the resident to a hospital. Appropriate isolation and evaluation shall be the responsibility of the hospital and physician. If a resident has or is suspected to have active TB, prior written approval for admission or readmission to the facility is required from the MDH TB State Consultant.

Subchapter 13 FOOD SERVICE Rule 48.13.1. Meals. The licensed facility shall provide residents with well-planned, attractive, and satisfying meals at least three (3) times daily, seven (7) days a week, which will meet their nutritional, social, emotional and therapeutic needs. The daily food allowance shall meet the current recommended dietary allowances. 1. Meals shall be planned one (1) week in advance. A record of meals served shall be maintained for a one (1) month period. Current menus must be posted and dated. 2. A record of all food purchases shall be maintained in the licensed facility for a one (1) month period. 3. All food served in licensed facilities shall comply with the following:

a. No game or home canned foods shall be served; and b. Other than fresh or frozen vegetables and fruit, all foods must be from commercial sources. 4. All meals for residents who require therapeutic diets shall be planned by a Licensed Dietitian. If a therapeutic diet is prescribed by the physician for the resident, the licensed dietitian shall visit the licensed facility at a minimum of once every thirty (30) days, and shall file a consulting report with the licensed facility.

Rule 48.14.1. A licensed facility with sixteen (16) or more residents shall obtain a Food Service Permit from the Mississippi State Department of Health. A licensed facility with fifteen (15) or fewer residents shall meet the requirements as set forth in the Facility Inspection Report issued by the Mississippi State Department of Health.

1. Licensed facilities shall have an employee dedicated to meal preparation and food service. 2. All employees engaged in handling, preparation and/or serving of food shall wear clean clothing at all times. 3. All employees engaged in handling and/or preparation of food shall wear hair nets, head bands, or caps to prevent the falling of hair. 4. All employees engaged in handling and/or preparation of food shall wash their hands thoroughly before starting to work and immediately after contact with any soiled matter.

1. No Schedule I drugs shall be allowed in the licensed facility. Residents requiring administration of Schedule II Narcotics as defined in the Uniform Controlled Substances Law may be admitted to a personal care home. Schedule drugs may only be allowed in a personal care home if they are administered or stored

utilizing proper procedures under the direct supervision of a licensed physician or nurse. 2. The licensed facility may keep on hand a limited amount of non-prescription, over-the- counter medications. 3. No intramuscular, subcutaneous, intravenous injectable, except for insulin and vitamin B-12, shall be allowed. 4. Insulin or vitamin B-12 may be administered only if the resident is able to administer his/her own injectable, or is administered by a licensed nurse.

1. All residents' prescription medications shall be stored in a secured area. The area shall be kept locked when not in use, with responsibility for the key designated in writing. 2. The prescription medication storage area shall be well-lighted, well-ventilated, and kept in a clean and orderly fashion. The temperature of the medication storage area should not exceed 85 degrees Fahrenheit at any time. 3. A refrigerator shall be provided for the storage of prescription medications requiring refrigeration. If the refrigerator houses food or beverages, the residents’ prescription medications shall be stored in a covered container or separate compartment. All refrigerators shall be equipped with thermometers.

2. Keeping a current prescription medication list, including frequency and dosage, which shall be updated at least every thirty (30) days, or with any significant change.

Rule 48.15.5. Disposal of Unused Prescription Medications. In the event any prescription medication is no longer in use for any reason, it shall be disposed of in accordance with the regulations of the Mississippi State Board of Pharmacy.

1. Adequate and activity-appropriate space shall be provided for the various resident activities. 2. Activities shall be provided on daily basis. 3. Available community resources shall be utilized in the activities program. 4. Supplies shall be available to implement an adequate activities program. 5. A non-resident employee shall be responsible for the activities program.

2. Living room; 3. Dining Area; 4. Toilet and bathing facilities; 5. Laundry; and 6. Kitchen.

Rule 48.18.2. Bedrooms. 1. Location. a. All resident bedrooms shall have an outside exposure and shall not be below grade. Window areas shall not be less than one-eighth (1/8) of the floor area. The window sill shall not be over thirty-six (36) inches from the floor. Windows shall be operable. b. Resident bedrooms shall be located so as to minimize the entrance of unpleasant odors, excessive noise, and other nuisances. c. Resident bedrooms shall be directly accessible from the main corridor. In no case shall a resident bedroom be used for access to another resident bedroom nor shall a resident bedroom be used for access to a required outside exit. d. All resident bedrooms shall be so located that the resident can travel from his/her bedroom to a living room, day room, dining room, or toilet or bathing facility without having to go through another resident bedroom. e. Resident bedrooms shall house no more than four (4) persons each. 2. Furnishings. a. Single beds shall be provided with good grade mattresses at least four (4) inches thick. Cots and roll-away beds shall not be used. b. Each bed shall be equipped with a pillow and clean linens to include sheets, pillow cases, spreads and blankets. An adequate supply of such linens shall be provided at all times to allow for a change of linen at least once a week. c. Chest of drawers or similar adequate storage space shall be provided for the clothing, toilet articles, and personal belongings of each resident. d. Adequate closet space shall be provided for each resident. e. An adequate number of comfortable, sturdy chairs shall be provided. f. At least one (1) mirror, a minimum of 18" x 24", shall be provided in each bedroom. g. The opportunity for personal expression shall be permitted. h. A resident shall be permitted to use personal furnishings in lieu of those provided by the licensed facility, when practical. 3. Floor Area. Minimum usable floor area per bed shall be 80 square feet.

Rule 48.18.3. Living Room. Living rooms, daybooks, and/or recreation rooms shall be provided for resident and visitors. Each licensed facility shall provide at least two (2) areas for this purpose: one (1) for small groups such as a private visit with relatives and friends; and one (1) for larger group activities. The living room must be equipped with attractive, functional, and comfortable furniture in sufficient number to accommodate all residents. A minimum of 18 square feet per bed shall be provided.

1. Separate toilet and bathing facilities shall be provided, on each floor, for each sex in the following ratios as a minimum. a. Bathtubs/showers 1 per 12 or fraction thereof for each sex b. Lavatories 1 per 6 or fraction thereof c. Toilets 1 per 6 or fraction thereof 2. A lavatory with mirror shall be provided in each toilet room or bedroom. 3. Bathtubs and showers shall be equipped with grab bars, towel racks and non-glass shower enclosures. Commodes shall be equipped with grab bars.

1. The laundry shall be located in a specifically designated area, and there shall be adequate room and space for sorting, processing and storage of soiled material. Laundry rooms or soiled linen storage areas shall not open directly into a resident's bedroom or food service area. Soiled materials shall not be transported through the food service area. The laundry area shall be kept clean and orderly. 2. If commercial laundry is used, separate satisfactory storage areas shall be provided for clean and soiled linens. 3. Provisions shall be made for proper mechanical ventilation of the laundry.

4. Provisions shall also made to prevent the recirculation of air through the heating and air-conditioning systems. 5. Adequate and effective lint traps shall be provided for dryers. 6. When laundry chutes are provided, they shall have a minimum diameter of two (2) feet; and they shall be installed with flushing ring, vent, and drain. a. An automatic sprinkler shall be provided at the top of the laundry chute and in any receiving room for a chute. b. A self-closing door shall be provided at the bottom of the chute. 7. Laundry equipment shall be of the type to adequately perform the laundry needs of the facility. The equipment shall be installed to comply with all local and state codes. 8. There shall be a separate and designated area for the storage of clean linen.

Factors to be considered in approving a site shall be convenient to medical and hospital services, approved water supply and sewage disposal, public transportation, community services, services of an organized fire department, and availability to labor supply. Not more than one-third (1/3) of a site shall be covered by a building(s) except by special approval of the licensing agency. One example whereby approval may be granted is were the structure is to be placed in a very desirable location where the grounds are limited and very expensive.

Where such approval is granted, the structure will be required to have a living room, day room, sun room, and recreational areas adequate to compensate for lack of required outside area.

1. The basement shall be considered as a story if one-half (1/2) or more of its clear height is above the average elevation of the ground adjoining the building on all sides. 2. No resident shall be housed on any floor that is below ground level.

2. Floor plan showing over-all dimensions of building(s); location, size, and purpose of all rooms; location and size of all doors, windows, and other openings with swing of doors properly indicated; dimensions of all corridors and hallways; and location of stairs, elevators, dumbwaiters, vertical shafts, and chimneys. 3. Outline specifications giving kinds and types of materials.

1. Final stage or working drawings and specifications shall include: 2. Architectural drawings 3. Structural drawings 4. Mechanical drawings to include plumbing, heat, and air-conditioning 5. Electrical drawings 6. Detailed specifications 7. Approval of working drawings and specifications shall be obtained from the licensing agency in writing prior to the beginning of actual construction.

licensing agency prior to the beginning of work set forth in any contract modification.

Rule 48.21.3. Lighting. Each resident's room shall have artificial light adequate for reading and other uses as needed. There should be a minimum brightness of ten (10) foot candles of lighting for general use in residents' rooms and a minimum brightness of thirty (30) foot candles of lighting for reading purposes. All entrances, hallways, stairways, ramps, cellars, attics, storerooms, kitchens, laundries, and service units shall have sufficient artificial lighting to prevent accidents and promote efficiency of service. Night lights shall be provided in all hallways, stairways, toilets, and bathing rooms.

All walls and doors shall meet the same fire rating as the stairwell.

Extinguishers shall be inspected and serviced periodically as recommended by the manufacturer. The date of inspection shall be entered on a tag attached to the extinguisher and signed by a reliable inspector such as the local fire chief or representative of a fire extinguisher servicing company.

licensing agency may, in its discretion, require more frequent inspections and treatments. The inspection and treatment reports shall be maintained at the licensed facility.

1. Building Protection. a. Automatic Sprinklers Required. Facilities licensed after the effective date of these regulations shall be protected throughout by a supervised automatic sprinkler system installed in accordance with the current edition of NFPA 13, Installation of Sprinkler Systems. b. In facilities licensed for sixteen (16) or fewer residents and where the characteristics of occupancy are comparable with one (1) and two (2) family residential fire potentials, an NFPA 13D-styled sprinkler system may be installed. 2. Building Construction. a. Single story. No requirements b. Multi-story (less than four floors). One hour fire resistance rating as prescribed by the current edition of the National Fire Protection Association (NFPA) Standard 220, types of Building Construction. (Example: Type II (111), or Type V (111). c. Mobile structures. No mobile structures are acceptable for housing residents.

The minimum cab size of the elevator shall be approximately six (6) feet eight (8) inches by five (5) feet and constructed of metal. The width of the shaft door shall be at least three (3) feet six (6) inches. The load weight capacity shall not be less than 2,500 pounds. The elevator shaft shall be enclosed by construction of not less than a two-hour fire resistive rating. Elevators shall not be counted as required exits.

1. Handrails shall be provided on both sides of the stairs. 2. The width of the stairs shall not be less than forty-four (44) inches. 3. The stairs shall be well lighted at all times.

2. Dead end hallways in excess of twenty (20) feet are not allowed. 3. Doors to the exterior shall be not less than thirty-six (36) inches wide and egress shall not be impeded by being locked. 4. Exit doors shall swing in the direction of exit and shall not obstruct the travel along any required exit. 5. Doors leading to stairways shall be not less than thirty-six (36) inches wide. 6. Revolving doors shall not be used as required exits.

1. Hallways and passageways shall be kept unobstructed.

2. Hallways and passageways which lead to the outside from any required stairway shall be enclosed as required for stairways.

1. Mechanical, electrical, plumbing, heating, air-conditioning, and water systems installed shall meet the requirements of local codes and ordinances as well as the applicable regulation of the licensing agency. Where there are no local codes or ordinances, the following codes and recommendations shall govern: a. National Electrical Code. b. National Plumbing Code. c. American Society of Heating, Refrigerating, and Air Conditioning Engineers, Inc. d. Recommendations of the American Society of Mechanical Engineers. e. Recommendations of American Gas Association. f. National Fire Protection Association. 2. The heating of licensed facilities shall be restricted to steam, hot water, or warm air systems employing central heating plants, or Underwriters Laboratories approved electric heating. The use of portable heaters of any kind is prohibited with the following exceptions: a. Gas heaters provided they meet all of the following: i. A circulating type with a recessed enclosed flame so designed that clothing or other inflammable material cannot be ignited. ii. Equipped with a safety pilot light. iii. Properly vented to the outside. iv. Approved by American Gas Association or Underwriters Laboratories. b. An approved type of electrical heater such as wall insert type. 3. Lighting (except for battery-operated emergency lighting) shall be restricted to electricity.

Rule 48.23.1. The Residential Living Facility shall develop and maintain a written preparedness plan utilizing the “All Hazards” approach to emergency and disaster planning. The plan must include procedures to be followed in the event of any act of terrorism or man-made or natural disaster as appropriate for the specific geographical location. The final draft of the Emergency Operations Plan (EOP), will be reviewed by the Office of Emergency Preparedness and Response, Mississippi State Department of Health, or their designates, for conformance with the “All Hazards Emergency Preparedness and Response Plan.” Particular attention shall be given to critical areas of concern which may arise during any “all hazards” emergency whether required to evacuate or to sustain in place. Additional plan criteria or a specified EOP format may be required as deemed necessary by the Office of Emergency Preparedness and Response. 1. The six (6) critical areas of consideration are: a. Communications - Facility status reports shall be submitted in a format and a frequency as required by the Office of EOP. b. Resources and Assets c. Safety and Security d. Staffing e. Utilities f. Clinical Activities. 2. Emergency Operations Plans (EOPs) must be exercised and reviewed annually or as directed by the Office of Emergency Preparedness and Response. Written evidence of current approval or review of provider EOPs, by the Office of Emergency Preparedness and Response, shall accompany all applications for facility license renewals

1. Written Records. Written records of all drills shall be maintained, indicating content of and attendance at each drill. 2. A fire evacuation plan shall be posted in each facility in a conspicuous place and kept current.

CHAPTER 49 MINIMUM STANDARDS OF OPERATION FOR INTERMEDIATE CARE FACILITIES FOR INDIVIDUALS WITH INTELLECTUAL DISABILITIES (ICF-IID) Subchapter 1 GENERAL: INSTITUTIONS FOR THE AGED OR INFIRM INCLUSIVE OF INTERMEDIATE CARE FACILITIES FOR INDIVIDUALS WITH INTELLECTUAL DISABILITIES (ICF-IID): LEGAL AUTHORITY Rule 49.1.1 Adoption of Rules, Regulations, and Minimum Standards. By virtue of authority vested in it by Mississippi Code Annotated §43-11-1 through §43-11-17, or as otherwise amended, the Mississippi State Department of Health (otherwise known as the licensing agency), does hereby adopt and promulgate the following Rules, Regulations, and Minimum Standards for Intermediate Care Facilities for Individuals with Intellectual Disabilities (hereinafter referred to as ICF-IID). Upon adoption of these Rules, Regulations, and Minimum Standards for ICFs-IID, any former rules, regulations and minimum standards, in conflict therewith, previously adopted by the licensing agency are hereby repealed.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*
- *SOURCE: Miss. Code Ann. §43-11-13 Subchapter 14 PHYSICAL FACILITIES.*
- *SOURCE: Miss. Code Ann. §43-11-13 Rule 48.14.2. Dietary Staffing.*
- *SOURCE: Miss. Code Ann. §43-11-13 Subchapter 15 DRUG HANDLING Rule 48.15.1. Restrictions. Licensed facilities shall be restricted in the quantity and classes of drugs allowed in the licensed facility.*
- *SOURCE: Miss. Code Ann. §43-11-13 Rule 48.15.2. Labeling. The medications of all residents shall be clearly labeled.*
- *SOURCE: Miss. Code Ann. §43-11-13 Rule 48.15.3. Storage of Prescription Medications. Proper storage of all prescription medications shall be provided.*
- *SOURCE: Miss. Code Ann. §43-11-13 Rule 48.15.4. Responsibility. A non-resident employee, appointed by the operator, shall be responsible for the following: 1. Storage of prescription medications.*
- *SOURCE: Miss. Code Ann. §43-11-13*
- *SOURCE: Miss. Code Ann. §43-11-13 Subchapter 16 SOCIAL SERVICES Rule 48.16.1. The licensed facility shall make provisions for referring residents with social and emotional needs to an appropriate social services agency.*
- *SOURCE: Miss. Code Ann. §43-11-13 Subchapter 17 RESIDENT ACTIVITIES Rule 48.17.1. Activities Program. An activities program shall be in effect which is appropriate to the needs and interests of each resident.*
- *SOURCE: Miss. Code Ann. §43-11-13 Subchapter 18 PHYSICAL ENVIRONMENT Rule 48.18.1. Required Areas/Rooms. The following areas/rooms are required to be provided in a licensed facility: 1. Bedrooms;*
- *SOURCE: Miss. Code Ann. §43-11-13*
- *SOURCE: Miss. Code Ann. §43-11-13*
- *SOURCE: Miss. Code Ann. §43-11-13 Rule 48.18.4. Dining Area. A dining area shall be provided which shall be adequate to seat all residents at the same meal seating. The dining area may also be used for social, recreational, and/or religious services when not in use as a dining facility. A minimum of 15 Square feet per bed shall be provided.*
- *SOURCE: Miss. Code Ann. §43-11-13 Rule 48.18.5. Toilet and Bathing Facilities.*
- *SOURCE: Miss. Code Ann. §43-11-13 Rule 48.18.6. Laundry. Laundry facilities shall be provided unless commercial laundries are used.*
- *SOURCE: Miss. Code Ann. §43-11-13 Rule 48.18.7. Kitchen. The kitchen area shall meet the requirements as set forth in these regulations.*
- *SOURCE: Miss. Code Ann. §43-11-13 Subchapter 19 GENERAL Rule 48.19.1. Licensed Facility Classification. To qualify for a license, the facility shall be planned to serve the type of residents to be admitted and shall meet the requirements as set forth in these regulations.*
- *SOURCE: Miss. Code Ann. §43-11-13 Rule 48.19.2. Location. All facilities and licensed facilities shall be located so that they are free from undue noise, smoke, dust, or foul odors and shall not be located adjacent to disposal plants, railroad tracks, etc.*
- *SOURCE: Miss. Code Ann. §43-11-13 Rule 48.19.3. Site. The proposed site for facility must be approved by the licensing agency.*
- *SOURCE: Miss. Code Ann. §43-11-13 Rule 48.19.4. Local Restrictions. The site and structure of all licensed facilities shall comply with local building, fire, and zoning ordinances. Proof of compliance shall be submitted to the licensing agency.*
- *SOURCE: Miss. Code Ann. §43-11-13 Rule 48.19.5. Transportation. Licensed facilities shall be located on streets or roads which are passable at all times. They should be located convenient to public transportation facilities.*
- *SOURCE: Miss. Code Ann. §43-11-13 Rule 48.19.6. Communications. There shall be not less than one telephone in the licensed facility and such additional telephones as are necessary to summon help in the event of fire or other emergency. The telephone shall be listed under the official licensed name or title of the licensed facility.*
- *SOURCE: Miss. Code Ann. §43-11-13 Rule 48.19.7. Occupancy. No part of the licensed facility may be rented, leased, or used for any purpose not related to the operation of the licensed facility.*
- *SOURCE: Miss. Code Ann. §43-11-13 Rule 48.19.8. Basement.*
- *SOURCE: Miss. Code Ann. §43-11-13 Subchapter 20 SUBMISSIONS OF PLANS AND SPECIFICATIONS, EFFECTIVE AUGUST 13, 2005 Rule 48.20.1. Minor Alterations and Remodeling. Minor alterations and remodeling which do not affect the structural integrity of the building, change functional operation, affect fire safety, or affect the license bed capacity, do not need to have plans submitted for review provided that a detailed explanation of the proposed alteration or remodeling is submitted to and approved by the licensing agency.*
- *SOURCE: Miss. Code Ann. §43-11-13 Rule 48.20.2. First Stage Submission-Preliminary Plans. First stage or preliminary plans shall include: 1. Plot plan showing size and shape of entire site; location of proposed building and any existing structure(s); adjacent streets, highways, sidewalks, railroads, etc., all properly designated; and size, characteristics, and location of all existing public utilities.*
- *SOURCE: Miss. Code Ann. §43-11-13 Rule 48.20.3. Final Stage Submission-Working Drawings and Specifications.*
- *SOURCE: Miss. Code Ann. §43-11-13 Rule 48.20.4. Preparation of Plans and Specifications. The preparation of drawings and specifications shall be executed by or under the immediate supervision of an architect who shall supervise construction and furnish a signed statement that construction was performed according to plans and specifications approved by the licensing agency.*
- *SOURCE: Miss. Code Ann. §43-11-13 Rule 48.20.5. Contract Modifications. Any contract modification which affects or changes the function, design, or purpose of a facility shall be submitted to and approved by the*
- *SOURCE: Miss. Code Ann. §43-11-13 Rule 48.20.6. Notification of Start of Construction. The licensing agency shall be informed in writing at the time construction is begun.*
- *SOURCE: Miss. Code Ann. §43-11-13 Rule 48.20.7. Inspections. The licensing agency or its authorized representatives shall have access at all times to the work for inspection whenever it is in preparation or progress, and the owner shall ascertain that proper facilities are made available for such access and inspection.*
- *SOURCE: Miss. Code Ann. §43-11-13 Rule 48.20.8. Limit of Approval. In construction delayed for a period of exceeding six (6) months from the time of approval of final working plans and specifications, a new evaluation and/or approval shall be obtained from the licensing agency.*
- *SOURCE: Miss. Code Ann. §43-11-13 Rule 48.20.9. Water Supply, Plumbing, Sewerage Disposal. The water supply and sewerage disposal shall be approved by the local county health department and/or the Division of Sanitary Engineering, Mississippi State Department of Health. No system of water supply, plumbing, sewerage, garbage, or refuse disposal shall be installed nor any such existing system materially altered or extended until complete plans and specifications for the installation, alteration, or extension have been so approved and submitted to the licensing agency for review and final determination.*
- *SOURCE: Miss. Code Ann. §43-11-13 Subchapter 21 GENERAL BUILDING REQUIREMENTS Rule 48.21.1. Structural Soundness and Repair. The building shall be structurally sound, free from leaks and excessive moisture, in good repair, and painted at sufficient intervals to be reasonably attractive inside and out. Walls and ceilings of hazardous areas shall be one (1) hour fire resistance rating.*
- *SOURCE: Miss. Code Ann. §43-11-13 Rule 48.21.2. Heating and Cooling Systems. Adequate heating and cooling systems shall be provided to maintain inside temperature between 68 degrees Fahrenheit and 78 degrees Fahrenheit depending on the season.*
- *SOURCE: Miss. Code Ann. §43-11-13*
- *SOURCE: Miss. Code Ann. §43-11-13 Rule 48.21.4. Emergency Lighting. At least one functioning, battery-operated emergency light shall be provided in each hallway.*
- *SOURCE: Miss. Code Ann. §43-11-13 Rule 48.21.5. Screens. All screen doors and non-stationary windows shall be equipped with tight fitting, full length, sixteen (16) mesh screens. Screen doors shall swing out and shall be equipped with self-closing devices.*
- *SOURCE: Miss. Code Ann. §43-11-13 Rule 48.21.6. Floors. All floors shall be smooth and free from defects such as cracks, and shall be finished so that they can be easily cleaned.*
- *SOURCE: Miss. Code Ann. §43-11-13 Rule 48.21.7. Walls and Ceilings. All walls and ceilings shall be of sound construction, with an acceptable surface, and shall be maintained in good repair.*
- *SOURCE: Miss. Code Ann. §43-11-13 Rule 48.21.8. Ceiling Height. All ceilings shall have a height of at least seven (7) feet, except that a height of six (6) feet six (6) inches may be approved for hallways or toilets and bathing rooms where the lighting fixtures are recessed.*
- *SOURCE: Miss. Code Ann. §43-11-13 Rule 48.21.9. Ramps and Inclines. Ramps and inclines, where installed for the use of residents, shall not exceed one (1) foot of rise in ten (10) feet of run, shall be furnished with a non-slip floor, and shall be provided with handrails on both sides.*
- *SOURCE: Miss. Code Ann. §43-11-13 Rule 48.21.10. Door Swing. Exit doors, other than from a living unit, shall swing in the director of exit from the structure.*
- *SOURCE: Miss. Code Ann. §43-11-13 Rule 48.21.11. Floor Levels. All differences in floor levels within the building shall be accomplished by stairs of not less than three (3) six-inch risers, ramps, or inclines, and shall be equipped with handrails on both sides.*
- *SOURCE: Miss. Code Ann. §43-11-13 Rule 48.21.12. Space Under Stairs. Space under stairs shall not be used for storage purposes.*
- *SOURCE: Miss. Code Ann. §43-11-13 Rule 48.21.13. Interior Finish and Floor Coverings. Interior finish and decorative material shall be not less than Class B and floor covering shall have a flame spread not to exceed 75.*
- *SOURCE: Miss. Code Ann. §43-11-13 Rule 48.21.14. Fire Extinguishers. Fire extinguishers of number, type, and capacity appropriate to the need shall be provided for each floor and for special fire hazard areas such as kitchen, laundry, and mechanical room. All extinguishers shall be of a type approved by the licensing agency. A vaporizing liquid extinguisher (such as carbon tetrachloride) will not be approved for use inside the building.*
- *SOURCE: Miss. Code Ann. §43-11-13 Rule 48.21.15. Smoke Detectors. Smoke detectors shall be installed in each hallway no more than thirty (30) feet apart, in all bedrooms and in all storage rooms.*
- *SOURCE: Miss. Code Ann. §43-11-13 Rule 48.21.16. Trash Chutes. Trash chutes are prohibited.*
- *SOURCE: Miss. Code Ann. §43-11-13 Rule 48.21.17. Housekeeping and Maintenance. The interior and exterior of the licensed facility shall be maintained in an attractive, safe and sanitary condition.*
- *SOURCE: Miss. Code Ann. §43-11-13 Rule 48.21.18. Pest Control. Pest control inspections and, if necessary, treatments, shall be made to control pests, vermin, insects and rodents, at a minimum of once every thirty (30) days, by a company that is licensed by the State of Mississippi. The*
- *SOURCE: Miss. Code Ann. §43-11-13 Rule 48.21.19. Water Temperature. The temperature of hot water at plumbing fixtures used by residents shall not exceed 115 degrees Fahrenheit and no less than 100 degrees Fahrenheit.*
- *SOURCE: Miss. Code Ann. §43-11-13 Rule 48.21.20. Combustion Air. Combustion air to all equipment requiring it must come from the outside.*
- *SOURCE: Miss. Code Ann. §43-11-13 Subchapter 22 BUILDING REQUIREMENTS Rule 48.22.1. Building Protection. Facilities licensed after August 13, 2005, shall be constructed to have;*
- *SOURCE: Miss. Code Ann. §43-11-13 Rule 48.22.2. Multi-story Building. Elevator Required. No resident shall be housed in a building three stories and above unless the building is equipped with an elevator.*
- *SOURCE: Miss. Code Ann. §43-11-13 Rule 48.22.3. Hazardous Areas and Combustible Storage. Heating apparatus and boiler and furnace rooms, basements, or attics used for the storage of combustible material and workrooms, shall be classified as hazardous areas and shall be separated from other areas by construction having a fire resistive rating of at least one (1) hour.*
- *SOURCE: Miss. Code Ann. §43-11-13 Rule 48.22.4. Stairs. Stairs shall be enclosed with at least one-hour fire rated construction.*
- *SOURCE: Miss. Code Ann. §43-11-13 Rule 48.22.5. Exit Doors. Exit doors shall meet the following: 1. At least two (2) remotely located exits shall be provided for each occupied story of a facility.*
- *SOURCE: Miss. Code Ann. §43-11-13 Rule 48.22.6. Hallways and Passageways.*
- *SOURCE: Miss. Code Ann. §43-11-13 Rule 48.22.7. Mechanical and Electric Systems.*
- *SOURCE: Miss. Code Ann. §43-11-13 Subchapter 23 EMERGENCY OPERATIONS PLAN*
- *SOURCE: Miss. Code Ann. §43-11-13 Subchapter 24 FACILITY FIRE PREPAREDNESS Rule 48.24.1. Fire Drills. Fire drills shall be conducted one (1) per shift per quarter. Employees shall participate in a fire drill at least four (4) times per year.*
- *SOURCE: Miss. Code Ann. §43-11-13*
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 49.1.2** Codes and Ordinances {#sec-16-49.1.2 omnilex-key=us-ms-regs-official--title-15--16#49.1.2}

Every ICF-IID or ICF-IID residential community home located inside the boundaries of a municipality shall comply with all local municipal codes and ordinances applicable thereto. In addition, each ICF-IID and/or ICF-IID residential community home shall comply with all applicable state and federal laws.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 49.1.3** Fire Safety {#sec-16-49.1.3 omnilex-key=us-ms-regs-official--title-15--16#49.1.3}

No ICF-IID or ICF-IID residential community home shall be licensed until it shows conformance to the safety regulations providing minimum standards for prevention and detection of fire as well as for protection of life and property against fire.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 49.1.4** Duty to Report {#sec-16-49.1.4 omnilex-key=us-ms-regs-official--title-15--16#49.1.4}

All fires, explosions, natural disasters as well as avoidable deaths or avoidable, serious, or life-threatening injuries to clients resulting from fires, explosions, and natural disasters shall be reported by telephone to the Fire Safety and Construction Division of the licensing agency by the next working day after the occurrence. The licensing agency will provide the appropriate forms to the ICF- IID which shall be completed and returned within fifteen (15) calendar days of the occurrence. All reports shall be complete and thorough and shall record, at a minimum the causal factors, date and time of occurrence, exact location of

occurrence within or without the ICF-IID, and attached thereto shall be all police, fire, or other official reports.

Rule 49.2.1 Active Treatment. The term active treatment shall mean that each client receive a continuous active treatment program, which includes aggressive consistent implementation of a program of specialized and generic training, treatment, health services, and related services that is directed toward the acquisition of the behaviors necessary for the client to function with as much self-determination and independence as possible; and for the prevention or deceleration of regression or loss of current optimal functional status.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13 Subchapter 2 Definitions.*
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 49.2.2** Administrator {#sec-16-49.2.2 omnilex-key=us-ms-regs-official--title-15--16#49.2.2}

The term "administrator" shall mean a person who is delegated responsibility for the interpretation, implementation, and proper application of policies and programs established by the governing authority and are delegated responsibility for the establishment of safe and effective administrative management, control, and operation of the services provided and as required in an ICF-IID. The administrator shall be duly licensed by the Mississippi State Board of Nursing Home Administrators. 1. “Administrator for ICF-IID Residential Community Home”. The Administrator for the ICF-IID Residential Community Home shall mean a highly responsible position under the direct supervision of the Executive Director/Governing Authority who is delegated responsibility over establishment of safe and effective administrative management, control, and operation of the services provided in the Residential Community Home. This individual at a minimum should hold a license as a Nursing Home Administrator with experience in an ICF-IID, or have a Master’s degree in a related field and meet the qualifications of a Qualified Intellectual Disabilities Professional (QIDP). An Administrator for an ICF-IID Residential Community Home shall administer homes within a 75 mile geographic service area of the governing authority.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 49.2.3** Allegation of Compliance {#sec-16-49.2.3 omnilex-key=us-ms-regs-official--title-15--16#49.2.3}

Allegation of Compliance shall mean a detailed corrective action taken by the ICF-IID or the ICF-IID residential community home to remove an immediate jeopardy, including the date the immediate jeopardy is removed, with sufficient detail outlining that the immediate jeopardy situation has been addressed, and resolved. Rule 49.2.4 Bed Capacity. The term "bed capacity" shall mean the largest number which can be installed or set up in an ICF-IID at any given time for use of clients, as printed

on the certificate of licensure. The bed capacity shall be based upon space designed and/or specifically intended for such use whether or not the beds are actually installed or set up.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 49.2.5** Bed Count {#sec-16-49.2.5 omnilex-key=us-ms-regs-official--title-15--16#49.2.5}

The term "bed count" shall mean the number of beds that are actually installed or set up for clients in an ICF-IID at a given time.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 49.2.6** Change of Ownership {#sec-16-49.2.6 omnilex-key=us-ms-regs-official--title-15--16#49.2.6}

The term "change of ownership" includes, but is not limited to, intervivos gifts, purchases, transfers, leases, cash and/or stock transactions or other comparable arrangements whenever the person or entity acquires a majority interest (Fifty percent [50%] or more) of the ICF-IID or services. Changes of ownership from partnerships, single proprietorships or corporations to another form of ownership are specifically included. Provided, however, "Change of Ownership" shall not include inherited interest acquired as a result of a testamentary instrument or under the laws of descent and distribution of the State of Mississippi

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 49.2.7** Client {#sec-16-49.2.7 omnilex-key=us-ms-regs-official--title-15--16#49.2.7}

The term "client" shall mean any person admitted to an intermediate care facility.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 49.2.8** Criminal History Record Checks {#sec-16-49.2.8 omnilex-key=us-ms-regs-official--title-15--16#49.2.8}

1. Affidavit. For the purpose of fingerprinting and criminal background history checks, the term “affidavit” means the use of Mississippi State Department of Health (MSDH) Form #210, or a copy thereof, which shall be placed in the individual’s personal file. 2. Employee. For the purpose of fingerprinting and criminal background history checks, employee shall mean any individual employed by a covered entity. The term “employee”, also includes any individual who by contract with the covered entity provides direct patient care in a patient’s, resident’s, or client’s room or in treatment rooms. The term “employee” does not include healthcare professional/technical students, as defined in Section 37-29-232, performing clinical training in a licensed entity under contracts between their schools and the licensed entity, and does not include students at high schools who observe the treatment and care of patients in a licensed entity as part of the requirements of an allied health course taught in the school if: a. The student is under the supervision of a licensed healthcare provider; and

b. The student has signed the affidavit that is on file at the student’s school stating that he or she has not been convicted of or plead guilty or nolo contendere to a felony of possession or sale of drugs, murder, manslaughter, armed robbery, rape, sexual battery, any sex offenses listed in section 45- 33-23 (g), child abuse, arson, grand larceny, burglary, gratification of lust, aggravated assault, or felonious abuse and/or battery of a vulnerable adult, or that any such conviction or plea was reversed on appeal or a pardon was granted for the conviction or plea. c. Further, applicants and employees of the University of Mississippi Medical Center for whom criminal history record checks and fingerprinting are obtained in accordance with Section 37-115-41 are exempt from application of the term employee under Section 43-11-13. 3. Covered Entity. For the purpose of criminal history record checks, “covered entity” means a licensed entity or a healthcare professional staffing agency. 4. Licensed Entity. For the purpose of criminal history record checks, the term “licensed entity” means a hospital, nursing home, personal care home, home health agency or hospice. 5. Health Care Professional/Vocational Technical Academic Program. For the purpose of criminal history record checks, “health care professional/vocational technical academic program” means an academic program in medicine, nursing, dentistry, occupational therapy, physical therapy, social services, speech therapy, or other allied-health professional whose purpose is to prepare professionals to render patient care services. 6. Health Care Professional/Vocational Technical Student. For purposes of criminal history record checks, the term means a student enrolled in a healthcare professional/vocational technical academic program. 7. Direct Patient Care or Services. For purposes of fingerprinting and criminal background history checks, the term “direct patient care” means direct hands- on medical patient care and services provided by an individual in a patient’s, resident’s or client’s room, treatment room or recovery room. Individuals providing direct patient care may be directly employed by the ICF-IID or provides patient care on a contractual basis. 8. Documented Disciplinary Action. For the purpose of fingerprinting and criminal background history checks, the term “documented disciplinary action” means any action taken against an employee for abuse or neglect of a patient.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 49.2.9** Day Shift {#sec-16-49.2.9 omnilex-key=us-ms-regs-official--title-15--16#49.2.9}

The term “day shift” shall mean a minimum eight (8) hour period between 6:00 a.m. and 6:00 p.m.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 49.2.10** Dentist {#sec-16-49.2.10 omnilex-key=us-ms-regs-official--title-15--16#49.2.10}

The term "dentist" shall mean a person currently licensed to practice dentistry in Mississippi by the State Board of Dental Examiners

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 49.2.11** Dietitian {#sec-16-49.2.11 omnilex-key=us-ms-regs-official--title-15--16#49.2.11}

The term “dietitian” shall mean a person who is licensed as a dietitian in the State of Mississippi, or a Registered Dietitian exempted from licensure by statute.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 49.2.12** Direct Support Personnel and/or Professionals {#sec-16-49.2.12 omnilex-key=us-ms-regs-official--title-15--16#49.2.12}

Direct Support Personnel and/or Professionals (DSPs) are persons who work directly with developmental disabilities with the aim of assisting the individual to lead a self-directed life and contribute to their surroundings. A DSP assists with activities of daily living, if needed, and encourages attitudes and behaviors that enhance community inclusion. A DSP may provide support to a person with a disability in their environment, be it in their home or residence setting, work, school, church, and other places. A DSP also acts as an advocate for the individual with disabilities, in communicating their needs, self-expression, and goals. A DSP shall have at a minimum a high school diploma or a GED.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 49.2.13** Existing ICF-IID {#sec-16-49.2.13 omnilex-key=us-ms-regs-official--title-15--16#49.2.13}

The term "existing ICF-IID" shall mean an ICF-IID that has obtained licensure prior to the adoption of these regulations.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 49.2.14** Governing Body {#sec-16-49.2.14 omnilex-key=us-ms-regs-official--title-15--16#49.2.14}

There shall be an organized governing body, or designated persons so functioning, that has the overall responsibility, for the conduct of the ICF-IID, in a manner consistent with the objective of making available high quality client care. The term "governing body" shall mean an individual or individuals identified by the ICF-IID that exercise general policy, budget, and operating direction over the ICF-IID; and provides, monitors, and revises as necessary policies and operating directions which ensure the necessary staffing, training, resources, equipment, and environment to provide individuals with active treatment and to provide for their health and safety at all times.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 49.2.15** Infectious Medical Waste {#sec-16-49.2.15 omnilex-key=us-ms-regs-official--title-15--16#49.2.15}

The term "infectious medical waste" includes solid or liquid wastes which may contain pathogens with sufficient virulence and quantity such that exposure to the waste by a susceptible host has been proven to result in an infectious disease. For purposes of this regulation, the following wastes shall be considered to be infectious medical wastes:

1. Waste resulting from the care of clients and animals who have Class I and (or) II diseases that are transmitted by blood and body fluid as defined in the rules and regulations governing reportable diseases as defined by the Mississippi State Department of Health; 2. Cultures and stocks of infectious agents; including specimen cultures collected from medical and pathological laboratories, cultures and stocks of infectious agents from research and industrial laboratories, wastes from the production of biological, discarded lie and attenuated vaccines, and culture dishes and devices used to transfer, inoculate, and mix cultures; 3. Blood and blood products such as serum, plasma, and other blood components. 4. All discarded sharps (e.g., hypodermic needles, syringes, Pasteur pipettes, broken glass, scalpel blades) which have come into contact with infectious agents; 5. Other wastes determined infectious by the generator or so classified by the Mississippi State Department of Health.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 49.2.16** Rule 49.2.16 {#sec-16-49.2.16 omnilex-key=us-ms-regs-official--title-15--16#49.2.16}

Intermediate Care for the Intellectually and/or Developmentally Disabled (ICF-IID) Facility either governmental or private who provides group living arrangements for four (4) or more persons who are unrelated to the operator and whose primary purpose is to provide health or rehabilitative services, active treatment, to individuals with intellectual or developmental disabilities and to provide food, shelter, and personal care whether any such place be organized or operated for profit or not. These ICF-IID services may be provided in an existing ICF-IID or a group home under the jurisdiction of an ICF-IID. 1. In an ICF-IID Residential Community Home, these services shall be provided in group living arrangements for no more than six (6) clients who are unrelated to the operator.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 49.2.17** Individual Program Plan (IPP) {#sec-16-49.2.17 omnilex-key=us-ms-regs-official--title-15--16#49.2.17}

Each client must have an individual program plan that is developed by an interdisciplinary team that represents the professions, disciplines or service areas relevant to identifying the client’s needs as described by the comprehensive functional assessments. This IPP shall be prepared within 30 days after admission.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 49.2.18** Rule 49.2.18 {#sec-16-49.2.18 omnilex-key=us-ms-regs-official--title-15--16#49.2.18}

Interdisciplinary Team: The Interdisciplinary team is composed of those individuals (professionals, paraprofessionals and non-professionals) who possess the knowledge, skills, and expertise necessary to accurately identify the

comprehensive array of the individual’s needs and design a program which is responsive to those needs.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 49.2.19** License {#sec-16-49.2.19 omnilex-key=us-ms-regs-official--title-15--16#49.2.19}

The term "license" shall mean the document issued by the licensing agency and signed by the State Health Officer of the Mississippi State Department of Health. Licensure shall constitute authority to receive clients and perform the services included within the scope of these rules, regulations, and minimum standards.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 49.2.20** Licensed Practical Nurse {#sec-16-49.2.20 omnilex-key=us-ms-regs-official--title-15--16#49.2.20}

The term "licensed practical nurse" shall mean a person who is currently licensed by the Mississippi Board of Nursing as a Licensed Practical Nurse.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 49.2.21** Licensee {#sec-16-49.2.21 omnilex-key=us-ms-regs-official--title-15--16#49.2.21}

The term "licensee" shall mean the person to which the license is issued and upon whom rests the responsibility for the operation of the institution in compliance with these rules, regulations, and minimum standards.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 49.2.22** IGRA(s) (Interferon-Gamma Release Assay(s) {#sec-16-49.2.22 omnilex-key=us-ms-regs-official--title-15--16#49.2.22}

A whole blood test used in to assist in diagnosing Mycobacterium Tuberculosis infection. The IGRA blood test used must be approved by the U.S. Food and Drug Administration (FDA).

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 49.2.23** Licensing Agency {#sec-16-49.2.23 omnilex-key=us-ms-regs-official--title-15--16#49.2.23}

The term "licensing agency" shall mean the Mississippi State Department of Health

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 49.2.24** Licensure Violation {#sec-16-49.2.24 omnilex-key=us-ms-regs-official--title-15--16#49.2.24}

The failure of an ICF-IID or an ICF-IID Residential Community Home to comply with the minimum standards or requirements contained within this Chapter 49.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 49.2.25** Mantoux Test {#sec-16-49.2.25 omnilex-key=us-ms-regs-official--title-15--16#49.2.25}

A method of skin testing that is performed by injecting one-tenth (0.1) milliliter of purified protein derivative-tuberculin containing five (5) tuberculin units into the dermis (i.e., the second layer of skin) of the forearm with a needle and syringe. The area is examined between forty-eight (48) and seventy- two (72) hours after the injection. A reaction is measured according to the size of the induration. The classification of a reaction as positive or negative depends on

the patient’s medical history and various risk factors (see definition for “significant tuberculin skin test”). This test is used to evaluate the likelihood that a person is infected with M. tuberculosis. The Mantoux (TST) test should be administered only by persons certified in the intradermal technique.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 49.2.26** Medical Waste {#sec-16-49.2.26 omnilex-key=us-ms-regs-official--title-15--16#49.2.26}

The term "medical waste" means all waste generated in direct client care or in diagnostic or research areas that is non-infectious.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 49.2.27** New ICF-IID {#sec-16-49.2.27 omnilex-key=us-ms-regs-official--title-15--16#49.2.27}

The term "new ICF-IID" shall mean an ICF-IID or an ICF-IID Residential Community Home that applies for licensure after the adoption of these regulations.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 49.2.28** Nurse Practitioner/Physician Assistant {#sec-16-49.2.28 omnilex-key=us-ms-regs-official--title-15--16#49.2.28}

The term “nurse practitioner” shall mean a person who is currently licensed by the Mississippi Board of Nursing as a nurse practitioner. The term “physician assistant” shall mean a physician assistant who is currently licensed as such by the Mississippi Board of Medical Licensure.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 49.2.29** Rule 49.2.29 {#sec-16-49.2.29 omnilex-key=us-ms-regs-official--title-15--16#49.2.29}

Nutritional Assessment: A nutritional assessment is conducted to assess nutritional status and includes determination of appropriateness of diet, adequacy of total food intake and the skills associated with eating, including chewing, sucking and swallowing disorders, food service practices, and monitoring and supervision of one’s own nutritional status. A Registered Dietician shall provide ongoing evaluation and assessment when individual needs are identified and, at minimum, on a quarterly basis and more often if indicated. The Registered Dietician shall be notified for intervention as appropriate when a change in nutritional status, weight loss or weight gain is noted. The initial nutritional assessment shall be completed within 30 days after admission.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 49.2.30** Person {#sec-16-49.2.30 omnilex-key=us-ms-regs-official--title-15--16#49.2.30}

The term "person" shall mean any individual, firm, partnership, corporation, company, association, or joint stock association, or any licensee herein or the legal successor thereof.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 49.2.31** Personal Care {#sec-16-49.2.31 omnilex-key=us-ms-regs-official--title-15--16#49.2.31}

The term "personal care" shall mean assistance rendered by personnel of the ICF-IID for clients in performing one or more of the activities of daily living which includes, but is not limited to, the bathing, walking, excretory functions, feeding, personal grooming, and dressing of such clients.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 49.2.32** Pharmacist {#sec-16-49.2.32 omnilex-key=us-ms-regs-official--title-15--16#49.2.32}

The term "pharmacist" shall mean a person currently licensed to practice pharmacy in Mississippi by the State Board of Pharmacy.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 49.2.33** Physician {#sec-16-49.2.33 omnilex-key=us-ms-regs-official--title-15--16#49.2.33}

The term "physician" shall mean any person currently licensed in Mississippi by the Mississippi State Board of Medical Licensure.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 49.2.34** Plan of Correction {#sec-16-49.2.34 omnilex-key=us-ms-regs-official--title-15--16#49.2.34}

Plan of Correction shall mean a plan developed by the ICF- IID and/or the ICF-IID Residential Community Home and approved by the licensure agency that describes the action the ICF-IID and/or the ICF-IID Residential Community Home will take to correct the licensure violation(s) and specifies the date by which these licensure violation(s) will be corrected.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 49.2.35** Rule 49.2.35 {#sec-16-49.2.35 omnilex-key=us-ms-regs-official--title-15--16#49.2.35}

Program Director: The term “Program Director” shall mean a person who works under the authority of the Administrator or the governing authority of an ICF-IID to ensure that health or rehabilitative services, active treatment is provided to individuals with intellectual or developmental disabilities. This individual shall have at a minimum a Master’s degree from an accredited four year college or university or graduation from a standard four-year high school and four years of experience working with individuals with intellectual or developmental disabilities. The Program Director must meet the qualifications of a Qualified Intellectual Disabilities Professional (QIDP). 1. A Program Director shall have no more than 60 clients under their supervisory authority.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 49.2.36** Qualified Dietary Manager {#sec-16-49.2.36 omnilex-key=us-ms-regs-official--title-15--16#49.2.36}

1. ICFs-IID shall have the following at a minimum: a. A Dietetic Technician who has successfully graduated from a Dietetic Technician program accredited by the American Dietetic Association Commission on Accreditation and Approval of Dietetic Education and earns 15 hours of continuing education units every year approved by the Dietary Manager's Association or the American Dietetic Association. b. A person who has successfully graduated from a didactic program in Dietetics approved by the American Dietetic Association Commission on Accreditation and Approval of Dietetic Education and earns 15 hours of

continuing education units every year approved by the Dietary Manager's Association or the American Dietetic Association. c. A person who has successfully completed a Dietary Manager's Course approved by the Dietary Manager's Association and who passes the credentialing examination and earns 15 hours of continuing education units every year approved by the Dietary Manager's Association or the American Dietetic Association. d. A person who has successfully completed a Dietary Manager's Course approved by the Dietary Manager's Association and earns 15 hours of continuing education units every year approved by the Dietary Manager's Association or the American Dietetic Association – 2. In addition, each ICF-IID Residential Community Home shall have the following at a minimum: a. A Licensed Registered Dietician (LRD) or a registered dietitian exempted from licensure by statute must be employed full time, part time, or on a consultant basis to ensure each client receives a nourishing, well balanced diet including modified and specially prescribed diets. Onsite visits of at least monthly must be provided by the RD to ensure compliance to written menus, prescribed diets and meal service. The RD will provide a nutritional assessment with recommended needs on an annual basis. Consultative written reports from the RD shall be kept on file in the ICF-IID.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 49.2.37** Qualified Intellectual Disabilities Professional (QIDP) {#sec-16-49.2.37 omnilex-key=us-ms-regs-official--title-15--16#49.2.37}

The QIDP must have at least one year of experience working directly with persons with intellectual and developmental disabilities; and is one of the following, a doctor of medicine osteopathy, a registered nurse, and/or an individual who holds a bachelor’s degree in a professional category.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 49.2.38** Registered Nurse {#sec-16-49.2.38 omnilex-key=us-ms-regs-official--title-15--16#49.2.38}

The term "registered nurse" shall mean a person who is currently licensed by the Nurses' Board of Examination and Registration of Mississippi Board of Nursing as a registered nurse.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 49.2.39** Restraint {#sec-16-49.2.39 omnilex-key=us-ms-regs-official--title-15--16#49.2.39}

The term "restraint" shall include any means, physical or chemical, which is intentionally used to restrict the freedom of movement of a person.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 49.2.40** Surveyor {#sec-16-49.2.40 omnilex-key=us-ms-regs-official--title-15--16#49.2.40}

The term "surveyor" shall mean an individual employed, or hired on a contractual basis, by the licensing agency for the purpose of conducting surveys, inspections, investigations, or other related functions as part of the licensing agency’s responsibility for licensure and regulation of ICFs-IID.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 49.2.41** Significant Tuberculin Skin Test {#sec-16-49.2.41 omnilex-key=us-ms-regs-official--title-15--16#49.2.41}

An induration of five (5) millimeters or greater is significant (or positive) in the following: 1. Persons known to have or suspected of having human immunodeficiency virus (HIV). 2. Close contacts of a person with infectious tuberculosis. 3. Persons who have a chest radiograph suggestive of previous tuberculosis. 4. Persons who inject drugs (if HIV status is unknown). 5. An induration of ten (10) millimeters or greater is significant (or positive) in all other persons tested in Mississippi. A tuberculin skin test is recorded in millimeters of induration. For accurate results, measure the widest diameter of the palpable induration transverse (across) the arm.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 49.2.42** Two-step Testing {#sec-16-49.2.42 omnilex-key=us-ms-regs-official--title-15--16#49.2.42}

A procedure used for the baseline testing of person who will periodically receive tuberculin skin tests (e.g., health care workers) to reduce the likelihood of mistaking a boosted reaction for a new infection. If the initial tuberculin-test result is classified as negative, a second test is repeated one (1) to three (3) weeks later. If the reaction to the second test is positive, it probably represents a boosted reaction. If the second test is also negative, the person is classified as not infected. A positive reaction to a subsequent test would indicate new infection (i.e., a skin-test conversion) in the person.

Subchapter 4 CLASSIFICATION OF AN ICF-IID OR AN ICF-IID RESIDENTIAL COMMUNITY HOME Rule 49.4.1 ICF-IID. To be classified as an ICF-IID or an ICF-IID Residential Community Home, the ICF-IID shall comply with the following staffing requirements: 1. Minimum requirements for nursing staff shall be arranged or employed so that licensed nursing staff are sufficient to care for clients’ health needs. Individuals on a medical care plan shall receive 24-hour nursing services as indicated by that plan. Individuals not on a medical care plan shall receive services as indicated by the assessment, the IPP, and in accordance with any changes in health status. 2. ICF-IID staffing is met when there are sufficient numbers of competent, trained staff to provide active treatment; and when there are sufficient numbers of staff to provide individuals’ health and safety. The ICF-IID must have available enough staff to carry out and monitor the various professional interventions in accordance with the stated goals and objectives of every individualized program plan.

3. The ICF-IID must ensure for the availability of physician services 24 hours per day. Procedures must be established that provide steps to be followed when the designated physician is not available. Staff should be aware of procedures for contacting physicians in the event of an emergency. 4. Each ICF-IID and/or Residential Community Home shall have the following personnel as a minimum: a. Program Director: There shall be a Program Director responsible for ensuring that all clients in the ICF-IID are following a specific IPP to meet their needs as an individual. The Program Director will ensure the clients’ records are properly maintained and reflects the programming the client is receiving b. There should be sufficient numbers of QIDPs to accomplish the job of providing an active treatment program to each client in an integrated, coordinated manner, and to monitor the active treatment program for each client. c. Professional Program Staff: Each client must receive the professional program services needed to implement the active treatment program defined by each client’s IPP. The ICF-IDD must have enough qualified professional staff to carry out and monitor the various professional interventions in accordance with the stated goals and objectives of every IPP. Professional program staff must be licensed, certified, or registered as applicable, to provide professional services as required by State Licensure.

d. Program staff responsible for therapeutic services must have at least a Master’s degree in a behavioral health or related field and hold current licensure as one of the following: a Psychologist from the MS Board of Psychology, a Licensed Professional Counselor from the MS Board of Licensed Professional Counselors, or a Licensed Certified Social Worker from the MS State Board of Examiners of Social Workers and Marriage & Family Therapists. Professional credentialing through the MS Department of Mental Health as a Certified Intellectual and Developmental Disabilities Therapist, Licensed Clinical Intellectual and Developmental Disabilities Therapist, Certified Mental Health Therapist, and Licensed Clinical Mental Health Therapist is also accepted.

e. Social Worker: A Social Worker licensed by the Mississippi State Board of Examiners of Social Workers and Marriage & Family Therapists. A social worker may hold current licensure as a Licensed Bachelor Social Worker, Licensed Master Social Worker or Licensed Certified Social Worker.

f. Recreational Therapist: To be designated as a professional recreation staff member an individual must have a bachelor’s degree in recreation or in a specialty area such as dance, music, or physical education. g. Direct Support Personnel and/or Professionals. The ICF-IID must provide sufficient direct support professionals to manage and supervise clients in accordance with their IPP. At any time, each ICF-IID is responsible for staffing as appropriate based on the required number of staff to carry out the goals and objectives of each client’s IPP. 5. All staff involved in food service shall be trained in food and beverage safety and handling procedures through a certification program accredited by the ANSI Conference for Food Protection. 6. There must be responsible trained staff on duty on a 24 hour basis (when clients are present) to respond to injuries and symptoms of illness, and to handle emergencies. The staff should be knowledgeable of each client’s IPP. There shall be at least two (2) employees on duty in the ICF-IID at all times seven (7) days a week, 24 hours a day, in the event of an emergency with a designated person in charge on each shift.

Subchapter 6 APPLICATION FOR LICENSE Rule 49.6.1 Application. Application for a license or renewal of a license shall be made in writing to the licensing agency on forms provided by the licensing agency which shall contain such information as the licensing agency may require. The application shall require reasonable, affirmative evidence of ability to comply with these rules, regulations, and minimum standards.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13 Subchapter 3 INSPECTION Rule 49.3.1 Inspections Required. Each ICF-IID for which a license has been issued shall be inspected by the licensing agency by persons delegated with authority by the licensing agency at such intervals as the licensing agency may direct. The licensing agency and/or its authorized representatives shall have the right to inspect construction work in progress. New ICFs-IID shall not be licensed without having first been inspected for substantial compliance with these rules, regulations, and minimum standards.*
- *SOURCE: Miss. Code Ann. §43-11-13*
- *SOURCE: Miss. Code Ann. §43-11-13 Subchapter 5 THE LICENSE Rule 49.5.1 License. A license shall be issued to each ICF-IID that meets the requirements as set forth in these regulations.*
- *SOURCE: Miss. Code Ann. §43-11-13*
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 49.6.2** Fees {#sec-16-49.6.2 omnilex-key=us-ms-regs-official--title-15--16#49.6.2}

Each initial and renewal licensure application, unless suspended or revoked, shall be accompanied by a fee as set by the Board, made payable to the Mississippi State Department of Health, either by business check, money order, or electronic means. Renewal of licenses shall occur on an annual basis. Fees are non-refundable.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 49.6.3** Name of ICF-IID {#sec-16-49.6.3 omnilex-key=us-ms-regs-official--title-15--16#49.6.3}

Every ICF-IID shall be designated by a permanent and distinctive name which shall be used in applying for a license and shall not be changed without first notifying the licensing agency in writing and receiving written approval of the change from the licensing agency. Such notice shall specify the name to be discontinued as well as the new name proposed. The words "hospital", "sanatarium", "sanatorium", "clinic" or any other word which would reflect a different type of ICF-IID shall not appear in the title of an ICFIID. Only the official name by which the ICF-IID is licensed shall be used in telephone listings, stationery, advertising, etc. Two or more facilities shall not be licensed under a similar name.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 49.6.4** Number of Beds {#sec-16-49.6.4 omnilex-key=us-ms-regs-official--title-15--16#49.6.4}

Each application for license shall specify the maximum number of beds in the ICF-IID as determined by Rule 49.2.3 of these regulations. The maximum number of beds for which the ICF-IID is licensed shall not be exceeded.

Subchapter 7 LICENSING Rule 49.7.1 Issuance of License. All licenses issued by the licensing agency shall set forth the name of the ICF-IID, the location, the name of the licensee, the classification of the ICF-IID , the type of building, the bed capacity for which the ICF-IID is licensed, and the license number.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 49.7.2** Separate License {#sec-16-49.7.2 omnilex-key=us-ms-regs-official--title-15--16#49.7.2}

Separate license shall be required for ICF-IIDs maintained on separate premises even though under the same management. However, separate

license are not required for buildings on the same grounds which are under the same management.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 49.7.3** Posting of License {#sec-16-49.7.3 omnilex-key=us-ms-regs-official--title-15--16#49.7.3}

The license shall be posted in a conspicuous place on the license premises and shall be available for review by an interested person.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 49.7.4** License Not Transferable {#sec-16-49.7.4 omnilex-key=us-ms-regs-official--title-15--16#49.7.4}

The license for an ICF-IID is not transferable or assignable to any other person except by written approval of the licensing agency and shall be issued only for the premises named in the application. The license shall be surrendered to the licensing agency on change of ownership, licensee, name or location of the institution, or in the event that the institution ceases to be operated as an ICF-IID. In event of change of ownership, licensee, name or location of the ICF-IID, a new application shall be filed.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 49.7.5** Expiration of License {#sec-16-49.7.5 omnilex-key=us-ms-regs-official--title-15--16#49.7.5}

Each license shall expire on March 31 following the date of issuance.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 49.7.6** Renewal of License {#sec-16-49.7.6 omnilex-key=us-ms-regs-official--title-15--16#49.7.6}

License shall be renewable by the licensee. 1. Filing of an application for renewal of licensee. 2. Submission of appropriate licensure renewal fee as mandated in Rule 49.6.2. 3. Approval of an annual report by the licensing agency. 4. Maintenance by the ICF-IID of minimum standards in its physical facility, staff, services and operation as set forth in these regulations.

1. Fraud on the part of the licensee in applying for a license.

2. A willful or repeated violation by the licensee of any of the provisions of §43- 11-1 et seq., of the Mississippi Code of 1972, as amended, and/or of the rules, regulations, and minimum standards established by the licensing agency. 3. Use of alcoholic beverages or narcotic drugs by the licensee or other personnel of the home, to the extent which threatens the well-being or safety of the resident. 4. Conviction of the licensee of a felony. 5. Publicly misrepresenting the home and/or its services. 6. Permitting, aiding, and abetting the commission of any unlawful act. 7. Conduct or practices detrimental to the health or safety of residents and employees of said facilities provided that this provision shall not be construed to have any reference to healing practices authorized by law. Detrimental practices include but are not necessarily limited to: a. Cruelty to clients or indifference of their needs which are essential to their general well being and health. b. Misappropriation of the money or property of a client. c. Failure to provide food adequate for the needs of the client. d. Inadequate staff to provide safe care and supervision of a client. e. Failure to call a physician or nurse practitioner/physician assistant when required by the client's condition. f. Failure to notify next of kin when a client's conditions become critical. g. Admission of a client whose condition demands care beyond the level of care provided by the ICF-IID as determined by its classification.

the date of notification the licensing agency shall fix a date not less than thirty (30) days from the date of such service at which time the applicant or licensee shall be given an opportunity for a prompt and fair hearing. 2. The licensing agency shall notify the licensee of a ban on all admissions imposed as a result of immediate jeopardy survey findings. The ban on admissions will be imposed five (5) calendar days after the receipt of the notice by the licensee of the ICF-IID and/or the ICF-IID residential community home. A hearing must be requested within five (5) calendar days of receipt of the notice. In addition, the licensing agency shall provide notice to the licensee related to compensation and per diem costs for a temporary manager and/or state monitoring as applicable. Within 15 days of receipt of the notice, the ICF- IID or the ICF-IID Residential Community Home shall pay the bill or request an administrative hearing to contest the costs for which it was billed. The licensing agency shall fix a date not less than ten (10) days from the date of such service at which time the licensee of the ICF-IID or the ICF-IID residential community home shall be given an opportunity for a prompt and fair hearing. 3. On the basis of such hearing or upon default of the applicant or licensee, the licensing agency shall make a determination specifying its findings of fact and conclusions of law. A copy of such determination shall be sent by registered mail to the last known address of the applicant or licensee or served personally upon the applicant or licensee. 4. The decision revoking, suspending, denying the application of license shall become final thirty (30) days after it is so mailed or served upon the applicant or licensee; however in matters involving the revocation, suspension, or denial of an application or license, or adverse actions imposed by the licensing agency as a result of immediate jeopardy survey findings resulting in a ban on all admissions, and compensation and per diem costs related to a temporary manager and/or state monitoring as applicable, the applicant or licensee may within such thirty (30) day period, appeal the decision to the Chancery Court pursuant to §43-11-23 of the Mississippi Code of 1972, as amended. An additional period of time may be granted at the discretion of the licensing agency.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13 Subchapter 8 DENIAL, SUSPENSION, OR REVOCATION OF LICENSE Rule 49.8.1 Denial or Revocation of License: Hearing and Review. The licensing agency after notice and opportunity for a hearing to the applicant or licensee is authorized to deny, suspend, or revoke a license in any case in which it finds that there has been a substantial failure to comply with the requirements established under the law and these regulations. Also, the following shall be grounds for denial or revocation of license.*
- *SOURCE: Miss. Code Ann. §43-11-13 Subchapter 9 PROVISION FOR HEARING AND APPEAL FOLLOWING DENIAL OR REVOCATION OF LICENSE; PENALTIES Rule 49.9.1 Administrative Decision. The licensing agency will provide an opportunity for a fair hearing to every applicant or licensee who is dissatisfied with administrative decisions made in the denial or revocation of a license or for adverse actions or who qualifies pursuant to Subchapter 8 to appeal 1. The licensing agency shall notify the applicant or licensee by certified mail or personal service the particular reasons for the proposed denial or revocation of license. Upon written request of applicant or licensee within ten (10) days of*
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 49.9.2** Penalties {#sec-16-49.9.2 omnilex-key=us-ms-regs-official--title-15--16#49.9.2}

Any person establishing, conducting, managing, or operating an institution for the aged or infirm (e.g. ICF-IID and/or a ICF-IID Residential Community Home ) without a license shall be declared in violations of these regulations and Chapter 451 of the Laws of Mississippi of the Regular Legislative Session of 1979 and subject to the penalties specified in §18 thereof.

Subchapter 10 ADMINISTRATION: THE AUTHORITY FOR ADMINISTRATION FOR INTERMEDIATE CARE FACILITIES FOR INDIVIDUALS WITH INTELLECTUAL DISABILITIES Rule 49.10.1 Responsibility. The governing authority, the owner, or the person(s) designated by the governing authority shall be the supreme authority in an ICF-IID responsible for the management, control, and operation of the institution including the appointment of qualified staff.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 49.10.2** Organization {#sec-16-49.10.2 omnilex-key=us-ms-regs-official--title-15--16#49.10.2}

Each ICF-IID should establish a written organizational plan, which may be an organizational chart that clearly establishes a line of authority, responsibilities, and relationships. Written personnel policies and job descriptions shall be prepared and given to each employee.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 49.10.3** Relationship of staff to Governing Authority {#sec-16-49.10.3 omnilex-key=us-ms-regs-official--title-15--16#49.10.3}

The administrator, personnel, and all auxiliary organizations shall be directly or indirectly responsible to the governing authority.

The licensee may serve as the administrator or may appoint someone to be the administrator. The licensee shall be responsible for submitting to the licensing agency the plans and specifications for the building, the applications for license, and such reports as are required. 1. Initial Application. The licensee shall submit the following with the initial application: a. References in regard to personal character, temperament, and experience background from three (3) responsible persons not related to him and/or her. The licensing agency reserves the right to make investigations from its own source regarding the character of the applicant. b. Whether the governing body will be a private proprietary, partnership, corporation, governmental, or other (non-profit, church, etc.). If a partnership, the full name and address of each partner. If a corporation or other, the name, addresses, and title of each officer. If governmental, the unit of government.

2. Application for License. Application for license or relicense shall be submitted in form and content pursuant to the instructions of the licensing agency.

1. There shall be a licensed administrator in an ICF-IID with authority and responsibility for the operation of the ICF-IID in all its administrative and professional functions subject only to the policies enacted by the governing authority and to such orders as it may issue. The administrator shall be the direct representative of the governing authority in the management of the ICF- IID and shall be responsible to said governing authority for the proper performance of duties. 2. There shall be a qualified individual present in the ICF-IID responsible to the administrator in matters of administration who shall represent him or her during the absence. The person shall not be a client of the ICF-IID.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13 Subchapter 11 THE LICENSEE Rule 49.11.1 Responsibility. The licensee shall be the person who the licensing agency will hold responsible for the operation of the home in compliance with these regulations.*
- *SOURCE: Miss. Code Ann. §43-11-13 Subchapter 12 ADMINISTRATOR Rule 49.12.1 Responsibility.*
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 49.12.2** Qualifications {#sec-16-49.12.2 omnilex-key=us-ms-regs-official--title-15--16#49.12.2}

The administrator and/or program director(s) shall be chosen primarily for their administrative ability to establish proper working relationship with physicians, nurse practitioners/physician assistants, and employees of the ICF- IID. 1. The administrator shall be at least twenty-one (21) years of age. 2. The administrator shall be of reputable and responsible character and in such state of physical and mental health as will permit him or her to satisfactorily direct the activities and services of the ICF-IID.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13 Subchapter 13 FINANCIAL Rule 49.13.1 Accounting. Accounting methods and procedures should be carried out in accordance with a recognized system of good business practice. The method and procedure used should be sufficient to permit annual audit, accurate determination of the cost of operation and the cost per client per day.*
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 49.13.2** Financial Structure {#sec-16-49.13.2 omnilex-key=us-ms-regs-official--title-15--16#49.13.2}

All facilities shall have a financial plan which guarantees sufficient resources to meet operating cost at all times and to maintain standards required by these regulations.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 49.13.3** Admission Agreement {#sec-16-49.13.3 omnilex-key=us-ms-regs-official--title-15--16#49.13.3}

Prior to or at the time of admission, the administrator and the client or the client’s responsible party shall execute in writing a financial agreement. This agreement shall be prepared and signed in two or more copies, one copy given to the client or his sponsor, and one copy placed on file in the licensed ICF-IID. As a minimum this agreement shall contain: 1. Basic charges agreed upon (room, board, laundry, nursing, and/or personal care). 2. Period to be covered in the charges. 3. Services for which special charges are made. 4. Agreement regarding refund for any payments made in advance. 5. An explanation of services/care to be provided.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 49.13.4** Rule 49.13.4 {#sec-16-49.13.4 omnilex-key=us-ms-regs-official--title-15--16#49.13.4}

No agreement or contract shall be entered into between the licensee and the client or his responsible party which will relieve the licensee of responsibility for the protection of the person and of the rights of the individual admitted to the ICF-IID for care, as set forth in these regulations.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 49.13.5** A record of all sums of money received from each client shall be kept up-to-date and available for inspection {#sec-16-49.13.5 omnilex-key=us-ms-regs-official--title-15--16#49.13.5}

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 49.13.6** Rule 49.13.6 {#sec-16-49.13.6 omnilex-key=us-ms-regs-official--title-15--16#49.13.6}

The client or his lawful agent shall be furnished a receipt signed by the lawful agent of the institution for all sums paid over to the ICF-IID.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 49.13.7** Rule 49.13.7 {#sec-16-49.13.7 omnilex-key=us-ms-regs-official--title-15--16#49.13.7}

Neither the licensee nor any employee shall misuse or misappropriate any property real or personal, belonging to a client of the ICF-IID.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 49.13.8** Rule 49.13.8 {#sec-16-49.13.8 omnilex-key=us-ms-regs-official--title-15--16#49.13.8}

Undue influence or coercion shall not be used in procuring a transfer of funds or property or in procuring a contract or agreement providing for payment of funds or delivery of property belonging to a client of the ICF-IID.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 49.13.9** Rule 49.13.9 {#sec-16-49.13.9 omnilex-key=us-ms-regs-official--title-15--16#49.13.9}

Agreements between an ICF-IID and a client relative to cost of care shall include adequate arrangements for such emergency medical or hospital care as may be required by the client.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 49.13.10** Rule 49.13.10 {#sec-16-49.13.10 omnilex-key=us-ms-regs-official--title-15--16#49.13.10}

No licensee, owner, or administrator of an ICF-IID; a member of their family; an employee of the ICF-IID; or a person who has financial interest in the home shall act as the legal guardian for a client of the ICF-IID. This requirement shall not apply if the client is related within the third degree as computed by civil law.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 49.13.11** Client Admission {#sec-16-49.13.11 omnilex-key=us-ms-regs-official--title-15--16#49.13.11}

Prior to initial licensure of each ICF-IID, a written schedule for client admission shall be developed and submitted to the licensing agency.

2. Resources and Assets 3. Safety and Security 4. Staffing

5. Utilities 6. Clinical Activities. 7. Emergency Operations Plans (EOPs) must be exercised and reviewed annually or as directed by the Office of Emergency Preparedness and Response. Written evidence of current approval or review of provider EOPs, by the Office of Emergency Preparedness and Response, shall accompany all applications for ICF-IID license renewals.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13 Subchapter 14 EMERGENCY OPERATIONS PLAN (EOP) Rule 49.14.1 The licensed entity shall develop and maintain a written preparedness plan utilizing the “All Hazards” approach to emergency and disaster planning. The plan must include procedures to be followed in the event of any act of terrorism or man-made or natural disaster as appropriate for the specific geographical location. The final draft of the Emergency Operations Plan (EOP), will be reviewed by the Office of Emergency Preparedness and Response, Mississippi State Department of Health, or their designates, for conformance with the “All Hazards Emergency Preparedness and Response Plan.” Particular attention shall be given to critical areas of concern which may arise during any “all hazards” emergency whether required to evacuate or to sustain in place. Additional plan criteria or a specified EOP format may be required as deemed necessary by the Office of Emergency Preparedness and Response. The six (6) critical areas of consideration are: 1. Communications - Facility status reports shall be submitted in a format and a frequency as required by the Office of EOP.*
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 49.14.2** ICF-IID and ICF-IID Residential Community Home Fire Preparedness 1 {#sec-16-49.14.2 omnilex-key=us-ms-regs-official--title-15--16#49.14.2}

Fire Drills. Fire drills shall be conducted one (1) per shift per quarter. Employees shall participate in a fire drill at least four (4) times per year. 2. Written Records. Written records of all drills shall be maintained, indicating content of and attendance at each drill. 3. A fire evacuation plan shall be posted in a conspicuous place and kept current.

1. As a minimum, the office space and/or administrative office(s) shall be provided with a desk, file drawer or cabinet, and related office equipment and supplies. 2. Each ICF-IID caring for twenty-five (25) or more clients should provide a separate room(s) for these facilities. 3. Each ICF-IID should provide a waiting room or space for the public. 4. ICF-IID Residential Community Homes are excluded from the requirements set forth in Rule 49.15.1.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13 Subchapter 15 PHYSICAL FACILITIES Rule 49.15.1 Administration Facilities. Each ICF-IID shall provide an office space and/or administrative office(s).*
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 49.15.2** Communication Facilities {#sec-16-49.15.2 omnilex-key=us-ms-regs-official--title-15--16#49.15.2}

Each ICF-IID and/or ICF-IID Residential Community Home shall have an adequate number of telephones and extensions to summon help in case of fire or other emergency, and these shall be located so as to be quickly accessible from all parts of the building. The telephone shall be listed under the official licensed name of the facility.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13 Subchapter 16 RECORDS AND REPORTS Rule 49.16.1 General. Each ICF-IID or ICF-IID Residential Community Home shall submit such records and reports as the licensing agency may request.*
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 49.16.2** Annual Report {#sec-16-49.16.2 omnilex-key=us-ms-regs-official--title-15--16#49.16.2}

An annual report shall be submitted to the licensing agency by each ICF-IID and/or ICF-IID Residential Community Home upon such uniform dates and shall contain such information in such form as the licensing agency prescribes.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 49.16.3** Criminal History Record Checks {#sec-16-49.16.3 omnilex-key=us-ms-regs-official--title-15--16#49.16.3}

Pursuant to Section 43-11-13, Mississippi Code of 1972, the covered entity shall require to be preformed a disciplinary check with the professional licensing agency, if any, for each employee to determine if any disciplinary action has been taken against the employee by the agency, and a criminal history record check on: 1. Every new employee of a covered entity who provides direct patient care or services and who is employed on or after July 01, 2003, and 2. Every employee of a covered entity employed prior to July 01, 2003, who has documented disciplinary action by his or her present employer. 3. Except as otherwise provided in this paragraph, no employee hired on or after July 01, 2003, shall be permitted to provide direct patient care until the results of the criminal history record check revealed no disqualifying record or the employee has been granted a waiver. Provided the covered entity has documented evidence of submission of fingerprints for the background check, any person may be employed and provide direct patient care on a temporary basis pending the results of the criminal history record check but any employment offer, contract, or arrangement with the person shall be voidable, if he/she receives a disqualifying criminal record check and no waiver is granted. 4. If such criminal history record check discloses a felony conviction; a guilty plea; and/or a plea of nolo contendere to a felony for one (1) or more of the following crimes which has not been reversed on appeal, or for which a pardon has not been granted, the applicant/employee shall not be eligible to be employed at the licensed ICF-IID: a. possession or sale of drugs b. murder

c. manslaughter d. armed robbery e. rape f. sexual battery g. sex offense listed in Section 45-33-23(g), Mississippi Code of 1972 h. child abuse i. arson j. grand larceny k. burglary l. gratification of lust m. aggravated assault n. felonious abuse and/or battery of vulnerable adult 5. Documentation of verification of the employee’s disciplinary status, if any, with the employee’s professional licensing agency as applicable, and evidence of submission of the employee’s fingerprints to the licensing agency must be on file and maintained by the ICF-IID prior to the new employees first date of employment. The covered entity shall maintain on file evidence of verification of the employee’s disciplinary status from any applicable professional licensing agency and of submission and/or completion of the criminal record check, the signed affidavit, if applicable, and/or a copy of the referenced notarized letter addressing the individual’s suitability for such employment. 6. Pursuant to Section 43-11-13, Mississippi Code of 1972, the licensing agency shall require every employee of a covered entity employed prior to July 01, 2003, to sign an affidavit stating that he or she does not have a criminal history as outlined in paragraph (3) above. 7. From and after December 31, 2003, no employee of a covered entity hired before July 01, 2003, shall be permitted to provide direct patient care unless the employee has signed an affidavit as required by this section. The covered entity shall place the affidavit in the employee’s personnel file as proof of compliance with this section. 8. If a person signs the affidavit required by this section, and it is later determined that the person actually had been convicted of or pleaded guilty or nolo contendere to any of the offenses listed herein, and the conviction or pleas has

not been reversed on appeal or a pardon has not been granted for the conviction or plea, the person is guilty of perjury as set out in Section 43-11-13, Mississippi Code of 1972. The covered entity shall immediately institute termination proceedings against the employee pursuant to the ICF-IID’s policies and procedures. 9. The covered entity may, in its discretion, allow any employee unable to sign the affidavit required by paragraph (7) of this subsection or any employee applicant aggrieved by the employment decision under this subsection to appear before the covered entity’s hiring officer, or his or her designee, to show mitigating circumstances that may exist and allow the employee or employee applicant to be employed at the covered entity. The covered entity, upon report and recommendation of the hiring officer, may grant waivers for those mitigating circumstances, which shall include, but not be limited to: (1) age at which the crime was committed; (2) circumstances surrounding the crime; (3) length of time since the conviction and criminal history since the conviction; (4) work history; (5) current employment and character references; and (6) other evidence demonstrating the ability of the individual does not pose a threat to the health or safety of the patients in the licensed ICF-IID. 10. The licensing agency may charge the covered entity submitting the fingerprints a fee not to exceed Fifty Dollars ($50.00). 11. Should results of an employee applicant’s criminal history record check reveal no disqualifying event, then the covered entity shall, within two (2) weeks of the notification of no disqualifying event, provide the employee applicant with a notarized letter signed by the chief executive officer of the covered entity, or his or her authorized designee, confirming the employee applicant’s suitability for employment based on his or her criminal history record check. An employee applicant may use that letter for a period of two (2) years from the date of the letter to seek employment at any covered entity licensed by the Mississippi State Department of Health without the necessity of an additional criminal record check. Any covered entity presented with the letter may rely on the letter with respect to an employee applicant’s criminal background and is not required for a period of two (2) years from the date of the letter to conduct or have conducted a criminal history check as required in this subsection. 12. For individuals contacted through a third party who provide direct patient care as defined herein, the covered entity shall require proof of a criminal history record check. 13. Pursuant to Section 43-11-13, Mississippi Code of 1972, the licensing agency, the covered entity, and their agents, officer, employees, attorneys, and representatives, shall be presumed to be acting in good faith for any employment decision or action taken under this section. The presumption of good faith may be overcome by a preponderance of the evidence in any civil action. No licensing agency, covered entity, nor their agents, officers,

employees, attorneys and representatives shall be held liable in any employment discrimination suit in which an allegation of discrimination is made regarding an employment decision authorized under this section.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 49.16.4** Employee Health Screening {#sec-16-49.16.4 omnilex-key=us-ms-regs-official--title-15--16#49.16.4}

All staff of an ICF-IID and/or ICF-IID Residential Community Home shall receive a health screening by a licensed physician, registered nurse, or nurse practitioner/physician assistant prior to employment and annually thereafter. The extent of the screening shall be determined by committee consisting of at least a licensed physician, nurse practitioner/physician assistant or a registered nurse, and the ICF-IID administrator.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 49.16.5** Employee Health Screening {#sec-16-49.16.5 omnilex-key=us-ms-regs-official--title-15--16#49.16.5}

All staff of an ICF-IID and/or ICF-IID Residential Community Home shall receive a health screening by a licensed physician, registered nurse, or nurse practitioner/physician assistant prior to employment and annually thereafter. The extent of the screening shall be determined by committee consisting of at least a licensed physician, nurse practitioner/physician assistant or a registered nurse, and the ICF-IID administrator. 1. There shall be written evidence on file at the ICF-IID indicating that such a committee met to develop a policy for the ICF-IID employee health screening program. This policy shall include: a. What constitutes an adequate health screening. b. The health professional designated to conduct the screening. 2. The written policy shall be evaluated periodically by said committee.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 49.16.6** Employee Testing for Tuberculosis 1 {#sec-16-49.16.6 omnilex-key=us-ms-regs-official--title-15--16#49.16.6}

Each employee, upon employment of a licensed entity and prior to contact with any patient/client, shall be evaluated for tuberculosis by one of the following methods:

a. IGRA (blood test) and an evaluation of the individual for signs and symptoms of tuberculosis by medical personnel; or

b. A two-step Mantoux tuberculin skin test administered and read by a licensed medical/nursing person certified in the techniques of tuberculin testing and an evaluation of the individual for signs and symptoms of tuberculosis by a licensed Physician, Physician’s Assistant, Nurse Practitioner or a Registered Nurse.

2. The IGRA/Mantoux testing and the evaluation of signs/symptoms may be administered/conducted on the date of hire or administered/read no more than 30 days prior to the individual’s date of hire; however, the individual must not be allowed contact with a patient or work in areas of the RBIR where patients have access until receipt of the results of the IGRA/assessment or at least the first of the two-step Mantoux test has been administered/read and assessment for the signs and symptoms completed.

3. If the Mantoux test is administered, results must be documented in millimeters. Documentation of the IGRA/TB skin test results and assessment must be documented in accordance with accepted standards of medical/nursing practice and must be placed in the individual’s personnel file no later than 7 days of the individual’s date of employment. If an IGRA is performed, results and quantitative values must be documented.

4. Any employee noted to have a newly positive IGRA, a newly positive Mantoux skin test or signs/symptoms indicative of tuberculin disease (TB) that last longer than three weeks (regardless of the size of the skin test or results of the IGRA), shall have a chest x-ray interpreted by a board certified Radiologist and be evaluated for active tuberculosis by a licensed physician within 72 hours. The employee shall not be allowed to work in any area where clients have routine access until evaluated by a physician/nurse practitioner/physician assistant and approved to return. Exceptions to this requirement may be made if the employee is asymptomatic and:

a. The individual is currently receiving or can provide documentation of having received a course of tuberculosis prophylactic therapy approved by the Mississippi State Department of Health (MSDH) Tuberculosis Program for tuberculosis infection, or

b. The individual is currently receiving or can provide documentation of having received a course of multi-drug chemotherapy approved by the MSDH Tuberculosis Program; or

c. The individual has a documented previous significant tuberculin skin reaction or IGRA reaction.

5. For individuals noted to have a previous positive to either Mantoux testin g or the IGRA, annual re-evaluation for the signs and symptoms must be conducted and must be maintained as part of the employee’s annual health screening. A follow-up annual chest x-ray is NOT required unless symptoms of active tuberculosis develop.

6. If using the Mantoux method, employees with a negative tuberculin skin test and

a negative symptom assessment shall have the second step of the two- step Mantoux tuberculin skin test performed and documented in the employees’ personal record within fourteen (14) days of employment.

7. The IGRA or the two-step protocol is to be used for each employee who has not been previously skin tested and/or for whom a negative test cannot be documented within the past 12 months. If the employer has documentation that the employee has had a negative TB skin test within the past 12 months, a single test performed thirty (30) days prior to employment or immediately upon hire will fulfill the two-step requirements. As above, the employee shall not have contact with clients or be allowed to work in areas of the RBIR to which clients have routine access prior to reading the skin test, completing a signs and symptoms assessment and documenting the results and findings.

8. Facilities shall comply with recommendations from the Centers for Disease Control and/or the Mississippi State Department of Health regarding baseline employee TB testing and routine serial employee TB testing and education. Staff exposed to an active infectious case of tuberculosis shall be treated as contacts and be managed appropriately. Individuals found to have a significant Mantoux tuberculin skin test reaction and a chest x-ray not suggestive of active tuberculosis, shall be evaluated by a physician or nurse practitioner/physician assistant for treatment of latent tuberculin infection

.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 49.16.7** Admission Record-Personal Information {#sec-16-49.16.7 omnilex-key=us-ms-regs-official--title-15--16#49.16.7}

Each ICF-IID and/or ICF-IID Residential Community Home shall prepare a record on each client at the time of admission on which the following minimum information shall be recorded: name; date of admittance; address at the time of admittance; race; sex; marital status; religious preference; date of birth; name; address, and telephone number of person responsible for client and his/her relationship to him/her; and name and telephone number of physician or nurse practitioner/physician assistant, and the diagnosis as defined by the current version of the Diagnostic and Statistical Manual of Mental Disorders (DSM). The date and reason for discharge shall be entered upon discharge of a client.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 49.16.8** Reporting of Tuberculosis Testing {#sec-16-49.16.8 omnilex-key=us-ms-regs-official--title-15--16#49.16.8}

The ICF-IID and/or ICF-IID Residential Community Home shall report and comply with the annual MSDH TB Program surveillance procedures.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13 Subchapter 17 CLIENTS’ RIGHTS*

##### **15 Miss. Admin. Code Pt. 16, R. 49.17.1** General {#sec-16-49.17.1 omnilex-key=us-ms-regs-official--title-15--16#49.17.1}

The ICF-IID shall maintain written policies and procedures regarding the rights and responsibilities of clients. These written policies and procedures shall be established in consultation with clients or responsible parties. Written policies and procedures regarding clients' rights shall be made available to clients or their guardian, next of kin, sponsoring agency or agencies, or lawful representative and to the public. There shall be documented evidence that the staff of the ICF-IID is trained and involved in the implementation of these policies and procedures. In- service on clients' rights and responsibilities shall be conducted annually. These rights and responsibilities shall be posted throughout the ICF-IID for the benefit of all staff and clients.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 49.17.2** Clients’ Rights {#sec-16-49.17.2 omnilex-key=us-ms-regs-official--title-15--16#49.17.2}

The clients' rights policies and procedures ensure that each client admitted to the ICF-IID: 1. is fully informed, as evidenced by the client's written acknowledgment, prior to or at the time of admission and during stay, of these rights and is given a statement of the ICF-IID's rules and regulations and an explanation of the client's responsibility to obey all reasonable regulations of the ICF-IID and to respect the personal rights and private property of other clients; 2. is fully informed, and is given a written statement prior to or at time of admission and during stay, of services available in the ICF-IID, and of related charges including any charges for services covered by the ICF-IID basic per diem rate; 3. is assured of adequate and appropriate medical care, is fully informed by a physician or nurse practitioner/physician assistant of his medical conditions unless medically contraindicated (as documented by a physician or nurse practitioner/physician assistant in his medical record), is afforded the opportunity to participate in the planning of his medical treatment, to not be limited in his/her choice of a pharmacy or pharmacist provider in accordance with state law, as referenced in House Bill 1439, which states that the ICF-IID shall not limit a client’s choice of pharmacy or pharmacy provider if that provider meets the same standards of dispensing guidelines required of long term care facilities, to refuse to participate in experimental research, and to refuse medication and treatment after fully informed of and understanding the consequences of such action; 4. is transferred or discharged only for medical reasons, or for his welfare or that of other clients, or for nonpayment for his stay (except as prohibited by sources of third-party payment), and is given a two weeks advance notice in writing to ensure orderly transfer or discharge. A copy of this notice is maintained in his medical record;

5. is encouraged and assisted, throughout his period of stay, to exercise his rights as a client and as a citizen, and to this end may voice grievances, has a right of action for damages or other relief for deprivations or infringements of his right to adequate and proper treatment and care established by an applicable statute, rule, regulation or contract, and to recommend changes in policies and services to ICF-IID staff and/or to outside representatives of his choice, free from restraint, interference, coercion, discrimination, or reprisal; 6. may manage his personal financial affairs, or is given at least a quarterly accounting of financial transactions made on his behalf should the ICF-IID accept his written delegation of this responsibility to the ICF-IID for any period of time in conformance with State law; 7. is free from mental, physical, and/or verbal abuse; and exploitation and/or misappropriation of client property 8. is free from restraint except by order of a physician or nurse practitioner/physician assistant, or unless it is determined that the client is a threat to himself or to others. Physical and chemical restraints shall be used for medical conditions that warrant the use of a restraint. Restraint is not to be used for discipline or staff convenience. The ICF-IID must have policies and procedures addressing the use and monitoring of restraint. A physician order for restraint must be countersigned within 24 hours of the emergency application of the restraint; 9. is assured security in storing personal possessions and confidential treatment of his personal and medical records, and may approve or refuse their release to any individual outside the ICF-IID, except, in the case of his transfer to another health care institution, or as required by law of third-party payment contract; 10. is treated with consideration, respect, and full recognition of his dignity and individuality, including privacy in treatment and in care for his personal needs; 11. is not required to perform services for the ICF-IID that are not included for therapeutic purposes in their individual program plan; 12. may associate and communicate privately with persons of his choice, may join with other clients or individuals within or outside of the ICF-IID to work for improvements in client care, and send and receive his personal mail unopened, unless medically contraindicated (as documented by his physician or nurse practitioner/physician assistant in his medical record); 13. may meet with, and participate in activities of, social, religious and community groups at his discretion, unless medically contraindicated (as documented by his physician or nurse practitioner/physician assistant in his medical record); 14. may retain and use his personal clothing and possessions as space permits, unless to do so would infringe upon rights of other clients, unless medically

contraindicated (as documented by his physician or nurse practitioner/physician assistant in his medical record); 15. if married, is assured privacy for visits by his/her spouse; if both are inpatients in the ICF-IID, they are permitted to share a room, unless medically contraindicated (as documented by the attending physician or nurse practitioner/physician assistant in the medical record); and 16. is assured of exercising his civil and religious liberties including the right to independent personal decisions and knowledge of available choice. The ICF- IID shall encourage and assist in the fullest exercise of these rights and shall communicate rights in a manner that is understandable to the client.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 49.17.3** Rule 49.17.3 {#sec-16-49.17.3 omnilex-key=us-ms-regs-official--title-15--16#49.17.3}

All rights and responsibilities specified in paragraph (1) through (16) of Section Rule 49.17.2, as they pertain to (1) a client adjudicated incompetent in accordance with State law, (2) a client who is found by his physician or nurse practitioner/physician assistant to be medically incapable of understanding these rights, or (3) a client who exhibits a communication barrier, devolve to and shall be exercised by the client's guardian, next of kin, sponsoring agencies, or representative payee (except when the ICF-IID is representative payee.

1. Overview of the mission and the policies and procedures of he ICF-IID; 2. Behavior Management and Intervention; 3. Basic First Aid; 4. Confidentiality; 5. Cardio-Pulmonary Resuscitation (CPR) ; 6. Fire Safety & Emergency Procedures; 7. Food Safety & Handling Procedures; 8. Hand-washing; 9. Infection Control;

10. Population Specific Training; 11. Rights of Individuals Receiving Services; 12. Standard Precautions; 13. Vulnerable Persons Act; 14. Lift/Transfer Procedures; 15. Vehicle & Safety Transportation Procedures;

**History**
- *SOURCE: Miss. Code Ann. §43-11-13 Subchapter 18 STAFF DEVELOPMENT Rule 49.18.1 Orientation. Each employee, prior to direct contact with clients, shall receive thorough orientation to the position, the ICF-IID and/or the ICF-IID Residential Community Home, and its policies which shall include but not be limited to:*
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 49.18.2** In-service Training {#sec-16-49.18.2 omnilex-key=us-ms-regs-official--title-15--16#49.18.2}

The ICF-IID must provide each employee with initial and continuing training that enables the employee to perform his or her duties effectively, efficiently, and competently. For employees that work with clients, training must focus on skills and competencies directed toward clients developmental, behavioral, and health needs. Staff must be able to demonstrate the skills and techniques necessary to administer interventions to manage the inappropriate behavior of clients, and the skills necessary to implement the individual program plans for each client for whom they are responsible.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 49.18.3** Annual in-service training programs {#sec-16-49.18.3 omnilex-key=us-ms-regs-official--title-15--16#49.18.3}

Annual in-service training programs shall be provided to all employees on an on-going basis and include but not be limited to 12 hours related to communication and interpersonal skills, first aid procedures, infection control, safety and emergency procedures including abdominal thrust and choking procedures, promoting client’s independence, respecting clients’ rights, personal care skills, and six (6) hours that are population specific.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 49.18.4** Training Records {#sec-16-49.18.4 omnilex-key=us-ms-regs-official--title-15--16#49.18.4}

A written record shall be maintained of all orientation and in- service training sessions.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 49.18.5** Administrator Mentoring {#sec-16-49.18.5 omnilex-key=us-ms-regs-official--title-15--16#49.18.5}

Administrators for ICFs-IID shall be scheduled to spend two (2) concurrent days with the licensing agency or its designee for the purpose of training and mentoring. Placement of an administrator with the licensing agency may include, but not be limited to, assignments within the licensing agency’s central offices or placement with a survey team. Any costs associated with placements for the purposes of this section shall be borne by the licensed ICF-IID at which the administrator is employed. The administrator shall keep confidential and not disclose to any other persons any identifying information

about any person or entity that he/she learned while observing operations as required by this section, except as otherwise mandated by law. 1. This section shall apply to administrators who: a. received their license from the Mississippi Board of Nursing Home Administrators on or after January 1, 2002; and b. have been employed by a licensed ICF-IID for less than six (6) months, during which time the placement must be completed 2. This section shall not apply to administrators who: a. received a license from the Mississippi Board of Nursing Home Administrators on or prior to December 31, 2001; or b. who were previously employed by the licensing agency in a surveyor capacity. 3. Failure to successfully complete the placement required under this section shall disqualify the administrator from serving in such capacity for a licensed ICF- IID until a placement is completed.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 49.18.6** Residential Community Home Administrator Mentoring {#sec-16-49.18.6 omnilex-key=us-ms-regs-official--title-15--16#49.18.6}

Administrator Mentoring for Residential Community Homes under the jurisdiction of the Department of Mental Health will be provided at the time and format designated by the Department of Mental Health and documentation of such shall be provided to the Department of Health to be maintained with the ICF-IID licensure application. 1. This section shall go into effect with the effective date of these regulations.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13 Subchapter 19 MEDICAL, NURSING, AND PERSONAL SERVICES: PHYSICAL FACILITIES Rule 49.19.1 ICF-IID and ICF-IID Residential Community Homes. Medical, nursing, and personal service shall be provided in an area which shall provide privacy, dignity and safety appropriate to the necessary intervention required under a client’s IPP.*
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 49.19.2** The maximum nursing unit shall be sixty (60) beds in an ICF-IID {#sec-16-49.19.2 omnilex-key=us-ms-regs-official--title-15--16#49.19.2}

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 49.19.3** ICF-IID and/or ICF-IID Residential Community Home 1 {#sec-16-49.19.3 omnilex-key=us-ms-regs-official--title-15--16#49.19.3}

Bedrooms. a. Location. i. All client bedrooms shall have an outside exposure and shall not be below grade. Window area shall not be less than one-eighth (1/8) of the required floor area. The window sill shall not be over thirty-six (36) inches from the floor. ii. Client bedrooms shall be located so as to minimize the entrance of unpleasant odors, excessive noise, and other nuisances. iii. Existing ICF-IID: Client bedrooms shall be directly accessible from the main corridor of the nursing unit providing that accessibility from any public space other than the dining room will be acceptable. In no case shall a client bedroom be used for access to another client bedroom. iv. All client bedrooms in an ICF-IID and/or ICF-IID Residential Community Home shall be so located that the client can travel from his/her bedroom to a living room, day room, dining room, toilet or bathing area without having to go through another client bedroom. v. ICF-IID Residential Community Homes: Each client shall have his/her own private bedroom. 2. Floor Area. Minimum usable floor area per bed shall be as follows: Private room one-hundred (100) square feet, Multi-bed room eighty (80) square feet, per client in existing ICf-IIDs. This provision shall apply to initial licensure, new construction, additions, and renovations. 3. Provisions for Privacy. a. In an ICF-IID, cubicle curtains, screening, or other suitable provisions for privacy shall be provided in multi-bed client bedrooms. Cubicle curtains shall completely enclose the bed from three (3) sides. 4. Accommodations for Clients. The minimum accommodations for each client shall include: a. Bed. The client shall be provided with either an adjustable bed or at a minimum a regular single bed, according to needs of the client, with a good grade mattress at least four (4) inches thick. Cots and roll-a-way beds are prohibited for client use. Full and half bed rails shall be available to assist in safe care of clients. b. Pillows, linens, and necessary coverings.

c. Chair. d. Bedside cabinet or table. e. Storage space for clothing, toilet articles, and personal belongings including rod for clothes hanging. f. Means at bedside for notifying staff as indicated in the client’s IPP. g. Bed pans or urinals for clients who need them. h. Over-bed tables as required. 5. Bed Maximum. Bedrooms in ICF-IID shall be limited to two (2) beds in ICFs larger than 8 beds. ICF-IID Residential Community Homes with six (6) or fewer beds are limited to one (1) individual per bedroom.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 49.19.4** Special Care Room {#sec-16-49.19.4 omnilex-key=us-ms-regs-official--title-15--16#49.19.4}

Each ICF-IID shall have a special care room which shall be a single bedroom with at least a private half bath (lavatory and water closet). There shall be a special care room for each thirty (30) beds or major fraction thereof. A special care room may be located anywhere in the building rather than a certain number per station.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 49.19.5** ICF-IID Nurses’ Station {#sec-16-49.19.5 omnilex-key=us-ms-regs-official--title-15--16#49.19.5}

1. Each ICF-IID shall have a nurses' station for each nursing unit. The nurses' station includes as minimum the following: a. Annunciator board or other equipment for client's call. b. The minimum areas of the medicine storage/preparation room shall be seventy-five (75) square feet. c. Storage space for clients' medical records and nurses' charts. d. Lavatory or sink with disposable towel dispenser. e. Desk or counter top space adequate for recording data and administering medications charting purposes by physicians, nurse practitioners/physician assistants, and nurses. In an ICF-IID Residential Community Home, there shall be sufficient space to allow for confidentiality and secure medical records. 2. The nurses' station area shall be well lighted.

3. It is recommended that a nurses' lounge with toilet be provided for nursing personnel adjacent to the station. A refrigerator for the storage of drugs shall be provided at each nurses’ station. Drugs and food for beverages for the clients may be stored together only if separate and secure compartments or containers are provided for the storage of drugs.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 49.19.6** Utility Room {#sec-16-49.19.6 omnilex-key=us-ms-regs-official--title-15--16#49.19.6}

Each ICF-IID shall provide a separate utility room for soiled and clean client care equipment, such as bed pans, urinals, etc. The soiled utility room shall contain, as a minimum, the following equipment. 1. Provision for cleaning utensils such as bed pans, urinals, et cetera. 2. Lavatory or sink and disposable towel dispenser. The utility room for clean equipment shall have suitable storage. 3. In an ICF-IID Residential Community Home there shall be a closet and/or laundry space that is adequate for separation of clean and soiled laundry.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 49.19.7** Toilet and Bathing Facilities in an ICF-IID 1 {#sec-16-49.19.7 omnilex-key=us-ms-regs-official--title-15--16#49.19.7}

Lavatory, toilet and bathing facilities shall be provided in each ICF-IID nursing unit as follows: a. Bathing Facilities 2 per nursing unit b. Combination toilet and lavatory 2 per nursing unit 2. As a minimum, showers shall be thirty (30) inches by sixty (60) inches without curbing. 3. Handrails shall be provided for all tubs, showers, and commodes in an ICF-IID and/or an ICF-IID Residential Community Home. 4. In addition to the requirements set forth above, a lavatory shall be provided in each client bedroom or in a toilet room that is directly accessible from the bedroom in an ICF-IID. 5. In addition to the requirements set forth above, a toilet shall be located in a room directly accessible from each client bedroom in an ICF-IID. The minimum area for a room containing only a toilet shall be three (3) feet by six (6) feet in an ICF-IID.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 49.19.8** Other rooms and areas {#sec-16-49.19.8 omnilex-key=us-ms-regs-official--title-15--16#49.19.8}

In addition to the above facilities, each nursing unit in an ICF-IID shall include the following rooms and areas: 1. linen closet; 2. wheelchair space.

2. Major physical and mental condition. 3. Current diagnosis. 4. Orders, dated and signed, by a physician or nurse practitioner/physician assistant for the immediate care of the client to include medication treatment, activities, and diet.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13 Subchapter 20 REQUIREMENTS FOR ADMISSION Rule 49.20.1 Physical Examination Required. Each client shall be given a complete physical examination 30 days prior to admission and annually thereafter, including a history of tuberculosis exposure and an assessment for signs and symptoms of tuberculosis, by a licensed physician or nurse practitioner/physician assistant. The findings shall be entered as part of the Admission Record. The report of the examination shall include: 1. Medical history (previous illnesses, drug reaction, emotional reactions, etc.).*
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 49.20.2** Tuberculosis (TB) {#sec-16-49.20.2 omnilex-key=us-ms-regs-official--title-15--16#49.20.2}

Admission Requirements to Rule Out Active Tuberculosis (TB) 1. The following are to be performed and documented within 30 days prior to the client’s admission to the “Licensed ICF-IID”: a. TB signs and symptoms assessment by a licensed Physician, Physician’s Assistant or a Licensed Nurse Practitioner, and b. A chest x-ray taken and a written interpretation. 2. Admission to the ICF-IID shall be based on the results of the required tests as follows: a. Clients with an abnormal chest x-ray and/or signs and symptoms assessment shall have the first step of a two-step Mantoux tuberculin skin test (TST) placed and read by certified personnel OR an IGRA (blood test) drawn and results documented within 30 days prior to the patient’s admission to the “Licensed ICF-IID”. Evaluation for active TB shall be at

the recommendation of the MSDH and shall be prior to admission. If TB is ruled out and the first step of the TST is negative, the second step of the two-step TST shall be completed and documented within 10-21 days of admission. TST administration and reading shall be done by certified personnel. If an IGRA (blood test) is done, TST (first and/or second step) is not done. b. Clients with a normal chest x-ray and no signs or symptoms of TB shall have a baseline IGRA test (blood test) OR a TST performed with the initial step of a the two-step Mantoux TST placed on or within 30 days prior to the day of admission. IF TST is done, the second step shall be completed within 10-21 days of the first step. TST administration and reading shall be done by certified personnel. If an IGRA (blood test) is done, a TST is not done (first or second step). c. Clients with a significant TST OR positive IGRA (blood test) upon baseline testing or who have documented prior significant TST shall be monitored regularly for signs and symptoms of active TB (cough, sputum production, chest pain, fever, weight loss, or night sweats, especially if the symptoms have lasted longer than three weeks) and if these symptoms develop, shall have an evaluation for TB per the recommendations of the MSDH within 72 hours. d. Clients with a non significant TST or negative IGRA (blood test) upon baseline testing shall have an annual tuberculosis testing within thirty (30) days of the anniversary of their last test. Note: Once IGRA testing is used, IGRA testing should continue to be used rather than TST testing. e. Clients with a new significant TST or newly positive IGRA (blood test) on annual testing shall be evaluated for active TB by a nurse practitioner or physician or physician’s assistant. f. Active or suspected Active TB Admission. If a client has or is suspected to have active TB, prior written approval for admission to the ICF-IID is required from the MSDH TB State Medical Consultant. g. Exceptions to TST/ IGRA requirement may be made if: i. Client has prior documentation of a significant TST/ positive IGRA. ii. Client has received or is receiving a MSDH approved treatment regimen for latent TB infection or for active TB disease. iii. Client is excluded by a licensed physician or nurse practitioner/physician assistant due to medical contraindications.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 49.20.3** Rule 49.20.3 {#sec-16-49.20.3 omnilex-key=us-ms-regs-official--title-15--16#49.20.3}

Transfer to another ICF-IID or return of a client to respite care shall be based on the above tests (Section 119.02 (2)) if done within the past 12 months and the patient has no signs and symptoms of TB.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 49.20.4** Transfer to a Hospital or Visit to a Physician Office {#sec-16-49.20.4 omnilex-key=us-ms-regs-official--title-15--16#49.20.4}

If a client has signs or symptoms of active TB (i.e., is a TB suspect) the licensed ICF-IID shall notify the MSDH, the hospital, transporting staff and the physician’s office prior to transferring the client to a hospital. Appropriate isolation and evaluation shall be the responsibility of the hospital and physician. If a client has or is suspected to have active TB, prior written approval for admission or readmission to the ICF-IID is required from the MSDH TB State Consultant.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13 Subchapter 21 CLIENT CARE Rule 49.21.1 Service Beyond Capability of the Home. Whenever a client requires hospitalization or medical, nursing, or other care beyond the capabilities and facilities of the home, prompt effort shall be made to transfer the patient/client to a hospital or other appropriate medical facility.*
- *SOURCE: Miss. Code Ann. §43-11-13 Subchapter 22 PHYSICIAN SERVICES Rule 49.22.1 General. A physician shall personally approve in writing a recommendation that an individual be admitted to an ICF-IID.*
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 49.22.2** Designated physician {#sec-16-49.22.2 omnilex-key=us-ms-regs-official--title-15--16#49.22.2}

Each client shall have a designated physician or nurse practitioner/physician assistant who is responsible for their care. In the absence of the designated physician or nurse practitioner/physician assistant, another physician or nurse practitioner/physician assistant shall be designated to supervise the client medical care.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 49.22.3** Emergency physician {#sec-16-49.22.3 omnilex-key=us-ms-regs-official--title-15--16#49.22.3}

Each ICF-IID and/or ICF-IID Residential Community Home shall ensure that emergency care protocols are in place and that staff have been adequately trained.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 49.22.4** Physician visit {#sec-16-49.22.4 omnilex-key=us-ms-regs-official--title-15--16#49.22.4}

The client shall be seen by a physician or nurse practitioner/physician assistant every sixty (60) days.

1. The therapies shall be provided by a qualified therapist. 2. Appropriate equipment and supplies shall be provided. 3. Each client’s medical record shall contain written evidence that services are provided in accordance with the written orders of an attending physician or nurse practitioner/physician assistant.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13 Subchapter 23 REHABILITATIVE SERVICES Rule 49.23.1 Rehabilitative services. Clients shall be provided rehabilitative services as needed upon the written orders of an attending physician or nurse practitioner/physician assistant.*
- *SOURCE: Miss. Code Ann. §43-11-13 Subchapter 24 PHARMACY SERVICES IN AN ICF-IID AND/OR ICF-IID RESIDENTIAL COMMUNITY HOME Rule 49.24.1 General. The ICF-IID and/or ICF-IID Residential Community Home shall provide routine drugs, emergency drugs and biologicals to its clients or obtain them by agreement.*
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 49.24.2** Policies and procedures {#sec-16-49.24.2 omnilex-key=us-ms-regs-official--title-15--16#49.24.2}

Each ICF-IID shall have policies and procedures to assure the following: 1. Accurate acquiring; 2. Receiving; 3. Dispensing; 4. Storage; and 5. Administration of all drugs and biologicals.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 49.24.3** Consultation {#sec-16-49.24.3 omnilex-key=us-ms-regs-official--title-15--16#49.24.3}

Each ICF-IID shall obtain the services of a licensed pharmacist who will be responsible for: 1. Establishing a system of records of receipt and disposition of all controlled drugs and to determine that drug records are in order and that an account of all controlled drugs are maintained and reconciled;

2. Provide drugs regimen review in the ICF-IID on each client every thirty (30) days by a licensed pharmacist; 3. Report any irregularities to the attending physician or nurse practitioner/physician assistant and the director or nursing; and 4. Records must reflect that the consultation pharmacist monthly report is acted upon.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 49.24.4** Labeling of drugs {#sec-16-49.24.4 omnilex-key=us-ms-regs-official--title-15--16#49.24.4}

Each ICF-IID shall follow the Mississippi State Board of Pharmacy labeling requirements.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 49.24.5** Disposal of drugs {#sec-16-49.24.5 omnilex-key=us-ms-regs-official--title-15--16#49.24.5}

1. Unused portions of medicine may be given to a discharged client or the responsible party upon orders of the prescribing physician or nurse practitioner/physician assistant. 2. Drugs and pharmaceuticals discontinued by the written orders of an attending physician or nurse practitioner/physician assistant or left in the ICF-IID on discharge or death of the client will be disposed of according to the Mississippi State Board of Pharmacy disposal requirements.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 49.24.6** Poisonous Substances {#sec-16-49.24.6 omnilex-key=us-ms-regs-official--title-15--16#49.24.6}

All poisonous substances such as insecticides, caustic cleaning agents, rodenticide, and other such agents must be plainly labeled and kept in locked cabinet or closet. No substances of this type shall be kept in the following areas: kitchen, dining area, food storage room or pantry, medicine cabinet or drug room, client's bedroom or toilet, public rooms, or spaces.

1. A medical record shall be maintained in accordance with accepted professional standards and practices on all clients admitted to the ICF-IID. The medical records shall be completely and accurately documented, readily accessible, and systematically organized to facilitate retrieving and compiling information. 2. A sufficient number of personnel, competent to carry out the functions of the medical record service, shall be employed. In an ICF IID Residenial

Community Home, medical record services can be provided through a contractual service. 3. The ICF-IID shall safeguard medical record information against loss, destruction, or unauthorized use. 4. All medical records shall maintain the following information: identification data and consent form; assessments of the client's needs by all disciplines involved in the care of the client; medical history and admission physical exam; annual physical exams; physician or nurse practitioner/physician assistant orders; observation, report of treatment, clinical findings and progress notes; and discharge summary, including the final diagnosis. 5. All entries in the medical record shall be signed and dated by the person making the entry. Authentication may include signatures, written initials, or computer entry. A list of computer codes and written signatures must be readily available and maintained under adequate safeguards. 6. All clinical information pertaining to the clients stay shall be centralized in the client's medical records. 7. Medical records of discharged clients shall be completed within thirty (30) days following discharge. 8. Medical records are to be retained for five (5) years from the date of discharge or, in the case of a minor, until the client reaches the age of twenty-one (21), plus an additional three (3) years.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13 Subchapter 25 MEDICAL RECORDS SERVICES Rule 45.25.1 Medical Records Management.*
- *SOURCE: Miss. Code Ann. §43-11-13 Subchapter 26 SOCIAL SERVICES AND CLIENT ACTIVITIES IN AN ICF-IID AND/OR ICF-IID RESIDENTIAL COMMUNITY HOME Rule 49.26.1 Program. Each ICF-IID or ICF-IID Residential Community Home shall provide services to assist all clients in dealing with social and related problems through one or more social services staff or through arrangements with an appropriate outside agency.*
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 49.26.2** Records {#sec-16-49.26.2 omnilex-key=us-ms-regs-official--title-15--16#49.26.2}

Social services information concerning each client shall be obtained and kept. This information shall cover social and emotional factors related to the client's condition and information concerning his home situation, financial resources and relationships with other people.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 49.26.3** Training {#sec-16-49.26.3 omnilex-key=us-ms-regs-official--title-15--16#49.26.3}

All nursing personnel and employees having contact with client shall receive social service orientation and in-service training toward understanding emotional problems and social needs of clients.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 49.26.4** Personnel {#sec-16-49.26.4 omnilex-key=us-ms-regs-official--title-15--16#49.26.4}

At least one person in each ICF-IID shall be designated as being responsible for the social services aspect for care in the ICF-IID.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 49.26.5** Office Space {#sec-16-49.26.5 omnilex-key=us-ms-regs-official--title-15--16#49.26.5}

Office space shall be provided for social service personnel. The office shall be accessible to clients and ensure privacy for interviews.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13 Subchapter 27 ACTIVITY COORDINATOR Rule 49.27.1 Activity Coordinator. An individual shall be designated as being in charge of client activities. This individual shall focus on the inclusion aspect of ensuring persons with disabilities contribute to the community and fully participate in all activities. Assessments in the areas of sensorimotor development and leisure skills shall be conducted with individualized training programs developed to improve functional abilities throughout all environments. This individual shall have experience and/or training in developing activities based upon personal choice, or shall have consultation made from a qualified recreation therapist or other professional regarding best practice and determining activities that are of meaningful -- value to the person with disabilities. Participation in activities should be documented in the client’s record.*
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 49.27.2** Activity Program {#sec-16-49.27.2 omnilex-key=us-ms-regs-official--title-15--16#49.27.2}

Provisions shall be made for suitable recreational and entertainment activities for client according to their needs and interests. These activities are an important adjunct to daily living and are to encourage restoration to self-care and resumption of normal activities. Variety in planning shall include some outdoor activities in suitable weather.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 49.27.3** Supplies and Equipment {#sec-16-49.27.3 omnilex-key=us-ms-regs-official--title-15--16#49.27.3}

The ICF-IID shall make available a variety of supplies and equipment adequate to satisfy the individual interests of clients.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 49.27.4** Living and/or Recreational Room(s) In An ICF-IID {#sec-16-49.27.4 omnilex-key=us-ms-regs-official--title-15--16#49.27.4}

1. Each ICF-IID shall provide adequate living room(s), day room(s) and/or recreational room(s) for clients and visitors. Each ICF-IID should provide at least two areas for this purpose-one for small groups such as private visits with relatives and friends and one for larger group activities. A minimum of eighteen (18) square feet per bed shall be provided. 2. Dining area. A dining area shall be provided in ICF-IID adequate to set at least three-fourths of the maximum capacity of the ICF-IID. The dining area may also be used for social, recreational, and/or religious services when not in use as a dining ICF-IID. A minimum of fifteen (15) square feet per person for three- fourths (3/4) of the capacity of the ICF-IID shall be provided.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 49.27.5** Special Activities Area {#sec-16-49.27.5 omnilex-key=us-ms-regs-official--title-15--16#49.27.5}

Each ICF-IID should provide space for hobbies and activities that cannot be included in a day room, living room, or recreational room.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 49.27.6** Outside Area {#sec-16-49.27.6 omnilex-key=us-ms-regs-official--title-15--16#49.27.6}

Adequate outside space should be provided for the use of clients in favorable weather.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13 Subchapter 28 FOOD AND NUTRITION SERVICES: GENERAL IN AN ICF-IID AND IN AN ICF-IID RESIDENTIAL COMMUNITY HOME Rule 49.28.1 Direction and Supervision. Food service is one of the basic services provided by the ICF-IID to its clients. Careful attention to adequate nutrition and prescribed modified diets contribute appreciably to the health and comfort to the client and stimulate his desire to achieve and maintain a higher level of self-care. The ICF- IID shall provide clients with well-planned, attractive, and satisfying meals which will meet their nutritional, social, emotional, and therapeutic needs. The Food and Nutrition Services Department of an ICF-IID shall be directed by a Registered Dietitian, a certified dietary manager, or a qualified dietary manager. If a qualified dietary manager is the director, he/she must receive frequent, regularly scheduled consultation from a licensed dietitian, or a registered dietitian exempted from licensure by statute.*
- *SOURCE: Miss. Code Ann. §43-11-13 Subchapter 29 FOOD HANDLING PROCEDURES IN AN ICF-IID AND AN ICF- IID RESIDENTIAL COMMUNITY HOME Rule 49.29.1 Safe Food Handling Procedures. Food shall be prepared, held, and served according to current Mississippi State Department of Health (MSDH) Food Code Regulations with appropriate records maintained to assure compliance with the MSDH Food Code Regulations.*
- *SOURCE: Miss. Code Ann. §43-11-13 Subchapter 30 MEAL SERVICE IN AN ICF-IID AND AN ICF-IID RESIDENTIAL COMMUNITY HOME Rule 49.30.1 Meal and Nutrition. At least three (3) meals in each twenty-four (24) hours shall be provided. The daily food allowance shall meet the current recommended dietary allowance of the Food and Nutrition Board of the National Research Council of the National Academy of Science adjusted for individual needs. A standard food planning guide (e.g., My Plate) or Nutrient Based Menu (determined by nutritional analysis) shall be used for planning and food purchasing. It is not intended to meet the nutritional needs of all clients. This guide must be adjusted to consider individual differences. Some clients will need more or less due to age, size, gender, physical activity, or state of health.*
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 49.30.2** Menu {#sec-16-49.30.2 omnilex-key=us-ms-regs-official--title-15--16#49.30.2}

The menu shall be planned and written at least one week in advance. The current week's menu shall be approved by the dietitian, dated, posted in the kitchen and followed as planned. Substitutions and changes on all diets shall be documented in writing. Copies of menus and substitutions shall be kept on file for at least thirty (30) days.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 49.30.3** Timing of Meals {#sec-16-49.30.3 omnilex-key=us-ms-regs-official--title-15--16#49.30.3}

A time schedule for serving meals to clients shall be established. Meals shall be served during customarily-accepted timeframes. There shall be no more than fourteen (14) hours between evening meal and breakfast meal. There may be 16 hours between the evening meal and breakfast meal if approved by the client involved and a substantial snack (including protein) is served before bedtime.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 49.30.4** Modified Diets {#sec-16-49.30.4 omnilex-key=us-ms-regs-official--title-15--16#49.30.4}

Modified diets which are a part of medical treatment shall be prescribed in written orders by the physician or nurse practitioner/physician assistant. All modified diets shall be planned in writing, approved by a Registered Dietician, and posted along with regular menus. Liberalized Geriatric Diets are encouraged for elderly clients when there is a need for moderate diet therapy. A current diet manual shall be available to personnel. The Registered Dietitian shall approve all modified diet menus, the diet manual used in the ICF-IID and/or the ICF-IID Residential Community Home, and possess a current diet manual. Refer also to Rule 49.2.34 for Registered Dietician requirements in an ICF-IID Residential Community Home.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 49.30.5** Food Preparation {#sec-16-49.30.5 omnilex-key=us-ms-regs-official--title-15--16#49.30.5}

Foods shall be prepared by methods that conserve optimum nutritive value, flavor, and appearance. Also, the food shall be acceptable to the

individuals served. A file of tested recipes shall be maintained to assure uniform quantity and quality of products.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 49.30.6** Food Supply {#sec-16-49.30.6 omnilex-key=us-ms-regs-official--title-15--16#49.30.6}

Supplies of perishable foods for at least a twenty-four (24) hour period and or non-perishable foods for a three (3) day period shall be on the premises to meet the requirements of the planned menus. The non-perishable foods shall consist of commercial type processed foods.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 49.30.7** Serving of Meals {#sec-16-49.30.7 omnilex-key=us-ms-regs-official--title-15--16#49.30.7}

1. Table should be of a type to seat not more than four (4) or six (6) clients. Clients who are not able to go to the dining room shall be provided sturdy tables (not TV trays) of proper heights. For those who are bedfast or infirm tray service shall be provided in their rooms with the tray resting on a firm support. 2. Personnel eating meals or snacks on the premises shall be provided facilities separate from and outside of food preparation, tray service, and dishwashing areas. 3. Foods shall be attractively and neatly served. All foods shall be served at proper temperature. Effective equipment shall be provided and procedures established to maintain food at proper temperature during serving. 4. All trays, tables, utensils and supplies such as china, glassware, flatware, linens and paper placemats, or tray covers used for meal service shall be appropriate, sufficient in quantity and in compliance with the applicable sanitation standard. 5. Food Service personnel. A competent person certified through an ANSI accredited food and beverage safety and handling program shall be designated by the administrator to be responsible for the total food service of the home. Sufficient staff shall be employed to meet the established standards of food service. Provisions should be made for adequate supervision and training of the employees. 6. The Registered Dietitian shall provide at a minimum, quarterly in-services to the ICF-IID and/or the ICF-IID Residential Community Home staff on food safety and/or other needed topics related to Food and Nutrition Services.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13 Subchapter 31 FOOD SERVICE AREAS IN AN ICF-IID AND/OR ICF-IID RESIDENTIAL COMMUNITY HOME*

##### **15 Miss. Admin. Code Pt. 16, R. 49.31.1** Floors {#sec-16-49.31.1 omnilex-key=us-ms-regs-official--title-15--16#49.31.1}

Floors in food service areas shall be of such construction so as to be easily cleaned, sound, smooth, non-absorbent, and without cracks or crevices. Also, floors shall be kept in good repair.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 49.31.2** Walls and Ceilings {#sec-16-49.31.2 omnilex-key=us-ms-regs-official--title-15--16#49.31.2}

Walls and ceilings of food service areas shall be of tight and substantial construction, smoothly finished, and painted in a light color. The walls and ceilings shall be without horizontal ledges and shall be washable up to the highest level reached by splash and spray. Roofs and walls shall be maintained free of leaks. All openings to the exterior shall be provided with doors or windows that will prevent the entrance of rain or dust during inclement weather.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 49.31.3** Screens and Outside Openings {#sec-16-49.31.3 omnilex-key=us-ms-regs-official--title-15--16#49.31.3}

Openings to the outside shall be effectively screened. Screen doors shall open outward and be equipped with self-closing devices.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 49.31.4** Lighting {#sec-16-49.31.4 omnilex-key=us-ms-regs-official--title-15--16#49.31.4}

The kitchen, dishwashing area, and dining room shall be provided with well distributed and unobstructed natural light or openings. Artificial light properly distributed and of an intensity of not less than thirty (30) foot candles shall be provided.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 49.31.5** Ventilation {#sec-16-49.31.5 omnilex-key=us-ms-regs-official--title-15--16#49.31.5}

The food service area shall be ventilated in a manner that will maintain comfortable working conditions, remove objectionable odors and fumes, and prevent excessive condensations.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 49.31.6** Employee Toilet Facilities {#sec-16-49.31.6 omnilex-key=us-ms-regs-official--title-15--16#49.31.6}

Toilet facilities with lockers shall be provided for employees in an ICF-IID. Toilet rooms shall not open directly into any room in which food is prepared, stored, displayed or served, nor into any room in which utensils are washed or stored. Toilet rooms shall have a lavatory and shall be well lighted and ventilated.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 49.31.7** Hand washing Facilities {#sec-16-49.31.7 omnilex-key=us-ms-regs-official--title-15--16#49.31.7}

Hand washing facilities with hot and cold water, soap dispenser and a supply of soap, and disposable towels shall be provided in all kitchens. The use of a common towel is prohibited. Hands shall not be washed in sinks where food is prepared or where utensils are cleaned.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 49.31.8** Refrigeration Facilities {#sec-16-49.31.8 omnilex-key=us-ms-regs-official--title-15--16#49.31.8}

Adequate refrigeration facilities, automatic in operation, for the storage of perishable foods shall be provided. Refrigeration temperatures for storing perishable foods such as meats, dairy products, fruits, and vegetables shall be maintained at forty-one (41) degrees Fahrenheit. Freezers shall be maintained at zero (0) degrees Fahrenheit or below. All refrigerators shall be provided with a thermometer. An ICF-IID with more than twenty-four (24) beds shall have commercial or institutional type refrigeration.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 49.31.9** Equipment and Utensil Construction {#sec-16-49.31.9 omnilex-key=us-ms-regs-official--title-15--16#49.31.9}

Equipment and utensils shall be constructed so as to be easily cleaned and shall be kept in good repair.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 49.31.10** Separation of Kitchen from Client Rooms and Sleeping Quarters {#sec-16-49.31.10 omnilex-key=us-ms-regs-official--title-15--16#49.31.10}

Any room used for sleeping quarters shall be separated from the food service area by a solid wall. Sleeping accommodations such as a cot, bed, or couch shall not be permitted within the food service area.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13 Subchapter 32 AREAS AND EQUIPMENT IN AN ICF-IID Rule 49.32.1 Location and Space Requirements. Food service facilities shall be located in a specifically designated area and shall include the following rooms and/or spaces: kitchen, dishwashing, food storage, and dining room.*
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 49.32.2** Kitchen {#sec-16-49.32.2 omnilex-key=us-ms-regs-official--title-15--16#49.32.2}

1. Size and Dimensions. The minimum area of kitchen (food preparation only) for less than twenty-five (25) beds shall be a minimum area of two hundred (200) square feet. In ICFs-IID with twenty five (25) beds to sixty (60) beds, a minimum of ten (10) square feet per bed shall be provided. In facilities with sixty-one (61) to eighty (80) beds, a minimum of six (6) square feet per bed shall be provided for each bed over sixty (60) in the home. In facilities with eighty-one (81) to one hundred (100) beds, a minimum of five (5) square feet per bed shall be provided for each bed over eighty (80). In facilities with more than one hundred (100) beds proportionate space approved by the licensing agency shall be provided. Also, the kitchen shall be of such size and dimensions in order to: a. Permit orderly and sanitary handling and processing of food. b. Avoid overcrowding and congestion of operations.

c. Provide at least three (3) feet between working areas and wider if space is used as a passageway. d. Provide a ceiling height of at least eight (8) feet. 2. Equipment. Minimum equipment in the kitchen in an ICF-IID shall include: a. Range and cooking equipment. Facilities with more than twenty-four (24) beds shall have institutional type ranges, ovens, steam cookers, fryers, etc., in appropriate sizes and number to meet the food preparation needs of the ICF-IID. The cooking equipment shall be equipped with a hood vented to the outside as appropriate. b. Refrigerator and Freezers. Facilities with more than twenty-four (24) beds shall have sufficient commercial or institutional type refrigeration/freezer units to meet the storage needs of the ICF-IID. c. Bulletin Board. d. Clock. e. Cook's table. f. Counter or table for tray set-up. g. Cans garbage (heavy plastic or galvanized). h. Lavatories, hand washing; conveniently located throughout the department. i. Pots, pans, silverware, dishes, and glassware in sufficient numbers with storage space for each. j. Pot and Pan Sink. A three compartment sink shall be provided for cleaning pots and pans. Each compartment shall be a minimum of twenty-four (24) inches by twenty-four (24) inches by sixteen (16) inches. A drain board of approximately thirty (30) inches shall be provided at each end of the sink, one to be used for stacking soiled utensils and the other for draining clean utensils. k. Food Preparation Sink. A double compartment food preparation sink shall provide for washing vegetables and other foods. A drain board shall be provided at each end of the sink. l. Ice Machine. At least one ice machine shall be provided. If there is only one (1) ice machine in the ICF-IID it shall be located adjacent to but not in the kitchen. If there is an ice machine located at nursing station, then ice machine for dietary shall be located in the kitchen. An ice machine is not

required in an ICF-IID Group Home or ICF-IID Residential Community Home. m. Office. An office shall be provided near the kitchen for the use of the food service supervisor. As a minimum, the space provided shall be adequate for a desk, two chairs and a filing cabinet. n. Coffee Tea and Milk Dispenser. (Milk dispenser not required if milk is served in individual cartons). o. Tray assembly line equipment with tables, hot food tables, tray slide, etc. p. Mixer. Institutional type mixer of appropriate size. q. Food Processor.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 49.32.3** Dishwashing {#sec-16-49.32.3 omnilex-key=us-ms-regs-official--title-15--16#49.32.3}

Commercial or institutional type dishwashing equipment shall be provided in ICFs-IID with more than twenty-four (24) beds. The dishwashing area shall be separated from the food preparation area. If sanitizing is to be accomplished by hot water, a minimum temperature of one hundred eighty (180) degrees Fahrenheit shall be maintained during the rinsing cycle. An alternate method of sanitizing through use of chemicals may be provided if sanitizing standards of the Mississippi State Department of Health Food Code Regulations are observed. Adequate counter-space for stacking soiled dishes shall be provided in the dishwashing area at the most convenient place of entry from the dining room, followed by a disposer with can storage under the counter. There shall be a pre- rinse sink, then the dishwasher and finally a counter or drain for clean dishes.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 49.32.4** Food Storage {#sec-16-49.32.4 omnilex-key=us-ms-regs-official--title-15--16#49.32.4}

A food-storage room with cross ventilation shall be provided in an ICF-IID. Adequate shelving, bins, and heavy plastic or galvanized cans shall be provided. The storeroom shall be of such construction as to prevent the invasion of rodents and insects, the seepage of dust and water leakage, or any other source of contamination. The food-storage room should be adjacent to the kitchen and convenient to the receiving area. The minimum area for a food-storage room shall equal two and one-half (2 1/2) square feet per bed and the width of the aisle shall be a minimum of three (3) feet. Food storage shall be maintained at 12 inches above the floor.

1. If at all possible, all water shall be obtained from a community public water supply (CWS). If not possible to obtain water from a community public water supply (CWS) source, the private water supply shall meet the approval of the local county health department and/or the Mississippi State Department of Health. 2. Water under pressure sufficient to operate fixtures at the highest point during maximum demand periods shall be provided. Water under pressure of at least twenty (20) pounds per square inch shall be piped to all sinks, toilets, lavatories, tubs, showers, and other fixtures requiring water. 3. It is recommended that the water supply into the ICF-IID can be obtained from two (2) separate water lines if possible. 4. A dual hot water supply shall be provided. The temperature of hot water to lavatories and bathing facilities shall not exceed one hundred fifteen (115) degrees Fahrenheit, nor shall hot water be less than one hundred (100) degrees Fahrenheit. 5. Each ICF-IID shall have a written agreement for an alternate source of potable water in the event of a disruption of the normal water supply.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13 Subchapter 33 SANITATION AND SEWERAGE: SANITATION IN THE ICF-IID AND/OR THE ICF-IID RESIDENTIAL COMMUNITY HOME Rule 49.33.1 Water Supply.*
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 49.33.2** Disposal of Liquid and Human Wastes {#sec-16-49.33.2 omnilex-key=us-ms-regs-official--title-15--16#49.33.2}

1. There shall be installed within the ICF-IID a properly designed waste disposal system connecting to all fixtures to which water under pressure is piped. 2. All liquid and human waste, including floor-wash water and liquid waste from refrigerators, shall be disposed of through trapped drains into a public sewer system where such system is available. 3. In localities where a public sanitary sewer is not available, liquid and human waste shall be disposed of through trapped drains into sewerage disposal system approved by the local county health department and/or the Mississippi State Department of Health. The sewerage disposal system shall be of a size and capacity based on the number of clients and personnel housed and employed in the ICF-IID. Where the sewerage disposal system is installed prior to the opening of the ICF-IID, it shall be assumed, unless proven otherwise, that the system was designed for ten (10) or fewer persons.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 49.33.3** Premises {#sec-16-49.33.3 omnilex-key=us-ms-regs-official--title-15--16#49.33.3}

The premises shall be kept neat, clean, and free of an accumulation of rubbish, weeds, ponded water, or other conditions which would have a tendency to create a health hazard.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 49.33.4** Control of insects, rodents, etc {#sec-16-49.33.4 omnilex-key=us-ms-regs-official--title-15--16#49.33.4}

The ICF-IID shall be kept free of ants, flies, roaches, rodents, and other insects and vermin. Proper methods for their eradication and control shall be utilized.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 49.33.5** Toilet Room Cleanliness {#sec-16-49.33.5 omnilex-key=us-ms-regs-official--title-15--16#49.33.5}

Floors, walls, ceilings, and fixtures of all toilet rooms shall be kept clean and free of objectionable odors. These rooms shall be kept free of an accumulation of rubbish, cleaning supplies, toilet articles, etc.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 49.33.6** Garbage Disposal {#sec-16-49.33.6 omnilex-key=us-ms-regs-official--title-15--16#49.33.6}

1. Garbage must be kept in water-tight suitable containers with tight fitting covers. Garbage containers must be emptied at frequent intervals and cleaned before using again. 2. Proper disposition of infectious materials shall be observed.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13 Subchapter 34 REGULATED MEDICAL WASTE IN AN ICF-IID AND/OR A ICF- IID RESIDENTIAL COMMUNITY HOME Rule 49.34.1 Standards and Requirements. All the requirements of the standards set forth in this section shall apply, without regard to the quantity of medical waste generated per month, to any generator of medical waste.*
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 49.34.2** Medical Waste {#sec-16-49.34.2 omnilex-key=us-ms-regs-official--title-15--16#49.34.2}

1. Medical waste must be kept in water-tight suitable containers with tight fitting covers. Medical waste containers must be emptied at frequent intervals and cleaned before using again. 2. Proper disposition of medical waste materials shall be observed.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 49.34.3** Medical Waste Management Plan {#sec-16-49.34.3 omnilex-key=us-ms-regs-official--title-15--16#49.34.3}

All generators of infectious medical waste and medical waste shall have a medical waste management plan that shall include, but is not limited to, the following: 1. Storage and Containment of Infectious Medical Waste and Medical Waste:

a. Containment of infectious medical waste and medical waste shall be in a manner and location which affords protection from animals, rain and wind, does not provide a breeding place or a food source for insects and rodents, and minimizes exposure to the public. b. Infectious medical waste shall be segregated from other waste at the point of origin in the producing ICF-IID. c. Unless approved by the licensing agency or treated and rendered non- infectious, infectious medical waste (except for sharps in approved containers) shall not be stored at a waste producing ICF-IID for more than seven days above a temperature of six (6) degrees Celsius (equivalent to thirty-eight [38] degrees Fahrenheit). Containment of infectious medical waste at the producing ICF-IID is permitted at or below a temperature of zero (0) degrees Celsius (equivalent to thirty-two [32] degrees Fahrenheit) for a period of not more than ninety (90) days without specific approval of the licensing agency. d. Containment of infectious medical waste shall be separate from other wastes. Enclosures or containers used for containment of infectious medical waste shall be so secured so as to discourage access by unauthorized persons and shall be marked with prominent warning signs on, or adjacent to, the exterior of entry doors, gates, or lids. Each container shall be prominently labeled with a sign using language to be determined by the licensing agency and legible during daylight hours. e. Infectious medical waste, except for sharps capable of puncturing or cutting, shall be contained in double disposable plastic bags or single bags (1.5 mills thick) which are impervious to moisture and have strength sufficient to preclude ripping, tearing, or bursting under normal conditions of usage. The bags shall be securely tied so as to prevent leakage or expulsion of solid or liquid wasted during storage, handling, or transport. f. All bags used for containment and disposal of infectious medical waste shall be of a distinctive color or display the Universal Symbol for infectious waste. Rigid containers of all sharps waste shall be labeled. g. Compactors or grinders shall not be used to process infectious medical waste unless the waste has been rendered noninfectious. Sharps containers shall not be subject to compaction by any compacting device except in the institution itself and shall not be placed for storage or transport in a portable or mobile trash compactor. h. Infectious medical waste and medical waste contained in disposable containers as prescribed above, shall be placed for storage, handling, or transport in disposable or reusable pails, cartons, drums, or portable bins.

The containment system shall be leak-proof, have tight fitting covers and be kept clean and in good repair: i. Reusable containers for infectious medical waste and medical waste shall be thoroughly washed and decontaminated each time they are emptied by a method specified by the licensing agency, unless the surfaces of the containers have been protected from contamination by disposable liners, bags, or other devices removed with the waste, as outlined in I.E. Approved methods of decontamination include, but are not limited to, agitation to remove visible soil combined with one or more of the following procedures: i. Exposure to hot water at least one-hundred eighty (180) degrees Fahrenheit for a minimum of fifteen (15) seconds. ii. Exposure to a chemical sanitizer by rinsing with or immersion in one of the following for a minimum of three (3) minutes: 1. Hypochlorite solution (500 ppm available chlorine). 2. Phenolic solution (500 ppm active agent). 3. Iodoform solution (100 ppm available iodine). 4. Quaternary ammonium solution (400 ppm active agent). iii. Reusable pails, drums, or bins used for containment of infectious waste shall not be used for containment of waste to be disposed of as noninfectious waste or for other purposed except after being decontaminated by procedures as described in 133.03 (i) of this section. j. Trash chutes shall not be used to transfer infectious medical waste. k. Once treated and rendered non-infectious, previously defined infectious medical waste will be classified as medical waste and may be land-filled in an approved landfill. 2. Treatment or disposal of infectious medical waste shall be by one of the following methods: a. By incineration in an approved incinerator which provides combustion of the waste to carbonized or mineralized ash. b. By sterilization by heating in a steam sterilizer, so as to render it noninfectious. Infectious medical waste so rendered non-infectious shall be disposable as medical waste. Operating procedures for steam sterilizers shall include, but not be limited to, the following:

i. Adoption of standard written operating procedures for each steam sterilizer including time, temperature, pressure, type of waste, type of container(s), closure on container(s), pattern of loading, water content, and maximum load quantity. ii. Check or recording and/or indicating thermometers during each complete cycle to ensure the attainment of a temperature of one-hundred twenty-one (121) degrees Celsius (equivalent to two-hundred fifty [250] degrees Fahrenheit) for one-half (1/2) hour or longer, depending on quantity and density of the load, in order to achieve sterilization of the entire load. Thermometers shall be checked for calibration at least annually. iii. Use of heat sensitive tape or other device for each container that is processed to indicate the attainment of adequate sterilization conditions. iv. Use of the biological indicator Bacillus stearothermophilus placed at the center of a load processed under standard operating conditions at least monthly to confirm the attainment of adequate sterilization conditions. v. Maintenance of records of procedures specified in (i), (ii), (iii) and (iv) above for period of not less than a year. c. By discharge to the approved sewerage system if the waste is liquid or semi- liquid, except as prohibited by the Mississippi State Department of Health or other regulatory agency. d. Recognizable human anatomical remains shall be disposed of by incineration or internment, unless burial at an approved landfill is specifically authorized by the Mississippi State Department of Health. e. Chemical sterilization shall use only those chemical sterilants recognized by the U. S. Environmental Protection Agency, Office of Pesticides and Toxic Substances. Ethylene oxide, glutaraldehyde, and hydrogen peroxide are examples of sterilants that, used in accordance with manufacturer recommendation, will render infectious waste non-infectious. Testing with Bacillus subtilis spores or other equivalent organisms shall be conducted quarterly to ensure the sterilization effectiveness of gas or steam treatment. f. Treatment and disposal of medical waste which is not infectious shall be by one of the following methods: i. By incineration in an approved incinerator which provides combustion of the waste to carbonized or mineralized ash. ii. By sanitary landfill, in an approved landfill which shall mean a disposal ICF-IID or part of an ICF-IID where medical waste is placed in or on land, and which is not a treatment ICF-IID.

1. The physical plant shall be kept in good repair, neat, and attractive. The safety and comfort of the client shall be the first consideration. 2. Janitor closets shall be provided with a mop-cleaning sink and be large enough in area to store house cleaning supplies and equipment. A separate janitor closet area and equipment should be provided for the food service area.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13 Subchapter 35 HOUSEKEEPING AND PHYSICAL PLANT IN AN ICF-IID AND/OR AN ICF-IID RESIDENTIAL COMMUNITY HOME Rule 49.35.1 Housekeeping Facilities and Services.*
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 49.35.2** Bathtubs, Showers, and Lavatories {#sec-16-49.35.2 omnilex-key=us-ms-regs-official--title-15--16#49.35.2}

Bathtubs, showers, and lavatories shall be kept clean and in proper working order. They shall not be used for laundering or for storage of soiled materials. Neither shall these facilities be used for cleaning mops, brooms, etc.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 49.35.3** Client Bedrooms {#sec-16-49.35.3 omnilex-key=us-ms-regs-official--title-15--16#49.35.3}

Client bedrooms shall be cleaned and dusted as often as necessary to maintain a clean, attractive appearance. All sweeping should be damp sweeping; all dusting should be damp dusting with a good detergent or germicide.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 49.35.4** Storage {#sec-16-49.35.4 omnilex-key=us-ms-regs-official--title-15--16#49.35.4}

1. Such items as beds, mattresses, mops, mop buckets, dust rags, etc. shall not be kept in hallways, corners, toilet or bathrooms, clothes closets, or client bedrooms. 2. The use of attics for storage of combustible materials is prohibited. 3. If basements are used for storage, they shall meet acceptable standards for storage and for fire safety.

Subchapter 37 PHYSICAL FACILITIES Rule 49.37.1 Location and Space Requirements. Each ICF-IID shall have laundry facilities unless commercial laundries are used. The laundry shall be located in a specifically designated area, and there shall be adequate room and space for sorting, processing, and storage of soiled material. Laundry rooms or soiled linen storage areas shall not open directly into a client bedroom or food service area. Soiled materials shall not be transported through the food service area. If commercial laundry is used, separate satisfactory storage areas shall be provided for clean and soiled linens. There shall be provided a clean linen storage area separate from the laundry area.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13 Subchapter 36 LAUNDRY: GENERAL Rule 49.36.1 Commercial Laundry. Facilities may use commercial laundries or they may provide a laundry within the institution.*
- *SOURCE: Miss. Code Ann. §43-11-13*
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 49.37.2** Ventilation {#sec-16-49.37.2 omnilex-key=us-ms-regs-official--title-15--16#49.37.2}

Provisions shall be made for proper mechanical ventilation of the laundry. Provisions shall be made to prevent the recirculation of air through the heating and air condition systems.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 49.37.3** Lint Traps {#sec-16-49.37.3 omnilex-key=us-ms-regs-official--title-15--16#49.37.3}

Adequate and effective lint traps shall be provided for driers.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 49.37.4** Laundry Chutes {#sec-16-49.37.4 omnilex-key=us-ms-regs-official--title-15--16#49.37.4}

When laundry chutes are provided they shall have a minimum diameter of two (2) feet; and they shall be installed with flushing ring, vent, and drain.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 49.37.5** Laundry Equipment {#sec-16-49.37.5 omnilex-key=us-ms-regs-official--title-15--16#49.37.5}

Laundry equipment shall be of the type to adequately perform the laundry needs of the institution. The equipment shall be installed to comply with all local and state codes.

1. To qualify for a license, the ICF-IID shall be planned to serve the type of patients to be admitted and shall comply with the following: a. All facilities constructed after the effective date of these regulations shall comply with the building requirements set forth in the regulations. b. After the effective date of these regulations, all additions to facilities shall comply with the building requirements for a license. Approval shall not be granted for an addition to an existing building which will increase the bed

capacity unless the existing structure is basically sound and is to be brought into a condition of acceptable conformity with the current regulations. c. Authority to Waiver. The licensing agency may waive certain requirements in these regulations at its discretion for facilities requesting licensure as an ICF-IID and/or an ICF-IID Residential Community Home provided the health and safety of clients will not be endangered. 2. Renovations within the exterior walls of an ICF-IID shall in no case be of such nature as to lower the character of the structure below the applicable building requirements for the type of license held by the ICF-IID.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13 Subchapter 38 PHYSICAL PLANT: GENERAL Rule 49.38.1 Building Classification.*
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 49.38.2** Location {#sec-16-49.38.2 omnilex-key=us-ms-regs-official--title-15--16#49.38.2}

All facilities established or constructed after the adoption of these regulations shall be located so that they are free from undue noise, smoke, dust, or foul odors and shall not be located adjacent to disposal plants, cemeteries, main line railroads, funeral home, airport, etc.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 49.38.3** Site {#sec-16-49.38.3 omnilex-key=us-ms-regs-official--title-15--16#49.38.3}

The proposed site for an ICF-IID must be approved by the licensing agency. Factors to be considered in approving a site in addition to the above may be convenience to medical and hospital services, approved water supply and sewerage disposal, public transportation, community services, services of an organized fire department, an availability to labor supply. Not more than one-third (1/3) of a site shall be covered by a building(s) except by special approval of the licensing agency. One example whereby approval may be granted is where the structure is to be placed in a very desirable location where the grounds are limited and very expensive. Where such approval is granted, the structure will be required to have a living room, day room, sun room, and recreational areas adequate to compensate for lack of required outside area.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 49.38.4** Local Restrictions {#sec-16-49.38.4 omnilex-key=us-ms-regs-official--title-15--16#49.38.4}

The site and structure of all facilities shall comply with local building, fire and zoning ordinances. Evidence to this effect signed by local building, fire, and zoning officials shall be presented.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 49.38.5** Transportation {#sec-16-49.38.5 omnilex-key=us-ms-regs-official--title-15--16#49.38.5}

Facilities shall be located on streets or roads which have all weather surfaces. They should be located convenient to public transportation facilities (if available).

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 49.38.6** Communication {#sec-16-49.38.6 omnilex-key=us-ms-regs-official--title-15--16#49.38.6}

There shall be not less than one telephone in the home and such additional telephones as are necessary to summon help in event of fire or other emergency. The telephone shall be listed under the official licensed name or title of the home.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 49.38.7** Occupancy {#sec-16-49.38.7 omnilex-key=us-ms-regs-official--title-15--16#49.38.7}

No part of the ICF-IID may be rented, leased, or used for any commercial purpose not related to the operation of the home.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 49.38.8** Basement {#sec-16-49.38.8 omnilex-key=us-ms-regs-official--title-15--16#49.38.8}

1. The basement shall be considered as a story if one-half (1/2) or more of its clear height is above the average elevation of the ground adjoining the building on all sides. 2. No client shall be housed on any floor that is below ground level.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13 Subchapter 39 SUBMISSION OF PLANS AND SPECIFICATIONS FOR ICF-IIDS OR ICF-IID RESIDENTIAL COMMUNITY HOMES Rule 49.39.1 New Construction, Additions, and Renovations. When construction is contemplated either for new buildings, conversions, additions, or alterations to existing buildings, one set of plans and specifications shall be submitted to the licensing agency for review and approval. The submission shall be made in not less than two stages preliminary and final. Floor plans shall be drawn to scale of one-eight (1/8) inch to equal one (1) foot or one-fourth (1/4) inch to equal one (1) foot.*
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 49.39.2** Minor Alterations and Remodeling {#sec-16-49.39.2 omnilex-key=us-ms-regs-official--title-15--16#49.39.2}

Minor alterations and remodeling which do not affect the structural integrity of the building, change functional operation, affect fire safety, or add beds or facilities or those for which the ICF-IID is licensed do not need to have plans submitted for review provided that a detailed explanation of the proposed alteration or remodeling is submitted to and approved by the licensing agency.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 49.39.3** First Stage Submission-Preliminary Plans.: First stage or preliminary plans shall include: {#sec-16-49.39.3 omnilex-key=us-ms-regs-official--title-15--16#49.39.3}

1. Plot plan showing size and shape of entire site; location of proposed building and any existing structure(s); adjacent streets, highways, sidewalks, railroads, etc., all properly designated; and size, characteristics, and location of all existing public utilities. 2. Floor plan showing over-all dimensions of building(s); location, size, and purpose of all rooms; location and size of all doors, windows, and other openings with swing of doors properly indicated; dimensions of all corridors and hallways; and location of stairs, elevators, dumbwaiters, vertical shafts, and chimneys. a. Outline specifications giving kinds and types of materials. b. A scaled drawing of one-fourth (1/4) inch to one (1) foot shall be submitted for the following areas: Kitchen, dishwashing area, nurses' station and utility room(s).

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 49.39.4** Rule 49.39.4 {#sec-16-49.39.4 omnilex-key=us-ms-regs-official--title-15--16#49.39.4}

Final Stage Submission-Working Drawings and Specifications.: Final stage or working drawings and specifications shall include: 1. Architectural drawings 2. Structural drawings 3. Mechanical drawings to include plumbing, heat, and air-conditioning 4. Electrical drawings 5. Detailed specifications 6. Approval of working drawings and specifications shall be obtained from the licensing agency in writing prior to the beginning of actual construction.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 49.39.5** Preparation of Plans and Specifications {#sec-16-49.39.5 omnilex-key=us-ms-regs-official--title-15--16#49.39.5}

The preparation of drawings and specifications shall be executed by or under the immediate supervision of an architect who shall supervise construction and furnish a signed statement that construction was performed according to plans and specifications approved by the licensing agency.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 49.39.6** Contract Modifications {#sec-16-49.39.6 omnilex-key=us-ms-regs-official--title-15--16#49.39.6}

Any contract modification which affects or changes the function, design, or purpose of an ICF-IID shall be submitted to and approved by

the licensing agency prior to the beginning of work set forth in any contract modification.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 49.39.7** Notification of Start of Construction {#sec-16-49.39.7 omnilex-key=us-ms-regs-official--title-15--16#49.39.7}

The licensing agency shall be informed in writing at the time construction is begun.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 49.39.8** Inspections {#sec-16-49.39.8 omnilex-key=us-ms-regs-official--title-15--16#49.39.8}

The licensing agency or its authorized representatives shall have access at all times to the work for inspection whenever it is in preparation or progress, and the owner shall ascertain that proper facilities are made available for such access and inspection.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 49.39.9** Limit of Approval {#sec-16-49.39.9 omnilex-key=us-ms-regs-official--title-15--16#49.39.9}

In construction delayed for a period of exceeding six (6) months from the time of approval of final working plans and specifications, a new evaluation and/or approval shall be obtained from the licensing agency.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 49.39.10** Water Supply, Plumbing, Sewerage Disposal {#sec-16-49.39.10 omnilex-key=us-ms-regs-official--title-15--16#49.39.10}

The water supply and sewerage disposal shall be approved by the local county health department and/or the Division of Sanitary Engineering, Mississippi State Department of Health. No system of water supply, plumbing, sewerage, garbage, or refuse disposal shall be installed nor any such existing system materially altered or extended until complete plans and specifications for the installation, alteration, or extension have been so approved and submitted to the licensing agency for review and final determination.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 49.39.11** Rule 49.39.11 {#sec-16-49.39.11 omnilex-key=us-ms-regs-official--title-15--16#49.39.11}

Availability of Approved Plans: Every licensed ICF-IID shall maintain, on the premises and available for inspection, a copy of current approved architectural plans and specifications.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13 Subchapter 40 GENERAL BUILDING REQUIREMENTS Rule 49.40.1 Scope. The provision of this section shall apply to all facilities except for those sections or paragraphs where a specific exception is granted for existing facilities.*
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 49.40.2** Structural Soundness and Repair; Fire Resistive Rating {#sec-16-49.40.2 omnilex-key=us-ms-regs-official--title-15--16#49.40.2}

The building shall be structurally sound, free from leaks and excessive moisture, in good repair, and painted at sufficient intervals to be reasonably attractive inside and out.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 49.40.3** Temperature {#sec-16-49.40.3 omnilex-key=us-ms-regs-official--title-15--16#49.40.3}

Adequate heating and cooling shall be provided in all rooms used by clients so that a minimum temperature of seventy-five (75) to eighty (80) degrees Fahrenheit may be maintained.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 49.40.4** Lighting {#sec-16-49.40.4 omnilex-key=us-ms-regs-official--title-15--16#49.40.4}

Each client's room shall have artificial light adequate for reading and other uses as needed. There should be a minimum of ten (10) foot-candles of lighting for general use in client's room and a minimum of thirty (30) foot-candles of lighting for reading purposes. All entrances, corridors, stairways, ramps, cellars, attics, storerooms, kitchens, laundries, and service units shall have sufficient artificial lighting to prevent accidents and promote efficiency of service. Night lights shall be provided in all corridors, stairways, toilets, and bathing rooms.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 49.40.5** Screens {#sec-16-49.40.5 omnilex-key=us-ms-regs-official--title-15--16#49.40.5}

All screen doors and non-stationary windows shall be equipped with tight fitting full length, sixteen (16) mesh screens. Screen doors shall swing out and shall be equipped with self-closing devices.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 49.40.6** Floors {#sec-16-49.40.6 omnilex-key=us-ms-regs-official--title-15--16#49.40.6}

All floors shall be smooth and free from defects such as cracks and be finished so that they can be easily cleaned.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 49.40.7** Walls and Ceilings {#sec-16-49.40.7 omnilex-key=us-ms-regs-official--title-15--16#49.40.7}

All walls and ceilings shall be of sound construction with an acceptable surface and shall be maintained in good repair. Generally the walls and ceilings should be painted a light color.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 49.40.8** Ceiling Height {#sec-16-49.40.8 omnilex-key=us-ms-regs-official--title-15--16#49.40.8}

All ceilings shall have a height of at least eight (8) feet except that a height of seven (7) feet and six (6) inches may be approved for corridors or toilets and bathing rooms where the lighting fixtures are recessed. Exception may be made for existing facilities.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 49.40.9** Handrails {#sec-16-49.40.9 omnilex-key=us-ms-regs-official--title-15--16#49.40.9}

In an ICF-IID, handrails shall be installed on both sides of all corridors and hallways used by clients. The handrails should be installed from thirty-two

(32) inches to thirty-six (36) inches above the floors. The handrails should have a return to the wall at each rail ending. An exception may be made for existing facilities. In addition, grab bars shall be installed in at least one bathroom beside the toilet and beside the lavatory in an ICF-IID Residential Community Home.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 49.40.10** Ramps and Inclines {#sec-16-49.40.10 omnilex-key=us-ms-regs-official--title-15--16#49.40.10}

Ramps and inclines, where installed for the use of clients, shall not exceed one (1) foot of rise in twelve (12) feet of run, shall be furnished with a non-slip floor, and shall be provided with handrails on both sides. Exception may be granted for existing ramps and inclines on existing facilities.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 49.40.11** Call System {#sec-16-49.40.11 omnilex-key=us-ms-regs-official--title-15--16#49.40.11}

A call system shall be in place in an ICF-IID at the nurses' station to receive client calls through a communication system to include audible and visual signals from bedrooms, toilets, and bathing facilities. In the residential community home setting, there shall be a communication system in place throughout the residence to address the immediate needs of the clients.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 49.40.12** Trash Chutes {#sec-16-49.40.12 omnilex-key=us-ms-regs-official--title-15--16#49.40.12}

The installation and/or use of trash chutes is prohibited.

1. New buildings and/or building not previously approved for use as a Residential Community Home (6 [Six] clients or less), Small ICF/IID (16 clients or less), or Large ICF/IID (More than 16 clients) on the effective date of these regulations shall comply with Chapter 32 “New Residential Board and Care” edition of the Life Safety Code (NFPA 101) effective on the date of application.

2. Existing buildings and/or building not previously approved for use as a Small ICF/IID (16 clients or less) or Large ICF/IID (More than 16 clients) on the effective date of these regulations shall comply with Chapter 33 “Existing Residential Board and Care” edition of the Life Safety Code (NFPA 101).

**History**
- *SOURCE: Miss. Code Ann. §43-11-13 Subchapter 41 FIRE SAFETY AND CONSTRUCTION Rule 49.41.1 Date of Construction and Life Safety Code Compliance.*
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 49.41.2** ICF-IID Required Rooms and Areas 1 {#sec-16-49.41.2 omnilex-key=us-ms-regs-official--title-15--16#49.41.2}

Client bedroom. (See Rule 49.19.3)

2. Special care room. (See Rule 49.19.4) 3. Nurses' Station. (See Rule 49.19.5) 4. Utility room. (See Rule 49.19.6) 5. Toilet and bathing facilities. (See Rule 49.19.7) 6. Clean linen storage. Adequate areas shall be provided for storing clean linens which shall be separate from dirty linen storage. 7. Wheelchair area. Adequate area shall be provided for storage of wheelchairs. 8. Kitchen. (See Rule 49.32.2 – 49.32.4) 9. Dining room. The dining area shall be large enough to seat three-fourth (3/4) of the maximum capacity of an ICF-IID. The dining area can also be used for social, recreational, or religious activities. It is recommended that a separate dining area be provided for personnel. 10. Food storage. A food storage room shall be provided convenient to the kitchen in all future licensed homes. It should have cross ventilation. All foods must be stored a minimum of twelve (12) inches above the floor. 11. Day room or living room. Adequate day or living room area shall be provided for clients or clients and guests. These areas shall be designated exclusively for this purpose and shall not be used as sleeping area or otherwise. It is recommended that at least two (2) such areas be provided and more in larger homes. 12. Janitor closet. At least one (1) janitor's closet shall be provided for each floor. The closet shall be equipped with a mop sink and be adequate in area to store cleaning supplies and equipment. A separate janitor's closet shall be provided for the food service area. 13. Garbage can cleaning and storage area. 14. General storage. A minimum area equal to at least five (5) square feet per bed shall be provided for general storage. 15. Laundry. If laundry is done in the institution, a laundry room shall be provided. Adequate equipment for the laundry load of the home shall be installed. The sorting, washing, and extracting process should be separated from the folding and ironing area-preferably in separate rooms. In addition refer to Subchapter 36, Laundry, General; and Subchapter 37, Physical Facilities. 16. Separate toilet room (lavatory and water closet) shall be provided for male and female employees.

17. A separate toilet room with a door that can be locked shall be provided for the public. 18. Food Service Supervisors Office. 19. Social Services Office.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 49.41.3** Immediate Jeopardy (Serious and Immediate to Health and Safety) {#sec-16-49.41.3 omnilex-key=us-ms-regs-official--title-15--16#49.41.3}

A situation in which the ICF-IID’s failure to meet one or more licensure requirements has caused, or is likely to cause, serious injury, harm, impairment, or death to a client.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 49.41.4** Rule 49.41.4 {#sec-16-49.41.4 omnilex-key=us-ms-regs-official--title-15--16#49.41.4}

Ban on all Admissions A ban on all admissions to an ICF-IID and/or the ICF-IID residential community home shall be imposed by the licensing agency when it has been determined by the licensing agency that the ICF-IID and/or the ICF-IID residential community home is not in compliance with program requirements or an immediate jeopardy is determined to exist based upon survey findings. These deficiencies must be determined as Immediate Jeopardy as defined under Rule 49.41.3.

ICF-IID Residential Community Home along with the notification that a ban on all admissions is to be imposed five calendar (5) days after the receipt of the notice by the ICF-IID and/or the ICF-IID residential community home unless a hearing is requested within five (5) calendar days following receipt of the notice from the licensing agency. If a hearing is requested by the ICF-IID, the administrative procedures established under Rule 49.9.1 shall be applied. 1. If the agency’s determination of noncompliance or Immediate Jeopardy on the day of the licensure visit/ survey is confirmed, a ban on all admissions shall be imposed until the ICF-IID or the ICF-IID residential community home achieves compliance and such compliance is verified by the licensing agency. The licensing agency will verify compliance of the ICF-IID and/or the ICF- residential community home’s corrective actions as soon as possible, but not later than 15 working days after the licensing agency receives an acceptable allegation of compliance and/or an acceptable plan of correction from the ICF- IID or the ICF-IID residential community home. If the hearing determines that an Immediate Jeopardy situation did not exist, as applicable, on the day of the licensure/survey visit, no ban on all admissions will be imposed.

2. The monitor has no financial interest or any ownership interest in the ICF-IID and/or the ICF-IID Residential Community Home. 3. The monitor has no immediate family member who has a relationship with the ICF-IID and/or the ICF-IID Residential Community Home to be monitored. 4. The monitor has no immediate family member who is a client in the ICF-IID and/or the ICF-IID Residential Community Home. 5. If an ICF-IID has not achieved substantial compliance within five (5) months of the annual licensure survey, the remedy of state monitoring will be imposed as determined by the licensing agency.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13 Subchapter 42 STATE MONITORING Rule 49.42.1 State Monitoring. A State Monitor may oversee the correction of cited deficiencies in an ICF-IID or an ICF-IID residential community home as a safeguard against further harm to clients when a finding of noncompliance has resulted in harm to a client or when there is a situation that is likely to cause serious injury, harm, impairment or death to a resident*
- *SOURCE: Miss. Code Ann. §43-11-13 Subchapter 43 DIRECTED PLAN OF CORRECTION Rule 49.43.1 A Directed Plan of Correction is a plan which the licensing agency, or the temporary manager, develops to require an ICF-IID or an ICF-IID residential community home to take action within specified time frames.*
- *SOURCE: Miss. Code Ann. §43-11-13 Subchapter 44 BAN ON ADMISSIONS PROCEDURE Rule 49.44.1 Ban on Admissions. If an immediate jeopardy is found to exist in an ICF-IID and/or in an ICF-IID residential community home as applicable, written notice of the determination shall be provided by the licensing agency to the ICF-IID or the*
- *SOURCE: Miss. Code Ann. §43-11-13 Subchapter 45 STATE MONITORING Rule 49.45.1 State Monitoring. Monitors are identified by the licensing agency as appropriate professionals to monitor cited deficiencies. A monitor shall meet the guidelines regarding conflicts of interests as follows: 1. The monitor does not currently work, or, within the past two (2) years, has worked as an employee, as employment agency staff at the ICF-IID and/or at the ICF-IID residential community home or as an officer, consultant, or agent for the ICF-IID and/or the ICF-IID Residential Community Home to be monitored.*
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 49.45.2** Compensation and Per Diem Costs {#sec-16-49.45.2 omnilex-key=us-ms-regs-official--title-15--16#49.45.2}

All compensation and per diem costs of the State Monitor shall be paid by the ICF-IID and/or the ICF-IID Residential Community Home. The licensing agency shall bill the ICF-IID and/or the ICF-IID Residential Community Home for the costs of the State Monitor after termination of the monitoring services. The costs of the State Monitor for any weekly forty (40) hour period (forty [40] hours per week) shall not exceed the maximum allowable owner/administrator salary of a like sized ICF-IID as described in the Mississippi State Medicaid Plan. Within fifteen (15) days of receipt of the bill, the ICF-IID and/or the ICF-IID Residential Community Home shall pay the bill or request an administrative hearing to contest the costs for which it was billed.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 49.45.3** Recommendation {#sec-16-49.45.3 omnilex-key=us-ms-regs-official--title-15--16#49.45.3}

If the ICF-IID and/or the ICF-IID Residential Community Home has not achieved substantial compliance with licensure requirements within six (6) months from the annual survey date, the licensing agency may revoke the license of the ICF-IID and/or the ICF-IID Residential Community Home.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13 Subchapter 46 DIRECTED PLAN OF CORRECTION Rule 49.46.1 Directed Plan of Correction. Directed Plan of Correction as defined under Rule 49.43. 1 may be imposed as follows: 1. The ICF-IID and/or the ICF-IID residential community home will be provided an opportunity to submit an acceptable Plan of Correction resultant to survey findings. If the licensing agency does not receive an acceptable plan of correction, the licensing agency may impose one or more of the following remedies: a. Directed Plan of Correction; and b. Revocation of State License.*
- *SOURCE: Miss. Code Ann. §43-11-13 Subchapter 47 TEMPORARY MANAGEMENT Rule 49.47.1 Recommendation for Appointment of Temporary Management. If the licensing agency recommends the appointment of a temporary manager, the recommendation shall specify the grounds upon which such recommendation is based, including an assessment of the capability of the ICF-IID and/or ICF-IID residential community home’s current management to achieve and maintain compliance with all Licensure requirements.*
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 49.47.2** Notice of Imposition of Temporary Management {#sec-16-49.47.2 omnilex-key=us-ms-regs-official--title-15--16#49.47.2}

A temporary manager may be imposed fifteen (15) days after the ICF-IID and/or the ICF-IID residential community home receives notice when a determination of an immediate jeopardy finding.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 49.47.3** Conditions of Temporary Management {#sec-16-49.47.3 omnilex-key=us-ms-regs-official--title-15--16#49.47.3}

The management of an ICF-IID or an ICF-IID residential community home must agree to relinquish control to the temporary manager and to pay his/her salary before the temporary manager can be installed in the ICF-IID and/or the ICF-IID residential community home. 1. The ICF-IID cannot retain final authority to approve changes of personnel or expenditures of ICF-IID funds and be considered to have relinquished control to the temporary manager. 2. The temporary manager must be given access to all ICF-IID bank accounts. 3. The temporary manager’s salary/per diem fee shall not exceed the maximum allowable owner/administrator salary of a like sized ICF-IID as described in the Mississippi State Medicaid Plan 4. All compensation and per diem costs of the temporary manager shall be paid by the ICF-IID and/or the ICF-IID residential community home. The licensing agency shall bill the ICF-IID for the costs of the temporary manager after termination of temporary management. Within fifteen (15) days of receipt of the bill, the ICF-IID shall pay the bill or request an administrative hearing to contest the costs for which it was billed.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 49.47.4** Selection of Temporary Manager {#sec-16-49.47.4 omnilex-key=us-ms-regs-official--title-15--16#49.47.4}

The licensing agency shall compile and maintain a list of individuals eligible to serve as temporary managers. The temporary manager must possess a Mississippi nursing home administrator’s license. A contractual agreement will be executed between the temporary manager and the licensing agency.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 49.47.5** Eligibility of Temporary Manager {#sec-16-49.47.5 omnilex-key=us-ms-regs-official--title-15--16#49.47.5}

The following individuals are not eligible to serve as temporary managers: 1. Any individual who has been found guilty of misconduct by any licensing board or professional society in any State; or a. Any individual who has, or whose immediate family members have, any financial interest in or pre-existing fiduciary duty to the ICF-IID and/or the ICF-IID residential community home to be managed. Indirect ownership

interest, such as through a mutual fund, does not constitute financial interest for the purpose of this restriction; or b. Any individual who currently serves or, within the past two (2) years, has served as a member of the staff of the ICF-IID and/or the ICF-IID residential community home or has a pre-existing fiduciary duty to the ICF-IID and/or the ICF-IID residential community home; c. Any individual who does not possess sufficient training, expertise, and experience in the operation of an ICF-IID and/or an ICF-IID residential community home as would be necessary to achieve the objectives of temporary management; or d. Any individual who at the time of the imposition of temporary management could stand to gain an unfair competitive advantage by being appointed as temporary manager of the ICF-IID and/or the ICF-IID residential community home.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 49.47.6** Condition of Appointment {#sec-16-49.47.6 omnilex-key=us-ms-regs-official--title-15--16#49.47.6}

As a condition of appointment, the temporary manager must agree not to purchase, lease, or manage the ICF-IID and/or the ICF- IID residential community home for a period of two (2) years following the end of the temporary management period.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 49.47.7** No Limitation {#sec-16-49.47.7 omnilex-key=us-ms-regs-official--title-15--16#49.47.7}

Nothing contained in these sections shall limit the right of any ICF-IID and/or ICF-IID residential community home owner to sell, lease, mortgage, or close any ICF-IID and/or ICF-IID residential community home in accordance with all applicable laws.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 49.47.8** Authority and Powers of the Temporary Manager {#sec-16-49.47.8 omnilex-key=us-ms-regs-official--title-15--16#49.47.8}

1. A temporary manager has the authority to direct and oversee the correction of the deficiencies/licensure violations; to oversee and direct the management, hiring, reassignment and/or discharge of any consultant or employee, including the administrator of the ICF-IID and/or the ICF-IID residential community home; to direct the expenditure of or obligate ICF-IID funds in a reasonable and prudent manner; to oversee the continuation of the business and the care of the clients; to oversee and direct those acts necessary to accomplish the goals of the licensure and/or certification requirements; to alter ICF-IID procedures; and to direct and oversee regular accountings and the provision of periodic reports to the licensing agency.

2. A temporary manager shall provide reports to the licensing agency by the fifteenth (15th) day of each month showing the compliance status of the ICF- IID and/or the ICF-IID residential community home; 3. A temporary manager shall observe the confidentiality of the operating policies, procedures, employment practices, financial information, and all similar business information of the ICF-IID and/or the ICF-IID residential community home except that the temporary manager shall make reports to the licensing agency as provided for in this section. 4. The temporary manager shall be liable for gross, willful or wanton negligence, intentional acts or omissions, unexplained shortfalls in the ICF-IID and/or the ICF-IID residential community home’s funds, and breaches of fiduciary duty. The temporary manager shall be bonded in an amount equal to the ICF-IID and/or the ICF-IID residential community home’s total revenues for the month preceding the appointment of the temporary manager.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 49.47.9** Authority of Temporary Manager {#sec-16-49.47.9 omnilex-key=us-ms-regs-official--title-15--16#49.47.9}

The temporary manager shall not have the authority to do the following: 1. To cause or direct the ICF-IID and/or the ICF-IID residential community Home or its owner to incur debt or to enter into any contract with a duration beyond the term of the temporary management of the ICF-IID and/or the ICF-IID residential community home; 2. To cause or direct the ICF-IID and/or the ICF-IID residential community home encumber its assets or receivables, or the premises on which it is located, with any lien or other encumbrances; 3. To cause or direct the sale of the ICF-IID or the ICF-IID residential community home, its assets, or the premises on which it is located; 4. To cause or direct the ICF-IID and/or the ICF-IID residential community home to cancel or reduce its liability or casualty insurance coverage; 5. To cause or direct the ICF-IID and/or the ICF-IID residential community home to default upon any valid obligations previously undertaken by the owners or operators of the ICF-IID and/or the ICF-IID residential community home including but not limited to, leases, mortgages, and security interests; and 6. To incur capital expenditures in excess of two-thousand dollars ($2,000.00) without the permission of the owner of the ICF-IID and/or the ICF-IID residential community home and the licensing agency.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 49.47.10** Duration of Temporary Manager {#sec-16-49.47.10 omnilex-key=us-ms-regs-official--title-15--16#49.47.10}

Temporary management shall continue until a license is revoked or the ICF-IID and/or the ICF-IID residential community home achieves substantial compliance and is capable of remaining in substantial compliance. The licensing agency may replace any temporary manager whose performance, in the discretion of the licensing agency, is deemed unsatisfactory. No formal procedure is required for such removal or replacement but written notice of any action shall be given to the ICF-IID and/or the ICF-IID residential community home including the name of any replacement manager. 1. An ICF-IID and/or the ICF-IID residential community home subject to temporary management may petition the licensing agency for replacement of a temporary whose performance it considers unsatisfactory. The licensing agency shall respond to a petition for replacement within three (3) business days after receipt of said petition. 2. Otherwise, the licensing agency shall not terminate temporary management until it has determined that the ICF-IID and/or the ICF-IID residential community home has the management capability to ensure continued compliance with all licensure requirements or until the facility’s license is revoked.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13 CHAPTER 50 MINIMUM STANDARDS OF OPERATION FOR ALZHEIMER’S DISEASE/DEMENTIA CARE UNIT: GENERAL ALZHEIMER'S DISEASE/DEMENTIA CARE UNIT Subchapter 1 DEFINITIONS Rule 50.1.1 Alzheimer's Disease. The term "Alzheimer's Disease" means a chronic progressive disease of unknown cause that attacks brain cells or tissues.*
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 50.1.2** Alzheimer's Disease/Dementia Care Unit (A/D Unit) {#sec-16-50.1.2 omnilex-key=us-ms-regs-official--title-15--16#50.1.2}

A licensed nursing home or licensed personal care home (hereinafter referred to as “licensed facility” unless specified otherwise) may establish a separate A/D Unit for residents suffering from a form of dementia or Alzheimer's Disease. The rules and regulations as set forth in these regulations are in addition to the licensure requirements for the licensed facility, and do not exempt a licensed facility from compliance therewith.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 50.1.3** Alzheimer's Disease/Dementia Care Unit Designation {#sec-16-50.1.3 omnilex-key=us-ms-regs-official--title-15--16#50.1.3}

Any licensed facility that establishes an A/D Unit, and meets the requirements as set forth in this chapter, shall have said designation printed upon the certificate of licensure issued

to said facility by the licensing agency. In order for an A/D Unit to receive designation, the facility must have also received licensure from the licensing agency as a nursing home or as a personal care home.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 50.1.4** Ambulation {#sec-16-50.1.4 omnilex-key=us-ms-regs-official--title-15--16#50.1.4}

The terms “ambulation” or “ambulatory” shall mean the resident’s ability to bear weight, pivot, and safely walk independently or with the use of a cane, walker, or other mechanical supportive device (i.e., including, but not limited to, a wheelchair). A resident who requires a wheelchair must be capable of transferring to and propelling the wheelchair independently or with prompting. No more than ten percent (10%) of the resident census of the A/D Unit shall require assistance during any staffing shift as described and required herein.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 50.1.5** Dementia {#sec-16-50.1.5 omnilex-key=us-ms-regs-official--title-15--16#50.1.5}

The term "dementia" means a clinical syndrome characterized by a decline of long duration in mental function in an alert individual. Symptoms of dementia include memory loss and the loss or diminution of other cognitive abilities, such as learning ability, judgment, comprehension, attention, and orientation to time and place and to oneself. Dementia can be caused by such diseases as: Alzheimer's Disease, Pick's Disease, Parkinson's and Huntington's Disease, Creutzfeldt-Jakob Disease, multi-infarct dementia, etc.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 50.1.6** Licensed Facility {#sec-16-50.1.6 omnilex-key=us-ms-regs-official--title-15--16#50.1.6}

The term “licensed facility” shall mean any nursing home or personal care home licensed by the Mississippi Department of Health. For additional licensure information, refer to “Regulations Governing Licensure of Nursing Home Facilities” and “Regulations Governing Licensure of Personal Care Home Facilities”.

2. A Registered Nurse or Licensed Practical Nurse shall be present on all shifts.

3. If the designated A/D Unit is not freestanding, licensed nursing staff may be shared with the rest of the facility for the purpose of meeting the minimum staffing requirements. 4. Only staff trained as specified in Rule 50.2.2 and Rule 50.2.3 below shall be assigned to the A/D Unit. 5. A minimum of two (2) staff members shall be on the A/D Unit at all times.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13 Subchapter 2 STAFFING Rule 50.2.1 Staffing. In addition to the staffing requirements as set forth for licensed facilities, the following staffing requirements shall apply to A/D Units: 1. Minimum requirements for nursing staff shall be based on the ratio of three (3.0) hours of nursing care per resident per twenty-four (24) hours Licensed nursing staff and nursing aides can be included in the ratio. Staffing requirements are based upon resident census.*
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 50.2.2** Staff Orientation {#sec-16-50.2.2 omnilex-key=us-ms-regs-official--title-15--16#50.2.2}

The goals of training and education for A/D Units are to enhance staff understanding and sensitivity toward the A/D Unit residents, to allow staff to master care techniques, to ensure better performance of duties and responsibilities, and to prevent staff burnout. The trainer(s) shall be qualified individuals with experience and knowledge in the care of individuals with Alzheimer's Disease and other forms of dementia. The licensed facility shall provide an orientation program to all new employees assigned to the A/D Unit. The orientation program shall be outlined in an orientation manual and shall include, but not be limited to: 1. The licensed facility's philosophy related to the care of residents with Alzheimer's Disease and other forms of dementia in the A/D Unit; 2. A description of Alzheimer's Disease and other forms of dementia;

3. The licensed facility's policies and procedures regarding the general approach to care provided in the A/D Unit, including therapies provided; treatment modalities; admission, discharge, and transfer criteria; basic services provided within the A/D Unit; policies regarding restraints, wandering and egress control, and medication management; nutrition management techniques; staff training; and family activities; and 4. Common behavior problems and recommended behavior management.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 50.2.3** In-Service Training {#sec-16-50.2.3 omnilex-key=us-ms-regs-official--title-15--16#50.2.3}

Ongoing in-service training shall be provided to all staff who may be in direct contact with residents of the A/D Unit. Staff training shall be provided at least quarterly. The licensed facility will keep records of all staff training provided and the qualifications of the trainer(s). The licensed facility shall provide hands on training on at least three (3) of the following topics each quarter: 1. The nature of Alzheimer's Disease, including the definition, the need for careful diagnosis, and knowledge of the stages of Alzheimer's Disease;

2. Common behavioral problems and recommended behavior management techniques; 3. Communication skills that facilitate better resident-staff relations; 4. Positive therapeutic interventions and activities, such- as exercise, sensory stimulation, activities of daily living skills, etc.; 5. The role of the family in caring for residents with Alzheimer's Disease, as well as the support needed by the family of these residents; 6. Environmental modifications to avoid problems and create a therapeutic environment; 7. Development of comprehensive and individual care plans and how to update and implement them consistently across shifts, establishing a baseline and concrete treatment goals and outcomes; and 8. New developments in diagnosis and therapy.

These assessments shall include the individual's family supports, level of activities of daily living functioning and level of behavioral impairment. The functional assessment shall demonstrate that the individual is appropriate for placement.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13 Subchapter 3 ASSESSMENT AND INDIVIDUAL CARE PLANS Rule 50.3.1 Assessments. Prior to admission to the A/D Unit, each individual shall receive a medical examination and assessment from a licensed physician or nurse practitioner/physician assistant. In addition, prior to admission, each individual shall be assessed by a licensed practitioner whose scope of practice includes assessment of cognitive, functional, and social abilities, and nutritional needs.*
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 50.3.2** Care Plans {#sec-16-50.3.2 omnilex-key=us-ms-regs-official--title-15--16#50.3.2}

Individual care plans shall be developed by the staff for each resident.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 50.3.3** Family Involvement {#sec-16-50.3.3 omnilex-key=us-ms-regs-official--title-15--16#50.3.3}

Whenever possible and appropriate, the family shall be involved in the development of a resident's care plan. The family shall be provided with information regarding social services, such as support groups for families and friends. A designated family member shall be notified in a timely manner of care plan sessions. Documentation of such notification shall be kept by the licensed facility.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 50.3.4** Review of Care Plans {#sec-16-50.3.4 omnilex-key=us-ms-regs-official--title-15--16#50.3.4}

Each care plan and functional assessment, developed upon admission to determine the resident's appropriateness for placement, shall be reviewed, evaluated for its effectiveness, and updated at least quarterly or more frequently if indicated by changing needs of the resident.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 50.3.5** Admission and Discharge Criteria {#sec-16-50.3.5 omnilex-key=us-ms-regs-official--title-15--16#50.3.5}

The following criteria must be applied and maintained for resident placement in an A/D Unit: 1. Only residents with a primary diagnosis of Alzheimer’s Disease or dementia, whose needs can be met by the licensed facility, shall be admitted. 2. For licensed facilities which are personal care homes, a person shall not be admitted or continue to reside in an A/D Unit if the person does not meet the admission criteria for the licensed facility unless otherwise exempted by such applicable laws and regulations. 3. The licensed facility must be able to identify at the time of admission and during continued stay those residents whose needs for services are consistent with these rules and regulations, and those residents who should be transferred to an appropriate level of care.

1. Activities shall be delivered at various hours. 2. Opportunities shall be provided for daily involvement with nature, and sunshine (i.e., as in outdoor activities) as weather permits. 3. Residents will not be observed with negative outcome for long periods without meaningful activities. 4. Activities will: a. tap into better long-term memory than short;

b. provide multiple short activities to work within short attention spans; c. provide experience with animals, nature, and children; and d. provide opportunities for physical, social, and emotional outlets. 5. Productive activities that create a feeling of usefulness shall be provided. 6. Leisure activities shall be provided. 7. Self-care activities shall be provided. 8. Planned and spontaneous activities shall be provided in the following areas: a. structured large and small groups; b. spontaneous intervention; c. domestic tasks/chores; d. life skills; e. work; f. relationships/social; g. leisure; h. seasonal; i. holidays, j. personal care; k. meal time; and l. intellectual, spiritual, creative, and physically active pursuits. 9. Activities will be based on cultural and lifestyle differences. 10. Activities shall be appropriate and meaningful for each resident, and shall respect a person's age, beliefs, culture, values, and life experience.

resident and support to family members, including but not limited to the following: 1. The socialization of a resident shall be incorporated in the resident's care plan. 2. The provision of support to the resident's family, including formation of family support groups, shall be offered by the licensed facility. 3. The social service consultation shall be onsite, and shall be a minimum of eight (8) hours per month.

2. A secured area for medication, storage, and workspace; 3. A secure, exterior exercise pathway that allows residents to walk on a level, non- slip path. The path shall have a minimum width of four (4) feet. Seating shall be next to the pathway, but outside the walking path. Lighting shall be indirect with a minimum brightness of fifty (50) foot candles; 4. High visual contrast between floors and walls, and doorways and walls, in resident use areas. With the exception of fire exits, door and access ways may be designed to minimize contrast to obscure or conceal areas the residents should not enter; 5. Floors, walls and ceiling that are non-reflective to minimize glare; 6. Adequate and even lighting which minimizes glare and shadows and is designed to meet the specific needs of the residents; 7. Service sections that are removed from resident areas. Kitchen services and storage shall be separated from resident areas by a secure enclosure;

8. Security controls on all entrances and exits; 9. Exterior fencing that shall be placed at the pathway level, at a minimum height of six (6) feet. Fencing shall be solid so as to block the view if mounted at the pathway level. No entrance gates shall be visible from the exterior area. If the grading allows, the fence shall be placed at the bottom of the central grade. An open fence may be utilized if it is separated by a grade change; and 10. Physical Design Waiver for Existing Facilities. The licensing agency, within its discretion, may waive only the requirements in this section for the designation of an A/D Unit for any licensed facility which was established prior to October 13, 1999, as documented in the records of the licensing agency, a separate, secured unit for the care of residents diagnosed with Alzheimer’s Disease or other forms of dementia. Waivers granted under this section may be granted, within the discretion of the licensing agency, with conditions.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13 Subchapter 4 THERAPEUTIC ACTIVITIES Rule 50.4.1 Therapeutic Activities. Therapeutic activities shall be provided to the residents of the A/D Unit seven (7) days per week. The therapeutic activities shall be scheduled by a Certified Therapeutic Recreation Specialist, a Qualified Therapeutic Recreation Specialist, or an Activity Consultant Certified, which must provide a minimum of eight (8) hours monthly in-house consultation to an activities designee.*
- *SOURCE: Miss. Code Ann. §43-11-13 Subchapter 5 SOCIAL SERVICES Rule 50.5.1 Social Services. A licensed social worker, licensed professional counselor, or licensed marriage and family therapist shall provide social services to both the*
- *SOURCE: Miss. Code Ann. §43-11-13 Subchapter 6 NUTRITIONAL SERVICES Rule 50.6.1 Nutritional Services. A nutritional assessment shall be completed for each resident. If the nutritional assessment identifies therapeutic nutritional needs, or is ordered by the resident’s physician, a registered dietician shall assess and plan a diet for the resident’s nutritional needs.*
- *SOURCE: Miss. Code Ann. §43-11-13 Subchapter 7 PHYSICAL LAYOUT Rule 50.7.1 Physical Design. In addition to the physical plant standards required for the licensed facility, an A/D Unit shall include the following: 1. A separate multipurpose room for dining, group, and individual activities, and family visits which is a minimum of forty (40) square feet per resident, but in no case shall be smaller than three hundred-twenty (320) square feet;*
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 50.7.2** Physical Environment and Safety {#sec-16-50.7.2 omnilex-key=us-ms-regs-official--title-15--16#50.7.2}

The A/D Unit shall: 1. Provide freedom of movement for the residents to common areas and to their personal spaces. The facility shall not lock residents out of or inside their rooms; 2. Provide trays, plates, and eating utensils which provide visual contrast between them and the table and that maximize the independence of the individual residents; 3. Label or inventory all residents' possessions; 4. Provide comfortable chairs, including at least one in the common use area that allows for gentle rocking or gliding; 5. Encourage and assist residents to decorate and furnish their rooms with personal items and furnishings based on the resident's needs, preferences and appropriateness; 6. Individually identify residents' rooms to assist residents in recognizing their room; 7. Keep corridors and passageways through common use areas free of objects which may cause falls; and 8. Only use a public address system in an A/D Unit (if one exists) for emergencies.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 50.7.3** Egress Control {#sec-16-50.7.3 omnilex-key=us-ms-regs-official--title-15--16#50.7.3}

The licensed facility shall develop policies and procedures to deal with residents who may attempt to wander outside of the A/D Unit. The procedures shall include actions to be taken in case a resident elopes.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

#### **Chapter 51** MINIMUM STANDARDS OF OPERATION FOR PSYCHIATRIC RESIDENTIAL TREATMENT FACILITIES

##### **15 Miss. Admin. Code Pt. 16, R. 51.1.1** Adoption of Rules, Regulations, and Minimum Standards {#sec-16-51.1.1 omnilex-key=us-ms-regs-official--title-15--16#51.1.1}

By virtue of authority vested in it by Mississippi Code Annotated, 43-11-1 through 43-11-27 (Supplemented 1986), The Mississippi Department of Health does hereby adopt and promulgate Rules, Regulations, and Minimum Standards for Institutions for the Aged and Infirm which includes Skilled Nursing Facilities, Intermediate Care Facilities, Personal Care Homes.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.1.2** Rule 51.1.2 {#sec-16-51.1.2 omnilex-key=us-ms-regs-official--title-15--16#51.1.2}

The 1990 Legislature amended the code to include Psychiatric Residential Treatment Facilities as an institution for the Aged or Infirm.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.1.3** Rule 51.1.3 {#sec-16-51.1.3 omnilex-key=us-ms-regs-official--title-15--16#51.1.3}

"Psychiatric Resident Treatment Facility" means any non-hospital establishment with permanent facilities which provides a twenty-four (24) hour program of care by qualified therapists including, but not limited to, duly licensed mental health professionals, psychiatrists, psychologists and licensed certified social workers, for emotionally disturbed children and adolescents referred to such facility by a court, local school district or by the Department of Human Services, who are not in an acute phase of illness requiring the services of a psychiatric hospital, and are in need of such restorative treatment services. For purposes of this paragraph, the term "emotionally disturbed" means a condition exhibiting one or more of the following characteristics over along period of time and to a marked degree, which adversely affects educational performance: 1. An inability to learn which cannot be explained by intellectual, sensory or health factors; 2. An inability to build or maintain satisfactory relationships with peers and teachers; 3. Inappropriate types of behavior or feelings under normal circumstances; 4. A general pervasive mood of unhappiness or depression; or 5. A tendency to develop physical symptoms or fears associated with personal or school problems.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13 Subchapter 2 TYPES OF LICENSE*

##### **15 Miss. Admin. Code Pt. 16, R. 51.2.1** Regular License {#sec-16-51.2.1 omnilex-key=us-ms-regs-official--title-15--16#51.2.1}

A license shall be issued to each institution for the aged or infirm that meets the requirements as set forth in these regulations. The license shall show the classification (Skilled Nursing Facility, Intermediate Care Facility, Personal Care Home, and Psychiatric Residential Treatment Facility).

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.2.2** Provisional License {#sec-16-51.2.2 omnilex-key=us-ms-regs-official--title-15--16#51.2.2}

Within its discretion, the Mississippi Department of Health may issue a provisional license when a temporary condition of non-compliance with these regulations exists in one or more particulars. A provisional license shall be issued only if the Department of Health is satisfied that preparations are being made to qualify for a regular license and that the health and safety of patients will not be endangered meanwhile. One conditional on which a provisional license may be issued is as follows: A new institution for the aged or infirm may be issued a provisional license prior to opening and subsequent to meeting the required minimum staffing personnel. The license issued under this condition shall be valid until the issuance of a regular license or March 31 following date of issuance whichever may be sooner. A provisional license may be reissued only if it is satisfactorily proven to the Department of Health that efforts are being made to fully comply with these regulations by a specified time.

The application shall require reasonable, affirmative evidence of ability to comply with these rules, regulations, and minimum standards.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13 Subchapter 3 APPLICATION FOR LICENSE Rule 51.3.1 Application. Application for a license or renewal of a license shall be made in writing to the licensing agency on forms provided by the Department of Health which shall contain such information as the Department of Health may require.*
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.3.2** Fees {#sec-16-51.3.2 omnilex-key=us-ms-regs-official--title-15--16#51.3.2}

. Each initial and renewal licensure application, unless suspended or revoked, shall be accompanied by a fee as set by the Board, made payable to the Mississippi State Department of Health,either by business check, money order, or electronic means. Renewal of licenses shall occur on an annual basis. Fees are non-refundable.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.3.3** Name of Institution {#sec-16-51.3.3 omnilex-key=us-ms-regs-official--title-15--16#51.3.3}

Every institution for the aged or infirm shall be designated by a permanent and distinctive name which shall be used in applying for a license and shall not be changed without first notifying the licensing agency in writing and receiving written approval of the change from the licensing agency. Such notice shall specify the name to be discontinued as well as the new name proposed. The words "hospital", "sanatarium", “sanatorium", "clinic", or any other word which would reflect a different type of institution shall not appear in the title of an

institution for the aged or infirm. In addition to these words, the word "nursing" shall not appear in the title of a Personal Care Home. Only the official name by which the institution is licensed shall be used in telephone listing, on stationery, in advertising, etc. Two or more facilities shall not be licensed under similar names in the same vicinity.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.3.4** Number of Beds {#sec-16-51.3.4 omnilex-key=us-ms-regs-official--title-15--16#51.3.4}

Each application for licensure shall specify the maximum number of beds in the institution for the aged or infirm. The maximum number of beds for which the facility is licensed shall not be exceeded.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13 Subchapter 4 LICENSING Rule 51.4.1 Issuance of License. All licenses issued by the Department of Health shall set forth the name of the facility, the location, the name of the licensee, the classification of the institution, the type of building, the bed capacity for which the institution is licensed, and the license number.*
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.4.2** Posting of License {#sec-16-51.4.2 omnilex-key=us-ms-regs-official--title-15--16#51.4.2}

The license shall be posted in a conspicuous place on the licensed premises and shall be available for review by an interested person.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.4.3** License Not Transferable {#sec-16-51.4.3 omnilex-key=us-ms-regs-official--title-15--16#51.4.3}

The license for an institution for the aged or infirm is not transferable or assignable to any other person except by written approval of the licensing agency and shall be issued only for the premises named in the application. The license shall be surrendered to the Department of Health on change of ownership, licensee, name or location of the institution, or in the event that the institution ceases to be operated as an institution for the aged or infirm. In event of change of ownership, licensee, name or location of the institution, a new application shall be filed.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.4.4** Expiration of License {#sec-16-51.4.4 omnilex-key=us-ms-regs-official--title-15--16#51.4.4}

Each license shall expire on March 31 following the date of issuance.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.4.5** Renewal of License {#sec-16-51.4.5 omnilex-key=us-ms-regs-official--title-15--16#51.4.5}

License shall be renewable by the licensee. 1. Filing of an application for renewal of licensee;

2. Submission of appropriate licensure renewal fee; 3. Approval of annual report by the licensing agency; and 4. Maintenance by the institution of minimum standards in its physical facility, staff, services, and operation as set forth in these regulations.

2. Willful or repeated violations by the licensee of any of the provisions of Sections 43-11-1 et seq., of the Mississippi Code of 1972, as amended, and/or the rules, regulations, and minimum standards established by the Department of Health; 3. Addiction to narcotic drug(s) by the licensee or other employees or personnel of the home; 4. Excessive use of alcoholic beverages by the licensee or other personnel of the home to the extent which threatens the well-being or safety of the patient or resident; 5. Conviction of the licensee of a felony; 6. Publicly misrepresenting the home and/or its services; 7. Permitting, aiding, abetting the commission of any unlawful act; 8. Conduct or practices detrimental to the health or safety of patients or residents and employees of said institutions provided that this provision shall not be construed to have any reference to healing practices authorized by law. Detrimental practices include but are not necessarily limited to: a. Cruelty to patient or resident or indifference to their needs which are essential to their general well-being and health; b. Misappropriation of the money or property of a patient or resident; c. Failure to provide food adequate for the needs of the patient or resident; d. Inadequate staff to provide safe care and supervision of patient or resident;

e. Failure to call a physician when required by patient's or resident's condition; f. Failure to notify next of kin when patient's or resident's conditions becomes critical; and g. Admission of a patient or resident whose condition demands care beyond the level or care provided by the home as determined by its classification. 9. The execution of any contract for care exceeding one year without written approval of licensing agency.

1. The licensing agency shall notify the applicant or licensee by registered mail or personal service the particular reasons for the proposed denial or revocation of license. Upon written request of applicant or licensee within ten (10) days of the date of notification the licensing agency shall fix a date not less than thirty (30) days from the date of such service at which time the applicant or licensee shall be given an opportunity for a prompt and fair hearing. 2. On the basis of such hearing or upon default of the applicant or licensee, the licensing agency shall make a determination specifying its findings of fact and conclusions of law. A copy of such determination shall be sent by registered mail to the last known address of the applicant of licensee or served personally upon the applicant or licensee. 3. The decision revoking, suspending, or denying the application or license shall become final thirty (30) days after it is so mailed or served unless the applicant or licensee, within such thirty (30) day period, appeals the decision to the Chancery Court pursuant to Section 12 (6964-12), Chapter 384, Laws 1952. An additional period of time may be granted at the discretion of the licensing agency.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13 Subchapter 5 DENIAL, SUSPENSION, OR REVOCATION OF LICENSE Rule 51.5.1 Denial or Revocation of License: Hearings and Review. The licensing agency after notice and opportunity for a hearing to the applicant or licensee is authorized to deny, suspend, or revoke a license in any case in which it finds that there has been a substantial failure to comply with the requirements established under the law and these regulations. Also, the following shall be grounds for denial or revocation of license: 1. Fraud on the part of the licensee in applying for a license;*
- *SOURCE: Miss. Code Ann. §43-11-13 Subchapter 6 PROVISION FOR HEARING AND APPEAL FOLLOWING DENIAL OR REVOCATION OF LICENSE; PENALTIES Rule 51.6.1 Administrative Decision. The Mississippi Department of Health will provide an opportunity for a fair hearing to every applicant or licensee who is dissatisfied with administrative decisions made in the denial or revocation of license.*
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.6.2** Penalties {#sec-16-51.6.2 omnilex-key=us-ms-regs-official--title-15--16#51.6.2}

Any person establishing, conducting, managing, or operating an institution for the aged or infirm without a license shall be declared in violations of these regulations and Chapter 451 of the Laws of Mississippi of the Regular Legislative Session of 1979 and subject to the penalties specified in Section 18 thereof.

Subchapter 7 FACILITY MANAGEMENT: GOVERNING BODY Rule 51.7.1 Every child/adolescent psychiatric residential treatment facility shall have a governing body that has overall responsibility for the operation of the facility. 1. A public facility shall have a written description of the administrative organization for the government agency within which it operates. 2. A public facility shall also have a written description of how the lines of authority within the government agency relate to the governing body of the facility. 3. A private facility shall have a charter, constitution, or bylaws.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.7.2** Rule 51.7.2 {#sec-16-51.7.2 omnilex-key=us-ms-regs-official--title-15--16#51.7.2}

The names and addresses of all owners or controlling parties of the facility (whether they are individuals; partnerships; corporate bodies; or subdivisions of other bodies, such a public agencies or religious, fraternal, or other charitable organizations) shall be fully disclosed. In case of corporations, the names and addresses of all officers, directors, and principal stockholders either beneficial or of record shall be disclosed.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.7.3** The governing body shall meet at least quarterly {#sec-16-51.7.3 omnilex-key=us-ms-regs-official--title-15--16#51.7.3}

1. Minutes of these meetings shall be kept and shall include at least the following; 2. The date of the meeting; 3. The names of members who attended; 4. The topics discussed; 5. The decisions reached and actions taken; 6. The dates for implementation of recommendations; and 7. The reports of the chief executive officer and others.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.7.4** Rule 51.7.4 {#sec-16-51.7.4 omnilex-key=us-ms-regs-official--title-15--16#51.7.4}

The governing body shall establish a committee structure to fulfill its responsibilities and to assess the results of the facility's activities.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.7.5** Rule 51.7.5 {#sec-16-51.7.5 omnilex-key=us-ms-regs-official--title-15--16#51.7.5}

The governing body, through the chief executive officer, shall have a written statement of the facility's goals and objectives, as well as written procedures for implementing these goals and objectives. 1. There shall be documentation that the statement and procedures are based upon a planning process, and that the facility's goals and objectives are approved by the governing body. 2. The governing body, through the chief executive officer, shall have a written plan for obtaining financial resources that are consonant with the facility's goals and objectives.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.7.6** Rule 51.7.6 {#sec-16-51.7.6 omnilex-key=us-ms-regs-official--title-15--16#51.7.6}

When a residential treatment program is a component of a larger facility, the staff of the residential treatment program, subject to the overall responsibility of the governing body, shall be given the authority necessary to plan, organize, and operate the program. The residential treatment program shall hire and assign its own staff. The categorical program shall employ a sufficient number of qualified and appropriately trained staff.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.7.7** Rule 51.7.7 {#sec-16-51.7.7 omnilex-key=us-ms-regs-official--title-15--16#51.7.7}

The governing body, through its chief executive officer, shall develop policies and shall make sufficient resources available (for example, funds, staff, equipment, supplies, and facilities) to assure that the program is capable of providing appropriate and adequate services to patients.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.7.8** The facility's physical and financial resources shall be adequately insured {#sec-16-51.7.8 omnilex-key=us-ms-regs-official--title-15--16#51.7.8}

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.7.9** Rule 51.7.9 {#sec-16-51.7.9 omnilex-key=us-ms-regs-official--title-15--16#51.7.9}

The governing body shall establish bylaws, rules and regulations, and a table of organization to guide relationships between itself and the responsible administration and professional staffs and the community. 1. The governing body may establish one set of bylaws, rules and regulations that clearly delineates the responsibilities and authority of the governing body and the administrative and professional staff. 2. Administrative and professional staffs may establish separate bylaws, rules and regulations that are consistent with policies established by the governing body.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.7.10** Rule 51.7.10 {#sec-16-51.7.10 omnilex-key=us-ms-regs-official--title-15--16#51.7.10}

Bylaws, rules and regulations shall comply with legal requirements, be designed to encourage high quality patient care, and be consistent with the facility's community responsibility.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.7.11** Rule 51.7.11 {#sec-16-51.7.11 omnilex-key=us-ms-regs-official--title-15--16#51.7.11}

Such bylaws, rules and regulations shall describe the powers and duties of the governing body and its officers and committees; or the authority and responsibilities of any person legally designed to function as the governing body, as well as the authority and responsibility delegated to the responsible administrative and professional staffs.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.7.12** Rule 51.7.12 {#sec-16-51.7.12 omnilex-key=us-ms-regs-official--title-15--16#51.7.12}

Such bylaws, rules and regulations shall state the eligibility criteria for governing body membership; the types of membership and the method of selecting members; frequency of governing body meetings; the number of members necessary for a quorum and other attendance requirements for governing body meetings; the requirement that meetings be documented in the form of written minutes and the duration of appointment or election for governing body members, officers, and committed chairpersons.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.7.13** Rule 51.7.13 {#sec-16-51.7.13 omnilex-key=us-ms-regs-official--title-15--16#51.7.13}

Such by laws, rules and regulations shall describe the qualifications, authority, and responsibilities of the chief executive officer.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.7.14** Such bylaws, rules and regulations shall specify the method for appointing the chief executive office {#sec-16-51.7.14 omnilex-key=us-ms-regs-official--title-15--16#51.7.14}

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.7.15** Rule 51.7.15 {#sec-16-51.7.15 omnilex-key=us-ms-regs-official--title-15--16#51.7.15}

Such bylaws, rules and regulations shall provide the administrative and professional staffs with the authority and freedom necessary to carry out their responsibilities within the organizational framework of the facility.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.7.16** Rule 51.7.16 {#sec-16-51.7.16 omnilex-key=us-ms-regs-official--title-15--16#51.7.16}

Such bylaws, rules and regulations shall provide the professional staff with the authority necessary to encourage high quality patient care.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.7.17** Rule 51.7.17 {#sec-16-51.7.17 omnilex-key=us-ms-regs-official--title-15--16#51.7.17}

Such bylaws, rules and regulations shall state the procedures under which the administrative and professional staff cooperatively function.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.7.18** Rule 51.7.18 {#sec-16-51.7.18 omnilex-key=us-ms-regs-official--title-15--16#51.7.18}

Such bylaws, rules and regulations shall require the establishment of controls designed to encourage each member of the professional staff to observe the standards of the profession and assume and carry out functions in accordance with local, state, and federal laws and rules and regulations.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.7.19** Rule 51.7.19 {#sec-16-51.7.19 omnilex-key=us-ms-regs-official--title-15--16#51.7.19}

Such bylaws, rules and regulations shall require the professional staff bylaws, rules and regulations to be subject to governing body approval.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.7.20** Rule 51.7.20 {#sec-16-51.7.20 omnilex-key=us-ms-regs-official--title-15--16#51.7.20}

Such bylaws, rules and regulations shall specify procedures for selecting professional staff officers, directors, and department or service chiefs.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.7.21** Rule 51.7.21 {#sec-16-51.7.21 omnilex-key=us-ms-regs-official--title-15--16#51.7.21}

Such bylaws, rules and regulations shall require that physicians with appropriate qualifications, licenses, and clinical privileges evaluate and authenticate medical histories and physical examinations, and prescribe medications.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.7.22** Rule 51.7.22 {#sec-16-51.7.22 omnilex-key=us-ms-regs-official--title-15--16#51.7.22}

Such bylaws, rules and regulations may also allow dentists with appropriate qualifications, licenses, and clinical privileges to prescribe medications.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.7.23** Rule 51.7.23 {#sec-16-51.7.23 omnilex-key=us-ms-regs-official--title-15--16#51.7.23}

Such bylaws, rules and regulations shall describe the procedure for conferring clinical privileges on all professional staff.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.7.24** Rule 51.7.24 {#sec-16-51.7.24 omnilex-key=us-ms-regs-official--title-15--16#51.7.24}

Such bylaws, rules and regulations shall define the responsibilities of physicians in relation to non-physician members of the professional staff.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.7.25** Rule 51.7.25 {#sec-16-51.7.25 omnilex-key=us-ms-regs-official--title-15--16#51.7.25}

Such bylaws, rules and regulations shall provide a mechanism through which the administrative and professional staffs report to the governing body.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.7.26** Rule 51.7.26 {#sec-16-51.7.26 omnilex-key=us-ms-regs-official--title-15--16#51.7.26}

Such by laws, rules and regulations shall define the means by which the administrative and professional staffs participate in the development of facility and program policies concerning program management and patient care, and shall include, but not be limited to:

1. Admission, transfer and discharge policies and procedures; 2. Prescription and administration of medication policies and procedures which shall be consistent with applicable federal and state laws and regulations; and 3. Case records policies and procedures which shall ensure confidentiality of patient records in accordance with state laws and regulations.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.7.27** Rule 51.7.27 {#sec-16-51.7.27 omnilex-key=us-ms-regs-official--title-15--16#51.7.27}

Such bylaws, rules and regulations shall require an orientation program for new governing body members and a continuing education program for all members of the governing body.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.7.28** Rule 51.7.28 {#sec-16-51.7.28 omnilex-key=us-ms-regs-official--title-15--16#51.7.28}

Such bylaws, rules and regulations shall require that the bylaws, rules and regulations be reviewed at least every two years, revised as necessary, and signed and dated to indicate the time of last review.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13 Subchapter 8 CHIEF EXECUTIVE OFFICER Rule 51.8.1 The governing body shall appoint a chief executive officer who shall be employed on a full-time basis.*
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.8.2** Rule 51.8.2 {#sec-16-51.8.2 omnilex-key=us-ms-regs-official--title-15--16#51.8.2}

The qualifications, authority, and duties of the chief executive officer shall be stated in the governing body's bylaws, rules and regulations.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.8.3** Rule 51.8.3 {#sec-16-51.8.3 omnilex-key=us-ms-regs-official--title-15--16#51.8.3}

The chief executive officer shall be a health professional with appropriate professional qualifications and experience, including previous administrative responsibility in a health facility.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.8.4** Rule 51.8.4 {#sec-16-51.8.4 omnilex-key=us-ms-regs-official--title-15--16#51.8.4}

The chief executive officer shall have a medical degree or at least a master's degree in administration, psychology, social work, education, or nursing; and, when required, should have appropriate licenses. Experience shall include previous administrative responsibility in a facility for children or adolescents. Experience may be substituted for a professional degree when it is carefully evaluated, justified, and documented by the governing body.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.8.5** Rule 51.8.5 {#sec-16-51.8.5 omnilex-key=us-ms-regs-official--title-15--16#51.8.5}

In accordance with the facility's bylaws, rules and regulations, the chief executive officer shall be responsible to the governing body for the overall operation of the facility, including the control, utilization, and conservation of its physical and financial assets and the recruitment and direction of staff.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.8.6** Rule 51.8.6 {#sec-16-51.8.6 omnilex-key=us-ms-regs-official--title-15--16#51.8.6}

The chief executive officer shall assist the governing body in formulating policy by preparing the following items and presenting them to and reviewing them with the governing body: 1. Long-term and short-term plans of the facility; 2. Reports on the nature and extent of funding and other available resources; 3. Reports describing the facility's operations; 4. Reports evaluating the efficiency and effectiveness of facility or program activity; and 5. Budgets and financial statements.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.8.7** Rule 51.8.7 {#sec-16-51.8.7 omnilex-key=us-ms-regs-official--title-15--16#51.8.7}

The chief executive officer shall be responsible for the preparation of a written manual that defines the facility policies and procedures and that is regularly revised and updated.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.8.8** There shall be documentation that the chief executive officer attends and participates in continuing education programs {#sec-16-51.8.8 omnilex-key=us-ms-regs-official--title-15--16#51.8.8}

**History**
- *SOURCE: Miss. Code Ann. §43-11-13 Subchapter 9 PROFESSIONAL STAFF ORGANIZATION Rule 51.9.1 There shall be a single organized professional staff that has the overall responsibility for the quality of all clinical care provided to patients, and for the ethical conduct and professional practices of its members, as well as for accounting therefore to the governing body. The manner in which the professional staff is organized shall be consistent with the facility's documented staff organization and bylaws, rules and regulations, and pertain to the setting where the facility is located. The professional staff bylaws, rules and regulations, and the rules and regulations of the governing authority shall require that a qualified physician be responsible for diagnosis and all care and treatment. The organization of the professional staff, and its bylaws, rules and regulations, shall be approved by the facility's governing body.*
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.9.2** Rule 51.9.2 {#sec-16-51.9.2 omnilex-key=us-ms-regs-official--title-15--16#51.9.2}

The professional staff shall strive to assure that each member is qualified for membership and shall encourage the optimal level of professional performance of its members through the appointment/reappointment procedure, the specific delineation of clinical privileges, and the periodic reappraisal of each staff member according to the provisions.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13 Subchapter 10 QUALIFICATIONS Rule 51.10.1 The appointment and reappointment of professional staff members shall be based upon well-defined, written criteria that are related to the goals and objectives of the facility as stated in the bylaws, rules and regulations of the professional staff and of the governing body.*
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.10.2** Rule 51.10.2 {#sec-16-51.10.2 omnilex-key=us-ms-regs-official--title-15--16#51.10.2}

Upon application or appointment to the professional staff, each individual must sign a statement to the effect that he or she has read and agrees to be bound by the professional staff and governing body bylaws, rules and regulations.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.10.3** Rule 51.10.3 {#sec-16-51.10.3 omnilex-key=us-ms-regs-official--title-15--16#51.10.3}

The initial appointment and continued professional staff membership shall be dependent upon clinical competence and ethical practice in keeping with the qualifications, standards, and requirements set forth in the professional staff and governing body bylaws, rules and regulations.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.10.4** Rule 51.10.4 {#sec-16-51.10.4 omnilex-key=us-ms-regs-official--title-15--16#51.10.4}

Unless otherwise provided by law, only those practitioners who are licensed, certified, or registered, or who have demonstrated competence and experience, shall be eligible for professional staff membership.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13 Subchapter 11 METHOD OF SELECTION Rule 51.11.1 Each facility is responsible for developing a process of appointment to the professional staff whereby it can satisfactorily determine that the person is appropriately licensed, certified, registered, or experienced, and qualified for the privileges and responsibilities he or she seeks.*
- *SOURCE: Miss. Code Ann. §43-11-13 Subchapter 12 PRIVILEGE DELINEATION*

##### **15 Miss. Admin. Code Pt. 16, R. 51.12.1** Privileges shall be delineated for each member of the professional staff, regardless of the size of the facility {#sec-16-51.12.1 omnilex-key=us-ms-regs-official--title-15--16#51.12.1}

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.12.2** Rule 51.12.2 {#sec-16-51.12.2 omnilex-key=us-ms-regs-official--title-15--16#51.12.2}

The delineation of privileges shall be based on all verified information available in the applicant's or staff member's credentials file.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.12.3** Clinical privileges shall be facility-specific {#sec-16-51.12.3 omnilex-key=us-ms-regs-official--title-15--16#51.12.3}

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.12.4** Rule 51.12.4 {#sec-16-51.12.4 omnilex-key=us-ms-regs-official--title-15--16#51.12.4}

The professional staff shall delineate in its bylaws, rules and regulations of the qualifications, status, clinical duties, and responsibilities of clinical practitioners who are not members of the professional staff but who services require that they be processed through the usual professional staff channels.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.12.5** Rule 51.12.5 {#sec-16-51.12.5 omnilex-key=us-ms-regs-official--title-15--16#51.12.5}

The training, experience, and demonstrated competence of individuals in such categories shall be sufficient to permit their performing their assigned functions.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.12.6** Rule 51.12.6 {#sec-16-51.12.6 omnilex-key=us-ms-regs-official--title-15--16#51.12.6}

There shall be provisions for individuals in such categories to receive professional supervision, when indicated, from their professional counterparts.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13 Subchapter 13 REAPPOINTMENT Rule 51.13.1 The facility's professional staff bylaws, rules and regulations shall provide for review and reappointment of each professional staff member at least once every three years.*
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.13.2** Rule 51.13.2 {#sec-16-51.13.2 omnilex-key=us-ms-regs-official--title-15--16#51.13.2}

The reappointment process should include a review of the individual's status by a designated professional staff committee, such as the credentials committee.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.13.3** Rule 51.13.3 {#sec-16-51.13.3 omnilex-key=us-ms-regs-official--title-15--16#51.13.3}

When indicated, the credentials committee shall require the individual to submit evidence of his or her current health status that verifies the individual's ability to discharge his or her responsibilities.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.13.4** Rule 51.13.4 {#sec-16-51.13.4 omnilex-key=us-ms-regs-official--title-15--16#51.13.4}

The committee's review of the clinical privileges of a staff member for reappointment should include the individual's past and current professional performance as well as his or her adherence to the governing body and professional staff bylaws, rules and regulations.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.13.5** Rule 51.13.5 {#sec-16-51.13.5 omnilex-key=us-ms-regs-official--title-15--16#51.13.5}

The professional staff bylaws, rules and regulations shall limit the time within which the professional staff reappointment and privilege delineation processes must completed.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13 Subchapter 14 ORGANIZATION Rule 51.14.1 The professional staff shall be organized to accomplish its required functions. The professional staff organization must provide a framework in which the staff can carry out its duties and functions effectively. The complexity of the organization shall be consonant with the size of the facility and the scope of its activities.*
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.14.2** Rule 51.14.2 {#sec-16-51.14.2 omnilex-key=us-ms-regs-official--title-15--16#51.14.2}

The professional staff bylaws, rules and regulations shall provide for the selection of officers for an executive committee, and when appropriate, for other organizational components of the facility.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.14.3** Rule 51.14.3 {#sec-16-51.14.3 omnilex-key=us-ms-regs-official--title-15--16#51.14.3}

The professional staff bylaws, rules and regulations should specify the organization needed to provide effective governance of the professional staff.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13 Subchapter 15 EXECUTIVE COMMITTEE Rule 51.15.1 The executive committee shall be empowered to act for the professional staff in the intervals between the staff meetings.*
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.15.2** The committee shall serve as a liaison mechanism between the professional staff and the administration {#sec-16-51.15.2 omnilex-key=us-ms-regs-official--title-15--16#51.15.2}

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.15.3** There shall be a mechanism that assures medical participation in the deliberations of the executive committee {#sec-16-51.15.3 omnilex-key=us-ms-regs-official--title-15--16#51.15.3}

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.15.4** Rule 51.15.4 {#sec-16-51.15.4 omnilex-key=us-ms-regs-official--title-15--16#51.15.4}

The professional staff bylaws, rules and regulations shall define the size, composition, method of selecting members, and frequency of meetings of the executive committee.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.15.5** The executive committee shall maintain a permanent record of its proceedings and actions {#sec-16-51.15.5 omnilex-key=us-ms-regs-official--title-15--16#51.15.5}

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.15.6** The functions and responsibilities of the executive committee shall include at least the following: 1 {#sec-16-51.15.6 omnilex-key=us-ms-regs-official--title-15--16#51.15.6}

Receiving and acting upon reports and recommendations from professional staff committees, departments, and services; 2. Implementing the approved policies of the professional staff; 3. Recommending to the governing body all matters relating to appointments and reappointments, staff categorization and assignments, clinical privileges, and except when such is a function of the professional staff or one of its committees, corrective action; 4. Fulfilling the professional staff's accountability to the governing body for the quality of the overall clinical care rendered to patients in the facility; and 5. Initiating and pursuing corrective action when warranted, in accordance with the provisions of the professional staff bylaws, rules and regulations.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13 Subchapter 16 PROFESSIONAL STAFF BYLAWS Rule 51.16.1 The professional staff shall develop and adopt bylaws, rules and regulations to establish a framework of self-government and a means of accountability to the governing body.*
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.16.2** The bylaws, rules and regulations shall be subject to the approval of the governing body {#sec-16-51.16.2 omnilex-key=us-ms-regs-official--title-15--16#51.16.2}

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.16.3** The professional staff shall regulate itself by its bylaws, rules and regulations {#sec-16-51.16.3 omnilex-key=us-ms-regs-official--title-15--16#51.16.3}

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.16.4** Rule 51.16.4 {#sec-16-51.16.4 omnilex-key=us-ms-regs-official--title-15--16#51.16.4}

The professional staff bylaws, rules and regulations shall reflect current staff practices, shall be enforced, and shall be periodically reviewed and revised as necessary.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.16.5** Rule 51.16.5 {#sec-16-51.16.5 omnilex-key=us-ms-regs-official--title-15--16#51.16.5}

The professional staff bylaws, rules and regulations shall include a requirement for an ethical pledge from each practitioner.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.16.6** Rule 51.16.6 {#sec-16-51.16.6 omnilex-key=us-ms-regs-official--title-15--16#51.16.6}

The professional staff bylaws, rules and regulations shall describe the specific role of each discipline represented on the professional staff or exercising clinical privileges in the care of patients.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.16.7** The professional staff bylaws, rules and regulations shall include the following patient record requirement: 1 {#sec-16-51.16.7 omnilex-key=us-ms-regs-official--title-15--16#51.16.7}

Symbols and abbreviations shall be used only when they have been approved by the professional staff and when there is an explanatory legend; 2. The categories of personnel who are qualified to accept and transcribe verbal orders, regardless of the mode of transmission of the orders, shall be specifically identified; 3. The period of time following admission to the facility within which a history and physical examination must be entered in the patient record shall be specified; 4. The time period in which patient records must be completed following discharge shall be specified and shall not exceed fourteen (14) days; and 5. The entries in patient records that must be dated and authenticated by the responsible practitioner shall be specified.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.16.8** Rule 51.16.8 {#sec-16-51.16.8 omnilex-key=us-ms-regs-official--title-15--16#51.16.8}

The professional staff bylaws, rules and regulations shall specify mechanisms for the denial of staff appointments and reappointments, as well as for denial, curtailment, suspension, or revocation of clinical privileges. When appropriate, this procedure shall provide for a practitioner to be heard, upon request, at some stage of the process.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13 Subchapter 17 WRITTEN PLAN FOR PROFESSIONAL SERVICES*

##### **15 Miss. Admin. Code Pt. 16, R. 51.17.1** Rule 51.17.1 {#sec-16-51.17.1 omnilex-key=us-ms-regs-official--title-15--16#51.17.1}

Within the scope of its activities, the facility shall have enough appropriately qualified health care professional, administrative and support staff available to adequately assess and address the identified clinical needs of patients. Appropriately qualified professional staff may include qualified child and/or adolescent psychiatrists and other physicians, clinical psychologists, social workers, psychiatric mental health nurse practitioners, psychiatric nurses, and other health care professionals in numbers and variety appropriate to the services offered by the facility and with training and experience working with children and/or adolescents.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.17.2** Rule 51.17.2 {#sec-16-51.17.2 omnilex-key=us-ms-regs-official--title-15--16#51.17.2}

The plan shall describe the services offered by the facility so that a frame of reference for judging the various aspects of the facility's operation is available. 1. The written plan for professional services shall describe the following: 2. The population served, including age groups and other characteristics of the patient population; 3. The hours and days the facility operates; 4. The methods used to carry out initial screening and/or triage; 5. The intake or admission process; including how the initial contact is made with the patient and the family or significant others; 6. The assessment and evaluation procedures provided by the facility; 7. The methods used to deliver services to meet the identified clinical needs of patients served; 8. The basic therapeutic programs offered by the facility; 9. The treatment planning process and the periodic review of therapy; 10. The discharge and post-therapy planning processes; 11. The organizational relationships of each of the facility's therapeutic programs, including channels of staff communication, responsibility, and authority, as well as supervisory relation-ships; and 12. The means by which the facility provides, or makes arrangements for the provision of, the following: a. Other medical, special assessments, and therapeutic services; b. Patient education services, whether provided from within or outside the facility;

c. Emergency services and crisis intervention; and d. Discharge and aftercare, including post-therapy planning and follow-up evaluation.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.17.3** Rule 51.17.3 {#sec-16-51.17.3 omnilex-key=us-ms-regs-official--title-15--16#51.17.3}

When the facility is organized by departments or services, the written plan for professional services shall describe how each department or service relates to the goals and other programs of the facility, specify lines of responsibility within each department of service, and define the rolls of department or service personnel and the methods for interdisciplinary collaboration.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.17.4** Rule 51.17.4 {#sec-16-51.17.4 omnilex-key=us-ms-regs-official--title-15--16#51.17.4}

When a facility is organized on a team or unit basis, either totally or in part, the written plan for professional services shall delineate the roles and responsibilities of team members in meeting the identified clinical needs of patients and in relation to the goals and programs of the facility.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.17.5** Rule 51.17.5 {#sec-16-51.17.5 omnilex-key=us-ms-regs-official--title-15--16#51.17.5}

The written plan for professional services shall be made known and available to all professional personnel and to the chief executive officer.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.17.6** Rule 51.17.6 {#sec-16-51.17.6 omnilex-key=us-ms-regs-official--title-15--16#51.17.6}

The plan shall be reviewed at least annually, and revised as necessary, in relation to the changing needs of the patients, the community, and the overall objectives and goals of the facility, and it shall be signed and dated by the reviewers.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.17.7** Rule 51.17.7 {#sec-16-51.17.7 omnilex-key=us-ms-regs-official--title-15--16#51.17.7}

Within the scope of its activities, the facility shall have enough appropriately qualified health care professional, administrative and support staff available to adequately assess and address the identified clinical needs of patients. Appropriately qualified professional staff may include qualified child and/or adolescent psychiatrists and other physicians, clinical psychologists, social workers, psychiatric nurses, and other health care professionals in numbers and variety appropriate to the services offered by the facility and with training and experience working with children and/or adolescents.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.17.8** Rule 51.17.8 {#sec-16-51.17.8 omnilex-key=us-ms-regs-official--title-15--16#51.17.8}

When appropriate qualified professional staff are not available or needed on a full-time basis, arrangements shall be made to obtain sufficient services on an attending continuing consultative or part-time basis.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.17.9** Rule 51.17.9 {#sec-16-51.17.9 omnilex-key=us-ms-regs-official--title-15--16#51.17.9}

The professional staff shall include, but not be limited to, the following appropriately qualified mental health professionals and paraprofessionals; child psychiatrists; child psychologists; social workers; psychiatric nurse; child care workers; educators; speech, hearing, and language specialists; activity and recreation specialists; and vocational counselors.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.17.10** Rule 51.17.10 {#sec-16-51.17.10 omnilex-key=us-ms-regs-official--title-15--16#51.17.10}

The professional staff who are assigned full time to the child/adolescent psychiatric residential treatment program, are not shared with other programs.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13 Subchapter 18 ADMISSION AND DISCHARGE CRITERIA Rule 51.18.1 Only a psychiatrist on the staff of the facility shall determine whether admission of a child/adolescent to the psychiatric residential facility is appropriate. The decision shall be based upon either a direct examination conducted personally by the psychiatrist or upon the psychiatrist’s review of the findings of an appropriately trained and trusted clinician. When the admitting psychiatrist is not a child psychiatrist, consultation with a child psychiatrist regarding the advisability of admission shall be required.*
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.18.2** Rule 51.18.2 {#sec-16-51.18.2 omnilex-key=us-ms-regs-official--title-15--16#51.18.2}

Each child/adolescent psychiatric residential treatment facility shall maintain written admission and discharge criteria which are consistent with its goals and objectives and state rules and regulations and which are subject to approval of the Mississippi Department of Health.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.18.3** The admission criteria must, at a minimum, provide that the child/adolescent meet each of the following criteria: 1 {#sec-16-51.18.3 omnilex-key=us-ms-regs-official--title-15--16#51.18.3}

Identification of a serious and persistent psychopathology as evidenced by: a. Severe thought disorder, or b. Severe mood disorder, or c. Severe anxiety/panic disorder, or d. Moderate thought disorder in conjunction with an impulse control disorder or a deficit in activities of daily living skills, or

e. Severe conduct disorder in conjunction with an impulse control disorder or a deficit in activities of daily living skills, or f. Severe personality disorder in conjunction with an impulse control disorder or a deficit in activities of daily living skills, or g. Complex, concurrent disorders (such as a physiologic disorder or other psychiatric disorder, including but not limited to an eating disorder or a substance abuse disorder), or h. Any combination of the above; 2. Intelligence Quotient equal to or greater than 60 unless medical documentation supports that suppressed score is due to the patient’s “emotional disorder”. 3. Attainment of at least the sixth birthday but no more than the twenty-first birthday; and 4. Presentation of no likelihood of serious harm to self or others, and 5. Failure of treatment at a lower level of care or available less restrictive treatment resources must have been considered and determined to be not available or not appropriate to the patient’s needs.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.18.4** Rule 51.18.4 {#sec-16-51.18.4 omnilex-key=us-ms-regs-official--title-15--16#51.18.4}

The admitting psychiatrist shall document the reasons why a lower level of care is not medically appropriate, which may include: 1. Complex case because of one or more complicating concurrent disorders requiring a higher level of care to provide medically necessary evaluation or active treatment, or 2. Lack of access, or 3. Inadequate support (family and/or school and/or community) to use a lower level of care, or 4. Patient lives alone, or lives with family members who are significantly impaired by psychiatric or substance abuse disorders, or 5. Persistent hampering of evaluation or treatment by family, making evaluation or treatment in an outpatient setting ineffective, or 6. Patient behavior which persists despite appropriate treatment in an outpatient setting and which either seriously disrupts family life or which arouses antagonism towards the patient, making treatment in an outpatient setting ineffective.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.18.5** Any additional admission criteria must relate to observable characteristics of the child/adolescent {#sec-16-51.18.5 omnilex-key=us-ms-regs-official--title-15--16#51.18.5}

Such criteria may include age and gender.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.18.6** Rule 51.18.6 {#sec-16-51.18.6 omnilex-key=us-ms-regs-official--title-15--16#51.18.6}

The discharge criteria must relate to the continued need of the individual child/adolescent for services in a residential treatment facility. Age in and of itself shall not be an appropriate basis for discharge from a residential treatment facility except that no resident may remain in a residential treatment facility after attaining the age of twenty-two.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13 Subchapter 19 STAFF COMPOSITION Rule 51.19.1 A child/adolescent psychiatric residential treatment facility shall continuously employ an adequate number of staff and an appropriate mix of staff to carry out its goals and objectives as well as to ensure the continuous provision of sufficient regular and emergency supervision of all patients 24 hours a day. As a component of the written plan for services and staff composition, the psychiatric residential treatment facility shall submit a written staffing rationale which justifies the staff to be utilized, the mix of staff and the plan for appropriate supervision and training. This staffing plan shall be based on the population to be served and the services to be provided. The staffing plan and its rationale shall be subjected to approval by the Mississippi Department of Health.*
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.19.2** At least fifty percent of the professional staff hours shall be provided by full time employees {#sec-16-51.19.2 omnilex-key=us-ms-regs-official--title-15--16#51.19.2}

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.19.3** Rule 51.19.3 {#sec-16-51.19.3 omnilex-key=us-ms-regs-official--title-15--16#51.19.3}

Professional staff are individuals who are qualified by training and experience to provide direct service under minimal supervision, and shall include, but not be limited to, the following: 1. Registered Nurse; 2. Occupational Therapist/Therapeutic Recreation Specialist/Rehabilitation Counselor; 3. Physician; 4. Child Psychiatrist;

5. Psychologist; 6. Licensed Clinical Social Worker/Licensed Professional Counselor; 7. Teacher; 8. Speech Pathologist; and 9. Licensed Master Level Social Worker.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.19.4** Rule 51.19.4 {#sec-16-51.19.4 omnilex-key=us-ms-regs-official--title-15--16#51.19.4}

Other professional disciplines may be included as professional staff provided that the discipline is from a field related to the treatment of mental illness, and the individual shall be licensed or certified in such discipline as required by state laws and regulations, and the individual shall have specialized training or experience in working with children/adolescents.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.19.5** Rule 51.19.5 {#sec-16-51.19.5 omnilex-key=us-ms-regs-official--title-15--16#51.19.5}

The child/adolescent psychiatric residential treatment facility shall have on staff an adequate number and mix of professional staff who meet the qualifications provided by these standards and other state laws and regulations. The staffing plan shall meet each of the following requirements. A single staff member may be counted against more than one requirement: 1. At least one full time Registered Nurse. 2. At least one additional person representing a professional staff category as delineated below shall be employed on a full-time basis: a. Physician; b. Child Psychiatrist; c. Psychologist; d. Licensed Clinical Social Worker/Licensed Professional Counselor; e. Teacher; or f. Licensed Professional Art Therapist. 3. Each patient shall receive a minimum of 15 hours of therapy per week from among the following professional staff categories: a. Child Psychiatrist; b. Psychologist;

c. Licensed Clinical Social Worker/Licensed Professional Counselor; d. Therapeutic Recreation Specialist; and e. Licensed Professional Art Therapist. 4. One full-time equivalent professional staff member shall be employed for each seven residents. 5. Each patient shall have a direct consultation at least once per week with the staff child psychiatrist or a psychiatric mental health nurse practitioner.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.19.6** Rule 51.19.6 {#sec-16-51.19.6 omnilex-key=us-ms-regs-official--title-15--16#51.19.6}

The child/adolescent residential treatment facility shall ensure that an adequate number of professional staff is qualified by training and experience to provide clinical supervision of other staff and to provide programmatic direction. The staffing composition pattern shall be subject to approval by the State Department of Health and shall include, but not be limited to, the following: 1. A licensed Registered Nurse who has at least three years of experience working with children/adolescents; and/or 2. A licensed psychiatric mental health nurse practitioner who has at least three years of experience working with children/adolescents; and/or 3. A licensed physician who is a board certified or board eligible pediatrician or who is board eligible in family practice; 4. A licensed physician who is a board certified or board eligible psychiatrist qualified in child psychiatry; 5. A licensed psychologist who has specialized training and experience in the evaluation and treatment of mental disorders of children and/or adolescents; 6. A licensed master level social worker who has a master’s degree and is clinically qualified by training and two years experience in working with mentally ill children/adolescents or a Licensed Professional Counselor who is clinically qualified by training and two years experience in working with mentally ill children/adolescents; 7. A qualified therapeutic recreation specialist; 8. A qualified rehabilitation counselor who has three years of experience in working with mentally ill children/adolescents.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.19.7** Rule 51.19.7 {#sec-16-51.19.7 omnilex-key=us-ms-regs-official--title-15--16#51.19.7}

The child/adolescent psychiatric residential treatment facility shall provide adequate supervision of patients in a safe therapeutic manner and shall meet the following minimum requirements: 1. At least two direct care staff members shall be assigned to patient care responsibilities during all hours the patients are awake and not in school. 2. At least one direct care staff member shall be assigned to direct care responsibilities for each five patients during all hours the patient are awake and not in school. 3. At least one direct care staff member shall be assigned patient care responsibility for each ten patients, be awake, and be continuously available to the children/adolescents on each living unit during hours the patient are asleep. A minimum of one additional direct care staff member for each fourteen children/adolescents shall be immediately available on site to assist with emergencies or problems which might occur at any time. 4. At least one licensed nurse (registered nurse or practical nurse) shall be on duty at all times, 24 hours a day, seven days a week. 5. During waking hours, one professional staff member (other than a nurse) shall be on duty for each 22 patients. 6. Other appropriate professional staff shall be available to assist in emergencies on at least an on-call basis at all times. 7. A licensed physician shall be available on at least an on-call basis at all times.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13 Subchapter 20 PSYCHIATRIC SERVICES Rule 51.20.1 Psychiatric services are under the supervision of a medical/clinical director, service chief or equivalent licensed physician who is qualified to provide the leadership required for an intensive treatment program.*
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.20.2** The director of psychiatric services shall be a qualified child psychiatrist {#sec-16-51.20.2 omnilex-key=us-ms-regs-official--title-15--16#51.20.2}

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.20.3** Rule 51.20.3 {#sec-16-51.20.3 omnilex-key=us-ms-regs-official--title-15--16#51.20.3}

Primary psychiatric care for all patients in a child/adolescent psychiatric residential care facility shall be provided by a qualified child psychiatrist directly or at least by consultation; or either by a qualified psychiatric mental health nurse practitioner.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.20.4** Rule 51.20.4 {#sec-16-51.20.4 omnilex-key=us-ms-regs-official--title-15--16#51.20.4}

The number of psychiatrists and/or number of psychiatric mental health nurse practitioners is commensurate with the size and scope of the child/adolescent residential treatment program.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.20.5** Rule 51.20.5 {#sec-16-51.20.5 omnilex-key=us-ms-regs-official--title-15--16#51.20.5}

Psychiatrists in a child/adolescent residential treatment program who have not completed an approved child fellowship be supervised by or regularly consult with a qualified child psychiatrist with regard to evaluation, treatment, and discharge of children/adolescents within the facility.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.20.6** All psychiatrists or psychiatric mental health nurse practitioners shall be licensed in the State of Mississippi {#sec-16-51.20.6 omnilex-key=us-ms-regs-official--title-15--16#51.20.6}

**History**
- *SOURCE: Miss. Code Ann. §43-11-13 Subchapter 21 MEDICAL SERVICES Rule 51.21.1 Physicians shall be available at all times to provide necessary medical and surgical diagnostic and treatment services, including specialized services.*
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.21.2** Rule 51.21.2 {#sec-16-51.21.2 omnilex-key=us-ms-regs-official--title-15--16#51.21.2}

If medical surgical diagnosis and treatment services are not available within the facility, qualified consultants or attending physicians are immediately available or arrangements are made to transfer patients to a general hospital.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.21.3** All physicians shall be licensed in the State of Mississippi {#sec-16-51.21.3 omnilex-key=us-ms-regs-official--title-15--16#51.21.3}

**History**
- *SOURCE: Miss. Code Ann. §43-11-13 Subchapter 22 NURSING SERVICES Rule 51.22.1 Nursing services shall be under the direct supervision of a registered nurse who has had at least two years of experience in psychiatric or mental health nursing and at least one year of experience in a supervisory position.*
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.22.2** Rule 51.22.2 {#sec-16-51.22.2 omnilex-key=us-ms-regs-official--title-15--16#51.22.2}

The number of registered professional nurses, licensed practical nurses, and other nursing personnel shall be adequate to formulate and carry out the nursing components of the individual treatment plan for each patient, and shall include at least one registered nurse for each sixty patients seven days a week. There shall be at least one licensed nurse on a 24 hour basis, seven days a week, for each sixty patients. The nurse staffing ratios, including licensed and unlicensed

nursing personnel, shall be subject to approval by the Mississippi Department of Health.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.22.3** All registered nurses and practical nurses shall be licensed in the State of Mississippi {#sec-16-51.22.3 omnilex-key=us-ms-regs-official--title-15--16#51.22.3}

1. Services to patients include evaluations, consultations, therapy, and program development. 2. Clinical psychological testing and evaluation procedures may only be provided by or under the supervision of a licensed and qualified psychologist.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13 Subchapter 23 PSYCHOLOGICAL SERVICES Rule 51.23.1 Patients shall be provided psychological services, in accordance with their needs by a qualified psychologist.*
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.23.2** Specialist with a Master’s or Bachelor’s degree in psychology shall be supervised by a qualified psychologist {#sec-16-51.23.2 omnilex-key=us-ms-regs-official--title-15--16#51.23.2}

**History**
- *SOURCE: Miss. Code Ann. §43-11-13 Subchapter 24 SOCIAL/CLINICAL SERVICES Rule 51.24.1 Social/Clinical services are under the supervision of a licensed clinical social worker or licensed professional counselor.*
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.24.2** All social workers shall be licensed in the State of Mississippi {#sec-16-51.24.2 omnilex-key=us-ms-regs-official--title-15--16#51.24.2}

All counselors shall have a minimum of a Master’s degree in counseling, or a related field.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.24.3** Social/Clinical services staff is qualified and adequate to provide the following services: 1 {#sec-16-51.24.3 omnilex-key=us-ms-regs-official--title-15--16#51.24.3}

Psychosocial data for diagnosis and treatment planning; 2. Direct therapeutic services to individual patients, patient groups or families; 3. Develop community resources; and

4. Participate in interdisciplinary conferences and meetings concerning treatment planning, including identification and utilization of other facilities and alternative forms of care and treatment.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13 Subchapter 25 ANCILLARY SERVICES Rule 51.25.1 Qualified therapists, consultants, assistants or aides are sufficient in number to provide comprehensive ancillary services, including at least occupational, recreational, or physical therapy or art therapy as needed, to assure that appropriate treatment is rendered for each patient, and to establish and maintain a therapeutic milieu.*
- *SOURCE: Miss. Code Ann. §43-11-13 Subchapter 26 EDUCATIONAL SERVICES Rule 51.26.1 Educational and vocational services available to patients of the psychiatric residential treatment facility shall, at a minimum, meet the requirements of the state law with regard to compulsory education. Compulsory education services may be provided directly by the residential treatment facility or may be provided by written agreement with the local school district. In any case, compulsory education services must be available either on the same site or in close physical proximity to the psychiatric residential treatment facility.*
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.26.2** Rule 51.26.2 {#sec-16-51.26.2 omnilex-key=us-ms-regs-official--title-15--16#51.26.2}

Appropriate written agreements among the State Department of Education, all respective local school districts and the psychiatric residential treatment facility shall be made regarding the provision of educational services for those youths not eligible to be ruled "emotionally handicapped" under this State's Department of Education's referral to placement regulations and guidelines for handicapped children and youth.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.26.3** Rule 51.26.3 {#sec-16-51.26.3 omnilex-key=us-ms-regs-official--title-15--16#51.26.3}

When compulsory education services are provided directly by the residential treatment facility, such services shall comply with the regulations of the State Board of Education. In such case, the psychiatric residential treatment facility shall comply with all appropriate requirements for the education of handicapped patients.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.26.4** Rule 51.26.4 {#sec-16-51.26.4 omnilex-key=us-ms-regs-official--title-15--16#51.26.4}

Educational services shall be provided by licensed teachers who shall have at least a bachelor's degree in education from an accredited institution, shall have

certification in special education, and preferably shall have training in the education of emotionally disturbed children/adolescents.

1. All personnel policies shall be reviewed and approved on an annual basis by the governing body. 2. There shall be documentation to verify that the written personnel policies and procedures are explained and made available to each employee. 3. The policies and procedures shall include a mechanism for determining that all personnel are medically and emotionally capable of performing assigned tasks and are free of communicable and infectious diseases.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13 Subchapter 27 PERSONNEL POLICIES AND PROCEDURES Rule 51.27.1 Personnel policies and procedures shall be developed in writing, adopted, and maintained to promote the objectives of the facility and to provide for an adequate number of qualified personnel during all hours of operation to support the functions of the facility and the provision of high quality care.*
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.27.2** There shall be written policies and procedures for handling cases of patient neglect and abuse {#sec-16-51.27.2 omnilex-key=us-ms-regs-official--title-15--16#51.27.2}

The policies and procedures on patient neglect or abuse shall be given to all personnel. Any alleged violations of these policies and procedures shall be investigated, and the results of such investigation shall be reviewed and approved by the director and reported to the governing body.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.27.3** A personnel record shall be kept on each staff member and shall contain the following items, as appropriate: 1 {#sec-16-51.27.3 omnilex-key=us-ms-regs-official--title-15--16#51.27.3}

Application for employment; 2. Written references and a record of verbal references; 3. Verification of all training and experience, and licensure, certification, registration and/or renewals; 4. Wage and salary information; 5. Performance appraisals; 6. Initial and subsequent health clearances; 7. Disciplinary and counseling actions;

8. Commendations; 9. Criminal background check; and 10. Record of orientation to the facility, its policies and procedures and the employee's position.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.27.4** Rule 51.27.4 {#sec-16-51.27.4 omnilex-key=us-ms-regs-official--title-15--16#51.27.4}

For each position in the facility, there shall be a written job description that specifies the duties and responsibilities of the position and the minimum level of education, training, and/or related work experience required or needed to fulfill it.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13 Subchapter 28 STAFF DEVELOPMENT Rule 51.28.1 The facility shall have a written plan of evidence of implementation of a program of staff development and in-service training that is consonant with the basic goals and objectives of the program.*
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.28.2** Staff development shall be under the supervision and direction of a committee or qualified person {#sec-16-51.28.2 omnilex-key=us-ms-regs-official--title-15--16#51.28.2}

This person or committee may delegate responsibility for any part of the program to appropriately qualified individuals.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.28.3** Rule 51.28.3 {#sec-16-51.28.3 omnilex-key=us-ms-regs-official--title-15--16#51.28.3}

The staff development plan shall include plans for orientation of new employees and shall specify subject areas to be covered in the orientation process.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.28.4** Rule 51.28.4 {#sec-16-51.28.4 omnilex-key=us-ms-regs-official--title-15--16#51.28.4}

Staff development program shall reflect all administrative and service changes in the facility and shall prepare personnel for promotions and responsibilities.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.28.5** Rule 51.28.5 {#sec-16-51.28.5 omnilex-key=us-ms-regs-official--title-15--16#51.28.5}

A continuous professional education program shall be provided to keep the professional staff informed of significant clinical and administrative developments and skills.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.28.6** Rule 51.28.6 {#sec-16-51.28.6 omnilex-key=us-ms-regs-official--title-15--16#51.28.6}

The facility shall provide continuing training for all staff and specific orientation for all new personnel in the principles of confidentiality, privacy, patients' rights, infection control, fire prevention, disaster preparedness, accident prevention and patient safety.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.28.7** Specialized training shall be provided for staff working with children and adolescents {#sec-16-51.28.7 omnilex-key=us-ms-regs-official--title-15--16#51.28.7}

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.28.8** Rule 51.28.8 {#sec-16-51.28.8 omnilex-key=us-ms-regs-official--title-15--16#51.28.8}

The facility shall have documentation of the staff development, in-service training and orientation activities of all employees. Facilities shall comply with recommendations from the Centers for Disease Control and/or Mississippi State Department of Health regarding baseline employee TB testing and routine serial employee TB testing and education.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13 Subchapter 29 PATIENT RIGHTS Rule 51.29.1 The facility shall support and protect the fundamental human, civil, constitutional, and statutory rights of each patient.*
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.29.2** Rule 51.29.2 {#sec-16-51.29.2 omnilex-key=us-ms-regs-official--title-15--16#51.29.2}

The facility shall have written policies and procedures that describe the rights of patients and the means by which these rights are protected and exercised. These rights shall include the following: 1. Each patient shall have impartial access to treatment, regardless of race, religion, sex, ethnicity, age, or handicap; 2. Each patient's personal dignity shall be recognized and respected in the provision of all care and treatment; 3. Each patient shall receive individualized treatment, which shall include at least the following: a. The provision of adequate and human services, regardless of source(s) of financial support; b. The provision of services within the least restrictive environment possible; c. The provision of an individual treatment plan; d. The periodic review of the patient's treatment plan; e. The active participation of patients over 12 years of age and their responsible parent, relative, or guardian in planning for treatment; and f. The provision of an adequate number of competent, qualified, and experienced professional clinical staff to supervise and implement the treatment plan.

4. Each a. The patient's family and significant others, regardless of their age, shall be allowed to visit the patient, unless such visits are clinically contraindicated; b. Suitable areas shall be provided for patients to visit in private, unless such privacy is contraindicated by the patient's treatment plan; c. Patients shall be allowed to send and receive mail without hindrance; d. Patients shall be allowed to conduct private telephone conversations with family and friends, unless clinically contraindicated; e. If therapeutic indications necessitate restrictions on visitors, telephone calls, or other communications, those restrictions shall be evaluated for therapeutic effectiveness by the clinically responsible staff at least every seven days; and f. If limitations on visitors, telephone calls, or other communications are indicated for practical reasons (for example, expense of travel or phone calls) such limitations shall be determined with the participation of the patient and the patient's family. All such restrictions shall be fully explained to the patient and the patient's family. 5. Each patient has the right to request the opinion of a consultant at his or her expense or to request an in-house review of the individual treatment plan, as provided in specific procedures of the facility.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.29.3** Each patient shall be informed of his or her rights in a language the patient understands {#sec-16-51.29.3 omnilex-key=us-ms-regs-official--title-15--16#51.29.3}

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.29.4** Rule 51.29.4 {#sec-16-51.29.4 omnilex-key=us-ms-regs-official--title-15--16#51.29.4}

Each patient shall receive a written statement of patient rights, and a copy of this statement shall be posted in various areas of the facility.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.29.5** Rule 51.29.5 {#sec-16-51.29.5 omnilex-key=us-ms-regs-official--title-15--16#51.29.5}

As appropriate, the patient, the patient's family, or the patient's legal guardian shall be fully informed about the following items: 1. The rights of patients; 2. The professional staff members responsible for his or her care, their professional status, and their staff relationship; 3. The nature of the care; procedures, and treatment that he or she will receive;

4. The current and future use and disposition of products of special observation and audiovisual techniques, such as one-way vision mirrors, tape recorders, television, movies, or photographs; 5. The risks, side effects; and benefits of all medications and treatment procedures used, especially those that are unusual or experimental; 6. The alternate treatment procedures that are available; 7. The right to refuse to participate in any research project without compromising his or her access to facility services; 8. The right, to the extent permitted by law, to refuse specific medications or treatments procedures; 9. The responsibility of the facility, when the patient refuses treatment, to seek appropriate legal alternatives or orders of involuntary treatment, or, in accordance with professional standards, to terminate the relationship with the patient upon reasonable notice; 10. As appropriate, the cost, itemized when possible, of services rendered; 11. The source of the facility's reimbursement, and any limitations placed on duration of services; 12. The reasons for any proposed change in the professional staff responsible for the patient, or for any transfer of the patient either within or outside of the facility; 13. The rules and regulations of the facility applicable to his or her conduct; 14. The right to initiate a complaint or grievance procedure and the appropriate means of requesting a hearing or review of the complaint; 15. The discharge plans; and 16. The plans for meeting continuing mental and physical health requirements following discharge.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.29.6** Rule 51.29.6 {#sec-16-51.29.6 omnilex-key=us-ms-regs-official--title-15--16#51.29.6}

In accordance with the requirements of any applicable law or any other applicable standard in this manual, a written, dated, and signed informed consent from shall be obtained from the patient, the patient's family, or the patient's legal guardian, as appropriate, for participation in any research project and for use or performance of the following: 1. Surgical procedures; 2. Electroconvulsive therapy;

3. Unusual medications; 4. Hazardous assessment procedures; 5. Audiovisual equipment; and 6. Other procedures where consent is required by law.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.29.7** Rule 51.29.7 {#sec-16-51.29.7 omnilex-key=us-ms-regs-official--title-15--16#51.29.7}

The maintenance of confidentiality of communications between patients and staff and of all information recorded in patient records shall be the responsibility of all staff. (Refer to the patient records section of this manual).

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.29.8** Rule 51.29.8 {#sec-16-51.29.8 omnilex-key=us-ms-regs-official--title-15--16#51.29.8}

The facility shall provide continuing training for all staff and specific orientation for all new personnel in the principles of confidentiality and privacy.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.29.9** The patient shall be allowed to work for the service provider only under the following conditions: 1 {#sec-16-51.29.9 omnilex-key=us-ms-regs-official--title-15--16#51.29.9}

The work is part of the individual treatment plan; 2. The work is performed voluntarily; 3. The patient receives wages commensurate with the economic value of the work; and 4. The work project complies with local, state, and federal laws and regulations.

2. The use of seclusion; 3. The use of electroconvulsive therapy and other forms of convulsive therapy; 4. The performance of psychosurgery of other surgical procedures for the intervention in, or alteration of, a mental, emotional, or behavioral disorder;

5. The use of behavior modification procedures that use painful stimuli; 6. The use of unusual medications and investigational and experimental drugs; 7. The prescribing and administering of drugs for maintenance use that have abuse potential (usually considered to be Schedule II drugs), and drugs that are known to involve substantial risk or to be associated with undesirable side effects; and 8. The use of research projects that involve inconvenience or risk to the patient.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13 Subchapter 30 SPECIAL TREATMENT PROCEDURES Rule 51.30.1 Treatment procedures that require special justification shall include, but not necessarily be limited to, the following: 1. The use of restraint;*
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.30.2** The rationale for using special treatment procedures shall be clearly stated in the patient's record {#sec-16-51.30.2 omnilex-key=us-ms-regs-official--title-15--16#51.30.2}

1. When appropriate, there shall be evidence in the patient's record that proposed special treatment procedures have been reviewed before implementation by the head of the professional staff and or his or her designee. 2. The plan for using special treatment procedures shall be consistent with the patient's rights and the facility's policies governing the use of such procedures. 3. The clinical indications for the use of special treatment procedures shall be documented in the patient's record. 4. The clinical indications for the use of special treatment procedures shall outweigh the known contraindications.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.30.3** The facility shall have written policies and procedures that govern the use of restraint or seclusion {#sec-16-51.30.3 omnilex-key=us-ms-regs-official--title-15--16#51.30.3}

1. The use of restraint or seclusion shall require clinical justification and shall be employed only to prevent a patient from injuring himself or others, or to prevent serious disruption of the therapeutic environment. Restraint or seclusion shall not be employed as punishment or for the convenience of staff. 2. The rationale for the use of restraint or seclusion shall address the inadequacy of less restrictive intervention techniques. 3. To ascertain that the procedure is justified, a physician shall conduct a clinical assessment of the patient before writing an order for the use of restraint or seclusion. 4. A written order from a physician shall be required for the use of restraint. 5. A written order from a physician shall be required for the use of seclusion for longer than one hour.

6. Written orders for the use of restraint or seclusion shall be time-limited. 7. The written approval of the head of the professional staff and/or his or her designee shall be required when restraint or seclusion is utilized for longer than 24 hours. 8. PRN orders shall not be used to authorize the use of restraint or seclusion. 9. All uses of restraint or seclusion shall be reported daily to the head of the professional staff and/or his or her designee. 10. The head of the professional staff and/or his or her designee shall review daily all uses of restraint or seclusion and investigate unusual or possibly unwarranted patterns of utilization. 11. Staff, who implement written orders for restraint and seclusion shall have documented training in the proper use of the procedure for which the order was written. 12. Restraint or seclusion shall not be used in a manner that causes undue physical discomfort, harm, or pain to the patient. 13. Appropriate attention shall be paid every 15 minutes to a patient in restraint or seclusion, especially in regard to regular meals, bathing, and use of the toilet. 14. There shall be documentation in the patient's record that such attention was given to the patient. 15. Under the following conditions, restraint or seclusion may be employed in an emergency without a written order from a physician: 16. The written order for restraint or seclusion is given by a member of the professional staff who is qualified by experience and training in the proper use of the procedure for which the order is written; 17. The professional staff member writing the order has observed and assessed the patient before writing the order; and 18. The written order of the physician who is responsible for the patient's medical care is obtained within not more than 24 hours after initial employment of the restraint or seclusion.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.30.4** Rule 51.30.4 {#sec-16-51.30.4 omnilex-key=us-ms-regs-official--title-15--16#51.30.4}

The facility shall have written policies and procedures that govern the use of time- out and the documentation of such procedures in the case record. 1. The use of time-out shall require clinical justification and shall not be employed for the convenience of staff.

2. Time-out procedures shall meet the following requirements: 3. A child/adolescent placed in time-out shall be under visual observation at intervals of fifteen minutes or less while in time-out; 4. A locked door shall not be a component of time-out; 5. Time-out shall be limited to a maximum of thirty minutes at one time for a child age ten years or under and shall be limited to a maximum of sixty minutes at one time for an adolescent age eleven years or older; and 6. No child/adolescent shall be in time-out for more than four hours in any 24 hour period.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.30.5** Rule 51.30.5 {#sec-16-51.30.5 omnilex-key=us-ms-regs-official--title-15--16#51.30.5}

Electroconvulsive (or other forms of convulsive therapies) shall not be administered in a child/adolescent psychiatric residential treatment facility but may be administered in an acute care medical or psychiatric hospital.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.30.6** Rule 51.30.6 {#sec-16-51.30.6 omnilex-key=us-ms-regs-official--title-15--16#51.30.6}

The facility shall have policies that prohibit the performance of psychosurgery or other surgical procedures for the intervention in, or alteration of, a mental, emotional, or behavioral disorder in children or adolescents.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.30.7** Behavior modification procedures that use painful stimuli shall be documented in the patient's record {#sec-16-51.30.7 omnilex-key=us-ms-regs-official--title-15--16#51.30.7}

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.30.8** Rule 51.30.8 {#sec-16-51.30.8 omnilex-key=us-ms-regs-official--title-15--16#51.30.8}

The written informed consent of the patient for the use of behavior modification procedures that use painful stimuli shall be obtained and made part of the patient's record. The patient may withdraw consent at any time. 1. When required, the written informed consent of the family and/or legal guardian shall be obtained and made part of the patient's record. The family and/or guardian may withdraw consent at any time. 2. In cases dealing with children or adolescents, the responsible parent(s), relative, or guardian and, when appropriate, the patient shall give written, dated, and signed informed consent. The family and/or guardian and, when appropriate, the child or adolescent patient may withdraw consent at any time.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.30.9** Rule 51.30.9 {#sec-16-51.30.9 omnilex-key=us-ms-regs-official--title-15--16#51.30.9}

The facility shall have written policies and procedures that govern the use of unusual medications and investigational and experimental drugs. 1. Unusual or experimental drugs shall be reviewed before use by the research review committee, the patient rights' review committee, or another appropriate peer review committee. 2. Investigational drugs shall be used only under the direct supervision of the principal investigator and with the approval of the physician members of the professional staff or an appropriate committee of the professional staff, the research review committee, and appropriate federal, state, and local agencies.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.30.10** Rule 51.30.10 {#sec-16-51.30.10 omnilex-key=us-ms-regs-official--title-15--16#51.30.10}

A central unit shall be established to maintain essential information on investigational drugs, such as drug dosage form, dosage range, storage requirements, adverse reactions, usage, and contraindications.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.30.11** Rule 51.30.11 {#sec-16-51.30.11 omnilex-key=us-ms-regs-official--title-15--16#51.30.11}

Investigational drugs shall not be administered to children or adolescents in a residential treatment facility, unless approved in writing by the Mississippi Department of Health on a case by case basis.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.30.12** Nurses may administer investigational drugs only after receiving basic pharmacologic information about the drugs {#sec-16-51.30.12 omnilex-key=us-ms-regs-official--title-15--16#51.30.12}

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.30.13** Rule 51.30.13 {#sec-16-51.30.13 omnilex-key=us-ms-regs-official--title-15--16#51.30.13}

The written informed consent of the patient for the use of unusual medications or investigational or experimental drugs shall be obtained and made part of the patient's record. The patient may withdraw consent at any time. 1. When required, the written informed consent of the family and/or legal guardian for the use of unusual medication or investigational or experimental drugs shall be obtained and made part of the patient record. The family and/or guardian may withdraw consent at any time. 2. In cases dealing with children and adolescents, the responsible parent(s), relative, or guardian and, when appropriate, the patient shall give written, dated, and signed informed consent, unless prohibited by law. The family and/or guardian and, when appropriate, the child or adolescent patient may withdraw consent at any time.

3. The denial of consent to take unusual medications of investigational or experimental drugs shall not be cause for denying or altering services indicated for the patient.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.30.14** Rule 51.30.14 {#sec-16-51.30.14 omnilex-key=us-ms-regs-official--title-15--16#51.30.14}

The facility shall have written policies and procedures that govern the prescribing and administering of drugs for maintenance use that have abuse potential (usually considered to be Schedule II drugs), and drugs that are known to involve a substantial risk or be associated with undesirable side effects. 1. Drugs that have abuse potential shall be prescribed and administered for maintenance use only when the following criteria are met: 2. A physician member of the professional staff has reviewed the patient's record and has recorded the reasons for prescribing the drug(s) in the patient's record; 3. The prescribed drug is listed in the facility's formulary; and 4. Prior to the administration of the drug, the patient and, when required by law, the patient's parent(s) or guardian are informed orally and in writing, and, if possible, in the patient's native language, of the benefits and hazards of the drug.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.30.15** Rule 51.30.15 {#sec-16-51.30.15 omnilex-key=us-ms-regs-official--title-15--16#51.30.15}

The facility shall have written policies and procedures that protect the rights of patients involved in research projects that involve inconvenience or risk to the patient.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13 Subchapter 31 PATIENT RECORDS Rule 51.31.1 A patient record shall be maintained, in accordance with accepted professional principles, for each patient admitted for care in the facility.*
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.31.2** Such records shall be kept confidential and only authorized personnel shall have access to the record {#sec-16-51.31.2 omnilex-key=us-ms-regs-official--title-15--16#51.31.2}

Staff members and other persons having access to patient records shall be required to abide by the written policies regarding confidentiality of patient records and disclosure of information in the record, as well as all applicable federal, state, and local laws, rules and regulations.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.31.3** Rule 51.31.3 {#sec-16-51.31.3 omnilex-key=us-ms-regs-official--title-15--16#51.31.3}

The facility shall have written policies and protect the confidentiality of patient records and govern the disclosure of information in the records. The policies and

procedures shall specify the conditions under which information on applicants or patients may be disclosed and the procedures for releasing such information.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.31.4** Rule 51.31.4 {#sec-16-51.31.4 omnilex-key=us-ms-regs-official--title-15--16#51.31.4}

A patient of his or her authorized representative may consent to the release of information provided that written consent is given on a form containing the following information: 1. Name of patient; 2. Name of program; 3. The name of the person, agency or organization to which the information is to e disclosed; 4. The specific information to be disclosed; 5. The purpose for the disclosure; 6. The date the consent was signed and the signature of the individual witnessing the consent; 7. The signature of the patient, parent, guardian or authorized representative; and 8. A notice that the consent is valid only for a specified period of time.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.31.5** Rule 51.31.5 {#sec-16-51.31.5 omnilex-key=us-ms-regs-official--title-15--16#51.31.5}

The written consent of a patient, or his or her authorized representative, to the disclosure of information shall be considered valid only if the following conditions have been met: 1. The patient or the representative shall be informed, in a manner calculated to assure his or her understanding, of the specific type of information that has been requested and, if known, the benefits and disadvantages of releasing the information; 2. The patient or the representative shall give consent voluntarily; 3. The patient or the representative shall be informed that the provision of services is not contingent upon his or her decision concerning the release of information; and 4. The patient's consent shall be acquired in accordance with all applicable federal, state, and local laws, rules and regulations.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.31.6** Rule 51.31.6 {#sec-16-51.31.6 omnilex-key=us-ms-regs-official--title-15--16#51.31.6}

Every consent for release of information, the actual date the information was released, the specific information released, and the signature of the staff member who released the information shall be made a part of the patient record.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.31.7** Rule 51.31.7 {#sec-16-51.31.7 omnilex-key=us-ms-regs-official--title-15--16#51.31.7}

In a life-threatening situation or when an individual's condition or situation precludes the possibility of obtaining written consent, the facility may release pertinent medical information to the medical personnel responsible for the individual's care without the individual's consent and without the authorization of the chief executive officer or a designee, if obtaining such authorization would cause an excessive delay in delivering treatment to the individual. 1. When information has been released under emergency conditions, the staff member responsible for the release of information shall enter all pertinent details of the transaction into the individual's record including at least the following items: 2. The date the information was released; 3. The person to whom the information was released; 4. The reason the information was released; 5. The reason written consent could not be obtained; and 6. The specific information released. 7. The patient or applicant shall be informed that the information was released as soon as possible after the release of information.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.31.8** Patient records shall not be removed from the facility except upon subpoena and court order {#sec-16-51.31.8 omnilex-key=us-ms-regs-official--title-15--16#51.31.8}

**History**
- *SOURCE: Miss. Code Ann. §43-11-13 Subchapter 32 PRESERVATION AND STORAGE Rule 51.32.1 Records shall be preserved, either in the original or by microfilm, for a period of time not less than that determined by the statue of limitations in the State of Mississippi.*
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.32.2** Rule 51.32.2 {#sec-16-51.32.2 omnilex-key=us-ms-regs-official--title-15--16#51.32.2}

Written policies and procedures shall govern the compilation, storage, dissemination, and accessibility of patient records. The policies and procedures shall be designed to assure that the facility fulfills its responsibility to safeguard and protect the patient record against loss, unauthorized alteration, or disclosure

of information; to assure that each patient record contains all required information; to uniformity in the format and forms in use in patient records; to require entries in patient records to be dated and signed.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.32.3** Rule 51.32.3 {#sec-16-51.32.3 omnilex-key=us-ms-regs-official--title-15--16#51.32.3}

The facility shall provide adequate facilities for the storage, processing, and handling of patient records, including suitably locked and secured rooms and files. When a facility stores patient data on magnetic tape, computer files, or other types of automated information systems, adequate security measures shall prevent inadvertent or unauthorized access to such data. A written policy shall govern the disposal of patient records. Methods of disposal shall be designed to assure the confidentiality of information in the records.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13 Subchapter 33 PERSONNEL Rule 51.33.1 The patient records department shall maintain, control, and supervise the patient records, and shall be responsible for maintaining the quality.*
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.33.2** Rule 51.33.2 {#sec-16-51.33.2 omnilex-key=us-ms-regs-official--title-15--16#51.33.2}

A qualified medical record individual who is employed on at least a part-time basis, consistent with the needs of the facility and the professional staff, shall be responsible for the patient records department. This individual shall be a registered record administrator or an accredited record technician.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.33.3** Rule 51.33.3 {#sec-16-51.33.3 omnilex-key=us-ms-regs-official--title-15--16#51.33.3}

When it can be demonstrated that the size, location or needs of the facility do not justify employment of a qualified individual, the facility must secure the consultative assistance of a registered record administrator at least twice a year to assure that the patient record department is adequate to meet the needs of the facility.

Subchapter 35 CONTENT OF RECORDS Rule 51.35.1 The medical record shall contain sufficient information to justify the diagnosis and warrant the treatment and end results. The patient record shall describe the patient's health status at the time of admission, the services provided and the patient's progress in the facility, and the patient's health status at the time of discharge. The patient record shall provide information for the review and evaluation of the treatment provided to the patient. When appropriate, data in the patient record shall be used in training, research, evaluation, and quality assurance programs. When indicated, the patient record shall contain documentation that the rights of the patient and of the patient's family are protected. The patient record shall contain documentation of the patient's and, as appropriate, family members' involvement in the patient's treatment program. The patient record shall contain identifying data that is recorded on standardized forms. This identifying data shall include the following: 1. Full name; 2. Home address; 3. Home telephone number; 4. Date of birth; 5. Sex; 6. Race or ethnic origin; 7. Next of kin; 8. Education; 9. Marital status; 10. Type and place of employment; 11. Date of initial contact or admission to the facility; 12. Legal status, including relevant legal documents; 13. Other identifying data as indicated; 14. Date the information was gathered; and 15. Signature of the staff member gathering the information.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13 Subchapter 34 CENTRALIZATION OF REPORTS Rule 51.34.1 All clinical information pertaining to a patient's stay shall be centralized in the patient's record. The original or all reports originating in the facility shall be filed in the medical record. Appropriate patient records shall be kept on the unit where the patient is being treated and shall be directly accessible to the clinician caring for the patient.*
- *SOURCE: Miss. Code Ann. §43-11-13*
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.35.2** The patient record shall contain information on any unusual occurrences such as the following: 1 {#sec-16-51.35.2 omnilex-key=us-ms-regs-official--title-15--16#51.35.2}

Treatment complications; 2. Accidents or injuries to the patient; 3. Morbidity; 4. Death of a patient; and 5. Procedures that place the patient at risk or that cause unusual pain.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.35.3** Rule 51.35.3 {#sec-16-51.35.3 omnilex-key=us-ms-regs-official--title-15--16#51.35.3}

As necessary, the patient record shall contain documentation of the consent of the patient, appropriate family members or guardians for admission, treatment, evaluation, aftercare, or research.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.35.4** Rule 51.35.4 {#sec-16-51.35.4 omnilex-key=us-ms-regs-official--title-15--16#51.35.4}

The patient record shall contain both physical and psychiatric diagnoses that have been made using a recognized diagnostic system.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.35.5** Rule 51.35.5 {#sec-16-51.35.5 omnilex-key=us-ms-regs-official--title-15--16#51.35.5}

The patient record shall contain reports of laboratory, roentgenographic, or other diagnostic procedures, and reports of medical/surgical services when performed.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.35.6** Rule 51.35.6 {#sec-16-51.35.6 omnilex-key=us-ms-regs-official--title-15--16#51.35.6}

The patient record shall contain correspondence concerning the patient's treatment, and signed and dated notations of telephone calls concerning the patient's treatment.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.35.7** Rule 51.35.7 {#sec-16-51.35.7 omnilex-key=us-ms-regs-official--title-15--16#51.35.7}

A discharge summary shall be entered in the patient's record within a reasonable period of time (not to exceed 14-days) following discharge as determined by the professional staff bylaws, rules and regulations.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.35.8** The patient record shall contain a plan for aftercare {#sec-16-51.35.8 omnilex-key=us-ms-regs-official--title-15--16#51.35.8}

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.35.9** All entries in the patient record shall be signed and dated {#sec-16-51.35.9 omnilex-key=us-ms-regs-official--title-15--16#51.35.9}

Symbols and abbreviations shall be used only if they have been approved by the professional

staff, and only when there is an explanatory legend. Symbols and abbreviations shall not be used in the recording of diagnoses.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.35.10** When a patient dies, a summation statement shall be entered in the record in the form of a discharge summary {#sec-16-51.35.10 omnilex-key=us-ms-regs-official--title-15--16#51.35.10}

The summation statement shall include the circumstances leading to death and shall be signed by a physician. An autopsy shall be performed whenever possible. When an autopsy is performed, a provisional anatomic diagnosis shall be recorded in the patient's record within 72 hours. The complete protocol shall be made part of the record within three months.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13 Subchapter 36 PROMPTNESS OF RECORD COMPLETION Rule 51.36.1 Current records shall be completed promptly upon admission. Records of patients discharged shall be completed within 14 days following discharge. The staff regulations of the facility shall provide for the suspension or termination of staff privileges of physicians who are persistently delinquent in completing records.*
- *SOURCE: Miss. Code Ann. §43-11-13 Subchapter 37 IDENTIFICATION, FILING AND INDEXING Rule 51.37.1 A system of identification and filing to ensure the prompt location of a patient's medical record shall be maintained.*
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.37.2** Rule 51.37.2 {#sec-16-51.37.2 omnilex-key=us-ms-regs-official--title-15--16#51.37.2}

The patient index cards shall bear at least the full name of the patient, the address, the birth date, and the medical record number.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.37.3** Records shall be indexed according to disease and physician and shall be kept up to date {#sec-16-51.37.3 omnilex-key=us-ms-regs-official--title-15--16#51.37.3}

For indexing, any recognized system may be used.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.37.4** Indexing shall be current within six months following discharge of the patient {#sec-16-51.37.4 omnilex-key=us-ms-regs-official--title-15--16#51.37.4}

**History**
- *SOURCE: Miss. Code Ann. §43-11-13 Subchapter 38 FACILITY AND PROGRAM EVALUATION*

##### **15 Miss. Admin. Code Pt. 16, R. 51.38.1** Rule 51.38.1 {#sec-16-51.38.1 omnilex-key=us-ms-regs-official--title-15--16#51.38.1}

Program evaluation is a management tool primarily utilized by the facility's administration to assess and monitor, on a priority bases, a variety of facility, service, and programmatic activities.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.38.2** The facility shall have a written statement of goals and objectives {#sec-16-51.38.2 omnilex-key=us-ms-regs-official--title-15--16#51.38.2}

1. The goals and objectives shall result from a planning process. 2. The goals and objectives shall be related to the needs of the population served.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.38.3** Rule 51.38.3 {#sec-16-51.38.3 omnilex-key=us-ms-regs-official--title-15--16#51.38.3}

The written statement of the goals and objectives of the facility service and programmatic activities shall be provided to the governing body and facility administration and shall be made available to staff.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.38.4** The facility shall have a written plan for evaluating its progress in attaining its goals and objectives {#sec-16-51.38.4 omnilex-key=us-ms-regs-official--title-15--16#51.38.4}

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.38.5** Rule 51.38.5 {#sec-16-51.38.5 omnilex-key=us-ms-regs-official--title-15--16#51.38.5}

The written plan shall specify the information to be collected and the methods to be used in retrieving and analyzing this information.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.38.6** Rule 51.38.6 {#sec-16-51.38.6 omnilex-key=us-ms-regs-official--title-15--16#51.38.6}

The written plan shall specify methods for assessing the utilization of staff and other resources to meet facility goals and objectives.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.38.7** The written plan shall specify when evaluations shall be conducted {#sec-16-51.38.7 omnilex-key=us-ms-regs-official--title-15--16#51.38.7}

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.38.8** Rule 51.38.8 {#sec-16-51.38.8 omnilex-key=us-ms-regs-official--title-15--16#51.38.8}

The written plan shall specify the criteria to be used in assessing the facility's progress in attaining its goals and objectives.

**History**
- *SOURCE: Miss. Code Ann. §43-11-3*

##### **15 Miss. Admin. Code Pt. 16, R. 51.38.9** The written plan shall require an explanation of any failure to achieve facility goals and objectives {#sec-16-51.38.9 omnilex-key=us-ms-regs-official--title-15--16#51.38.9}

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.38.10** Rule 51.38.10 {#sec-16-51.38.10 omnilex-key=us-ms-regs-official--title-15--16#51.38.10}

There shall be documentation that the goals and objectives of facility, service, and programmatic activities shall be evaluated at least annually and revised as necessary.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.38.11** Rule 51.38.11 {#sec-16-51.38.11 omnilex-key=us-ms-regs-official--title-15--16#51.38.11}

There shall be documentation that the results of the evaluation shall be provided to the governing body and facility administration and shall be made available to staff.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.38.12** There shall be documentation that the findings of the evaluation have influenced facility and program planning {#sec-16-51.38.12 omnilex-key=us-ms-regs-official--title-15--16#51.38.12}

**History**
- *SOURCE: Miss. Code Ann. §43-11-13 Subchapter 39 FISCAL MANAGEMENT Rule 51.39.1 The facility shall annually prepare a formal, written budget of expected revenues and expenses.*
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.39.2** The budget shall categorize revenues for the facility by source {#sec-16-51.39.2 omnilex-key=us-ms-regs-official--title-15--16#51.39.2}

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.39.3** The budget shall categorize expenses by the types of services of programs provided {#sec-16-51.39.3 omnilex-key=us-ms-regs-official--title-15--16#51.39.3}

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.39.4** The budget shall be reviewed and approved by the governing body prior to the beginning of the fiscal year {#sec-16-51.39.4 omnilex-key=us-ms-regs-official--title-15--16#51.39.4}

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.39.5** Revisions made in the budget during the fiscal year shall be reviewed and approved by the governing body {#sec-16-51.39.5 omnilex-key=us-ms-regs-official--title-15--16#51.39.5}

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.39.6** The fiscal management system shall include a fee schedule {#sec-16-51.39.6 omnilex-key=us-ms-regs-official--title-15--16#51.39.6}

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.39.7** Rule 51.39.7 {#sec-16-51.39.7 omnilex-key=us-ms-regs-official--title-15--16#51.39.7}

The facility shall maintain current, written schedules of rate and charge policies that have been approved by the governing body.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.39.8** The fee schedule shall be accessible to personnel and to individuals served by the facility {#sec-16-51.39.8 omnilex-key=us-ms-regs-official--title-15--16#51.39.8}

**History**
- *SOURCE: Miss. Code Ann. §43-11-13 Subchapter 40 UTILIZATION REVIEW Rule 51.40.1 The facility shall demonstrate appropriate allocation of its resources by conducting a utilization review program. The program shall address underutilization, over- utilization, and inefficient scheduling of the facility's resources.*
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.40.2** The facility shall implement a written plan that describes the utilization review program and governs its operations {#sec-16-51.40.2 omnilex-key=us-ms-regs-official--title-15--16#51.40.2}

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.40.3** The written plan shall include at least the following: 1 {#sec-16-51.40.3 omnilex-key=us-ms-regs-official--title-15--16#51.40.3}

a delineation of the responsibilities and authority of those involved in utilization review activities, including members of the professional staff, the utilization review committees, the administration, and when applicable, any qualified outside organization contracted to perform review activities; 2. a conflict of interest policy applicable to everyone involved in utilization review activities; 3. a confidentiality policy applicable to all utilization review activities and to resultant findings and recommendations; 4. a description of the method(s) used to identify utilization-related problems; 5. the procedures for conducting concurrent review; and 6. a mechanism for initiating discharge planning.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.40.4** The written plan shall be approved by the professional staff, the administration, and the governing body {#sec-16-51.40.4 omnilex-key=us-ms-regs-official--title-15--16#51.40.4}

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.40.5** Rule 51.40.5 {#sec-16-51.40.5 omnilex-key=us-ms-regs-official--title-15--16#51.40.5}

The methods for identifying utilization-related problems shall include analysis of the appropriateness and clinical necessity of admission, continued stays, and supportive services; analysis of delays in the provision of supportive services; and

examination of the findings of related quality assurance activities and other current relevant documentation.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.40.6** Rule 51.40.6 {#sec-16-51.40.6 omnilex-key=us-ms-regs-official--title-15--16#51.40.6}

Such documentation may include, but is not limited to, profile analyses; the results of patient care evaluation studies, medication usage reviews, and infection control activities; and reimbursement agency utilization reports that are program/service- specific.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.40.7** Rule 51.40.7 {#sec-16-51.40.7 omnilex-key=us-ms-regs-official--title-15--16#51.40.7}

To identify problems and document the impact of corrective actions taken, retrospective monitoring of the facility's utilization of resources shall be ongoing.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.40.8** Rule 51.40.8 {#sec-16-51.40.8 omnilex-key=us-ms-regs-official--title-15--16#51.40.8}

The procedures for conducting concurrent review shall specify the time period following admission within which the review is to be initiated and the length-of- stay norms and percentiles to be used in assigning continued stay review dates.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.40.9** Sources of payment shall not be the sole basis for determining which patients are to be reviewed concurrently {#sec-16-51.40.9 omnilex-key=us-ms-regs-official--title-15--16#51.40.9}

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.40.10** Rule 51.40.10 {#sec-16-51.40.10 omnilex-key=us-ms-regs-official--title-15--16#51.40.10}

Written measurable criteria and length-of-stay norms that have been approved by the professional staff shall be utilized in performing concurrent review and shall be included in, or appended to, the facility's utilization review plan.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.40.11** Length-of-stay norms must be specific to diagnoses, problems, or procedures {#sec-16-51.40.11 omnilex-key=us-ms-regs-official--title-15--16#51.40.11}

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.40.12** Rule 51.40.12 {#sec-16-51.40.12 omnilex-key=us-ms-regs-official--title-15--16#51.40.12}

To facilitate discharge when care is no longer required, discharge planning shall be initiated as soon as the need for it can be determined.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.40.13** Rule 51.40.13 {#sec-16-51.40.13 omnilex-key=us-ms-regs-official--title-15--16#51.40.13}

Criteria for initiating discharge planning may be developed to identify those patients whose diagnoses, problems or psychosocial circumstances usually require discharge planning.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.40.14** Rule 51.40.14 {#sec-16-51.40.14 omnilex-key=us-ms-regs-official--title-15--16#51.40.14}

Discharge planning shall not be limited to placement in long term facilities, but shall also include provision for, or referral to, services that the patient may require to improve or maintain his or her mental health status.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.40.15** Rule 51.40.15 {#sec-16-51.40.15 omnilex-key=us-ms-regs-official--title-15--16#51.40.15}

The facility's utilization review program, including the written plan, criteria, and length-of-stay norms, shall be reviewed and evaluated at least annually and revised as necessary to reflect the findings of the program's activities.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.40.16** A record shall be maintained or reviews of, and revisions to, the utilization review program {#sec-16-51.40.16 omnilex-key=us-ms-regs-official--title-15--16#51.40.16}

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.40.17** Rule 51.40.17 {#sec-16-51.40.17 omnilex-key=us-ms-regs-official--title-15--16#51.40.17}

The findings of such reviews shall be reported to the appropriate committee of the professional staff and to the governing body.

2. The records to be kept on all applicants; 3. The statistical data to be kept on the intake process; and 4. The procedures to be followed when an applicant or a referral is found ineligible for admission.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13 Subchapter 41 INDIVIDUALIZED COMPREHENSIVE TREATMENT PLANNING INTAKES Rule 51.41.1 Written policies and procedures governing the intake process shall specify the following: 1. The information to be obtained on all applicants or referrals for admission;*
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.41.2** Criteria for determining the eligibility of children/adolescents for admission shall be clearly stated in writing {#sec-16-51.41.2 omnilex-key=us-ms-regs-official--title-15--16#51.41.2}

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.41.3** The intake procedure shall include an initial assessment of the child/adolescent {#sec-16-51.41.3 omnilex-key=us-ms-regs-official--title-15--16#51.41.3}

**History**
- *SOURCE: Miss. Code Ann. §43-11-13 Subchapter 42 INTAKE ASSESSMENT*

##### **15 Miss. Admin. Code Pt. 16, R. 51.42.1** The intake assessment shall be done by a member of the professional staff {#sec-16-51.42.1 omnilex-key=us-ms-regs-official--title-15--16#51.42.1}

The results of the intake assessment shall be clearly explained to the patient (when appropriate) and to the patient's parents, legal guardian, or other authorized representative.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13:*

##### **15 Miss. Admin. Code Pt. 16, R. 51.42.2** Rule 51.42.2 {#sec-16-51.42.2 omnilex-key=us-ms-regs-official--title-15--16#51.42.2}

Acceptance of a child/adolescent for treatment shall be based on an intake procedure that meets the following conclusions: 1. The treatment required by the patient is appropriate to the intensity and restrictions of care provided by the facility or program component; and/or 2. The treatment required can be appropriately provided by the facility or program component; and 3. The alternatives for less intensive and restrictive treatment are not available.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.42.3** Rule 51.42.3 {#sec-16-51.42.3 omnilex-key=us-ms-regs-official--title-15--16#51.42.3}

During the intake process, every effort shall be made to assure that the child/adolescent and the parents, legal guardian, or other authorized adult understand the following: 1. The nature and goals of the treatment program; 2. The treatment costs to be borne by the family, if any; and 3. The rights and responsibilities of patients, including the rules governing patient conduct and the types of infractions that can result in disciplinary action or discharge from the facility or program component.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.42.4** Facilities shall have policies and procedures that adequately address the following items for each patient: 1 {#sec-16-51.42.4 omnilex-key=us-ms-regs-official--title-15--16#51.42.4}

Responsibility for medical and dental care, including consents for medical or surgical care and treatment; 2. When appropriate, arrangements for family participation in the treatment program; 3. Arrangements for clothing, allowances, and gifts; 4. Arrangements regarding the patient's departure from the facility or program; and 5. Arrangements regarding the patient's departure from the facility or program against clinical advice.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.42.5** Rule 51.42.5 {#sec-16-51.42.5 omnilex-key=us-ms-regs-official--title-15--16#51.42.5}

When a patient is admitted on court order, the rights and responsibilities of the patient and the patient's family shall be explained to them.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.42.6** Rule 51.42.6 {#sec-16-51.42.6 omnilex-key=us-ms-regs-official--title-15--16#51.42.6}

This explanation of the rights and responsibilities of the patient and the patient's family shall be documented in the patient's record.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.42.7** Sufficient information shall be collected during the intake process to develop a preliminary treatment plan {#sec-16-51.42.7 omnilex-key=us-ms-regs-official--title-15--16#51.42.7}

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.42.8** Rule 51.42.8 {#sec-16-51.42.8 omnilex-key=us-ms-regs-official--title-15--16#51.42.8}

Staff members who will be working with the patient but who did not participate in the initial assessment shall be informed about the patient prior to meeting him or her.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13 Subchapter 43 ASSESSMENTS Rule 51.43.1 Within 7 days of admission, the staff shall conduct a complete assessment of each patient's needs. The assessment shall include, but shall not necessarily be limited to physical, emotional, behavioral, social, recreational, nutritional, and when appropriate, legal and vocational.*
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.43.2** Rule 51.43.2 {#sec-16-51.43.2 omnilex-key=us-ms-regs-official--title-15--16#51.43.2}

A licensed physician or either a psychiatric mental health nurse practitioner shall be responsible for assessing each patient's physical health. The health assessment shall include a medical history; a physical examination; and neurological examination when indicated and a laboratory workup. The physical examination shall be completed within 24 hours after admission.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.43.3** Rule 51.43.3 {#sec-16-51.43.3 omnilex-key=us-ms-regs-official--title-15--16#51.43.3}

In facilities serving children and adolescents, each patient's physical health assessment shall also include evaluations of the following: motor development and functioning; sensorimotor functioning; speech, hearing, and language functioning, visual functioning; and immunization status. Facilities serving children and adolescents shall have access to all necessary diagnostic tools and personnel available to perform physical health assessments.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.43.4** A registered nurse shall be responsible for obtaining a nursing history and assessment at the time of admission {#sec-16-51.43.4 omnilex-key=us-ms-regs-official--title-15--16#51.43.4}

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.43.5** A psychiatric evaluation of each patient shall be completed and entered into the patient's record {#sec-16-51.43.5 omnilex-key=us-ms-regs-official--title-15--16#51.43.5}

The evaluation shall include, but not be limited to, the following items: 1. A history of previous emotional, behavioral, and psychiatric problems and treatment; 2. The patient's current emotional and behavioral functioning; 3. When indicated, psychological assessments, including intellectual and personality testing.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.43.6** Rule 51.43.6 {#sec-16-51.43.6 omnilex-key=us-ms-regs-official--title-15--16#51.43.6}

When the admitting psychiatrist is not a qualified child psychiatrist, the psychiatric evaluation shall be reviewed by a qualified child psychiatrist who shall also directly evaluate the child/adolescent within seven days of admission to the psychiatric residential treatment facility.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.43.7** Rule 51.43.7 {#sec-16-51.43.7 omnilex-key=us-ms-regs-official--title-15--16#51.43.7}

A social assessment of each patient shall be completed by the qualified social worker and entered in the patient's record. The assessment shall include information relating to the following areas, as necessary: 1. Environment and home 2. Religion 3. Childhood developmental history 4. Financial status 5. The social, peer-group, and environmental setting from which the patient comes; 6. The patient's family circumstances, including the constellation of the family group, the current living situation, and social, ethnic, cultural, emotional, and health factors.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.43.8** Rule 51.43.8 {#sec-16-51.43.8 omnilex-key=us-ms-regs-official--title-15--16#51.43.8}

An educational assessment of each patient shall be completed by a qualified special education teacher and entered into the patient's record. The assessment shall include, but not be limited, to the following information:

1. Previous school history with regard to academic, social, and behavioral skills and deficits as well as school disciplinary actions; and 2. Psychometric measures as appropriate for the child/adolescent.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.43.9** Rule 51.43.9 {#sec-16-51.43.9 omnilex-key=us-ms-regs-official--title-15--16#51.43.9}

A recreational assessment of each patient shall be completed by the qualified recreational therapist and shall include information relating to the individual's current skills, talents, aptitudes, and interests.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.43.10** Rule 51.43.10 {#sec-16-51.43.10 omnilex-key=us-ms-regs-official--title-15--16#51.43.10}

A nutritional assessment shall be conducted by the food service supervisor or registered dietitian and shall be documented in the patient's record.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.43.11** Rule 51.43.11 {#sec-16-51.43.11 omnilex-key=us-ms-regs-official--title-15--16#51.43.11}

When appropriate, a vocational assessment of the patient shall be undertaken and shall include, but not be limited to, the following areas: 1. Vocational history; 2. Educational history, including academic and vocational training, and 3. A preliminary discussion between the individual and the staff member doing the assessment concerning the individual's past experiences with, and attitudes toward work, present motivations or areas of interest, and possibilities for future education, training, and employment.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.43.12** Rule 51.43.12 {#sec-16-51.43.12 omnilex-key=us-ms-regs-official--title-15--16#51.43.12}

When appropriate, a legal assessment of the patient shall be undertaken and shall include, but not be limited to, the following areas: 1. A legal history; and 2. A preliminary discussion to determine the extent to which the individual's legal situation will influence his or her progress in treatment and the urgency of the legal situation.

Rule 51.44.2. Overall development and implementation of the treatment plan shall be assigned to an appropriate member of the professional staff.

2. A brief description or the patient's problems, strengths, conditions, disabilities, or needs; 3. Objectives relating to the patient's problems, conditions, disabilities and needs, and the treatments, therapies, and staff actions which will be implemented to accomplish these objectives; and

2. A brief description of the patient's problems, strengths, conditions, disabilities, functional deficits or needs; 3. A brief description of the treatment and treatment planning which demonstrates that the program is addressing the functional deficits of the patient which substantiated the patient's eligibility for admission to the psychiatric residential treatment facility; 4. Goals to address the patient's problems, conditions, disabilities, and needs which indicate the expected duration of the patient's need for services in the psychiatric residential treatment facility;

5. Objectives relating to the patient's goals. Objectives must be written to reflect the expected progress of the patient. Interventions for accomplishing these objectives should be specific; 6. Specific treatments, therapies and staff interventions which will be implemented to accomplish each of the objectives and goals. These must be stated clearly to enable all staff members participating in the treatment program to implement the goals and objectives; 7. If the facility utilizes a case management system, the name of the clinical staff member, designated as case coordinator, exercising primary responsibility for the patient; 8. Identification of the staff members who will provide the specified services, experiences and therapies; 9. Documentation of participation by the patient in the development of the treatment plan whenever possible and by the patient's parent or guardian and/or authorized adult, and by representatives of the patient's school district, where appropriate; 10. Date for the next scheduled review of the treatment plan; 11. Documentation that information obtained from the patient's school district of origin, when available, was considered in developing or revising the comprehensive treatment plan; and 12. A copy of an individual's education plan.

1. Documentation of implementation of the treatment plan; 2. Documentation of all treatment rendered to the patient; 3. Documentation of all progress in the patient's education program as determined in the patient's individual education plan; 4. Description of changes in the patient's condition; and 5. Descriptions of the response of the patient to treatment, the outcome of treatment, and the response of significant others to important inter-current events. Rule 51.45.3 Progress notes shall be dated and signed by the individual making the entry.

Subchapter 46 TREATMENT PLAN REVIEW Rule 51.46.1 Interdisciplinary case conferences shall be regularly conducted to review and evaluate each patient's treatment plan and his or her progress in attaining the stated treatment goals and objectives.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13 Subchapter 44 TREATMENT PLANS Rule 51.44.1. Each patient shall have a written individual treatment plan that is based on assessments of his or her clinical needs.*
- *SOURCE: Miss. Code Ann. §43-11-13*
- *SOURCE: Miss. Code Ann. §43-11-13 Rule 51.44.3. The master treatment plan shall be developed within fourteen days of admission.*
- *SOURCE: Miss. Code Ann. §43-11-13 Rule 51.44.4. Appropriate therapeutic efforts may begin before a fully developed treatment plan is finalized.*
- *SOURCE: Miss. Code Ann. §43-11-13 Rule 51.44.5. An initial interdisciplinary treatment plan shall be completed for each patient within 24 hours of admission to a psychiatric residential treatment facility. The initial treatment plan shall include: 1. Admission diagnosis or diagnostic impression;*
- *SOURCE: Miss. Code Ann. §43-11-13 Rule 51.44.6. If the patient's stay in a facility exceeds ten days the interdisciplinary team shall develop a comprehensive treatment plan within fourteen days of admission which shall be reviewed at least monthly for the first six months, and at least every ninety days thereafter. The comprehensive treatment plan shall include: 1. Diagnosis;*
- *SOURCE: Miss. Code Ann. §43-11-13 Rule 51.44.7. When appropriate, the patient and the patient's parents, legal guardian, or authorized adult shall participate in the development of his or her treatment plan, and such participation shall be documented in the patient's record.*
- *SOURCE: Miss. Code Ann. §43-11-13 Subchapter 45 PROGRESS NOTES Rule 51.45.1. Progress notes shall be recorded by the physician, psychiatric mental health nurse practitioners, nurse, social worker and, when appropriate, others significantly involved in treatment. The frequency of progress notes is determined by the condition of the patient but should be recorded at least monthly.*
- *SOURCE: Miss. Code Ann. §43-11-13 Rule 51.45.2. Progress notes shall be entered in the patient's record and shall include the following:*
- *SOURCE: Miss. Code Ann. §43-11-13 Rules 51.45.4 All entries involving subjective interpretation of the patient's progress should be supplemented with a description of the actual behavior observed.*
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.46.2** Rule 51.46.2 {#sec-16-51.46.2 omnilex-key=us-ms-regs-official--title-15--16#51.46.2}

Interdisciplinary case conferences shall be documented and the results of the review and evaluation shall be recorded in the patient's record. The review and update shall be completed no later than thirty (30) days following the first 14 days of treatment and at least monthly for the first six months and at least every 90 days thereafter.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13 Subchapter 47 DISCHARGE PLANNING/AFTERCARE Rule 51.47.1 The facility maintains a centralized coordinated program to ensure that each patient has a planned program of continuing care which meets his post-discharge needs.*
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.47.2** Each patient shall have an individualized discharge plan which reflects input from all disciplines involved in his care {#sec-16-51.47.2 omnilex-key=us-ms-regs-official--title-15--16#51.47.2}

The patient, patient's family, and/or significant others shall be involved in the discharge planning process.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.47.3** An initial discharge plan shall be developed within 14 days of admission {#sec-16-51.47.3 omnilex-key=us-ms-regs-official--title-15--16#51.47.3}

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.47.4** The facility shall maintain written discharge planning policies and procedures which describe: 1 {#sec-16-51.47.4 omnilex-key=us-ms-regs-official--title-15--16#51.47.4}

How the discharge coordinator will function, and his authority and relationships with the facility's staff; 2. The time period in which each patient's need for discharge planning is determined (within fourteen days of admission); 3. The maximum time period after which re-evaluation of each patient's discharge plan is made; 4. Local resources available to the facility and the patient to assist in developing and implementing individual discharge plan; and 5. Provisions for periodic review and re-evaluation of the facility's discharge planning program (at least annually).

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.47.5** An interdisciplinary case conference shall be held prior to the patient's discharge {#sec-16-51.47.5 omnilex-key=us-ms-regs-official--title-15--16#51.47.5}

Representatives from aftercare agencies including the anticipated school system will be encouraged to attend. The discharge/aftercare plan must be approved by a qualified child psychiatrist and shall be reviewed with the patient, patient's family and/or significant others.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.47.6** Rule 51.47.6 {#sec-16-51.47.6 omnilex-key=us-ms-regs-official--title-15--16#51.47.6}

The facility shall have documentation that the aftercare plan has been implemented and shall have documentation of follow-ups to assure referrals to appropriate community agencies.

2. Brief summary of treatment; 3. Reason for discharge;

4. Assessment of treatment plan goals and objectives; and 5. Recommendations and arrangements for further treatment, including prescribed medications and aftercare.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13 Subchapter 48 DISCHARGE SUMMARY Rule 51.48.1 A discharge summary shall be entered in the patient's record within fourteen (14) days following discharge. The discharge summary shall include but not be limited to: 1. Reason for admission;*
- *SOURCE: Miss. Code Ann. §43-11-13 Subchapter 49 SUPPORT SERVICES: PHARMACY Rule 51.49.1 Direction and Supervision. A Facility must provide pharmaceutical services (including procedures that assure the accurate acquiring, receiving, dispensing, and administering of all drugs and biological) to meet the needs of each patient.*
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.49.2** Rule 51.49.2 {#sec-16-51.49.2 omnilex-key=us-ms-regs-official--title-15--16#51.49.2}

The facility must provide routine and emergency drugs and biological to its residents, or obtain them under an agreement part.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.49.3** The facility must employ or obtain the services of a licensed pharmacist who: 1 {#sec-16-51.49.3 omnilex-key=us-ms-regs-official--title-15--16#51.49.3}

Provides consultation on all aspects of the provision of pharmacy services in the facility; 2. Establishes a system of records of receipt and disposition of all controlled drugs in sufficient detail to enable an accurate reconciliation; 3. Determines that drug records are in order and that an account of all controlled drugs is maintained and periodically reconciled; and 4. The pharmacist must submit a written report at least monthly to the CEO of the status of the performance of nursing personnel and any discrepancies noted in record keeping.

Subchapter 51 LABELING Rule 51.51.1 The facility must label drugs and biological in accordance with currently accepted professional principles, and include the appropriate accessory and cautionary instructions, and the expiration date.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13 Subchapter 50 CONTROL OF TOXIC OR DANGEROUS DRUGS Rule 51.50.1 Policies shall be established to control the administration of toxic or dangerous drugs with specific reference to the duration of the order and the dosage. The facility shall establish a written policy that all toxic or dangerous medications, not specifically prescribed as to time or number of doses, shall be automatically stopped after a reasonable time limit. The classification ordinarily thought of a toxic, dangerous or abuse drugs shall be narcotics, sedatives, anti-coagulants, antibiotics, oxytocics and cortisone products, and shall include other categories so established by federal, state or local laws.*
- *SOURCE: Miss. Code Ann. §43-11-13*
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.51.2** Rule 51.51.2 {#sec-16-51.51.2 omnilex-key=us-ms-regs-official--title-15--16#51.51.2}

The facility shall have written policies and procedures designed to ensure that all medications are dispensed and administered safely and properly in accordance with the applicable federal, state, and local laws and regulations.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.51.3** An up-to-date list of authorized prescribers shall be available in all areas where medication is dispensed {#sec-16-51.51.3 omnilex-key=us-ms-regs-official--title-15--16#51.51.3}

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.51.4** Telephone orders shall be accepted only from individuals on the list of authorized prescribers {#sec-16-51.51.4 omnilex-key=us-ms-regs-official--title-15--16#51.51.4}

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.51.5** Rule 51.51.5 {#sec-16-51.51.5 omnilex-key=us-ms-regs-official--title-15--16#51.51.5}

Telephone orders shall be limited to situations that have been defined in writing in the facility's policies and procedures manual.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.51.6** Telephone orders shall be accepted and written in the patient's record only by staff authorized to administer medication {#sec-16-51.51.6 omnilex-key=us-ms-regs-official--title-15--16#51.51.6}

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.51.7** Rule 51.51.7 {#sec-16-51.51.7 omnilex-key=us-ms-regs-official--title-15--16#51.51.7}

Telephone orders shall be signed by an authorized prescriber on the next regular working day, but in all events within 72 hours.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.51.8** A written order signed by the authorized prescriber shall be included in patient's record {#sec-16-51.51.8 omnilex-key=us-ms-regs-official--title-15--16#51.51.8}

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.51.9** Rule 51.51.9 {#sec-16-51.51.9 omnilex-key=us-ms-regs-official--title-15--16#51.51.9}

Medication orders that contain abbreviations and chemical symbols shall be carried out only if the abbreviations and symbols are on a standard list approved by the physician members of the professional staff.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.51.10** There shall be automatic stop orders on specified medications {#sec-16-51.51.10 omnilex-key=us-ms-regs-official--title-15--16#51.51.10}

Refer to 301.5.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.51.11** There shall be a specific routine of drug administration, indicating dose schedules and standardization of abbreviations {#sec-16-51.51.11 omnilex-key=us-ms-regs-official--title-15--16#51.51.11}

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.51.12** Rule 51.51.12 {#sec-16-51.51.12 omnilex-key=us-ms-regs-official--title-15--16#51.51.12}

Only pharmacists, physicians, psychiatric mental health nurse practitioners, registered nurses, or licensed practical nurses shall administer medications.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.51.13** Self administration of medication shall be permitted only when specifically ordered by the responsible physician {#sec-16-51.51.13 omnilex-key=us-ms-regs-official--title-15--16#51.51.13}

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.51.14** Rule 51.51.14 {#sec-16-51.51.14 omnilex-key=us-ms-regs-official--title-15--16#51.51.14}

Drugs brought into the facility by patients shall not be administered unless they can be absolutely identified, and unless written orders to administer these specific drugs are given by the responsible physician. If the drugs that the patient brings to the facility are not to be used, they shall be packaged, sealed, and stored, and, if approved by the responsible physician, they shall be returned to the patient, family, or significant others at the time of discharge.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.51.15** Rule 51.51.15 {#sec-16-51.51.15 omnilex-key=us-ms-regs-official--title-15--16#51.51.15}

The patient and, when appropriate, the family shall be instructed about which medications, if any, are to be administered at home.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.51.16** Medications administered, medication errors and adverse drug reactions shall be documented in the patient's record {#sec-16-51.51.16 omnilex-key=us-ms-regs-official--title-15--16#51.51.16}

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.51.17** Rule 51.51.17 {#sec-16-51.51.17 omnilex-key=us-ms-regs-official--title-15--16#51.51.17}

Facilities should implement a reporting system under which the reporting program of the federal Food and Drug Administration and the drug manufacturer are advised of unexpected adverse drug reactions.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.51.18** There shall be methods of detecting drug side effects or toxic reactions {#sec-16-51.51.18 omnilex-key=us-ms-regs-official--title-15--16#51.51.18}

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.51.19** Rule 51.51.19 {#sec-16-51.51.19 omnilex-key=us-ms-regs-official--title-15--16#51.51.19}

Investigational drugs shall be used only under the direct supervision of the principal investigator and with the approval of research review committee and either the physician members of the professional staff or an appropriate committee of the professional staff.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13 Subchapter 52 SPACE FOR STORAGE OF DRUGS Rule 51.52.1 Adequate space shall be provided in the on premises Pharmacy for storage of drugs and for keeping of necessary records. The pharmacy shall be capable of being securely locked in accordance with regulations regarding storage of dangerous drugs. Adequate space is defined on a minimum of 350 square feet for 50 beds or less; 500 sq. ft. for 75 beds or less; 750 sq. ft. for 100 beds or less, and 1000 sq. ft. for 100 beds or more.*
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.52.2** Rule 51.52.2 {#sec-16-51.52.2 omnilex-key=us-ms-regs-official--title-15--16#51.52.2}

If there is no full-time pharmacists employed by the facility and if medications administered to patients are dispensed by pharmacist(s) elsewhere...then only the storage of pre-dispensed, individual medications (either medication containers or unit-dose medications) shall be allowed in the facility. The exception is for the allowance of Emergency Medications.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.52.3** Rule 51.52.3 {#sec-16-51.52.3 omnilex-key=us-ms-regs-official--title-15--16#51.52.3}

Storage of Medications, as outlined directly above, in the facility shall be in an area to measure not less than 100 square feet of space. This storage area is to be designated as the Medication Preparation Area/Room, and is to have the following personality: 1. Medication Refrigerator (for storage of drugs and biological); 2. Hand washing lavatory with hot water capability, and paper towel dispenser; 3. Medication Preparation Area/Room to have self-closing self-locking door(s); 4. The air temperature in the Medication Preparation Area/Room is not to exceed 85 degrees Fahrenheit or fall below 50 degrees Fahrenheit; 5. Medication Preparation Area/Room to have counter-top space provided for medication preparation; and 6. The facility must provide separately locked, permanently affixed compartments for storage of controlled drugs listed in Schedule II of the Comprehensive Drug Abuse Prevention and Control Act of 1970 and other drugs subject to abuse, except when the facility uses single unit package drug distribution systems in which the quantity stored is minimal and a missing dose can be readily detected.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.52.4** All medication orders shall be reviewed monthly by the responsible physician {#sec-16-51.52.4 omnilex-key=us-ms-regs-official--title-15--16#51.52.4}

Adverse drug reactions and medication errors shall be reported to the physician responsible for the patient, and shall be documented in the patient's record.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.52.5** Rule 51.52.5 {#sec-16-51.52.5 omnilex-key=us-ms-regs-official--title-15--16#51.52.5}

The pharmacist in charge of dispensing medications shall provide for monthly inspection of all storage units including emergency boxes and emergency carts.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.52.6** A record of these inspections shall be maintained in order to verify the following: 1 {#sec-16-51.52.6 omnilex-key=us-ms-regs-official--title-15--16#51.52.6}

Disinfectants and drugs for external use are stored separately from internal and injectable medications. 2. Drugs requiring special conditions for storage to ensure stability are properly stored.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.52.7** Rule 51.52.7 {#sec-16-51.52.7 omnilex-key=us-ms-regs-official--title-15--16#51.52.7}

Adequate precautions shall be taken to store medications under proper conditions of sanitation, temperature, light, moisture, ventilation, segregation, and security.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.52.8** All drugs shall be kept in locked storage {#sec-16-51.52.8 omnilex-key=us-ms-regs-official--title-15--16#51.52.8}

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.52.9** Rule 51.52.9 {#sec-16-51.52.9 omnilex-key=us-ms-regs-official--title-15--16#51.52.9}

A central unit shall be established where essential information on investigational drugs, such as dosage form, dosage range, storage requirements, adverse reactions, usage, and contraindications, is maintained.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.52.10** Investigational drugs shall be properly labeled {#sec-16-51.52.10 omnilex-key=us-ms-regs-official--title-15--16#51.52.10}

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.52.11** Nurses may administer investigational drugs only after receiving basic pharmacologic information about the drugs {#sec-16-51.52.11 omnilex-key=us-ms-regs-official--title-15--16#51.52.11}

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.52.12** The facility shall have specific methods for controlling and accounting for drug products {#sec-16-51.52.12 omnilex-key=us-ms-regs-official--title-15--16#51.52.12}

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.52.13** Rule 51.52.13 {#sec-16-51.52.13 omnilex-key=us-ms-regs-official--title-15--16#51.52.13}

The pharmacy service shall maintain records of its transactions as required by law and as necessary to maintain adequate control of, and accountability for, all drugs. These records shall document all supplies issued to units, departments, or services of the facility, as well as prescription drugs dispensed.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.52.14** Rule 51.52.14 {#sec-16-51.52.14 omnilex-key=us-ms-regs-official--title-15--16#51.52.14}

Records and inventories of the drugs listed in the current Comprehensive Drug Abuse Prevention and Control Act shall be maintained as required by the act and regulations.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.52.15** Rule 51.52.15 {#sec-16-51.52.15 omnilex-key=us-ms-regs-official--title-15--16#51.52.15}

Distribution and administration of controlled drugs are adequately documented, and inspection of these records by the pharmacist is documented.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.52.16** There is an emergency kit that is: 1 {#sec-16-51.52.16 omnilex-key=us-ms-regs-official--title-15--16#51.52.16}

Made up under the supervision of responsibility of the pharmacist, and approved by the Clinical Director; 2. Readily available to staff yet not accessible to patients; 3. Constituted so as to be appropriate to the needs of the patients; and 4. Inspected monthly to remove deteriorated and outdated drugs and to ensure completeness of content.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.52.17** Rule 51.52.17 {#sec-16-51.52.17 omnilex-key=us-ms-regs-official--title-15--16#51.52.17}

The pharmacist responsible for the emergency kit shall provide a list of its contents and appropriate instructions, and shall authenticate this list with his signature.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.52.18** Poisons, external drugs, and internal drugs shall be stored on separate shelves or in separate cabinets {#sec-16-51.52.18 omnilex-key=us-ms-regs-official--title-15--16#51.52.18}

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.52.19** Rule 51.52.19 {#sec-16-51.52.19 omnilex-key=us-ms-regs-official--title-15--16#51.52.19}

Medications that are stored in a refrigerator containing items other than drugs shall be kept in a separate compartment or container with proper security.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.52.20** Rule 51.52.20 {#sec-16-51.52.20 omnilex-key=us-ms-regs-official--title-15--16#51.52.20}

Antidote charts and the telephone number of the Regional Poison Control Center shall be kept in all drug storage and preparation areas.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.52.21** Rule 51.52.21 {#sec-16-51.52.21 omnilex-key=us-ms-regs-official--title-15--16#51.52.21}

Up-to-date pharmaceutical reference material shall be provided so that appropriate staff will have adequate information concerning drugs.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.52.22** Rule 51.52.22 {#sec-16-51.52.22 omnilex-key=us-ms-regs-official--title-15--16#51.52.22}

Current editions of text and reference books covering the following topics shall be provided; theoretical and practical pharmacy; general, organic, pharmaceutical, and biological chemistry; toxicology; pharmacology; bacteriology; sterilization and disinfection; and other subjects important to good patient care.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13 Subchapter 53 DIETARY ORGANIZATION Rule 51.53.1 The facility shall have an organized dietary department directed by a qualified food service supervisor, with services of a registered dietitian on at least a consultant basis. However, a facility which has a contract with an outside food management company may be found to meet this requirement if the company has a therapeutic dietitian who serves, as required by scope and complexity of the services, on a full-time, part-time, or consultant basis to the facility. If the dietitian is not employed full-time, a certified food service supervisor should direct the dietary department.*
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.53.2** The qualified dietitian shall be registered or eligible for registration by the Commission on Dietetic Registration {#sec-16-51.53.2 omnilex-key=us-ms-regs-official--title-15--16#51.53.2}

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.53.3** Rule 51.53.3 {#sec-16-51.53.3 omnilex-key=us-ms-regs-official--title-15--16#51.53.3}

When a qualified dietitian is employed on a part-time or consultative basis, the dietitian shall devote enough time to accomplish the following tasks: 1. Assure continuity of services; 2. Direct the nutritional aspects of patient care; 3. Assure that dietetic instructions are carried out; and 4. On occasion, supervise the serving of meals; and assist in the evaluation of the dietetic services.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.53.4** Rule 51.53.4 {#sec-16-51.53.4 omnilex-key=us-ms-regs-official--title-15--16#51.53.4}

Regular written reports shall be submitted to the chief executive officer on the extent of services provided by the dietitian.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.53.5** Rule 51.53.5 {#sec-16-51.53.5 omnilex-key=us-ms-regs-official--title-15--16#51.53.5}

There shall be written policies and procedures for food storage, preparation, and service developed by a registered dietitian.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.53.6** Rule 51.53.6 {#sec-16-51.53.6 omnilex-key=us-ms-regs-official--title-15--16#51.53.6}

The dietetic service shall have an adequate number of appropriately qualified individuals to meet the dietetic needs of the facility's patients. Dietetic service personnel shall assist patients when necessary in making appropriate food choices from the planned daily menu. Dietetic services personnel shall be made aware that emotional factors may cause patients to change their food habits. Dietetic service personnel shall inform appropriate members of the professional staff of any change in a patient's food habits.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.53.7** Written job descriptions of all dietary employees shall be available {#sec-16-51.53.7 omnilex-key=us-ms-regs-official--title-15--16#51.53.7}

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.53.8** There shall be procedures to control dietary employees with infectious and open lesions {#sec-16-51.53.8 omnilex-key=us-ms-regs-official--title-15--16#51.53.8}

Routine health examinations shall meet local and state codes for food service personnel.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.53.9** Rule 51.53.9 {#sec-16-51.53.9 omnilex-key=us-ms-regs-official--title-15--16#51.53.9}

There shall be an on-going planned in-service training program for dietary employees which includes the proper handling of food and personal grooming, safety, sanitation, behavioral and therapeutic needs of patients.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13 Subchapter 54 FACILITIES Rule 51.54.1 Adequate space, equipment, ventilation and supplies as well as any necessary written procedure and precautions, shall be provided for the safe and sanitary operation of the dietetic service and the safe and sanitary handling and distribution of food.*
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.54.2** The food service area should be appropriately located {#sec-16-51.54.2 omnilex-key=us-ms-regs-official--title-15--16#51.54.2}

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.54.3** The dietitian's office should be easily accessible to all who require consultation services {#sec-16-51.54.3 omnilex-key=us-ms-regs-official--title-15--16#51.54.3}

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.54.4** Sufficient space shall be provided for support personnel to perform their duties {#sec-16-51.54.4 omnilex-key=us-ms-regs-official--title-15--16#51.54.4}

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.54.5** Rule 51.54.5 {#sec-16-51.54.5 omnilex-key=us-ms-regs-official--title-15--16#51.54.5}

The layout of the department and the type, amount, size, and placement of equipment shall make possible the efficient and sanitary preparation and distribution of food.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.54.6** Rule 51.54.6 {#sec-16-51.54.6 omnilex-key=us-ms-regs-official--title-15--16#51.54.6}

Lavatories with wrist action blades, soap dispenser and disposable towel dispenser shall be located throughout the dietary department.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.54.7** Rule 51.54.7 {#sec-16-51.54.7 omnilex-key=us-ms-regs-official--title-15--16#51.54.7}

Dry or staple food items shall be stored in a ventilation room which is not subject to sewage or waste water backflow, or contamination by condensation, leakage, rodents or vermin.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.54.8** All perishable foods shall be refrigerated at the appropriate temperature and in an orderly and sanitary manner {#sec-16-51.54.8 omnilex-key=us-ms-regs-official--title-15--16#51.54.8}

Each refrigerator shall contain a thermometer in good working order.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.54.9** Foods being displayed or transported shall be protected from contamination {#sec-16-51.54.9 omnilex-key=us-ms-regs-official--title-15--16#51.54.9}

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.54.10** Rule 51.54.10 {#sec-16-51.54.10 omnilex-key=us-ms-regs-official--title-15--16#51.54.10}

Dishwashing procedures and techniques shall be developed and carried out in compliance with the state and local health codes.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.54.11** Rule 51.54.11 {#sec-16-51.54.11 omnilex-key=us-ms-regs-official--title-15--16#51.54.11}

All garbage and kitchen refuse which is not disposed of mechanically shall be kept in leak-proof non-absorbent containers with close fitting covers and be disposed of routinely in a manner that will not permit transmission of disease, a nuisance, or a breeding place for flies.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.54.12** All garbage containers are to be thoroughly cleaned inside and outside each time emptied {#sec-16-51.54.12 omnilex-key=us-ms-regs-official--title-15--16#51.54.12}

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.54.13** Rule 51.54.13 {#sec-16-51.54.13 omnilex-key=us-ms-regs-official--title-15--16#51.54.13}

All dietary areas, equipment, walls, floors, etc., shall be kept maintained in good working condition and sanitary at all times.

2. Revisions to the diet manual shall be approved by the facility's physician; 3. The diet manual should be used to standardize the ordering of diets; 4. The policies and procedures shall provide for dietetic counseling; 5. The nutritional deficiencies of any diet in the manual shall be indicated; 6. The policies and procedures shall require the recording of dietetic orders in the patient's record; 7. The policies and procedures shall require the recording of all observations and information pertinent to dietetic treatment in the patient's record by the food service supervisor or dietitian; 8. The policies and procedures shall require the use of standards for nutritional care in evaluating the nutritional adequacy of the patient's diet and in ordering diet supplements. The current Recommended Dietary Allowances of the Food and Nutrition Board of the National Research Council of the National Academy of Sciences is suggested as a guide in developing these standards; 9. The policies and procedures shall describe the methods for assuring that each patient on a special diet received the prescribed diet regimen; 10. The policies and procedures shall provide for altering diets or diet schedules as well as for discontinuing diets;

11. Dietetic service personnel shall conduct periodic food acceptance studies among the patients and should encourage them to participate in menu planning; 12. The results of food acceptance studies should be reflected in revised menus; and 13. All menus shall be approved by a qualified dietitian.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13 Subchapter 55 DIETS Rule 51.55.1 There shall be a systematic record of diets, correlated when appropriate, with the medical records. The dietitian shall have available an up-to-date manual of regimens for all therapeutic diets, approved jointly by the dietitian and medical staff, which is available to dietary supervisory personnel. Diets served to patients shall be in compliance with these established diet principles: 1. The diet manual shall be reviewed annually and revised as necessary by a qualified dietitian, and shall be dated to identify the time of the review;*
- *SOURCE: Miss. Code Ann. §43-11-13 Subchapter 56 FOOD SERVICE AND DINING Rule 51.56.1 Food shall be served in an appetizing and attractive manner, at planned and realistic mealtimes, and in a congenial and relaxed atmosphere.*
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.56.2** Dining areas should be attractive and maintained at appropriate temperatures {#sec-16-51.56.2 omnilex-key=us-ms-regs-official--title-15--16#51.56.2}

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.56.3** Rule 51.56.3 {#sec-16-51.56.3 omnilex-key=us-ms-regs-official--title-15--16#51.56.3}

The dietetic services shall be patient-oriented and should take into account the many factors that contribute to the wide variations in patient eating habits, including cultural, religious, and ethnic factors.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.56.4** Snacks shall be available as appropriate to the nutritional needs of the patient and the needs of the facility {#sec-16-51.56.4 omnilex-key=us-ms-regs-official--title-15--16#51.56.4}

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.56.5** The dietetic service shall be prepared to give extra food to individual patients {#sec-16-51.56.5 omnilex-key=us-ms-regs-official--title-15--16#51.56.5}

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.56.6** Appropriate food should be available for patients with special or limited dietary needs {#sec-16-51.56.6 omnilex-key=us-ms-regs-official--title-15--16#51.56.6}

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.56.7** There shall be adequate equipment provided for tray assembly and tray delivery {#sec-16-51.56.7 omnilex-key=us-ms-regs-official--title-15--16#51.56.7}

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.56.8** Facilities or arrangements shall be available for family and friends to eat with patients when possible {#sec-16-51.56.8 omnilex-key=us-ms-regs-official--title-15--16#51.56.8}

Subchapter 57 RECREATION Rule 51.57.1 The facility shall provide or make arrangements for the provision of recreation services to all patients in accordance with their needs and interests and as appropriate within the scope of the facility's program.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.57.2** Rule 51.57.2 {#sec-16-51.57.2 omnilex-key=us-ms-regs-official--title-15--16#51.57.2}

The facility shall have a written plan that describes the organization of their recreation services or the arrangements made for the provision of recreation services. The recreation services shall have a well-organized plan for using community resources. The goals and objectives of the facility's recreation services shall be stated in writing.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.57.3** Rule 51.57.3 {#sec-16-51.57.3 omnilex-key=us-ms-regs-official--title-15--16#51.57.3}

The facility shall have written policies and procedures for the recreation services which are made available to recreation services and other appropriate personnel. The policies and procedures shall be reviewed and revised at least annually.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.57.4** Recreational activities shall be provided to all patients during the day, in the evening, and on weekends {#sec-16-51.57.4 omnilex-key=us-ms-regs-official--title-15--16#51.57.4}

The daily recreation program shall be planned to provide a consistent and well-structured yet flexible framework for daily living. Whenever possible, patients should participate in planning recreational services.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.57.5** Recreation schedules shall be posted in places accessible to patients and staff {#sec-16-51.57.5 omnilex-key=us-ms-regs-official--title-15--16#51.57.5}

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.57.6** The recreation program shall be reviewed and revised according to the changing needs of the patients {#sec-16-51.57.6 omnilex-key=us-ms-regs-official--title-15--16#51.57.6}

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.57.7** When indicated, recreation services shall be incorporated in the patient's treatment plan {#sec-16-51.57.7 omnilex-key=us-ms-regs-official--title-15--16#51.57.7}

Recreation services that are included in a patient's treatment plan shall reflect an assessment of the patient's needs, interests, life experiences, capacities, and deficiencies. Recreation services staff shall collaborate with other professional staff in delineating goals for patient's treatment, health maintenance, and vocational adjustments.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.57.8** Rule 51.57.8 {#sec-16-51.57.8 omnilex-key=us-ms-regs-official--title-15--16#51.57.8}

The patient's record shall contain progress notes that describe the patient's response to recreation services and other pertinent observations.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.57.9** Rule 51.57.9 {#sec-16-51.57.9 omnilex-key=us-ms-regs-official--title-15--16#51.57.9}

There shall be documentation that patients are given leisure time and that they are encouraged to use their leisure time in a way that fulfills their cultural and receational interests and their feelings of human dignity.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.57.10** Vehicles used for transportation shall not be labeled in a manner that calls unnecessary attention to the patient {#sec-16-51.57.10 omnilex-key=us-ms-regs-official--title-15--16#51.57.10}

**History**
- *SOURCE: Miss. Code Ann. §43-11-13 Subchapter 58 QUALITY ASSURANCE ACTIVITIES Rule 51.58.1 The recreation services shall have written procedures for ongoing review and revision of its goals, objectives, and role within the facility.*
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.58.2** The recreation service shall maintain statistical and other records on the functioning and utilization of the services {#sec-16-51.58.2 omnilex-key=us-ms-regs-official--title-15--16#51.58.2}

Recreation service staff shall participate in appropriate clinical and administrative committees and conferences. Recreation services staff shall receive training and demonstrate competence in handling medical and psychiatric emergencies. The recreation service shall encourage extramural studies and evaluations of recreation services and extramural research in recreation services.

2. Space for offices, storages, and supplies shall be adequate and accessible;

3. When indicated, equipment and supplies that enable the activity to be brought to the patient should be used; and 4. Space, equipment and facilities utilized both inside and outside the facility shall meet federal, state, and local requirements for safety, fire prevention, health, and sanitation.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13 Subchapter 59 CONTINUING EDUCATION Rule 51.59.1 The facility service shall maintain ongoing staff development programs.*
- *SOURCE: Miss. Code Ann. §43-11-13 Subchapter 60 FUNCTIONAL SAFETY AND SANITATION Rule 51.60.1 Appropriate space, equipment, and facilities shall be provided to meet the needs of patients for recreation services: 1. Facilities and equipment designated for recreation services shall be constructed or modified in such a manner as to provide, insofar as possible, pleasant and functional areas that are accessible to all patients regardless of their disabilities;*
- *SOURCE: Miss. Code Ann. §43-11-13 Subchapter 61 PHYSICAL AND OCCUPATIONAL THERAPY Rule 51.61.1 The facility shall provide, or arrange for, under written agreement, physical and occupational therapy services as needed by patients to improve and maintain functioning.*
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.61.2** Rule 51.61.2 {#sec-16-51.61.2 omnilex-key=us-ms-regs-official--title-15--16#51.61.2}

Qualified therapists, consultants, volunteers, assistants, or aides, are sufficient in number to provide comprehensive occupation and physical therapy services, as needed, to assure that appropriate treatment is rendered for each patient in accordance with stated goals and objectives.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.61.3** Services are provided only upon the written order of a licensed physician {#sec-16-51.61.3 omnilex-key=us-ms-regs-official--title-15--16#51.61.3}

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.61.4** The therapist must: 1 {#sec-16-51.61.4 omnilex-key=us-ms-regs-official--title-15--16#51.61.4}

Record regularly and evaluate periodically the treatment training progress; and 2. Use the treatment training progress as the basis for continuation or change in the program.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.61.5** Treatment training programs shall be designed to: 1 {#sec-16-51.61.5 omnilex-key=us-ms-regs-official--title-15--16#51.61.5}

Preserve and improve abilities for independent function, such as range of motion, strength, tolerance, coordination, and activities of daily living; and 2. Prevent, insofar as possible, irreducible disabilities through means such as the use of orthotic and prosthetic appliances, assistive and adaptive devices, positioning, behavior adoptions, and sensory stimulation.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.61.6** Rule 51.61.6 {#sec-16-51.61.6 omnilex-key=us-ms-regs-official--title-15--16#51.61.6}

Evaluation results, treatment objectives, plans and procedures and progress notes shall be recorded in the patient's record.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.61.7** Rule 51.61.7 {#sec-16-51.61.7 omnilex-key=us-ms-regs-official--title-15--16#51.61.7}

For effective and efficient physical and occupational therapy services, the facility shall provide sufficient space, equipment and supplies.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.61.8** Physical and occupational therapists shall meet the qualifications of Rule 51.25.1 {#sec-16-51.61.8 omnilex-key=us-ms-regs-official--title-15--16#51.61.8}

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.61.9** Therapy assistants must work under the supervision of the qualified therapist {#sec-16-51.61.9 omnilex-key=us-ms-regs-official--title-15--16#51.61.9}

**History**
- *SOURCE: Miss. Code Ann. §43-11-13 Subchapter 62 EDUCATION Rule 51.62.1 The facility shall provide, or make arrangements for the provision of, education services to meet the needs of all patients.*
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.62.2** Rule 51.62.2 {#sec-16-51.62.2 omnilex-key=us-ms-regs-official--title-15--16#51.62.2}

Special education services shall be provided for patients whose emotional disturbances make it difficult for them to learn.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.62.3** Rule 51.62.3 {#sec-16-51.62.3 omnilex-key=us-ms-regs-official--title-15--16#51.62.3}

Education services shall provide opportunities for patients who have fallen behind because of their disorder, to correct deficiencies in their education.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.62.4** Rule 51.62.4 {#sec-16-51.62.4 omnilex-key=us-ms-regs-official--title-15--16#51.62.4}

Facilities that operate their own education service shall have adequate staff and space to meet the educational needs of patients. These facilities shall adhere to all regulations and standards of the State Department of Education that would assure receipt of approval for all work successfully completed within each individual's education plan and transferable to other educational providers, e.g. local public school districts in the State, following the patient's discharge.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.62.5** Rule 51.62.5 {#sec-16-51.62.5 omnilex-key=us-ms-regs-official--title-15--16#51.62.5}

An education director and staff who meet state and/or local certification requirements for education and/or special education shall be provided.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.62.6** Special education teachers shall be certified for individuals with emotional disabilities {#sec-16-51.62.6 omnilex-key=us-ms-regs-official--title-15--16#51.62.6}

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.62.7** Rule 51.62.7 {#sec-16-51.62.7 omnilex-key=us-ms-regs-official--title-15--16#51.62.7}

An appropriate ratio of teachers to students shall be provided so teachers can give special attention to students or to groups of students who are at different stages of treatment and education.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.62.8** Rule 51.62.8 {#sec-16-51.62.8 omnilex-key=us-ms-regs-official--title-15--16#51.62.8}

The education service shall have space and materials commensurate with the scope of its activities, including an adequate number of classrooms.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.62.9** When indicated, patients shall participate in education programs in the community {#sec-16-51.62.9 omnilex-key=us-ms-regs-official--title-15--16#51.62.9}

Teachers in the community shall be given the information necessary to work effectively with the patient.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.62.10** Clinicians shall periodically confer with teachers or principals on the progress of each patient {#sec-16-51.62.10 omnilex-key=us-ms-regs-official--title-15--16#51.62.10}

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.62.11** When appropriate, patients shall be encouraged to take part in extracurricular school activities {#sec-16-51.62.11 omnilex-key=us-ms-regs-official--title-15--16#51.62.11}

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.62.12** Rule 51.62.12 {#sec-16-51.62.12 omnilex-key=us-ms-regs-official--title-15--16#51.62.12}

There shall be documentation in each patient's record of periodic evaluations of educational achievement in relation to developmental level, chronological age, sex, special handicaps, medications, and psychotherapeutic needs.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13 Subchapter 63 VOCATIONAL REHABILITATION Rule 51.63.1 Policies and Procedures: When appropriate, patients shall receive counseling on their specific vocational needs, for example, vocational strengths and weaknesses, the demands of their current or future job, the responsibilities of holding a job, and the problems related to vocational training, placement, and employment.*
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.63.2** A facility may delegate vocational rehabilitation responsibilities to an outside vocational rehabilitation agency {#sec-16-51.63.2 omnilex-key=us-ms-regs-official--title-15--16#51.63.2}

However, the agency must assign an individual

approved by the facility to serve as the facility's coordinator of vocational rehabilitation and agree to comply with the standards in this section.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.63.3** Rule 51.63.3 {#sec-16-51.63.3 omnilex-key=us-ms-regs-official--title-15--16#51.63.3}

Facilities that have a vocational rehabilitation service shall have written policies and procedures to govern the operation of the service.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.63.4** The vocational rehabilitation service shall assess the patient’s vocational needs with regard to the following: 1 {#sec-16-51.63.4 omnilex-key=us-ms-regs-official--title-15--16#51.63.4}

Current work skills and potential for improving skills or developing new ones; 2. Educational background; 3. Aptitudes, interests, and motivations for getting involved in various job-related activities; 4. Physical abilities; 5. Skills and experiences in seeking jobs; 6. Work habits related to tardiness, absenteeism, dependability, honesty, and relations with co-workers and their supervisor; 7. Personal grooming and appearance; 8. Expectations regarding the personal, financial, and social benefits to be derived from working; and 9. Amenability to vocational counseling.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.63.5** Vocational services shall be provided according to an individualized treatment plan {#sec-16-51.63.5 omnilex-key=us-ms-regs-official--title-15--16#51.63.5}

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.63.6** The criteria for determining a patient's job readiness shall be stated in the patient's treatment plan {#sec-16-51.63.6 omnilex-key=us-ms-regs-official--title-15--16#51.63.6}

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.63.7** Rule 51.63.7 {#sec-16-51.63.7 omnilex-key=us-ms-regs-official--title-15--16#51.63.7}

A record shall be kept of vocational rehabilitation activities, including the date and a description of the activity, participants, and results.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.63.8** All work programs must conform to federal, state, and local rules and regulations {#sec-16-51.63.8 omnilex-key=us-ms-regs-official--title-15--16#51.63.8}

**History**
- *SOURCE: Miss. Code Ann. §43-11-13 Subchapter 64 STAFF COMPOSITION AND SUPERVISION Rule 51.64.1 The facility's vocational rehabilitation service shall have a sufficient number of appropriately qualified staff and support personnel thru direct or contractual services.*
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.64.2** A person or team shall be assigned responsibility for the implementation of vocational rehabilitation services {#sec-16-51.64.2 omnilex-key=us-ms-regs-official--title-15--16#51.64.2}

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.64.3** Rule 51.64.3 {#sec-16-51.64.3 omnilex-key=us-ms-regs-official--title-15--16#51.64.3}

Vocational Rehabilitative Services shall be provided by at least one qualified vocational rehabilitation counselor or qualified occupational therapist available who is responsible for the professional standards, coordination, and delivery of vocational rehabilitation services.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.64.4** Rule 51.64.4 {#sec-16-51.64.4 omnilex-key=us-ms-regs-official--title-15--16#51.64.4}

All personnel providing vocational rehabilitation services shall have training, experience, and competence consistent with acceptable standards of their specialty field.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.64.5** Rule 51.64.5 {#sec-16-51.64.5 omnilex-key=us-ms-regs-official--title-15--16#51.64.5}

Sufficient qualified vocational rehabilitation counselors and support personnel shall be available to meet the needs of patients.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13 Subchapter 65 SPEECH, LANGUAGE, AND HEARING Rule 51.65.1 Policies and Procedures: Speech, language, and hearing services shall be available, either within the facility or by written arrangement with another facility or a qualified clinician, to provide assessments of speech, language, or hearing when indicated, and to provide counseling, treatment, and rehabilitation when needed.*
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.65.2** Rule 51.65.2 {#sec-16-51.65.2 omnilex-key=us-ms-regs-official--title-15--16#51.65.2}

Facilities that have a speech, language, and hearing service shall have written policies and procedures to govern the operation of the service.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.65.3** The speech, language, and hearing service shall provide the following services: 1 {#sec-16-51.65.3 omnilex-key=us-ms-regs-official--title-15--16#51.65.3}

Speech and language screening of patients when deemed necessary by members of the treatment team, the family, or significant others; 2. Comprehensive speech and language evaluation of patients when indicated by screening results; 3. Comprehensive audiological assessment of patients when indicated; 4. Procurement, maintenance, or replacement of hearing aids when specified by a qualified audiologist; and 5. Rehabilitation programs, when appropriate, to establish the speech skills necessary for comprehension and expression.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.65.4** Rule 51.65.4 {#sec-16-51.65.4 omnilex-key=us-ms-regs-official--title-15--16#51.65.4}

Assessment and treatment results shall be reported accurately and systematically and in a manner that accomplishes the following: 1. Defines the problem; 2. Provides a basis for formulating a plan that contains treatment objectives and procedures; 3. Provides information of staff working with the patient; and 4. Provides evaluations and summary reports for inclusion in the patient's record.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13 Subchapter 66 STAFF COMPOSITION AND SUPERVISION Rule 51.66.1 The speech, language, and hearing service shall be administered and supervised by qualified speech-language and hearing clinicians.*
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.66.2** Rule 51.66.2 {#sec-16-51.66.2 omnilex-key=us-ms-regs-official--title-15--16#51.66.2}

All staff with independent responsibilities shall have a Certificate of Clinical Competence or a Statement of Equivalence in either speech pathology or audiology from the American Speech-Language-Hearing Association, or have documented equivalent training and experience; and shall meet current legal requirements of licensure or registration.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.66.3** Rule 51.66.3 {#sec-16-51.66.3 omnilex-key=us-ms-regs-official--title-15--16#51.66.3}

Support personnel, such as speech pathology assistants and communication aides, shall be qualified by training and/or experience for level of work they perform and shall be appropriately supervised by a staff speech-language pathologist or audiologist.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13 Subchapter 67 QUALITY ASSURANCE ACTIVITIES Rule 51.67.1 Equipment shall meet the standards of the American Board of Examiners in Speech Pathology and Audiology of the American Speech-Language-Hearing Association, including the standards concerning the location, calibration, and maintenance of equipment; or equipment shall meet equivalent standards.*
- *SOURCE: Miss. Code Ann. §43-11-13 Subchapter 68 DENTAL Rule 51.68.1 Policies and Procedures: The facility shall have a written plan that outlines the procedures used to assess and treat the dental health care needs of patients.*
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.68.2** The written dental health care plan shall describe the following: 1 {#sec-16-51.68.2 omnilex-key=us-ms-regs-official--title-15--16#51.68.2}

Mechanisms for evaluating each patient's need for dental treatment; 2. Provisions for emergency dental services; 3. Policies on oral hygiene and preventive dentistry; 4. Provisions for coordinating dental services with other services provided by the facility; and 5. A mechanism for the referral of patients for services not provided by the facility.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.68.3** Rule 51.68.3 {#sec-16-51.68.3 omnilex-key=us-ms-regs-official--title-15--16#51.68.3}

When a facility provides dental services, a written policy shall delineate the functions of the service and the specific services provided.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.68.4** Reports of all dental services provided shall be made a part of the patient's record {#sec-16-51.68.4 omnilex-key=us-ms-regs-official--title-15--16#51.68.4}

**History**
- *SOURCE: Miss. Code Ann. §43-11-13 Subchapter 69 STAFF COMPOSITION AND SUPERVISION*

##### **15 Miss. Admin. Code Pt. 16, R. 51.69.1** Rule 51.69.1 {#sec-16-51.69.1 omnilex-key=us-ms-regs-official--title-15--16#51.69.1}

A dental service provided by the facility shall be directed by a fully licensed dentist who is a member of the professional staff and qualified to assume management and administrative responsibility for the dental service.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.69.2** Rule 51.69.2 {#sec-16-51.69.2 omnilex-key=us-ms-regs-official--title-15--16#51.69.2}

A dental service provided by the facility shall have a sufficient number of adequately trained personnel to meet the needs of patients.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13 Subchapter 70 FUNCTIONAL SAFETY AND SANITATION Rule 51.70.1 A dental service provided by the facility shall have adequate space, equipment, instruments, and supplies to meet the needs of patients.*
- *SOURCE: Miss. Code Ann. §43-11-13 Subchapter 71 REFERRALS Rule 51.71.1 The facility shall have written policies and procedures that facilitate the referral of patients and the provision of consultation between the facility's program components and between the facility and other service providers in the community. The written policies and procedures shall describe the conditions under which referrals can be made and consultations provided. These conditions shall provide for the examinations, assessments, or consultations that are not within the professional domain or expertise of the staff; special treatment services; and assistance from providers who can contribute to the patient's well- being.*
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.71.2** The written policies and procedures shall describe the methods by which continuity of care is assured for the patient {#sec-16-51.71.2 omnilex-key=us-ms-regs-official--title-15--16#51.71.2}

These methods shall include, but not be limited to, providing the facility, program component, or other service provider to which the patient is referred with the following: 1. Background information on the referral; 2. Information on the patient's treatment, for example, current treatment, diagnostic assessments, and special requirements; 3. Treatment objectives desired; 4. Suggestions for continued coordination between the referring and the receiving resource; 5. Special clinical management requirements; and

6. Information on how the patient can be returned to the referring facility or program component.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.71.3** Rule 51.71.3 {#sec-16-51.71.3 omnilex-key=us-ms-regs-official--title-15--16#51.71.3}

The facility shall ask the facility, program component, or other service provider to which the patient is referred to submit a follow-up report within a designated time period.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.71.4** The written policies and procedures shall describe the mechanism by which a patient may request a referral {#sec-16-51.71.4 omnilex-key=us-ms-regs-official--title-15--16#51.71.4}

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.71.5** Rule 51.71.5 {#sec-16-51.71.5 omnilex-key=us-ms-regs-official--title-15--16#51.71.5}

The written policies and procedures shall describe the means by which the facility assists in the referral of individuals who are seeking services that the facility does not provide.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.71.6** Rule 51.71.6 {#sec-16-51.71.6 omnilex-key=us-ms-regs-official--title-15--16#51.71.6}

The written policies and procedures shall be reviewed and approved annually by the director and appropriate administrative and professional staff members. The annual review and approval shall be documented.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.71.7** Rule 51.71.7 {#sec-16-51.71.7 omnilex-key=us-ms-regs-official--title-15--16#51.71.7}

Each community service provider to which patients are referred shall express in writing its willingness to abide by federal and state standards concerning confidentiality of patient information.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.71.8** The facility shall have a letter of agreement and/or contract with community service providers that it uses repeatedly {#sec-16-51.71.8 omnilex-key=us-ms-regs-official--title-15--16#51.71.8}

Emergency services shall be provided by the facility or through clearly defined arrangements with another facility.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13 Subchapter 72 EMERGENCY Rule 51.72.1 The facility shall have written procedures for taking care of emergencies.*
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.72.2** Rule 51.72.2 {#sec-16-51.72.2 omnilex-key=us-ms-regs-official--title-15--16#51.72.2}

When emergency services are provided by an outside facility, a written plan shall delineate the type of emergency services available and the arrangements for

referring or transferring patients to another facility. The written plan shall be available to all professional staff and shall clearly specify the following: 1. The staff of the facility who are available and authorized to provide necessary emergency evaluations; 2. The staff of the facility who are authorized to arrange for patients to be referred or transferred to another facility when necessary; 3. The arrangements the facility had made for exchanging records with the outside facility when it is necessary for the care of the patient; 4. The location of the outside facility and the names of the appropriate personnel to contact; 5. The method of communication between the two facilities; 6. The arrangements the facility has made to assure that when a patient requiring emergency care is transferred to a non-psychiatric or substance abuse service or facility, he or she will receive further evaluation and/or treatment of his or her psychiatric or substance abuse problem, as needed; 7. The arrangements the facility has made for transporting patients, when necessary, from the facility to the facility providing emergency services; 8. The policy for referring patients needing continued care after emergency services back to the referring facility; and 9. Policies concerning notification of patient's family of emergencies and of arrangements that have been made for referring or transferring the patient to another facility.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13 Subchapter 73 LIBRARY Rule 51.73.1 Library services shall be made available to meet the professional and technical needs of the facility's staff.*
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.73.2** Rule 51.73.2 {#sec-16-51.73.2 omnilex-key=us-ms-regs-official--title-15--16#51.73.2}

Facilities that do not maintain a professional library shall have an arrangement with a nearby facility or institution to use its professional library.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.73.3** Current reference material, books, and basic health care journals shall be available in each facility {#sec-16-51.73.3 omnilex-key=us-ms-regs-official--title-15--16#51.73.3}

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.73.4** Rule 51.73.4 {#sec-16-51.73.4 omnilex-key=us-ms-regs-official--title-15--16#51.73.4}

The library shall establish regular and convenient hours of service so that staff may have prompt access to current materials.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.73.5** Rule 51.73.5 {#sec-16-51.73.5 omnilex-key=us-ms-regs-official--title-15--16#51.73.5}

When a facility operates its own library, the professional library service shall provide pertinent, current and useful medical, psychiatric, psychological, alcohol, drug, educational, and related materials.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.73.6** A facility providing extensive library services should utilize the services of a professional librarian {#sec-16-51.73.6 omnilex-key=us-ms-regs-official--title-15--16#51.73.6}

**History**
- *SOURCE: Miss. Code Ann. §43-11-13 Subchapter 74 LABORATORY/RADIOLOGY Rule 51.74.1 The facility shall have provisions for promptly obtaining required laboratory, x- ray, and other diagnostic services.*
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.74.2** Rule 51.74.2 {#sec-16-51.74.2 omnilex-key=us-ms-regs-official--title-15--16#51.74.2}

If the facility provides its own laboratory and x-ray services, these shall meet the applicable standards established for hospital licensure. Refer to Subchapter 21 & Subchapter 22; and Subchapters 57-61; and Subchapters 70-73 of the Minimum Standards of Operation for Mississippi Hospitals.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.74.3** Rule 51.74.3 {#sec-16-51.74.3 omnilex-key=us-ms-regs-official--title-15--16#51.74.3}

If the facility itself does not provide such services, arrangements shall be made for obtaining these services from a licensed and certified laboratory.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.74.4** Rule 51.74.4 {#sec-16-51.74.4 omnilex-key=us-ms-regs-official--title-15--16#51.74.4}

All laboratory and x-ray services shall be provided only on the orders of the attending physician or the psychiatric mental health nurse practitioners.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.74.5** The facility shall assist the patient, if necessary, in arranging for transportation to and from the source of service {#sec-16-51.74.5 omnilex-key=us-ms-regs-official--title-15--16#51.74.5}

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.74.6** Rule 51.74.6 {#sec-16-51.74.6 omnilex-key=us-ms-regs-official--title-15--16#51.74.6}

All signed and dated reports of laboratory, x-ray, and other diagnostic services shall be filed with the patient's medical record.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13 Subchapter 75 VOLUNTEER Rule 51.75.1 In facilities where volunteer services are utilized, the objectives and scope of the volunteer service shall be clearly stated in writing.*
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.75.2** Rule 51.75.2 {#sec-16-51.75.2 omnilex-key=us-ms-regs-official--title-15--16#51.75.2}

An appropriately qualified and experienced staff member shall be assigned to select and evaluate volunteers and to coordinate volunteer activities.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.75.3** The authority and responsibilities of the volunteer coordinator shall be clearly stated in writing {#sec-16-51.75.3 omnilex-key=us-ms-regs-official--title-15--16#51.75.3}

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.75.4** The volunteer coordinator shall perform the following functions: 1 {#sec-16-51.75.4 omnilex-key=us-ms-regs-official--title-15--16#51.75.4}

Assist staff in determining the need for volunteer services and in developing assignments; 2. Plan and implement the program for recruiting volunteers; 3. Coordinate efforts to recruit, select, and train volunteers, and to place volunteers in appropriate services or units; 4. Instruct staff on the proper, effective, and creative use of volunteers; 5. Keep staff and the community informed about volunteer services and activities; 6. Provide opportunities for volunteers to acquire the qualifications for certification when applicable; and 7. Assign an appropriate staff member to provide ongoing supervision, in-service training, and evaluation of volunteers.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.75.5** Rule 51.75.5 {#sec-16-51.75.5 omnilex-key=us-ms-regs-official--title-15--16#51.75.5}

An orientation program shall be conducted to familiarize volunteers with the facility's goals and services and to provide appropriate clinical orientation regarding the facility's patients.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.75.6** The orientation program shall include explanations of at least the following: {#sec-16-51.75.6 omnilex-key=us-ms-regs-official--title-15--16#51.75.6}

1. The importance of maintaining confidentiality and protecting patients' rights; 2. The procedures for responding to unusual events and incidents; and 3. The program's channels of communication and the distinctions between administrative and clinical authority and responsibility.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.75.7** Rule 51.75.7 {#sec-16-51.75.7 omnilex-key=us-ms-regs-official--title-15--16#51.75.7}

Volunteers shall be under the direct supervision of the staff of the service or unit utilizing their services, and shall receive general direction and guidance form the volunteer coordinator.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.75.8** Rule 51.75.8 {#sec-16-51.75.8 omnilex-key=us-ms-regs-official--title-15--16#51.75.8}

The use of volunteers as members of treatment teams to supplement the total treatment program shall be done only in collaboration with appropriate professional staff members and after consideration of the patients' needs for continuity.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.75.9** Rule 51.75.9 {#sec-16-51.75.9 omnilex-key=us-ms-regs-official--title-15--16#51.75.9}

Supervisory professional staff shall be available to help volunteers establish the most effective relationship with patients.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.75.10** Rule 51.75.10 {#sec-16-51.75.10 omnilex-key=us-ms-regs-official--title-15--16#51.75.10}

Procedures shall be established to assure that the observations of volunteers are reported to the professional staff members responsible for the patient. These observations may be recorded in the patient's record.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.75.11** Volunteers may be utilized to help meet patients' basic needs for social interaction, self-esteem, and self-fulfillment {#sec-16-51.75.11 omnilex-key=us-ms-regs-official--title-15--16#51.75.11}

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.75.12** Rule 51.75.12 {#sec-16-51.75.12 omnilex-key=us-ms-regs-official--title-15--16#51.75.12}

Volunteer activity records and reports shall contain information that can be used to evaluate the effectiveness of the volunteer services.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.75.13** At least the following records shall be maintained by the volunteer service: 1 {#sec-16-51.75.13 omnilex-key=us-ms-regs-official--title-15--16#51.75.13}

A personnel record that includes the volunteer's application, record of assignments, and progress reports;

2. A master assignment schedule for all volunteers, including times and units of assignment; and 3. A current job description for each volunteer.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13 Subchapter 76 RESEARCH (OPTIONAL) Rule 51.76.1 When a facility or program conducts or participates in research with human subjects, policies shall be designed and written to assure that rigorous review is made of the merits of each research project and of the potential effects of the research procedures on the participants.*
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.76.2** An interdisciplinary research review committee shall review all research projects utilizing human subjects {#sec-16-51.76.2 omnilex-key=us-ms-regs-official--title-15--16#51.76.2}

The committee shall be either a permanent standing committee or a committee convened on an as-needed basis.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.76.3** Members of the research review committee shall be qualified by training and experience to serve on the committee {#sec-16-51.76.3 omnilex-key=us-ms-regs-official--title-15--16#51.76.3}

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.76.4** Individuals who have appropriate experience in the research areas being reviewed shall be included on the committee {#sec-16-51.76.4 omnilex-key=us-ms-regs-official--title-15--16#51.76.4}

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.76.5** Rule 51.76.5 {#sec-16-51.76.5 omnilex-key=us-ms-regs-official--title-15--16#51.76.5}

A majority of the committee members should be individuals who are not directly associated with the research project under consideration.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.76.6** Some committee members should be individuals who are not formally associated with the facility {#sec-16-51.76.6 omnilex-key=us-ms-regs-official--title-15--16#51.76.6}

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.76.7** Rule 51.76.7 {#sec-16-51.76.7 omnilex-key=us-ms-regs-official--title-15--16#51.76.7}

Prior to the authorization and initiation of each research project, the research committee shall conduct a detailed review of the project

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.76.8** This review shall include the following: {#sec-16-51.76.8 omnilex-key=us-ms-regs-official--title-15--16#51.76.8}

1. The adequacy of the research design; 2. The qualifications of the individuals responsible for coordinating the project; 3. The benefits of the research in general; 4. The benefits and risks to the participants; 5. The benefits to the facility; 6. The compliance of the research design with accepted ethical standards; 7. The process to be used to obtain informed consent from participants; and 8. The procedures for dealing with any potentially harmful effects that may occur in the course of the research activities.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.76.9** Rule 51.76.9 {#sec-16-51.76.9 omnilex-key=us-ms-regs-official--title-15--16#51.76.9}

This initial review shall form the basis for a written report that shall be submitted by the committee to the chief executive officer.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.76.10** Rule 51.76.10 {#sec-16-51.76.10 omnilex-key=us-ms-regs-official--title-15--16#51.76.10}

All individuals asked to participate in a research project shall be given the following information before being asked to give their consent: 1. A description of the benefits to be expected; 2. A description of the potential discomforts and risks; 3. A description of alternative services that might prove equally advantageous to them; and 4. A full explanation of the procedures to be followed, especially those that are experimental in nature.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.76.11** Rule 51.76.11 {#sec-16-51.76.11 omnilex-key=us-ms-regs-official--title-15--16#51.76.11}

If the investigator does not wish to fully disclose the purpose, nature, expected outcome, and implications of the research to the participants before it begins, the investigator shall clearly and rigorously justify to the research review committee that such disclosure is inadvisable and that failure to give full disclosure is not detrimental to the participants. Under such conditions, disclosure may be deferred until the research project is completed.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.76.12** Rule 51.76.12 {#sec-16-51.76.12 omnilex-key=us-ms-regs-official--title-15--16#51.76.12}

All research project participants shall sign a consent form that indicates their willingness to participate in the project.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.76.13** Rule 51.76.13 {#sec-16-51.76.13 omnilex-key=us-ms-regs-official--title-15--16#51.76.13}

All consent forms, except as provided in Rule 51.76.11 shall address all of the information specified in Rule 51.76.10 and shall indicate the name of the person who supplied the participant with the information and the date the form was signed.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.76.14** The informed consent document shall address the participant's right to privacy and confidentiality {#sec-16-51.76.14 omnilex-key=us-ms-regs-official--title-15--16#51.76.14}

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.76.15** Rule 51.76.15 {#sec-16-51.76.15 omnilex-key=us-ms-regs-official--title-15--16#51.76.15}

Neither the consent form nor any written or oral agreement entered into by the participant shall include any language that releases the facility, its agents, or those responsible for conducting the research from liability for negligence.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.76.16** Rule 51.76.16 {#sec-16-51.76.16 omnilex-key=us-ms-regs-official--title-15--16#51.76.16}

All prospective participants over the age of 12 and all parents or guardians of participants under the age of 18 shall sign a written consent form that indicates willingness to participate in the project.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.76.17** Rule 51.76.17 {#sec-16-51.76.17 omnilex-key=us-ms-regs-official--title-15--16#51.76.17}

The consent form shall address all of the information specified in Rule 51.76.10 and shall indicate the name of the individual who supplied the participant with the information and the date the consent form was signed.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.76.18** Rule 51.76.18 {#sec-16-51.76.18 omnilex-key=us-ms-regs-official--title-15--16#51.76.18}

Prospective participants under the age of 18, and all prospective participants who are legally or functionally incompetent to provide informed consent, shall participate only when and if consent has been given by a person legally empowered to consent, and such consent has been reviewed by an independent advocacy group, if available.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.76.19** Rule 51.76.19 {#sec-16-51.76.19 omnilex-key=us-ms-regs-official--title-15--16#51.76.19}

Such legal guardian and/or advocate shall receive the same information as required in Standard 174.10 and shall sign the consent form.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.76.20** Rule 51.76.20 {#sec-16-51.76.20 omnilex-key=us-ms-regs-official--title-15--16#51.76.20}

A patient's refusal to participate in a research project shall not be a cause for denying or altering the provision of indicated services to that patient.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.76.21** Rule 51.76.21 {#sec-16-51.76.21 omnilex-key=us-ms-regs-official--title-15--16#51.76.21}

Participants shall be allowed to withdraw consent and discontinue participation in a research project at any time without affecting their status in the program.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.76.22** Privacy and confidentiality should be strictly maintained at all times {#sec-16-51.76.22 omnilex-key=us-ms-regs-official--title-15--16#51.76.22}

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.76.23** Rule 51.76.23 {#sec-16-51.76.23 omnilex-key=us-ms-regs-official--title-15--16#51.76.23}

Upon completion of the research procedures, the principal investigator shall attempt to remove any confusion, misinformation, stress, physical discomfort, or other harmful consequences that may have arisen with respect to the participants as a result of the procedures.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.76.24** Rule 51.76.24 {#sec-16-51.76.24 omnilex-key=us-ms-regs-official--title-15--16#51.76.24}

Investigators and others directly involved in research shall, both in obtaining consent and in conducting research, adhere to the ethical standards of their respective professions concerning the conduct of research and should be guided by the regulations of the US Department of Health and Human Services and other federal, state, and local statues and regulations concerning the protection of human subjects.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.76.25** Rule 51.76.25 {#sec-16-51.76.25 omnilex-key=us-ms-regs-official--title-15--16#51.76.25}

Upon completion of the research, the principle investigator, whether a member of the facility's staff or an outside researcher, shall be responsible for communicating the purpose, nature, outcome, and possible practical or theoretical implications of the research to the staff of the program in a manner which they can understand.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.76.26** Rule 51.76.26 {#sec-16-51.76.26 omnilex-key=us-ms-regs-official--title-15--16#51.76.26}

Reports of all research projects shall be submitted to the chief executive officer and the research committee and shall be maintained by the facility.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13 Subchapter 77 PHYSICAL PLANT MANAGEMENT: INFECTION CONTROL Rule 51.77.1 Because infections, acquired in a facility or brought into a facility from the community, are potential hazards for all persons having contact with the facility, there shall be an infection control program. Effective measures shall be developed to prevent, identify, and control infections.*
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.77.2** Rule 51.77.2 {#sec-16-51.77.2 omnilex-key=us-ms-regs-official--title-15--16#51.77.2}

Written policies and procedures pertaining to the operation of the infection control program shall be established, reviewed at least annually, and revised as necessary.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.77.3** Rule 51.77.3 {#sec-16-51.77.3 omnilex-key=us-ms-regs-official--title-15--16#51.77.3}

A practical system shall be developed for reporting, evaluating, and maintaining records of infections among patients and personnel. This system shall include assignment of responsibility for the ongoing collection and analysis of data, as well as for the implementation of required follow-up action. Corrective action taken on the basis of records and reports of infections and infection potentials among patients and personnel shall be documented.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.77.4** Rule 51.77.4 {#sec-16-51.77.4 omnilex-key=us-ms-regs-official--title-15--16#51.77.4}

All new employees shall be instructed in the importance of infection control and personal hygiene, and in their responsibility in the infection control program. There shall be documentation that in-service education in infection prevention and control is provided to employees in all services and program components.

2. Cultures and stocks of infectious agents; including specimen cultures collected from medical and pathological laboratories, cultures and stocks of infectious agents from research and industrial laboratories, wastes from the production of biological, discarded live and attenuated vaccines, and culture dishes and devices used to transfer, inoculate, and mix cultures; 3. Blood and blood products such as serum, plasma, and other blood components; 4. Pathological wastes, such as tissues, organs, body parts, and body fluids that are removed during surgery and autopsy;

5. Contaminated carcasses, body parts, and bedding of animals that were exposed to pathogens in medical research; 6. All discarded sharps (e.g., hypodermic needles, syringes, Pasteur pipettes, broken glass, scalpel blades) which have come into contact with infectious agents; 7. Other wastes determined infectious by the generator or so classified by the Mississippi Department of Health.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13 Subchapter 78 MEDICAL WASTE Rule 51.78.1 "Infectious medical wastes" include solid or liquid wastes which may contain pathogens with sufficient virulence and quantity such that exposure to the waste by a susceptible host has been proven to result in an infectious disease. For purposes of this Regulation, the following wastes shall be considered to be infectious medical wastes: 1. Wastes resulting from the care of patients and animals who have Class I and (or) II diseases that are transmitted by blood and body fluid as defined in the rules and regulations governing reportable diseases, as defined by the Mississippi Department of Health;*
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.78.2** Rule 51.78.2 {#sec-16-51.78.2 omnilex-key=us-ms-regs-official--title-15--16#51.78.2}

"Medical Waste" means all waste generated in direct patient care or in diagnostic or research areas that is non-infectious but aesthetically repugnant if found in the environment."

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.78.3** Rule 51.78.3 {#sec-16-51.78.3 omnilex-key=us-ms-regs-official--title-15--16#51.78.3}

All generators of infectious medical waste and medical waste shall have a medical waste management plan that shall include, but is not limited to, the following: 1. Storage and Containment of Infectious Medical Waste and Medical Waste: a. Containment of infectious medical waste and medical waste shall be in a manner and location which affords protection from animals, rain and wind, does not provide a breeding place or a food source for insects and rodents, and minimizes exposure to the public. b. Infectious medical waste shall be segregated from other waste at the point of origin in the producing facility. c. Unless approved by the Mississippi Department of Health or treated and rendered non-infectious, infectious medical waste (except for sharps in approved containers) shall not be stored at a waste producing facility for more than seven days above a temperature of 6 C (38F). Containment of infectious medical waste at the producing facility is permitted at or below a temperature of 0 C (32F) for a period of not more than 90 days without specific approval of the Mississippi Department of Health. d. Containment of infectious medical waste shall be separate from other wastes. Enclosures or containers used for containment of infectious medical waste shall be so secured so as to discourage access by unauthorized persons and shall be marked with prominent warning signs on, or adjacent to, the exterior of entry doors, gates, or lids. Each container shall be prominently labeled with a sign using language to be determined by the Department and legible during daylight hours. e. Infectious medical waste, except for sharps capable of puncturing or cutting, shall be contained in double disposable plastic bags or single bags (1.5 mills

thick) which are impervious to moisture and have a strength sufficient to preclude ripping, tearing, or bursting under normal conditions of usage. The bags shall be securely tied so as to prevent leakage or expulsion of solid or liquid wasted during storage, handling, or transport. f. All bags used for containment and disposal of infectious medical waste shall be of a distinctive color or display the Universal Symbol for infectious waste. Rigid containers of all sharps waste shall be labeled. g. Compactors or grinders shall not be used to process infectious medical waste unless the waste has been rendered non-infectious. Sharps containers shall not be subject to compaction by any compacting device except in the institution itself and shall not be placed for storage or transport in a portable or mobile trash compactor. h. Infectious medical waste and medical waste contained in disposable containers as prescribed above, shall be placed for storage, handling, or transport in disposable or reusable pails, cartons, drums, or portable bins. The containment system shall be leak-proof, have tight-fitting covers and be kept clean and in good repair. i. Reusable containers for infectious medical waste and medical waste shall be thoroughly washed and decontaminated each time they are emptied by a method specified by the Mississippi Department of Health, unless the surfaces of the containers have been protected from contamination by disposable liners, bags, or other devices removed with the waste, as outlined in I.E. j. Approved methods of decontamination include, but are not limited to, agitation to remove visible soil combined with one or more of the following procedures: i. Exposure to hot water at least 180 F for a minimum of 15 seconds. ii. Exposure to a chemical sanitizer by rinsing with or immersion in one of the following for a minimum of 3 minutes: a. Hypochlorite solution (500 ppm available chlorine); b. Phenolic solution (500 ppm active agent); c. Iodoform solution (100 ppm available iodine); and d. Quaternary ammonium solution (400 ppm active agent). 2. Reusable pails, drums, or bins used for containment of infectious waste shall not be used for containment of waste to be disposed of as non infectious waste or for other purposed except after being decontaminated by procedures as described in part (10) of this section.

a. Trash chutes shall not be used to transfer infectious medical waste. b. Once treated and rendered non-infectious, previously defined infectious medical waste will be classified as medical waste and may be land-filled in an approved landfill. 3. Treatment or disposal of infectious medical waste shall be by one of the following methods: a. By incineration in an approved incinerator which provides combustion of the waste to carbonized or mineralized ash. b. By sterilization by heating in a steam sterilizer, so as to render the non- infectious. 4. Infectious medical waste so rendered non-infectious shall be disposable as medical waste. Operating procedures for steam sterilizers shall include, but not be limited to, the following: a. Adoption of standard written operating procedures for each steam sterilizer including time, temperature, pressure, type of waste, type of container(s), closure on container(s), pattern of loading, water content, and maximum load quantity. b. Check or recording and/or indicating thermometers during each complete cycle to ensure the attainment of a temperature of 121 C (250 F) for one-half hour or longer, depending on quantity and density of the load, in order to achieve sterilization of the entire load. Thermometers shall be checked for calibration at least annually. c. Use of heat sensitive tape or other device for each container that is processed to indicate the attainment of adequate sterilization conditions. d. Use of the biological indicator Bacillus stearothermophilus placed at the center of a load processed under standard operating conditions at least monthly to confirm the attainment of adequate sterilization conditions. e. Maintenance of records of procedures specified in (a), (b), (c) and (d) above for period of not less than a year. f. By discharge to the approved sewerage system if the waste is liquid or semi- liquid, except as prohibited by the Mississippi Department of Health. g. Recognizable human anatomical remains shall be disposed of by incineration or internment, unless burial at an approved landfill is specifically authorized by the Mississippi Department of Health.

h. Chemical sterilization shall use only those chemical sterilants recognized by the US Environmental Protection Agency, Office of Pesticides and Toxic Substances. Ethylene oxide, glutaraldehyde, and hydrogen peroxide are examples of sterilants that, used in accordance with manufacturer recommendation, will render infectious waste non-infectious. Testing with Bacillus subtilis spores or other equivalent organisms shall be conducted quarterly to ensure the sterilization effectiveness of gas or steam treatment. 5. Treatment and disposal of medical waste which is not infectious shall be by one of the following methods: a. By incineration in an approved incinerator which provides combustion of the waste to carbonized or mineralized ash. b. By sanitary landfill, in an approved landfill which shall mean a disposal facility or part of a facility where medical waste is placed in or on land, and which is not a treatment facility.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.78.4** Rule 51.78.4 {#sec-16-51.78.4 omnilex-key=us-ms-regs-official--title-15--16#51.78.4}

All the requirements of these standards shall apply, without regard to the quantity of medical waste generated per month, to any generator of medical waste.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13 Subchapter 79 THERAPEUTIC ENVIRONMENT Rule 51.79.1 The facility shall establish an environment that enhances the positive self-image of patients and preserves their human dignity.*
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.79.2** The grounds of the facility shall have adequate space for the facility to carry out its stated goals {#sec-16-51.79.2 omnilex-key=us-ms-regs-official--title-15--16#51.79.2}

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.79.3** Rule 51.79.3 {#sec-16-51.79.3 omnilex-key=us-ms-regs-official--title-15--16#51.79.3}

When patient needs or facility goals involve outdoor activities, areas appropriate to the ages and clinical needs of the patients shall be provided.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.79.4** Rule 51.79.4 {#sec-16-51.79.4 omnilex-key=us-ms-regs-official--title-15--16#51.79.4}

The facility shall be accessible to individuals with physical disabilities, or the facility shall have written policies and procedures that describe how individuals with physical disabilities can gain access to the facility for necessary services.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.79.5** Rule 51.79.5 {#sec-16-51.79.5 omnilex-key=us-ms-regs-official--title-15--16#51.79.5}

Waiting or reception areas shall be comfortable; and their design, location, and furnishings shall accommodate the characteristics of patient and visitors, the anticipated waiting time, the need for privacy and/or support form staff, and the goals of the facility.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.79.6** Appropriate staff shall be available in waiting or reception areas to address the needs of patients and visitors {#sec-16-51.79.6 omnilex-key=us-ms-regs-official--title-15--16#51.79.6}

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.79.7** Rest rooms shall be available for patients and visitors {#sec-16-51.79.7 omnilex-key=us-ms-regs-official--title-15--16#51.79.7}

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.79.8** A telephone shall be available for private conversations {#sec-16-51.79.8 omnilex-key=us-ms-regs-official--title-15--16#51.79.8}

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.79.9** An adequate number of drinking units shall be accessible at appropriate heights {#sec-16-51.79.9 omnilex-key=us-ms-regs-official--title-15--16#51.79.9}

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.79.10** If drinking units employ cups, only single-use, disposable cups shall be used {#sec-16-51.79.10 omnilex-key=us-ms-regs-official--title-15--16#51.79.10}

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.79.11** Rule 51.79.11 {#sec-16-51.79.11 omnilex-key=us-ms-regs-official--title-15--16#51.79.11}

Facilities that do not have emergency medical care resources shall have first-aid supply kits available in appropriate places.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.79.12** All supervisory staff shall be familiar with the locations, contents, and use of the first-aid kits {#sec-16-51.79.12 omnilex-key=us-ms-regs-official--title-15--16#51.79.12}

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.79.13** The facility shall provide an environment appropriate to the needs of patients {#sec-16-51.79.13 omnilex-key=us-ms-regs-official--title-15--16#51.79.13}

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.79.14** Rule 51.79.14 {#sec-16-51.79.14 omnilex-key=us-ms-regs-official--title-15--16#51.79.14}

The design, structure, furnishing, and lighting of the patient environment shall promote clear perceptions of people and functions.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.79.15** When appropriate, lighting shall be controlled by patients {#sec-16-51.79.15 omnilex-key=us-ms-regs-official--title-15--16#51.79.15}

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.79.16** Whenever possible the environment shall provide views of the outdoors {#sec-16-51.79.16 omnilex-key=us-ms-regs-official--title-15--16#51.79.16}

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.79.17** Areas that are primarily used by patients shall have windows or skylights {#sec-16-51.79.17 omnilex-key=us-ms-regs-official--title-15--16#51.79.17}

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.79.18** Rule 51.79.18 {#sec-16-51.79.18 omnilex-key=us-ms-regs-official--title-15--16#51.79.18}

Appropriate types of mirrors that distort as little as possible shall be placed at reasonable heights in appropriate places to aid in grooming and to enhance patients' self-awareness.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.79.19** Clocks and calendars should be provided in at least major use areas to promote awareness of time and season {#sec-16-51.79.19 omnilex-key=us-ms-regs-official--title-15--16#51.79.19}

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.79.20** Ventilation shall contribute to the habitability of the environment {#sec-16-51.79.20 omnilex-key=us-ms-regs-official--title-15--16#51.79.20}

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.79.21** Direct outside air ventilation shall be provided to each patient's room by air conditioning or operable windows {#sec-16-51.79.21 omnilex-key=us-ms-regs-official--title-15--16#51.79.21}

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.79.22** Ventilation shall be sufficient to remove undesirable odors {#sec-16-51.79.22 omnilex-key=us-ms-regs-official--title-15--16#51.79.22}

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.79.23** All areas and surfaces shall be free of undesirable odors {#sec-16-51.79.23 omnilex-key=us-ms-regs-official--title-15--16#51.79.23}

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.79.24** Door locks and other structural restraints should be used minimally {#sec-16-51.79.24 omnilex-key=us-ms-regs-official--title-15--16#51.79.24}

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.79.25** The use of door locks or closed sections shall be approved by the professional staff and the governing body {#sec-16-51.79.25 omnilex-key=us-ms-regs-official--title-15--16#51.79.25}

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.79.26** Rule 51.79.26 {#sec-16-51.79.26 omnilex-key=us-ms-regs-official--title-15--16#51.79.26}

The facility shall have written policies and procedures to facilitate staff-patient interaction, particularly when structural barriers in the therapeutic environment separate staff from patients.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.79.27** Staff should respect a patient's right to privacy by knocking on the door of the patient's room before entering {#sec-16-51.79.27 omnilex-key=us-ms-regs-official--title-15--16#51.79.27}

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.79.28** Areas with the following characteristics shall be available to meet the needs of patients: 1 {#sec-16-51.79.28 omnilex-key=us-ms-regs-official--title-15--16#51.79.28}

Areas that accommodate a full range of social activities, from two-person conversations to group activities; 2. Attractively furnished areas in which a patient can be alone, when appropriate; and 3. Attractively furnished areas for private conversations with other occupants, family or friends.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.79.29** Appropriate furnishings and equipment shall be available {#sec-16-51.79.29 omnilex-key=us-ms-regs-official--title-15--16#51.79.29}

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.79.30** Furnishings shall be clean and in good repair {#sec-16-51.79.30 omnilex-key=us-ms-regs-official--title-15--16#51.79.30}

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.79.31** Furnishings shall be appropriate to the age and physical conditions of the patients {#sec-16-51.79.31 omnilex-key=us-ms-regs-official--title-15--16#51.79.31}

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.79.32** All furnishings, equipment, and appliances shall be maintained in good operating order {#sec-16-51.79.32 omnilex-key=us-ms-regs-official--title-15--16#51.79.32}

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.79.33** Broken furnishings and equipment shall be repaired promptly {#sec-16-51.79.33 omnilex-key=us-ms-regs-official--title-15--16#51.79.33}

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.79.34** Dining areas shall be comfortable, attractive, and conducive to pleasant living {#sec-16-51.79.34 omnilex-key=us-ms-regs-official--title-15--16#51.79.34}

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.79.35** Rule 51.79.35 {#sec-16-51.79.35 omnilex-key=us-ms-regs-official--title-15--16#51.79.35}

Dining arrangements shall be based on a logical plan that meets the needs of the patients and the requirements of the facility.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.79.36** Rule 51.79.36 {#sec-16-51.79.36 omnilex-key=us-ms-regs-official--title-15--16#51.79.36}

Dining tables should seat small groups of patients, unless other arrangements are justified on the basis of patient needs.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.79.37** Rule 51.79.37 {#sec-16-51.79.37 omnilex-key=us-ms-regs-official--title-15--16#51.79.37}

When staff members do not eat with the patients, the dining rooms shall be adequately supervised and staffed to provide assistance to patients when needed and to assure that each patient received an adequate amount and variety of food.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.79.38** Sleeping areas shall have doors for privacy {#sec-16-51.79.38 omnilex-key=us-ms-regs-official--title-15--16#51.79.38}

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.79.39** Patient rooms shall contain no more than four patients {#sec-16-51.79.39 omnilex-key=us-ms-regs-official--title-15--16#51.79.39}

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.79.40** Rule 51.79.40 {#sec-16-51.79.40 omnilex-key=us-ms-regs-official--title-15--16#51.79.40}

The number of patients in a room shall be appropriate to the ages, developmental levels, and clinical needs of the patients and to the goals of the facility.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.79.41** Sleeping areas shall be assigned on the basis of individual needs {#sec-16-51.79.41 omnilex-key=us-ms-regs-official--title-15--16#51.79.41}

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.79.42** Areas shall be provided for personal hygiene {#sec-16-51.79.42 omnilex-key=us-ms-regs-official--title-15--16#51.79.42}

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.79.43** The areas for personal hygiene shall provide privacy {#sec-16-51.79.43 omnilex-key=us-ms-regs-official--title-15--16#51.79.43}

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.79.44** Bathrooms and toilets shall have partitions and doors {#sec-16-51.79.44 omnilex-key=us-ms-regs-official--title-15--16#51.79.44}

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.79.45** Toilets shall have seats {#sec-16-51.79.45 omnilex-key=us-ms-regs-official--title-15--16#51.79.45}

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.79.46** Rule 51.79.46 {#sec-16-51.79.46 omnilex-key=us-ms-regs-official--title-15--16#51.79.46}

Good standards of personal hygiene and grooming shall be taught and maintained, particularly in regard to bathing, brushing teeth, caring for hair and nails, and using the toilet.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.79.47** Rule 51.79.47 {#sec-16-51.79.47 omnilex-key=us-ms-regs-official--title-15--16#51.79.47}

Patients shall have the personal help needed to perform these activities and, when indicated, to assume responsibility for self-care.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.79.48** The services of a barber and beautician shall be available to patients either within the facility or in the community {#sec-16-51.79.48 omnilex-key=us-ms-regs-official--title-15--16#51.79.48}

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.79.49** Rule 51.79.49 {#sec-16-51.79.49 omnilex-key=us-ms-regs-official--title-15--16#51.79.49}

Articles for grooming and personal hygiene that are appropriate to the patient's age, developmental level, and clinical status shall be readily available in a space reserved near the patient's sleeping area.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.79.50** If clinically indicated, a patient's personal articles may be kept under lock and key by staff {#sec-16-51.79.50 omnilex-key=us-ms-regs-official--title-15--16#51.79.50}

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.79.51** Ample closet and drawer space shall be provided for storing personal property and property provided for patient's use {#sec-16-51.79.51 omnilex-key=us-ms-regs-official--title-15--16#51.79.51}

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.79.52** Lockable storage space should be provided {#sec-16-51.79.52 omnilex-key=us-ms-regs-official--title-15--16#51.79.52}

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.79.53** Rule 51.79.53 {#sec-16-51.79.53 omnilex-key=us-ms-regs-official--title-15--16#51.79.53}

Patients shall be allowed to keep and display personal belongings and to add personal touches to the decoration of their rooms.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.79.54** The facility should have written rules to govern the appropriateness of such decorative display {#sec-16-51.79.54 omnilex-key=us-ms-regs-official--title-15--16#51.79.54}

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.79.55** Rule 51.79.55 {#sec-16-51.79.55 omnilex-key=us-ms-regs-official--title-15--16#51.79.55}

If access to potentially dangerous grooming aides or other personal articles is contraindicated for clinical reasons, the professional staff shall explain to the patient the conditions under which the articles may be used and shall document

the clinical rationale for these conditions under which the articles may be used and shall document the clinical rationale for these conditions in the patient's record.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.79.56** Rule 51.79.56 {#sec-16-51.79.56 omnilex-key=us-ms-regs-official--title-15--16#51.79.56}

If the hanging of pictures on walls and similar activities are privileges to be earned for treatment purposes, the professional staff shall explain to the patient the conditions under which the privileges may be granted and shall document the treatment and granting of privileges in the patient's record.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.79.57** Rule 51.79.57 {#sec-16-51.79.57 omnilex-key=us-ms-regs-official--title-15--16#51.79.57}

Patients shall be encouraged to take responsibility for maintaining their own living quarters and for other day-to-day housekeeping activities of the program, as appropriate to their clinical status.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.79.58** Rule 51.79.58 {#sec-16-51.79.58 omnilex-key=us-ms-regs-official--title-15--16#51.79.58}

Such responsibilities shall be clearly defined in writing, and staff assistance and equipment shall be provided as needed.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.79.59** Descriptions of such responsibilities shall be included in the patients' orientation program {#sec-16-51.79.59 omnilex-key=us-ms-regs-official--title-15--16#51.79.59}

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.79.60** Documentation shall be provided that these responsibilities have been incorporated into the patient's treatment plan {#sec-16-51.79.60 omnilex-key=us-ms-regs-official--title-15--16#51.79.60}

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.79.61** Patients shall be allowed to wear their own clothing {#sec-16-51.79.61 omnilex-key=us-ms-regs-official--title-15--16#51.79.61}

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.79.62** If clothing is provided by the program, it shall be appropriate and shall not be dehumanizing {#sec-16-51.79.62 omnilex-key=us-ms-regs-official--title-15--16#51.79.62}

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.79.63** Training and help in the selection and proper care of clothing shall be available as appropriate {#sec-16-51.79.63 omnilex-key=us-ms-regs-official--title-15--16#51.79.63}

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.79.64** Clothing shall be suited to the climate {#sec-16-51.79.64 omnilex-key=us-ms-regs-official--title-15--16#51.79.64}

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.79.65** Rule 51.79.65 {#sec-16-51.79.65 omnilex-key=us-ms-regs-official--title-15--16#51.79.65}

Clothing shall be becoming, in good repair, of proper size, and similar to the clothing worn by the patient's peers in the community.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.79.66** An adequate amount of clothing shall be available to permit laundering, cleaning, and repair {#sec-16-51.79.66 omnilex-key=us-ms-regs-official--title-15--16#51.79.66}

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.79.67** A laundry room should be accessible so patients may wash their clothing with appropriate supervision {#sec-16-51.79.67 omnilex-key=us-ms-regs-official--title-15--16#51.79.67}

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.79.68** Rule 51.79.68 {#sec-16-51.79.68 omnilex-key=us-ms-regs-official--title-15--16#51.79.68}

The use and location of noise-producing equipment and appliances, such as television, radios, and record players, shall not interfere with other therapeutic activities.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.79.69** A place and equipment shall be provided for table games and individual hobbies {#sec-16-51.79.69 omnilex-key=us-ms-regs-official--title-15--16#51.79.69}

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.79.70** Toys, equipment, and games shall be stored on shelves that are accessible to patients as appropriate {#sec-16-51.79.70 omnilex-key=us-ms-regs-official--title-15--16#51.79.70}

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.79.71** Rule 51.79.71 {#sec-16-51.79.71 omnilex-key=us-ms-regs-official--title-15--16#51.79.71}

Books, magazines, and arts and crafts materials shall be available in accordance with patients' recreational, cultural, and educational backgrounds and needs.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.79.72** Rule 51.79.72 {#sec-16-51.79.72 omnilex-key=us-ms-regs-official--title-15--16#51.79.72}

Each facility shall formulate its own policy regarding the availability and care of pets and other animals, consistent with the goals of the facility and with the requirements of good health and sanitation.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.79.73** Rule 51.79.73 {#sec-16-51.79.73 omnilex-key=us-ms-regs-official--title-15--16#51.79.73}

Depending on the size of the program, facilities shall be available for serving snacks and preparing meals for special occasions and recreational activities, for example, baking cookies or making popcorn or candy. These facilities shall permit patient participation.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.79.74** Rule 51.79.74 {#sec-16-51.79.74 omnilex-key=us-ms-regs-official--title-15--16#51.79.74}

Unless contraindicated for therapeutic reasons, the facility shall accommodate the patients' need to be outdoors through the use of nearby parks and playgrounds, adjacent countryside, and facility grounds.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.79.75** Rule 51.79.75 {#sec-16-51.79.75 omnilex-key=us-ms-regs-official--title-15--16#51.79.75}

Recreational facilities and equipment shall be available, consistent with the patients' needs and the therapeutic program.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.79.76** Recreational equipment shall be maintained in working order {#sec-16-51.79.76 omnilex-key=us-ms-regs-official--title-15--16#51.79.76}

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.79.77** The environment shall be maintained and equipped so as to ensure the health and safety of the patients {#sec-16-51.79.77 omnilex-key=us-ms-regs-official--title-15--16#51.79.77}

Physical health and safety features of the environment shall conform to requirements of local, state, and federal authorities having jurisdiction. In any event, the facility shall provide verification of the following: 1. Patients shall be protected against the danger of fire and smoke; 2. Patients shall be protected against injury attributable to the design and equipment of the environment; 3. Patients shall be protected against electrical hazard; and 4. Patients shall be protected against spread of disease and infection.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.79.78** Fire Control and Internal Disaster {#sec-16-51.79.78 omnilex-key=us-ms-regs-official--title-15--16#51.79.78}

The facility shall provide fire protection by the elimination of fire hazards, by the installation of necessary safeguards such as extinguishers, sprinkling devices, fire barriers to insure rapid and effective fire control and the adoption of written fire control and evacuation plans rehearsed at least three times a year by key personnel.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.79.79** Rule 51.79.79 {#sec-16-51.79.79 omnilex-key=us-ms-regs-official--title-15--16#51.79.79}

Written fire control plans shall contain provisions for prompt reporting of all fire extinguishing fires; protection of patients, personnel and guests evacuation; training of personnel in use of first aid fire fighting equipment and cooperation with fire fighting authorities.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.79.80** The facility shall have: {#sec-16-51.79.80 omnilex-key=us-ms-regs-official--title-15--16#51.79.80}

1. Written evidence of regular inspections and approval by state or local fire control agencies; 2. Stairwells kept closed by fire doors and equipped with unimpaired automatic closing devices; 3. Fire extinguishers refilled when necessary and kept in condition for instant use. There shall be an annual inspection of each fire extinguisher which shall include a tag showing the month and year of the inspection and the initials of the inspector. Each liquid type extinguisher shall be hydrostatically tested every five years; 4. Proper routine storage and prompt disposal of trash; 5. "No Smoking" signs prominently displayed where appropriate, with rules governing the ban on smoking in designated areas enforced and obeyed by all personnel; 6. Fire regulations easily available to all personnel and all fire codes rigidly observed and carried out; and 7. Corridors and exits clear of all obstructions except for permanently mounted handrails.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13 Subchapter 80 PHYSICAL PLANT CONSTRUCTION Rule 51.80.1 General. Every institution subject to these Minimum Standards shall be housed in a safe building which contains all the facilities required to render the services contemplated in the application for license.*
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.80.2** Codes {#sec-16-51.80.2 omnilex-key=us-ms-regs-official--title-15--16#51.80.2}

The term "safe" as used in Subchapter 80 hereof shall be interpreted in the light of compliance with the requirements of the latest codes presently in effect, which are incorporated by reference as a part of these Minimum Standards; National Fire Codes which includes the Life Safety Code, National Fire Protection Association or Standard Building Code, Southern Building Code Congress and Standard Plumbing Code, Southern Building Code Congress or American Standard National Plumbing Code, American Standards Association No. 17.3; and Sanitary Code of the Mississippi Department of Health.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.80.3** New buildings must conform to the codes listed in the paragraph above {#sec-16-51.80.3 omnilex-key=us-ms-regs-official--title-15--16#51.80.3}

Where a choice of codes is provided above, an applicant may choose which of the codes he will follow, and the provisions of the code chosen shall apply throughout except to the extent that these Minimum Standards specifically permit deviation therefrom.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13 Subchapter 81 SUBMISSION OF PLANS AND SPECIFICATIONS Rule 51.81.1 Construction shall not be started for any institution subject to these standards (whether new or remodeling or additions to an existing facility) until the plans and specifications for such construction or remodeling have been submitted to the Licensing Agency in writing and its approval of the changes given in writing.*
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.81.2** Exception {#sec-16-51.81.2 omnilex-key=us-ms-regs-official--title-15--16#51.81.2}

Foundation changes made necessary by unanticipated conditions, or any conditions which present a hazard to life or property if not immediately corrected.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.81.3** Rule 51.81.3 {#sec-16-51.81.3 omnilex-key=us-ms-regs-official--title-15--16#51.81.3}

Plans and specifications for any substantial construction or remodeling should be prepared by competent architects and engineers licensed to practice in the state and who assume responsibility for supervising the construction. The following plans shall be submitted to the Licensing Agency for review: 1. Preliminary Plans - To include schematics of building, plot plans showing size and shape of entire site, existing structures, if any, streets and location and characteristics of all needed utilities, floor plans of every floor diminished and with proposed use of each room or area shown. If for additions or remodeling, plan of existing building showing all proposed alterations, outline specifications to include a general description of the construction, type of finishes, and type of heating, ventilating, plumbing and electrical systems proposed. 2. Final Working Drawings and Specifications - Complete and in sufficient detail to be the basis for the award of construction contracts.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.81.4** Rule 51.81.4 {#sec-16-51.81.4 omnilex-key=us-ms-regs-official--title-15--16#51.81.4}

All plans submitted for review must be accompanied in their first submission by an order of the governing board indicating the type and scope of license to be applied for.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.81.5** Rule 51.81.5 {#sec-16-51.81.5 omnilex-key=us-ms-regs-official--title-15--16#51.81.5}

Plans receiving approval by the Licensing Agency upon which construction has not begun within six (6) months following such approval must be resubmitted for approval.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.81.6** Rule 51.81.6 {#sec-16-51.81.6 omnilex-key=us-ms-regs-official--title-15--16#51.81.6}

In all new facilities, plans must be submitted to all regulatory agencies, such as the County Health Department, etc., for approval prior to starting construction.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.81.7** Rule 51.81.7 {#sec-16-51.81.7 omnilex-key=us-ms-regs-official--title-15--16#51.81.7}

Upon completion of construction an inspection shall be made by the Licensing Agency and approval given prior to occupying the building or any part thereof.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.81.8** Environment {#sec-16-51.81.8 omnilex-key=us-ms-regs-official--title-15--16#51.81.8}

All facilities shall be so located that they are reasonably free from undue noises, smoke, dust or foul odors, and should not be located adjacent to railroads, freight yards, schools, children's playgrounds, airports, industrial plants or disposal plants.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.81.9** Zoning Restrictions {#sec-16-51.81.9 omnilex-key=us-ms-regs-official--title-15--16#51.81.9}

The locations of an institution shall comply with all local zoning ordinances.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.81.10** Access {#sec-16-51.81.10 omnilex-key=us-ms-regs-official--title-15--16#51.81.10}

Institutions located in rural areas must be served by good roads which can be kept passable at all times.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.81.11** Elements of Construction {#sec-16-51.81.11 omnilex-key=us-ms-regs-official--title-15--16#51.81.11}

Corridors-shall be 6'0" wide and 7'6" high (clear). The surface of all floors and walls shall be washable. All corridors longer than 150' shall be subdivided by a smoke barrier and must be maintained free of obstruction.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.81.12** Doors {#sec-16-51.81.12 omnilex-key=us-ms-regs-official--title-15--16#51.81.12}

All doors in corridors shall be 20-minutes fire rated floors (1-3/4" solid core wood door as a minimum). All doors to patient bedrooms, diagnostic and treatment areas, and other doors used by residents shall be at least 36" wide. No door shall swing into the corridor except closet doors. Doors to hazardous areas defined in the Life Safety Code shall be 1-1/2 hours "B" labeled fire doors. Exit doors shall conform to the requirements set forth in the Life Safety Code.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.81.13** Stairs {#sec-16-51.81.13 omnilex-key=us-ms-regs-official--title-15--16#51.81.13}

Shall be 44" wide, minimum; be in a 2-hour fire enclosure; and have a "B" (1-1/2 hour) level door at all landings.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.81.14** Elevators {#sec-16-51.81.14 omnilex-key=us-ms-regs-official--title-15--16#51.81.14}

One power driven elevator is required in all facilities having patient rooms above the first floor. Two or more elevators are required if 60 or more patients are housed above the ground floor.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.81.15** One-Story Building {#sec-16-51.81.15 omnilex-key=us-ms-regs-official--title-15--16#51.81.15}

Wall, ceiling and roof construction shall be of a type approved as being of 1-hour fire resistive construction as defined by National Bureau of Fire Underwriters or the Bureau of Standards. Floor systems shall be of non-combustible construction.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.81.16** Multi-Story Building {#sec-16-51.81.16 omnilex-key=us-ms-regs-official--title-15--16#51.81.16}

Must be of two-hour fire resistive constructions as defined in Standard Building Code or comply with the Life Safety Code of National Fire Protection Association as applied to hospitals.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.81.17** Fire Reporting and Protection {#sec-16-51.81.17 omnilex-key=us-ms-regs-official--title-15--16#51.81.17}

A manually operated electrically supervised fire alarm system shall be installed in each facility. There must be a telephone in the building to summon help in case of fire.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.81.18** Sprinkler systems tied into the fire alarm system shall be provided at least for hazardous areas {#sec-16-51.81.18 omnilex-key=us-ms-regs-official--title-15--16#51.81.18}

Adequate water supply shall be provided for the sprinkler system. Hazardous areas are: Laundries, Storage Areas, Repair and Maintenance Shops, Soiled Linen Collection Rooms, Trash Collection Rooms, Laundry Chutes, and Trash Chutes.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.81.19** Rule 51.81.19 {#sec-16-51.81.19 omnilex-key=us-ms-regs-official--title-15--16#51.81.19}

Flame Spread Rate (ASTM Standard E84-61) on all wall and ceiling surfaces in required exists and hazardous areas shall be 25 or less. All other areas shall have a flame spread rating of not more than 75, except that up to 10% of the aggregate wall and ceiling area may have a finish with a rating up to 200.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.81.20** Heating and Ventilating {#sec-16-51.81.20 omnilex-key=us-ms-regs-official--title-15--16#51.81.20}

Suitable artificial heat shall be furnished to maintain 75 degrees F, inside temperature with 10 degrees F, outside temperature. Circulating hot water from a remote boiler or vapor-steam with circulating pumps and controls on emergency electrical service to provide heating in case of power failures are the preferred methods of heating. Electrical heating will be approved provided a standby electric generator is provided of capacity to furnish 80% of the maximum heating load in addition to other power and lighting loads that may be connected to it, or the facility is supplied by two electric service lines connected

to separate transformers at the sub-station so arranged that electric services can be maintained in case of failure of one line or transformer. Direct fired units are forbidden except in areas such as laundries, storerooms, kitchens, and similar occupancies and then only if in ductwork or more than 8 feet above the floor. Open flame heaters are prohibited. Gas fired ranges and other appliances (except Bunsen burners) may be used where no hazard is created, but must be services with rigid pipe connections. Gas fired sterilizer, water heater, and other like appliances shall have provided adequate air intake for combustion and full venting for combustion products. No hall will be used as a plenum. Mechanical ventilation shall be installed in all toilets and janitors closets.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.81.21** Toilets, janitors’ closets, soiled linen, dishwashing and similar areas shall have six (6) air changes per hour {#sec-16-51.81.21 omnilex-key=us-ms-regs-official--title-15--16#51.81.21}

Areas occupied by patients shall have two (2) air changes per hour.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.81.22** Plumbing {#sec-16-51.81.22 omnilex-key=us-ms-regs-official--title-15--16#51.81.22}

All institutions subject to these standards shall be connected to an approved municipal water system or to a private supply whose purity has been certified by the laboratory of the Mississippi Department of Health. Private supplies must be sampled, tested, and its purity certified at least twice annually and immediately following any repair or modification to the underground lines, the elevated tank, or to the well or pump. Supply must be adequate, both as to volume and pressure, for fire fighting purposes. Deficiencies in either must be remedied by the provision of auxiliary pumps, pressure tanks or elevated tanks as may be required.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.81.23** An approved circulating method of supplying hot water for all uses must be provided {#sec-16-51.81.23 omnilex-key=us-ms-regs-official--title-15--16#51.81.23}

Water to lavatories and bathing areas must be 100 degrees-110 degrees F. Water to mechanical dishwashers must be delivered at 180 degrees F. for rinsing.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.81.24** Rule 51.81.24 {#sec-16-51.81.24 omnilex-key=us-ms-regs-official--title-15--16#51.81.24}

Supply piping within the building shall be in accordance with plumbing code incorporated by reference in Rule 51.81.22 hereof. Special care must be taken to avoid use of any device or installation which might cause contamination of the supply through back-siphonage or cross connections.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.81.25** Sewage Disposal {#sec-16-51.81.25 omnilex-key=us-ms-regs-official--title-15--16#51.81.25}

All institutions subject to these standards shall dispose of all sanitary wastes through connection to a suitable municipal sewerage system or through a private sewerage system that has been approved in writing by the

Sanitary Engineering Department of the Mississippi Department of Health and the Air and Water Pollution Board.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.81.26** Rule 51.81.26 {#sec-16-51.81.26 omnilex-key=us-ms-regs-official--title-15--16#51.81.26}

All fixtures located in the kitchen, including the dishwasher, shall be installed so as to empty into a drain which is not directly connected to the sanitary house drain. Kitchen drain may empty into a manhole or catch basin having a perforated cover with an elevation of at least 24" below the kitchen floor elevation, and thence to the sewer. Exceptions: existing licensed institutions which have no plumbing fixtures installed on floors which are above the floor on which the kitchen is located.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13 Subchapter 82 EMERGENCY ELECTRIC SERVICE Rule 51.82.1 General: To provide electricity during an interruption of the normal electric supply that could affect the medical care, treatment, or safety of the occupants, an emergency source of electricity shall be provided and connected to certain circuits for lighting and power. The source of this emergency electric service shall be an emergency generator, with a stand-by supply of fuel of 24 hours. Emergency electrical systems shall be provided in accordance with the applicable section of the Life Safety Code.*
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.82.2** Patient Rooms {#sec-16-51.82.2 omnilex-key=us-ms-regs-official--title-15--16#51.82.2}

Each patient room shall meet the following requirements: 1. Shall contain 100 sq. ft. of floor area for a single bedroom and 80 sq. ft. per bed in multi-bedrooms; 2. Ceiling Height. Shall be 8'0" minimum; 3. All rooms housing patients shall be outside rooms and shall have window area equal to 1/8 of the floor area. The sill shall not be higher than 36 inches above the floor and shall be above grade. Windows shall not have any obstruction to vision (wall, cooling tower, etc.) within 50 feet as measured perpendicular to the plane of the window; 4. Each patient shall be provided with a hanging storage space of not less than 16" X 24" X 52" for his personal belongings; 5. Each patient room shall be equipped with a quality bed acceptable for his environment; 6. A bedside cabinet or table shall be provided;

7. Rooms shall be equipped with curtains or blinds at windows. All curtains shall have a flame spread of 25 or less; 8. All walls shall be suitable for washing; 9. All walls and ceilings shall have a 1-hour fire rating; 10. A lavatory shall be located in the bedroom or in a private toilet room; and 11. Patient bed light shall be provided which shall be capable of control by the patient.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.82.3** Service Areas {#sec-16-51.82.3 omnilex-key=us-ms-regs-official--title-15--16#51.82.3}

The size of each service area will depend on the number beds within the unit and shall include the following: 1. Nurses Station. For charting, communication and storage for supplies and nurses personal effects; 2. Nurses Toilet with Lavatory. Convenient to nurses’ station; 3. Clean Work Room. For storage and assembly of supplies. Shall contain storage cabinets or storage carts, work counter and sink; 4. Soiled Utility. Shall contain deep sink work counter, waste receptacle, soiled linen receptacle; 5. Medicine Station. Adjacent to nurses’ station, with sink, small refrigerator, locked storage and work counter. (May be in clean work room in self-contained cabinet.); 6. Clean Linen Storage. A closet large enough to hold an adequate supply of clean linen; 7. Provision for between-meal nourishments; 8. Patient Bath. At least one tub or shower stall for each 18 patients not served by private bath; 9. Fire Extinguisher. One approved Class 2A unit for each 3000 sq/ ft.; and 10. Janitor's Closet. Closet large enough to contain floor receptor with plumbing and space for some supplies and mop buckets.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.82.4** Special Care Room for Isolation {#sec-16-51.82.4 omnilex-key=us-ms-regs-official--title-15--16#51.82.4}

It shall contain: 1. One patient bed per room; and

2. Private lavatory and toilet.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.82.5** Seclusion Room {#sec-16-51.82.5 omnilex-key=us-ms-regs-official--title-15--16#51.82.5}

If a seclusion room is provided, it shall be provided with a key- only lock or an electronic lock on the door tied into the fire alarm system, and a security screen on the window.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.82.6** Dietary {#sec-16-51.82.6 omnilex-key=us-ms-regs-official--title-15--16#51.82.6}

Construction and equipment shall comply with Mississippi Department of Health regulations, and shall include: 1. Food preparation center. Provide lavatory (without mirror) with wrist action blades, soap dispenser and disposable towel dispenser. All cooking appliances to have ventilating hood; 2. Food serving facilities. If dining space is provided, it shall contain a minimum of 15 sq. ft. per person seated; 3. Dishwashing room. Provide commercial type dishwashing equipment; 4. Pot washing facilities; 5. Refrigerated storage (three day supply); 6. Day storage (three day supply); 7. Cart cleaning facilities (can be in dishwashing room); 8. Can wash and storage (must be fly-tight); 9. Cart storage; 10. Dietitian's office; 11. Janitors closet; 12. Personnel toilets and lockers convenient to, but not in, the kitchen proper; and 13. Approved automatic fire extinguisher system in range hood. In addition, Class 1B extinguisher to be installed in the kitchen.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.82.7** Administrative Area: To include: 1 {#sec-16-51.82.7 omnilex-key=us-ms-regs-official--title-15--16#51.82.7}

Business office with information desk, and personnel toilets;

2. Administrator's office; 3. Admitting area; 4. Lobby or foyer, with public toilets; 5. Medical Library (This area should be as close to medical records as possible); 6. Space for conferences and in-service training; 7. Medical records--office and storage; 8. Director of Nurses' office; and 9. Fire Extinguisher. An approved Class 2A unit shall be provided.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.82.8** Housekeeping Area {#sec-16-51.82.8 omnilex-key=us-ms-regs-official--title-15--16#51.82.8}

To include: 1. Housekeeper's office or suitable area designated for record keeping; and 2. Storage space for the maid's carts, if used.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.82.9** Laundry {#sec-16-51.82.9 omnilex-key=us-ms-regs-official--title-15--16#51.82.9}

To include: 1. Soiled linen room with lavatory with wrist action blades; 2. Clean linen and mending area. (To include space for storage of clean linen carts); 3. Laundry process room. Commercial type equipment sufficient for the needs of the facility. (If laundry is processed outside facility, this area not needed); 4. Janitors closet; and 5. Facilities shall be provided for personal laundry for use by patients. This area shall be separated from areas by a one hour fire rated wall.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.82.10** General Storage {#sec-16-51.82.10 omnilex-key=us-ms-regs-official--title-15--16#51.82.10}

There shall be a two hour fire rated lockable room large enough to provide five square feet of general storage for each bed provided. If storage is provided in a separate building it must be fifty feet away.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.82.11** Boiler Room {#sec-16-51.82.11 omnilex-key=us-ms-regs-official--title-15--16#51.82.11}

Space shall be adequate for the installation and maintenance of the required machinery.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.82.12** Maintenance Area {#sec-16-51.82.12 omnilex-key=us-ms-regs-official--title-15--16#51.82.12}

Sufficient area for performing routine maintenance activities shall be provided and shall include an office or suitable area designated for recordkeeping.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.82.13** Day Room {#sec-16-51.82.13 omnilex-key=us-ms-regs-official--title-15--16#51.82.13}

At least two general areas for use as living room, day room or recreation shall be provided. A minimum of 18 square feet per patient bed shall be available for this purpose.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.82.14** Dining Room {#sec-16-51.82.14 omnilex-key=us-ms-regs-official--title-15--16#51.82.14}

A minimum of 15 square feet per patient bed shall be provided for use as a Dining Room. Adequate tables and chairs shall be provided to seat all patients, staff and guests.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.82.15** Counseling Rooms {#sec-16-51.82.15 omnilex-key=us-ms-regs-official--title-15--16#51.82.15}

At least one small room shall be provided for each 20 patients for the purpose of individual private treatment or counseling.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.82.16** Examination and Treatment Room {#sec-16-51.82.16 omnilex-key=us-ms-regs-official--title-15--16#51.82.16}

At least one room shall be provided for the purpose of examination and treatment. The room shall be equipped with a lavatory and towel dispenser, examination table and storage space, with adequate lighting.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.82.17** Group Counseling Rooms {#sec-16-51.82.17 omnilex-key=us-ms-regs-official--title-15--16#51.82.17}

At least two rooms shall be provided large enough to accommodate 8-10 patients for the purpose of group counseling sessions.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13 Subchapter 83 GLOSSARY Rule 51.83.1 Administrative. Relates to the fiscal and general management of a facility rather than to the direct provision of services to patients.*
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.83.2** Aftercare {#sec-16-51.83.2 omnilex-key=us-ms-regs-official--title-15--16#51.83.2}

Services that are provided to a patient after discharge and that support and increase the gains made during treatment.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.83.3** Applicant {#sec-16-51.83.3 omnilex-key=us-ms-regs-official--title-15--16#51.83.3}

An individual who has applied for admission to a program but who has not completed the intake process.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.83.4** Approved {#sec-16-51.83.4 omnilex-key=us-ms-regs-official--title-15--16#51.83.4}

Acceptable to the authority having jurisdiction.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.83.5** Assessment {#sec-16-51.83.5 omnilex-key=us-ms-regs-official--title-15--16#51.83.5}

Those procedures by which a program evaluates an individual's strengths, weakness, problems and needs.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.83.6** Audiological Assessment {#sec-16-51.83.6 omnilex-key=us-ms-regs-official--title-15--16#51.83.6}

The audiological tests for delineating the site of auditory dysfunction, including such tests as pure tone air-conduction and bone- conduction threshold, speech reception thresholds, speech discrimination measurements, impedance measurements, and others.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.83.7** Audiologists, Qualified {#sec-16-51.83.7 omnilex-key=us-ms-regs-official--title-15--16#51.83.7}

An individual who is certified by the American Speech- Language-Hearing Association as clinically competent in the area of audiology and is licensed by the State.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.83.8** Audiometric Screening {#sec-16-51.83.8 omnilex-key=us-ms-regs-official--title-15--16#51.83.8}

A process that may include such tests as pure tone aid conduction thresholds, pure tone air-conduction thresholds, pure tone air- conduction suprathreshold screenings, impedance measurements, or observations of reactions to auditory stimuli.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.83.9** Audit, Financial {#sec-16-51.83.9 omnilex-key=us-ms-regs-official--title-15--16#51.83.9}

An independent review by a public accountant certifying that a facility's financial reports reflect its financial status.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.83.10** Authentication {#sec-16-51.83.10 omnilex-key=us-ms-regs-official--title-15--16#51.83.10}

Proof of authority and responsibility by written signature, identifiable initials, computer key, or other method. The use of a rubber stamp signature is acceptable only under the following conditions: the person whose signature the rubber stamp represents is the only one who has possession of the stamp and is the only one who uses it, and this person gives the chief executive officer a signed statement that he or she is the only one who has the stamp and is the only one who will use it.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.83.11** Authority Having Jurisdiction {#sec-16-51.83.11 omnilex-key=us-ms-regs-official--title-15--16#51.83.11}

The organization, office, or individual responsible for approving a piece of equipment, an installation, or a procedure.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.83.12** Bylaws {#sec-16-51.83.12 omnilex-key=us-ms-regs-official--title-15--16#51.83.12}

The laws, rules, or regulations adopted for the government of the facility. Also used for the laws, rules, or regulations of the professional staff.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.83.13** Chief Executive Officer {#sec-16-51.83.13 omnilex-key=us-ms-regs-official--title-15--16#51.83.13}

A job-descriptive term used to identify the individual appointed by the governing body to act on its behalf in the overall management of the facility. Other job titles may include administrator, superintendent, director, president, vice-president, and executive vice-president.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.83.14** Child Psychiatrist, Qualified {#sec-16-51.83.14 omnilex-key=us-ms-regs-official--title-15--16#51.83.14}

A doctor of medicine who specializes in the assessment and treatment of children and/or adolescents having psychiatric disorders and who is fully licensed to practice medicine in the state in which he or she practices. The individual shall have successfully completed training in a child psychiatry fellowship program approved by the Liaison Committee on Graduate Medical Education of the American Medical Association or have been certified in child psychiatry by the American Board of Psychiatry and Neurology.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.83.15** Child Psychologist, Qualified {#sec-16-51.83.15 omnilex-key=us-ms-regs-official--title-15--16#51.83.15}

An individual licensed by the State Board of Psychological Examiners with a specialty area in either developmental psychology or in clinical or counseling psychology with demonstrated educational background and experience in the evaluation and treatment of children and/or adolescents.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.83.16** Department {#sec-16-51.83.16 omnilex-key=us-ms-regs-official--title-15--16#51.83.16}

A staff entity organized on administrative, functional, or disciplinary lines.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.83.17** Dietetic Services {#sec-16-51.83.17 omnilex-key=us-ms-regs-official--title-15--16#51.83.17}

The provision of services to meet the nutritional needs of patients, with specific emphasis on patients who have special dietary needs, for example, patients who are allergic to certain foods or who cannot accept a regular diet.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.83.18** Diet Manual {#sec-16-51.83.18 omnilex-key=us-ms-regs-official--title-15--16#51.83.18}

An up-to-date, organized system for standardizing the ordering of diets.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.83.19** Discharge {#sec-16-51.83.19 omnilex-key=us-ms-regs-official--title-15--16#51.83.19}

The point at which the patient's active involvement with a facility is terminated and the facility no longer maintains active responsibility for the patient.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.83.20** Drug History {#sec-16-51.83.20 omnilex-key=us-ms-regs-official--title-15--16#51.83.20}

A delineation of the drugs used by a patient, including prescribed and unprescribed drugs and alcohol. A drug history includes, but is not necessarily limited to, the following: drugs used in the past; drugs used recently, especially within the preceding 48 hours; drugs of preference; frequency with which each drug is used; route of administration of each drug; drugs used in combination; dosages used; year of first use of each drug; previous occurrences of overdose, withdrawal, or adverse drug reactions; and history or previous treatment received for alcohol or drug abuse.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.83.21** Emergency Kit {#sec-16-51.83.21 omnilex-key=us-ms-regs-official--title-15--16#51.83.21}

A kit designed to provide the medical supplies and pharmaceutical agents required during an emergency. In compiling emergency kits, staff should consider the patients' needs for psychotropic, anticholinergic, and adrenalin agents.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.83.22** External Disaster {#sec-16-51.83.22 omnilex-key=us-ms-regs-official--title-15--16#51.83.22}

A catastrophe that occurs outside the facility and for which the facility, based on its size, and resources must be prepared to serve the community.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.83.23** Facility {#sec-16-51.83.23 omnilex-key=us-ms-regs-official--title-15--16#51.83.23}

An organization that provides psychiatric substance abuse, and/or mental health services to patients.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.83.24** Fiscal Management {#sec-16-51.83.24 omnilex-key=us-ms-regs-official--title-15--16#51.83.24}

Procedures used to control a facility's overall financial and general operations. Such procedures may include cost accounting, program budgeting, materials purchasing, and patient billing.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.83.25** Formulary {#sec-16-51.83.25 omnilex-key=us-ms-regs-official--title-15--16#51.83.25}

A catalog of the pharmaceuticals approved for use in a facility. A formulary lists the names of the drugs and information regarding dosage, contraindications, and unit dispensing size.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.83.26** Goal {#sec-16-51.83.26 omnilex-key=us-ms-regs-official--title-15--16#51.83.26}

An expected result or condition that takes time to achieve, that is specified in a statement of relatively broad scope, and that provides guidance in establishing intermediate objectives directed towards its attainment.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.83.27** Governing Body {#sec-16-51.83.27 omnilex-key=us-ms-regs-official--title-15--16#51.83.27}

The person or person with ultimate authority and responsibility for the overall operation of the facility.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.83.28** Guardian {#sec-16-51.83.28 omnilex-key=us-ms-regs-official--title-15--16#51.83.28}

A parent, trustee, committee, conservator, or other person or agency empowered by law to act on behalf of, or have responsibility for, an applicant or patient.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.83.29** Hazardous Area {#sec-16-51.83.29 omnilex-key=us-ms-regs-official--title-15--16#51.83.29}

Any area in which the following are used: products that are highly combustible, highly flammable, or explosive; or materials that are likely to burn with extreme rapidity or produce poisonous fumes or gases. Consult the 1972 edition of the Life Safety Code (NFPA 101) for further clarification.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.83.30** Hazardous Procedures {#sec-16-51.83.30 omnilex-key=us-ms-regs-official--title-15--16#51.83.30}

Procedures that place the patient at physical or psychological risk or in pain.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.83.31** Human Subject Research {#sec-16-51.83.31 omnilex-key=us-ms-regs-official--title-15--16#51.83.31}

The use of patients receiving services in the systematic study, observation, or evaluation of factors related to the prevention, assessment, treatment and understanding of an illness. This involves all behavioral and medical experimental research that involves human beings and experimental subjects.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.83.32** Incident Reports {#sec-16-51.83.32 omnilex-key=us-ms-regs-official--title-15--16#51.83.32}

Documentation of events or actions that are likely to lead to adverse effects and/or that vary from established policies and procedures pertaining to patient care.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.83.33** Intake {#sec-16-51.83.33 omnilex-key=us-ms-regs-official--title-15--16#51.83.33}

The administrative and assessment process for admission to a program.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.83.34** Interdisciplinary Team {#sec-16-51.83.34 omnilex-key=us-ms-regs-official--title-15--16#51.83.34}

A group of clinical staff composed of representative from different professions, disciplines, or service areas.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.83.35** Listed {#sec-16-51.83.35 omnilex-key=us-ms-regs-official--title-15--16#51.83.35}

Used to indicate equipment or materials included in a list published by a nationally recognized testing laboratory, inspection agency, or other organization concerned with product evaluation. The organization periodically inspects the production of listed equipment or materials, and the organization's list states that the equipment or material either meets nationally recognized standards or has been tested and found suitable for use in a specified manner.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.83.36** May {#sec-16-51.83.36 omnilex-key=us-ms-regs-official--title-15--16#51.83.36}

Used to reflect an acceptable method of compliance with a standard that is recognized but not preferred. See shall and should.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.83.37** Medical Record Administrator, Qualified {#sec-16-51.83.37 omnilex-key=us-ms-regs-official--title-15--16#51.83.37}

A registered record administrator who has successfully passed an appropriate examination conducted by the American Medical Record Association.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.83.38** Medical Record Technician, Qualified {#sec-16-51.83.38 omnilex-key=us-ms-regs-official--title-15--16#51.83.38}

An accredited record technician who has successfully passed the appropriate accreditation examination conducted by the American Medical Record Association.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.83.39** NFPA {#sec-16-51.83.39 omnilex-key=us-ms-regs-official--title-15--16#51.83.39}

National Fire Protection Association, 470 Atlantic Avenue, Boston, Massachusetts 02210.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.83.40** Nurse {#sec-16-51.83.40 omnilex-key=us-ms-regs-official--title-15--16#51.83.40}

A person licensed and registered to practice nursing in the state in which he or she practices.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.83.41** Nurse, Practical {#sec-16-51.83.41 omnilex-key=us-ms-regs-official--title-15--16#51.83.41}

A person licensed or registered as a practical or vocational nurse in the state in which he or she practices.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.83.42** Nurse, Psychiatric, Qualified and/or Psychiatric Mental Health Nurse Practitioners {#sec-16-51.83.42 omnilex-key=us-ms-regs-official--title-15--16#51.83.42}

A licensed nurse who has had at least three years of experience in psychiatric or mental health nursing and at least one year of experience in a supervisory position.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.83.43** Objective {#sec-16-51.83.43 omnilex-key=us-ms-regs-official--title-15--16#51.83.43}

An unexpected result or condition that takes less time to achieve than a goal, is stated in measurable terms, has a specified time for achievement, and is related to the attainment of a goal.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.83.44** Occupational Therapist, Qualified {#sec-16-51.83.44 omnilex-key=us-ms-regs-official--title-15--16#51.83.44}

An individual who is a graduate of an occupational therapy program approved by a nationally recognized accrediting body, or who currently holds certification by the American Occupational Therapy Association as an occupational therapist, registered, who meets any current legal requirements of licensure or registration; and who is currently competent in the field.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.83.45** Outreach {#sec-16-51.83.45 omnilex-key=us-ms-regs-official--title-15--16#51.83.45}

The process of systematically interacting with the community to identify persons in need of services, alert persons and their families to the availability of services, locate needed services, and enable persons to enter the service delivery system.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.83.46** Parenteral Product {#sec-16-51.83.46 omnilex-key=us-ms-regs-official--title-15--16#51.83.46}

Sterile, pharmaceutical preparations ingested by the body through a route other than the alimentary canal.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.83.47** Patient {#sec-16-51.83.47 omnilex-key=us-ms-regs-official--title-15--16#51.83.47}

An individual who receives treatment services. Patient is synonymous with client, resident, consumer, and recipient of treatment services.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.83.48** Personnel Record {#sec-16-51.83.48 omnilex-key=us-ms-regs-official--title-15--16#51.83.48}

The complete employment record of a staff member or an employee, including job application, education and employment history, performance evaluation, and, when applicable, evidence of current licensure, certification, or registration.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.83.49** Pharmacist, Qualified {#sec-16-51.83.49 omnilex-key=us-ms-regs-official--title-15--16#51.83.49}

An individual who has a degree in pharmacy and is licensed and registered to prepare, preserve, compound, and dispense drugs and chemicals in the state in which he or she practices.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.83.50** Physical Therapist {#sec-16-51.83.50 omnilex-key=us-ms-regs-official--title-15--16#51.83.50}

A graduate of a physical therapy program approved by a nationally recognized accrediting body, or shall hold current registration and is currently competent in the field.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.83.51** Physician, Qualified {#sec-16-51.83.51 omnilex-key=us-ms-regs-official--title-15--16#51.83.51}

A doctor of medicine or doctor of osteopathy who is fully licensed to practice medicine in the state in which he or she practices.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.83.52** Program {#sec-16-51.83.52 omnilex-key=us-ms-regs-official--title-15--16#51.83.52}

A general term for an organized system of services designed to address the treatment needs of patients.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.83.53** Program Evaluation {#sec-16-51.83.53 omnilex-key=us-ms-regs-official--title-15--16#51.83.53}

An assessment component of a facility that determines the degree to which a program is meeting its stated goals and objectives.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.83.54** Recreation Therapist, Qualified {#sec-16-51.83.54 omnilex-key=us-ms-regs-official--title-15--16#51.83.54}

An individual who is a qualified recreation specialist; or has a bachelors' degree in recreation and one year of recreational experience in a health care setting; or has an associate degree in recreation or in a specialty area such as art or music plus completion of comprehensive in-service training in recreation.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.83.55** Recreation Services {#sec-16-51.83.55 omnilex-key=us-ms-regs-official--title-15--16#51.83.55}

Structured activities designed to develop an individual's creative, physical, and social skills through participation in recreational, art, dance, drama, social, and other activities.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.83.56** Rehabilitation Counselor {#sec-16-51.83.56 omnilex-key=us-ms-regs-official--title-15--16#51.83.56}

An individual who has a bachelor's degree in rehabilitation counseling and three years of experience in working with children/adolescents.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.83.57** Restraint {#sec-16-51.83.57 omnilex-key=us-ms-regs-official--title-15--16#51.83.57}

A physical or mechanical device used to restrict the movement of the whole or a portion of a patient's body. This does not include mechanisms used to

assist a patient in obtaining and maintaining normative body functioning, for example, braces and wheelchairs.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.83.58** Seclusion {#sec-16-51.83.58 omnilex-key=us-ms-regs-official--title-15--16#51.83.58}

A procedure that isolates the patient to a specific environmental area removed from the patient community.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.83.59** Service {#sec-16-51.83.59 omnilex-key=us-ms-regs-official--title-15--16#51.83.59}

Used to indicate a functional division of a program or of the professional staff. Also used to indicate the delivery of care.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.83.60** Shall {#sec-16-51.83.60 omnilex-key=us-ms-regs-official--title-15--16#51.83.60}

Used to indicate a mandatory standard.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.83.61** Should {#sec-16-51.83.61 omnilex-key=us-ms-regs-official--title-15--16#51.83.61}

Used in a standard to indicate the commonly accepted method of compliance.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.83.62** Social Assessment {#sec-16-51.83.62 omnilex-key=us-ms-regs-official--title-15--16#51.83.62}

The process of evaluating each patient's environment, religious background, childhood developmental history, financial status, reasons for seeking treatment, and other pertinent information that may contribute to the development of the individualized treatment plan.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.83.63** Social Worker, Qualified {#sec-16-51.83.63 omnilex-key=us-ms-regs-official--title-15--16#51.83.63}

An individual who is licensed in the State with a master's degree from an institution accredited by the Council on Social Work Education, and is clinically qualified by training with two years experience in working with mentally ill children/adolescents.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.83.64** Speech Screening {#sec-16-51.83.64 omnilex-key=us-ms-regs-official--title-15--16#51.83.64}

A process that may include such tests as articulation in connected speech and formula testing situations; voice in terms of judgments of pitch, intensity, and quality and determinations of appropriate vocal hygiene; and fluency, usually measured in terms of frequency and severity of stuttering or dysfluency (based upon evaluation of speech flow-sequence, duration, rhythm, rate, and fluency).

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.83.65** Support Staff {#sec-16-51.83.65 omnilex-key=us-ms-regs-official--title-15--16#51.83.65}

Employees or volunteers whose primary work activities involve clerical, housekeeping, security, laboratory, recordkeeping, and other functions necessary for the overall clinical and administrative operation of the facility.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.83.66** Teacher, Qualified {#sec-16-51.83.66 omnilex-key=us-ms-regs-official--title-15--16#51.83.66}

An individual licensed and who has at least a bachelor's degree in education from an accredited institution. The individual shall have certification in special education, and preferably shall have training in the education or emotionally disturbed children/adolescents.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.83.67** Therapeutic Recreational Services {#sec-16-51.83.67 omnilex-key=us-ms-regs-official--title-15--16#51.83.67}

Goal-oriented activities designed to help an individual develop expressive and/or performance skills through participation in art, crafts, dance, drama, movement, music, prevocational, recreation, self-care, and social activities.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.83.68** Transfer {#sec-16-51.83.68 omnilex-key=us-ms-regs-official--title-15--16#51.83.68}

Movement of a patient from one treatment service or location to another.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.83.69** Utilization Review {#sec-16-51.83.69 omnilex-key=us-ms-regs-official--title-15--16#51.83.69}

The process of using predefined criteria to evaluate the necessity and appropriateness of allocated services and resources to assure the facility's services are necessary, cost efficient, and effectively utilized.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.83.70** Vocational Assessments {#sec-16-51.83.70 omnilex-key=us-ms-regs-official--title-15--16#51.83.70}

The process of evaluating each patient's past experiences and attitudes toward work; current motivations or areas of interest; and possibilities of future education, training, and/or employment.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 51.83.71** Professional Art Therapist, Qualified {#sec-16-51.83.71 omnilex-key=us-ms-regs-official--title-15--16#51.83.71}

A persons who has completed a master’s or doctoral degree program in art therapy, or an equivalent course of study, from an accredited educational institution and who is licensed by the State of Mississippi.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13 CHAPTER 52 MINIMUM STANDARDS FOR CHEMICAL DEPENDENCY UNITS Subchapter 1 INTRODUCTION LEGISLATIVE AUTHORITY*

##### **15 Miss. Admin. Code Pt. 16, R. 52.1.1** Rule 52.1.1 {#sec-16-52.1.1 omnilex-key=us-ms-regs-official--title-15--16#52.1.1}

Mississippi Department of Health Mississippi Code Annotated 43-11-1 through 43-11-27 (Supplement 1986) The Mississippi Health Care Commission adopted additional regulations for Chemical Dependency Units on August 19, 1982. The regulations became effective, September 19, 1982. The Mississippi Department of Health took over the licensing duties of the Mississippi Health Care Commission effective July 1, 1986.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 52.1.2** Rule 52.1.2 {#sec-16-52.1.2 omnilex-key=us-ms-regs-official--title-15--16#52.1.2}

A Chemical Dependency Unit is a hospital or an established and dedicated unit of a "general", "psychiatric", or "rehabilitation" hospital, or a "freestanding" unit, which has beds that are organized, properly staffed and equipped to render services over a continuous period exceeding 24-hours to individuals requiring diagnosis and treatment of alcohol and other drug-related dependencies.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 52.1.3** Rule 52.1.3 {#sec-16-52.1.3 omnilex-key=us-ms-regs-official--title-15--16#52.1.3}

These standards are to applied in conjunction with the Minimum Standards of Operation for Mississippi Hospitals where applicable.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 52.1.4** Rule 52.1.4 {#sec-16-52.1.4 omnilex-key=us-ms-regs-official--title-15--16#52.1.4}

The standards are written so that they closely parallel the standards for accreditation of alcohol and drug abuse programs established by the Joint Commission on Accreditation of Hospitals. By basing these standards on the Joint Commission's standards, we have developed standards which have the input of a national panel of knowledgeable experts and skilled people on alcoholism and drug abuse treatment.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17 Subchapter 2 FACILITY MANAGEMENT: GOVERNING BODY Rule 52.2.1 Every facility shall have a governing body that has overall responsibility for the operation of the facility.*
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 52.2.2** Rule 52.2.2 {#sec-16-52.2.2 omnilex-key=us-ms-regs-official--title-15--16#52.2.2}

A public facility shall have a written description of the administrative organization for the agency within which it operates.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 52.2.3** Rule 52.2.3 {#sec-16-52.2.3 omnilex-key=us-ms-regs-official--title-15--16#52.2.3}

A public facility shall also have a written description of how the lines of authority within the government agency relate to the governing body of the facility.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 52.2.4** A private facility shall have a charter or constitution, bylaws {#sec-16-52.2.4 omnilex-key=us-ms-regs-official--title-15--16#52.2.4}

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 52.2.5** Rule 52.2.5 {#sec-16-52.2.5 omnilex-key=us-ms-regs-official--title-15--16#52.2.5}

The names and addresses of all owners or controlling parties of the facility (whether they are individuals; partnerships; corporate bodies; or subdivisions of other bodies, such a public agencies or religious, fraternal, or other charitable organizations) shall be fully disclosed.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 52.2.6** Rule 52.2.6 {#sec-16-52.2.6 omnilex-key=us-ms-regs-official--title-15--16#52.2.6}

In case of corporations, the names and addresses of all officers, directors, and principal stockholders either beneficial or of record shall be disclosed.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 52.2.7** The governing body shall meet at least quarterly {#sec-16-52.2.7 omnilex-key=us-ms-regs-official--title-15--16#52.2.7}

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 52.2.8** Minutes of these meetings shall be kept and shall include at least the following: 1 {#sec-16-52.2.8 omnilex-key=us-ms-regs-official--title-15--16#52.2.8}

The date of the meeting 2. The names of members who attended 3. The topics discussed 4. The decisions reached and actions taken 5. The dates for implementation of recommendations 6. The reports of the chief executive officer and others.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 52.2.9** Rule 52.2.9 {#sec-16-52.2.9 omnilex-key=us-ms-regs-official--title-15--16#52.2.9}

The governing body shall establish a committee structure to fulfill its responsibilities and to assess the results of the facility's activities.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 52.2.10** Rule 52.2.10 {#sec-16-52.2.10 omnilex-key=us-ms-regs-official--title-15--16#52.2.10}

The governing body, through the chief executive officer, shall have a written statement of the facility's goals and objectives, as well as written procedures for implementing these goals and objectives.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 52.2.11** Rule 52.2.11 {#sec-16-52.2.11 omnilex-key=us-ms-regs-official--title-15--16#52.2.11}

There shall be documentation that the statement and procedures are based upon a planning process, and that the facility's goals and objectives are approved by the governing body.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 52.2.12** Rule 52.2.12 {#sec-16-52.2.12 omnilex-key=us-ms-regs-official--title-15--16#52.2.12}

The governing body, through the chief executive officer, shall have a written plan for obtaining financial resources that are consonant with the facility's goals and objectives.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 52.2.13** Rule 52.2.13 {#sec-16-52.2.13 omnilex-key=us-ms-regs-official--title-15--16#52.2.13}

When a categorical program (for example, a child, adolescent, or adult psychiatric, alcoholism, or drug abuse program) is a component of a larger facility, the staff of the categorical program, subject to the overall responsibility of the governing body, shall be given the authority necessary to plan, organize, and operate the program.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 52.2.14** The categorical program shall hire and assign its own staff {#sec-16-52.2.14 omnilex-key=us-ms-regs-official--title-15--16#52.2.14}

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 52.2.15** The categorical program shall employ a sufficient number of qualified and appropriately trained staff {#sec-16-52.2.15 omnilex-key=us-ms-regs-official--title-15--16#52.2.15}

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 52.2.16** Rule 52.2.16 {#sec-16-52.2.16 omnilex-key=us-ms-regs-official--title-15--16#52.2.16}

The governing body, through its chief executive officer, shall develop policies and shall make sufficient resources available (for example, funds, staff, equipment, supplies, and facilities) to assure that the program is capable of providing appropriate and adequate services to patients.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 52.2.17** The facility's physical and financial resources shall be adequately insured {#sec-16-52.2.17 omnilex-key=us-ms-regs-official--title-15--16#52.2.17}

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 52.2.18** Rule 52.2.18 {#sec-16-52.2.18 omnilex-key=us-ms-regs-official--title-15--16#52.2.18}

Members of the governing body and appropriate administrative and professional staff should have adequate comprehensive liability insurance.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 52.2.19** Rule 52.2.19 {#sec-16-52.2.19 omnilex-key=us-ms-regs-official--title-15--16#52.2.19}

The governing body shall establish bylaws, rules and regulations, and a table of organization to guide relationships between itself and the responsible administration and professional staffs and the community.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 52.2.20** Rule 52.2.20 {#sec-16-52.2.20 omnilex-key=us-ms-regs-official--title-15--16#52.2.20}

The governing body may establish one set of bylaws, rules and regulations that clearly delineates the responsibilities and authority of the governing body and the administrative and professional staff.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 52.2.21** Rule 52.2.21 {#sec-16-52.2.21 omnilex-key=us-ms-regs-official--title-15--16#52.2.21}

Administrative and professional staffs may establish separate bylaws, rules and regulations that are consistent with policies established by the governing body.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 52.2.22** Rule 52.2.22 {#sec-16-52.2.22 omnilex-key=us-ms-regs-official--title-15--16#52.2.22}

All bylaws, rules and regulations shall comply with legal requirements, be designed to encourage high quality patient care, and be consistent with the facility's community responsibility.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 52.2.23** Rule 52.2.23 {#sec-16-52.2.23 omnilex-key=us-ms-regs-official--title-15--16#52.2.23}

Such bylaws, rules and regulations shall describe the powers and duties of the governing body and its officers and committees; or the authority and responsibilities of any person legally designed to function as the governing body, as well as the authority and responsibility delegated to the responsible administrative and professional staffs.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 52.2.24** Rule 52.2.24 {#sec-16-52.2.24 omnilex-key=us-ms-regs-official--title-15--16#52.2.24}

Such bylaws, rules and regulations shall state the eligibility criteria for governing body membership; the types of membership and the method of selecting members; frequency of governing body meetings; the number of members necessary for a quorum and other attendance requirements for governing body meetings; the requirement that meetings be documented in the form of written minutes and the duration of appointment or election for governing body members, officers, and committed chairpersons.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 52.2.25** Rule 52.2.25 {#sec-16-52.2.25 omnilex-key=us-ms-regs-official--title-15--16#52.2.25}

Such bylaws, rules and regulations shall state the eligibility criteria for governing body membership; the types of membership and the method of selecting members; frequency of governing body meetings; the number of members necessary for a quorum and other attendance requirements for governing body meetings; the requirement that meetings be documented in the form of written minutes and the duration of appointment or election for governing body members, officers, and committed chairpersons.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 52.2.26** Rule 52.2.26 {#sec-16-52.2.26 omnilex-key=us-ms-regs-official--title-15--16#52.2.26}

Such bylaws, rules and regulations shall describe the qualifications, authority, and responsibilities of the chief executive officer.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 52.2.27** Such bylaws, rules and regulations shall specify the method for appointing the chief executive officer {#sec-16-52.2.27 omnilex-key=us-ms-regs-official--title-15--16#52.2.27}

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 52.2.28** Rule 52.2.28 {#sec-16-52.2.28 omnilex-key=us-ms-regs-official--title-15--16#52.2.28}

Such bylaws, rules and regulations shall provide the administrative and professional staffs with the authority and freedom necessary to carry out their responsibilities within the organizational framework of the facility.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 52.2.29** Rule 52.2.29 {#sec-16-52.2.29 omnilex-key=us-ms-regs-official--title-15--16#52.2.29}

Such bylaws, rules and regulations shall provide the professional staff with the authority necessary to encourage high quality patient care.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 52.2.30** Rule 52.2.30 {#sec-16-52.2.30 omnilex-key=us-ms-regs-official--title-15--16#52.2.30}

Such bylaws, rules and regulations shall state the procedures under which the administrative and professional staff cooperatively function.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 52.2.31** Rule 52.2.31 {#sec-16-52.2.31 omnilex-key=us-ms-regs-official--title-15--16#52.2.31}

Such bylaws, rules and regulations shall require the establishment of controls designed to encourage each member of the professional staff to observe the standards of the profession and assume and carry out functions in accordance with local, state, and federal laws and rules and regulations.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 52.2.32** Rule 52.2.32 {#sec-16-52.2.32 omnilex-key=us-ms-regs-official--title-15--16#52.2.32}

Such bylaws, rules and regulations shall require the professional staff bylaws, rules and regulations to be subject to governing body approval.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 52.2.33** Rule 52.2.33 {#sec-16-52.2.33 omnilex-key=us-ms-regs-official--title-15--16#52.2.33}

Such bylaws, rules and regulations shall specify procedures for selecting professional staff officers, directors, and department or service chiefs.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 52.2.34** Rule 52.2.34 {#sec-16-52.2.34 omnilex-key=us-ms-regs-official--title-15--16#52.2.34}

Such bylaws, rules and regulations shall require that physicians with appropriate qualifications, licenses, and clinical privileges evaluate and authenticate medical histories and physical examinations, and prescribe medications.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 52.2.35** Rule 52.2.35 {#sec-16-52.2.35 omnilex-key=us-ms-regs-official--title-15--16#52.2.35}

Such bylaws, rules and regulations may also allow dentists with appropriate qualifications, licenses, and clinical privileges to prescribe medications.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 52.2.36** Rule 52.2.36 {#sec-16-52.2.36 omnilex-key=us-ms-regs-official--title-15--16#52.2.36}

Such bylaws, rules and regulations shall describe the procedure for conferring clinical privileges on all professional staff.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 52.2.37** Rule 52.2.37 {#sec-16-52.2.37 omnilex-key=us-ms-regs-official--title-15--16#52.2.37}

Such bylaws, rules and regulations shall define the responsibilities of physicians in relation to non-physician members of the professional staff.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 52.2.38** Rule 52.2.38 {#sec-16-52.2.38 omnilex-key=us-ms-regs-official--title-15--16#52.2.38}

Such bylaws, rules and regulations shall provide a mechanism through which the administrative and professional staffs report to the governing body.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 52.2.39** Rule 52.2.39 {#sec-16-52.2.39 omnilex-key=us-ms-regs-official--title-15--16#52.2.39}

Such bylaws, rules and regulations shall define the means by which the administrative and professional staffs participate in the development of facility and program policies concerning program management and patient care.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 52.2.40** Rule 52.2.40 {#sec-16-52.2.40 omnilex-key=us-ms-regs-official--title-15--16#52.2.40}

Such bylaws, rules and regulations shall require an orientation program for new governing body members and a continuing education program for all members of the governing body.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 52.2.41** Rule 52.2.41 {#sec-16-52.2.41 omnilex-key=us-ms-regs-official--title-15--16#52.2.41}

Such bylaws, rules and regulations shall require that the bylaws, rules and regulations be reviewed at least every two years, revised as necessary, and signed and dated to indicate the time of last review.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17 Subchapter 3 CHIEF EXECUTIVE OFFICER Rule 52.3.1 The governing body shall appoint a chief executive officer who shall be employed on a full-time basis.*
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 52.3.2** Rule 52.3.2 {#sec-16-52.3.2 omnilex-key=us-ms-regs-official--title-15--16#52.3.2}

The qualifications, authority, and duties of the chief executive officer shall be stated in the governing body's bylaws, rules and regulations.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 52.3.3** Rule 52.3.3 {#sec-16-52.3.3 omnilex-key=us-ms-regs-official--title-15--16#52.3.3}

The chief executive officer shall be a health professional with appropriate professional qualifications and experience, including previous administrative responsibility in a health facility.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 52.3.4** Rule 52.3.4 {#sec-16-52.3.4 omnilex-key=us-ms-regs-official--title-15--16#52.3.4}

The chief executive officer shall have a medical degree or at least a master's degree in administration, psychology, social work, education, or nursing; and, when required, should have appropriate licenses. Experience shall include previous administrative responsibility in a facility for children or adolescents. Experience may be substituted for a professional degree when it is carefully evaluated, justified, and documented by the governing body.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 52.3.5** Rule 52.3.5 {#sec-16-52.3.5 omnilex-key=us-ms-regs-official--title-15--16#52.3.5}

In facilities primarily serving children or adolescents, the chief executive officer shall have appropriate professional qualifications and experience, including previous administrative responsibility in a facility for children or adolescents.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 52.3.6** Rule 52.3.6 {#sec-16-52.3.6 omnilex-key=us-ms-regs-official--title-15--16#52.3.6}

In accordance with the facility's bylaws, rules and regulations, the chief executive officer shall be responsible to the governing body for the overall operation of the facility, including the control, utilization, and conservation of its physical and financial assets and the recruitment and direction of staff.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 52.3.7** Rule 52.3.7 {#sec-16-52.3.7 omnilex-key=us-ms-regs-official--title-15--16#52.3.7}

The chief executive officer shall assist the governing body in formulating policy by preparing the following items and presenting them to and reviewing them with the governing body: 1. Long-term and short-term plans of the facility. 2. Reports on the nature and extent of funding and other available resources. 3. Reports describing the facility's operations. 4. Reports evaluating the efficiency and effectiveness of facility or program activity. 5. Budgets and financial statements.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 52.3.8** Rule 52.3.8 {#sec-16-52.3.8 omnilex-key=us-ms-regs-official--title-15--16#52.3.8}

The chief executive officer shall be responsible for the preparation of a written manual that defines the facility policies and procedures and that is regularly revised and updated.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 52.3.9** There shall be documentation that the chief executive officer attends and participates in continuing education programs {#sec-16-52.3.9 omnilex-key=us-ms-regs-official--title-15--16#52.3.9}

**History**
- *SOURCE: Miss. Code Ann. §41-9-17 Subchapter 4 PROFESSIONAL STAFF ORGANIZATION Rule 52.4.1 There shall be a single organized professional staff that has the overall responsibility for the quality of all clinical care provided to patients, and for the ethical conduct and professional practices of its members, as well as for accounting therefore to the governing body. The manner in which the professional staff is organized shall be consistent with the facility's documented staff organization and bylaws, rules and regulations, and pertain to the setting where the facility is located. The professional staff bylaws, rules and regulations, and the rules and regulations of the governing authority shall require that a qualified physician be responsible for diagnosis and all care and treatment. The organization of the professional staff, and its bylaws, rules and regulations shall be approved by the facility's governing body.*
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 52.4.2** Rule 52.4.2 {#sec-16-52.4.2 omnilex-key=us-ms-regs-official--title-15--16#52.4.2}

The professional staff shall strive to assure that each member is qualified for membership and shall encourage the optimal level of professional performance of its members through the appointment/reappointment procedure, the specific delineation of clinical privileges, and the periodic reappraisal of each staff member according to the provisions.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 52.4.3** Qualifications {#sec-16-52.4.3 omnilex-key=us-ms-regs-official--title-15--16#52.4.3}

The appointment and reappointment of professional staff members shall be based upon well-defined, written criteria that are related to the goals and objectives of the facility as stated in the bylaws, rules and regulations of the professional staff and of the governing body. 1. Upon application or appointment to the professional staff, each individual must sign a statement to the effect that he or she has read and agrees to be bound by the professional staff and governing body bylaws, rules and regulations. 2. The initial appointment and continued professional staff membership shall be dependent upon clinical competence and ethical practice in keeping with the qualifications, standards, and requirements set forth in the professional staff and governing body bylaws, rules and regulations. 3. Unless otherwise provided by law, only those practitioners who are licensed, certified, or registered, or who have demonstrated competence and experience, shall be eligible for professional staff membership.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 52.4.4** Method of Selection {#sec-16-52.4.4 omnilex-key=us-ms-regs-official--title-15--16#52.4.4}

Each facility is responsible for developing a process of appointment to the professional staff whereby it can satisfactorily determine that the person is appropriately licensed, certified, registered, or experienced, and qualified for the privileges and responsibilities he or she seeks.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 52.4.5** Privilege Delineation {#sec-16-52.4.5 omnilex-key=us-ms-regs-official--title-15--16#52.4.5}

Privileges shall be delineated for each member of the professional staff, regardless of the type and size of the facility and the age and disability group served. 1. Delineation of privileges shall be based on all verified information available in the applicant's or staff member's credentials file. 2. Whatever method is used to delineate clinical privileges for each professional staff applicant, there must be evidence that the granting of such privileges is based on the member's demonstrated current competence. 3. Clinical privileges shall be facility-specific. 4. The professional staff shall delineate in its bylaws, rules and regulations of the qualifications, status, clinical duties, and responsibilities of clinical practitioners who are not members of the professional staff but whose services require that they be processed through the usual professional staff channels. 5. The training, experience, and demonstrated competence of individuals in such categories shall be sufficient to permit their performing their assigned functions. 6. There shall be provisions for individuals in such categories to receive professional supervision, when indicated, from their professional counterparts.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 52.4.6** Reappointment {#sec-16-52.4.6 omnilex-key=us-ms-regs-official--title-15--16#52.4.6}

The facility's professional staff bylaws, rules and regulations shall provide for review and reappointment of each professional staff member at least once every two years. 1. The reappointment process should include a review of the individual's status by a designated professional staff committee, such as the credentials committee. 2. When indicated, the credentials committee shall require the individual to submit evidence of his or her current health status that verifies the individual's ability to discharge his or her responsibilities. 3. The committee's review of the clinical privileges of a staff member for reappointment should include the individual's past and current professional performance as well as his or her adherence to the governing body and professional staff bylaws, rules and regulations.

4. The professional staff bylaws rules and regulations shall limit the time within which the professional staff reappointment and privilege delineation processes must completed.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 52.4.7** Professional Staff Organization {#sec-16-52.4.7 omnilex-key=us-ms-regs-official--title-15--16#52.4.7}

The professional staff shall be organized to accomplish its required functions. 1. The professional staff organization must provide a framework in which the staff can carry out its duties and functions effectively. The complexity of the organization shall be consistent with the size of the facility and the scope of its activities. 2. The professional staff bylaws, rules and regulations shall provide for the selection of officers for an executive committee and when appropriate, for other organizational components of the facility. 3. The professional staff bylaws, rules and regulations should specify the organization needed to provide effective governance of the professional staff.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 52.4.8** Executive Committee {#sec-16-52.4.8 omnilex-key=us-ms-regs-official--title-15--16#52.4.8}

The executive committee shall be empowered to act for the professional staff in the intervals between the staff meetings. The committee shall serve as a liaison mechanism between the professional staff and the administration. 1. There shall be a mechanism that assures medical participation in the deliberations of the executive committee. 2. The professional staff bylaws, rules and regulations shall define the size, composition, method of selecting members, and frequency of meetings of the executive committee. 3. The executive committee shall maintain a permanent record of its proceedings and actions. 4. The functions and responsibilities of the executive committee shall include at least the following: a. Receiving and acting upon reports and recommendations from professional staff committees, departments, and services. b. Implementing the approved policies of the professional staff. c. Recommending to the governing body all matters relating to appointments and reappointments, staff categorization and assignments, clinical privileges, and

except when such is a function of the professional staff or one of its committees, corrective action. d. Fulfilling the professional staff's accountability to the governing body for the quality of the overall clinical care rendered to patients in the facility; and e. Initiating and pursuing corrective action when warranted, in accordance with the provisions of the professional staff bylaws, rules and regulations.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 52.4.9** Professional Staff Bylaws {#sec-16-52.4.9 omnilex-key=us-ms-regs-official--title-15--16#52.4.9}

The professional staff shall develop and adopt bylaws, rules and regulations to establish a framework of self-government and a means of accountability to the governing body. The bylaws, rules and regulations shall be subject to the approval of the governing body. 1. The professional staff shall regulate itself by its bylaws, rules and regulations. 2. The professional staff bylaws, rules and regulations shall reflect current staff practices, shall be enforced, and shall be periodically reviewed and revised as necessary. 3. The professional staff bylaws, rules and regulations shall include a requirement for an ethical pledge from each practitioner. 4. The professional staff bylaws, rules and regulations shall describe the specific role of each discipline represented on the professional staff or exercising clinical privileges in the care of patients. 5. The professional staff bylaws, rules and regulations shall include the following patient record requirements. 6. Symbols and abbreviations shall be used only when they have been approved by the professional staff and when there is an explanatory legend; 7. The categories of personnel who are qualified to accept and transcribe verbal orders, regardless of the mode of transmission of the orders, shall be specifically identified; 8. The period of time following admission to the facility within which a history and physical examination must be entered in the patient record shall be specified; 9. The time period in which patient records must be completed following discharge shall be specified and shall not exceed fourteen (14) days; and 10. The entries in patient records that must be dated and authenticated by the responsible practitioner shall be specified.

11. The professional staff bylaws, rules and regulations shall specify mechanisms for review, evaluation, and monitoring of professional staff practices. 12. The professional staff bylaws, rules and regulations shall specify mechanisms for the denial of staff appointments and reappointments, as well as for denial, curtailment, suspension, or revocation of clinical privileges. 13. When appropriate, this procedure shall provide for a practitioner to be heard, upon request, at some stage of the process.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17 Subchapter 5 WRITTEN PLAN FOR PROFESSIONAL SERVICES AND STAFF COMPOSITION Rule 52.5.1 The facility shall formulate and specify in a written plan for professional services its goals, objectives, policies, and programs so that its performance can be measured.*
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 52.5.2** Rule 52.5.2 {#sec-16-52.5.2 omnilex-key=us-ms-regs-official--title-15--16#52.5.2}

The plan shall describe the services offered by the facility so that a frame of reference for judging the various aspects of the facility's operation is available.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 52.5.3** The written plan for professional services shall describe the following: 1 {#sec-16-52.5.3 omnilex-key=us-ms-regs-official--title-15--16#52.5.3}

the population served, including age groups and other characteristics of the patient population; 2. the hours and days the facility operates; 3. the methods used to carry out initial screening and/or triage; 4. the intake or admission process; including how the initial contact was made with the patient and the family or significant others; 5. the assessment and evaluation procedures provided by the facility; 6. the methods used to deliver services to meet the identified clinical needs of patients served; 7. the basic therapeutic programs offered by the facility; 8. the treatment planning process and the periodic review of therapy; 9. the discharge and post-therapy planning processes;

10. the organizational relationships of each of the facility's therapeutic programs, including channels of staff communication, responsibility, and authority, as well as supervisory relation-ships; and 11. the means by which the facility provides, or makes arrangements for the provision of, the following: a. other medical, special assessments, and therapeutic services; b. patient education services, whether provided from within or outside the facility; c. emergency services and crisis intervention; and d. discharge and aftercare, including post-therapy planning and follow-up evaluation.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 52.5.4** Rule 52.5.4 {#sec-16-52.5.4 omnilex-key=us-ms-regs-official--title-15--16#52.5.4}

When the facility is organized by departments or services, the written plan for professional services shall describe how each department or service relates to the goals and other programs of the facility, specify lines of responsibility within each department or service, and define the rolls of department or service personnel and the methods for interdisciplinary collaboration.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 52.5.5** Rule 52.5.5 {#sec-16-52.5.5 omnilex-key=us-ms-regs-official--title-15--16#52.5.5}

When a facility is organized on a team or unit basis, either totally or in part, the written plan for professional services shall delineate the roles and responsibilities of team members in meeting the identified clinical needs of patients and in relation to the goals and programs of the facility.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 52.5.6** Rule 52.5.6 {#sec-16-52.5.6 omnilex-key=us-ms-regs-official--title-15--16#52.5.6}

The written plan for professional services shall be made known and available to all professional personnel and to the chief executive officer.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 52.5.7** Rule 52.5.7 {#sec-16-52.5.7 omnilex-key=us-ms-regs-official--title-15--16#52.5.7}

The plan shall be reviewed at least annually, and revised as necessary, in relation to the changing needs of the patients, the community, and the overall objectives and goals of the facility, and it shall be signed and dated by the reviewers.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 52.5.8** Rule 52.5.8 {#sec-16-52.5.8 omnilex-key=us-ms-regs-official--title-15--16#52.5.8}

Within the scope of its activities, the facility shall have enough appropriately qualified health care professional, administrative and support staff available to adequately assess and address the identified clinical needs of patients.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 52.5.9** Rule 52.5.9 {#sec-16-52.5.9 omnilex-key=us-ms-regs-official--title-15--16#52.5.9}

Appropriately qualified professional staff may include qualified child and/or adolescent psychiatrists and other physicians, clinical psychologists, social workers, psychiatric nurses, and other health care professionals in numbers and variety appropriate to the services offered by the facility and with training and experience working with children and/or adolescents.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 52.5.10** Rule 52.5.10 {#sec-16-52.5.10 omnilex-key=us-ms-regs-official--title-15--16#52.5.10}

When appropriate qualified professional staff are not available or needed on a fulltime basis, arrangements shall be made to obtain sufficient services on an attending continuing consultative, or part-time basis.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 52.5.11** Rule 52.5.11 {#sec-16-52.5.11 omnilex-key=us-ms-regs-official--title-15--16#52.5.11}

There shall be documentation to verify that health care professional staff meets all federal, state, and local requirements for licensing, registration, or certification.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 52.5.12** Medical Services {#sec-16-52.5.12 omnilex-key=us-ms-regs-official--title-15--16#52.5.12}

A physician licensed in the State of Mississippi shall be responsible for diagnosis and all medical care and treatment. Medical services shall be provided directly or on call 24-hours a day, 7 days a week. Upon admission there shall be written orders for the immediate care of the patient.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 52.5.13** Nursing Services {#sec-16-52.5.13 omnilex-key=us-ms-regs-official--title-15--16#52.5.13}

Nursing services shall be under the direct supervision of a registered professional nurse who has had at least one (1) year of experience in psychiatric or mental health nursing or has had previous work experience in chemical dependency units. 1. The number of registered professional nurses, licensed practical nurses, and other nursing personnel shall be adequate to formulate and carry out the nursing components of the individual treatment plan for each patient. 2. There shall be a registered professional nurse on duty 24-hours a day, 7-days a week, to plan, assign, supervise, and evaluate nursing care, and to provide for the delivery of nursing care to patients.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 52.5.14** Psychiatric Services {#sec-16-52.5.14 omnilex-key=us-ms-regs-official--title-15--16#52.5.14}

Patients shall be provided with psychiatric services, in accordance with their needs by a psychiatrist licensed in the State of Mississippi. Services to patients include evaluations, consultations therapy and program development.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 52.5.15** Psychiatric Services {#sec-16-52.5.15 omnilex-key=us-ms-regs-official--title-15--16#52.5.15}

Psychiatric services are under the supervision of a clinical director, service chief or equivalent licensed physician who is qualified to provide the leadership required for an intensive treatment program.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 52.5.16** Psychological Services {#sec-16-52.5.16 omnilex-key=us-ms-regs-official--title-15--16#52.5.16}

Patients shall be provided psychological services in accordance with their needs by a qualified psychologist. 1. Services to patients include evaluations, consultations, therapy and program development. 2. A qualified psychologist is an individual licensed by the State Board of Psychological Examiners with a specialty area in Clinical or Counseling Psychology (refer to Mississippi Code of 1972, annotated and amended, Section 73-31-1).

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 52.5.17** Social Services {#sec-16-52.5.17 omnilex-key=us-ms-regs-official--title-15--16#52.5.17}

Social work services are under the supervision of a licensed qualified social worker. 1. The director of the service or department shall have a master's degree from an accredited school of social work, or have been certified by the Academy of Certified Social Workers. 2. Social work staff shall be qualified and numerically adequate to provide the following services: a. Psychosocial data for diagnosis and treatment planning. b. Direct therapeutic services to individual patients, patient groups or families. c. Develop community resources. d. Participate in interdisciplinary conferences and meetings concerning treatment planning, including identification and utilization of other facilities and alternative forms of care and treatment.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 52.5.18** Activity Services {#sec-16-52.5.18 omnilex-key=us-ms-regs-official--title-15--16#52.5.18}

Activity service staff shall be sufficient in number and skills to meet the needs of patients and achieve the goals of the service. The activity service shall be supervised by a qualified activity director. A qualified activity director is an individual with a bachelor's degree who has at least one-year of experience in assessing, planning, and coordinating activity services in a health care setting.

Subchapter 6 PERSONNEL POLICIES AND PROCEDURES Rule 52.6.1 Personnel policies and procedures shall be developed in writing, adopted, and maintained to promote the objectives of the facility and to provide for an adequate number of qualified personnel during all hours of operation to support the functions of the facility and the provision of high quality care.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 52.6.2** All personnel policies shall be reviewed and approved on an annual basis by the governing body {#sec-16-52.6.2 omnilex-key=us-ms-regs-official--title-15--16#52.6.2}

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 52.6.3** Rule 52.6.3 {#sec-16-52.6.3 omnilex-key=us-ms-regs-official--title-15--16#52.6.3}

There shall be documentation to verify that the written personnel policies and procedures are explained and made available to each employee.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 52.6.4** Rule 52.6.4 {#sec-16-52.6.4 omnilex-key=us-ms-regs-official--title-15--16#52.6.4}

The policies and procedures shall include a mechanism for determining that all personnel are medically and emotionally capable of performing assigned tasks and are free of communicable and infectious diseases.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 52.6.5** There shall be written policies and procedures for handling cases of patient neglect and abuse {#sec-16-52.6.5 omnilex-key=us-ms-regs-official--title-15--16#52.6.5}

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 52.6.6** The policies and procedures on patient neglect or abuse shall be given to all personnel {#sec-16-52.6.6 omnilex-key=us-ms-regs-official--title-15--16#52.6.6}

Any alleged violations of these policies and procedures shall be investigated, and the results of such investigation shall be reviewed and approved by the director and reported to the governing body.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 52.6.7** A personnel record shall be kept on each staff member and shall contain the following items, as appropriate: 1 {#sec-16-52.6.7 omnilex-key=us-ms-regs-official--title-15--16#52.6.7}

Application for employment 2. Written references and a record of verbal references 3. Verification of all training and experience, and licensure, certification, registration and/or renewals 4. Wage and salary information

5. Performance appraisals 6. Initial and subsequent health clearances 7. Disciplinary and counseling actions 8. Commendations 9. Employee incident reports 10. Record of orientation to the facility, its policies and procedures and the employee's position. 11. For each position in the facility, there shall be a written job description that specifies the duties and responsibilities of the position and the minimum level of education, training, and/or related work experience required or needed to fulfill it.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17 Subchapter 7 STAFF DEVELOPMENT Rule 52.7.1 The facility shall have a written plan as evidence of implementation of a program of staff development and in-service training that is consistent with the basic goals and objectives of the program.*
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 52.7.2** Staff development shall be under the supervision and direction of a committee or qualified person {#sec-16-52.7.2 omnilex-key=us-ms-regs-official--title-15--16#52.7.2}

This person or committee may delegate responsibility for any part of the program to appropriately qualified individuals.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 52.7.3** Rule 52.7.3 {#sec-16-52.7.3 omnilex-key=us-ms-regs-official--title-15--16#52.7.3}

The staff development plan shall include plans for orientation of new employees and shall specify subject areas to be covered in the orientation process.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 52.7.4** Rule 52.7.4 {#sec-16-52.7.4 omnilex-key=us-ms-regs-official--title-15--16#52.7.4}

The staff development program shall reflect all administrative and service changes in the facility and shall prepare personnel for promotions and responsibilities.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 52.7.5** Rule 52.7.5 {#sec-16-52.7.5 omnilex-key=us-ms-regs-official--title-15--16#52.7.5}

A continuous professional education program shall be provided to keep the professional staff informed of significant clinical and administrative developments and skills.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 52.7.6** Rule 52.7.6 {#sec-16-52.7.6 omnilex-key=us-ms-regs-official--title-15--16#52.7.6}

The facility shall provide continuing training for all staff and specific orientation for all new personnel in the principles of confidentiality, privacy, patients' rights, infection control, fire prevention, disaster preparedness, accident prevention and patient safety.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 52.7.7** Specialized training shall be provided for staff working with children and adolescents {#sec-16-52.7.7 omnilex-key=us-ms-regs-official--title-15--16#52.7.7}

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 52.7.8** Rule 52.7.8 {#sec-16-52.7.8 omnilex-key=us-ms-regs-official--title-15--16#52.7.8}

The facility shall have documentation of the staff development, in-service training and orientation activities of all employees.

2. Physical restraints and seclusion shall be used only in extreme cases to protect the patient from injuring himself or others, and when all other alternatives are exhausted. They shall not be used as punishment of staff convenience. a. There shall be documentation verifying that patients under physical restraint or in seclusion are observed by a staff member at least every thirty (30) minutes. b. Authorization for the use of physical restraints and/or seclusion shall be written as justified in the patient's record by the attending physician. This authorization shall be renewed at least every twenty-four (24) hours. 3. The patient has the right, to the extent permitted by law, to refuse specific medications or treatment procedures. The responsibility of the facility, when the patient refuses treatment, is to seek appropriate legal alternatives or orders of involuntary treatment or, in accordance with professional standards, to terminate the relationship with the patient upon reasonable notice. 4. The risks associated with the use of any drugs and/or procedures shall be fully explained to the patient in terms that he/she can understand. The decision as to whether or not the patient is able to exercise sound judgment rests with the physician and must be documented in the patient's clinical record.

5. The patient shall give his consent in writing prior to the use of potentially hazardous drugs and procedures. In the event that the patient is unable to exercise sound judgment, the written consent of family members having the legal right to consent must be obtained prior to the use of potentially hazardous drugs and procedures. Potentially hazardous drugs and procedures shall be administered in accordance with accepted clinical practice and shall be directed and supervised by a physician. 6. There shall be written policies and procedures for reviewing and responding to patient's communications, e.g. opinions, recommendations, and grievances, in a way that will preserve and foster conflict resolution and problem solving. The written policies shall also delineate the means by which patients are familiarized with these procedures. Each patient's personal privacy shall be assured and protected within the constraints of the individual treatment plan. 7. There shall be procedures designed to protect the patient's rights and privacy with respect to facility visitors, e.g. educational or other individual or group visitations through the program. The patients shall be informed in advance of such visitations, which shall be conducted so as to minimally interrupt the patient's usual activities and therapeutic program. 8. The facility shall provide the patient with means of communication with persons outside the program in at least the following ways, unless contraindicated by physician. Patients shall be allowed to conduct private telephone conversations with family and friends. Patients shall be allowed to send and receive unopened mail. 9. The facility shall inform the patient, the patient's family, or legal guardian as appropriate, of the cost (itemized when possible) of services rendered. 10. The facility shall assure confidential treatment of personal and Medical Records, and may approve or refuse their release to any individual outside the family, except, in case of transfer to another health care institution, or as required by law or third-party payment contract. 11. Each patient's personal dignity shall be recognized and respected in the provision of all care and treatment.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17 Subchapter 8 PATIENT RIGHTS Rule 52.8.1 There shall be written policies and procedures designed to enhance the dignity of all patients and to protect their rights as human beings. These written policies and procedures shall include but not be limited to the following standards: 1. There shall be procedures to inform all patients of their legal and human rights and the rules and regulations of the facility applicable to his or her conduct. There shall be documentation of implementation of these procedures.*
- *SOURCE: Miss. Code Ann. §41-9-17 Subchapter 9 MEDICAL RECORDS Rule 52.9.1 Organization. A Medical Record shall be maintained in accordance with accepted professional principles for each patient admitted for care in the facility.*
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 52.9.2** Such records shall be kept confidential and only authorized personnel shall have access to the record {#sec-16-52.9.2 omnilex-key=us-ms-regs-official--title-15--16#52.9.2}

Staff members and other persons having access to patient records shall be required to abide by the written policies regarding confidentiality of patient records and disclosure of information in the records as well as all applicable federal, state, and local laws, rules, and regulations. Policies on confidentiality of records shall also conform to the alcohol and drug abuse confidentiality regulations as published in Part IV of the July 1, 1975 Federal Register.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 52.9.3** Rule 52.9.3 {#sec-16-52.9.3 omnilex-key=us-ms-regs-official--title-15--16#52.9.3}

The facility shall have written policies and procedures that protect the confidentiality of patient records and govern the disclosure of information in the records. The policies and procedures shall specify the conditions under which information on applicants or patients may be disclosed and the procedures for releasing such information.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 52.9.4** Rule 52.9.4 {#sec-16-52.9.4 omnilex-key=us-ms-regs-official--title-15--16#52.9.4}

A patient or his or her authorized representative may consent to the release of information provided that written consent is given on a form containing the following information: 1. name of patient 2. name of program 3. the name of the person, agency or organization to which the information is to be disclosed 4. the specific information to be disclosed 5. the purpose for the disclosure 6. the date the consent was signed and the signature of the individual witnessing the consent 7. the signature of the patient, guardian or authorized representative, and 8. a notice that the consent is valid only for a specified period of time.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 52.9.5** Rule 52.9.5 {#sec-16-52.9.5 omnilex-key=us-ms-regs-official--title-15--16#52.9.5}

The written consent of a patient, or his or her authorized representative, to the disclosure of information shall be considered valid only if the following conditions have been met:

1. the patient or the representative shall be informed, in a manner calculated to assure his or her understanding, of the specific type of information that has been requested and, if known, the benefits and disadvantages of releasing the information; 2. the patient or the representative shall give consent voluntarily; 3. the patient or the representative shall be informed that the provision of services is not contingent upon his or her decision concerning the release of information; and 4. the patient's consent shall be acquired in accordance with all applicable federal, state, and local laws, rules and regulations.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 52.9.6** Rule 52.9.6 {#sec-16-52.9.6 omnilex-key=us-ms-regs-official--title-15--16#52.9.6}

Every consent for release of information, the actual date the information was released, the specific information released, and the signature of the staff member who released the information shall be made a part of the patient record.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 52.9.7** Rule 52.9.7 {#sec-16-52.9.7 omnilex-key=us-ms-regs-official--title-15--16#52.9.7}

In a life-threatening situation or when an individual's condition or situation precludes the possibility of obtaining written consent, the facility may release pertinent medical information to the medical personnel responsible for the individual's care without the individual's consent and without the authorization of the chief executive officer or a designee, if obtaining such authorization would cause an excessive delay in delivering treatment to the individual.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 52.9.8** Rule 52.9.8 {#sec-16-52.9.8 omnilex-key=us-ms-regs-official--title-15--16#52.9.8}

When information has been release under emergency conditions, the staff member responsible for the release of information shall enter all pertinent details of the transaction into the individual's record, including at least the following items: 1. the date the information was released; 2. the person to whom the information was released; 3. the reason the information was released; 4. the reason written consent could not be obtained; and 5. the specific information released.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 52.9.9** Rule 52.9.9 {#sec-16-52.9.9 omnilex-key=us-ms-regs-official--title-15--16#52.9.9}

The patient or applicant shall be informed that the information was released as soon as possible after the release of information.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 52.9.10** Medical Records shall not be removed from the facility except upon subpoena and court order {#sec-16-52.9.10 omnilex-key=us-ms-regs-official--title-15--16#52.9.10}

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 52.9.11** Preservation and Storage {#sec-16-52.9.11 omnilex-key=us-ms-regs-official--title-15--16#52.9.11}

Records shall be preserved, either in the original or by microfilm, for a period of time not less than that determined by the statute of limitations in the State of Mississippi.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 52.9.12** Rule 52.9.12 {#sec-16-52.9.12 omnilex-key=us-ms-regs-official--title-15--16#52.9.12}

Written Policies and Procedures shall govern the compilation, storage, dissemination, and accessibility of patient records. The policies and procedures shall be designed to assure that the facility fulfills its responsibility to safeguard and protect the patient record against loss, unauthorized alteration, or disclosure of information; to assure that each patient record contains all required information; to assure uniformity in the format and forms in use in patient records; to require entries in patient records to be dated and signed.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 52.9.13** Rule 52.9.13 {#sec-16-52.9.13 omnilex-key=us-ms-regs-official--title-15--16#52.9.13}

The facility shall provide adequate facilities for the storage, processing, and handling of patient records, including suitably locked and secured rooms and files. When a facility stores patient data on magnetic tape, computer files, or other types of automated information systems, adequate security measures shall prevent inadvertent or unauthorized access to such data. A written policy shall govern the disposal of patient records. Methods of disposal shall be designed to assure the confidentially of information in the records.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 52.9.14** Personnel {#sec-16-52.9.14 omnilex-key=us-ms-regs-official--title-15--16#52.9.14}

The patient records department shall maintain, control, and supervise the patient records, and shall be responsible for maintaining the quality.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 52.9.15** Rule 52.9.15 {#sec-16-52.9.15 omnilex-key=us-ms-regs-official--title-15--16#52.9.15}

A qualified medical record individual who is employed on at least a part-time basis, consistent with the needs of the facility and the professional staff, shall be responsible for the patient records department. This individual shall be a registered record administrator or an accredited record technician who has successfully completed examination requirements of the American Medical Record Association, or an individual with the documented equivalent in training and/or experience.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 52.9.16** Rule 52.9.16 {#sec-16-52.9.16 omnilex-key=us-ms-regs-official--title-15--16#52.9.16}

When it can be demonstrated that the size, location, or needs of the facility do not justify employment of a qualified individual, the facility must secure the consultative assistance of a qualified record administrator at least twice a year to assure that the patient record department is adequate to meet the needs of the facility.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 52.9.17** Centralization of Reports {#sec-16-52.9.17 omnilex-key=us-ms-regs-official--title-15--16#52.9.17}

All clinical information pertaining to a patient's stay shall be centralized in the patient's record. The original or all reports originating in the facility shall be filed in the medical record. Appropriate patient records shall be kept on the unit where the patient is being treated and shall be directly accessible to the clinicians caring for the patient.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 52.9.18** Contents of Records {#sec-16-52.9.18 omnilex-key=us-ms-regs-official--title-15--16#52.9.18}

The medical record shall contain sufficient information to justify the diagnosis and warrant the treatment and end results. The patient record shall describe the patient's health status at the time of admission, the services provided and the patient's progress in the facility, and the patient's health status at the time of discharge. The patient record shall provide information for the review and evaluation of the treatment provided to the patient. When appropriate, data in the patient record shall be used in training, research, evaluation, and quality assurance programs. When indicated, the patient record shall contain documentation that the rights of the patient and of the patient's family are protected. The patient record shall contain documentation of the patient's and, as appropriate, family members' involvement in the patient's treatment program. When appropriate, a separate record may need to be maintained on each family member involved in the patient's treatment program. The patient record shall contain identifying data that is recorded on standardized forms. This identifying data shall include the following: 1. full name; 2. home address; 3. home telephone number; 4. date of birth; 5. sex; 6. race or ethnic origin; 7. next of kin; 8. education;

9. marital status; 10. type and place of employment; 11. date of initial contact or admission to the facility; 12. legal status, including relevant legal documents; 13. other identifying data as indicated; 14. date the information was gathered; and 15. signature of the staff member gathering the information.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 52.9.19** The patient record shall contain information on any unusual occurrences, such as the following: 1 {#sec-16-52.9.19 omnilex-key=us-ms-regs-official--title-15--16#52.9.19}

treatment complications; 2. accidents or injuries to the patient; 3. morbidity; 4. death of a patient; and 5. procedures that place the patient at risk or that cause unusual pain.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 52.9.20** Rule 52.9.20 {#sec-16-52.9.20 omnilex-key=us-ms-regs-official--title-15--16#52.9.20}

As necessary, the patient record shall contain documentation of the consent of the patient, appropriate family member or guardians for admission, treatment, evaluation, aftercare, or research.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 52.9.21** Rule 52.9.21 {#sec-16-52.9.21 omnilex-key=us-ms-regs-official--title-15--16#52.9.21}

The patient record shall contain both physical and emotional diagnoses that have been made using a recognized diagnostic system.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 52.9.22** Rule 52.9.22 {#sec-16-52.9.22 omnilex-key=us-ms-regs-official--title-15--16#52.9.22}

The patient record shall contain reports of laboratory, roentgenographic, or other diagnostic procedures, and reports of medical/surgical services when performed.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 52.9.23** Rule 52.9.23 {#sec-16-52.9.23 omnilex-key=us-ms-regs-official--title-15--16#52.9.23}

The patient record shall contain correspondence concerning the patient's treatment, and signed and dated notations of telephone calls concerning the

patient's treatment. A discharge summary shall be entered in the patient's record within a reasonable period of time (not to exceed 14-days) following discharge as determined by the professional staff bylaws, rules and regulations.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 52.9.24** The patient record shall contain a plan for aftercare {#sec-16-52.9.24 omnilex-key=us-ms-regs-official--title-15--16#52.9.24}

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 52.9.25** All entries in the patient record shall be signed and dated {#sec-16-52.9.25 omnilex-key=us-ms-regs-official--title-15--16#52.9.25}

Symbols and abbreviations shall be used only if they have been approved by the professional staff, and only when there is an explanatory legend. Symbols and abbreviations shall not be used in the recording of diagnoses.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 52.9.26** When a patient dies, a summation statement shall be entered in the record in the form of a discharge summary {#sec-16-52.9.26 omnilex-key=us-ms-regs-official--title-15--16#52.9.26}

The summation statement shall include the circumstances leading to death and shall be signed by a physician. An autopsy shall be performed whenever possible. When an autopsy is performed, a provisional anatomic diagnosis shall be recorded in the patient's record within 72 hours. The complete protocol shall be made part of the record within three months.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 52.9.27** Promptness of Record Completion {#sec-16-52.9.27 omnilex-key=us-ms-regs-official--title-15--16#52.9.27}

Current records shall be completed promptly upon admission. Records of patients discharged shall be completed within 14 days following discharge. The staff regulations of the facility shall provide for the supervision or termination of staff privileges of physicians who are persistently delinquent in completing records.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 52.9.28** Identification, Filing and Indexing {#sec-16-52.9.28 omnilex-key=us-ms-regs-official--title-15--16#52.9.28}

A system of identification and filing to ensure the prompt location of a patient's medical records shall be maintained. 1. The patient index cards shall bear at least the full name of the patient, the address, the birth date, and the medical record number. 2. Records shall be indexed according to disease and physician and shall be kept up to date. For indexing, any recognized system may be used. 3. Indexing shall be current within six months following discharge of the patient.

Subchapter 10 FACILITY AND PROGRAM EVALUATION Rule 52.10.1 Program evaluation is a management tool primarily utilized by the facility's administration to assess and monitor, on a priority basis, a variety of facility, service, and programmatic activities.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 52.10.2** The facility shall have a written statement of goals and objectives {#sec-16-52.10.2 omnilex-key=us-ms-regs-official--title-15--16#52.10.2}

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 52.10.3** The goals and objectives shall result from a planning process {#sec-16-52.10.3 omnilex-key=us-ms-regs-official--title-15--16#52.10.3}

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 52.10.4** The goals and objectives shall be related to the needs of the population served {#sec-16-52.10.4 omnilex-key=us-ms-regs-official--title-15--16#52.10.4}

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 52.10.5** Rule 52.10.5 {#sec-16-52.10.5 omnilex-key=us-ms-regs-official--title-15--16#52.10.5}

The written statement of the goals and objectives of the facility service and programmatic activities shall be provided to the governing body and facility administration and shall be made available to staff.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 52.10.6** The facility shall have a written plan for evaluating its progress in attaining its goals and objectives {#sec-16-52.10.6 omnilex-key=us-ms-regs-official--title-15--16#52.10.6}

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 52.10.7** Rule 52.10.7 {#sec-16-52.10.7 omnilex-key=us-ms-regs-official--title-15--16#52.10.7}

The written plan shall specify the information to be collected and the methods to be used in retrieving and analyzing this information.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 52.10.8** Rule 52.10.8 {#sec-16-52.10.8 omnilex-key=us-ms-regs-official--title-15--16#52.10.8}

The written plan shall specify methods for assessing the utilization of staff and other resources to meet facility goals and objectives.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 52.10.9** The written plan shall specify when evaluations shall be conducted {#sec-16-52.10.9 omnilex-key=us-ms-regs-official--title-15--16#52.10.9}

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 52.10.10** Rule 52.10.10 {#sec-16-52.10.10 omnilex-key=us-ms-regs-official--title-15--16#52.10.10}

The written plan shall specify the criteria to be used in assessing the facility's progress in attaining its goals and objectives.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 52.10.11** The written plan shall require an explanation of any failure to achieve facility goals and objectives {#sec-16-52.10.11 omnilex-key=us-ms-regs-official--title-15--16#52.10.11}

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 52.10.12** Rule 52.10.12 {#sec-16-52.10.12 omnilex-key=us-ms-regs-official--title-15--16#52.10.12}

There shall be documentation that the goals and objectives of facility, service, and programmatic activities shall be evaluated at least annually and revised as necessary.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 52.10.13** Rule 52.10.13 {#sec-16-52.10.13 omnilex-key=us-ms-regs-official--title-15--16#52.10.13}

There shall be documentation that the results of the evaluation shall be provided to the governing body and facility administration and shall be made available to staff.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 52.10.14** There shall be documentation that the findings of the evaluation have influenced facility and program planning {#sec-16-52.10.14 omnilex-key=us-ms-regs-official--title-15--16#52.10.14}

**History**
- *SOURCE: Miss. Code Ann. §41-9-17 Subchapter 11 FISCAL MANAGEMENT Rule 52.11.1 The facility shall annually prepare a formal, written budget of expected revenues and expenses.*
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 52.11.2** The budget shall categorize revenues for the facility by source {#sec-16-52.11.2 omnilex-key=us-ms-regs-official--title-15--16#52.11.2}

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 52.11.3** The budget shall categorize expenses by the types of services of programs provided {#sec-16-52.11.3 omnilex-key=us-ms-regs-official--title-15--16#52.11.3}

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 52.11.4** The budget shall be reviewed and approved by the governing body prior to the beginning of the fiscal year {#sec-16-52.11.4 omnilex-key=us-ms-regs-official--title-15--16#52.11.4}

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 52.11.5** Revisions made in the budget during the fiscal year shall be reviewed and approved by the governing body {#sec-16-52.11.5 omnilex-key=us-ms-regs-official--title-15--16#52.11.5}

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 52.11.6** The facility management system shall include a fee schedule {#sec-16-52.11.6 omnilex-key=us-ms-regs-official--title-15--16#52.11.6}

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 52.11.7** Rule 52.11.7 {#sec-16-52.11.7 omnilex-key=us-ms-regs-official--title-15--16#52.11.7}

The facility shall maintain current, written schedules of rate and charge policies that have been approved by the governing body.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 52.11.8** The fee schedule shall be accessible to personnel and to individuals served by the facility {#sec-16-52.11.8 omnilex-key=us-ms-regs-official--title-15--16#52.11.8}

2. the records to be kept on all applicants; 3. the statistical data to be kept on the intake process; and 4. the procedures to be followed when an applicant or a referral is found ineligible for admission.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17 Subchapter 12 INDIVIDUALIZED COMPREHENSIVE TREATMENT PLANNING INTAKE Rule 52.12.1 Written policies and procedures governing the intake process shall specify the following: 1. the information to be obtained on all applicants or referrals for admission;*
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 52.12.2** Criteria for determining the eligibility of individuals for admission shall be clearly stated in writing {#sec-16-52.12.2 omnilex-key=us-ms-regs-official--title-15--16#52.12.2}

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 52.12.3** The intake procedure shall include an initial assessment of the patient {#sec-16-52.12.3 omnilex-key=us-ms-regs-official--title-15--16#52.12.3}

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 52.12.4** The intake assessment shall be done by professional staff {#sec-16-52.12.4 omnilex-key=us-ms-regs-official--title-15--16#52.12.4}

The results of the intake assessment shall be clearly explained to the patient.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 52.12.5** The results of the intake assessment shall be clearly explained to the patient's family when appropriate {#sec-16-52.12.5 omnilex-key=us-ms-regs-official--title-15--16#52.12.5}

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 52.12.6** Acceptance of a patient for treatment shall be based on an intake procedure that results in the following conclusions: 1 {#sec-16-52.12.6 omnilex-key=us-ms-regs-official--title-15--16#52.12.6}

the treatment required by the patient is appropriate to the intensity and restrictions of care provided by the facility or program component; and/or 2. the treatment required can be appropriately provided by the facility or program component; and 3. the alternatives for less intensive and restrictive treatment are not available.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 52.12.7** During the intake process, every effort shall be made to assure that applicants understand the following: 1 {#sec-16-52.12.7 omnilex-key=us-ms-regs-official--title-15--16#52.12.7}

the nature and goals of the treatment programs; 2. the treatment costs to be borne by the patient, if any; and 3. the rights and responsibilities of patients, including the rules governing patient conduct and the types of infractions that can result in disciplinary action or discharge from the facility or program component.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 52.12.8** Facilities shall have policies and procedures that adequately address the following items for each patient: 1 {#sec-16-52.12.8 omnilex-key=us-ms-regs-official--title-15--16#52.12.8}

responsibility for medical and dental care, including consents for medical or surgical care and treatment; 2. when appropriate, arrangements for family participation in the treatment program; 3. arrangements for clothing, allowances, and gifts; 4. arrangements regarding the patient's departure from the facility or program; and 5. arrangements regarding the patient's departure from the facility or program against clinical advice.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 52.12.9** Rule 52.12.9 {#sec-16-52.12.9 omnilex-key=us-ms-regs-official--title-15--16#52.12.9}

When a patient is admitted on court order, the rights and responsibilities of the patient and the patient's family shall be explained to them.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 52.12.10** Sufficient information shall be collected during the intake process to develop a preliminary treatment plan {#sec-16-52.12.10 omnilex-key=us-ms-regs-official--title-15--16#52.12.10}

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 52.12.11** Rule 52.12.11 {#sec-16-52.12.11 omnilex-key=us-ms-regs-official--title-15--16#52.12.11}

Staff members who will be working with the patient but who did not participate in the initial assessment shall be informed about the patient prior to meeting him or her.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17 Subchapter 13 ASSESSMENTS Rule 52.13.1 Within 72 hours of admission, the staff shall conduct a complete assessment of each patient's needs. The assessment shall include, but shall not necessarily be limited to, physical, emotional, behavioral, social, recreational, and nutritional needs.*
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 52.13.2** A licensed physician shall be responsible for assessing each patient's physical health {#sec-16-52.13.2 omnilex-key=us-ms-regs-official--title-15--16#52.13.2}

The health assessment shall include a medical, alcohol and drug history; a physical examination; neurological examination when indicated and a laboratory workup. The physical examination shall be completed, within 24 hours after admission.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 52.13.3** Rule 52.13.3 {#sec-16-52.13.3 omnilex-key=us-ms-regs-official--title-15--16#52.13.3}

In facilities serving children and adolescents, each patient's physical health assessment shall also include evaluations of the following: motor development and functioning; sensorimotor functioning; speech, hearing, and language functioning; visual functioning; and immunization status. Facilities serving children and adolescents shall have all necessary diagnostic tools and personnel available to perform physical health assessments.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 52.13.4** A registered nurse shall be responsible for obtaining a nursing history and assessment at the time of admission {#sec-16-52.13.4 omnilex-key=us-ms-regs-official--title-15--16#52.13.4}

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 52.13.5** An emotional and behavioral assessment of each patient shall be completed and entered in the patient's record {#sec-16-52.13.5 omnilex-key=us-ms-regs-official--title-15--16#52.13.5}

The assessment shall include, but not be limited to, the following items: 1. a history of previous emotional and behavioral functioning;

2. the patient's current emotional and behavioral functioning; 3. when indicated, a direct psychiatric evaluation; and 4. when indicated, psychological assessments, including intellectual and personality testing.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 52.13.6** Rule 52.13.6 {#sec-16-52.13.6 omnilex-key=us-ms-regs-official--title-15--16#52.13.6}

A social assessment of each patient shall be completed by the qualified social worker and entered in the patient's record. The assessment shall include information relating to the following areas, as necessary: 1. environment and home; 2. religion; 3. childhood history; 4. military service history; 5. financial status; 6. the social, peer-group, and environment setting from which the patient comes; and 7. the patient's family circumstances, including the constellation of the family group, the current living situation; and social, ethnic, cultural, emotional, and health factors, including drug and alcohol use.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 52.13.7** Rule 52.13.7 {#sec-16-52.13.7 omnilex-key=us-ms-regs-official--title-15--16#52.13.7}

When appropriate, an activities assessment of each patient shall be completed by the qualified activity director and shall include information relating to the individual's current skills, talents, aptitudes, and interest.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 52.13.8** Rule 52.13.8 {#sec-16-52.13.8 omnilex-key=us-ms-regs-official--title-15--16#52.13.8}

A nutritional assessment shall be conducted by the food service supervisor or registered dietitian and shall be documented in the patient's record.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17 Subchapter 14 TREATMENT PLANS Rule 52.14.1 Each patient shall have a written individual treatment plan that is based on assessments of his or her clinical needs.*
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 52.14.2** Rule 52.14.2 {#sec-16-52.14.2 omnilex-key=us-ms-regs-official--title-15--16#52.14.2}

Overall development and implementation of the treatment plan shall be assigned to an appropriate member of the professional staff.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 52.14.3** The treatment plan shall be developed as soon as possible after the patient's admission {#sec-16-52.14.3 omnilex-key=us-ms-regs-official--title-15--16#52.14.3}

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 52.14.4** Appropriate therapeutic efforts may begin before a fully developed treatment plan is finalized {#sec-16-52.14.4 omnilex-key=us-ms-regs-official--title-15--16#52.14.4}

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 52.14.5** Upon admission, a prelimary treatment plan shall be formulated on the basis of the intake assessment {#sec-16-52.14.5 omnilex-key=us-ms-regs-official--title-15--16#52.14.5}

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 52.14.6** Rule 52.14.6 {#sec-16-52.14.6 omnilex-key=us-ms-regs-official--title-15--16#52.14.6}

Within 72 hours following admission a designated member of the treatment team shall develop an initial treatment plan that is based on at least an assessment of the patient's presenting problems, physical health, emotional status, and behavioral status. This initial treatment plan shall be utilized to implement immediate treatment objectives.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 52.14.7** Rule 52.14.7 {#sec-16-52.14.7 omnilex-key=us-ms-regs-official--title-15--16#52.14.7}

If a patient's stay in a facility is ten days or less, only a discharge summary will be required in addition to be initial treatment plan.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 52.14.8** Rule 52.14.8 {#sec-16-52.14.8 omnilex-key=us-ms-regs-official--title-15--16#52.14.8}

If a patient's stay in a facility exceeds ten days, the interdisciplinary team shall develop a master treatment plan that is based on a comprehensive assessment of the patient's needs.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 52.14.9** The master treatment plan shall contain objectives and methods for achieving them {#sec-16-52.14.9 omnilex-key=us-ms-regs-official--title-15--16#52.14.9}

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 52.14.10** Rule 52.14.10 {#sec-16-52.14.10 omnilex-key=us-ms-regs-official--title-15--16#52.14.10}

The treatment plan shall reflect the facility's philosophy of treatment and the participation of staff from appropriate disciplines.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 52.14.11** The treatment plan shall reflect consideration of the patient's clinical needs {#sec-16-52.14.11 omnilex-key=us-ms-regs-official--title-15--16#52.14.11}

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 52.14.12** The treatment plan shall specify the services necessary to meet the patient's needs {#sec-16-52.14.12 omnilex-key=us-ms-regs-official--title-15--16#52.14.12}

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 52.14.13** The treatment plan shall include referrals for needed services that are not provided directly by the facility {#sec-16-52.14.13 omnilex-key=us-ms-regs-official--title-15--16#52.14.13}

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 52.14.14** Rule 52.14.14 {#sec-16-52.14.14 omnilex-key=us-ms-regs-official--title-15--16#52.14.14}

The treatment plan shall contain specific goals that the patient must achieve to attain, maintain, and/or reestablish emotional and/or physical health as well as maximum growth and adaptive capabilities. These goals shall be based on assessments of the patient and, as appropriate, the patient's family.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 52.14.15** Rule 52.14.15 {#sec-16-52.14.15 omnilex-key=us-ms-regs-official--title-15--16#52.14.15}

The treatment plan shall contain specific objectives that related to the goals, are written in measureable terms, and include expected achievements dates.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 52.14.16** Rule 52.14.16 {#sec-16-52.14.16 omnilex-key=us-ms-regs-official--title-15--16#52.14.16}

The treatment plan shall describe the services, activities, and programs planned for the patient, and shall specify the staff members assigned to work with the patient.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 52.14.17** The treatment plan shall specify the frequency of treatment procedures {#sec-16-52.14.17 omnilex-key=us-ms-regs-official--title-15--16#52.14.17}

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 52.14.18** The treatment plan shall delineate the specific criteria to be met for termination of treatment {#sec-16-52.14.18 omnilex-key=us-ms-regs-official--title-15--16#52.14.18}

Such criteria shall be a part of the initial treatment plan.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 52.14.19** Rule 52.14.19 {#sec-16-52.14.19 omnilex-key=us-ms-regs-official--title-15--16#52.14.19}

When appropriate, the patient shall participate in the development of his or her treatment plan, and such participation shall be documented in the patient's record.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 52.14.20** A specific plan for involving the family or significant others shall be included in the treatment plan when indicated {#sec-16-52.14.20 omnilex-key=us-ms-regs-official--title-15--16#52.14.20}

Subchapter 15 PROGRESS NOTES Rule 52.15.1 Progress notes shall be recorded by the physician, nurse, social worker and, when appropriate, others significantly involved in treatment. The frequency of progress notes is determined by the condition of the patient but should be recorded at least weekly for the first two (2) months and at least monthly thereafter.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 52.15.2** Progress notes shall be entered in the patient's record and shall include the following: 1 {#sec-16-52.15.2 omnilex-key=us-ms-regs-official--title-15--16#52.15.2}

documentation of implementation of the treatment plan; 2. documentation of all treatment rendered to the patient; 3. description of change in the patient's condition; and 4. descriptions of the response of the patient to treatment, the outcome of treatment, and the response of significant others to important intercurrent events.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 52.15.3** Progress notes shall be dated and signed by the individual making the entry {#sec-16-52.15.3 omnilex-key=us-ms-regs-official--title-15--16#52.15.3}

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 52.15.4** Rule 52.15.4 {#sec-16-52.15.4 omnilex-key=us-ms-regs-official--title-15--16#52.15.4}

All entries involving subjective interpretation of the patient's progress should be supplemented with a description of the actual behavior observed.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17 Subchapter 16 TREATMENT PLAN REVIEW Rule 52.16.1 Interdisciplinary case conferences shall be regularly conducted to review and evaluate each patient's treatment plan and his or her progress in attaining the stated treatment goals and objectives.*
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 52.16.2** Rule 52.16.2 {#sec-16-52.16.2 omnilex-key=us-ms-regs-official--title-15--16#52.16.2}

Interdisciplinary case conferences shall be documented, and the results of the review and evaluation shall be recorded in the patient's record. The review and update shall be completed no later than thirty (30) days following the first 10-days of treatment and at least every sixty (60) days thereafter.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17 Subchapter 17 DISCHARGE PLANNING/AFTERCARE*

##### **15 Miss. Admin. Code Pt. 16, R. 52.17.1** Rule 52.17.1 {#sec-16-52.17.1 omnilex-key=us-ms-regs-official--title-15--16#52.17.1}

The facility maintains a centralized coordinated program to ensure that each patient has a planned program of continuing care which meets his post discharge needs.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 52.17.2** Each patient shall have an individualized discharge plan which reflects input from all disciplines involved in his care {#sec-16-52.17.2 omnilex-key=us-ms-regs-official--title-15--16#52.17.2}

The patient, patient's family, and/or significant others shall be involved in the discharge planning process.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 52.17.3** Discharge planning data shall be collected at the time of admission or within seven (7) days thereafter {#sec-16-52.17.3 omnilex-key=us-ms-regs-official--title-15--16#52.17.3}

The chief executive officer shall delegate the responsibility for discharge planning, in writing, to one or more staff members.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 52.17.4** The facility shall maintain written discharge planning policies and procedures which describe: 1 {#sec-16-52.17.4 omnilex-key=us-ms-regs-official--title-15--16#52.17.4}

how the discharge coordinator will function, and his authority and relationships with the facility's staff; 2. the time period in which each patient's need for discharge planning is determined (within seven days after admission); 3. the maximum time period after which reevaluation of each patient's discharge plan is made; 4. local resources available to the facility and the patient to assist in developing and implementing individual discharge plans; and 5. provisions for periodic review and reevaluation of the facility's discharge planning program (at least annually).

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 52.17.5** An interdisciplinary case conference shall be held prior to the patient's discharge {#sec-16-52.17.5 omnilex-key=us-ms-regs-official--title-15--16#52.17.5}

The discharge/aftercare plan shall be reviewed with the patient, patient's family and/or significant others.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 52.17.6** Rule 52.17.6 {#sec-16-52.17.6 omnilex-key=us-ms-regs-official--title-15--16#52.17.6}

The facility shall have documentation that the aftercare plan has been implemented and shall have documentation of follow-ups to assure referrals to appropriate community agencies.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 52.17.7** Rule 52.17.7 {#sec-16-52.17.7 omnilex-key=us-ms-regs-official--title-15--16#52.17.7}

Discharge Summary: A discharge summary shall be entered in the patient's record within fourteen (14) days following discharge. The discharge summary shall include but not be limited to: 1. reason for admission; 2. brief summary of treatment; 3. reason for discharge; 4. assessment of treatment plan goals and objectives; and 5. recommendations and arrangements for further treatment, including prescribed medications and aftercare.

Provision shall be made for emergency pharmaceutical services.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17 Subchapter 18 SUPPORT SERVICES: PHARMACY Rule 52.18.1 Direction and Supervision. The hospital shall have a pharmacy directed by a registered pharmacist, who has had, by education or experience, training in the specialized area of hospital pharmacy. The pharmacy or drug room shall be administered in accordance with accepted professional principles. The pharmacist shall be assisted, as needed, by additional qualified pharmacists and ancillary personnel. Pharmacy assistants shall work under the supervision of a pharmacist and shall not be assigned duties that are required to be performed only by registered pharmacists.*
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 52.18.2** Records {#sec-16-52.18.2 omnilex-key=us-ms-regs-official--title-15--16#52.18.2}

Records shall be kept of the transactions of the pharmacy (or drug room) and correlated with other hospital records where indicated. Such special records shall be kept as required by law. The pharmacy shall establish and maintain a satisfactory system of records and accountability in accordance with the policies of the hospital for maintaining adequate control over the requisitioning and dispensing of all drugs and pharmaceutical supplies.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 52.18.3** Rule 52.18.3 {#sec-16-52.18.3 omnilex-key=us-ms-regs-official--title-15--16#52.18.3}

A record of the stock on hand and of the dispensing of all narcotic drugs shall be maintained in such a manner that the disposition of any particular item may be readily traced.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 52.18.4** Rule 52.18.4 {#sec-16-52.18.4 omnilex-key=us-ms-regs-official--title-15--16#52.18.4}

The label of each outpatient's individual prescription medication container shall bear the lot and control number of the drug, the name of the manufacturer (or trademark) and, unless the physician directs otherwise, the name of the medication dispensed.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 52.18.5** Control of Toxic or Dangerous Drugs {#sec-16-52.18.5 omnilex-key=us-ms-regs-official--title-15--16#52.18.5}

Policies shall be established to control the administration of toxic or dangerous drugs with specific reference to the duration of the order and the dosage. The facility shall establish a written policy that all toxic or dangerous medications, not specifically prescribed as to time or number of doses, shall be automatically stopped after a reasonable time limit. The classification ordinarily thought of as toxic, dangerous or abuse drugs shall be narcotics, sedatives, anticoagulants, antibiotics, oxytocics and cortisone products, and shall include other categories so established by federal, state or local laws.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 52.18.6** Drugs to be Dispensed {#sec-16-52.18.6 omnilex-key=us-ms-regs-official--title-15--16#52.18.6}

The pharmacist, with the advice and guidance or the pharmacy and therapeutics committee, shall be responsible for specifications as to quality, quantity, and source of supply of all drugs.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 52.18.7** Rule 52.18.7 {#sec-16-52.18.7 omnilex-key=us-ms-regs-official--title-15--16#52.18.7}

There shall be available a formulary or list of drugs accepted for use in the facility which is developed and amended at regular intervals by the pharmacy and therapeutics committee (or equivalent committee) with the cooperation of the pharmacist and the administration.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 52.18.8** The pharmacy or drug room shall be adequately supplied with preparations as approved {#sec-16-52.18.8 omnilex-key=us-ms-regs-official--title-15--16#52.18.8}

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 52.18.9** Committee {#sec-16-52.18.9 omnilex-key=us-ms-regs-official--title-15--16#52.18.9}

There shall be a pharmacy and therapeutics committee (or equivalent committee) composed of physicians and pharmacists, and registered professional nurses established in the facility.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 52.18.10** Rule 52.18.10 {#sec-16-52.18.10 omnilex-key=us-ms-regs-official--title-15--16#52.18.10}

It shall represent the organizational line of communication and the liaison between the professional staff and the pharmacist.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 52.18.11** Rule 52.18.11 {#sec-16-52.18.11 omnilex-key=us-ms-regs-official--title-15--16#52.18.11}

The committee shall assist in the formulation of board professional policies regarding the evaluation, appraisal, selection, procurement, storage, distribution, use, and safety procedures, and all other matters relating to drugs in hospitals.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 52.18.12** The committee shall perform the following specific functions: 1 {#sec-16-52.18.12 omnilex-key=us-ms-regs-official--title-15--16#52.18.12}

serve as an advisory group to the professional staff and the pharmacist on matters pertaining to the choice of drugs; 2. develop and review periodically a formulary or drug list for use in the facility; 3. establish standards concerning the use and control of investigational drugs and research in the use of recognized drugs; 4. evaluate clinical data concerning new drugs or preparations requested for use in the facility; 5. make recommendations concerning drugs to be stocked on the nursing unit floors and by other services; and 6. prevent unnecessary duplication in stocking drugs and drugs in combination having identical amounts of the same therapeutic ingredients. 7. The committee shall meet at least quarterly and report to the professional staff.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 52.18.13** Medication Control {#sec-16-52.18.13 omnilex-key=us-ms-regs-official--title-15--16#52.18.13}

The facility shall have written policies and procedures designed to ensure that all medications are dispensed and administered safely and properly in accordance with the applicable federal, state, and local laws and regulations. 1. Medication orders shall be written only by authorized prescribers. 2. An up-to-date list of authorized prescribers shall be available in all areas where medication is dispensed. 3. Telephone orders shall be accepted only from individuals on the list of authorized prescribers. 4. Telephone orders shall be limited to emergency situations that have been defined in writing in the facility's policies and procedures manual. 5. Telephone orders shall be accepted and written in the patient's record only by staff authorized to administer medication.

6. Telephone orders shall be signed by an authorized prescriber on the next regular working day, but in all events within 72 hours. 7. A written order signed by the authorized prescriber shall be included in patient's record. 8. Medication orders that contain abbreviations and chemical symbols shall be carried out only if the abbreviations and symbols are on a standard list approved by the physician members of the professional staff. 9. There shall be automatic stop orders on specified medications. Refer to Rule 52.18.5. 10. There shall be a specific routine of drug administration, indicating dose schedules and standardization of abbreviations. 11. Only pharmacists, physicians, registered nurses, or licensed practical nurses shall administer medications. 12. Self-administration of medication shall be permitted only when specifically ordered by the responsible physician. 13. Drugs brought into the facility by patients shall not be administered unless they can be absolutely identified, and unless written orders to administer these specific drugs are given by the responsible physician. If the drugs that the patient brings to the facility are not to be used, they shall be packaged, sealed, and stored, and, if approved by the responsible physician, they shall be returned to the patient, family, or significant others at the time of discharge. 14. The patient and, when appropriate, the family shall be instructed about which medications if any, are to be administered at home. 15. Medications administered, medication errors, and adverse drug reactions shall be documented in the patient's record. 16. Facilities should implement a reporting system under which the reporting program of the federal Food and Drug Administration and the drug manufacturer are advised of unexpected adverse drug reactions. 17. There shall be methods of detecting drug side effects of toxic reactions. 18. Investigational drugs shall be used only under the direct supervision of the principal investigator and with the approval of research review committee and either the physician members of the professional staff or an appropriate committee of the professional staff.

19. A central unit shall be established where essential information on investigational drugs, such as dosage form, dosage range, storage requirements, adverse reactions, usage, and contraindications, is maintained. 20. Investigational drugs shall be properly labeled. 21. Nurses may administer investigational drugs only after receiving basic pharmacologic information about the drugs. 22. The facility shall have specific methods for controlling and accounting for drug products. 23. The pharmacy service shall maintain records of its transactions as required by law and as necessary to maintain adequate control of, and accountability for, all drugs. 24. These records shall document all supplies issued to units, departments, or services of the facility, as well as all prescription drugs dispensed. 25. Records and inventories of the drugs listed in the current Comprehensive Drug Abuse Prevention and Control Act shall be maintained as required by the act and regulations. 26. Distribution and administration of controlled drugs are adequately documented, and inspections of these records by the pharmacist is documented.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 52.18.14** Emergency Medication Kit {#sec-16-52.18.14 omnilex-key=us-ms-regs-official--title-15--16#52.18.14}

There is an emergency kit that is: 1. made up under the supervision and responsibility of the pharmacist, and is approved by the Pharmacy and Therapeutic Committee; 2. readily available to staff yet not accessible to patients; 3. constituted so as to be appropriate to the needs of the patients; and 4. inspected monthly to remove deteriorated and outdated drugs and to ensure completeness of content. SOURCE Miss. Code Ann. §41-9-17 Rule 52.18.15 The pharmacist responsible for the emergency kit shall provide a list of its contents and appropriate instructions, and shall authenticate this list with his signature.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 52.18.16** Storage of Drugs {#sec-16-52.18.16 omnilex-key=us-ms-regs-official--title-15--16#52.18.16}

Drug storage shall be maintained in accordance with the security requirements of federal, state, and local laws. Drugs preparation areas

and drug storage area shall be well-lighted and shall be so located that personnel will not be interrupted when handling drugs. All drugs shall be kept in locked storage. 1. Poisons, external drugs, and internal drugs shall be stored on separate shelves or in separate cabinets. 2. Medications that are stored in a refrigerator containing items other than drugs shall be kept in a separate compartment or container with proper security. 3. Antidote charts and the telephone number of the regional poison control center shall be kept in all drug storage and preparation areas.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 52.18.17** Space for Storage of Drugs {#sec-16-52.18.17 omnilex-key=us-ms-regs-official--title-15--16#52.18.17}

Adequate space shall be provided in the Pharmacy for storage of drugs and for keeping of necessary records. The pharmacy shall be capable of being securely locked in accordance with regulations regarding storage of dangerous drugs. Adequate space is defined on a minimum of 250 sq. ft. for 50 beds or less; 500 sq. ft. of storage for 75 beds or less; 750 sq. ft. for 100 beds or less; and 1000 sq. ft. for 100 beds or more.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 52.18.18** Quality Assurance Activities {#sec-16-52.18.18 omnilex-key=us-ms-regs-official--title-15--16#52.18.18}

A pharmacist shall regularly review the medication records of patients. 1. All medication orders shall be reviewed monthly by the responsible physician. Adverse drug reactions and medication errors shall be reported to the physician responsible for the patient, and shall be documented in the patient's record. 2. The pharmacist in charge of dispensing medications, shall provide for monthly inspection of all storage units, including emergency boxes and emergency carts. 3. A record of these inspections shall be maintained in order to verify the following: 4. Disinfectants and drugs for external use are stored separately from internal and injectable medications. 5. Drugs requiring special conditions for storage to ensure stability are properly stored.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 52.18.19** Continuing Education {#sec-16-52.18.19 omnilex-key=us-ms-regs-official--title-15--16#52.18.19}

The director of the pharmacy service shall receive orientation in the specialized functions of the facility.

1. A pharmacist should participate in staff development programs for the clinical staff. 2. As appropriate, a pharmacist should participate in drug abuse education programs conducted by the facility. 3. As appropriate, a pharmacist should participate in public education and information programs relative to the services of the facility. 4. Up-to-date pharmaceutical reference material shall be provided so that appropriate staff will have adequate information concerning drugs. 5. Current editions of text and reference books covering the following topics shall be provided: theoretical and practical pharmacy; general, organic, pharmaceutical, and biological chemistry; toxicology; pharmacology; bacteriology; sterilization and disinfection; and other subjects important to good patient card.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 52.18.20** Functional Safety and Sanitation {#sec-16-52.18.20 omnilex-key=us-ms-regs-official--title-15--16#52.18.20}

Adequate precautions shall be taken to store medications under proper conditions of sanitation, temperature, light, moisture, ventilation, segregation, and security. 1. All drugs shall be kept in locked storage. 2. Security shall be maintained in accordance with local and state laws. 3. Poisons, external drugs, and internal drugs shall be stored on separate shelves or in separate containers. 4. Drug preparation and storage areas shall be well-lighted and shall be located where personnel will not be interrupted when handling drugs. 5. Metric-apothecaries' weight and measure conversion charts shall be posted in each drug preparation area and wherever else they are needed.

1. The qualified dietitian shall be registered or eligible for registration by the Commission on Dietetic Registration. 2. When a qualified dietitian is employed on a part-time or consultative basis, the dietitian shall devote enough time to accomplish the following tasks: a. Assure continuity of services; b. Direct the nutritional aspects of patient care; c. Assure that dietetic instructions are carried out; d. On occasion, supervise the serving of meals; and e. Assist in the evaluation of the dietetic services. 3. Regular written reports shall be submitted to the chief executive officer on the extent of services provided by the dietitian. 4. There shall be written policies and procedures for food storage, preparation, and service developed by a registered dietitian. 5. The dietetic service shall have an adequate number of appropriately qualified individuals to meet the dietetic needs of the facility's patients. 6. Written job descriptions of all dietary employees shall be available. 7. There shall be procedures to control dietary employees with infectious and open lesions. Routine health examinations shall meet local and state codes for food service personnel. 8. There shall be an on-going planned in-service training program for dietary employees which includes the proper handling of food and personal grooming, safety, sanitation, behavioral and therapeutic needs of patients.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17 Subchapter 19 DIETARY Rule 52.19.1 Organization. The facility shall have an organized dietary department directed by a qualified food service supervisor, with services of a registered dietitian on at least a consultant basis. However, a facility which has a contract with an outside food management company may be found to meet this requirement if the company has a therapeutic dietitian who serves, as required by scope and complexity of the services, on a full-time, part-time, or consultant basis to the facility.*
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 52.19.2** Facilities {#sec-16-52.19.2 omnilex-key=us-ms-regs-official--title-15--16#52.19.2}

Adequate space, equipment, ventilation and supplies as well as any necessary written procedure and precautions, shall be provided for the safe and sanitary operation of the dietetic service and the safe and sanitary handling and distribution of food. 1. The food service area should be appropriately located. 2. The dietitian's office should be easily accessible to all who require consultation services. 3. Sufficient space shall be provided for support personnel to perform their duties.

4. The layout of the department and the type amount, size, and placement of equipment shall make possible the efficient preparation and distribution of food. 5. Lavatories with wrist action blades, soap dispenser and disposable towel dispenser shall be located throughout the dietary department. 6. Dry or staple food items shall be stored in a ventilation room which is not subject to sewage or waste water back flow, or contamination by condensation, leakage, rodents or vermin. 7. All perishable foods shall be refrigerated at the appropriate temperature and in an orderly and sanitary manner. Each refrigerator shall contain a thermometer in good working order. 8. Foods being displayed or transported shall be protected from contamination. 9. Dishwashing procedures and techniques shall be developed and carried out in compliance with the state and local health codes. 10. All garbage and kitchen refuse which is not disposed of mechanically shall be kept in leak-proof non-absorbent containers with close fitting covers and be disposed of routinely in a manner that will not permit transmission of disease, a nuisance, or a breeding place for files. All garbage containers are to be thoroughly cleaned inside and outside each time emptied. 11. All dietary areas, equipment, walls, floors, etc., shall be kept maintained in good working condition and sanitary at all times.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 52.19.3** Diets {#sec-16-52.19.3 omnilex-key=us-ms-regs-official--title-15--16#52.19.3}

There shall be systematic record of diets, correlated when appropriate, with the medical records. The dietitian shall have available an up-to-date manual of regimens for all therapeutic diets, approved jointly by the dietitian and medical staff, which is available to dietary supervisory personnel. Diets serve to patients shall be in compliance with these established diet principles. 1. The diet manual shall be reviewed annually and revised as necessary by a qualified dietitian, and shall be dated to identify the time of the review. 2. Revisions to the diet manual shall be approved by the facility's physician. 3. The diet manual should be used to standardize the ordering of diets. 4. The policies and procedures shall provide for dietetic counseling. 5. The nutritional deficiencies of any diet in the manual shall be indicated.

6. The policies and procedures shall require the recording of dietetic orders in the patient's record. 7. The policies and procedures shall require the recording of all observations and information pertinent of dietetic treatment in the patient's record by the food service supervisor or dietitian. 8. The policies and procedures shall require the use of standards for nutritional care in evaluating the nutritional adequacy of the patient's diet and in ordering diet supplements. The current Recommended Dietary Allowances of the Food and Nutrition Board of the National Research Council of the National Academy of Sciences is suggested as a guide in developing these standards. 9. The policies and procedures shall describe the methods for assuring that each patient on a special diet receives the prescribed diet regimen. 10. The policies and procedures shall provide for altering diets or diet schedules as well as for discontinuing diets. 11. Dietetic service personnel shall conduct periodic food acceptance studies among the patients and should encourage them to participate in menu planning. 12. The results of food acceptance studies should be reflected in revised menus. 13. All menus shall be approved by a qualified dietitian.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 52.19.4** Food Service and Dining {#sec-16-52.19.4 omnilex-key=us-ms-regs-official--title-15--16#52.19.4}

Food shall be served in an appetizing and attractive manner, at planned and realistic mealtimes, and in a congenial and relaxed atmosphere. 1. Dining areas should be attractive and maintained at appropriate temperatures. 2. The dietetic services shall be patient-oriented and should take into account the many factors that contribute to the wide variations in patient eating habits, including cultural, religious, and ethnic factors. 3. Snacks shall be available as appropriate to the nutritional needs of the patients and the needs of the facility. 4. The dietetic service shall be prepared to give extra food to individual patients. 5. Appropriate food should be available for patients with special or limited dietary needs. 6. There shall be adequate equipment provided for tray assembly and tray delivery.

7. Facilities or arrangements shall be available for family and friends to eat with patients when possible.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17 Subchapter 20 ACTIVITY SERVICES Rule 52.20.1 The facility shall provide, or make arrangements for the provision of activity services to all patients in accordance with their needs and interests and as appropriate within the scope of the facility's program.*
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 52.20.2** Rule 52.20.2 {#sec-16-52.20.2 omnilex-key=us-ms-regs-official--title-15--16#52.20.2}

The facility shall have a written plan that describes the organization of their activity services or the arrangements made for the provision of activity services. The activity services shall have a well-organized plan for using community resources. The goals and objectives of the facility's activity services shall be stated in writing.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 52.20.3** Rule 52.20.3 {#sec-16-52.20.3 omnilex-key=us-ms-regs-official--title-15--16#52.20.3}

The facility shall have written policies and procedures for the activity services which are made available to activity services and other appropriate personnel. The policies and procedures shall be reviewed and revised at least annually.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 52.20.4** Appropriate activities shall be provided to all patients during the day, in the evening, and on weekends {#sec-16-52.20.4 omnilex-key=us-ms-regs-official--title-15--16#52.20.4}

The daily activities program shall be planned to provide a consistent and well-structured yet flexible framework for daily living. Whenever possible, patients should participate in planning activity services.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 52.20.5** Activity schedules shall be posted in places accessible to patients and staff {#sec-16-52.20.5 omnilex-key=us-ms-regs-official--title-15--16#52.20.5}

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 52.20.6** The activities program shall be reviewed and revised according to the changing needs of patients {#sec-16-52.20.6 omnilex-key=us-ms-regs-official--title-15--16#52.20.6}

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 52.20.7** When indicated, activity services shall be incorporated in the patient's treatment plan {#sec-16-52.20.7 omnilex-key=us-ms-regs-official--title-15--16#52.20.7}

Activity services that are included in a patient's treatment plan shall reflect an assessment of the patient's needs, interests, life experiences, capacities, and deficiencies. Activity services staff shall collaborate with other professional staff

in delineating goals for patients' treatment, health maintenance, and vocational adjustments.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 52.20.8** Rule 52.20.8 {#sec-16-52.20.8 omnilex-key=us-ms-regs-official--title-15--16#52.20.8}

The patient's record shall contain progress notes that describe the patient's response to activity services and other pertinent observations.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 52.20.9** Rule 52.20.9 {#sec-16-52.20.9 omnilex-key=us-ms-regs-official--title-15--16#52.20.9}

There shall be documentation that patients are given leisure time and that they are encouraged to use their leisure time in a way that fulfills their cultural and recreational interests and their feelings of human dignity.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 52.20.10** Vehicles used for transportation shall not be labeled in a manner that calls unnecessary attention to the patients {#sec-16-52.20.10 omnilex-key=us-ms-regs-official--title-15--16#52.20.10}

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 52.20.11** Quality Assurance Activities {#sec-16-52.20.11 omnilex-key=us-ms-regs-official--title-15--16#52.20.11}

The activity service shall have written procedures for ongoing review and revision of its goals, objectives, and role within the family. The activity service shall maintain statistical and other records on the functioning and utilization of the services.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 52.20.12** Continuing Education {#sec-16-52.20.12 omnilex-key=us-ms-regs-official--title-15--16#52.20.12}

The facility shall maintain ongoing staff development programs. 1. Activity service staff shall participate in appropriate clinical and administrative committees and conferences. 2. Activity service staff shall receive training and demonstrate competence in handling medical and psychiatric emergencies. 3. The activity service shall encourage extramural studies and evaluations of activity services and extramural research in activity services.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 52.20.13** Functional Safety and Sanitation {#sec-16-52.20.13 omnilex-key=us-ms-regs-official--title-15--16#52.20.13}

Appropriate space, equipment, and facilities shall be provided to meet the needs of patients for activity services: 1. Facilities and equipment designated for activity services shall be constructed or modified in such a manner as to provide, insofar as possible, pleasant and functional areas that are accessible to all patients regardless of their disabilities.

2. Space for offices, storage, and supplies shall be adequate and accessible. 3. When indicated, equipment and supplies that enable the activity to be brought to the patient should be used. 4. Space, equipment and facilities utilized both inside and outside the facility shall meet federal, state, and local requirements for safe fire prevention, health and sanitation.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17 Subchapter 21 REFERRALS Rule 52.21.1 The facility shall have written policies and procedures that facilitate the referral of patients and the provision of consultation between the facility's program components and between the facility and other service providers in the community.*
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 52.21.2** The written policies and procedures shall describe the methods by which continuity of care is assured for the patient {#sec-16-52.21.2 omnilex-key=us-ms-regs-official--title-15--16#52.21.2}

These methods shall include, but not be limited to, providing the facility, program component, or other service provider to which the patient is referred with the following: 1. background information on the referral; 2. information on the patient's treatment, for example, current treatment, diagnostic assessments, and special requirements; 3. treatment objectives desired; 4. suggestions for continued coordination between the referring and the receiving resource; 5. special clinical management requirements; and 6. information on how the patient can be returned to the referring facility or program component.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 52.21.3** Rule 52.21.3 {#sec-16-52.21.3 omnilex-key=us-ms-regs-official--title-15--16#52.21.3}

The referring facility shall ask the receiving facility, program component, or other service provider to which the patient is referred, to submit a follow-up report within a designated time period.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 52.21.4** The written policies and procedures shall describe the mechanism by which a patient may be referred {#sec-16-52.21.4 omnilex-key=us-ms-regs-official--title-15--16#52.21.4}

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 52.21.5** Rule 52.21.5 {#sec-16-52.21.5 omnilex-key=us-ms-regs-official--title-15--16#52.21.5}

The written policies and procedures shall describe the means by which the facility assists in the referral of individuals who are seeking services that the facility does not provide.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 52.21.6** Rule 52.21.6 {#sec-16-52.21.6 omnilex-key=us-ms-regs-official--title-15--16#52.21.6}

The written policies and procedures shall be reviewed and approved annually by the director and appropriate administrative and professional staff members. The annual review and approval shall be documented.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 52.21.7** Rule 52.21.7 {#sec-16-52.21.7 omnilex-key=us-ms-regs-official--title-15--16#52.21.7}

Each community service provider to which patients are referred shall express in writing its willingness to abide by federal and state standards concerning confidentiality of patient information.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 52.21.8** The facility shall have a letter of agreement and/or contract with community service providers that it uses repeatedly {#sec-16-52.21.8 omnilex-key=us-ms-regs-official--title-15--16#52.21.8}

**History**
- *SOURCE: Miss. Code Ann. §41-9-17 Subchapter 22 LABORATORY AND RADIOLOGIC SERVICES Rule 52.22.1 The facility shall have provisions for promptly obtaining required laboratory, x- ray, and other diagnostic services.*
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 52.22.2** Rule 52.22.2 {#sec-16-52.22.2 omnilex-key=us-ms-regs-official--title-15--16#52.22.2}

If the facility provides its own laboratory and x-ray services, these shall meet the applicable standards established for hospital censure. Refer to Subchapter 21, Subchapters 57-61 & Rule 41.71.3 of the Minimum Standards of Operation for Mississippi Hospitals.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 52.22.3** Rule 52.22.3 {#sec-16-52.22.3 omnilex-key=us-ms-regs-official--title-15--16#52.22.3}

If the facility itself does not provide such services, arrangements shall be made for obtaining these services from a licensed and certified laboratory.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 52.22.4** All laboratory and x-ray services shall be provided only on the orders of the attending physician {#sec-16-52.22.4 omnilex-key=us-ms-regs-official--title-15--16#52.22.4}

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 52.22.5** The facility shall assist the patient, if necessary, in arranging for transportation to and from the source of service {#sec-16-52.22.5 omnilex-key=us-ms-regs-official--title-15--16#52.22.5}

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 52.22.6** Rule 52.22.6 {#sec-16-52.22.6 omnilex-key=us-ms-regs-official--title-15--16#52.22.6}

All signed and dated reports of laboratory, x-ray, and other diagnostic services shall be filed with the patient's medical record.

1. Facilities that do not maintain a professional library shall have an arrangement with a nearby facility or institution to use its professional library. 2. Current reference material, books, and basic health care journals shall be available in each facility. 3. The library service shall establish regular and convenient hours of service so that staff may have prompt access to current materials. 4. When a facility operates its own library, the professional library service shall provide pertinent, current and useful medical, psychiatric, psychological, alcohol, drug, educational, and related materials. A facility providing extensive library services should utilize the services of a professional librarian.

Emergency services shall be provided by the facility or through clearly defined arrangements with another facility.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17 Subchapter 23 LIBRARY SERVICES Rule 52.23.1 Library services shall be made available to meet the professional and technical needs of the facility's staff.*
- *SOURCE: Miss. Code Ann. §41-9-17 Subchapter 24 EMERGENCY SERVICES Rule 52.24.1 The facility shall have written procedures for taking care of emergencies.*
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 52.24.2** Rule 52.24.2 {#sec-16-52.24.2 omnilex-key=us-ms-regs-official--title-15--16#52.24.2}

When emergency services are provided by an outside facility, a written plan shall delineate the type of emergency services available and the arrangements for referring or transferring patients to another facility. The written plan shall be available to all professional staff and shall clearly specify the following: 1. The staff of the facility who are available and authorized to provide necessary emergency evaluations;

2. The staff of the facility who are authorized to arrange for patients to be referred or transferred to another facility when necessary; 3. The arrangements the facility has made for exchanging records with the outside facility when it is necessary for the care of the patient; 4. The location of the outside facility and the names of the appropriate personnel to contact; 5. The method of communication between the two facilities; 6. The arrangements the facility has made to assure that when a patient requiring emergency care is transferred to a non-psychiatric or substance abuse service or facility, he or she will receive further evaluation and/or treatment of his or her psychiatric or substance abuse program, as needed; 7. The arrangements the facility has made for transporting patients, when necessary, from the facility to the facility providing emergency services; 8. The policy for referring patients needing continued care after emergency services back to the referring facility; and 9. Policies concerning notification of the patient's family of emergencies and of arrangements that have been made for referring or transferring that patient to another facility.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 52.24.3** Rule 52.24.3 {#sec-16-52.24.3 omnilex-key=us-ms-regs-official--title-15--16#52.24.3}

When an emergency service is provided by the facility, the service shall be well organized, properly directed, and integrated with other services of the facility and shall comply with Chapter 41, Subchapters 25-26

**History**
- *SOURCE: Miss. Code Ann. §41-9-17 Subchapter 25 PHYSICAL PLANT MANAGEMENT: INFECTION CONTROL Rule 52.25.1 Because infections acquired in a facility or brought into a facility from the community are potential hazards for all persons having contact with the facility, there shall be an infection control program.*
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 52.25.2** Effective measures shall be developed to prevent, identify and control infections {#sec-16-52.25.2 omnilex-key=us-ms-regs-official--title-15--16#52.25.2}

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 52.25.3** Rule 52.25.3 {#sec-16-52.25.3 omnilex-key=us-ms-regs-official--title-15--16#52.25.3}

Written policies and procedures pertaining to the operation of the infection control program shall be established, reviewed at least annually, and revised as necessary.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 52.25.4** Rule 52.25.4 {#sec-16-52.25.4 omnilex-key=us-ms-regs-official--title-15--16#52.25.4}

A practical system shall be developed for reporting, evaluating, and maintaining records of infections among patients and personnel. This system shall include assignment of responsibility for the ongoing collection and analysis of data, as well as for the implementation of required follow-up action. Corrective action taken on the basis of records and reports of infections and infection potentials among patients and personnel shall be documented.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 52.25.5** Rule 52.25.5 {#sec-16-52.25.5 omnilex-key=us-ms-regs-official--title-15--16#52.25.5}

All new employees shall be instructed in the importance of infection control and personal hygiene, and in their responsibility in the infection control program. There shall be documentation that inservice education-in infection prevention and control is provided to employees in all services and program components.

2. Cultures and stocks of infectious agents; including specimen cultures collected from medical and pathological laboratories, cultures and stocks of infectious agents from research and industrial laboratories, wastes from the production of biologicals, discarded live and attenuated vaccines, and culture dishes and devices used to transfer, inoculate, and mix cultures; 3. Blood and blood products such as serum, plasma, and other blood components; 4. Pathological wastes, such as tissues, organs, body parts, and body fluids that are removed during surgery and autopsy; 5. Contaminated carcasses, body parts, and bedding of animals that were exposed to pathogens in medical research; 6. All discarded sharps (e.g., hypodermic needles, syringes, Pasteur pipettes, broken glass, scalpel blades) which have come into contact with infectious agents;

7. Other wastes determined infectious by the generator or so classified by the MS Department of Health. 8. `Medical Waste' means all waste generated in direct patient care or in diagnostic or research areas that is non-infectious but aesthetically repugnant if found in the environment."

**History**
- *SOURCE: Miss. Code Ann. §41-9-17 Subchapter 26 REGULATED MEDICAL WASTE Rule 52.26.1 "Infectious medical wastes" includes solid or liquid wastes which may contain pathogens with sufficient virulence and quantity such that exposure to the waste by a susceptible host has been proven to result in an infectious disease. For purposes of this Regulation, the following wastes shall be considered to be infectious medical wastes: 1. Wastes resulting from the care of patients and animals who have Class I and (or) II diseases that are transmitted by blood and body fluid as defined in the rules and regulations governing reportable diseases. (See attached) as defined by the Mississippi Department of Health;*
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 52.26.2** Medical Waste Management Plan {#sec-16-52.26.2 omnilex-key=us-ms-regs-official--title-15--16#52.26.2}

All generators of infectious medical waste and medical waste shall have a medical waste management plan that shall include, but is not limited to, the following: 1. Storage and Containment of Infectious Medical Waste and Medical Waste a. Containment of infectious medical waste and medical waste shall be in a manner and location which affords protection from animals, rain and wind, does not provide a breeding place or a food source for insects and rodents, and minimizes exposure to the public. b. Infectious medical waste shall be segregated from other waste at the point of origin in the producing facility. c. Unless approved by the Mississippi Department of Health or treated and rendered non-infectious. Infectious medical waste (except for sharps in approved containers) shall not be stored at a waste producing facility for more than seven days above a temperature of 6 C (38F). Containment of infectious medical waste at the producing facility is permitted at or below a temperature of O C (32F) for a period of not more than 90 days without specific approval of the Department of Health. d. Containment of infectious medical waste shall be separate from other wastes. Enclosures or containers used for containment of infectious medical waste shall be so secured so as to discourage access by unauthorized persons and shall be marked with prominent warning sings on, or adjacent to, the exterior of entry doors, gates, or lids. Each container shall be prominently labeled with a sign using language to be determined by the Department and legible during daylight hours. e. Infectious medical waste, except for sharps capable of puncturing or cutting, shall be contained in double disposable plastic bags or single bags (1.5 mills thick) which are impervious to moisture and have a strength sufficient to preclude ripping, tearing, or bursting under normal conditions of usage. The bags shall be securely tied so as to prevent leakage or expulsion of solid or liquid wasted during storage, handling, or transport.

f. All sharps shall be contained for disposal in leak-proof, rigid, puncture resistant containers which are taped closed or tightly lidded to preclude loss of the contents. g. All bags used for containment and disposal of infectious medical waste shall be of a distinctive color or display the Universal Symbol for infectious waste. Rigid containers of all sharps waste shall be labeled. h. Compactors or grinders shall not be used to process infectious medical waste unless the waste has been rendered non-infectious. Sharps containers shall not be subject to compaction by any compacting device except in the institution itself and shall not be placed for storage or transport in a portable or mobile trash compactor. i. Infectious medical waste and medical waste contained in disposable containers as prescribed above, shall be placed for storage, handling, or transport in disposable or reusable pails, cartons, drums, or portable bins. The containment system shall be leak-proof, have tight-fitting covers and be kept clean and in good repair. j. Reusable containers for infectious medical waste and medical waste shall be thoroughly washed and decontaminated each time they are emptied by a method specified by the Mississippi Department of Health, unless the surfaces of the containers have been protected from contamination by disposable liners, bags, or other devices removed with the waste, as outlined in I.E. k. Approved methods of decontamination include, but are not limited to, agitation to remove visible soil combined with one or more of the following procedures: i. Exposure to hot water at least 180 F for a minimum of 15 seconds. ii. Exposure to a chemical sanitizer by rinsing with or immersion in one of the following for a minimum of 3 minutes: a. Hypochlorite solution (500 ppm available chlorine). b. Phenolic solution (500 ppm active agent). c. Iodoform solution (100 ppm available iodine). d. Quaternary ammonium solution (400 ppm active agent). b. Reusable pails, drums, or bins used for containment of infectious waste shall not be used for containment of waste to be disposed of as noninfectious waste or for other purposes except after being decontaminated by procedures as described in part (10) of this section. i. Trash chutes shall not be used to transfer infectious medical waste.

ii. Once treated and rendered non-infectious, previously defined infectious medical waste will be classified as medical waste and may be land-filled in an approved landfill. 2. Treatment or disposal of infectious medical waste shall be by one of the following methods: a. By incineration in an approved incinerator which provides combustion of the waste to carbonized or mineralized ash. b. By sterilization by heating in a steam sterilizer, so as to render the waste non- infectious. Infectious medical waste so rendered non-infectious shall be disposable as medical waste. Operating procedures for steam sterilizers shall include, but not be limited to, the following: i. Adoption of standard written operating procedures for each steam sterilizer including time, temperature, pressure, type of waste, type of container(s), closure on container(s), pattern of loading, water content, and maximum load quantity. ii. Check or recording and/or indicating thermometers during each complete cycle to ensure the attainment of a temperature of 121 C (250 F) for one-half hour or longer, depending on quantity and density of the load, in order to achieve sterilization of the entire load. Thermometers shall be checked for calibration at least annually. iii. Use of heat sensitive tape or other device for each container that is processed to indicate the attainment of adequate sterilization conditions. iv. Use of the biological indicator Bacillus stearothermophilus placed at the center of a load processed under standard operating conditions at least monthly to confirm the attainment of adequate sterilization conditions. v. Maintenance of records of procedures specified in (a), (b), (c) and (d) above for period of not less than a year. c. By discharge to the approved sewerage system if the waste is liquid or semi- liquid, except as prohibited by the MS Department of Health. d. Recognizable human anatomical remains shall be disposed of by incineration or internment, unless burial at an approved landfill is specifically authorized by the Mississippi Department of Health. e. Chemical sterilization shall use only those chemical sterilants recognized by the U.S. Environmental Protection Agency, Office of Pesticides and Toxic Substances. Ethylene oxide, glutaraldehyde, and hydrogen peroxide are examples of sterilants that, used in accordance with manufacturer recommendation, will render infectious waste noninfectious. Testing with

Bacillus subtilis spores or other equivalent organisms shall be conducted quarterly to ensure the sterilization effectiveness of gas or steam treatment. 3. Treatment and disposal of medical waste which is not infectious shall be by one of the following methods: a. By incineration in an approved incinerator which provides combustion of the waste to carbonized or mineralized ash. b. By sanitary landfill, in an approved landfill which shall mean a disposal facility or part of a facility where medical waste is placed in or on land, and which is not a treatment facility. 4. All the requirements of these standards shall apply, without regard to the quantity of medical waste generated per month, to any generator of medical waste.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17 Subchapter 27 THERAPEUTIC ENVIRONMENT Rule 52.27.1 The facility shall establish an environment that enhances the positive self-image of the patient and preserves human dignity.*
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 52.27.2** Patients shall be allowed to wear their own clothing {#sec-16-52.27.2 omnilex-key=us-ms-regs-official--title-15--16#52.27.2}

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 52.27.3** Rule 52.27.3 {#sec-16-52.27.3 omnilex-key=us-ms-regs-official--title-15--16#52.27.3}

Patients shall be allowed to keep and display personal belongings and to add personal touches to the decoration of their own room.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 52.27.4** Rule 52.27.4 {#sec-16-52.27.4 omnilex-key=us-ms-regs-official--title-15--16#52.27.4}

Articles for grooming and personal hygiene shall be readily available for the individual patient in a space reserved adjacent to his sleeping area.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 52.27.5** All areas and surfaces shall be free of undesirable odors {#sec-16-52.27.5 omnilex-key=us-ms-regs-official--title-15--16#52.27.5}

SOURCE Miss. Code Ann. §41-9-17 Rule 52.27.6 There shall be ample closet and drawer space for the storage of personal property provided for the patient's use.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 52.27.7** Rule 52.27.7 {#sec-16-52.27.7 omnilex-key=us-ms-regs-official--title-15--16#52.27.7}

Program personnel shall respect the patient's right to privacy by knocking on the door of the patient's room before entering.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 52.27.8** A laundry room in which a patient may wash his own clothing shall be accessible {#sec-16-52.27.8 omnilex-key=us-ms-regs-official--title-15--16#52.27.8}

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 52.27.9** The services of a barber and a beautician shall be made available at the patient's request {#sec-16-52.27.9 omnilex-key=us-ms-regs-official--title-15--16#52.27.9}

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 52.27.10** Staff areas should be open to promote patient-personnel interaction {#sec-16-52.27.10 omnilex-key=us-ms-regs-official--title-15--16#52.27.10}

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 52.27.11** Patients shall be encouraged to take responsibility for maintaining their own living quarters {#sec-16-52.27.11 omnilex-key=us-ms-regs-official--title-15--16#52.27.11}

Such responsibilities shall be clearly defines in writing and provided to the patient at orientation.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 52.27.12** The environment shall contribute to the development of therapeutic relationships in at least the following ways {#sec-16-52.27.12 omnilex-key=us-ms-regs-official--title-15--16#52.27.12}

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 52.27.13** Areas shall be available for a range of social activities for all patients {#sec-16-52.27.13 omnilex-key=us-ms-regs-official--title-15--16#52.27.13}

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 52.27.14** Rule 52.27.14 {#sec-16-52.27.14 omnilex-key=us-ms-regs-official--title-15--16#52.27.14}

Attractively furnished areas shall be available where a patient can be alone, when this would not be in conflict with a therapeutic prescription for group activities.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 52.27.15** Rule 52.27.15 {#sec-16-52.27.15 omnilex-key=us-ms-regs-official--title-15--16#52.27.15}

Attractively furnished areas shall be provided to ensure privacy for conversations with other patients, family, or friends.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 52.27.16** The environments shall be designed to allow views of the outdoors {#sec-16-52.27.16 omnilex-key=us-ms-regs-official--title-15--16#52.27.16}

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 52.27.17** To promote awareness of the time and season, clocks and calendars should be provided at least in the major use areas {#sec-16-52.27.17 omnilex-key=us-ms-regs-official--title-15--16#52.27.17}

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 52.27.18** Rule 52.27.18 {#sec-16-52.27.18 omnilex-key=us-ms-regs-official--title-15--16#52.27.18}

There shall be documentation of planned programs, consistent with the needs of the patients, for social, educational and recreational activities for all patients for daytime, evenings, and weekends.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 52.27.19** Rule 52.27.19 {#sec-16-52.27.19 omnilex-key=us-ms-regs-official--title-15--16#52.27.19}

The facility shall assure accessibility for handicapped individuals, preferably through its physical environment, or as an alternative, through a written plan that indicates how the patient or potential patient shall receive necessary services.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 52.27.20** The environment shall be maintained and equipped so as to ensure the health safety of the patients {#sec-16-52.27.20 omnilex-key=us-ms-regs-official--title-15--16#52.27.20}

Physical health and safety features of the environment shall conform to requirements of local, state, and federal authorities having jurisdiction. In any event, the facility shall provide verification of the following: 1. patients shall be protected against the dangers of fire and smoke. 2. patients shall be protected against injury attributable to the design and equipment of the environment. 3. patients shall be protected against electrical hazards. 4. patients shall be protected against spread of disease and infection.

8. Rule 41.9.5 9. Rule 41.9.6 10. Rule 41.9.7 Environment 11. Rule 41.9.8 Zoning Restrictions 12. Rule 41.9.9 Access 13. Rule 41.9.10 Elements of Construction a. Corridors - shall be 60" wide and 7'6" high (clear). The surface of all floors and walls shall be washable. All corridors longer than 150' shall be subdivided by a smoke barrier and must be maintained free of obstruction. b. Doors-all doors in corridors shall be 20-minutes fire rated doors (1-3/4" solid core wood door as a minimum). All doors to patient bedrooms, diagnostic and treatment areas, and other doors used by residents shall be at least 36" wide. No door shall swing into the corridor except closet doors. Doors to hazardous areas defined in the Life Safety Code shall be 1-1/2 hour "B" labeled fire doors. Exit doors shall conform to the requirements set forth in the Life Safety code. 14. Subchapter 10 Fire Reporting and Protection 15. Rule 41.10.1 16. Rule 41.102 17. Rule 41.10.3Heating and Ventilating 18. Subchapter 11 Plumbing 19. Rule 41.11.1 20. Rule 41.11.2 21. Rule 41.11.3 22. Subchapter 12 Sewage Disposal 23. Rule 41.12.1 24. Rule 41.12.2 25. Rule 41.13.2

a. Nurses' Call System: A minimum of 10% of the facility bedrooms be equipped with a nurses' call system. The rooms that are equipped with nurses' call system shall be located adjacent to the nurses' station. b. These rooms are generally intended for initial detoxification or special treatment. 26. Subchapter 14 Emergency Electrical Services 27. Rule 41.14.1 28. Rule 41.14.2 29. Emergency Electrical Systems: Emergency electrical service shall be provided in accordance with the applicable section of the Life Safety Code. 30. Rule 41.14.3 31. Rule 41.14.3(1) 32. Rule 41.14.3(2) 33. Rule 41.14.3(3) 34. Rule 41.14.3(4) 35. Rule 41.14.4 Finishings: a. Bed-each patient room shall be equipped with a quality bed acceptable for this environment. b. Bedside Cabinet-A bedside cabinet or table shall be provided. 36. Rule 41.14.5 37. Rule 41.14.6 Delete (Cubicle Curtains) 38. Rule 41.14.7 39. Rule 41.14.8 40. A lavatory shall be located in the bedroom or in a private toilet room. 41. Rule 41.14.9 Service Areas 42. Rule 41.14.10 Delete (Isolation Room) 43. Rule 41.14.11 Detention Room

44. Subchapter 15 Delete (Special Care) 45. Subchapter 31 Delete (Newborn Nursery) 46. Rule 41.15.9 Delete (Pediatric Unit) 47. Rule 41.16.9 48. Subchapter 17 Delete (Central Sterile Supply) 49. Subchapter 19: Outpatient Area: An outpatient area shall be provided when indicated. 50. Subchapter 20 Radiology Suite (Delete if provided by arrangement) 51. Subchapter 21 Laboratory (Delete if provided by arrangement) 52. Subchapter 22 Drug Room-Refer to Subchapters 66-69-Pharmacy Services 53. Subchapter 23 Dietary 54. Subchapter 24 Administrative Area 55. Rule 41.24.2: a. Housekeeping Area-to include: Housekeeper's office or suitable area designated for record keeping. b. Storage space for maid's carts, if used. 56. Rule 41.24.3 Laundry: Facilities shall be provided for personal laundry for use by patients. This area shall be separated from areas by a one hour fire rated wall. 57. Rule 41.24.4 General Storage: There shall be a two hour fire rated lockable room large enough to provide five square feet of general storage for each bed provided. 58. Rule 41.24.5 Boiler Room 59. Rule 41.24.6 Maintenance Area: Sufficient area for performing routine maintenance activities shall be provided and shall include an office or suitable area designated for record keeping.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17 Subchapter 28 PHYSICAL PLANT CONSTRUCTION REFERENCES Rule 52.28.1 The following minimum standards as stated in previous parts are also applicable to chemical dependency units: Chapter 41- Physical Plant 1. Rule 41.8.1 General 2. Rule 41.8.2 Codes 3. Subchapter 9 Submission of Plans 4. Rule 41.9.1 5. Rule 41.9.2 6. Rule 41.9.3 7. Rule 41.9.4*
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 52.28.2** Add the following sections: 1 {#sec-16-52.28.2 omnilex-key=us-ms-regs-official--title-15--16#52.28.2}

Day Room: At least two general areas for use as living room, day room or recreation shall be provided. A minimum of 18 square feet per patient bed shall be available for this purpose.

2. Dining Room: A minimum of 15 square feet per patient bed shall be provided for use as a Dining Room. Adequate tables and chairs shall be provided to seat all patients, staff and guests. 3. Counseling Rooms: At least one, small room shall be provided for each 20 patients for the purpose of individual private treatment or counseling. 4. Examination & Treatment Room: At least one room shall be provided for the purpose of examination and treatment. The room shall be equipped with a lavatory and towel dispenser, examination table and storage space, with adequate lighting. 5. Group Counseling Rooms: At least two rooms shall be provided large enough to accommodate 8-10 patients for the purpose of group counseling sessions. 6. Subchapter 42 Fire Control and Internal Disaster 7. Rule 41.46.1 Housekeeping 8. Rule 41.46.2 9. Rule 41.46.3 Delete 10. Rule 41.46.4 11. Rule 41.46.5 12. Rule 41.46.6 13. Rule 41.46.7 14. Rule 41.46.8 15. Rule 41.46.9 16. Subchapter 47 Laundry and Linen

**History**
- *SOURCE: Miss. Code Ann. §41-9-17 Subchapter 29 GLOSSARY Rule 52.29.1 Activity Director, Qualified. An individual with a bachelor's degree who has at least one year of experience in assessing, planning, and coordinating activity services.*
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 52.29.2** Activity Services {#sec-16-52.29.2 omnilex-key=us-ms-regs-official--title-15--16#52.29.2}

Structured activities designed to develop an individuals creative, physical, and social skills through participation in recreational, art, dance, drama, social, and other activities.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 52.29.3** Administrative {#sec-16-52.29.3 omnilex-key=us-ms-regs-official--title-15--16#52.29.3}

Relates to the fiscal and general management of a facility rather than to the direct provision of services to patients.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 52.29.4** Aftercare {#sec-16-52.29.4 omnilex-key=us-ms-regs-official--title-15--16#52.29.4}

Services that are provided to a patient after discharge and that support and increase the gains made during treatment.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 52.29.5** Assessment {#sec-16-52.29.5 omnilex-key=us-ms-regs-official--title-15--16#52.29.5}

Those procedures by which a person evaluates an individual's strengths, weaknesses, problems and needs.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 52.29.6** Authentication {#sec-16-52.29.6 omnilex-key=us-ms-regs-official--title-15--16#52.29.6}

Proof of authority and responsibility by written signature, identifiable initials, computer key, or other method. The use of a rubber stamp signature is acceptable only under the following conditions: the person whose signature the rubber stamp represents is the only one who has possession of the stamp and is the only one who uses it, and this person gives the chief executive officer a signed statement that he or she is the only one who has the stamp and is the only one who will use it.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 52.29.7** Authority Having Jurisdiction {#sec-16-52.29.7 omnilex-key=us-ms-regs-official--title-15--16#52.29.7}

The organization, office, or individual responsible for approving a piece of equipment, an installation, or a procedure.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 52.29.8** Bylaws {#sec-16-52.29.8 omnilex-key=us-ms-regs-official--title-15--16#52.29.8}

The laws, rules, or regulations adopted for the government of the facility. Also used for the laws, rules, or regulations of the professional staff.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 52.29.9** Chemical Dependency Unit {#sec-16-52.29.9 omnilex-key=us-ms-regs-official--title-15--16#52.29.9}

A hospital or an established and dedicated unit of a "general", "psychiatric" or "rehabilitation" hospital, or a "free-standing" unit, which has beds that are organized, properly staffed and equipped to render services over a continuous period exceeding 24 hours to individuals requiring diagnosis and treatment of alcohol and other drug-related dependencies.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 52.29.10** Chief Executive Officer {#sec-16-52.29.10 omnilex-key=us-ms-regs-official--title-15--16#52.29.10}

A job-descriptive term used to identify the individual appointed by the governing body to act on its behalf in the overall management of the facility. Other job titles may include administrator, superintendent, director, president, vice-president, and executive vice-president.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 52.29.11** Clinical Privileges {#sec-16-52.29.11 omnilex-key=us-ms-regs-official--title-15--16#52.29.11}

Authorization of the governing body to render patient care and treatment services in the facility within well-defined limits, based upon the individual's professional qualifications, experience, competence, ability, and judgment.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 52.29.12** Consultant {#sec-16-52.29.12 omnilex-key=us-ms-regs-official--title-15--16#52.29.12}

An individual who provides professional advice or services upon request.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 52.29.13** Contract {#sec-16-52.29.13 omnilex-key=us-ms-regs-official--title-15--16#52.29.13}

A formal agreement with any organization, agency, or individual, approved by the governing body, that specifies the services, personnel, and/or space to be provided to, or on behalf of, the facility and the monies to be expended in exchange.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 52.29.14** Counselor {#sec-16-52.29.14 omnilex-key=us-ms-regs-official--title-15--16#52.29.14}

An individual with specialized training.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 52.29.15** Department {#sec-16-52.29.15 omnilex-key=us-ms-regs-official--title-15--16#52.29.15}

A staff entity organized on administrative, functional, or disciplinary lines.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 52.29.16** Detoxification {#sec-16-52.29.16 omnilex-key=us-ms-regs-official--title-15--16#52.29.16}

The systematic reduction of the amount of a toxic agent in the body or the elimination of a toxic agent from the body.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 52.29.17** Dietetic Services {#sec-16-52.29.17 omnilex-key=us-ms-regs-official--title-15--16#52.29.17}

The provision of services to meet the nutritional needs of patients, with specific emphasis on patients who have special dietary needs, for example, patients who are allergic to certain foods or who cannot accept a regular diet.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 52.29.18** Dietitian, Qualified {#sec-16-52.29.18 omnilex-key=us-ms-regs-official--title-15--16#52.29.18}

An individual who is registered by the Commission on Dietetic Registration of the American Dietetic Association.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 52.29.19** Diet Manual {#sec-16-52.29.19 omnilex-key=us-ms-regs-official--title-15--16#52.29.19}

An up-to-date, organized system for standardizing the ordering of diets.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 52.29.20** Discharge {#sec-16-52.29.20 omnilex-key=us-ms-regs-official--title-15--16#52.29.20}

The point at which the patient's active involvement with a facility is terminated and the facility no longer maintains active responsibility for the patient.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 52.29.21** Drug History {#sec-16-52.29.21 omnilex-key=us-ms-regs-official--title-15--16#52.29.21}

A delineation of the drugs used by a patient, including prescribed and unprescribed drugs and alcohol. A drug history includes, but is not necessarily limited to, the following: drugs used in the past; drugs used recently, especially within the preceding 48 hours; drugs of preference; frequency with which each drug is used; route of administration of each drug; drugs used in combination; dosages used; year of first use of each drug; previous occurrences of overdose, withdrawal, or adverse drug reactions; and history or previous treatment received for alcohol or drug abuse.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 52.29.22** Emergency Kit {#sec-16-52.29.22 omnilex-key=us-ms-regs-official--title-15--16#52.29.22}

A kit designed to provide the medical supplies and pharmaceutical agents required during an emergency. In compiling emergency kits, staff should consider the patients' needs for psychotropic, anticholinergic, and adrenalin agents.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 52.29.23** External Disaster {#sec-16-52.29.23 omnilex-key=us-ms-regs-official--title-15--16#52.29.23}

A catastrophe that occurs outside the facility and for which the facility, based on its size, and resources must be prepared to serve the community.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 52.29.24** Facility {#sec-16-52.29.24 omnilex-key=us-ms-regs-official--title-15--16#52.29.24}

An organization that provides psychiatric substance abuse, and/or mental health services to patients.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 52.29.25** Fiscal Management {#sec-16-52.29.25 omnilex-key=us-ms-regs-official--title-15--16#52.29.25}

Procedures used to control a facility's overall financial and general operations. Such procedures may include cost accounting, program budgeting, materials purchasing, and patient billing.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 52.29.26** Formulary {#sec-16-52.29.26 omnilex-key=us-ms-regs-official--title-15--16#52.29.26}

A catalog of the pharmaceuticals approved for use in a facility. A formulary lists the names of the drugs and information regarding dosage, contraindications, and unit dispensing size.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 52.29.27** Goal {#sec-16-52.29.27 omnilex-key=us-ms-regs-official--title-15--16#52.29.27}

An expected result or condition that takes time to achieve, that is specified in a statement of relatively broad scope, and that provides guidance in establishing intermediate objectives directed towards its attainment.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 52.29.28** Governing Body {#sec-16-52.29.28 omnilex-key=us-ms-regs-official--title-15--16#52.29.28}

The person or person with ultimate authority and responsibility for the overall operation of the facility.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 52.29.29** Guardian {#sec-16-52.29.29 omnilex-key=us-ms-regs-official--title-15--16#52.29.29}

A parent, trustee, committee, conservator, or other person or agency empowered by law to act on behalf of, or have responsibility for, an applicant or patient.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 52.29.30** Hazardous Area {#sec-16-52.29.30 omnilex-key=us-ms-regs-official--title-15--16#52.29.30}

Any area in which the following are used: products that are highly combustible, highly flammable, or explosive; or materials that are likely to burn with extreme rapidity or produce poisonous fumes or gases. Consult the 1972 edition of the Life Safety Code (NFPA 101) for further clarification.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 52.29.31** Hazardous Procedures {#sec-16-52.29.31 omnilex-key=us-ms-regs-official--title-15--16#52.29.31}

Procedures that place the patient at physical or psychological risk or in pain.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 52.29.32** Incident Reports {#sec-16-52.29.32 omnilex-key=us-ms-regs-official--title-15--16#52.29.32}

Documentation of events or actions that are likely to lead to adverse effects and/or that vary from established policies and procedures pertaining to patient care.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 52.29.33** Interdisciplinary Team {#sec-16-52.29.33 omnilex-key=us-ms-regs-official--title-15--16#52.29.33}

A group of clinical staff composed of representative from different professions, disciplines, or service areas.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 52.29.34** May {#sec-16-52.29.34 omnilex-key=us-ms-regs-official--title-15--16#52.29.34}

Used to reflect an acceptable method of compliance with a standard that is recognized but not preferred. See shall and should.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 52.29.35** Medical Record Administrator, Qualified {#sec-16-52.29.35 omnilex-key=us-ms-regs-official--title-15--16#52.29.35}

A registered record administrator who has successfully passed an appropriate examination conducted by the American Medical Record Association.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 52.29.36** Medical Record Technician, Qualified {#sec-16-52.29.36 omnilex-key=us-ms-regs-official--title-15--16#52.29.36}

An accredited record technician who has successfully passed the appropriate accreditation examination conducted by the American Medical Record Association.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 52.29.37** NFPA {#sec-16-52.29.37 omnilex-key=us-ms-regs-official--title-15--16#52.29.37}

National Fire Protection Association, 470 Atlantic Avenue, Boston, Massachusetts 02210.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 52.29.38** Nurse {#sec-16-52.29.38 omnilex-key=us-ms-regs-official--title-15--16#52.29.38}

A person licensed and registered to practice nursing in the state in which he or she practices.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 52.29.39** Nurse, Practical {#sec-16-52.29.39 omnilex-key=us-ms-regs-official--title-15--16#52.29.39}

A person licensed or registered as a practical or vocational nurse in the state in which he or she practices.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 52.29.40** Objective {#sec-16-52.29.40 omnilex-key=us-ms-regs-official--title-15--16#52.29.40}

An unexpected result or condition that takes less time to achieve than a goal, is stated in measurable terms, has a specified time for achievement, and is related to the attainment of a goal.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 52.29.41** Occupational Therapist, Qualified {#sec-16-52.29.41 omnilex-key=us-ms-regs-official--title-15--16#52.29.41}

An individual who is a graduate of an occupational therapy program approved by a nationally recognized accrediting body, or who currently holds certification by the American Occupational Therapy Association as an occupational therapist, registered, who meets any current legal requirements of licensure or registration; and who is currently competent in the field.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 52.29.42** Parenteral Product {#sec-16-52.29.42 omnilex-key=us-ms-regs-official--title-15--16#52.29.42}

Sterile, pharmaceutical preparations ingested by the body through a route other than the alimentary canal.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 52.29.43** Patient {#sec-16-52.29.43 omnilex-key=us-ms-regs-official--title-15--16#52.29.43}

An individual who receives treatment services. Patient is synonymous with client, resident, consumer, and recipient of treatment services.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 52.29.44** Personnel Record {#sec-16-52.29.44 omnilex-key=us-ms-regs-official--title-15--16#52.29.44}

The complete employment record of a staff member or an employee, including job application, education and employment history, performance evaluation, and, when applicable, evidence of current licensure, certification, or registration.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 52.29.45** Pharmacist {#sec-16-52.29.45 omnilex-key=us-ms-regs-official--title-15--16#52.29.45}

An individual who has a degree in pharmacy and is licensed and registered to prepare, preserve, compound, and dispense drugs and chemicals in the state in which he or she practices.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 52.29.46** Physician, Qualified {#sec-16-52.29.46 omnilex-key=us-ms-regs-official--title-15--16#52.29.46}

A doctor of medicine or doctor of osteopathy who is fully licensed to practice medicine in the state in which he or she practices.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 52.29.47** Program {#sec-16-52.29.47 omnilex-key=us-ms-regs-official--title-15--16#52.29.47}

A general term for an organized system of services designed to address the treatment needs of patients.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 52.29.48** Program Evaluation {#sec-16-52.29.48 omnilex-key=us-ms-regs-official--title-15--16#52.29.48}

An assessment component of a facility that determines the degree to which a program is meeting its stated goals and objectives.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 52.29.49** Psychiatrist, Qualified {#sec-16-52.29.49 omnilex-key=us-ms-regs-official--title-15--16#52.29.49}

A doctor of medicine who specializes in the assessment and treatment of individuals having psychiatric disorders and who is fully licensed to practice medicine in the state in which he or she practices.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 52.29.50** Psychologist, Qualified {#sec-16-52.29.50 omnilex-key=us-ms-regs-official--title-15--16#52.29.50}

An individual licensed by the State Board of Psychological Examiners with a specialty area in clinical or counseling psychology (refer to Mississippi Code of 1972, annotated and amended. Section 73-31-1)

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 52.29.51** Restraint {#sec-16-52.29.51 omnilex-key=us-ms-regs-official--title-15--16#52.29.51}

A physical or mechanical device used to restrict the movement of the whole or a portion of a patient's body. This does not include mechanisms used to

assist a patient in obtaining and maintaining normative body functioning, for example, braces and wheelchairs.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 52.29.52** Seclusion {#sec-16-52.29.52 omnilex-key=us-ms-regs-official--title-15--16#52.29.52}

A procedure that isolates the patient to a specific environmental area removed from the patient community.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 52.29.53** Service {#sec-16-52.29.53 omnilex-key=us-ms-regs-official--title-15--16#52.29.53}

Used to indicate a functional division of a program or of the professional staff. Also used to indicate the delivery of care.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 52.29.54** Shall {#sec-16-52.29.54 omnilex-key=us-ms-regs-official--title-15--16#52.29.54}

Used to indicate a mandatory standard.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 52.29.55** Should {#sec-16-52.29.55 omnilex-key=us-ms-regs-official--title-15--16#52.29.55}

Used in a standard to indicate the commonly accepted method of compliance.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 52.29.56** Social Assessment {#sec-16-52.29.56 omnilex-key=us-ms-regs-official--title-15--16#52.29.56}

The process of evaluating each patient's environment, religious background, childhood developmental history, financial status, reasons for seeking treatment , and other pertinent information that may contribute to the development of the individualized treatment plan.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 52.29.57** Social Worker, Qualified {#sec-16-52.29.57 omnilex-key=us-ms-regs-official--title-15--16#52.29.57}

An individual who is licensed in the State with a master's degree from an institution accredited by the Council on Social Work Education, and is clinically qualified by training with two years experience in working with mentally ill children/adolescents.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 52.29.58** Substance Abuse Worker {#sec-16-52.29.58 omnilex-key=us-ms-regs-official--title-15--16#52.29.58}

Professionals representing multiple disciplines who have clinical training and/or experience specifically related to providing substance abuse services.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 52.29.59** Therapeutic Activity Services {#sec-16-52.29.59 omnilex-key=us-ms-regs-official--title-15--16#52.29.59}

Goal-oriented activities designed to help an individual develop expressive and/or performance skills through participation in art, crafts, dance, drama, movement, music, prevocational, recreational, self-care, and social activities.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 52.29.60** Transfer {#sec-16-52.29.60 omnilex-key=us-ms-regs-official--title-15--16#52.29.60}

Movement of a patient from one treatment service or location to another.

CHAPTER 53 DRUG AND ALCOHOL TESTING REGULATIONS

Subchapter 1 AUTHORITY AND PURPOSE.

**History**
- *SOURCE: Miss. Code Ann. §41-9-17*

##### **15 Miss. Admin. Code Pt. 16, R. 53.1.1** Rule 53.1.1 {#sec-16-53.1.1 omnilex-key=us-ms-regs-official--title-15--16#53.1.1}

The following rules and regulations for drug and alcohol testing of employees and job applicants by public and private employers are duly adopted and promulgated by the Mississippi State Department of Health pursuant to the authority expressly conferred by the laws of the State of Mississippi at Sections 71-7-1, et. al., of the Mississippi Code of 1972, Ann., hereinafter referred to as “the Act.”

**History**
- *SOURCE: Miss. Code Ann. § 71-7-21*

##### **15 Miss. Admin. Code Pt. 16, R. 53.1.2** The purpose of these rules and regulations is to promulgate standards and guidelines concerning: 1 {#sec-16-53.1.2 omnilex-key=us-ms-regs-official--title-15--16#53.1.2}

Standards for drug and alcohol testing, laboratory certification, suspension and revocation of certification; 2. Body specimens that are appropriate for drug and alcohol testing; 3. Retention and storage procedures to ensure reliable results on confirmation tests and retests; 4. Initial drug and alcohol tests and confirmation tests; and 5. Standard language to be included in employer’s drug and alcohol testing notices concerning: a. A statement advising the employee of the existence of state statutes on employer drug and alcohol testing; b. A general statement concerning confidentiality; and c. Procedures for how employees can confidentially report the use of prescription or nonprescription medications prior to being tested.

Rule 53.2.1 In the State of Mississippi, every public and private employer who voluntarily implements a drug and alcohol testing policy and program, pursuant to the Act,

shall do so in accordance with these regulations. Any person or entity who collects specimens for drug and alcohol testing, who conducts initial and/or confirmation tests, or who conducts retests on specimens after a positive confirmation test, pursuant to the Act, shall do so in accordance with these regulations.

Rule 53.3.1 Alcohol. Ethyl alcohol.

**History**
- *SOURCE: Miss. Code Ann. § 71-7-21 Subchapter 2 SCOPE.*
- *SOURCE: Miss. Code Ann. § 71-7-21 Subchapter 3 DEFINITIONS.*
- *SOURCE: Miss. Code Ann. § 71-7-21*

##### **15 Miss. Admin. Code Pt. 16, R. 53.3.2** The Act {#sec-16-53.3.2 omnilex-key=us-ms-regs-official--title-15--16#53.3.2}

Sections 71-7-1, et.al., of the Mississippi Code of 1972, Ann.

**History**
- *SOURCE: Miss. Code Ann. § 71-7-21*

##### **15 Miss. Admin. Code Pt. 16, R. 53.3.3** Board {#sec-16-53.3.3 omnilex-key=us-ms-regs-official--title-15--16#53.3.3}

The Mississippi Board of Health.

**History**
- *SOURCE: Miss. Code Ann. § 71-7-21*

##### **15 Miss. Admin. Code Pt. 16, R. 53.3.4** Confirmation Test {#sec-16-53.3.4 omnilex-key=us-ms-regs-official--title-15--16#53.3.4}

A drug and alcohol test on a specimen to substantiate the results of a prior drug and alcohol test on the specimen. The confirmation test must use an alternate method of equal or greater specificity than that used in the previous drug and alcohol test.

**History**
- *SOURCE: Miss. Code Ann. § 71-7-21*

##### **15 Miss. Admin. Code Pt. 16, R. 53.3.5** Department {#sec-16-53.3.5 omnilex-key=us-ms-regs-official--title-15--16#53.3.5}

The Mississippi State Department of Health.

**History**
- *SOURCE: Miss. Code Ann. § 71-7-21*

##### **15 Miss. Admin. Code Pt. 16, R. 53.3.6** Drug {#sec-16-53.3.6 omnilex-key=us-ms-regs-official--title-15--16#53.3.6}

An illegal drug, or a prescription or nonprescription medication.

**History**
- *SOURCE: Miss. Code Ann. § 71-7-21*

##### **15 Miss. Admin. Code Pt. 16, R. 53.3.7** Drug and Alcohol Test {#sec-16-53.3.7 omnilex-key=us-ms-regs-official--title-15--16#53.3.7}

A chemical test administered for the purpose of determining the presence or absence of a drug or alcohol or their metabolites in a person’s bodily fluids.

**History**
- *SOURCE: Miss. Code Ann. § 71-7-21*

##### **15 Miss. Admin. Code Pt. 16, R. 53.3.8** Employee {#sec-16-53.3.8 omnilex-key=us-ms-regs-official--title-15--16#53.3.8}

Any person who supplies a service for remuneration or pursuant to any contract for hire to a private or public employer in this state.

**History**
- *SOURCE: Miss. Code Ann. § 71-7-21*

##### **15 Miss. Admin. Code Pt. 16, R. 53.3.9** Employer {#sec-16-53.3.9 omnilex-key=us-ms-regs-official--title-15--16#53.3.9}

Any individual, organization or government body, subdivision or agency thereof, including partnership, association, trustee, estate, corporation, joint stock company, insurance company or legal representative, whether domestic or foreign, or the receiver, trustee in bankruptcy, trustee or successor thereof, and any common carrier by mail, motor, water, air or express company doing business in or operating within this state, or which has offered or may offer employment to one or more individuals in this state.

**History**
- *SOURCE: Miss. Code Ann. § 71-7-21*

##### **15 Miss. Admin. Code Pt. 16, R. 53.3.10** Illegal Drugs {#sec-16-53.3.10 omnilex-key=us-ms-regs-official--title-15--16#53.3.10}

Any substance, other than alcohol, having psychological and/or physiological effects on a human being and that is not a prescription or nonprescription medication, including controlled dangerous substances and controlled substance analogs or volatile substances which produce the psychological and/or physiological effects of a controlled dangerous substance through deliberate introduction into the body.

**History**
- *SOURCE: Miss. Code Ann. § 71-7-21*

##### **15 Miss. Admin. Code Pt. 16, R. 53.3.11** Initial Test {#sec-16-53.3.11 omnilex-key=us-ms-regs-official--title-15--16#53.3.11}

An initial drug or alcohol test to determine the presence or absence of drugs or alcohol or their metabolites in specimens.

**History**
- *SOURCE: Miss. Code Ann. § 71-7-21*

##### **15 Miss. Admin. Code Pt. 16, R. 53.3.12** Laboratory {#sec-16-53.3.12 omnilex-key=us-ms-regs-official--title-15--16#53.3.12}

Any laboratory that is currently certified or accredited by the federal Clinical Laboratory Improvement Act, as amended, by the federal Substance Abuse and Mental Health Services Administration, by the College of American Pathologists, or that has been deemed by the State Board of Health to have been certified or accredited by an appropriate federal agency, organization or another state.

**History**
- *SOURCE: Miss. Code Ann. § 71-7-21*

##### **15 Miss. Admin. Code Pt. 16, R. 53.3.13** MRO {#sec-16-53.3.13 omnilex-key=us-ms-regs-official--title-15--16#53.3.13}

Medical Review Officer.

**History**
- *SOURCE: Miss. Code Ann. § 71-7-21*

##### **15 Miss. Admin. Code Pt. 16, R. 53.3.14** Medical Review Officer {#sec-16-53.3.14 omnilex-key=us-ms-regs-official--title-15--16#53.3.14}

A licensed physician responsible for receiving laboratory results generated by an employer’s drug and/or alcohol testing program who has knowledge of substance abuse disorders and has appropriate medical training to interpret and evaluate an individual’s positive test result together with his or her medical history and any other relevant biomedical information.

**History**
- *SOURCE: Miss. Code Ann. § 71-7-21*

##### **15 Miss. Admin. Code Pt. 16, R. 53.3.15** Nonprescription Medication {#sec-16-53.3.15 omnilex-key=us-ms-regs-official--title-15--16#53.3.15}

A drug that is authorized pursuant to federal or state laws for general distribution and use without a prescription in the treatment of human diseases, ailments, or injuries.

**History**
- *SOURCE: Miss. Code Ann. § 71-7-21*

##### **15 Miss. Admin. Code Pt. 16, R. 53.3.16** Prescription Medication {#sec-16-53.3.16 omnilex-key=us-ms-regs-official--title-15--16#53.3.16}

A drug prescribed for use by a duly licensed physician, dentist or other medical practitioner licensed to issue prescriptions.

**History**
- *SOURCE: Miss. Code Ann. § 71-7-21*

##### **15 Miss. Admin. Code Pt. 16, R. 53.3.17** SAMHSA {#sec-16-53.3.17 omnilex-key=us-ms-regs-official--title-15--16#53.3.17}

Substance Abuse and Mental Health Services Administration.

**History**
- *SOURCE: Miss. Code Ann. § 71-7-21*

##### **15 Miss. Admin. Code Pt. 16, R. 53.3.18** Specimen {#sec-16-53.3.18 omnilex-key=us-ms-regs-official--title-15--16#53.3.18}

A tissue or product of the human body chemically capable of revealing the presence of drugs in the human body.

Rule 53.4.1 An employer may include in its drug and alcohol testing protocols marijuana, cocaine, opiates, amphetamines, phencyclidine, alcohol and other controlled substances. However, if testing for controlled substances other than those specifically named above is conducted, testing for such substances can be done only if an appropriate federal agency has established an approved protocol and positive threshold for each such substance.

**History**
- *SOURCE: Miss. Code Ann. § 71-7-21 Subchapter 4 THE DRUGS.*
- *SOURCE: Miss. Code Ann. § 71-7-21*

##### **15 Miss. Admin. Code Pt. 16, R. 53.4.2** Rule 53.4.2 {#sec-16-53.4.2 omnilex-key=us-ms-regs-official--title-15--16#53.4.2}

Specimens collected under Department regulations may only be used to test for controlled substances designated for testing as described in this section and shall not be used to conduct any other analysis or test unless otherwise specifically authorized by Department regulations.

**History**
- *SOURCE: Miss. Code Ann. § 71-7-21*

##### **15 Miss. Admin. Code Pt. 16, R. 53.4.3** Rule 53.4.3 {#sec-16-53.4.3 omnilex-key=us-ms-regs-official--title-15--16#53.4.3}

This section does not prohibit procedures reasonably incident to analysis of specimens for controlled substances (e.g., determination of pH or tests for specific gravity, creatinine concentration or presence of adulterants).

Rule 53.5.1 Drugs - Urine for initial and confirmation tests.

**History**
- *SOURCE: Miss. Code Ann. § 71-7-21 Subchapter 5 BODY SPECIMENS APPROPRIATE FOR DRUG AND ALCOHOL TESTING.*
- *SOURCE: Miss. Code Ann. § 71-7-21*

##### **15 Miss. Admin. Code Pt. 16, R. 53.5.2** Alcohol - Breath and/or saliva for initial tests; Blood for confirmation tests {#sec-16-53.5.2 omnilex-key=us-ms-regs-official--title-15--16#53.5.2}

Rule 53.6.1 Employers who implement a drug and alcohol testing program pursuant to the Act shall contract with manufacturers, vendors, or other providers of drug and alcohol testing devices, or with a laboratory, for the purpose of initial drug and alcohol testing of employees to: 1. Train employees of the employer implementing the drug and alcohol testing program in the collecting of specimens and the administering of initial tests; or 2. Provide the employer with personnel to collect specimens and administer the initial tests.

**History**
- *SOURCE: Miss. Code Ann. § 71-7-21 Subchapter 6 COLLECTION OF SPECIMENS; INITIAL TESTING AND ANALYSIS PROCEDURES.*
- *SOURCE: Miss. Code Ann. § 71-7-21*

##### **15 Miss. Admin. Code Pt. 16, R. 53.6.2** A specimen for a drug and alcohol test may be taken by any of the following persons: 1 {#sec-16-53.6.2 omnilex-key=us-ms-regs-official--title-15--16#53.6.2}

A physician, a registered nurse or a licensed practical nurse; 2. A qualified person employed by a laboratory; 3. An employee or an independent contractor of the employer conducting a drug and alcohol testing program pursuant to the Act who has been trained in the collecting of specimens by a manufacturer, vendor, or other provider of drug and alcohol testing devices, or by a laboratory; or 4. Any person deemed qualified by the State Board of Health.

**History**
- *SOURCE: Miss. Code Ann. § 71-7-21*

##### **15 Miss. Admin. Code Pt. 16, R. 53.6.3** Any initial drug or alcohol test yielding a positive result shall be followed by an appropriate confirmation test {#sec-16-53.6.3 omnilex-key=us-ms-regs-official--title-15--16#53.6.3}

Rule 53.7.1 Employers who implement a drug and alcohol testing program pursuant to the Act shall contract with a laboratory to conduct confirmation tests on specimens which produce a positive result in testing for drugs or alcohol in the initial.

**History**
- *SOURCE: Miss. Code Ann. § 71-7-21 Subchapter 7 CONFIRMATION TEST - LABORATORY ANALYSIS PROCEDURES - REPORTING RESULTS.*
- *SOURCE: Miss. Code Ann. § 71-7-21*

##### **15 Miss. Admin. Code Pt. 16, R. 53.7.2** Rule 53.7.2 {#sec-16-53.7.2 omnilex-key=us-ms-regs-official--title-15--16#53.7.2}

Laboratories, as certified or accredited as defined herein, which conduct confirmation drug and alcohol tests are required to have the following: 1. Methods of analysis and procedures to ensure reliable drug and alcohol testing results, including standards for initial tests and confirmation tests. 2. Chain-of-custody procedures to ensure proper identification, labeling and handling of specimens being tested, 3. Retention and storage procedures to ensure reliable results on confirmation tests and retests, and 4. Guidelines on how to establish cut-off detection levels for drugs or their metabolites for the purposes of determining a positive test result.

**History**
- *SOURCE: Miss. Code Ann. § 71-7-21*

##### **15 Miss. Admin. Code Pt. 16, R. 53.7.3** Rule 53.7.3 {#sec-16-53.7.3 omnilex-key=us-ms-regs-official--title-15--16#53.7.3}

Results of the confirmation test shall be reported by the laboratory to the employer’s Medical Review Officer in accordance with the provisions set forth herein.

**History**
- *SOURCE: Miss. Code Ann. § 71-7-21*

##### **15 Miss. Admin. Code Pt. 16, R. 53.7.4** Rule 53.7.4 {#sec-16-53.7.4 omnilex-key=us-ms-regs-official--title-15--16#53.7.4}

All employers shall have a Medical Review Officer who shall be responsible for receiving and interpreting laboratory results of drug and alcohol tests. Said MRO shall be the sole person authorized to review the results of such tests.

**History**
- *SOURCE: Miss. Code Ann. § 71-7-21*

##### **15 Miss. Admin. Code Pt. 16, R. 53.7.5** Rule 53.7.5 {#sec-16-53.7.5 omnilex-key=us-ms-regs-official--title-15--16#53.7.5}

The laboratory shall report confirmation test results to the employer’s Medical Review Officer within an average of five (5) working days after receipt of the specimen by the laboratory. The report shall identify the drugs/metabolites tested for, whether positive or negative, the specimen number assigned by the employer, and the laboratory specimen identification number (accession number).

**History**
- *SOURCE: Miss. Code Ann. § 71-7-21*

##### **15 Miss. Admin. Code Pt. 16, R. 53.7.6** Rule 53.7.6 {#sec-16-53.7.6 omnilex-key=us-ms-regs-official--title-15--16#53.7.6}

The laboratory shall report as negative all specimens that are negative on the initial test or negative on the confirmation test. Only specimens confirmed positive shall be reported positive for a specific drug or alcohol.

**History**
- *SOURCE: Miss. Code Ann. § 71-7-21*

##### **15 Miss. Admin. Code Pt. 16, R. 53.7.7** Rule 53.7.7 {#sec-16-53.7.7 omnilex-key=us-ms-regs-official--title-15--16#53.7.7}

The laboratory shall send only to the Medical Review Officer the drug or alcohol testing results which, in the case of a report positive for drug or alcohol use, shall be signed by the individual responsible for day-to-day management of the laboratory or the individual responsible for attesting to the validity of the test reports.

**History**
- *SOURCE: Miss. Code Ann. § 71-7-21*

##### **15 Miss. Admin. Code Pt. 16, R. 53.7.8** Rule 53.7.8 {#sec-16-53.7.8 omnilex-key=us-ms-regs-official--title-15--16#53.7.8}

Unless otherwise instructed by the employer in writing, all records pertaining to a given urine or blood specimen shall be retained by the drug testing laboratory for a minimum of 2 years.

**History**
- *SOURCE: Miss. Code Ann. § 71-7-21*

##### **15 Miss. Admin. Code Pt. 16, R. 53.7.9** Rule 53.7.9 {#sec-16-53.7.9 omnilex-key=us-ms-regs-official--title-15--16#53.7.9}

Laboratories will preserve positive specimens in such a manner as to ensure that said specimens will be available for any necessary retests in accordance with the Act.

Rule 53.8.1 A laboratory, as defined herein, is such a facility that is currently certified or accredited by the federal Clinical Laboratory Improvement Act, as amended, by the federal Substance Abuse and Mental Health Services Administration, by the College of American Pathologists, or that has been deemed by the State Board of Health to have been certified or accredited by an appropriate federal agency, organization or another state. Suspension and/or revocation of its standing as a laboratory by its certifying or accrediting body shall be deemed as suspension and/or revocation of its standing as a laboratory for the purposes of drug and alcohol testing.

Rule 53.9.1 Any employer in the State of Mississippi who utilizes an employee and/or job applicant drug and alcohol testing program, pursuant to the Act, shall in its written policy statement and notice to employees include as a part of such written policy statement and notice the following wording: 1. You are hereby advised that (Insert name of employer here) has implemented a drug and alcohol policy and conducts a testing program, pursuant to Sections 71- 7-1, et.al., of the Mississippi Code of 1972, Ann. (hereinafter referred to as “the Act”), and you are hereby advised of the existence of said Act. 2. All information, interviews, reports, statements, memoranda and test results, written or otherwise, received by (Insert name of employer here) through its drug and alcohol testing program are confidential communications and may not be used or received in evidence, obtained in discovery, or disclosed in any public or private proceedings, except in accordance with the Act and these regulations. Any information obtained by (Insert name of employer here) pursuant to the Act and these regulations shall be the property of the employer. (Insert name of

employer here) shall not release to any person other than the employee or job applicant, or employer medical, supervisory or other personnel, as designated by (Insert name of employer here) on a need to know basis, information related to drug and alcohol test results unless: (a) The employee or job applicant has expressly, in writing, granted permission for (Insert name of employer here) to release such information; it is necessary to introduce a positive confirmed test result into an arbitration proceeding pursuant to a collective bargaining agreement, an administrative hearing under applicable state or local law, or a judicial proceeding, provided that information is relevant to the hearing or proceeding, or the information must be disclosed to a federal or state agency or other unit of the state or United States government as required under law, regulation or order, or in accordance with compliance requirements of a state or federal government contract, or disclosed to a drug abuse rehabilitation program for the purpose of evaluation or treatment of an employee; or there is a risk to public health or safety that can be minimized or prevented by the release of such information; provided, however, that unless such risk is immediate, a court order permitting the release shall be obtained prior to the release of the information. The confidentiality provisions provided for by the Act shall not apply to other parts of an employee’s or job applicant’s personnel or medical files. If an employee refuses to sign a written consent form for release of information to persons as permitted in the Act, (Insert name of employer here) shall not be barred from discharging or disciplining the employee. 3. An employee or job applicant to be tested shall be given (1) a medication disclosure form to permit the employee or job applicant to disclose any non- prescription or prescription medications that have been taken within forty-five (45) days prior to being tested, and (2) a statement that the form shall be submitted directly to the employer’s designated Medical Review Officer, ensuring that no person or entity has access to the information disclosed on the form other than the Medical Review Officer.

Subchapter 2 AUTHORITY. Rule 54.2.1 Administrative Hearings are held pursuant to Title 42 of the Code of Federal Regulations (CFR), Sections 483.156(a), Establishment of Registry, and 483.158(c), Registry Content.

However, it shall include, but not be limited to, exploitation, involuntary seclusion, physical abuse, psychological abuse, psychosocial well-being, sexual abuse and/or verbal abuse.

**History**
- *SOURCE: Miss. Code Ann. § 71-7-21 Subchapter 8 LABORATORY CERTIFICATION, SUSPENSION AND REVOCATION OF CERTIFICATION.*
- *SOURCE: Miss. Code Ann. § 71-7-21 Subchapter 9 STANDARD LANGUAGE.*
- *SOURCE: Miss. Code Ann. § 71-7-21 CHAPTER 54 MINIMUM STANDARDS FOR CERTIFIED NURSE AIDES Subchapter 1 GENERAL PURPOSE Rule 54.1.1 Any aide that has been found by the licensing agency to have abused neglected, or misappropriated the property of a long-term care resident, shall be placed on the Nurse Aide Registry. Only the licensing agency may flag and/or place adverse findings against a nurse aide due to resident abuse, resident neglect, or misappropriation of resident property on the Nurse Aide Registry. The purpose of these regulations is to provide the procedural guidelines relating to all aspects of the administrative hearing process, should one be requested, for the placement of findings against a nurse aide on the Nurse Aide Registry.*
- *SOURCE: Miss. Code Ann. §43-11-13*
- *SOURCE: Miss. Code Ann. §43-11-13 Subchapter 3 DEFINITIONS Rule 54.3.1 Abuse. Shall mean the willful infliction of physical pain, intimidation, injury or mental anguish on a long-term care resident, or the willful deprivation of goods or services which are necessary to attain or maintain the physical, mental, and/or psychosocial health of a long-term care resident. This presumes that instances of abuse of all residents, even those in a coma, cause physical harm, or pain or mental anguish. “Abuse” shall not mean conduct which is a part of the treatment and care of, and in furtherance of the health and safety of a patient or resident.*
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 54.3.2** Exploitation {#sec-16-54.3.2 omnilex-key=us-ms-regs-official--title-15--16#54.3.2}

Shall mean the illegal or improper use of a resident or his resources for another’s profit or advantage.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 54.3.3** Involuntary Seclusion {#sec-16-54.3.3 omnilex-key=us-ms-regs-official--title-15--16#54.3.3}

Shall mean separation of a resident from other residents or from his or her room or confinement to his or her room (with or without roommates) against the resident’s will, or the will of the resident’s legal representative. Emergency or temporary monitored separation from other residents will not be considered involuntary seclusion and may be permitted if used for a limited period of time as a therapeutic intervention to reduce agitation as determined by professional staff and consistent with the resident’s plan of care or until professional staff can develop a plan of care to meet the resident’s needs.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 54.3.4** Physical Abuse {#sec-16-54.3.4 omnilex-key=us-ms-regs-official--title-15--16#54.3.4}

Shall include hitting, slapping, pinching, kicking, etc..., by which physical and/or psychological harm or trauma occurs. It also includes controlling behavior through corporal punishment.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 54.3.5** Psychological Abuse {#sec-16-54.3.5 omnilex-key=us-ms-regs-official--title-15--16#54.3.5}

Shall include, but is not limited to, intentional humiliation, harassment, threats of punishment or deprivation, whereby individuals suffer psychological harm or trauma.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 54.3.6** Sexual Abuse {#sec-16-54.3.6 omnilex-key=us-ms-regs-official--title-15--16#54.3.6}

Shall include, but is not limited to, sexual harassment, sexual coercion, or sexual assault.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 54.3.7** Verbal Abuse {#sec-16-54.3.7 omnilex-key=us-ms-regs-official--title-15--16#54.3.7}

Is defined as any use of oral, written or gestured language that willfully includes disparaging and derogatory terms to residents or their families, or within their hearing distance, regardless of their age, ability to comprehend, or disability. Examples of verbal abuse include, but are not limited to: threats of harm, saying things to frighten a resident, such as telling a resident that he/she will never be able to see her/his family again.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 54.3.8** Mental Abuse {#sec-16-54.3.8 omnilex-key=us-ms-regs-official--title-15--16#54.3.8}

Shall include, but is not limited to, humiliation, harassment, threats of punishment or deprivation.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 54.3.9** Aide {#sec-16-54.3.9 omnilex-key=us-ms-regs-official--title-15--16#54.3.9}

Shall mean a certified nurse aide (CNA) who has met all requirements of the licensing agency and whose name appears on the Nurse Aide Registry. For purposes of alleged violation(s) by a student/trainee nurse aide, said individual is to be considered under the same guidelines as an aide.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 54.3.10** Court {#sec-16-54.3.10 omnilex-key=us-ms-regs-official--title-15--16#54.3.10}

Shall mean the chancery court of the county in which the nurse aide resides or the First Judicial District Chancery Court of Hinds County.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 54.3.11** Department {#sec-16-54.3.11 omnilex-key=us-ms-regs-official--title-15--16#54.3.11}

Shall mean the Mississippi Department of Health.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 54.3.12** Director {#sec-16-54.3.12 omnilex-key=us-ms-regs-official--title-15--16#54.3.12}

Shall mean the Director of Division of Health Facilities Licensure and Certification, Mississippi Department of Health.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 54.3.13** Finding {#sec-16-54.3.13 omnilex-key=us-ms-regs-official--title-15--16#54.3.13}

Shall mean a determination made by the licensing agency that validates allegations of abuse, neglect, mistreatment, or misappropriation against a long- term care resident by an aide. The determination shall be based on clear and convincing evidence.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 54.3.14** Hearing Officer {#sec-16-54.3.14 omnilex-key=us-ms-regs-official--title-15--16#54.3.14}

Shall mean an individual appointed by the Director to preside over the Administrative Hearing with power to administer oaths, take testimony, rule on questions of evidence and make agency determinations of fact. The Hearing Officer may be employee of the Department or the Licensing Agency provided this individual is not directly involved in the investigation.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 54.3.15** Investigator {#sec-16-54.3.15 omnilex-key=us-ms-regs-official--title-15--16#54.3.15}

Shall mean an employee of the licensing agency who is a surveyor assigned to collect information regarding all alleged charges of resident abuse, resident neglect or misappropriation of resident property by an aide towards a resident.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 54.3.16** Licensing Agency {#sec-16-54.3.16 omnilex-key=us-ms-regs-official--title-15--16#54.3.16}

Shall mean the Division of Licensure and Certification of the Mississippi Department of Health, which is the Mississippi Survey Agency.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 54.3.17** Long-Term Care Resident {#sec-16-54.3.17 omnilex-key=us-ms-regs-official--title-15--16#54.3.17}

Shall mean any resident of a skilled nursing facility (SNF) and/or nursing facility (NF). For the purposes of these regulations, “resident” shall mean resident of a long-term care facility.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 54.3.18** Misappropriation of Resident Property {#sec-16-54.3.18 omnilex-key=us-ms-regs-official--title-15--16#54.3.18}

Is defined as the patterned or deliberate misplacement, exploitation, or wrongful, temporary or permanent use of a resident’s belongings or money without the resident’s consent.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 54.3.19** Neglect {#sec-16-54.3.19 omnilex-key=us-ms-regs-official--title-15--16#54.3.19}

Shall mean the failure to supply the long term care resident with the care, food, clothing, goods, shelter, health care, supervision, or other services which are necessary to maintain his/her mental and physical health. Neglect occurs on an individual basis when a resident does not receive care in one or more areas (e.g., absence of frequent monitoring for a resident known to be incontinent, resulting in being left to lie in urine or feces).

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 54.3.20** Surveyor {#sec-16-54.3.20 omnilex-key=us-ms-regs-official--title-15--16#54.3.20}

Shall mean an individual who has successfully completed the Health Care Financing Administration approved training and passed the Surveyor Minimum Qualifications Test (SMQT).

**History**
- *SOURCE: Miss. Code Ann. §43-11-13 Subchapter 4 PROCEDURE*

##### **15 Miss. Admin. Code Pt. 16, R. 54.4.1** Rule 54.4.1 {#sec-16-54.4.1 omnilex-key=us-ms-regs-official--title-15--16#54.4.1}

Whenever information is received, or when the licensing agency has cause to believe that an aide has abused, neglected, or misappropriated the property of a long-term care resident, the licensing agency shall investigate the same. Documentation of said investigation shall be made including, but not limited to, the nature of the allegation and the evidence that led the licensing agency to conclude that the allegation was valid or not.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 54.4.2** Rule 54.4.2 {#sec-16-54.4.2 omnilex-key=us-ms-regs-official--title-15--16#54.4.2}

Once an allegation that resident neglect, resident abuse, or misappropriation of resident property is found valid, based on oral or written evidence and investigation, the State completes the following notification procedures: The State notifies the following in writing within ten (10) working days of the investigation: 1. Aide(s) implicated in the investigation; 2. The current administrator of the facility in which the incident occurred; and 3. Nurse Aide Registry.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 54.4.3** Rule 54.4.3 {#sec-16-54.4.3 omnilex-key=us-ms-regs-official--title-15--16#54.4.3}

Upon receipt of a copy of the notice of right to hearing by the Nurse Aide Registry, a disciplinary flag will be entered in the Nurse Aide Registry to indicate that an investigation has been conducted, allegations have been found valid by the licensing agency, and the aide has been notified of his/her right to a hearing. No specific details are entered on the Nurse Aide Registry at this time.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 54.4.4** Rule 54.4.4 {#sec-16-54.4.4 omnilex-key=us-ms-regs-official--title-15--16#54.4.4}

Notice of Right to Hearing is sent to the aide at his/her last known address registered with the nursing home or the licensing agency. Attached to the notice shall be a written finding by the Licensing Agency stating the reasons for its determination. The notice is sent via regular United States Postal Services mail and Certified Mail, Return Receipt Requested.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 54.4.5** The notice will include the following information: 1 {#sec-16-54.4.5 omnilex-key=us-ms-regs-official--title-15--16#54.4.5}

A statement informing the aide of the nature of the allegation and his/her conduct constituting the violation and confirmation of the findings by the licensing agency’s investigator; 2. Date and approximate time of the occurrence;

3. A statement that the aide has a right to a hearing and must request a hearing in writing within thirty (30) days from the date of the notice; 4. A statement that the “Request for Hearing Form” accompanying the notice may be used to request a hearing; 5. A statement that if the aide fails to request a hearing in writing or the time to request a hearing has expired, it will be interpreted as a waiver of his/her right to a hearing and the Licensing Agency’s findings will be reported to the Nurse Aide Registry; 6. A statement of the Licensing Agency’s intent to place substantiated findings by an Administrative Hearing Officer on the Nurse Aide Registry; 7. A statement advising the aide of the consequences of waiving the right to a hearing and/or the consequences of a finding by the hearing officer that the resident abuse or resident neglect or misappropriation of resident property did occur (e.g., findings must be included and remain in the registry permanently, unless the finding was made in error, the individual was found not guilty in a court of law, or the State is notified of the individual’s death); 8. A statement that any prospective employer, or others, checking the aide’s status on the Nurse Aide Registry will be advised of any pending hearing and/or final decision; 9. A statement that whether or not a hearing is requested, the aide has the right to submit a written statement disputing the allegations if he/she chooses to do so; and 10. Right of the accused aide to be represented by an attorney at the individual’s own expense.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 54.4.6** If a hearing is requested, the same shall be held within sixty (60) days of the request {#sec-16-54.4.6 omnilex-key=us-ms-regs-official--title-15--16#54.4.6}

A “Notice of Administrative Hearing” shall be sent stating the date, time, and place of the hearing.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 54.4.7** The notice will be sent to the following individuals: 1 {#sec-16-54.4.7 omnilex-key=us-ms-regs-official--title-15--16#54.4.7}

Aide(s) implicated in the investigation; 2. The current administrator of the facility in which the incident occurred; and 3. Attorney for the aide (if applicable).

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 54.4.8** The notice will include the following information: 1 {#sec-16-54.4.8 omnilex-key=us-ms-regs-official--title-15--16#54.4.8}

A statement that the aide may appear with or without counsel, shall have the right to cross-examine all witnesses, present evidence/testimony, either written or oral, on his or her own behalf, and to refute any testimony or evidence presented; 2. A statement that formal rules of evidence and procedure will not apply, but a record of said hearing shall be made. The licensing agency shall present its case, and the aide will then present his/her case; and 3. A statement that if the aide requests a hearing but fails to appear for the scheduled hearing, this will be interpreted by the Licensing Agency as a waiver of the aide’s right to a hearing and findings against the aide will be placed on the Nurse Aide Registry.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 54.4.9** The notice will be sent via United States Postal Service regular and Certified Mail, Return Receipt Requested {#sec-16-54.4.9 omnilex-key=us-ms-regs-official--title-15--16#54.4.9}

A copy of the “Regulations Regarding Placement of Findings of Resident Abuse, Resident Neglect, and/or Misappropriation of Resident Property Against a Nurse Aide Registry” will be included with the notice.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13 Subchapter 5 CONDUCT OF HEARING Rule 54.5.1 A Hearing Officer will be appointed by the Director.*
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 54.5.2** Rule 54.5.2 {#sec-16-54.5.2 omnilex-key=us-ms-regs-official--title-15--16#54.5.2}

The State must hold a hearing and complete the hearing record within 120 days from the date of receipt of the hearing request.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 54.5.3** Rule 54.5.3 {#sec-16-54.5.3 omnilex-key=us-ms-regs-official--title-15--16#54.5.3}

The State must hold the hearing in a manner consistent with State practice, at a time and place established by the licensing agency.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 54.5.4** Formal rules of evidence and procedure will not apply, but a record of said hearing shall be made {#sec-16-54.5.4 omnilex-key=us-ms-regs-official--title-15--16#54.5.4}

The licensing agency shall present its case, and the aide will then present his/her case. In order for the licensing agency’s decision to be upheld, the facts constituting the violation must be proved by substantial evidence.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 54.5.5** Rule 54.5.5 {#sec-16-54.5.5 omnilex-key=us-ms-regs-official--title-15--16#54.5.5}

At the close of the hearing, the Administrative Hearing Officer shall, within sixty (60) days, prepare written findings and conclusions, and an order. This order will be the final agency decision.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 54.5.6** Rule 54.5.6 {#sec-16-54.5.6 omnilex-key=us-ms-regs-official--title-15--16#54.5.6}

If the Administrative Hearing Officer finds that the aide neglected or abused a resident or misappropriated a resident’s property, the substantiated findings must be reported in writing within ten (10) days to: 1. Aide; 2. Attorney for aide (if applicable); 3. Current administrator of the facility in which the incident occurred; 4. The administrator of the facility that currently employs the individual, if it is not the same facility in which the incident occurred; 5. The Division of Medicaid; and 6. The Nurse Aide Registry.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 54.5.7** Rule 54.5.7 {#sec-16-54.5.7 omnilex-key=us-ms-regs-official--title-15--16#54.5.7}

The notification sent to the aide will be mailed via United States Postal Service regular and Certified Mail, Return Receipt Requested. A copy of the Administrative Hearing Officer’s decision will be attached to the notice. The notification will include the following: 1. A statement that the Administrative Hearing Officer found that the aide did abuse a resident, neglect a resident, and/or misappropriated a resident’s property; 2. A statement that the aide is not eligible to work in a long-term care facility in Mississippi; 3. A statement that if an aide is aggrieved of the final decision, the aide may appeal on the record to the appropriate chancery court; and 4. A statement that the aide will bear the cost of transcription of the earlier proceedings, and preparation of the record, should an appeal be taken.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13 Subchapter 6 REPORTING FINDINGS TO THE NURSE AIDE REGISTRY Rule 54.6.1 The licensing agency must notify the Nurse Aide Registry of the findings.*
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 54.6.2** Rule 54.6.2 {#sec-16-54.6.2 omnilex-key=us-ms-regs-official--title-15--16#54.6.2}

The Administrative Hearing Officer’s findings of resident abuse, resident neglect or misappropriation of resident property must be included in the Nurse Aide Registry within ten (10) working days of the Administrative Hearing Officer’s decision.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 54.6.3** Rule 54.6.3 {#sec-16-54.6.3 omnilex-key=us-ms-regs-official--title-15--16#54.6.3}

The following information must be included and remain in the registry permanently, unless the findings was made in error, the individual was found not guilty in a court of law, or the State is notified of the individual’s death: 1. Documentation of the investigation, including the nature of the allegation and the evidence that led to the conclusion that the allegation was valid; 2. The date of the hearing, if such request was made, and its outcome; 3. The date of the court decision (i.e., review of Hearing Officer’s decision by a court or criminal conviction by a court), and its outcome; and 4. A statement by the individual disputing the allegation if the individual chose to make one.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 54.6.4** Rule 54.6.4 {#sec-16-54.6.4 omnilex-key=us-ms-regs-official--title-15--16#54.6.4}

If an aide is found guilty by a court of law or pleads nolo contendere for abusing or neglecting a resident or misappropriating a resident’s property, it is not necessary to offer an administrative hearing concerning the same incident before making a notation in the registry. The trial and court order satisfy the Social Security Act’s requirements for a hearing. In this case, the findings of the court will be placed on the Nurse Aide Registry.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 54.6.5** Rule 54.6.5 {#sec-16-54.6.5 omnilex-key=us-ms-regs-official--title-15--16#54.6.5}

If the Administrative Hearing Officer finds that the aide did not neglect or abuse a resident or misappropriate a resident’s property, the disciplinary flag will be removed and the aide’s name restored to full capacity on the Nurse Aide Registry.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13 Subchapter 7 CONFIDENTIALITY OF RECORDS Rule 54.7.1 Information relating to complaints/allegations that are found to be invalid shall not be disclosed.*
- *SOURCE: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 54.7.2** Rule 54.7.2 {#sec-16-54.7.2 omnilex-key=us-ms-regs-official--title-15--16#54.7.2}

Prior to a hearing or the opportunity for hearing, information relating to complaints/allegations that are found to be valid will be disclosed as set forth in paragraph 103.02 above. Along with the fact that adverse findings against a nurse aide have been placed on the Nurse Aide Registry, other information shall be released pursuant to Title 42 of the Code of Federal Regulations, Section 483.156 (d), Disclosure of Information. The records and documentation concerning the investigation and findings will be permanently maintained by the licensing agency. These records shall include, where applicable, documentation of the investigation, including the nature of the allegation and evidence that led the licensing agency to conclude that the allegation was valid; any statements made by the aide in writing, disputing the allegation; and the date and outcome of the hearing.

**History**
- *SOURCE: Miss. Code Ann. §43-11-13 CHAPTER 82 MINIMUM STANDARDS FOR UTILIZATION REVIEW AGENTS Subchapter 1 AUTHORITY AND PURPOSE*

##### **15 Miss. Admin. Code Pt. 16, R. 82.1.1** Rule 82.1.1 {#sec-16-82.1.1 omnilex-key=us-ms-regs-official--title-15--16#82.1.1}

The following Rules and Regulations for Utilization Review in Mississippi are duly adopted and promulgated by the Mississippi State Board of Health pursuant to the authority expressly conferred by Section 41-83-1 et seq., Mississippi Code of 1972 Annotated.

**History**
- *SOURCE: Miss. Code Ann. §41.83.1*

##### **15 Miss. Admin. Code Pt. 16, R. 82.1.2** Rule 82.1.2 {#sec-16-82.1.2 omnilex-key=us-ms-regs-official--title-15--16#82.1.2}

The purpose of these rules and regulations is to promote the delivery of quality health care in a cost effective manner; foster greater coordination between payors and providers conducting utilization review activities; protect patients, business and providers by ensuring that private review agents are qualified to perform utilization activities and to make informed decisions on the appropriateness of medical care; and to ensure that private review agents maintain the confidentiality of medical records.

**History**
- *SOURCE: Miss. Code Ann. §41.83.1 Subchapter 2 SCOPE*

##### **15 Miss. Admin. Code Pt. 16, R. 82.2.1** Rule 82.2.1 {#sec-16-82.2.1 omnilex-key=us-ms-regs-official--title-15--16#82.2.1}

In the State of Mississippi, every health insurance plan or every insurer proposing to issue or deliver a health insurance policy or contract or administer a health benefit program which provides for the coverage of hospital and medical benefits and the utilization review of those benefits; every health insurer proposing to issue or deliver in this state a group or blanket health insurance policy or administer a health benefit program which provides for the coverage of hospital and medical benefits and the utilization review of such benefits shall:

1. Have a certificate in accordance with these regulations; 2. Contract with a private review agent that has a certificate in accordance with these regulations.

**History**
- *SOURCE: Miss. Code Ann. §41.83.1*

##### **15 Miss. Admin. Code Pt. 16, R. 82.2.2** Rule 82.2.2 {#sec-16-82.2.2 omnilex-key=us-ms-regs-official--title-15--16#82.2.2}

Notwithstanding any provisions of these regulations, for claims where medical necessity of the provision of a covered benefit is disputed, an insurer that does not meet the requirements of this section shall pay any person or hospital entitled to reimbursement under the policy or contract.

2. Attending Physician: The physician with primary responsibility for the care provided to a patient in a hospital or other health care facility. 3. Certificate: A certificate of registration granted by the Mississippi Department of Health to a private review agent, and is not transferable. 4. Certification: A determination by a utilization review organization that an admission, extension of stay, or other medical service has been reviewed and based on the information provided, qualifies as medically necessary and appropriate under the medical review requirements of the applicable health benefit plan. 5. Certification Number: The number assigned to each certified private review agent. This number is not transferable. 6. Certified Private Review Agent: A private review agent who meets all the criteria for certification as set forth in these rules and regulations, has paid all current fees, and has been assigned a certification number. 7. Concurrent Review: Utilization review conducted during a patient's hospital stay or course of treatment. 8. Consulting Physician: A Medical Doctor, Doctor of Osteopathy, Dentist, Psychologist, Podiatrist or Chiropractor who possess the degree of skill ordinarily possessed and used by members of his or her profession in good standing, and actively engaged in the same type of practice and relevant specialty. The medical and osteopathy specialist shall be certified by the Boards within the American Board of Medical Specialists or the American Board of Osteopathy.

9. Department: The Mississippi Department of Health. 10. Director: The Director of the Division of Health Facilities Licensure and Certification of the Mississippi Department of Health. 11. Enrollee: The individual who has elected to contract for, or participate in, a health benefit plan for their self and/or their dependents. 12. Expedited Appeal: A request for additional review of a utilization review organization's determination not to certify an admission, extension of stay, or other medical service. An expedited appeal request may be called a reconsideration request by some utilization review organizations. 13. Hospital: An institution which is primarily engaged in providing to inpatients, by or under the supervision of physicians, diagnostic services and therapeutic services for medical diagnosis, treatment and care of injured, disabled or sick persons, or rehabilitation services for the rehabilitation of injured, disabled or sick persons, and also, means a place devoted primarily to the maintenance and operation of facilities for the diagnosis, treatment and illness, disease, injury or deformity, or a place devoted primarily to providing obstetrical or other medical, surgical or nursing care of individuals, whether or not any such place be organized or operated for profit and whether any such place be publicly or privately owned. The term "Hospital" does not include convalescent or boarding homes, children's homes, homes for the aged or other like establishments where room and board only are provided, nor does it include offices or clinics where patients are not regularly kept as bed patients. 14. Patient: The intended recipient of the proposed health care, his/her representative, and/or the enrollee. 15. Physician Advisor: A physician representing the claim administrator/utilization review organization who provides advice on whether to certify an admission, extension of stay, or other medical service as being medically necessary and appropriate. 16. Private Review Agent: A non-hospital affiliated person or entity performing utilization review on behalf of: a. An employer or employees in the State of Mississippi; or b. A third party that provides or administers hospital and medical benefits to citizens of this state, including: a health maintenance organization issued a certificate of authority under and by virtue of the laws of the State of Mississippi, or a health insurer, nonprofit health service plan, health insurance service organization, or preferred provider organization or other entity offering health insurance policies, contracts or benefits in this state.

17. Provider Utilization Review Representative: The person(s) in a physician's office or hospital designated by the physician or hospital to provide the necessary information to complete the review process. 18. Review Criteria: The written policies, decision rules, medical protocols, or guides used by the utilization review organization to determine certification [e.g., Appropriateness Evaluation Protocol (AEP) and Intensity of Service, Severity of Illness, Discharge, and Appropriateness Screens (ISD-A)]. 19. Utilization Review: A system for reviewing the appropriate and efficient allocation of hospital resources and medical services given or proposed to be given to a patient or group of patients. More specifically, utilization review refers to pre-service determination of the medical necessity or appropriateness of services to be rendered in a hospital setting either on an inpatient or outpatient basis, when such determination results in approval or denial of payment for the services. It includes both prospective and concurrent review and may include retrospective review under certain circumstances. 20. Utilization Review Plan: A description of the utilization review procedures of a private review agent.

**History**
- *SOURCE: Miss. Code Ann. §41.83.1 Subchapter 3 DEFINITIONS 1. Appeal: A formal request to reconsider a determination not to certify an admission, extension of stay, or other medical service.*
- *SOURCE: Miss. Code Ann. §41.83.1 Subchapter 4 APPLICATION FOR CERTIFICATION Rule 82.4.1 A private review agent who approves or denies payment or who recommends approval or denial of payment for hospital or medical services or whose review results in approval or denial of payment for hospital or medical services on a case by case basis, may not conduct utilization review in this state unless the Mississippi Department of Health has granted the private review agent a certificate.*
- *SOURCE: Miss. Code Ann. §41.83.1*

##### **15 Miss. Admin. Code Pt. 16, R. 82.4.2** Rule 82.4.2 {#sec-16-82.4.2 omnilex-key=us-ms-regs-official--title-15--16#82.4.2}

The Mississippi Department of Health shall issue a certificate to any applicant that has met all the requirements and all applicable regulations of the department.

**History**
- *SOURCE: Miss. Code Ann. §41.83.1*

##### **15 Miss. Admin. Code Pt. 16, R. 82.4.3** A certificate is not transferable {#sec-16-82.4.3 omnilex-key=us-ms-regs-official--title-15--16#82.4.3}

When there is a change of ownership of the Certified Organization, a new application will be required and a new number will be issued.

**History**
- *SOURCE: Miss. Code Ann. §41.83.1*

##### **15 Miss. Admin. Code Pt. 16, R. 82.4.4** Rule 82.4.4 {#sec-16-82.4.4 omnilex-key=us-ms-regs-official--title-15--16#82.4.4}

Any information required by the Department with respect to customers, patients or utilization review procedures of a private review agent shall be held in confidence and not disclosed to the public.

**History**
- *SOURCE: Miss. Code Ann. §41.83.1’*

##### **15 Miss. Admin. Code Pt. 16, R. 82.4.5** A Private Review Agent applying for a certificate shall submit the following documentation to the Department: 1 {#sec-16-82.4.5 omnilex-key=us-ms-regs-official--title-15--16#82.4.5}

A completed application, signed and verified by the applicant; 2. An fee, as set by the Mississippi State Board of Health, made payable to Mississippi State Department of Health, either by business check, money order, or by electronic means; and 3. A utilization review plan which shall include all of the following components used by the private review agent to approve or deny payment or recommend approval or denial of payment in advance for proposed or delivered inpatient or outpatient care or retrospectively approve or deny under certain circumstances: a. Elements of review for: i. Preadmission ii. Admission iii. Preauthorization iv. Second Surgical Opinion v. Discharge Planning vi. Concurrent Review vii. Retrospective Review viii. Readmission Review b. Procedures for review, including: i. Any form used during the review process; ii. Time frames that shall be met during the review; and iii. A written protocol describing every aspect of the review process; iv. A description and examples of review criteria to be used for the review; v. The provisions, procedures, and time frames by which patients, physicians, and hospitals may seek reconsideration or appeal of adverse decisions by the private review agent, including:

4. A written protocol describing the appeals procedure; 5. Any form which shall be completed during the appeals procedure; 6. Time frames that shall be met during the appeal procedure; and 7. The names and qualifications of personnel making final appeal determinations; a. The number, type, and qualification or qualifications of the personnel either employed or under contract to perform the utilization review; b. The policies and procedures to ensure that a representative of the private review agent is accessible to patients and providers five (5) days a week during normal business hours in this state, 9 A.M. to 5 P.M.; and that a free telephone number be provided with adequate lines available and staffed. The procedure for handling after-hours inquiries shall be specified. c. The policies and procedures to ensure that all applicable state and federal laws to protect the confidentiality of individual medical records are followed; d. A copy of the materials designed to inform applicable patients and providers of the requirements of the utilization review plan; and e. A list (names and addresses) of the third party payors for which the private review agent is performing utilization review in this state. .

**History**
- *SOURCE: Miss. Code Ann. §41.83.1 Subchapter 5 RENEWAL OF CERTIFICATION*

##### **15 Miss. Admin. Code Pt. 16, R. 82.5.1** Rule 82.5.1 {#sec-16-82.5.1 omnilex-key=us-ms-regs-official--title-15--16#82.5.1}

A certificate expires on the second anniversary of its effective date unless certification has been renewed for a two (2) year term.

**History**
- *SOURCE: Miss. Code Ann. §41.83.1*

##### **15 Miss. Admin. Code Pt. 16, R. 82.5.2** Rule 82.5.2 {#sec-16-82.5.2 omnilex-key=us-ms-regs-official--title-15--16#82.5.2}

Before the certification expires, the certified private review agent may renew its certification for an additional two (2) year term, if the certified private review agent: 1. Is otherwise entitled to be certified; 2. Pays to the Department the renewal fee as set by the Board of Health, made payable to the Mississippi State Department of Health, either by business check, money order, or by electronic means; and

3. Submits to the Department: a. A renewal application on the form that the Department requires b. An update of information as required under Part IV of these rules and regulations c. An annual report.

**History**
- *SOURCE: Miss. Code Ann. §41.83.1*

##### **15 Miss. Admin. Code Pt. 16, R. 82.5.3** Rule 82.5.3 {#sec-16-82.5.3 omnilex-key=us-ms-regs-official--title-15--16#82.5.3}

The Department shall renew the certification of each certified private review agent, if the requirements of these regulations are met.

**History**
- *SOURCE: Miss. Code Ann. §41.83.1 Subchapter 6 DENIAL OR REVOCATION OF CERTIFICATION AND PENALTY*

##### **15 Miss. Admin. Code Pt. 16, R. 82.6.1** The Director shall deny a certificate to an applicant if the Department finds that the applicant does not: 1 {#sec-16-82.6.1 omnilex-key=us-ms-regs-official--title-15--16#82.6.1}

Have available the services of a sufficient number of registered nurses, that are supervised by appropriate physicians to efficiently carry out its utilization review activities; 2. Meet any applicable provisions of these rules and regulations relating to the qualifications of private review agents or the performance of utilization review the Department adopts relating to the qualifications of private review agents or the performance of utilization review; 3. Have policies and procedures which protect the confidentiality of medical records in accordance with applicable state and federal laws; or 4. Make itself accessible to patients and providers five (5) working days a week during normal business hours in this state.

**History**
- *SOURCE: Miss. Code Ann. §41.83.1*

##### **15 Miss. Admin. Code Pt. 16, R. 82.6.2** The Director may revoke the certification of a private review agent if the Department finds that the agent: 1 {#sec-16-82.6.2 omnilex-key=us-ms-regs-official--title-15--16#82.6.2}

Does not comply with performance assurances; 2. Violates any provision of these rules and regulations; 3. Fails to substantially meet the standards and qualifications adopted by the Director; or

4. Fails to comply with the regulations adopted by the Department.

**History**
- *SOURCE: Miss. Code Ann. §41.83.1*

##### **15 Miss. Admin. Code Pt. 16, R. 82.6.3** Before denying or revoking a certificate, the Director shall provide the applicant or certificate holder: 1 {#sec-16-82.6.3 omnilex-key=us-ms-regs-official--title-15--16#82.6.3}

Written notice of the reasons for the denial or revocation; 2. Thirty (30) days in which to supply additional information demonstrating compliance with the requirements; and 3. The opportunity to request a hearing in accordance with the Mississippi Administrative Procedures Law, Section 25-43-17, Mississippi Code of 1972.

**History**
- *SOURCE: Miss. Code Ann. §41.83.1*

##### **15 Miss. Admin. Code Pt. 16, R. 82.6.4** Rule 82.6.4 {#sec-16-82.6.4 omnilex-key=us-ms-regs-official--title-15--16#82.6.4}

If the applicant requests a hearing, the Director shall send a hearing notice by certified mail, return receipt requested, at least thirty (30) days before the hearing.

**History**
- *SOURCE: Miss. Code Ann. §41.83.1*

##### **15 Miss. Admin. Code Pt. 16, R. 82.6.5** Rule 82.6.5 {#sec-16-82.6.5 omnilex-key=us-ms-regs-official--title-15--16#82.6.5}

A private review agent may not disclose or publish individual medical records or any other confidential medical information obtained in the performance of utilizaition review activities without the patient's authorization or an order of a county, circuit or chancery court of Mississippi or a U. S. District Court. It is provided, however, that nothing in these regulations shall prohibit private review agents from providing information to the third party with whom the private review agent is under contract or acting on behalf of.

**History**
- *SOURCE: Miss. Code Ann. §41.83.1*

##### **15 Miss. Admin. Code Pt. 16, R. 82.6.6** Rule 82.6.6 {#sec-16-82.6.6 omnilex-key=us-ms-regs-official--title-15--16#82.6.6}

A person who violates any provision of these regulations is guilty of a misdemeanor, and on conviction is subject to a penalty not exceeding $1,000.00.

Rule 82.7.1. Responsibility for Obtaining Certification 1. In the absence of any contractual agreement to the contrary, the enrollee is responsible for notifying the private review agent in a timely manner and obtaining certification for health care services. A private review agent shall allow any licensed hospital, physician, or responsible patient

representative, including a family member, to assist in fulfilling that responsibility. 2. To assure confidentiality, a private review agent must, when contacting a physician's office or hospital, provide its certification number, the caller's name, and professional qualification to the designated utilization review representative in the physician's office or hospital.

**History**
- *SOURCE: Miss. Code Ann. §41.83.1 Subchapter 7 UTILIZATION REVIEW STANDARDS*
- *SOURCE: Miss. Code Ann. §41.83.1*

##### **15 Miss. Admin. Code Pt. 16, R. 82.7.2** Information Upon Which Utilization Review is Conducted 1 {#sec-16-82.7.2 omnilex-key=us-ms-regs-official--title-15--16#82.7.2}

When conducting routine prospective and concurrent utilization review, the private review agent shall collect only the information necessary to certify the admission, procedure or treatment and length of stay. 2. A private review agent should not routinely expect hospitals and physicians to supply numerically codified diagnoses or procedures. The private review agent may ask for such coding, since if it is known, its inclusion in the data collected increases the effectiveness of the communication. 3. The private review agent shall not routinely request copies of medical records on all patients reviewed. During prospective and concurrent review, copies of medical records should only be required when a difficulty develops in certifying the medical necessity or appropriateness of the admission or extension of stay. In those cases, only the necessary or pertinent sections of the record should be required. 4. Private review agents may request copies of medical records retrospectively for a number of purposes, including auditing the services provided, quality assurance, evaluation of compliance with the terms of the health benefit plan or UR provisions. With the exception of the reviewing of records associated with an appeal or with an investigation of data discrepancies and unless otherwise provided for by contract or law, health care providers should be reimbursed the reasonable direct costs of duplicating requested records for retrospective review.

**History**
- *SOURCE: Miss. Code Ann. §41.83.1*

##### **15 Miss. Admin. Code Pt. 16, R. 82.7.3** Rule 82.7.3 {#sec-16-82.7.3 omnilex-key=us-ms-regs-official--title-15--16#82.7.3}

Except as otherwise provided in these standards, a private review agent should limit its initial data requirements to the following elements: 1. Patient Information a. Name b. Address

c. Date of Birth d. Sex e. Social Security Number or Patient ID Number f. Name of Carrier or Plan g. Plan ID Number 2. Enrollee Information a. Name b. Address c. Social Security Number or Employee ID Number d. Relation to Patient e. Employer f. Health Benefit Plan g. Group Number/Plan ID Number h. Other Coverage Available (Workers Comp., Medicare, etc.) 3. Attending Physician/Practitioner Information a. Name b. Address c. Phone Number d. Degree e. Specialty/Certification Status f. Tax ID or Other ID Number 4. Diagnosis/Treatment Information a. Primary Diagnosis b. Secondary Diagnosis c. Proposed Procedure(s) or Treatment(s)

d. Surgical Assistant Requirement e. Anesthesia Requirement f. Proposed Admission or Service Date(s) g. Proposed Procedure Date h. Proposed Length of Stay 5. Clinical Information. Sufficient information for support of appropriateness and level of service proposed 6. Facility Information a. Type (such as in-patient, out-patient, rehab, etc.) b. Status (DRG exempt status, as needed) c. Name d. Address e. Phone Number f. Tax ID or Other ID Number 7. Concurrent (Continued Stay) Review Information a. Clinical Contact Person b. Additional Days/Services Proposed c. Reasons for Extension d. Diagnosis (same/changed) e. Clinical Information (Sufficient to support, as above) 8. Admissions to Facilities Other Than Acute Medical/Surgical Hospitals a. History of Present Illness b. Patient Treatment Plan and Goals c. Prognosis d. Staff Qualifications e. 24 Hour Availability of Staff

1. Additional information may be required for other specific review functions such as discharge planning or catastrophic case management. Second opinion information may also be required, when applicable, sufficient to support benefit plan requirements. 2. Information in addition to that described in this section may be requested by the private review agent or voluntarily submitted by the provider, when there is significant lack of agreement between the private review agent and health care provider regarding the appropriateness of certification during the review or appeal process. "Significant lack of agreement" means that the private review agent has: a. Tentatively determined, through its professional staff, that a service cannot be certified; b. Referred the case to a physician for review; and c. Talked to or attempted to talk to the attending physician for further information. 3. A private review agent should share all clinical and demographic information on individual patients among its various divisions (e.g., certification, discharge planning, case management) to avoid duplicate requests for information from enrollee or providers.

**History**
- *SOURCE: Miss. Code Ann. §41.83.1 Rule 82.7.4. Special Situations*
- *SOURCE: Miss. Code Ann. §41.83.1*

##### **15 Miss. Admin. Code Pt. 16, R. 82.7.5** Procedures For Review Determination {#sec-16-82.7.5 omnilex-key=us-ms-regs-official--title-15--16#82.7.5}

1. Each private review agent shall have written procedures to assure that reviews are conducted in a timely manner. 2. Each private review agent shall make certification determinations within two working days of receipt of the necessary information on a proposed admission or service requiring a review determination. Collection of the necessary information may necessitate a discussion with the attending physician or, based on the requirements of the health benefit plan, may involve a completed second opinion review. 3. A private review agent may review ongoing inpatient stays, but shall not routinely conduct daily review on all such stays. The frequency of the review for extension of the initial determination should vary based on the

severity or complexity of the patient's condition or on necessary treatment and discharge planning activity. Routine concurrent review generally should not be necessary earlier than 24 hours prior to the lapse of the certified length of stay. 4. Each private review agent shall have in place written procedures for providing notification of its determination regarding certification, recertification, or extensions of previously authorized length of stay in accordance with the following: 5. When an initial determination is made to certify, notification shall be provided promptly either by telephone or in writing, to the attending physician. The notification shall be transmitted in writing to the hospital and attending physician, as well as to the enrollee or patient, within two working days. 6. A determination to certify resulting from concurrent review shall be transmitted to the attending physician by telephone or in writing within one working day of receipt of all information necessary to complete the review process or prior to the end of the current certified period. 7. If a private review agent transmits written confirmation of certification for continued hospitalization, that notification shall include the number of extended days, the new total number of days approved, and the date of admission. 8. When a determination is made not to certify a hospital or surgery facility admission or extension of a hospital stay or other service requiring review determination, the attending physician shall be notified by telephone within one working day and a written notification should be sent within one working day to the hospital, attending physician and the enrollee or patient. The written notification shall include the principal reason(s) for the determination and the way to initiate an appeal of the determination if the enrollee, patient, or their representative so chooses. Reasons for a determination not to certify shall include, among other things, the lack of adequate information to certify after a reasonable attempt has been made to contact the attending physician.

**History**
- *SOURCE: Miss. Code Ann. §41.83.1*

##### **15 Miss. Admin. Code Pt. 16, R. 82.7.6** Rule 82.7.6 {#sec-16-82.7.6 omnilex-key=us-ms-regs-official--title-15--16#82.7.6}

Notwithstanding language to the contrary elsewhere contained herein, if a licensed physician certifies in writing to an insurer within seventy-two (72) hours of an admission that the insured person admitted was in need of emergency admission to hospital care, such shall constitute a prima facie case of the medical necessity of the admission. An emergency admission results from sudden onset of a medical condition manifested by acute symptoms of sufficient severity that absence of immediate inpatient hospitalization could reasonably result in:

1. Permanently placing the patient's health in jeopardy; 2. Serious impairment to bodily functions; or 3. Serious and permanent dysfunction of any bodily organ or part, or other serious medical consequences.

**History**
- *SOURCE: Miss. Code Ann. §41.83.1*

##### **15 Miss. Admin. Code Pt. 16, R. 82.7.7** Rule 82.7.7 {#sec-16-82.7.7 omnilex-key=us-ms-regs-official--title-15--16#82.7.7}

To overcome this, the entity requesting the utilization review and/or the private review agent must show by clear and convincing evidence that the admitted person was not in need of immediate hospital care.

**History**
- *SOURCE: Miss. Code Ann. §41.83.1*

##### **15 Miss. Admin. Code Pt. 16, R. 82.7.8** Rule 82.7.8 {#sec-16-82.7.8 omnilex-key=us-ms-regs-official--title-15--16#82.7.8}

Private review agents shall have in place written procedures to address the failure of a health care provider, patient, or their representative to provide the necessary information for review. If the patient or provider will not release the necessary information to the UR Organization, the UR Organization may deny certification in accordance with its own policy or that of the health benefit plan.

2. Notwithstanding any provision of this act, the insured shall have the express right to pursue any legal remedies he may have in a court of competent jurisdiction.

**History**
- *SOURCE: Miss. Code Ann. §41.83.1 Subchapter 8 APPEALS OF DETERMINATIONS NOT TO CERTIFY Rule 82.8.1 Each private review agent shall have in place procedures for appeals of determinations not to certify an admission, procedure, service or extension of stay. The right to appeal shall be available to the patient or enrollee, and to the attending physician on behalf of the patient. The procedures for appeals shall include, at a minimum, the following statement: 1. Any person aggrieved by a final decision of the department or a private review agent in a contested case under this act shall have the right of judicial appeal to the chancery court of the county of the residence of the aggrieved person.*
- *SOURCE: Miss. Code Ann. §41.83.1 Subchapter 9 EXPEDITED APPEAL*

##### **15 Miss. Admin. Code Pt. 16, R. 82.9.1** Rule 82.9.1 {#sec-16-82.9.1 omnilex-key=us-ms-regs-official--title-15--16#82.9.1}

When an initial determination not to certify a health care service is made prior to or during an ongoing service requiring review, and the attending physician believes that the determination warrants immediate appeal, the attending physician shall

have an opportunity to appeal that determination over the telephone on an expedited basis, within one working day. Each private review agent shall provide for reasonable access to its consulting physician(s) for such appeals. Both providers of care and private review agents should attempt to share the maximum information by phone, FAX, or otherwise to resolve the expedited appeal (sometimes called a reconsideration request) satisfactorily.

**History**
- *SOURCE: Miss. Code Ann. §41.83.1*

##### **15 Miss. Admin. Code Pt. 16, R. 82.9.1** Expedited appeals which do not resolve a difference of opinion may be resubmitted through the standard appeal process {#sec-16-82.9.1 omnilex-key=us-ms-regs-official--title-15--16#82.9.1}

**History**
- *SOURCE: Miss. Code Ann. §41.83.1 Subchapter 10 STANDARD APPEAL Rule 82.10.1 The private review agents shall establish procedures for appeals to be made in writing and/or by telephone.*
- *SOURCE: Miss. Code Ann. §41.83.1*

##### **15 Miss. Admin. Code Pt. 16, R. 82.10.2** Rule 82.10.2 {#sec-16-82.10.2 omnilex-key=us-ms-regs-official--title-15--16#82.10.2}

Each private review agent shall notify in writing the patient, provider and claims administrator of its determination on the appeal as soon as practical, but in no case later that 60 days after receiving the required documentation on the appeal. The documentation required by the private review agent may include copies of part or all of the medical record and/or a written statement from the attending physician.

**History**
- *SOURCE: Miss. Code Ann. §41.83.1*

##### **15 Miss. Admin. Code Pt. 16, R. 82.10.3** Rule 82.10.3 {#sec-16-82.10.3 omnilex-key=us-ms-regs-official--title-15--16#82.10.3}

Prior to upholding the original decision not to certify for clinical reasons, the private review agent shall conduct a review of such documentation by a physician who did not make the original determination not to certify.

**History**
- *SOURCE: Miss. Code Ann. §41.83.1*

##### **15 Miss. Admin. Code Pt. 16, R. 82.10.4** Rule 82.10.4 {#sec-16-82.10.4 omnilex-key=us-ms-regs-official--title-15--16#82.10.4}

The process established by a private review agent may include a period within which an appeal must be filed to be considered.

**History**
- *SOURCE: Miss. Code Ann. §41.83.1*

##### **15 Miss. Admin. Code Pt. 16, R. 82.10.5** Rule 82.10.5 {#sec-16-82.10.5 omnilex-key=us-ms-regs-official--title-15--16#82.10.5}

An attending physician who has been unsuccessful in an attempt to reverse a determination not to certify should be provided, upon request, the clinical basis for the determination.

**History**
- *SOURCE: Miss. Code Ann. §41.83.1*

##### **15 Miss. Admin. Code Pt. 16, R. 82.11.1** Subchapter 11 NOTIFICATION TO THE CLAIMS ADMINISTRATOR {#sec-16-82.11.1 omnilex-key=us-ms-regs-official--title-15--16#82.11.1}

Each private review agent shall forward, either electronically or in writing, a notification of certification or determination not to certify to the appropriate claims administrator for the health benefit plan.

2. Used solely for the purposes of utilization review, quality assurance, discharge planning and catastrophic case management; and 3. Shared with only those agencies (such as the claims administrator) who have authority to receive such information.

**History**
- *SOURCE: Miss. Code Ann. §41.83.1 Subchapter 12 CONFIDENTIALITY Rule 82.12 Each private review agent shall have written procedures for assuring that patient- specific information obtained during the process of utilization review will be: 1. Kept confidential in accordance with applicable federal and state laws;*
- *SOURCE: Miss. Code Ann. §41.83.1*

##### **15 Miss. Admin. Code Pt. 16, R. 82.12.2** Rule 82.12.2 {#sec-16-82.12.2 omnilex-key=us-ms-regs-official--title-15--16#82.12.2}

Summary data shall not be considered confidential if it does not provide sufficient information to allow identification of individual patients.

**History**
- *SOURCE: Miss. Code Ann. §41.83.1 Subchapter 13 STAFF AND PROGRAM QUALIFICATIONS Rule 82.13.1 Each private review agent shall have utilization review staff who are properly trained, qualified, supervised and supported by written clinical criteria and review procedures. Clinical criteria and review procedures shall be established with appropriate involvement from physicians.*
- *SOURCE: Miss. Code Ann. §41.83.1*

##### **15 Miss. Admin. Code Pt. 16, R. 82.13.2** Rule 82.13.2 {#sec-16-82.13.2 omnilex-key=us-ms-regs-official--title-15--16#82.13.2}

Nurses, physicians and other licensed health professionals conducting reviews of medical services, and other clinical reviewers conducting specialized reviews in their area of specialty shall be currently licensed or certified by an approved state licensing agency in the United States.

**History**
- *SOURCE: Miss. Code Ann. §41.83.1*

##### **15 Miss. Admin. Code Pt. 16, R. 82.13.3** Rule 82.13.3 {#sec-16-82.13.3 omnilex-key=us-ms-regs-official--title-15--16#82.13.3}

A physician shall review all cases in which the private review agent has concluded that a determination not to certify for clinical reasons is appropriate. The physician should be reasonably available by telephone to discuss the determination with the attending physician.

**History**
- *SOURCE: Miss. Code Ann. §41.83.1*

##### **15 Miss. Admin. Code Pt. 16, R. 82.13.4** Rule 82.13.4 {#sec-16-82.13.4 omnilex-key=us-ms-regs-official--title-15--16#82.13.4}

In cases where an appeal to reverse a determination not to certify for clinical reasons is unsuccessful, the private review agent should assure that a physician in the same or similar general specialty as typically manages the medical condition, procedure or treatment under discussion is reasonably available, as appropriate, to review the case. For the purpose of this review, the phrase "reasonably available" shall mean within one working day, unless extenuating circumstances exist. These extenuating circumstances shall be in writing.

**History**
- *SOURCE: Miss. Code Ann. §41.83.1*

##### **15 Miss. Admin. Code Pt. 16, R. 82.13.5** Private review agents shall utilize the following: 1 {#sec-16-82.13.5 omnilex-key=us-ms-regs-official--title-15--16#82.13.5}

Written clinical criteria, as needed, for the purpose of determining the Appropriateness of the certification; such criteria should be periodically evaluated and updated; 2. Physician consultants or specialists who are certified by the Boards within the American Board of Medical Specialists or the American Board of Osteopathy from the major areas of clinical services; 3. A formal program for orientation and training of UR staff; and 4. Written documentation of an active Quality Assessment Program.

**History**
- *SOURCE: Miss. Code Ann. §41.83.1 Subchapter 14 ACCESSIBILITY AND ON-SITE REVIEW PROCEDURES Rule 82.14.1 Each private review agent shall provide access to its review staff by a toll free or collect call phone line, at a minimum, from 9:00 A.M. to 5:00 P.M. of each normal business day in this state.*
- *SOURCE: Miss. Code Ann. §41.83.1*

##### **15 Miss. Admin. Code Pt. 16, R. 82.14.2** Rule 82.14.2 {#sec-16-82.14.2 omnilex-key=us-ms-regs-official--title-15--16#82.14.2}

Each private review agent shall also have a mechanism to receive timely call- backs from providers and shall establish written procedures for receiving or redirecting after-hours calls, either in person or by recording.

**History**
- *SOURCE: Miss. Code Ann. §41.83.1*

##### **15 Miss. Admin. Code Pt. 16, R. 82.14.3** Rule 82.14.3 {#sec-16-82.14.3 omnilex-key=us-ms-regs-official--title-15--16#82.14.3}

Each private review agent shall conduct its telephone and on-site information gathering reviews and hospital communications during the hospitals' and physicians' reasonable and normal business hours, unless otherwise mutually agreed.

**History**
- *SOURCE: Miss. Code Ann. §41.83.1*

##### **15 Miss. Admin. Code Pt. 16, R. 82.14.4** Rule 82.14.4 {#sec-16-82.14.4 omnilex-key=us-ms-regs-official--title-15--16#82.14.4}

Each private review agent's staff shall identify themselves by name and by the name of their organization and, for on-site reviews, should carry picture identification and the private review agent company identification card. On-site reviews should, whenever possible, be scheduled at least one business day in advance with the appropriate hospital contact. Private review agents shall agree, if so requested, that the medical records remain available in designated areas during the on-site review and that reasonable hospital administrative procedures shall be followed by on-site review staff so as to not disrupt hospital operations or patient care. Such procedures, however, should not limit the ability of the private review agent to efficiently conduct the necessary review on behalf of the patient's health benefit plan.

**History**
- *SOURCE: Miss. Code Ann. §41.83.1 Subchapter 15 REPORTING REQUIREMENTS Rule 82.15.1 The Director shall establish reporting requirements to: 1. Evaluate the effectiveness of private review agents 2. Determine if all the utilization review programs are in compliance with the provisions of these rules and regulations.*
- *SOURCE: Miss. Code Ann. §41.83.1 Subchapter 16 EXEMPTIONS Rule 82.16.1 The Director may waive the requirements of these rules and regulations for a private review agent that operates solely under contract with federal government for utilization review of patients eligible for hospital services under Title XVIII of the Social Security Act (Medicare) and Title XIX (Medicaid).*
- *SOURCE: Miss. Code Ann. §41.83.1*

##### **15 Miss. Admin. Code Pt. 16, R. 82.16.2** Rule 82.16.2 {#sec-16-82.16.2 omnilex-key=us-ms-regs-official--title-15--16#82.16.2}

No certificate is required for utilization review by any Mississippi licensed pharmacist or pharmacy, or organizations of either, while engaged in the practice of pharmacy in this state.

**History**
- *SOURCE: Miss. Code Ann. §41.83.1*

##### **15 Miss. Admin. Code Pt. 16, R. 82.16.8** Rule 82.16.8 {#sec-16-82.16.8 omnilex-key=us-ms-regs-official--title-15--16#82.16.8}

No certificate is required for those private review agents conducting general in- house utilization review for hospitals, home health agencies, preferred provider organizations or other managed care entities, clinics, private physician offices or any other health facility or entity, so long as the review does not result in the approval or denial of payment for hospital or medical services for a particular case. Such general in-house utilization review is completely exempt.

Subchapter 17 AMENDMENTS Rule 82.17.1 House Bill 1330 of the Mississippi Legislature 2000 Regular Session amended Section 41-83-31, Mississippi Code of 1972, as follows: 1. 41-83-31. Any program of utilization review with regard to hospital, medical or other health care services provided in this state shall comply with the following: a. No determination adverse to a patient or to any affected health care provider shall be made on any question relating to the necessity or justification for any form of hospital, medical or other health care services without prior evaluation and concurrence in the adverse determination by a physician licensed to practice in Mississippi. The physician who made the adverse determination shall discuss the reasons for any adverse determination with the affected health care provider, if the provider so requests. The physician shall comply with this request within fourteen (14) calendar days of being notified of a request. Adverse determination by a physician shall not be grounds for any disciplinary action against the physician by the State Board of Medical Licensure. b. Any determination regarding hospital, medical or other health care services rendered or to be rendered to a patient which may result in a denial of third-party reimbursement or a denial of pre- certification for that service shall include the evaluation, findings and concurrence of a physician trained in the relevant specialty or subspecialty, if requested by the patient(s physician, to make a final determination that care rendered or to be rendered was, is, or may be medically inappropriate. c. The requirement in this section that the physician who makes the evaluation and concurrence in the adverse determination must be licensed to practice in Mississippi shall not apply to the Comprehensive Health Insurance Risk Pool Association or its policyholders and shall not apply to any utilization review company which reviews fewer than ten persons residing in the State of Mississippi.

CHAPTER 83. MINIMUM STANDARDS FOR ADULT FOSTER CARE FACILITIES SUBCHAPTER 1. GENERAL : LEGAL AUTHORITY

**History**
- *SOURCE: Miss. Code Ann. §41.83.1*
- *SOURCE: Miss. Code Ann. §41.83.1*

##### **15 Miss. Admin. Code Pt. 16, R. 83.1.1** Adoption of Rules, Regulations, and Minimum Standards {#sec-16-83.1.1 omnilex-key=us-ms-regs-official--title-15--16#83.1.1}

By virtue of authority vested in it by the Legislature of the State of Mississippi as per Section 43-11-13 of the Mississippi Code of 1972, as amended, the Mississippi State Department of Health does hereby adopt and promulgate the following Rules, Regulations, and Minimum Standards for Adult Foster Care Facilities. Upon adoption of these Rules, Regulations, and Minimum Standards, all former rules, regulations and minimum standards in conflict therewith, previously adopted by the licensing agency, are hereby repealed.

**History**
- *Source: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 83.1.2** Codes and Ordinances {#sec-16-83.1.2 omnilex-key=us-ms-regs-official--title-15--16#83.1.2}

Every licensed facility located inside the boundaries of a municipality shall comply with all local municipal codes and ordinances applicable thereto. In addition, each licensed facility shall comply with all applicable state and federal laws.

**History**
- *Source: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 83.1.3** Fire Safety {#sec-16-83.1.3 omnilex-key=us-ms-regs-official--title-15--16#83.1.3}

No facility may be licensed until it shows conformance to the safety regulations providing minimum standards for prevention and detection of fire as well as for protection of life and property against fire.

**History**
- *Source: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 83.1.4** Duty to Report {#sec-16-83.1.4 omnilex-key=us-ms-regs-official--title-15--16#83.1.4}

All fires, explosions, natural disasters as well as avoidable deaths, or avoidable, serious, or life-threatening injuries to residents resulting from fires, explosions, and natural disasters shall be reported by telephone to the Life Safety Code Division of the licensing agency by the next working day after the occurrence

**History**
- *Source: Miss. Code Ann. §43-11-13 SUBCHAPTER 2. DEFINITIONS Rule 83.2.1 Adult Foster Care. The term “adult foster care” shall mean the provision of services to individuals who require personal care services through individualized plans of care which provide a variety of health, social, and related support services in a protective setting, enabling persons to live in the community.*
- *Source: Miss. Code Ann. §43-11-13 Rule 83.2.2. Ambulation. The terms “ambulation” or “ambulatory” shall mean the resident’s ability to bear weight, pivot, and safely walk independently or with the use of a cane, walker, or other mechanical supportive device (i.e., including, but not limited to, a wheelchair). A resident who requires a wheelchair must be capable of transferring to and propelling the wheelchair independently or with prompting.*
- *Source: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 83.2.3** Criminal History Record Checks {#sec-16-83.2.3 omnilex-key=us-ms-regs-official--title-15--16#83.2.3}

1. Employee. For the purpose of fingerprinting and criminal background history checks, employee shall mean any individual employed by a licensed entity. The term “employee”, also includes any individual who by contract with the facility provides patient care in a patient’s, resident’s, or client’s room or in treatment rooms. The term employee does not include healthcare professional/technical students, as defined in Section 37-29-232, performing clinical training in a licensed entity under contracts between their schools and the licensed entity, and does not include students at high schools who observe the treatment and care of patients in a licensed entity as part of the requirements of an allied health course taught in the school if: a. The student is under the supervision of a licensed healthcare provider; and b. The student has signed the affidavit that is on file at the student’s school stating that he or she has not been convicted of or plead guilty or nolo contendere to a felony of possession or sale of drugs, murder, manslaughter, armed robbery, rape, sexual battery, any sexual offenses listed in section 45-33-23 (g), child abuse, arson, grand larceny, burglary, gratification of lust, aggravated assault, or felonious abuse and/or battery of a vulnerable adult, or that any such conviction or plea was reversed on appeal or a pardon was granted for the conviction or plea. c. Further, applicants and employees of the University of Mississippi Medical Center for whom criminal history record checks and fingerprinting are obtained in accordance with Section 37-115-41 are exempt from application of the term employee under Section 43-11- 13. 2. Covered Entity. For the purpose of criminal history record checks, “covered entity” means a licensed entity, or a healthcare professional staffing agency. 3. Licensed Entity. For the purpose of criminal history record checks, the term “licensed entity” means an adult foster care facility, hospital, nursing home, personal care home, home health agency or hospice. 4. Health Care Professional/Vocational Technical Academic Program. For the purpose of criminal history record checks, “health care professional/vocational technical academic program” means an academic program in medicine, nursing, dentistry, occupational therapy, physical therapy, social services, speech therapy, or other allied-health professional whose purpose is to prepare professionals to render patient care services.

5. Health Care Professional/Vocational Technical Student. For purposes of criminal history record checks, the term means a student enrolled in a healthcare professional/vocational technical academic program. 6. Direct Patient Care or Services. For the purposes of fingerprinting and criminal background history checks, the term “direct patient care” means direct hands-on medical patient care and services provided by an individual in a patient, resident or client’s room, treatment room or recovery room. Individuals providing direct patient care may be directly employed by the facility or employed on a contractual basis. 7. Documented Disciplinary Action. For the purpose of fingerprinting and criminal background history checks, the term “documented disciplinary action” means any action taken against an employee for abuse or neglect of a patient.

**History**
- *Source: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 83.2.4** Facility {#sec-16-83.2.4 omnilex-key=us-ms-regs-official--title-15--16#83.2.4}

The term “facility” shall mean any home or institution that (1) has sought or is currently seeking designation as a “licensed facility” under the terms of these regulations; or (2) is operating a home or institution unlawfully which, by its nature and operational intent, is required to be a licensed facility under the terms of these regulations.

**History**
- *Source: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 83.2.5** Immediate Jeopardy (Serious and Immediate to Health and Safety) {#sec-16-83.2.5 omnilex-key=us-ms-regs-official--title-15--16#83.2.5}

A situation in which the licensed facility’s failure to meet one or more regulatory requirements has caused, or is likely to cause, serious injury, harm, impairment, or death to a resident.

**History**
- *Source: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 83.2.6** Licensing Agency {#sec-16-83.2.6 omnilex-key=us-ms-regs-official--title-15--16#83.2.6}

The term "licensing agency" shall mean the Mississippi State Department of Health

**History**
- *Source: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 83.2.7** IGRA(s) (Interferon-Gamma Release Assay(s) {#sec-16-83.2.7 omnilex-key=us-ms-regs-official--title-15--16#83.2.7}

A whole blood test used in to assist in diagnosing Mycobacterium Tuberculosis infection. The IGRA blood test used must be approved by the U.S. Food and Drug Administration (FDA).

**History**
- *Source: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 83.2.8** Licensed Facility {#sec-16-83.2.8 omnilex-key=us-ms-regs-official--title-15--16#83.2.8}

The term “licensed facility” shall mean adult foster care facility which has been issued a license for operation by the licensing agency.

**History**
- *Source: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 83.2.9** Mantoux Test {#sec-16-83.2.9 omnilex-key=us-ms-regs-official--title-15--16#83.2.9}

A method of skin testing that is performed by injecting one- tenth (0.1) milliliter of purified protein derivative-tuberculin containing five (5) tuberculin units into the dermis (i.e., the second layer of skin) of the forearm with a needle and syringe. The area is examined between forty-eight (48) and seventy-two (72) hours after the injection. A reaction is measured according to the size of the induration. The classification of a reaction as positive or negative depends on the patient’s medical history and various risk factors (see definition for significant tuberculin skin test. This test is used to evaluate the likelihood that a person is infected with M. tuberculosis. . The Mantoux (TST) test should be administered only by persons certified in the intradermal technique.

**History**
- *Source: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 83.2.10** Medication Administration {#sec-16-83.2.10 omnilex-key=us-ms-regs-official--title-15--16#83.2.10}

For the purposes of these regulations, the term “medication administration” is limited to these decisions, made by someone other than the person for whom the medication has been prescribed, regarding (1) which medication is to be taken, (2) the dosage of the medication, or (3) the time at which the medication is to be taken.

**History**
- *Source: Miss. Code Ann. §43-11-13 Rule.83.2.11 Medication Assistance. For the purposes of these regulations, the term “medication assistance” is any form of delivering medication which has been prescribed which is not defined as “medication administration” including, but not limited to, the physical act of handing an oral prescription medication to the patient along with liquids to assist the patient in swallowing.*
- *Source: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 83.2.12** Personal Care {#sec-16-83.2.12 omnilex-key=us-ms-regs-official--title-15--16#83.2.12}

The term "personal care" shall mean the assistance rendered by personnel of the licensed facility to residents in performing one or more of the activities of daily living, including but not limited to bathing, walking, excretory functions, feeding, personal grooming, and dressing.

**History**
- *Source: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 83.2.13** Plan of Care {#sec-16-83.2.13 omnilex-key=us-ms-regs-official--title-15--16#83.2.13}

(Care Plan) A written document established and maintained for each resident admitted to the licensed Adult Foster Care Facility. Care provided to a resident must be in accordance with the plan. The plan must include a comprehensive assessment of the individual’s needs and the identification of services needed to attain or maintain the resident’s highest practicable physical, mental, and psychosocial well-being.

**History**
- *Source: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 83.2.14** Significant Tuberculin Skin Test {#sec-16-83.2.14 omnilex-key=us-ms-regs-official--title-15--16#83.2.14}

An induration of five (5) millimeters or greater is significant (or positive) in the following:

8. Persons known to have or suspected of having human immunodeficiency virus (HIV). 9. Close contacts of a person with infectious tuberculosis. 10. Persons who have a chest radiograph suggestive of previous tuberculosis. 11. Persons who inject drugs (if HIV status is unknown). An induration of ten (10) millimeters or greater is significant (or positive) in all other persons tested in Mississippi. A tuberculin skin test is recorded in millimeters of induration. For accurate results, measure the widest diameter of the palpable induration transverse (across) the arm.

**History**
- *Source: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 83.2.15** Supervision {#sec-16-83.2.15 omnilex-key=us-ms-regs-official--title-15--16#83.2.15}

Supervision means guidance of the resident as the individual carries out activities of daily living including reminding a resident to maintain his/her medication schedule as directed by his/her physician, reminding him/her of important activities to be carried out, assisting him/her in keeping appointments and being aware of his/her general whereabouts even though he/she may travel independently about the community.

**History**
- *Source: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 83.2.16** Surveyor {#sec-16-83.2.16 omnilex-key=us-ms-regs-official--title-15--16#83.2.16}

The term "surveyor" shall mean an individual employed, or hired on a contractual basis, by the licensing agency for the purpose of conducting surveys, inspections, investigations, or other related functions as part of the licensing agency’s responsibilities for licensure and regulation of institutions for the aged and infirm.

**History**
- *Source: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 83.2.17** Two-step Testing {#sec-16-83.2.17 omnilex-key=us-ms-regs-official--title-15--16#83.2.17}

A procedure used for the baseline testing of person who will periodically receive tuberculin skin tests (e.g., health care workers) to reduce the likelihood of mistaking a boosted reaction for a new infection. If the initial tuberculin-test result is classified as negative, a second test is repeated one (1) to three (3) weeks later. If the reaction to the second test is positive, it probably represents a boosted reaction. If the second test is also negative, the person is classified as not infected. A positive reaction to a subsequent test would indicate new infection (i.e., a skin-test conversion) in the person.

**History**
- *Source: Miss. Code Ann. §43-11-13 SUBCHAPTER 3. PROCEDURE GOVERNING ADOPTION AND AMENDMENT*

##### **15 Miss. Admin. Code Pt. 16, R. 83.3.1** Authority {#sec-16-83.3.1 omnilex-key=us-ms-regs-official--title-15--16#83.3.1}

The licensing agency shall have the power to adopt, amend, promulgate and enforce such rules, regulations and minimum standards as it deems appropriate, within the law.

SUBCHAPTER 4. INSPECTION Rule 83.4.1 Inspections Required. Each licensed facility shall be inspected by the licensing agency or by persons delegated with authority by said licensing agency at such intervals as the licensing agency may direct. The licensing agency and/or its authorized representatives shall have the right to inspect construction work in progress. New facilities shall not be licensed without having first been inspected for compliance with these rules, regulations, and minimum standards.

SUBCHAPTER 5. CLASSIFICATION Rule 83.5.1 Adult Foster Care Facility. The term “Adult Foster Care Facility” means a home setting for vulnerable adults in the community who are unable to live independently due to physical, emotional, developmental or mental impairments, or in need of emergency and continuing protective social services for purposes of preventing further abuse or neglect and for safeguarding and enhancing the welfare of the abused or neglected vulnerable adult. Adult foster care programs shall be designed to meet the needs of the vulnerable adults with impairments through individual plans of care, which provide a variety of health, social and related support services in a protective setting, enabling participants to live in the community. Adult Foster Care programs may be: 1. Traditional, where the foster care provider lives in the residence and is the primary caregiver to clients in the home; 2. Corporate, where the foster care home is operated by a corporation or other entity with shift staff delivery services to clients; or 3. Shelter, where the foster care home accepts clients on an emergency short- term basis for up to thirty (30) days.

1. Traditional, where the foster care provider lives in the residence and is the primary caregiver to clients in the home; 2. Corporate, where the foster care home is operated by a corporation or other entity with shift staff delivery services to clients; or 3. Shelter, where the foster care home accepts clients on an emergency short- term basis for up to thirty (30) days. The licensing agency shall have the power and authority to waive any provision herein it deems appropriate for any license issued for the Shelter class facility.

**History**
- *Source: Miss. Code Ann. §43-11-13*
- *Source: Miss. Code Ann. §43-11-13*
- *Source: Miss. Code Ann. §43-11-13 SUBCHAPTER 6. TYPES OF LICENSE Rule 83.6.1 Regular License. A license shall be issued to each facility that meets the requirements as set forth in these regulations. Each license shall be issued under one of the following classes:*
- *Source: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 83.6.2** Provisional License {#sec-16-83.6.2 omnilex-key=us-ms-regs-official--title-15--16#83.6.2}

Within its discretion, the licensing agency may issue a provisional license only if the licensing agency is satisfied that preparations are being made to qualify for regular license and that the health and safety of residents will not be endangered.

**History**
- *Source: Miss. Code Ann. §43-11-13 SUBCHAPTER 7. APPLICATION OR RENEWAL OF LICENSE Rule 83.7.1 Rule 83.7.1 Application. Application for a license or renewal of a license shall be made in writing to the licensing agency, on forms provided by the licensing agency, which shall contain such information as the licensing agency may require.*
- *Source: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 83.7.2** Fees {#sec-16-83.7.2 omnilex-key=us-ms-regs-official--title-15--16#83.7.2}

1. Each application for initial licensure or renewal licensure for an adult foster care facility, unless suspended or revoked, shall be accompanied by an application license fee in an amount set by the Board, for each person or bed of licensed capacity, with a minimum fee, set by the Board, per home or institution, which shall be made payable to the Mississippi State Department of Health, either by business check, money order, or electronic means. Fees are non-refundable. 2. Applicants for initial licensure, or licensees, shall pay a user fee, in an amount set by the Board, and shall be made payable to the Mississippi State Department of Health, either by check, money order or electronic means when it is required to review and/or inspect the proposal of any licensed facility in which there are additions, renovations, modernizations, expansions, alterations, conversions, modifications, or replacements. Fees are non-refundable.

**History**
- *Source: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 83.7.3** Name of Facility {#sec-16-83.7.3 omnilex-key=us-ms-regs-official--title-15--16#83.7.3}

Only the official name, as approved by the licensing agency and by which the facility is licensed shall be used in telephone listing, on stationery, in advertising, etc.

**History**
- *Source: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 83.7.4** Number of Beds {#sec-16-83.7.4 omnilex-key=us-ms-regs-official--title-15--16#83.7.4}

The maximum number of beds for which the facility is licensed shall not be exceeded.

**History**
- *Source: Miss. Code Ann. §43-11-13 SUBCHAPTER 8. LICENSING Rule 83.8.1 Issuance of License. All licenses issued by the licensing agency shall set forth the name of the facility, the location, the name of the licensee, the classification of the facility, the type of building, the bed capacity for which the facility is licensed and the licensed number.*
- *Source: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 83.8.2** Posting of License {#sec-16-83.8.2 omnilex-key=us-ms-regs-official--title-15--16#83.8.2}

The license shall be posted in a conspicuous place on the licensed premises and shall be available for review by an interested person.

**History**
- *Source: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 83.8.3** License Not Transferable {#sec-16-83.8.3 omnilex-key=us-ms-regs-official--title-15--16#83.8.3}

The license is not transferable or assignable to any other person except by written approval of the licensing agency.

SUBCHAPTER 9. DENIAL, SUSPENSION, OR REVOCATION OF LICENSE Rule 83.9.1 Denial or Revocation of License: Hearings and Review. The licensing agency, after notice and opportunity for a hearing to the applicant or licensee, is authorized to deny, suspend, or revoke a license, or deny renewal of a license, in any case in which it finds that there has been a substantial failure to comply with the requirements established under the law and these regulations. Also, the following shall be grounds for denial or revocation of license: 1. Fraud on the part of the licensee in applying for a license, or renewal of license. 2. Willful or repeated violations by the licensee of any of the provisions of Sections 43-11-1 et seq, of the Mississippi Code of 1972, as amended, and/or of the rules, regulations, and minimum standards established by the licensing agency.

3. Addiction to narcotic drug(s) by the licensee or other employees or personnel of the licensed facility. 4. Use of alcoholic beverages by the licensee or other personnel of the licensed facility to the extent which threatens the well-being or safety of the residents. 5. Conviction of the licensee of a felony. 6. Publicly misrepresenting the licensed facility and/or its services. 7. Permitting, aiding, or abetting the commission of any unlawful act. 8. Conduct or practices detrimental to the health or safety of residents and employees of said licensed facility. Detrimental practices include but are not limited to: a. Cruelty to a resident or indifference to the needs which are essential to the general well-being and health. b. Misappropriation of the money or property of a resident. c. Failure to provide food adequate for the needs of a resident. d. Inadequate staff to provide safe care and supervision of a resident. e. Failure to call a physician or nurse practitioner/physician assistant when required by a resident’s condition. f. Failure to notify next of kin when a resident’s condition becomes critical. g. Admission of a resident whose condition demands care beyond the level of care provided by the licensed facility as determined by its classification, including but not limited to the failure to ensure that a care plan was developed within twenty-four (24) hours of admission if not developed prior to admission for a resident admitted to the licensed facility, and that care plans are continually revised as necessary for the resident to attain their highest practicable physical, mental, and psychosocial well-being. h. For failure to implement the plan of care for a resident admitted to the licensed facility. 9. A violation of 24-hour supervision requirement and/or the transfer of a resident(s) from the licensed facility to any unlicensed facility may result in the facility’s license being made provisional for a period of 90 days. At the end of that 90-day period, if corrective actions have not been taken by the licensed facility, that Provisional License may be revoked.

**History**
- *Source: Miss. Code Ann. §43-11-13*
- *Source: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 83.9.2** Rule 83.9.2 {#sec-16-83.9.2 omnilex-key=us-ms-regs-official--title-15--16#83.9.2}

Immediate Revocation of License: Pursuant to Section 41-3-15, the State Department of Health is authorized and empowered, to revoke, immediately, the license and require closure of any institution for the aged or infirm, including any other remedy less than closure to protect the health and safety of the residents of said institution or the health and safety of the general public.

1. The licensing agency shall notify the applicant or licensee by registered mail or personal service the particular reasons for the proposed denial or revocation of license. Upon written request of applicant or licensee within ten (10) days of the date of notification, the licensing agency shall fix a date within thirty (30) days from the date of such service at which time the applicant or licensee shall be given an opportunity for a prompt and fair hearing. 2. On the basis of such hearing or upon default of the applicant or licensee, the licensing agency shall make a determination specifying its findings of fact and conclusions of law. A copy of such determination shall be sent by registered mail to the last known address of the applicant or licensee or served personally upon the applicant or licensee. 3. The decision revoking, suspending, or denying the application or license shall become final thirty (30) days after it is so mailed or served unless the applicant or licensee, within such thirty (30) day period, appeals the decision in Chancery Court pursuant to Section 43-11-23 of the Mississippi Code of 1972. An additional period of time may be granted at the discretion of the licensing agency.

**History**
- *Source: Miss. Code Ann. §43-11-13 SUBCHAPTER 10. PROVISION FOR HEARING AND APPEAL FOLLOWING DENIAL OR REVOCATION OF LICENSE; PENALTIES Rule 83.10.1 Administrative Decision. The licensing agency will provide an opportunity for a fair hearing to every applicant or licensee who is dissatisfied with administrative decisions made in the denial or revocation of license.*
- *Source: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 83.10.2** Penalties {#sec-16-83.10.2 omnilex-key=us-ms-regs-official--title-15--16#83.10.2}

Any person establishing, conducting, managing, or operating facility without a license shall be declared in violation of these regulations and may be punished as set forth in the enabling statute. Further, any person who violates any provision of the enabling statute, or of these regulations promulgated thereto shall, upon conviction thereof, be guilty of a misdemeanor. Such misdemeanor shall, upon conviction, be punishable as referenced in Section 43- 11-25 of the Mississippi Code of 1972, Annotated.

**History**
- *Source: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 83.10.3** Ban on Admissions {#sec-16-83.10.3 omnilex-key=us-ms-regs-official--title-15--16#83.10.3}

If a condition of immediate jeopardy exists at a licensed facility, written notice of the determination of the condition shall be provided by the licensing agency to the licensed facility, along with the notification that a ban on all admissions is to be imposed five (5) calendar days after the receipt of the notice by the licensed facility. If the licensing agency’s determination of a condition of immediate jeopardy on the day of the licensure visit/survey is confirmed, a ban on all admissions shall be imposed until the licensed facility achieves compliance and such compliance is verified by the licensing agency. The licensing agency will verify the licensed facility’s corrective actions as soon as possible after the licensing agency receives a plan of correction from the licensed facility.

**History**
- *Source: Miss. Code Ann. §43-11-13 SUBCHAPTER 11. ADMINISTRATION Rule 83.11.1 Operator. There shall be a full-time employee designated as operator of the licensed facility who shall be responsible for the management of the licensed facility. The operator shall be at least twenty-one years of age and shall be a high school graduate, or have passed the GED, and shall not be a resident of the licensed facility. The operator shall have verification that he is not listed on the "Mississippi Nurses Aide Abuse Registry." When the operator is not within the licensed facility, there shall be an individual onsite at the licensed facility who shall represent the operator, and be capable of assuming the responsibility of operator. Said person must be at least twenty-one (21) years or age and shall be a high school graduate, or have passed the GED, and shall have verification that he is not listed on the "Mississippi Nurses Aide Abuse Registry."*
- *Source: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 83.11.2** Other Personnel {#sec-16-83.11.2 omnilex-key=us-ms-regs-official--title-15--16#83.11.2}

All direct care employees shall be a minimum of 18 years of age, and shall have verification that they are not listed on the "Mississippi Nurses Aide Abuse Registry." Personnel shall receive training on a quarterly basis on topics and issues related to the population being served in the licensed facility. Training shall be documented by a narrative of the content and signatures of those attending. Personnel shall be employed and on duty, awake, and fully dressed to provide personal care to the residents. The following staffing ratio shall apply: 1. one (1) resident attendant per fifteen (15) or fewer residents for the hours of 7:00 a.m. until 7:00 p.m. 2. one (1) resident attendant per twenty-five (25) or fewer residents for the hours of 7:00 p.m. until 7:00 a.m.

**History**
- *Source: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 83.11.3** Criminal History Record Checks {#sec-16-83.11.3 omnilex-key=us-ms-regs-official--title-15--16#83.11.3}

1. The covered entity shall require to be performed a disciplinary check with the professional licensing agency, if any, for each employee to determine if any disciplinary action has been taken against the employee by the agency, and a criminal history check on: a. Every new employee of a covered entity who provides direct patient care or services and who is employed after or on July 01, 2003, and b. Every employee of a covered entity employed prior to July 01, 2003, who has documented disciplinary action by his or her present employer. 2. Except as otherwise provided in this paragraph, no employee hired on or after July 1, 2003, shall be permitted to provide direct patient care until the results of the criminal history record check revealed no disqualifying record or the employee has been granted a waiver. Provide the covered entity has documented evidence of submission of fingerprints for the background check, any person may be employed and provide direct patient care on a temporary basis pending the results of the criminal history record check buy any employment offer, contract, or arrangement with the person shall be voidable if he/she receives a disqualifying criminal record check and no waiver is granted. 3. If such criminal history record check discloses a felony conviction; a guilty plea; and/or a plea of nolo contendere to a felony for one (1) or more of the following crimes which has not been reversed on appeal, or for which a pardon has not been granted, the applicant/employee shall not be eligible to be employed at the license facility: a. possession or sale of drugs b. murder c. manslaughter d. armed robbery e. rape f. sexual battery g. sex offense listed in Section 45-33-23, Mississippi Code of 1972 h. child abuse i. arson

j. grand larceny k. burglary l. gratification of lust m. aggravated assault n. felonious abuse and/or battery of vulnerable adult 4. Documentation of verification of the employee’s disciplinary status, if any, with the employee’s professional licensing agency as applicable, and evidence of submission of the employee’s fingerprints to the licensing agency must be on file and maintained by the facility prior to the new employees first date of employment. The covered entity shall maintain on file evidence of verification of the employee’s disciplinary status from any applicable professional licensing agency and of submission and/or completion of the criminal record check, the signed affidavit, if applicable, and/or a copy of the referenced notarized letter addressing the individual’s suitability for such employment. 5. The licensing agency may charge the licensed entity submitting the fingerprints a fee not to exceed Fifty Dollars ($50.00). 6. Should results of an employee applicant’s criminal history record check reveal no disqualifying event, then the covered entity shall, within two (2) weeks of the notification of no disqualifying event, provide the employee applicant with a notarized letter signed by the chief executive officer of the covered entity, or his or her authorized designee, confirming the employee applicant’s suitability for employment based on his or her criminal history record check. An employee applicant may use that letter for a period of two (2) years from the date of the letter to seek employment at any covered entity licensed by the Mississippi State Department of Health without the necessity of an additional criminal record check. Any covered entity presented with the letter may rely on the letter with respect to an employee applicant’s criminal background and is not required for a period of two (2) years from the date of the letter to conduct or have conducted a criminal history record check as required in this subsection. 7. For individuals contracted through a third party who provide direct patient care as defined herein, the covered entity shall require proof of a criminal history record check. 8. The licensing agency, the covered entity, and their agents, officers, employees, attorneys and representatives, shall be presumed to be acting in good faith for any employment decision or action taken under this section. The presumption of good faith may be overcome by a preponderance of the evidence in any civil action. No licensing agency, covered entity, nor their

agents, officers, employees, attorneys and representatives shall be held liable in any employment discrimination suit in which an allegation of discrimination is made regarding an employment decision authorized under this section.

**History**
- *Source: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 83.11.4** Employee's Health Status {#sec-16-83.11.4 omnilex-key=us-ms-regs-official--title-15--16#83.11.4}

All licensed facility personnel shall receive a health screening by a licensed physician, a nurse practitioner/physician assistant, or a registered nurse prior to employment and annually thereafter. Records of this health screening shall be kept on file in the licensed facility.

**History**
- *Source: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 83.11.5** Employee Testing for Tuberculosis {#sec-16-83.11.5 omnilex-key=us-ms-regs-official--title-15--16#83.11.5}

1. Each employee, upon employment of a licensed entity and prior to contact with any patient/client, shall be evaluated for tuberculosis by one of the following methods:

d. IGRA (blood test) and an evaluation of the individual for signs and symptoms of tuberculosis by medical personnel; or

e. A two-step Mantoux tuberculin skin test administered and read by a licensed medical/nursing person certified in the techniques of tuberculin testing and an evaluation of the individual for signs and symptoms of tuberculosis by a licensed Physician, Physician’s Assistant, Nurse Practitioner or a Registered Nurse.

2. The IGRA/Mantoux testing and the evaluation of signs/symptoms may be administered/conducted on the date of hire or administered/read no more than 30 days prior to the individual’s date of hire; however, the individual must not be allowed contact with a patient or work in areas of the RBIR where patients have access until receipt of the results of the IGRA/assessment or at least the first of the two-step Mantoux test has been administered/read and assessment for the signs and symptoms completed.

3. If the Mantoux test is administered, results must be documented in millimeters. Documentation of the IGRA/TB skin test results and assessment must be documented in accordance with accepted standards of medical/nursing practice and must be placed in the individual’s personnel file no later than 7 days of the individual’s date of employment. If an IGRA is performed, results and quantitative values must be documented.

4. Any employee noted to have a newly positive IGRA, a newly positive Mantoux skin test or signs/symptoms indicative of tuberculin disease (TB) that last longer than three weeks (regardless of the size of the skin test or results of the IGRA), shall have a chest x-ray interpreted by a board certified Radiologist and be evaluated for active tuberculosis by a licensed physician within 72 hours. The employee shall not be allowed to work in any area where clients have routine access until evaluated by a physician/nurse practitioner/physician assistant and approved to return. Exceptions to this requirement may be made if the employee is asymptomatic and:

a. The individual is currently receiving or can provide documentation of having received a course of tuberculosis prophylactic therapy approved by the Mississippi State Department of Health (MSDH) Tuberculosis Program for tuberculosis infection, or

b. The individual is currently receiving or can provide documentation of having received a course of multi-drug chemotherapy approved by the MSDH Tuberculosis Program; or

c. The individual has a documented previous significant tuberculin skin reaction or IGRA reaction.

5. For individuals noted to have a previous positive to either Mantoux testing or the IGRA, annual re-evaluation for the signs and symptoms must be conducted and must be maintained as part of the employee’s annual health screening. A follow-up annual chest x-ray is NOT required unless symptoms of active tuberculosis develop.

6. If using the Mantoux method, employees with a negative tuberculin skin test and a negative symptom assessment shall have the second step of the two- step Mantoux tuberculin skin test performed and documented in the employees’ personal record within fourteen (14) days of employment.

7. The IGRA or the two-step protocol is to be used for each employee who has not been previously skin tested and/or for whom a negative test cannot be documented within the past 12 months. If the employer has documentation that the employee has had a negative TB skin test within the past 12 months, a single test performed thirty (30) days prior to employment or immediately upon hire will fulfill the two-step requirements. As above, the employee shall not have contact with clients or be allowed to work in areas of the RBIR to which clients have routine access prior to reading the skin test, completing a signs and symptoms assessment and documenting the results and findings.

8. Facilities shall comply with recommendations from the Centers for Disease Control and/or the Mississippi State Department of Health regarding baseline employee TB testing and routine serial employee TB testing and education. Staff exposed to an active infectious case of tuberculosis shall be treated as contacts and be managed appropriately. Individuals found to have a significant Mantoux tuberculin skin test reaction and a chest x-ray not suggestive of active tuberculosis, shall be evaluated by a physician or nurse practitioner/physician assistant for treatment of latent tuberculin infection.

**History**
- *Source: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 83.11.6** Admission Agreement {#sec-16-83.11.6 omnilex-key=us-ms-regs-official--title-15--16#83.11.6}

Prior to, or at the time of admission, the operator and the resident or the resident's responsible party shall execute in writing a financial agreement. This agreement shall be prepared and signed in two or more copies, one copy given to the resident or his/her responsible party, and one copy placed on file in the licensed facility. 1. As a minimum, this agreement shall contain specifically: a. Basic charges agreed upon (room, board, laundry, and personal care). b. Period to be covered in the charges. c. Services for which special charges are made. d. Agreement regarding refunds for any payments made in advance. e. A statement that the operator shall make the resident's responsible party aware, in a timely manner, of any changes in resident's status, including those which require transfer and discharge; or operators who have been designated as a resident's responsible party shall ensure prompt and efficient action to meet resident's needs. 2. No agreement or contract shall be entered into between the licensee and the resident or his responsible agent which will relieve the licensee of the responsibility for the protection of the person and personal property of the individual admitted to the licensed facility for care. 3. Any funds given or provided for the purpose of supplying services to any patient in any licensed facility, and any funds otherwise received and held from, for or on behalf of any such resident, shall be deposited by the director or other proper officer of the licensed facility to the credit of that patient in an account which shall be known as the Resident's Personal Deposit Fund. No more than one (1) month charge for the care, support, maintenance, and medical attention of the patient shall be applied from such account at any one

(1) time. After the death, discharge, or transfer of any resident for whose benefit any such fund has been provided, any unexpended balance remaining in his personal deposit fund shall be applied for the payment of care, cost of support, maintenance, and medical attention which is accrued. In the event any unexpended balance remains in that resident's personal deposit fund after complete reimbursement has been made for payment of care, support, maintenance, and medical attention, and the director or other proper officer of the licensed facility has been or shall be unable to locate the person or persons entitled to such unexpended balance. The director or other property officer shall treat the unexpended balance in compliance with the Uniform Disposition of Unclaimed Property Act. 4. The resident or his responsible party shall be furnished a receipt signed by the licensee of the licensed facility or his lawful agent, for all sums of money paid to the licensed facility. 5. Written notification shall be given to the resident/responsible party when basic charges and/or licensed facility policies change.

**History**
- *Source: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 83.11.7** Records and Reports {#sec-16-83.11.7 omnilex-key=us-ms-regs-official--title-15--16#83.11.7}

1. The operator shall maintain a record of the residents for whom he or she serves as the conservator or a representative payee. This record shall include evidence of the means by which the conservatorship or representative payee relationship was established and evidence of separate accounts in a bank for each resident whose conservator or representative payee is the operator of the licensed facility. 2. Inspection reports from the licensing agency, any branch or division thereof by the operator in the licensed facility, and submitted to the licensing agency as required, or when requested. 3. Resident records shall contain the following: a. Admission agreement(s) and financial statements. b. Residents' rights and licensed facility’s rules, signed, dated, and witnessed. c. Medical evaluation and referral from physician or nurse practitioner/physician assistant. d. Current medication record, including any reactions to such medication. e. Social services and activity contacts.

f. General information form. g. Representative payee statement, if applicable. h. Physician orders or nurse practitioner/physician assistant orders (including, but not limited to, therapies, diets, medications, etc.) and medication administration records. i. The resident’s current Plan of Care. In addition, the facility shall maintain documented evidence of the Plans of Care previously in effect in the resident’s record and shall be available for review by the licensing agency throughout the resident’s stay in the licensed facility until thirty (30) days from the date the resident is discharged from the facility. j. The resident’s grievances and complaints during his/her stay in the licensed facility shall be maintained which shall include copies of all the resident’s grievances or complaints filed in chronological order. The facility’s report to the grievance shall be maintained in the record and shall include the nature of the complaint, the date of the complaint and a statement indicating how the issue was resolved. 4. The records as described in this section shall be made available to the resident, the resident’s family, or other responsible party for the resident upon reasonable request. 5. Reporting of Tuberculosis Testing. The facility shall report and comply with the annual MSDH TB Program surveillance procedures.

**History**
- *Source: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 83.11.8** Licensed Facility Policies {#sec-16-83.11.8 omnilex-key=us-ms-regs-official--title-15--16#83.11.8}

Written policies shall be available which indicate services to be provided, and which include policies including but not limited to admission, transfer and discharge of residents and for developing, revising, and implementing plans of care by qualified personnel in accordance with state law for residents admitted to the licensed facility.

**History**
- *Source: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 83.11.9** Written Grievance Policy {#sec-16-83.11.9 omnilex-key=us-ms-regs-official--title-15--16#83.11.9}

The licensed facility shall have a written grievance policy which outlines the procedures to be followed by a resident in presenting a grievance to the licensee concerning the care received by the resident in the adult foster care facility.

**History**
- *Source: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 83.11.10** Residents' Rights {#sec-16-83.11.10 omnilex-key=us-ms-regs-official--title-15--16#83.11.10}

These rights and licensed facility rules must be in writing and be made available to all residents, employees, sponsors, and posted for public viewing. Each resident shall: 1. Have the right to attend religious and other activities of his/her choice. 2. Have the right to manage his/her personal financial affairs, or is given at least a quarterly accounting of financial transactions made on his/her behalf should the facility accept the written delegation from the resident or from his/her responsible party of this responsibility to the facility for any period of time in conformance with State law. 3. Not be required to perform services for the licensed facility. 4. Have the right to communicate with persons of his/her choice, and may receive mail unopened or in compliance with the policies of the home. 5. Be treated with consideration, kindness, respect, and full recognition of his/her dignity and individuality. 6. May retain and use personal clothing and possessions as space permits. 7. Have the right to voice grievances and complaints to the licensee regarding the care he/she is receiving in the licensed facility and recommend changes in licensed facility policies and services. 8. Shall not be confined to the licensed facility against his/her will, and shall be allowed to move about in the community at liberty. Physical and/or chemical restraints are prohibited. 9. Not be limited in his/her choice of a pharmacy or pharmacist provider in accordance with State Law. 10. Has the right to participate in their care planning and review his/her care plan, or the resident’s responsible party has the right to review the resident’s care plan when acting on behalf of the resident. Additionally, the resident has the right to refuse treatment in accordance with their Plan of Care. However, whenever there appears to be a conflict between a resident’s right and the resident’s health or safety, the licensed facility should accommodate both the exercise of the resident’s rights and the resident’s health, including exploration of care alternatives through a thorough care planning process in which the resident may participate.

**History**
- *Source: Miss. Code Ann. §43-11-13 SUBCHAPTER 12. MEDICAL AND PERSONAL CARE SERVICES*

##### **15 Miss. Admin. Code Pt. 16, R. 83.12.1** Admission and Discharge {#sec-16-83.12.1 omnilex-key=us-ms-regs-official--title-15--16#83.12.1}

The following criteria must be applied and maintained for resident placement in a licensed facility. 1. A person shall not be admitted or continue to reside in a licensed facility if the person: a. Is not ambulatory; b. Requires physical restraints; c. Poses a serious threat to himself or herself or others; d. Requires nasopharyngeal and/or tracheotomy suctioning; e. Requires gastric feedings; f. Requires intravenous fluids, medications, or feedings; g. Requires a indwelling urinary catheter; h. Requires sterile wound care; or i. Requires treatment of decubitus ulcer or exfoliative dermatitis. j. Upon admission or within 24 hours of admission, the adult foster care facility shall develop and document an individualized plan of care for each resident admitted to the facility. 2. Licensed facilities which are not accessible to individuals with disabilities through the A.N.S.I. Standards as they relate to facility accessibility may not accept wheelchair bound residents. Only those persons who, in an emergency, would be physically and mentally capable of traveling to safety may be accepted. For multilevel facilities, no residents may be placed above the ground floor level that are unable to descend the stairs unassisted. 3. The licensed facility must be able to identify at the time of admission and during continued stay those residents whose needs for services are consistent with these rules and regulations, and those residents who should be transferred to an appropriate level of care. 4. The licensed facility which accepts and admits residents requiring mental health services shall help arrange transportation to mental health appointments and cooperate with the community mental health center or other provider of mental health care, as necessary, to ensure access to and the coordination of care, within limits of the confidentiality and privacy rights of the individual receiving services.

**History**
- *Source: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 83.12.2** Medical Evaluation {#sec-16-83.12.2 omnilex-key=us-ms-regs-official--title-15--16#83.12.2}

Each person applying for admission to a licensed facility shall be given a thorough examination by a licensed physician or certified nurse practitioner/physician assistant within thirty (30) days prior to admission. The examination shall indicate the appropriateness of admission, according to the above criteria, to a licensed facility with an annual update by a physician and/or nurse practitioner/physician assistant.

**History**
- *Source: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 83.12.3** Admission Requirements to Rule Out Active Tuberculosis (TB) {#sec-16-83.12.3 omnilex-key=us-ms-regs-official--title-15--16#83.12.3}

1. The following are to be performed and documented within 30 days prior to the resident’s admission to the “Licensed facility”: a. TB signs and symptoms assessment by a licensed Physician, Physician Assistant or a Licensed Nurse Practitioner, and b. A chest x-ray taken and a written interpretation. 2. Admission to the facility shall be based on the results of the required tests as follows: a. Residents with an abnormal chest x-ray and/or signs and symptoms assessment shall have the first step of a two-step Mantoux tuberculin skin test (TST) placed and read by certified personnel OR an IGRA (blood test) drawn and results documented within 30 days prior to the patient’s admission to the “Licensed facility”. Evaluation for active TB shall be at the recommendation of the MSDH and shall be prior to admission. If TB is ruled out and the first step of the TST is negative, the second step of the two-step TST shall be completed and documented within 10-21 days of admission. TST administration and reading shall be done by certified personnel. If an IGRA (blood test) is done, TST (first and/or second step) is not done. b. Residents with a normal chest x-ray and no signs or symptoms of TB shall have a baseline IGRA test (blood test) OR a TST performed with the initial step of the two-step Mantoux TST placed on or within 30 days prior to the day of admission. IF TST is done, the second step shall be completed within 10-21 days of the first step. TST administration and reading shall be done by certified personnel. If an IGRA (blood test) is done, a TST is not done (first or second step). c. Residents with a significant TST OR positive IGRA (blood test) upon baseline testing or who have documented prior significant TST shall be monitored regularly for signs and symptoms of active TB (cough, sputum production, chest pain, fever, weight loss, or night sweats, especially if the symptoms have lasted longer than three weeks) and if these symptoms develop, shall have an evaluation for TB per the recommendations of the MSDH within 72 hours.

d. Residents with a non significant TST or negative IGRA (blood test) upon baseline testing shall have an annual tuberculosis testing within thirty (30) days of the anniversary of their last test. Note: Once IGRA testing is used, IGRA testing should continue to be used rather than TST testing. e. Residents with a new significant TST or newly positive IGRA (blood test) on annual testing shall be evaluated for active TB by a nurse practitioner or physician or physician assistant. h. Active or suspected Active TB Admission. If a resident has or is suspected to have active TB, prior written approval for admission to the facility is required from the MSDH TB State Medical Consultant. i. Exceptions to TST/ IGRA requirement may be made if: iii. Resident has prior documentation of a significant TST/ positive IGRA. iv. Resident has received or is receiving a MSDH approved treatment regimen for latent TB infection or for active TB disease. v. Resident is excluded by a licensed physician or nurse practitioner/physician assistant due to medical contraindications.

**History**
- *Source: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 83.12.4** Rule 83.12.4 {#sec-16-83.12.4 omnilex-key=us-ms-regs-official--title-15--16#83.12.4}

Transfer to another facility or return of resident to respite care shall be based on the above tests (Section 111.03) if done within the past 12 months and the patient has no signs and symptoms of TB.

**History**
- *Source: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 83.12.5** Transfer to a Hospital or Visit to a Physician Office {#sec-16-83.12.5 omnilex-key=us-ms-regs-official--title-15--16#83.12.5}

If a resident has signs or symptoms of active TB (i.e., is a TB suspect) the facility shall notify the MSDH, the hospital, transporting staff, and physician’s office prior to transferring the resident to a hospital. Appropriate isolation and evaluation shall be the responsibility of the hospital and physician. If a resident has or is suspected to have active TB, prior written approval for admission or readmission to the facility is required from the MSDH TB State Consultant.

The daily food allowance shall meet the current recommended dietary allowances.

1. Meals shall be planned one (1) week in advance. Not more than 15 hours shall elapse between the evening and morning meal. A record of meals served shall be maintained for a one (1) month period. Current menus must be posted and dated. 2. A record of all food purchases shall be maintained in the licensed facility for a one (1) month period. 3. All food served in licensed facilities shall comply with the following: a. No game or home canned foods shall be served; and b. Other than fresh or frozen vegetables and fruit, all foods must be from commercial sources. 4. All meals for residents who require therapeutic diets shall be planned by a Licensed Dietitian. If a therapeutic diet is prescribed by the physician for the resident, the licensed dietitian shall visit the licensed facility at a minimum of once every thirty (30) days, and shall file a consulting report with the licensed facility.

**History**
- *Source: Miss. Code Ann. §43-11-13 SUBCHAPTER 13. FOOD SERVICE Rule 83.13.1 Meals. The licensed facility shall provide residents with well-planned, attractive, and satisfying meals at least three (3) times daily, seven (7) days a week, which will meet their nutritional, social, emotional and therapeutic needs.*
- *Source: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 83.13.2** Physical Facilities {#sec-16-83.13.2 omnilex-key=us-ms-regs-official--title-15--16#83.13.2}

1. A licensed facility with sixteen (16) or more residents shall obtain a Food Service Permit from the Mississippi State Department of Health. 2. A licensed facility with fifteen (15) or fewer residents shall meet the requirements as set forth in the Facility Inspection Report issued by the Mississippi State Department of Health.

**History**
- *Source: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 83.13.3** Dietary Staffing {#sec-16-83.13.3 omnilex-key=us-ms-regs-official--title-15--16#83.13.3}

1. Licensed facilities shall have an employee dedicated to meal preparation and food service. 2. All employees engaged in handling, preparation and/or serving of food shall wear clean clothing at all times. 3. All employees engaged in handling and/or preparation of food shall wear hair nets, head bands, or caps to prevent the falling of hair. 4. All employees engaged in handling and/or preparation of food shall wash their hands thoroughly before starting to work and immediately after contact with any soiled matter.

1. No Schedule I drugs shall be allowed in the licensed facility. Residents requiring administration of Schedule II Narcotics as defined in the Uniform Controlled Substances Law may be admitted to an adult foster care facility. Schedule drugs may only be allowed in an adult foster care facility if they are administered or stored utilizing proper procedures under the direct supervision of a licensed physician or nurse. 2. The licensed facility may keep on hand a limited amount of non-prescription, over-the- counter medications. 3. No intramuscular, subcutaneous, intravenous injectable, except for insulin and vitamin B-12, shall be allowed. 4. Insulin or vitamin B-12 may be administered only if the resident is able to administer his/her own injectable, or is administered by a licensed nurse.

**History**
- *Source: Miss. Code Ann. §43-11-13 SUBCHAPTER 14. DRUG HANDLING Rule 83.14.1 Restrictions. Licensed facilities shall be restricted in the quantity and classes of drugs allowed in the licensed facility.*
- *Source: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 83.14.2** Labeling {#sec-16-83.14.2 omnilex-key=us-ms-regs-official--title-15--16#83.14.2}

The medications of all residents shall be clearly labeled.

**History**
- *Source: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 83.14.3** Storage of Prescription Medications {#sec-16-83.14.3 omnilex-key=us-ms-regs-official--title-15--16#83.14.3}

Proper storage of all prescription medications shall be provided. 1. All residents' prescription medications shall be stored in a secured area. The area shall be kept locked when not in use, with responsibility for the key designated in writing. 2. The prescription medication storage area shall be well-lighted, well- ventilated, and kept in a clean and orderly fashion. The temperature of the medication storage area should not exceed 85 degrees Fahrenheit at any time. 3. A refrigerator shall be provided for the storage of prescription medications requiring refrigeration. If the refrigerator houses food or beverages, the residents’ prescription medications shall be stored in a covered container or separate compartment. All refrigerators shall be equipped with thermometers.

**History**
- *Source: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 83.14.4** Responsibility {#sec-16-83.14.4 omnilex-key=us-ms-regs-official--title-15--16#83.14.4}

A non-resident employee, appointed by the operator, shall be responsible for the following: 1. Storage of prescription medications. 2. Keeping a current prescription medication list, including frequency and dosage, which shall be updated at least every thirty (30) days, or with any significant change.

**History**
- *Source: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 83.14.5** Disposal of Unused Prescription Medications {#sec-16-83.14.5 omnilex-key=us-ms-regs-official--title-15--16#83.14.5}

In the event any prescription medication is no longer in use for any reason, it shall be disposed of in accordance with the regulations of the Mississippi State Board of Pharmacy.

SUBCHAPTER 16. RESIDENT ACTIVITIES Rule 83.16.1 Activities Program. An activities program shall be in effect which is appropriate to the needs and interests of each resident. 1. Adequate and activity-appropriate space shall be provided for the various resident activities. 2. Activities shall be provided on daily basis. 3. Available community resources shall be utilized in the activities program. 4. Supplies shall be available to implement an adequate activities program. 5. A non-resident employee shall be responsible for the activities program.

2. Living room; 3. Dining Area; 4. Toilet and bathing facilities; 5. Laundry; and 6. Kitchen.

**History**
- *Source: Miss. Code Ann. §43-11-13 SUBCHAPTER 15. SOCIAL SERVICES Rule 83.15.1 The licensed facility shall make provisions for referring residents with social and emotional needs to an appropriate social services agency.*
- *Source: Miss. Code Ann. §43-11-13*
- *Source: Miss. Code Ann. §43-11-13 SUBCHAPTER 17. PHYSICAL ENVIRONMENT Rule 83.17.1 Required Areas/Rooms. The following areas/rooms are required to be provided in a licensed facility: 1. Bedrooms;*
- *Source: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 83.17.2** Bedrooms {#sec-16-83.17.2 omnilex-key=us-ms-regs-official--title-15--16#83.17.2}

1. Location. a. All resident bedrooms shall have an outside exposure and shall not be below grade. Window areas shall not be less than one-eighth (1/8) of the floor area. The window sill shall not be over thirty-six (36) inches from the floor. Windows shall be operable. b. Resident bedrooms shall be located so as to minimize the entrance of unpleasant odors, excessive noise, and other nuisances. c. Resident bedrooms shall be directly accessible from the main corridor. In no case shall a resident bedroom be used for access to another resident bedroom nor shall a resident bedroom be used for access to a required outside exit. d. All resident bedrooms shall be so located that the resident can travel from his/her bedroom to a living room, day room, dining room, or toilet or bathing facility without having to go through another resident bedroom. e. Resident bedrooms shall house no more than four (4) persons each. 2. Furnishings. a. Single beds shall be provided with good grade mattresses at least four (4) inches thick. Cots and roll-away beds shall not be used. b. Each bed shall be equipped with a pillow and clean linens to include sheets, pillow cases, spreads and blankets. An adequate supply of such linens shall be provided at all times to allow for a change of linen at least once a week. c. Chest of drawers or similar adequate storage space shall be provided for the clothing, toilet articles, and personal belongings of each resident.

d. Adequate closet space shall be provided for each resident. e. An adequate number of comfortable, sturdy chairs shall be provided. f. At least one (1) mirror, a minimum of 18” x 24”, shall be provided in each bedroom. g. The opportunity for personal expression shall be permitted. h. A resident shall be permitted to use personal furnishings in lieu of those provided by the licensed facility, when practical. 3. Floor Area. Minimum usable floor area per bed shall be 80 square feet

**History**
- *Source: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 83.17.3** Living Room {#sec-16-83.17.3 omnilex-key=us-ms-regs-official--title-15--16#83.17.3}

Living rooms, daybooks, and/or recreation rooms shall be provided for resident and visitors. Each licensed facility shall provide at least two (2) areas for this purpose: one (1) for small groups such as a private visit with relatives and friends; and one (1) for larger group activities. The living room must be equipped with attractive, functional, and comfortable furniture in sufficient number to accommodate all residents. A minimum of 18 square feet per bed shall be provided.

**History**
- *Source: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 83.17.4** Dining Area {#sec-16-83.17.4 omnilex-key=us-ms-regs-official--title-15--16#83.17.4}

A dining area shall be provided which shall be adequate to seat all residents at the same meal seating. The dining area may also be used for social, recreational, and/or religious services when not in use as a dining facility. A minimum of 15 Square feet per bed shall be provided.

**History**
- *Source: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 83.17.5** Toilet and Bathing Facilities {#sec-16-83.17.5 omnilex-key=us-ms-regs-official--title-15--16#83.17.5}

1. Separate toilet and bathing facilities shall be provided, on each floor, for each sex in the following ratios as a minimum. Bathtubs/showers 1 per 12 or fraction thereof for each sex Lavatories 1 per 6 or fraction thereof Toilets 1 per 6 or fraction thereof 2. A lavatory with mirror shall be provided in each toilet room or bedroom. 3. Bathtubs and showers shall be equipped with grab bars, towel racks and non- glass shower enclosures. Commodes shall be equipped with grab bars.

**History**
- *Source: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 83.17.6** Laundry {#sec-16-83.17.6 omnilex-key=us-ms-regs-official--title-15--16#83.17.6}

Laundry facilities shall be provided unless commercial laundries are used. 1. The laundry shall be located in a specifically designated area, and there shall be adequate room and space for sorting, processing and storage of soiled material. Laundry rooms or soiled linen storage areas shall not open directly into a resident's bedroom or food service area. Soiled materials shall not be transported through the food service area. The laundry area shall be kept clean and orderly. 2. If commercial laundry is used, separate satisfactory storage areas shall be provided for clean and soiled linens. 3. Provisions shall be made for proper mechanical ventilation of the laundry. 4. Provisions shall also made to prevent the recirculation of air through the heating and air-conditioning systems. 5. Adequate and effective lint traps shall be provided for dryers. 6. When laundry chutes are provided, they shall have a minimum diameter of two (2) feet; and they shall be installed with flushing ring, vent, and drain. a. An automatic sprinkler shall be provided at the top of the laundry chute and in any receiving room for a chute. b. A self-closing door shall be provided at the bottom of the chute. 7. Laundry equipment shall be of the type to adequately perform the laundry needs of the facility. The equipment shall be installed to comply with all local and state codes. 8. There shall be a separate and designated area for the storage of clean linen.

**History**
- *Source: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 83.17.7** Kitchen {#sec-16-83.17.7 omnilex-key=us-ms-regs-official--title-15--16#83.17.7}

The kitchen area shall meet the requirements as set forth in these regulations.

**History**
- *Source: Miss. Code Ann. §43-11-13 SUBCHAPTER 18. GENERAL PHYSICAL PLANT Rule 83.18.1 Licensed Facility Classification. To qualify for a license, the facility shall be planned to serve the type of residents to be admitted and shall meet the requirements as set forth in these regulations.*
- *Source: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 83.18.2** Location {#sec-16-83.18.2 omnilex-key=us-ms-regs-official--title-15--16#83.18.2}

All facilities and licensed facilities shall be located so that they are free from undue noise, smoke, dust, or foul odors and shall not be located adjacent to disposal plants, railroad tracks, etc.

**History**
- *Source: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 83.18.3** Site {#sec-16-83.18.3 omnilex-key=us-ms-regs-official--title-15--16#83.18.3}

The proposed site for facility must be approved by the licensing agency. Factors to be considered in approving a site shall be convenient to medical and hospital services, approved water supply and sewage disposal, public transportation, community services, services of an organized fire department, and availability to labor supply. Not more than one-third (1/3) of a site shall be covered by a building(s) except by special approval of the licensing agency. One example whereby approval may be granted is where the structure is to be placed in a very desirable location where the grounds are limited and very expensive. Where such approval is granted, the structure will be required to have a living room, day room, sun room, and recreational areas adequate to compensate for lack of required outside area.

**History**
- *Source: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 83.18.4** Local Restrictions {#sec-16-83.18.4 omnilex-key=us-ms-regs-official--title-15--16#83.18.4}

The site and structure of all licensed facilities shall comply with local building, fire, and zoning ordinances. Proof of compliance shall be submitted to the licensing agency.

**History**
- *Source: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 83.18.5** Transportation {#sec-16-83.18.5 omnilex-key=us-ms-regs-official--title-15--16#83.18.5}

Licensed facilities shall be located on streets or roads which are passable at all times. They should be located convenient to public transportation facilities.

**History**
- *Source: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 83.18.6** Communications {#sec-16-83.18.6 omnilex-key=us-ms-regs-official--title-15--16#83.18.6}

There shall be no less than one telephone in the licensed facility and such additional telephones as are necessary to summon help in the event of fire or other emergency. The telephone shall be listed under the official licensed name or title of the licensed facility.

**History**
- *Source: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 83.18.7** Occupancy {#sec-16-83.18.7 omnilex-key=us-ms-regs-official--title-15--16#83.18.7}

No part of the licensed facility may be rented, leased, or used for any purpose not related to the operation of the licensed facility.

**History**
- *Source: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 83.18.8** Rule 83.18.8 {#sec-16-83.18.8 omnilex-key=us-ms-regs-official--title-15--16#83.18.8}

Basement: The basement shall be considered as a story if one-half (1/2) or more of its clear height is above the average elevation of the ground adjoining the building on all sides.

1. No resident shall be housed on any floor that is below ground level.

**History**
- *Source: Miss. Code Ann. §43-11-13 SUBCHAPTER 19. SUBMISSIONS OF PLANS AND SPECIFICATIONS, EFFECTIVE AUGUST 13, 2005 Rule 83.19.1 Minor Alterations and Remodeling. Minor alterations and remodeling which do not affect the structural integrity of the building, change functional operation, affect fire safety, or affect the license bed capacity, do not need to have plans submitted for review provided that a detailed explanation of the proposed alteration or remodeling is submitted to and approved by the licensing agency.*
- *Source: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 83.19.2** First Stage Submission-Preliminary Plans {#sec-16-83.19.2 omnilex-key=us-ms-regs-official--title-15--16#83.19.2}

1. First stage or preliminary plans shall include: a. Plot plan showing size and shape of entire site; location of proposed building and any existing structure(s); adjacent streets, highways, sidewalks, railroads, etc., all properly designated; and size, characteristics, and location of all existing public utilities. b. Floor plan showing over-all dimensions of building(s); location, size, and purpose of all rooms; location and size of all doors, windows, and other openings with swing of doors properly indicated; dimensions of all corridors and hallways; and location of stairs, elevators, dumbwaiters, vertical shafts, and chimneys. c. Outline specifications giving kinds and types of materials.

**History**
- *Source: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 83.19.3** Final Stage Submission-Working Drawings and Specifications {#sec-16-83.19.3 omnilex-key=us-ms-regs-official--title-15--16#83.19.3}

Final stage or working drawings and specifications shall include: 1. Architectural drawings 2. Structural drawings 3. Mechanical drawings to include plumbing, heat, and air-conditioning

4. Electrical drawings 5. Detailed specifications

**History**
- *Source: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 83.19.4** Rule 83.19.4 {#sec-16-83.19.4 omnilex-key=us-ms-regs-official--title-15--16#83.19.4}

Approval of working drawings and specifications shall be obtained from the licensing agency in writing prior to the beginning of actual construction.

**History**
- *Source: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 83.19.5** Preparation of Plans and Specifications {#sec-16-83.19.5 omnilex-key=us-ms-regs-official--title-15--16#83.19.5}

The preparation of drawings and specifications shall be executed by or under the immediate supervision of an architect who shall supervise construction and furnish a signed statement that construction was performed according to plans and specifications approved by the licensing agency.

**History**
- *Source: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 83.19.6** Contract Modifications {#sec-16-83.19.6 omnilex-key=us-ms-regs-official--title-15--16#83.19.6}

Any contract modification which affects or changes the function, design, or purpose of a facility shall be submitted to and approved by the licensing agency prior to the beginning of work set forth in any contract modification.

**History**
- *Source: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 83.19.7** Notification of Start of Construction {#sec-16-83.19.7 omnilex-key=us-ms-regs-official--title-15--16#83.19.7}

The licensing agency shall be informed in writing at the time construction is begun.

**History**
- *Source: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 83.19.8** Inspections {#sec-16-83.19.8 omnilex-key=us-ms-regs-official--title-15--16#83.19.8}

The licensing agency or its authorized representatives shall have access at all times to the work for inspection whenever it is in preparation or progress, and the owner shall ascertain that proper facilities are made available for such access and inspection.

**History**
- *Source: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 83.19.9** Limit of Approval {#sec-16-83.19.9 omnilex-key=us-ms-regs-official--title-15--16#83.19.9}

In construction delayed for a period of exceeding six (6) months from the time of approval of final working plans and specifications, a new evaluation and/or approval shall be obtained from the licensing agency.

**History**
- *Source: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 83.19.10** Water Supply, Plumbing, Sewerage Disposal {#sec-16-83.19.10 omnilex-key=us-ms-regs-official--title-15--16#83.19.10}

The water supply and sewerage disposal shall be approved by the local county health department and/or the Division of Sanitary Engineering, Mississippi State Department of Health. No system of water supply, plumbing, sewerage, garbage, or refuse disposal shall be

installed nor any such existing system materially altered or extended until complete plans and specifications for the installation, alteration, or extension have been so approved and submitted to the licensing agency for review and final determination.

**History**
- *Source: Miss. Code Ann. §43-11-13 SUBCHAPTER 20. GENERAL BUILDING REQUIREMENTS Rule 83.20.1 Structural Soundness and Repair. The building shall be structurally sound, free from leaks and excessive moisture, in good repair, and painted at sufficient intervals to be reasonably attractive inside and out. Walls and ceilings of hazardous areas shall be one (1) hour fire resistance rating.*
- *Source: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 83.20.2** Heating and Cooling Systems {#sec-16-83.20.2 omnilex-key=us-ms-regs-official--title-15--16#83.20.2}

Adequate heating and cooling systems shall be provided to maintain inside temperature between 68 degrees Fahrenheit and 78 degrees Fahrenheit depending on the season.

**History**
- *Source: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 83.20.3** Lighting {#sec-16-83.20.3 omnilex-key=us-ms-regs-official--title-15--16#83.20.3}

Each resident's room shall have artificial light adequate for reading and other uses as needed. There should be a minimum brightness of ten (10) foot candles of lighting for general use in residents' rooms and a minimum brightness of thirty (30) foot candles of lighting for reading purposes. All entrances, hallways, stairways, ramps, cellars, attics, storerooms, kitchens, laundries, and service units shall have sufficient artificial lighting to prevent accidents and promote efficiency of service. Night lights shall be provided in all hallways, stairways, toilets, and bathing rooms.

**History**
- *Source: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 83.20.4** Emergency Lighting {#sec-16-83.20.4 omnilex-key=us-ms-regs-official--title-15--16#83.20.4}

At least one functioning, battery-operated emergency light shall be provided in each hallway.

**History**
- *Source: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 83.20.5** Screens {#sec-16-83.20.5 omnilex-key=us-ms-regs-official--title-15--16#83.20.5}

All screen doors and non-stationary windows shall be equipped with tight fitting, full length, sixteen (16) mesh screens. Screen doors shall swing out and shall be equipped with self-closing devices.

**History**
- *Source: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 83.20.6** Floors {#sec-16-83.20.6 omnilex-key=us-ms-regs-official--title-15--16#83.20.6}

All floors shall be smooth and free from defects such as cracks, and shall be finished so that they can be easily cleaned.

**History**
- *Source: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 83.20.7** Walls and Ceilings {#sec-16-83.20.7 omnilex-key=us-ms-regs-official--title-15--16#83.20.7}

All walls and ceilings shall be of sound construction, with an acceptable surface, and shall be maintained in good repair.

**History**
- *Source: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 83.20.8** Ceiling Height {#sec-16-83.20.8 omnilex-key=us-ms-regs-official--title-15--16#83.20.8}

All ceilings shall have a height of at least seven (7) feet, except that a height of six (6) feet six (6) inches may be approved for hallways or toilets and bathing rooms where the lighting fixtures are recessed.

**History**
- *Source: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 83.20.9** Ramps and Inclines {#sec-16-83.20.9 omnilex-key=us-ms-regs-official--title-15--16#83.20.9}

Ramps and inclines, where installed for the use of residents, shall not exceed one (1) foot of rise in ten (10) feet of run, shall be furnished with a non-slip floor, and shall be provided with handrails on both sides.

**History**
- *Source: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 83.20.10** Door Swing {#sec-16-83.20.10 omnilex-key=us-ms-regs-official--title-15--16#83.20.10}

Exit doors, other than from a living unit, shall swing in the director of exit from the structure.

**History**
- *Source: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 83.20.11** Floor Levels {#sec-16-83.20.11 omnilex-key=us-ms-regs-official--title-15--16#83.20.11}

All differences in floor levels within the building shall be accomplished by stairs of not less than three (3) six-inch risers, ramps, or inclines, and shall be equipped with handrails on both sides.

**History**
- *Source: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 83.20.12** Space Under Stairs {#sec-16-83.20.12 omnilex-key=us-ms-regs-official--title-15--16#83.20.12}

Space under stairs shall not be used for storage purposes. All walls and doors shall meet the same fire rating as the stairwell.

**History**
- *Source: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 83.20.13** Interior Finish and Floor Coverings {#sec-16-83.20.13 omnilex-key=us-ms-regs-official--title-15--16#83.20.13}

Interior finish and decorative material shall be not less than Class B and floor covering shall have a flame spread not to exceed 75.

**History**
- *Source: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 83.20.14** Fire Extinguishers {#sec-16-83.20.14 omnilex-key=us-ms-regs-official--title-15--16#83.20.14}

Fire extinguishers of number, type, and capacity appropriate to the need shall be provided for each floor and for special fire hazard areas such as kitchen, laundry, and mechanical room. All extinguishers shall be of a type approved by the licensing agency. A vaporizing liquid extinguisher (such as carbon tetrachloride) will not be approved for use inside the building. Extinguishers shall be inspected and serviced periodically as recommended by the manufacturer. The date of inspection shall be entered on a tag attached to the

extinguisher and signed by a reliable inspector such as the local fire chief or representative of a fire extinguisher servicing company.

**History**
- *Source: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 83.20.15** Smoke Detectors {#sec-16-83.20.15 omnilex-key=us-ms-regs-official--title-15--16#83.20.15}

Smoke detectors shall be installed in each hallway no more than thirty (30) feet apart, in all bedrooms and in all storage rooms.

**History**
- *Source: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 83.20.16** Trash Chutes {#sec-16-83.20.16 omnilex-key=us-ms-regs-official--title-15--16#83.20.16}

Trash chutes are prohibited.

**History**
- *Source: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 83.20.17** Housekeeping and Maintenance {#sec-16-83.20.17 omnilex-key=us-ms-regs-official--title-15--16#83.20.17}

The interior and exterior of the licensed facility shall be maintained in an attractive, safe and sanitary condition.

**History**
- *Source: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 83.20.18** Pest Control {#sec-16-83.20.18 omnilex-key=us-ms-regs-official--title-15--16#83.20.18}

Pest control inspections and, if necessary, treatments, shall be made to control pests, vermin, insects and rodents, at a minimum of once every thirty (30) days, by a company that is licensed by the State of Mississippi. The licensing agency may, in its discretion, require more frequent inspections and treatments. The inspection and treatment reports shall be maintained at the licensed facility.

**History**
- *Source: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 83.20.19** Water Temperature {#sec-16-83.20.19 omnilex-key=us-ms-regs-official--title-15--16#83.20.19}

The temperature of hot water at plumbing fixtures used by residents shall not exceed 115 degrees Fahrenheit and no less than 100 degrees Fahrenheit.

**History**
- *Source: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 83.20.20** Combustion Air {#sec-16-83.20.20 omnilex-key=us-ms-regs-official--title-15--16#83.20.20}

Combustion air to all equipment requiring it must come from the outside.

1. Building Protection. a. Automatic Sprinklers Required. Facilities licensed after the effective date of these regulations shall be protected throughout by a supervised

automatic sprinkler system installed in accordance with the current edition of NFPA 13, Installation of Sprinkler Systems. b. In facilities licensed for sixteen (16) or fewer residents and where the characteristics of occupancy are comparable with one (1) and two (2) family residential fire potentials, an NFPA 13D-styled sprinkler system may be installed. 2. Building Construction. a. Single story. No requirements. b. Multi-story (less than four floors). One hour fire resistance rating as prescribed by the current edition of the National Fire Protection Association (NFPA) Standard 220, types of Building Construction. (Example: Type II (111), or Type V (111). c. Mobile structures. No mobile structures are acceptable for housing residents.

**History**
- *Source: Miss. Code Ann. §43-11-13 SUBCHAPTER 21. BUILDING REQUIREMENTS Rule 83.21.1 Building Protection. Facilities licensed after August 13, 2005 shall be constructed to have;*
- *Source: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 83.21.2** Multi-story Building {#sec-16-83.21.2 omnilex-key=us-ms-regs-official--title-15--16#83.21.2}

Elevator Required. No resident shall be housed in a building three stories and above unless the building is equipped with an elevator. The minimum cab size of the elevator shall be approximately six (6) feet eight (8) inches by five (5) feet and constructed of metal. The width of the shaft door shall be at least three (3) feet six (6) inches. The load weight capacity shall not be less than 2,500 pounds. The elevator shaft shall be enclosed by construction of not less than a two-hour fire resistive rating. Elevators shall not be counted as required exits.

**History**
- *Source: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 83.21.3** Hazardous Areas and Combustible Storage {#sec-16-83.21.3 omnilex-key=us-ms-regs-official--title-15--16#83.21.3}

Heating apparatus and boiler and furnace rooms, basements, or attics used for the storage of combustible material and workrooms, shall be classified as hazardous areas and shall be separated from other areas by construction having a fire resistive rating of at least one (1) hour.

**History**
- *Source: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 83.21.4** Stairs {#sec-16-83.21.4 omnilex-key=us-ms-regs-official--title-15--16#83.21.4}

Stairs shall be enclosed with at least one-hour fire rated construction. 1. Handrails shall be provided on both sides of the stairs. 2. The width of the stairs shall not be less than forty-four (44) inches. 3. The stairs shall be well lighted at all times.

**History**
- *Source: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 83.21.5** Exit Doors {#sec-16-83.21.5 omnilex-key=us-ms-regs-official--title-15--16#83.21.5}

Exit doors shall meet the following: 1. At least two (2) remotely located exits shall be provided for each occupied story of a facility. 2. Dead end hallways in excess of twenty (20) feet are not allowed. 3. Doors to the exterior shall be not less than thirty-six (36) inches wide and egress shall not be impeded by being locked. 4. Exit doors shall swing in the direction of exit and shall not obstruct the travel along any required exit. 5. Doors leading to stairways shall be not less than thirty-six (36) inches wide. 6. Revolving doors shall not be used as required exits.

**History**
- *Source: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 83.21.6** Hallways and Passageways {#sec-16-83.21.6 omnilex-key=us-ms-regs-official--title-15--16#83.21.6}

1. Hallways and passageways shall be kept unobstructed. 2. Hallways and passageways which lead to the outside from any required stairway shall be enclosed as required for stairways.

**History**
- *Source: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 83.21.7** Mechanical and Electric Systems {#sec-16-83.21.7 omnilex-key=us-ms-regs-official--title-15--16#83.21.7}

1. Mechanical, electrical, plumbing, heating, air-conditioning, and water systems installed shall meet the requirements of local codes and ordinances as well as the applicable regulation of the licensing agency. where there are no local codes or ordinances, the following codes and recommendations shall govern: a. National Electrical Code. b. National Plumbing Code. c. American Society of Heating, Refrigerating, and Air Conditioning Engineers, Inc. d. Recommendations of the American Society of Mechanical Engineers. e. Recommendations of American Gas Association.

f. National Fire Protection Association. 2. The heating of licensed facilities shall be restricted to steam, hot water, or warm air systems employing central heating plants, or Underwriters Laboratories approved electric heating. The use of portable heaters of any kind is prohibited. a. Gas heaters provided they meet all of the following: i. A circulating type with a recessed enclosed flame so designed that clothing or other inflammable material cannot be ignited. ii. Equipped with a safety pilot light. iii. Properly vented to the outside. iv. Approved by American Gas Association or Underwriters Laboratories. b. An approved type of electrical heater such as wall insert type. 3. Lighting (except for battery-operated emergency lighting) shall be restricted to electricity.

SUBCHAPTER 22. EMERGENCY OPERATIONS PLAN (EOP) Rule 83.22.1 The licensed entity shall develop and maintain a written preparedness plan utilizing the “All Hazards” approach to emergency and disaster planning. The plan must include procedures to be followed in the event of any act of terrorism or man-made or natural disaster as appropriate for the specific geographical location. The final draft of the Emergency Operations Plan (EOP), will be reviewed by the Office of Emergency Preparedness and Response, Mississippi State Department of Health, or their designates, for conformance with the “All Hazards Emergency Preparedness and Response Plan.” Particular attention shall be given to critical areas of concern which may arise during any “all hazards” emergency whether required to evacuate or to sustain in place. Additional plan criteria or a specified EOP format may be required as deemed necessary by the Office of Emergency Preparedness and Response. The six (6) critical areas of consideration are: 1. Communications: Facility status reports shall be submitted in a format and a frequency as required by the Office of EOP.

2. Resources and Assets

3. Safety and Security

4. Staffing

5. Utilities

6. Clinical Activities.

**History**
- *Source: Miss. Code Ann. §43-11-13*
- *Source: Miss. Code Ann. §43-11-13*

##### **15 Miss. Admin. Code Pt. 16, R. 83.22.2** Rule 83.22.2 {#sec-16-83.22.2 omnilex-key=us-ms-regs-official--title-15--16#83.22.2}

Emergency Operations Plans (EOPs) must be exercised and reviewed annually or as directed by the Office of Emergency Preparedness and Response. Written evidence of current approval or review of provider EOPs, by the Office of Emergency Preparedness and Response, shall accompany all applications for facility license renewals.

Written Records. Written records of all drills shall be maintained, indicating content of and attendance at each drill. A fire evacuation plan shall be posted in each facility in a conspicuous place and kept current.

**History**
- *Source: Miss. Code Ann. §43-11-13 SUBCHAPTER 23. FACILITY FIRE PREPAREDNESS Rule 83.23.1 Fire Drills. Fire drills shall be conducted one (1) per shift per quarter. Employees shall participate in a fire drill at least four (4) times per year.*
- *Source: Miss. Code Ann. §43-11-13 CHAPTER 84 MINIMUM STANDARDS OF OPERATION FOR COUNTY HEALTH DEPARTMENTS Subchapter 1 GENERAL: LEGAL AUTHORITY Rule 84.1.1 Adoption of Rules, Regulations, and Minimum Standards. By virtue of the authority vested in it by Mississippi Code Annotated §41-3-15, or as otherwise amended, the Mississippi State Department of Health does hereby adopt and promulgate the following Rules, Regulations, and Minimum Standards for Operation for County Health Departments.*
- *SOURCE: Miss. Code Ann. §41-3-15*

##### **15 Miss. Admin. Code Pt. 16, R. 84.1.2** Purpose {#sec-16-84.1.2 omnilex-key=us-ms-regs-official--title-15--16#84.1.2}

The purpose of these minimum standards is to protect and promote the public welfare by providing for the development, establishment, maintenance, and operation of “county health departments and county health department buildings” which will ensure safe, sanitary, and nationally recognized best practice standards for public health clinic services for Mississippians.

City and County governments provide county health department buildings throughout the state. The department provides staffing, technical expertise, and coordination of public health programs designed to protect and advance the health, well-being and safety of everyone in Mississippi. Miss. Code Ann. §41-3-53 authorizes the board of supervisors to: 1. make such appropriations for the department of health as may be necessary to pay the salary of the director, and salaries of all necessary sanitary inspectors, nurses, and such other employees as may be employed for carrying on the work;

2. to pay all necessary traveling expenses of said employees in the performance of their duties;

3. to pay for all necessary medicine, materials, and supplies; and

4. to do any and all things necessary and proper to maintain and support a health department. In addition, Miss. Code Ann. §41-3-53, states that the board of supervisors shall provide an office for its health department, and furnish said office, and its employees, with all necessary record books, stationery, stamps, tables, chairs, furniture and all other necessary articles.

**History**
- *SOURCE: Miss. Code Ann. §41-3-15 and §41-3-53*

##### **15 Miss. Admin. Code Pt. 16, R. 84.1.3** Definitions 1 {#sec-16-84.1.3 omnilex-key=us-ms-regs-official--title-15--16#84.1.3}

“American Disabilities Act (ADA) Standards for Accessible Design” means the standards known as the 2010 Standards for State and Local Government Facilities Title II.

2. “County Health Department” means a local public health clinic operated by the department.

3. “County Health Department Building” means a building provided by the city or county to operate a County Health Department.

4. “Department, the Department, or MSDH” means the Mississippi State Department of Health, as established by Miss. Code Ann. §43-3-1, et seq. (Rev. 2006).

**History**
- *SOURCE: Miss. Code Ann. §41-3-15*

##### **15 Miss. Admin. Code Pt. 16, R. 84.1.4** Inspections Required {#sec-16-84.1.4 omnilex-key=us-ms-regs-official--title-15--16#84.1.4}

The Department shall inspect each county health department building on an annual basis at such intervals the Department may direct. The Department and/or its authorized representatives shall have the right to inspect construction work in progress. New county health department buildings shall not be operated as a county health department without having first been inspected for compliance with these rules, regulations, and minimum standards.

A report of any inspection performed on a county health department building will be provided to the applicable board of supervisors and/or other applicable local officials, and the Chief, Community Health and Clinical Services.

**History**
- *SOURCE: Miss. Code Ann. §41-3-15*

##### **15 Miss. Admin. Code Pt. 16, R. 84.1.5** Corrective Action Plan {#sec-16-84.1.5 omnilex-key=us-ms-regs-official--title-15--16#84.1.5}

If the Department determines a county health department building is not in compliance with these minimum standards, the Department may require that the county board of supervisors submit a corrective action plan that demonstrates a good-faith effort to remedy each violation by a specific date, subject to the approval of the Department.

**History**
- *SOURCE: Miss. Code Ann. §41-3-15*

##### **15 Miss. Admin. Code Pt. 16, R. 84.1.6** Codes and Ordinances {#sec-16-84.1.6 omnilex-key=us-ms-regs-official--title-15--16#84.1.6}

Every county health department building located inside the boundaries of a municipality shall comply with all local municipal codes and ordinances applicable thereto. In addition, each county health department building shall comply with all applicable state and federal laws.

1. Existing county health department buildings, as of the date of this standard, may meet, at a minimum, Existing Business Occupancies chapter of NFPA 101, Life Safety Code, current edition.

2. In the event of the construction of a new county health department building or substantial modification of an existing facility, any subsequent edition of NFPA, Life Safety Code may be used, provided the local jurisdiction approve the use of such edition and that all construction and/or modifications meet the requirements of the approved edition.

3. Automatic sprinklers, if required by local jurisdiction shall be installed in accordance with the current edition of NFPA 13, Installation of Sprinkler Systems.

4. Fire extinguishers shall be available in every county health department building in accordance with NFPA 10, Standards for Portable Fire Extinguishers.

5. Fire alarms and smoke detectors, if installed in a county health department building shall be in accordance with current edition of NFPA 72, National Fire Alarm Code.

6. The county health department building shall provide sufficient space and equipment for patient and visitor waiting areas, examination and treatment rooms, and for staff and administrative areas. Exam rooms shall each have at least 80 square feet of area.

7. Entrances for patients shall be connected to the public right-of-way by a hard-surfaced, unobstructed walkway in good repair. Access for handicapped individuals shall be provided at a minimum of one entrance. A hard-surfaced, unobstructed road or driveway for use by ambulance or other emergency vehicles shall run from at least one entrance of the building to the public right-of-way. The doorway of such entrance shall be immediately adjacent to the road or driveway. If such doorway is not on the same level as the road, a ramp shall provide a continuous, unobstructed plane to the entrance.

8. Clinic services provided in multi-story county health department buildings shall be accessible by an elevator of adequate size to accommodate a standard wheeled litter patient with two attendants. Multi-story county health department buildings will be considered to have met this requirement when patients are located only on ground level floors with outside exits.

**History**
- *SOURCE: Miss. Code Ann. §41-3-15 Subchapter 2 LIFE SAFETY CODES: PHYSICAL PLANT AND OPERATIONAL STANDARDS Rule 84.2.1 Construction.*
- *SOURCE: Miss. Code Ann. §41-3-15*

##### **15 Miss. Admin. Code Pt. 16, R. 84.2.2** Rule 84.2.2 {#sec-16-84.2.2 omnilex-key=us-ms-regs-official--title-15--16#84.2.2}

The county health department building shall be constructed, equipped, and maintained to assure the safety of patients and personnel. The following requirements shall apply:

1. Exam rooms shall be designed and located to prevent traffic through them to any other part of the county health department.

2. The walls and floors of examination rooms and staff dressing areas will be of material that will permit frequent washing and cleaning.

3. Toilet and handwashing facilities shall be accessible to patients and staff and meet American Disabilities Act (ADA) accessibility standards. Bathrooms shall be equipped with handrails for toilets and showers. Convenient handwashing facilities shall be provided for both staff and patients and shall be provided with soap dispenser and individual or disposable towels. Infant changing tables should be available in both men’s and women’s restrooms.

**History**
- *SOURCE: Miss. Code Ann. §41-3-15*

##### **15 Miss. Admin. Code Pt. 16, R. 84.2.3** Rule 84.2.3 {#sec-16-84.2.3 omnilex-key=us-ms-regs-official--title-15--16#84.2.3}

The county health department building shall be arranged and organized in such a manner as to ensure the comfort, safety, hygiene, privacy, and dignity of patients treated therein. 1. The county health department building shall provide space and facilities for administrative activities, including offices, and storage of supplies.

2. A waiting room and patient registration area shall be provided.

3. The county health department building must facilitate appropriate administrative, technical, and physical safeguards to protect the privacy of protected health information. In an area where multiple patient-staff communications routinely occur, use of cubicles, dividers, shields, curtains, or similar barriers may constitute a reasonable safeguard. For example, a large clinic intake area may reasonably use cubicles or shield-type dividers, rather than separate rooms, or providers could add curtains or screens to areas where discussions often occur between practitioners and patients or among professionals treating the patient.

4. For county health departments providing moderate or high complexity testing there shall be enough space, ventilation, and utilities necessary to conduct testing and minimize contamination.

**History**
- *SOURCE: Miss. Code Ann. §41-3-15*

##### **15 Miss. Admin. Code Pt. 16, R. 84.2.4** All electrical work and equipment shall be designed and installed in accordance with state and local laws and ordinances {#sec-16-84.2.4 omnilex-key=us-ms-regs-official--title-15--16#84.2.4}

1. All areas of the county health department building shall have sufficient artificial lighting for designated purposes.

2. All county health department buildings shall have an alternative lighting source for emergency use in the event of a power failure.

3. All county health departments shall have a transfer switch for connection to emergency generators that supports, at minimum, critical functions of the county health department.

4. There shall be a local plan for providing emergency power to local county health department buildings.

5. It is recommended that each county health department building be equipped with adequate generating power to maintain full power to the building in the case of power failure.

**History**
- *SOURCE: Miss. Code Ann. §41-3-15*

##### **15 Miss. Admin. Code Pt. 16, R. 84.2.5** Rule 84.2.5 {#sec-16-84.2.5 omnilex-key=us-ms-regs-official--title-15--16#84.2.5}

All county health department buildings shall have a preventive maintenance program to ensure that all essential mechanical, electrical and patient-care equipment is maintained in safe operating conditions.

**History**
- *SOURCE: Miss. Code Ann. §41-3-15*

##### **15 Miss. Admin. Code Pt. 16, R. 84.2.6** All county health department buildings shall be set up to ensure proper storage of drugs, vaccines, and biologicals {#sec-16-84.2.6 omnilex-key=us-ms-regs-official--title-15--16#84.2.6}

**History**
- *SOURCE: Miss. Code Ann. §41-3-15*

##### **15 Miss. Admin. Code Pt. 16, R. 84.2.7** Rule 84.2.7 {#sec-16-84.2.7 omnilex-key=us-ms-regs-official--title-15--16#84.2.7}

All county health department buildings will have sufficient parking for staff and patients on a maintained paved or concrete surface and have visible parking lines. Accessible parking spaces shall be in accordance with ADA accessibility standards and at least one of every six accessible spaces, or fraction of six, in each parking lot must be sized to accommodate vans.

6. Paint 7. Parking lots 8. Signage 9. Emergency generators if on-site

**History**
- *SOURCE: Miss. Code Ann. §41-3-15 Subchapter 3 MAINTENANCE Rule 84.3.1 County health department buildings shall be inspected and properly maintained to ensure delivery of services including, but not limited to: 1. Roofs 2. Windows and doors 3. Electrical systems 4. Heating and air conditioning systems 5. Plumbing*
- *SOURCE: Miss. Code Ann. §41-3-15*

### **Part 17** Drinking Water Systems Improvements Revolving Loan Fund Program Regulations - DW SRF Base Intended Use Plan

##### **15 Miss. Admin. Code Pt. 17** Drinking Water Systems Improvements Revolving Loan Fund Program Regulations - DW SRF Base Intended Use Plan {#sec-17 omnilex-key=us-ms-regs-official--title-15--17}

STATE OF MISSISSIPPI
LOCAL GOVERNMENTS AND RURAL WATER SYSTEMS IMPROVEMENTS BOARD
Title 33: Public Health - Local Governments & Rural Water Systems Improvements Board
Part 17: Drinking Water Systems Improvements Revolving Loan Fund Program Regulations DW SRF
Base Intended Use Plan

STATE OF MISSISSIPPI
DRINKING WATER SYSTEMS IMPROVEMENTS
REVOLVING LOAN FUND PROGRAM

FFY-2024 INTENDED USE PLAN

Approved by the Board
9/27/2024

LOCAL GOVERNMENTS AND RURAL WATER SYSTEMS

IMPROVEMENTS BOARD

P. O. BOX 1700 SUITE U-232

JACKSON, MISSISSIPPI 39215-1700

(Blank)

STATE OF MISSISSIPPI
LOCAL GOVERNMENTS AND RURAL WATER SYSTEMS IMPROVEMENTS BOARD
Title 33: Public Health - Local Governments & Rural Water Systems Improvements Board
Part 17: Drinking Water Systems Improvements Revolving Loan Fund Program Regulations

DRINKING WATER SYSTEMS IMPROVEMENTS REVOLVING LOAN FUND

FFY-2024 INTENDED USE PLAN

TABLE OF CONTENTS
I. INTRODUCTION ........................................................... ERROR! BOOKMARK NOT DEFINED.
A. STATE OF MISSISSIPPI’S DRINKING WATER STATE REVOLVING LOAN FUND ............... ERROR!
BOOKMARK NOT DEFINED.
B. PROGRAM OVERVIEW ........................................................... ERROR! BOOKMARK NOT DEFINED.
C. PUBLIC INPUT, REVIEW, AND COMMENT PROCEDURES ....... ERROR! BOOKMARK NOT DEFINED.
II. GOALS OF MISSISSIPPI’S DRINKING WATER SYSTEMS IMPROVEMENTS
REVOLVING LOAN FUND (DWSIRLF) PROGRAM ........ ERROR! BOOKMARK NOT DEFINED.
A. BASIC GOALS ......................................................................... ERROR! BOOKMARK NOT DEFINED.
B. LONG-TERM DWSIRLF GOALS ........................................... ERROR! BOOKMARK NOT DEFINED.
III. STRUCTURE OF THE MISSISSIPPI DWSIRLF ........ ERROR! BOOKMARK NOT DEFINED.
A. DWSIRLF LOAN/OPERATIONS FUND ................................... ERROR! BOOKMARK NOT DEFINED.
1. Types of Eligible Projects: ....................................................................... Error! Bookmark not defined.
2. Set-aside Accounts: ................................................................................. Error! Bookmark not defined.
B. DWSIRLF STATE MATCH FUNDS ......................................... ERROR! BOOKMARK NOT DEFINED.
C. DRINKING WATER SYSTEMS EMERGENCY LOAN FUND (DWSELF) ... ERROR! BOOKMARK NOT
DEFINED.
IV. FINANCIAL STATUS OF THE DWSIRLF .................. ERROR! BOOKMARK NOT DEFINED.
A. SOURCE AND USE OF FUNDS .................................................. ERROR! BOOKMARK NOT DEFINED.
1. Federal Allotment ................................................................................... Error! Bookmark not defined.
2. State Match Requirements ....................................................................... Error! Bookmark not defined.
3. Loan Increase Reserve ............................................................................ Error! Bookmark not defined.
B. FINANCIAL PLANNING PROCESS ........................................... ERROR! BOOKMARK NOT DEFINED.
1. Efficient Bond Management ..................................................................... Error! Bookmark not defined.
2. Interest Rate Determination ..................................................................... Error! Bookmark not defined.
C. FINANCIAL TERMS OF LOANS ............................................... ERROR! BOOKMARK NOT DEFINED.
1. Funding Limit ......................................................................................... Error! Bookmark not defined.
2. Interest Rate ............................................................................................ Error! Bookmark not defined.
3. Administration Fee .................................................................................. Error! Bookmark not defined.
4. FFY-2024 Appropriation Special Provisions ............................................ Error! Bookmark not defined.
5. Other Related Issues................................................................................ Error! Bookmark not defined.
V. SET-ASIDE ACTIVITIES .............................................. ERROR! BOOKMARK NOT DEFINED.
A. ADMINISTRATION .................................................................. ERROR! BOOKMARK NOT DEFINED.
B. SMALL SYSTEM TECHNICAL ASSISTANCE ............................ ERROR! BOOKMARK NOT DEFINED.
C. STATE PROGRAM MANAGEMENT .......................................... ERROR! BOOKMARK NOT DEFINED.
D. LOCAL ASSISTANCE AND OTHER STATE PROGRAMS............ ERROR! BOOKMARK NOT DEFINED.
VI. PRIORITY SYSTEM ..................................................... ERROR! BOOKMARK NOT DEFINED.

A. FUNDING AND RANKING RATIONALE .................................... ERROR! BOOKMARK NOT DEFINED.
1. Funding Lists and Bypass Procedure ....................................................... Error! Bookmark not defined.
2. FFY-2024 Green Infrastructure Requirement ........................................... Error! Bookmark not defined.
3. Loan Decreases....................................................................................... Error! Bookmark not defined.
4. Match for Special Appropriations Project (SPAP) Grants ........................ Error! Bookmark not defined.
5. Subsidization from FFY-2024 Federal Appropriation............................... Error! Bookmark not defined.
C. PRIORITY RANKING CRITERIA .............................................. ERROR! BOOKMARK NOT DEFINED.
D. PRIORITY SYSTEM DEADLINES ............................................. ERROR! BOOKMARK NOT DEFINED.
VII. FFY-2024 PRIORITY LIST .................................... ERROR! BOOKMARK NOT DEFINED.
VIII. EXPECTED PUBLIC HEALTH OUTCOMES & PERFORMANCE MEASURES ..... ERROR!
BOOKMARK NOT DEFINED.
APPENDICES ERROR! BOOKMARK NOT DEFINED.
APPENDIX A ERROR! BOOKMARK NOT DEFINED.
APPENDIX B - PROJECTED SCHEDULE OF OUTLAYS FOR CAPITALIZATION GRANT
SET-ASIDES ERROR! BOOKMARK NOT DEFINED.
APPENDIX C - PROJECTED PAYMENT (FEDERAL LETTER OF CREDIT) SCHEDULE
ERROR! BOOKMARK NOT DEFINED.
APPENDIX D - PROJECTED SCHEDULE OF DRAWDOWNS AGAINST FEDERAL LETTER
OF CREDIT (ACH DRAW SCHEDULE) ............................ ERROR! BOOKMARK NOT DEFINED.
APPENDIX E - MISSISSIPPI SMALL SYSTEMS TECHNICAL ASSISTANCE SET-ASIDE
WORK PLAN ERROR! BOOKMARK NOT DEFINED.
APPENDIX F - MISSISSIPPI STATE PROGRAM MANAGEMENT SET-ASIDE ANNUAL
WORK PLAN ERROR! BOOKMARK NOT DEFINED.
APPENDIX G - LOCAL ASSISTANCE AND OTHER STATE PROGRAMS ANNUAL WORK
PLAN ERROR! BOOKMARK NOT DEFINED.
APPENDIX H - COORDINATION SCHEDULES FOR JOINTLY FUNDED PROJECTS . ERROR!
BOOKMARK NOT DEFINED.
APPENDIX I - DRINKING WATER SYSTEMS EMERGENCY LOAN FUND PROGRAM
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APPENDIX J - CERTIFICATIONS ...................................... ERROR! BOOKMARK NOT DEFINED.
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I. INTRODUCTION

A. State of Mississippi’s Drinking Water State Revolving Loan Fund

The Safe Drinking Water Act Amendments of 1996 (SDWA) established the national
Drinking Water State Revolving Fund (DWSRF) Program. That program allows the
Environmental Protection Agency (EPA) to make capitalization (Cap) grants to states to,
in turn, provide low-cost loans to public water systems to help achieve or maintain
compliance with SDWA requirements. Accordingly, the State Legislature (through
Section 41-3-16, MS Code of 1972 Annotated) created what is now called the Drinking
Water Systems Improvements Revolving Loan Fund (DWSIRLF) Program, to receive the
federal DWSRF capitalization grants from EPA, and to provide low-cost loans to the state’s
public water systems to finance needed infrastructure improvements. This legislation also
allows the DWSIRLF, subject to the authority of State Law, to make loans that may utilize
additional subsidization beyond standard DWSIRLF loans as well as setting appropriate
criteria to determine eligible recipients.

That same legislation created the "Local Governments and Rural Water Systems
Improvements Board" (Board), to oversee the administration of the DWSIRLF Program.
The Mississippi State Department of Health (Department), as the state’s drinking water
primacy agency, supplies the staff and facilities necessary to administer the program. The
Board is composed of the following nine (9) members: the State Health Officer, who shall
serve as chairman of the Board; the Executive Director of the Mississippi Development
Authority; the Executive Director of the Department of Environmental Quality; the
Executive Director of the Department of Finance and Administration; the Executive
Director of the Mississippi Association of Supervisors; the Executive Director of the
Mississippi Municipal League; the Executive Director of the American Council of
Engineering Companies; the State Director of the United States Department of Agriculture,
Rural Development; and a manager of a rural water system. Each agency director may
appoint a designee to serve in his or her place on the Board. The Governor appoints the
rural water system manager. In the creation of the Program, it was the intent of the
Legislature that the Board endeavor to ensure that the costs of administering the DWSIRLF
Program are as low as possible in order to provide the water consumers of Mississippi with
safe drinking water at affordable prices.

As a condition of receiving the DWSRF Cap grants, the SDWA requires that each state
annually prepare an Intended Use Plan (IUP) designed to outline how a state will utilize
DWSRF’s funds to assist in protecting public health. The DWSIRLF consists of both state
and federal funds. Federal funds are provided to the states in the form of awarded Cap
grants. Each state’s allotment of those grants is based on EPA’s Needs Survey that is
performed every four years. State matching funds totaling 20% of the federal grant amount
to that state are required to be deposited into the Fund and have historically been provided
through the issuance of bonds; however, the State legislature has provided the required
State match funds as a direct agency appropriation. The purpose of this IUP is to convey

the State of Mississippi’s (State) DWSRF plan for Federal Fiscal Year (FFY) 2024 to EPA,
other state agencies, the State’s public water supplies, and the public.

B. Program Overview

The basic framework under which the DWSIRLF Program operates is established by two
documents. The first document is the Drinking Water State Revolving Fund Loan Program
Operating Agreement (Operating Agreement) between the Mississippi State Department
of Health and the Environmental Protection Agency, Region IV. The current Operating
Agreement was agreed to by both parties and approved on March 21, 2021. The Operating
Agreement establishes the basic framework of the DWSIRLF that is not expected to change
from year to year. The second document is the IUP which describes how the State of
Mississippi will use the funding received from the EPA Cap grant which is received each
year.

The authorized allotment of the FFY-2024 Cap Grant from EPA for Mississippi is
$5,837,000. The Program intent to apply for the full amount of this cap grant and the BIL
Supplemental cap grant. These funds must be used in the period of July 2024 through June
2028. As a condition of the FFY-2024 Cap Grant the program agrees to comply with
DWSRF regulations, the general grant regulations at 40 CFR part 200, and specific
conditions of the capitalization grant and to enter data into SRF Data System no less than
quarterly. The FFY-2024 IUP will show in detail the goals (basic, long-term, and short-
term), the structure, and the financial status of the Program; the role of the set-aside
activities within the state; and most importantly, the distribution of funds towards public
water system improvements projects and the criteria used to determine their ranking within
the priority system. Those desiring to receive a copy of this document may contact Brittney
Carmichael, Program Support Specialist, at (601) 576-7649.

The United States Congress passed the Infrastructure Investment and Jobs Act (AKA the
Bipartisan Infrastructure Law or BIL) which was signed by the President on November
15, 2021. The bill appropriates an additional $2.202 billion to DWSRF for any eligible
projects. Of the $2.4 billion additional allotment, the State’s 2024 allotment (1.25%) for
eligible projects was $28,785,000(2024 TBD) with a required state contribution (20%) of
$5,757,000. The maximum principal forgiveness (49%) allowable to Eligible Borrowers
will be $14,104,650. The Program will take action to follow its priority and planning list
to apply the funding as applicable. See Appendix K for additional details.

C. Public Input, Review, and Comment Procedures

To ensure that the public has an ample opportunity to review and comment upon the IUP,
the Department and the Board follows the requirements of the “Mississippi Administrative
Procedures Law” prior to final submission of the IUP to EPA. A public notice period of at
least twenty-five (25) days allows for review and comment before an oral proceeding.
After adoption by the Board, a second filing with the Secretary of State’s Office occurs; if
no additional comments are received the IUP becomes law 30 days after the second filing.

Public notice will be given in The Clarion Ledger, a newspaper of statewide circulation,
for written and oral comments on this IUP. An oral proceeding will be held at 9:00 a.m.
on Sept. 26, 2024. Minutes of the oral proceeding, recording any comments and
recommended solutions, will be submitted to the EPA along with the Final IUP. Those
desiring to receive a copy of the oral proceeding transcript should contact Brittney
Carmichael, Program Support Specialist, at (601) 576-7649. A copy of the “Mississippi
Administrative Procedures Law” may be obtained from the Mississippi Secretary of State’s
Office and can also be found on the Mississippi State Department of Health’s website at
www.healthyms.com/dwsrf.

II. Goals of Mississippi’s Drinking Water Systems Improvements Revolving Loan Fund
(DWSIRLF) Program

The Board has established certain goals for the DWSIRLF Program with the objective of
improving the Program on an ongoing basis. The goals have been classified into three
categories that include basic, long-term, and short-term. These goals were developed to
address the necessary requirements of federal and state regulations, as well as the state’s
need and desire to maintain and enhance the Program. Congress and the State of
Mississippi have placed particular emphasis on assisting smaller drinking water systems
under the DWSIRLF to ensure that these systems have adequate technical, managerial, and
financial resources to achieve or maintain compliance and provide safe drinking water.
A. Basic Goals

1. Maintain a financially sound DWSIRLF in perpetuity; meet a portion of the
drinking water needs in the state within a reasonable period of time; and fund
projects in order of public health importance. Attaining these basic goals will help
ensure that Mississippi's drinking water supplies remain safe and affordable, and
that those public water systems that receive funding will be properly operated and
maintained.

2. Determine the DWSIRLF’s yearly interest rate, taking into consideration that it
must be competitive with the private sector, as well as with other available funding
sources within the state. This will ensure the timely use of available funds, as well
as ensure sufficient income is generated to provide for the perpetuity of the Fund.
Further details of loan terms and priority ranking are outlined in Sections IV and
VI of this IUP.

3. Ensure the program’s goal align with the EPA’s Strategic Goal of “Ensuring Clean
and Safe Water for All Communities”.
i. Tackling the climate crisis
ii. Taking decisive action to advance Environmental Justice and civil rights
iii. Enforcing environmental laws and ensuring compliance
iv. Improving air quality and reducing localized pollution and health impacts
v. Ensuring clean and safe water for all communities
vi. Cleaning up and revitalizing communities
vii. Ensuring the safety of chemicals for people and the environment

B. Long-Term DWSIRLF Goals

1. Enhance and/or improve loan application and repayment procedures. MSDH
intends to periodically evaluate the existing Program requirements and procedures
to determine ways to streamline the DWSIRLF Program’s application and
repayment procedures, making it more user-friendly, attractive, and beneficial to
loan recipients, while ensuring continued compliance with all federal and state
regulations and requirements.

2. Program staff are exploring the feasibility of creating a universal web-based
ranking form for all lending agencies within the state. The proposed form would
ask a few simple questions, recommend a lending program based on the responses,
and submit the ranking form to the appropriate agency. This could help potential
loan recipients find the program that is right for their water utility, quickly and
easily.

3. Continue programs to protect the State’s ground water by using designated funds
from the Cap grants to fund abandonment and plugging of wells. Since FFY-2012
the Program has been using the Local Assistance and Other State Programs set-
asides to properly abandon inactive wells and open holes. Inactive wells and open
holes are potential avenues of contamination to the aquifer and a danger to humans.
This program is a worthwhile endeavor that will protect the source water of the
state’s water supplies.

4. Develop a tracking system to manage programmatic and financial documentation.
A tracking system will provide DWSIRLF loan recipients and their representatives
an opportunity to view the status and/or location of documents mailed to the
Program for review and/or processing. This tracking system will also assist
Program staff in tracking/monitoring program documentation reviews as well as
disbursements.

5. Develop a comprehensive engineering project manager (PM) manual. The Bureau
of Public Water Supply continues to make changes to the personnel involved with
the DWSIRLF Program as the need arises. A comprehensive manual for project

management will help ensure new PMs will have all the necessary tools and
reference materials at their disposal to ensure the ongoing project flow will be
uninterrupted. Since regulations change periodically, once the manual is completed
it will be maintained by assigned staff.

C. Short-Term DWSIRLF Goals

1. Enhance and/or improve the Program by making it more attractive to public water
systems. The evaluation of this goal will be based on input received from “one-on-
one” visits with staff at engineering firms, town conferences, and general feedback
obtained from loan recipients and consulting engineers during the loan process.
These meetings will be conducted with firms currently participating in the
DWSIRLF Program to collect data regarding the effectiveness of the loan
application process currently being implemented.

2. Explore the possibility of developing web-based checklists and forms to
electronically store and process project management information.

3. Assist applicants in addressing capacity assessment deficiencies found during
annual inspections by using technical solutions afforded by the technical assistance
set-aside contractors. New or forthcoming regulations may make this a key goal in
the future.

4. Train new staff members using available training sessions provided by EPA Region
IV staff.

5. Meet special funding goals: Executive Order 13858, Strengthening Buy-American
Provisions for Infrastructure Projects, may introduce additional provisions that will
require additional compliance monitoring, thus creating an additional burden to the
Program.

6. Automatic repayment collection system: Continue the implementation of an
automatic repayment collection system; many loan recipients in the Program’s
repayment mode desire an automatic electronic repayment system as is available in
the public sector. The DWSIRLF, by instituting this payment option, will ensure a
timely receipt of monthly repayments, as well as make the repayment process much
more convenient for our loan recipients.

7. Implement a Cash Flow Model (CFM) to forecast all cash flows of the Drinking
Water State Revolving Funds to optimize the Program’s lending capacity.

III. Structure of the Mississippi DWSIRLF

The Mississippi DWSIRLF is structured around three separate funds that sustain the
Program and help it achieve the basic, short-term, and long-term goals. The funds are
broken down further into designated accounts, each having a specific function.

A. DWSIRLF Loan/Operations Fund

Monies in the Fund support a majority of the functions of the DWSIRLF. These functions
include program administration, set-aside operations, and most importantly provide
disbursements to public water systems for eligible projects. The DWSIRLF is a
reimbursement program, meaning that after the loan is awarded, costs associated with
planning, designing, and constructing the project are reimbursed to the recipient. Cap
grants from EPA, loan repayments and interest earnings are deposited into this Fund.

1. Types of Eligible Projects:

Many types of projects are eligible for funding by the Program. For a more detailed
explanation of eligible costs for projects, please reference Appendix A of the
DWSIRLF Regulations.

2. Set-aside Accounts:

The set-aside accounts reside under the umbrella of the Fund and are distinctly
designated by reporting categories. A listing of the set-asides taken by Mississippi
includes the following for FFY-2024:
a. Administrative Set-aside: Provides financial support to administer the loan
Program and other non-project-related activities.
b. Small System Technical Assistance Set-aside: Provides technical assistance to
small water systems.
c. State Program Management Set-aside: Provides additional financial support to
MSDH – Bureau of Public Water Supply for Public Water System Supervision
Program.
d. Local Assistance and Other State Programs: Provides funding for the
implementation of a wellhead protection program.

B. DWSIRLF State Match Funds

As required by the SDWA, the State of Mississippi must match the Cap grant with state
funds equaling 20% of the federal allotment. While state match monies are maintained
separately from the Fund for accounting purposes, they are still considered to be under
the “umbrella” protection of the DWSRF.

C. Drinking Water Systems Emergency Loan Fund (DWSELF)

The Board also oversees the DWSELF. This fund contains only State dollars that are
utilized solely for public water supply loans which meet the definition of emergency.
For further information see Appendix I.

IV. Financial Status of the DWSIRLF

This section outlines all sources of funding available to the DWSIRLF Program and
indicates intended uses. This section also describes the financial assistance terms
available through the Program.

A. Source and Use of Funds

The FFY-2024 EPA Capitalization Grant allotment for Mississippi of $5,837,000 has a
20% state match of $1,167,400 is required and the FFY-2024 BIL Supplemental
Capitalization Grant allotment of $28,785,000 with a 20% the state match requirement of
$5,757,000 this provides an amount of $41,546,400for both loans and set-aside activities.

A national reallotment of funding made available to the State after Wyoming passed on its
2021 allotment. The State will amend its 2021 capitalization grant to access the additional
$30,000 in funding. State match of $6,000 will be earmarked from funding available to the
program to meet the required 20%.

The FFY-2024 “Set-aside” uses for the standard Cap grant and BIL Supplemental Cap
grant are outlined in Section V of this IUP. Necessary work plans showing utilization of
these funds are found in the appendices of this IUP.

1. Federal Allotment

With the FFY-2024 Capitalization Grant for Mississippi of $5,837,000 the state
match requirement to federal grant funds will be 20% state match funds to 80%
federal grant funds; this requirement will be stated in the grant application.

The FFY-2024 BIL Supplemental Capitalization Grant allotment for Mississippi
of $28,785,000 the state match requirement to federal grant funds will be 20%
state match funds to 80% federal grant funds; this requirement will be stated in
the grant application.

2. State Match Requirements

The 2024 State Legislature will authorize an appropriation or the issuance of bonds
to be used as match for the FFY-2024 EPA Capitalization Grants. An amount of
$6,531,800 is required to fully match the FFY-2024 EPA Capitalization Grants.

3. Loan Increase Reserve

Beginning in FFY-2003 the Board began to make loan awards after approval of the
facilities plans and loan application, rather than after completion of the project
design. This change in the loan award sequence increased the likelihood that bid
overruns on some projects could be greater than the construction contingency
included in the loan agreement. In order to be able to provide loan increases (when
needed) to existing loans, the Board intends to set-aside the $2,000,000 for such
loan increases; loan increases will be awarded on a first-come, first-served basis.
Any funds not obligated for these purposes by the end of the fiscal year may be

made available for new loan awards to the highest-ranking project(s) that is ready
for loan award at the time funds become available.
B. Financial Planning Process

In accordance with the Board's desire to maintain a financially sound DWSIRLF loan
Fund in perpetuity, while at the same time meeting a substantial portion of the drinking
water needs in the state within a reasonable period of time, the following financial
decisions were made regarding the Fund:

1. Efficient Bond Management

The Board intends that the MSDH apply for the entire state Cap grant allotment
under the federal DWSRF, including the set-asides described in Section V below.
State bond proceeds obtained shall be deposited into the DWSIRLF and shall be
used as the state match for federal DWSRF Cap grants.

2. Interest Rate Determination

It is the Board’s intention to adjust interest rates such that the demand will equal
the funds available. In order to ensure that this interest rate will be at or below the
prevailing market rates at the time a loan is made, this rate will be compared to the
twenty-year (20) triple-A rated, tax-exempt insured revenue bond yield published
by fmsbonds, Inc. (fmsbonds Online, https://www.fmsbonds.com/market-yields/).

3. Investment

Investment Procedures for Excess Cash - According to the State Treasurer, the
excess cash in the Fund is invested by the State Treasurer in securities prescribed
in Section 27-105-33, et. Seq., of the Mississippi Code of 1972 Annotated, as
amended. The securities in which state funds may be invested include certificates
of deposit with qualified state depositories, repurchase agreements (fully secured
by direct United States Treasury obligations, United States Government agency
obligations, United States Government instrumentalities or United States
Government sponsored enterprise obligations), direct United States Treasury
obligations, United States Government agency obligations, United States
Government instrumentalities or United States Government sponsored enterprise
obligations, and any other open-ended or closed-ended management type
investment company or investment trust registered under the provisions of 15
U.S.C. Section 80(a)-1 et. Seq, provided that the portfolio is limited to direct
obligations issued by the United States of America, United States Government
agency obligations, United States Government instrumentalities or United States
Government sponsored enterprise obligations and to repurchase agreements fully
collateralized by the securities listed above for repurchase agreements.

C. Financial Terms of Loans

The following terms will be used for the purpose of making loans to the public water
systems within the State of Mississippi.

1. Funding Limit

Under state law, the Board has the discretion to set the maximum amount for
DWSIRLF loans. For FFY-2024 the Board has set a maximum loan amount of
$5,000,000 per borrower. The Board may allow (on a case-by-case basis if
requested by the borrower and the need has been justified) the maximum loan limit
to be exceeded by a vote of the Board. Furthermore, during FFY-2024, no more
than one loan per borrower will be allowed. At the end of the fiscal year, if funds
are available, systems previously receiving an award during FFY-2024 may obtain
an additional award(s) or an increase to a previous award, if no other eligible
systems are evident.

2. Interest Rate

All loan terms will be the lesser of 1.95% annual interest rate or the twenty-year
(20) triple-A rated, tax-exempt insured revenue bond yield published by fmsbonds,
Inc., compounded monthly, with a standard 20-year term. The maximum loan
amortization allowable will be 30 years, or 40 years for disadvantaged communities
(the America’s Water Infrastructure Act of 2018). These maximums may not,
however exceed the design life of the project. Interest will accrue based on the
current loan agreement in conjunction with the DWSIRLF Regulations.

3. Administration Fee

THIS IS NOT AN ADDITIONAL FEE TO OUR LOAN RECIPENTS. This
revenue is diverted from the interest portion of loan repayments to defray
administrative costs related to the program. The program will collect up to 5% of
the initial loan principal or the total amount of interest due over the life of the loan,
whichever is less, to defray administrative cost. This fee will be collected from the
interest portion of loan repayments on all FFY-2024 loans.

4. FFY-2024 Appropriation Special Provisions

The Federal 2024 appropriations bill has been finalized and the final EPA FFY-
2024 Cap Grant allotment amounts, and any additional federal requirements are
known. Subsidization requirements will be required for the FFY-2024 Cap Grant;
the subsidization is in the form of “principal forgiveness”, “negative interest rates”,
or a combination of the two. The amount of subsidization is a minimum of 26% of
the Cap Grant amount. The FFY-2024 Cap Grant is $5,837,000 and the
subsidization amount will be $1,517,620 (26%) of the Cap Grant amount.
Furthermore, all loans made with all or part FFY-2024 federal appropriation funds
will include the Davis-Bacon Act, American Iron and Steel, and BABA signage
requirements. Appropriate language will be added to all FFY-2024 loan

agreements identifying the additional responsibilities for loan recipients. “Green
Infrastructure” requirements are not an appropriation requirement. However, the
Program will continue to encourage those types of projects to seek funding from
the DWSIRLF.

5. Other Related Issues

a. Type of Assistance Provided: The assistance to be provided under the
DWSIRLF Program will be loans to public, tax-exempt entities which are
authorized under state law to collect, treat, store, and distribute piped water for
human consumption; able to enter into a DWSIRLF loan agreement; and have
the ability to repay the DWSIRLF loan. With the funds provided through the
FFY-2024 federal appropriation, the DWSIRLF program will be able to make
loans that will have an amount of “principal forgiveness”, if the loan recipient
is designated a disadvantaged community. To ensure that the assistance is
dispersed as far as possible, the Board has set a limit ($500,000) which a loan
recipient may receive in subsidy for one loan. When the mandatory 26%
subsidy requirements have not been met by awards, the Board may allow (on a
case-by-case basis if requested by the borrower and the need has been justified)
the limit to be exceeded by a vote of the Board. Once the limit of the
appropriation subsidy funds has been reached for FFY-2024, loans will return
to the DWSIRLF’s standard terms without principal forgiveness. In all cases,
loans will be for the construction of eligible drinking water production,
treatment, and distribution facilities.

b. Project Costs Eligibility: Eligible/allowable project costs will include those
costs that are eligible, reasonable, necessary, and allocable to the project, within
the established project scope and budget, in conformance with the DWSIRLF
regulations and approved by MSDH.

c. Loan Participation: DWSIRLF loan participation will be at 100% of eligible
project costs, less any funding made available from other agencies for these
same eligible project costs.

d. Pre-Award Costs: Project costs incurred prior to loan award will be DWSIRLF
loan eligible provided:
i. The debt is for work under a construction contract for which the “Notice
to Proceed” was issued on or after October 1, 2024, and the DWSIRLF
loan is awarded by September 30, 2024.
ii. The project is in compliance with all applicable DWSIRLF Program
regulations and obtains MSDH approval of all applicable documents
prior to award of the DWSIRLF loan.
iii. The prospective loan recipient agrees that by incurring costs prior to
loan award, it proceeds at its own risk and relieves the Board, the
Department, and the Department’s staff of all responsibility and liability

should such costs later be determined unallowable for any reason or
should such funding not become available for any reason.
iv. The prospective loan recipient agrees that by incurring costs prior to
loan award, no future commitment of funding a refinanced project is
provided.

e. Priority List: The FFY-2024 Priority List expires on September 30, 2024.
Projects listed in the FFY-2024 Priority List that do not receive funding by this
date will not be funded under the FFY-2024 funding cycle and will be subject
to the requirements of subsequent IUPs and Priority Lists. Detailed information
for the FFY-2024 DWSIRLF projects is shown in Section VIII of this IUP. To
facilitate the use of FFY-2024 federally appropriated funds, the priority list may
be adjusted to allow funds to be disbursed according to the federal requirements.

V. Set-Aside Activities

The SDWA allows each state to set-aside up to 31 percent of its federal Cap grant to support
non-project-related drinking water programs which includes administration of the loan
program, technical assistance to public water systems, state program management, and
other special activities. The FFY-2024 EPA Capitalization Grant amount of $5,837,000,
the state plans to use $1,677,825 of the FFY-2024 Federal Capitalization grant to support
the non-project-related drinking water programs activities. The state plans to utilize
$4,300,572 of the BIL Supplemental Cap Grant amount for set-aside activities. These non-
project-related programs will be operated by MSDH within the agency itself or through
contracts with other agencies or organizations. Contracts between the MSDH and other
agencies or organizations will be approved by the Board. Work plans showing how the
set-asides funds will be expended are included as appendices within this IUP; additionally,
progress reports will be included in the Annual Report. The state has elected not to take
any additional set-asides from the FFY-2024 Local Assistance and Other State Programs
set-aside but reserves the right to make revisions to utilize additional funds from this set-
aside. See Appendix B for the funding breakdown of each category.

A. Administration

The SDWA-DWSRF amendments in the 2017 Water Infrastructure Improvements for the
Nation Act (Pub. L. 114-332) (2017 WIIN Act – EPA memorandum dated June 6, 2017)
states that the Administrative Set-Asides that can be taken (the greatest of: $400,000, 1/5
percent of the current valuation of the fund, or an amount equal to 4 percent of all grant
awards to the fund for the fiscal year). The State plans to use the maximum allowable for
"Administrative" purposes from the FFY2024 Cap Grant. The State also plans to use a
percentage for "Administrative" purposes from the FFY2024 BIL Supplemental Cap Grant.
Costs beyond this amount will be paid from the funds generated by the 5% administrative
fee taken from loan repayments.

The state will continue to exercise its right to reserve the administrative amounts from
previous Cap Grants. Reserving previous years’ 4% administrative set-aside can ensure

that the Program will continue to operate with an adequate DWSIRLF staff for proper
management of the Program.

B. Small System Technical Assistance

The state will use the Small Systems Technical Assistance (Up to 2%) set-aside from the
FFY-2024 Cap Grant and the BIL Supplemental Cap Grant to provide technical assistance
to public water systems serving areas with populations of 10,000 or less. With approval
by the Board, the state intends to use this set-aside to fund contracts for the following
activities: Special Technical Assistance to Referred Systems; Board Management Training
for Water System Officials; On-Site Technical Assistance; PEER Review Program; Hands-
on Operator Training; and Asset Management Training. Each of these activities is
described in detail in the State of Mississippi’s Small Systems Technical Assistance Set-
Aside Work Plan included as Appendix E to this IUP.

C. State Program Management

The state intends to utilize these funds which is allowed up to a 10% set-aside from the
FFY-2024 Cap grant, as authorized by Section 1452(g) (2) of the Safe Drinking Water Act
of 1996 for State Program Management. The funds will be used for Public Water System
Supervision (PWSS) activities conducted under Section 1443(a) of the Act. These
activities are described in more detail in the State of Mississippi’s State Program
Management Set-aside Annual Work Plan included as Appendix F to this IUP.

The SDWA-DWSRF amendments in the 2018 Water Infrastructure Improvements for the
Nation Act (Pub. L. 114-332) (2017 WIIN Act – EPA memorandum dated June 6, 2017)
removed the requirement for the State 1:1 match for the 10% State Program Management
set-aside.

D. Local Assistance and Other State Programs

The state intends to use (10%) of the 15% set-aside amount which is allowed from the
FFY-2024 Cap grant to provide funding for wellhead protection projects throughout the
state. These funds will be used to properly abandon inactive wells that pose a risk to
existing active public water supply source water wells, as well as the environment. See
Appendix G.

The state intends to use (10%) of the 15% BIL Supp set-aside amount which is allowed
from the FFY-2024 Cap grant to provide funding for consolidation and regionalization
projects throughout the state. These funds will be used to survey the State’s drinking water
system to identify, plan, and assist water systems in consolidation or regionalization to
create a more sustainable model that best serves the consumers of Mississippi’s drinking
water. See Appendix L.

VI. Priority System

The SDWA provides the state with the flexibility to determine how to best utilize the Cap
grant. To meet the particular and unique issues facing the public water systems in
Mississippi, SDWA requirements allow states to give priority to those projects which:

1. address the most serious risk to human health.
2. are necessary to ensure compliance with the SDWA requirements.
3. assist systems most in need, on a per household basis.

A. Funding and Ranking Rationale

Projects will be placed on the fundable portion of the Priority List according to both priority
ranking and readiness to proceed. The term “ready to proceed” means that all loan
application requirements established in the Program regulations are met, and all documents
necessary for loan award are approved. If a project cannot reasonably be expected to meet
the Priority System deadlines, then the project will not be placed on the current year’s
Priority List but will be placed on the Planning List. It is the Board’s judgment with input
from the DWSIRLF staff as to when a project is ready to proceed. Loans will be awarded
to projects (within available funds) that are above the funding line on the current year’s
Priority List, that have met all Priority System deadlines and are ready to proceed.
Additionally, when potential loan recipients are deciding on the needs for their public water
supplies, they should ensure that all public health and state safe drinking water laws are
followed. If a state regulation becomes an additional requirement of Mississippi’s public
water supplies, appropriate planning and design of the project(s) will be necessary in order
to receive funding. However, if it is understood that a proposed project is designed to meet
specific SDWA compliance requirement(s) unrelated to a state requirement, the Board may
waive the state requirement upon request from the potential loan recipient. This waiver
would require concurrence from the Bureau of Public Water Supply.

1. Funding Lists and Bypass Procedure

Should any projects on the FFY-2024 Priority List (which are above the funding
line) fail to comply with the deadlines in Section D, the project shall be bypassed,
and the funds reserved for said project will be released. Released funds will first
be made available to listed projects, to ensure that all projects above the funding
line meeting priority system deadlines are funded. Any remaining funds will be
made available to the highest-ranking project(s) shown below the funding line that
is ready for loan award at the time funds become available. If no projects above
the funding line are ready for loan award at the time funds become available,
projects shown below the funding line will be funded on a first-come, first-served
basis as they become ready for loan award and until the released funds are awarded.
This same process will continue as each deadline passes and released funds become
available.

2. FFY-2024 Green Infrastructure Requirement

The FFY-2024 federal appropriation is not expected to require that a percentage of
the funds appropriated for the Revolving Funds be designated for projects that
exhibit the elements of green infrastructure, water efficiency improvements, energy
efficiency improvements or other environmentally innovative projects. However,
projects that wish to be classified in the following elements will be reported as
green infrastructure to the EPA through its “Project and Benefits Report Database”
and noted in the future annual report. Projects may exhibit one or more of the
“green” elements and the details of the project’s “green” content will be identified
in the business case required for each project if the recipient so chooses.

- Green infrastructure projects include a wide array of practices at multiple
scales; green infrastructure projects will manage wet weather and will maintain
and restore natural hydrology by infiltrating, evapotranspiring, and harvesting
and using storm water. On a regional scale, green infrastructure is the
preservation and restoration of natural landscape features, such as forests,
floodplains, and wetlands, coupled with policies such as infill and redevelopment
that reduce overall imperviousness in a watershed. On the local scale, it may
consist of site- and neighborhood-specific practices, such as bio-retention, trees,
green roofs, permeable pavements, and cisterns.

- Water efficiency projects are designed to use improved technologies and
practices to deliver equal or better services with less water. It encompasses
conservation and reuse efforts, as well as water loss reduction and prevention, to
protect water resources for the future.

- Energy efficiency projects are designed to use improved technologies and
practices to reduce the energy consumption of water projects, use energy in a
more efficient way, and/or produce/utilize renewable energy.

- Environmentally innovative projects include projects that demonstrate new
and/or innovative approaches to deliver services or manage water resources in a
more sustainable way.

Projects desiring to be classified as “green” will be judged for eligibility based on
the guidance supplied by the EPA and that is available at our website
www.healthyms.com/dwsrf. Systems desiring “Green Infrastructure” classification
will be required to present a “business case” establishing justification for the
classification request. Guidance for establishing a “business case” is available to
assist potential loan recipients in preparation of the documentation.
3. Loan Decreases

Any funds recovered from loan decreases during the year will be used:

a) first to fund bid overruns, if funds from the loan increase reserve are not
sufficient to cover the bid overruns;

b) then to ensure that all projects above the funding line meeting the priority
system deadlines are funded (for at least the amount shown on the priority list);
and
c) then to fund other loans and/or increases on a first-come, first-served basis.

Any funds not obligated for these purposes may be made available for new loan
awards ready to proceed on a first-come, first-served basis.

4. Match for Special Appropriations Project (SPAP) Grants

On October 10, 2001, EPA issued policy memorandum DWSRF 02-01 to notify
regions and states of a change in policy regarding the use of DWSRF monies for
providing local match for SPAP grants. This change in EPA policy will allow the
state to use non-federal, non-state match DWSIRLF funds to provide loans that can
be used as local match for SPAP grants awarded for drinking water projects.

These non-federal, non-state match DWSIRLF loan funds may be made available
to eligible SPAP grant recipients that are on the priority list for use as local match
funds for their SPAP grants, provided the grant is for loan eligible work. Such
projects will be funded in accordance with the Priority System and until all non-
federal, non-state match monies have been obligated or demand for such funds has
been met.

5. Subsidization from FFY-2024 Federal Appropriation

The FFY-2024 EPA Capitalization Grant mandates a minimum of 26% (12%
SDWA Disadvantaged Communities Subsidy + 14% Congressional Subsidy) and
maximum 49% (26% min + 23% discretionary SDWA Disadvantaged
Communities Subsidy) of the Grant be provided as additional subsidization to
disadvantaged communities. Based on the Grant of $5,837,000, a minimum of
$1,517,620 ($880,740 & 754,920) in subsidization is required. The DWSIRLF’s
subsidization will be in the form of “Principal Forgiveness” (PF) to individual
public water supplies that are considered disadvantaged communities, and which
received reimbursements with Federal Cap grant funds during the construction of
the project. If the amount of PF which a project is eligible exceeds the amount of
Federal Cap grant funds which it received, the amount of PF extended will be
limited to the amount of Federal Cap grant funds used for reimbursement.

Subsidization may be used over a two-year period. Subsidization remaining from
a previous year may be awarded to loans which are eligible for PF over a two-year
period. Subsidization for FFY-2024 may be awarded to projects eligible for PF in
FFY-2024 and FFY-2025.

Disadvantaged Community Program

a. DWSRF Capitalization Grant funds

During FFY-2024, the following Principal Forgiveness (PF) methodology will
be used to meet the requirements of both the America’s Water Infrastructure
Act of 2018, the Consolidated Appropriations Act of 2020, and Infrastructure
Investment and Jobs Act of 2021 for providing subsidy for disadvantaged
systems. A minimum of 26% subsidy will be made available and up to 49% can
be subsidized to eligible recipients.

The amount of PF for which a potential “Loan Recipient” (LR) may be
eligible will be determined by calculating the percentage of the “Median
Household Income” (MHI) of the potential LR versus the MHI of the State of
Mississippi ($52,719) as a whole.

90% < LR MHI < 100% - 15% Principal Forgiveness
80% < LR MHI < 90% - 25% Principal Forgiveness
70% < LR MHI < 80% - 35% Principal Forgiveness
LR MHI < 70% - 45% Principal Forgiveness

PF will be extended to projects until all mandated subsidy funds are obligated.
Due to the limited amount of PF funds, the maximum amount of PF funds a
loan recipient may receive for a project will be set at $500,000. The amount of
PF given will be assigned at loan award after the project goes to the bid phase.
Once this happens, the amount of PF assigned can only change if the project’s
costs increase, PF is still available, PF assigned has not reached the specified
maximum, and the Board approves a waiver allowing additional subsidization.
Once subsidy funds are depleted, only standard loans will be made with
DWSIRLF funds.

In the event that a LR declines their loan that includes PF, the released PF may
be reallocated to other projects for the present fiscal year that are eligible for
PF, or the PF may be carried over to projects for the next fiscal year.

If returned PF funds are reallocated to projects awarded during the existing
fiscal year. The reallocation of PF will be given first to projects which did not
receive their full allowable amount based on the above table up to the maximum
allowed limit.

If all projects have received their full allowable amount, returned PF funds may
be reallocated to projects awarded PF during the existing fiscal year based on a
percentage of the individual LR’s initial loan amount to the total loan amount
of loans awarded PF during the fiscal year.

In all cases, the amount of PF which is awarded to a project may not exceed the
amount of Federal Cap grant funds which the project was reimbursed during
the construction of the project.

b. BIL Supplemental Funds

During FFY-2024, the following Principal Forgiveness (PF) methodology will
be used to meet the requirements of the Infrastructure Investment and Jobs Act
of 2021. The annual BIL Supplemental grant is to be subsidize at 49% with
those subsidies as assistance agreements of 100% principal forgiveness or
grants. Potential Loan Recipients ranked highest on the program’s Priority List
serving a population with a Median Household Income less than $52,719 (MS
MHI) will be eligible to receive 100% principal forgiveness loans to the extent
funding allows. The FFY 2024 BIL Supplemental allotment for the Program is
$28,785,000. The maximum principal forgiveness (49%) allowable to eligible
borrowers will be $14,104,650.

B. Priority System Categories

Emergency Projects

The Project Priority List may be amended during the year for declarations of
emergencies designated by the Governor (pursuant to §33-15-11(b)(17)) or the State
Health Officer (pursuant to §41-26-1 et sec.). The emergency project must meet all
eligibility and loan requirements, but the additional public review and comment
requirement may be waived. Once an emergency has been declared and the project is
determined eligible, Emergency projects will take priority over all other project
categories. Any emergency project must be documented in the DWSRF Annual
Report and is subject to EPA oversight review.

Standard DWSRF Projects

Projects in Category I are funded each year to the extent funds are available. Projects
in Categories II through XI are ranked in priority order; that is, all Category II projects
are ranked higher than Category III projects, etc. Ranking is established in like manner
through all remaining categories. Adjustments are made as necessary to comply with
small community set-aside provisions of the Federal SDWA and as established by the
Board [Section 1542(a) (2) of SDWA]. As stated previously, the order of Categories
II - XI is intended to give highest priority to those projects that address the most serious
risks to human health. Projects within each category will be ranked as described in
Section C.

1. Category I - Segmented Projects
This category of projects includes any remaining segments of projects that
previously received funding for an integral portion of that project and are necessary
for the entire project to be functional. Projects will be funded under this category
in order of their regular priority ranking provided they meet the deadlines
established in Section D.

In order to maintain continuity, the Board intends to make some amount of funds
available for each ongoing-segmented project. Preference in the amount of funds

to be provided will be given to the projects that received the earliest loan award for
their initial segment.

2. Category II - Previous Year Certified Projects
Priority for this category will be given to the previous year Category II projects to
the maximum extent practicable. This category of projects includes projects that:
(1) were listed immediately below the funding line on the previous year’s Priority
List within an amount of approximately 25% of that year’s total available funds;
(2) met all Priority System deadlines in the previous fiscal year; and (3) were not
funded due to lack of DWSIRLF funds or did not receive an assurance of CDBG,
ARC, RUS, or other match funding in the previous fiscal year. Within this
category, projects will be ranked according to the current Priority Ranking Criteria.

3. Category III - Primary Drinking Water Standards
This category includes projects to facilitate compliance with Primary Drinking
Water Standards. To qualify for this category, projects must correct deficiencies
resulting in non-compliance with the primary drinking water standards. Depending
on the nature of the project, additional treatment requirements may be necessary as
part of the proposed project.

4. Category IV - One Well
This category includes projects to provide additional water supply to systems that
have neither a backup well nor an MSDH-approved emergency tie-in to another
system to ensure safe drinking water; thereby protecting the health of the existing
population. Depending on the nature of the project, additional treatment
requirements may be necessary as part of the proposed project.

5. Category V – Pressure Deficiencies
This category includes projects to correct documented deficiencies that result in
existing systems routinely failing to maintain minimum acceptable dynamic
pressure. Experience has shown that failure of water systems to maintain
minimum acceptable dynamic pressure is the major cause of system
contamination in Mississippi. System contamination that results from inadequate
water system pressure is considered by the MSDH to be one of the most serious
drinking water-related threats to public health in Mississippi.

6. Category VI - Source Water Protection Projects
This category includes projects to manage potential sources of
contaminants/pollutants and/or prevent contaminants/pollutants from reaching
sources of drinking water. To be eligible for loan participation, potential
contaminants/pollutants and source water protection areas must have been
identified in the public water systems source water assessment plan report (swapr)
prepared by the Mississippi Department of Environmental Quality’s Groundwater
Planning Branch (deq-gpb). If the public water system has not received its swapr
from the deq-gpb yet, or has documentation that may change its swap, it shall
provide in the facilities plan suitable documentation of potential sources of

contaminants/pollutants that is acceptable to the deq-gpb before the project will
be deemed eligible.

The projects will be ranked: first in order of the highest source water
classification that would be negatively impacted by source water contaminants;
secondly, within each classification in order of the public water systems
susceptibility assessment ranking as determined by the deq-gpb; and thirdly,
within each susceptibility assessment ranking in order of the highest number of
connections served by the public water system. Source water classifications will
be ranked in the following order: surface water sources; shallow (generally ≤ 300’
in depth) unconfined water wells; shallow (generally ≤ 300’ in depth) confined
water wells; and deep confined water wells.

7. Category VII - System Capacity Expansion to Serve Existing Unserved
Residences/Businesses
This category includes projects to either expand existing system capacity or
construct a new drinking water system to ensure safe drinking water (source,
treatment and/or distribution) to serve existing residences/businesses in currently
unserved areas.

8. Category VIII - Back-up Water Supply Sources Projects
This category includes projects to provide additional supply to systems with
insufficient back-up water supply sources to ensure safe drinking water, and
thereby protect the health of the existing population. As a minimum, a system using
ground water should be able to lose any one of the wells supplying the system and
still maintain minimum acceptable dynamic pressure throughout the entire system.

9. Category IX – Existing Facilities Upgrades (Meeting Primary Standards)
This category includes projects to rehabilitate, replace, protect or upgrade
deteriorated, worn, aged or obsolete equipment, facilities, etc., to assure continued,
dependable operation of water systems where such systems are already meeting
Primary Drinking Water Standards. Depending on the nature of the project,
additional treatment requirements may be necessary as part of the proposed project.

10. Category X - Fluoride Addition
This category is for projects that either rehabilitate existing fluoride treatment
facilities at well or treatment plant sites or add new facilities to existing well or
treatment plants.

11. Category XI - Secondary Drinking Water Standards Projects
This category includes projects to provide treatment that brings systems into
compliance with Secondary Drinking Water Regulations. Depending on the nature
of the project, additional treatment requirements may be necessary as part of the
proposed project.

12. Category XII – Consolidation Projects

This category includes projects to consolidate separate systems into a single system
for purposes other than those related to Categories II through IX. Consolidation
will also be considered in establishing priority ranking within all categories, as
described in the Priority Ranking Criteria in Section C.

13. Category XIII – Other
This category includes projects that do not meet the criteria of any other listed
category and have been determined loan eligible in accordance with the DWSIRLF
loan program regulations.

C. Priority Ranking Criteria

The criteria for ranking Standard DWSRF projects within each category is intended to give
priority to projects that: (1) benefit the most people per dollar expended; (2) assist systems
most in need on a per household affordability basis as required by the SDWA (3) use
consolidation with other systems to correct existing deficiencies and improve management;
(4) take into consideration the system’s current capacity; (5) encourage participation in
short-term and long-term technical assistance programs; and (6) encourage an Asset
Management Plan participation in the Drinking Water Needs Survey. These considerations
are addressed by the Priority Ranking Criteria in the following manner:

1. Benefit/Cost
Benefit/Cost points assigned to each project will be determined using the following
formula:

Benefit/Cost Points = Number of benefiting connections
Total eligible cost of improvements (in $1.0 millions)

The number of benefiting connections must be included in the facilities plan
submitted by the applicant; be defined as the sum of individual connections
currently experiencing deficiencies that will be corrected by the improvement;
and include only existing residences, businesses, and public buildings. Applicants
must furnish information (including hydraulic analysis, if necessary) to support
their estimate of the number of benefiting connections. The total eligible cost is in
millions of dollars (i.e., $800,000 = $0.8 M).

2. Affordability Factor
An affordability factor will be assigned to each project to reflect the relative needs
of applicants on a per household basis. The Benefit/Cost points calculated in
Section C.1. will be adjusted using the affordability factor in the following formula:

Adjusted Benefit/Cost Points = (Affordability Factor) x (Benefit/Cost Points)

The affordability factor used in the calculation is defined as the ratio of the “Median
Household Income” (MHI) for the State of Mississippi ($52,719) to the MHI for

the affected community. The affordability factor used in the calculation will be no
less than 1.0 and no greater than 1.5.
3. Consolidation
Any project that includes consolidation (ownership and management) of separate
existing systems into a single system will receive consolidation points equal to 0.5
times the Adjusted Benefit/Cost points assigned to the project. The purpose of
assigning consolidation points is to promote reliability, efficiency and economy of
scale that can be achieved with larger water systems while discouraging the
proliferation of numerous separate small systems with their inherent inefficiencies
and limitations. Projects, in any priority category, that do not include consolidation
will receive zero consolidation points in the final calculation of total priority points.

Consolidation Points = 0.5 x (Adjusted Benefit/Cost Points)

4. System Capacity
Any project that includes scope of work to address critical design capacity issues
(systems that are currently overloaded or within two (2) years of reaching their
current design capacity, as determined by MSDH) will receive additional priority
points equal to 25% of the Adjusted Benefit/Cost points assigned to the project.
Documentation of the system capacity analysis and recommendations to address
the design capacity issues must be addressed in the facilities plan to be eligible for
these additional priority points.

System Capacity Points = 0.25 x (Adjusted Benefit/Cost Points)

5. Participation in Short-Term & Long-Term Assistance Programs
The MSDH, with the Board’s approval, has contracted with Mississippi State
University Extension Service to provide both short-term and long-term assistance
to designated water systems in the state based on their scores on the latest Capacity
Assessment Form (CAF). This assistance is provided at no cost to the water
systems.

Participation by the water systems in these assistance programs is voluntary;
however, any water system that has participated in either of these assistance
programs within the past two years will be eligible to receive additional priority
points equal to 5% of their Adjusted Benefit/Cost Points. Water systems that have
implemented all the recommendations made by Mississippi State University
Extension Service will receive additional priority points equal to 5% of their
Adjusted Benefit/Cost Points for a total of 10%. Documentation of participation in
either of these assistance programs and implementation of the recommendations
made by Mississippi State University Extension Service must be included in the
facilities plan before additional priority points will be granted.

Assistance Points = ** x (Adjusted Benefit/Cost Points)

** 5% if the water system participates in the assistance, or 10% if the

water system participates in the assistance and implements all
recommendations

6. Asset Management Plan

Any water system certifying and providing support of their Asset Management
Plan’s implementation or maintenance to MSDH will be eligible to receive
additional priority points equal to 10% of their Adjusted Benefit/Cost Points.

Asset Management Plan = 0.10 x (Adjusted Benefit/Cost Points)

7. Ranking Within Each Category
Within each category, projects will be ranked in order based on the total points
assigned the project using the following formula:

Total Priority Points = Adjusted Benefit/Cost Points + Consolidation Points +
System Capacity Points + Assistance Program Points + Needs Survey Points

Projects receiving the most priority points will be given the highest ranking on the
Priority List. In case of a tie in the number of priority points, projects with the
lowest median household income will receive the highest ranking.

8. Small Community Set-Aside
Following completion of the ranking process, the Priority List will be reviewed to
determine if at least 15% of available funding for projects above the funding line is
for public water systems which regularly serve fewer than 5,000 people, which the
Board has defined as a small community for the purposes of this set-aside. If this
is not the case, the Priority List will be adjusted by exchanging the lowest ranking
projects above the funding line that serve 5,000 or more with the highest-ranking
projects below the funding line that serve fewer than 5,000, until the 15%
requirement is satisfied.

D. Priority System Deadlines

1. By October 2, 2023, a complete DWSIRLF facilities plan, prepared in accordance
with the DWSIRLF loan program regulations, must be submitted to MSDH.
A complete DWSIRLF facilities plan includes: all Intergovernmental Review
(IGR) agency comments; proof of publication of advertisement for public hearing;
a transcript of the public hearing comments; copies of any comments received from
the public; and a summary of how each comment was addressed. The loan
applicant should provide a copy of the facilities plan to USDA - Rural Utilities
Service (RUS); if the loan applicant has an existing debt with RUS, their approval
to incur the additional debt must be obtained and provided as part of the plan.

Any significant changes made to the facilities plan (i.e., changes in the chosen
alternative location of the facility, cost increases that substantially affect the

financial capability of the loan recipient) after this date will be considered a first
submittal of the facilities plan. The loan applicant will then be in violation of the
Priority System deadline and the project will be placed on the planning portion of
the priority list. If the change is made after adoption of the IUP, funds reserved for
this project may be released and made available to other projects.

This deadline also applies to all projects competing for released funds during FFY-
2024 and to be able to qualify for the Previous Year Certified Projects Category in
the next FFY’s IUP.

2. By May 1, 2024, a completed DWSIRLF loan application and all associated
documents as described in the DWSIRLF regulations must be submitted to the
Department. Prior to preparing these documents, the potential applicant and/or its
registered engineer must request and receive a DWSIRLF application and
guidance. It is recommended that they request a pre-application conference with
DWSIRLF staff as early in the application process as practical. This deadline also
applies to all projects competing for released funds during FFY-2024 and to be able
to qualify for the Previous Year Certified Projects Category in the next FFY’s IUP.

3. By August 1, 2024, all approvable documents and responses to comments necessary
for loan award must be submitted to the Department for its review and approval.
This deadline also applies to all projects competing for released funds during FFY-
2024 and to be able to qualify for the Previous Year Certified Projects Category in
the next FFY’s IUP.

VII. FFY-2024 PRIORITY LIST
FINAL
Fiscal Year - 2024 Mississippi Drinking Water Systems Improvements
Revolving Loan Fund Program Priority List

Project Project Title Zip Priority Service Area Eligible Loan Amount Statewide

Code Points Population PF Amount Requested Cum. $
Category III: Primary Drinking Water Standards Projects

Clayton Village Water Association New Well, Elevated Tank, Water Mains 39759 418 4984 $500,000 $4,971,000 $4,971,000
Category IV: One Well Projects

City Point Water Association Consolidation 38862 312 2455 $500,000 $4,133,630 $9,104,630
Category V: Pressure Deficiencies Projects

Evergreen Water Association Pressure Deficiencies 39043 10127 3100 $0 $190,000
$9,294,630

Star Water Company Pressure Deficiencies 39167 2762 993 $30,000 $200,000
$9,494,630

Mound Bayou, City of Pressure Deficiencies 38762 741 1500 $382,500 $850,000
$10,344,630
Category VII: System Capacity Expansion to Serve Existing Unserved Residences/Businesses

G.T.&Y Utility District Service to New Area/ Capacity Improvements 38901 342 4000 $500,000 $4,334,067
$14,678,697

Shuqualak, Town of Extending Public Water Service to Unserved Areas 39361 176 575 $500,000 $2,844,000
$17,522,697

Harrison Co. Utility Authority Service to Existing Unserved Areas 39503 31 624 $360,000 $2,477,550
$20,000,247
Category VIII: Back-up Water Supply Sources Projects

Meridian, City of New Well 39301 2794 36347 $500,000 $6,699,116
$26,699,363

Cason Water Association Surface Water Connection 38858 1623 4543 $435,575 $1,244,500
$27,943,863

Mt. Olivet Water Association New Well/Paint Elevated Tank 38606 708 1300 $129,010 $516,040
$28,459,903
Category IX: Existing Facilities Upgrade (Meeting Primary Standards)

Clarkdale Water Association SCADA Upgrade 39301 11242 4000 $500,000 $2,158,032
$30,617,935

Hernando, City of Treatment Plant Upgrades and Distribution Impro 38632 7626 15000 $0 $931,000
$31,548,935

Clarksdale Public Utilities Rehab/ Replacement of Existing Facilities 39814 4654 17962 $500,000 $2,375,000
$33,923,935

Philadelphia Utilities Rehab Water Plant 39350 2963 7477 $500,000 $1,723,000
$35,646,935

N.E. Itawamba Water Association Rehab/ Replacement of Existing Facilities 38847 2943 4700 $364,725 $810,500
$36,457,435

Pearl, City of New Elevated Water Tank 39208 2485 26500 $0 $4,800,000 $41,257,435

Project Project Title Zip Priority Service Area Eligible Loan Amount Statewide

Code Points Population PF Amount Requested Cum. $
------FUNDING LINE------

Brookhaven, City of Rehab/ Replacement of Existing Facilities 39206 2042 12500 $500,000 $3,870,350 $45,127,785

Magee, City of Rehab Existing Facilities 39111 1728 4800 $303,450 $867,000 $45,994,785

Alcorn Co. Water Association Renovate Elevated tanks/Replace Water Lines 38834 1718 6500 $500,0000 $2,146,021 $48,140,806

Midway Community Water Association Distribution Improvements 39039 1667 1680 $279,000 $620,000 $48,760,806

Hattiesburg, City of Rehab/ Replacement of Existing Facilities 39403 907 41951 $500,000 $5,000,000 $53,760,806

Bay St. Louis, City of New Elevated Storage Tank 39520 890 9284 $500,000 $3,016,250 $56,777,056

Hancock County Water & Sewer District New 250,000 gallon Elevated Storage Tank 39556 751 5570 $500,000 $4,968,114
$61,745,170

Clarksdale Public Utilities Replacing Wells and Distribution 39814 732 17962 $500,000 $15,110,000
$76,855,170

Union, City of Rehab/ Replacement of Existing Facilities 39365 636 1897 $460,013 $3,066,750
$79,921,920

Mooreville-Richmond Water Association Tie-in/ Distribution Improvements 38857 515 107880 $500,000 $11,350,000
$91,271,920

Bay St. Louis, City of Distribution Improvements 39250 494 9284 $500,000 $5,429,250
$96,701,170

Magnolia, City of Rehab/ Replacement of Existing Facilities 39652 471 2420 $500,000 $2,798,860
$99,500,030

Jumpertown ,Town of Rehab/ Replacement of Existing Facilities 38829 345 1150 $500,000 $2,458,600
$101,958,630

Raymond, City of Replace Water Mains/Hydrants/Rehab Storage Tank 39154 324 2894 $360,000 $2,400,000
$104,358,630

Crawford, Town of Elevated Tank Rehabilitation 39743 257 631 $500,000 $2,086,400
$106,445,030

Stonewall, Town of Rehab/ Replacement of Existing Facilities 39363 220 933 $500,000 $3,300,725
$109,745,755

North District One Water Association New Well 38967 199 787 $500,000 $2,000,000
$111,745,755

Hickory, Town of New Well/ Elevated Tank/ Pipe Extension 39332 189 1000 $500,000 $4,629,771
$116,375,526

Crenshaw, Town of Elevated Storage Tank, Distribution Improvements 38621 163 588 $500,000 $3,169,810
$119,545,336

Eskridge Rose Hill Water Association Emergency Tie-In 38925 132 343 $500,000 $1,500,000
$121,045,336

Kiln Utility & Fire District Replace 2 Miles of Waterline 39556 95 6349 $500,000 $4,474,250
$125,519,586

Poplar Springs Water District Rehab/ Replacement of Existing Facilities 39114 88 1188 $500,000 $4,534,031
$130,053,617

Okalona, City of Rehab/ Replacement of Existing Facilities 38860 73 2700 $500,000 $2,592,250
$132,645,867
Category XIII: Other

Verona, City of New Generator 38879 18098 3019 $54,900 $122,000 $132,767,867

Notes: See section VI.B. of this document for more details. Applications exceeding a loan request of $5,000,000 require further approval by the Board. See section IV.C.1 of this document.

The “Eligible PF Amount” listed here is based on the process outlined for the base cap grant allotment (Section VI.A.5a). Potential Loan Recipients ranked highest on the program’s
Priority List serving a population with a Median Household Income less than $52,719 (MS MHI) will be eligible to receive BIL funding that allows for 100% principal forgiveness loans
to the extent funding allows (Section VI.A.5b).

The Funding line was set to conform with the program’s SFY 2025 budget authority ($45,000,000).

FFY-2024 Planning List
FINAL
Fiscal Year - 2025 and After Planning List
Mississippi Drinking Water Systems Improvements Revolving Loan Fund Program
Projects included on the Planning List did not meet all submission deadlines, are not projected to be ready to proceed during the FFY, or had multiple requests and
asked to be placed on the Planning List. These projects have been ranked on the Planning List based on information provided on the submitted Request for Ranking Form.
A determination of a project’s program eligibility cannot be completed until the facilities plan has been submitted and reviewed.

Project Project Title Zip Priority Service Area Eligible Loan Amount Loan Amount

Code Points Population PF Amount Requested Cumulative
Category III: Primary Drinking Water Standards Projects

Smithville, Town of Water Treatment Plant Repair 38870 4598 2004
$0 $142,636 $142,636
Edwards, Town of New Charcoal Filtration System 39066 260 1050 $0 $2,685,000 $2,827,636
Category IV: One Well Projects

Winterville Water Association New Water Well 38703 64 108 $456,435 $1,014,300 $3,841,936
Falcon, Town of Back-up Well, Distribution Improvements 38670 35 96 $500,000 $1,998,676 $5,840,612
Category VII: System Capacity Expansion to Serve Existing Unserved Residences/Businesses

Bernard Bayou Industrial District Paint 2 Elevated Storage Tanks 39503 846 6000 $0 $354,675 $6,195,287
Jackson Co. Utility Authority Expansion to Unserved Area/ Consolidation 39567 63 12000 $0 $5,000,000 $11,195,287
Category VIII: Back-up Water Supply Sources Projects

Aberdeen, Town of 400 P Well/100,000 Gal. Elev.Tank/Rehab Lines 39730 3127 6415 $500,000 $1,481,949 $12,677,236
Eupora, City of New Water Well 39744 1659 5564 $308,250 $1,233,000 $13,910,236
Central Water Association Rehab/ Replacement of Existing Facilities 39350 415 20143 $0 $11,370,738 $25,280,974
Braxton, Town of Construction of New Well 39044 288 775 $0 $819,000 $26,099,974
Category IX: Existing Facilities Upgrade (Meeting Primary Standards)

CS&I Water Association Rehab/ Replacement of Existing Facilities 39150 6450 945 $0 $80,000 $26,179,974
Highway 28 Water Association Distribution Improvements 39111 5327 1500 $36,750 $105,000 $26,284,974
Crystal Springs, City of Rehab/ Replacement of Existing Facilities 39059 5271 5050 $138,880 $396,800 $26,681,774
Carthage, City of Rehab/ Replacement of Existing Facilities 39051 5079 5075 $255,150 $567,000 $27,248,774
Natchez Water Works Rehab/ Replacement of Existing Facilities 39121 3756 15792 $500,000 $3,250,000 $30,498,774
Central Yazoo Water Association Elevated Water Tank & SCADA Upgrades 39194 2740 9960 $0 $1,500,000 $31,998,774
West Tallahatchie Utilities Association Rehab/ Replacement of Existing Facilities 38966 2282 7500 $0 $1,643,067 $33,641,841
Bassfield, Town of Well Rehabilitation 39241 2101 1165 $0 $332,718 $33,974,559
Clinton, City of New Well/ Distribution Improvements 39056 2010 28100 $435,000 $4,084,100 $38,058,659

Project Project Title Zip Priority Service Area Eligible Loan Amount Loan Amount

Code Points Population PF Amount Requested Cumulative
Bear Creek Water Association Replace Tank With New 2 Mil Gal Tank 39046 1534 45000 $0 $4,890,000 $42,948,659
Sunnyhill Water Association New 500 gpm Well/ Booster Station/ Water Main 39649 1450 3828 $0 $1,500,000 $44,448,659
Webb, Town of Repair/Rehab Water Tank 38966 1250 586 $105,840 $235,200 $44,683,859
Lewisburg Water Association New Treatment Plant/ New 500,000 gallon Well 38654 1234 8277 $0 $2,683,000 $47,366,859
Crystal Springs, City of Water System Improvements 39059 1083 5050 $500,000 $1,931,368 $49,298,227
Canton Municipal Utilities Water System Improvements 39046 1036 8000 $500,000 $2,825,000 $52,123,227
H&H Water System, Inc. Distribution Improvements 39080 1030 3012 $367,500 $1,050,000 $53,173,227
Hattiesburg, City of Rehab/ Replacement of Existing Facilities 39403 907 45951 $500,000 $15,000,000 $68,173,227
Isola, Town of Rehab/ Replacement of Existing Facilities 38754 903 713 $209,250 $465,000 $68,638,227
Batesville, City of New Well/ Storage Tank 38606 820 9973 $500,000 $4,482,780 $73,121,007
Casey Jones Water Association Rehab/ Replacement of Existing Facilities 39179 713 1112 $405,000 $900,000 $74,021,007
Shannon, Town of Rehab/ Replacement of Existing Facilities 38868 691 1850 $0 $1,079,325 $75,100,332
Metcalfe, Town of Rehab/ Replacement of Existing Facilities 38760 678 1125 $424,125 $942,500 $76,042,832
Bolton, Town of Rehab/ Replacement of Existing Facilities 39041 665 640 $118,188 $337,681 $76,380,513
Quitman, City of Rehab/ Replacement of Existing Facilities 39355 607 2386 $500,000 $2,613,060 $78,993,573
Harland Creek Water Association Rehab/ Replacement of Existing Facilities 39095 554 1338 $500,000 $2,484,300 $81,477,873
Acona Water Assocaiation Rehab/ Replacement of Existing Facilities 39095 549 1550 $500,000 $1,419,800 $82,897,673
East Madison Water Association Distribution Improvements 39046 544 7265 $500,000 $5,000,000 $87,897,673
Poorhouse Water Association New Main, Distribution Improvements 38902 494 4550 $0 $2,543,800 $90,441,473
Mendenhall, City of New 500 GPM Well/250,000 Gal Tank/Treatment Plant 39114 476 2504 $500,000 $2,634,100 $93,075,573
Topisaw Creek Water Association Rehab/ Replacement of Existing Facilities 39662 473 4910 $477,750 $3,185,000 $96,260,573
Greenville, City of Rehab Facilities 38701 459 30000 $500,000 $40,000,000 $136,260,573
Looxahoma Water Association Distribution Improvement/ AMR Upgrade 38668 457 686 $0 $500,000 $136,760,573
Youngs Water & Sewer District New 100,000 Gal. Elevated Storage Tank 38922 436 925 $0 $1,055,673 $137,816,246
Lake Eddins Rehab/ Replacement of Existing Facilities 39347 419 294 $500,000 $1,369,941 $139,186,187
Big Field Water Association Rehab/ Replacement of Existing Facilities 38646 371 599 $383,426 $852,057 $140,038,244
Paynes Water Association Rehab Existing Facilities 38921 330 549 $0 $917,061 $140,955,305
Lumberton, City of Replace Existing Water Lines/Mains 39455 328 2200 $500,000 $3,453,197 $144,408,502
Fannin Water Association New 300,000 Gal Tank 39047 297 6500 $0 $3,372,320 $147,780,822
Morton, City of New Well/ New Water Mains/ Rehab Tank 39117 292 7000 $0 $7,000,000 $154,780,822
Mize, Town of New Well 39116 287 537 $0 $737,000 $155,517,822
East Leflore Water & Sewer District Rehab/ Replacement of Existing Facilities 38930 264 5161 $500,000 $11,168,871 $166,686,693
Cross-Roads Water Association Rehab/ Replacement of Existing Facilities 38916 221 1600 $500,000 $3,057,336 $169,744,029
Hatten Water Association New Facility, New Well, New Water Mains 39168 180 1182 $500,000 $2,304,648 $172,048,677

Project Project Title Zip Priority Service Area Eligible Loan Amount Loan Amount

Code Points Population PF Amount Requested Cumulative
Highway 98 East Water Association Replace Approx. 50,000 LF Water Mains 39429 172 1650 $500,000 $1,220,000 $173,268,677
Pachuta, Village of Rehab/ Replacement of Existing Facilities 39347 165 143 $426,665 $948,145 $174,216,822
Starkville, City of Replace Existing Water Main 39759 162 25339 $0 $1,850,000 $176,066,822
McCarley Water Association Rehab/ Replacement of Existing Facilities 38943 153 647 $0 $2,394,289 $178,461,111
Sardis, City of Distribution Improvements 38666 138 1756 $500,000 $1,788,550 $180,249,661
Neely Utilities New Storage/ Extend to Unserved Area 39461 132 499 $0 $1,343,992 $181,593,653
Winterville Water Association Rehab/ Replacement of Existing Facilities 38703 130 90 $233,100 $518,000 $182,111,653
South Newton Rural Water Association Rehab Treatment Plant 39345 128 3010 $0 $7,191,247 $189,302,900
Cleaveland, City of Rehab Existing Facilities 38732 119 12000 $500,000 $2,114,701 $191,417,601
Pittsboro, Town of Rehab/ Replacement of Existing Facilities 38951 100 1077 $0 $4,055,512 $195,473,113
Morgan City Water Association Rehab/ Replacement of Existing Facilities 38946 97 250 $0 $1,552,953 $197,026,066
Lake Water Works Tank Rehab, New Water Mains 39092 69 439 $0 $3,300,400 $200,326,466
Mount Olive, Town of New Water Treatment Plant 39119 51 982 $0 $2,000,000 $202,326,466
Valley Park Water Association Water System Improvements 39177 23 448 $175,077 $500,221 $202,826,687
Harrison Co. Utility Authority Distribution Improvements 39503 21 624 $500,000 $6,950,000 $209,776,687
Category XII: Consolidation Projects

Jackson Co. Utility Authority Consolidation 39567 53 75000 $0 $31,750,000 $241,526,687
Jackson Co. Utility Authority Consolidation 39567 49 75000 $0 $1,270,000 $242,796,687
Jackson Co. Utility Authority Consolidation 39567 22 6600 $0 $279,400 $243,076,087
Jackson Co. Utility Authority Consolidation 39567 0 12000 $0 $2,540,000 $245,616,087

Note: See section VI.B. of this document for more details. Applications exceeding $5,000,000 amount require further approval by the Board. See section IV.C.1 of this document.

VIII. EXPECTED PUBLIC HEALTH OUTCOMES & PERFORMANCE
MEASURES

The objective of this program is to disperse all available loan and grant funds in a timely
manner to achieve the public health protection benefits resulting from the projects
identified in the FFY-2024 IUP, and to ensure compliance with loan agreements, as
required by state and federal laws and regulations.

By implementing the FFY-2024 IUP and funding projects shown on the FFY-2024 Priority
List (Section VII), the Board will have the means to plan for and fund projects that will
address the most serious public health risks facing the public water supply systems in the
state. Funding of the system projects will be determined by the amount of funding to be
received for FFY-2024.

The success of the DWSIRLF Program will be defined by the ability of the MSDH to
successfully meet commitments in the FFY-2024 DWSRF Work Plan.

Additionally, the majority of the projects as proposed should have minimal impact on the
environment due to the nature of their design. Where necessary, appropriate environmental
reviews will occur and proper permitting through the Mississippi Department of
Environmental Quality will be required to ensure minimal impact on the environment.

APPENDICES

APPENDIX A
DRINKING WATER SYSTEMS IMPROVEMENTS REVOLVING LOAN FUND PROGRAM
ANTICIPATED FUNDS REPORT - July 1, 2024
FFY-2024 (OCT. 1, 2023 - SEPT. 30, 2024)
Funding (Federal and State)
National Title I DWSRF Appropriation - Mississippi's Allotment + $5,837,000
State Match Required (20% of Mississippi's Allotment) + $1,167,400
SRF Supplemental Allotment

+ $28,785,000
State Match Required (20% of Mississippi's Allotment) + $5,757,000
Wyoming 2021 Reallotment + $30,000
State Match Required (20% WYs Reallotment) + $6,000
Capitalization Grant for DWSRF w BIL Supplemental = $41,582,400

State Match Status
State Match Required + $6,924,400
Legislated State Match (HB)) - $7,670,600
Remaining State Match Required = $740,200

Cap Grant Set-Asides
DWSRF Administrative Expenses [SDWA Sec. 1452(g)(2) - 4%] + $402,873
Small Systems Technical Assistance [SDWA Sec. 1452(g)(2) - 2%] + $112,407
Local Assistance and Other State Program [SDWA Sec. 1452(k)(2) - 15%] + $583,700
State Program Management [SDWA Sec. 1452(g)(2) -10%] + $570,845
BIL Administrative Expenses [SDWA Sec. 1452(g)(2) - 4%] + $495,112
BIL Small Systems Technical Assistance [SDWA Sec. 1452(g)(2) - 2%] + $77,425
BIL Local Assistance and Other State Program [SDWA Sec. 1452(k)(2) - 15%] + $2,636,800
BIL State Program Management [SDWA Sec. 1452(g)(2) -10%] + $1,091,235
Total Cap Grant Set-Asides = $5,970,397

Cap Grant Funds Available for Loan Obligation
DWSRF Capitalization & BIL Supplemental Grants + $41,546,400
Cap Grant Set-asides - ($1,677,825)
BIL Supplemental Set-asides - ($4,300,572)
Total Cap Grant Funds Available for Loan Obligation = $35,612,003
Funds Anticipated to be Available for Loan Awards
Cap Grant Federal and State Funds Anticipated to be Available for Loan Obligation + $35,612,003
Unobligated Funds Carried Over from FFY-2022 + $21,774,897
Loan Repayments (P&I) Deposited to the Fund 10/01/23 - 09/30/24 + $14,865,535
Interest Earned on Deposits to the Fund 10/01/22 - 06/30/23 + $2,578,939
Loan Increase Reserve

- ($2,000,000.00)
Total Funds Anticipated to be Available for Loan Awards = $72,831,374

APPENDIX B - PROJECTED SCHEDULE OF OUTLAYS
FOR CAPITALIZATION GRANT SET-ASIDES

FFY 2023 Cap Grant & BIL Supplemental
Federal Set-Asides FFY 2023 Q1 FFY 2023 Q2 FFY 2023 Q3 FFY 2023 Q4 Totals
Administrative
$101,449 $101,449 $101,449 $101,449 $405,797
$124,526 $124,526 $124,526 $124,526 $498,102
Small System Tech Assist.
$35,474 $35,474 $35,474 $35,474 $141,898
$7,438 $7,438 $7,438 $7,438 $29,750
Local Asst. & Other St. Programs
$187,500 $187,500 $187,500 $187,500 $750,000
$483,200 $483,200 $483,200 $483,200 $1,932,800
State Program Management.
$188,600 $188,600 $188,600 $188,600 $754,400
$0 $0 $0 $0 $0
Base Cap. Grant Total: $513,024 $513,024 $513,024 $513,024 $2,052,095
BIL Supplemental Cap. Grant Total: $615,163 $615,163 $615,163 $615,163 $2,460,652
Total: $1,128,187 $1,128,187 $1,128,187 $1,128,187 $4,512,747

FFY 2024 Cap Grant & BIL Supplemental

Federal Set-Asides
FFY 2024
Q1
FFY 2024
Q2
FFY 2024
Q3
FFY 2024
Q4
Totals
Administrative
$102,718 $102,718 $102,718 $102,718 $402,873
$123,778 $123,778 $123,778 $123,778 $495,112
Small System Tech Assist.
$28,102 $28,102 $28,102 $28,102 $112,407
$19,356 $19,356 $19,356 $19,356 $77,425
Local Asst. & Other St. Programs
$145,925 $145,925 $145,925 $145,925 $583,700
$659,200 $659,200 $659,200 $659,200 $2,636,800
State Program Management
$142,711 $142,711 $142,711 $142,711 $570,845
$272,809 $272,809 $272,809 $272,809 $1,091,235
Base Cap. Grant Total: $419,456 $419,456 $419,456 $419,456 $1,677,825
BIL Supplemental Cap. Grant Total: $1,075,143 $1,075,143 $1,075,143 $1,075,143 $4,300,572
Total:
$1,494,599 $1,494,599 $1,494,599 $1,494,599 $5,970,397

Appendix C - Projected Payment (Federal Letter of Credit) Schedule
(Schedule of Increases to ACH Ceiling)

FFY-2023

FFY-2023
Cap Grant
No. 1 of 4
1
st
Quarter
FFY-2024
$1,886,000
$4,842,000
$1,886,000
$4,842,000
$6,728,000
FFY-2023
Cap Grant
No. 2 of 4
2nd Quarter
FFY-2024
$1,886,000
$4,842,000
$3,772,000
$9,684,000
$13,456,000
FFY-2023
Cap Grant
No. 3 of 4
3rd Quarter
FFY-2024
$1,886,000
$4,842,000
$5,658,000
$14,526,000
$20,184,000
FFY-2023
Cap Grant
No. 4 of 4
4th Quarter
FFY-2024
$1,886,000
$4,842,000
$7,544,000
$19,368,000
$26,912,000

FFY-2024

FFY-2024 1
st
Quarter $1,459,250 $1,459,250
Cap Grant FFY-2025 $7,196,250 $7,196,250
No. 1 of 4

$8,655,500
FFY-2024 2nd Quarter $1,459,250 $2,918,500
Cap Grant FFY-2025 $7,196,250 $14,392,500
No. 2 of 4

$17,311,000
FFY-2024 3rd Quarter $1,459,250 $4,377,750
Cap Grant FFY-2025 $7,196,250 $21,588,750
No. 3 of 4

$25,966,500
FFY-2024 4th Quarter $1,459,250 $5,837,000
Cap Grant FFY-2025 $7,196,250 $28,785,000
No. 4 of 4

$34,622,000

Amount Cumulative
FFY-2021 1
st
Quarter $0 $0
Cap Grant FFY-2025
FFY-2021 2nd Quarter $30,000 $30,000
Cap Grant FFY-2025
FFY-2021 3rd Quarter $0 $30,000
Cap Grant FFY-2025
FFY-2021 4th Quarter $0 $30,000
Cap Grant FFY-2025

APPENDIX D - PROJECTED SCHEDULE OF DRAWDOWNS AGAINST FEDERAL
LETTER OF CREDIT
(ACH DRAW SCHEDULE)

FFY-2023
Outlay
Quarter
Federal Outlay
Amount
Cumulative Outlay
Amount
1
st
Quarter $1,886,000
$4,842,000
$1,886,000
$4,842,000
$6,728,000
2nd Quarter $1,886,000
$4,842,000
$3,772,000
$9,684,000
$13,456,000
3rd Quarter $1,886,000
$4,842,000
$5,658,000
$14,526,000
$20,184,000
4th Quarter $1,886,000
$4,842,000
$7,544,000
$19,368,000
$26,912,000

FFY-2024

Quarter Federal Outlay Amount Cumulative Outlay Amount
1
st
Quarter
$1,459,250 $1,459,250
$7,196,250 $7,196,250
2nd Quarter
$1,459,250 $2,918,500
$7,196,250 $14,392,500
3rd Quarter
$1,459,250 $4,377,750
$7,196,250 $21,588,750
4th Quarter
$1,459,250 $5,837,000
$7,196,250 $28,785,000
$34,622,000

Amount Cumulative
FFY-2021 1
st
Quarter $0 $0
Cap Grant FFY-2025
FFY-2021 2nd Quarter $30,000 $30,000
Cap Grant FFY-2025
FFY-2021 3rd Quarter $0 $30,000
Cap Grant FFY-2025
FFY-2021 4th Quarter $0 $30,000
Cap Grant FFY-2025

APPENDIX E - MISSISSIPPI SMALL SYSTEMS TECHNICAL ASSISTANCE
SET-ASIDE WORK PLAN

INTRODUCTION
The Mississippi State Department of Health (MSDH), Bureau of Public Water Supply
(Department), proposes to use the Small Systems Technical Assistance Set-Aside of the
DWSRF in an assistance and training program directed at improving the technical,
managerial, and financial capabilities of small community public water systems in the state.
The goal of this program is to assure that assistance is provided to all small community public
water systems that require such assistance to maintain adequate technical, financial, and
managerial capabilities necessary to comply with requirements of the SDWA.

SELECTION PROCESS
The current technical assistance contracts expire on June 30, 2024.

Prior to the expiration of the existing contracts an Invitation for Bids (IFB) for the technical
assistance contracts will be sent out to potential contractors. All proposals will be evaluated
by the Department and recommendations for award will be presented to the Board (at a
regularly scheduled Board meeting); all contracts will be awarded.

The contracts for technical assistance are currently awarded to:

• Small Systems Technical Assistance (long-term and intermediate technical assistance)
– Communities Unlimited;
• Board Management Training Monitoring and Coordination for Water System Officials
- Mississippi State University Extension Service;
• Hands-On Operator Training - MS Water and Pollution Control Operators Association;
• PEER Review Program for Public Water Supplies - Mississippi Rural Water
Association, Inc.;
• Asset Management - Mississippi Rural Water Association, Inc.

PROGRAM ACTIVITIES
The technical assistance program consists of five major categories of activities that will be
accomplished through contracts with qualified organizations that are experienced in providing
the type of support required by each activity. These categories may be updated and/or revised
as a result of work plan reviews that will be conducted annually during the life of the program.
Amendments will be submitted whenever activities or budgets change and when required to
extend the term of the work plan.

Small Systems Technical Assistance:

Comprehensive and Intermediate technical assistance shall be provided to an equivalent of
twelve (12) small public water systems annually.

1. Long-term technical assistance:
Comprehensive assistance must be provided to a minimum of six (6) small public water
systems for the contract period. The MSDH – Bureau of Public Water Supply will
provide the contractor a list of systems that are to receive this assistance. Within 30
days of the start date for that contract year, the contractor will identify, with the help of
MSDH, systems that will receive comprehensive technical assistance, complete an
initial assessment of the needs of each system and develop a work plan for each water
system. The contractor shall submit an assessment and work plan for each system to
MSDH for approval prior to initiating technical assistance. MSDH shall use its latest
report of Capacity Ratings of Public Water Systems, along with the recommendations
of MSDH staff and the contractor, to identify those public water systems that are to
receive this assistance.

Activity Objective - provide long-term on-site comprehensive technical assistance to resolve
problems identified by contractor. A minimum of six (6) systems will be chosen from a prepared
list.

Reporting/Evaluation - written progress reports using a format approved by MSDH will be
furnished monthly to MSDH and members of the Board by the contractor. The reports shall
identify progress made on the work plan developed for each system. The contractor shall meet
with the Board on a quarterly basis to update the Board on accomplishments under this contract
and answer any questions the Board might have regarding the implementation of this contract.

2. Intermediate technical assistance:
This assistance is selective in nature and consists of one or more additional contact or
non-contact hours for public water systems previously receiving short-term assistance
or systems not requiring comprehensive long-term assistance. Selection of systems
will be based on the list supplied by MSDH for the remaining public water systems
from the initially prepared list.

Intermediate technical assistance projects will be counted toward the minimum twelve
(12) required comprehensive projects at a ratio of 2:1 (two intermediate projects will
be the equivalent of one comprehensive project).

Activity Objective - provide intermediate on-site technical assistance to selected systems covering
the subject(s) determined by the contractor to be most needed.

Reporting/Evaluation - written progress reports using a format approved by MSDH will be
furnished monthly to MSDH and members of the Board by the contractor. The reports shall
identify the assistance provided to each system. The contractor shall meet with the Board on a
quarterly basis to update the Board on accomplishments under this contract and answer any
questions the Board might have regarding the implementation of this contract.

Coordination and Monitoring of Board Management Training for Water System Officials:

Section 41-26-101 of the Mississippi Code of 1972, Annotated, states “Each member elected
or reelected after June 30, 1998, to serve on a governing board of any community public water
system, except systems operated by municipalities with a population greater than ten thousand
(10,000), shall attend a minimum of eight (8) hours of management training within two (2)
years following the election of that board member. If a board member has undergone training
and is reelected to the board, that board member shall not be required to attend training. The
management training shall be organized by the MSDH. The management training shall include
information on water system management and financing, rate setting and structures, operations
and maintenance, applicable laws and regulations, ethics, the duties and responsibilities of the
association and other organizations. The Department shall develop and provide all training
materials. To avoid board members having to interfere with their jobs or employment,
management training sessions may be divided into segments and, to the greatest extent
possible, shall be scheduled for evening sessions. The Department shall conduct management
training on a regional basis.” The contractor shall: serve as the coordinator for MSDH in
regards to all activities related to the implementation of the training program in the state;
randomly attend training sessions to ensure the established curriculum is being followed and
that the curriculum is relevant and effective; manage the Board Member Training Curriculum
Review Committee; continue to update the established computerized database to accurately
track the most current status of each board member attending the program; and other related
duties.

Activity Objective - manage those activities related to the effective training of the members of
the governing boards of small community public water systems.

Reporting/Evaluation - Randomly attend at least two sessions/contract year/training
organization unannounced and furnish both MSDH and the Board members a written report
within 7 days of attendance including the following information: review of presentation by
trainer(s); any needed remedial action; attendee comments; attendance roster; and other related
items. Written and oral quarterly reports shall be furnished to MSDH and the Board members
that include: attendee evaluation of the trainers and training material; contractor evaluation of
trainer(s); attendee comments; attendance rosters; needed remedial action; curriculum review
committee meetings; itemized costs of training organization(s). Monthly reports containing the
above information shall be submitted to MSDH along with the invoices for work performed
under the contract. MSDH, affected board members, and affected entities shall be provided with
periodic reports listing those board members who have not completed the board member training
and the time remaining for completion of the training.

Hands-On Operator Training:

The Contractor will provide practical, applied, “hands-on” training for public water system
operators in the State of Mississippi. MSDH defines hands-on operator training for the
purposes of this contract as training that provides functional instruction in the necessary skills
and knowledge to be able to better fulfill the job requirements of a drinking water system

operator. The hands-on training will include a comprehensive approach (lecture plus physical,
hands-on sessions with equipment) for all operators attending the training. Trainings are to
include equipment/props pertinent to the training topic(s) as a part of the training discussion.

Activity Objectives - Provide a minimum of fourteen (14) hands-on operator training sessions
within the year.

Reporting/Evaluation - written quarterly reports using a format approved by MSDH on Hands-
On Operator Training. The reports shall include but are not limited to: a) details of sessions
conducted; b) number of attendees and their comments; c) related problems that occurred during
or as a result of a training session and any solution(s); d) an itemized list of the costs incurred
by the training organization; and e) other related items. The contractor shall meet with the Board
on a quarterly basis to update the Board on accomplishments under this contract and answer any
questions the Board might have regarding the implementation of this contract.

Peer Review Assistance:
Through the use of trained volunteers, this assistance will be conducted on-site with the
systems either selected from a list provided to the contractor by MSDH or with prior MSDH
approval. A cooperative agreement between the contractor and the Mississippi Water and
Pollution Control Operators’ Association will help provide qualified volunteers to serve as
peer review team members. There will be a goal of a minimum of fourteen (14) Peer reviews
per contract year with a minimum of three (3) peer reviews per quarter. Each volunteer shall
be paid $75 per day for each actual peer review in which the volunteer participates. The
contractor will maintain a directory of trained volunteers.

Activity Objectives - provide short-term (less 8 contact hours) on-site technical assistance to
selected systems covering the subject(s) determined by the contractor to be most needed.

Reporting/Evaluation - copies of all completed peer review reports will be provided to both
MSDH and the Board within 30 days of completion of each peer review. Written progress
reports using a format approved by MSDH will be furnished monthly to MSDH and members
of the Board by the contractor. The name of the system undergoing the peer review shall be
removed and be identified by a code only known to the contractor. The report shall include: an
assessment of which type of capacity was the worst at the time of the visit; a listing of all
suggested remedial action; officials present shall be listed by title; an evaluation form
(previously approved by MSDH) rating the assistance provided that was completed by the
system; any conditions currently or potentially endangering public health; and any other related
items. The contractor shall meet with the Board on a quarterly basis to update the Board on
accomplishments under this contract and answer any questions the Board might have regarding
the implementation of this contract.

Asset Management Training:

The Contractor will provide practical, applied, asset management training for public water
system operators in the State of Mississippi using the guidance provided by the EPA in its
publication titled “Asset Management: A Best Practices Guide”. Training will be provided at
three different locations in the state, one per Public Health Region and will be provided at no
cost to attendees.

Activity Objectives - provide asset management training to water system operator statewide.

Reporting/Evaluation - written quarterly reports using a format approved by MSDH. The reports
shall include but are not limited to: a) details of sessions conducted; b) number of attendees and
their comments; c) related problems that occurred during or as a result of a training session and
any solution(s); d) an itemized list of the costs incurred by the training organization; and e) other
related items. The contractor shall meet with the Board on a quarterly basis to update the Board
on accomplishments under this contract and answer any questions the Board might have
regarding the implementation of this contract.

AGENCY RESPONSIBILITIES

The MSDH will conduct Small Systems Technical Assistance Set-aside activities through
Board approved contracts with providers who will be selected following procedures of the
State of Mississippi’s Department of Finance and Administration Public Procurement Review
Board. Contracts of a regulatory nature will be handled solely by MSDH. All providers will
report to and be responsible to the MSDH for all contract activities. No additional full time
equivalent (FTE) requirement is anticipated for state agencies to implement the provisions of
this set-aside.

APPENDIX F - Mississippi State Program Management
Set-Aside Annual Work Plan
Section 1452(g)(2) - Safe Drinking Water Act Amendments of 1996

PUBLIC WATER SYSTEM MANAGEMENT PROGRAM
BACKGROUND

This work plan describes how the Drinking Water State Revolving Fund (DWSRF) State
Program Management set-aside funds will be expended to support the Public Water Systems
Supervision (PWSS) Program.

After review of the Draft FFY-2024 Intended Use Plan (IUP) by the Local Governments &
Rural Water Systems Improvements Board (Board), the Board will authorize the publication
of a legal notice in The Clarion-Ledger for the IUP. The notice will request the public to
provide comments on the Draft FFY-2024 Intended Use Plan (IUP). The IUP reserves 10%
of the state’s Drinking Water State Revolving Fund (DWSRF) capitalization grant for the
State Program Management activities to support the MSDH PWSS Program as allowed under
Section 1452(g)(2) of the SDWA Amendments of 1996.

After a public notice period of at least twenty-five (25) days, an oral proceeding will be held
to receive and consider comments from the public on the Draft IUP. After the resolution of
any comments from the public, the Final FFY-2024 IUP will be presented to the Board for
adoption at their next scheduled Board meeting. After adoption by the Board, a second filing
with the Secretary of State’s Office occurs. The Final FFY-2024 IUP will be effective thirty
(30) days from the date of the second filing with the Secretary of State’s Office.

FUNDING AMOUNT (Standard Capitalization Grant)

The state reserves 10% ($754,400) of the FFY-2024 DWSRF capitalization grant as a set-
aside for State Program Management activities of the PWSS Program. The reserved amount
will offset the salary, fringe, and indirect cost expenses of a portion of the PWSS personnel
positions in the PWSS Program.

NUMBER OF FTE’s PROJECTED FOR IMPLEMENTING THIS SET-ASIDE

The state projects twenty-eight (28) full time equivalents (FTE) will be required to
implement the FFY-2024/2024 PWSS Program.

GOALS, OBJECTIVES, OUTPUT, AND DELIVERABLES

One of the set-asides authorized under the 1996 SDWA amendments is the management of
the state program, which can be funded by up to 10% of the federal allotment. These funds
will support public water system supervision program activities as required to maintain state
primacy and to support the activities of the DWSIRLF. MSDH’s PWSS Work Plan outlines
in detail the aspects of the PWSS that are supported by this set-aside. Items covered by the

set-aside include: (1) State Primacy Requirements, (2) Non-Primacy Requirements, and (3)
Auxiliary Services.

Primacy Requirements

As required to maintain state primacy, MSDH maintains the PWSS programs on an ongoing
or as-needed basis. These programs include: revising current primacy programs by adopting
new Federal regulations as needed; coordinating for Mid-Year and End-of-Year review with
EPA Regional Office; maintaining a sanitary survey program with discrepancy follow-up;
participating in state data verification audits; ensuring public water systems (PWSs) are
utilizing approved laboratories and a certification program for those laboratories is in place;
participating in the EPA Regional oversight; operating in accordance with requirements of
the National Primary Drinking Water Regulations; maintaining an active water system design
and construction plan and specification review program; ensuring labs used by PWSs within
the state are capable of the workload created by regulations; participating in PWS and PWSS
training on rule requirements; informing EPA Region 4 of any special state initiatives under
the rules or provisions of the SDWA; maintaining records for all rule/policies, enforcing
reporting and record keeping as required; maintaining appropriate administrative penalty
authority; implementing the PWS definition; attending State/EPA planning and
implementation meetings; ensuring that newly permitted PWSs have design/construction
capable of compliance with the present and upcoming SDWA regulations; ensuring
analytical methods are being applied to demonstrate compliance with the regulations;
notifying (if necessary) EPA of intent not to adopt or implement any portion of the rules; and
responding to EPA requests for information or verification of state rules implementation.

Additionally, MSDH will provide annual summaries of the status of: each effective variance
and exemption to EPA; community PWSs that are allowed to monitor less frequently than
monthly; and non-community PWSs that are allowed to monitor less frequently than
quarterly to EPA. MSDH will also oversee and enforce requirements for rules and
regulations adopted with approved federal primacy. These regulations include the SDWA
and all applicable rules present and future, primacy packages, and extension agreements of
the SDWA.

Non-primacy Requirements

In addition to the requirements of the PWSS program, monies from this set-aside provide
support to activities that are of a non-primacy nature. Those activities are not required to
maintain state primacy. However, to run a highly effective, efficient program and most
importantly protect the public health, these activities are vital.

Capacity Development (CD) Program

As required by the SDWA, each state is required to develop and implement a Public
Water System Capacity Development Program in order to receive full funding annually
under the DWSRF Program. Public water system capacity assessment is a full evaluation
of the PWS’s technical, managerial, and financial ability to provide safe drinking water to

its customers by complying with all state and Federal regulations. In accordance with the
Federal requirements, MSDH has developed and implemented a CD program for both
new and existing PWSs. The MSDH CD program takes the form of a rating that each
community water system (CWS) and non-transient non-community water system
(NTNCWS) receives at their annual sanitary survey. The criteria used in the rating
system incorporate laws, regulations, and other valuable information to evaluate the areas
of technical, managerial, and financial capacity. The program is also designed to evolve
from year-to-year through an annual meeting of an advisory committee that will make
suggestions as to possible changes and/or additions to the rating criteria. As required by
regulation, an annual report is made to the Governor on the efficacy of the strategy and
progress towards improving the capacity of PWSs in the state. Additionally, annual
documentation of ongoing implementation of the CD strategy is to be provided with
DWSRF Capitalization Grant application.

Unregulated Contaminant Monitoring Rule

This particular aspect of the PWSS involves informing systems with populations greater
than 10,000 in the state monitoring plan of their responsibilities to monitor for
Unregulated Contaminant Monitoring Rule; assisting the EPA in sampling systems in the
state monitoring plan as determined by the state and EPA in the UCMR Partnership
Agreement; adding vulnerable systems to the plan for monitoring UCMR List 3
contaminants based on guidance; review UCMR data from public water systems to
ensure that it meets quality assurance and PWS reporting requirements necessary;
informing EPA of potential changes needed in the data and, with mutual agreement of the
state and EPA, make changes to the data; and responding as requested by the EPA for
information on verification of state UCMR implementation.

Operator Certification

As mandated by the SDWA to maintain full funding for the DWSIRLF, operator
certification is an essential part of the PWSS program. Activities required to maintain the
operator certification program include: providing documentation and evaluation of
ongoing program implementation for all annual program submittals subsequent to the
initial submittal; supply as required certification of changes and documentation of those
change that are made to the regulations of statutes; perform internal and external program
reviews as required by state law.

Source Water Assessment Program

On an annual basis, MSDH reports to EPA on Source Water Assessment Program
implementation activities. Beginning December 1, 2009, all groundwater systems began
either Source Water Monitoring or 4-Log Compliance Monitoring. Additionally,
Mississippi is required to conduct routine sanitary surveys of all public water systems and
identify significant deficiencies. The Rule also requires systems to take corrective actions
for significant deficiencies and for source water fecal contamination.

Auxiliary Services

These services include various aspects related to data management, compliance, and
enforcement of the PWSS Program.

Information Management and the Safe Drinking Water Inspection System
(SDWIS)/Fed Reporting
These ongoing activities include: overseeing and enforcing requirements of data
management and the Safe Drinking Water Inspection System (SDWIS) /Fed reporting;
reporting the state’s PWSS inventory at least annually to SDWIS/Fed; reporting the
state’s violations and enforcement actions at least quarterly; participating in EPA/state
data managers conference calls; identifying the data manager and alternate for the
purpose of making secure transmissions of data intended for SDWIS/Fed through EPA’s
Central Data Exchange; establishing and following quality assurance procedures to
ensure that PWS data eventually entered in SDWIS/Fed is of the highest reliability and
maximum value to the public.

Inspection Strategy
This activity includes overseeing and enforcing requirements of the regulatory
requirements.

Management System for Non-compliant Systems
These activities include overseeing and enforcing requirements of management systems
for non-compliant systems; provide current versions of its enforcement response guide;
assurances that the EPA has up-to-date information.

Rule Task Force
This requires participation in the Rule Writing Task Force and Rule Workshops.

Enforcement and Management of Significant Non-compliers (SNC’s)
Activities of this auxiliary service include overseeing and complying with the
requirements of management significant non-compliers (SNC’s); and reporting the state’s
response to instances of significant noncompliance at public water systems.

The commitments as stated here and in the PWSS Work plan are adopted as
commitments of the State Program Management set-aside.

SCHEDULE FOR COMPLETING ACTIVITIES
The schedule for completing State Program activities under this work plan will be the
schedule established by dates entered in the “Date Due” column of the MSDH PWSS Work
plan.

AGENCY RESPONSIBILITIES
The MSDH is the agency responsible for implementing required activities under the State
Program Management set-aside.

EVALUATION PROCESS TO ASSESS THE SUCCESS OF SET-ASIDE ACTIVITIES
The success of State Program Activities will be defined by the ability of the MSDH to
successfully meet commitments in the PWSS Work Plan. Quarterly and annual
reports/submittals required by the PWSS program include documentation and evaluation of
ongoing program implementation and success in meeting stated commitments.

APPENDIX G - LOCAL ASSISTANCE AND OTHER STATE PROGRAMS
ANNUAL WORK PLAN
Section 1452(g)(2) - Safe Drinking Water Act Amendments of 1996

INTRODUCTION

The Mississippi State Department of Health (MSDH), Bureau of Public Water Supply
(Department), will use the Local Assistance and Other State Programs Set-aside of the
DWSRF in a wellhead protection and assistance program. The program will be eliminating
inactive wells and/or open holes which pose a contamination risk to the state’s groundwater
aquifers, by properly abandoning them in accordance with state guidelines. Local
governments realize that the inactive wells/open holes pose a risk of contamination to the
groundwater which may be utilize via their active wells; however, funds to properly abandon
wells/holes are limited. The financial assistance provided through this set-aside will allow
the state, by way of contractual agreement(s), to identify and then properly abandon inactive
wells/open holes posing contamination risks to the state’s groundwater aquifers.

SELECTION PROCESS

The contract for coordination of the decommissioning/properly closing inactive water
wells/open holes was bid and awarded; the current contract runs until June 30, 2024. A new
contract for the decommissioning/properly closing inactive water wells/open holes is
currently being developed in accordance with new State contracting requirements.

An Invitation for Bids (IFBs) for the coordination of the decommissioning/properly closing
inactive water wells/open holes was sent to qualified potential contractors. Bids received
were reviewed by the Department to select the lowest and best bid for the agency.
Recommendations for award of a contract were presented to the Board at their regularly
scheduled Board meeting; following authorization by the Board, the coordination contract
was awarded.

The contracts for the coordination and decommissioning/properly closing inactive water
wells/open holes currently reside as following:

The first contract (the coordination contract) - Engineering Service.

The second contract (closure contract) – is currently being developed in accordance with
new State contracting requirements.

PROGRAM ACTIVITIES

The activities described herein will be accomplished through a four-part process:
Identification of wells / holes needing proper abandonment for the protection of aquifers and
the overall public health; communication with public water supply that owns well/hole to
encourage proper abandonment; mobilization of well contractor to identified site to perform
the work; and confirmation that the work has been completed.

Identification – The contractor will use a list provided by the Department through a
cooperative effort with the Mississippi Department of Environmental Quality Office of
Groundwater Resources (MDEQ) to identify wells or open holes owned by particular water
systems to be abandoned. Wells/holes deemed high risk by MDEQ will be sought out first
for abandonment. Upon completion, wells/holes that are considered medium risk will be
addressed next, then low risk.

Communication – Staff from the contractor will meet with system officials to encourage
them to properly abandon existing inactive wells or open holes posing risk of contamination
to their water system and aquifer. This is considered essential to successfully achieving the
goal of abandoning those wells/holes posing risk.

Mobilization – Once the communication phase has been completed, staff of the MSW&MW,
the licensed well driller contractor and the well closure coordinator will mobilize to the
selected site and commence with the proper abandonment of the well/hole. This will be
accomplished in accordance with established guidelines set forth by the MDEQ Office of
Groundwater. When the abandonment is complete, the well contractor will contact the well
closure coordinator to inform them of project completion.

Confirmation – Staff of the well closure coordinator will perform site visits to confirm
proper abandonment of the wells/holes. When the abandonment is confirmed, the well
closure coordinator will notify the Department to ensure that each abandoned well matches
invoices submitted for payment.

SCHEDULE FOR COMPLETING ACTIVITIES

The schedule for completing Local Assistance and Other Program activities under this work
plan will be the schedule established by set contractual dates.

AGENCY RESPONSIBILITIES

The MSDH will be monitoring contractors throughout the process to ensure effective
completion of contractual assignments.

EVALUATION PROCESS TO ASSESS THE SUCCESS OF SET-ASIDE ACTIVITIES

The success of this set-aside will be defined by the ability of the MSDH through the solicited
contractor(s) to remove by proper abandonment wells or open holes that potentially pose a
risk to existing water supplies and the aquifers which supply the well water.

APPENDIX H - COORDINATION SCHEDULES FOR JOINTLY FUNDED PROJECTS

FFY-2024 DWSIRLF COORDINATION SCHEDULES FOR JOINTLY FUNDED
PROJECTS

These schedules are designed to help assure coordination between the DWSIRLF Program and
the Appalachian Regional Commission (ARC) Grant Program, Community Development
Block Grant (CDBG) Program, and Rural Utilities Service (RUS) Loan/ Grant Program.
These schedules are, however, subject to change due to the timing of federal appropriations or
program changes.

Schedule Item(s)/Deadline(s)
Date(s) ARC CDBG RUS*
May 1,
2022
Mississippi Appalachian
Regional Office (MARO)
notifies potential applicants
& local Planning &
Development Districts of
the September 1, 2022,
deadline for submitting
complete ARC grants
applications.
(N/A) (N/A)
Sept 1,
2022
All FY-2024 ARC project
applications due at MARO
in Tupelo, MS by 5:00 p.m.
Proposals received
afterward will only be
considered as "back-up"
projects.
(N/A) (N/A)
Oct 1,
2024**
Deadline for loan applicant
to submit a complete
DWSIRLF facilities plan to
MS State Department of
Health (MSDH). The plan
must reflect anticipated
ARC funding and must
indicate if the loan applicant
intends to proceed with the
project; 1) only if ARC
funds are received, or 2)
regardless of ARC funding.
**
Deadline for loan applicant
to submit a complete
DWSIRLF facilities plan to
MS State Department of
Health (MSDH). The plan
must reflect anticipated
CDBG funding and must
indicate if the loan
applicant intends to proceed
with the project; 1) only if
CDBG funds are received,
or 2) regardless of CDBG
funding. **
Deadline for loan applicant
to submit a complete
DWSIRLF facilities plan to
MS State Department of
Health (MSDH). The plan
must reflect anticipated
RUS funding and must
indicate if the loan
applicant intends to
proceed with the project; 1)
only if RUS funds are
received, or 2) regardless
of RUS funding. **
Oct,
2024
MS State Dept. of Health
(MSDH) notifies MARO of
loan applicants who have
submitted complete
facilities plans which
indicate anticipated FY-
2024 ARC funding.
MS State Dept. of Health
(MSDH) notifies
Mississippi Development
Authority (MDA) of loan
applicants who have
submitted facilities plans
which indicate anticipated
FY-2024 CDBG funding.
MS State Dept. of Health
(MSDH) notifies U. S.
Department of Agriculture,
Rural Utilities Service
(RUS) of loan applicants
who have submitted
facilities plans which

MARO notifies MSDH of
ARC grant applicants who
submitted pre-applications
which indicate anticipated
FY-2024 DWSIRLF
funding.
indicate anticipated FY-
2024 RUS funding

Date(s) ARC CDBG RUS
Nov 15,
2024
MARO completes review of
FY-2024 projects and briefs
Governor on proposed
Priority 1 and Priority 2
project lists, as well as
projects not eligible to be
funded.
(N/A) (N/A)
Nov 15-
30, 2024
MARO notifies local
Planning & Development
Districts of projects that have
been selected for the P1
(fundable priority list).
MARO will copy MSDH on
these notification letters if
grantee has indicated that it
is pursuing DWSIRLF loan
funds for the project. MSDH
will not award a DWSIRLF
loan until this notification
from MARO is provided.
(N/A) (N/A)
Oct 18,
2024
(N/A) CDBG program application
workshops. ***
(N/A)
Nov,
2024
MSDH advertises Draft
DWSIRLF FFY-2024
Intended Use Plan for public
comment.
MSDH advertises Draft
DWSIRLF FFY-2024
Intended Use Plan for
public comment.
MSDH advertises Draft
DWSIRLF FFY-2024
Intended Use Plan for
public comment.
Dec 30,
2024
Deadline for all FY-2024
Priority 1 documentation and
forms to be submitted to
MARO.
(N/A) (N/A)

Date(s) ARC CDBG RUS
Dec,
2024
Board adopts FFY-2024
DWSIRLF Intended Use
Plan accounting for
anticipated ARC award
amounts if identified in
facilities plan.
Board adopts FFY-2024
DWSIRLF Intended Use
Plan, accounting for
anticipated CDBG award
amounts if identified in
facilities plan. CDBG
public facilities
applications, along with
one copy of the DWSRLF
loan application with maps
and appropriate
attachments will be
accepted from 12/7/2024
until 8/2024
Board adopts FFY-2024
DWSIRLF Intended Use
Plan, accounting for
anticipated RUS award
amounts if identified in
facilities plan.
Jan 20,
2024
(N/A) Deadline for a CDBG grant
applicant to submit a water
viability review form to
MDA.
(N/A)
Jan,
2024
MSDH notifies MARO of
projects included on Final
FFY-2024 Priority List that
anticipate receiving FFY-
2024 ARC funds.
MSDH notifies MDA of
projects included on the
Final FFY-2024 Priority
List that anticipate
receiving FFY-2024
CDBG funds.

MSDH notifies RUS of
projects included on the
Final FFY-2024 Priority
List that anticipate
receiving FFY-2024 RUS
funds.

Date(s) ARC CDBG RUS
Feb 1,
2024
MARO sends project
applications to ARC-
Washington to start final
funding approval process.
(N/A) (N/A)
Feb 16,
2024
(N/A) CDBG public facilities
applications, along with
one copy of the DWSIRLF
loan application with maps
and appropriate
attachments, will be
accepted from 2/16/2024
until 4:00 p.m. on
2/17/2024.
(N/A)
Feb- Jun,
2022
ARC-Washington starts the
final funding approval
process and awards ARC
grants during the spring or
summer of 2024.
(N/A) (N/A)

Date(s) ARC CDBG RUS
Mar,
2024
(N/A) MDA provides notification
to MSDH that complete
CDBG applications have
been received.

(N/A)
May 1,
2024**
Deadline for loan
applicants to submit a
completed DWSIRLF loan
application to MSDH for
the total DWSIRLF eligible
costs, less the amount of
anticipated ARC award to
be applied to DWSIRLF
eligible costs. **
Deadline for loan
applicants to submit a
completed DWSIRLF loan
application to MSDH for
the total DWSIRLF eligible
costs, less amount of
anticipated CDBG award to
be applied to the
DWSIRLF eligible costs.
**
(NOTE: If the loan
recipient is pursuing a
CDBG grant to cover part
of the cost of construction,
the loan recipient has the
option to include the
anticipated CDBG grant
amount in the detailed cost
breakdown in the
application or may request
100% DWSIRLF funding
with the possibility of
amending the loan
application later if the loan
recipient is awarded a
CDBG grant prior to
receipt of bids for
construction. However, the
DWSIRLF loan application
must be consistent with the
DWSIRLF facilities plan
for the project.)
Deadline for loan applicants
to submit complete
DWSIRLF loan
applications to MSDH for
the total DWSIRLF eligible
costs, less amount of
anticipated RUS award to
be applied to DWSIRLF
eligible costs. **
(NOTE: If the loan recipient
is pursuing an RUS
grant/loan to cover part of
the cost of construction, the
loan recipient has the option
to include the anticipated
RUS grant/loan amount in
the detailed cost breakdown
in the application or may
request 100% DWSIRLF
funding with the possibility
of amending the loan
application later if the loan
recipient is awarded an
RUS grant/loan prior to
receipt of bids for
construction. However, the
DWSIRLF loan application
must be consistent with the
DWSIRLF facilities plan
for the project)

Date(s) ARC CDBG RUS
May,
2024
(N/A) MDA provides notification
to MSDH of which
projects fall within the
funding range for CDBG
grants for construction
contingent upon matching
funds being in place.
(NOTE: MSDH will not
award a DWSIRLF loan
until this notification from
MDA is provided.)
(N/A)
Jun, 2024 MSDH provides
notification to MARO that
complete DWSIRLF loan
applications have been
received.
MSDH provides
notification to MDA that
complete DWSIRLF loan
applications have been
received. MDA provides
conformation to MSDH of
which projects fall within
the funding range for
CDBG grants for
construction contingent
upon matching funds being
in place.
MSDH provides
notification to RUS that
complete DWSIRLF loan
applications have been
received.
(Upon
Grant
Award)
MARO provides
notification to MSDH that
ARC awards have been
made.
MDA provides notification
to MSDH that CDBG
awards have been made.
RUS provides notification
that RUS awards have been
made
Aug 1,
2024**
All approvable documents
and responses to comments
necessary for loan award
must be submitted to
MDEQ for review and
approval. **
All approvable documents
and responses to comments
necessary for loan award
must be submitted to
MDEQ for review and
approval. **
All approvable documents
and responses to comments
necessary for loan award
must be submitted to
MDEQ for review and
approval. **

Date(s) ARC CDBG RUS
May-Sep,
2024
Loan applicants receive
DWSIRLF loan awards
from MSDH. The amount
of the loan will be the total
DWSIRLF eligible cost less
the ARC award amount to
be applied to DWSIRLF
eligible costs.
Loan applicants receive
DWSIRLF loan awards
from MSDH. The amount
of the loan will be the total
DWSIRLF eligible cost
less the CDBG award
amount to be applied to
DWSIRLF eligible costs.
Loan applicants receive
DWSIRLF loan awards
from MSDH. The amount
of the loan will be the total
DWSIRLF eligible cost less
the RUS award amount to
be applied to DWSIRLF
eligible costs.
If loan applicant desires
DWSIRLF loan award prior
to RUS award, loan
applicant must provide
MSDH with a copy of letter
from RUS which states
their project will be funded
only contingent upon
receipt of DWSIRLF
matching funds. MSDH
will not award a DWSIRLF
loan until that notification
from RUS is provided.

(Upon
Loan
Award)
MSDH sends a copy of the
award letter to MARO.
MSDH sends a copy of the
award letter to MDA.
MSDH sends a copy of the
award letter to RUS.

* General Guidance regarding DWSIRLF/RUS coordination: The RUS is an agency of the
United States Department of Agriculture which provides loans and grants for water and
wastewater projects. Eligible applicants must be public entities, nonprofit organizations, or
Indian tribes that serve communities with populations under 10,000. RUS funds may be used in
conjunction with other Federal, State, or local funds. Applications for RUS funds will be
accepted at any time during the year and involve an environmental review that includes public
notifications and comment periods. RUS projects are funded at any time during the year as long
as funds are available. RUS funds are allocated by Congress in October of each year and are
usually spent as complete applications are received. Therefore, it is generally to the applicant’s
advantage to file applications earlier in the year. To receive an application package or other
information, contact Rural Utilities Service, 100 West Capitol Street, Suite 831, Jackson, MS
39269; telephone: (601) 965-5460; fax: 844-325-7034.

** FFY-2024 DWSIRLF Priority System Deadline

*** “To Be Announced” (Date has not yet been set.)

APPENDIX I - DRINKING WATER SYSTEMS EMERGENCY LOAN FUND
PROGRAM

Section 41-3-16, Mississippi Code of 1972, as amended, created the Drinking Water Systems
Emergency Loan Fund Program (DWSELF). This program provides loans to counties,
municipalities, districts, or other (tax exempt) water organizations for emergency construction,
repair, or replacement of drinking water facilities. This entirely state-funded loan program
provides a ready funding source for such emergency projects without the federal cross-cutter
requirements required in the Drinking Water Systems Improvements Revolving Loan Fund
(DWSIRLF) Program, thereby saving valuable time and expense. The Board encourages eligible
water organizations throughout the state to utilize this program whenever emergency drinking
water projects are needed.

The basic provisions of this program are: 1) a current interest rate of 2.0%; 2) a maximum single
loan amount as determined by the Board; 3) a maximum repayment period of five (5) years; and
4) the project must meet the definition of an emergency as established in the program
regulations. It is also important to note that loan recipients do not pay interest during the original
construction period (capitalized interest), and that loan repayments do not begin until after
project completion.

Allowable costs for the project may not be incurred prior to the budget period established in the
loan agreement, which may not begin more than 30 days prior to receipt of the loan application.

Costs for the project will be paid on a reimbursement basis, based upon the actual allowable
expenditures of the loan recipient.

APPENDIX J - CERTIFICATIONS

In addition to the assurances included below, the state acknowledges that there are additional
assurances that the state has agreed to in both the Operating Agreement between the State and
EPA Region IV and the annual capitalization grants. These two documents are hereby
incorporated into this IUP by reference.

1. The state certifies that all drinking water facility projects in this IUP identified in Section
VII as being subject to the federal cross-cutting requirements are or will be in compliance
with all such requirements prior to the state entering into an assistance agreement with
the recipient.

2. The state certifies that it will make an annual report to the Regional Administrator on the
actual uses of the funds and how the state has met the goals and objectives for the
previous two fiscal years as identified in the IUPs; and to annually have conducted an
independent audit of the funds to be conducted in accordance with generally accepted
government accounting standards.

3. The state certifies that this IUP will be subjected to public review and comment prior to
final submission to EPA. The state certifies that it will follow the “Mississippi
Administrative Procedures Law” in seeking public review and comments on this IUP. A
copy of the “Mississippi Administrative Procedures Law” can be obtained from the
Mississippi Secretary of State’s Office and can be found on the Mississippi State
Department of Health’s website at www.healthyms.com/dwsrf.

Through this public review process, the State, Board, and Program hope to include a
diverse set of potential interested parties, including community groups, neighborhood
associations, environmental organizations, environmental justice organizations, and
public health groups, that represent a broad spectrum of community interests.

An oral proceeding will be held to receive written and oral comments on this IUP. A
transcript of the public hearing recording the comments and recommended solutions will
be submitted to EPA along with the Final IUP. Anyone desiring to receive a copy of the
oral proceeding transcript should contact Jonathan Diaz, Program Support Specialist, at
(601) 576-7518 to request copies.

4. The state certifies that all drinking water facility projects in this IUP are on the project
Priority List developed pursuant to the requirements of Section 1452(b)(3)(B), SDWA.

5. The state certifies that it will enter into binding commitments for 120% of the amount of
each payment (LOC) under the capitalization grant within one year after receipt of each
payment (LOC).

6. The state certifies that it will commit and expend all Drinking Water Systems
Improvements Revolving Loan Fund (DWSIRLF) Program monies as efficiently as
possible, and to disburse the funds in a timely and expeditious manner.

7. The state certifies that it will conduct environmental reviews on all DWSIRLF cross-
cutter equivalency projects in accordance with the State Environmental Review Process
(SERP).

8. The state certifies that prior to adding any new projects to the “FFY-2023 and After
Planning List” for the purpose of funding such a project during FFY-2024 that the state
will follow the “Mississippi Administrative Procedures Law” in amending this IUP to
allow for public review and comments.

9. The state certifies that it has developed and implemented a Capacity Development (CD)
strategy to assist public water systems in acquiring and maintaining technical,
managerial, and financial capacity as required in Section 1420(c) of the 1996
Amendments to the SDWA. This CD program is currently approved by EPA.

10. The state certifies the State’s Operator Certification Program is currently approved by
EPA.

11. The State is committed to and ensures that program’s activities comply with Title VI of
the Civil Rights Act of 1964

xxvii

APPENDIX K – INFRASTRUCTURE INVESTMENT AND JOBS ACT

Sections of the Infrastructure Investment and Jobs Act (H.R. 3684) that impact the Drinking
Water SRFs:

I. Funding
The bill appropriates $30.713 billion for the Drinking Water State Revolving Funds
(SRFs) over five years. (This is actual funding.) (See Division J – Appropriations, Title
VI Department of Interior, Environment and Related Agencies, State and Tribal
Assistance Grants: Starts on page 2,565 of the bill.)

II. Reauthorization & Policy
The bill includes The Drinking Water and Wastewater Infrastructure Act (S. 914) which
reauthorizes funding levels for the SRFs and amends SRF provisions in the Clean Water
Act and the Safe Drinking Water Act. (See Division E – Drinking Water and Wastewater
Infrastructure: Starts with Section 50001 on page 1,887 of the bill.)

III. Buy America / Buy American
The bill expands domestic preference procurement provisions for programs across
government, including the SRFs. (See Division G – Other Authorizations, Title IX Build
America, Buy America: Starts with 70901 on page 2,303 of the bill.)

I. Funding

The bill provides three pots of funding for SRFs over the next five years:
• Any Eligible Project:
o $11,713,000,000 for the Drinking Water SRF for any eligible project.
• Lead Remediation:
o $15 billion for the Drinking Water SRF for lead service line replacement,
including planning, identification, and design (includes inventories).
• Emerging Contaminants Remediation:
o $4 billion for remediation of emerging contaminants with a focus on PFAS/PFOA
for the Drinking Water SRF.

Key points for this supplemental appropriation:
• Funding is intended to be in addition to annual appropriations.
• Funding is available “until expended.”
• State match is not required for appropriations dedicated to lead service line replacement
and remediation of emerging contaminants.
• State match is 10% for 2022-2023 and 20% for 2024-2026 for appropriations for any
eligible project.
• 100% of the capitalization grant for emerging contaminants must be used for additional
subsidy. A flat 49% of the annual capitalization grant for any eligible project and lead
service line replacement must be used for additional subsidy.

xxviii

• Additional subsidy must be provided in the form of assistance agreements with 100%
principal forgiveness or grants.

Year
Drinking Water SRF
Any Eligible Project
State
Match
Mandated
Additional
Subsidy
2022 $1,902,000,000 10% 49%
2023 $2,202,000,000 10% 49%
2024 $2,403,000,000 20% 49%
2025 $2,603,000,000 20% 49%
2026 $2,603,000,000 20% 49%
Total $11,713,000,000

Year
Drinking Water SRF
Emerging
Contaminants
State
Match
Mandated
Additional
Subsidy
2022 $800,000,000 0% 100%
2023 $800,000,000 0% 100%
2024 $800,000,000 0% 100%
2025 $800,000,000 0% 100%
2026 $800,000,000 0% 100%
Total $4,000,000,000

Year
Drinking Water SRF
Lead
State
Match
Mandated
Additional
Subsidy
2022 $3,000,000,000 0% 49%
2023 $3,000,000,000 0% 49%
2024 $3,000,000,000 0% 49%
2025 $3,000,000,000 0% 49%
2026 $3,000,000,000 0% 49%
Total $15,000,000,000

Total $30,713,000,000

II. Reauthorization & Policy

The bill includes The Drinking Water and Wastewater Infrastructure Act of 2022 (S.
914) which passed the U.S. Senate on Thursday, April 29, by a vote of 89 – 2 (9 not voting).
The bill contained the following provisions. (Policy provisions apply to annual
appropriations, not supplemental appropriations in the bill.)

Funding
• Reauthorizes Drinking Water SRFs at the same levels for the next five years:
o 2022: $2.4 billion
o 2023: $2.75 billion

xxix

o 2024: $3 billion
o 2025 and 2026: $3.25 billion
• Reauthorizes SWIFIA: $5 million annually for the next five years, 2023 through
2026.

Additional Subsidy
• Defines additional subsidization as “forgiveness of principal, grants, negative interest
loans, other loan forgiveness, and through buying, refinancing, or restructuring debt”
for both SRFs and excludes loans with 0% or higher interest are not additional from
being considered additional subsidy.
• Mandates minimum additional subsidy for as long as there are eligible applications:
o Drinking Water SRFs: Increases additional subsidy from 6% to 12% of the
capitalization grant for additional subsidy for disadvantaged communities.

III. Buy America / Buy American

The legislation also expands domestic preference procurement requirements for SRF projects
from American Iron and Steel to construction materials and manufactured products.

xxx

APPENDIX L - LOCAL ASSISTANCE AND OTHER STATE PROGRAMS
ANNUAL WORK PLAN
Section 1452(g)(2) - Safe Drinking Water Act Amendments of 1996

INTRODUCTION

The Mississippi State Department of Health (MSDH), Bureau of Public Water Supply
(Department), will use the Local Assistance and Other State Programs Set-aside of the
DWSRF in a Consolidation Regionalization assistance program. The program will be
surveying the State’s drinking water system to identify, plan, and assist water systems in
consolidation or regionalization to create a more sustainable model that best serves the
consumers of Mississippi’s drinking water.

SELECTION PROCESS

The contract for coordination of the program will run on a State Fiscal Year Basis. A
contract is currently being developed in accordance with State contracting requirements.

A Request for Qualifications will be advertised statewide. Qualifications received will be
reviewed by the Department to select the best qualified candidate for the agency.
Recommendations for award of a contract will be presented to the Board at their regularly
scheduled Board meeting; following authorization by the Board, the coordination contract
will be awarded.

PROGRAM ACTIVITIES

The activities described herein will be accomplished through a four-part process:
identification of potential consolidation or regionalization opportunities; communication
with public water supply; mobilization of contractor to identified site to develop plans and
specifications; and confirmation that the work has been performed.

Identification – The contractor will survey the State’s drinking water system to identify
water systems that would benefit from consolidation or regionalization to create a more
sustainable model that best serves the consumers of Mississippi’s drinking water.

Communication – Staff from the contractor will meet with system officials to inform them
of the program, explain what consolidation or regionalization looks like for their system, and
encourage them to consider the possibility of taking advantage of funding through our
program.

Mobilization – Once the communication phase has been completed and the system request
to move forward, staff of the contractor will mobilize to the selected site and commence with
the plan and design of the proposed project.

Confirmation – Staff of the contractor will provide the BPWS Regional Engineers with
drafts of the plans and specifications.

xxxi

SCHEDULE FOR COMPLETING ACTIVITIES

The schedule for completing Local Assistance and Other Program activities under this work
plan will be the schedule established by set contractual dates.

AGENCY RESPONSIBILITIES

The MSDH will be monitoring contractors throughout the process to ensure effective
completion of contractual assignments.

EVALUATION PROCESS TO ASSESS THE SUCCESS OF SET-ASIDE ACTIVITIES

The success of this set-aside will be defined by the ability of the MSDH through the solicited
contractor(s) to identify, plan, and assist water systems in consolidation or regionalization to
create a more sustainable model that best serves the consumers of Mississippi’s drinking
water.

xxxii

### **Part 18** Onsite Wastewater

##### **15 Miss. Admin. Code Pt. 18, R. 1.1.2** Definitions {#sec-18-1.1.2 omnilex-key=us-ms-regs-official--title-15--18#1.1.2}

The terms in this Chapter apply as stated unless otherwise specified for an Individual On-site Wastewater Disposal System (IOWDS): 1. Administrative Fine – a fine imposed by the Department for violation(s) of statute(s), regulation(s) and order(s) of the Department. 2. Affidavit (Exemption) – a sworn statement in writing by a Person to the State of Mississippi attesting that an IOWDS is installed and constructed in compliance with Section 41-67-6(7). 3. Affidavit (Installation) – a sworn statement in writing by a Certified Installer, Certified Professional Evaluator or Licensed Professional Engineer to the State of Mississippi attesting that an IOWDS is installed, constructed, repaired, or replaced and is in compliance with statutes, requirements, regulations, and permit conditions. 4. Affidavit (Maintenance) – a sworn statement in writing by a property owner to the State of Mississippi agreeing to a continuing maintenance agreement on the installed Advanced Treatment System at the end of the required Certified Manufacturer’s maintenance agreement. 5. Applicant – an owner, lessee or developer. 6. Biochemical Oxygen Demand (BOD5) – a quantitative measure of the amount of oxygen consumed by bacteria while stabilizing, digesting, or treating biodegradable organic matter under aerobic conditions over a five (5) day incubation period; expressed in milligrams per liter (mg/l). 7. Carbonaceous Biochemical Oxygen Demand (CBOD5) – a quantitative measure of the amount of oxygen consumed by bacteria while stabilizing, digesting, or treating biodegradable organic matter under aerobic conditions over a five (5) day incubation

period while in the presence of a chemical inhibitor to block nitrification; expressed in milligrams per liter (mg/l). 8. Commercial Application – notification by an Applicant to the Department prior to construction and submission of all required information, which is used by the Department to initiate the process to evaluate property for the suitability of multiple connections to an IOWDS or multiple IOWDS. 9. Continuing Education Unit (CEU) – an educational course provided through the Department or other entities approved by the Department for the purpose of meeting continuing education. Professional Development Hours (PDH) can be obtained in lieu of the CEU course by performing tasks listed on the PDH table for appropriate certifications. Certified Installers must earn four (4) CEU credits or thirty (30) PDH credits per year and Certified Pumpers must earn four (4) CEU credits or fifteen (15) PDH credits per year. 10. Decentralized Wastewater Treatment System – an IOWDS and/or cluster wastewater disposal system used to treat, disperse, or discharge small volumes of wastewater, generally from dwellings and businesses that are located relatively close together. Decentralized systems in a particular management area or jurisdiction are managed by a common management entity or may be used by a commercial development consisting of fewer than ten (10) lots. 11. Department of Environmental Quality – the Mississippi State Department of Environmental Quality, Office of Pollution Control. 12. Design-based System – an IOWDS designed and installed in accordance with Chapter 5: Design Standards. 13. Developer – a Person who develops real estate for residential or commercial use. 14. Discharge – to pour forth, emit or release treated effluent on the surface of the property of the generator. 15. Division – the Mississippi State Department of Health, Division of On-site Wastewater. 16. Engineer-based System – an IOWDS designed by a Person meeting § 73-13-23(1) and submittal meeting Chapter 2: Certification. 17. Feasibility Study – a written evaluation and analysis of the potential of a proposed project that is based on investigation and research by a Licensed Professional Engineer to give cost comparison between centralized or decentralized treatment and disposal and IOWDS. 18. Fecal Coliform – indicator bacteria common to the digestive systems of warm-blooded animals that is cultured in standard tests to indicate either contamination from sewage or the level of disinfection; generally measured as number of colonies/100 ml or most probable number (MPN).

19. Federal Clean Water Act – federal legislation amended in 1972 to regulate discharges of pollutants into the water of the United States. It gave the United States Environmental Protection Agency (EPA) the authority to implement pollution control programs such as setting wastewater standards for industry. The Clean Water Act also continued requirements to set water quality standards for all contaminants in surface waters. The Act made it unlawful for any Person to discharge any pollutants from a point source into navigable waters, unless a permit was obtained under its provision. 20. Functioning – an IOWDS that has no hydraulically overloaded soil conditions, seepage or discharge to the surface of the property of the generator. 21. Failure – breakage, weakness, or defect that causes a malfunction in the treatment, distribution, disposal, or dispersal of effluent into the soil absorption field, or that causes a wash-out or disruption of the effluent disposal field as evidenced by: a. Surfacing or ponding of effluent at, over or around any component. b. Backing up of sewage within the residence or establishment. c. Contamination of ground or surface waters. 22. Individual On-site Wastewater Disposal System – a sewage treatment and effluent disposal system that does not discharge into waters of the state, that serves only one (1) legal tract, that accepts only residential waste and similar waste streams maintained on the property of the generator, and that is designed and installed in accordance with the law and regulations of the Board: a. New – a Design-based IOWDS installed, inspected and documented by Final Approval. b. Operational – an IOWDS that is being utilized on a daily basis, including the day of inspection, with no evidence of treated effluent leaving the property nor partially treated effluent seeping to the surface. c. Non-operational – an IOWDS that is not in daily use, including the day of inspection. d. Repaired – an existing malfunctioning IOWDS that is operational but requires the restoration or installation of either a treatment or disposal portion. 23. Malfunctioning – any IOWDS or component part that fails to operate as intended or not in compliance with regulation or state laws. 24. Performance-based System – an IOWDS designed by a Licensed Professional Engineer to meet standards established to designate a level of treatment of wastewater that an IOWDS must meet, including, but not limited to Biochemical Oxygen Demand (BOD), Total Suspended Solids (TSS), nutrient reduction and fecal coliform.

25. Portable Toilet (Self-Contained) – a single or multi-unit toilet and holding tank combination system that is required to be collected, removed, transported and disposed by a Certified Pumper. 26. Private Water Well – a deep hole or shaft sunk into the earth to obtain potable water for an individual lot, tract or parcel. 27. Property of the Generator – land owned by or under permanent legal easement or lease to the generator in perpetuity to the generator, duly recorded in the courthouse. 28. Quality Assurance – a program for the systematic monitoring and evaluation of the various aspects of the Department’s on-site wastewater program to ensure that standards of quality, laws and regulations are being met. 29. Revocation – a permanent withdrawal of rights and privileges granted to the certified entity/Person for a minimum of two (2) years. 30. Seeping – wastewater surfacing typically from an underground system as indicated by hydraulically overloaded soil conditions. 31. Soil and Site Evaluation – the evaluation to determine if a property can support an IOWDS by use of a soil auger to a depth of five (5) feet to determine the soil texture, color, mottling and Seasonal High Water Table. 32. Suspension – temporary withdrawal of rights and privileges granted to a certified entity/Person. 33. Total Nitrogen – measure of the complete nitrogen content in wastewater including nitrate (NO3-), nitrite (NO2-), ammonia (NH3-), ammonium (NH4+), and organic nitrogen, expressed as mg/l of N; all these forms of nitrogen (as well as nitrogen [N2]), can be biochemically converted from one form to another and are constituents of the nitrogen cycle. 34. Total Phosphorous – sum of all forms of phosphorous in effluent. 35. Total Suspended Solids – measure of all suspended solids in a liquid, typically expressed in mg/l; to measure, a well-mixed sample is filtered through a standard glass fiber filter and the residue retained on the filter is dried to a constant weight at 217 to 221 degrees F (103 to 105 degrees C); the increase in the weight of the filter represents the amount of total suspended solids. 36. Variance – a written agreement between the Department and an Applicant that allows the Applicant to deviate from the rules and regulations of the Board. 37. Violation – an act of defying the statutes, regulations, orders of the Board, permit conditions or certification standards.

38. Wastewater Advisory Council – a group of members who meet with the Department for providing advice on IOWDS. 39. Water – public or private waters used for recreation (swimming, skiing, fishing), shellfish harvesting, potable water intake or other situations where people are likely to come into contact with the water. 40. Watercourse – any natural lake, river, creek, cut, or other natural body of fresh water or channel having definite banks and bed with visible evidence of the flow or occurrence of water, except such lakes without outlet to which only one (1) landowner is riparian.

Subchapter 2: Treatment and Disposal Requirements Rule 1.2.1 Connection. At all places where person(s) reside, are employed and/or congregate there shall be a sanitary method for disposal of all human excreta and other liquid waste: 1. Where a Centralized Wastewater Treatment System is available, all places shall have a properly constructed connection to the centralized wastewater treatment system which all human excreta and other liquid waste shall be disposed. 2. Where a Centralized Wastewater Treatment System is not available, all human excreta and other liquid waste shall be disposed of into a properly constructed and maintained IOWDS. 3. No such system shall be allowed to discharge in a manner which will jeopardize public health, welfare, or the environment.

**History**
- *Source: Miss. Code Ann. § 41-67-3.*
- *Source: Miss. Code Ann. § 41-67-3.*

##### **15 Miss. Admin. Code Pt. 18, R. 1.2.2** Connection (Public Water) {#sec-18-1.2.2 omnilex-key=us-ms-regs-official--title-15--18#1.2.2}

For the purposes of Miss. Code Ann. § 41-67-5(2), a “connection” as described therein shall be understood to take place upon either: (1) the setting of a water meter on the property of a newly constructed dwelling, regardless of whether the dwelling is occupied at the time the water meter is set; or (2) any change in the water-utility-responsible party on a property with an existing dwelling when the ownership of that property has changed.

**History**
- *Source: Miss. Code Ann. § 41-67-3.*

##### **15 Miss. Admin. Code Pt. 18, R. 1.2.3** Maintenance {#sec-18-1.2.3 omnilex-key=us-ms-regs-official--title-15--18#1.2.3}

All IOWDS require periodic maintenance in accordance with the Certified Manufacturer’s requirements in accordance with § 41-67-10. All Advanced Treatment Systems must comply with § 41-67-7(5).

Subchapter 3. Department Staff Rule 1.3.1 Responsibility. The Division, Environmental Health Program Specialist, District Environmentalist, Regional Environmentalist, Environmentalist and Environmentalist Trainee must comply with the following: 1. Division: a. Attend and conduct all training courses. b. Provide necessary regulations, forms, documents, and evaluations to determine the suitability of property for an IOWDS and enter the data in the wastewater computer program. c. Provide or deny certifications or registrations issued to Certified Manufacturers, Certified Professional Evaluators, Certified Installers and Certified Pumpers. d. Suspend or revoke certifications for Certified Manufacturers, Certified Professional Evaluators, Certified Installers and Certified Pumpers. e. Review and approve the submittal for all designs submitted by Certified Professional Evaluators or Licensed Professional Engineers. f. Coordinate and provide initial certification, continuing education and training for Certified Professional Evaluators, Certified Installers and Certified Pumpers of IOWDS as outlined in Chapter 2: Certification. g. Review submissions and requirements for registration of all specified manufactured wastewater products. h. Promulgate rules and regulations for Design and Performance-based Systems. i. Determine the feasibility of Centralized Wastewater Treatment System for developments. j. Develop and implement policy and procedures. k. Provide technical assistance. 2. Environmental Health Program Specialist: a. Coordinate training, continuing education and determine competency of Environmentalists.

b. Monitor commercial development/establishments and Performance-based System evaluations, document findings and enter in the wastewater computer program. c. Review, inspect and approve/disapprove Performance-based Systems and enter appropriate data related to system into wastewater computer program. d. Inspect, approve/disapprove all IOWDS prior to issuance of Final Approval. e. Monitor Districts/Counties and Certified Professional Evaluators through the Quality Assurance program implemented by the Division. f. Ensure computer data is accurate and updated for all certifications and registrations. g. Conduct field evaluations on all designs submitted by Certified Professional Evaluators or Licensed Professional Engineers. h. Conduct field inspections on all specified manufactured wastewater products, as deemed necessary. i. Schedule with Hearing Officer within ten (10) working days on all enforcement proceedings for Certified Manufacturers and Certified Professional Evaluators. j. Perform Quality Assurance for Environmentalists and Certified Professional Evaluators. 3. District Environmentalist: a. Attend all training courses as outlined by the Division. b. Demonstrate to the Department that § 41-67-19 is satisfactorily met. c. Provide supervision over Environmentalist(s) to ensure the design, construction, installation and approval of an IOWDS. d. Suspend or revoke certifications for Certified Installers and Certified Pumpers. e. Inspect, and/or designate inspections of, Certified Pumper’s vehicle(s). f. Verify all information needed prior to performing the Soil and Site Evaluation. g. Ensure that Environmentalists are recommending all approvable options. h. Demonstrate competency as a Certified Professional Evaluator. i. Ensure that all regulations are applied uniformly in their area of the State. j. Monitor and enter all referred encounters and complaints into the wastewater computer program.

k. Ensure or perform the Soil and Site Evaluation within five (5) working days of receiving a completed Notice of Intent. l. Ensure or process the Permit/Recommendation within ten (10) working days of the completed Notice of Intent. m. Inspect, approve/disapprove all Design-based Systems prior to issuance of Final Approval. n. Schedule a hearing within the required ten (10) working days on all enforcement proceedings for Certified Installer and Certified Pumper. o. Report findings of all enforcement proceedings for Certified Installer or Certified Pumper to the Division. p. Attend a minimum of four (4) hours of Continuing Education Units endorsed by the Division in a calendar year to maintain certification. 4. Regional Environmentalist: a. Attend all training courses as outlined by the Division. b. Demonstrate to the Department that § 41-67-19 is satisfactorily met. c. Provide supervision over Environmentalist(s) to ensure the design, construction, installation and approval of an IOWDS. d. Issue notice to suspend or revoke certifications for Certified Installers and Certified Pumpers. e. Inspect, or designate inspections of, Certified Pumper’s vehicle(s). f. Verify all information needed prior to performing the Soil and Site Evaluation. g. Ensure that Environmentalists are recommending all approvable options. h. Coordinate with the District Environmentalist on all enforcement issues. i. Ensure that all regulations are applied uniformly in their area of the State. j. Monitor and/or enter all referred encounters or complaints into the wastewater computer program. k. Ensure or process the Soil and Site Evaluation within five (5) working days of receiving a complete Notice of Intent. l. Ensure or process the Permit/Recommendation within ten (10) working days of the completed Notice of Intent.

m. Inspect, approve/disapprove all Design-based Systems prior to issuance of Final Approval. n. Attend a minimum of four (4) hours of Continuing Education Units endorsed by the Division in a calendar year to maintain certification. 5. Environmentalist: a. Attend all training courses as outlined by the Division. b. Demonstrate to the Department that § 41-67-19 is satisfactorily met. c. Ensure the design of an IOWDS can be installed and approved. d. Issue notice to suspend or revoke certifications for Certified Installers and Certified Pumpers. e. Inspect Certified Pumper’s vehicle(s). f. Verify all information needed prior to performing the Soil and Site Evaluation. g. Investigate complaints and enforce all applicable statutes, regulations, and certification violations for the Certified Installer and Certified Pumper. h. Coordinate with the Regional Environmentalist on all enforcement issues. i. Perform the Soil and Site Evaluation within five (5) working days of the submittal of a completed Notice of Intent. j. Process the Permit/Recommendation within ten (10) working days of completing the Soil and Site Evaluation. k. Inspect, approve/disapprove all Design-based Systems prior to issuance of Final Approval. l. Initiate all wastewater complaints received within forty-eight (48) hours. m. Monitor and/or enter all environmental health related encounters and complaints into the wastewater computer program. n. Attend a minimum of four (4) hours of Continuing Education Units endorsed by the Division in a calendar year to maintain certification. 6. Environmentalist Trainee: a. Attend all training courses as outlined by the Division. b. Demonstrate to the Department that § 41-67-19 is satisfactorily met.

c. Perform all Soil and Site Evaluations, existing inspections, collect water samples, and investigate wastewater complaints with Regional/District Environmentalist under probationary status. d. Demonstrate competency as an Environmentalist/Certified Professional Evaluator.

Subchapter 4. Applicant Rule 1.4.1 Responsibilities. All Applicants must comply with the following: 1. Submitting a Notice of Intent to the Department prior to constructing or placing any mobile, modular or permanently constructed residence, building or facility, which may require the installation of an IOWDS. 2. Submit the Permit/Recommendation, for a water service connection (water meter) which is an approved plan for a sewage treatment and disposal system. 3. Select an IOWDS to be installed and approved from the option(s) listed on the Permit/Recommendation form. 4. Provide the following to the Department after the chosen IOWDS has been installed and inspected: a. Signed and dated Affidavit (Installation) or, if eligible, Affidavit (Exemption). b. Signed and dated Affidavit (Maintenance), for an Advanced Treatment System only. c. Fee (Final Approval).

Subchapter 5: New System Rule 1.5.1 Prohibited Uses. Any waste stream that is non-typical residential in its constituents shall be referred to the Mississippi Department of Environmental Quality, Office of Pollution Control.

**History**
- *Source: Miss. Code Ann. § 41-67-3.*
- *Source: Miss. Code Ann. § 41-67-3.*
- *Source: Miss. Code Ann. § 41-67-3.*
- *Source: Miss. Code Ann. § 41-67-3.*

##### **15 Miss. Admin. Code Pt. 18, R. 1.5.2** Temporary Use {#sec-18-1.5.2 omnilex-key=us-ms-regs-official--title-15--18#1.5.2}

Any IOWDS can be installed through Notice of Intent procedure in an area where the Department has written proof from the providing entity that a connection to Centralized Wastewater Treatment System will be available within thirty-six (36) months. Upon completion of the Centralized Wastewater Treatment System, all temporary use systems must be properly abandoned.

**History**
- *Source: Miss. Code Ann. § 41-67-3.*

##### **15 Miss. Admin. Code Pt. 18, R. 1.5.3** Notice of Intent {#sec-18-1.5.3 omnilex-key=us-ms-regs-official--title-15--18#1.5.3}

Prior to construction or placement of any mobile, modular, or permanently constructed residence which may require the installation of a single residential IOWDS and the need for a “new” water meter or drilling of a “new” private water well, the Applicant shall complete the Notice of Intent and provide the following to the Department: 1. Legal description. 2. Plot Plan (plat). 3. Fee.

**History**
- *Source: Miss. Code Ann. § 41-67-3.*

##### **15 Miss. Admin. Code Pt. 18, R. 1.5.4** Soil and Site Evaluation {#sec-18-1.5.4 omnilex-key=us-ms-regs-official--title-15--18#1.5.4}

An Environmentalist will perform an evaluation in accordance with Chapter 4: Soil and Site Evaluation.

**History**
- *Source: Miss. Code Ann. § 41-67-3.*

##### **15 Miss. Admin. Code Pt. 18, R. 1.5.5** Permit/Recommendation {#sec-18-1.5.5 omnilex-key=us-ms-regs-official--title-15--18#1.5.5}

Following the Soil and Site Evaluation, the Department will provide a document that indicates a specific type(s) of IOWDS available in order for the Applicant to make an informed decision for meeting a minimum standard of proper treatment and disposal. The Permit/Recommendation is nontransferable and will be valid for two (2) years. The Permit/Recommendation shall be made null and void by the Department if extensive grading occurs or if site/dwelling deviates from the originally submitted Plot Plan (plat).

**History**
- *Source: Miss. Code Ann. § 41-67-3.*

##### **15 Miss. Admin. Code Pt. 18, R. 1.5.6** IOWDS Classifications {#sec-18-1.5.6 omnilex-key=us-ms-regs-official--title-15--18#1.5.6}

All residential IOWDS must comply with one (1) of the following: 1. Design-based. An IOWDS that meets the following: a. Treatment: i. Septic Tank.

ii. Advanced Treatment System. b. Disposal: i. Aggregate. ii. Aggregate Replacement. iii. Elevated Sand Mound. iv. Drip Irrigation. v. Spray Irrigation (disinfected). vi. Overland Discharge (disinfected). vii. Non-water borne. 2. Engineer-based. An IOWDS that meets the following: a. Design-based. b. Performance-based. 3. Performance-based. An IOWDS that is certified by a Licensed Professional Engineer to meet the following minimum effluent standards: a. BOD5 – 10 mg/l. b. TSS – 10 mg/l. c. PO4-P – 15 mg/l. d. NH4-N – 10 mg/l. e. Fecal Coliform – 10,000 cfu/1000 ml. f. All IOWDS effluent must comply with the minimum effluent standards unless background water quality is a higher number than these levels. In this case, the background level will become the standard of performance. g. Background water levels and IOWDS effluent must be sampled in accordance with Department guidelines. (To be forthcoming.)

**History**
- *Source: Miss. Code Ann. § 41-67-3.*

##### **15 Miss. Admin. Code Pt. 18, R. 1.5.7** Inspection {#sec-18-1.5.7 omnilex-key=us-ms-regs-official--title-15--18#1.5.7}

All IOWDS which require a Final Approval must be evaluated and, if mechanical, operated to determine compliance with the applicable regulations.

**History**
- *Source: Miss. Code Ann. § 41-67-3.*

##### **15 Miss. Admin. Code Pt. 18, R. 1.5.8** Passed Inspection {#sec-18-1.5.8 omnilex-key=us-ms-regs-official--title-15--18#1.5.8}

All IOWDS must be installed in compliance with the applicable rules and regulations from Chapter 1: Administrative, Chapter 2: Certification and Chapter 5: Design Standards or reviewed and found to be in compliance with Engineer or Performance-based System.

**History**
- *Source: Miss. Code Ann. § 41-67-3.*

##### **15 Miss. Admin. Code Pt. 18, R. 1.5.9** Failed Inspection {#sec-18-1.5.9 omnilex-key=us-ms-regs-official--title-15--18#1.5.9}

All IOWDS not meeting the requirements of the regulations must be inspected until passed by the Environmentalist. A fee will be charged for each inspection.

**History**
- *Source: Miss. Code Ann. § 41-67-3.*

##### **15 Miss. Admin. Code Pt. 18, R. 1.5.10** Approval {#sec-18-1.5.10 omnilex-key=us-ms-regs-official--title-15--18#1.5.10}

The following documentation shall be collected by the Environmentalist prior to issuance of the Final Approval to the Applicant: 1. Inspection (Form 305). 2. Affidavit (Installation). 3. Affidavit (Maintenance), for an Advanced Treatment System only. 4. Fee.

Subchapter 6: Existing System Rule 1.6.1 Classifications. All IOWDS installed prior to July 1, 2014, shall be grandfathered in until a substantiated complaint is registered or until the property owner requests an inspection: 1. Operational. 2. Non-operational.

**History**
- *Source: Miss. Code Ann. § 41-67-3.*
- *Source: Miss. Code Ann. § 41-67-3.*

##### **15 Miss. Admin. Code Pt. 18, R. 1.6.2** Inspection {#sec-18-1.6.2 omnilex-key=us-ms-regs-official--title-15--18#1.6.2}

An existing IOWDS will be evaluated based on: a request from the Applicant; a new water service connection as described in Miss. Code Ann. § 41-67-5(2) and in Rule 1.2.2; a substantiated complaint; or a Medical Exception request received by the Department. All Advanced Treatment Systems must be inspected by a Certified Manufacturer’s authorized

representative and appropriate inspection forms or proof of continuous maintenance agreement must be submitted. Properties exempted under Miss. Code Ann. § 41-67-6(7) are not subject to existing system connection inspection events: 1. Operational: a. Environmentalist shall make a diligent effort to locate the treatment and disposal area as shown on the Existing System – Application. b. If there is no evidence of treated effluent leaving the property, nor partially treated effluent seeping to the surface, an Acceptance will be issued to the Applicant. 2. Non-operational: a. A Permit/Recommendation will be provided to the Applicant.

**History**
- *Source: Miss. Code Ann. § 41-67-3.*

##### **15 Miss. Admin. Code Pt. 18, R. 1.6.3** Failed Inspection {#sec-18-1.6.3 omnilex-key=us-ms-regs-official--title-15--18#1.6.3}

For any IOWDS which has evidence of treated effluent leaving the property, or partially treated effluent seeping to the surface, the Applicant shall be issued a letter stating the violation with options for repair. If replacement is required, a Permit/Recommendation will be issued.

**History**
- *Source: Miss. Code Ann. § 41-67-3.*

##### **15 Miss. Admin. Code Pt. 18, R. 1.6.4** Approval {#sec-18-1.6.4 omnilex-key=us-ms-regs-official--title-15--18#1.6.4}

All IOWDS in need of repair that requires approval must meet the following requirements by upgrading either treatment or disposal: 1. Reduce the volume of effluent. 2. Adequately treat the effluent. 3. Confine the discharge to the property of the generator to the greatest extent possible.

**History**
- *Source: Miss. Code Ann. § 41-67-3.*

##### **15 Miss. Admin. Code Pt. 18, R. 1.6.5** Replacement {#sec-18-1.6.5 omnilex-key=us-ms-regs-official--title-15--18#1.6.5}

Any malfunctioning IOWDS that will require the installation of both treatment and disposal within 45 days of one another will require the Applicant to comply with Subchapter 5: New System.

**History**
- *Source: Miss. Code Ann. § 41-67-3.*

##### **15 Miss. Admin. Code Pt. 18, R. 1.6.6** Connection-Event Existing System Inspections {#sec-18-1.6.6 omnilex-key=us-ms-regs-official--title-15--18#1.6.6}

1. A connection-event inspection is required when a “connection” as defined in Rule 1.2.2 occurs for a property served by an existing IOWDS, unless exempt under Miss. Code Ann. § 41-67-6(7). 2. Connection-event inspections may be performed by: a. Division Environmentalists, who may perform connection-event inspections on: i. Single family residential dwellings; and ii. Commercial developments and establishments. b. Certified Installers recognized by the Board, who may perform connection-event inspections on: i. Single family residential dwellings. 3. Properties exempt under Miss. Code Ann. § 41-67-6(7) are not subject to connection- event inspection requirements.

**History**
- *Source: Miss. Code Ann. § 41-67-3.*

##### **15 Miss. Admin. Code Pt. 18, R. 1.6.7** Interaction with Statutory Requirements {#sec-18-1.6.7 omnilex-key=us-ms-regs-official--title-15--18#1.6.7}

1. Installations Inspection – Nothing in this Subchapter alters the requirements of Miss. Code Ann. § 41-67-6(5) regarding Division inspection of installations. 2. Design Authority – Nothing in this Subchapter limits the authority of a Licensed Professional Engineer or Certified Professional Evaluator under Miss. Code Ann. § 41- 67-6(1). 3. Approval Authority – Only the Division may issue Approvals, Acceptances, Repair Authorizations, or Final Approvals for IOWDS.

**History**
- *Source: Miss. Code Ann. § 41-67-3.*

##### **15 Miss. Admin. Code Pt. 18, R. 1.6.8** Classification of Systems During Connection-Event Inspections by Certified Installers {#sec-18-1.6.8 omnilex-key=us-ms-regs-official--title-15--18#1.6.8}

An IOWDS inspected under Rule 1.6.6 shall be classified as one of the following: 1. Operational – A system functioning as intended with no evidence of treated or partially- treated effluent leaving the property and no evidence of surfacing effluent. The Certified Installer shall submit proper certifying documents confirming operational status. 2. Non-operational – A system not in daily use on the day of inspection. The Certified Installer shall notify the Property Owner to contact the Division for repair/replacement recommendations for use should the existing system fail once in use.

3. Failed Inspection – Any IOWDS which has evidence of treated effluent leaving the property, or partially-treated effluent seeping to the surface. The Certified Installer shall notify the Property Owner to contact the Division for acceptable system repair or system replacement options compliant with the law and regulations.

**History**
- *Source: Miss. Code Ann. § 41-67-3.*

##### **15 Miss. Admin. Code Pt. 18, R. 1.6.9** Authority Limitations for Certified Installers {#sec-18-1.6.9 omnilex-key=us-ms-regs-official--title-15--18#1.6.9}

1. Certified Installers performing connection-event inspections may not: a. Prescribe repairs beyond routine maintenance as outlined in Rule 1.6.10. b. Design systems. c. Perform installation inspections for system replacement. d. Perform connection-event inspections on any property covered by Rule 3.1.11 (commercial developments and establishments). 2. Certified Installers performing connection-event inspections must: a. Physically perform the inspection in person (cannot be performed by an unlicensed designated agent). b. Submit required documentation and signed attestations. c. Document all observed conditions.

**History**
- *Source: Miss. Code Ann. § 41-67-3.*

##### **15 Miss. Admin. Code Pt. 18, R. 1.6.10** Advanced Treatment Systems {#sec-18-1.6.10 omnilex-key=us-ms-regs-official--title-15--18#1.6.10}

1. ATS units must be inspected by a Certified Installer who is also an authorized representative of the Certified Manufacturer of the existing system being inspected. 2. Proof of a continuous maintenance agreement must be submitted to the Division. 3. Certified Installers may perform general maintenance in order to bring a system into compliance. Acceptable general maintenance acts include, at least, spray head replacement, aerator or pump replacement, or replacement of chlorine tablets.

**History**
- *Source: Miss. Code Ann. § 41-67-3.*

##### **15 Miss. Admin. Code Pt. 18, R. 1.6.11** Required Documentation for Certified Installers {#sec-18-1.6.11 omnilex-key=us-ms-regs-official--title-15--18#1.6.11}

1. Certified Installers who perform a connection-event inspection shall submit to the Division: a. A Connection-Event Inspection Form with signed attestations.

b. Photographic documentation (if required by the Division). c. Referral documentation (when applicable). d. An application and fee for a Certificate of Acknowledgement from the Division confirming that the submission meets administrative requirements. 2. Routine maintenance activities, structural deficiencies, and other required observations should be captured on the inspection checklist. Continuous maintenance agreements shall be included in the submittal for existing ATSs.

**History**
- *Source: Miss. Code Ann. § 41-67-3.*

##### **15 Miss. Admin. Code Pt. 18, R. 1.6.12** Division Review and Follow-Up {#sec-18-1.6.12 omnilex-key=us-ms-regs-official--title-15--18#1.6.12}

1. The Division shall review all submitted Certified Installer connection-event inspections. 2. The Division shall determine whether: a. A Certificate of Acknowledgement may be issued. b. A full Division inspection is necessary or warranted. c. A system repair or system replacement is required after a Division inspection when a Certified Installer inspection issues a Failed Inspection or Non- Operational determination (as described in Rule 1.6.8). It is the responsibility of the Property Owner to contact the Division for system repair or system replacement options. 3. Enforcement actions may only be initiated by the Division.

**History**
- *Source: Miss. Code Ann. § 41-67-3.*

##### **15 Miss. Admin. Code Pt. 18, R. 1.6.13** Enforcement and Legal Considerations {#sec-18-1.6.13 omnilex-key=us-ms-regs-official--title-15--18#1.6.13}

1. Certified Installers are not responsible for enforcement actions. 2. Certified Installers are liable for the work performed and should carry appropriate liability coverage for performing connection-event existing system inspections. 3. The Division retains full enforcement authority. 4. Documentation submitted by Certified Installers may be used in an enforcement action but must be verified by the Division before the enforcement action.

**History**
- *Source: Miss. Code Ann. § 41-67-3.*

##### **15 Miss. Admin. Code Pt. 18, R. 1.6.14** Certificate of Acknowledgement and Liability {#sec-18-1.6.14 omnilex-key=us-ms-regs-official--title-15--18#1.6.14}

1. Upon receipt of a Connection Event Inspection Packet under this Subchapter, the Division shall review the submission for administrative completeness, including verification that: a. The Connection-Event Inspection Application is complete. b. The required fee has been submitted. c. All required documentation has been provided to the Division. 2. If the submission is administratively complete, the Division shall issue a Certificate of Acknowledgement, which confirms only that the submission meets administrative requirements. 3. A Certificate of Acknowledgement from the Division does not: a. Constitute an approval, acceptance, or verification of a system’s condition. b. Represent a determination of compliance. c. Certify the accuracy of the Certified Installer’s findings. d. Limit the Division’s authority to conduct further inspection. 4. Certified Installers are solely responsible and liable for the accuracy, truthfulness, and completeness of the information submitted to the Division. 5. The Division retains the right to initiate enforcement actions against: a. The Certified Installer for violations of certification standards. b. The Property Owner for violations of state statutes or Division regulations. 6. The Division may conduct additional inspections at its discretion, regardless of whether a Certificate of Acknowledgement has been issued.

Subchapter 7: Exception, Exemption and Variance Rule 1.7.1 Medical Exception. A temporary connection made to an operational existing system, provided the flow is not projected to increase significantly and the residence is removed on the date specified in the doctor’s statement. This exception shall be valid for not more than 24 months from the date of issue.

**History**
- *Source: Miss. Code Ann. § 41-67-3.*
- *Source: Miss. Code Ann. § 41-67-3.*

##### **15 Miss. Admin. Code Pt. 18, R. 1.7.2** Exemption {#sec-18-1.7.2 omnilex-key=us-ms-regs-official--title-15--18#1.7.2}

Utilization of the exemption by the Applicant requires the following: 1. Applicant must attest that a single residence will be placed on a single two (2)-acre or larger tract of land during the Notice of Intent process and must acknowledge that they have been informed the following entities may require the Department’s Final Approval: a. Board of Supervisors (Ordinance). b. Water Supplier/Association (Bylaws and/or Water User’s Agreement). c. Lending Institution. d. Utility Authority. e. Others (subdivision covenants, etc.). 2. If an additional residence on the same tract is requested to be exempt, the tract must be five (5) acres or larger. 3. Commercial facilities as defined by Rule 3.1.11.1 are not eligible for exemption.

**History**
- *Source: Miss. Code Ann. § 41-67-3.*

##### **15 Miss. Admin. Code Pt. 18, R. 1.7.3** Variance {#sec-18-1.7.3 omnilex-key=us-ms-regs-official--title-15--18#1.7.3}

An Applicant may request the review of a Permit/Recommendation which indicates no Design- based IOWDS can be authorized for installation or if the Applicant disagrees with the Permit/Recommendation made by the Department: 1. Applicant must write and submit a letter to the Director of the Office of Environmental Health requesting a review of the property to determine if the current rules and regulations of the Department have created an unforeseen hardship. The following must be included: a. Name and mailing address. b. Telephone number and/or email address. c. Copy of the Permit/Recommendation. 2. Applicant must write and submit a letter to the Director of the Division of On-site Wastewater requesting a review of the design. The following must be included: a. Name and mailing address. b. Telephone number and/or email address. c. Copy of the Permit/Recommendation.

d. Copy of the report from the Licensed Professional Engineer for a proposed IOWDS that will properly treat and maintain wastewater on the property. e. Copy of the Licensed Professional Engineer’s errors and omissions insurance.

Subchapter 8: Hearing and Appeal Procedure Rule 1.8.1 Hearing. Any Applicant who has been denied an approval or whose property has been declared unsuitable for recommendation of any wastewater disposal system, or who has been charged with a violation of this regulation, may request a fact-finding hearing in writing within ten (10) days of notification of the denial or violation. A hearing will be scheduled within ten (10) calendar days after the request has been filed. The appellant will be notified in writing of the decision of the District Hearing Officer.

**History**
- *Source: Miss. Code Ann. § 41-67-3.*
- *Source: Miss. Code Ann. § 41-67-3.*

##### **15 Miss. Admin. Code Pt. 18, R. 1.8.2** Appeal {#sec-18-1.8.2 omnilex-key=us-ms-regs-official--title-15--18#1.8.2}

The appellant shall have the right to appeal an unfavorable decision to the State Health Officer in writing within ten (10) days of notification of results of the district-level hearing. A hearing will be scheduled within thirty (30) calendar days after the request has been filed. The decision of the State Health Officer or his/her designee as Hearing Officer will be based solely on the oral, written and documentary evidence presented. The appellant will be notified in writing of the decision.

**History**
- *Source: Miss. Code Ann. § 41-67-3.*

##### **15 Miss. Admin. Code Pt. 18, R. 1.8.3** Further Appeal {#sec-18-1.8.3 omnilex-key=us-ms-regs-official--title-15--18#1.8.3}

Any Person who is aggrieved by any final decision of the Board may appeal that final decision to the Chancery Court of the county of the situs in whole or in part of the subject matter. No individual may file a petition for judicial review with a court of competent jurisdiction until a final written decision and order have been issued by the Department.

Subchapter 9: Holding Tanks Rule 1.9.1 Minimum Size. All holding tanks shall be 1,000 gallons at a minimum and shall be capable of holding twice the projected daily wastewater flow of the facility.

**History**
- *Source: Miss. Code Ann. § 41-67-3.*
- *Source: Miss. Code Ann. § 41-67-3.*

##### **15 Miss. Admin. Code Pt. 18, R. 1.9.2** Alarm Requirements {#sec-18-1.9.2 omnilex-key=us-ms-regs-official--title-15--18#1.9.2}

Holding tanks shall be equipped with a high water alarm with the capability to sound at ½ capacity and ¾ capacity and meet all requirements of Rule 5.3.4.

**History**
- *Source: Miss. Code Ann. § 41-67-3.*

##### **15 Miss. Admin. Code Pt. 18, R. 1.9.3** Application Requirements {#sec-18-1.9.3 omnilex-key=us-ms-regs-official--title-15--18#1.9.3}

All applications for holding tanks shall include the following: 1. Specifications (including material and size) for the tank to be used: a. If a tank is to be installed in a situation other than intended by the manufacturer, a Professional Engineer’s approval is required. 2. Site plan showing the location of all proposed holding tanks. 3. Contract with a Certified Pumper for the duration of holding tank usage.

**History**
- *Source: Miss. Code Ann. § 41-67-3.*

##### **15 Miss. Admin. Code Pt. 18, R. 1.9.4** Permit Renewal {#sec-18-1.9.4 omnilex-key=us-ms-regs-official--title-15--18#1.9.4}

Permits for Holding Tanks shall be renewed yearly, must include all pump receipts from the previous year, and a current contract for the permit period.

**History**
- *Source: Miss. Code Ann. § 41-67-3.*

##### **15 Miss. Admin. Code Pt. 18, R. 1.9.5** Inspection Authority {#sec-18-1.9.5 omnilex-key=us-ms-regs-official--title-15--18#1.9.5}

MSDH reserves the right to inspect any active holding tank at any time for compliance.

Chapter 2 Certification Subchapter 1: Introduction Rule 2.1.1 Purpose. The purpose of this regulation is to establish a regulatory standard regarding certification of the Manufacturers, Professional Evaluators, Installers, Pumpers, Maintenance Providers, and Qualified Homeowner Maintenance Providers that applies for the design, construction, installation, repair, maintenance, operation, removal and disposal of liquid waste of Individual On-Site Wastewater Disposal Systems.

**History**
- *Source: Miss. Code Ann. § 41-67-3.*
- *Source: Miss. Code Ann. § 41-67-3.*

##### **15 Miss. Admin. Code Pt. 18, R. 2.1.2** Authority {#sec-18-2.1.2 omnilex-key=us-ms-regs-official--title-15--18#2.1.2}

The State Board of Health is authorized to promulgate these rules under and by virtue of Section 41-3-15(1)(b)(ii), (4)(a)(b)(c)(e)(h)(i), Section 41-3-17 and Section 41-67-1 through 41-67-39, Mississippi Code of 1972 Annotated.

**History**
- *Source: Miss. Code Ann. § 41-67-3.*

##### **15 Miss. Admin. Code Pt. 18, R. 2.1.3** Definitions {#sec-18-2.1.3 omnilex-key=us-ms-regs-official--title-15--18#2.1.3}

1. Advanced Treatment System – an individual on-site wastewater treatment system that complies with Section 41-67-10. 2. Advanced Treatment Unit Distributor – a person authorized by the registered manufacturer to sell aerobic treatment units to authorized Certified Installer(s) in the State of Mississippi. 3. Advanced Treatment Unit Manufacturer – a person authorized by the American National Standards Institute/National Sanitation Foundation (ANSI/NSF) International Standard Number 40 to construct an aerobic treatment unit that is listed and registered by the State of Mississippi. 4. Alternative techniques/technologies – a technique or technology used to achieve acceptable treatment and dispersal of wastewater through advanced treatment schemes as deemed by the Department. 5. Authorized Representative – an organization, group, individual, or other entity that is authorized by the manufacturer to distribute, sell, install, or service residential wastewater treatment systems.

6. Certification – the act of confirming competency to design, construct, maintain, install, removal and/or disposal of sludge and liquid waste from Individual On-site Wastewater Disposal Systems. 7. Certified Installer – any person who has met the requirements of Section 41-67-25. 8. Certified Maintenance Provider – any person who holds a written certification issued by the Department allowing the person to provide maintenance services associated with approved on-site wastewater treatment and disposal systems. 9. Certified Professional Evaluator – any person who has met the requirements of Section 41-67-35. 10. Certification Training Program – a program developed by the Mississippi State Department of Health to confirm competency to design, construction, installation, repair, maintenance, operation, and removal and disposal of liquid waste of Individual On-Site Wastewater Disposal Systems. 11. Certified Pumper – a person engaged in the business or practice of removing and disposing of the sludge and liquid waste from Individual On-site Wastewater Disposal Systems. 12. Cleaning – the removal and transportation of septage or other liquid waste from an onsite sewage treatment and disposal system or Portable Toilet (Self-contained) to an approved disposal location. 13. Components – all physical, mechanical, and electrical components of any wastewater disposal system. 14. Continuing Education Unit (CEU) – an educational course provided through the Department or other entities approved by the Department for the purpose of meeting continuing education. Professional Development Hours (PDH) can be obtained in lieu of the CEU course by performing tasks listed on the PDH table for appropriate certifications. Certified Installers must earn four (4) CEU credits or thirty (30) PDH credits per year and Certified Pumpers must earn four (4) CEU credits or fifteen (15) PDH credits per year. 15. Conventional System – an Individual On-Site Wastewater Disposal System consisting of a septic tank and subsurface disposal field. 16. Errors and Omission – coverage protecting the insured against legal liability resulting from negligence, carelessness or a failure to act causing property damage or personal injury to others. Coverage may include burglary and theft. 17. General Business Liability Insurance – coverage protecting the insured against legal liability resulting from negligence, carelessness or a failure to act causing property damage or personal injury to others. Coverage may include burglary and theft.

18. Holding Tank – a vessel used to hold effluent for a limited time as specified in Section 41-67-11. 19. Lime – a dry white powder consisting essentially of calcium hydroxide that is made by treating quicklime with water. 20. Manufacturer – a person operating a business in or doing business in the State of Mississippi that develops, designs and fabricates residential wastewater treatment systems and their components. 21. Maintenance – the inspecting and evaluating of an Advanced Treatment System. The replacement of any component registered with a specific Advanced Treatment System (i.e. aerator, diffuser, control panel, etc.). 22. Monitoring Visit – an inspection performed by the third-party certifier to ensure that the manufacturer, distributor and installer are complying with American National Standards Institute/National Sanitation Foundation (ANSI/NSF) International Standard Number 40 requirements. 23. Person – any individual, trust, firm, joint-stock company, public or private corporation (including a government corporation), partnership, association, state, or any agency or institution thereof, municipality, commission, political subdivision of a state or any interstate body, and includes any officer or governing or managing body of any municipality, political subdivision, or the United States or any officer or employee thereof. 24. Portable Toilet (Self-Contained) – a single or multi-unit toilet and holding tank system combination that is required to be collected, removed, transported and disposed by a Certified Pumper. 25. Qualified Homeowner Maintenance Provider – the current owner of a specific residence where they reside and has met the requirements of the Department of Health regulation. 26. Surety – a three-party agreement where the insurer agrees to pay a second party (the obligee) or make complete an obligation in response to the default, acts or omissions of a third party (the principal). 27. Third-Party Certifier – a certifying program which complies with the following provisions for systems which it has certified to be installed in Mississippi: a. Be accredited by the American National Standards Institute (ANSI). b. Have established procedures which send representatives to distributors in Mississippi on a recurring basis to conduct evaluations to assure that distributors of certified advanced treatment systems are providing proper maintenance, have sufficient replacement parts available and are maintaining service records.

c. Notify the Department of the results of monitoring visits to manufacturers and distributors within 60 calendar days of the conclusion of the monitoring. d. Submit completion reports on testing and any other information as the Department may require for its review.

**History**
- *Source: Miss. Code Ann. § 41-67-3.*

##### **15 Miss. Admin. Code Pt. 18, R. 2.1.4** Registered Manufacturer {#sec-18-2.1.4 omnilex-key=us-ms-regs-official--title-15--18#2.1.4}

A person may operate as a Manufacturer in the State of Mississippi if they hold a valid certification of registration.

**History**
- *Source: Miss. Code Ann. § 41-67-3.*

##### **15 Miss. Admin. Code Pt. 18, R. 2.1.5** Products {#sec-18-2.1.5 omnilex-key=us-ms-regs-official--title-15--18#2.1.5}

1. Treatment: a. Advanced Treatment Units. b. Septic Tanks. c. Holding Tanks. d. Non-water borne Systems. e. Alternative wastewater technology. 2. Disposal: a. Aggregate Replacement. b. Subsurface Drip. c. Spray Irrigation. d. Alternative wastewater technology. 3. Disinfection. 4. Effluent Filter.

**History**
- *Source: Miss. Code Ann. § 41-67-3.*

##### **15 Miss. Admin. Code Pt. 18, R. 2.1.6** Requirements {#sec-18-2.1.6 omnilex-key=us-ms-regs-official--title-15--18#2.1.6}

It is unlawful for a Manufacturer of an Individual On-site Wastewater Disposal System or alternative treatment or disposal components to operate a business in or to do business in the State of Mississippi without holding a valid manufacturer’s registration issued by the Department.

**History**
- *Source: Miss. Code Ann. § 41-67-3.*

##### **15 Miss. Admin. Code Pt. 18, R. 2.1.7** Application {#sec-18-2.1.7 omnilex-key=us-ms-regs-official--title-15--18#2.1.7}

All Manufacturers must complete and submit the following: 1. Application. 2. Listing and identification of all Fabricators and Distributors of their products and a list of authorized Certified Installers and Certified Maintenance Providers. 3. Contact information of all technical staff providing training. 4. Electronic or detailed drawing(s), construction material(s), installation and/or homeowner manual(s) of each product. 5. Fee.

**History**
- *Source: Miss. Code Ann. § 41-67-3.*

##### **15 Miss. Admin. Code Pt. 18, R. 2.1.8** Treatment {#sec-18-2.1.8 omnilex-key=us-ms-regs-official--title-15--18#2.1.8}

1. Advanced Treatment: a. Registration and requirements for testing and listing of manufacturers of advanced treatment systems. b. Documentation, from a Third-Party Certifier accredited by the American National Standards Institute, that the manufacturer’s product has successfully completed the testing and listing process as outlined in American National Standards Institute/National Sanitation Foundation (ANSI/NSF) International Standard Number 40 and/or 245 or later edition. c. On or before October 1, 1996, each Manufacturer not currently tested and listed by a Third-Party Certifier accredited by the American National Standards Institute shall submit to the Department evidence that such manufacturer has commenced the testing/listing process. Within 9 months after the submission of such evidence, each Manufacturer must have completed the testing/listing process. d. Each manufacturer must have established procedures which send representatives to a minimum of 10 percent of its distributors in Mississippi on an annual basis to conduct evaluations to assure the distributor of certified advanced treatment systems is providing proper maintenance, has sufficient replacement parts available and is maintaining service records. Annual monitoring reports from the manufacturer and Third-Party Certifier must be submitted to the Division prior to re-registration.

**History**
- *Source: Miss. Code Ann. § 41-67-3.*

##### **15 Miss. Admin. Code Pt. 18, R. 2.1.9** Third-Party Certifier {#sec-18-2.1.9 omnilex-key=us-ms-regs-official--title-15--18#2.1.9}

1. Advanced treatment systems and other treatment technologies may be installed only if they have been tested and listed by a third-party certifying program. Such advanced treatment systems shall be in compliance with standards for Class I systems as defined by the most current revision of American National Standards Institute/National Sanitation Foundation (ANSI/NSF) International Standard Number 40, hereby incorporated by reference. An approved third-party certifying program shall comply with the following provisions in order for systems which it has certified to be installed in Mississippi: a. On and after October 1, 1996, an approved Third-Party certifying program shall be accredited by the American National Standards Institute (ANSI). b. Have established procedures which send representatives to a minimum of 1 distributor of each Manufacturer in Mississippi on an annual basis to conduct evaluations to assure the distributor of certified advanced treatment systems is providing proper maintenance, has sufficient replacement parts available and is maintaining service records. c. Notify the Division of the results of monitoring visits to manufacturers and distributors within 60 calendar days of the conclusion of the monitoring. d. Submit completed reports on testing and evaluation of each advanced treatment system verifying compliance with American National Standards Institute/National Sanitation Foundation (ANSI/NSF) International Standard Number 40. Such reports shall include but not be limited to the following: i. Materials. ii. Design and construction. iii. Performance requirement (BOD, TSS, pH). iv. Operation and maintenance. e. The Third-Party certifying entity must be disassociated with, and have no vested interest in, the manufacturer to which certification services are provided. f. Information including specifications of each system and/or component part of the system as deemed necessary by the Department for review. g. Design, construction and reinforcement must comply and conform to applicable rules and regulations of Chapter 5, Subchapter 1. i. Septic Tanks – The Division shall review, including an on-site inspection, the plans, specifications, and construction criteria and shall determine them to be in compliance with the regulation.

h. Design, construction and reinforcement must comply and conform to applicable rules and regulations of Chapter 5, Subchapter 1. i. Holding Tanks – The Division shall review, including an on-site inspection, the plans, specifications, and construction criteria and shall determine them to be in compliance with the regulation. i. Design, construction and reinforcement must comply and conform to applicable rules and regulations of Chapter 5, Subchapter 1. j. Non-waterborne System – Third-Party certification that product has successfully completed testing and listing process as outlined in American National Standards Institute/National Sanitation Foundation (ANSI/NSF) International Standard Number 41. 2. Alternative Wastewater Technology – Treatment and/or disposal systems/products must be documented, reviewed, and approved by the Division to verify compliance with the applicable standards. All Manufacturers must provide a copy of installation and/or homeowner manual(s) for each of their products. Hydraulic calculations on an alternative system installation on all products that may be required to be pressurized as part of the dispersal process, including but not limited to Subsurface Drip, Spray Irrigation, Elevated Sand Mound, and normally gravity-fed dispersal systems that would have to be pressurized. List of all component parts authorized for use in the installation of the product, including but not limited to elbows, connectors, geo-textile fabric, and methods of equal distribution: a. Aggregate Replacement System – The Division shall review, including on-site inspection(s) if deemed necessary, the plans, specifications and construction criteria and shall determine them to be in compliance with the regulation. The Division shall require a complete design from primary treatment to disposal for the minimum and maximum sized system, which shall also include pump chamber, pump chamber alarm(s), pump(s), filter(s), valve(s), air release(s), aggregate replacement product and connector(s). b. Subsurface Drip – The Division shall review, including on-site inspection(s) if deemed necessary, the plans, specifications and construction criteria in order to determine compliance with the regulation. The Division shall require a complete design from primary treatment to disposal, which shall also include pump chamber, pump chamber alarm(s), pump(s), filter(s), valve(s), air release(s), tubing and connector(s). This must be presented as a total package with hydraulics for the minimum and maximum sized system. c. Spray Irrigation – The Division shall review equipment intended to be utilized in the construction of spray irrigation systems to verify compliance with the regulation. The Division shall require a complete design from primary treatment to disposal, to include pump chamber, pump chamber alarm(s), pump(s), filter(s),

valve(s), spray head(s) and connector(s). This must be presented as a total package with hydraulics for the minimum and maximum sized system. d. Alternative Wastewater Technology – All alternative wastewater treatment and/or disposal systems/products must be documented and reviewed by the Division to verify compliance with the applicable standards. 3. Disinfection – The Division shall review, including on-site inspection(s) if deemed necessary, the plans, specifications and construction criteria and shall determine them to be in compliance with the regulation. The Division shall require a complete design from primary treatment to disposal. 4. Effluent Filter – Design and construction must comply and conform to applicable rules and regulations of Chapter 5, Subchapter 1.

**History**
- *Source: Miss. Code Ann. § 41-67-3.*

##### **15 Miss. Admin. Code Pt. 18, R. 2.1.10** Responsibilities: Manufacturer {#sec-18-2.1.10 omnilex-key=us-ms-regs-official--title-15--18#2.1.10}

1. All Manufacturers must demonstrate that all processes necessary to comply and conform to Regulations and Manufacturer specifications by the following. 2. Provide documentation to the Division necessary for registration to include testing and listing of manufacturers of Advanced Treatment Systems. 3. Provide documentation on the maintenance agreement for any alternative on-site wastewater disposal system, with a copy of the maintenance agreement outlining the type of service, length of service and frequency of service to be provided. 4. Notify the Division of the results of monitoring visits to manufacturers and distributors within 60 calendar days of the conclusion of the monitoring. 5. Provide technical trained staff to the Division for utilization during the on-site maintenance training program for all alternate disposal systems certified in Mississippi. 6. Provide documentation that an installer of Alternative Systems or products has been trained as a factory-trained and authorized representative and must furnish documentation to the Division certifying the satisfactory completion of factory training and the establishment of the installer as an authorized manufacturer’s representative.

**History**
- *Source: Miss. Code Ann. § 41-67-3.*

##### **15 Miss. Admin. Code Pt. 18, R. 2.1.11** Responsibilities: Fabricators {#sec-18-2.1.11 omnilex-key=us-ms-regs-official--title-15--18#2.1.11}

1. All Fabricators must demonstrate that all processes necessary to comply and conform to Regulations and Manufacturer specifications by the following. 2. Provide documentation of all concrete purchases, concrete providers, types of reinforcement and date of fabrication.

3. Provide documentation that the mold meets the Manufacturer’s specifications and indicate location of Mississippi State Department of Health registration ID. 4. Provide documentation from Manufacturer that annual inspection has been made on the product. 5. Provide a list of Distributors and Certified Installers authorized by the Manufacturer to install the product.

**History**
- *Source: Miss. Code Ann. § 41-67-3.*

##### **15 Miss. Admin. Code Pt. 18, R. 2.1.12** Expiration: Manufacturer {#sec-18-2.1.12 omnilex-key=us-ms-regs-official--title-15--18#2.1.12}

Manufacturer certifications shall expire on December 31 unless suspended or revoked.

**History**
- *Source: Miss. Code Ann. § 41-67-3.*

##### **15 Miss. Admin. Code Pt. 18, R. 2.1.13** Renewal: Manufacturer {#sec-18-2.1.13 omnilex-key=us-ms-regs-official--title-15--18#2.1.13}

1. A Manufacturer may apply for renewal not more than 60 calendar days prior to the expiration of his Manufacturer certification. If more than 31 calendar days have elapsed from December 31, the Department shall require an Applicant to comply with the provisions of initial certification. Suspended certifications are not renewable until reinstated by the Department; revoked certifications cannot be renewed. 2. A Manufacturer shall file a complete application in a form provided by the Division and pay the application fee. Submittal Reports shall include the following: a. Provide proof and certification that Manufacturer has factory trained installers or other factory representatives to educate the homeowner with the necessary knowledge to provide maintenance to the homeowner’s system, thus allowing the homeowner to meet the requirements of Section 41-67-6(8). b. Provide documentation when a Certified Installer of alternative systems or products has been factory-trained and listed as an authorized representative. c. Provide notification to the Division within 10 working days whenever the Manufacturer no longer authorizes any Certified Installer, Certified Maintenance Provider or Qualified Homeowner Maintenance Provider. d. Provide notification of any changes made to a product by following Section 103.04. If a Third-Party Certifier must approve the change, this documentation must be submitted to the Division prior to the implementation of the changes approved by the Third-Party Certifier.

**History**
- *Source: Miss. Code Ann. § 41-67-3.*

##### **15 Miss. Admin. Code Pt. 18, R. 2.1.14** Informal Fact Finding and Hearing: Manufacturer {#sec-18-2.1.14 omnilex-key=us-ms-regs-official--title-15--18#2.1.14}

1. Whenever the Department intends to take action to suspend or revoke a Manufacturer’s certification, there must be an informal fact finding conference before the Department, where proper notice has been given to the affected party: a. The Manufacturer shall be notified in writing. The notice must be hand delivered or sent by certified mail. The notice must provide the factual and legal basis for the contemplated action and must give the date, time, place, and location of the informal fact finding conference. b. The informal fact finding conference is to be conducted by the Department. The conference shall be conducted in accordance with, but is not limited to, the requirements of Administrative Procedural Code of Mississippi and may include the creation of a verbatim or summary record of the proceedings. c. The Department shall render a decision based on the informal fact finding conference in a timely manner, and shall as deemed appropriate initiate suspension or revocation proceedings in accordance with regulations. d. When action is taken to suspend a Manufacturer’s certification, that suspension shall be for a specified period of time. Remedial actions including, but not limited to, notification by Third-Party Certifier that manufacturer has corrected all deficiencies, updating or modifying training procedures, and correction to components of any registered product as may be specified in the suspension notice.

**History**
- *Source: Miss. Code Ann. § 41-67-3.*

##### **15 Miss. Admin. Code Pt. 18, R. 2.1.15** Penalties: Manufacturer {#sec-18-2.1.15 omnilex-key=us-ms-regs-official--title-15--18#2.1.15}

1. The Department may suspend or revoke a Manufacturer certification for failure to comply with any law administered by the Board, Department, any regulations of the Board, any order of the Board or Department after due notice. 2. Actions that may result in suspension or revocation include, but are not limited to, falsifying any document, and any act of misrepresentation. 3. If any person or contractor fails to comply with all requirements and regulations in the installation of the system, the Board, after due notice and hearing, may levy an administrative fine not to exceed Ten Thousand Dollars ($10,000.00). Each wastewater system installed not in compliance with this chapter or applicable rules and regulations of the Board shall be considered a separate offense.

**History**
- *Source: Miss. Code Ann. § 41-67-3.*

##### **15 Miss. Admin. Code Pt. 18, R. 2.1.16** Reinstatement: Manufacturer {#sec-18-2.1.16 omnilex-key=us-ms-regs-official--title-15--18#2.1.16}

A person whose Manufacturer certification has been revoked, pursuant to statutes or regulations, may apply to the Division for reinstatement as a Manufacturer no sooner than 2 years after the effective date of the revocation. Reinstatement of a Manufacturer certification shall include:

1. An application, fee and statement (if applicable) that no activities took place after certification was revoked. 2. Provide documentation that the Applicant has satisfactorily completed any remedial actions required as a result of the revocation. Remedial actions including, but not limited to, notification by Third-Party Certifier that manufacturer has corrected all deficiencies, updating or modifying training procedures, and correction to components of any registered product as may be specified in the suspension notice.

**History**
- *Source: Miss. Code Ann. § 41-67-3.*

##### **15 Miss. Admin. Code Pt. 18, R. 2.1.17** Certified Professional Evaluator: General {#sec-18-2.1.17 omnilex-key=us-ms-regs-official--title-15--18#2.1.17}

Nothing in this chapter shall preclude a Certified Professional Evaluator or registered Professional Engineer from providing services relating to the design of an Individual On-site Wastewater Disposal System to comply with this chapter, except for Performance-based Systems. A Certified Professional Evaluator or registered Professional Engineer shall notify the department in writing of those services being provided, including the type of treatment, the type of disposal, and the property address for the treatment and disposal system. Construction or installation shall not begin prior to authorization by the department. The department shall respond within ten (10) business days with authorization that the Certified Professional Evaluator or registered Professional Engineer fulfills the requirements of the law.

**History**
- *Source: Miss. Code Ann. § 41-67-3.*

##### **15 Miss. Admin. Code Pt. 18, R. 2.1.18** Certified Professional Evaluator Requirements {#sec-18-2.1.18 omnilex-key=us-ms-regs-official--title-15--18#2.1.18}

1. A person may not operate as a Certified Professional Evaluator in this state unless the Department currently certifies that person. 2. A person must meet one (1) of the following requirements, in addition to the additional requirements set forth in other sections of this chapter and rules and regulations of the Board, in order to be eligible to become a Certified Professional Evaluator: a. Be a professional Geologist registered in the State of Mississippi. b. Be a Professional Soil Classifier licensed in the State of Mississippi. c. Be a person who possesses a demonstrable, adequate and appropriate record of professional experience and/or training as determined by the Department. 3. The Division shall issue a certification to a Certified Professional Evaluator if the Certified Professional Evaluator: a. Completes an application form that complies with this chapter and rules adopted under this chapter. b. Satisfactorily completes the Certified Professional Evaluator training program provided by the department.

c. Provides proof of having an errors and omissions policy or surety in effect with liability limits of at least Fifty Thousand Dollars ($50,000.00) per occurrence and at least One Hundred Thousand Dollars ($100,000.00) in total aggregate amount. d. Pays the certification fee. 4. Performance-based systems may only be designed by a registered Professional Engineer.

**History**
- *Source: Miss. Code Ann. § 41-67-3.*

##### **15 Miss. Admin. Code Pt. 18, R. 2.1.19** Certified Professional Evaluator Application {#sec-18-2.1.19 omnilex-key=us-ms-regs-official--title-15--18#2.1.19}

Any specified person may apply to the Division for certification if: 1. Complete application is filed. 2. Passes written and field examinations. 3. Submits 3 professional references. 4. Pays fee. 5. Those holding a current certificate as a Professional Engineer from the Mississippi Board of Licensure for Professional Engineers and Surveyors shall be eligible to provide services without a certificate as a Certified Professional Evaluator. 6. Demonstrates and provides documentation to the satisfaction of the Division that he/she has a minimum of 1 year of full-time experience evaluating soil and site conditions for Individual On-site Wastewater Disposal Systems in Mississippi in accordance with the Board of Health’s regulations and a 4 year college degree in a related study in science or engineering, and shall be eligible to receive a certificate as a Professional Evaluator provided: a. The Applicant successfully completes a training program or programs designated and approved by the Division. b. The Applicant successfully completes the written and field examinations approved by the Division. 7. Demonstrates to the satisfaction of the Division that he/she has a minimum of 2 years of full-time experience evaluating soil and site conditions for Individual On-site Wastewater Disposal Systems in Mississippi in accordance with the Board of Health’s regulations and a 2 or 4 year college degree, and shall be eligible to receive a certificate as a Professional Evaluator provided: a. The Applicant successfully completes a training course or courses designated and approved by the Division. b. The Applicant passes the written and field examinations.

c. The Applicant provides a written statement signed by a current or former supervisor or a Certified Professional Evaluator with a current certification stating that the person is sufficiently experienced to become a Professional Evaluator. 8. Demonstrates to the satisfaction of the Division that he/she has a minimum of 3 years experience evaluating soil and site conditions for Individual On-site Wastewater Disposal Systems in Mississippi in accordance with the Board of Health’s regulations, and shall be eligible to receive a certificate as a Professional Evaluator provided: a. The Applicant successfully completes a training program or programs designated and approved by the Division. b. The Applicant successfully completes the written and field examinations approved by the Division. c. The Applicant provides a written statement signed by a current or former supervisor or a Certified Professional Evaluator with a current certification stating that the person is sufficiently experienced to become a Professional Evaluator. 9. Qualification review: a. The Department shall review applications and determine if the Applicant is eligible for the examination. b. Applicants who have been determined ineligible for any reason may request further consideration by submitting, in writing, evidence of additional qualifications, training, or experience to the Department for further review. No additional fee will be required provided the additional information is submitted and received within 1 year from the date of the original application. After such period, a new application shall be required. c. If the Department finds that the Applicant has not met the minimum requirements for certification as a Professional Evaluator, the Applicant shall be sent written notification, by certified mail or hand delivered, stating the reasons for denial of the certification. The notice to the Applicant of denial shall also state that the Applicant has the right to a hearing to challenge the certification denial. Any request for a hearing must be received by the Department within 30 calendar days of the affected party’s receipt of written notice of the decision. d. Before approving a Professional Evaluator application, the Department may make further inquiries and investigations with respect to the qualifications of the Applicant and all references to confirm the information supplied. A personal interview with the Applicant may also be requested. 10. Those persons taking written and field examinations specified in Section 41-67-23(2)(b) shall pay a fee for such testing as determined by the Department based on the actual costs of preparing and administering the examinations.

**History**
- *Source: Miss. Code Ann. § 41-67-3.*

##### **15 Miss. Admin. Code Pt. 18, R. 2.1.20** Training Program and Examination: Certified Professional Evaluator {#sec-18-2.1.20 omnilex-key=us-ms-regs-official--title-15--18#2.1.20}

1. Basic Soils Training will be a 1 week course focusing on soil principles and evaluation techniques, specifically focusing on evaluating soils for use with on-site wastewater disposal. 2. Advanced Soils Training will be a 2 day field course with the candidate in the location or area of expertise. General soil conditions of the specific area will be reviewed. 3. On-site Wastewater Disposal System training will be a 1 week course focusing on the design, placement, operation and maintenance of on-site systems. Department will select sites for candidates and provide access to 5 proposed on-site wastewater disposal system sites. The candidate will provide soil information along with their written recommendation(s) for these sites. These 5 proposed recommendations will be evaluated by the Division of On-site Wastewater using the Mississippi State Department of Health Wastewater Quality Assurance Review Process: a. The candidate must score 80% or better to receive a probation certification. All sites done under a probation certification must be evaluated by the Division before an approval is given. b. A permanent certification will be issued after his/her first 10 sites are evaluated and scores of 80% or higher are achieved. 4. Certifications shall be revoked when an individual’s work is evaluated and their overall evaluated sites score less than 90% in the Mississippi State Department of Health, Division of On-Site Wastewater Quality Assurance Review Process. 5. Certified Professional Evaluator certificates are subject to immediate revocation if a recommendation is made that violates Mississippi State Law or regulation(s).

**History**
- *Source: Miss. Code Ann. § 41-67-3.*

##### **15 Miss. Admin. Code Pt. 18, R. 2.1.21** Responsibilities: Certified Professional Evaluator {#sec-18-2.1.21 omnilex-key=us-ms-regs-official--title-15--18#2.1.21}

1. Provide complete information, including all applicable requirements and regulations on all systems recommended to the owner, lessee or developer which shall have the right to choose among systems. 2. Notify the Department at least 48 hours before beginning construction if acting as the Certified Installer of an Individual On-site Wastewater Disposal System and, at that time, schedule a time for inspection of the system with the appropriate county Department of Health.

3. Provide a signed affidavit and any additional required documentation that the system was installed in compliance with all requirements, regulations and permit conditions applicable to the system installed. This applies only if the Certified Professional Evaluator is acting as the Certified Installer. The Affidavit must be given to the Applicant of the Notice of Intent. 4. Furnish proof of certification to a property owner or the owner’s representative of the property before performing a site evaluation of the property on which an individual on- site wastewater disposal system is to be designed, constructed, repaired or installed by the Certified Professional Evaluator and to the Department or its authorized representative, if requested. 5. Notify the Department of any change in address, business partnership or affiliation, or any other status that affects his/her standing as a Professional Evaluator. Such notice must be in writing and must be delivered to the Department within 10 working days. 6. Shall not knowingly associate in a business venture with, or permit the use of the Professional Evaluator’s name or firm name by, any person or firm where there is reason to believe that person or firm is engaging in activity of a fraudulent or dishonest nature or is violating any law or regulations of the Department. 7. Except as provided in paragraph 9 of this section, a Certified Professional Evaluator shall not utilize the evaluations, design, drawings or work of another Certified Professional Evaluator without the knowledge and written consent of the Certified Professional Evaluator or organization of ownership that originated the design, drawings or work. In the event that the Certified Professional Evaluator who generated the original document is no longer employed by the firm retaining ownership of the original documents or is deceased, another Certified Professional Evaluator who is a partner or officer in the firm retaining ownership of the original documents may authorize utilization of the original documents by another Certified Professional Evaluator or firm. This fact must be disclosed to the Department when submitting applications supported by Certified Professional Evaluator materials and certifications. 8. Utilizing information contained in the Department records on which a decision to approve or refer a site has been made shall be considered to be in the public domain and may be utilized by a Certified Professional Evaluator without permission. 9. Provide information, if utilizing information in the Department’s files or has received permission to modify or otherwise utilize the evaluation, design, drawings or work of another Certified Professional Evaluator, may certify that work only after a thorough review of the evaluation, design, drawings or work and after he/she determines that he/she is willing to assume full responsibility for all design, drawings or work on which he/she relies for his/her opinion. 10. Public: a. False Statements – A Certified Professional Evaluator shall not knowingly fail to disclose a material fact requested in connection with an application submitted to

the Department by himself or any other individual or business entity for certification, renewal or reinstatement. b. Conflicts of interest – The Certified Professional Evaluator shall promptly and fully inform an employer or client of any business association, interest, or circumstance or circumstances that may influence the Certified Professional Evaluator’s judgment or the quality of service. c. Good standing – A Certified Professional Evaluator certified to practice soil and site evaluations or to design Individual On-site Wastewater Disposal Systems in other jurisdictions shall be in good standing and shall not have had a certificate suspended, revoked or surrendered in connection with a disciplinary action or have been the subject of discipline in another jurisdiction. 11. Submittal Reports: a. System Application: i. The Certified Professional Evaluator must submit the appropriate residential or commercial application to the Division with evaluation and design documentation. ii. Applications that are incomplete or substandard in any manner shall be returned to the Applicant. The Applicant and Certified Professional Evaluator will be notified of any deficiencies. If an application has been returned, the Applicant or his/her agent may submit a new application to correct the deficiency or deficiencies contained in his/her first application. If the application is received within 45 days of the first, the Division will waive all fees associated with the new application. This waiver may be granted not more than once per site. iii. No Certified Professional Evaluator shall certify a site evaluation and/or design unless such evaluation and/or design comply with the minimum requirements of the Regulations and such certification and/or design is produced in accordance with this chapter. A Certified Professional Evaluator shall make a good faith effort to secure complete, accurate, and timely information regarding site and soil conditions, including relevant factors on adjacent parcels, including but not limited to utilities, water supplies, and other sewage systems. The Certified Professional Evaluator shall certify that all information submitted is true and correct to the best of his/her knowledge and shall be required to be aware of all information in agency files pertaining to the site he/she is certifying. iv. Any system proposed for authorization in accordance with performance standards must be designed and certified by a Professional Engineer registered in the State of Mississippi who is a Certified Engineer Evaluator.

b. Soil and Site Evaluation: i. All soil and site evaluation reports submitted to the Department shall be in a form approved by the Division, shall contain the minimum information specified by the Division, and shall be certified as fully complying with the Regulations. A statement approved by the Department shall be used to certify that a site evaluation and/or design comply with the Board’s regulations for on-site sewage systems. No approval shall be granted pursuant to this chapter for any site that has not been certified by a Certified Professional Evaluator. ii. Additional information may be included with a Certified Professional Evaluator submission in order to facilitate processing the application. However, for the purposes of a Certified Professional Evaluator certifying that an evaluation and/or design complies with the Regulations and is “deemed approvable,” only those requirements contained in the regulations are considered to apply unless a local government has requested the Department to implement a more restrictive local ordinance. Wastewater system sites proposed for use must be defined in a manner that allows them to be identified on the plat with the accuracy and precision of 3 feet or less. c. Design – A complete design packet must contain the following: i. Legal description. ii. Plat showing location and/or dimensions of: water supply, residence, property, sensitive waters (if applicable), and setbacks on contours with 2 foot intervals (if applicable). iii. Soil Profile Sheet and location of each soil boring. iv. Individual On-Site Wastewater Disposal System chosen by the Applicant. v. Individual On-site Wastewater Disposal System option(s). d. Design calculations used to establish the design parameters of the recommended system, including the minimum information deemed appropriate by the Division. e. Provide 2 sets of construction drawings and specifications for the recommended system in accordance with statutes and regulations. f. A statement stamped and certified by the Certified Professional Evaluator that the site and soil conditions and design conform to the Regulations. g. Additional information based on standard procedures can be submitted when a Certified Professional Evaluator believes it may be in the interest of public health, the environment, or the client.

h. Field Analysis – The Department is not required to perform a field analysis of Certified Professional Evaluator evaluations and designs prior to issuing a Permit/Recommendation approval; however, the Department may conduct a field analysis, as deemed necessary to protect public health and to ensure licensure integrity. Whenever a field analysis is performed, the Department shall make a record of the results.

**History**
- *Source: Miss. Code Ann. § 41-67-3.*

##### **15 Miss. Admin. Code Pt. 18, R. 2.1.22** Expiration: Certified Professional Evaluator {#sec-18-2.1.22 omnilex-key=us-ms-regs-official--title-15--18#2.1.22}

Professional Evaluator certifications shall expire on June 30, unless revoked or suspended.

**History**
- *Source: Miss. Code Ann. § 41-67-3.*

##### **15 Miss. Admin. Code Pt. 18, R. 2.1.23** Renewal: Certified Professional Evaluator {#sec-18-2.1.23 omnilex-key=us-ms-regs-official--title-15--18#2.1.23}

A Certified Professional Evaluator may apply for renewal not more than 60 calendar days prior to the expiration of his/her Certified Professional Evaluator certification. If more than 31 calendar days have elapsed from the expiration of the most recent certification, the Department shall require an Applicant to comply with the provisions of initial certification. Any person applying for renewal shall file with the Division: 1. Completed application. 2. Proof of CEU or PDH credits. 3. Proof of Errors and Omissions Policy or Surety. 4. Fee.

**History**
- *Source: Miss. Code Ann. § 41-67-3.*

##### **15 Miss. Admin. Code Pt. 18, R. 2.1.24** Informal Fact Finding and Hearing: Certified Professional Evaluator {#sec-18-2.1.24 omnilex-key=us-ms-regs-official--title-15--18#2.1.24}

1. Whenever the Department intends to take action to suspend or revoke a Professional Evaluator certification, there must be an informal fact finding conference and proper notice must be given to the affected party: a. The Professional Evaluator shall be notified in writing. The notice must be hand delivered or sent by certified mail. The notice must provide the factual and legal basis for the contemplated action and must give the date, time, place, and location of the informal fact finding conference. b. The informal fact finding conference is to be conducted by the Board of Certified Professional Evaluators. The conference shall be conducted in accordance with, but is not limited to, the requirements of Administrative Procedural Code of Mississippi and may include the creation of a verbatim or summary record of the proceedings.

c. The Department shall render a recommendation from the informal fact finding conference within 30 calendar days. Such recommendations shall be sent to the Division upon which appropriate enforcement action shall be initiated. d. When action is taken to suspend a Professional Evaluator certification, that suspension shall be for a specified period of time. Remedial actions including, but not limited to, additional training courses, additional testing, and reevaluation of a site and/or redesign of an Individual On-site Wastewater Disposal System.

**History**
- *Source: Miss. Code Ann. § 41-67-3.*

##### **15 Miss. Admin. Code Pt. 18, R. 2.1.25** Penalties: Certified Professional Evaluator {#sec-18-2.1.25 omnilex-key=us-ms-regs-official--title-15--18#2.1.25}

1. The Department may suspend or revoke a certification for failure to comply with any law administered by the Board, Department, any regulations of the Board, any order of the Board or Department after due notice from the Department. 2. Actions that may result in suspension or revocation include, but are not limited to, certifying as suitable a site that does not comply with the minimum requirements of the Regulations, falsifying any document, and any act of misrepresentation made related to Professional Evaluator activities. 3. If any person operates in the state as a Certified Professional Evaluator without certification by the Board, the Board, after due notice and opportunity for a hearing, may impose a monetary penalty not to exceed Ten Thousand Dollars ($10,000.00) for each violation.

**History**
- *Source: Miss. Code Ann. § 41-67-3.*

##### **15 Miss. Admin. Code Pt. 18, R. 2.1.26** Reinstatement: Certified Professional Evaluator {#sec-18-2.1.26 omnilex-key=us-ms-regs-official--title-15--18#2.1.26}

Any person whose certification has been revoked may apply to the Division for reinstatement no sooner than 2 years after the effective date of the revocation. Reinstatement of a Certified Professional Evaluator’s certification shall include: 1. An application, fee and statement (if applicable) that no activities took place after certification was revoked. 2. Documentation that the Applicant has satisfactorily completed any remedial actions required as a result of the revocation. Remedial actions including, but not limited to, additional training courses, additional testing, and reevaluation of a site and/or redesign of an on-site sewage system may be specified as conditions for reinstatement. 3. At least 10 sites must be evaluated using the Department’s Quality Assurance Review Process in the first year. All sites must score at least 80% with no violation of Mississippi State Law or Mississippi State Department of Health regulation which promotes the violation of state law.

**History**
- *Source: Miss. Code Ann. § 41-67-3.*

##### **15 Miss. Admin. Code Pt. 18, R. 2.1.27** Certified Installer: General {#sec-18-2.1.27 omnilex-key=us-ms-regs-official--title-15--18#2.1.27}

A Certified Installer can construct, install, repair, replace, service, conduct a connection-event existing system inspection, or maintain an Individual On-Site Wastewater Disposal System upon which he/she has been certified by the Manufacturer. This will include the construction, installation, and repair or replacement of any sewage treatment and disposal system: 1. A person may not operate as a Certified Installer of Individual On-Site Wastewater Disposal Systems unless the Division currently certifies that person. 2. A person who installs a Conventional (septic tank and aggregate disposal) Individual On- site Wastewater Disposal System on his/her own property for his/her primary residence must comply with all Sections except for Rules 2.1.27(1), 2.1.28, 2.1.29(3), 2.1.29(8) and 2.1.30.

**History**
- *Source: Miss. Code Ann. § 41-67-3.*

##### **15 Miss. Admin. Code Pt. 18, R. 2.1.28** Certified Installer Requirements {#sec-18-2.1.28 omnilex-key=us-ms-regs-official--title-15--18#2.1.28}

The Board shall issue a certification to an installer if the installer: 1. Completes an application form that complies with this chapter and rules adopted under this chapter. 2. Satisfactorily completes the training program provided by the Division. 3. Provides proof of having a valid General Business Liability Insurance policy in effect with liability limits of at least Fifty Thousand Dollars ($50,000.00) per occurrence and at least One Hundred Thousand Dollars ($100,000.00) in total aggregate amount. 4. Pays the certification fee.

**History**
- *Source: Miss. Code Ann. § 41-67-3.*

##### **15 Miss. Admin. Code Pt. 18, R. 2.1.29** Certified Installer Application {#sec-18-2.1.29 omnilex-key=us-ms-regs-official--title-15--18#2.1.29}

1. A person may apply for certification by filing a complete application provided by the Division, attending and satisfactorily completing the training program, providing proof of General Business Liability Insurance and paying the application fee in accordance with Section 43-3-15(4)(e). 2. Prior to receipt of a certification, the Applicant shall complete an examination demonstrating his/her knowledge and comprehension of the Individual On-site Wastewater Disposal System Regulations. Within 30 days of passing the examination, the Certified Installer must submit insurance and fee. 3. Certificates issued in accordance with this regulation shall not be transferable. Nothing within this regulation shall be construed to limit the power of any municipal, county, or governmental entity to enforce other license requirements or additional measures for the

restrictions of persons in the business of constructing, installing, repairing and replacing any Individual On-Site Wastewater Disposal System(s).

**History**
- *Source: Miss. Code Ann. § 41-67-3.*

##### **15 Miss. Admin. Code Pt. 18, R. 2.1.30** Certified Installer Responsibilities {#sec-18-2.1.30 omnilex-key=us-ms-regs-official--title-15--18#2.1.30}

1. May not design, construct or install, or cause to be designed, constructed or installed an Individual On-site Wastewater Disposal System that does not comply with this chapter and rules and regulations of the Board. 2. Provide documentation and certification from the Manufacturer that a Certified Installer of alternative systems or products has been factory-trained and listed as an authorized representative. 3. Furnish proof of certification to a property owner, lessee, the owner’s representative or occupant of the property on which an Individual On-Site Wastewater Disposal System is to be designed, constructed, repaired or installed by that Certified Installer and to the Department or its authorized representative, if requested. 4. Notify the Department at least 24 hours before beginning construction of an Individual On-site Wastewater Disposal System and, at that time, schedule a time for inspection of the system with the appropriate county Department. 5. Shall be present on the jobsite at the time of the scheduled inspection. 6. Shall not cover his/her work with soil or other surface material unless the installer has received authorization to cover the system after an inspection by a county Department of Health inspector. 7. Provide a signed affidavit from the Certified Installer, Certified Professional Evaluator or registered Professional Engineer and any additional required documentation that the system was installed in compliance with all requirements, regulations and permit conditions applicable to the system installed. The Affidavit must be given to the Applicant of the Notice of Intent. 8. Notify the Division within 10 working days of any change in address, business partnership or affiliation, or any other status that affects his/her standing as a Certified Installer. Such notice must be in writing or by fax and must be delivered to the Division as soon as practicable after the effective date of the change. 9. Pay the required re-inspection fee. 10. Comply with National Sanitation Foundation/American National Standard Institute Standard 40 and Rule 2.1.30(11) if providing maintenance. 11. Maintenance Provider Responsibilities:

a. Provide on all Advanced Treatment Systems an affidavit from the property owner agreeing to a continuing maintenance agreement on the installed system at the end of the required manufacturer’s maintenance agreement. b. Provide the property owner with a continuing maintenance agreement on all Advanced Treatment Systems in perpetuity. c. Furnish proof of certification to an individual before entering a contract with that individual for the continuing maintenance of an individual on-site wastewater disposal system. d. Provide 2 inspections annually to the homeowner. Each must include the homeowner name/address, date, time and list of components repaired or replaced. This report must be submitted to the Division on a yearly basis. e. Provide a sample contract and/or list of services to the Division, when requested. f. Submittal Reports: i. Inspecting and evaluating Individual On-Site Wastewater Disposal Systems to determine if they are compliant with state law and being properly maintained. ii. Keeping accurate records of systems inspected and repaired. iii. Issuing inspection reports to property owners and the Division on a biannual basis from date of contract.

**History**
- *Source: Miss. Code Ann. § 41-67-3.*

##### **15 Miss. Admin. Code Pt. 18, R. 2.1.31** Certified Installer Training Program and Examination {#sec-18-2.1.31 omnilex-key=us-ms-regs-official--title-15--18#2.1.31}

1. Those persons taking the written examination specified in Section 41-67-25(3)(b) shall pay a fee for such testing as determined by the Department based on the actual costs of preparing and administering the examinations. 2. Attendance of the Department’s 2 day Certified Installers training course. 3. Applicant must achieve a score of 80% or better on the closed book examination. 4. All persons completing the above items will be granted a probationary certificate. A person will be probationary until he/she installs 3 Individual On-site Wastewater Disposal Systems as indicated from a Permit/Recommendation and work has been inspected by the Division during installation with no deficiencies indicated on Inspection (Form 305). Probationary status will remain in effect until the person is deemed competent by the Division.

**History**
- *Source: Miss. Code Ann. § 41-67-3.*

##### **15 Miss. Admin. Code Pt. 18, R. 2.1.32** Expiration: Certified Installer {#sec-18-2.1.32 omnilex-key=us-ms-regs-official--title-15--18#2.1.32}

Certified Installer certifications shall expire June 30 unless suspended or revoked.

**History**
- *Source: Miss. Code Ann. § 41-67-3.*

##### **15 Miss. Admin. Code Pt. 18, R. 2.1.33** Renewal: Certified Installer {#sec-18-2.1.33 omnilex-key=us-ms-regs-official--title-15--18#2.1.33}

A Certified Installer may apply for renewal not more than 60 calendar days prior to the expiration of his/her Certified Installer certification. If more than 31 calendar days have elapsed from the expiration of the most recent certification, the Department shall require an Applicant to comply with the provisions of initial certification. Any person applying for renewal shall file with the Division: 1. Completed application. 2. Proof of CEU or PDH credits. 3. Proof of General Business Liability Insurance Policy. 4. Fee.

**History**
- *Source: Miss. Code Ann. § 41-67-3.*

##### **15 Miss. Admin. Code Pt. 18, R. 2.1.34** Informal Fact Finding and Hearing: Certified Installer {#sec-18-2.1.34 omnilex-key=us-ms-regs-official--title-15--18#2.1.34}

Whenever the Department intends to take action to suspend or revoke a certification, there must be an informal fact finding conference and proper notice must be given to the affected party: 1. The Certified Installer shall be notified in writing. The notice must be hand delivered or sent by certified mail. The notice must provide the factual and legal basis for the contemplated action and must give the date, time, place, and location of the informal fact finding conference. 2. The informal fact finding conference is to be conducted by an employee of the Department. The conference shall be conducted in accordance with, but is not limited to, the requirements of Administrative Procedural Code of Mississippi and may include the creation of a verbatim or summary record of the proceedings. 3. The Department shall render a decision from the informal fact finding conference in a timely manner. Such decisions shall constitute the final administrative decision and may be appealed. 4. When action is taken to suspend an Installer certification, that suspension shall be for a specified period of time. Remedial actions including, but not limited to, additional training courses, additional testing, and installing or repairing of the Individual On-Site Wastewater Disposal System as conditions of any suspension.

**History**
- *Source: Miss. Code Ann. § 41-67-3.*

##### **15 Miss. Admin. Code Pt. 18, R. 2.1.35** Penalties: Certified Installer {#sec-18-2.1.35 omnilex-key=us-ms-regs-official--title-15--18#2.1.35}

1. The Department may suspend or revoke certification for failure to comply with any law administered by the Board, Department, or any regulation of the Board, any order of the Board or Department after due notice from the Department. 2. Actions that may result in suspension or revocation include, but are not limited to, constructing, installing, repairing, replacing or causing the construction, installation, repairing, replacing of an Individual On-Site Wastewater Disposal System on a site that does not comply with the minimum requirements of the Regulations, falsifying any document, and any act of misrepresentation. 3. If any person is operating in the state as an installer without certification by the Board, the Board, after due notice and opportunity for a hearing, may impose a monetary penalty not to exceed Ten Thousand Dollars ($10,000.00) for each violation. 4. If any person or contractor fails to comply with all requirements and regulations in the installation of the system, the Board, after due notice and hearing, may levy an administrative fine not to exceed Ten Thousand Dollars ($10,000.00). Each wastewater system installed not in compliance with this chapter or applicable rules and regulations of the Board shall be considered a separate offense.

**History**
- *Source: Miss. Code Ann. § 41-67-3.*

##### **15 Miss. Admin. Code Pt. 18, R. 2.1.36** Reinstatement: Certified Installer {#sec-18-2.1.36 omnilex-key=us-ms-regs-official--title-15--18#2.1.36}

Any person whose certification has been revoked may apply to the Division for reinstatement no sooner than 2 years after the effective date of the revocation. Reinstatement of a Certified Installer’s certification shall include: 1. An application, fee and a written statement (if applicable) that no activities took place after certification was revoked. 2. Provide documentation that the Applicant has satisfactorily completed any remedial actions required as a result of the revocation. Remedial actions including, but not limited to, additional training courses, additional testing, and installation or repairing of the Individual On-Site Wastewater Disposal System may be specified as conditions for reinstatement.

**History**
- *Source: Miss. Code Ann. § 41-67-3.*

##### **15 Miss. Admin. Code Pt. 18, R. 2.1.37** Certified Pumper: General {#sec-18-2.1.37 omnilex-key=us-ms-regs-official--title-15--18#2.1.37}

A person may not be engaged in the business of removing and disposing of the sludge and liquid waste (septage) from Individual On-site Wastewater Disposal Systems in this state unless that person has a valid license issued by the Department. Licensing a person constitutes the issuance of a certification with all rights and privileges to clean, pump and dispose of any sludge and liquid waste (septage) from any Individual On-Site Wastewater Disposal Systems, Portable Toilet (Self-Contained), grease trap and/or holding tank.

**History**
- *Source: Miss. Code Ann. § 41-67-3.*

##### **15 Miss. Admin. Code Pt. 18, R. 2.1.38** Certified Pumper Requirements {#sec-18-2.1.38 omnilex-key=us-ms-regs-official--title-15--18#2.1.38}

The Department shall issue a license to a pumper if the pumper: 1. Completes an application that complies with this chapter and rules adopted under this chapter. 2. Satisfactorily complies with the requirements of his/her pumping and hauling equipment. 3. Provides annual documentation of a disposal site approved by the Department of Environmental Quality, Office of Pollution Control. 4. Provides proof of having a valid General Business Liability Insurance policy in effect with liability limits of at least Fifty Thousand Dollars ($50,000.00) per occurrence and at least One Hundred Thousand Dollars ($100,000.00) in total aggregate amount. 5. Submits passing inspection of each vehicle. 6. Pays the license fee.

**History**
- *Source: Miss. Code Ann. § 41-67-3.*

##### **15 Miss. Admin. Code Pt. 18, R. 2.1.39** Certified Pumper Application {#sec-18-2.1.39 omnilex-key=us-ms-regs-official--title-15--18#2.1.39}

1. A person may apply for certification by filing a complete application provided by the Division, attending and satisfactorily completing the training program, providing proof of General Business Liability Insurance, submittal of vehicle inspection from the County Health Department and paying the inspection and application fees as specified in Section 43-3-15(4)(e). In addition, all Applicants shall list each approved disposal facility they intend to use. Written verification of permission to use each disposal facility shall accompany the application. 2. Prior to receipt of a certification, the Applicant shall complete an examination demonstrating his/her knowledge and comprehension of the Individual On-site Wastewater Disposal System Regulations. Within 30 days of passing the examination, the Certified Pumper must submit insurance and fee. 3. Certificates issued in accordance with this regulation shall not be transferable. Nothing within this regulation shall be construed to limit the power of any municipal, county, or governmental entity to enforce other license requirements or additional measures for the restrictions of persons in the business of removing and disposing of sludge and liquid waste from Individual On-Site Wastewater Disposal System(s).

**History**
- *Source: Miss. Code Ann. § 41-67-3.*

##### **15 Miss. Admin. Code Pt. 18, R. 2.1.40** Certified Pumper Inspection: County Health Department {#sec-18-2.1.40 omnilex-key=us-ms-regs-official--title-15--18#2.1.40}

1. Complete Inspection form and return to Division.

2. Verify that all jobs are being recorded on the Data Log sheet.

**History**
- *Source: Miss. Code Ann. § 41-67-3.*

##### **15 Miss. Admin. Code Pt. 18, R. 2.1.41** Certified Pumper Responsibilities {#sec-18-2.1.41 omnilex-key=us-ms-regs-official--title-15--18#2.1.41}

1. Notifying the Department within 10 working days of adding, replacing or deleting the inventory of vehicles for the purpose of updating the application of any change in address, business partnership or affiliation, or any other status that affects his/her standing as a Certified Pumper. 2. Keep a record on all systems cleaned, pumped and disposed of by address, type of treatment unit, amount pumped, and receipt of disposal at waste treatment facility permitted by the Mississippi Department of Environmental Quality (MDEQ). The proper cleaning of any septic tank or similar unit shall include the substantial removal of its contents: a. Discharge of septage or other liquid waste shall be allowed only at those specific locations designated by the owners/operators of approved disposal facilities. b. Discharge of septage or other liquid waste into a public sewage collection system, without the consent and permission of the owner/operator of such system, is prohibited. c. Records shall be made available at time of the inspection by the Department. Records must be retained for a minimum of 2 years. d. Provide authorization letter from a Mississippi Department of Environmental Quality (MDEQ) permitted facility upon inspection and/or request. 3. Deliver vehicle(s) to the appropriate county health office for inspection purposes. This will require the Certified Pumper to contact the county health office. 4. Keep available 5 dry gallons of Lime, ensuring spillage, pumping and transporting of septage or other liquid waste shall be delivered in a manner that is safe and does not create a nuisance or public health hazard. 5. Label the carrier tank “SEPTAGE AND LIQUID WASTE ONLY” at or near the inlet and outlet valve. The use of the carrier tank for other purposes is prohibited. The required lettering shall be a minimum of 2 inches in height. 6. Label vehicle with name of the company, address and certification number. The required lettering shall be a minimum of 2 inches in height. 7. Supervise employees and ensure that all systems for which the licensee is responsible shall be pumped and cleaned in accordance with Regulation and other applicable regulations, permits, and standards issued by the Department. 8. Training Program and Examination:

a. A person taking written examinations shall pay a fee as specified in Section 43-3- 15(4)(e) for such testing as determined by the Department based on the actual costs of preparing and administering the examinations. b. A person taking a Department-sponsored training course or courses as specified shall pay the fee as specified in Section 43-3-15(4)(e) for such course as determined by the Department. Fees for such course or courses will be based on the Department’s actual expenses in preparing course materials and conducting the training. This section is not intended to prevent or discourage training courses recognized by the Department and offered by entities other than the Department. In the case of training that is not directly sponsored by the Department, Applicants will pay appropriate fees to the sponsoring entity. c. Attendance of the Department’s 1-day Certified Pumper Training Course. d. Applicant must achieve a score of 80% or better on the closed book examination. e. A person making application shall provide documentation that he/she has earned four (4) continuing education units (CEUs) or fifteen (15) PDH credits in a calendar year. For the purposes of this chapter, a CEU shall be equivalent to four (4) contact hours of instruction in subject matter and from sources prior approved by the Division. Each Certified Pumper shall be responsible for maintaining appropriate records and providing proof of credit earned.

**History**
- *Source: Miss. Code Ann. § 41-67-3.*

##### **15 Miss. Admin. Code Pt. 18, R. 2.1.42** Expiration: Certified Pumper {#sec-18-2.1.42 omnilex-key=us-ms-regs-official--title-15--18#2.1.42}

Certified Pumper certifications shall expire September 30 unless revoked or suspended.

**History**
- *Source: Miss. Code Ann. § 41-67-3.*

##### **15 Miss. Admin. Code Pt. 18, R. 2.1.43** Renewal: Certified Pumper {#sec-18-2.1.43 omnilex-key=us-ms-regs-official--title-15--18#2.1.43}

A Certified Pumper may apply for renewal not more than 60 calendar days prior to the expiration of his/her Certified Pumper certification. If more than 31 calendar days have elapsed from the expiration of the most recent certification, the Department shall require an Applicant to comply with the provisions of initial certification. Any person applying for renewal shall file with the Division: 1. Completed application. 2. Copy of Inspection from County Health Department. 3. Proof of CEU or PDH credits. 4. Proof of General Business Liability Insurance Policy. 5. Copy of letter from disposal site(s).

6. Fee.

**History**
- *Source: Miss. Code Ann. § 41-67-3.*

##### **15 Miss. Admin. Code Pt. 18, R. 2.1.44** Informal Fact Finding and Hearing: Certified Pumper {#sec-18-2.1.44 omnilex-key=us-ms-regs-official--title-15--18#2.1.44}

Whenever the Department intends to take action to suspend or revoke a Pumper certification, there must be an informal fact finding conference in accordance with this rule and proper notice must be given to the affected party: 1. The Certified Pumper shall be notified in writing. The notice must be hand delivered or sent by certified mail. The notice must provide the factual and legal basis for the contemplated action and must give the date, time, place, and location of the informal fact finding conference. 2. The informal fact finding conference is to be conducted by an employee of the Department. The conference shall be conducted in accordance with, but is not limited to, the requirements of Administrative Procedural Code of Mississippi and may include the creation of a verbatim or summary record of the proceedings. 3. The Department shall render a decision from the informal fact finding conference in a timely manner. Such decisions shall constitute the final administrative decision and may be appealed. 4. When action is taken to suspend a Pumper certification, that suspension shall be for a specified period of time. Remedial actions including, but not limited to, additional training courses, additional testing, and certification by manufacturer of pumping equipment.

**History**
- *Source: Miss. Code Ann. § 41-67-3.*

##### **15 Miss. Admin. Code Pt. 18, R. 2.1.45** Penalties: Certified Pumper {#sec-18-2.1.45 omnilex-key=us-ms-regs-official--title-15--18#2.1.45}

1. The Department may suspend or revoke certification for failure to comply with any law administered by the Board, Department, or any regulation of the Board, any order of the Board or Department after due notice from the Department. 2. Actions that may result in suspension or revocation include, but are not limited to, constructing, installing, repairing, replacing or causing the construction, installation, repairing, replacing of an Individual On-Site Wastewater Disposal System on a site that does not comply with the minimum requirements of the Mississippi State Department of Health Regulations; spillage, septage or other liquid waste from equipment; dumping or disposing of septage or other liquid waste in an unpermitted or unapproved site; falsifying any document; and any act of misrepresentation made related to Certified Pumper activities.

3. If any person operates in the state as a licensed pumper without a license by the Board, the Board, after due notice and opportunity for a hearing, may impose a monetary penalty not to exceed Ten Thousand Dollars ($10,000.00) for each violation. 4. If any person or contractor fails to comply with all requirements and regulations in the installation of the system, the Board, after due notice and hearing, may levy an administrative fine not to exceed Ten Thousand Dollars ($10,000.00). Each wastewater system installed not in compliance with this chapter or applicable rules and regulations of the Board shall be considered a separate offense. Section 41-67-6(6).

**History**
- *Source: Miss. Code Ann. § 41-67-3.*

##### **15 Miss. Admin. Code Pt. 18, R. 2.1.46** Reinstatement: Certified Pumper {#sec-18-2.1.46 omnilex-key=us-ms-regs-official--title-15--18#2.1.46}

Any person whose Certified Pumper’s certification has been revoked may apply to the Department for reinstatement as a Pumper no sooner than 2 years after the effective date of the revocation. Reinstatement of a Certified Pumper’s certification shall include: 1. An application, fee and a written statement (if applicable) that no activities took place after certification was revoked. 2. Provide documentation that the Applicant has satisfactorily completed any remedial actions required as a result of the revocation. Remedial actions including, but not limited to, additional training courses, additional testing, and certification by manufacturer of pumping equipment.

**History**
- *Source: Miss. Code Ann. § 41-67-3.*

##### **15 Miss. Admin. Code Pt. 18, R. 2.1.47** Certified Maintenance Provider: General {#sec-18-2.1.47 omnilex-key=us-ms-regs-official--title-15--18#2.1.47}

A Certified Maintenance Provider can perform maintenance on an Individual On-Site Wastewater Disposal System which he/she has under contract. This will include the repair or replacement of a component originally installed by a Certified Installer. This shall exclude any repairs or replacement of the disposal system that would require the person to be a Certified Installer. A person may not operate as a maintenance provider in this state unless that person is a maintenance provider certified by the department on April 26, 2011, or is a Certified Installer.

**History**
- *Source: Miss. Code Ann. § 41-67-3.*

##### **15 Miss. Admin. Code Pt. 18, R. 2.1.48** Certified Maintenance Provider Responsibilities {#sec-18-2.1.48 omnilex-key=us-ms-regs-official--title-15--18#2.1.48}

1. Provide on all Advanced Treatment Systems an affidavit from the property owner agreeing to a continuing maintenance agreement on the installed system at the end of the required manufacturer’s maintenance agreement. 2. Providing the property owner with a continuing maintenance agreement on all Advanced Treatment Systems in perpetuity.

3. Furnish proof of certification to an individual before entering a contract with that individual for the continuing maintenance of an individual on-site wastewater disposal system. 4. Provide 2 inspections annually to the homeowner. Each must include the homeowner name/address, date, time and list of components repaired or replaced. This report must be submitted to the Division on a yearly basis. 5. Provide a sample contract and/or list of services to the Division, when requested. 6. Submittal Reports: a. Inspecting and evaluating Individual On-Site Wastewater Disposal Systems to determine if they are compliant with state law and being properly maintained. b. Keeping accurate records of systems inspected and repaired. c. Issuing inspection reports to property owners and the Division on a biannual basis from date of contract.

**History**
- *Source: Miss. Code Ann. § 41-67-3.*

##### **15 Miss. Admin. Code Pt. 18, R. 2.1.49** Expiration: Certified Maintenance Provider {#sec-18-2.1.49 omnilex-key=us-ms-regs-official--title-15--18#2.1.49}

Certified Maintenance Provider certifications shall expire on December 31, unless suspended or revoked. This certification is valid for 2 years. This is only for the currently certified person; no further certifications will be issued by the Department.

**History**
- *Source: Miss. Code Ann. § 41-67-3.*

##### **15 Miss. Admin. Code Pt. 18, R. 2.1.50** Informal Fact Finding and Hearing: Certified Maintenance Provider {#sec-18-2.1.50 omnilex-key=us-ms-regs-official--title-15--18#2.1.50}

Whenever the Department intends to take action to suspend or revoke a Maintenance Provider certification, there must be an informal fact-finding conference and proper notice must be given to the affected party: 1. The Certified Maintenance Provider shall be notified in writing. The notice must be hand delivered or sent by certified mail. The notice must provide the factual and legal basis for the contemplated action and must give the date, time, place, and location of the informal fact finding conference. 2. The informal fact finding conference is to be conducted by an employee of the Department. The conference shall be conducted in accordance with, but is not limited to, the requirements of Administrative Procedural Code of Mississippi and may include the creation of a verbatim or summary record of the proceedings. 3. The Department shall render a decision from the informal fact finding conference in a timely manner. Such decisions shall constitute the final administrative decision and may be appealed.

4. When action is taken to suspend a Maintenance Provider certification, that suspension shall be for a specified period of time. Remedial actions including, but not limited to, additional training courses, examination, and installation or repairing of the Individual On-Site Wastewater Disposal System(s). 5. Submitting false information to the property owner or to the Department is grounds for certification revocation. 6. Falsifying inspection reports is grounds for certification revocation. 7. Violating Mississippi State Laws or Regulations Governing On-site Wastewater Disposal Systems, or encouraging property owners to violate said laws and regulations, is grounds for certification revocation.

**History**
- *Source: Miss. Code Ann. § 41-67-3.*

##### **15 Miss. Admin. Code Pt. 18, R. 2.1.51** Penalties: Certified Maintenance Provider {#sec-18-2.1.51 omnilex-key=us-ms-regs-official--title-15--18#2.1.51}

1. The Department may suspend or revoke certification for failure to comply with any law administered by the Board, Department, or any regulation of the Board, any order of the Board or Department after due notice from the Department. 2. Actions that may result in suspension or revocation include, but are not limited to, repairing, replacing or causing the repairing, replacing of an Individual On-Site Wastewater Disposal System that does not comply with the minimum requirements of the Mississippi State Department of Health Regulations, falsifying any document, and any act of misrepresentation made related to Certified Maintenance Provider activities.

**History**
- *Source: Miss. Code Ann. § 41-67-3.*

##### **15 Miss. Admin. Code Pt. 18, R. 2.1.52** Qualified Homeowner Maintenance Provider: General {#sec-18-2.1.52 omnilex-key=us-ms-regs-official--title-15--18#2.1.52}

A Qualified Homeowner Maintenance Provider can repair or replace any component on an installed Individual On-Site Wastewater Disposal System at his/her primary residence which utilizes an Advanced Treatment System. This will include the repair or replacement of any component used as primary treatment or disposal.

**History**
- *Source: Miss. Code Ann. § 41-67-3.*

##### **15 Miss. Admin. Code Pt. 18, R. 2.1.53** Qualified Homeowner Maintenance Provider: Requirements {#sec-18-2.1.53 omnilex-key=us-ms-regs-official--title-15--18#2.1.53}

A person shall not operate as a Qualified Homeowner Maintenance Provider on any Individual On-Site Wastewater Disposal Systems unless that person is trained by a Certified Installer authorized by the specific Manufacturer of the homeowner’s Advanced Treatment System with documentation from the Manufacturer being provided to the Department.

**History**
- *Source: Miss. Code Ann. § 41-67-3.*

##### **15 Miss. Admin. Code Pt. 18, R. 2.1.54** Qualified Homeowner Maintenance Provider Responsibilities {#sec-18-2.1.54 omnilex-key=us-ms-regs-official--title-15--18#2.1.54}

1. Provide continuous maintenance on his/her Advanced Treatment System in perpetuity. 2. Successfully complete manufacturer’s training and certification. Those whose Advanced Treatment Systems are certified for sale in Mississippi shall be allowed by the Department to perform on-site wastewater maintenance on that manufacturer’s Advanced Treatment System. 3. Provide 1 inspection based on date of installation. Each must include the homeowner name/address, date, time and list of any components repaired or replaced and present the report every 2 years to the Division with certification renewal. 4. Submittal Reports: a. Inspect and evaluate his/her on-site systems. b. Keeping accurate records of systems inspected and repaired. c. Issuing inspection reports to the Division on an annual basis.

**History**
- *Source: Miss. Code Ann. § 41-67-3.*

##### **15 Miss. Admin. Code Pt. 18, R. 2.1.55** Informal Fact Finding and Hearing: Qualified Homeowner Maintenance Provider {#sec-18-2.1.55 omnilex-key=us-ms-regs-official--title-15--18#2.1.55}

1. Whenever the Department intends to take action to suspend or revoke a Qualified Homeowner Maintenance Provider certification, there must be an informal fact-finding conference and proper notice must be given to the affected party: a. The Qualified Homeowner Maintenance Provider shall be notified in writing. The notice must be hand delivered or sent by certified mail. The notice must provide the factual and legal basis for the contemplated action and must give the date, time, place, and location of the informal fact-finding conference. b. The informal fact-finding conference is to be conducted by an employee of the Department. The conference shall be conducted in accordance with, but is not limited to, the requirements of Administrative Procedural Code of Mississippi and may include the creation of a verbatim or summary record of the proceedings. c. The Department designee shall render a decision from the informal fact-finding conference in a timely manner. Such decisions shall constitute the final administrative decision and may be appealed. d. When action is taken to suspend a Qualified Homeowner Maintenance Provider certification, that suspension shall be for a specified period of time. Remedial actions including, but not limited to, additional training courses, examination, and installation or repairing of the Individual On-Site Wastewater Disposal System(s).

**History**
- *Source: Miss. Code Ann. § 41-67-3.*

##### **15 Miss. Admin. Code Pt. 18, R. 2.1.56** Penalties: Qualified Homeowner Maintenance Provider {#sec-18-2.1.56 omnilex-key=us-ms-regs-official--title-15--18#2.1.56}

1. The Department may suspend or revoke certification for failure to comply with any law administered by the Board, Department, or any regulation of the Board, any order of the Board or Department after due notice from the Department. 2. Actions that may result in suspension or revocation include, but are not limited to, repairing, replacing or causing the repairing, replacing of an Individual On-Site Wastewater Disposal System that does not comply with the minimum requirements of the Mississippi State Department of Health Regulations, certifying any Individual On-Site Wastewater Disposal System where proof of ownership is not filed with the Division, transferring of ownership without notifying the Division, falsifying any document, and any act of misrepresentation made related to Qualified Homeowner Maintenance Provider activities.

**History**
- *Source: Miss. Code Ann. § 41-67-3.*

##### **15 Miss. Admin. Code Pt. 18, R. 2.1.57** Hearing Procedure {#sec-18-2.1.57 omnilex-key=us-ms-regs-official--title-15--18#2.1.57}

1. Prior to assessing and collecting the administrative fine, the Department shall provide written notification by Certified Mail/Return Receipt Requested to the violator, stating the basis for the fine, and setting an administrative hearing date within 10 working days of mailing of such notification. 2. Upon determination of the first hearing, if sufficient reason for the fine to be assessed, the installer shall have 10 working days from receipt of such determination to request an additional hearing at the second level, if he/she wishes to appeal the decision of the hearing officer. 3. At the second level, a hearing officer appointed by the State Health Officer shall conduct a hearing to be scheduled within 30 calendar days of receipt of the request for such hearing. 4. The second level hearing shall be held at the Mississippi State Department of Health, 570 E. Woodrow Wilson, Jackson, Mississippi. The appellant will be provided procedural rules. 5. The decision to be made by the State Health Officer or appointee will be based solely on the oral, written and documentary evidence presented. After considering all findings of fact, conclusions of law and recommendations of the hearing officer, the State Health Officer will make the final decision whether to sustain the decision made by the first level hearing official and assess and collect the fine. The decision of the State Health Officer will be binding on the Department. The appellant will be notified in writing by certified mail of the State Health Officer’s decision. 6. In case of an adverse decision the appellant will be advised of the right to pursue judicial review.

7. No individual may file a petition for judicial review with a court of competent jurisdiction until a final written decision and order have been provided by the Mississippi State Department of Health. 8. A certification may be summarily suspended by the issuing official pending a hearing, as herein provided, if the holder of the certification acts in such a manner as to pose an immediate or serious threat to the public health. In the case of a summary suspension, the certified installer shall be given a hearing as soon as possible after the issuing official receives a written request for a hearing.

**History**
- *Source: Miss. Code Ann. § 41-67-3.*

##### **15 Miss. Admin. Code Pt. 18, R. 2.1.58** Professional Development Hours: Certified Installers and Certified Professional Evaluators {#sec-18-2.1.58 omnilex-key=us-ms-regs-official--title-15--18#2.1.58}

1. Certified Installers and Certified Professional Evaluators need thirty (30) hours of Professional Development Hours (PDH) that they may use in lieu of Continuing Education Units (CEU). 2. PDH credits may be earned by installers through a variety of tasks, including passed final inspections, site consultations with Environmentalists, successfully completing a college short course or home study course deemed relevant by the Division of On-site Wastewater such as business, computer, science or math classes, or assisting MSDH with training new environmentalists. See Rule 2.1.58(6) for specific PDH credit amounts for Certified Installers and Certified Professional Evaluators. 3. The Certified Installer will be responsible for collecting and submitting the appropriate documentation to show they have earned their PDH credits. 4. Documents issued by the MSDH and emails or other written documentation from Environmentalists, Supervising Environmentalists and Program Specialists will serve as documentation. 5. A registration fee of $32.50 will be required to file the PDH credits with the Division of On-site Wastewater. 6. Approved Activities for PDH Credit for Certified Installers and Certified Professional Evaluators: Approved PDH Activities for Certified Installers and Certified Professional Evaluators Approved Activity PDH Credits Passing the final inspection on a new or repair installation. 2 Site consultation or system layout with environmentalists. 5 Training of probationary installers onsite during installation. 10 Volunteer for final approval inspection for new environmentalists training. 15

Tank fabrication training for new environmentalists. 20 Completion of a pre-approved community college course. Proof of participation is required for credit. 30 Attendance to a pre-approved wastewater conference. Proof of seminar participation required for credit. 30 MSDH-approved home study courses. 30 Pre-approved charity installations or donation of materials. Written proof from recipient required. Recognizable non-profit organization must document activity participation. 30 Participation on the Wastewater Advisory Council. WAC Members get full credit. Non-members can attend all yearly meetings for full credit or receive 5 PDH per meeting as a Guest 30 (Member) 5/Meeting (Guest) Attend an MSDH CI/CP continuing education class 30

**History**
- *Source: Miss. Code Ann. § 41-67-3.*

##### **15 Miss. Admin. Code Pt. 18, R. 2.1.59** Professional Development Hours: Certified Pumpers {#sec-18-2.1.59 omnilex-key=us-ms-regs-official--title-15--18#2.1.59}

1. Certified Pumpers need 15 hours of Professional Development Hours (PDH) that they may use in lieu of Continuing Education Units (CEU). 2. PDH credits may be earned by Certified Pumpers through a variety of tasks, including documenting the pumping of a tank, documentation of providing, advising or ensuring lid security to customers, confirmed dumping at a permitted MDEQ disposal site, a written emergency spill plan in pump truck(s) verified during the yearly truck inspection, attendance in pre-approved pumper conference, participation on the Wastewater Advisory Council, MSDH approved home study courses, completion of pre-approved community college course, non-profit charity verified tank pump-out, and attendance of an MSDH CI/CP CEU class. See Rule 2.1.59(6) for specific PDH credit amounts for Certified Pumpers. 3. The Certified Pumper will be responsible for collecting and submitting the appropriate documentation to show they have earned their PDH credits. 4. Documents issued by the MSDH and emails or other written documentation from Environmentalists, Supervising Environmentalists and Program Specialists will serve as documentation. 5. A registration fee of $32.50 will be required to file the PDH credits with the Division of On-site Wastewater. 6. Approved Activities for PDH Credit for Certified Pumpers: Approved PDH Activities for Certified Pumpers

Approved Activity PDH Credits Documented pumping of a tank or vessel containing wastewater. 1 Documentation of providing, advising or ensuring lid security to customers. 1 Confirmed dumping at a permitted MDEQ disposal site. 1 A written emergency spill plan in pump truck(s) verified during the yearly truck inspection. 5 Attendance of a pre-approved pumper conference. Certificate of seminar participation required for credit. 15 Participation on the Wastewater Advisory Council. WAC Members get full credit. Non-members can attend all yearly meetings for full credit or receive 2.5 PDH per meeting as a Guest. 15 MSDH-approved home study course. 15 Completion of pre-approved community college course. Proof of participation is required for credit. 15 Pre-approved non-profit verified charity tank pump-out. 15 Attend an MSDH CI/CP continuing education class. 15

Chapter 3 Commercial Development Subchapter 1: Subdivision Rule 3.1.1 Purpose. The purpose of this regulation is to establish procedures and protocols for the review and subsequent approval, referral or disapproval of proposed subdivisions planning to utilize individual onsite wastewater disposal systems.

**History**
- *Source: Miss. Code Ann. § 41-67-3.*
- *Source: Miss. Code Ann. § 41-67-3.*

##### **15 Miss. Admin. Code Pt. 18, R. 3.1.2** Authority {#sec-18-3.1.2 omnilex-key=us-ms-regs-official--title-15--18#3.1.2}

The State Board of Health is authorized to promulgate these rules under and by virtue of Section 41-3-15(4)(a)(b)(f) and Section 41-67-1 through 41-67-29, Mississippi Code of 1972, Annotated.

**History**
- *Source: Miss. Code Ann. § 41-67-3.*

##### **15 Miss. Admin. Code Pt. 18, R. 3.1.3** Definitions {#sec-18-3.1.3 omnilex-key=us-ms-regs-official--title-15--18#3.1.3}

1. Available space – sufficient area in which to properly install the required individual onsite wastewater disposal system including the working area necessary to prevent excessive and unnecessary equipment traffic over the system and space allowance for future extensions. 2. Bedroom – a room designed primarily for sleeping or a room which is expected to routinely provide sleeping accommodations for occupants. 3. Board – the Mississippi State Board of Health. 4. Covenant Running with the Land – a covenant which goes with the land and which cannot be separated from the land and transferred without it. This covenant is said to run with the land when not only the original parties or their representatives, but each successive owner of the land, will be entitled to its benefits, or be liable to its obligation. 5. Department – the Mississippi State Department of Health. 6. Developer – a person who creates a subdivision development, multi-family dwelling, manufactured home development, commercial establishment or recreational vehicle park as herein defined. 7. Division – the Mississippi State Department of Health, Division of On-Site Wastewater.

8. Dwelling – a house, manufactured home, shelter, structure, or building, or portion thereof, which is not readily mobile and is occupied in whole or in part as the home, residence, or sleeping place of one or more people. 9. Feasibility study – a report composed by a Professional Engineer comparing the most cost-effective central sewage collection system to the appropriate individual onsite wastewater disposal system as regulated by the Mississippi Department of Health. 10. Establishment – a multi-family housing apartment, condominium or townhouse complex, a manufactured home park or recreational vehicle park, a non-residential commercial or institutional development or places of business or assembly. An establishment includes all buildings or structures, and the land appertaining thereto and shall have a legal entity which is responsible for ownership and maintenance/operation of the sewage treatment and disposal facilities. 11. Flooding – a covering of the soil surface by water from any source, such as streams overflowing their banks, runoff from adjacent or surrounding slopes, elevation of the ground water table exceeding that of the soil surface, or combinations of these. Terms also associated with flooding and used elsewhere in this Chapter are: a. Frequent – flooding is likely to occur often under usual weather conditions (more than a 50 percent chance of flooding in a year, or more than 50 times in 100 years). 12. Impaired Water Bodies – water bodies identified as impaired due to pathogens, organic enrichment/low DO, biological impairment and fecal coliform in Sections A and C of the most recent approved TMDL 303d listing as published by the Mississippi Department of Environmental Quality. 13. Individual On-Site Wastewater Disposal System – a sewage treatment and effluent disposal system that does not discharge into waters of the state, that serves only 1 legal tract, that accepts only human sanitary waste and other similar waste streams maintained on the property of the generator, and that is designed and installed in accordance with law and regulations of the Board. 14. Manufactured Home Development – any parcel or tract of land under the control of a person wherein sites are offered for the use of the public for the establishment of living sites for two or more manufactured homes. 15. Multiple Family Dwelling – a dwelling where occupying individuals are not related to within the third degree of kinship based on Miss. Code. 16. Person – any individual, trust, firm, joint-stock company, public or private corporation (including a government corporation), partnership, association, state, or any agency or institution thereof, municipality, commission, political subdivision of a state or any interstate body, and includes any officer or governing or managing body of any municipality, political subdivision, or the United States or any officer or employee thereof.

17. Plat – a property depiction (map/drawing), prepared by a professional land surveyor/professional engineer in accordance with the rules and regulations governing the profession, drawn to a scale adequate to provide information in a clear and legible manner, be suitable for recording and showing the location and boundaries of the parcel and of all lots if subdivided and including details as specified by these regulations. Any detail specified by these regulations for a surveyed plat must be depicted exactly per the survey and shall not be hand drawn in as may be done on a plot plan. 18. Professional Engineer – a person that has met the qualifications as required under Section 73-13-23(1), Miss. Code of 1972, Annotated and who has been issued a certificate of registration as a professional engineer. 19. Recreational Vehicle – a vehicular-type unit designed as living quarters for recreational, camping, or travel use, which either has its own motive power or is mounted on or towed by another vehicle. The basic entities include, but are not limited to, a travel trailer, camping trailer, truck camper, van or motor home. 20. Recreational Vehicle Campground – any parcel or tract of land under the control of any person, organization, or governmental entity wherein sites are offered for the use of the public or members of an organization for the establishment of living sites for two or more recreational vehicles. 21. Wastewater – human body waste and wastewater, including bath and toilet waste, residential laundry waste, residential kitchen waste, and other similar waste from appurtenances at a residence or establishment: a. Domestic sewage waste ranges: i. Carbonaceous Biochemical Oxygen Demand (CBOD5), maximum 300 mg/l. ii. Total Suspended Solids (TSS), maximum 200 mg/l. iii. pH, 6–8; or within 1 pH unit of the water supply pH. iv. Nitrogen (Total Kjeldahl Nitrogen, TKN), maximum 100 mg/l. 22. Sensitive Waters – private waters used for recreation (swimming, skiing, fishing), or other situations where people are likely to come into contact with the water and state waters classified as shellfish harvesting, public water supply, ephemeral or recreational in the Mississippi Commission on Environmental Quality Regulation WPC-2, Water Quality Criteria for Intrastate, Interstate and Coastal Waters. 23. Site Plan – see Plat. 24. Subdivision – any land that is divided into 10 or more lots, tracts, sites or parcels for the purpose of residential development.

25. Water Storage Easement – an entitlement in perpetuity allowing the holder of the easement to impound water in a reservoir, and inundate land up to a specified contour elevation above mean sea level.

**History**
- *Source: Miss. Code Ann. § 41-67-3.*

##### **15 Miss. Admin. Code Pt. 18, R. 3.1.4** General Provisions {#sec-18-3.1.4 omnilex-key=us-ms-regs-official--title-15--18#3.1.4}

It is the policy of the Board that connection to a public sewer system is recommended when a proposed development has access to such existing sewer system. It is the policy of the Board that connection to a public water system is recommended when a proposed development has access to such public water system.

**History**
- *Source: Miss. Code Ann. § 41-67-3.*

##### **15 Miss. Admin. Code Pt. 18, R. 3.1.5** Subdivision Approval Required {#sec-18-3.1.5 omnilex-key=us-ms-regs-official--title-15--18#3.1.5}

No person shall commence any act which would constitute building a development on 10 or more lots for residential use utilizing on-site sewage disposal systems prior to submitting the Subdivision Application from the Department. Nothing in this Chapter shall be construed to prevent the department from conducting soil borings, any other preliminary testing and/or inspection.

**History**
- *Source: Miss. Code Ann. § 41-67-3.*

##### **15 Miss. Admin. Code Pt. 18, R. 3.1.6** Subdivision Review Required {#sec-18-3.1.6 omnilex-key=us-ms-regs-official--title-15--18#3.1.6}

1. Any person proposing to develop a subdivision, or an addition to a subdivision utilizing on-site wastewater disposal, shall submit to the Department the information for review outlined on the Subdivision Review Checklist Form provided by the Department. 2. For purposes of these regulations, the subdividing of property into 10 or more lots, tracts, sites or parcels for the purpose of residential or commercial development shall constitute development of a subdivision. 3. Once all of the required information is submitted, the development will be evaluated following the flow chart found at 2.35 Procedures, Chart I of this regulation. 4. The following activities shall not be considered as creating a subdivision: a. Dividing a parcel of land for the purpose of a bona fide gift. b. Dividing a parcel of land under the provisions of a will or under the laws of intestate succession. c. The mere sale, lease or rental of land, provided that the sale, lease or rental does not take place in conjunction with building development.

**History**
- *Source: Miss. Code Ann. § 41-67-3.*

##### **15 Miss. Admin. Code Pt. 18, R. 3.1.7** Responsibilities {#sec-18-3.1.7 omnilex-key=us-ms-regs-official--title-15--18#3.1.7}

1. The Mississippi State Department of Health shall be responsible for the following: a. Evaluating the site for proposed subdivision development, commercial establishment, multi-family dwelling, manufactured home development or recreational vehicle park for the placement and use of Individual On-site Wastewater Disposal Systems. The evaluation will be based on soil/site conditions and the amount of available area to place these systems. The property must be evaluated by staff from the Division of On-site Wastewater. 2. If the property is to be subdivided, have a multi-family residence, a commercial establishment, a manufactured home development or recreational vehicle campground, the property owner shall be responsible for the following: a. Furnishing a legal description and site plan of the entire area to be developed. The site plan shall show lot lines, lot sizes (dimensions and total area), and existing ground contours. The site plan shall show all lakes, ponds, streams, and any known or possible wetland areas. Names of the adjacent property owners and their property lines abutting the proposed development shall be shown. If the developer has title to or has a vested interest in property adjoining his/her proposed development the developer must indicate the property on the plat and provide a letter of intention concerning this property. In addition to the above requirements, developers of Multi-Family residences, Manufactured Home Developments or Recreational Vehicle Campgrounds must also submit information regarding the placement of residences, manufactured homes, or recreational vehicles on the site plan. Developers of recreational vehicle campgrounds must also indicate the location and size of RV dump stations and bath houses. b. Submitting the feasibility study to the Mississippi State Department of Health, Division of On-site Wastewater, whenever 35 or more lots are involved. This study must be completed before any lot is approved. When residential subdivisions are proposed which are composed of fewer than 35 lots, but more than 10 lots, and no system of sanitary sewer is available to which collection sewers may be feasibly connected, the State Health Officer may waive the requirement for a feasibility study. Such waiver of the feasibility study will not be granted if the proposed development meets any one of the following criteria: i. Is within a wastewater utility district where that utility has certified it will provide service. ii. Is within a regional wastewater authority that has certified it will provide service. iii. Is within one mile of a city with sewer availability that has certified it will provide sewer service.

iv. MSDH analysis reflects that soil and site conditions may not be conducive for Individual On-site Wastewater Disposal Systems. c. No Feasibility Study or community sewage system shall be required for subdivisions designed, laid out, platted or partially constructed before July 1, 1988, or subdivisions platted and recorded between July 1, 1995 and June 30, 1996.

**History**
- *Source: Miss. Code Ann. § 41-67-3.*

##### **15 Miss. Admin. Code Pt. 18, R. 3.1.8** Subdivisions Requiring a Feasibility Study {#sec-18-3.1.8 omnilex-key=us-ms-regs-official--title-15--18#3.1.8}

1. The developer shall employ a Professional Engineer to prepare the feasibility study to determine the proper, adequate method of sewage disposal for the proposed subdivision. 2. The Feasibility Study and all accompanying materials shall be prepared and submitted to the Division for review. The complete submittal must contain all original signatures and seals and include an electronic copy of the plat. The Feasibility Study should be submitted well in advance of the anticipated construction date, since a lack of necessary information could cause additional delays: a. If all required information is not provided with the submittal, the applicant shall be notified in writing and review withheld until the complete information is received. 3. The feasibility study shall be accompanied by the following attachments: a. A vicinity map. b. A subdivision plat showing: i. The name of the subdivision. ii. A layout drawn to scale of proposed lots, streets and easements which shows the location of existing and proposed wells. The scale of the plats shall be adequate to provide information in a clear and legible manner. iii. Actual lot sizes and lot sizes excluding easements, rights of way and other similar areas. Easements and rights of way must be identified as to their purpose, i.e., electrical, water, etc. iv. Phases, sectors, block and lot numbers, and street names or identification. v. A minimum of one corner of the proposed development identified in State Plane Coordinates or longitude and latitude. vi. Topography of the area, with contours to show existing and proposed drainage, existing grades, and finished grades where changes are anticipated.

vii. An adequate plan showing frequently flooded areas, existing and proposed drainage, and easements for surface and subsurface drainage. Normal and flood elevations of lakes shall be clearly and accurately shown. viii. All soil borings performed in the subdivision, located accurately and properly identified. ix. When a subdivision includes land within a water storage easement or flood easement, a letter shall be required from the easement holder, addressing the proposed development’s compliance with any rules or guidelines of the easement holder. 4. After the feasibility study has been submitted and reviewed, a final report shall be completed by the Division of On-site Wastewater indicating the determination of feasibility of on-site systems or central collection and treatment. The final report shall be returned to the applicant or his/her agent with written notice of actions taken.

**History**
- *Source: Miss. Code Ann. § 41-67-3.*

##### **15 Miss. Admin. Code Pt. 18, R. 3.1.9** Subdivisions in Wetlands or Frequently Flooded Areas {#sec-18-3.1.9 omnilex-key=us-ms-regs-official--title-15--18#3.1.9}

All subdivisions to be developed utilizing onsite sewage disposal systems wholly or partially within a wetland or a frequently flooded area as defined in this regulation shall, in addition to the other requirements of this regulation, comply with the following requirements: 1. No approval shall be given for any Subdivision which lies wholly within a wetland or a frequently flooded area. 2. Where a proposed Subdivision is located partially within a wetland or a frequently flooded area, that portion of the Subdivision not within the wetland or frequently flooded area may be considered for approval.

**History**
- *Source: Miss. Code Ann. § 41-67-3.*

##### **15 Miss. Admin. Code Pt. 18, R. 3.1.10** Procedures and Protocol {#sec-18-3.1.10 omnilex-key=us-ms-regs-official--title-15--18#3.1.10}

1. Once all required information is submitted, the Division of On-site Wastewater shall complete the review of the development or request additional information within thirty calendar days. 2. The review of the proposed project for determination of the requirement for a feasibility study will be made utilizing the steps outlined in a flow chart. 3. Subdivisions will be considered feasible for central collection if the cost of a central system does not exceed 150 percent of the aggregate cost of an individual on-site wastewater disposal system on each lot.

**History**
- *Source: Miss. Code Ann. § 41-67-3.*

##### **15 Miss. Admin. Code Pt. 18, R. 3.1.11** Rule 3.1.11 {#sec-18-3.1.11 omnilex-key=us-ms-regs-official--title-15--18#3.1.11}

On-site Systems Serving Commercial Establishments, Multi-Family Residences, Manufactured Home Developments and Recreational Vehicle Campgrounds. 1. A property owner planning to build, construct or otherwise place more than two families, manufactured homes or recreational vehicles or a single commercial establishment on a single tract of land and is planning to utilize an Individual On-site Wastewater Disposal System, designed to treat and dispose of residential strength wastewater, must submit information on the Multi-Family Residence and Manufactured Home Development/Recreational Vehicle Campground Checklist Form provided by the Department. 2. Multi-Family residences must count each separate unit as one “lot” in the development. 3. The planned sewage flow for each lot in a manufactured home development shall be 390 gallons per day. 4. More than one commercial establishment, recreational vehicle or multi-family dwelling may be connected to a single on-site wastewater disposal system, provided that one person is accountable for the on-site sewage disposal system in accordance with these regulations for all dwellings involved. 5. Commercial establishments, multi-family dwellings and recreational vehicle campgrounds where the connection of more than one dwelling to an on-site sewage disposal system is proposed, the application to install an on-site disposal system shall include the information in Rule 3.1.11(2) and the following additional information: a. A complete layout of streets, parking areas, on-site sewage disposal systems, sewer lines, water lines, easements, underground utilities and dwelling locations. b. Total acreage or square footage of the proposed property. c. A notarized statement signed by the property owner, stating that the property will not be subdivided or lots sold, and that the on-site sewage disposal system will be under the responsibility of one person, and giving the name of that person, with address and telephone number. d. For multi-family dwellings, each building plan shall show the number of dwelling units and number of bedrooms. 6. Projects with projected wastewater flows in excess of fifteen hundred (1,500) gallons per day and flows of high strength waste (not typical of domestic sewage waste) must be designed and submitted by an engineer. 7. The property involved shall not be developed in excess of its capacity to properly treat and dispose of sewage flows generated by the project. 8. The property owner of commercial establishments, recreational vehicle campgrounds or multi-family dwellings where multiple units are connected to a single onsite system shall

establish covenants running with the land which shall include, at a minimum, the following: a. The responsible person originally owning or developing the property shall own and be responsible for the operation and maintenance of the common sewage disposal system(s). The responsible party shall not disestablish itself without the concurrence of the Department, in which case its responsibilities shall pass to its successors or assigns. b. The covenants shall be binding on present and future owners until such time as the system(s) is/are no longer required by the Regulation, the same being the case when each space (lot) is connected to a public or private sanitary sewer system. 9. Once the developer has assembled the required documentation it must be submitted to the department for review. Upon completion of the review the developer or his/her agent will receive authorization to proceed with the project.

**History**
- *Source: Miss. Code Ann. § 41-67-3.*

##### **15 Miss. Admin. Code Pt. 18, R. 3.1.12** Hearing and Appeals {#sec-18-3.1.12 omnilex-key=us-ms-regs-official--title-15--18#3.1.12}

1. Any person aggrieved by the Department’s determination of feasibility disapproval or requirements for an on-site wastewater disposal system as provided by the department may request a review of the determination. The request for review must be submitted in writing to the Director of the Office of Environmental Health. The request for review shall identify the matter contested and state the name of the development, developer’s name, mailing address and home and daytime phone numbers. Within 10 business days of the receipt of the request for review, the Department shall issue in writing a ruling and determination to the person and if any corrections are necessary to any correspondence or form previously issued by the department, then new correspondence or forms shall be submitted to the person. 2. Any person aggrieved by the ruling issued by the Director of the Office of Environmental Health may apply for a hearing. Any hearing shall be conducted by a hearing officer designated by the Department. At the hearing, the hearing officer and any person affected by the proposal being reviewed may conduct reasonable questioning of persons who make relevant factual allegations concerning the proposal. The Hearing Officer shall require that all persons be sworn before they may offer any testimony at the hearing, and the hearing officer is authorized to administer oaths. Any person so choosing may be represented by counsel at the hearing. A record of the hearing shall be made, which shall consist of a transcript of all testimony received, all documents and other material introduced by any interested person, the staff report and recommendation, and any other material as the hearing officer considers relevant, including his/her own recommendation. He/she shall make a recommendation within a reasonable period of time after the hearing is closed and after he/she has had an opportunity to review, study and analyze the evidence presented during the hearing. The completed record shall be certified to the State Health Officer, who shall consider only the record in making his/her decision, and shall not consider any evidence or material which is not included. All final decisions

regarding the disapproval or requirements for an on-site wastewater disposal system shall be made by the State Health Officer. The State Health Officer shall make his/her written findings and issue his/her order after reviewing the record. The findings and decision of the State Health Officer shall not be deferred to any later date, and any deferral shall result in an automatic order of disapproval.

Subchapter 2: Recreational Vehicle Campgrounds Rule 3.2.1 Purpose. The purpose of this regulation is to establish minimum design/construction standards regarding sanitary facilities, and to establish requirements for persons engaged in the operation of Recreational Vehicle Campgrounds (RV Campgrounds).

**History**
- *Source: Miss. Code Ann. § 41-67-3.*
- *Source: Miss. Code Ann. § 41-67-3.*

##### **15 Miss. Admin. Code Pt. 18, R. 3.2.2** Authority {#sec-18-3.2.2 omnilex-key=us-ms-regs-official--title-15--18#3.2.2}

The State Board of Health is authorized to promulgate these rules under and by virtue of Section 41-3-17 and Section 41-25-13, Mississippi Code of 1972, Annotated.

**History**
- *Source: Miss. Code Ann. § 41-67-3.*

##### **15 Miss. Admin. Code Pt. 18, R. 3.2.3** Definitions {#sec-18-3.2.3 omnilex-key=us-ms-regs-official--title-15--18#3.2.3}

1. Department – the Mississippi State Department of Health. 2. Department of Environmental Quality – the Mississippi Department of Environmental Quality, Office of Pollution Control. 3. Health Authority – an authorized representative of the Mississippi State Department of Health. 4. Non Self-Contained Unit – a recreational vehicle which does not have a flush toilet, bathtub or shower, handwashing compartment, and internal storage compartments of potable water supply and sewage holding. 5. Permit – a written permit issued by the Agency permitting the campground to operate under this regulation. 6. Person – any individual, firm, partnership, corporation, company, association, or governmental unit. 7. Recreational Vehicle – a vehicular-type unit designed as living quarters for recreational, camping, or travel use, which either has its own motive power or is mounted on or towed by another vehicle. The basic entities include, but are not limited to, a travel trailer, camping trailer, truck camper, van, and motor home.

8. Recreational Vehicle Campground – any parcel or tract of land under the control of any person, organization, or governmental entity wherein sites are offered for the use of the public or members of an organization for the establishment of living sites for two or more recreational vehicles. 9. Recreational Vehicle Lodging Park – a recreational vehicle campground with approved water and sewer connections provided to each living site for the accommodation of “self- contained unit” recreational vehicle parking. 10. Recreational Vehicle Waste Disposal Station – a properly designed facility used for receiving and disposing of liquid wastes from recreational vehicle holding tanks. 11. Self-Contained Unit – a recreational vehicle which has a flush toilet, bathtub or shower, handwashing compartment, and internal storage compartments of potable water supply and sewage holding. 12. Sewered – a living site within a campground that is provided an individual sewer drop (connection) to a central collection and disposal sanitary sewer system. 13. Unsewered – a living site within a campground that is not provided an individual sewer drop (connection) to a central collection and disposal sanitary sewer system.

**History**
- *Source: Miss. Code Ann. § 41-67-3.*

##### **15 Miss. Admin. Code Pt. 18, R. 3.2.4** Permits {#sec-18-3.2.4 omnilex-key=us-ms-regs-official--title-15--18#3.2.4}

1. General Provisions: It shall be unlawful for any person to maintain, or operate any recreational vehicle campground within the State of Mississippi unless he/she holds a valid permit issued annually by the Department in the name of such person for the specific campground. All applications for permits shall be made, prior to any construction of the campground, to the applicable county health department which shall issue a permit only after a final inspection of the completed RV campground has indicated all requirements of the regulations are met. No permit shall be transferable from one location to another location or from one person to another person. Every person holding such a permit shall give notice in writing to the Department within 48 hours after having sold, transferred, given away, or otherwise disposed of interest in or control of any recreational vehicle campground. Such notice shall include the name and address of the person succeeding to the ownership or control of such campground. 2. Plan Submittal: A complete plan for the purpose of obtaining a new permit to be issued by the Department shall show: a. A vicinity map showing the general location of the campground. b. The area and dimensions of the tract of land. c. The number, location, and size of all camping sites and their designated usage. d. The location and width of roadways.

e. The location of all service buildings and other proposed structures. f. The location, size, slope and other applicable data on water and sewer lines. 3. Application for Permits: a. Application for new permits shall be in triplicate on forms provided by the Department, signed by the applicant, and shall contain the following: i. The name, address, and telephone number of the applicant. ii. The interest of the applicant in and the location and legal description of the campground. iii. A complete plan of the campground, showing compliance with all applicable provisions of this regulation. iv. Such further information as may be requested by the Department to enable it to determine that the proposed campground will comply with legal requirements. b. It shall be unlawful for any person to construct a RV campground until the local health authority has approved the application, including the plans/specifications of the proposed campground. c. Application for renewal of permits shall be made as above by the holder of the permit and shall contain the following: i. Any change in the information submitted since the time the original permit was issued or the latest renewal granted. ii. Such other information as the Agency may require. 4. Permit Hearings: Any person whose application for a permit under this regulation has been denied may request and shall be granted a hearing on the matter before the health authority under the procedure provided by Rule 3.2.6 of this regulation. 5. Notices: Whenever, upon inspection of any recreational vehicle campground, the health authority finds that conditions or practices exist which are in violation of any provision of this regulation, the health authority shall give notice in writing in accordance with Rule 3.2.6(1) to the owner or agent that, unless such conditions or practices are corrected within a reasonable period of time specified in the notice by the health authority, the permit will be suspended. At the end of such period, the health authority shall reinspect such campground and, if such conditions or practices have not been corrected, shall suspend the permit and give notice in writing of such suspension to the owner or agent. Upon receipt of such notice of suspension, such person shall cease to accept new occupants in such campground.

6. Permit Suspension: Any person whose permit has been suspended, or who has received notice from the health authority that his/her permit will be suspended unless certain conditions or practices at the campground are corrected, may request and shall be granted a hearing on the matter before the health authority under the procedures provided by Rule 3.2.6(2) of this regulation. If no hearing is requested, the permit shall be automatically revoked 10 days following the day on which notice of suspension was served.

**History**
- *Source: Miss. Code Ann. § 41-67-3.*

##### **15 Miss. Admin. Code Pt. 18, R. 3.2.5** Inspection of Campgrounds {#sec-18-3.2.5 omnilex-key=us-ms-regs-official--title-15--18#3.2.5}

1. The health authority shall make inspections to determine the condition of recreational vehicle campgrounds in order that he/she may perform his/her duty of safeguarding the health and safety of occupants of campgrounds and of the general public. 2. Right of Entry: The health authority shall have the power to enter at reasonable times upon any private or public property for the purpose of inspecting and investigating conditions relating to the enforcement of this regulation. It shall be the duty of the owners or occupants of the campgrounds, or of the person in charge thereof, to give the health authority free access to such premises at reasonable times for the purpose of inspection.

**History**
- *Source: Miss. Code Ann. § 41-67-3.*

##### **15 Miss. Admin. Code Pt. 18, R. 3.2.6** Notices, Hearings, and Orders {#sec-18-3.2.6 omnilex-key=us-ms-regs-official--title-15--18#3.2.6}

1. Notices: Whenever the health authority determines that there are reasonable grounds to believe that there has been a violation of any provision of this regulation, he/she shall give notice of such alleged violation to the owner or agent of the campground, as hereinafter provided. Such notice shall: a. Be in writing. b. Include a statement of the reasons for its issuance. c. Allow a reasonable time for the performance of any act it requires. d. Be served upon the owner or his/her agent as the case may require, provided such notice or order shall be deemed to have been properly served upon such owner or agent when a copy of the inspection report form or other notice has been delivered personally to the permit holder or person in charge, or such notice has been sent by registered mail to his/her last known address, or when he/she has been served with such notice by any other method authorized or required by the laws of this state. e. Contain an outline of remedial action which, if taken, will effect compliance with the provisions of this regulation. 2. Hearings: Any person affected by any notice which has been issued in connection with the enforcement of any provision of this regulation may request and shall be granted a

hearing on the matter before the health authority. Such person shall file in the office of the health authority a written petition requesting such hearing and setting forth a brief statement on the grounds therefor. Upon receipt of such petition, the health authority shall set a time and place for such hearing, and the petitioner shall be given an opportunity to be heard and to show why such notice should be modified or withdrawn. The hearing shall be commenced not later than 10 days after the day on which the petition was filed. However, upon application of the petitioner, the health authority may postpone the date of the hearing for a reasonable time beyond such 10-day period when in his/her judgment the petitioner has submitted good and sufficient reasons for such postponement. 3. Orders: After such hearing, the health authority shall make findings as to compliance with the provisions of this regulation and shall issue an order in writing sustaining, modifying, or withdrawing the notice which shall be served as provided in Rule 3.2.6(1)(d). Upon failure to comply with any order sustaining or modifying a notice, the permit of the campground affected by the order shall be revoked. Revoked permits may not be reissued, but a new permit may be issued if all requirements of this regulation are met. 4. Emergency Situations: Whenever the health authority finds that an emergency exists which requires immediate action to protect the public health, he/she may, without notice or hearing, issue an order citing the existence of such an emergency and requiring that such action be taken as he/she may deem necessary to meet the emergency, including the suspension of the permit. Notwithstanding any other provisions of this regulation, such order shall be effective immediately. Any person to whom such an order is directed shall comply therewith immediately, but upon petition to the health authority shall be afforded a hearing as provided in Rule 3.2.6(2). The provisions of Rules 3.2.6(3) and 3.2.6(4) shall be applicable to such hearing and the order issued thereafter. 5. Notice of Revocation: When a permit to operate a recreational vehicle campground has been revoked, the health authority shall notify all occupants of the revocation.

**History**
- *Source: Miss. Code Ann. § 41-67-3.*

##### **15 Miss. Admin. Code Pt. 18, R. 3.2.7** Location, Space, and General Layout {#sec-18-3.2.7 omnilex-key=us-ms-regs-official--title-15--18#3.2.7}

1. Location: The campground shall be located on a well-drained site and shall be reasonably free from marshes, swamps, or other potential breeding places for insects or rodents. 2. Space Requirements: Each camping site shall contain a minimum of 1,000 square feet and shall be a minimum of 50 feet in length and a minimum of 20 feet in width. Roadways shall not be included in the calculation of the camp site space requirements. The campground area shall be large enough to satisfactorily accommodate: a. The designated number of each type of camping sites proposed. b. Necessary streets, roadways, and parking areas.

**History**
- *Source: Miss. Code Ann. § 41-67-3.*

##### **15 Miss. Admin. Code Pt. 18, R. 3.2.8** Water Supply {#sec-18-3.2.8 omnilex-key=us-ms-regs-official--title-15--18#3.2.8}

1. General: a. In all recreational vehicle campgrounds, a pressurized water system, adequate to serve all anticipated needs, shall be provided. b. Water supplies shall meet all current requirements of the Department. They shall be properly located, constructed, and protected to exclude surface contamination and to minimize the potential of contamination from sanitary hazards. All portions of the water system located in the campground shall be easily accessible for maintenance. The ownership of all portions of the water system serving the campground shall be made a matter of record to the Department. 2. Plan Review: a. For all proposed new recreational vehicle campgrounds with 15 or more campsites, the water systems shall comply with the Mississippi State Board of Health Regulation Governing Public Water Systems. Plans and specifications for such water systems must be submitted to and approved by the Bureau of Water Supply, Mississippi State Department of Health prior to the beginning of construction of the campground. b. Water systems serving recreational vehicle campgrounds with no more than 14 campsites must meet all of the requirements of the health authority. Plans and specifications for such water systems must be submitted to, and approved by, the local county health department. 3. Public Water Supplies: If a proposed recreational vehicle campground is to be located in a municipality which has a public water system or in the certificated area of an existing community water system or sanitary district, the campground must be served by the existing public system if, in the opinion of the Department, the existing public system can provide an adequate supply of water. 4. Construction Procedures: a. The water system of the campground shall be connected to all comfort stations and service buildings and will include a method of protection against the hazards of backflow and back-siphonage. b. All water piping shall be constructed and maintained in accordance with state and local codes and regulations. The water piping system shall not be connected with nonpotable or questionable water supplies, and shall be protected against the hazards of backflow or back-siphonage by an approved device or method. All plastic pipe used must bear the NSF (National Sanitation Foundation) seal of approval.

c. Where drinking fountains are provided for public use, they shall be of a type and in locations approved by the health authority. d. Individual water service connections which are provided for direct use by recreational vehicles shall be so constructed that they will not be damaged by the parking of vehicles. The individual water supply connections shall be so designed and constructed as to prevent backflow or back-siphonage. A minimum of 30 inches of cover shall be maintained over all underground water lines. The campground water system shall be adequate to provide a minimum of 20 pounds per square inch of pressure at all outlets under peak flow conditions. e. Underground stop-and-waste cocks shall not be installed on any connection. f. Individual service connections shall be constructed so as to protect the line from contamination by ground water. 5. Outlets: Water outlets shall be convenient of access and when not piped to individual campsites, shall not be located farther than 500 feet from any site. Each sewered site must have a water outlet located within 15 feet. Provisions shall be made to prevent accumulations of standing water or the creation of muddy conditions at each water outlet. 6. Recreational Vehicle Watering Stations: a. A watering station, if provided, for filling recreational vehicle water tanks shall be located at least 50 feet from a waste disposal station. When such is provided, adjacent to the potable water outlet, there shall be posted a sign of durable material, not less than 2 feet by 2 feet in size, and inscribed thereon in clearly legible letters shall be: “POTABLE WATER, NOT TO BE USED FOR FLUSHING WASTE TANKS.” b. The potable water supply station shall be protected from backflow and back- siphonage by means of an approved device located downstream from the last shutoff valve.

**History**
- *Source: Miss. Code Ann. § 41-67-3.*

##### **15 Miss. Admin. Code Pt. 18, R. 3.2.9** Sewage Disposal {#sec-18-3.2.9 omnilex-key=us-ms-regs-official--title-15--18#3.2.9}

1. General Provisions: All sewage and other liquid wastes generated within a campground shall be disposed of in accordance with the Mississippi State Board of Health Regulations Governing Individual Onsite Wastewater Disposal Systems and/or Mississippi Department of Environmental Quality, Office of Pollution Control regulations. The proposed method of sewage disposal shall have the approval of the appropriate authority prior to the commencement of any construction and shall comply with all appropriate state laws and regulations. 2. Recreational Vehicle Waste Disposal Stations:

a. In all recreational vehicle campgrounds, a minimum of one recreational vehicle waste disposal station shall be provided for each 50 recreational vehicle stands, or part thereof, which are not equipped with individual sewer connections. b. Each station shall be level, convenient of access from the service road, and shall provide easy ingress and egress for recreational vehicles. c. Construction of Waste Disposal Stations: i. Unless other approved means are used, each station shall have a concrete slab with drain inlet located so as to be on the road (left) side of the recreational vehicle. ii. The slab shall be not less than 3 feet by 3 feet, at least 5 inches thick and properly reinforced, the surface of which is troweled to a smooth finish and sloped from each side inward to a sewer inlet. iii. The sewer inlet shall consist of a 4-inch, self-closing foot-operated hatch of approved material with cover milled to fit tight [see Figure 1, Sewer Inlet Cover]. The hatch body shall be set in the concrete of the slab with the lip of the opening flush with its surface to facilitate the cleansing of the slab with water. The hatch shall be properly connected to a sewer inlet which shall discharge to an approved sanitary sewage disposal facility. d. Flushing Facilities: i. At all waste disposal stations a means for flushing the recreational vehicle holding tank and the slab shall be provided. It shall consist of a piped supply of water under pressure, terminating in a valved outlet located and installed so as to minimize damage by automobiles or recreational vehicles. The flushing device shall consist of a properly supported riser terminating at least 2 feet above the ground surface, with a 3/4-inch valved outlet to which is screwed a flexible hose [see Figure 2, Flushing Device]. ii. The water supply to the flushing device shall be protected from backflow and back-siphonage, and be equipped with a retractable, spring coiled water delivery device. iii. Adjacent to the flushing arrangement there shall be posted a sign of durable material, not less than 2 feet by 2 feet in size, and inscribed thereon in clearly legible letters shall be: “DANGER – NOT TO BE USED FOR DRINKING OR DOMESTIC PURPOSES.”

**History**
- *Source: Miss. Code Ann. § 41-67-3.*

##### **15 Miss. Admin. Code Pt. 18, R. 3.2.10** Solid Waste Disposal {#sec-18-3.2.10 omnilex-key=us-ms-regs-official--title-15--18#3.2.10}

All solid waste generated by occupants of the campground shall be stored in a manner approved by the health authority. The disposal of solid waste generated in the campground is the responsibility of the campground owner and shall comply with all appropriate state laws and regulations.

**History**
- *Source: Miss. Code Ann. § 41-67-3.*

##### **15 Miss. Admin. Code Pt. 18, R. 3.2.11** Supervision {#sec-18-3.2.11 omnilex-key=us-ms-regs-official--title-15--18#3.2.11}

The person to whom a permit for a campground is issued shall at all times operate the campground in compliance with this regulation and shall provide adequate supervision to maintain the campground, its facilities, and equipment in good repair and in a clean and sanitary condition at all times.

**History**
- *Source: Miss. Code Ann. § 41-67-3.*

##### **15 Miss. Admin. Code Pt. 18, R. 3.2.12** Sanitary Conveniences {#sec-18-3.2.12 omnilex-key=us-ms-regs-official--title-15--18#3.2.12}

1. Toilet and Shower Facilities: a. Comfort stations shall be provided at one or more locations in every recreational vehicle campground. They shall be convenient of access and shall be located within 500 feet from any campsite not provided with water and sewer connections. b. If facilities for both males and females are housed within the same structure, they shall be separated and appropriately marked. c. All doors to the exterior shall open outward, be self-closing, and shall be screened by means of a vestibule or wall to prevent direct view of the interior when the exterior doors are open. Such screening shall not be required on single unit toilet buildings. d. The interior finish of walls shall be moisture resistant for their entire height to facilitate washing and cleaning. e. The floors shall be constructed of material impervious to water and shall be easily cleanable. A floor drain shall be provided in the toilet room. f. All rooms shall be adequately lighted and well ventilated, with all openings effectively screened. g. Facilities shall be provided to adequately supply hot water to all showers and lavatories during times of peak demand. 2. Number, Location and Arrangement of Toilets, Urinals, Lavatories, and Showers:

a. All recreational vehicle campgrounds shall be provided with flush toilets. Recreational Vehicle Lodging Parks accepting only self-contained units are exempt from providing toilet and bathhouse accommodations. b. Facilities shall be provided as follows: i. A minimum of 1 toilet, 1 lavatory, and 1 shower for each sex shall be provided for each 15 unsewered campsites up to the first 30 such campsites. For each additional thirty unsewered sites or less, an additional toilet, lavatory, and shower shall be provided for each sex. ii. A minimum of 1 toilet, 1 lavatory and 1 shower for each sex shall be provided for each 50 sewered campsites. iii. In recreational vehicle campgrounds, urinals shall be substituted for one- third of the toilets required in the men’s facilities. Only individual stalls or wall-hung urinals shall be acceptable. c. Each toilet shall be in a separate compartment and shall be provided with a door with a latch for privacy and a holder or dispenser for toilet paper. Dividing walls or partitions shall be at least 5 feet high and shall be separated from the floor by a space not greater than 18 inches. d. Toilet compartments shall not be less than 30 inches in width and there shall be not less than 30 inches of clear space in front of each toilet. 3. Showers: a. Each shower provided shall be of the individual type, be screened from view, and be not less than 36 inches by 36 inches in area. Each shower area shall be designed to minimize the flow of water into the dressing area and shall be properly connected to the sewerage system by means of a trapped inlet. b. A dressing area, equivalent to a minimum of 9 square feet per shower, shall be provided. Each dressing area shall be equipped with a minimum of two clothing hooks per shower. c. The floors of showers and dressing areas shall have an impervious skid resistant surface.

**History**
- *Source: Miss. Code Ann. § 41-67-3.*

##### **15 Miss. Admin. Code Pt. 18, R. 3.2.13** Exemptions {#sec-18-3.2.13 omnilex-key=us-ms-regs-official--title-15--18#3.2.13}

1. All organized campgrounds holding a valid license from the Mississippi State Department of Health, issued under Sections 75-74-1 et seq., Mississippi Code of 1972 (Mississippi Youth Camp Safety and Health Law) and deer camps regulated under Section 49-7-39, Mississippi Code of 1972, are exempt from this regulation.

2. Rule 3.2.4(2) of this regulation will be waived for all recreational vehicle parks existing prior to the original July 13, 1983 enactment of this regulation that provide water and sewer service from systems that have been approved or permitted by the Mississippi State Department of Health or Department of Environmental Quality. 3. Any parcel or tract of land wherein living sites are available only for the private use of family members. 4. Fairgrounds and stadiums that allow parking of recreational vehicles for short-term events such as fairs, festivals and ball games shall not be defined as a campground and shall be exempt from this regulation. 5. Recreational vehicle dealers, providing factory authorized service and/or repair with five (5) or fewer overnight parking facilities for customers seeking such repair/service, shall be exempt from this regulation.

**History**
- *Source: Miss. Code Ann. § 41-67-3.*

##### **15 Miss. Admin. Code Pt. 18, R. 3.2.14** Penalties {#sec-18-3.2.14 omnilex-key=us-ms-regs-official--title-15--18#3.2.14}

In accordance with Section 41-25-13, Mississippi Code of 1972, violation of this regulation is a misdemeanor. Each day on which a violation thereof continues is a separate offense.

**History**
- *Source: Miss. Code Ann. § 41-67-3.*

##### **15 Miss. Admin. Code Pt. 18, R. 3.2.15** Unconstitutionality Clause {#sec-18-3.2.15 omnilex-key=us-ms-regs-official--title-15--18#3.2.15}

Should any section, paragraph, sentence, clause, or phrase of this regulation be declared unconstitutional or invalid for any reason, the remainder shall not be affected thereby.

FIGURE 1 – Sewer Inlet Cover.

FIGURE 2 – Flushing Device.

Chapter 4 Soil and Site Evaluation Subchapter 1: Introduction Rule 4.1.1 Authority. The State Board of Health is authorized to promulgate these rules under and by virtue of Section 41-3-15(1)(b)(ii), (4)(a)(b)(c)(e)(h)(i), Section 41-3-17 and Section 41-67-1 through 41-67-39, Mississippi Code of 1972, Annotated.

**History**
- *Source: Miss. Code Ann. § 41-67-3.*
- *Source: Miss. Code Ann. § 41-67-3.*
- *Source: Miss. Code Ann. § 41-67-3.*
- *Source: Miss. Code Ann. § 41-67-3.*

##### **15 Miss. Admin. Code Pt. 18, R. 4.1.2** Definitions {#sec-18-4.1.2 omnilex-key=us-ms-regs-official--title-15--18#4.1.2}

1. Applicant – an owner, lessee, or developer. 2. Available Space – the area necessary for the system and space allowance for future expansion, repair or replacement. 3. Board – the Mississippi State Board of Health. Section 41-67-2(c). 4. Department – the Mississippi State Department of Health. Section 41-67-2(h). 5. Drainage way – a course or channel along which water moves in draining an area. 6. Department of Environmental Quality – the Mississippi Department of Environmental Quality (MDEQ), Office of Pollution Control. 7. Flooding – the temporary covering of the soil surface by flowing water from any source, such as streams overflowing their banks, runoff from adjacent or surrounding slopes, inflow from high tides, or any combination of sources. The frequency of the event determines the limitation assigned to each category: a. Rare: Flooding unlikely but possible under unusual weather conditions; 1 to 5 percent chance of flooding in any year or 1 to 5 times in 100 years. (Slight limitations; includes: None or no chance of flooding.) b. Occasional: Flooding occurs infrequently under usual weather conditions; 5 to 50 percent chance of flooding in any year or more than 5 to 50 times in 100 years. (Moderate limitations.) c. Frequent: Flooding is likely to occur often under usual weather conditions; more than a 50 percent chance of flooding in any year or more than 50 times in 100 years, but less than a 50 percent chance of flooding in all months in any year. (Severe limitations.)

d. Very Frequent: Flooding is likely to occur very often under usual weather conditions with more than a 50 percent chance of flooding in all months of any year. (Extreme limitations.) 8. Flood-prone Area – an area that is generally subject to being flooded 50 times in 100 years or greater than a 50 percent chance in any year. This definition refers to an area that is subject to frequent flooding as observed, or as indicated by soil characteristics defined in the standards of the National Soil Survey Handbook, United States Department of Agriculture. 9. Fragipan – a dense, natural subsurface layer of hard soil with relatively slow permeability to water, mostly because of its extreme density or compactness rather than its high clay content or cementation. 10. Generator – any person whose act or process produces sewage or other material suitable for disposal in an Individual On-site Wastewater Disposal System. Section 41-67-2(i). 11. High Shrink Swell Soils (H3S) – soils that have relatively high clay content and a dominant mineral type that causes significant swelling when wet and shrinking when dry. 12. Hydric Soils – soils that formed under conditions of saturation, flooding or ponding long enough to develop anaerobic conditions in the upper part. 13. Impervious – resistant to penetration by air, water, and roots. 14. Maximum Flexibility – the latitude of judgment to be used by the Department to recommend all applicable wastewater disposal systems in compliance with statutes, regulations and rules of the State of Mississippi. 15. Munsell Soil Color Chart – a color space standard that specifies colors based on 3 color dimensions: hue, value (lightness) and chroma (color purity). 16. Natural Ground Surface – the more or less naturally occurring surface of the earth which has not been significantly altered or disturbed by artificial means such as cutting and/or filling (does not include plowing for agricultural purposes). Except where severely eroded, the ground surface normally begins with a dark, organic matter enriched layer (topsoil) of varying thickness followed usually with a brighter colored layer (subsoil) increasing with clay content with depth. 17. Permeability – a qualitative estimate of the relative ease with which soil transmits water. 18. Person – any individual, trust, firm, joint-stock company, public or private corporation (including a government corporation), partnership, association, state, or any agency or institution thereof, municipality, commission, political subdivision of a state or any interstate body, and includes any officer or governing or managing body of any municipality, political subdivision, or the United States or any officer or employee thereof. Section 41-67-2(m).

19. Ponding – standing water in a depression that is removed only by percolation, evaporation, and/or transpiration that lasts greater than 7 days. 20. Redoximorphic Features – a color pattern in a soil due to loss (depletion) or gain (concentration) of pigment compared to the matrix color, formed by oxidation/reduction of Fe (iron) and/or Mn (manganese) coupled with their removal, translocation, or accrual; or a soil matrix color controlled by the presence of Fe+2. Field Book for Describing and Sampling Soils, NRCS, USDA. 21. Restrictive Horizon/Layer (Water Movement) – a layer in the soil more than 3 inches thick that significantly retards the downward movement of water or hinders acceptable treatment and renovation of effluent. A restrictive horizon/layer generally has Redoximorphic Features associated with it, at least in the upper part of the restrictive layer, as well as in the horizon above it. 22. Seasonal High Water Table – the water table that is part of a discontinuous saturated zone in a soil, as indicated in the Munsell Soil Color Chart, by a value of 4 or more and a chroma 2 or less (Munsell Soil Color Chart) Redoximorphic Feature. 23. Sensitive Water – public or private waters used for recreation (swimming, skiing, fishing), shellfish harvesting, potable water intake or other situations where people are likely to come into contact. 24. Slope – deviation of a plane surface from the horizontal; when given in percent, it is the rise or fall of the land surface in feet per 100 feet of horizontal distance (i.e., linear, concave and convex). 25. Soil – a medium used to filter effluent from an Individual On-site Wastewater Disposal System in order to remove bacterium, nutrients, and viruses. The ideal medium is 25 percent water, 25 percent air, 45 percent mineral and 5 percent organic matter. 26. Soil Auger – a short cylinder with a cutting edge attached to a rod and handle. 27. Soil and Site Evaluation – the evaluation to determine if a property can support an Individual On-Site Wastewater Disposal System by use of a soil auger to a depth up to 5 feet to determine the soil texture, color, mottling and seasonal water table. 28. Soil Horizon – a layer of soil approximately parallel to the land surface and differing from adjacent genetically related layers in physical, chemical, and biological properties or characteristics including but not limited to color, structure, texture, consistence and pH. 29. Soil Profile – a description of a soil horizon based on depth, texture, color, and mottles resulting in the correlation of the seasonal water table and restrictive horizon. This refers to Soil Horizons O, A, E, B, C and R. 30. Soil Resource Map – a general representation. [See Figure 3: Soil Resource Areas of Mississippi.]

31. Soil Texture – the numerical proportion (percent by weight) of sand, silt, and clay in a soil, United States Department of Agriculture (USDA). 32. Soil Mapping Unit – a soil series based on texture of the surface Soil Horizon. Examples include: SME – Smithdale sandy loam 12 to 17 percent; SbA – Savannah loam, 0 to 2 percent slopes. 33. Texture Class – standardized terms used to convey textural makeup of the fine-earth fraction less than 2 millimeters in diameter. The fine earth fraction includes sand (2.0– 0.05mm in size), silt (0.05mm–0.002mm in size) and clay (less than 0.002mm in size) particles, United States Department of Agriculture (USDA). [See Figure 4: Texture-by- Feel Analysis and Figure 5: Texture Class Triangle.] 34. Topography – the relative position and elevations of the natural or manmade features of an area that describe the configuration of its surface (i.e., hilly, rolling, level, steep, severe, moderate, etc.). 35. Vertical Separation – the vertical separation between the bottom of the trench and a restrictive layer/horizon or Seasonal High Water Table. 36. Watercourse – any natural lake, river, creek, cut, or other natural body of fresh water or channel having definite banks and bed with visible evidence of the flow or occurrence of water, except such lakes without outlet to which only one (1) landowner is riparian. 37. Water Table – the highest part of the soil or underlying rock that is wholly saturated with water. In some places an upper or Seasonal High Water Table may be separated from a lower one by a dry zone.

Subchapter 2: Soil and Site Evaluation Method Rule 4.2.1 General. This Soil and Site Evaluation method will be used by Environmentalists, Certified Professional Evaluators and registered Professional Engineers for the design of all Individual On-site Wastewater Disposal Systems, prior to construction of any dwelling or placement of any mobile, modular, or permanently constructed residence.

**History**
- *Source: Miss. Code Ann. § 41-67-3.*
- *Source: Miss. Code Ann. § 41-67-3.*

##### **15 Miss. Admin. Code Pt. 18, R. 4.2.2** Criteria {#sec-18-4.2.2 omnilex-key=us-ms-regs-official--title-15--18#4.2.2}

1. Absence of Frequent Flooding. 2. Landscape position. 3. Drainage way.

4. Slope (topography). 5. Depth to seasonal high water table (chroma 2 or less) in inches. 6. Depth (inches) to restrictive Soil Horizon (i.e., bedrock, fragipan, plinthite, etc.). 7. Soil texture, Munsell Soil Color Chart, and depth (inches) of Soil Horizons. 8. Setbacks. 9. Residence, property line, or other external structures. 10. Water supply. 11. Sensitive Waters. 12. Available Space.

Rule 4.2.3 Texture-by-Feel Analysis. Texture-by-Feel Analysis shall be performed in accordance with United States Department of Agriculture, Natural Resource Conservation Service standards: 1. The soil determination will be made based on soil borings to a depth up to 5 feet or to a depth sufficient to reach a restrictive Soil Horizon. Restrictive soil or site conditions may preclude the use of any Individual On-site Wastewater Disposal System. 2. The soil information such as texture, structure, landscape position, color and seasonal high water table depths, will determine the treatment and disposal system to be installed, constructed and approved by the Department. 3. The Soil Profile is recorded in inches on the Soil Profile Sheet by indicating the following: a. Natural Ground Surface (0 inches). b. Depth of each Soil Horizon with: i. The Soil Texture. [See Figure 4: Texture-by-Feel Analysis.] ii. The Munsell Soil Color Chart (moist soil conditions). iii. Seasonal High Water Table indicator, if applicable:

(1) Seasonal High Water Table indicators may be determined by the presence of colors of chroma 2 or less (Munsell Soil Color Chart) at ≥2 percent of soil volume in mottles or matrix of a Soil Horizon. (2) Seasonal High Water Table indicator may be determined by the indication of redoximorphic features at ≥2 percent of soil volume of a Soil Horizon in accordance with methods in the Field Book for Describing and Sampling Soils, NRCS, USDA. This procedure shall take precedence over Sub-item (1) of this Section. The Field Book is hereby incorporated by reference, including any subsequent amendments and editions. (3) Another method to determine Seasonal Water Table indicators is outlined in Section 104.03. iv. Restrictive Horizon depth, if applicable.

FIGURE 3 – Soil Resource Areas of Mississippi.

FIGURE 4 – Texture-by-Feel Analysis.

FIGURE 5 – Texture Class Triangle.

Chapter 5 Individual Onsite Wastewater Disposal Design Standards Subchapter 1: Septic Tanks Rule 5.1.1 Definitions. 1. Air Space – the space required between the lid of a septic tank and the bottom of the outlet pipe for the capture of gases generated by the anaerobic bacteria. Vent pipes within the facility or residence plumbing remove these gases from the septic tank. 2. Anaerobic – a process that utilizes bacteria that grow only without free dissolved oxygen. They obtain oxygen from breaking down complex organic substances. 3. Filter – a device used to remove solids from the effluent of a septic tank. 4. Access Opening – a resealable opening in the treatment unit that allows for inspection, maintenance and entry if necessary. 5. Septic Tank – a water-tight, covered receptacle for treatment of sewage; receives the discharge of sewage from a building, separates settleable and floating solids from the liquid, digests organic matter by anaerobic bacterial action, stores digested solids through a period of detention, allows clarified liquids to discharge for additional treatment and final dispersal, and attenuates flows. 6. Synthetic Fiber Reinforcement – synthetic fibers of polypropylene or polypropylene/polyethylene blend used in place of welded wire or other accepted reinforcing materials for the purpose of providing structural integrity to concrete.

**History**
- *Source: Miss. Code Ann. § 41-67-3; Mississippi State Department of Health (MSDH) – Title 15, Part 3, Subpart 77, Chapter 5; United States Environmental Protection Agency (EPA) – On-site Wastewater Treatment Systems Manual EPA/625/R-00/008.*
- *Source: Miss. Code Ann. § 41-67-3.*
- *Source: Miss. Code Ann. § 41-67-3.*
- *Source: Miss. Code Ann. § 41-67-3.*
- *Source: Miss. Code Ann. § 41-67-3.*
- *Source: Miss. Code Ann. § 41-67-3.*

##### **15 Miss. Admin. Code Pt. 18, R. 5.1.2** General {#sec-18-5.1.2 omnilex-key=us-ms-regs-official--title-15--18#5.1.2}

Septic tanks shall be constructed from concrete, steel, fiberglass or polyethylene. The septic tank size is based on the number of bedrooms or twice the daily flow for nonresidential application.

**History**
- *Source: Miss. Code Ann. § 41-67-3.*

##### **15 Miss. Admin. Code Pt. 18, R. 5.1.3** Location {#sec-18-5.1.3 omnilex-key=us-ms-regs-official--title-15--18#5.1.3}

1. Septic tanks shall not be located in depressed areas where surface water will accumulate. This water may enter the septic tank causing it to flood. 2. The area over the septic tank shall not be used for vehicular traffic or vehicular parking. 3. The septic tank must be installed according to the following minimum distances:

a. Foundation: five (5) feet. b. Property lines: ten (10) feet. c. Potable water supplies and all private wells: fifty (50) feet. 4. Septic tanks shall not be located under dwellings or other structures. 5. Where all or part of the Individual On-site Wastewater Disposal System is proposed to be installed on property other than the owner’s, an easement in perpetuity shall be legally recorded in the proper county. The easement shall be of sufficient area to permit access, construction and maintenance of the Individual On-site Wastewater Disposal System. 6. Easements or right-of-way areas for utilities, surface or subsurface drainage, roads, streets, ponds or lakes shall not be used as available space for location of Individual On- site Wastewater Disposal Systems.

**History**
- *Source: Miss. Code Ann. § 41-67-3.*

##### **15 Miss. Admin. Code Pt. 18, R. 5.1.4** Design {#sec-18-5.1.4 omnilex-key=us-ms-regs-official--title-15--18#5.1.4}

All septic tanks (prefabricated concrete, steel, fiberglass or polyethylene) must be designed according to minimum standards as follows: 1. General: a. The septic tank shall be watertight, structurally sound and not subject to excessive corrosion or decay. The outlet of the septic tank should be placed so as not to be located below the Seasonal High Water Table. b. The minimum hydraulic detention time of the septic tank must be two (2) days (48 hours) based on daily sewage flows. In no case shall the septic tank have a minimum effective liquid capacity of less than seven hundred fifty (750) gallons. c. All tanks manufactured in two (2) sections must have an interlocking type joint. Tanks manufactured in two sections must be sealed and joined with an approved sealant such as butyl rubber or other approved pliable sealant that is waterproof, corrosion-resistant and is warranted by the manufacturer for sealing concrete septic tanks. d. All septic tanks with a capacity of greater than fifteen hundred (1,500) gallons shall be deemed structurally sound by a licensed Professional Engineer via stamped letter. 2. Tank Dimensions: a. The inside length of a rectangular septic tank shall be a minimum of 1.5 times the width. The minimum inside width of a septic tank shall not be less than 3.5 feet.

b. The minimum liquid depth of all septic tanks shall be thirty (30) inches. c. A minimum air space of seventeen (17) percent of the liquid depth must be provided. 3. Tank Inlet and Outlet: a. The inlet and outlet of the septic tank must be large enough to accommodate a four (4) inch Schedule Forty (40) pipe and be equipped with a sanitary tee or baffle. b. The inlet and outlet pipes must extend a minimum of three (3) feet onto undisturbed soil before entering and after exiting the septic tank. c. The inlet invert shall enter the septic tank a minimum of two (2) inches above the liquid level of the tank. The inlet tee or baffle shall be provided to divert the incoming sewage downward and extend a minimum of six (6) inches below the liquid level of the tank. d. The outlet tee or baffle shall extend eighteen (18) inches below the liquid depth of the tank. 4. Baffle Walls and Two Compartment Tanks: a. The first compartment shall be between sixty (60) and sixty-seven (67) percent of the total capacity of the tank. b. The baffle forming the two (2) compartments shall have an opening four (4) to six (6) inches wide, located in the center of the baffle and at fifty (50) percent of the liquid depth of the tank. c. If the tank is to be made of concrete, the baffle wall shall be constructed of concrete and be structurally sound. This shall be interpreted as a minimum of three thousand (3,000) pound concrete containing six (6) inch by six (6) inch number ten (10) concrete wire and having a minimum thickness of two and one- half inches. d. Baffle walls shall be securely and permanently fastened to the septic tank. All fasteners shall be of sound and durable material not subject to corrosion or decay. 5. Access Openings: a. A resealable opening above each tee and baffle must be provided in each tank top. These openings provide for cleaning or rodding out of the inlet or outlet pipe and access for pumping. b. Openings covering the inlet and outlet shall be accessible and visible at finished grade once the septic tank is covered.

c. Rectangular openings shall be a minimum of fifteen (15) inches by fifteen (15) inches as measured from the bottom side of the lid of the septic tank. d. Circular openings shall be a minimum diameter of seventeen (17) inches as measured from the bottom side of the lid of the septic tank. e. Multi-slab tank lids and one-piece lids that can be removed manually to include but not limited to steel and fiberglass require the slab or lid over the inlet and outlet tee or baffle to have a minimum access opening of 6 inches by 6 inches if rectangular or 8 inches in diameter if round. f. All concrete covers, access openings and slabs must have a handle of 3/8 inch steel rebar or other corrosion resistant material of the size necessary to facilitate the removal of the cover, opening or slab.

**History**
- *Source: Miss. Code Ann. § 41-67-3.*

##### **15 Miss. Admin. Code Pt. 18, R. 5.1.5** Effluent Filters {#sec-18-5.1.5 omnilex-key=us-ms-regs-official--title-15--18#5.1.5}

Effluent filters shall meet the following criteria: 1. The filter shall retain all particles greater than one-eighth (1/8) inch in size. 2. The assembly shall perform as a conventional tank outlet, meeting the requirements of Rule 5.1.4(3), when the filter is removed. 3. The filter must be designed to handle the flow of the system it is to serve and not result in excessive maintenance. For a single-family dwelling, maintenance is considered “excessive” when the filter requires service or cleaning more than one (1) time per year. Service shall be performed each time the tank is pumped, and in accordance with manufacturer’s specifications.

**History**
- *Source: Miss. Code Ann. § 41-67-3.*

##### **15 Miss. Admin. Code Pt. 18, R. 5.1.6** Minimum Standards for Septic Tank Construction {#sec-18-5.1.6 omnilex-key=us-ms-regs-official--title-15--18#5.1.6}

1. General: a. All septic tanks manufactured for sale in the state of Mississippi shall bear an imprint identifying the manufacturer, the serial number assigned to the manufacturer’s plans and specifications approved by the Department, the liquid or working capacity of the tank and be marked with the date of manufacture. These imprints and markings must be visible at the time of inspection by the Department. b. All openings and lids shall be capable of being sealed in a way that will prevent entrance of surface water and groundwater.

c. Tank openings shall be securely fastened or sealed to prevent unwarranted access to the contents of the tanks; vandal, tamper and child resistant. Acceptable protection of openings may include, but is not limited to: i. A padlock. ii. An “O” ring with twist lock cover requiring special tools for removal. iii. Covers weighing sixty-five (65) pounds or more, net weight. iv. Stainless steel or other corrosion resistant fasteners for fiberglass or polyethylene lids. 2. Prefabricated Concrete Septic Tank: a. A minimum twenty-eight (28)-day concrete compressive strength of three thousand (3,000) pounds per square inch must be used in the construction of the septic tank. The concrete must achieve a minimum compressive strength of two thousand five hundred (2,500) pounds per square inch before removal of the tank from the manufactured site. It shall be the responsibility of the manufacturer to certify that this condition has been met before shipment. Accelerated curing in the mold by use of propane gas or other fuels is prohibited, except by accepted methods and upon approval of the Department. b. Lids, walls and bottom thickness must be a minimum of three (3) inches. The bottom and walls must be a monolithic pour. 3. Steel Septic Tanks: a. Steel septic tanks must meet Underwriter’s Laboratory Standard UL-70 for the tank coating. Only tanks listed as approved under the current published listing will be approved for installation. 4. Fiberglass and Polyethylene Septic Tanks: a. Resins and sealants used in the tank manufacturing process shall be capable of effectively resisting the corrosive influences of the liquid components of sewage, sewage gases and soil burial. Materials used shall be formulated to withstand shock, vibration, normal household chemicals, earth and hydrostatic pressure when either full or empty. b. Not less than thirty (30) percent of the total weight of the tank shall be fiberglass reinforcement. Fiberglass tanks with an effective liquid capacity of not over one thousand five hundred (1,500) gallons shall have a minimum wall thickness of 1/4 inch. However, a wall thickness of not less than 3/16 inch will be allowed in small isolated areas of a tank.

c. Internal surfaces shall be coated with an appropriate gel coating to provide a smooth, nonporous, watertight surface. d. Tanks shall be constructed so that all parts of the tank meet the following mechanical requirements: i. Ultimate tensile strength – minimum twelve thousand (12,000) PSI when tested in accordance with ASTM D 638-89, Standard Method of Test for Tensile Properties of Plastics. ii. Flexural strength – minimum nineteen thousand (19,000) PSI when tested in accordance with ASTM D 790-86, Standard Method of Test for Flexural Properties of Unreinforced and Reinforced Plastics and Electrical Insulating Materials. iii. Flexural modules of elasticity – minimum eight hundred thousand (800,000) PSI when tested in accordance with ASTM D 790-86, Standard Method of Test for Flexural Properties of Unreinforced and Reinforced Plastics and Electrical Insulating Materials. e. A test report from an independent testing laboratory is required to substantiate that individual tank design and material formulations meet the requirements of Rule 5.1.6(4)(d).

**History**
- *Source: Miss. Code Ann. § 41-67-3.*

##### **15 Miss. Admin. Code Pt. 18, R. 5.1.7** Minimum Standards for Concrete Reinforcement {#sec-18-5.1.7 omnilex-key=us-ms-regs-official--title-15--18#5.1.7}

1. Tanks Reinforced with Welded Steel Concrete Wire: a. The reinforcing wire shall be a minimum number ten (10) gauge six (6) inch on centers. The reinforcing wire shall be lapped a minimum of six (6) inches. b. Lids for prefabricated septic tanks shall have one (1) 3/8 inch steel reinforcing rod per foot of length and width. 2. Tanks Reinforced with Synthetic Structural Fibers: a. Manufacturer of synthetic structural fibers shall provide certification showing fibers meet the requirements outlined in this section. b. Synthetic fibers shall be monofilament and made of a polypropylene or polypropylene/polyethylene blend in accordance with ASTM C 1116, Section 4.1.3, Part III. c. Synthetic structural fibers shall have a minimum length of 1.5 inches.

d. Synthetic structural fibers shall produce concrete with a minimum average residual strength of one hundred fifty (150) psi when tested in accordance with ASTM C 1399. e. Fiber dosage rate shall be a minimum of 3 lb/yd3 of concrete.

**History**
- *Source: Miss. Code Ann. § 41-67-3.*

##### **15 Miss. Admin. Code Pt. 18, R. 5.1.8** Maintenance {#sec-18-5.1.8 omnilex-key=us-ms-regs-official--title-15--18#5.1.8}

The septic tank should be pumped at a frequency depending on the wastewater flow. The recommended pumping cycle is three (3) to five (5) years, but pumping should not occur until the settleable solids have reached a depth of 1/3 the septic tank liquid depth. This can be determined by “sticking” the tank.

**History**
- *Source: Miss. Code Ann. § 41-67-3.*

##### **15 Miss. Admin. Code Pt. 18, R. 5.1.9** Septic Tank Sizing {#sec-18-5.1.9 omnilex-key=us-ms-regs-official--title-15--18#5.1.9}

The effective liquid capacity of septic tanks for dwellings shall be based on the number of bedrooms proposed or anticipated as shown in the table below: Septic Tank Sizing by Number of Bedrooms Number of Bedrooms Number of Occupants Minimum Effective Liquid Capacity (gallons) without baffle or effluent filter Minimum Effective Liquid Capacity (gallons) with baffle or effluent filter 2 or less 4 or less 750 750 3 6 900 900 4 8 1200 1000 5 10 1500 1250 6 12 1800 1500

Subchapter 2: Advanced Treatment Systems Rule 5.2.1 General. 1. All Advanced Treatment Systems installed in the state of Mississippi shall be in compliance with the current revision of the National Sanitation Foundation/American National Standard Institute International Standard 40 or 245 testing protocol, hereby incorporated into regulation by reference, and shall be certified by an approved third- party certification program. The Division will maintain a current listing of registered and certified manufacturers. The current list will be made available by the Department.

2. The Department shall only approve individual Advanced Treatment Systems that have no discharge of wastewater off the property of the generator. 3. All Advanced Treatment Systems must be installed according to the Certified Manufacturer’s specifications by a factory-trained installer that is an authorized representative of the manufacturer.

**History**
- *Source: Miss. Code Ann. § 41-67-3.*
- *Source: Miss. Code Ann. § 41-67-3.*

##### **15 Miss. Admin. Code Pt. 18, R. 5.2.2** Definitions {#sec-18-5.2.2 omnilex-key=us-ms-regs-official--title-15--18#5.2.2}

1. Aerator – a mechanical device that provides dissolved oxygen to an Advanced Treatment System. 2. Advanced Treatment System – treatment component that utilizes oxygen to degrade or decompose wastewater.

**History**
- *Source: Miss. Code Ann. § 41-67-3.*

##### **15 Miss. Admin. Code Pt. 18, R. 5.2.3** Location {#sec-18-5.2.3 omnilex-key=us-ms-regs-official--title-15--18#5.2.3}

1. Advanced Treatment Systems shall be installed level on undisturbed soil. If leveling or elevation change is necessary, the Advanced Treatment System must be placed on a bed of sand. 2. It is recommended the outlet of the Advanced Treatment System should be placed so as not to be below the Seasonal High Water Table. 3. An Advanced Treatment System should not be located in an area that collects surface water. This water may enter the Advanced Treatment System causing a failure by flooding. This flooding will cause the effluent to be discharged before it is properly treated. 4. The Advanced Treatment System must be installed according to the following minimum distances: a. Foundations: five (5) feet. b. Property lines: ten (10) feet. c. Potable water supplies and all private wells: fifty (50) feet. 5. The area over the Advanced Treatment System shall not be used for vehicular traffic or vehicular parking. 6. Advanced Treatment Systems shall not be located under dwellings or other structures. 7. Where all or part of the Individual On-site Wastewater Disposal System is proposed to be installed on property other than the owner’s, an easement in perpetuity shall be legally

recorded in the proper county. The easement shall be of sufficient area to permit access, construction and maintenance of the Individual On-site Wastewater Disposal System. 8. Easements or right-of-way areas for utilities, surface or subsurface drainage, roads, streets, ponds or lakes shall not be used as available space for location of Individual On- site Wastewater Disposal Systems.

**History**
- *Source: Miss. Code Ann. § 41-67-3.*

##### **15 Miss. Admin. Code Pt. 18, R. 5.2.4** Inlet and Outlet {#sec-18-5.2.4 omnilex-key=us-ms-regs-official--title-15--18#5.2.4}

1. The inlet and outlet must be Schedule Forty (40) pipe four (4) inches in diameter. A three (3) inch house sewer stubout, when used, shall be connected to the four (4) inch pipe from the septic tank inlet using manufactured fittings designed for that purpose. 2. The inlet and outlet pipe (Schedule 40, four (4) inch) must extend a minimum of three (3) feet onto undisturbed soil before entering and after exiting the Advanced Treatment System.

**History**
- *Source: Miss. Code Ann. § 41-67-3.*

##### **15 Miss. Admin. Code Pt. 18, R. 5.2.5** Maintenance {#sec-18-5.2.5 omnilex-key=us-ms-regs-official--title-15--18#5.2.5}

1. All Advanced Treatment Systems should be pumped at a frequency based on the wastewater volume generated by the residence or establishment. The pumping cycle will depend on the level of the sludge in the Advanced Treatment System. The sludge should not be allowed to accumulate more than the recommended depth specified by the manufacturer of the Advanced Treatment System. If the sludge is allowed to discharge, a clogging problem may occur if any additional treatment or disposal system is used in conjunction with the Advanced Treatment System. 2. All Advanced Treatment Systems shall be maintained and inspected as required by the Certified Manufacturer.

**History**
- *Source: Miss. Code Ann. § 41-67-3.*

##### **15 Miss. Admin. Code Pt. 18, R. 5.2.6** Aerators {#sec-18-5.2.6 omnilex-key=us-ms-regs-official--title-15--18#5.2.6}

The type of aerator used with the Advanced Treatment System is mandated by the manufacturer. The maintenance of the aerator is outlined in the manual provided by the Certified Manufacturer or his/her authorized representative.

**History**
- *Source: Miss. Code Ann. § 41-67-3.*

##### **15 Miss. Admin. Code Pt. 18, R. 5.2.7** Sizing {#sec-18-5.2.7 omnilex-key=us-ms-regs-official--title-15--18#5.2.7}

Advanced Treatment System sizing shall be determined by the number of bedrooms as shown in the table below:

Advanced Treatment System Sizing by Number of Bedrooms Number of Bedrooms Minimum Capacity (gallons per day) 2 or less 400 3 400 4 520 5 650 6 780 For each additional bedroom add 130 gallons. For each additional occupant over 2 per bedroom add 65 gallons. For a nonresidential application, use the estimated daily flow.

Subchapter 3: Pumps and Pump Chambers Rule 5.3.1 General. Effluent pumping is required in cases where the disposal site is at a higher elevation than the treatment facility or the disposal system is one that utilizes pressure distribution. In these cases the effluent must be moved using pumps. Pumps and associated equipment must be manufactured and warrantied for the purpose of pumping treated wastewater. In all installations the manufacturer’s recommendations must be followed. Pumps and pressure lines must be sized correctly to assure that the system is hydraulically sound.

**History**
- *Source: Miss. Code Ann. § 41-67-3.*
- *Source: Miss. Code Ann. § 41-67-3.*

##### **15 Miss. Admin. Code Pt. 18, R. 5.3.2** General Requirements {#sec-18-5.3.2 omnilex-key=us-ms-regs-official--title-15--18#5.3.2}

1. Pump chambers shall have a storage volume as required per each system type; for subsurface drip, overland disposal and spray systems. Pump chambers for septic tank systems shall be a minimum of 400 gallons. 2. The pump chamber shall be constructed to withstand normally encountered earth pressures and manufactured with approved materials resistant to the corrosive effects of wastewater, common household chemicals and chemicals used for disinfection. 3. The pump chamber shall be equipped with an audible high water alarm.

4. The pump chamber shall have a grade level access large enough to allow servicing and/or removal of the largest component in the chamber. Access ports shall be protected against unauthorized entrance. 5. The pump chamber shall be vented through the grade level access or by means of a separate vent. In either case the vent shall be a minimum of one inch in diameter. 6. All openings shall be sealed with a mastic, butyl rubber or other pliable sealant that is waterproof, corrosion resistant and approved for use in contact with wastewater and chemicals used for disinfection, in a manner to prevent the entrance of surface and groundwater. 7. When pumping to normally gravity fed systems the use of a stilling chamber (baffled distribution box) shall be required. The stilling chamber must be sized larger than the maximum volume pumped in a single dose so as not to flood the chamber. 8. The stilling chamber shall be constructed and placed so it will drain between doses into the treatment and/or disposal site.

**History**
- *Source: Miss. Code Ann. § 41-67-3.*

##### **15 Miss. Admin. Code Pt. 18, R. 5.3.3** Minimum Pump Specifications {#sec-18-5.3.3 omnilex-key=us-ms-regs-official--title-15--18#5.3.3}

1. The pump shall be equipped with a low water cutoff to prevent damage during low water conditions in the dosing chamber. 2. The pump shall be constructed of corrosion resistant materials suitable for effluent pumping. 3. The pump shall be sized per manufacturers’ specifications to meet or exceed the hydraulic requirements of the system. 4. The pump shall be installed in compliance with manufacturers’ specifications so as not to violate the pump warranty. 5. The suction and pressure lines shall be PVC Schedule 40 or equal and be sized to meet the hydraulic requirements of the system.

**History**
- *Source: Miss. Code Ann. § 41-67-3.*

##### **15 Miss. Admin. Code Pt. 18, R. 5.3.4** Electrical {#sec-18-5.3.4 omnilex-key=us-ms-regs-official--title-15--18#5.3.4}

All electrical components shall be in compliance with the National Electrical Code.

Subchapter 4: Aggregate Rule 5.4.1 General.

In a conventional on-site wastewater system treatment begins in the septic tank, under anaerobic conditions. Final treatment and disposal takes place in the soil of the drainfield, an aerobic environment. It is necessary for this aerobic condition to exist in the soil of the drainfield for proper treatment of the effluent.

**History**
- *Source: Miss. Code Ann. § 41-67-3.*
- *Source: Miss. Code Ann. § 41-67-3.*

##### **15 Miss. Admin. Code Pt. 18, R. 5.4.2** Definitions {#sec-18-5.4.2 omnilex-key=us-ms-regs-official--title-15--18#5.4.2}

1. Aggregate System – any subsurface disposal system that utilizes gravel, crushed stone, tire chips or other approved aggregate media. 2. Conventional Subsurface Aggregate Disposal System – any gravity-fed subsurface disposal field utilizing a loose aggregate media ranging from 36 to 12 inches in depth: a. Standard Subsurface Disposal: 25 in. to 36 in. b. Shallow Subsurface Disposal: 12 in. to 24 in. 3. Tire Chips – coarse aggregate made from recycled tires to substitute volumetrically for mineral aggregate for use as media in a conventional subsurface disposal field.

**History**
- *Source: Miss. Code Ann. § 41-67-3.*

##### **15 Miss. Admin. Code Pt. 18, R. 5.4.3** Site Evaluation {#sec-18-5.4.3 omnilex-key=us-ms-regs-official--title-15--18#5.4.3}

1. Information obtained during the soil and site evaluation will determine which type(s) of IOWDS may be utilized for an individual lot. 2. Prior to completing the Soil and Site Evaluation/System Recommendation, the Environmentalist shall visit the lot and conduct the soil and site evaluation. 3. The soil determinations will be made based on soil borings to a depth of five feet or to a depth sufficient to reach a restrictive horizon. Restrictive soil or site conditions may preclude the use of any subsurface disposal system. 4. A soil and site evaluation will be based on the following criteria: a. Absence of or protection from frequent flooding. b. Landscape position with good surface runoff. c. Slopes of less than 15%. d. Depth to high water table of greater than four feet. e. Depth to bedrock, fragipan or plinthite of greater than four feet.

f. Soil texture and color defined by the Natural Resource Conservation Service as indicating good drainage and suitability for soil absorption, based on a soil boring of five feet. g. Available area in which to install an individual onsite wastewater disposal system meeting all requirements of this regulation. The area for repairs and future extensions shall be no less than 50% of the space required for the recommended system. Systems utilizing surface land application discharge are exempt from the 50% additional area requirement. h. The non-compliance of one or more of the above items may require a design alteration of an underground system.

**History**
- *Source: Miss. Code Ann. § 41-67-3.*

##### **15 Miss. Admin. Code Pt. 18, R. 5.4.4** Location of Onsite Wastewater Disposal Systems {#sec-18-5.4.4 omnilex-key=us-ms-regs-official--title-15--18#5.4.4}

1. All components of the onsite wastewater disposal system shall be located a minimum of: a. Five (5) feet from any dwelling. b. Ten (10) feet from any property line. 2. Any vessel holding wastewater shall be located a minimum of 50 feet from any public, private or individual potable water source. 3. The effluent disposal field shall be located at a lower elevation or in a landscape position that will preclude any surface runoff from flowing in the direction of the well site and a minimum of 100 feet from any public, private or individual potable water source. 4. Potable water lines shall not pass under or through any part of the sewage disposal system. Where a water supply line must cross a sewer line, the bottom of the water service within ten feet of the point of crossing shall be at least 12 inches above the top of the sewer line. The sewer line shall be of Schedule 40 pipe with cemented joints at least ten feet on either side of the crossing. Water and sewer lines shall not be laid in the same trench. The water and sewer lines, when laid on the same elevation, shall maintain a minimum separation distance of 10 feet. 5. The surface of or the surface above the disposal field shall not be used for vehicular traffic or vehicular parking. 6. No portion of an onsite wastewater disposal system shall be located under dwellings or other permanent structures. 7. Effluent disposal systems shall not be located in depressed areas where surface water will accumulate. Provision shall be made to minimize the flow of surface water over the effluent disposal field. 8. Subsurface wastewater disposal field setbacks from sensitive waters. [See Table 1.]

9. Slopes of greater than 30% shall not be considered for subsurface disposal installation. 10. Where all or part of the onsite wastewater disposal system is proposed to be installed on property other than the owner’s, an easement in perpetuity shall be legally recorded in the proper county. The easement shall be of sufficient area to permit access, construction and maintenance of the onsite sewage disposal system. 11. No site for an effluent disposal field or expansion area shall be approved which is located wholly within an area which is frequently flooded, swamp, marsh, or wetland. Except that if permits have been issued by the proper regulatory agency authorizing the use of wetlands for building sites, the property shall be evaluated using standard soil and site criteria for IOWDS. 12. When a proposed lot is located partially within a frequently flooded area, that portion of said lot not within the flood prone area may be considered for approval for the effluent disposal field. 13. There shall be maintained a minimum of 12 inches of unsaturated soil between the bottom of the subsurface disposal system and a perched or seasonal water table in soils that contain a restrictive horizon (fragipan, chalk, bedrock, clay or silty clay) within five feet of the surface. 14. There shall be maintained a minimum of 24 inches of unsaturated soil between the bottom of the subsurface disposal system and any perched or seasonal water table in soils that do not contain a restrictive horizon (fragipan, chalk, bedrock, clay or silty clay) within five feet of the surface. 15. Easements or right-of-way areas for utilities, surface or subsurface drainage, roads, streets, ponds or lakes shall not be used as available space for location of individual onsite sewage disposal systems.

**History**
- *Source: Miss. Code Ann. § 41-67-3.*

##### **15 Miss. Admin. Code Pt. 18, R. 5.4.5** Underground Absorption {#sec-18-5.4.5 omnilex-key=us-ms-regs-official--title-15--18#5.4.5}

1. The size of the subsurface sewage disposal system shall be determined by soil texture. [See Table 2.] 2. Soils with excessively rapid permeability rates, gravel and coarse sand, shall be considered unsuitable for subsurface disposal unless the native soil is replaced with a suitably thick (greater than two feet) layer of loamy sand or sand textured soil. 3. Soils with excessively slow permeability rates, silty clay and clay, shall be considered unsuitable for conventional subsurface disposal. 4. Subsurface disposal systems shall be placed no deeper than 36 inches below the surface. 5. Conventional subsurface disposal systems shall have a minimum 12 inches of soil backfill. [See Figure 6 and Figure 7.]

6. The minimum distance between absorption trench sidewalls shall be six feet. 7. Aggregate-type absorption trenches shall be a minimum of 24 inches and a maximum of 36 inches in width. 8. Trenches shall not be excavated when the soil is wet enough to smear or compact easily. 9. The bottom of the trenches or bed and the distribution lines shall have a grade from level to no greater than two inches fall per 100 feet. 10. There shall be a minimum of three feet of undisturbed soil between the excavation for the septic tank or treatment plant and the beginning of the absorption trench, bed or effluent line. 11. Media for the disposal fields shall extend from at least two inches above the top of the perforated field line pipe to at least six inches below the bottom of the perforated field line pipe, a minimum of 12 inches total. [See Figure 6.] 12. Stone media for the disposal fields shall consist of crushed rock, gravel or other suitable material, as approved by the Mississippi Department of Health, Division of Onsite Wastewater, varying in size from ½ to 2½ inches. The material shall be free from dust, sand, clay, or excessive fines. 13. Tire chips shall be allowed for use as coarse aggregate in onsite wastewater treatment and disposal system drainfields and may substitute for stone aggregate on a one-for-one basis, volumetrically, when the following physical properties are met: a. Tire chips are to be a nominal two (2) inches in size and may range from one-half (1/2) inch to a maximum of four (4) inches in any direction. b. Exposed wire may protrude no more than one-half (1/2) inch from the sides of the chip. No more than ten percent (10%) by weight shall exceed this standard. c. No more than ten percent (10%) by weight shall pass through a one-half (1/2) inch screen. d. At least eighty percent (80%) of the bead wire must be removed from the tires to be chipped. e. Fines of less than 2 mm in size are prohibited. Fines in this context is defined as particles or substances which can settle to the bottom of the absorption trench and contribute to the clogging or blocking of infiltrative surfaces (dirt, dust, grit, crumb rubber and similar substances). 14. The media for the disposal fields shall be covered with untreated building paper, heavy craft paper, a layer of straw at least two inches thick, or other acceptable material, as approved by the Mississippi Department of Health, Division of Onsite Wastewater.

15. Soil material excavated from trenches shall be used in backfilling and should be left mounded over the trenches until initial settling has taken place. 16. When a change in elevation of the disposal trench is required, a connecting lateral or crossover must be used. At the point where a crossover line leaves a lateral, the trench for the crossover line shall be dug no deeper than the top of the aggregate in the preceding trench so that an undisturbed block of earth will remain in place for the full depth of the aggregate. Crossover lines shall be laid on undisturbed earth. The invert of the crossover must be at least four inches lower than the invert of the septic tank effluent line. 17. Standard manufactured fittings compatible with the pipe shall be used to connect all pipes within the effluent disposal field.

**History**
- *Source: Miss. Code Ann. § 41-67-3.*

##### **15 Miss. Admin. Code Pt. 18, R. 5.4.6** Certification {#sec-18-5.4.6 omnilex-key=us-ms-regs-official--title-15--18#5.4.6}

1. Any manufacturer wishing to provide tire chips for use in onsite sewage treatment and disposal system drainfields in the state of Mississippi must first receive a certification from the State Department of Health, Division of Onsite Wastewater. Manufacturers must provide proof they can produce a tire chip coarse aggregate in conformance with the standards in Rule 5.4.5(13). 2. Tire chip coarse aggregate from certified manufacturers shall be labeled as drainfield aggregate on the freight bill-of-lading. The bill-of-lading shall clearly certify that the material meets the requirements for drainfield use. Contractors purchasing tire chip coarse aggregate shall retain a copy of the freight bill-of-lading as documentation of the aggregate size and quality.

**History**
- *Source: Miss. Code Ann. § 41-67-3.*

##### **15 Miss. Admin. Code Pt. 18, R. 5.4.7** Alternating Disposal Fields {#sec-18-5.4.7 omnilex-key=us-ms-regs-official--title-15--18#5.4.7}

1. An alternating effluent disposal field system provides two complete disposal fields, separated by a valving system so that each system could alternately be used and rested. This “resting” is useful in regenerating the soil’s capability for absorbing the effluent. 2. The size of each field can be from 50 to 100 percent of the required square footage of a single disposal field. 3. The length of time each field would be used and then rested will be determined on a case- by-case basis.

**History**
- *Source: Miss. Code Ann. § 41-67-3.*

##### **15 Miss. Admin. Code Pt. 18, R. 5.4.8** Shallow Disposal Fields {#sec-18-5.4.8 omnilex-key=us-ms-regs-official--title-15--18#5.4.8}

Shallow aggregate systems can sometimes be used where the depth to the restrictive horizon or water table is less than 25 inches. Placement of the system may be as shallow as 12 inches for

aggregate systems. [See Figure 7 and Rule 5.4.5(14) and (15) of this design standard.] Shallow installations may be placed in any texture shown as suitable in Table 2.

**History**
- *Source: Miss. Code Ann. § 41-67-3.*

##### **15 Miss. Admin. Code Pt. 18, R. 5.4.9** Absorption Beds {#sec-18-5.4.9 omnilex-key=us-ms-regs-official--title-15--18#5.4.9}

1. Absorption beds and trenches should be located a minimum of 10 feet from any trees, except for subsurface drip irrigation. 2. Absorption beds have a smaller “footprint” than the same square footage of trench system. This lends them useful in certain installations where the amount of useable space is limited. [See Figure 8.] 3. The amount of bottom absorption area required shall be the same as shown in Table 2. The bottom of the bed should have a relatively level grade. 4. Lines for distributing effluent shall be spaced from 3 to 6 feet apart and not greater than 3 feet from the sidewall. The number of lines will depend on the square feet and width of the bed to be constructed. 5. Care should be taken to prevent heavy machinery from damaging the bed during backfilling. 6. The effluent must be equally distributed to the bed by means of a distribution box or with a pipe manifold. [See Figure 9.]

**History**
- *Source: Miss. Code Ann. § 41-67-3.*

##### **15 Miss. Admin. Code Pt. 18, R. 5.4.10** Distribution of Effluent {#sec-18-5.4.10 omnilex-key=us-ms-regs-official--title-15--18#5.4.10}

1. When a change in elevation of the disposal trench is required, a distribution box, connecting lateral or crossover must be used. At the point where a crossover line leaves a lateral, the trench for the crossover line shall be dug no deeper than the top of the aggregate in the preceding trench so that an undisturbed block of earth will remain in place for the full depth of the aggregate. The distribution box shall be level and supply all lines equally. Field lines must be equal lengths when served by one distribution box. 2. Distribution boxes may be used to connect the effluent line to the effluent distribution lines. Non-perforated rigid pipe shall exit the distribution box for a minimum of five feet at level grade before the effluent distribution line (perforations) begins. [See Figure 12.] 3. Crossover lines shall be laid on undisturbed earth. The invert of the crossover must be at least four inches lower than the invert of the septic tank outlet line: a. Crossovers shall be constructed as shown in Figure 10.

TABLE 1 - SETBACK REQUIREMENTS FROM SENSITIVE WATER (Aggregate Systems) Minimum Distance from the Water Edge Soil Textural Class Slope of Less Than 8 Percent Slope of More Than 8 Percent Gravel NOT APPLICABLE Coarse Sand 50 feet 50 feet Medium Sand 50 feet 50 feet Fine Sand 50 feet 50 feet Loamy Sand 50 feet 50 feet Sandy Loam 50 feet 50 feet Light Loam 50 feet 50 feet Heavy Loam 50 feet 50 feet Silt Loam 50 feet 50 feet Sandy Clay Loam 50 feet 50 feet Light Clay Loam 50 feet 50 feet Heavy Clay Loam 50 feet 50 feet Light Silty Clay Loam 50 feet 50 feet Heavy Silty Clay Loam 50 feet 50 feet Sandy Clay 50 feet 50 feet Silty Clay 50 feet 50 feet Clay 50 feet 50 feet

The effluent disposal setback is based on the soil texture of the horizon in which the absorption trench or bed is to be placed. These setbacks are to be used on all individual on-site wastewater disposal systems except spray irrigation disposal and overland discharge.

TABLE 2 - SIZING: AGGREGATE (Gravel, Crushed Stone, Tire Chips, or other approved media) Results of the Soil and Site Evaluation Soil Textural Class Ribbon Lengths (Inches) EPA Manual Application Rate GPD/ Ft

Absorption Area Per Bedroom (3’ Trench)* Additional Absorption Area Over 2 Persons Per Bedroom Ft

Lf Ft

Lf Gravel - - NOT SUITABLE Coarse Sand - 1.2 108 36 54 18 Medium Sand - 1.2 108 36 54 18 Fine Sand - 0.8 163 54 81 27 Loamy Sand - 0.8 163 54 81 27 Sandy Loam <.5 0.6 217 72 108 36 Light Loam <.5 0.6 217 72 108 36 Heavy Loam .5 – 1 0.45 289 96 144 48 Silt Loam <1 0.45 289 96 144 48 Sandy Clay Loam 1 – 2 0.45 289 96 144 48 Light Clay Loam 1 – 1.5 0.30 433 144 217 72 Heavy Clay Loam 1.5 – 2.0 0.20 650 217 325 108

Light Silty Clay Loam 1 – 1.5 0.30 433 144 217 72 Heavy Silty Clay Loam 1.5 – 2.0 0.20 650 217 325 108 Sandy Clay >2.0 - NOT SUITABLE Silty Clay >2.0 - NOT SUITABLE Clay >2.0 - NOT SUITABLE *Bedroom is equivalent to 130 GPD.

FIGURE 6 – Conventional Subsurface Absorption

FIGURE 7 – Ultra Shallow Absorption Field

FIGURE 8 – Conventional Absorption Bed

FIGURE 9 – Effluent Distribution for Absorption Beds

FIGURE 10 – Connection Lateral (Spillovers)

FIGURE 11 – Conventional Absorption Bed

FIGURE 12 – Distribution Box

Subchapter 5: Aggregate Replacement Rule 5.5.1 General. In a conventional on-site wastewater system treatment begins in the septic tank, under anaerobic conditions. Final treatment and disposal takes place in the soil of the drain field, an aerobic environment. It is necessary for this aerobic condition to exist in the soil of the drain field for proper treatment of the effluent.

**History**
- *Source: Miss. Code Ann. § 41-67-3.*
- *Source: Miss. Code Ann. § 41-67-3.*
- *Source: Miss. Code Ann. § 41-67-3.*
- *Source: Miss. Code Ann. § 41-67-3.*
- *Source: Miss. Code Ann. § 41-67-3.*
- *Source: Miss. Code Ann. § 41-67-3.*
- *Source: Miss. Code Ann. § 41-67-3.*
- *Source: Miss. Code Ann. § 41-67-3*
- *Source: Miss. Code Ann. § 41-67-3.*
- *Source: Miss. Code Ann. § 41-67-3.*
- *Source: Miss. Code Ann. § 41-67-3.*

##### **15 Miss. Admin. Code Pt. 18, R. 5.5.2** Definitions {#sec-18-5.5.2 omnilex-key=us-ms-regs-official--title-15--18#5.5.2}

1. Chamber System – a system of bottomless molded plastic chambers installed in direct contact with the trench bottom to infiltrate primary treated effluent into the soil for final treatment and disposal. 2. Aggregate Replacement Disposal System – any normally gravity-fed subsurface disposal field utilizing an alternate media or technology to act as a replacement for the aggregate media. These system depths range from 36 to 6 inches in depth: a. Standard Subsurface Disposal: 25 in. to 36 in. b. Shallow Subsurface Disposal: 13 in. to 24 in. c. Ultra-shallow Subsurface Disposal: 6 in. to 12 in. 3. Large Diameter Aggregate Replacement System – subsurface disposal system that utilizes large diameter pipe covered with a filtering material approved by the Mississippi State Department of Health for use in IOWDS systems. 4. Multi-Pipe Aggregate Replacement System – subsurface disposal system that utilizes a multiple arrangement of piping, approved by the Mississippi State Department of Health, to replace the aggregate media of conventional soil absorption systems for use in IOWDS systems. 5. Treatment – a process applied to wastewater which causes the resulting effluent to meet or exceed EPA secondary standards for treated wastewater for surface discharge and which does not endanger the public health.

**History**
- *Source: Miss. Code Ann. § 41-67-3.*

##### **15 Miss. Admin. Code Pt. 18, R. 5.5.3** Site Evaluation {#sec-18-5.5.3 omnilex-key=us-ms-regs-official--title-15--18#5.5.3}

1. Information obtained during the soil and site evaluation will determine which type(s) of IOWDS may be utilized for an individual lot. 2. Prior to completing the Soil and Site Evaluation/System Recommendation, the Environmentalist shall visit the lot and conduct the soil and site evaluation.

3. The soil determinations will be made based on soil borings to a depth of five feet or to a depth sufficient to reach a restrictive horizon. Restrictive soil or site conditions may preclude the use of any subsurface disposal system. 4. A soil and site evaluation will be based on the following criteria: a. Absence of or protection from frequent flooding. b. Landscape position with good surface runoff. c. Slopes of less than 15%. d. Depth to high water table of greater than four feet. e. Depth to bedrock, fragipan or plinthite of greater than four feet. f. Soil texture and color defined by the Natural Resource Conservation Service as indicating good drainage and suitability for soil absorption, based on a soil boring of five feet. g. Available area in which to install an individual onsite wastewater disposal system meeting all requirements of this regulation. The area for repairs and future extensions shall be no less than 50% of the space required for the recommended system. Systems utilizing surface land application discharge are exempt from the 50% additional area requirement. 5. The noncompliance of one or more of the above items may require a design alteration of an underground system.

**History**
- *Source: Miss. Code Ann. § 41-67-3.*

##### **15 Miss. Admin. Code Pt. 18, R. 5.5.4** Location of Onsite Wastewater Disposal Systems {#sec-18-5.5.4 omnilex-key=us-ms-regs-official--title-15--18#5.5.4}

1. All components of the onsite wastewater disposal system shall be located a minimum of: a. Five feet from any dwelling. b. Ten feet from any property line. 2. Any vessel holding wastewater shall be located a minimum of 50 feet from any public, private or individual potable water source. 3. The effluent disposal field shall be located at a lower elevation or in a landscape position that will preclude any surface runoff from flowing in the direction of the well site and a minimum of 100 feet from any public, private or individual potable water source. 4. Potable water lines shall not pass under or through any part of the sewage disposal system. Where a water supply line must cross a sewer line, the bottom of the water service within ten feet of the point of crossing shall be at least 12 inches above the top of

the sewer line. The sewer line shall be of Schedule 40 pipe with cemented joints at least ten feet on either side of the crossing. Water and sewer lines shall not be laid in the same trench. The water and sewer lines, when laid on the same elevation, shall maintain a minimum separation distance of 10 feet. 5. The surface of or the surface above the disposal field shall not be used for vehicular traffic or vehicular parking. 6. No portion of an onsite wastewater disposal system shall be located under dwellings or other permanent structures. 7. Effluent disposal systems shall not be located in depressed areas where surface water will accumulate. Provision shall be made to minimize the flow of surface water over the effluent disposal field. 8. Subsurface wastewater disposal field setbacks from sensitive waters. [See Table 3.] 9. Slopes of greater than 30% shall not be considered for subsurface disposal installation. 10. Where all or part of the onsite wastewater disposal system is proposed to be installed on property other than the owner’s, an easement in perpetuity shall be legally recorded in the proper county. The easement shall be of sufficient area to permit access, construction and maintenance of the onsite sewage disposal system. 11. No site for an effluent disposal field or expansion area shall be approved which is located wholly within an area which is frequently flooded, swamp, marsh, or wetland. Except that if permits have been issued by the proper regulatory agency authorizing the use of wetlands for building sites, the property shall be evaluated using standard soil and site criteria for IOWDS. 12. When a proposed lot is located partially within a frequently flooded area, that portion of said lot not within the flood prone area may be considered for approval for the effluent disposal field. 13. There shall be maintained a minimum of 12 inches of unsaturated soil between the bottom of the subsurface disposal system and a perched or seasonal water table in soils that contain a restrictive horizon (fragipan, chalk, bedrock, clay or silty clay) within five feet of the surface. 14. There shall be maintained a minimum of 24 inches of unsaturated soil between the bottom of the subsurface disposal system and any perched or seasonal water table in soils that do not contain a restrictive horizon (fragipan, chalk, bedrock, clay or silty clay) within five feet of the surface. 15. Easements or right-of-way areas for utilities, surface or subsurface drainage, roads, streets, ponds or lakes shall not be used as available space for location of individual onsite sewage disposal systems.

**History**
- *Source: Miss. Code Ann. § 41-67-3.*

##### **15 Miss. Admin. Code Pt. 18, R. 5.5.5** Underground Absorption {#sec-18-5.5.5 omnilex-key=us-ms-regs-official--title-15--18#5.5.5}

1. Aggregate replacement systems shall comply with all criteria for subsurface gravel disposal systems except in sections pertaining to the gravel media or as specified in this regulation. 2. The size of the subsurface sewage disposal system shall be determined by soil texture and estimated wastewater flow. 3. Soils with excessively rapid permeability rates, gravel and coarse sand, shall be considered unsuitable for subsurface disposal unless the native soil is replaced with a suitably thick (greater than two feet) layer of loamy sand or sand textured soil. 4. Soils with excessively slow permeability rates, silty clay and clay, shall be considered unsuitable for conventional subsurface disposal. 5. Subsurface disposal systems shall be placed no deeper than 36 inches below the surface. 6. Aggregate replacement subsurface disposal systems shall have a minimum 12 inches of soil backfill. 7. The minimum distance between absorption trench sidewalls shall be six feet. 8. Trenches shall not be excavated when the soil is wet enough to smear or compact easily. 9. There shall be a minimum of three feet of undisturbed soil between the excavation for the septic tank or treatment plant and the beginning of the absorption trench, bed or effluent line. 10. The bottom of the outlet of the septic tank, aerobic treatment plant or vessel supplying effluent to the pipe must be a minimum of one inch above the top of the aggregate replacement system. 11. Care must be taken when backfilling to prevent the pipe from shifting during the backfilling process. 12. Soil material excavated from trenches shall be used in backfilling and should be left mounded over the trenches until initial settling has taken place. 13. Standard manufactured fittings compatible with the pipe shall be used to connect all pipes within the effluent disposal field.

**History**
- *Source: Miss. Code Ann. § 41-67-3.*

##### **15 Miss. Admin. Code Pt. 18, R. 5.5.6** Alternating Disposal Fields {#sec-18-5.5.6 omnilex-key=us-ms-regs-official--title-15--18#5.5.6}

1. An alternating effluent disposal field system provides two complete disposal fields, separated by a valving system so that each system could alternately be used and rested. This “resting” is useful in regenerating the soil’s capability for absorbing the effluent. 2. The size of each field can be from 50 to 100 percent of the required square footage of a single disposal field. 3. The length of time each field would be used and then rested will be determined on a case- by-case basis.

**History**
- *Source: Miss. Code Ann. § 41-67-3.*

##### **15 Miss. Admin. Code Pt. 18, R. 5.5.7** Shallow and Ultra-shallow Disposal Fields {#sec-18-5.5.7 omnilex-key=us-ms-regs-official--title-15--18#5.5.7}

Shallow or ultra-shallow systems can sometimes be used where the depth to the restrictive horizon or water table is less than the minimum required. Placement of the system may be as shallow as 6 inches for large diameter double-six aggregate replacement pipe systems. Ultra- shallow installations shall be restricted to soil textures of loam or lighter. Shallow installations may be placed in any texture shown as suitable in the system specific sizing tables.

**History**
- *Source: Miss. Code Ann. § 41-67-3.*

##### **15 Miss. Admin. Code Pt. 18, R. 5.5.8** Sizing {#sec-18-5.5.8 omnilex-key=us-ms-regs-official--title-15--18#5.5.8}

The large diameter aggregate replacement systems shall be sized in accordance with Table 4.

**History**
- *Source: Miss. Code Ann. § 41-67-3.*

##### **15 Miss. Admin. Code Pt. 18, R. 5.5.9** Construction {#sec-18-5.5.9 omnilex-key=us-ms-regs-official--title-15--18#5.5.9}

1. Large diameter aggregate replacement absorption trenches shall be a minimum of 24 inches and a maximum of 36 inches in width. 2. The bottom of the trenches or bed and the distribution lines shall have a grade from level to no greater than two inches fall per 100 feet for double six inch large diameter aggregate replacement pipe and one inch fall per 100 feet for eight and ten inch large diameter aggregate replacement pipe. 3. Overlap filter wrap at coupling joints and seal using factory approved methods. 4. The 4” pipe from the septic tank, aerobic treatment plant or vessel supplying effluent to the aggregate replacement pipe shall be installed into an offset connector particular to the type and manufacturer of the pipe. These connectors will also be used when crossovers are constructed to change elevations of field system. 5. Fabric must be pulled over offset connector and sealed using a factory approved method. 6. The ends of the large diameter aggregate replacement pipe shall be closed with an end cap particular to the type and manufacturer of the pipe.

7. Care must be taken during backfilling to prevent the aggregate replacement pipe from “crawling” when backfill is applied.

**History**
- *Source: Miss. Code Ann. § 41-67-3.*

##### **15 Miss. Admin. Code Pt. 18, R. 5.5.10** Distribution of Effluent: Aggregate Replacement Pipe Systems {#sec-18-5.5.10 omnilex-key=us-ms-regs-official--title-15--18#5.5.10}

1. Aggregate Replacement Pipe Systems: a. When a change in elevation of the disposal trench is required, a distribution box, connecting lateral or crossover must be used. At the point where a crossover line leaves a lateral, the trench for the crossover line shall be dug no deeper than the top of the aggregate replacement pipe in the preceding trench so that an undisturbed block of earth will remain in place for the full depth of the aggregate replacement pipe. The distribution box shall be level and supply all lines equally. Field lines must be equal lengths when served by one distribution box. b. Distribution boxes may be used to connect the effluent line to the effluent distribution lines. Non-perforated rigid pipe shall exit the distribution box for a minimum of five feet at level grade before the effluent distribution line (perforations) begins. c. Crossover lines shall be laid on undisturbed earth. The invert of the crossover must be at least four inches lower than the invert of the septic tank outlet line. Crossovers shall be constructed as shown in Figure 13.

**History**
- *Source: Miss. Code Ann. § 41-67-3.*

##### **15 Miss. Admin. Code Pt. 18, R. 5.5.11** Absorption Beds {#sec-18-5.5.11 omnilex-key=us-ms-regs-official--title-15--18#5.5.11}

Absorption beds may be constructed using large diameter aggregate replacement filter wrap pipe: 1. Absorption beds and trenches should be located a minimum of 10 feet from any trees. 2. The amount of linear footage required shall be the same as for trench configurations. The bottom of the bed should have a relatively level grade; the grade within the bed shall not exceed the grade allowed for trench installations. 3. Lines for distributing effluent shall be spaced from 3 to 6 feet apart with the first and last pipe placed next to the sidewall of the bed. The number of lines will depend on the linear feet of aggregate replacement line [Table 4] and width of the bed to be constructed. 4. Care should be taken to prevent heavy machinery from damaging the bed during backfilling. 5. The effluent must be equally distributed to the bed by means of a distribution box or with a pipe manifold.

6. When a change in elevation of the disposal trench is required, a connecting lateral or crossover must be used. At the point where a crossover line leaves a lateral, the trench for the crossover line shall be dug no deeper than the top of the aggregate replacement pipe in the preceding trench so that an undisturbed block of earth will remain in place for the full depth of the pipe. Crossover lines shall be laid on undisturbed earth. The invert of the crossover must be at least four inches lower than the invert effluent line of the septic tank, aerobic treatment plant or vessel supplying effluent to the pipe. [See Figure 13.]

**History**
- *Source: Miss. Code Ann. § 41-67-3.*

##### **15 Miss. Admin. Code Pt. 18, R. 5.5.12** Multi-Pipe Aggregate Replacement Systems {#sec-18-5.5.12 omnilex-key=us-ms-regs-official--title-15--18#5.5.12}

1. General: The multi-pipe aggregate replacement system is a system that utilizes bundles of four inch perforated pipe to provide a void space. The top pipe in one bundle of this system receives the treated effluent for distribution throughout the disposal system. All multi-pipe aggregate replacement systems must be installed by a Certified Installer that is factory-trained and authorized by the manufacturer. 2. Sizing: The multi-pipe aggregate replacement systems shall be sized in accordance with Table 5. 3. Construction: a. The bottom of the trenches and the distribution lines shall have a grade from level to no greater than two inches fall per 100 feet for multi-pipe aggregate replacement systems. b. Multi-pipe aggregate replacement system trenches shall be a minimum of 24 and a maximum of 36 inches in width. c. The multi-pipe aggregate replacement system must be installed with effluent being distributed to each trench distribution pipe by use of a distribution box or a level pipe header: i. When a change in elevation of the disposal trench is required, a distribution box or approved crossover shall be used. The distribution box, if used, shall be level and supply all lines equally. ii. Distribution boxes may be used to connect the effluent line to the effluent distribution lines. Non-perforated rigid pipe shall exit the distribution box for a minimum of five feet at level grade before the effluent distribution line (perforations) begins. d. The system shall be covered with a manufacturer-approved, geotextile cloth before backfilling. e. The geotextile cloth shall cover the open ends of the void and distribution pipes at their termination at the ends of the trench.

**History**
- *Source: Miss. Code Ann. § 41-67-3.*

##### **15 Miss. Admin. Code Pt. 18, R. 5.5.13** Change in Elevation {#sec-18-5.5.13 omnilex-key=us-ms-regs-official--title-15--18#5.5.13}

When a change in elevation of the disposal trench is required, an additional distribution box or connecting lateral/crossover must be used. At the point where a crossover line leaves a lateral, the trench for the crossover line shall be dug no deeper than the top of the multi-pipe aggregate replacement distribution pipe in the preceding trench so that an undisturbed block of earth will remain in place for the full depth of the distribution system. Crossover lines shall be laid on undisturbed earth. The invert of the crossover must be at least four inches lower than the invert effluent line of the septic tank, aerobic treatment plant or vessel supplying effluent to the pipe.

**History**
- *Source: Miss. Code Ann. § 41-67-3.*

##### **15 Miss. Admin. Code Pt. 18, R. 5.5.14** Absorption Bed: Multi-Pipe System {#sec-18-5.5.14 omnilex-key=us-ms-regs-official--title-15--18#5.5.14}

1. Multi-pipe systems installed in a bed configuration shall have the same linear footage requirements as indicated for their respective trench configurations. The length and width of the bed to be constructed will be determined by the number of multi-pipe systems wide and the length selected to comply with the linear footage required under Table 5. 2. The multi-pipe system shall be placed side by side in the bed. Any side-by-side placement of multi-pipe systems shall constitute a bed. 3. The bottom of the bed should have a relatively level grade, from end to end and side to side. The grade within the bed shall not exceed the grade allowed for trench installations. 4. The effluent must be equally distributed to the bed by means of a distribution box or with a pipe manifold. 5. The multi-pipe system may be cut in order to accommodate setbacks. The multi-pipe system shall be cut to a length which preserves the integrity of the banded void pipes and provides adequate banding of the system a minimum of every 18 inches to a maximum of every 20 inches. Manufactured couplers shall be used to join cut ends of the void pipes. 6. The system shall be covered with a manufacturer-approved geotextile cloth before backfilling. 7. The geotextile cloth shall cover the open ends of the void pipes. 8. Care should be taken to prevent heavy machinery from damaging the bed during backfilling.

**History**
- *Source: Miss. Code Ann. § 41-67-3.*

##### **15 Miss. Admin. Code Pt. 18, R. 5.5.15** Expanded Polystyrene (EPS) Aggregate Systems {#sec-18-5.5.15 omnilex-key=us-ms-regs-official--title-15--18#5.5.15}

1. General: The EPS Aggregate system utilizes bundles of expanded polystyrene aggregate to replace rock aggregate in a subsurface disposal system. Effluent is distributed via a 4 inch perforated pipe incorporated into the center of one EPS bundle. System configurations of multiple bundles will incorporate one bundle run containing the 4 inch perforated pipe in conjunction with bundles containing only EPS aggregate. This 4 inch perforated pipe receives the treated effluent for distribution throughout the trench. The expanded polystyrene aggregate must be contained in a material that is resistant to the effects of wastewater, will prevent the loss of aggregate from the container and strong enough to retain the shape of the bundles during system installation and backfilling. All EPS Aggregate Systems must be installed by a factory-trained installer that is an authorized representative of the manufacturer. 2. Sizing: The EPS aggregate replacement systems shall be sized in accordance with Table 6 (Horizontal Configurations) and Table 7 (Triangular Configurations). 3. Construction: a. The EPS Aggregate System absorption trenches shall be a minimum of 24 inches and a maximum of 36 inches in width. b. The bottom of the trenches and the distribution lines shall have a grade from level to no greater than two inches fall per 100 feet. c. The grade shall be measured from the trench bottom and not the effluent distribution line encased in the EPS bundle. d. The EPS Aggregate system shall be covered with an approved cover material before backfilling. Covering material shall consist of craft paper or other bio- degradable product approved and/or supplied by the manufacturer. 4. Distribution of Effluent – EPS Aggregate System: a. When a change in elevation of the disposal trench is required, a distribution box, connecting lateral or crossover must be used. At the point where a crossover line leaves a lateral, the trench for the crossover line shall be dug no deeper than the top of the distribution pipe in the preceding trench so that an undisturbed block of earth will remain in place for the full depth of the system. [See Figure 14.] The invert of the crossover must be at least four inches lower than the invert of the septic tank outlet line. b. Distribution boxes may be used to connect the effluent line to the effluent distribution lines. The distribution box shall be level and supply all lines equally. Field lines must be equal lengths when served by one distribution box. Non- perforated rigid pipe shall exit the distribution box for a minimum of five feet at level grade before the effluent distribution line (perforations) begins.

5. Absorption Beds – EPS Aggregate Systems: Absorption beds may be constructed using the EPS Aggregate system (Horizontal configuration only): a. Absorption beds and trenches should be located a minimum of 10 feet from any trees. b. The amount of linear footage required for EPS horizontal systems shall be the same as for trench configurations. [See Table 6.] The bottom of the bed should have a relatively level grade; the grade within the bed shall not exceed the grade allowed for EPS trench installations. EPS triangular systems shall not be used in bed configurations. c. The EPS bundles shall be placed side by side in the bed. The number of bundles will depend on the linear footage required and the width of the bed to be constructed. d. Care should be taken to prevent heavy machinery from damaging the bed during backfilling. e. The effluent must be equally distributed to the bed by means of a distribution box or with a pipe manifold. 6. Homeowners may install 1-14 configuration EPS, provided that all applicable regulations of the Department are observed.

**History**
- *Source: Miss. Code Ann. § 41-67-3.*

##### **15 Miss. Admin. Code Pt. 18, R. 5.5.16** Chamber Subsurface Disposal Systems {#sec-18-5.5.16 omnilex-key=us-ms-regs-official--title-15--18#5.5.16}

1. General: Chamber systems utilize molded plastic bottomless chambers which are installed in a drain field excavation with the open bottom of the chamber in direct contact with the trench bottom. The chambers are linked together in such a manner as to completely cover the excavation with adjacent chambers in contact with each other. Effluent is introduced into the chambers and is absorbed into the soil for final treatment and disposal. All chamber systems must be installed by a factory trained and authorized installer. 2. Chamber Class Designation: a. Each model of chamber will be assigned a class designation based on the bottom square footage of the chamber section. This square footage will be derived by a multiple of the outside width and the useable length of the chamber section. b. Chamber models will be assigned a class designation according to Table 8.

**History**
- *Source: Miss. Code Ann. § 41-67-3.*

##### **15 Miss. Admin. Code Pt. 18, R. 5.5.17** Construction: Chamber Systems {#sec-18-5.5.17 omnilex-key=us-ms-regs-official--title-15--18#5.5.17}

1. The chamber system absorption trenches shall be a minimum of 18 inches and a maximum of 36 inches in width. 2. The bottom of the trenches shall have a grade from level to no greater than two (2) inches fall per 100 feet. 3. The grade shall be measured from the trench bottom and not the chamber top. 4. The chamber system shall be covered as per the manufacturer’s specifications. In all cases there shall be a minimum of 12 inches of soil cover over the chamber system. 5. The minimum height of a chamber, at its centerline, shall be 8 inches. 6. The last chamber in each “run” shall be terminated with an end plate.

**History**
- *Source: Miss. Code Ann. § 41-67-3.*

##### **15 Miss. Admin. Code Pt. 18, R. 5.5.18** Distribution of Effluent: Chamber Systems {#sec-18-5.5.18 omnilex-key=us-ms-regs-official--title-15--18#5.5.18}

1. When a change in elevation of the chamber system is required, a distribution box, connecting lateral or crossover must be used. At the point where a crossover line leaves a lateral, the trench for the crossover line shall be dug no deeper than the top of the endplate inlet or the inlet in the top of the chamber in the preceding trench so that an undisturbed block of earth will remain in place for the full depth of the system. The invert of the crossover must be at least four inches lower than the invert of the septic tank outlet line. 2. Distribution boxes may be used to connect the effluent line to the effluent distribution lines. The distribution box shall be level and supply all lines equally. Field lines (chambers) must be equal lengths when served by one distribution box. Non-perforated rigid pipe shall exit the distribution box for a minimum of five feet at level grade before the effluent distribution line begins.

**History**
- *Source: Miss. Code Ann. § 41-67-3.*

##### **15 Miss. Admin. Code Pt. 18, R. 5.5.19** Sizing of the Chamber System {#sec-18-5.5.19 omnilex-key=us-ms-regs-official--title-15--18#5.5.19}

1. Chamber systems installed in a trench configuration shall be sized in accordance with Table 9. 2. Chamber systems installed in a bed configuration shall have the same number of chamber sections as indicated for a trench system. The length and width of the bed to be constructed will depend on the number of chamber sections to be installed as indicated by Table 9. Any side-by-side placement of chambers shall constitute a bed: a. Absorption beds and trenches should be located a minimum of 10 feet from any trees.

b. The bottom of the bed should have a relatively level grade; the grade within the bed shall not exceed the grade allowed for trench installations. c. The chambers shall be placed side by side in a bed with separation between each chamber row per individual manufacturer’s requirements. d. Care should be taken to prevent heavy machinery from damaging the bed during backfilling. e. The effluent must be equally distributed to the bed by means of a distribution box or with a pipe manifold.

TABLE 3 - SETBACK REQUIREMENTS FROM SENSITIVE WATER Minimum Distance from the Water Edge Soil Textural Class Slope of Less Than 8 Percent Slope of More Than 8 Percent Gravel NOT APPLICABLE Coarse Sand 50 feet 50 feet Medium Sand 50 feet 50 feet Fine Sand 50 feet 50 feet Loamy Sand 50 feet 50 feet Sandy Loam 50 feet 50 feet Light Loam 50 feet 50 feet Heavy Loam 50 feet 50 feet Silt Loam 50 feet 50 feet Sandy Clay Loam 50 feet 50 feet Light Clay Loam 50 feet 50 feet Heavy Clay Loam 50 feet 50 feet Light Silty Clay Loam 50 feet 50 feet Heavy Silty Clay Loam 50 feet 50 feet Sandy Clay 50 feet 50 feet Silty Clay 50 feet 50 feet Clay 50 feet 50 feet The effluent disposal setback is based on the soil texture of the horizon in which the absorption trench or bed is to be placed. These setbacks are to be used on all individual on-site wastewater disposal systems except spray irrigation disposal and overland discharge.

TABLE 4 - SIZING: AGGREGATE REPLACEMENT (Large Diameter Pipe) Results of the Soil and Site Evaluation Soil Textural Class Ribbon Lengths (Inches) Application Rate GPD/ Ft

** Absorption Area Per Bedroom*** Additional Absorption Area Over 2 Persons Per Bedroom*** Ft

Lf* Ft

Lf*

6” 8” 10” 6” 8” 10” 6” 8” 10” 6” 8” 10” Gravel - - NOT SUITABLE Coarse Sand - 1.2 164 164 108 55 55 36 82 82 54 27 27 18 Medium Sand - 1.2 164 164 108 55 55 36 82 82 54 27 27 18 Fine Sand - 0.8 247 247 165 82 82 55 124 124 82 41 41 27 Loamy Sand - 0.8 247 247 165 82 82 55 124 124 82 41 41 27 Sandy Loam <.5 0.6 325 325 217 108 108 72 163 163 108 54 54 36 Light Loam <.5 0.6 325 325 217 108 108 72 163 163 108 54 54 36 Heavy Loam .5 – 1 0.45 437 437 290 146 146 97 218 218 145 73 73 48 Silt Loam <1 0.45 437 437 290 146 146 97 218 218 145 73 73 48 Sandy Clay Loam 1 – 2 0.45 437 437 290 146 146 97 218 218 145 73 73 48 Light Clay Loam 1 – 1.5 0.30 650 650 433 217 217 144 325 325 217 108 108 72 Heavy Clay Loam 1.5 – 2.0 0.20 975 975 650 325 325 217 488 488 325 163 163 108 Light Silty Clay Loam 1 – 1.5 0.30 650 650 433 217 217 144 325 325 217 108 108 72 Heavy Silty Clay Loam 1.5 – 2.0 0.20 975 975 650 325 325 217 488 488 325 163 163 108 Sandy Clay >2.0 - NOT SUITABLE Silty Clay >2.0 - NOT SUITABLE Clay >2.0 - NOT SUITABLE Minimum and maximum trench widths are 24 and 36 inches, respectively. *Linear footages assume 24 inch 36-inch trench width. **Application rate assumes 10” pipe. *** Bedroom is equivalent to 130 gallons per day.

TABLE 5 – SIZING: AGGREGATE REPLACEMENT (Multi-Pipe System) Results of the Soil and Site Evaluation Soil Textural Class Ribbon Lengths (Inches) Absorption Area Per Bedroom** Additional Absorption Over 2 Person Per Bedroom** MPS -14 & 36XX ***

MPS-13 MPS-11 MPS-9 MPS-14 & 36XX ***

MPS-13 MPS-11 MPS-9 Ft

Lf Lf Lf Lf Ft

Lf Lf Lf Lf Gravel - NOT SUITABLE Coarse Sand - 108 36 28 32 38 54 18 14 16 19 Medium Sand - 108 36 28 32 38 54 18 14 16 19 Fine Sand - 163 54 42 49 58 81 27 21 24 29 Loamy Sand - 163 54 42 49 58 81 27 21 24 29 Sandy Loam <.5 217 72 55 64 76 108 36 28 32 38 Light Loam <.5 217 72 55 64 76 108 36 28 32 38 Heavy Loam .5 – 1 289 96 74 86 102 144 48 37 43 51 Silt Loam <1 289 96 74 86 102 144 48 37 43 51 Sandy Clay Loam 1 – 2 289 96 74 86 102 144 48 37 43 51 Light Clay Loam 1 – 1.5 433 144 110 128 171 217 72 55 64 77 Heavy Clay Loam 1.5 – 2.0 650 217 165 193 230 325 108 82 97 115 Light Silty Clay Loam 1 – 1.5 433 144 110 128 171 217 72 55 64 77 Heavy Silty Clay Loam 1.5 – 2.0 650 217 165 193 230 325 108 82 97 115 Sandy Clay >2.0 NOT SUITABLE Silty Clay >2.0 NOT SUITABLE Clay >2.0 NOT SUITABLE Minimum and maximum trench widths are 24 and 36 inches, respectively. ** Bedroom is equivalent to 130 gallons per day. ***XX represents either 9, 11, or 14 pipes. Note – A design using a GPD value rather than a bedroom number may be converted to a bedroom equivalent by dividing the GPD value by 130, then using that bedroom equivalent value to determine the required disposal area.

TABLE 6 - SIZING: AGGREGATE REPLACEMENT (Expanded Polystyrene System) “Horizontal” Configuration Results of the Soil and Site Evaluation Soil Textural Class Ribbon Lengths (Inches) Absorption Area Per Bedroom** Additional Absorption Over 2 Person Per Bedroom** 3-10H 1-12 2-12 3-12 1-14 3-10H 1-12 2-12 3-12 1-14 Ft

Lf Lf Lf Lf Lf Ft

Lf Lf Lf Lf Lf Gravel - NOT SUITABLE Coarse Sand - 108 30 75 37 25 36 54 15 38 19 13 18 Medium Sand - 108 30 75 37 25 36 54 15 38 19 13 18 Fine Sand - 163 46 114 57 38 55 81 23 57 29 19 28 Loamy Sand - 163 46 114 57 38 55 81 23 57 29 19 28 Sandy Loam <.5 217 60 151 75 50 72 108 30 76 38 25 36 Light Loam <.5 217 60 151 75 50 72 108 30 76 38 25 36 Heavy Loam .5 – 1 289 81 201 101 67 97 144 40 101 52 33 49 Silt Loam <1 289 81 201 101 67 97 144 40 101 52 33 49 Sandy Clay Loam 1 – 2 289 81 201 101 67 97 144 40 101 52 33 49 Light Clay Loam 1 – 1.5 433 120 299 153 100 144 217 60 100 77 50 72 Heavy Clay Loam 1.5 – 2.0 650 178 449 225 150 217 325 89 225 113 75 109 Light Silty Clay Loam 1 – 1.5 433 120 299 153 100 144 217 60 100 77 50 72 Heavy Silty Clay Loam 1.5 – 2.0 650 178 449 225 150 217 325 89 225 113 75 109 Sandy Clay >2.0 NOT SUITABLE Silty Clay >2.0 NOT SUITABLE Clay >2.0 NOT SUITABLE Minimum and maximum trench widths are 24 and 36 inches, respectively. ** Bedroom is equivalent to 130 gallons per day. Note – A design using a GPD value rather than a bedroom number may be converted to a bedroom equivalent by dividing the GPD value by 130, then using that bedroom equivalent value to determine the required disposal area.

TABLE 7 - SIZING: AGGREGATE REPLACEMENT (Expanded Polystyrene System) “Triangular” Configuration Results of the Soil and Site Evaluation Soil Textural Class Ribbon Lengths (Inches) Application Rate GPD/ Ft

Absorption Area Per Bedroom** Additional Absorption Over 2 Person Per Bedroom** 3-10 Inch 3-10 Inch Ft

Lf Ft

Lf Gravel - - NOT SUITABLE Coarse Sand - 2.41 54 27 26 13 Medium Sand - 2.41 54 27 26 13 Fine Sand - 1.57 83 42 42 21 Loamy Sand - 1.57 83 42 42 21 Sandy Loam <.5 1.19 109 55 55 28 Light Loam <.5 1.19 109 55 55 28 Heavy Loam .5 – 1 0.89 146 73 73 36 Silt Loam <1 0.89 146 73 73 36 Sandy Clay Loam 1 – 2 0.89 146 73 73 36 Light Clay Loam 1 – 1.5 0.60 217 108 109 55 Heavy Clay Loam 1.5 – 2.0 0.40 326 163 163 81 Light Silty Clay Loam 1 – 1.5 0.60 217 108 109 55 Heavy Silty Clay Loam 1.5 – 2.0 0.40 326 163 163 81 Sandy Clay >2.0 - NOT SUITABLE Silty Clay >2.0 - NOT SUITABLE Clay >2.0 - NOT SUITABLE Minimum and maximum trench widths are 24 and 36 inches, respectively. The Triangular Configuration can only be installed in a trench. ** Bedroom is equivalent to 130 gallons per day.

TABLE 8 - CHAMBER SYSTEM CLASSIFICATIONS CLASS SQUARE FEET/CHAMBER SECTION I 7.51 – 9.50 II 9.51 – 11.50 III 11.51 – 13.50 IV 13.51 – 15.50 V 15.51 – 17.50 VI 17.51 – 19.50 VII 19.51 – 21.50 VIII 21.51 – 23.50

TABLE 9 - SIZING: AGGREGATE REPLACEMENT (Chamber System) Results of the Soil and Site Evaluation Soil Textural Class Ribbon Lengths (Inches) Application Rate GPD/ Ft

Absorption Area in Ft

Per Bedroom** Number of Pieces Per Bedroom based on Chamber Class** Additional Pieces Over 2 Persons Per Bedroom Based on Chamber Class** I II III IV I II III IV Gravel - - NOT SUITABLE Coarse Sand - 1.71 76 9 7 6 5 5 4 3 3 Medium Sand - 1.71 76 9 7 6 5 5 4 3 3 Fine Sand - 1.13 115 13 11 10 8 7 6 5 4 Loamy Sand - 1.13 115 13 11 10 8 7 6 5 4 Sandy Loam <.5 0.85 152 17 15 12 10 9 8 6 5 Light Loam <.5 0.85 152 17 15 12 10 9 8 6 5 Heavy Loam .5 – 1 0.64 204 23 19 16 14 9 8 6 5 Silt Loam <1 0.64 204 23 19 16 14 12 10 8 7 Sandy Clay Loam 1 – 2 0.64 204 23 19 16 14 12 10 8 7 Light Clay Loam 1 – 1.5 0.43 303 33 28 24 21 17 14 12 11 Heavy Clay Loam 1.5 – 2.0 0.29 455 50 43 34 30 25 22 17 15 Light Silty Clay Loam 1 – 1.5 0.43 303 33 28 24 21 17 14 12 11 Heavy Silty Clay Loam 1.5 – 2.0 0.29 455 50 43 34 30 25 22 17 15 Sandy Clay >2.0 - NOT SUITABLE Silty Clay >2.0 - NOT SUITABLE Clay >2.0 - NOT SUITABLE Minimum and maximum trench widths are 18 and 36 inches, respectively. ** Bedroom is equivalent to 130 gallons per day.

FIGURE 13 – Top View of Connecting Laterals for Large Diameter Pipes

FIGURE 14 – Connection Laterals of Multi-pipe System, Expanded Polystyrene System, and Chamber System

Subchapter 6: Subsurface Drip Irrigation Rule 5.6.1 General. Subsurface Drip Irrigation is a system that utilizes three basic design principles: (1) uniform distribution of effluent, (2) dosing and resting cycles, and (3) shallow placement of tubing. This system uses small diameter pipe with emitters and must be preceded by a treatment system that conforms to the manufacturer’s specifications particular to that system. The effluent must be adequately filtered before distribution to the disposal field(s). Only Subsurface Drip Irrigation Systems that provide for timed dosing are acceptable. The term manufacturer, unless otherwise specified, is considered the manufacturer of the treatment device. [See Figure 15.]

**History**
- *Source: Miss. Code Ann. § 41-67-3.*
- *Source: Miss. Code Ann. § 41-67-3.*
- *Source: Miss. Code Ann. § 41-67-3.*
- *Source: Miss. Code Ann. § 41-67-3.*
- *Source: Miss. Code Ann. § 41-67-3.*
- *Source: Miss. Code Ann. § 41-67-3.*
- *Source: Miss. Code Ann. § 41-67-3.*
- *Source: Miss. Code Ann. § 41-67-3.*
- *Source: Miss. Code Ann. § 41-67-3.*
- *Source: Miss. Code Ann. § 41-67-3.*
- *Source: Miss. Code Ann. § 41-67-3.*

##### **15 Miss. Admin. Code Pt. 18, R. 5.6.2** Definitions {#sec-18-5.6.2 omnilex-key=us-ms-regs-official--title-15--18#5.6.2}

1. Advanced Treatment System – an Individual On-site Wastewater treatment system that complies with Section 41-67-10, Miss. Code of 1972, Annotated § 41-67-2(a). 2. Components – all physical, mechanical, and electrical components of any wastewater disposal system. 3. Distribution manifold – PVC pipe that delivers the treated effluent to the drip tubing. 4. Emitter – small labyrinth inside of drip tubing that eliminates pressure and releases drops of treated effluent. 5. Maintenance – the inspecting and evaluating of an Alternative System or Advanced Treatment System. The replacement of any component registered with a specific Advanced Treatment System (i.e., aerator, diffuser, control panel, etc.). 6. Subsurface Drip Irrigation System – a system that relies on advanced treatment and filtration of the treated effluent. Final disposal occurs in the upper limits of the soil horizon and is distributed through small diameter tubes that have emitters that slowly drip the treated water into the soil. 7. Tubing – a small diameter line made of a material that forms a tube which contains emitter and manufacturer’s fittings. 8. Vacuum breakers/air release valve – relieves pressure off the treated effluent and allows air to escape the system without causing damage.

**History**
- *Source: Miss. Code Ann. § 41-67-3.*

##### **15 Miss. Admin. Code Pt. 18, R. 5.6.3** Design {#sec-18-5.6.3 omnilex-key=us-ms-regs-official--title-15--18#5.6.3}

Utilizing USDA soil groups as classified by textures is the most appropriate criteria on which to base loading rates for this system. The size of the disposal field shall be based on the most restrictive soil, naturally occurring within 2 feet of the ground surface or to a depth of 1 foot

below the trench bottom, whichever is deeper. Criteria and techniques for soil and site evaluation can be found in Chapter 4: Soil and Site Evaluation: 1. Prior to the design of the Subsurface Drip Irrigation System, the suitability of the site must be demonstrated through acceptable soil permeability rates, acceptable soil conditions [Table 10] and other topographic characteristics. The design and construction of the Subsurface Drip Irrigation System must conform to the drip tubing manufacturer’s specifications. [See Figure 15.] 2. A minimum of 6 inches of naturally occurring soil must be present above a restrictive horizon or a predominantly gray soil (>50%) before placement of appropriate fill. Subsurface Irrigation System is not recommendable on hydric soils conditions. 3. Except where hydric soils are present, a clean fill material may be used to overcome seasonal water table limitation. The fill material shall consist of a minimum of 50 percent sand particles equal to or greater than 0.25 mm. Clay content shall be 20 percent or less. Organic matter shall be removed from the native soil surface prior to placing and incorporating the fill. This fill must be incorporated into the native soil to prevent a textural interface from developing. When fill material is used the entire fill area must be sodded to prevent erosion, or other effective erosion control methods used. The full depth of fill material must extend at least 2 feet in all directions from drip tubing and at that point shall be sloped at a grade of no steeper than 3 to 1. 4. In soils that contain a restrictive horizon, within 5 feet of the surface, there shall be a minimum of 12 inches of unsaturated soil between the bottom of the drip tubing and any perched or seasonal water table. 5. In soils that do not contain a restrictive horizon, within 5 feet of the surface, there shall be a minimum of 24 inches of unsaturated soil between the bottom of the drip tubing and any perched or seasonal water table. 6. Drip tubing must be installed a minimum of 6 inches deep. The maximum depth may not exceed 18 inches. In all cases there shall be a minimum of 12 inches separation between the water table and restrictive horizon. 7. Minimum separation between drip emitters shall be 2 feet. A 2-foot horizontal separation must be maintained between drip tubing lines for slopes of less than 20 percent; for slopes of 20 percent or greater the minimum horizontal separation shall be 3 feet. 8. Drip tubing shall either be placed 4 inches lower than the supply manifolds or water breaks shall be used to prevent effluent from flowing along the drip tubing to the supply manifold trenches. 9. Valves, fittings, level control switches and all other components must be designed and manufactured to resist the corrosive effects of wastewater and common household chemicals.

10. Electrical equipment shall be protected with safety devices (overload interrupting devices, fuses, etc.). Electrical equipment shall comply with appropriate National Electrical Manufacturer’s Association (NEMA) requirements. Electrical component parts shall be covered by the manufacturer’s limited warranty.

**History**
- *Source: Miss. Code Ann. § 41-67-3.*

##### **15 Miss. Admin. Code Pt. 18, R. 5.6.4** Location/Setbacks {#sec-18-5.6.4 omnilex-key=us-ms-regs-official--title-15--18#5.6.4}

1. All components of the Subsurface Drip Irrigation System shall be located a minimum of: a. Water Supply (Public/Private): i. 100 feet from any public, private or individual potable water sources, unless protected by topographic features. ii. 50 feet from any public, private or individual potable water source for all vessel(s) holding wastewater. b. Water Supply Components: i. 10 feet horizontal separation from any potable water line. ii. 10 feet horizontal separation from any water meter. iii. Potable water lines must not pass under or through any part of the wastewater disposal system which includes the collection and distribution of the wastewater or effluent. c. Sensitive Waters: i. 100 feet on slopes of greater than 8 percent. ii. Slopes of less than or equal to 8 percent: see Table 11. d. Property Lines: i. 10 feet down slope or same grade. ii. 10 feet up slope. e. Residence and Buildings: i. 5 feet from habitable and non-habitable structures. f. Additional Structures: i. 5 feet from porches, patios, decks, walkways, driveways and parking areas.

ii. 25 feet from swimming pools. 2. No vehicular traffic or parking is allowed in the area of the treatment and disposal system. 3. Advanced treatment, pump chamber, and Subsurface Drip Irrigation field shall not be located under dwellings or other permanent structures. 4. Disposal shall not be located in depressed areas where surface water will accumulate. Provision shall be made to minimize the flow of surface water. 5. Where all or part of the treatment and disposal system is proposed to be installed on property other than the owner’s, a deeded easement in perpetuity shall be legally recorded in the appropriate county. The deeded easement shall be obtained to include a sufficient area to permit access, construction and maintenance. 6. Deeded easements or right-of-way areas for utilities, surface or subsurface drainage, roads, streets, ponds or lakes shall not be used as available space for location of a Subsurface Drip Irrigation System. 7. Drip tubing shall be on contour and shall not be installed perpendicular (or up and down) to the slope. Elevation differences in a line or the entire grid shall not exceed the drip tubing manufacturers’ specifications.

**History**
- *Source: Miss. Code Ann. § 41-67-3.*

##### **15 Miss. Admin. Code Pt. 18, R. 5.6.5** Treatment {#sec-18-5.6.5 omnilex-key=us-ms-regs-official--title-15--18#5.6.5}

1. Wastewater effluent must meet the requirement established by American National Standards Institute/National Sanitation Foundation (ANSI/NSF) International Standard Number 40 testing protocol, as set forth in Regulations Governing Residential Individual Onsite Wastewater Disposal Systems: Certification. The type of treatment must also conform to drip tubing manufacturers’ specifications. 2. The treatment and dosing chamber shall be designed, constructed and installed so all joints, seams, and component parts shall preclude infiltration of groundwater, and prevent escape of wastewater or liquids.

**History**
- *Source: Miss. Code Ann. § 41-67-3.*

##### **15 Miss. Admin. Code Pt. 18, R. 5.6.6** Distribution {#sec-18-5.6.6 omnilex-key=us-ms-regs-official--title-15--18#5.6.6}

1. Drip Tubing: a. The drip tubing may be installed using any of the following methods: i. Excavation by a trenching machine.

ii. Approved plowing method as determined by the tubing manufacturer. The insertion tool must be of the type that does not pull or stretch the drip line during insertion. The use of “cable plows” or any type insertion method that employs pulling the drip line through the plowed trench is prohibited. b. To ensure equal dosing of the field there can be no more than a 10 percent variance in the flow between any 2 emitters in the entire field. c. The length of each distribution line shall not exceed drip tubing manufacturer’s specifications to ensure equal distribution to each emitter. d. If necessary, pressure compensating devices or regulators shall ensure equal distribution from all emitters at +/− 10% of the designed discharge rate. e. Emitter outlet orifices are non-directional devices. 2. Pump Chambers: a. During normal operating procedures the inlet to the treatment system shall not become surcharged. b. The pump chamber shall have a minimum capacity of 1.5 times the estimated daily flow. c. The pump chamber shall be equipped with an audible high-water alarm and may utilize a functional self-opening relief valve. d. The pump chamber shall have a grade level access allowing a minimum of 17- inch diameter or 15-inch square, to allow servicing and/or removal of the largest component in the chamber. Access ports shall be protected against unauthorized entrance or removal, by use of tamper proof fasteners or a lid weighing 65 pounds or more. e. The pump chamber shall be vented through the grade level access or by means of a separate vent. In either case, the vent shall be a minimum of 1 inch in diameter. f. The pump chamber shall be made of material resistant to the corrosive effects of wastewater and designed to withstand the lateral and bearing loads to which it is expected to be subjected. g. All openings shall be sealed with mastic, butyl rubber or other pliable sealant that is waterproof, corrosion resistant and approved for use in contact with wastewater, in a manner to prevent the entrance of surface and groundwater. h. The high-water alarm must be set so as to allow a reserve capacity equal to ½ day estimated flow. 3. Minimum Pump Specifications:

a. The pumping system shall be capable of dosing the disposal field a minimum of 6 equally spaced doses per 24 hour period. Each dose volume shall not exceed the estimated maximum daily flow divided by the number of dosing cycles. It is acceptable that daily usage of less than the design flow rate will result in a diminished number of cycles. An emergency override float is required to accommodate conditions which exceed the normal daily flow rate. [See Table 12.] b. The pumping system shall be designed to discharge the required volume of wastewater within the pressure range specified by all component manufacturers. c. The pump shall be equipped with a low water cutoff to prevent damage to the pump during low water conditions in the pump chamber. d. The pump shall be constructed of corrosion resistant materials suitable for effluent pumping. e. The pump shall be sized per pump and components manufacturers’ specifications to meet or exceed the hydraulic requirement of the system. f. The pump shall be installed so as not to violate the pump warranty. g. The suction and pressure lines shall be Schedule 40 or equal and be sized to meet or exceed the hydraulic requirements of the system. 4. Minimum Filter Specifications: a. The filter shall filter effluent to prevent clogging to the specifications of the drip tubing manufacturer. b. The filter shall achieve the required filtration at a rate equal to or greater than the peak discharge rate, including filter and/or system backwash. c. An independent third party, acceptable to the Division, shall certify the filter performance. Verification from a manufacturer of filters or by an independent registered Professional Engineer. d. The filter shall be made of material resistant to the corrosive effects of wastewater and common household chemicals. e. The filter shall be readily accessible for inspection, service and/or maintenance. f. The filter flush volume and velocity shall be per filter manufacturer’s specifications. g. The filter residue shall be returned to the treatment system. h. The Subsurface Drip Irrigation System must provide an automatic field flush to prevent the build-up of solids in the distribution system, with its discharge

returning to the treatment system and be capable of achieving a flushing velocity of a minimum of 1 foot per second. The return line must be permanently installed as a component of the system. A hose bib shall be prohibited as a component. 5. Component Specifications: a. Vacuum breakers shall be installed as per drip tubing manufacturer’s specification, a minimum of 1 vacuum breaker/air release valve for each drip field zone. b. Vacuum breakers shall be located in a protective enclosure that will prevent the accumulation of any substance that would prevent their proper operation and shall have a grade level access. c. All materials shall meet applicable American Society for Testing and Materials (ASTM) standards and be resistant to common household chemicals. The drip tubing manufacturer must certify drip tubing as designed and manufactured for the disposal of wastewater. The drip tubing must be color coded, by the manufacturer, to be easily identified as tubing designed for wastewater disposal. d. Equipment susceptible to freezing must be adequately protected.

**History**
- *Source: Miss. Code Ann. § 41-67-3.*

##### **15 Miss. Admin. Code Pt. 18, R. 5.6.7** Documentation {#sec-18-5.6.7 omnilex-key=us-ms-regs-official--title-15--18#5.6.7}

1. Installation Manual: a. The drip manufacturer must provide for registration, detailed instructions for installation, initiation of service and operation and maintenance to the distributor, installer and Division of On-site Wastewater. Specific instructions shall include but not be limited to: i. Recommendations concerning types of wastewater which cannot be disposed of by the system. ii. Arrangement of plumbing connections. iii. Electrical wiring of components. iv. Installation instructions that specify how to locate the system in well drained areas that also provide protection for vents, pumps, filters and controls from snow, ice, or water vapor accumulations. v. A drawing with each major component numbered, and identified with the same designation on an illustration, photograph, or print. vi. Recommended frequency of maintenance; maintenance instructions; and procedures for removal and disposal of waste.

2. Homeowner’s Manual: a. A Homeowner’s manual shall be provided to the consumer by the drip tubing and advanced treatment unit manufacturers with each Subsurface Drip Irrigation system. The manual shall include: i. Model number. ii. Design and flow diagrams. iii. Limited warranties. iv. Replacement and service policies. v. General installation instructions that specify how to locate the system in well-drained areas that also provide protection for vents, pumps, filters, and controls from snow, ice, or water vapor accumulations. vi. Detailed operation and maintenance requirements (including consumer responsibility, parts, and service). vii. Recommendations concerning types of wastewater which cannot be disposed of by the system. viii. Arrangement of plumbing connections. ix. Electrical wiring of components. 3. Limited Warranty: a. The manufacturer shall provide a 2-year limited warranty, from date of installation, covering all parts and materials. b. Each manufacturer shall furnish the consumer with a limited warranty identifying the replacement policy covering all mechanical and electrical component parts. 4. Initial Service Policy: a. A 2-year initial service policy shall be furnished to the consumer by the manufacturer and shall be included in the original purchase price. This policy shall provide as a minimum: i. The 4 inspection/service calls (at least one every 6 months) over the 2-year period including inspection, adjustment, and servicing of mechanical, electrical, and other applicable component parts to ensure proper function. The first inspection shall be conducted a minimum of 6 months from installation.

b. If any improper operation is observed which cannot be corrected at the time of the service call, the consumer and the Department shall be notified immediately in writing of the conditions and the estimated date of correction. 5. Continuing Maintenance Agreement: a. A continuing maintenance agreement, in perpetuity, is required on Subsurface Drip Irrigation Systems. Property owner must submit an Affidavit (Maintenance) and a copy of the current continuing maintenance agreement before system is approved or re-approved as an existing system. 6. Stand-by Parts: a. Standby mechanical and electrical component parts shall be stocked by the local distributor for use when the drip system’s mechanical or electrical components must be removed from the installation site for repairs. 7. Guaranteed Parts: a. The physical, mechanical and electrical component parts shall be guaranteed against any defects in material and workmanship as warranted. The cost of replacing damaged component parts, not due to reasonable wear and tear, is excluded from this provision. 8. Mechanical Parts: a. Mechanical parts shall be protected against damage or impairment of efficiency by flooding or surcharging. b. Mechanical parts shall not require periodic maintenance or adjustment by the consumer other than changing a fuse and similar devices, or visual inspection of the warning light. c. Mechanical parts shall be covered by the manufacturer’s limited warranty. 9. Service: a. Service shall be available within no more than 2 days following a request. 10. Service Label: a. A clearly visible, permanently attached label or plate, giving instructions for obtaining service, shall be placed at the audible signal.

**History**
- *Source: Miss. Code Ann. § 41-67-3.*

##### **15 Miss. Admin. Code Pt. 18, R. 5.6.8** Responsibility {#sec-18-5.6.8 omnilex-key=us-ms-regs-official--title-15--18#5.6.8}

The consumer shall be responsible for maintaining and operating the Subsurface Drip Irrigation System in accordance with the Regulations Governing Individual On-site Wastewater Disposal Systems, Appendixes, advanced treatment system manufacturer’s specifications and the drip tubing manufacturer’s specifications.

**History**
- *Source: Miss. Code Ann. § 41-67-3.*

##### **15 Miss. Admin. Code Pt. 18, R. 5.6.9** Existing System {#sec-18-5.6.9 omnilex-key=us-ms-regs-official--title-15--18#5.6.9}

In addition to the visual inspection conducted by the Environmentalist the following will apply: 1. The system must be inspected by a Certified Installer that is manufacturer’s authorized representative to verify that the Subsurface Drip Irrigation System is functioning. 2. The manufacturer’s authorized representative must furnish written verification, to the Department, that an inspection was made.

Treatmen t Field Flush Return Line Filter Backwash Return Line Air Vent (Highest Point) Dosing Chamber Pump - Filter Unit

Distribution Manifold Subsurface Drip Disposal Field

Dwelling FIGURE 15 – Subsurface Drip Irrigation System (Example Sketch Only)

TABLE 10 – SIZING: Drip Irrigation Results of the Soil and Site Evaluation Soil Textural Class Drip Factor (Lf/GPD)** (Lf) Per Bedroom* Additional Lf/Person (Over 2 Persons Per BR) Depth of Drip Line in Inches Gravel NOT SUITABLE Coarse Sand 1.0 130 65 6-18 Medium Sand 1.0 130 65 6-18 Fine Sand 1.0 130 65 6-18 Loamy Sand 1.0 130 65 6-18 Sandy Loam 1.67 217 109 6-18 Light Loam 1.67 217 109 6-18 Heavy Loam 1.67 217 109 6-18 Silt Loam 1.67 217 109 6-18 Sandy Clay Loam 1.67 217 109 6-18 Light Clay Loam 3.34 434 217 6-18 Heavy Clay Loam 3.34 434 217 6-18 Light Silty Clay Loam 3.34 434 217 6-18 Heavy Silty Clay Loam 3.34 434 217 6-18 Sandy Clay 3.34 434 217 6-18 Silty Clay 10.0 1300 650 6-18 Clay 10.0 1300 650 6-18 * Bedroom is equivalent to 130 GPD. ** To estimate the required disposal, multiply GPD by the Drip Factor. Ex: 500 GPD x 1.67 (Silt Loam) = 835 Lf disposal required.

TABLE 11 - SETBACK REQUIREMENTS FROM SENSITIVE WATER (Minimum Distance from the Water Edge) Soil Textural Class Slope of Less Than 8 Percent Slope of More Than 8 Percent Gravel NOT APPLICABLE Coarse Sand 100 feet 100 feet Medium Sand 100 feet 100 feet Fine Sand 100 feet 100 feet Loamy Sand 100 feet 100 feet Sandy Loam 100 feet 100 feet Light Loam 50 feet 100 feet Heavy Loam 50 feet 100 feet Silt Loam 50 feet 100 feet Sandy Clay Loam 50 feet 100 feet Light Clay Loam 50 feet 100 feet Heavy Clay Loam 50 feet 100 feet Light Silty Clay Loam 50 feet 100 feet Heavy Silty Clay 50 feet 100 feet Sandy Clay 100 feet 100 feet Silty Clay 100 feet 100 feet Clay 100 feet 100 feet

TABLE 12 – Subsurface Drip Irrigation Pump Cycles (Minimum Requirements)

Pump Cycles/24 Hours Gallons Pumped/Bedroom/Cycle Additional Gallons Pumped Per Person Over 2 Per Bedroom 6 25 12.5 8 18.75 9.375 10 15 7.5 12 12.5 6.25

**History**
- *Source: Miss. Code Ann. § 41-67-3.*
- *Source: Miss. Code Ann. § 41-67-3.*
- *Source: Miss. Code Ann. § 41-67-3.*
- *Source: Miss. Code Ann. § 41-67-3.*
- *Source: Miss. Code Ann. § 41-67-3.*

##### **15 Miss. Admin. Code Pt. 18, R. 5.6.10** Design of Elevated Sand Mound Disposal System {#sec-18-5.6.10 omnilex-key=us-ms-regs-official--title-15--18#5.6.10}

1. These guidelines present requisite site characteristics, design criteria, and construction techniques for on-site mound sewage systems. These guidelines provide a systematic approach to mound system design for typical domestic household wastewater. For systems serving other than single family dwellings the designer is cautioned that simple extrapolation of this information may not be appropriate. 2. When addressing wastewater flows that differ from a septic tank, such as those characterized by high biological oxygen demand (BOD5), total suspended solids (TSS), or oil and grease, the elevated sand-mound has inherent limitations. Wastewater from non-domestic sources should be evaluated on a case-by-case basis, to determine the amount of pretreatment necessary to apply to an elevated sand mound. The wastewater applied to an elevated sand mound should not exceed 220 mg/l BOD5 or 145 mg/l TSS (no TSS particles should be retained on a 1/8th inch screen). 3. Mounds are an excellent treatment and disposal choice on appropriate sites, but they are not very forgiving. Special attention must be given to siting, design, pre-construction planning, site preparation, filter media selection, construction and maintenance of these systems. Quality control throughout the process cannot be overemphasized.

**History**
- *Source: Miss. Code Ann. § 41-67-3.*

##### **15 Miss. Admin. Code Pt. 18, R. 5.6.11** General: Elevated Sand Mound {#sec-18-5.6.11 omnilex-key=us-ms-regs-official--title-15--18#5.6.11}

1. Successful function of any on-site system is characterized by a two-fold process: treatment and disposal. The final treatment is accomplished predominantly by physical and microbiological/chemical processes within the soil environment. These processes are affected by: a. Wastewater strength and characteristics. b. Soil moisture levels. c. The nature of the receiving soil. d. The soil loading rate. 2. Disposal is primarily affected by the depth of the unsaturated receiving soils, their hydraulic conductivity, and the area available for disbursement. The mound system relies on a single-pass flow pattern in unsaturated flow conditions through specified filter media (sand) for sewage treatment. The elevated sand-mound system incorporates the disposal component by discharging directly into the underlying soil. 3. An elevated sand-mound system is characterized by: a. A pretreatment device (a septic tank with an approved filter, or a treatment plant).

b. Pressure distribution components (pumping chamber, pump and controls, and distribution laterals). c. The “mound.” [See Figure 16.] The “mound” consists of: i. Filter media (sand). ii. An absorption area. iii. A distribution system. iv. A soil cap and topsoil cover. 4. A septic tank with an approved filter or an aerobic treatment unit may be used as the pretreatment for the elevated sand mound. The effluent, pumped from the pump chamber into the distribution network in the absorption bed area, flows through the filter media where it is treated through biological and chemical processes. The treated effluent then passes into the natural soil, which must have at least six (6) inches of unsaturated soil.

**History**
- *Source: Miss. Code Ann. § 41-67-3.*

##### **15 Miss. Admin. Code Pt. 18, R. 5.6.12** Pre-Treatment: Elevated Sand Mound {#sec-18-5.6.12 omnilex-key=us-ms-regs-official--title-15--18#5.6.12}

The preliminary treatment for an elevated sand-mound will be either an aerobic treatment unit or a septic tank with an approved filter. The pre-treatment method selected shall comply with the applicable sections of the Regulation Governing Individual Disposal.

**History**
- *Source: Miss. Code Ann. § 41-67-3.*

##### **15 Miss. Admin. Code Pt. 18, R. 5.6.13** Pumping Chambers: Elevated Sand Mound {#sec-18-5.6.13 omnilex-key=us-ms-regs-official--title-15--18#5.6.13}

1. The pumping chamber shall have a minimum capacity of 750 gallons or twice the daily flow, whichever is the largest. 2. The pumping chamber shall be equipped with an audible and/or visual high-water alarm. 3. The high-water alarm must be set to allow a reserve capacity of 50% in the chamber when activated. 4. The pumping chamber shall have a grade level access large enough to allow servicing and/or removal of the largest component in the chamber. Access ports shall be protected against unauthorized entrance or removal. 5. The pumping chamber shall be vented through the grade level access or by means of a separate vent. In either case, the vent shall be equal to or greater than two times the diameter of the inlet port of the pump. 6. The pumping chamber shall be made of material resistant to the corrosive effects of wastewater and designed to withstand the lateral and bearing loads to which it is subjected.

7. All openings shall be sealed with a mastic, butyl rubber, or other pliable sealant that is waterproof, corrosion resistant and approved for use in contact with wastewater, in a manner to prevent the entrance of surface and groundwater.

**History**
- *Source: Miss. Code Ann. § 41-67-3.*

##### **15 Miss. Admin. Code Pt. 18, R. 5.6.14** Minimum Pump Specifications: Elevated Sand Mound {#sec-18-5.6.14 omnilex-key=us-ms-regs-official--title-15--18#5.6.14}

1. Although timed dosed systems are preferred, an elevated sand mound may utilize either a timed dosed or on-demand dosing cycles. Each dose volume shall not exceed the estimated maximum daily flow divided by the number of dosing cycles. 2. The pump selected must be able to fully charge the distribution system without hydraulically overloading the absorption area. 3. The pump shall be constructed of corrosion resistant materials suitable for effluent pumping. 4. The pump shall be equipped with a low water cutoff to prevent damage to the pump during low water conditions. 5. The pump shall be sized per manufacturer’s specifications to meet or exceed the hydraulic head of the system. 6. The pump shall be installed in compliance with the manufacturers’ specifications so as not to violate pump warranty. 7. The suction and pressure lines shall be Schedule 40 or equal and be sized to meet or exceed the hydraulic head of the system.

**History**
- *Source: Miss. Code Ann. § 41-67-3.*

##### **15 Miss. Admin. Code Pt. 18, R. 5.6.15** Distribution System Specifications: Elevated Sand Mound {#sec-18-5.6.15 omnilex-key=us-ms-regs-official--title-15--18#5.6.15}

The distribution system in an elevated sand mound shall consist of three components: a. A pressurized distribution manifold, which shall consist of a small diameter (1”–1.5”) Schedule 40 pipe to receive the effluent from the pump. This pipe shall be connected so as not to create any dead ends, and shall have 3/8” holes drilled in it every 36” pointing up. [See Figures 17 and 18.] The effluent from the pump must come to the center of this distribution manifold and absorption area. b. A field drain pipe to house the pressurized distribution manifold – A 4” field line pipe with the holes pointing down is acceptable. Other field drain pipe designs may be acceptable, but must first go through the experimental protocol. c. Distribution media – ½” to 2.5” gravel to a depth of 1’ is acceptable. The design of the absorption area must comply with design guidelines for gravel underground absorption. If

other distribution media is approved, they must comply with the appropriate regulations and guidelines.

**History**
- *Source: Miss. Code Ann. § 41-67-3.*

##### **15 Miss. Admin. Code Pt. 18, R. 5.6.16** Site Requirements for Elevated Sand Mounds {#sec-18-5.6.16 omnilex-key=us-ms-regs-official--title-15--18#5.6.16}

It is not possible to outline every conceivable soil, site or design situation which may occur. The following section addresses basic criteria that every elevated sand-mound will need to follow: 1. Site conditions where elevated sand mounds are applicable: a. Permeable soils with high water tables: The elevated sand mound is useful in many difficult soils and can be effective in overcoming high water tables. In fact, the use of an elevated sand mound on permeable soils with high water tables may be the most practical use of this system. Whether the water table is seasonal or permanent, these soils have inadequate vertical separation to provide satisfactory treatment with conventional systems. The mound system addresses these conditions by elevating the absorption area to achieve the needed vertical separation. Passing the effluent through the filter media will result in a more thoroughly treated effluent, before it reaches the water table. b. Slowly permeable soils: The elevated sand mound has an application on these soils, although may be costly due to the size of the basal area required. The elevated sand mound applies the effluent to the lighter textured top soil over a large area moving laterally until it is absorbed into the less permeable subsoil. On slowly permeable soils with high water tables, 5:1 side slopes are recommended. c. Excessively permeable soils: These sites present the risk of inadequate wastewater treatment before it reaches unprotected aquifers. The elevated sand-mound system treats the wastewater to a higher level before it reaches the excessively permeable sub-soil. 2. Slope limitations with elevated sand mounds: Slope limitations for elevated sand-mounds are more restrictive than for conventional systems, particularly for mounds used on sites with slowly permeable soils. Elevated sand-mounds should not be considered on sites with slowly permeable soils and slopes of 6% or steeper. Elevated sand-mounds should not be considered on sites with permeable soils and slopes of 12% or greater. [See Figures 19 and 20 for placement on flat and sloping sites.] 3. Minimum soil depth requirements: This is probably the most important factor determining how well the elevated sand-mound will function. If the soil has a restrictive horizon, the seasonal water table may not be any closer than 6 inches from the surface. If the soil does not have a restrictive horizon, the seasonal water table may not be any closer than 12 inches from the surface. If the restrictive horizon is not well defined, 12 inches of unsaturated soil is required. In all cases, there shall be a minimum of a 24-inch separation between the bottom of the absorption area and the water table.

4. Topography – Slopes: On permeable soils the maximum slope for the elevated sand mound is 12%. On slowly permeable soils (light clay loam or heavier) the maximum allowable slope for the elevated sand-mound is 6%. A crest of a slope is preferred because the elevated sand-mound can be situated to allow flow in both directions away from the filled area. It is certainly preferred that the design allows for the effluent to flow away from the elevated sand mound. 5. Level sites: Design should allow the effluent to flow in every direction away from the elevated sand-mound. On level sites with slowly permeable soils, effluent may have a tendency to stack under the absorption area that may result in surface seepage around the base of the mound. The elevated sand-mounds should be placed in areas that allow the effluent to flow away from the filled area. 6. Setback requirements: The setback requirements in Table 13 are provided as measured from the perimeter of the basal area, although no part of the system shall extend fully to a property line. The edge of the side slope must be at least 3 feet from a property line. 7. Reserve area: An area must be set aside to replace the elevated sand mound in the case of failure. Due to the nature of a mound failure the following criteria must be met: a. The area must be large enough to replace the entire system in a new untouched area. b. The area must meet all the initial requirements of the original mound system, including but not limited to soil conditions, water table restrictions and setback requirements. c. The area must not be used by the property owner in a way which would adversely affect the placement of a new elevated sand mound system.

**History**
- *Source: Miss. Code Ann. § 41-67-3.*

##### **15 Miss. Admin. Code Pt. 18, R. 5.6.17** System Design: Elevated Sand Mound {#sec-18-5.6.17 omnilex-key=us-ms-regs-official--title-15--18#5.6.17}

1. A soil and site evaluation must be performed on the lot. The loading rate of the natural soil must be determined from Table 14. 2. Determine the average daily flow from the residence: Number of bedrooms × 130 gallons per day. 3. Determining the size of the absorption area, basal area, side slopes, and maximizing length requirements: a. Sizing the absorption area – The absorption area size shall be determined by the loading rate of the fill material. The fill material shall be coarse sand, 0.5–1.0 mm (USDA designation), and is the same as concrete sand (Section S-703, MS Standard Specification for State Aid road and bridge construction). The loading rate of this material is 1.2 gallons per day per square foot. Note: A fill material as

heavy as a light loam may be used, but this will change the size of the absorption area. Use the appropriate loading rate of the fill to calculate the absorption area: i. Example: Three (3) bedroom home at 390 gallons per day. ii. 390 gallons per day / 1.2 gallons per day per square foot = 325 square feet. iii. Absorption area = 325 square feet. b. Sizing the basal area: Using the information gathered from the soil and site evaluation, determine the loading rate of the natural soil within two (2) feet of the surface. Use the heaviest textured soil loading rate to size the basal area. Divide the average daily flow from the residence by the loading rate of the natural soil: i. Example: Three (3) bedroom home at 390 gallons per day with a natural soil of a heavy loam. ii. 390 gallons per day / 0.45 gallons per day per square foot = 867 square feet basal area. c. Maximizing length of the elevated sand mound: To the greatest extent possible, the elevated sand mound should be as long as possible. The length of the basal area and absorption area must always be at least 4 times the width. However, the width of the absorption area shall never be less than 2 feet. d. Filter media depth: There shall be a vertical separation between the seasonal water table and the bottom of the absorption area of at least 2 feet in every situation. This separation may include up to 12 inches of unsaturated natural soil. e. Calculation of side slopes: Side slope requirements will be different on level sites than on sloping sites. [See Figure 21.] The side slope on the downhill side must be longer than the side slope going uphill. Table 15 provides the correction factors for side slopes: i. Example: Given: 3’ high mound with 9’ side slopes placed on a 6% slope. ii. Correction Factors: See Table 15 for the slope correction factors for sand mound disposal. iii. Upslope side slope: 9’ × .85 = 7.65’ side slope. iv. Downslope side slope: 9’ × 1.22 = 10.98’ side slope.

**History**
- *Source: Miss. Code Ann. § 41-67-3.*

##### **15 Miss. Admin. Code Pt. 18, R. 5.6.18** System Placement: Elevated Sand Mound {#sec-18-5.6.18 omnilex-key=us-ms-regs-official--title-15--18#5.6.18}

All components of the elevated sand mound system shall comply with the following placement requirements.

1. All components of the elevated sand mound system shall be located a minimum of: a. Five feet from any dwelling. b. Ten feet from any property line. 2. The aerobic treatment plant, septic tank, and pump chamber shall be located a minimum of 50 feet from any public, private or individual potable water source. 3. The elevated sand mound shall be located at a lower elevation and a minimum of 100 feet from any public, private, or individual potable water source. 4. Potable water lines shall not pass under or through any part of the elevated sand mound system. Where a water supply line must cross a sewer line, the bottom of the water service within ten feet of the point of crossing shall be at least 12 inches above the top of the sewer line. The sewer line shall be of Schedule 40 pipe with cemented joints at least ten feet on either side of the crossing. Water and sewer lines shall not be laid in the same trench. The water and sewer lines shall maintain a minimum separation distance of ten feet. 5. The area for the mound or the replacement area shall not be used for vehicular traffic or vehicular parking. 6. Aerobic treatment plants, septic tanks, pumping chambers or disposal systems shall not be placed under a dwelling or other permanent structure. 7. Elevated sand mounds shall not be located in depressed areas where surface water will accumulate. Provisions shall be made to minimize the flow of surface water over the disposal system area. 8. Elevated sand mounds located on slopes of less than eight percent shall have a minimum setback from recreational waters, shellfish waters or other sensitive areas as prescribed in Table 13. 9. Elevated sand mounds located on slopes of greater than eight percent shall be located a minimum of 100 feet from recreational waters, shellfish waters and other sensitive areas. 10. Where all or part of the elevated sand mound is proposed to be installed on property other than the owner’s, an easement in perpetuity shall be legally recorded in the proper county. The easement shall be of sufficient area to permit access, construction and maintenance of the elevated sand mound. 11. No site for an elevated sand mound or replacement area shall be located wholly within an area which is frequently flooded, swamp, marsh, or wetland. Except that if permits have been issued by the proper regulatory agency authorizing the use of wetlands for building sites and the installation of an individual onsite wastewater disposal system, the property shall be evaluated using standard soil and site criteria for IOWDS.

12. When a proposed lot is located partially within a frequently flooded area, that portion of said lot not within the flood prone area may be considered for approval for the elevated sand mound. 13. A minimum of six (6) inches of naturally occurring soil must be present above a restrictive horizon or a predominantly gray soil before placement of any fill. 14. Easements or right-of-way areas for utilities, surface or subsurface drainage, roads, streets, ponds or lakes shall not be used as available space for an elevated sand mound.

**History**
- *Source: Miss. Code Ann. § 41-67-3.*

##### **15 Miss. Admin. Code Pt. 18, R. 5.6.19** Construction: Elevated Sand Mound {#sec-18-5.6.19 omnilex-key=us-ms-regs-official--title-15--18#5.6.19}

Good construction techniques are essential if the mound is to function properly. 1. Site Preparation: a. Step 1: Rope off the site to prevent damage to the area during other construction activity on the lot. Vehicular traffic over the area should be prohibited to avoid soil compaction. b. Step 2: Stake out the mound perimeter and bed in the proper orientation. Reference stakes set some distance from the mound perimeter are also required in case the corner stakes are disturbed. c. Step 3: Cut and remove any excessive vegetation. Trees should be cut at ground surface and the stumps left in place. d. Step 4: Measure the average ground elevation along the upslope edge of the bed to determine the bottom elevation of the bed. e. Step 5: Install the delivery pipe from the dosing chamber to the center of the mound. Lay the pipe below the frost or slope it uniformly back to the dosing chamber so it may drain after dosing. Back fill and compact the soil around the pipe. f. Step 6: Plow the area within the mound perimeter. Use a two bottom or larger moldboard plow, plowing 7 to 8 inches deep parallel to the contour. Single bottom plows should not be used, as the trace wheel runs in every furrow, compacting the soil. Each furrow should be thrown upslope. A chisel plow may be used in place of a moldboard plow. Roughening the surface with backhoe teeth may be satisfactory, especially in wooded sites with stumps. Rototilling is not recommended because of the damage it does to the soil structure. However, rototilling may be used in granular soils, such as sands. Plowing should not be done when the soil is too wet. Smearing and compaction of the soil will occur. If a sample of the soil taken from the plow depth forms a wire when rolled between the palms, the soil is too wet. If it crumbles, plowing may proceed.

2. Fill Placement: a. Step 1: Place the fill material on the upslope edges of the plowed area. Keep trucks off the plowed area. Minimize traffic on the downslope side. b. Step 2: Move the fill material into place using a small track type tractor with a blade. Always keep a minimum of 6 inches of material beneath the tracks of the tractor to minimize compaction of the natural soil. The fill material should be worked in this manner until the height of the fill reaches the elevation of the top of the absorption bed. c. Step 3: With the blade of the tractor, form the absorption bed. Hand level the bottom of the bed, checking it for the proper elevation. Shape the sides to the desired slope. 3. Distribution Network Placement: a. Step 1: Carefully place the coarse aggregate in the bed. Do not create ruts in the bottom of the bed. Level the aggregate to a minimum depth of 6 inches. b. Step 2: Assemble the distribution network on the aggregate. The manifold should be placed so it will drain between doses, either out of the laterals or back into the pump chamber. The laterals should be laid level. c. Step 3: Place additional aggregate to a depth of at least 2 inches over the crown of the pipe. d. Step 4: Place a suitable backfill barrier over the aggregate. 4. Covering: a. Step 1: Place finer textured soil material such as clay or silt loam over the top of the bed to a minimum depth of 6 inches. b. Step 2: Place 6 inches of good quality topsoil over the entire mound surface. c. Step 3: Plant grass over the entire mound using grasses adapted to the area. Shrubs can be planted around the base and up the sideslopes. Shrubs should be somewhat moisture tolerant since the downslope perimeter may become moist during early spring and late fall. Plantings on top of the mound should be drought tolerant, as the upper portion of the mound can become dry during the summer. 5. Operation and Maintenance: a. Routine Maintenance: A properly designed and constructed mound should operate satisfactorily with virtually no regular maintenance.

b. Rehabilitation: Three failure conditions may occur within the mound: (1) severe clogging at the bottom of the absorption area, (2) severe clogging at the fill material and natural soil interface, and (3) plugging of the distribution network. Usually these failures can be easily corrected: i. If severe clogging occurs at the bottom of the absorption bed, its cause should first be determined. If it is due to failure to maintain the pretreatment unit, hydrogen peroxide to oxidize the accumulated organics at the infiltrative surface could be used. The chemical can be applied directly to the bed or through the dosing chamber. Because of the danger in handling this strong oxidant, this treatment should be done by professionals. ii. If the clogging is due to overloading or unusual wastewater characteristics, efforts should be made to reduce the wastewater volume or strength. It may be necessary to enlarge the mound. The mound cap should be removed and the aggregate in the absorption bed stripped out. The area downslope of the mound should be plowed and additional fill added to enlarge the mound to the proper size. The absorption bed can then be reconstructed. iii. Severe clogging at the fill and natural soil interface will cause surface seepage at the base of the mound. This area should be permitted to dry and the downslope area plowed. Additional fill can then be added. If this does not correct the problem, the site may have to be abandoned. iv. Partial plugging of the distribution piping may be detected by extremely long dosing times. The ends of the distribution laterals should be exposed and the pump activated to flush out any solid material. If necessary, the pipe can be rodded.

FIGURE 1 – Elevated Sand Mound (Example Sketch Only)

FIGURE 2 – Side View of Distribution System and Absorption Area

FIGURE 3 – Top View of Absorption Area with Distribution Network and Field Line Pipe

FIGURE 19 – Level Site Placement

FIGURE 20 – Sloping Site Placement

FIGURE 21 – Side Slope Calculation (Examples)

TABLE 13 – Sand Mound Setbacks (from edge of Basal Area)

TABLE 14 – Soil Loading Rates (sand mounds)

TABLE 15 – Slope Correction Factors

Subchapter 7: Spray Irrigation Disposal System Rule 5.7.1 General. 1. The treatment facility and pump/dosing chamber shall be designed, constructed and installed so all joints, seams, and component parts preclude infiltration of surface and groundwater, while preventing the escape of wastewater or other liquids. 2. Electrical equipment shall be protected with safety devices (overload interrupting devices, fuses, etc.). Electrical equipment shall comply with appropriate National Electrical Manufacturer’s Association (NEMA) requirements. Electrical component parts shall be covered by the manufacturer’s limited warranty and must be installed in a manner to eliminate potential contact with sewage or effluent, including connections.

**History**
- *Source: Miss. Code Ann. § 41-67-3.*
- *Source: Miss. Code Ann. § 41-67-3*
- *Source: Miss. Code Ann. § 41-67-3.*
- *Source: Miss. Code Ann. § 41-67-3.*
- *Source: Miss. Code Ann. § 41-67-3.*
- *Source: Miss. Code Ann. § 41-67-3.*
- *Source: Miss. Code Ann. § 41-67-3.*
- *Source: Miss. Code Ann. § 41-67-3.*
- *Source: Miss. Code Ann. § 41-67-3.*
- *Source: Miss. Code Ann. § 41-67-3.*
- *Source: Miss. Code Ann. § 41-67-3.*

##### **15 Miss. Admin. Code Pt. 18, R. 5.7.2** Soil and Site Evaluation: Spray Irrigation {#sec-18-5.7.2 omnilex-key=us-ms-regs-official--title-15--18#5.7.2}

1. A satisfactory soil and site evaluation will comply with the following criteria: a. Absence of or protection from frequent flooding. b. Landscape position with positive surface runoff. c. Slopes of less than sixteen (16)%. d. Depth to high water table of greater than six (6) inches. e. Depth to bedrock, fragipan, redoximorphic features or plinthite of greater than twelve (12) inches. f. Soil texture and color defined by the Natural Resource Conservation Service as indicating good drainage and suitable for surface application of wastewater, based on a soil boring of five (5) feet. 2. Sizing of the spray disposal field will be based on the most restrictive soil within twelve (12) inches of the naturally occurring ground surface. [See Table 16.] 3. To overcome the lack of sufficient depth to a restrictive horizon and/or Seasonal High Water Table, a clean fill material of a texture of sandy loam may be used as fill material. Organic matter shall be removed from the native soil surface prior to placing and incorporating the fill. This fill must be incorporated into the native soil to prevent a textural interface from developing. When fill material is used the entire fill area must be sodded to prevent erosion, or other effective erosion control methods used. The full depth of fill material must extend at least ten (10) feet in all directions from the outer edge of the spray field and at that point shall be sloped at a grade of no steeper than 3 to 1. [See Table 17.]

4. The noncompliance of one or more of the above items may (1) require a design alteration or (2) prohibit the use of a Spray Irrigation Disposal system. Slopes of greater than sixteen (16)% may be considered on a case-by-case basis.

**History**
- *Source: Miss. Code Ann. § 41-67-3.*

##### **15 Miss. Admin. Code Pt. 18, R. 5.7.3** Location of Spray Irrigation Disposal Systems {#sec-18-5.7.3 omnilex-key=us-ms-regs-official--title-15--18#5.7.3}

1. All components of the spray irrigation disposal system shall be located a minimum of: a. Five (5) feet from any dwelling or permanent structure. b. Ten (10) feet from any property line. 2. The Advanced Treatment System and pump/dosing chamber shall be located a minimum of fifty (50) feet from any public, private or individual potable water source. 3. Potable water lines and wastewater lines shall not be laid in the same trench. The potable water lines and wastewater lines shall maintain a minimum horizontal separation of 10 feet. Where a potable water line must cross a wastewater line, the potable water line within ten (10) feet of the point of crossing shall be at least twelve (12) inches above the wastewater line. 4. Spray Irrigation systems shall not be located in depressed areas where surface water will accumulate. Provisions shall be made to minimize the flow of surface water over the effluent disposal field. 5. There shall be maintained, from the outer edge of the spray pattern, the following distances: a. One hundred (100) feet from any public, private or individual potable water source, located at a lower elevation. b. Fifty (50) feet from recreational waters, shellfish waters or other sensitive areas for spray fields located on slopes of less than eight (8) percent or if the soil texture is sandy loam or lighter or sandy clay or heavier. c. Seventy five (75) feet from recreational waters, shellfish waters or other sensitive areas for spray fields located on slopes of greater than eight (8) percent or if the soil texture is sandy loam or lighter or sandy clay or heavier. d. Twenty five (25) feet from dwellings, swimming pools, businesses or other inhabited structures. e. Twenty five (25) feet from lot lines, porches, patios and decks. f. Fifteen (15) feet from outbuildings. g. Ten (10) feet from walkways, private roads, driveways and parking areas.

h. Effluent should not be sprayed upon any vessel containing wastewater. 6. Where all or part of the Spray Irrigation system is proposed to be installed on property other than the owner’s, an easement in perpetuity shall be legally recorded in the proper county and a copy furnished to the local county Health Department prior to listing Spray Irrigation as an option. The easement shall be of sufficient area to permit access, construction and maintenance of the system. 7. It is the intent of these regulations that a minimum separation of fifty (50) feet between independent spray disposal fields be maintained. Overlapping of the required setback from property lines cannot be negated by the granting of easements. 8. In soils that contain a restrictive horizon (fragipan, chalk, bedrock, clay or silty clay) within two (2) feet of the surface, there shall be maintained a minimum of six (6) inches of unsaturated soil between the Seasonal High Water Table. 9. In soils that do not contain a restrictive horizon (fragipan, chalk, bedrock, clay or silty clay) within two (2) feet of the surface, there shall be maintained a minimum of twelve (12) inches of unsaturated soil between the Seasonal High Water Table.

**History**
- *Source: Miss. Code Ann. § 41-67-3.*

##### **15 Miss. Admin. Code Pt. 18, R. 5.7.4** Registration: Spray Irrigation {#sec-18-5.7.4 omnilex-key=us-ms-regs-official--title-15--18#5.7.4}

The term “manufacturer” for this section will mean the Certified Manufacturer of the treatment method, unless otherwise specified. Each manufacturer’s treatment and disposal components shall be registered with the Department as a system. The treatment method shall be in compliance with the current standards of National Sanitation Foundation/American National Standards Institute International Standard 40 and/or 245 and the applicable sections of the regulations.

**History**
- *Source: Miss. Code Ann. § 41-67-3.*

##### **15 Miss. Admin. Code Pt. 18, R. 5.7.5** Pump/Dosing Chambers: Spray Irrigation {#sec-18-5.7.5 omnilex-key=us-ms-regs-official--title-15--18#5.7.5}

1. The pump/dosing chamber shall have a minimum working capacity of 1.5 times the maximum volume produced for timed-dose, or should be sized per the manufacturer’s specifications for demand-dose systems. 2. The dosing chamber shall be equipped with an audible high-water alarm. 3. The pump/dosing chamber shall have a grade level access large enough to allow servicing and/or removal of the largest component in the chamber. Access ports shall be protected against unauthorized entrance or removal. 4. The pump/dosing chamber shall be vented through the grade level access or by means of a separate vent. In either case the vent shall be a minimum of one (1) inch in diameter.

5. The pump/dosing chamber shall be made of material resistant to the corrosive effects of wastewater, chemicals used for disinfection and designed to withstand the lateral and bearing loads to which it is expected to be subjected.

**History**
- *Source: Miss. Code Ann. § 41-67-3.*

##### **15 Miss. Admin. Code Pt. 18, R. 5.7.6** Minimum Pump Specifications: Spray Irrigation {#sec-18-5.7.6 omnilex-key=us-ms-regs-official--title-15--18#5.7.6}

1. The pumping system shall be designed to deliver wastewater at the required volume and pressure specified by the spray irrigation head manufacturer. 2. The pumping system shall be equipped with a low water cutoff to prevent damage to the pump during low water conditions in the dosing chamber. 3. The pump shall be constructed of corrosion resistant materials suitable for effluent pumping. 4. The pump shall be sized per manufacturer’s specifications to meet or exceed the hydraulic head of the system while delivering the required volume. 5. The pump shall be installed in compliance with manufacturer’s specifications so as not to violate pump warranty. 6. The suction and pressure lines shall be PVC Schedule 40 and shall be sized to deliver the required volume at the design pressure while not exceeding a velocity of five (5) feet per second.

**History**
- *Source: Miss. Code Ann. § 41-67-3.*

##### **15 Miss. Admin. Code Pt. 18, R. 5.7.7** Minimum Filter Specifications: Spray Irrigation {#sec-18-5.7.7 omnilex-key=us-ms-regs-official--title-15--18#5.7.7}

1. The filter shall filter the effluent to the minimum specifications of the spray irrigation head manufacturer to prevent clogging. 2. The filter shall be made of material resistant to the corrosive effects of wastewater and chemicals used for disinfection. 3. The filters shall be readily accessible for inspection and/or service.

**History**
- *Source: Miss. Code Ann. § 41-67-3.*

##### **15 Miss. Admin. Code Pt. 18, R. 5.7.8** Minimum Specifications for Irrigation Equipment {#sec-18-5.7.8 omnilex-key=us-ms-regs-official--title-15--18#5.7.8}

1. Sprinklers, valves, controllers and all other equipment used in a spray irrigation system shall be designed, manufactured and warranted by their manufacturer for use in effluent disposal systems. 2. Sprinklers must be of low trajectory type designed to reduce aerosols. Low trajectory spray sprinklers have a nozzle trajectory equal to or less than thirty (30) degrees.

3. Sprinklers shall be connected to their supply line by means of polyethylene (PE) pipe or a swing joint manufactured specifically for this purpose. 4. Radius reduction by means of nozzle retaining screw, distance control diffuser pin or other similar devices shall not be allowed. 5. Impact and pop-up sprinklers may be used. Sprinkler risers greater than twenty-four (24) inches in height must be braced. 6. Equipment susceptible to freezing must be adequately protected to prevent freezing.

**History**
- *Source: Miss. Code Ann. § 41-67-3.*

##### **15 Miss. Admin. Code Pt. 18, R. 5.7.9** Minimum Specifications for Disinfection: Spray Irrigation {#sec-18-5.7.9 omnilex-key=us-ms-regs-official--title-15--18#5.7.9}

Effluent discharge from spray irrigation systems shall be adequately disinfected prior to surface application. The method of disinfection and the disinfection equipment must be in compliance with Chapter 6: Disinfection.

**History**
- *Source: Miss. Code Ann. § 41-67-3.*

##### **15 Miss. Admin. Code Pt. 18, R. 5.7.10** Minimum Specifications for the Spray Field {#sec-18-5.7.10 omnilex-key=us-ms-regs-official--title-15--18#5.7.10}

1. Spray irrigation systems may not be installed in drain ways, swamps, marshes, floodplain, concave landscape positions or other areas which would be prohibited. 2. Treated effluent shall be sprayed evenly over the entire spray field area with non- overlapping patterns. The spray field shall consist of a minimum of three (3) spray heads. 3. The effluent distribution system shall be designed, constructed and maintained to provide for even distribution of effluent throughout the spray field. 4. Surface runoff of sprayed effluent from the spray field area shall not be permitted. Rainwater shall be diverted away from the spray field area. 5. The spray field area shall be designed and operated to prevent surface accumulation of sprayed effluent. 6. In order to prevent entrapped air causing serious problems, pipelines shall be routed on contour, downhill or even uphill but not up and downhill along the same section of pipe. 7. The size of the spray field area shall be determined by soil texture and slope of the site to be sprayed. [See Table 16.]

TABLE 16 – SIZING: Spray Irrigation Results of the Soil and Site Evaluation Soil Textural Class Ribbon Lengths (Inches) Spray Factor (Sq-Ft/GPD)* Absorption Area in Ft

/Bedroom** Additional Absorption Area Over 2 Persons Per Bedroom Slope Slope 0 to 8 % 9 to 12% 13 to 16% 0 to 8 % 9 to 12% 13 to 16% Gravel NOT SUITABLE Coarse and Medium Sand Fine and Loamy Sand Sandy Loam

< 0.5

5.34

1,040

Loam Silt Loam Sandy Clay Loam < 0.5 – 1.0 < 0.5- 1.0 1.0 – 2.0

10.67

Silt Clay Loam Clay Loam Sandy Clay 1.0 – 2.0 1.0 – 2.0 > 2.0 21.4 2782 4637 6951 1391 2319 3476 Silty Clay Clay > 2.0 53.46 6951 8693 11588 3476 4347 5794 *Spray Factor assumes a 0%-8% slope. To estimate required disposal area, multiply GPD by the Spray Factor. Ex: 500 GPD x 21.4 (Clay Loam soils) = 10,700 sq-ft spray footprint required. **Bedroom is equivalent to 130 GPD.

TABLE 17 – FILL MATERIAL REQUIREMENT Seasonal High Water Table Depth (inches) ...with a Restrictive Horizon/Layer (inches) ...without a Restrictive Horizon/Layer (inches) 0 6 12 1 5 11 2 4 10 3 3 9 4 2 8 5 1 7 6 - 6 7 - 5 8 - 4 9 - 3 10 - 2 11 - 1 12 - -

Advanced Treatment System Pre-treatment Unit (if applicable) Flex tubing/Swing Joint Assembly Generator FIGURE 22 - SPRAY IRRIGATION SYSTEM

Pump Chamber (appropriately sized) Spray heads (3 minimum)

FIGURE 23 - FLEX TUBE/SWING JOINT ASSEMBLY

Subchapter 8: Reserved.

Subchapter 9: Overland Discharge Rule 5.9.1 General. Overland Discharge is a system used to dispose Advanced/Alternate treated effluent. Overland Discharge may be a single (1) point discharge or multi-point (2 or 4) discharge, with a level manifold. These discharge options can be gravity-fed or pressurized, with the use of a pump. Careful evaluation of the site, soils and geographical conditions are necessary to prevent runoff, erosion, groundwater pollution and nuisance conditions.

**History**
- *Source: Miss. Code Ann. § 41-67-3.*
- *Source: Miss. Code Ann. § 41-67-3.*
- *Source: Miss. Code Ann. § 41-67-3.*
- *Source: Miss. Code Ann. § 41-67-3.*
- *Source: Miss. Code Ann. § 41-67-3.*
- *Source: Miss. Code Ann. § 41-67-3.*
- *Source: Miss. Code Ann. § 41-67-3.*

##### **15 Miss. Admin. Code Pt. 18, R. 5.9.2** Definitions {#sec-18-5.9.2 omnilex-key=us-ms-regs-official--title-15--18#5.9.2}

1. Advanced Treatment System – an Individual On-site Wastewater treatment system that complies with Section 41-67-10, Miss. Code of 1972, Annotated § 41-67-2(a). 2. Components – all physical, mechanical, and electrical components of any wastewater disposal system. 3. Discharge area – area of land receiving the treated effluent. 4. Distribution box – a connection source for a single inlet line to multiple distribution lines. 5. Manifold – 3” or larger Schedule 40 PVC pipe used in distributing a flowing discharge from some type of advanced treatment unit or treatment filter, such as a Plant Rock Filter or Sand Filter. 6. Maintenance – the inspecting and evaluating of an Alternative System or Advanced Treatment System. The replacement of any component registered with a specific Advanced Treatment System (i.e., aerator, diffuser, control panel, etc.). 7. Multi-point discharge – 2 or 4 discharge points that deliver effluent from a level manifold. [See Figures 24, 25, and 27.] 8. Single point discharge – discharge line consisting of 1 point only.

**History**
- *Source: Miss. Code Ann. § 41-67-3.*

##### **15 Miss. Admin. Code Pt. 18, R. 5.9.3** Design {#sec-18-5.9.3 omnilex-key=us-ms-regs-official--title-15--18#5.9.3}

1. The discharge area receiving the effluent shall have a minimum 6 inches of naturally occurring soil free of a restrictive horizon, redoximorphic feature or predominantly gray color (>50%) and shall be maintained to prevent surface accumulation or ponding. Overland Discharge is not recommendable on hydric soils conditions.

2. The texture of the subsoil material having the slowest permeability rates within 2 feet below the surface receiving effluent shall be used to determine setback. 3. The discharge area must be sufficiently sized to maintain the outermost edge of the effluent. 4. Slopes of greater than 20 percent shall not be considered for discharge areas unless justified by a Certified Engineer Evaluator.

**History**
- *Source: Miss. Code Ann. § 41-67-3.*

##### **15 Miss. Admin. Code Pt. 18, R. 5.9.4** Location/Setbacks {#sec-18-5.9.4 omnilex-key=us-ms-regs-official--title-15--18#5.9.4}

1. The discharge area must be seeded, maintained with sod, permanent vegetative cover, or a wooded area. 2. Discharge area must be a minimum of: a. Water Supply: i. 100 feet from any public, private or individual potable water sources, unless protected by topographic features. ii. 50 feet from any public, private or individual potable water source for all vessel(s) holding wastewater. iii. 10 feet horizontal separation from any potable water line. iv. 10 feet horizontal separation from any water meter. v. Potable water lines must not pass under or through any part of the wastewater disposal system which includes the collection and distribution of the wastewater or effluent. b. Sensitive Waters: i. 100 feet on slopes of greater than 8 percent. ii. 50 feet on slopes of less than or equal to 8 percent. c. Property Lines: i. 50 feet down slope or same grade. ii. 10 feet up slope. d. Residence and Buildings: i. 25 feet from habitable structures.

ii. 15 feet from non-habitable structures. e. Additional Structures: i. 25 feet from porches, patios and decks. ii. 10 feet from walkways, driveways and parking areas. iii. 25 feet from swimming pools. iv. 10 feet horizontal separation from an Advanced Treatment System. 3. Discharge area shall not be located in depressed areas where surface water will accumulate. Provisions shall be made to minimize the flow of surface water over the effluent disposal area. 4. Where all or part of the treatment and disposal system is proposed to be installed on property other than the owner’s, a deeded easement in perpetuity shall be legally recorded in the appropriate county. The deeded easement shall be obtained to include a sufficient area to permit access, construction and maintenance. 5. Deeded easements or right-of-way areas for utilities, surface or subsurface drainage, roads, streets, ponds or lakes shall not be used as available space for location of discharge areas. 6. No site utilizing a discharge area shall be approved which is located wholly within an area which is frequently flooded, swamp, marsh, wetland, or drain-way. When a site is located partially within this area, that portion not directly affected may be considered for discharge area. 7. Treatment, disposal, disinfection and/or pump chambers shall not be located under dwellings or other permanent structures.

**History**
- *Source: Miss. Code Ann. § 41-67-3.*

##### **15 Miss. Admin. Code Pt. 18, R. 5.9.5** Treatment {#sec-18-5.9.5 omnilex-key=us-ms-regs-official--title-15--18#5.9.5}

1. Wastewater disposed of by Overland Discharge must meet the requirement established by American National Standards Institute/National Sanitation Foundation (ANSI/NSF) International Standard Number 40 testing protocol, as set forth in Regulation Governing Residential Individual Onsite Wastewater Disposal Systems: Certification. 2. Treated effluent must be adequately disinfected as outlined in Chapter 6: Disinfection.

**History**
- *Source: Miss. Code Ann. § 41-67-3.*

##### **15 Miss. Admin. Code Pt. 18, R. 5.9.6** Distribution {#sec-18-5.9.6 omnilex-key=us-ms-regs-official--title-15--18#5.9.6}

The inlet and outlet on the tank (septic tank or ATU) must be 4 inch Schedule 40 pipe for a minimum of 3 feet onto undisturbed soil. Once the outlet pipe has extended a minimum of 3 feet

onto undisturbed soil, it can then be reduced to a minimum of 3 inch Schedule 40 pipe for the entire discharge line: 1. Gravity Fed: a. Single point discharge: Gravity-fed discharge using a single point discharge line on 1% or greater slope. b. Distribution manifold: For gravity-fed multi-point discharge distribution by manifold, the level manifold must be constructed using flow diverting devices [see Figure 24] in such a manner as to be self-draining. A distribution box may be used for multi-point discharge. The distribution box must be installed level to ensure equal distribution of effluent. Outlet lines should have equal slopes for a minimum of 5 feet after leaving the D-box. The D-box should have a baffle wall, or some means of reducing the pressure from the inlet flow. [See Figure 26.] 2. Pressurized Distribution: a. Distribution box: A distribution box may be used for multi-point discharge. The distribution box must be installed level to ensure equal distribution of effluent. Outlet lines should have equal slopes for a minimum of 5 feet after leaving the D- box. The D-box should have a baffle wall, or some means of reducing the pressure from the inlet flow. [See Figure 26.] b. Distribution manifold: If effluent is to be delivered to a level manifold under pressure, the distribution system shall be designed to provide pressure at the point of discharge not to exceed 5 pounds per square inch. This can be achieved by pumping directly into the head of the manifold or into a baffled distribution box. [See Figure 27.]

FIGURE 24 – Gravity Fed Manifold

FIGURE 25 – Terrace Plant Beds

FIGURE 26 – Distribution Box

FIGURE 27 – Pressurized Manifold

Subchapter 10: Non-Waterborne Wastewater Systems Rule 5.10.1 General. In remote areas of the State or certain transient or temporary locations, the use of non-waterborne systems such as sanitary pit privies, portable toilets, incinerating toilets, composting toilets, and related sewage disposal systems may be approved. Due to their limited capacities, these systems are restricted to receive excreta only. Since such systems require regular service and maintenance to prevent their malfunction and overflow, they shall only be used where the local health department approves such use. Typical locations of non-waterborne systems are rural camps, seasonal recreation areas, construction sites, public gatherings, and similar transient or temporary locations: 1. Portable toilets may be approved by county health departments for temporary or transient locations where numbers of people congregate for periods of short duration for a specified length of time. A contract for maintenance shall be provided in writing to the county health department prior to approval. 2. Sanitary pit privy installation shall be permitted only in remote locations, but in no case shall such installation be permitted for buildings with indoor plumbing and where water under pressure is located in the structure. Construction of the pit privy will be in compliance with Figures 28 and 29.

**History**
- *Source: Miss. Code Ann. § 41-67-3.*
- *Source: Miss. Code Ann. § 41-67-3.*
- *Source: Miss. Code Ann. § 41-67-3.*
- *Source: Miss. Code Ann. § 41-67-3.*
- *Source: Miss. Code Ann. § 41-67-3.*
- *Source: Miss. Code Ann. § 41-67-3.*

##### **15 Miss. Admin. Code Pt. 18, R. 5.10.2** Construction {#sec-18-5.10.2 omnilex-key=us-ms-regs-official--title-15--18#5.10.2}

1. There shall be maintained a minimum of two feet separation between the bottom of the privy vault and indicators of seasonal water (gray mottles). 2. The privy shall be a minimum of 100 feet, downgrade, from any potable water source. 3. The privy shall be located 100 feet from sensitive waters. 4. The privy shall be constructed to prevent surface water from running into the pit. 5. When the pit becomes filled to within sixteen inches of the ground surface, a new pit shall be excavated and the old pit shall be backfilled to the surface.

**History**
- *Source: Miss. Code Ann. § 41-67-3.*

##### **15 Miss. Admin. Code Pt. 18, R. 5.10.3** Registration {#sec-18-5.10.3 omnilex-key=us-ms-regs-official--title-15--18#5.10.3}

Manufacturers of non-waterborne toilets that incorporate mechanical or non-mechanical technology for the collection and/or treatment of human excreta must submit documentation to the Division of Sanitation verifying the performance of their product. Upon approval, these systems will be placed on an approved list of registered systems.

FIGURE 28 – Side View of Pit Privies

FIGURE 29 – Details of Pit Privies

Chapter 6 Disinfection Rule 6.1.1 Introduction. The discharge of treated wastewater shall be disinfected when the effluent will be disposed of by means of a surface discharge (Overland Discharge or Spray Irrigation). Individual On-site Wastewater Disposal Systems that utilize surface discharge shall have an approved method of effluent disinfection prior to disposal. The most common disinfectant is chlorine. Other methods of wastewater disinfection are ultra-violet and ozone.

**History**
- *Source: Miss. Code Ann. § 41-67-3*
- *Source: Miss. Code Ann. § 41-67-3*
- *Source: Miss. Code Ann. § 41-67-3.*
- *Source: Miss. Code Ann. § 41-67-3.*

##### **15 Miss. Admin. Code Pt. 18, R. 6.1.2** Definitions {#sec-18-6.1.2 omnilex-key=us-ms-regs-official--title-15--18#6.1.2}

1. Advanced Treatment System (ATS) – an Individual On-site Wastewater Disposal System that treats and complies with Section 41-67-10. § 41-67-2(a). 2. Chlorine – a highly irritating, greenish-yellow gaseous halogen, capable of combining with nearly all other elements, produced principally by electrolysis of sodium chloride and used widely to purify water, as a disinfectant and bleaching agent, and in the manufacture of many important compounds including chloroform and carbon tetrachloride. 3. Chlorinator – a device that allows the treated effluent to pass around and over calcium hypochlorite tablets or the treated effluent is dosed with a specific amount of liquid chlorine by the use of an approved dispersal method. 4. Chlorine Contact Chamber – chamber designed to provide a minimum of 1 hour detention time at the peak design flow. 5. Chlorine (liquid) – an aqueous solution of calcium hypochlorite used as a disinfection agent. 6. Chlorine (tablet) – a solid form of calcium hypochlorite, a common disinfectant. These tablets dissolve in the wastewater, releasing the hypochlorite, which then becomes hypochlorous acid, the primary disinfectant. 7. Chlorine Residual – free chlorine remaining after the chlorination process has occurred. 8. Disinfection – treatment to destroy harmful microorganisms and viruses. 9. Feeder Tube – a device which holds Chlorine tablets in place in order to contact effluent. 10. Ozone – an unstable, poisonous allotrope of oxygen, O3, which is formed naturally in the ozone layer from atmospheric oxygen by electric discharge or exposure to ultraviolet radiation, also produced in the lower atmosphere by the photochemical reaction of certain

pollutants. It is a highly reactive oxidizing agent used to deodorize air, purify water, and treat industrial wastes. 11. Pathogen – an agent that causes disease, especially living microorganisms such as bacteria, viruses, or fungus. 12. Swimming Pool Chlorine – chlorine made from Trichloroisocyanuric acid instead of calcium hypochlorite. These tablets are not acceptable for use in on-site systems. They do not dissolve as quickly as wastewater grade tablets and do not treat effluent as required. Also, if not continually immersed in water, these tablets can be explosive due to the release of nitrogen chloride gas. 13. Ultra-violet disinfection – a disinfection device that uses ultra-violet light source to eliminate or destroy bacteria, viruses and other pathogenic organisms. 14. Ultra-violet light – radiation lying in the ultra-violet range; wave lengths shorter than light but longer than X-rays.

**History**
- *Source: Miss. Code Ann. § 41-67-3.*

##### **15 Miss. Admin. Code Pt. 18, R. 6.1.3** Design {#sec-18-6.1.3 omnilex-key=us-ms-regs-official--title-15--18#6.1.3}

It is important that wastewater be adequately treated prior to disinfection. The effectiveness of a disinfection system depends on the characteristics of the wastewater, the amount of time the microorganisms are exposed to the disinfectant, and the chamber configuration. The design for each type of disinfection is as follows: 1. Chlorine Tablet or Liquid: a. The Chlorine Contact Chamber must meet the following requirements: i. Constructed from concrete, fiberglass or polyethylene in accordance with Rule 5.1.6. ii. Constructed to withstand the earth pressures encountered and able to withstand the chemical effects of chlorine and wastewater. iii. Equipped with baffles or provided with an inlet to provide adequate mixing and contact of chlorine and effluent. The inlet and outlet must be Schedule 40 PVC pipe, 4 inches in diameter with the outlet tee extending 6 inches from the bottom of the chamber. [See Figure 30.] iv. Designed and located to have access a minimum of 6 inches above final grade. v. Provide 65 gallons (minimum) capacity or 1 hour retention. NOTE: If the chlorine contact chamber is an integral component part of the design of the Advanced Treatment System the efficiency shall be certified by the third- party certifying entity.

vi. Sealed (water-tight) to prevent the entry of surface or ground water. It is recommended that the outlet be placed above any seasonal water tables as indicated by gray mottles. An approved sealant shall be applied to the lid, inlet, outlet and access opening to prevent groundwater and surface water intrusion. vii. Consideration will be given to 2 flow-through units with common-wall construction so that each side satisfies the detention requirements. The chlorine feed rate will be proportioned in accordance with the flow and the chlorine demand of the wastewater. Adequate mixing during the chlorine contact period will be insured by the installation of adequate baffling. viii. Pumped periodically for sludge accumulation and properly disposed. b. The feeder tube and liquid chlorinator dosing compartment must meet the following requirements: i. Installed level on undisturbed earth or backfilled with sand. ii. Charged with a minimum of 3 calcium hypochlorite chlorine tablets or the dosing compartment is ½ filled with liquid chlorine. iii. Equipped with a method for removal. The method of removal must be within 3 inches of the chlorinator opening. iv. Constructed of Schedule 40 PVC pipe, 3 inches in diameter and provide removal of all chlorine tablets when feeder tube is removed from chlorinator. [See Figure 31.] v. Childproof and tamper resistant, or limited access cover. 2. Ultra-violet: a. The main components of an ultra-violet disinfection system are mercury arc lamps, a reactor, and ballasts. The source of the ultra-violet radiation is either the low-pressure or medium-pressure mercury arc lamp with low or high intensities. b. The optimum wavelength to effectively inactivate microorganisms is in the range of 250 to 270 nm. Low-pressure lamps emit essentially monochromatic light at a wavelength of 253.7 nm. Standard lengths with diameter of 1.5–2.0 cm. The ideal lamp wall temperature is between 95 and 122ºF. c. The effectiveness of an ultra-violet disinfection system depends on the characteristics of the wastewater, the intensity of the ultra-violet radiation, the amount of time the microorganisms are exposed to the radiation, and the reactor configuration.

d. All ultra-violet disinfection must provide a flow either parallel or perpendicular to the lamps and have a ballast or control box which provides a starting voltage for the lamps and maintains a continuous current. e. There are two types of ultra-violet disinfection reactor configurations that exist: i. Contact: This reactor contains a series of mercury lamps enclosed in quartz sleeves to minimize the cooling effects of the wastewater. The lamps are placed parallel or perpendicular to the direction of the wastewater flow. Flap gates or weirs are used to control the level of the wastewater. ii. Noncontact: This reactor contains mercury lamps suspended outside the transparent conduit, which carries the wastewater to be disinfected. f. The ultra-violet disinfection must provide the following: i. Necessary hydraulic properties for maximum exposure to ultra-violet radiation. ii. Necessary intensity of ultra-violet radiation needed for effective inactivation of microorganisms. iii. Necessary radiation for peak flow condition, suspended or colloidal solids, initial bacterial density and any other physical and chemical parameters (i.e., hardness, iron, pH or TSS). g. The ultra-violet disinfection system must ensure that sufficient radiation is transmitted to the organisms to render them sterile. All surfaces between the radiation and target organisms must be clean, and the ballast, lamps, and reactors must be functioning at peak efficiency. h. The sleeves or tubes must be cleaned regularly by mechanical wipers, ultrasonics, or chemicals. The cleaning frequency is dependent upon the wastewater characteristics produced by the Advanced Treatment System. i. The retention time for complete inactivation will be determined by size of reactor and lamp intensity. j. All disinfection systems certified by American National Standards Institute/National Sanitation Foundation International Standard 46 will be accepted for registration in Mississippi provided documentation is submitted with application. k. All disinfection systems not certified by American National Standards Institute/National Sanitation Foundation International Standard 46 must submit all documentation to determine compliance with Rules 6.1.3 through 6.1.7.

3. Ozone: a. These products will be reviewed by the Division in accordance with design, construction and installation for the specific location and usage. b. These products will only be approved by the Division after certification by a Professional Engineer registered in the State of Mississippi after having shown it can be constructed and installed by the Certified Installer. c. This product will require that the Professional Engineer train and certify the Maintenance Provider in its routine operation and maintenance, as well as safety guidelines.

**History**
- *Source: Miss. Code Ann. § 41-67-3.*

##### **15 Miss. Admin. Code Pt. 18, R. 6.1.4** Location/Setbacks {#sec-18-6.1.4 omnilex-key=us-ms-regs-official--title-15--18#6.1.4}

1. The disinfection system shall not be located in an area that collects surface water. 2. The disinfection system shall be installed according to the following setbacks: a. 5 feet from foundations, deck, out-building, etc. b. 10 feet from property lines. c. 50 feet from any public, private or individual potable water source. 3. No vehicular traffic shall be allowed over the tank(s), disinfection system or any part of the Individual On-site Wastewater Disposal System. 4. Tanks and disinfection system shall not be located under dwellings or other permanent structures.

**History**
- *Source: Miss. Code Ann. § 41-67-3.*

##### **15 Miss. Admin. Code Pt. 18, R. 6.1.5** Treatment {#sec-18-6.1.5 omnilex-key=us-ms-regs-official--title-15--18#6.1.5}

1. Tablets shall not be in contact with treated effluent except during times of flow. Other designs that meet the criteria of proper effluent contact will be considered suitable after review by the Division. 2. The level of chlorination is a chlorine residual of not less than 0.1 to no greater than 1 ppm (parts per million) or a maximum of 400 fecal colonies/100 ml.

FIGURE 30 – Chlorine Contact Chamber (65 gallon minimum)

Riser

4 inch Sch 40 PVC

Inlet 4 inch Sch 40 PVC

6 inches from bottom of contact Chamber Depth must be greater than or equal to diameter

O R FIGURE 31 – Cross Section of Chlorinator Feeder Tube.

Chapter 7

Fees Rule 7.1 Fee Schedule. The Department shall assess fees in the amount for the following processes. In the discretion of the Board, a person shall be liable for a penalty equal to one and one-half (1½) times the amount of the fee due and payable for failure to pay the fee on or before the date due, plus any amount necessary to reimburse the cost of collection. All fees due the Department shall be paid by check or money order.

Subchapter 1: Administrative 1. Soil and Site Evaluation: a. Permit/Recommendation: $150. b. Existing System (Inspection): $100. 2. Final Approval: a. Design-based System: $97.50. b. Performance-based System: $325. c. Re-inspection (per inspection): $32.50. 3. Examination: $130. 4. Registration (Certification and CEU/PDH): $32.50. 5. Return Check: $65. 6. Late: 1/2 certification fee. 7. Re-Evaluation by Program Staff: $65. 8. Paper Application Entry Fee: $25.

Subchapter 2: Certification 1. Certified Manufacturer: a. Product Review: $325.

b. Certification of Registration: $450. 2. Certified Professional Evaluator: a. Initial Certification: $780. b. Renewal Certification: $650. 3. Certified Installer: a. Initial Certification: $225. b. Renewal Certification: $225. 4. Certified Pumper: a. Initial Certification: $225. b. Inspection: $32.50/Vehicle. c. Renewal Certification: $225.

Subchapter 3: Review 1. Subdivision: $325 + $6.50/lot. 2. Commercial Development: $65 + $2.60/lot. 3. Commercial Establishment: $65. 4. Commercial Wastewater System Review: $250. 5. Submittal (PE or CPE): a. Design-based System: $130. b. Performance-based System: $325. c. 1,500 gpd or more: $325. d. High strength waste streams: $325.

**History**
- *Source: Miss. Code Ann. § 41-67-3.*
- *Source: Miss. Code Ann. § 41-67-3.*
- *Source: Miss. Code Ann. § 41-67-3.*
- *Source: Miss. Code Ann. § 41-67-3.*
- *Source: Miss. Code Ann. § 41-67-3; Miss. Code Ann. § 41-3-65; Miss. Code Ann. § 41-67- 12(1)(a), as amended.*
- *Source: Miss. Code Ann. § 41-67-3; Miss. Code Ann. § 41-3-65; Miss. Code Ann. § 41-67- 12(1)(c), as amended (Certified Manufacturer, Certification of Registration); Miss. Code Ann. § 41-67-25(3)(c), as amended (Certified Installer); Miss. Code Ann. § 41-67-12(1)(b), as amended (Certified Pumper).*
- *Source: Miss. Code Ann. § 41-67-3.*

##### **15 Miss. Admin. Code Pt. 18, R. 7.2** Fee Exemptions {#sec-18-7.2 omnilex-key=us-ms-regs-official--title-15--18#7.2}

Fees authorized under this section shall not be assessed for any system operated by state agencies or institutions, including, without limitation, foster homes licensed by the State Department of Human Services. The fee authorized under this section shall not be charged again after payment of the initial fee for any system that has been installed in accordance with this chapter, within a period of 24 months following the date that the system was originally installed.

**History**
- *Source: Miss. Code Ann. § 41-67-3.*

### **Part 19** Bureau of Professional Licensure

#### **Chapter 1** REGULATIONS GOVERNING LICENSURE OF ATHLETIC TRAINERS Subchapter 1: General: Rule 1.1.1 Purpose: The purpose of these regulations is to safeguard the public's health, safety, and welfare by establishing minimum qualifications and creating exclusive titles corresponding to the level of qualifications for individuals who wish to offer athletic trainer services to the public. Further, in order to insure the highest degree of professional conduct by those engaged in offering athletic trainer services to the public, it is the purpose of these regulations to provide and impose disciplinary sanctions, be they civil or criminal, against persons who do not meet or adhere to the procedures, qualifications, and standards set out in this chapter

##### **15 Miss. Admin. Code Pt. 19, R. 1.1.2** Rule 1.1.2 {#sec-19-1.1.2 omnilex-key=us-ms-regs-official--title-15--19#1.1.2}

Legal Authority: The Mississippi State Board of Health is authorized to establish and enforce these rules and procedures by virtue of "The Mississippi Athletic Trainers Act of 1991,” Sections 73-55-1 et seq. of Mississippi Code of 1972, annotated.

**History**
- *SOURCE: Miss. Code Ann. §73-55-17.*

##### **15 Miss. Admin. Code Pt. 19, R. 1.1.3** Definitions: The following terms shall have the meaning set forth below, unless the context otherwise requires: 1 {#sec-19-1.1.3 omnilex-key=us-ms-regs-official--title-15--19#1.1.3}

"Board" shall mean the Mississippi State Board of Health. 2. "Council" shall mean the Mississippi Council of Advisors in Athletic Training 3. "License" shall mean the document of licensure issued by the Board. 4. "Athletic Training" means the treatment of an athlete for risk management and athletic injury prevention, the clinical evaluation and assessment of an athlete for an injury or illness, or both, the immediate care and treatment for an injury or illness, or both, and the rehabilitation and reconditioning of an athlete's injury or illness, or both, as long as those activities are performed under the direction of a licensed physician, nurse practitioner or physician assistant. The practice of athletic training does not include the practice of physical therapy, the practice of medicine, the practice of osteopathic medicine and surgery, the practice of nursing or the practice of chiropractic.

5. "Athletic Trainer" means a person licensed by the Department of Health as an athletic trainer after meeting the requirements of these rules and regulations who, upon the advice, consent and oral or written prescriptions or referrals of a licensed physician, nurse practitioner or physician assistant, carries out the practice of athletic training, and in carrying out these functions the athletic trainer is authorized to use physical modalities, such as heat, light, sound, cold, electricity or mechanical devices related to prevention, recognition, evaluation, management, disposition, rehabilitation and treatment. An athletic trainer shall practice only in those areas in which the athletic trainer is competent due to training or experience that can be substantiated by records or other evidence found acceptable by the board in the exercise of the board's considered discretion. 6. "Practice and Performance of Athletic Training" means functioning in the nonclinical and clinical setting under the direction of a physician, nurse practitioner, or physician assistant, evaluating, treating, and providing appropriate immediate care and treatment to injuries incurred by an athlete during participation in or training for scholastic, recreational, professional, or sanctioned amateur athletic activities. Evaluation and treatment by an athletic trainer in the nonclinical setting to supportive staff, spectators, and other persons other than an athlete shall be limited to immediate care and treatment. An athletic trainer functioning in a clinical setting may evaluate and provide treatment for an athletic injury under the direction or referral of a licensed physician, nurse practitioner or physician assistant. An athletic trainer functioning in the nonclinical and clinical setting may use therapeutic exercise and modalities such as heat, cold, light, air, massage, water, sound and electricity for the treatment of musculoskeletal injuries and the use of passive (manual and mechanical) techniques for the purpose of treatment. 7. "Athlete" means an individual who participates in exercises, sports, or games requiring physical strength, agility, flexibility, range of motion, speed or stamina; or an individual with an athletic injury that a licensed physician, nurse practitioner or physician assistant deems would benefit from athletic training services. 8. “Athletic Injury" means any injury sustained by a person as a result of the person's participation in sports, games or recreational activities requiring physical strength, flexibility, range of motion, speed or stamina, or comparable injury. 9. "Clinical Setting" means a hospital, department, outpatient facility, or clinic whose primary purpose is sports medicine, rehabilitation, or wellness. 10. "Nonclinical Setting" means a location where school, professional, recreational, or sanctioned amateur athletic activities are being held. 11. "Physician" means a physician licensed by the State Board of Medical Licensure.

12. "BOC, Inc.," means the Board of Certification, Incorporated, or its successor agency, the National Credentialing Agency of Athletic Trainers; formerly referred to as the National Athletic Trainers' Association Board of Certification, Inc. 13. "Act" means the Mississippi Athletic Trainers Licensure Act of 1991, Section 73- 55-1 et seq. of Mississippi Code of 1972, annotated. 14. "Department" shall mean the Mississippi State Department of Health.

**History**
- *SOURCE: Miss. Code Ann. §73-55-17.*

##### **15 Miss. Admin. Code Pt. 19, R. 1.1.4** Rule 1.1.4 {#sec-19-1.1.4 omnilex-key=us-ms-regs-official--title-15--19#1.1.4}

Publication: The Department shall publish, a list of the names and addresses of all persons licensed by the Board as Athletic Trainers, and a list of all persons whose licenses have been suspended, revoked, denied renewal, put on probationary status, censured or reprimanded.

Subchapter 2: Athletic Trainers Advisory Council (“Council”) Rule 1.2.1 Council Structure and Purpose: The Council shall consist of five (5) members as set forth in the Act, for the terms indicated therein, and shall serve under the jurisdiction of the Mississippi State Board of Health. The purpose of the Council is to aid the Board in administering the provisions of the Act.

Rule 1.2.2. Meeting: The Council shall meet as set forth in the Act. A quorum shall consist of three (3) members of the Council, including the chairperson, and shall be necessary for the Council to take action by vote.

Subchapter 3: State Board of Health (“Board”) Rule 1.3.1 Responsibilities: The Board, authorizes the Department with the advice of the council to: 1. establish licensing and renewal of license criteria for applicants; 2. maintain an up-to-date list of all individuals licensed to practice as athletic trainers, with such list being available, upon request, to the public; 3. refer disciplinary actions of any individual engaged in the practice of athletic training to the appropriate government agency for prosecution, whether licensed or otherwise, or, in its discretion, refer same to the appropriate committee or council; 4. conduct disciplinary hearings, upon specified charges, of a licensee;

5. maintain an up-to-date list of all individuals whose license has been suspended, revoked, or denied, and make such list available to public inspection, and shall supply such list to similar regulatory boards in other states or jurisdictions; 6. keep a record of all proceedings of the Board, and make said record available to the public. 7. delegate, authorize, promulgate and regulate, as may be necessary, to accomplish the purpose of the Act.

Subchapter 4: Licensure Rule 1.4.1 Licensure Requirements: An applicant for licensure shall submit to the Department, verified by oath, written evidence in form and content satisfactory to the Department that the applicant; 1. Has satisfactorily completed all of the BOC, Inc, qualifications and is certified as an athletic trainer by BOC, Inc, and is in good standing, or 2. Holds a degree in physical therapy and has completed the BOC, Inc., certification requirements.

**History**
- *SOURCE: Miss. Code Ann. §73-55-17.*
- *SOURCE: Miss. Code Ann. §73-55-17.*
- *SOURCE: Miss. Code Ann. §73-55-17.*
- *SOURCE: Miss. Code Ann. §73-55-17.*
- *SOURCE: Miss. Code Ann. § 73-55-7; Miss. Code Ann. § 73-55-17.*

##### **15 Miss. Admin. Code Pt. 19, R. 1.4.2** Rule 1.4.2 {#sec-19-1.4.2 omnilex-key=us-ms-regs-official--title-15--19#1.4.2}

Abandonment: An application shall be deemed abandoned by the Department if, after six (6) months from the date of filing, the requirements for licensing have not been completed and submitted to the Department.

Subchapter 5: Professional Identification Rule 1.5.1 Titles and Abbreviation: No person shall engage in athletic training or use the titles "athletic trainer," "certified athletic trainer" or "licensed athletic trainer" or use the letters "LAT," or "AT" or any other facsimile thereof, whether or not compensation is received or expected, unless he or she is licensed as an athletic trainer in the State of Mississippi.

**History**
- *SOURCE: Miss. Code Ann. §73-55-17.*
- *SOURCE: Miss. Code Ann. §73-55-17.*

##### **15 Miss. Admin. Code Pt. 19, R. 1.5.2** Rule 1.5.2 {#sec-19-1.5.2 omnilex-key=us-ms-regs-official--title-15--19#1.5.2}

Production and Display of License: A person issued a license to practice athletic training by the Mississippi State Board of Health shall show said license when requested.

Subchapter 6: Renewal of License Rule 1.6.1 General Provisions 1. The Board shall issue licenses that shall be renewed annually. 2. The licensure year shall be construed as January 1 through December 31.

**History**
- *SOURCE: Miss. Code Ann. §73-55-17.*
- *SOURCE: Miss. Code Ann. §73-55-17.*

##### **15 Miss. Admin. Code Pt. 19, R. 1.6.2** Rule 1.6.2 {#sec-19-1.6.2 omnilex-key=us-ms-regs-official--title-15--19#1.6.2}

Procedure for Renewal of License: The Department shall mail a renewal notice, at least thirty (30) days prior to the renewal date, to the last address registered with the Department, to the persons to whom licenses were issued or renewed during the preceding renewal period. The licensee shall, either in written form or electronically if within the specified renewal time: 1. complete the renewal form, and 2. submit proof of continuing education credit as detailed in Subchapter 7 of these regulations, if required, and 3. enclose the renewal fee, and 4. file the above with the Department prior to the end of the renewal period.

**History**
- *SOURCE: Miss. Code Ann. §73-55-17.*

##### **15 Miss. Admin. Code Pt. 19, R. 1.6.3** Failure to Renew 1 {#sec-19-1.6.3 omnilex-key=us-ms-regs-official--title-15--19#1.6.3}

A licensee who does not file, with the Department, his renewal application within the renewal period will be deemed to have allowed his license to lapse. Said licensee may be reinstated by the Department, in its discretion, by the payment of the renewal fee and a reinstatement fee, provided said application for reinstatement is made within one (1) year of the end of the renewal period. 2. Any person seeking re-licensure after allowing a license to lapse shall be required to meet all licensing requirements in effect at the time of the application for relicensure.

Subchapter 7: Continuing Education Rule 1.7.1 Definition and philosophy: Each individual licensed as an Athletic Trainer is responsible for optimum service to the consumer and is accountable to the consumer, the employer, and the profession for evidence of maintaining high levels of skill and knowledge. Pursuant to the Act, continuing education is mandatory. Continuing education is defined as education beyond the basic

preparation required for entry into the profession, directly related to the performance and practice of Athletic Training.

**History**
- *SOURCE: Miss. Code Ann. §73-55-17.*
- *SOURCE: Miss. Code Ann. §73-55-17.*

##### **15 Miss. Admin. Code Pt. 19, R. 1.7.2** Requirements 1 {#sec-19-1.7.2 omnilex-key=us-ms-regs-official--title-15--19#1.7.2}

Continuing education requirements for license renewal shall be fulfilled during two-year periods running concurrently with the requirement to maintain certification through the BOC, Inc. Proof of the completion of continuing education as required by this section shall be turned in to the Department at the time of renewal of license, if requested. 2. Persons who fail to accrue the required continuing education hours shall be issued a probationary license for a term of one (1) year. Failure to accrue the delinquent hours will result in the revocation of the license. Hours accrued are first credited for the delinquent hours lacking from the previous continuing education cycle. 3. Probationary licenses will be issued for one licensure term only. No ensuing license may be probationary as a result of not meeting continuing education requirements. 4. Continuing education requirements for all licensees, as to the substance and the number of hours, shall be the same as that for BOC certification.

**History**
- *SOURCE: Miss. Code Ann. §73-55-17.*

##### **15 Miss. Admin. Code Pt. 19, R. 1.7.3** Rule 1.7.3 {#sec-19-1.7.3 omnilex-key=us-ms-regs-official--title-15--19#1.7.3}

Sources of Continuing Education: Continuing education hours may be accrued from the following sources: Attendance at Mississippi Athletic Trainers Association (MATA) sponsored meetings; National Athletic Trainers Association (NATA) sponsored meetings approved for continuing education credit by BOC, Inc., or other meetings or sources approved for continuing education credit by BOC, Inc.

Subchapter 8: Revocation, Suspension and Denial of License Rule 1.8.1 Standards of Conduct: Licensees may, at the discretion of the Board, have their license suspended, revoked, or denied at the time of renewal if the Board determines that the licensee is guilty of any of the following: 1. Is guilty of fraud or deceit in procuring or attempting to procure a license or renewal of a license to practice athletic training. 2. Is unfit or incompetent by reason of gross ignorance, negligence, habits, or other causes of incompetency.

3. Is habitually intemperate in the use of alcoholic beverage. 4. Is convicted of an offense involving moral turpitude. 5. Is knowingly practicing while suffering with a contagious or infectious disease. 6. Is in violation of any of the applicable provisions of the Code for Professional Practice of the National Athletic Trainers Association, Inc. 7. Is addicted to, or has improperly obtained, possessed, used, or distributed habit- forming drugs or narcotics. 8. Is guilty of dishonest or unethical conduct. 9. Has practiced athletic training without a valid license. 10. Has violated, aided, or abetted others in violation of any provision of the Act, or these regulations. 11. Has engaged in any conduct considered by the Board to be detrimental to the profession of athletic training.

**History**
- *SOURCE: Miss. Code Ann. §73-55-17.*
- *SOURCE: Miss. Code Ann. §73-55-17.*

##### **15 Miss. Admin. Code Pt. 19, R. 1.8.2** Rule 1.8.2 {#sec-19-1.8.2 omnilex-key=us-ms-regs-official--title-15--19#1.8.2}

Summary Suspension: The Board may summarily suspend a license without a hearing, simultaneously with the filing of a formal complaint and notice of hearing, if the Board determines that: 1. The health, safety, or welfare of the general public is in imminent danger; or 2. The licensee's physical capacity to practice his profession is in issue; or 3. The licensee's mental capacity to practice his profession is in issue.

**History**
- *SOURCE: Miss. Code Ann. §73-55-17.*

##### **15 Miss. Admin. Code Pt. 19, R. 1.8.3** Rule 1.8.3 {#sec-19-1.8.3 omnilex-key=us-ms-regs-official--title-15--19#1.8.3}

Complaints: All complaints concerning a licensee, his business, or professional practice, shall be reviewed by the Department. Each complaint received shall be logged, recording at a minimum the following information: 1. licensee's name 2. name of the complaining party, if known; 3. date of complaint; 4. brief statement of complaint; and 5. disposition

**History**
- *SOURCE: Miss. Code Ann. §73-55-17.*

##### **15 Miss. Admin. Code Pt. 19, R. 1.8.4** Rule 1.8.4 {#sec-19-1.8.4 omnilex-key=us-ms-regs-official--title-15--19#1.8.4}

Investigation: All complaints will be investigated and evaluated by the administrative secretary or other authorized employee of the Department.

**History**
- *SOURCE: Miss. Code Ann. §73-55-17.*

##### **15 Miss. Admin. Code Pt. 19, R. 1.8.5** Notice of Charges and Hearing: 1 {#sec-19-1.8.5 omnilex-key=us-ms-regs-official--title-15--19#1.8.5}

Following the investigative process, the Department may file formal charges against the licensee. Such formal complaint shall, at a minimum, inform the licensee of the facts which are the basis of the charge and which are specific enough to enable the licensee to defend against the charges. 2. Each licensee, whose conduct is the subject of a formal charge which seeks to impose disciplinary action against the licensee, shall be served notice of the formal charge at least thirty (30) days before the date of hearing. A hearing shall be presided over by the Board or the Board's designee. Service shall be considered to have been given if the notice was personally received by the licensee, or the notice was mailed certified, return receipt requested, to the licensee at the licensee's last known address as listed with the state agency. 3. The notice of the formal hearing shall consist at a minimum of the following information: a. The time, place and date of hearing; b. That the licensee shall appear personally at the hearing and may be represented by counsel; c. That the licensee shall have the right to produce witnesses and evidence in the licensee's behalf and shall have the right to cross-examine adverse witnesses and evidence; d. That the hearing could result in disciplinary action being taken against the licensee's license; e. That rules for the conduct of these hearings exist and it may be in the licensee's best interest to obtain a copy; and f. That the Board, or its designee, shall preside at the hearing and following the conclusion of the hearing shall make findings of facts, conclusions of law and recommendations, separately stated, to the Board as to what disciplinary action, if any, should be imposed on the licensee. 4. The Board or its designee shall hear evidence produced in support of the formal charges and contrary evidence produced by the licensee. At the conclusion of the hearing, the Board shall issue an order, within sixty (60) days.

5. Disposition of any complaints may be made by consent order or stipulation between the Board and the licensee. 6. All proceedings pursuant to this section are matters of public record and shall be preserved pursuant to State law.

**History**
- *SOURCE: Miss. Code Ann. § 73-55-17.*

##### **15 Miss. Admin. Code Pt. 19, R. 1.8.6** Rule 1.8.6 {#sec-19-1.8.6 omnilex-key=us-ms-regs-official--title-15--19#1.8.6}

Board Sanctions: The Board may impose any of the following sanctions, singly or in combination, when it finds that a licensee is guilty of any of the above offenses: 1. Revocation of the license; 2. Suspension of the license, for any period of time; 3. Censure the licensee; 4. Issue a letter of reprimand to the licensee; 5. Place a license on probationary status and require the licensee to submit to any of the following: a. report regularly to the Board upon matters which are the basis of probation; b. continue to renew professional education until a satisfactory degree of skill has been attained in those areas which are the basis of probation; or c. such other reasonable requirements or restrictions as are proper. 6. Refuse to renew a license; or 7. Revoke probation which has been granted and impose any other disciplinary action in this subsection when the requirements of probation have not been fulfilled or have been violated.

**History**
- *SOURCE: Miss. Code Ann. § 73-55-17.*

##### **15 Miss. Admin. Code Pt. 19, R. 1.8.7** Rule 1.8.7 {#sec-19-1.8.7 omnilex-key=us-ms-regs-official--title-15--19#1.8.7}

Appeal: Any person aggrieved by a decision of the Board shall have a right of appeal to the Chancery Court of the county where the hearing was held in the manner provided for in the enabling statute and the Laws of the State of Mississippi.

Subchapter 9: Exceptions and Exemptions Rule 1.9.1 Exceptions: No person shall represent himself to be an athletic trainer unless he is licensed by the Board. 1. The provisions of this chapter shall not restrict coaches and physical education instructors in the performance of their duties. 2. The provisions of this chapter shall not restrict athletic trainers from other nations, states, or territories performing their duties for their respective teams or organizations and only during the course of their team or organization's stay in this state. 3. Nothing in these regulations is intended to limit, preclude, or otherwise interfere with the practices of other persons and health providers licensed by appropriate agencies of the State of Mississippi. 4. Nothing in these regulations shall be construed to authorize the practice of medicine or nursing by any person not licensed by the State Board of Medical Licensure or the Mississippi Board of Nursing.

Subchapter 10: Criminal Offenses and Punishment Rule 1.10.1 Offenses: It is a violation for any person to: 1. Sell, fraudulently obtain or furnish any athletic trainer permit, license, record, or aid or abet therein. 2. Practice athletic training under cover of any athletic training diploma, permit, license, or record illegally or fraudulently obtained or issued. 3. Impersonate in any manner or pretend to be an athletic trainer or use the titles, "Athletic Trainer" the letters, "A.T." or any other words letters, signs, symbols or devices to indicate the person using them is a licensed Athletic Trainer, unless duly authorized by license or permit. 4. Practice athletic training during the time his license or permit is suspended, revoked, or expired. 5. Fail to notify the board of the suspension, probation or revocation of any past or currently held licenses, required to practice athletic training in this or any other jurisdiction. 6. Make false representations, impersonate, act as a proxy for another person, allow, or aid any person to impersonate him in connection with any examination or application for licensing or request to be examined or licensed.

7. Make a material, false statement in an application for licensure, or in a response to any inquiry by the State Department of Health or the Board. 8. Otherwise violate any provisions of the Act.

**History**
- *SOURCE: Miss. Code Ann. § 73-55-17.*
- *SOURCE: Miss. Code Ann. § 73-55-17.*
- *SOURCE: Miss. Code Ann. § 73-55-17.*

##### **15 Miss. Admin. Code Pt. 19, R. 1.10.2** Rule 1.10.2 {#sec-19-1.10.2 omnilex-key=us-ms-regs-official--title-15--19#1.10.2}

Punishment: Such violation shall be punishable by a fine of not less than One Hundred Dollars ($100.00), nor more than Five Hundred Dollars ($500.00) or by imprisonment of not less than ten (10) days nor more than sixty (60) days, or by both fine and imprisonment for each violation.

Subchapter 11: Fees Rule 1.11.1 Method of Payment: The following fees, where applicable, are payable to the Mississippi State Department of Health by personal check, certified check, cashier’s check, or money order. Fees paid to the State Board of Health are non- refundable.

**History**
- *SOURCE: Miss. Code Ann. §73-55-17.*
- *SOURCE: Miss. Code Ann. §73-55-17.*

##### **15 Miss. Admin. Code Pt. 19, R. 1.11.2** Rule 1.11.2 {#sec-19-1.11.2 omnilex-key=us-ms-regs-official--title-15--19#1.11.2}

Schedule of Fees: Application and Initial Licensure Fee - $100.00 Renewal Fee - $50.00 Reinstatement Fee - $200.00 Replacement Fee - $50.00

Subchapter 12: Administrative Grievance Procedure Rule 1.12.1 Administrative Appeals: All persons aggrieved by a decision regarding the initial application for licensure, or the renewal of licensure, shall have the right of administrative appeal and a hearing to be conducted according to the policy of the Department of Health.

**History**
- *SOURCE: Miss. Code Ann. §73-55-17.*
- *SOURCE: Miss. Code Ann. § 73-55-17.*

##### **15 Miss. Admin. Code Pt. 19, R. 1.12.2** Rule 1.12.2 {#sec-19-1.12.2 omnilex-key=us-ms-regs-official--title-15--19#1.12.2}

Notification: Written notice will be provided to all applicants regarding denial of an original license or a renewal license. Such notice shall contain the reason thereof and shall offer the applicant an opportunity to submit additional information pertinent to their application for a second review by the Department.

**History**
- *SOURCE: Miss. Code Ann. § 73-55-17.*

##### **15 Miss. Admin. Code Pt. 19, R. 1.12.3** Rule 1.12.3 {#sec-19-1.12.3 omnilex-key=us-ms-regs-official--title-15--19#1.12.3}

Hearing: If requested in writing within the specified time frame a hearing will be provided in which the applicant may show cause why the license should be granted or renewed. Within sixty (60) days of the hearing, or other such time frame as determined during the hearing, written findings of fact, together with a recommendation for action on the license in question, shall be forwarded to the State Health Officer. The State Health Officer shall decide what action will be taken on the recommendation within five days of its receipt. Written notice shall be provided to the applicant.

**History**
- *SOURCE: Miss. Code Ann. § 73-55-17.*

#### **Chapter 2** REGULATIONS GOVERNING LICENSURE OF PROFESSIONAL ART THERAPISTS Subchapter 1: General Provisions Rule 2.1.1 Legal Authority: The State Board of Health is authorized to establish and enforce these rules and procedures by virtue of Chapter 73-65-1 et seq of the Mississippi Code 1972 Annotated.

##### **15 Miss. Admin. Code Pt. 19, R. 2.1.2** Rule 2.1.2 {#sec-19-2.1.2 omnilex-key=us-ms-regs-official--title-15--19#2.1.2}

Purpose: The purpose of these regulations is to safeguard the public(s health, safety, and welfare by establishing minimum qualifications and creating exclusive titles corresponding to the level of qualifications for individuals who wish to perform art therapy. Further, in order to insure the highest degree of professional conduct by those engaged in the performance of art therapy, it is the purpose of these regulations to provide and impose disciplinary sanctions, be they civil or criminal, against persons who do not meet or adhere to the procedures, qualifications, and standards set out in this chapter.

**History**
- *SOURCE: Miss. Code Ann. §73-65-1*

##### **15 Miss. Admin. Code Pt. 19, R. 2.1.3** Definitions: The following terms shall have the meaning set forth below, unless the context otherwise requires: 1 {#sec-19-2.1.3 omnilex-key=us-ms-regs-official--title-15--19#2.1.3}

Board shall mean the Mississippi State Board of Health. 2. Council shall mean the Professional Art Therapists Advisory Council. 3. Licensed Professional Art Therapist means a person who has completed a master’s or doctoral degree program in art therapy, or an equivalent course of study, from an accredited educational institution and who is licensed by the Board, or who received registration from the American Art Therapy Association (ATR) before 1980.

4. License Holder means a licensed professional art therapist licensed under the provisions of this act. 5. Accredited Institution means a university or college accredited by a nationally recognized accrediting agency of institutions of higher education, or an institution and clinical program approved by the American Art Therapy Association, Inc. 6. Department shall mean the Mississippi Department of Health. 7. Act shall mean Chapter 73-65-1 et seq of the Mississippi Code 1972 Annotated.+

**History**
- *SOURCE: Miss. Code Ann. §73-65-1.*

##### **15 Miss. Admin. Code Pt. 19, R. 2.1.4** Rule 2.1.4 {#sec-19-2.1.4 omnilex-key=us-ms-regs-official--title-15--19#2.1.4}

Publication: The Department shall publish, annually, a list of the names and addresses of all persons licensed by the Board as Professional Art Therapists, and a list of all persons whose license has been suspended, revoked, denied renewal, put on probationary status, censured or reprimanded.

Subchapter 2: Professional Art Therapists Advisory Council (“Council”) Rule 2.2.1 Council Structure and Purpose: The Council shall consist of six (6) members as set forth in the Act, for the terms indicated therein, and shall serve under the jurisdiction of the Board. The purpose of the Council is to serve in an advisory capacity to the Board in matters relating to the administration and interpretation of provisions of the Act.

**History**
- *SOURCE: Miss. Code Ann. §73-65-1.*
- *SOURCE: Miss. Code Ann. §73-65-1.*

##### **15 Miss. Admin. Code Pt. 19, R. 2.2.2** Meetings: The Council shall meet at least twice annually {#sec-19-2.2.2 omnilex-key=us-ms-regs-official--title-15--19#2.2.2}

A chairperson and a secretary shall be elected at the first meeting of the year. Additional meetings may be called at the discretion of the chairperson, upon written request of two (2) members of the Council. A quorum shall consist of three (3) members of the Council, including the chairperson, and shall be necessary for the Council to take action by vote.

Subchapter 3: State Board of Health (“Health”) Rule 2.3.1 Responsibilities: The Board shall: 1. Establish examination, licensure, and renewal of licensure criteria for applicants; 2. Maintain an up-to-date list of all individuals licensed as Professional Art Therapists, with such list being available, upon request, to the public;

3. Refer disciplinary actions of any individual engaged in art therapy to the appropriate government agency for prosecution, whether licensed or otherwise, or in its discretion, refer same to the appropriate committee or council; 4. Conduct disciplinary hearings, upon specified charges; 5. Maintain an up-to-date list of all individuals whose license has been suspended, revoked, or denied, and make such list available to public inspection, and shall supply such list to similar regulatory boards in other states or jurisdictions; 6. Keep a record of all proceedings of the Board, and make said record available to the public; 7. Delegate, authorize, and direct the Department to promulgate regulations to accomplish the purpose of the Act.

Subchapter 4: Licensure Rule 2.4.1 Licensure Requirements 1. An applicant for licensure shall submit to the Department, verified by oath, written evidence in form and content satisfactory to the Department that the applicant: 2. Is at least twenty-one (21) years of age; 3. Has passed the Art Therapy Credentials Board Examination as administered by the Art Therapy Credentials Board, Inc.; 4. Is registered as an art therapist as defined by the Art Therapy Credentials Board, Inc.; 5. Is certified as an art therapist by the Art Therapy Credentials Board, Inc.; and, 6. Has been awarded a master’s degree or doctoral degree in art therapy that includes six hundred (600) hours of supervised internship experience from an accredited institution and has completed an additional one thousand (1000) client contact hours of postgraduate experience under appropriate supervision; or,

**History**
- *SOURCE: Miss. Code Ann. §73-65-1.*
- *SOURCE: Miss. Code Ann. §73-65-1.*
- *SOURCE: Miss. Code Ann. §73-65-1.*

##### **15 Miss. Admin. Code Pt. 19, R. 2.4.2** Rule 2.4.2 {#sec-19-2.4.2 omnilex-key=us-ms-regs-official--title-15--19#2.4.2}

Licensed By Endorsement An applicant for licensure shall submit to the Department, verified by oath, written evidence in form and content satisfactory to the Department that:

1. The applicant holds a valid regulatory document issued by the appropriate examining board under the laws of any other state or territory of the United States, the District of Columbia, or any foreign nation; 2. The requirements for said document are substantially equivalent to, or exceed, the requirements as set forth in Rule 2.4.1 of these regulations; and, 3. Said document is in good standing, and is not, presently suspended or revoked.

**History**
- *SOURCE: Miss. Code Ann. §73-65-1.*

##### **15 Miss. Admin. Code Pt. 19, R. 2.4.3** Rule 2.4.3 {#sec-19-2.4.3 omnilex-key=us-ms-regs-official--title-15--19#2.4.3}

**History**
- *SOURCE: Miss. Code Ann. §73-65-1*

##### **15 Miss. Admin. Code Pt. 19, R. 2.4.4** [Reserved] {#sec-19-2.4.4 omnilex-key=us-ms-regs-official--title-15--19#2.4.4}

Provisional Licensure The Board may, in its discretion, issue a provisional license to an applicant at least 21 years of age, pending the completion of the requirements for licensure, providing the applicant submits to the Department, verified by oath, in form and content satisfactory to the Department that the applicant: 1. Will be supervised according to Rule 2.4.5 of the regulations; and, 2. Has not taken the examination recognized by the Department or received registration from the Art Therapy Credentials Board, Inc. 3. In its discretion, and upon application, the Board may renew a provisional license. Proof satisfactory to the Department that the provisional license holder has been in the process of meeting the licensure requirements must be submitted at the time of renewal.

**History**
- *SOURCE: Miss. Code Ann. §73-65-1.*

##### **15 Miss. Admin. Code Pt. 19, R. 2.4.5** Conditions of a Provisional License 1 {#sec-19-2.4.5 omnilex-key=us-ms-regs-official--title-15--19#2.4.5}

Documentation in form and substance satisfactory to the Department that the conditions of Rule 2.4.5(2)(3) of the regulations have been met must be on file with the Department before a provisional license will be issued. 2. A provisional license holder may only practice under the supervision of the individual licensed as a professional art therapist in Mississippi who is the listed supervisor on file with the Department. 3. A provisional license holder must be supervised one (1) hour for every ten (10) hours of face-to-face client contact. 4. A provisional license holder shall restrict his practice to the State of Mississippi.

5. Only an individual issued a regular license by the Department may supervise a provisional license holder. 6. Notice of Termination: The supervisor shall notify the Department in writing of the termination of the supervisory relationship with a provisional license holder. The notice shall include the effective date of the termination and must be filed with the Department or postmarked no later than three (3) calendar days from the date of termination.

**History**
- *SOURCE: Miss. Code Ann. §73-65-1.*

##### **15 Miss. Admin. Code Pt. 19, R. 2.4.6** Rule 2.4.6 {#sec-19-2.4.6 omnilex-key=us-ms-regs-official--title-15--19#2.4.6}

Retirement of Licensure: A license holder shall notify the Department in writing of intent to retire as a licensed professional art therapist prior to the expiration date of his current license.

**History**
- *SOURCE: Miss. Code Ann. §73-65-1.*

##### **15 Miss. Admin. Code Pt. 19, R. 2.4.7** Renewal/reinstatement of Licensure 1 {#sec-19-2.4.7 omnilex-key=us-ms-regs-official--title-15--19#2.4.7}

The license holder shall request a renewal/reinstatement application from the Department in writing within five (5) years of the year of retirement. 2. The license holder shall submit the renewal/reinstatement application, all lapsed license renewal fees, and the continuing education requirement to the Department for review.

**History**
- *SOURCE: Miss. Code Ann. §73-65-1.*

##### **15 Miss. Admin. Code Pt. 19, R. 2.4.8** Conditions of a Universal Occupational License: {#sec-19-2.4.8 omnilex-key=us-ms-regs-official--title-15--19#2.4.8}

1. Notwithstanding any other provision of law, the Department shall issue a license in art therapy and at the same practice level to a person who establishes residence in this state if, upon application to the Department: a. The applicant holds a current and valid license in good standing in another state in an occupation with a similar scope of practice, as determined by the Department, and has held this license from the occupational licensing board in the other state for at least one (1) year; and b. There were minimum education requirements and, if applicable, work experience, examination, and clinical supervision requirements in effect, and the other state verifies that the applicant met those requirements in order to be licensed in that state; and c. The applicant has not committed any act in the other state that would have constituted grounds for refusal, suspension, or revocation of a license to practice that occupation in Mississippi at the time the act was committed, and

the applicant does not have a disqualifying criminal record as determined by the Department under Mississippi law; and d. The applicant did not surrender a license because of negligence or intentional misconduct related to the applicant's work in the occupation in another state; and e. The applicant does not have a complaint, allegation, or investigation pending before an occupational licensing board or other board in another state that relates to unprofessional conduct or an alleged crime. If the applicant has a complaint, allegation, or investigation pending, the Department shall not issue or deny a license to the applicant until the complaint, allegation, or investigation is resolved, or the applicant otherwise satisfies the criteria for licensure in Mississippi to the satisfaction of the Department; and f. The applicant pays all applicable fees in Mississippi. 2. Notwithstanding any other law, the Department shall issue a license to an applicant in art therapy and at the same practice level, as determined by the Department, to a person who establishes residence in this state based on work experience in another state, if all the following apply: a. The applicant worked in a state that does not use a license to regulate a lawful occupation, but Mississippi uses a license to regulate a lawful occupation with a similar scope of practice, as determined by the Department; b. The applicant worked for at least three (3) years in the lawful occupation; and c. The applicant satisfies the provisions of paragraphs (c) through (f) of Rule 2.4.8(1). 3. The Department may require an applicant to pass a jurisprudential examination specific to relevant state laws in Mississippi that regulate professional art therapists if the issuance of a license in Mississippi requires an applicant to pass a jurisprudential examination specific to relevant state statutes and administrative rules in Mississippi that regulate professional art therapists. 4. The Department may require proof of residency. Residency may be established by demonstrating proof of a state-issued identification card or one (1) of the following: a. Current Mississippi residential utility bill with the applicant's name and address; b. Documentation of the applicant's current ownership, or current lease of a residence in Mississippi; c. Documentation of current in-state employment or a notarized letter of the promise of employment of the applicant or his or her spouse; or

d. Any verifiable documentation demonstrating Mississippi residency. 5. A license issued under this section is valid only in this state and does not make the person eligible to be part of an interstate compact. 6. The Department shall issue or deny the license to the applicant within one hundred twenty (120) days after receiving an application. 7. If the application requires longer than two (2) weeks to process, the Department shall issue a temporary practice permit within thirty (30) days after receiving the application if the applicant submits an affidavit, under penalties of perjury, affirming that he or she satisfies the provisions of Rule 2.4.8(3) or Rule 2.4.8(4) and pays all applicable fees as required by Rule 2.4.8(1)(f). a. The applicant may practice under the temporary permit until a license is granted, or until a notice to deny the license is issued, in accordance with rules adopted by the Department. A temporary license will expire in three hundred sixty-five (365) days after its issuance if the applicant fails to satisfy the requirement for licensure in Rule 2.4.8(1) through Rule 2.4.8(3), as applicable. 8. The Department shall issue a license as a licensed professional art therapist to any person who files a completed application, accompanied by the required fees, and who submits satisfactory evidence that the applicant is at least twenty-one (21) years of age, is a registered art therapist as defined by the Art Therapy Credentials Board, Inc., demonstrates professional competency by satisfactorily passing the required examination, and is a board-certified art therapist as defined by the Art Therapy Credentials Board, Inc. 9. The Department may approve on a case-by-case basis applicants who have a master's degree or a doctoral degree from nonaccredited institutions. 10. If an applicant has met all of the requirements for licensure except satisfactorily passing the required examination, the applicant shall be scheduled to take the next examination following the approval of the examination. 11. The Department may issue a license to an applicant without examination if the person possesses a valid regulatory document issued by the appropriate examining board under the laws of any other state or territory of the United States, the District of Columbia, or any foreign nation that in the judgment of the Department has requirements substantially equivalent to or exceeding the requirements in this section. The issuance of a license by reciprocity to a military-trained applicant, military spouse, or person who establishes residence in this state shall be subject to the provisions of Section §73-50-1 or §73-50-2 of the Mississippi Code of 1972 as applicable. 12. The Department may issue provisional licensure as a professional art therapist to any person who has completed the educational requirements established by the Art Therapy Credentials Board, Inc., and has met all requirements for licensure as a

professional art therapist, except the experience and/or examination requirements, and is under the supervision of a supervisor acceptable to the Department. 13. The Department may set criteria for continuing education and supervisory experience. 14. Denial of Universal License a. The applicant may appeal any of the following decisions of the Department to a court of general jurisdiction: (i) Denial of a license; (ii) Determination of the occupation; (iii) Determination of the similarity of the scope of practice of the license issued; or (iv) Other determinations under this section. b. The court shall determine all questions of law, including the interpretation of a constitutional or statutory provision or a rule adopted by the Department, without regard to any previous determination that may have been made on the question in any action before the Department.

**History**
- *SOURCE: Miss. Code Ann. §73-14-1.*

##### **15 Miss. Admin. Code Pt. 19, R. 2.4.9** Rule 2.4.9 {#sec-19-2.4.9 omnilex-key=us-ms-regs-official--title-15--19#2.4.9}

Abandonment: An application shall be deemed abandoned by the Department if, after six (6) months from the date of filing, the requirements for licensing have not been completed and submitted to the Department.

Subchapter 5: Professional Identification Rule 2.5.1 Titles and Abbreviation: No person shall use the title “Licensed Professional Art Therapist” or hold himself out as having this status, unless he is licensed as such by the Board.

**History**
- *SOURCE: Miss. Code Ann. §73-14-1.*
- *SOURCE: Miss. Code Ann. §73-65-1.*

##### **15 Miss. Admin. Code Pt. 19, R. 2.5.2** Rule 2.5.2 {#sec-19-2.5.2 omnilex-key=us-ms-regs-official--title-15--19#2.5.2}

Production and Display of License: A person issued a license as a “Licensed Professional Art Therapist” by the Mississippi State Board of Health shall display said license in the professional setting and shall carry the Licensure Identification Card at all times when practicing as a “Licensed Professional Art Therapist.”

Subchapter 6: Renewal of License Rule 2.6.1 General Provisions 1. The Board shall issue licenses which shall be renewed biennially. 2. The licensure period shall be construed as January 1 of even-numbered years through December 31 of odd- numbered years.

**History**
- *SOURCE: Miss. Code Ann. §73-65-1.*
- *SOURCE: Miss. Code Ann. §73-65-1.*

##### **15 Miss. Admin. Code Pt. 19, R. 2.6.2** Procedure for Renewal of Licensure 1 {#sec-19-2.6.2 omnilex-key=us-ms-regs-official--title-15--19#2.6.2}

The Department shall mail a renewal form, approximately sixty (60) days prior to the expiration date, to the last home address registered with the Department, to the persons to whom licensure was issued or renewed during the preceding licensure period. The applicant for renewal shall: a. Complete the renewal form, and b. Submit proof of continuing education credit as detailed in Subchapter 7 of these regulations, and c. Enclose the renewal fee, and d. File the above with the Department prior to the date of expiration of the license.

**History**
- *SOURCE: Miss. Code Ann. §73-65-1*

##### **15 Miss. Admin. Code Pt. 19, R. 2.6.3** Failure to Renew: 1 {#sec-19-2.6.3 omnilex-key=us-ms-regs-official--title-15--19#2.6.3}

Late Renewal: License holders are allowed a ninety (90) day grace period for the late renewal of licensure following expiration of the licensure period. The applicant for late renewal during this period shall: a. Complete the renewal form; and, b. Submit proof of continuing education credit as detailed in Subchapter 7 of these regulations; and, c. Enclose the renewal fee and the late renewal fee; and, d. File the above with the Department prior to the end of the grace period. 2. Suspension: A license is automatically suspended if the license holder does not renew his license prior to the end of the grace period.

3. Reinstatement: The Department may reinstate a license if the late renewal requirements and the reinstatement fee are filed with the Department within ninety (90) days of the date of suspension. A license is automatically revoked if it is not reinstated within the ninety (90) day period following suspension.

Subchapter 7: Continuing Education Rule 2.7.1 Definition and Philosophy: Each individual licensed by the Board is responsible for maintaining high levels of skill and knowledge. Continuing education is defined as education beyond the basic preparation required for licensure and related to the performance of art therapy.

**History**
- *SOURCE: Miss. Code Ann. §73-65-1.*
- *SOURCE: Miss. Code Ann. §73-65-1.*

##### **15 Miss. Admin. Code Pt. 19, R. 2.7.2** Requirements: 1 {#sec-19-2.7.2 omnilex-key=us-ms-regs-official--title-15--19#2.7.2}

Regulations set the requirement of forty (40) clock hours to be accrued during the licensure term for license holders who are not certified and in good standing with the Art Therapy Credentials Board, Inc. 2. License holders certified and in good standing with the Art Therapy Credentials Board, Inc., may submit proof, in form and content satisfactory to the Department, of having met the continuing education requirements of the Art Therapy Credentials Board, Inc., in lieu of the provisions of this section. 3. Individuals applying for initial licensure within a licensure term must accrue continuing education hours on a prorated scale. Written notification of required hours will be sent to the applicant at the time of licensure. 4. Individuals holding a provisional license must meet the same requirements as an individual applying for an initial license. 5. Persons who fail to accrue the required continuing education hours shall be issued a CE probationary license for the entire licensure period. Failure to accrue the required hours during the CE probationary period will result in the revocation of the license. 6. CE probationary licenses will be issued for one licensure period only. No ensuing license may be CE probationary as a result of not meeting continuing education requirements. 7. NOTE: Reinstatement of a license revoked for failure to meet continuing education requirements is subject to the discretion of the Department. If said license is permitted to be reinstated, the renewal fee and the late renewal/reinstatement fee as stated in Section 106 of these regulations will be required.

**History**
- *SOURCE: Miss. Code Ann. §73-65-1*

##### **15 Miss. Admin. Code Pt. 19, R. 2.7.3** Rule 2.7.3 {#sec-19-2.7.3 omnilex-key=us-ms-regs-official--title-15--19#2.7.3}

Content Criteria: The content must apply to the field of art therapy and performance and must be designed to meet one of the following goals: 1. Update knowledge and skills required for competent performance beyond entry level as described in current legislation and regulations. 2. Allow the licensee to enhance his knowledge and skills. 3. Provide opportunities for interdisciplinary learning. 4. Extend limits of professional capabilities and opportunities. 5. Facilitate personal contributions to the advancement of the profession.

**History**
- *SOURCE: Miss. Code Ann. §73-65-1*

##### **15 Miss. Admin. Code Pt. 19, R. 2.7.4** Rule 2.7.4 {#sec-19-2.7.4 omnilex-key=us-ms-regs-official--title-15--19#2.7.4}

Sources of Continuing Education: Continuing education hours may be accrued from the following sources when the content of the programs relates to the profession of art therapy: 1. Attendance at programs sponsored or approved for continuing education by the following groups: a. The American Art Therapy Association (AATA). b. The Mississippi Art Therapy Association (MSATA) or AATA chapter of another state or the District of Columbia. c. Regulatory boards for art therapy in any jurisdiction in the United States. d. Regulatory boards governing the practices of social workers, licensed professional counselors, and marriage and family counselors. e. The National Association of Social Workers or its state affiliate members. f. The American Psychological Association or its state affiliate and/or subsidiary members. g. The American Medical Association or its state affiliate and/or subsidiary members. h. The American Nursing Association or its state affiliate and/or subsidiary members. 2. Presentations, including posters, made before art therapists, medical practitioners, or other health related professionals and directly related to the profession of art therapy. To be considered for continuing education credit, material outline and a

synopsis must be submitted to the Council at least sixty (60) days prior to the presentation date. Notice of approval or disapproval will be sent following a review by the Council. For approved presentations, the presenter may accrue one (1) hour of continuing education credit for each hour of the actual presentation, and one (1) hour of preparation time, for a total of (2) two hours. Presenter credit is given one (1) time only, even though the session may be presented multiple times. No more than 30% of total required hours may be accrued through presentations. Presentations approved by the MATA, whether prior to or subsequent to the presentation, will be accepted for continuing education credit. 3. Academic course work taken from a regionally accredited college or university, either for credit or audit. The courses must relate to the profession of art therapy. Courses in supporting fields must have prior approval of the Council. One academic semester hour shall be equivalent to fifteen (15) clock hours for continuing education credit. No more than fifty percent (50%) of total required hours may be accrued through academic course work. 4. Professional publications where the license holder is an author. To be considered for continuing education credit, a reprint of the published article must be submitted to the department. Notice of approval or disapproval will be sent out after review by the department. A maximum of three (3) contact hours may be accrued through professional publication.

**History**
- *SOURCE: Miss. Code Ann. §73-65-1.*

##### **15 Miss. Admin. Code Pt. 19, R. 2.7.5** Rule 2.7.5 {#sec-19-2.7.5 omnilex-key=us-ms-regs-official--title-15--19#2.7.5}

Reporting Procedures for Continuing Education: Continuing education hours are reported on the application for license renewal during the license renewal period prior to its expiration. It is the responsibility of the licensee to insure that the following criteria are met with respect to continuing education credit: 1. Attendance at seminars, workshops, presentations, etc., approved by the organizations listed in Rule 2.7.4(1) are automatically accepted for credit unless sessions are duplicated. Verification of attendance may be made by the submission of a continuing education certificate, or a continuing education reporting form from the organization issuing continuing education hours and proof of approval. 2. Presentation credits: Submit a copy of the program listing the presentation and a copy of the prior letter of approval from the council. 3. Academic course work credits must meet the content criteria in Rule 2.7.3, and must be accompanied by a course description from the college or university catalog and a copy of the transcript or final grade report.

4. Professional publication: Submit a copy of the letter of approval from the council.

Subchapter 8: Revocation, Suspension and Denial of Licensure Rule 2.8.1 Standards of Conduct: Individuals who are licensed may, at the discretion of the Board, have their licenses suspended, revoked, or denied if the Board determines that the individual is guilty of any of the following: 1. Is guilty of fraud or deceit in procuring or attempting to procure a license or renewal of licensure. 2. Is unfit or incompetent by reason of gross ignorance, negligence, habits, or other causes of incompetence. 3. Is habitually intemperate in the use of alcoholic beverage. 4. Is convicted of an offense involving moral turpitude. 5. Is knowingly practicing while suffering with a contagious or infectious disease. 6. Is addicted to, or has improperly obtained, possessed, used, or distributed habit- forming drugs or narcotics. 7. Is guilty of dishonest or unethical conduct. 8. Has represented himself as a licensed professional art therapist after his license has expired or has been suspended. 9. Has practiced as a licensed art therapist under cover of any permit or license illegally or fraudulently obtained or issued. 10. Has violated, aided, or abetted others in violation of any provision of law, or these regulations. 11. Has engaged in any conduct considered by the Board to be detrimental to the profession of art therapy. 12. Has violated the current code of ethics of the American Art Therapy Association. 13. Has had disciplinary action taken against the license holder’s license, certificate, registration, etc., in another jurisdiction.

**History**
- *SOURCE: Miss. Code Ann. §73-65-1.*
- *SOURCE: Miss. Code Ann. §73-65-1.*

##### **15 Miss. Admin. Code Pt. 19, R. 2.8.2** Rule 2.8.2 {#sec-19-2.8.2 omnilex-key=us-ms-regs-official--title-15--19#2.8.2}

Summary Suspension: The Board may summarily suspend licensure without a hearing, simultaneously with the filing of a formal complaint and notice of hearing, if the Board determines that:

1. The health, safety, or welfare of the general public is in immediate danger; or 2. The individual's physical capacity to practice his profession is in issue; or 3. The individual's mental capacity to practice his profession is in issue.

**History**
- *SOURCE: Miss. Code Ann. §73-65-1.*

##### **15 Miss. Admin. Code Pt. 19, R. 2.8.3** Rule 2.8.3 {#sec-19-2.8.3 omnilex-key=us-ms-regs-official--title-15--19#2.8.3}

Complaints: All complaints concerning a licensed individual, his business, or professional practice, shall be reviewed by the Department. Each complaint received shall be logged, recording at a minimum the following information: 1. name of the licensed individual; 2. name of the complaining party, if known; 3. date of complaint; 4. brief statement of complaint; and 5. disposition

**History**
- *SOURCE: Miss. Code Ann. §73-65-1.*

##### **15 Miss. Admin. Code Pt. 19, R. 2.8.4** Rule 2.8.4 {#sec-19-2.8.4 omnilex-key=us-ms-regs-official--title-15--19#2.8.4}

Investigation: All complaints will be investigated and evaluated by an authorized employee of the Department or a Council member designated by the Department.

**History**
- *SOURCE: Miss. Code Ann. §73-65-1.*

##### **15 Miss. Admin. Code Pt. 19, R. 2.8.5** Rule 2.8.5 {#sec-19-2.8.5 omnilex-key=us-ms-regs-official--title-15--19#2.8.5}

Notice of Charges and Hearing: Following the investigative process, the Department may file formal charges against the licensed individual. Such formal complaint shall, at a minimum, inform the respondent of the facts which are the basis of the charge and which are specific enough to enable the respondent to defend against the charges. 1. Each respondent, whose conduct is the subject of a formal charge which seeks to impose disciplinary action against him, shall be served notice of the formal charge at least thirty (30) days before the date of hearing. A hearing shall be presided over by the Board or the Board's designee. Service shall be considered to have been given if the notice was personally received by the respondent, or the notice was mailed certified, return receipt requested, to the respondent at his last know address as listed with the state agency. 2. The notice of the formal hearing shall consist at a minimum of the following information: a. The time, place and date of hearing;

b. That the respondent shall appear personally at the hearing and may be represented by counsel; c. That the respondent shall have the right to produce witnesses and evidence in his own behalf and shall have the right to cross-examine adverse witnesses; and evidence d. That the hearing could result in disciplinary action being taken against the respondent’s license. e. That rules for the conduct of these hearings exist and it may be in the respondent’s best interest to obtain a copy; and f. That the Board, or its designee, shall preside at the hearing and following the conclusion of the hearing shall make findings of facts, conclusions of law and recommendations, separately stated, to the Board as to what disciplinary action, if any, should be imposed on the respondent. i. The Board or its designee shall hear evidence produced in support of the formal charges and contrary evidence produced by the respondent. At the conclusion of the hearing, the Board shall issue an order within sixty (60) days. ii. Disposition of any complaints may be made by consent order or stipulation between the Board and the respondent. iii. All proceedings pursuant to this section are matters of public record and shall be preserved pursuant to State law.

**History**
- *SOURCE: Miss. Code Ann. §73-65-1.*

##### **15 Miss. Admin. Code Pt. 19, R. 2.8.6** Rule 2.8.6 {#sec-19-2.8.6 omnilex-key=us-ms-regs-official--title-15--19#2.8.6}

Board Sanctions: The Board may impose any of the following sanctions, singly or in combination, when it finds that a respondent is guilty of any of the above offenses: 1. Revocation of the license; 2. Suspension of the license, for any period of time; 3. Censure the licensed individual; 4. Issue a letter of reprimand to the licensed individual; 5. Place a license on probationary status and require the individual to submit to any of the following: a. Report regularly to the board upon matters which are the basis of probation;

b. continue to renew professional education until a satisfactory degree of skill has been attained in those areas which are the basis of probation; or c. such other reasonable requirements or restrictions as are proper; d. Refuse to renew a license; or e. Revoke probation which has been granted and impose any other disciplinary action in this subsection when the requirements of probation have not been fulfilled or have been violated.

**History**
- *SOURCE: Miss. Code Ann. §73-65-1.*

##### **15 Miss. Admin. Code Pt. 19, R. 2.8.7** Rule 2.8.7 {#sec-19-2.8.7 omnilex-key=us-ms-regs-official--title-15--19#2.8.7}

Appeal: Any person aggrieved by a decision of the Board shall have a right of appeal as provided for in the Laws of the State of Mississippi.

Subchapter 9: Exceptions and Exemptions Rule 2.9.1 Exceptions: 1. Nothing in these regulations is intended to limit, preclude or otherwise interfere with the practices of other persons and health providers licensed by appropriate agencies of the State of Mississippi. 2. Nothing in these regulations shall be construed to limit, interfere with, or restrict the practice, descriptions of services, or manner in which the “activities professionals” at licensed nursing facilities hold themselves out to the public.

**History**
- *SOURCE: Miss. Code Ann. §73-65-1.*
- *SOURCE: Miss. Code Ann. §73-65-1.*

##### **15 Miss. Admin. Code Pt. 19, R. 2.9.2** Good Samaritan Act: Left Blank on Purpose {#sec-19-2.9.2 omnilex-key=us-ms-regs-official--title-15--19#2.9.2}

Subchapter 10: Left Blank on Purpose

Subchapter 11: Criminal Offenses and Punishment Rule 2.11.1 Offenses: It is a violation of the law for any person to: 1. Sell, fraudulently obtain or furnish any license, or aid or abet therein. 2. Use the title, "Licensed Professional Art Therapist" or any words letters, signs, symbols or devices to indicate the person using them has received a license from the Mississippi Department of Health.

3. Fail to notify the Board of the suspension, probation or revocation of any past or currently held licenses or certifications, required to practice art therapy in this or any other jurisdiction. 4. Make false representations, impersonate, act as a proxy for another person, allow, or aid any person to impersonate him in connection with any examination or application for license or request to be examined or licensed. 5. Make a material, false statement in an application for licensure, or in a response to any inquiry by the Mississippi Department of Health or the Board. 6. Otherwise violate any provisions of the Act, or regulations of the Board.

**History**
- *SOURCE: Miss. Code Ann. §73-65-1.*
- *SOURCE: Miss. Code Ann. §73-65-1.*
- *SOURCE: Miss. Code Ann. §73-65-1.*

##### **15 Miss. Admin. Code Pt. 19, R. 2.11.2** Rule 2.11.2 {#sec-19-2.11.2 omnilex-key=us-ms-regs-official--title-15--19#2.11.2}

Punishment: Such violations shall be a misdemeanor, and shall be punishable by a fine not to exceed Five Hundred Dollars, ($500.00) or by imprisonment in the county jail for not more than three (3) months, or by both.

Subchapter 12: Fees Rule 2.12.1 Method of Payment: The following fees, where applicable, are payable to the Department of Health by check, or money order. Fees paid to the Mississippi Department of Health are non-refundable.

**History**
- *SOURCE: Miss. Code Ann. §73-65-1.*
- *SOURCE: Miss. Code Ann. §73-65-1.*

##### **15 Miss. Admin. Code Pt. 19, R. 2.12.2** Schedule of Fees 1 {#sec-19-2.12.2 omnilex-key=us-ms-regs-official--title-15--19#2.12.2}

Application and Initial Licensure Fee ...........................................................$100.00 2. Renewal Fee .................................................................................................$ 75.00 3. Late Renewal Fee .........................................................................................$100.00 4. Reinstatement Fee ........................................................................................$100.00 5. Verification Fee ............................................................................................$ 25.00 6. Duplicate License Fee ...................................................................................$ 25.00 7. License Replacement Fee .............................................................................$ 25.00 8. Card Replacement Fee ..................................................................................$ 10.00

**History**
- *SOURCE: Miss. Code Ann. §73-65-1.*

##### **15 Miss. Admin. Code Pt. 19, R. 2.12.3** Examination Fee: Fees for examination are to be paid directly to the appropriate testing organization {#sec-19-2.12.3 omnilex-key=us-ms-regs-official--title-15--19#2.12.3}

Subchapter 13: Administrative Grievance Procedure Rule 2.13.1 Administrative Appeals: All persons aggrieved by a decision regarding the initial application for licensure, or the renewal of licensure, shall have the right of administrative appeal and a hearing to be conducted according to the rules of the Department of Health.

**History**
- *SOURCE: Miss. Code Ann. §73-65-1.*
- *SOURCE: Miss. Code Ann. §73-65-1.*

##### **15 Miss. Admin. Code Pt. 19, R. 2.13.2** Rule 2.13.2 {#sec-19-2.13.2 omnilex-key=us-ms-regs-official--title-15--19#2.13.2}

Notification: Written notice will be provided to all applicants regarding denial of an original license or a renewal license. Such notice shall contain the reason thereof and shall offer the applicant an opportunity to submit additional information pertinent to their application for a second review by the Department.

**History**
- *SOURCE: Miss. Code Ann. §73-65-1.*

##### **15 Miss. Admin. Code Pt. 19, R. 2.13.3** Rule 2.13.3 {#sec-19-2.13.3 omnilex-key=us-ms-regs-official--title-15--19#2.13.3}

Hearing: If requested in writing within the specified time frame a hearing will be provided in which the applicant may show cause why the license should be granted or renewed. Within sixty (60) days of the hearing, or other such time frame as determined during the hearing, written findings of fact, together with a recommendation for action on the license in question, shall be forwarded to the State Health Officer. The State Health Officer shall decide what action will be taken on the recommendation within five days of its receipt. Written notice shall be provided to the applicant.

**History**
- *SOURCE: Miss. Code Ann. §73-65-1.*

#### **Chapter 3** REGULATIONS GOVERNING LICENSURE OF DIETITIANS Subchapter 1: General Rule 3.1.1 Purpose: The purpose of these regulations is to safeguard the public's health, safety, and welfare by establishing minimum qualifications and creating exclusive titles corresponding to the level of qualifications for individuals who wish to offer dietetic and nutritional services to the public. Further, in order to insure the highest degree of professional conduct by those engaged in offering dietetic and nutritional services to the public, it is the purpose of these regulations to provide and impose disciplinary sanctions, be they civil or criminal, against persons who do not meet or adhere to the procedures, qualifications, and standards set out in the Act and in these regulations.

##### **15 Miss. Admin. Code Pt. 19, R. 3.1.2** Rule 3.1.2 {#sec-19-3.1.2 omnilex-key=us-ms-regs-official--title-15--19#3.1.2}

Legal Authority: The State Board of Health is authorized to establish and enforce these rules and procedures by virtue of the "Mississippi Dietetics Practice Act of 1986," Sections 73-10-1 et seq. of Mississippi Code of 1972, annotated.

**History**
- *SOURCE: Miss. Code Ann. § 73-10-21.*

##### **15 Miss. Admin. Code Pt. 19, R. 3.1.3** Definitions: The following terms shall have the meaning set forth below, unless the context otherwise requires: 1 {#sec-19-3.1.3 omnilex-key=us-ms-regs-official--title-15--19#3.1.3}

"Board" shall mean the Mississippi State Board of Health. 2. "Advisory Council" shall mean the Mississippi Council of Advisors in Dietetics. 3. "Association" means the American Dietetic Association (ADA). 4. "Mississippi Association" means the Mississippi Dietetic Association, an affiliate of the American Dietetic Association (MDA). 5. "Commission on Dietetic Registration" (CDR) means the Commission on Dietetic Registration that is a member of the National Commission for Health Certifying Agencies. 6. "Degree" means a degree received from a college or university that was accredited through the Council on Post-secondary Accreditation and the U.S. Department of Education at the time the degree was conferred. 7. "Registered Dietitian" means a person registered by the Commission on Dietetic Registration. 8. "Licensed Dietitian" means a person licensed pursuant to these regulations. 9. "Provisionally Licensed Dietitian" means a person provisionally licensed pursuant to these regulations. 10. "Dietetics Practice" means the integration and application of the principles derived from the sciences of nutrition, biochemistry, food, physiology, management and behavioral and social sciences to achieve and maintain people's health. Dietetic practice includes, but is not limited to: a. Providing medical nutrition therapy. b. Development, administration, evaluation, and consultation regarding nutritional care standards of quality in food services and medical nutrition therapy. c. Providing nutrition counseling in health and disease. d. Developing, implementing and managing nutrition care systems.

e. Providing case management services. 11. "Medical nutrition therapy" is a nutritional diagnostic therapy and counseling services for the purpose of disease management. It means the assessment of the nutritional status of patients with a condition, illness, or injury that appropriately requires medical nutrition therapy as part of the treatment. The assessment includes review and analysis of medical and diet history, blood chemistry lab values and anthropometric measurements to determine nutritional status and treatment modalities. a. Therapy ranges from diet modification and nutrition counseling to administration of specialized nutrition therapies such as intravenous medical nutritional products as determined necessary to manage a condition or treat illness or injury. b. Administration of specialized nutrition therapies does not include the clinical aspects of insertion of the nasogastric tube, initiation of the intravenous line, nor administration of nutritional feedings/fluids or medications via the intravenous, nasogastric, or gastrostomy route. 12. "Diet modification and nutrition counseling" means intervention and advice in assisting individuals or groups in the development of personal diet plans to achieve appropriate nutritional intake. To develop the diet plan, the dietitian integrates information from the nutritional assessment with information on food and other sources of nutrients and meal preparation consistent with cultural background and socioeconomic status. 13. "Specialized nutrition therapies" mean medical foods, enteral nutrition delivered via tube, or parenteral nutrition delivered by intravenous infusion. 14. "Nutrition Educator" shall mean one who communicates scientific nutrition information to individuals and/or groups and who provides information on food sources of nutrients to meet normal nutrition need based on the most current "Recommended Dietary Allowances" of the Food and Nutrition Board, National Academy of Sciences, National Research Council. 15. "Dietitian" means one engaged in dietetics practice, medical nutrition therapy or nutrition education. The terms dietitian or dietician are used interchangeably in this chapter. 16. "Direct technical supervision" means the direct, technical supervision by a licensed dietitian, as prescribed in regulations by the Board, of the dietetics practice or medical nutrition therapy provided to an individual and/or group by a provisionally licensed dietitian. 17. "License" shall mean the document of licensure issued by the Board. 18. "Department" shall mean the Mississippi Department of Health.

19. "Examination" shall mean the Registration Examination for Dietitians as administered by the Commission on Dietetic Registration or other examination that the Department may designate. 20. "Act" shall mean the "Mississippi Dietetics Practice Act of 1986," Sections 73- 10-1 et seq. of Mississippi Code of 1972, annotated. 21. “Nonmedical Weight Control” shall mean the provision of services for the purpose of reducing, maintaining, or gaining weight that does not constitute the treatment and management of a disease or medical condition. The term includes weight control services for healthy population groups to achieve or maintain a healthy weight.

**History**
- *SOURCE: Miss. Code Ann. § 73-10-21.*

##### **15 Miss. Admin. Code Pt. 19, R. 3.1.4** Rule 3.1.4 {#sec-19-3.1.4 omnilex-key=us-ms-regs-official--title-15--19#3.1.4}

Publication: The Department shall make available, upon request and payment of a fee, a list of the names and addresses of all persons licensed by the Department as Dietitians, and a list of all persons whose licenses have been suspended, revoked, denied renewal, put on probationary status, censured, or reprimanded during the current licensure term.

Subchapter 2: Mississippi Council of Advisors in Dietetics (“Council”) Rule 3.2.1 Council Structure and Purpose: The Council shall consist of seven (7) members as set forth in the enabling statute, for the terms indicated therein, and shall serve under the jurisdiction of the State Board of Health. The purpose of the Council is to serve in an advisory capacity to the Board in matters relating to the administration and interpretation of the enabling statute.

**History**
- *SOURCE: Miss. Code Ann. § 73-10-21.*
- *SOURCE: Miss. Code Ann. § 73-10-21.*

##### **15 Miss. Admin. Code Pt. 19, R. 3.2.2** Meetings: The Council shall meet at least twice each year {#sec-19-3.2.2 omnilex-key=us-ms-regs-official--title-15--19#3.2.2}

Additional meetings may be held, at the discretion of the chairman of the Council or of the Board, upon ten (10) day written notice to the Council members. A quorum shall consist of four (4) members of the Council, including the chairman, and shall be necessary for the Council to take action by vote.

Subchapter 3: State Board of Health (“Board”) Rule 3.3.1 Responsibilities: The Board, with the advice of the council, shall: 1. establish licensing and renewal of license criteria for applicants;

2. refer disciplinary actions of any individual engaged in the practice of dietetics to the appropriate government agency for prosecution, whether licensed or otherwise, or, in its discretion, refer same to the appropriate committee or council; 3. conduct disciplinary hearings, upon specified charges, of a licensee; and 4. direct the Department to promulgate and implement rules and procedures to carry out the purpose of the Act.

Subchapter 4: Licensure Rule 3.4.1 Licensure Requirements: An applicant for licensure shall submit to the Department, verified by oath, written evidence in form and content satisfactory to the Department that the applicant: 1. has passed an examination as administered by the Commission on Dietetic Registration or other examination as approved by the Department; 2. is in good standing in any other state or jurisdiction where licensed; 3. is of good moral character; and 4. is presently in good standing with the Commission on Dietetic Registration.

**History**
- *SOURCE: Miss. Code Ann. § 73-10-21.*
- *SOURCE: Miss. Code Ann. § 73-10-21.*
- *SOURCE: Miss. Code Ann. § 73-10-21.*

##### **15 Miss. Admin. Code Pt. 19, R. 3.4.2** Rule 3.4.2 {#sec-19-3.4.2 omnilex-key=us-ms-regs-official--title-15--19#3.4.2}

Provisional License: The Board may, in its discretion, issue a provisional license for the practice of dietetics for a period of one (1) year, providing the applicant submits to the Department, verified by oath, in form and content satisfactory to the Department that the applicant: 1. is a resident of the State of Mississippi; and 2. has received a baccalaureate or post-baccalaureate degree from a college or university accredited through the U.S. Department of Education, Office of Postsecondary Education, with a major in dietetics or an equivalent major course of study as approved by the Department; and 3. Submits proof of having successfully completed a planned program of dietetic experience which makes the applicant eligible for registration by the Commission on Dietetic Registration, or its successor organization: and a. will be practicing only under the direct technical supervision of a dietitian. b. is of good moral character.

4. In its discretion, and upon application, the Board may renew a provisional license from year to year, not to exceed five (5) years, from the date of the issuance of the original provisional license.

**History**
- *SOURCE: Miss. Code Ann. § 73-10-21.*

##### **15 Miss. Admin. Code Pt. 19, R. 3.4.3** Rule 3.4.3 {#sec-19-3.4.3 omnilex-key=us-ms-regs-official--title-15--19#3.4.3}

Direct Technical Supervision: Direct technical supervision shall mean a periodic review, by the licensed dietitian on file as the supervisor with the Department, of the practice of the provisional licensee. A review shall be conducted no less then once a month, and shall include a written assessment of the practice of the provisional licensee. Rule 3.4.4 Conditions of a Universal Occupational License: 1. Notwithstanding any other provision of law, the Department shall issue a license in dietetics and at the same practice level to a person who establishes residence in this state if, upon application to the Department: a. The applicant holds a current and valid license in good standing in another state in an occupation with a similar scope of practice, as determined by the occupational licensing board in Mississippi, and has held this license from the occupational licensing board in the other state for at least one (1) year; and b. There were minimum education requirements and, if applicable, work experience, examination, and clinical supervision requirements in effect, and the other state verifies that the applicant met those requirements in order to be licensed in that state; and c. The applicant has not committed any act in the other state that would have constituted grounds for refusal, suspension, or revocation of a license to practice that occupation in Mississippi at the time the act was committed, and the applicant does not have a disqualifying criminal record as determined by the occupational licensing board in Mississippi under Mississippi law; and d. The applicant did not surrender a license because of negligence or intentional misconduct related to the applicant's work in the occupation in another state; and e. The applicant does not have a complaint, allegation, or investigation pending before an occupational licensing board or other board in another state that relates to unprofessional conduct or an alleged crime. If the applicant has a complaint, allegation, or investigation pending, the occupational licensing board in Mississippi shall not issue or deny a license to the applicant until the complaint, allegation, or investigation is resolved, or the applicant otherwise satisfies the criteria for licensure in Mississippi to the satisfaction of the occupational licensing board in Mississippi; and

f. The applicant pays all applicable fees in Mississippi. 2. Notwithstanding any other law, the Department shall issue a license to an applicant in dietetics and at the same practice level, as determined by the Department, to a person who establishes residence in this state based on work experience in another state, if all the following apply: a. The applicant worked in a state that does not use a license to regulate a lawful occupation, but Mississippi uses a license to regulate a lawful occupation with a similar scope of practice, as determined by the Department; b. The applicant worked for at least three (3) years in the lawful occupation; and c. The applicant satisfies the provisions of paragraphs (c) through (f) of Rule 3.4.4(1). 3. The Department may require an applicant to pass a jurisprudential examination specific to relevant state laws in Mississippi that regulate dietitians if the issuance of a license in Mississippi requires an applicant to pass a jurisprudential examination specific to relevant state statutes and administrative rules in Mississippi that regulate dietitians. 4. The Department may require proof of residency. Residence may be established by demonstrating proof of a state-issued identification card or one (1) of the following: a. Current Mississippi residential utility bill with the applicant's name and address; b. Documentation of the applicant's current ownership, or current lease of a residence in Mississippi; c. Documentation of current in-state employment or a notarized letter of a promise of employment of the applicant or his or her spouse; or d. Any verifiable documentation demonstrating Mississippi residency. 5. A license issued under this section is valid only in this state and does not make the person eligible to be part of an interstate compact. 6. The occupational licensing board shall issue or deny the license to the applicant within one hundred twenty (120) days after receiving an application. 7. If the application requires longer than two (2) weeks to process, the Department shall issue a temporary practice permit within thirty (30) days after receiving the application if the applicant submits an affidavit, under penalties of perjury,

affirming that he or she satisfies the provisions of Rule 3.4.4(3) or Rule 3.4.4(4) and pays all applicable fees as required by Rule 3.4.4(1)(f).

a. The applicant may practice under the temporary permit until a license is granted, or until a notice to deny the license is issued, in accordance with rules adopted by the Department. A temporary license will expire in three hundred sixty-five (365) days after its issuance if the applicant fails to satisfy the requirement for licensure in subsections (3) through (5), as applicable. 8. A nonresident dietitian may practice dietetics in Mississippi for five (5) days per year with a current other state's licensure or with current registration with the Commission on Dietetics Registration. 9. The Department may waive the prescribed examination for licensure and grant a license to any person who shall present proof of current licensure as a dietitian in another state, the District of Columbia, or territory of the United States which requires standards for licensure considered by the advisory council to be greater than or equal to the requirements for licensure of this chapter if such state or territory extends reciprocity to licensees of the State of Mississippi. The issuance of a license by reciprocity to a military-trained applicant, military spouse, or person who establishes residence in this state shall be subject to the provisions of Section 73-50-1 or 73-50-2, as applicable. 10. Denial of Universal License a. The applicant may appeal any of the following decisions of an occupational licensing board to a court of general jurisdiction: (i) Denial of a license; (ii) Determination of the occupation; (iii) Determination of the similarity of the scope of practice of the license issued; or (iv) Other determinations under this section. b. The court shall determine all questions of law, including the interpretation of a constitutional or statutory provision or a rule adopted by the Department, without regard to any previous determination that may have been made on the question in any action before the Department.

**History**
- *SOURCE: Miss. Code Ann. § 73-10-21.*

##### **15 Miss. Admin. Code Pt. 19, R. 3.4.5** Rule 3.4.5 {#sec-19-3.4.5 omnilex-key=us-ms-regs-official--title-15--19#3.4.5}

Abandonment: An application shall be deemed abandoned by the Department if, after two years from the date of filing, the requirements for licensing have not been completed and submitted to the Department.

Subchapter 5: Professional Practice and Identification Rule 3.5.1 Practice, Titles and Abbreviation: It shall be unlawful for any person, corporation or association to, in any manner, represent himself or itself as a dietitian or nutritionist, send out billings as providing services covered in Section 100.03 10, 11, 12, and 13, or use in connection with his or its name, the titles "dietitian" or "nutritionist" or use the letters "LD," "LN" or any other facsimile thereof when he or she is not licensed in accordance with the provisions of these regulations or meets the exemptions set forth in Section 108 herein. Notwithstanding any other provision of these regulations, a dietitian registered by the Commission on Dietetic Registration (CDR) shall have the right to use the title "Registered Dietitian" and the designation "R.D.” Registered dietitians must be licensed pursuant to these regulations to practice dietetics or provide medical nutrition therapy.

**History**
- *SOURCE: Miss. Code Ann. § 73-10-21.*
- *SOURCE: Miss. Code Ann. § 73-10-21.*

##### **15 Miss. Admin. Code Pt. 19, R. 3.5.2** Rule 3.5.2 {#sec-19-3.5.2 omnilex-key=us-ms-regs-official--title-15--19#3.5.2}

Production and Display of License: A person issued a license to practice dietetics by the Mississippi State Board of Health shall carry said license at all times and show said license when requested.

Subchapter 6: Renewal of License Rule 3.6.1 General Provisions: 1. The Board shall issue licenses which, upon expiration of the initial license, shall be renewed biennially. 2. The licensure term for regular licenses shall be construed as April 1 of even numbered years through March 31 of odd numbered years. 3. The Department shall issue provisional licenses which, upon expiration of the initial provisional license, shall be renewed annually. 4. The licensure term for provisional licenses shall be construed as April 1 through March 31.

**History**
- *SOURCE: Miss. Code Ann. § 73-10-21.*
- *SOURCE: Miss. Code Ann. § 73-10-21.*

##### **15 Miss. Admin. Code Pt. 19, R. 3.6.2** Rule 3.6.2 {#sec-19-3.6.2 omnilex-key=us-ms-regs-official--title-15--19#3.6.2}

Procedure for Renewal of License: The Department shall mail notices, at least thirty (30) days prior to the renewal date, to the last home address registered with the Board, to the persons to whom licenses were issued or renewed during the preceding licensure term. The licensee shall: 1. complete the renewal form; 2. submit proof of continuing education credit as detailed in Section 106 of these regulations; 3. enclose the renewal fee; and 4. file the above with the Department prior to the end of the licensure term, which is the expiration date of the license.

**History**
- *SOURCE: Miss. Code Ann. § 73-10-21.*

##### **15 Miss. Admin. Code Pt. 19, R. 3.6.3** Rule 3.6.3 {#sec-19-3.6.3 omnilex-key=us-ms-regs-official--title-15--19#3.6.3}

Failure to Renew: A licensee who does not file, with the Department, the renewal application within the renewal period will be deemed to have allowed his license to lapse. Said licensee may be reinstated by the Department, in its discretion, by the payment of the renewal fee and a reinstatement fee, provided said application for reinstatement is made within two (2) years of the end of the licensure term. Any license that has lapsed for a full licensure term must, upon re-application, meet the requirements for licensure at the time of the application.

Subchapter 7: Continuing Education Rule 3.7.1 Requirements: 1. Regulations set the requirement for continuing education at thirty (30) clock hours to be accrued during the two year licensure term. 2. For provisional licensees, regulations set the requirement for continuing education at fifteen (15) clock hours to be accrued during the one year provisional licensure term. 3. Licensees registered and in good standing with the Commission on Dietetic Registration may submit proof, in form and content satisfactory to the Department, of having met the continuing education requirements of the CDR in lieu of the provisions of this section. 4. Individuals applying for initial licensure within a licensing term must accrue continuing education hours on a prorated scale. Written notification of required hours will be sent to the applicant at the time of licensure.

5. Persons who fail to accrue the required continuing education hours shall be issued a probationary license for a term of two (2) years or in the case of provisional licensees, for one (1) year. Failure to accrue the required hours will automatically result in the revocation of the license. Hours accrued are first credited for the delinquent hours lacking from the previous licensure period, and then applied to the present licensing period. 6. Probationary licenses will be issued for one licensure term only. No ensuing license may be probationary as a result of not meeting continuing education requirements.

**History**
- *SOURCE: Miss. Code Ann. § 73-10-21.*
- *SOURCE: Miss. Code Ann. § 73-10-21.*

##### **15 Miss. Admin. Code Pt. 19, R. 3.7.2** Sources of Continuing Education: Continuing education hours may be accrued from the following sources: 1 {#sec-19-3.7.2 omnilex-key=us-ms-regs-official--title-15--19#3.7.2}

Attendance at Mississippi Dietetic Association (MDA) sponsored meetings, American Dietetic Association (ADA) sponsored meetings, or other meetings approved for continuing education credit by MDA or ADA. 2. Presentations made before dietitians, medical practitioners, or other health related professionals and directly related to the profession of dietetics. To be considered for continuing education credit, material outline and a synopsis must be submitted to the Department at least sixty (60) days prior to the presentation date. Notice of approval or disapproval will be sent following a review by the council. For approved presentations, the presenter may accrue one (1) hour of continuing education credit for each hour of the actual presentation, and one (1) hour of preparation time, for a total of (2) two hours. Presenter credit is given one (1) time only, even though the session may be presented multiple times. No more than 30% of total required hours may be accrued through presentations. Presentations approved by the MDA, whether prior to or subsequent to the presentation, will be accepted for continuing education credit. 3. Academic course work taken from a regionally accredited college or university for credit or with a grade of at least a C. The courses must relate to the profession of dietetics. Courses in supporting fields must have prior approval of the Department. One academic semester hour shall be equivalent to fifteen (15) clock hours for continuing education credit. No more than fifty percent (50%) of total required hours may be accrued through academic course work.

**History**
- *SOURCE: Miss. Code Ann. § 73-10-21.*

##### **15 Miss. Admin. Code Pt. 19, R. 3.7.3** Rule 3.7.3 {#sec-19-3.7.3 omnilex-key=us-ms-regs-official--title-15--19#3.7.3}

Reporting Procedures for Continuing Education: It is the responsibility of the licensee to insure that the following criteria are met with respect to continuing education credit: 1. Attendance at seminars, workshops, presentations, etc., approved by the MDA and ADA are automatically accepted for credit unless sessions are duplicated.

Verification of attendance may be made by a roster signed by the program chairman, submission of a continuing education certificate, or a continuing education reporting form signed by the program chairman. 2. Presentation credits will be accrued when cited on the continuing education form and accompanied by a copy of the program listing the presentation, and a copy of the prior letter of approval from the council. 3. Academic course work credits to be accrued must meet the content criteria in Sections 106.03, be cited by title on the continuing education form, and must be accompanied by a course description from the college or university catalog and a copy of the transcript or final grade report.

Subchapter 8: Revocation, Suspension and Denial of License Rule 3.8.1 Standards of Conduct: Licensees may, at the discretion of the Board, have their license suspended, revoked, or denied at the time of renewal if the Board determines that the licensee: 1. Is guilty of fraud, misrepresentation, concealment of material facts, or deceit in procuring or attempting to procure a license or renewal of a license to practice dietetics. 2. Is unfit or incompetent by reason of negligence, habits, or other causes of incompetency. 3. Is habitually intemperate in the use of alcoholic beverage. 4. Is addicted to, or has improperly obtained, possessed, used or distributed habit- forming drugs or narcotics. 5. Is guilty of dishonest or unethical conduct. 6. Is in violation of the Code of Ethics of the American Dietetic Association. 7. Has practiced dietetics after his license has expired or has been suspended. 8. Has practiced dietetics under cover of any permit or license illegally or fraudulently obtained or issued. 9. Has violated, aided, or abetted others in violation of any provision of these regulations, rules of the Board or Department, or the Act. 10. Is convicted of a crime in any court other than a misdemeanor. 11. Has engaged in any conduct considered by the Board to be detrimental to the profession of dietetics.

**History**
- *SOURCE: Miss. Code Ann. § 73-10-21.*
- *SOURCE: Miss. Code Ann. § 73-10-21.*

##### **15 Miss. Admin. Code Pt. 19, R. 3.8.2** Rule 3.8.2 {#sec-19-3.8.2 omnilex-key=us-ms-regs-official--title-15--19#3.8.2}

Summary Suspension: The Board may summarily suspend a license without a hearing, simultaneously with the filing of a formal complaint and notice of hearing, if the Board determines that: 1. The health, safety, or welfare of the general public is in immediate danger; or 2. The licensee's physical capacity to practice his profession is in issue; or 3. The licensee's mental capacity to practice his profession is in issue.

**History**
- *SOURCE: Miss. Code Ann. § 73-10-21.*

##### **15 Miss. Admin. Code Pt. 19, R. 3.8.3** Rule 3.8.3 {#sec-19-3.8.3 omnilex-key=us-ms-regs-official--title-15--19#3.8.3}

Complaints: All complaints concerning a licensee shall be reviewed by the Department to determine what action, if any, shall be initiated.

**History**
- *SOURCE: Miss. Code Ann. § 73-10-21.*

##### **15 Miss. Admin. Code Pt. 19, R. 3.8.4** Notice of Charges and Hearing: 1 {#sec-19-3.8.4 omnilex-key=us-ms-regs-official--title-15--19#3.8.4}

Following the investigative process, the Department may file formal charges against the licensee. Such formal complaint shall, at a minimum, inform the licensee of the facts which are the basis of the charge and which are specific enough to enable the licensee to defend against the charges. 2. Each licensee, whose conduct is the subject of a formal charge which seeks to impose disciplinary action against the licensee, shall be served notice of the formal charge at least fifteen (15) days before the date of hearing. A hearing shall be presided over by the Board or the Board's designee. Service shall be considered to have been given if the notice was personally received by the licensee, or the notice was mailed certified, return receipt requested, to the licensee at the licensee's last known home address as listed with the state agency. 3. The notice of the formal hearing shall consist at a minimum of the following information: a. The time, place and date of hearing; b. That the licensee shall appear personally at the hearing and may be represented by counsel; c. That the licensee shall have the right to produce witnesses and evidence in the licensee's behalf and shall have the right to cross-examine adverse witnesses and evidence; d. That the hearing could result in disciplinary action being taken against the licensee's license;

e. That rules for the conduct of these hearings exist and it may be in the licensee's best interest to obtain a copy; and f. That the Board, or its designee, shall preside at the hearing and following the conclusion of the hearing shall make findings of facts, conclusions of law and recommendations, separately stated, to the Board as to what disciplinary action, if any, should be imposed on the licensee. 4. The Board or its designee shall hear evidence produced in support of the formal charges and contrary evidence produced by the licensee. At the conclusion of the hearing, the Board shall issue an order, within sixty (60) days. 5. Disposition of any complaints may be made by consent order or stipulation between the Board and the licensee. 6. All proceedings pursuant to this section are matters of public record and shall be preserved pursuant to state law.

**History**
- *SOURCE: Miss. Code Ann. § 73-10-21.*

##### **15 Miss. Admin. Code Pt. 19, R. 3.8.5** Rule 3.8.5 {#sec-19-3.8.5 omnilex-key=us-ms-regs-official--title-15--19#3.8.5}

Board Sanctions: The Board may impose any of the following sanctions, singly or in combination, when it finds that a licensee is guilty of any of the above offenses: 1. Revocation of the license; 2. Suspension of the license, for any period of time; 3. Censure the licensee; 4. Issue a letter of reprimand to the licensee; 5. Place a license on probationary status and require the licensee to submit to any of the following: a. report regularly to the Board upon matters which are the basis of probation; b. continue to renew professional education until a satisfactory degree of skill has been attained in those areas which are the basis of probation; or c. such other reasonable requirements or restrictions as are proper; d. Refuse to renew a license; or e. Impose a cost assessment; or

f. Revoke probation which has been granted and impose any other disciplinary action in this subsection when the requirements of probation have not been fulfilled or have been violated.

**History**
- *SOURCE: Miss. Code Ann. § 73-10-21.*

##### **15 Miss. Admin. Code Pt. 19, R. 3.8.6** Rule 3.8.6 {#sec-19-3.8.6 omnilex-key=us-ms-regs-official--title-15--19#3.8.6}

Appeal: Any person aggrieved by a decision of the Board shall have a right of appeal in the manner provided for in the Act and the Laws of the State of Mississippi.

Subchapter 9: Exceptions and Exemptions Rule 3.9.1 Exceptions: No person shall engage in the practice of dietetics or represent himself to be a dietitian unless he is licensed by the Board, except as otherwise provided in this section. 1. A student enrolled in an approved academic program in dietetics, if such practice constitutes a part of a supervised course of study, and if the student is designated by a title which clearly indicated his or her status as a student or trainee. 2. A registered dietitian who is serving in the Armed Forces or the Public Health Service of the United States or is employed by the Veteran Affairs provided such practice is related to such service or employment. 3. Any person providing dietetic services, including but not limited to dietetic technicians, dietetic assistants, and dietary managers, working under the direct technical supervision of a licensed dietitian, except that such persons may not use the title "dietitian" or "nutritionist." 4. Persons licensed or registered to practice the health professions when covered under the scope of practice of his or her profession, except that such persons may not use the title "dietitian" or "nutritionist." 5. Persons who perform the activities and services of a nutrition educator in the employ of a federal, state, county or municipal agency, or another political subdivision, or a chartered elementary or secondary school or accredited degree- granting educational institution insofar as such activities and services are part of a salaried position except that such persons may not use the title "dietitian" or "nutritionist.". 6. Federal, state, county or local employees involved with programs providing the services of nutrition educator that help to prevent disease and maintain good nutritional health, including but not limited to the Cooperative Extension Service, the Child Nutrition Program, and Project Head Start, except that such persons may not use the title "dietitian" or "nutritionist."

7. Individuals who do not hold themselves out to be dietitians from marketing or distributing food products including dietary supplements as defined by the Food and Drug Administration or from engaging in the explanation and education of customers regarding the use of such products, except that such persons may not use the title "dietitian" or "nutritionist." 8. Any individual who provides individualized nutrition recommendations, nutrition information, guidance, encouragement, health coaching, holistic and wellness education, motivation, behavior change management, or non-medical weight control services, provided that the individual does not: (i) provide medical nutrition therapy as defined in Rule 3.1.3(11) or (ii) hold himself or herself out as a licensed dietitian or licensed nutritionist as prohibited under Rule 3.5.1. 9. A nonresident dietitian may practice dietetics in Mississippi for five (5) days with other state's licensure or with registration with the American Dietetics Association.

Subchapter 10: Criminal Offenses and Punishment Rule 3.10.1 Offenses: Any person who violates any provision of the Act, or these regulations promulgated thereto shall, upon conviction thereof, be guilty of a misdemeanor.

**History**
- *SOURCE: Miss. Code Ann. § 73-10-21.*
- *SOURCE: Miss. Code Ann. § 73-10-21.*
- *SOURCE: Miss. Code Ann. § 73-10-21.*

##### **15 Miss. Admin. Code Pt. 19, R. 3.10.2** Rule 3.10.2 {#sec-19-3.10.2 omnilex-key=us-ms-regs-official--title-15--19#3.10.2}

Punishment: Such misdemeanor shall, upon conviction, be punishable by a fine of not more than One Thousand Dollars ($1,000.00) or by imprisonment for not more than six (6) months or by both fine and imprisonment for each offense.

Subchapter 11: Fees Rule 3.11.1 Method of Payment: In accordance with the enabling statute, the following fees, where applicable, are payable to the State Board of Health by certified check, cashiers check, or money order. Fees paid are non-refundable.

**History**
- *SOURCE: Miss. Code Ann. § 73-10-21.*
- *SOURCE: Miss. Code Ann. § 73-10-21.*

##### **15 Miss. Admin. Code Pt. 19, R. 3.11.2** Schedule of Fees: 1 {#sec-19-3.11.2 omnilex-key=us-ms-regs-official--title-15--19#3.11.2}

Initial Licensure Fee - $100.00 2. Renewal Fee - $100.00 3. Provisional License Fee - $50.00 4. Provisional License Renewal Fee - $50.00

5. Provisional License Upgrade Fee - $50.00 6. Reinstatement Fee - $200.00 7. Replacement Fee - $50.00 8. License Verification Fee - $25.00

**History**
- *SOURCE: Miss. Code Ann. § 73-10-21.*

##### **15 Miss. Admin. Code Pt. 19, R. 3.11.3** Examination Fee: Fees for examination are to be paid directly to the appropriate testing organization {#sec-19-3.11.3 omnilex-key=us-ms-regs-official--title-15--19#3.11.3}

Subchapter 12: Administrative Grievance Procedure Rule 3.12.1 Administrative Appeals: All persons aggrieved by a decision regarding the initial application for licensure or the renewal of licensure shall have the right of administrative appeal and a hearing to be conducted according to the policy of the Department of Health.

**History**
- *SOURCE: Miss. Code Ann. § 73-10-21.*
- *SOURCE: Miss. Code Ann. § 73-10-21.*

##### **15 Miss. Admin. Code Pt. 19, R. 3.12.2** Rule 3.12.2 {#sec-19-3.12.2 omnilex-key=us-ms-regs-official--title-15--19#3.12.2}

Notification: Written notice will be provided to all applicants regarding denial of an original license or a renewal license. Such notice shall contain the reason thereof and shall offer the applicant an opportunity to submit additional information pertinent to their application for a second review by the Department.

**History**
- *SOURCE: Miss. Code Ann. § 73-10-21.*

##### **15 Miss. Admin. Code Pt. 19, R. 3.12.3** Hearing: 1 {#sec-19-3.12.3 omnilex-key=us-ms-regs-official--title-15--19#3.12.3}

If requested in writing within the specified time frame a hearing will be provided in which the applicant may show cause why the license should be granted or renewed. 2. Within sixty (60) days of the hearing, or other such time frame as determined during the hearing, written findings of fact, together with a recommendation for action on the license in question, shall be forwarded to the State Health Officer. The State Health Officer shall decide what action will be taken on the recommendation within five days of its receipt. Written notice shall be provided to the applicant.

**History**
- *SOURCE: Miss. Code Ann. § 73-10-21.*

#### **Chapter 4** REGULATIONS GOVERNING CERTIFICATION OF EYE ENUCLEATION

##### **15 Miss. Admin. Code Pt. 19, R. 4.1.1** Rule 4.1.1 {#sec-19-4.1.1 omnilex-key=us-ms-regs-official--title-15--19#4.1.1}

Purpose: The purpose of these regulations is to safeguard the public's health, safety, and welfare by establishing minimum qualifications and creating exclusive titles corresponding to the level of qualifications for individuals who wish to perform eye enucleation. Further, in order to insure the highest degree of professional conduct by those engaged in the performance of eye enucleation, it is the purpose of these regulations to provide and impose disciplinary sanctions, be they civil or criminal, against persons who do not meet or adhere to the procedures, qualifications, and standards set out in this chapter.

**History**
- *SOURCE: Miss. Code Ann. § 41-39-11.*

##### **15 Miss. Admin. Code Pt. 19, R. 4.1.2** Rule 4.1.2 {#sec-19-4.1.2 omnilex-key=us-ms-regs-official--title-15--19#4.1.2}

Legal Authority: The State Board of Health is authorized to establish and enforce these rules and procedures by virtue of Sections 41-39-11 of Mississippi Code of 1972, annotated.

**History**
- *SOURCE: Miss. Code Ann. § 41-39-11.*

##### **15 Miss. Admin. Code Pt. 19, R. 4.1.3** Definitions The following terms shall have the meaning set forth below, unless the context otherwise requires: 1 {#sec-19-4.1.3 omnilex-key=us-ms-regs-official--title-15--19#4.1.3}

Board shall mean the Mississippi State Board of Health. 2. Council shall mean the Eye Enucleation Advisory Council. 3. Certified and Certification shall mean the issuance of a certificate of competence by the Board. 4. Eye Enucleation shall mean the removal of the eyeball after the eye muscles and optic nerve has been severed. 5. Performance of Eye Enucleation shall mean an enucleation of the eye conforming to the medical standards of the Eye Bank Association of America. 6. Licensed for the Practice of Funeral Services shall mean an individual, licensed by the Mississippi State Department of Health, to engage in the practice of funeral services, including the practice of embalming, pursuant to Section 73-11-43 et seq. of Mississippi Code of 1972, annotated. 7. Department shall mean the Mississippi Department of Health. 8. Act shall mean Section 41-39-11 of Mississippi Code of 1972, annotated.

**History**
- *SOURCE: Miss. Code Ann. § 41-39-11.*

##### **15 Miss. Admin. Code Pt. 19, R. 4.1.4** Rule 4.1.4 {#sec-19-4.1.4 omnilex-key=us-ms-regs-official--title-15--19#4.1.4}

Publication: The Department shall publish, annually, a list of the names and addresses of all persons certified by the Board as Eye Enucleator, and a list of all persons whose certification has been suspended, revoked, denied renewal, put on probationary status, censured or reprimanded.

Subchapter 2: Eye Enucleator Advisory Council (“Council”) Rule 4.2.1 Council Structure and Purpose: The Council shall consist of five (5) members, who shall serve without compensation. They shall be selected by the Department, to serve under the jurisdiction of the Department for a three (3) year term. The purpose of the Council is to serve in an advisory capacity to the Department in matters relating to the administration and interpretation of the Act.

**History**
- *SOURCE: Miss. Code Ann. § 41-39-11.*
- *SOURCE: Miss. Code Ann. § 41-39-11.*

##### **15 Miss. Admin. Code Pt. 19, R. 4.2.2** Meeting: The Council shall meet at places and at times designated by the Department {#sec-19-4.2.2 omnilex-key=us-ms-regs-official--title-15--19#4.2.2}

A quorum shall consist of three (3) members of the Council, including the chairman, and shall be necessary for the Council to take action by vote.

Subchapter 3: State Board of Health Rule 4.3.1 Responsibilities The Board shall: 1. Establish examination, certification, and renewal of certification criteria for applicants. 2. Maintain an up-to-date list of all individuals certified to perform eye enucleation, with such list being available, upon request, to the public. 3. Refer disciplinary actions of any individual engaged in the performance of eye enucleation to the appropriate government agency for prosecution, whether certified or otherwise, or, in its discretion, refer same to the appropriate committee or council. 4. Conduct disciplinary hearings, upon specified charges. 5. Maintain an up-to-date list of all individuals whose certification has been suspended, revoked, or denied, make such list available to public inspection, and shall supply such list to similar regulatory boards in other states or jurisdictions. 6. Keep a record of all proceedings of the Board, and make said record available to the public.

7. Delegate, authorize, and direct the Department to promulgate and regulate, as may be necessary, to accomplish the purpose of the Act.

Subchapter 4: Certification Rule 4.4.1 Certification Requirement An applicant for certification shall submit to the Department, verified by oath, written evidence in form and content satisfactory to the Department that the applicant: 1. Is licensed for the practice of funeral services as defined in Section 1-3 (F) of these rules and regulations. 2. Has successfully completed a course, approved by the Department, in eye enucleation.

**History**
- *SOURCE: Miss. Code Ann. § 41-39-11.*
- *SOURCE: Miss. Code Ann. § 41-39-11.*
- *SOURCE: Miss. Code Ann. § 41-39-11.*

##### **15 Miss. Admin. Code Pt. 19, R. 4.4.2** Rule 4.4.2 {#sec-19-4.4.2 omnilex-key=us-ms-regs-official--title-15--19#4.4.2}

**History**
- *SOURCE: Miss. Code Ann. § 41-39-11*

##### **15 Miss. Admin. Code Pt. 19, R. 4.4.3** Certified By Endorsement: LEFT BLANK ON PURPOSE {#sec-19-4.4.3 omnilex-key=us-ms-regs-official--title-15--19#4.4.3}

**History**
- *SOURCE: Miss. Code Ann. § 41-39-11*

##### **15 Miss. Admin. Code Pt. 19, R. 4.4.4** Grandfather Clause: LEFT BLANK ON PURPOSE {#sec-19-4.4.4 omnilex-key=us-ms-regs-official--title-15--19#4.4.4}

**History**
- *SOURCE: Miss. Code Ann. § 41-39-11*

##### **15 Miss. Admin. Code Pt. 19, R. 4.4.5** Temporary Permit: LEFT BLANK ON PURPOSE {#sec-19-4.4.5 omnilex-key=us-ms-regs-official--title-15--19#4.4.5}

Abandonment: An application shall be deemed abandoned by the Department if, after six (6) months from the date of filing, the requirements for certification have not been completed and submitted to the Department.

Subchapter 5: Professional Identification Rule 4.5.1 Titles and Abbreviation: A person issued a certificate of competence to perform Eye Enucleation by the Mississippi State Board of Health may use the title, "State Certified Eye Enucleator."

**History**
- *SOURCE: Miss. Code Ann. § 41-39-11.*
- *SOURCE: Miss. Code Ann. § 41-39-11.*

##### **15 Miss. Admin. Code Pt. 19, R. 4.5.2** Rule 4.5.2 {#sec-19-4.5.2 omnilex-key=us-ms-regs-official--title-15--19#4.5.2}

Production and Display of License A person issued a certificate of competence to perform eye enucleation by the Mississippi State Board of Health shall show said certificate when requested.

Subchapter 6: Renewal of License Rule 4.6.1 General Provisions: 1. The Board shall issue certification, which shall be renewed biennially. 2. The certification year shall be construed as January 1 through December 31.

**History**
- *SOURCE: Miss. Code Ann. § 41-39-11.*
- *SOURCE: Miss. Code Ann. § 41-39-11.*

##### **15 Miss. Admin. Code Pt. 19, R. 4.6.2** Rule 4.6.2 {#sec-19-4.6.2 omnilex-key=us-ms-regs-official--title-15--19#4.6.2}

Procedure for Renewal of License: The Department shall mail a renewal form, at least thirty (30) days prior to the renewal date, to the last address registered with the Department, to the persons to whom certification were issued or renewed during the preceding renewal period. The applicant for renewal shall: 1. Complete the renewal form. 2. Submit proof of continuing education credit as detailed in Section VII of these regulations. 3. Enclose the renewal fee. 4. File the above with the Department prior to the end of the renewal period.

**History**
- *SOURCE: Miss. Code Ann. § 41-39-11.*

##### **15 Miss. Admin. Code Pt. 19, R. 4.6.3** Rule 4.6.3 {#sec-19-4.6.3 omnilex-key=us-ms-regs-official--title-15--19#4.6.3}

Failure to Renew: An individual who does not file, with the Department, his renewal application within the renewal period will be deemed to have allowed his certification to lapse. Said certification may be reinstated by the Department, in its discretion, by the payment of the renewal fee provided said application for reinstatement is made within six (6) months of the end of the renewal period.

**History**
- *SOURCE: Miss. Code Ann. § 41-39-11.*

##### **15 Miss. Admin. Code Pt. 19, R. 4.7.1** Subchapter 7: Continuing Education {#sec-19-4.7.1 omnilex-key=us-ms-regs-official--title-15--19#4.7.1}

Definition and Philosophy: Each individual certified by the Board is responsible for maintaining high levels of skill and knowledge. Continuing education is defined as education beyond the basic preparation required for certification and related to the performance of eye enucleation.

**History**
- *SOURCE: Miss. Code Ann.§ 41-39-11.*

##### **15 Miss. Admin. Code Pt. 19, R. 4.7.2** Requirements: Regulations set the requirements for continuing education as follows: {#sec-19-4.7.2 omnilex-key=us-ms-regs-official--title-15--19#4.7.2}

1. The performance of an eye enucleation during the two year licensure period.

2. Recertification in eye enucleation by the “Mississippi Lions Eye Bank, Inc.” or other such course as approved by the Department.

**History**
- *SOURCE: Miss. Code Ann.§ 41-39-11.*

##### **15 Miss. Admin. Code Pt. 19, R. 4.7.3** Rule 4.7.3 {#sec-19-4.7.3 omnilex-key=us-ms-regs-official--title-15--19#4.7.3}

**History**
- *SOURCE: Miss. Code Ann.§ 41-39-11*

##### **15 Miss. Admin. Code Pt. 19, R. 4.7.4** Content Criteria: LEFT BLANK ON PURPOSE {#sec-19-4.7.4 omnilex-key=us-ms-regs-official--title-15--19#4.7.4}

**History**
- *SOURCE: Miss. Code Ann.§ 41-39-11.*

##### **15 Miss. Admin. Code Pt. 19, R. 4.7.5** Sources of Continuing Education: LEFT BLANK ON PURPOSE {#sec-19-4.7.5 omnilex-key=us-ms-regs-official--title-15--19#4.7.5}

Reporting Procedures for Continuing Education: Each application for renewal of certification shall have, attached to it, proof that the requirements as set forth in Section 7-2 have been fulfilled.

Subchapter 8: Revocation, Suspension and Denial of Certification Rule 4.8.1 Standards of conduct: individuals who are certified may, at the discretion of the board, have their certification suspended, revoked, or denied at the time of renewal if the board determines that the individual is guilty of any of the following:

1. Is guilty of fraud or deceit in procuring or attempting to procure a certification or renewal of certification to perform eye enucleation.

2. Is unfit or incompetent by reason of gross ignorance, negligence, habits, or other causes of incompetence.

3. Is habitually intemperate in the use of alcoholic beverage.

4. Is knowingly practicing while suffering with a contagious or infectious disease.

5. Is addicted to, or has improperly obtained, possessed, used, or distributed habit- forming drugs or narcotics.

6. Is guilty of dishonest or unethical conduct.

7. Has performed eye enucleation after his certification has expired or has been suspended.

8. Has practice eye enucleation under cover of any permit or license illegally or fraudulently obtained or issued.

9. Has violated, aided, or abetted others in violation of any provision of law, or these regulations.

10. Has engaged in any conduct considered by the board to be detrimental to the profession of eye enucleation, or the practice of funeral service, as defined in section 1-3 of these regulations.

**History**
- *SOURCE: Miss. Code Ann.§ 41-39-11.*
- *Source: Miss. Code Ann .§ 41-39-11.*

##### **15 Miss. Admin. Code Pt. 19, R. 4.8.2** Rule 4.8.2 {#sec-19-4.8.2 omnilex-key=us-ms-regs-official--title-15--19#4.8.2}

Summary suspension: the board may summarily suspend certification without a hearing, simultaneously with the filing of a formal complaint and notice of hearing, if the board determines that:

1. The health, safety, or welfare of the general public is in immediate danger.

2. The individual's physical capacity to practice his profession is in issue.

3. The individual's mental capacity to practice his profession is in issue.

**History**
- *Source: Miss. Code Ann. § 41-39-11.*

##### **15 Miss. Admin. Code Pt. 19, R. 4.8.3** Rule 4.8.3 {#sec-19-4.8.3 omnilex-key=us-ms-regs-official--title-15--19#4.8.3}

Complaints: all complaints concerning a certified individual, his business, or professional practice, shall be reviewed by the department. Each complaint received shall be logged, recording at a minimum the following information:

1. Name of individual certified;

2. Name of the complaining party, if known;

3. Date of complaint;

4. Brief statement of complaint; and

5. Disposition.

**History**
- *Source: Miss. Code Ann. § 41-39-11.*

##### **15 Miss. Admin. Code Pt. 19, R. 4.8.4** Rule 4.8.4 {#sec-19-4.8.4 omnilex-key=us-ms-regs-official--title-15--19#4.8.4}

Investigation: All complaints will be investigated and evaluated by the administrative secretary or other authorized employee of the department.

**History**
- *Source: Miss. Code Ann. § 41-39-11.*

##### **15 Miss. Admin. Code Pt. 19, R. 4.8.5** Notice of Charges and Hearing {#sec-19-4.8.5 omnilex-key=us-ms-regs-official--title-15--19#4.8.5}

1. Following the investigative process, the department may file formal charges against the certified individual. Such formal complaint shall, at a minimum, inform the respondent of the facts which are the basis of the charge and which are specific enough to enable the respondent to defend against the charges.

2. Each respondent, whose conduct is the subject of a formal charge which seeks to impose disciplinary action against him, shall be served notice of the formal charge at least thirty (30) days before the date of hearing. A hearing shall be presided over by the board or the board's designee. Service shall be considered to have been given if the notice was personally received by the respondent, or the notice was mailed certified, return receipt requested, to the respondent at his last know address as listed with the state agency. The notice of the formal hearing shall consist at a minimum of the following information:

A. The time, place and date of hearing;

B. That the respondent shall appear personally at the hearing and may be represented by counsel;

C. That the respondent shall have the right to produce witnesses and evidence in his own behalf and shall have the right to cross-examine adverse witnesses; and evidence

D. That the hearing could result in disciplinary action being taken against the respondent’s certification.

E. That rules for the conduct of these hearings exist and it may be in the respondent best interest to obtain a copy; and

F. That the board, or its designee, shall preside at the hearing and following the conclusion of the hearing shall make findings of facts, conclusions of law and recommendations, separately stated, to the board as to what disciplinary action, if any, should be imposed on the respondent.

3. The board or its designee shall hear evidence produced in support of the formal charges and contrary evidence produced by the respondent. At the conclusion of the hearing, the board shall issue an order, within sixty (60) days.

4. Disposition of any complaints may be made by consent order or stipulation between the board and the respondent.

5. All proceedings pursuant to this section are matters of public record and shall be preserved pursuant to state law.

**History**
- *Source: Miss. Code Ann .§ 41-39-11.*

##### **15 Miss. Admin. Code Pt. 19, R. 4.8.6** Rule 4.8.6 {#sec-19-4.8.6 omnilex-key=us-ms-regs-official--title-15--19#4.8.6}

board sanctions: the board may impose any of the following sanctions, singly or in combination, when it finds that a respondent is guilty of any of the above offenses:

1. Revocation of the certification;

2. Suspension of the certification, for any period of time;

3. Censure the individual certified;

4. Issue a letter of reprimand to the individual certified;

5. Place a certification on probationary status and require the individual to submit to any of the following:

A. Report regularly to the board upon matters which are the basis of probation;

B. Continue to renew professional education until a satisfactory degree of skill has been attained in those areas which are the basis of probation; or

C. Such other reasonable requirements or restrictions as are proper;

D. Refuse to renew a certification; or

E. Revoke probation which has been granted and impose any other disciplinary action in this subsection when the requirements of probation have not been fulfilled or have been violated.

**History**
- *Source: Miss. Code Ann. § 41-39-11.*

##### **15 Miss. Admin. Code Pt. 19, R. 4.8.7** Rule 4.8.7 {#sec-19-4.8.7 omnilex-key=us-ms-regs-official--title-15--19#4.8.7}

Appeal: any person aggrieved by a decision of the board shall have a right of appeal as provided for in the laws of the state of Mississippi.

Subchapter 9 Exceptions and Exemptions Rule 4.9.1 Exceptions: Nothing in these regulations is intended to limit, preclude, or otherwise interfere with the practices of other persons and health providers licensed by appropriate agencies of the State of Mississippi.

**History**
- *Source: miss. Code ann.§ 41-39-11.*
- *SOURCE: Miss. Code Ann. § 41-39-11.*

##### **15 Miss. Admin. Code Pt. 19, R. 4.9.2** Good Samaritan Act: LEFT BLANK ON PURPOSE {#sec-19-4.9.2 omnilex-key=us-ms-regs-official--title-15--19#4.9.2}

Subchapter 10 Aides, Assistants and Apprentices Rule 4.10.1 Registration: LEFT BLANK ON PURPOSE

**History**
- *SOURCE: Miss. Code Ann. § 41-39-11.*
- *SOURCE: Miss. Code Ann. § 41-39-11.*

##### **15 Miss. Admin. Code Pt. 19, R. 4.10.2** Rule 4.10.2 {#sec-19-4.10.2 omnilex-key=us-ms-regs-official--title-15--19#4.10.2}

**History**
- *SOURCE: Miss. Code Ann. § 41-39-11.*

##### **15 Miss. Admin. Code Pt. 19, R. 4.10.3** Notice of Termination: LEFT BLANK ON PURPOSE {#sec-19-4.10.3 omnilex-key=us-ms-regs-official--title-15--19#4.10.3}

Subchapter 11 Criminal Offenses and Punishment Rule 4.11.1 Offenses: It is a violation of the law for any person to: 1. Sell, fraudulently obtain or furnish any certificate of competence, or aid or abet therein. 2. Use the title, "State Certified Eye Enucleator" or any words letters, signs, symbols or devices to indicate the person using them has received a certificate of competence from the Mississippi State Department of Health. 3. Fail to notify the Board of the suspension, probation or revocation of any past or currently held licenses or certifications, required to perform eye enucleation in this or any other jurisdiction. 4. Make false representations, impersonate, act as a proxy for another person, allow, or aid any person to impersonate him in connection with any examination or application for certification or request to be examined or licensed. 5. Make a material, false statement in an application for certification, or in a response to any inquiry by the State Department of Health or the Board. 6. Otherwise violate any provisions of the Act, or regulations of the Board.

**History**
- *SOURCE: Miss. Code Ann. § 41-39-11.*
- *SOURCE: Miss. Code Ann. § 41-39-11.*

##### **15 Miss. Admin. Code Pt. 19, R. 4.11.2** Rule 4.11.2 {#sec-19-4.11.2 omnilex-key=us-ms-regs-official--title-15--19#4.11.2}

Punishment; Such violations shall be a misdemeanor, and shall be punishable by a fine not to exceed Five Hundred Dollars, ($500.00) or by imprisonment in the county jail for not more than six (6) months, or by both.

Subchapter 12 Fees Rule 4.12.1 Method of Payment: The following fees, where applicable, are payable to the State Board of Health by check, or money order. Fees paid to the State Board of Health are non-refundable.

**History**
- *SOURCE: Miss. Code Ann. § 41-39-11.*
- *SOURCE: Miss. Code Ann. § 41-39-11.*

##### **15 Miss. Admin. Code Pt. 19, R. 4.12.2** Schedule of Fees 1 {#sec-19-4.12.2 omnilex-key=us-ms-regs-official--title-15--19#4.12.2}

Application and Initial Licensure Fee - $10.00 2. Renewal Fee - $10.00 3. Reinstatement Fee - $5.00 4. Replacement Fee - $5.00 5. Duplication Fee - $5.00 6. Name Change Fee - $5.00

**History**
- *SOURCE: Miss. Code Ann. § 41-39-11.*

##### **15 Miss. Admin. Code Pt. 19, R. 4.12.3** Examination Fee: Fees for examination are to be paid directly to the appropriate testing organization {#sec-19-4.12.3 omnilex-key=us-ms-regs-official--title-15--19#4.12.3}

Subchapter 13 Administrative Grievance Procedure Rule 4.13.1 Administrative Appeals: All persons aggrieved by a decision regarding the initial application for certification, or the renewal of certification shall have the right of administrative appeal and a hearing to be conducted according to the rules of the Department of Health.

**History**
- *SOURCE: Miss. Code Ann. § 41-39-11.*
- *SOURCE: Miss. Code Ann. § 41-39-11.*

##### **15 Miss. Admin. Code Pt. 19, R. 4.13.2** Rule 4.13.2 {#sec-19-4.13.2 omnilex-key=us-ms-regs-official--title-15--19#4.13.2}

Notification: Written notice will be provided to all applicants regarding denial of an original license or a renewal license. Such notice shall contain the reason thereof and shall offer the applicant an opportunity to submit additional information pertinent to their application for a second review by the Department.

**History**
- *SOURCE: Miss. Code Ann. § 41-39-11.*

##### **15 Miss. Admin. Code Pt. 19, R. 4.13.3** Hearing {#sec-19-4.13.3 omnilex-key=us-ms-regs-official--title-15--19#4.13.3}

1. If requested in writing within the specified time frame a hearing will be provided in which the applicant may show cause why the license should be granted or renewed. 2. Within sixty (60) days of the hearing, or other such time frame as determined during the hearing, written findings of fact, together with a recommendation for action on the license in question, shall be forwarded to the State Health Officer. The State Health Officer shall decide what action will be taken on the recommendation within five days of its receipt. Written notice shall be provided to the applicant.

**History**
- *SOURCE: Miss. Code Ann. § 41-39-11.*

#### **Chapter 5** REGULATIONS GOVERNING REGISTRATION OF INDIVIDUALS PERFORMING HAIR BRAIDING Subchapter 1: General provisions Rule 5.1.1 Legal Authority: The Mississippi Department of Health is authorized to establish, adopt, and enforce these rules and regulations by virtue of Sections 73 - 7-31 and 32 of Mississippi Code of 1972, annotated.

##### **15 Miss. Admin. Code Pt. 19, R. 5.1.2** Definitions 1 {#sec-19-5.1.2 omnilex-key=us-ms-regs-official--title-15--19#5.1.2}

Hair Braiding shall mean the use of techniques that result in tension on hair strands or roots by twisting, wrapping, weaving, extending, locking or braiding of the hair by hand or mechanical device, but does not include the application of dyes, reactive chemicals, or other preparations to alter the color of the hair or to straighten, curl or alter the structure of the hair 2. Board shall mean the Mississippi State Board of Health. 3. Department shall mean the Mississippi Department of Health. 4. Brochure shall mean a publication prepared by the Department of Health containing information about infection control techniques that are appropriate for hair braiding in or outside of a salon setting, and containing a self-test with questions on the information contained in the brochure. 5. Establishment shall mean the place or premises where a person is engaged in Hair Braiding for compensation. 6. Business Hours shall mean the time period from 8:00 A.M. to 8:00 P.M. 7. Act shall mean Sections 73-7-31 and 32 et seq. of Mississippi Code of 1972, annotated.

**History**
- *SOURCE: Miss. Code Ann. §73-7-71 Subchapter 2: Requirement For Registration Rule 5.2.1 Any person engaged in Hair Braiding for compensation in the State of Mississippi, and not exempted pursuant to Subchapter 4 of these Rules, shall Register with the Department, in form and substance satisfactory to the Department. The cost of Registration shall be $25.00.*
- *SOURCE: Miss. Code Ann. §73-7-71 Subchapter 3: Requirement for Self Test Rule 5.3.1 Any person engaged in Hair Braiding for compensation in the State of Mississippi, and not exempted pursuant to Subchapter 4 of these Rules, shall be required to complete the self test contained within the Brochure and to keep said Brochure at the premises.*
- *SOURCE: Miss. Code Ann. §73-7-71 Subchapter 4: Exemption Rule 5.4.1 These Regulations do not apply to cosmetologists, barbers, or wig specialists licensed to practice in Mississippi in their respective fields.*
- *SOURCE: Miss. Code Ann. §73-7-71 Subchapter 5: Inspection Rule 5.5.1 Representatives of the Department may visit any Establishment in which Hair Braiding is performed at any time during business hours to determine if the brochure and completed self-test are available.*
- *SOURCE: Miss. Code Ann. §73-7-71*

#### **Chapter 6** REGULATIONS GOVERNING LICENSURE OF HEARING AID SPECIALISTS Subchapter 1: General Rule 6.1.1 Purpose: The purpose of these regulations is to safeguard the public's health, safety, and welfare by establishing minimum qualifications and creating exclusive titles corresponding to the level of qualifications for individuals who wish to offer hearing aid services to the public. Further, in order to insure the highest degree of professional conduct by those engaged in offering these services to the public, it is the purpose of these regulations to provide and impose disciplinary sanctions, be they civil or criminal, against persons who do not meet or adhere to the procedures, qualifications, and standards set out in these regulations.

##### **15 Miss. Admin. Code Pt. 19, R. 6.1.2** Rule 6.1.2 {#sec-19-6.1.2 omnilex-key=us-ms-regs-official--title-15--19#6.1.2}

Legal Authority: The State Board of Health established and empowered by Section 41-3-1 et seq., Mississippi Code of 1972, shall discharge as additional duties and responsibilities the provisions of this chapter in the examination, licensing and regulation of persons who sell and fit hearing aids and who test hearing while engaged in the selling and fitting of hearing aids.

**History**
- *SOURCE: Miss. Code Ann. §73-14-1*

##### **15 Miss. Admin. Code Pt. 19, R. 6.1.3** Rule 6.1.3 {#sec-19-6.1.3 omnilex-key=us-ms-regs-official--title-15--19#6.1.3}

Definitions (Revised 5/12/96): The following definitions apply as used in this chapter, unless the context otherwise requires: 1. Board means the Mississippi State Board of Health. 2. License includes a temporary or regular license. 3. Hearing aid shall mean any wearable instrument or device designed for or offered for the purpose of aiding or compensating for impaired human hearing and any parts, attachments or accessories, including ear molds, but excluding such things as telephone devices, batteries and cords. 4. Hearing aid specialist means an individual licensed by the board to engage in the practice of dispensing and fitting hearing aids. 5. Practice of dispensing and fitting hearing aids means the evaluation or measurement of powers or range of human hearing by means of an audiometer and the consequent selection or adaptation or sale of hearing aids intended to compensate for hearing loss, including the making of an impression of the ear. 6. Sell or sale means any transfer of title or of the right to use by lease, bailment or any other contract, excluding wholesale transactions with distributors or dealers. 7. Unethical conduct means: a. The obtaining of any fee or the making of any sale by fraud or misrepresentation. b. Knowingly employing directly or indirectly any suspended or unlicensed person to perform any work covered by this chapter. c. Representing that the professional services or advice of a physician or audiologist will be used or made available in the selling, fitting, adjustment, maintenance or repair of hearing aids when that is not true, or using the words "doctor," "clinic," "clinical," and/or "research audiologist," "audiologic," or any other like words, abbreviations or symbols which tend to connote audiological or professional services, when such use is not accurate. d. Permitting another to use his license. e. Quoting prices of competitive hearing aids or devices without disclosing that they are not the present current prices, or showing, demonstrating or representing competitive models as being current models when such is not the fact.

f. Imitating or simulating the trademarks, trade names, brands or labels of competitors with the capacity and tendency or effect of misleading or deceiving purchasers or prospective purchasers. g. Defaming competitors by falsely imputing to them dishonorable conduct, inability to perform contracts, questionable credit standing, or by other false representations, or falsely disparaging the products of competitors in any respect, or their business methods, selling prices, values, credit terms, policies or services. h. Stating or implying that the use of any hearing aid will restore or preserve hearing, prevent or retard progression of a hearing impairment. i. Dispensing and selling a hearing aid to a child under the age of eighteen (18) years who has not been examined and cleared for hearing aid use by a licensed physician within a six-month period immediately prior to dispensing and selling the hearing aid. j. Representing himself as being an audiologist as defined in §73-83-3 of the Mississippi Code of 1972, annotated. k. Not meeting the minimum requirements of test procedures and test equipment to be used in the fitting of hearing aids, as established by the Department, and not retaining all records of fittings, for a period of three years. 8. Council means the Advisory Council. 9. Act means the Mississippi Hearing Aid Specialist Licensure law. 10. Department shall mean the Mississippi State Department of Health.

**History**
- *SOURCE: Miss. Code Ann. §73-14-1*

##### **15 Miss. Admin. Code Pt. 19, R. 6.1.4** Rule 6.1.4 {#sec-19-6.1.4 omnilex-key=us-ms-regs-official--title-15--19#6.1.4}

Publication: The Board shall publish, annually, a list of the names and addresses of all persons licensed by the Board as Hearing Aid Specialists and a list of all persons whose licenses have been suspended, revoked, denied renewal, put on probationary status, censured, or reprimanded, pursuant to the sections in these regulations.

2. The Council shall serve in an advisory capacity to the Department in matters relating to the administration and interpretation of the Act. 3. The council shall conduct its business according to its operating procedures.

**History**
- *SOURCE: Miss. Code Ann. §73-14-1 Subchapter 2: Hearing Aid Specialist Council of Advisors ("Council") Rule 6.2.1 Council Structure and Purpose: 1. The Council shall consist of seven (7) members as set forth in the Act, for the terms indicated therein, and shall serve under the jurisdiction of the State Board of Health.*
- *SOURCE: Miss. Code Ann. §73-14-1*

##### **15 Miss. Admin. Code Pt. 19, R. 6.2.2** Meetings: 1 {#sec-19-6.2.2 omnilex-key=us-ms-regs-official--title-15--19#6.2.2}

The Council shall meet at least one time each fiscal year at a time and place designated by the Department. Additional special meetings may be held if, at the discretion of the Department, such special meetings are necessary. Meetings may be called by giving 10 days written notice. 2. Four of the seven members of the Council shall constitute a quorum, and if the quorum is not present at the time of such called meeting, same may be adjourned to a date to be designated by the Chairman. 3. Absence from two (2) consecutive meetings without good cause constitutes grounds for removal from the council.

2. Supervise and administer qualifying examinations to test the knowledge and proficiency of applicants for a license. 3. License persons who apply to the Department and meet requirements for licensure as stated in Rule 6.4.1 of these regulations. 4. Establish minimum requirements of test procedures and test equipment to be used in the fitting of hearing aids. Also, the retention of all records of fittings by the dealer must be kept for a period of three (3) years. 5. Name an advisory council as prescribed by law. 6. Establish licensing and renewal of license criteria for applicants. 7. Carry out the periodic inspection of facilities and equipment of persons who practice the fitting and selling of hearing aids. 8. Suspend or revoke licenses pursuant to the provisions of the Act and these regulations. 9. Direct the Department to promulgate and implement rules and procedures to carry out the purpose of the Act.

**History**
- *SOURCE: Miss. Code Ann. §73-14-1 Subchapter 3: State Board of Health Rule 6.3.1 Duties and Responsibilities: The Board, with the advice of the council, shall: 1. Make and publish rules and regulations not inconsistent with the laws of this state which are necessary to carry out the provisions of the Act.*
- *SOURCE: Miss. Code Ann. §73-14-1 Subchapter 4: Licensure*

##### **15 Miss. Admin. Code Pt. 19, R. 6.4.1** Rule 6.4.1 {#sec-19-6.4.1 omnilex-key=us-ms-regs-official--title-15--19#6.4.1}

Licensure Requirements (Revised 5/12/96): An applicant for licensure shall submit to the Department written evidence in form and content satisfactory to the Department that the applicant: 1. is twenty-one (21) years of age or older; 2. minimally, has an education equivalent to a four-year course in an accredited high school; 3. has passed an examination approved by the Department; and 4. has paid the required fee(s).

**History**
- *SOURCE: Miss. Code Ann. §73-14-1*

##### **15 Miss. Admin. Code Pt. 19, R. 6.4.2** Examination: (Revised 5/12/96; 5/15/99) 1 {#sec-19-6.4.2 omnilex-key=us-ms-regs-official--title-15--19#6.4.2}

Examinations will be administered quarterly on the third Wednesday of January, April, July, and October. 2. The exam consists of three (3) sections: a written exam, a practical exam, and a state law exam. Written exam scores from other jurisdictions are considered valid for twelve (12) months from the date of examination if the exam is the same as the one used by this jurisdiction. 3. Applicants who fail one or more sections of the initial exam are required to re-test failed sections on the subsequent exam in the following manner: a. Written examination section - Retake the entire section. b. Mississippi Law section - Retake the entire section. c. Practical examination section - requires retesting of each failed subsection only. 4. Applicants are limited to two (2) attempts (1 test and the subsequent re-test) to successfully complete the examination. After an unsuccessful retest to complete the licensure examination, the applicant must take the entire examination at his next sitting with the exception of those applicants who satisfy Rule 6.4.2(2)(a) of these regulations. 5. The examinations, written/oral/practical, under this section shall not include questions requiring a medical or surgical education. It is the intent of this section that the exams administered under this chapter be of such a level as to provide, that at a minimum, an individual having a high school level education or its equivalent, and with appropriate study, training and supervision under the direction of a licensee deemed qualified by Subchapter 10 of these regulations, should be able to pass. 6. The practical portion of the examination shall include the following areas of proficiency: a. Pre-test procedure b. Pure tone air conduction and masking c. Pure tone bone conduction and masking

d. Speech audiometry and masking e. Ear Impressions f. Audiogram Interpretation and Fitting g. Trouble shooting hearing aids

**History**
- *SOURCE: Miss. Code Ann. §73-14-1*

##### **15 Miss. Admin. Code Pt. 19, R. 6.4.3** Licensure by Reciprocity 1 {#sec-19-6.4.3 omnilex-key=us-ms-regs-official--title-15--19#6.4.3}

An applicant for licensure by reciprocity shall submit to the Department written evidence in form and content satisfactory to the Department: a. That the applicant is currently licensed as a Hearing Aid Specialist under the laws of another state or the District of Columbia. b. That the requirements for said license are equivalent to or greater than those required in this state as set forth in Rule 6.4.2 of these regulations. c. That said license is in good standing and has not been suspended or revoked. d. That verification of all licenses that have been issued are on file with the Department. e. That the state issuing the current license has a current reciprocity agreement on file with the Department. 2. Applicants who have complaints pending against them in another state will not be granted a Mississippi license until such complaints are resolved and resolution validated by the initial licensing agency. 3. Any person making application for licensure under the provisions of this section may, at the discretion of the Department, be required to pass an examination selected by the Department.

**History**
- *SOURCE: Miss. Code Ann. §73-14-1*

##### **15 Miss. Admin. Code Pt. 19, R. 6.4.4** Temporary Licensure 1 {#sec-19-6.4.4 omnilex-key=us-ms-regs-official--title-15--19#6.4.4}

A temporary license may be granted to an applicant for licensure meeting the requirements of Rule 6.4.1 of these regulations who has not previously applied to take the approved examination. 2. The Department may issue a temporary license to applicants meeting the requirements in Rule 6.4.1 of these regulations, which shall entitle the applicant to practice the fitting and dispensing of hearing aids for a period ending thirty (30) days after the conclusion of the next examination given after the minimum ninety (90) day training period has elapsed. 3. No temporary license shall be issued by the Department under this section unless the applicant shows to the satisfaction of the Department that he is or will be supervised and trained by a person who holds

a current Mississippi license and meets the supervisory requirements in Subchapter 10 of these regulations. 4. The first regularly scheduled examination after the minimum ninety (90) day training period must be taken by the temporary licensee or the temporary license shall not be renewed, except for good cause shown to the satisfaction of the Department. 5. If a person who holds a temporary license issued under this section fails to pass the next examination given after the minimum ninety (90) day training period, the Department may renew the temporary license for a period ending thirty (30) days after the date of renewal is announced. In no event shall more than one (1) renewal be permitted.

**History**
- *SOURCE: Miss. Code Ann. §73-14-1*

##### **15 Miss. Admin. Code Pt. 19, R. 6.4.5** Out-of-State Licensure 1 {#sec-19-6.4.5 omnilex-key=us-ms-regs-official--title-15--19#6.4.5}

A person who holds a license or temporary license to practice as a hearing aid specialist in this state but whose principal place of business is not in this state shall certify to the Department that they will: a. display their Mississippi license while conducting business in Mississippi; and b. make all records regarding clients who are residents of Mississippi available to the licensing authority within seventy-two (72) hours of receiving such a request in writing; and c. retain all records of fittings by the dealer for a period of three (3) years.

**History**
- *SOURCE: Miss. Code Ann. §73-14-1*

##### **15 Miss. Admin. Code Pt. 19, R. 6.4.6** Conditions of a Universal Occupational License: {#sec-19-6.4.6 omnilex-key=us-ms-regs-official--title-15--19#6.4.6}

2. Notwithstanding any other provision of law, the Department shall issue a license for a hearing aid specialist and at the same practice level to a person who establishes residence in this state if, upon application to the Department: a. The applicant holds a current and valid license in good standing in another state in an occupation with a similar scope of practice, as determined by the Department, and has held this license from the occupational licensing board in the other state for at least one (1) year; and b. There were minimum education requirements and, if applicable, work experience, examination, and clinical supervision requirements in effect, and the other state verifies that the applicant met those requirements in order to be licensed in that state; and c. The applicant has not committed any act in the other state that would have constituted grounds for refusal, suspension, or revocation of a license to practice that occupation in Mississippi at the time the act was committed, and the applicant does not have a disqualifying criminal record as determined by the Department under Mississippi law; and b. The applicant did not surrender a license because of negligence or intentional misconduct related to the applicant's work in the occupation in another state; and

e. The applicant does not have a complaint, allegation, or investigation pending before an occupational licensing board or other board in another state that relates to unprofessional conduct or an alleged crime. If the applicant has a complaint, allegation, or investigation pending, the Department shall not issue or deny a license to the applicant until the complaint, allegation, or investigation is resolved, or the applicant otherwise satisfies the criteria for licensure in Mississippi to the satisfaction of the Department; and f. The applicant pays all applicable fees in Mississippi. 2. Notwithstanding any other law, the Department shall issue a license to an applicant as a hearing aid specialist and at the same practice level, as determined by the Department, to a person who establishes residence in this state based on work experience in another state, if all the following apply: d. The applicant worked in a state that does not use a license to regulate a lawful occupation, but Mississippi uses a license to regulate a lawful occupation with a similar scope of practice, as determined by the Department; e. The applicant worked for at least three (3) years in the lawful occupation; and f. The applicant satisfies the provisions of paragraphs (c) through (f) of Rule 6.4.6(1). 15. The Department may require an applicant to pass a jurisprudential examination specific to relevant state laws in Mississippi that regulate hearing aid specialists if the issuance of a license in Mississippi requires an applicant to pass a jurisprudential examination specific to relevant state statutes and administrative rules in Mississippi that regulate hearing aid specialists. 16. The Department may require proof of residency. Residency may be established by demonstrating proof of a state-issued identification card or one (1) of the following: e. Current Mississippi residential utility bill with the applicant's name and address; f. Documentation of the applicant's current ownership, or current lease of a residence in Mississippi; g. Documentation of current in-state employment or a notarized letter of the promise of employment of the applicant or his or her spouse; or h. Any verifiable documentation demonstrating Mississippi residency. 17. A license issued under this section is valid only in this state and does not make the person eligible to be part of an interstate compact. 18. The Department shall issue or deny the license to the applicant within one hundred twenty (120) days after receiving an application. 19. If the application requires longer than two (2) weeks to process, the Department shall issue a temporary practice permit within thirty (30) days after receiving the application if the applicant submits an affidavit, under penalties of perjury, affirming that he or she satisfies the provisions of Rule 6.4.6(3) or Rule 6.4.6(4) and pays all applicable fees as required by Rule 6.4.6(1)(f).

a. The applicant may practice under the temporary permit until a license is granted, or until a notice to deny the license is issued, in accordance with rules adopted by the Department. A temporary license will expire in three hundred sixty-five (365) days after its issuance if the applicant fails to satisfy the requirement for licensure in Rule 6.4.6(1) through Rule 6.4.6(3), as applicable. 20. The department may license as a hearing aid specialist, and furnish a certificate of licensure, to any applicant who presents evidence, satisfactory to the department of having passed an examination before a similar lawfully authorized examining agency or board of hearing aid specialists of another state or the District of Columbia, if the standards for the registration of hearing aid specialists or for licensure as a hearing aid specialist in such state or district are determined by the department to be as high as those of this state, and if that jurisdiction affords licensees of this state reciprocity. 21. Any person making an application for licensure under the provisions of this section may, at the discretion of the board, be required to pass an examination selected by the board. The issuance of a license by reciprocity to a military trained applicant. military spouse, or person who establishes residence in this state shall be subject to the provisions of Section §73-50-1 or §73-50-2, Mississippi Code of 1972, as applicable. 22. Denial of Universal License a. The applicant may appeal any of the following decisions of the Department to a court of general jurisdiction: (v) Denial of a license; (vi) Determination of the occupation; (vii) Determination of the similarity of the scope of practice of the license issued; or (viii) Other determinations under this section. b. The court shall determine all questions of law, including the interpretation of a constitutional or statutory provision or a rule adopted by the Department, without regard to any previous determination that may have been made on the question in any action before the Department.

**History**
- *SOURCE: Miss. Code Ann. §73-14-1.*

##### **15 Miss. Admin. Code Pt. 19, R. 6.4.7** Rule 6.4.7 {#sec-19-6.4.7 omnilex-key=us-ms-regs-official--title-15--19#6.4.7}

Abandonment (Revised 5/15/99): An application shall be deemed abandoned by the Department if, after six (6) months from the date of filing, the requirements for licensing have not been completed and submitted to the Department.

Subchapter 5: Renewal of License Rule 6.5.1 General Provisions (Revised 5/12/96) 1. The Department shall issue licenses which shall be renewed biennially.

2. The licensure period shall be construed as July 1 through June 30.

**History**
- *SOURCE: Miss. Code Ann. §73-14-1.*
- *SOURCE: Miss. Code Ann. §73-14-1*

##### **15 Miss. Admin. Code Pt. 19, R. 6.5.2** Rule 6.5.2 {#sec-19-6.5.2 omnilex-key=us-ms-regs-official--title-15--19#6.5.2}

Procedure for Renewal of License (Revised 5/12/96): The Department shall mail notices, at least thirty (30) days prior to the renewal date, to the last address registered with the Department, to the persons to whom licenses were issued or renewed during the preceding licensure period. The licensee shall: 1. complete the renewal form; 2. submit proof of continuing education credit as detailed in Subchapter 7 of these regulations; 3. enclose the renewal fee; 4. submit proof of the annual inspection and calibration of audiometric testing equipment; 5. submit a renewal addendum listing the worksite(s) where the licensee practices; and 6. file the above with the Department prior to the end of the renewal period.

**History**
- *SOURCE: Miss. Code Ann. §73-14-1*

##### **15 Miss. Admin. Code Pt. 19, R. 6.5.3** Failure to Renew (Revised 5/12/96) 1 {#sec-19-6.5.3 omnilex-key=us-ms-regs-official--title-15--19#6.5.3}

A grace period extending through July 30 shall be allowed after the expiration of a license, during which a license may be renewed with no penalty. A licensee who does not file, with the Department, his renewal application on or before July 30th will be deemed to have allowed his license to lapse. Failure to submit a renewal application postmarked on or before July 30th shall result in the necessity of the payment of a reinstatement fee. Said license may be reinstated by the Department, in its discretion, by the payment of the reinstatement fee and the required continuing education hours provided said application for reinstatement is made within one (1) year from the date of lapse of the license. 2. A license may not be reinstated after having lapsed for one (1) year from the date of lapse of the license. A new application must be made and the licensure regulations in effect at that time must be met.

**History**
- *SOURCE: Miss. Code Ann. §73-14-1 Subchapter 6: Continuing Education Rule 6.6.1 Definition and Philosophy: Each individual licensed as a hearing aid specialist is responsible for optimum service to the consumer and is accountable to the consumer, the employer, and the profession for evidence of maintaining high levels of skill and knowledge. Continuing education is defined as education beyond the basic preparation required for entry into the profession, directly related to the hearing aid specialist's performance and practice.*
- *SOURCE: Miss. Code Ann. §73-14-1*

##### **15 Miss. Admin. Code Pt. 19, R. 6.6.2** Requirements: (Revised 5/12/96) 1 {#sec-19-6.6.2 omnilex-key=us-ms-regs-official--title-15--19#6.6.2}

Regulations set the requirement of twenty (20) contact hours to be accrued during the licensing period (July 1 -June 30). No carryover of continuing education hours from one licensure period to another shall be allowed. 2. A temporary licensee shall not be responsible for accruing continuing education. 3. Failure to accrue the minimum continuing education requirement will result in a license not being renewed. A license that has expired/lapsed because of failure to meet the continuing education requirement, may be renewed or reinstated, at the Department's discretion, upon the presentation of satisfactory evidence of the required hours and upon the payment of all fees due.

**History**
- *SOURCE: Miss. Code Ann. §73-14-1*

##### **15 Miss. Admin. Code Pt. 19, R. 6.6.3** Rule 6.6.3 {#sec-19-6.6.3 omnilex-key=us-ms-regs-official--title-15--19#6.6.3}

Content Criteria: The content must apply to the hearing aid specialist profession and must be designed to meet one of the following goals: 1. Update knowledge and skills required for competent performance beyond entry level. 2. Allow the licensee to enhance his knowledge and skills. 3. Extend limits of professional capabilities and opportunities. 4. Include a minimum of one (1) educational hour per year relating to Ethical Practices specific to the Hearing Aid Specialist as defined in Rule 6.1.3(7) “Unethical Conduct” and Rule 6.5.3(2) “Advertising.”

**History**
- *SOURCE: Miss. Code Ann. §73-14-1*

##### **15 Miss. Admin. Code Pt. 19, R. 6.6.4** Rule 6.6.4 {#sec-19-6.6.4 omnilex-key=us-ms-regs-official--title-15--19#6.6.4}

Sources of Continuing Education: (Revised 5/15/99): Continuing education hours may be accrued from the following sources, provided the sources include continuing education annually that relate to the hearing aid specialist’s fitting and ethical practices as defined in Rule 6.1.3(7) “Unethical Conduct” and Rule 6.5.3(2) “Adverting.” PLEASE NOTE: No more than 50% of the total required hours may be accrued via online or home study courses. 1. Attendance at educational programs where continuing education credit is given and approved by the National Institute for Hearing Instrument Studies (NIHIS); 2. Attendance at educational programs where continuing education credit is given and approved by the American Speech-Language-Hearing Association (ASHA) and its state affiliated associations; 3. Attendance at educational programs where continuing education credit is given and approved by the Mississippi Hearing Aid Association (MHAA) or hearing aid associations of other states; 4. Attendance at educational programs where continuing education credit is given and approved by the Academy of Doctors of Audiology;

5. Attendance at educational programs where continuing education credit is given and approved by the American Academy of Audiologists; 6. Attendance at educational programs where continuing education credit is given and approved by an accredited university.

**History**
- *SOURCE: Miss. Code Ann. §73-14-1*

##### **15 Miss. Admin. Code Pt. 19, R. 6.6.5** Rule 6.6.5 {#sec-19-6.6.5 omnilex-key=us-ms-regs-official--title-15--19#6.6.5}

Reporting Procedures: It is the responsibility of the licensee to insure that the following criteria are met with respect to continuing education credit: Attendance at programs approved by the organizations in Rule 6.7.4 of these regulations are automatically accepted for credit unless sessions are duplicated. Verification of attendance may be made by submission of a continuing education certificate (must include licensee name, source, number of hours and date of attendance).

2. Is guilty of securing, or attempting to secure a license or certificate through fraud or deceit. 3. Is guilty of unethical conduct, or gross ignorance, or inefficiency in the conduct of his practice. 4. Is guilty of knowingly practicing while suffering with a contagious or infectious disease. 5. Has used a false name or alias in the practice of his profession. 6. Is unfit or incompetent by reason of negligence, habits, or other causes of incompetence. 7. Continued practice although the licensee has become unfit to practice as a hearing aid specialist due to: a. failure to keep abreast of current professional theory or practice; or b. physical or mental disability; the entry of an order or judgement by a court of competent jurisdiction that a licensee is in need of mental treatment or is incompetent shall constitute mental disability; or c. addiction or severe dependency upon alcohol or other drugs which may endanger the public by impairing the licensee's ability to practice. 8. Has practiced as a Hearing Aid Specialist after his license or permit has expired or has been suspended.

9. Has practiced as a Hearing Aid Specialist under cover of any permit or license illegally or fraudulently obtained or issued. 10. Has violated or aided or abetted others in violation of any provision of the Act or regulations promulgated thereto. 11. Has engaged in any conduct considered by the Board to be detrimental to the profession of Hearing Aid Specialists. 12. Has violated the provisions of any applicable federal laws or regulations. 13. Has been disciplined by another jurisdiction if at least one (1) of the grounds for the discipline is the same or substantially equivalent to those set forth in the Act or rules and regulations promulgated pursuant to the Act.

**History**
- *SOURCE: Miss. Code Ann. §73-14-1 Subchapter 7: Revocation, Suspension and Denial of License Rule 6.7.1 Standards of Conduct: Licensees may, at the discretion of the Board, have their license suspended, revoked, or denied at the time of renewal if the Board determines that the licensee: 1. Was convicted of an offense involving moral turpitude. The record of such conviction, or certified copy thereof from the clerk of the court where such conviction occurred or by the judge of that court, shall be sufficient evidence to warrant revocation or suspension.*
- *SOURCE: Miss. Code Ann. §73-14-1*

##### **15 Miss. Admin. Code Pt. 19, R. 6.7.2** Summary Suspensions: 1 {#sec-19-6.7.2 omnilex-key=us-ms-regs-official--title-15--19#6.7.2}

The Department may summarily suspend a license without a hearing, simultaneously with the filing of a formal complaint and notice of hearing, if the Department determines that: a. The health, safety, or welfare of the general public is in immediate danger; or b. The licensee's physical capacity to practice his profession is in issue; or c. The licensee's mental capacity to practice his profession is in issue. 2. If the Department summarily suspends a license, a hearing must begin within twenty (20) days after such suspension begins, unless continued at the request of the licensee.

**History**
- *SOURCE: Miss. Code Ann. §73-14-1*

##### **15 Miss. Admin. Code Pt. 19, R. 6.7.3** Rule 6.7.3 {#sec-19-6.7.3 omnilex-key=us-ms-regs-official--title-15--19#6.7.3}

Complaints: All complaints concerning a licensee, his business, or professional practice, shall be reviewed by the Department. Each complaint received shall be logged, recording at a minimum the following information: 1. licensee's name; 2. name of the complaining party, if known; 3. date of complaint; 4. brief statement of complaint; and 5. disposition.

**History**
- *SOURCE: Miss. Code Ann. §73-14-1*

##### **15 Miss. Admin. Code Pt. 19, R. 6.7.4** Investigations: All complaints will be investigated and evaluated by the Department, or its designee(s) {#sec-19-6.7.4 omnilex-key=us-ms-regs-official--title-15--19#6.7.4}

**History**
- *SOURCE: Miss. Code Ann. §73-14-1*

##### **15 Miss. Admin. Code Pt. 19, R. 6.7.5** Notice of Charges and Hearing: 1 {#sec-19-6.7.5 omnilex-key=us-ms-regs-official--title-15--19#6.7.5}

Following the investigative process, the Department may file formal charges against the licensee. Such formal complaint shall, at a minimum, inform the licensee of the facts which are the basis of the charge and which are specific enough to enable the licensee to defend against the charges. 2. Each licensee, whose conduct is the subject of a formal charge which seeks to impose disciplinary action against the licensee, shall be served notice of the formal charge at least twenty (20) days before the date of hearing. A hearing shall be presided over by the Board or the Board's designee. Service shall be considered to have been given if the notice was personally received by the licensee, or the notice was mailed certified, return receipt requested, to the licensee at the licensee's last known address as listed with the Department. The notice of the formal hearing shall consist at a minimum of the following information: a. The time, place and date of hearing; b. That the licensee shall appear personally at the hearing and may be represented by counsel; c. That the licensee shall have the right to produce witnesses and evidence in the licensee's behalf and shall have the right to cross-examine adverse witnesses and evidence; d. That the hearing could result in disciplinary action being taken against the licensee's license; e. That rules for the conduct of these hearings exist and it may be in the licensee's best interest to obtain a copy; and f. That the Board, or its designee, shall preside at the hearing and following the conclusion of the hearing shall make findings of facts, conclusions of law and recommendations, separately stated, to the Board as to what disciplinary action, if any, should be imposed on the licensee. 3. The Department may order a licensee to submit to a reasonable physical or mental examination if the licensee's physical or mental capacity to practice safely is at issue in a disciplinary proceeding. Failure to comply with a Department order to submit to a physical or mental examination shall render a licensee subject to the summary suspension procedures described in Rule 6.8.2 of these regulations. 4. The Board or its designee shall hear evidence produced in support of the formal charges and contrary evidence produced by the licensee. At the conclusion of the hearing, the Board shall issue an order, within sixty (60) days. 5. Disposition of any complaints may be made by consent order or stipulation between the Board and the licensee.

6. All proceedings pursuant to this section are matters of public record and shall be preserved pursuant to state law.

**History**
- *SOURCE: Miss. Code Ann. §73-14-1*

##### **15 Miss. Admin. Code Pt. 19, R. 6.7.6** Rule 6.7.6 {#sec-19-6.7.6 omnilex-key=us-ms-regs-official--title-15--19#6.7.6}

Board Sanctions: The Board may impose any of the following sanctions, singly or in combination, when it finds that a licensee is guilty of any of the above offenses: 1. Revocation of the license; 2. Suspension of the license, for any period of time; 3. Censure the licensee; 4. Impose a monetary penalty of not more than Two Hundred Dollars ($200.00); 5. Place a licensee on probationary status and require the licensee to submit to any of the following: a. report regularly to the Department, or its designee, upon matters which are the basis of probation; b. continue to renew professional education until a satisfactory degree of skill has been attained in those areas which are the basis of probation; or c. such other reasonable requirements or restrictions as are proper; 6. Refuse to renew a license; or 7. Revoke probation which has been granted and impose any other disciplinary action in this subsection when the requirements of probation have not been fulfilled or have been violated. 8. The Board may reinstate any licensee to good standing under this chapter if, after hearing, the Board is satisfied that the applicant's renewed practice is in the public interest. 9. The Board may seek the counsel of the Council regarding disciplinary actions.

**History**
- *SOURCE: Miss. Code Ann. §73-14-1*

##### **15 Miss. Admin. Code Pt. 19, R. 6.7.7** Rule 6.7.7 {#sec-19-6.7.7 omnilex-key=us-ms-regs-official--title-15--19#6.7.7}

Appeal: Any person aggrieved by a decision of the Board shall have a right of appeal in the manner provided for in the Act and the Laws of the State of Mississippi.

**History**
- *SOURCE: Miss. Code Ann. §73-14-1 Subchapter 8: Exceptions and Exemptions*

##### **15 Miss. Admin. Code Pt. 19, R. 6.8.1** Exceptions: The Act and the regulations promulgated thereto: 1 {#sec-19-6.8.1 omnilex-key=us-ms-regs-official--title-15--19#6.8.1}

Is not intended to prevent any person from engaging in the practice of measuring human hearing for the purpose of selection of hearing aids, provided such person, or organization employing such person, does not sell hearing aids or accessories thereto, except in the case of ear molds to be used only for the purpose of audiologic evaluation. 2. Shall not apply to any physician or surgeon licensed by the State of Mississippi. 3. Does not apply to a person while he is engaged in the fitting of hearing aids provided it is part of the academic curriculum of an accredited institution of higher education, or part of a program conducted by a public tax-supported institution or agency or nonprofit organization, unless such person or institution or agency sells hearing aids, and/or accessories, except ear molds.

**History**
- *SOURCE: Miss. Code Ann. §73-14-1*

##### **15 Miss. Admin. Code Pt. 19, R. 6.8.2** Rule 6.8.2 {#sec-19-6.8.2 omnilex-key=us-ms-regs-official--title-15--19#6.8.2}

**History**
- *SOURCE: Miss. Code Ann. §73-14-1 Subchapter 9: Supervision of a Temporary Licensee Rule 6.9.1 Credentials of Supervisor: A supervisor of a temporary licensee must hold a current license to practice in Mississippi, and: 1. hold a current and valid document of being National Board Certified in Hearing Instrument Sciences by the International Hearing Society (IHS); or 2. hold a current and valid Certificate of Clinical Competence in Audiology (CCC-A) from the American Speech-Language Hearing Association (ASHA); or 3. have had a minimum of three (3) years experience in the testing of hearing, fitting of hearing aids and dispensing of hearing aids.*
- *SOURCE: Miss. Code Ann. §73-14-1*

##### **15 Miss. Admin. Code Pt. 19, R. 6.9.2** Supervisor's Responsibilities: (Revised 5/15/99) 1 {#sec-19-6.9.2 omnilex-key=us-ms-regs-official--title-15--19#6.9.2}

The supervision of the temporary licensee must entail the personal and direct involvement of the supervisor in any and all ways that will permit the supervisor to attest to the adequacy of the supervisee's performance in the training experience. Knowledge of the temporary licensee's work may be obtained in a variety of ways such as: conference, audio and video tape recordings, written reports, staffing, and discussions with other persons who have participated in the training of the temporary licensee. Supervision must include direct observation of the temporary licensee performing puretone air and bone conduction speech audiometric evaluations, interpretation of audiograms, trouble-shooting hearing aids and sound-field testing of subjects, taking case history information, and performing such other activities considered important to the preparation for licensure. Employment of unlicensed personnel may be cause for revocation of a supervisor's license.

2. The supervisor is responsible for the services delivered to the client by the temporary licensee. 3. The Supervisor: a. Shall be responsible for the supervision of the trainee with a minimum of one-third (1/3) of supervision to be direct, on-site for the duration of the temporary license. b. Shall provide the trainee with materials and equipment necessary for appropriate audiometric and hearing aid evaluation and fitting procedures. c. Shall supplement the trainee with background information through reading lists and other references. d. Shall conduct in-service training for trainees. e. Shall act as consultant to the trainee, i.e., provide time for conferences for the trainee and provide a variety of resource materials, approaches, and techniques which are based on sound theory, successful practice and/or documented research. f. Shall submit to the Department a statement verifying trainee has completed one hundred and fifty (150) clock hours of supervised training (fifty (50) hours face-to-face), before sitting for the licensing examination. g. Shall notify the Department within ten (10) days following termination of trainee supervision. h. Shall be responsible to the Department for disseminating all material and information to the trainee and for returning to the Department all forms relating to the training period for licensure.

**History**
- *SOURCE: Miss. Code Ann. §73-14-1*

##### **15 Miss. Admin. Code Pt. 19, R. 6.9.3** Rule 6.9.3 {#sec-19-6.9.3 omnilex-key=us-ms-regs-official--title-15--19#6.9.3}

Elements of Supervision: (Revised 5/12/96): The supervised training experience is construed to mean direct fitting and dispensing activities performed on consumers as listed below: 1. Twenty-five (25) hours in pure tone air conduction, bone conduction, and speech audiometry. 2. Twenty-five (25) hours in hearing aid evaluation and post-fit counseling. 3. Twenty (20) hours in hearing aid fittings with actual clients. 4. Twenty (20) hours in earmold orientation, types, uses and terminology. 5. Fifteen (15) hours in earmold impressions and otoscopic examination of the ear. 6. Fifteen (15) hours in trouble-shooting of defective hearing aids. 7. Ten (10) hours in case history with actual clients. 8. Three (3) hours in laws governing the licensure of practice, FDA and FTC regulations.

9. Seventeen (17) hours of supplemental work in any of the above areas.

**History**
- *SOURCE: Miss. Code Ann. §73-14-1*

##### **15 Miss. Admin. Code Pt. 19, R. 6.9.4** Rule 6.9.4 {#sec-19-6.9.4 omnilex-key=us-ms-regs-official--title-15--19#6.9.4}

Length of Supervision (Revised 5/12/96): The training period shall be a minimum of ninety (90) days but no more than nine (9) months.

2. Use a false name or alias in the practice of his profession. 3. Fail to notify the Department of the suspension, probation or revocation of any past or currently held licenses, required to practice as a Hearing Aid Specialist in this or any other jurisdiction. 4. Make false representations or impersonate or act as a proxy for another person or allow or aid any person to impersonate him in connection with any examination or application for licensing or request to be examined or licensed. 5. Sell, barter or offer to sell or barter a license. 6. Purchase or procure by barter a license with intent to use it as evidence of the holder's qualifications to practice the fitting and dispensing of hearing aids. 7. Alter materially a license with fraudulent intent. 8. Use or attempt to use as a valid license one which has been purchased, fraudulently obtained, counterfeited or materially altered. 9. Willfully make a false material statement in an application for registration or for renewal of a license. 10. Violate any of the provisions of the Act or any rules or regulations promulgated thereto.

**History**
- *SOURCE: Miss. Code Ann. §73-14-1 Subchapter 10: Criminal Offenses and Punishment Rule 6.10.1 Offenses: It is a misdemeanor for any person to: 1. Secure a license or certificate through fraud or deceit.*
- *SOURCE: Miss. Code Ann. §73-14-1*

##### **15 Miss. Admin. Code Pt. 19, R. 6.10.2** Rule 6.10.2 {#sec-19-6.10.2 omnilex-key=us-ms-regs-official--title-15--19#6.10.2}

Punishment: Violation of any provision of this chapter is a misdemeanor punishable upon conviction by a fine of not less that One Hundred Dollars ($100.00) nor more than Five Hundred Dollars ($500.00), or by imprisonment for not more than ninety (90) days in the county jail, or by both.

**History**
- *SOURCE: Miss. Code Ann. §73-14-1 Subchapter 11: Fees*

##### **15 Miss. Admin. Code Pt. 19, R. 6.11.1** Rule 6.11.1 {#sec-19-6.11.1 omnilex-key=us-ms-regs-official--title-15--19#6.11.1}

Method of Payment: In accordance with the Act, the following non-refundable fees, where applicable, are payable to the Department by check or money order.

**History**
- *SOURCE: Miss. Code Ann. §73-14-1*

##### **15 Miss. Admin. Code Pt. 19, R. 6.11.2** Schedule of Fees: (Revised 5/12/96) 1 {#sec-19-6.11.2 omnilex-key=us-ms-regs-official--title-15--19#6.11.2}

Application and License Fee ............................................................................$100.00 2. Application & Temporary License fee ............................................................$100.00 3. Renewal Fee .....................................................................................................$200.00 4. Temporary License Renewal Fee......................................................................$ 50.00 5. Reinstatement Fee ............................................................................................$250.00 6. License Replacement Fee .................................................................................$ 25.00 7. License Duplication Fee ...................................................................................$ 25.00 8. ID Card Replacement Fee .................................................................................$ 10.00 9. License Verification Fee ...................................................................................$ 25.00 10. Examination Fee: Contact Professional Licensure Branch for current examination fee.

**History**
- *SOURCE: Miss. Code Ann. §73-14-1*

##### **15 Miss. Admin. Code Pt. 19, R. 6.11.3** Examination Fee: Fees for the examination are to be paid to the appropriate examination administrant {#sec-19-6.11.3 omnilex-key=us-ms-regs-official--title-15--19#6.11.3}

2. Any person aggrieved by a decision rendered after the second review shall have the right of administrative appeal and a public hearing to be conducted in accordance with the policies of the Department of Health.

**History**
- *SOURCE: Miss. Code Ann. §73-14-1 Subchapter 12: Administrative Grievance Procedure Rule 6.12.1 Administrative Appeals: 1. Any person aggrieved by a decision regarding the initial application for licensure or the renewal of licensure shall have the right of a second review by the Department or its designee.*
- *SOURCE: Miss. Code Ann. §73-14-1*

##### **15 Miss. Admin. Code Pt. 19, R. 6.12.2** Rule 6.12.2 {#sec-19-6.12.2 omnilex-key=us-ms-regs-official--title-15--19#6.12.2}

Notification: Written notice will be provided to all applicants regarding denial of an original license or a renewal license. Such notice shall contain the reason thereof.

**History**
- *SOURCE: Miss. Code Ann. §73-14-1*

##### **15 Miss. Admin. Code Pt. 19, R. 6.12.3** Hearing 1 {#sec-19-6.12.3 omnilex-key=us-ms-regs-official--title-15--19#6.12.3}

If requested in writing within the specified time frame a hearing will be provided in which the applicant may show cause why the license should be granted or renewed. 2. Within sixty (60) days of the hearing, or other such time frame as determined during the hearing, written findings of fact, together with a recommendation for action on the license in question, shall be forwarded to the State Health Officer. The State Health Officer shall decide what action will be taken on the recommendation within five days of its receipt. Written notice shall be provided to the applicant.

**History**
- *SOURCE: Miss. Code Ann. §73-14-1*

#### **Chapter 7** REGULATION GOVERNING REGISTRATION OF MEDICAL RADIATION TECHNOLOGISTS Subchapter 1: General Rule 7.1.1 Legal Authority: The State Board of Health is authorized to establish and enforce these rules and procedures by virtue of Sections 41-58-1 et seq. of Mississippi Code of 1972, annotated.

##### **15 Miss. Admin. Code Pt. 19, R. 7.1.2** Definitions: The following terms shall have the meaning set forth below, unless the context otherwise requires: 1 {#sec-19-7.1.2 omnilex-key=us-ms-regs-official--title-15--19#7.1.2}

"Department" means the Mississippi Department of Health. 2. "Licensed practitioner" means a person licensed or otherwise authorized by law to practice medicine, dentistry, chiropractic, osteopathy or podiatry, or a licensed nurse practitioner, or physician assistant. 3. "Ionizing radiation" means x-rays and gamma rays, alpha and beta particles, high speed electrons, neutrons and other nuclear particles. 4. "X-radiation" means penetrating electromagnetic radiation with wavelengths short than ten (10) nanometers produced by bombarding a metallic target with fast electrons in a vacuum. 5. "Supervision" means responsibility for, and control of, quality radiation safety and protection, and technical aspects of the application of ionizing radiation to human beings for diagnostic and/or therapeutic purposes. 6. "Medical radiation technology" means the science and art of applying ionizing radiation to human beings for diagnostic and/or therapeutic purposes. The Department issues three (3) types of registrations for certain specialized disciplines of medical radiation technology as further described in Rule 7.3.1. The Department does not issue registrations to limited x-ray machine operators.

7. "Radiologic technologist" means a person other than a licensed practitioner who has passed a national certification examination recognized by the Department such as the American Registry of Radiologic Technologist examination or its equivalent, who applies x-radiation or ionizing radiation to any part of the human body for diagnostic purposes and includes the administration of parenteral and enteral contrast media and administration of other medications or procedures incidental to radiologic examinations. 8. “Nuclear medicine technologist” means a person other than a licensed practitioner who has passed a national certification examination such as the American Registry of Radiologic Technologist examination or the Nuclear Medicine Technology Certification Board examination or its equivalent, who performs in vivo imaging and measurement procedures and in vitro non-imaging laboratory studies, prepares radiopharmaceuticals, and administers diagnostic/therapeutic doses of radiopharmaceuticals and administers other medications or procedures incidental for nuclear medicine exams to human beings while under the supervision of a licensed practitioner who is licensed to possess and use radioactive material. A certified nuclear medicine technologist also may perform diagnostic CT exams on hybrid equipment for diagnostic purposes, including the administration of parenteral and enteral contrast media and administration of other medications or procedures incidental to CT exams. Certified nuclear medicine technologists who perform CT scans must be certified in CT by the American Registry of Radiologic Technologists, the Nuclear Medicine Technology Certification Board, or other CT certifying body. A certified nuclear medicine technologist may do on-the-job training on hybrid equipment provided that the certified nuclear medicine technologist is supervised by a certified technologist and obtains a CT certification within six (6) months of that training. 9. "Radiation therapist" means a person other than a licensed practitioner who has passed a national certification examination recognized by the Department such as the American Registry of Radiologic Technologist examination or its equivalent, who applies x-radiation and the ionizing radiation emitted from particle accelerators, cobalt sixty (60) units and sealed sources of radioactive material to human beings for therapeutic purposes while under the supervision of a licensed radiation oncologist or a board certified radiologist who is licensed to possess and use radioactive material. 10. "Council" means the Medical Radiation Advisory Council. 11. "Act" shall mean Section 41-58-1 et seq. of Mississippi Code of 1972, annotated. 12. "State" shall mean the State of Mississippi". 13. “Limited X-ray Machine Operator” means a person other than a licensed practitioner or radiologic technologist who is issued a Permit by the State Board of Medical Licensure to perform medical radiation technology limited to specific radiographic procedures on certain parts of the human anatomy, specifically the chest, abdomen and skeletal structures, and excluding fluoroscopic, both stationary and mobile (C-arm), and contrast studies, computed tomography, nuclear medicine, radiation therapy studies and mammography. Limited X-ray machine operators are regulated by the State Board of Medical Licensure.

**History**
- *SOURCE: Miss. Code Ann. § 41-58-3.*

##### **15 Miss. Admin. Code Pt. 19, R. 7.2.1** Council Structure and Purpose: 1 {#sec-19-7.2.1 omnilex-key=us-ms-regs-official--title-15--19#7.2.1}

The Council shall consist of nine (9) members, who shall serve without compensation. They shall be selected by the Department, to serve under the jurisdiction of the Department for a three (3) year term, except for those members appointed to the first council, four (4) of whom shall be appointed for two (2) year terms, and five (5) of whom shall be appointed for three (3) year terms. 2. The council composition shall be as follows: a. One (1) radiologist who is an active practitioner and member of the Mississippi Radiological Society; b. One (1) licensed family physician; c. One (1) licensed practitioner; d. Two (2) registered radiological technologists; e. One (1) nuclear medicine technologist; f. One (1) radiation therapist; g. One (1) radiation physicist; h. One (1) hospital administrator; and i. The State Health Officer, or his designee, who shall serve as ex officio chairman with no voting authority. 3. All council members engaged in medical radiation technology and not exempt from registration must, at the time of appointment, be registered with the Department. Any other person serving on the council who is a practitioner of a profession or occupation required to be licensed, credentialed, or certified in the state, shall hold an appropriate license, credential, or certificate issued by the state. The purpose of the Council is to serve in an advisory capacity to the Department in matters relating to the administration and interpretation of the Act.

**History**
- *SOURCE: Miss. Code Ann. § 41-58-3.*

##### **15 Miss. Admin. Code Pt. 19, R. 7.2.2** Meeting: The Council shall meet at places and at times designated by the Department {#sec-19-7.2.2 omnilex-key=us-ms-regs-official--title-15--19#7.2.2}

A quorum shall consist of five (5) members of the Council, and shall be necessary for the Council to take action by vote.

Subchapter 3: Registration Rule 7.3.1 Types of Registration: 1. “Radiologic technologist registration” means the registration issued by the Department which permits a person to apply x-radiation or ionizing radiation to any part of the human body for

diagnostic purposes, includes the administration of parenteral and enteral contrast media and administration of other medications or procedures incidental to radiologic examinations. 2. “Nuclear medicine technologist registration” means the registration which permits a person to perform in vivo imaging and measurement procedures and in vitro non-imaging laboratory studies, to prepare radiopharmaceuticals, and to administer diagnostic and therapeutic doses of radiopharmaceuticals to human beings while under the supervision of a licensed practitioner who is identified as an authorized user on a Department license that authorizes the medical use of radioactive material. 3. “Radiation therapist registration” means the registration issued by the Department which permits a person to apply x-radiation and the ionizing radiation emitted from particle accelerators, cobalt-60 units and sealed sources of radioactive material to human beings for therapeutic purposes while under the supervision of a licensed radiation oncologist or a board certified radiologist who is identified as an authorized user by the Department to possess and apply x-radiation and the ionizing radiation emitted from particle accelerators, cobalt-60 units and sealed sources of radioactive material to human beings for therapeutic purposes.

**History**
- *SOURCE: Miss. Code Ann. § 41-58-3.*
- *SOURCE: Miss. Code Ann. § 41-58-3.*

##### **15 Miss. Admin. Code Pt. 19, R. 7.3.2** Rule 7.3.2 {#sec-19-7.3.2 omnilex-key=us-ms-regs-official--title-15--19#7.3.2}

General Requirements: An applicant for registration shall submit to the Department, verified under oath, written evidence in form and content satisfactory to the Department that the applicant: 1. Is a United States citizen or has status as a legal resident alien, which is a continuing requirement for registration. 2. Has not been declared mentally incompetent by any court, and if any such decree has ever been rendered, that the decree has since been changed, which is a continuing requirement for registration. 3. Is free from dependency on alcohol or drugs, which is a continuing requirement for registration. 4. Has not had a license or registration in medical radiation technology suspended or revoked in any other state, jurisdiction, or country, which is a continuing requirement for registration.

**History**
- *SOURCE: Miss. Code Ann. § 41-58-3.*

##### **15 Miss. Admin. Code Pt. 19, R. 7.3.3** Specific Registration Requirements: 1 {#sec-19-7.3.3 omnilex-key=us-ms-regs-official--title-15--19#7.3.3}

Radiologic technologist registration- An applicant for registration as a radiologic technologist shall submit to the Department written evidence in form and content satisfactory to the Department that the applicant is an American Registry of Radiologic Technologist (ARRT) Registered Medical Radiologic Technologist. 2. Nuclear medicine technologist registration - An applicant for registration as a nuclear medicine technologist shall submit to the Department, verified by oath, written evidence in form and content satisfactory to the Department that the applicant is an American Registry of Radiologic Technologist (ARRT) Registered Nuclear Medicine Technologist and/or the Nuclear Medicine Technologist Certifying Board (NMTCB).

3. Radiation therapist registration - An applicant for registration as a radiation therapist technologist shall submit to the Department written evidence in form and content satisfactory to the Department that the applicant is an American Registry of Radiologic Technologist (ARRT) Registered Radiation Therapist Technologist.

**History**
- *SOURCE: Miss. Code Ann. § 41-58-3.*

##### **15 Miss. Admin. Code Pt. 19, R. 7.3.4** Rule 7.3.4 {#sec-19-7.3.4 omnilex-key=us-ms-regs-official--title-15--19#7.3.4}

Temporary Permit: The Department may, in its discretion, issue a temporary permit to practice a specialty of medical radiation technology for a period of six (6) months to an applicant for a registration, pending the completion of the requirements for registration, providing the applicant submits to the Department, verified by oath, in form and content satisfactory to the Department that: 1. the applicant has successfully completed an approved program accredited by the JRCERT or the JRCNMT, or their successor organizations, in the registration specialty; and 2. the applicant has qualified to sit for the appropriate ARRT or NMTCB specialty examination. 3. applications under this section must be submitted within 1 year from the date of graduation from an approved program.

**History**
- *SOURCE: Miss. Code Ann. § 41-58-3.*

##### **15 Miss. Admin. Code Pt. 19, R. 7.3.5** Rule 7.3.5 {#sec-19-7.3.5 omnilex-key=us-ms-regs-official--title-15--19#7.3.5}

Abandonment: An application shall be deemed abandoned by the Department if, after two years from the date of filing, the requirements for registration have not been completed and submitted to the Department.

**History**
- *SOURCE: Miss. Code Ann. § 41-58-3.*

##### **15 Miss. Admin. Code Pt. 19, R. 7.3.6** Rule 7.3.6 {#sec-19-7.3.6 omnilex-key=us-ms-regs-official--title-15--19#7.3.6}

Production and Display of Registration: A person registered to practice medical radiation technology in the State of Mississippi shall be issued a “Certificate of Registration” and “Registration Identification Letter.” The “Certificate of Registration” or copy thereof shall be on record at the place(s) of employment. The licensee shall carry the “Registration Identification Letter” with them at all times when providing services and show said Registration Identification Letter when requested.

Subchapter 4: Renewal of Registration Rule 7.4.1 General Provisions: 1. The Department shall issue registrations which shall be renewed biennially, after the initial registration phase. 2. The licensure year shall be construed as September 1st through August 31st.

**History**
- *SOURCE: Miss. Code Ann. § 41-58-3.*
- *SOURCE: Miss. Code Ann. § 41-58-3.*

##### **15 Miss. Admin. Code Pt. 19, R. 7.4.2** Rule 7.4.2 {#sec-19-7.4.2 omnilex-key=us-ms-regs-official--title-15--19#7.4.2}

Procedure for Renewal of Registration: The Department shall mail notices, at least thirty (30) days prior to the renewal date, to the last address registered with the board, to the persons to whom registrations were issued or renewed during the preceding renewal period. The registrant shall: 1. complete the renewal form; 2. submit proof of continuing education credit as detailed in Section 5 of these regulations; 3. file the above with the Department prior to the end of the renewal period with the appropriate fee.

**History**
- *SOURCE: Miss. Code Ann. § 41-58-3.*

##### **15 Miss. Admin. Code Pt. 19, R. 7.4.3** Rule 7.4.3 {#sec-19-7.4.3 omnilex-key=us-ms-regs-official--title-15--19#7.4.3}

Failure to Renew: A registrant who does not file, with the Department, his renewal application within the renewal period will be deemed to have allowed his registration to lapse. Said registration may be reinstated by the Department, in its discretion, by the payment of the renewal fee and a reinstatement fee, provided said application for reinstatement is made within two (2) years of the end of the renewal period.

Subchapter 5: Continuing Education Rule 7.5.1 Requirements: 1. Regulations set the requirement of twenty-four (24) clock hours to be accrued during the registration term. 2. Individuals applying for initial registration within a registration term must accrue continuing education hours on a prorated scale. Written notification of required hours will be sent to the applicant at the time of registration.

**History**
- *SOURCE: Miss. Code Ann. § 41-58-3.*
- *SOURCE: Miss. Code Ann. § 41-58-3.*

##### **15 Miss. Admin. Code Pt. 19, R. 7.5.2** Rule 7.5.2 {#sec-19-7.5.2 omnilex-key=us-ms-regs-official--title-15--19#7.5.2}

Sources of Continuing Education: All continuing education hours for individuals registered with the Mississippi Department of Health must be approved by the American Registry of Radiologic Technologists (A.R.R.T.).

**History**
- *SOURCE: Miss. Code Ann. § 41-58-3.*

##### **15 Miss. Admin. Code Pt. 19, R. 7.5.3** Reporting Procedures for Continuing Education: 1 {#sec-19-7.5.3 omnilex-key=us-ms-regs-official--title-15--19#7.5.3}

If requested, it is the responsibility of the registrant to submit, at the time of renewal, written evidence in form and content satisfactory to the Department, proof that the continuing education requirement has been met. 2. Persons who fail to accrue the required continuing education hours shall be issued a probationary registration for one (1) registration term. Failure to satisfy the terms and conditions of the probation and to accrue the required hours will result in the revocation of the registration. Hours accrued are first credited for the delinquent hours lacking from the previous registration period, and then applied to the present registration term. 3. Probationary registrations will be issued for one registration term only. No ensuing registration may be probationary as a result of not meeting continuing education requirements.

Subchapter 6: Exceptions and Exemptions Rule 7.6.1 Exceptions: No person shall practice medical radiation technology unless he is registered by the Department, except as otherwise provided in this section. 1. A student enrolled in and participating in an approved course of study for diagnostic radiologic technology, nuclear medicine technology or radiation therapy, who as a part of his clinical course of study applies ionizing radiation to a human being while under the supervision of a licensed practitioner, registered radiologic technologist, registered nuclear medicine technologist or registered radiation therapist; 2. Laboratory personnel who use radiopharmaceuticals for in vitro studies; 3. A dental hygienist or a dental assistant who is not a radiologic technologist, nuclear medicine technologist or radiation therapist, who possesses a radiology permit issued by the Board of Dental Examiners and applies ionizing radiation under the specific direction of a licensed dentist; 4. A chiropractic assistant who is not a radiologic technologist, nuclear medicine technologist or radiation therapist, who possesses a radiology permit issued by the Board of Chiropractic Examiners and applies ionizing radiation under this specific direction of a licensed chiropractor; 5. An individual who is not a radiologic technologist, nuclear medicine technologist or radiation therapist, is permitted as a Limited X-Ray Machine Operator by the Board of Medical

Licensure and applies ionizing radiation in a physician's office or a radiology clinic under the specific direction of a licensed practitioner as defined in Rule 7.1.2 Item 2., in these regulations; and 6. An individual who is not a radiologic technologist, nuclear medicine technologist or radiation therapist, is permitted as a Limited X-Ray Machine Operator by the Board of Medical Licensure and applies ionizing radiation in a licensed hospital under the specific direction of a licensed practitioner as defined in Rule 7.1.2 Item 2., in these regulations. 7. Nothing in these regulations is intended to limit, preclude, or otherwise interfere with the practices of a licensed practitioner as defined in the definitions of these regulations, who is duly licensed or registered by the appropriate agency of the State of Mississippi, provided that the agency specifically recognizes that the procedures covered by these regulations are within the scope of practice of the licensee or registrant. 8. A student enrolled in and participating in an accredited course of study for diagnostic radiologic technology, nuclear medicine technology or radiation therapy and is employed by a physician’s office, radiology clinic or a licensed hospital in Mississippi and applies ionizing radiation under the specific direction of a licensed practitioner.

Subchapter 7: Criminal Offenses and Punishment Rule 7.7.1 Offenses: It is a misdemeanor for any person to violate any provisions these regulations.

**History**
- *SOURCE: Miss. Code Ann. § 41-58-3.*
- *SOURCE: Miss. Code Ann. § 41-58-3.*
- *SOURCE: Miss. Code Ann. § 41-58-3.*

##### **15 Miss. Admin. Code Pt. 19, R. 7.7.2** Rule 7.7.2 {#sec-19-7.7.2 omnilex-key=us-ms-regs-official--title-15--19#7.7.2}

Punishment: Such misdemeanor shall, upon conviction, be punishable by a fine of not more than One Thousand Dollars ($1,000.00) or by imprisonment for not more than six (6) months or by both fine and imprisonment for each offense.

Subchapter 8: Revocation, Suspension and Denial of Registration Rule 7.8.1 Standards of Conduct: Registrants may, at the discretion of the Department, have their registration placed on probation, suspended or revoked, or, denied at the time of application or renewal, or have such other disciplinary action taken as deemed appropriate, if the Department determines that the registrant: 1. Is guilty of fraud or deceit in procuring or attempting to procure a registration or renewal of a registration to practice medical radiation technology. 2. Has failed to service a patient in a professional manner, or is unfit or incompetent by reason of negligence, habits, or other causes of incompetency. 3. Is habitually intemperate in the use of alcoholic beverage.

4. Is addicted to, or has improperly obtained, possessed, used, or distributed habit-forming drugs or narcotics. 5. Is guilty of dishonest or unethical conduct. 6. Has practiced medical radiation technology after his registration has expired or has been suspended. 7. Has practiced medical radiation technology under cover of any registration illegally or fraudulently obtained or issued. 8. Has violated any of the rules, regulations, or Standards of Ethics of the American Registry of Radiologic Technologists. 9. Has been convicted of any crime involving dishonest or unethical conduct. 10. Has been convicted of any felony. 11. Has violated, aided, or abetted others in violation of any provision of the Act or the regulations promulgated thereto. 12. Has engaged in any conduct considered by the Department to be detrimental to the profession of medical radiation technology.

**History**
- *SOURCE: Miss. Code Ann. § 41-58-3.*
- *SOURCE: Miss. Code Ann. § 41-58-3.*

##### **15 Miss. Admin. Code Pt. 19, R. 7.8.2** Rule 7.8.2 {#sec-19-7.8.2 omnilex-key=us-ms-regs-official--title-15--19#7.8.2}

Summary Suspension: The Department may summarily suspend a registration without a hearing, simultaneously with the filing of a formal complaint and notice of hearing, if the Department determines that: 1. The health, safety, or welfare of the general public is in immediate danger; or 2. The registrant's physical capacity to practice his profession is in issue; or 3. The registrant's mental capacity to practice his profession is in issue.

**History**
- *SOURCE: Miss. Code Ann. § 41-58-3.*

##### **15 Miss. Admin. Code Pt. 19, R. 7.8.3** Rule 7.8.3 {#sec-19-7.8.3 omnilex-key=us-ms-regs-official--title-15--19#7.8.3}

Complaints: All complaints concerning a registrant, his business, or professional practice, shall be reviewed, evaluated, and if required, investigated by the Department.

**History**
- *SOURCE: Miss. Code Ann. § 41-58-3.*

##### **15 Miss. Admin. Code Pt. 19, R. 7.8.4** Notice of Charges and Hearing: 1 {#sec-19-7.8.4 omnilex-key=us-ms-regs-official--title-15--19#7.8.4}

Following the investigative process, the Department may file formal charges against the registrant. Such formal complaint shall, at a minimum, inform the registrant of the facts which are the basis of the charge and which are specific enough to enable the registrant to defend against the charges. 2. Each registrant, whose conduct is the subject of a formal charge which seeks to impose disciplinary action against the registrant, shall be served notice of the formal charge at least fifteen (15) days

before the date of hearing. A hearing shall be presided over by the Department's designee. Service shall be considered to have been given if the notice was personally received by the registrant, or the notice was mailed certified, return receipt requested, to the registrant at the registrant's last known address as listed with the Department. 3. The notice of the formal hearing shall consist at a minimum of the following information: a. The time, place and date of hearing; b. That the registrant shall appear personally at the hearing and may be represented by counsel; c. That the registrant shall have the right to produce witnesses and evidence in the registrant's behalf and shall have the right to cross-examine adverse witnesses and evidence; d. That the hearing could result in disciplinary action being taken against the registrant's registration; e. That rules for the conduct of these hearings exist and it may be in the registrant's best interest to obtain a copy; and f. That the Department's designee shall preside at the hearing and following the conclusion of the hearing shall make findings of facts, conclusions of law and recommendations, separately stated to the State Health Officer as to what disciplinary action, if any, should be imposed on the registration. 4. The Department's designee shall hear evidence produced in support of the formal charges and contrary evidence produced by the registration. At the conclusion of the hearing, the State Health Officer shall issue an order, within sixty (60) days. 5. Disposition of any complaints may be made by consent order or stipulation between the Department and the registrant. 6. All proceedings pursuant to this section are matters of public record and shall be preserved pursuant to state law.

**History**
- *SOURCE: Miss. Code Ann. § 41-58-3.*

##### **15 Miss. Admin. Code Pt. 19, R. 7.8.5** Rule 7.8.5 {#sec-19-7.8.5 omnilex-key=us-ms-regs-official--title-15--19#7.8.5}

Department Sanctions: The Department may impose any of the following sanctions, singly or in combination, when it finds that a registrant is guilty of any of the offenses set forth in Rule 7.8.1 and Rule 7.8.2 above: 1. Revocation of the registration; 2. Suspension of the registration, for any period of time; 3. Censure the registrant; 4. Issuance of a letter of reprimand to the registrant; 5. Place a registrant on probationary status and require the registrant to submit to any of the following:

a. report regularly to the board upon matters which are the basis of probation; b. continue to renew professional education until a satisfactory degree of skill has been attained in those areas which are the basis of probation; or c. such other reasonable requirements or restrictions as are proper; 6. Refuse to renew a registration; or 7. Revoke probation which has been granted and impose any other disciplinary action in this subsection when the requirements of probation have not been fulfilled or have been violated.

**History**
- *SOURCE: Miss. Code Ann. § 41-58-3.*

##### **15 Miss. Admin. Code Pt. 19, R. 7.8.6** Rule 7.8.6 {#sec-19-7.8.6 omnilex-key=us-ms-regs-official--title-15--19#7.8.6}

Appeal: Any person aggrieved by a decision of the Board shall have a right of appeal to the Hinds County Circuit Court, in the manner provided for in the Laws of the State of Mississippi.

Subchapter 9: Fees Rule 7.9.1 Method of Payment: The following fees, where applicable, are payable to the Mississippi Department of Health by certified check, cashiers check, or money order. Fees paid to the Department are non-refundable.

**History**
- *SOURCE: Miss. Code Ann. § 41-58-3.*
- *SOURCE: Miss. Code Ann. § 41-58-3.*

##### **15 Miss. Admin. Code Pt. 19, R. 7.9.2** Schedule of Fees 1 {#sec-19-7.9.2 omnilex-key=us-ms-regs-official--title-15--19#7.9.2}

Initial Registration Fee - $50.00 2. Renewal Fee-$50.00 3. Temporary Permit - $25.00 4. Reinstatement Fee - $200.00 5. Replacement Fee - $50.00 6. Registration Verification Fee - $25.00

Subchapter 10: Administrative Grievance Procedure Rule 7.10.1 Administrative Appeals: All persons aggrieved by a decision regarding the initial application for registration or the renewal of registration shall have the right of administrative appeal and a hearing to be conducted according to the policy of the Department of Health.

**History**
- *SOURCE: Miss. Code Ann. § 41-58-3.*
- *SOURCE: Miss. Code Ann. § 41-58-3.*

##### **15 Miss. Admin. Code Pt. 19, R. 7.10.2** Rule 7.10.2 {#sec-19-7.10.2 omnilex-key=us-ms-regs-official--title-15--19#7.10.2}

Notification: Written notice will be provided to all applicants regarding denial of an original registration or a renewal registration. Such notice shall contain the reason thereof and shall offer the applicant an opportunity to submit additional information pertinent to their application for a second review by the Department.

**History**
- *SOURCE: Miss. Code Ann. § 41-58-3*

##### **15 Miss. Admin. Code Pt. 19, R. 7.10.3** Hearing: 1 {#sec-19-7.10.3 omnilex-key=us-ms-regs-official--title-15--19#7.10.3}

If requested in writing within the specified time frame a hearing will be provided in which the applicant may show cause why the registration should be granted or renewed. 2. Within sixty (60) days of the hearing, or other such time frame as determined during the hearing, written findings of fact, together with a recommendation for action on the registration in question, shall be forwarded to the State Health Officer. The State Health Officer shall decide what action will be taken on the recommendation.

CHAPTER 8 REGULATIONS GOVERNING LICENSURE OF OCCUPATIONAL THERAPISTS AND OCCUPATIONAL THERAPY ASSISTANTS

**History**
- *SOURCE: Miss. Code Ann. § 41-58-3.*

##### **15 Miss. Admin. Code Pt. 19, R. 8.1.1** Subchapter 1: General {#sec-19-8.1.1 omnilex-key=us-ms-regs-official--title-15--19#8.1.1}

Purpose: The purpose of these regulations is to safeguard the public's health, safety, and welfare by establishing minimum qualifications and creating exclusive titles corresponding to the level of qualifications for individuals who wish to offer occupational therapy services to the public. Further, in order to ensure the highest degree of professional conduct by those engaged in offering occupational therapy services to the public, it is the purpose of these regulations to provide and impose disciplinary sanctions, be they civil or criminal, against persons who do not meet or adhere to the procedures, qualifications, and standards set out in these regulations.

**History**
- *SOURCE: Miss. Code Ann. §73-24-13*

##### **15 Miss. Admin. Code Pt. 19, R. 8.1.2** Legal Authority: The State Board of Health established and empowered by Section 41-3-1 et seq {#sec-19-8.1.2 omnilex-key=us-ms-regs-official--title-15--19#8.1.2}

of Mississippi Code of 1972, annotated, is authorized to establish and enforce these rules and procedures by virtue of "Mississippi Occupational Therapy Practice Law," Sections 73-24-1, et seq. of Mississippi Code of 1972, annotated.

**History**
- *SOURCE: Miss. Code Ann. §73-24-13*

##### **15 Miss. Admin. Code Pt. 19, R. 8.1.3** Rule 8.1.3 {#sec-19-8.1.3 omnilex-key=us-ms-regs-official--title-15--19#8.1.3}

Definitions: The following terms shall have the meaning set forth below, unless the context the context otherwise requires: 1. Board shall mean the Mississippi State Board of Health.

2. Council shall mean the Mississippi Advisory Council in Occupational Therapy. 3. License shall mean the document of licensure issued by the Board. 4. Act shall mean the "Mississippi Occupational Therapy Practice Law" sections 73-24-1 et seq. of Mississippi Code of 1972, annotated. 5. Examination shall mean the examination approved by the Board. 6. Department shall mean the Mississippi State Department of Health. 7. The Practice of Occupational therapy means the therapeutic use of everyday life occupations with persons, groups, or populations (clients) to support occupational performance and participation. Occupational therapy practice includes clinical reasoning and professional judgment to evaluate, analyze, and diagnose occupational challenges (e.g., issues with client factors, performance patterns, and performance skills) and provide occupation-based interventions to address them. Occupational therapy services include habilitation, rehabilitation, and the promotion of physical and mental health and wellness for clients with all levels of ability-related needs. These services are provided for clients who have or are at risk for developing an illness, injury, disease, disorder, condition, impairment, disability, activity limitation, or participation restriction. Through the provision of skilled services and engagement in everyday activities, occupational therapy promotes physical and mental health and well-being by supporting occupational performance in people with, or at risk of experiencing, a range of developmental, physical, and mental health disorders.

a. Evaluation of factors affecting activities of daily living (ADLs), instrumental activities of daily living (IADLs), health management, rest and sleep, education, work, play, leisure, and social participation, including 1. Context (environmental and personal factors) and occupational and activity demands that affect performance.

(i) Performance patterns including habits, routines, roles, and rituals;

(ii) Performance skills, including motor skills (e.g., moving oneself or moving and interacting with objects), process skills (e.g., actions related to selecting, interacting with, and using tangible task objects), and social interaction skills (e.g., using verbal and nonverbal skills to communicate);

(iii) Client factors, including body functions (e.g., neuromuscular, sensory, visual, mental, psychosocial, cognitive, pain factors), body structures (e.g., cardiovascular, digestive, nervous, integumentary, and genitourinary systems; structures related to movement), values, and spirituality;

b. Methods or approaches to identify and select interventions, such as;

(i) Establishment, remediation, or restoration of a skill or ability that has not yet developed, is impaired, or is in decline;

(iI) Compensation, modification, or adaptation of occupations, activities, and contexts to improve or enhance performance;

(iii) Maintenance of capabilities to prevent decline in performance in everyday life occupations;

(iv) Health promotion and wellness to enable or enhance performance in everyday life activities and quality of life;

(v) Prevention of occurrence or emergence of barriers to performance and participation, including injury and disability prevention; c. Interventions and procedures to promote or enhance safety and performance in ADLs, IADLs, health management, rest and sleep, education, work, play, leisure, and social participation include but are not limited to:

(i) Therapeutic use of occupations and activities;

(ii) Training in self-care, self-management, health management (e.g., medication management, health routines), home management, community/work integration, school activities, and work performance;

(iii) Identification, development, remediation, or compensation of physical, neuromusculoskeletal, sensory–perceptual, emotional regulation, visual, mental, and cognitive functions; pain tolerance and management; praxis; developmental skills; and behavioral skills;

(iv) Education and training of persons, including family members, caregivers, groups, populations, and others;

(v) Care coordination, case management, and transition services;

(vi) Consultative services to persons, groups, populations, programs, organizations, and communities;

(vii) Virtual interventions (e.g., simulated, real-time, and near-time technologies, including telehealth and mobile technology); (viii) Modification of contexts (environmental and personal factors in settings such as home, work, school, and community) and adaptation of processes, including the application of ergonomic principles; (viii) Modification of contexts (environmental and personal factors in settings such as home, work, school, and community) and adaptation of processes, including the application of ergonomic principles;

(ix) Assessment, design, fabrication, application, fitting, and training in seating and positioning, assistive technology, adaptive devices, and orthotic devices, and training in the use of prosthetic devices;

(x) Assessment, recommendation, and training in techniques to enhance functional mobility, including fitting and management of wheelchairs and other mobility devices;

(xi) Exercises, including tasks and methods to increase motion, strength, and endurance for occupational participation;

(xii) Remediation of and compensation for visual deficits, including low vision rehabilitation;

(xiii) Driver rehabilitation and community mobility;

(xiv) Management of feeding, eating, and swallowing to enable eating and feeding performance;

(xv) Application of physical agent and mechanical modalities and use of a range of specific therapeutic procedures (e.g., wound care management; techniques to enhance sensory, motor, perceptual, and cognitive processing; manual therapy techniques) to enhance performance skills;

(xvi) Facilitating the occupational participation of persons, groups, or populations through modification of contexts (environmental and personal) and adaptation of processes;

(xvii) Efforts directed toward promoting occupational justice and empowering clients to seek and obtain resources to fully participate in their everyday life occupations;

(xviii) Group interventions (e.g., use of dynamics of group and social interaction to facilitate learning and skill acquisition across the life course). 8. Occupational therapy intervention includes: a. remediation or restoration of performance abilities that are limited due to impairment in biological, physiological, psychological or neurological processes;

b. adaptation of task, process or the environment, or the teaching of compensatory techniques in order to enhance functional performance; c. disability prevention methods and techniques which facilitate the development or safe application of functional performance skills; or d. health promotion strategies and practices which enhance functional performance abilities. 9. Occupational therapy service includes, but is not limited to: a. evaluating, developing, improving, sustaining or restoring skill in activities of daily living (ADLS), work or productive activities, including instrumental activities of daily living (IADLS), play and leisure activities; b. evaluating, developing, remediating or restoring physical, sensorimotor, cognitive or psycho social components of performance; c. designing, fabricating, applying or training in the use of assistive technology or orthotic devices, and training in the use of prosthetic devices; d. adaptation of environments and processes, including the application of ergonomic principles, to enhance functional performance and safety in daily life roles; e. application of physical agent modalities as an adjunct to or in preparation for engagement in an occupation or functional activity; f. evaluating and providing intervention in collaboration with the client, family, caregiver or other person responsible for the client; g. educating the client, family, caregiver or others in carrying out appropriate nonskilled interventions; h. consulting with groups, programs, organizations or communities to provide population-based services; or i. participation in administration, education, and research, including both clinical and academic environments. 10. Occupational Therapist means a person licensed in this state to practice occupational therapy as defined in these regulations and whose license is in good standing. 11. Occupational Therapy Assistant means a person licensed to assist in the practice of occupational therapy under the supervision of or with the consultation of a licensed occupational therapist and whose license is in good standing. 12. Occupational Therapy Aide means a person who is not licensed in the field of occupational therapy and who assists occupational therapists and occupational therapy assistants in the practice of occupational therapy under direct supervision. The occupational therapy aides' activities require an understanding of occupational therapy.

13. Person means any individual, partnership, unincorporated organization, or corporate body, except that only an individual may be licensed under this chapter. 14. Direct supervision means the daily, direct, on-site contact at all times of a licensed occupational therapist or occupational therapy assistant when an occupational therapy aide assists in the delivery of patient care. 15. Association shall mean the Mississippi Occupational Therapy Association. 16. Dry needling shall mean a physical agent modality that aims to restore and/or optimize the neuro- muscular-skeletal systems. Dry needling involves the use and insertion of solid filiform needles for the treatment of musculoskeletal pain and soft tissue dysfunction by increased blood flow, decreased banding, decreased spontaneous electrical activity, biomechanical and central nervous system changes.

**History**
- *SOURCE: Miss. Code Ann. §73-24-13*

##### **15 Miss. Admin. Code Pt. 19, R. 8.1.4** Rule 8.1.4 {#sec-19-8.1.4 omnilex-key=us-ms-regs-official--title-15--19#8.1.4}

Requirements to Perform Dry Needling: As with all other physical agent modalities in occupational therapy, dry needling is to be utilized in the therapeutic process in order to ultimately achieve improved function and therefore not to be applied as a stand-alone treatment. Dry needling does not include the stimulation of auricular or distal points. Dry needling is not part of an occupational therapist’s academic or clinical preparation for entry-level practice; therefore, this rule establishes the minimum standards required for an occupational therapist to be deemed competent to perform dry needling.

1. Dry needling shall be performed only by an occupational therapist who is competent by education and training to perform dry needling as specified in this regulation. Online/virtual/remote study and/or self-study for dry needling instruction shall not be considered appropriate training.

2. An occupational therapist must meet the following requirements in order to be deemed competent to perform dry needling:

a. A minimum of 3 years clinical experience as a licensed occupational therapist

b. Documented successful completion of dry needling course(s) of study approved by the Department that includes:

(i) A minimum of 50 hours face-to-face instruction; an online study is not allowed. Advanced dry needling (i.e., craniofacial, spine, abdominal, etc..,) will require more advanced training than the minimum requirements. It is the responsibility of each occupational therapist to acquire specialty certification through additional training beyond the minimum requirements.

(ii) Each course shall specify which anatomical regions/structures are included in the certification and whether the instruction was introductory or advanced concepts in dry needling

(iii) Every course instructor must be a licensed healthcare provider and have a minimum of two years of experience performing dry needling

(iv) A practical examination and a written examination with a passing score

(v) Anatomical review for safety and effectiveness

(vi) Indications and contraindications for dry needling

(vii) Management of adverse effects

(vii) Evidence-based instructions on the theory of dry needling

(ix) Sterile needle procedures which shall include the standards of the U.S. centers for disease control or the U.S. occupational safety and health administration

c. An occupational therapist performing dry needling in his/her practice must have written informed consent for each patient that is maintained in the patient’s chart/medical record. The patient must sign and receive a copy of an informed consent form created by the therapist. The consent form must, at a minimum, clearly state the following information:

(i) Risks and benefits of dry needling

(ii) The occupational therapist’s level of education and training in dry needling

(iii) The occupational therapist will not dry needle any auricular or points distal to the identified treatment area

3. Each licensed occupational therapist performing dry needling must have a written physician’s order for dry needling or receive verbal authorization from the patient’s physician approving dry needling that is documented in the patient’s chart/medical record.

4. When dry needling is performed, the occupational therapist must document in the patient’s daily/encounter/procedure note. The note shall indicate how the patient tolerated the intervention as well as the outcome of the intervention, including any adverse reactions/events that occurred if any.

5. Dry needling shall not be delegated and must be performed only by a qualified, licensed occupational therapist who has met the minimum standards in this section.

6. Dry needling is not to be performed by an occupational therapy assistant under any circumstances including certification training or supervision.

7. After completion of the Department approved dry needling course, the occupational therapist will submit proof of certification. This will include confirmation of passing scores on written and practical exams. The Department must review and approve documents prior to beginning use of dry needling. This also includes any advanced courses that may follow.

8. Failure of an occupational therapist who is performing dry needling to provide written documentation that confirms he/she has met the requirements of this section shall be evidence that the occupational therapist is not competent and not permitted to perform dry needling. An occupational therapist performing dry needling in violation of this section shall be subject to disciplinary action as specified in Rule 8.8.1(1), (2), (6), (20), and (21).

**History**
- *SOURCE: Miss. Code Ann. §73-24-13*

##### **15 Miss. Admin. Code Pt. 19, R. 8.1.5** Rule 8.1.5 {#sec-19-8.1.5 omnilex-key=us-ms-regs-official--title-15--19#8.1.5}

Telehealth: A licensee may provide occupational therapy services to a client utilizing a telehealth visit if the occupational therapy services are provided in accordance with all requirements of this Act.

1. “Telehealth Visit” means the provision of occupational therapy services by a licensee to a client using technology where the licensee and client are not in the same physical location for the occupational therapy service.

2. A licensee engaged in a telehealth visit shall utilize technology that is secure and compliant with state and federal law.

3. A licensee engaged in a telehealth visit shall be held to the same standard of care as a licensee who provides in-person occupational therapy. A licensee shall not utilize a telehealth visit if the standard of care for the particular occupational therapy services cannot be met using technology.

a. If a licensee determines, either before or during the provision of occupational therapy services, that services cannot be provided through telehealth in a manner that is consistent with in-person standards of care, the licensee shall not provide or supervise services through telehealth. In making the determination of whether services should be performed in-person or via telehealth, the licensee shall consider at a minimum: (i) The complexity of the patient’s condition;

(ii) The licensee’s knowledge, skills, and abilities;

(iii) The patient’s environment and resources;

(iv) The nature and complexity of the required intervention; and

(v) The capacity and quality of the technological interface available;

b. A licensee who determines that services cannot be provided through telehealth shall advise the client to obtain services in-person. 4. Telehealth services provided by the occupational therapist or occupational therapy assistant shall be provided synchronously unless it requires the use of services to be reviewed or utilized outside of a treatment session (i.e. home exercise program instructions, safety instructions), then it can be provided asynchronously.

a. “Synchronous” means real-time interactive technology.

b. “Asynchronous“ means using transmission to another site for review at a later time that uses a camera or other technology to capture images or data to be recorded. Best practice is to consult payer policy directly to confirm availability of this service under the payer’s plan.

5. Supervision of Occupational Therapy Assistants, Aides, and students using telehealth technologies must follow existing state law and guidelines regarding supervision, regardless of the method of supervision.

**History**
- *SOURCE: Miss. Code Ann. §73-24-13*

##### **15 Miss. Admin. Code Pt. 19, R. 8.1.6** Rule 8.1.6 {#sec-19-8.1.6 omnilex-key=us-ms-regs-official--title-15--19#8.1.6}

Publication: The Department shall publish, annually, a list of the names and addresses of all persons licensed by the department and a list of all persons whose licenses have been suspended, revoked, denied renewal, put on probationary status, censured, or reprimanded.

Subchapter 2: Mississippi Advisory Council in Occupational Therapy (“Council”) Rule 8.2.1 Council Structure and Purpose: There is hereby established the Mississippi Advisory Council in Occupational Therapy under the jurisdiction of the State Board of Health. The Council shall consist of five (5) members as set forth in the Act, for the terms indicated therein, and shall serve under the jurisdiction of the State Board of Health. The purpose of the Council is to serve in an advisory capacity to the Department.

**History**
- *SOURCE: Miss. Code Ann. §73-24-13*
- *SOURCE: Miss. Code Ann. §73-24-13*

##### **15 Miss. Admin. Code Pt. 19, R. 8.2.2** Meetings: The Council shall meet during the first month of the year {#sec-19-8.2.2 omnilex-key=us-ms-regs-official--title-15--19#8.2.2}

Additional meetings may be held, at the discretion of the chairperson of the Council or the written request of any two (2)

members of the council. A quorum shall consist of three (3) members of the Council, including the chairperson, and shall be necessary for the Council to take action by vote.

2. maintain an up-to-date list of all individuals licensed to practice occupational therapy, with such list being available, upon request, to the public; 3. investigate alleged or suspected violations of the provisions of these regulations or other laws of this state pertaining to occupational therapy and any rules and regulations adopted by the board; for this purpose, any authorized agents of the department shall have the power and right to enter and make reasonable inspections of any place where occupational therapy is practiced, and may inspect and/or copy any records pertaining to clients or the practice of occupational therapy under these regulations; 4. refer disciplinary actions of any individual engaged in the practice of occupational therapy to the appropriate government agency for prosecution, whether licensed or otherwise, or, in its discretion, refer same to the appropriate committee or council; 5. conduct disciplinary hearings, upon specified charges, of a licensee; 6. maintain an up-to-date list of all individuals whose license has been suspended, revoked, or denied and make such list available to public inspection and supply such list to similar regulatory boards in other states or jurisdictions; 7. keep a record of all proceedings of the Board, and make said record available to the public; and 8. direct the Department to promulgate and implement rules and procedures to carry out the purpose of the Act.

2. has been awarded a degree from an education program recognized by the Board; 3. has successfully completed a supervised field experience; a. for an occupational therapist, as reflected in the current accrediting standards;

b. for an occupational therapy assistant, as reflected in the current accrediting standards; 4. has passed an examination approved by the Department; and 5. has paid the required fee(s). 6. For an occupational therapist, the program shall be accredited by the Accreditation Council for Occupational Therapy Education of the American Occupational Therapy Association, or, the board-recognized accrediting body. 7. For an occupational therapy assistant, the program shall be approved by the Accreditation Council for Occupational Therapy Education of the American Occupational Therapy Association, or the board-recognized accrediting body.

**History**
- *SOURCE: Miss. Code Ann. §73-24-13 Subchapter 3: State Board of Health (“Board”) Rule 8.3.1 Responsibilities: The Board, with the advice of the council, shall: 1. approve the examination, establish licensing and renewal of license criteria for applicants;*
- *SOURCE: Miss. Code Ann. §73-24-13 Subchapter 4: Licensure Rule 8.4.1 Licensure Requirements: An applicant for a regular license as an occupational therapist or occupational therapy assistant shall submit to the Department, verified by oath, written evidence in form and content satisfactory to the Department that the applicant: 1. is of good moral character;*
- *SOURCE: Miss. Code Ann. §73-24-13*

##### **15 Miss. Admin. Code Pt. 19, R. 8.4.2** Rule 8.4.2 {#sec-19-8.4.2 omnilex-key=us-ms-regs-official--title-15--19#8.4.2}

Licensure By Endorsement: An applicant for licensure by endorsement shall submit to the Department, verified by oath, written evidence in form and content satisfactory to the Department that: 1. the applicant is currently licensed to practice occupational therapy under the laws of another state, territory, or jurisdiction; and 2. the requirements for said license are equivalent to or greater than those required in this state as set forth in Rules 8.4.1 and 8.4.3 of these regulations; and 3. said license is in good standing, and is not, presently, suspended or revoked; and 4. certification from NBCOT has not been subject to disciplinary action.

**History**
- *SOURCE: Miss. Code Ann. §73-24-13*

##### **15 Miss. Admin. Code Pt. 19, R. 8.4.3** Rule 8.4.3 {#sec-19-8.4.3 omnilex-key=us-ms-regs-official--title-15--19#8.4.3}

Foreign Trained Individuals: An applicant for licensure who has been trained as an occupational therapist or an occupational therapy assistant in a foreign country, and desires to be licensed pursuant to the laws of the State of Mississippi, shall submit to the Department, verified by oath, in form and content satisfactory to the Department: 1. that the applicant is of good moral character; and 2. that the applicant has successfully completed an educational program and a supervised fieldwork experience program for occupational therapists or occupational therapy assistants; and 3. documentary evidence that the educational program and the supervised fieldwork experience are substantially equivalent to that required of a non-foreign trained applicant for licensure; and 4. that the applicant has passed an examination approved by the Department; and 5. demonstrable proficiency in the English language by passing all of the following English language examinations with scores to be determined by the Department:

a. Test of English as a Foreign Language (TOEFL); and b. Test of Spoken English (TSE); and c. Test of Written English (TWE). 6. An applicant who is a graduate of an accredited school of occupational therapy located in one of the following countries may request an exemption from the required English proficiency examinations: a. England b. Scotland c. Ireland d. Wales e. Australia f. New Zealand g. Canada (except the province of Quebec) 7. The department reserves the right to require a personal interview with any applicant from any of the above countries for final determination of the exemption request.

**History**
- *SOURCE: Miss. Code Ann. §73-24-13*

##### **15 Miss. Admin. Code Pt. 19, R. 8.4.4** Rule 8.4.4 {#sec-19-8.4.4 omnilex-key=us-ms-regs-official--title-15--19#8.4.4}

Limited Permit: A limited permit to practice as an occupational therapist or occupational therapy assistant may be granted to an applicant for licensure meeting the requirements of Rule 8.4.1 or 8.4.3 who has not taken the approved examination or has not received the results of the examination, subject to the conditions of Rule 8.4.5.

**History**
- *SOURCE: Miss. Code Ann. §73-24-13*

##### **15 Miss. Admin. Code Pt. 19, R. 8.4.5** Conditions of a Limited Permit: 1 {#sec-19-8.4.5 omnilex-key=us-ms-regs-official--title-15--19#8.4.5}

A limited permit shall be granted for a period not to exceed ninety (90) days. 2. A limited permit holder shall restrict his practice to the State of Mississippi. 3. Supervision of Limited Permit a. An occupational therapist issued a limited permit shall practice under the supervision of or in consultation with an occupational therapist currently licensed in Mississippi. Supervision or in consultation with an occupational therapist for the purposes of this section means direct contact at least every 2 weeks at each treatment facility, with interim contact occurring by other methods, such as telephone or written communication.

b. An occupational therapy assistant issued a limited permit shall practice under the supervision of or in consultation with an occupational therapist currently licensed in Mississippi. Supervision or in consultation with for the purposes of this section means direct contact at least every week at each treatment facility, with interim supervision occurring by other methods, such as telephone or written communication. c. An occupational therapist issued a limited permit may not supervise any licensed OT or OTA. d. Direct contact for either an occupational therapist or an occupational therapy assistant should include: i. A review of activities with appropriate revision or termination of the plan of care ii. An assessment of utilization of outside resources (whenever applicable) iii. Documentary evidence of such visit iv. Discharge planning as indicated 4. Documentation in form and substance acceptable to the Department that the conditions of Rule 8.4.5(3)(a)(b) have been met must be on file with the Department before a limited permit will be issued. 5. The limited permit of a person who is required to take the approved examination and fails to take said examination will not be renewed. 6. A limited permit may be renewed, at the discretion of the department, only one time, through the date that the next examination results are made public. 7. Any person who has taken but not passed the required examination in another jurisdiction shall not be eligible for a limited permit.

**History**
- *SOURCE: Miss. Code Ann. §73-24-13*

##### **15 Miss. Admin. Code Pt. 19, R. 8.4.6** Inactive License: 1 {#sec-19-8.4.6 omnilex-key=us-ms-regs-official--title-15--19#8.4.6}

A licensee may be granted inactive status upon filing a written request in form and content satisfactory to the department and upon payment of the required fee. A licensee granted inactive status shall not practice or hold himself or herself out as an occupational therapist or occupational therapy assistant and is not responsible for accruing the continuing education requirements. 2. A licensee granted inactive status for five (5) licensure years must successfully complete the following reentry requirements before resuming practice: a. An American Occupational Therapy Association recognized reentry course. b. Practice under the supervision of a currently licensed occupational therapist for a period of ninety (90) calendar days.

**History**
- *SOURCE: Miss. Code Ann. §73-24-13*

##### **15 Miss. Admin. Code Pt. 19, R. 8.4.7** Conditions of a Universal Occupational License: {#sec-19-8.4.7 omnilex-key=us-ms-regs-official--title-15--19#8.4.7}

1. Notwithstanding any other provision of law, the Department shall issue a license as an occupational therapist or occupational therapy assistant at the same practice level to a person who establishes residence in this state if, upon application to the Department: a. The applicant holds a current and valid license in good standing in another state in an occupation with a similar scope of practice, as determined by the Department, and has held this license from the occupational licensing board in the other state for at least one (1) year; and b. There were minimum education requirements and, if applicable, work experience, examination, and clinical supervision requirements in effect, and the other state verifies that the applicant met those requirements in order to be licensed in that state; and c. The applicant has not committed any act in the other state that would have constituted grounds for refusal, suspension, or revocation of a license to practice that occupation in Mississippi at the time the act was committed, and the applicant does not have a disqualifying criminal record as determined by the Department under Mississippi law; and b. The applicant did not surrender a license because of negligence or intentional misconduct related to the applicant's work in the occupation in another state; and e. The applicant does not have a complaint, allegation, or investigation pending before an occupational licensing board or other board in another state that relates to unprofessional conduct or an alleged crime. If the applicant has a complaint, allegation, or investigation pending, the Department shall not issue or deny a license to the applicant until the complaint, allegation, or investigation is resolved, or the applicant otherwise satisfies the criteria for licensure in Mississippi to the satisfaction of the Department; and f. The applicant pays all applicable fees in Mississippi. 2. Notwithstanding any other law, the Department shall issue a license to an applicant in occupational therapy and at the same practice level, as determined by the Department, to a person who establishes residence in this state based on work experience in another state, if all the following apply: g. The applicant worked in a state that does not use a license to regulate a lawful occupation, but Mississippi uses a license to regulate a lawful occupation with a similar scope of practice, as determined by the Department; h. The applicant worked for at least three (3) years in the lawful occupation; and i. The applicant satisfies the provisions of paragraphs (c) through (f) of Rule 8.4.7(1). 3. The Department may require an applicant to pass a jurisprudential examination specific to relevant state laws in Mississippi that regulate occupational therapy if the issuance of a license in Mississippi requires an applicant to pass a jurisprudential examination specific to relevant state statutes and administrative rules in Mississippi that regulate occupational therapy.

4. The Department may require proof of residency. Residence may be established by demonstrating proof of a state-issued identification card or one (1) of the following: a. Current Mississippi residential utility bill with the applicant's name and address; b. Documentation of the applicant's current ownership, or current lease of a residence in Mississippi; c. Documentation of current in-state employment or a notarized letter of the promise of employment of the applicant or his or her spouse; or d. Any verifiable documentation demonstrating Mississippi residency. 5. A license issued under this section is valid only in this state and does not make the person eligible to be part of an interstate compact. 6. The Department shall issue or deny the license to the applicant within one hundred twenty (120) days after receiving an application. 7. If the application requires longer than two (2) weeks to process, the Department shall issue a temporary practice permit within thirty (30) days after receiving the application if the applicant submits an affidavit, under penalties of perjury, affirming that he or she satisfies the provisions of Rule 8.4.7(3) or Rule 8.4.7(4) and pays all applicable fees as required by Rule 8.4.7(1)(f). a. The applicant may practice under the temporary permit until a license is granted, or until a notice to deny the license is issued, in accordance with rules adopted by the Department. A temporary license will expire in three hundred sixty-five (365) days after its issuance if the applicant fails to satisfy the requirement for licensure in Rule 8.4.7(1) through Rule 8.4.7(3), as applicable. 8. The Department shall grant a license to any person certified prior to July 1, 1988, as an Occupational Therapist Registered (OTR) or a Certified Occupational Therapy Assistant (COTA) by the American Occupational Therapy Association (AOTA). The Department may waive the examination, education, or experience requirements and grant a license to any person certified by AOTA after July 1, 1988, if the Department determines the requirements for such certification are equivalent to the requirements for licensure in these Regulations. 9. The Department may waive the examination, education, or experience requirements and grant a license to any applicant who shall present proof of current licensure as an occupational therapist or occupational therapy assistant in another state, the District of Columbia, or territory of the United States which requires standards for licensure considered by the Department to be equivalent to the requirements for licensure of this chapter. The issuance of a license by reciprocity to a military-trained applicant, military spouse, or person who establishes residence in this state shall be subject to the provisions of Section §73-50-1 or §73-50-2 of the Mississippi Code of 1972, as applicable. 10. Foreign-trained occupational therapists and occupational therapy assistants shall satisfy the examination requirements of Miss. Code Ann. §73-24-19. The Department shall require foreign- trained applicants to furnish proof of good moral character and completion of educational and supervised fieldwork requirements substantially equal to those contained in Miss. Code Ann. §73-24- 19 before taking the examination.

11. Denial of Universal License a. The applicant may appeal any of the following decisions of the Department to a court of general jurisdiction: (ix) Denial of a license; (x) Determination of the occupation; (xi) Determination of the similarity of the scope of practice of the license issued; or (xii) Other determinations under this section. b. The court shall determine all questions of law, including the interpretation of a constitutional or statutory provision or a rule adopted by the Department, without regard to any previous determination that may have been made on the question in any action before the Department.

**History**
- *SOURCE: Miss. Code Ann. §73-24-13*

##### **15 Miss. Admin. Code Pt. 19, R. 8.4.8** Rule 8.4.8 {#sec-19-8.4.8 omnilex-key=us-ms-regs-official--title-15--19#8.4.8}

Abandonment: An application shall be deemed abandoned by the Department if, after six (6) months from the date of filing, the requirements for licensing have not been completed and submitted to the Department.

Subchapter 5: Professional Identification Rule 8.5.1 Titles and Abbreviations: It is unlawful for any person who is not licensed under these regulations as an occupational therapist or as an occupational therapy assistant, or whose license has been suspended or revoked, to in any manner represent himself as someone who provides occupational therapy services, or use , in connection with his name or place of business the words "occupational therapist," "licensed occupational therapy assistant," or the letters "O.T.”,"O.T.L.”,"L.O.T. "O.T.R.," "O.T.A." or O.T.A.L. "C.O.T.A." or any other words, letters, abbreviations or insignia indicating or implying that he is an occupational therapist or an occupational therapy assistant or that he provides occupational therapy services; or to show in any way, orally, in writing, in print or by sign, directly or by implication, or to represent himself as an occupational therapist or an occupational therapy assistant, or someone who provides occupational therapy services.

**History**
- *SOURCE: Miss. Code Ann. §73-24-13*
- *SOURCE: Miss. Code Ann. §73-24-13*

##### **15 Miss. Admin. Code Pt. 19, R. 8.5.2** Rule 8.5.2 {#sec-19-8.5.2 omnilex-key=us-ms-regs-official--title-15--19#8.5.2}

Production and Display of License: A person licensed to practice occupational therapy in Mississippi shall be issued a "Certificate of Licensure" and "License Identification Letter.” The licensee shall prominently display the “Certificate of Licensure” or copy thereof at their place(s) of employment.

**History**
- *SOURCE: Miss. Code Ann. §73-24-13 Subchapter 6: Renewal of License*

##### **15 Miss. Admin. Code Pt. 19, R. 8.6.1** General Provisions: 1 {#sec-19-8.6.1 omnilex-key=us-ms-regs-official--title-15--19#8.6.1}

The Board shall issue licenses which shall be subject to renewal biennially. 2. The licensure period shall be construed as May 1 through April 30 of even numbered years.

**History**
- *SOURCE: Miss. Code Ann. §73-24-13*

##### **15 Miss. Admin. Code Pt. 19, R. 8.6.2** Rule 8.6.2 {#sec-19-8.6.2 omnilex-key=us-ms-regs-official--title-15--19#8.6.2}

Procedure for Renewal of License: The Department shall mail renewal notices, approximately sixty (60) days prior to the end of the licensure period, to the last home address registered with the Department, to the persons to whom licenses were issued or renewed during the preceding licensure period. The licensee shall: 1. complete the renewal form(s); 2. submit proof of continuing education credit as detailed in Subchapter 7 of these regulations; 3. pay the renewal fee; and 4. file the above with the Department prior to the end of the licensure period.

**History**
- *SOURCE: Miss. Code Ann. §73-24-13*

##### **15 Miss. Admin. Code Pt. 19, R. 8.6.3** Failure to Renew: 1 {#sec-19-8.6.3 omnilex-key=us-ms-regs-official--title-15--19#8.6.3}

A licensee who does not file, with the Department, his renewal application prior to the end of the licensure period will be deemed to have allowed his license to lapse. Said license may be reinstated by the Department, in its discretion, by the payment of the renewal fee, the late renewal/reinstatement fee, and the required continuing education hours provided said application for renewal is made within two (2) years after its last expiration date. 2. A license may not be reinstated after having lapsed for two (2) consecutive years. A new application must be made and the licensure regulations in effect at that time must be met.

**History**
- *SOURCE: Miss. Code Ann. §73-24-13 Subchapter 7: Continuing Education (CE) Rule 8.7.1 Definition and philosophy: Each individual licensed as an occupational therapist or occupational therapy assistant is responsible for optimum service to the consumer and is accountable to the consumer, the employer, and the profession for evidence of maintaining high levels of skill and knowledge. Continuing education is defined as education beyond the basic preparation required for entry into the profession, directly related to the performance and practice of occupational therapy.*
- *SOURCE: Miss. Code Ann. §73-24-13*

##### **15 Miss. Admin. Code Pt. 19, R. 8.7.2** Requirements: {#sec-19-8.7.2 omnilex-key=us-ms-regs-official--title-15--19#8.7.2}

1. Regulations set the requirement of 20 contact hours (CH) or 2 Continuing Education Units (CEU) to be accrued during the licensure period. No carryover of continuing education hours from one licensure period to another shall be allowed. Minimum requirements shall be: a. Thirteen (13) hours are required to be live face-to-face training (i.e., no non-live internet training, video training, television training, etc.) Live webinars will be accepted, but the certificate must specify the CEU was provided in a live format. At least six (6) of the thirteen (13) required CEU live face-to face training hours must be directly related to the clinical practice of occupational therapy. b. Two (2) contact hours of an ethic courses(s) related to the practice of occupational therapy shall be required during each licensure period. Ethi8cs training may be live face-to-face or non-live training. The hours awarded shall e included in the hours allowed for the type of training selected. If received in a non-live format, this will count as 2 of the 7 allowed non- live total hours. If received in a live face-to-face format, this will count as 2 of the 13 required live hours. If the NBCOT certificate is submitted, the ethic 2-hour requirement must be submitted in addition to the NBCOT certificate. i. Ethics course include those that involve: moral philosophy, bias, professional conduct, integrity in practice, moral decision making, practice standards, value-based practice, professional responsibility, standards of practice, etc. c. Of the remaining required CEU hours, seven (7) may be non-live face-to-face training or non- live training may include home study courses, video, internet, non-live webinars, etc. Two (2) contact hours of an ethics course specifically related to the practice of occupational therapy shall be required during each licensure period. Ethics training may be live face-to-face training or non-live training. The hours awarded shall be included in the hours allowed for the type of training selected. d. All training shall be from approved sources as listed in Rule 8.74. 2. Individuals may choose to renew licensure by submitting proof of the National Board for Certification in Occupational Therapy (NBCOT)’s certification in lieu of continuing education certificates with the exception of the 2 hours of ethic requirement. NBCOT certification must be current and active at the time of licensure renewal. All NBCOT hours can be obtained online as approved by NBCOT. 3. Individuals applying for initial licensure within a licensing term must accrue continuing education hours on a prorated scale. Written notification of required hours will be sent to the applicant at the time of licensure. 4. Persons who fail to accrue the required continuing education hours shall be issued a CE probationary license for the licensure term. Failure to accrue the required hours during the CE probationary period will result in the revocation of the license. Hours accrued are first credited for the delinquent hours lacking from the previous licensure period, and then applied to the current (CE probationary) licensing period. 5. CE probationary licenses will be issued for one licensure term only. No ensuing license may be CE probationary as a result of not meeting continuing education requirements.

**History**
- *SOURCE: Miss. Code Ann. §73-24-13*

##### **15 Miss. Admin. Code Pt. 19, R. 8.7.3** Rule 8.7.3 {#sec-19-8.7.3 omnilex-key=us-ms-regs-official--title-15--19#8.7.3}

Content Criteria: The content must apply to the field of occupational therapy and performance and must be designed to meet one of the following goals:

1. Update knowledge and skills required for competent performance beyond entry level as described in current legislation and regulations.

2. Allow the licensee to enhance his knowledge and skills.

3. Provide opportunities for interdisciplinary learning.

4. Extend limits of professional capabilities and opportunities.

5. Facilitate personal contributions to the advancement of the profession.

**History**
- *SOURCE: Miss. Code Ann. §73-24-13*

##### **15 Miss. Admin. Code Pt. 19, R. 8.7.4** Rule 8.7.4 {#sec-19-8.7.4 omnilex-key=us-ms-regs-official--title-15--19#8.7.4}

Sources of Continuing Education: Continuing education hours may be accrued from the following sources, when the content of the programs relates to the profession of occupational therapy:

1. Attendance at educational programs:

a. Attendance at educational programs where continuing education credit is given and approved by the Mississippi Occupational Therapy Association (MSOTA).

b. Attendance at educational programs where continuing education credit is given and approved by the American Occupational Therapy Association (AOTA), including other state association educational programs.

c. Attendance at educational programs where continuing education credit is given and/or approved by the National Board for Certification in Occupational Therapy (NBCOT).

d. Attendance at educational programs where continuing education credit is given and approved by the American Medical Association (AMA) and its components.

e. Attendance at other programs approved for continuing education credit by AOTA, AMA, APTA, ASHA, or their components.

f. Attendance at educational programs where continuing education credit is given and approved by accredited universities or colleges.

g. Attendance at educational programs where continuing education credit is given and approved by a licensure authority of any jurisdiction in the United States for occupational therapy.

h. Attendance at educational programs where continuing education credit is given and approved by the American Physical Therapy Association (APTA), including other state association educational programs.

i. Attendance at educational programs where continuing education credit is given and approved by the American Speech and Hearing Association (ASHA), including other state association educational programs.

j. A course/provider not approved by one of the organizations listed in Rule 8.7.4(1) will not be accepted as continuing education for licensure renewal purposes. A course not approved by an organization listed in this section of the regulations may be reviewed by the department. Contact the department for information.

2. Presentations made before recognized groups of occupational therapists, medical practitioners, or other health related professionals and directly related to the profession of occupational therapy. To be considered for continuing education credit, material outline and a synopsis must be submitted to the Department prior to the presentation date. Notice of approval or disapproval will be sent following a review by the Department. For approved presentations, the presenter may accrue one (1) hour of continuing education credit for each hour of the actual presentation, and one (1) hour of preparation time, for a total of (2) two hours. Presenter credit is given one (1) time only, even though the session may be presented multiple times. No more than 30% of total required hours may be accrued through presentations.

3. Academic course work:

a. Academic course work taken for credit from a regionally accredited college or university. The courses must relate to the profession of occupational therapy. One academic semester hour shall be equivalent to fifteen (15) clock hours for continuing education credit. No more than fifty percent (50%) of total required hours may be accrued through academic course work. Undergraduate level courses are acceptable only when they can be demonstrated to update or enhance competency in licensee's specific practice field, and documented that course work has not been taken previously, to the satisfaction of the department. Graduate level courses are acceptable for occupational therapists. Undergraduate courses are acceptable for occupational therapy assistants.

b. Academic course work taken by an OT/OTA for credit toward an

advanced degree in occupational therapy may be counted as meeting the full continuing education requirements.

4. Home Study Courses approved by the department.

5. Professional publications where the licensee is an author. To be considered for continuing education credit, a reprint of the published article must be submitted to the department. Notice of approval or disapproval will be sent out after review by the department. A maximum of 3 contact hours may be accrued through professional publication.

6. Supervision of Level I and Level II occupational therapy and occupational therapy assistant students by a Mississippi licensed occupational therapy practitioner may not exceed 12 hours during a licensure period. Supervision of Doctoral Capstone occupational therapist students by a Mississippi licensed occupational therapist may not exceed 14 hours during a licensure period. Level I and Level II student supervision hours may not be combined with Doctoral Capstone supervision hours. To be considered for continuing education credit, full direct supervision of a student must be performed for a complete clinical rotation. The educational institution must provide written documentation of the supervision.

a. Supervision of Level I occupational therapy and occupational therapy assistant students. One continuing education hour per student supervised will be awarded for the full supervision. No more than a maximum of twelve (12) hours may be accrued under this provision during a licensure period. Only the primary supervisor is eligible to receive continuing education credit under this provision.

b. Supervision of Level II occupational therapy and occupational therapy assistant students. One continuing education hour per week of supervision per student supervised will be awarded for the full supervision. The supervising OT(s) shall record dates and times of supervision provided to each student. No more than a maximum of twelve (12) hours may be accrued under this provision during a licensure period.

c. Supervision of Doctoral Capstone occupational therapist students. One continuing education hour per week of supervision per student supervised will be awarded for full supervision. The supervising OT shall record dates and times of supervision provided to each student. No more than a maximum of fourteen (14) hours may be accrued under this provision during a licensure period.

7. Specific UNACCEPTABLE activities include:

a. All in-service programs not approved under Rule 8.7.4(1) of these regulations.

b. Orientation to specific work-site programs dealing with organizational structures, processes, or procedures.

c. Meetings for purposes of policy decision.

d. Non-educational meetings at annual conferences, chapter, or organizational meetings.

e. Entertainment or recreational meetings or activities.

f. Committee meetings, holding of office, serving as an organizational delegate.

g. CPR education.

h. Self-directed studies other than those previously outlined.

**History**
- *SOURCE: Miss. Code Ann. §73-24-13*

##### **15 Miss. Admin. Code Pt. 19, R. 8.7.5** Rule 8.7.5 {#sec-19-8.7.5 omnilex-key=us-ms-regs-official--title-15--19#8.7.5}

Reporting Procedures for Continuing Education: It is the responsibility of the licensee to insure that the following criteria are met with respect to continuing education credit:

1. Attendance at seminars, workshops, presentations, etc., approved by an organization listed in Rule 8.7.4(1) is automatically accepted for credit unless sessions are duplicated. Verification of attendance may be made by submitting a continuing education certificate (must include source, number of continuing education hours and date of attendance) and proof of approval for the program/provider.

2. Credit for presentations: Submit a copy of the Department's approval letter.

3. Academic course work credits must meet the content criteria in Rule 8.7.3, and must be accompanied by a course description from the college or university catalog and a copy of the transcript or final grade report. A minimum course grade of "C" is required for CE credit.

4. Home Study Course: A certificate of completion must be submitted to receive continuing education credit.

5. Publication: A letter of approval from the department.

**History**
- *SOURCE: Miss. Code Ann. §73-24-13*

##### **15 Miss. Admin. Code Pt. 19, R. 8.8.1** Subchapter 8: Revocation, Suspension and Denial of License {#sec-19-8.8.1 omnilex-key=us-ms-regs-official--title-15--19#8.8.1}

Standards of Conduct: Licensees subject to these regulations shall conduct their activities, services, and practice in accordance with this section. Licensees may be subject to the exercise of the disciplinary sanctions enumerated in Rule 8.8.6 of these regulations if the Department finds that a licensee is guilty of any of the following: 1. Negligence in the practice or performance of professional services or activities. 2. Engaging in dishonorable, unethical or unprofessional conduct of a character likely to deceive, defraud or harm the public in the course of professional services or activities. 3. Perpetrating or cooperating in fraud or material deception in obtaining or renewing a license or attempting the same. 4. Being convicted of any crime which has a substantial relationship to the licensee's activities and services or an essential element of which is misstatement, fraud, or dishonesty. 5. Being convicted of any crime which is a felony under the laws of this state or the United States. 6. Engaging in or permitting the performance of unacceptable services personally or by others working under the licensee's supervision due to the licensee's deliberate or negligent act or acts or failure to act, regardless of whether actual damage or damages to the public is established. 7. Continued practice although the licensee has become unfit to practice as a occupational therapist or occupational therapy assistant due to: a. failure to keep abreast of current professional theory or practice; or b. physical or mental disability; the entry of an order or judgment by a court of competent jurisdiction that a licensee is in need of mental treatment or is incompetent shall constitute mental disability; or c. addiction or severe dependency upon alcohol or other drugs which may endanger the public by impairing the licensee's ability to practice. 8. Having disciplinary action taken against the licensee's license in another state. 9. Making differential, detrimental treatment against any person because of race, color, creed, sex, religion or national origin. 10. Engaging in lewd conduct in connection with professional services or activities. 11. Engaging in false or misleading advertising. 12. Contracting, assisting, or permitting unlicensed persons to perform services for which a license is required under these regulations. 13. Violation of any probation requirements placed on a license by the Board. 14. Revealing confidential information except as may be required by law.

15. Failing to inform clients of the fact that the client no longer needs the services or professional assistance of the licensee. 16. Charging excessive or unreasonable fees or engaging in unreasonable collection practices. 17. For treating or attempting to treat ailments or other health conditions of human beings other than by occupational therapy as authorized by these regulations. 18. For applying or offering to apply occupational therapy as an occupational therapist within the scope of occupational therapy, or for acting as an occupational therapy assistant other than under the supervision or in consultation with a licensed occupational therapist. 19. Violations of the current code of ethics for occupational therapists and occupational therapy assistants adopted by the American Occupational Therapy Association or its successor organization. 20. Violations of any rules or regulations promulgated pursuant to these regulations. 21. Has engaged in any conduct considered by the Board to be detrimental to the profession of occupational therapy. 22. The Department may order a licensee to submit to a reasonable physical or mental examination if the licensee's physical or mental capacity to practice safely is at issue in a disciplinary proceeding. Failure to comply with a board order to submit to a physical or mental examination shall render a licensee subject to the summary suspension procedures described in Rule 8.8.2 of these regulations.

**History**
- *SOURCE: Miss. Code Ann. §73-24-13*

##### **15 Miss. Admin. Code Pt. 19, R. 8.8.2** Summary Suspension: 1 {#sec-19-8.8.2 omnilex-key=us-ms-regs-official--title-15--19#8.8.2}

The Department may summarily suspend a license without a hearing, simultaneously with the filing of a formal complaint and notice of hearing, if the Department determines that: a. the health, safety, or welfare of the general public is in immediate danger; or b. the licensee's physical capacity to practice his profession is in issue; or c. the licensee's mental capacity to practice his profession is in issue. 2. If the Department summarily suspends a license, a hearing must begin within twenty (20) days after such suspension begins, unless continued at the request of the licensee.

**History**
- *SOURCE: Miss. Code Ann. §73-24-13*

##### **15 Miss. Admin. Code Pt. 19, R. 8.8.3** Rule 8.8.3 {#sec-19-8.8.3 omnilex-key=us-ms-regs-official--title-15--19#8.8.3}

Complaints: All complaints concerning a licensee, his business, or professional practice, shall be reviewed by the Department. Each complaint received shall be logged, recording at a minimum the following information: 1. licensee's name;

2. name of the complaining party, if known; 3. date of complaint; 4. brief statement of complaint; and 5. disposition.

**History**
- *SOURCE: Miss. Code Ann. §73-24-13*

##### **15 Miss. Admin. Code Pt. 19, R. 8.8.4** Investigation: All complaints will be investigated and evaluated by Department {#sec-19-8.8.4 omnilex-key=us-ms-regs-official--title-15--19#8.8.4}

**History**
- *SOURCE: Miss. Code Ann. §73-24-13*

##### **15 Miss. Admin. Code Pt. 19, R. 8.8.5** Notice of Charges and Hearing 1 {#sec-19-8.8.5 omnilex-key=us-ms-regs-official--title-15--19#8.8.5}

Following the investigative process, the Department may file formal charges against the licensee. Such formal complaint shall, at a minimum, inform the licensee of the facts which are the basis of the charge and which are specific enough to enable the licensee to defend against the charges. 2. Each licensee, whose conduct is the subject of a formal charge which seeks to impose disciplinary action against the licensee, shall be served notice of the formal charge at least thirty (30) days before the date of hearing. A hearing shall be presided over by the Board or the Board's designee. Service shall be considered to have been given if the notice was personally received by the licensee, or the notice was mailed certified, return receipt requested, to the licensee at the licensee's last known address as listed with the Department. The notice of the formal hearing shall consist at a minimum of the following information: a. the time, place and date of hearing; b. that the licensee shall appear personally at the hearing and may be represented by counsel; c. that the licensee shall have the right to produce witnesses and evidence in the licensee's behalf and shall have the right to cross-examine adverse witnesses and evidence; d. that the hearing could result in disciplinary action being taken against the licensee's license; e. that rules for the conduct of these hearings exist and it may be in the licensee's best interest to obtain a copy; and f. that the Department, or its designee, shall preside at the hearing and following the conclusion of the hearing shall make findings of facts, conclusions of law and recommendations, separately stated, to the Board as to what disciplinary action, if any, should be imposed on the licensee. 3. The Department may order a licensee to submit to a reasonable physical or mental examination if the licensee's physical or mental capacity to practice safely is at issue in a disciplinary proceeding. Failure to comply with a board order to submit to a physical or mental examination shall render a licensee subject to the summary suspension procedures described in Rule 8.8.2 of these regulations.

4. The Department or its designee shall hear evidence produced in support of the formal charges and contrary evidence produced by the licensee. At the conclusion of the hearing, the Board shall issue an order, within sixty (60) days. 5. Disposition of any complaints may be made by consent order or stipulation between the Board and the licensee. 6. All proceedings pursuant to this section are matters of public record and shall be preserved pursuant to state law.

**History**
- *SOURCE: Miss. Code Ann. §73-24-13*

##### **15 Miss. Admin. Code Pt. 19, R. 8.8.6** Rule 8.8.6 {#sec-19-8.8.6 omnilex-key=us-ms-regs-official--title-15--19#8.8.6}

Sanctions: The Department may impose any of the following sanctions, singly or in combination, when it finds that a licensee is guilty of any of the above offenses: 1. Revoke the license. 2. Suspend the license, for any period of time. 3. Censure the licensee. 4. Impose a monetary penalty of not more than Two Hundred Dollars ($200.00). 5. Place a licensee on probationary status and require the licensee to submit to any of the following: a. report regularly to the Department, or its designee, upon matters which are the basis of probation; b. continue to renew professional education until a satisfactory degree of skill has been attained in those areas which are the basis of probation; or c. such other reasonable requirements or restrictions as are proper. 6. Refuse to renew a license. 7. Revoke probation which has been granted and impose any other disciplinary action in this subsection when the requirements of probation have not been fulfilled or have been violated. 8. The Department may seek the counsel of the Mississippi Advisory Council in Occupational Therapy regarding disciplinary actions. 9. Disposition of any formal complaint may be made by consent order or stipulation between the board and the licensee. Rule 8.8.7 Appeals: Any person aggrieved by a decision of the Department shall have a right of appeal in the manner provided for in the Act and the Laws of the State of Mississippi

2. Any person who is employed as an occupational therapist or occupational therapy assistant by the United States armed services, the U.S. Public Health Service, the Veteran's Administration or other federal agencies, if such person provides occupational therapy solely under the director or control of the organization by which he is employed; 3. Any person pursuing a course of study leading to a degree or certificate in occupational therapy in an accredited, recognized or approved educational program, or advanced training in a specialty area, if such activities and services constitute a part of the supervised course of study, and if such person is designated by a title which clearly indicates his status as a trainee or student; 4. Any person fulfilling the supervised fieldwork experience requirements of Section 73-24-19, if such activities and services constitute a part of the experience necessary to meet the requirements of that section; 5. Any person employed as an occupational therapy aide or who works under the supervision of a licensed occupational therapist; or 6. Any person performing occupational therapy services in the state, if these services are performed for no more than thirty (30) days in a calendar year under the supervision of an occupational therapist licensed under this chapter, if: a. The person is licensed under the law of another state which has licensure requirements at least as stringent as the requirements of this chapter, or b. The person is certified as an Occupational Therapist Registered (OTR) or a Certified Occupational Therapy Assistant (COTA), established by the National Board for Certification in Occupational Therapy (NBCOT) or its successor organization. 7. Any licensee who will supervise a person performing occupational therapy services in the state shall ensure that the following information is on file and satisfactory with the department prior to the person performing occupational therapy services: a. Proof that the person meets one or both of the requirements in subsection 6(a)(b) of this section of the regulations; and b. A schedule indicating when the person will be performing occupational therapy services; and c. The name(s) of the facility(ies) where the person will perform occupational therapy services.

8. Any person certified by the American Board of Certification in Orthotics and Prosthetics as a Certified Orthotist, C.O., Certified Prosthetist, C.P., Certified Prosthetist/Orthotist, C.P.O., or anyone working under their direct supervision.

2. To assist with but not perform total patient evaluations. 3. To perform treatment procedures as delegated by the occupational therapist. 4. To supervise other supportive personnel as charged by the occupational therapist. 5. To notify the occupational therapist of changes in the patient's status, including all untoward patient responses. 6. To discontinue immediately any treatment procedures which in their judgment appear to be harmful to the patient. 7. To refuse to carry out treatment procedures that they believe to be not in the best interest of the patient.

**History**
- *SOURCE: Miss. Code Ann. §73-24-13 Subchapter 9: Exceptions and Exemptions Rule 8.9.1 Exceptions: Nothing in this chapter shall be construed as preventing or restricting the practice, services or activities of: 1. Any person, licensed in this state by any other law, from engaging in the profession or occupation for which he or she is licensed;*
- *SOURCE: Miss. Code Ann. §73-24-13 Subchapter 10: Occupational Therapy Assistant Rule 8.10.1 Definition: An occupational therapy assistant (OTA), shall be defined as an individual who meets the qualifications and requirements as set forth in Subchapter 4 of these regulations, and has been issued a license by the Department. The roles and responsibilities of an OTA are: 1. To practice only under the supervision of, or in consultation with, an occupational therapist licensed to practice in Mississippi.*
- *SOURCE: Miss. Code Ann. §73-24-13*

##### **15 Miss. Admin. Code Pt. 19, R. 8.10.2** Rule 8.10.2 {#sec-19-8.10.2 omnilex-key=us-ms-regs-official--title-15--19#8.10.2}

Supervision or Consultation: Supervision is defined as aid, direction, and instruction provided by an occupational therapist to adequately ensure the safety, welfare, and best treatment practices of clients during the course of occupational therapy treatment. 1. An occupational therapy assistant issued a limited permit (see Rule 8.4.5). 2. An occupational therapy assistant issued a regular license. To maintain compliance with supervision regulations, the occupational therapist will select from any of the two tiers of guidelines based on need of the patient/client and skill level of occupational therapy assistant. i. Direct Supervision: Supervision I which the occupational therapist, the occupational therapy assistant, and patient/client are present face-to-face for immediate availability within the treatment area to give aid direction, and instruction when occupational therapy procedures or activities are performed. The occupational therapist must provide written documentation of the supervisory visit at least once every seven (7) therapy visits or twenty- one (21) calendar days whichever comes first.

ii. Indirect Supervision: The supervising occupational therapist has faced-to-face contact with the patient/client once every seven (7) therapy visits or twenty-one (21) calendar days whichever comes first and communicates with the occupational therapy assistant by verbal communication as well as documented evidence of the communication. b. Supervision or consultation which means face-to-face meetings of supervisor and supervisee (OT and OTA) to review and evaluate treatment and progress at the work site, and regular interim communication between the supervisor and supervisee. A face-to-face meeting is held at least once every seventh treatment day or 21 calendar days, whichever comes first. c. The supervising occupational therapist must be accessible by telecommunications to the occupational therapy assistant on a daily basis while the occupational therapy assistant is treating patients. d. Regardless of the practice setting, the following requirements must be observed when the occupational therapist is supervising or consulting with the occupational therapy assistant: i. The initial visit for evaluation of the patient and establishment of a plan of care must be made by the supervising or consulting occupational therapist. ii. A joint supervisory visit must be made by the supervising occupational therapist and the occupational therapy assistant with the patient present at the patient's residence or treatment setting once every 7 treatment days or every 21 days, whichever comes first. iii. A supervisory visit should include: 1. A review of activities with appropriate revision or termination of the plan of care; 2. An assessment of utilization of outside resources (whenever applicable); 3. Documentary evidence of such visit; 4. Discharge planning as indicated. iv. An occupational therapist may not supervise/consult with more than two (2) occupational therapy assistants except in school settings, or settings where maintenance or tertiary type services are provided, such as the regional treatment centers under the direction of the Department of Mental Health. 3. Occupational therapy aides: a. An occupational therapy aide is an unlicensed person who assists an occupational therapist or occupational therapy assistant as defined in Rule 8.1.3 of these regulations. An occupational therapy aide is a worker who is trained on the job. b. Duties assigned to an occupational therapy aide must be determined and directly supervised by a licensed occupational therapist or occupational therapy assistant and must not exceed the level of specific training, knowledge, skill and competence of the individual being supervised.

c. The supervising occupational therapist or occupational therapy assistant is professionally responsible for the acts or actions performed by any occupational therapy aide supervised by the licensee in the occupational therapy setting. d. Documentation of all training specific to the aide's duties must be in the aide's file. e. Duties or functions which occupational therapy aides shall not perform include the following: i. Interpreting referrals or prescriptions for occupational therapy services; ii. Performing evaluative procedures; iii. Developing, planning, adjusting, or modifying treatment procedures; iv. Preparing written documentation of patient treatment or progress; and v. Act independently without the direct supervision of a licensed occupational therapist or occupational therapy assistant during patient therapy sessions. 4. The supervising occupational therapist must be accessible by telecommunications to the occupational therapy assistant daily while treating patients. 5. Regardless of the practice setting, the following requirements must be observed when the occupational therapist is supervising or consulting with the occupational therapy assistant: a. The initial visit for evaluation of the patient and establishment of a plan of care must be made by the supervising or consulting occupational therapist. b. A supervisory visit should include: i. A review of activities with appropriate revision or termination of the plan of care; ii. An assessment of utilization of outside resources (whenever applicable); iii. Documentary evidence of such visit which includes the date, time, and the names of individuals involved; iv. Discharge planning as indicated. c. An occupational therapist may not supervise/consult with more than two (2) occupational therapy assistants except I school settings, or settings where maintenance or tertiary type services are provided, such as the regional treatment centers

1. Any person who violates any provision of Subchapter 5 of these regulations, upon conviction, shall be guilty of a misdemeanor and shall be fined not more than One Thousand Dollars ($1,000.00) for each violation. 2. Any person who knowingly shall make a material false statement in his application for license under these regulations or in response to any inquiry by the department or the board shall be fined not less than One Hundred Dollars ($100.00) nor more than Five Hundred Dollars ($500.00) or imprisoned for not less than ten (10) days nor more than sixty (60) days, or both such fine and imprisonment.

**History**
- *SOURCE: Miss. Code Ann. §73-24-13 Subchapter 11: Criminal Offenses and Punishment Rule 8.11.1 Criminal Offenses and Punishment*
- *SOURCE: Miss. Code Ann. §73-24-13 Subchapter 12: Fees Rule 8.12.1 Method of Payment In accordance with the Act, the following non-refundable fees, where applicable, are payable to the Mississippi State Department of Health by check or money order.*
- *SOURCE: Miss. Code Ann. §73-24-13*

##### **15 Miss. Admin. Code Pt. 19, R. 8.12.2** Schedule of Fees: 1 {#sec-19-8.12.2 omnilex-key=us-ms-regs-official--title-15--19#8.12.2}

Application Fee ................................................................................................ $100.00 2. Initial Licensure fee a. Occupational Therapist ............................................................................. $150.00 b. Occupational Therapy Assistant ............................................................... $100.00 3. Renewal Fee a. Occupational Therapist ............................................................................. $150.00 b. Occupational Therapy Assistant ............................................................... $100.00 4. Late Renewal/Reinstatement Fee .................................................................... $125.00 5. License Verification Fee .................................................................................. $ 25.00 6. Inactive License Fee ......................................................................................... $ 50.00 7. Examination Fee: a. Occupational Therapist ...................................................................................... ** b. Occupational Therapy Assistant ........................................................................ ** **Contact the examination administrant for current examination fees.

**History**
- *SOURCE: Miss. Code Ann. §73-24-13*

##### **15 Miss. Admin. Code Pt. 19, R. 8.12.3** Examination Fee: Fees for the examination are to be paid to the appropriate examination administrant {#sec-19-8.12.3 omnilex-key=us-ms-regs-official--title-15--19#8.12.3}

**History**
- *SOURCE: Miss. Code Ann. §73-24-13*

#### **Chapter 9** REGULATIONS GOVERNING LICENSURE OF RESPIRATORY CARE PRACTITIONERS Subchapter 1: GENERAL Rule 9.1.1 Purpose: The purpose of these regulations is to safeguard the public's health, safety, and welfare by establishing minimum qualifications and creating exclusive titles corresponding to the level of qualifications for individuals who wish to offer respiratory care services to the public. Further, in order to insure the highest degree of professional conduct by those engaged in offering respiratory care services to the public, it is the purpose of these regulations to provide and impose disciplinary sanctions, be they civil or criminal, against persons who do not meet or adhere to the procedures, qualifications, and standards set out in this chapter.

##### **15 Miss. Admin. Code Pt. 19, R. 9.1.2** Rule 9.1.2 {#sec-19-9.1.2 omnilex-key=us-ms-regs-official--title-15--19#9.1.2}

Legal Authority: The State Board of Health is authorized to establish and enforce these rules and procedures by virtue of the "Mississippi Respiratory Care Practice Act of 1991," Sections 73-57-1 et seq. of Mississippi Code of 1972, annotated.

**History**
- *SOURCE: Miss. Code Ann. §73-57-13.*

##### **15 Miss. Admin. Code Pt. 19, R. 9.1.3** Definitions: The following terms shall have the meaning set forth below, unless the context otherwise requires: 1 {#sec-19-9.1.3 omnilex-key=us-ms-regs-official--title-15--19#9.1.3}

"Board" shall mean the Mississippi State Board of Health. 2. "Council" shall mean the Respiratory Care Advisory Council. 3. "License" shall mean the document of licensure issued by the Board. 4. “Respiratory care" shall mean the allied health professions responsible for the treatment, management, diagnostic, testing, control, and care of patients with deficiencies and abnormalities associated with the cardiopulmonary system, pursuant to the orders of a physician licensed in the State of Mississippi,and includes "inhalation therapy" and "respiratory therapy." 5. "Practice of respiratory care" shall include, but not be limited to: direct and indirect respiratory care services, including but not limited to the administration of pharmacological, diagnostic, and therapeutic agents related to respiratory care procedures necessary to implement a treatment, disease prevention, pulmonary rehabilitative, or diagnostic regimen prescribed by a physician; transcription and implementation of the written or verbal orders of a physician pertaining to the practice of respiratory care; observing and monitoring signs and symptoms, general behavior, general physical response to respiratory care treatment and diagnostic testing, including determination of whether such

signs, symptoms, reactions, behavior or general response exhibit abnormal characteristics; and implementation based on observed abnormalities, of appropriate reporting, referral, respiratory care protocols or changes in treatment, pursuant to a prescription by a person authorized to practice medicine under the laws of the State of Mississippi; or the initiation of emergency procedures under the regulations of the Board or as otherwise permitted in this act. The practice of respiratory care may be performed in any clinic, hospital, skilled nursing facility, and private dwelling, or other place deemed appropriate or necessary of the Board, in accordance with the prescription or verbal order of a physician. 6. "Performance of respiratory care" means respiratory care in accordance with the prescription of a licensed physician and includes, but is not limited to, the diagnostic and therapeutic use of the following: administration of medical gases (except for the purpose of anesthesia), aerosols and humidification; environmental control mechanisms and hyperbaric therapy; pharmacologic agents related to respiratory care procedures; mechanical or physiological ventilatory support; bronchopulmonary hygiene; cardiopulmonary resuscitation; maintenance of the natural airway; insertion and maintenance of artificial airways; specific diagnostic and testing techniques employed in the medical management of patients to assist in diagnosis, monitoring, treatment and research of pulmonary abnormalities, including measurements of ventilatory volumes, pressures, flows, collection of specimens of blood and blood gases, expired and inspired gas samples, respiratory secretions, and pulmonary function testing; and hemodynamic and other related physiologist measurements of the cardiopulmonary system. 7. "Respiratory care practitioner" means: a. A person employed in the practice of respiratory care who has the knowledge and skill necessary to administer respiratory care. b. A person who is capable of serving as a resource to the physician in relation to the technical aspects of respiratory care as to safe and effective methods for administering respiratory care modalities; c. A person who is able to function in situations of unsupervised patient contact requiring great individual judgment; and d. A person capable of supervising, directing and teaching less skilled personnel in the provision of respiratory care services. 8. [Reserved] 9. [Reserved] 10. "Examination" shall mean an entry-level examination as administered by the National Board for Respiratory Care (NBRC), or its successor Board, to practice respiratory care or other examination that the Board may approve. 11. "Department" shall mean the Mississippi Department of Health.

12. "Initiation of Emergency Procedure" shall include, but not be limited to, Advanced Cardiac Life Support, Pediatric Advanced Life Support, and Neonatal Resuscitation Program, in emergency situations. Procedures not covered in ( 1-3(e) and (f) above may be performed by only those Licensed Respiratory Care Practitioners who have successfully completed a course in each respective appropriate discipline as governed by the American Heart Association, in accordance with the prescription or verbal order of a physician, and shall be performed under a qualified medical director. 13. “Written orders of a physician” shall include, in a hospital licensed in the State of Mississippi, a set of criteria/requirements outlined and adopted by the appropriate medical advisory body within the institution and made part of the formal hospital procedure for respiratory care.

**History**
- *SOURCE: Miss. Code Ann. §73-57-13.*

##### **15 Miss. Admin. Code Pt. 19, R. 9.1.4** Rule 9.1.4 {#sec-19-9.1.4 omnilex-key=us-ms-regs-official--title-15--19#9.1.4}

Publication: The Department shall publish, annually, a list of the names and addresses of all persons licensed by the Board as Respiratory Care Practitioners and a list of all persons whose licenses have been suspended, revoked, denied renewal, put on probationary status, censured, or reprimanded.

Subchapter 2: RESPIRATORY CARE ADVISORY COUNCIL ("COUNCIL") Rule 9.2.1 Council Structure and Purpose: The Council shall consist of nine (9) members as set forth in the enabling statute, for the terms indicated therein, and shall serve under the jurisdiction of the State Board of Health. The purpose of the Council is to serve in an advisory capacity to the Board in matters relating to the administration and interpretation of the enabling statute.

**History**
- *SOURCE: Miss. Code Ann. §73-57-13.*
- *SOURCE: Miss. Code Ann. §73-57-13.*

##### **15 Miss. Admin. Code Pt. 19, R. 9.2.2** Meeting: The Council shall meet at least twice each year {#sec-19-9.2.2 omnilex-key=us-ms-regs-official--title-15--19#9.2.2}

Additional meetings may be held, at the discretion of the chairperson of the Council or of the Board, upon ten (10) day written notice to the Council members. A quorum shall consist of five (5) members of the Council, including the chairperson, and shall be necessary for the Council to take action by vote.

Subchapter 3: State Board of Health (“Board”) Rule 9.3.1 Responsibilities: The Board, with the advice of the council, shall: 1. establish examination, licensing, and renewal of license criteria for applicants; 2. maintain an up-to-date list of all individuals licensed to practice respiratory care, with such list being available, upon request, to the public;

3. refer disciplinary actions of any individual engaged in the practice of respiratory care to the appropriate government agency for prosecution, whether licensed or otherwise, or, in its discretion, refer same to the appropriate committee or council; 4. conduct disciplinary hearings, upon specified charges, of a licensee; 5. maintain an up-to-date list of all individuals whose license has been suspended, revoked, or denied and make such list available to public inspection and supply such list to similar regulatory boards in other states or jurisdictions; 6. keep a record of all proceedings of the Board, and make said record available to the public; and 7. direct the Department to promulgate and implement rules and procedures to carry out the purpose of the Act.

Subchapter 4: Licensure Rule 9.4.1 Licensure Requirements: An applicant for licensure shall submit to the Department, verified by oath, written evidence in form and content satisfactory to the Department that the applicant holds a credential, conferred by the National Board of Respiratory Care, or its successor Board, as a Certified Respiratory Technician (CRT) and/or a Registered Respiratory Therapist (RRT), or their successor credentials, providing such credentials have not been suspended or revoked, or at the time of application have not lapsed.

**History**
- *SOURCE: Miss. Code Ann. §73-57-13.*
- *SOURCE: Miss. Code Ann. §73-57-13.*
- *SOURCE: Miss. Code Ann. §73-57-13.*

##### **15 Miss. Admin. Code Pt. 19, R. 9.4.2** Rule 9.4.2 {#sec-19-9.4.2 omnilex-key=us-ms-regs-official--title-15--19#9.4.2}

**History**
- *SOURCE: Miss. Code Ann. §73-57-13.*

##### **15 Miss. Admin. Code Pt. 19, R. 9.4.3** [Reserved] {#sec-19-9.4.3 omnilex-key=us-ms-regs-official--title-15--19#9.4.3}

Temporary Permit: The Board may, in its discretion, issue a temporary permit to practice respiratory care for a period of six (6) months to an applicant for a license, pending the compliance of the requirements for licensure, providing the applicant submits to the Department, verified by oath, in form and content satisfactory to the Department that the applicant is a student in an approved respiratory care education program and expects to graduate within thirty (30) days of the application for a temporary permit and who is eligible to sit for the CRT, RRT, or their successor examination.

**History**
- *SOURCE: Miss. Code Ann. §73-57-13.*

##### **15 Miss. Admin. Code Pt. 19, R. 9.4.4** Rule 9.4.4 {#sec-19-9.4.4 omnilex-key=us-ms-regs-official--title-15--19#9.4.4}

Abandonment: An application shall be deemed abandoned by the Department if, after two years from the date of filing, the requirements for licensing have not been completed and submitted to the Department.

Subchapter 5: Professional Identification Rule 9.5.1 Titles and Abbreviation: A person issued a license to practice respiratory care by the Mississippi State Board of Health may use the title "Licensed Respiratory Care Practitioner" and the abbreviations "L.R.C.P.," "R.C.P.," or "R.C.P.-L."

**History**
- *SOURCE: Miss. Code Ann. §73-57-13.*
- *SOURCE: Miss. Code Ann. §73-57-13.*

##### **15 Miss. Admin. Code Pt. 19, R. 9.5.2** Rule 9.5.2 {#sec-19-9.5.2 omnilex-key=us-ms-regs-official--title-15--19#9.5.2}

Production and Display of License: A person issued a license to practice respiratory care by the Mississippi State Board of Health shall show said license when requested.

Subchapter 6: Renewal of License Rule 9.6.1 General Provisions: 1. The Board shall issue licenses which shall be renewed biennially, beginning with the first renewal term after the issuance of the license. 2. The licensure period for renewal purposes shall be construed as September 1 st through August 31 st of the odd numbered years.

**History**
- *SOURCE: Miss. Code Ann. §73-57-13.*
- *SOURCE: Miss. Code Ann. §73-57-13.*

##### **15 Miss. Admin. Code Pt. 19, R. 9.6.2** Rule 9.6.2 {#sec-19-9.6.2 omnilex-key=us-ms-regs-official--title-15--19#9.6.2}

Procedure for Renewal of License: The Department shall provide notices, at least thirty (30) days prior to the renewal date, to the last address registered with the board, to the persons to whom licenses were issued or renewed during the preceding renewal period. The notice of renewal shall indicate the renewal process and required fees to be completed before the date of expiration.

**History**
- *SOURCE: Miss. Code Ann. §73-57-13.*

##### **15 Miss. Admin. Code Pt. 19, R. 9.6.3** Rule 9.6.3 {#sec-19-9.6.3 omnilex-key=us-ms-regs-official--title-15--19#9.6.3}

Failure to Renew: A licensee who does not file, with the Department, his renewal application within the renewal period will be deemed to have allowed his license to lapse. Said licensee may be reinstated by the Department, in its discretion, by the payment of the renewal fee and a reinstatement fee, provided said application for reinstatement is made within two (2) years of the end of the renewal period.

**History**
- *SOURCE: Miss. Code Ann. §73-57-13 Subchapter 7: Continuing Education Rule 9.7.1 Definition and Philosophy: Each individual licensed as a respiratory care Practitioner is responsible for optimum service to the consumer and is accountable to the consumer, the employer, and the profession for evidence of maintaining high levels of skill and knowledge. Pursuant to the Act, continuing education is mandatory. Continuing education is defined as education beyond the basic preparation required for entry into the profession, directly related to the performance and practice of respiratory care.*
- *SOURCE: Miss. Code Ann. §73-57-13.*

##### **15 Miss. Admin. Code Pt. 19, R. 9.7.2** Requirements: 1 {#sec-19-9.7.2 omnilex-key=us-ms-regs-official--title-15--19#9.7.2}

Regulations set the requirement of twenty (20) clock hours to be accrued during the licensing term. 2. Individuals applying for initial licensure within a licensing term must accrue continuing education hours on a prorated scale. Written notification of required hours will be sent to the applicant at the time of licensure. 3. Individuals holding a temporary permit are not required to accrue continuing education hours. 4. Persons who fail to accrue the required continuing education hours shall be issued a probationary license for a term of two (2) years. Failure to accrue the required hours will result in the revocation of the license. Hours accrued are first credited for the delinquent hours lacking from the previous licensure period, and then applied to the present licensing period. 5. Probationary licenses will be issued for one licensure term only. No ensuing license may be probationary as a result of not meeting continuing education requirements.

**History**
- *SOURCE: Miss. Code Ann. §73-57-13.*

##### **15 Miss. Admin. Code Pt. 19, R. 9.7.3** Rule 9.7.3 {#sec-19-9.7.3 omnilex-key=us-ms-regs-official--title-15--19#9.7.3}

Content Criteria: The content must apply to the field of respiratory care practice or health care and performance and must be designed to meet one of the following goals: 1. Update knowledge and skills required for competent performance beyond entry level as described in current legislation and regulations. 2. Allow the licensee to enhance his knowledge and skills. 3. Provide opportunities for interdisciplinary learning. 4. Extend limits of professional capabilities and opportunities. 5. Facilitate personal contributions to the advancement of the profession.

**History**
- *SOURCE: Miss. Code Ann. §73-57-13.*

##### **15 Miss. Admin. Code Pt. 19, R. 9.7.4** Sources of Continuing Education: 1 {#sec-19-9.7.4 omnilex-key=us-ms-regs-official--title-15--19#9.7.4}

Continuing education hours may be accrued from the following sources: a. Mississippi Society for Respiratory Care b. American Association for Respiratory Care c. Mississippi Nursing Association d. American Nursing Association

e. American Nurses Credentialing Center f. Critical Care Nurses Association g. American Medical Association 2. Academic course work taken for credit, with a passing grade, from a regionally accredited college or university. The courses must relate to the profession of respiratory care. One academic semester hour shall be equivalent to fifteen (15) clock hours for continuing education credit. No more than fifty percent (50%) of total required hours may be accrued through academic course work.

**History**
- *SOURCE: Miss. Code Ann. §73-57-13.*

##### **15 Miss. Admin. Code Pt. 19, R. 9.7.5** Reporting Procedures for Continuing Education: Continuing education hours shall be submitted at the time of renewal {#sec-19-9.7.5 omnilex-key=us-ms-regs-official--title-15--19#9.7.5}

It is the responsibility of the licensee to insure that the following criteria are met with respect to continuing education credit: 1. Attendance at seminars, workshops, presentations: Verification of attendance shall be made by the submission of a continuing education certificate, a continuing education reporting form signed by the program chairperson, or proof of having filed with the AARC. 2. Academic course work credits to be accrued must meet the content criteria in Sections 7-3, be cited by title on the continuing education form, and must be accompanied by a course description from the college or university catalog and a copy of the transcript or final grade report.

Subchapter 8: Revocation, Suspension and Denial of License Rule 9.8.1 Standards of Conduct: Licensees may, at the discretion of the Board, have their license suspended, revoked, or denied at the time of application or renewal if the Board determines that the licensee: 1. Is guilty of fraud or deceit in procuring or attempting to procure a license or renewal of a license to practice respiratory care. 2. Is unfit or incompetent by reason of negligence, habits, or other causes of incompetence. 3. Is habitually intemperate in the use of alcoholic beverage. 4. Is addicted to, or has improperly obtained, possessed, used, or distributed habit- forming drugs or narcotics. 5. Is guilty of dishonest or unethical conduct. 6. Has practiced respiratory care after his license or permit has expired, lapsed, or has been suspended. 7. Has practiced respiratory care under cover of any permit or license illegally or fraudulently obtained or issued.

8. Has violated, aided, or abetted others in violation of any provision of this act. 9. Has engaged in any conduct considered by the Board to be detrimental to the profession of respiratory care. 10. Failed to disclose to an employer, upon the written request of the employer, any potential conflict of interest, including but not limited to concurrent employment by both a Durable Medical Equipment Company and/or a Home Health Company, and a Hospital or Clinic. 11. Failed to service a patient and/or equipment in a home setting as required by a contract to which the Licensee is a party. 12. Has participated in a Hospital or Clinical Agency setting in a "captive referral arrangement", whereby patients were directed to utilize a particular supplier of home medical equipment unless so directed by Hospital or Clinic policy. 13. Failed to follow the principles of ethical professional behavior. 14. Has had a license to practice any health related profession revoked, suspended, placed on probation, reprimanded, or censured, in any jurisdiction.

**History**
- *SOURCE: Miss. Code Ann. §73-57-13.*
- *SOURCE: Miss. Code Ann. §73-57-13.*

##### **15 Miss. Admin. Code Pt. 19, R. 9.8.2** Rule 9.8.2 {#sec-19-9.8.2 omnilex-key=us-ms-regs-official--title-15--19#9.8.2}

Summary Suspension: The Board may summarily suspend a license without a hearing, simultaneously with the filing of a formal complaint and notice of hearing, if the Board determines that: 1. The health, safety, or welfare of the general public is in immediate danger; or 2. The licensee's physical capacity to practice his profession is in issue; or 3. The licensee's mental capacity to practice his profession is in issue.

**History**
- *SOURCE: Miss. Code Ann. §73-57-13.*

##### **15 Miss. Admin. Code Pt. 19, R. 9.8.3** Rule 9.8.3 {#sec-19-9.8.3 omnilex-key=us-ms-regs-official--title-15--19#9.8.3}

Complaints: All complaints concerning a licensee, his business, or professional practice, shall be reviewed by the Department. Each complaint received shall be logged, recording at a minimum the following information: 1. licensee's name 2. name of the complaining party, if known; 3. date of complaint; 4. brief statement of complaint; and 5. disposition.

**History**
- *SOURCE: Miss. Code Ann. §73-57-13.*

##### **15 Miss. Admin. Code Pt. 19, R. 9.8.4** Rule 9.8.4 {#sec-19-9.8.4 omnilex-key=us-ms-regs-official--title-15--19#9.8.4}

Investigation: All complaints will be evaluated, and if deemed necessary, investigated, by the authorized employee of the Department.

**History**
- *SOURCE: Miss. Code Ann. §73-57-13.*

##### **15 Miss. Admin. Code Pt. 19, R. 9.8.5** Notice of Charges and Hearing: 1 {#sec-19-9.8.5 omnilex-key=us-ms-regs-official--title-15--19#9.8.5}

Following the investigative process, the Department may file formal charges against the licensee. Such formal complaint shall, at a minimum, inform the licensee of the facts which are the basis of the charge and which are specific enough to enable the licensee to defend against the charges. 2. Each licensee, whose conduct is the subject of a formal charge which seeks to impose disciplinary action against the licensee, shall be served notice of the formal charge at least fifteen (15) days before the date of hearing. A hearing shall be presided over by the Board or the Board's designee. Service shall be considered to have been given if the notice was personally received by the licensee, or the notice was mailed certified, return receipt requested, to the licensee at the licensee's last known address as listed with the state agency. 3. The notice of the formal hearing shall consist at a minimum of the following information: a. The time, place, and date of hearing; b. That the licensee shall appear personally at the hearing and may be represented by counsel; c. That the licensee shall have the right to produce witnesses and evidence in the licensee's behalf and shall have the right to cross-examine adverse witnesses and evidence; d. That the hearing could result in disciplinary action being taken against the licensee's license; e. That rules for the conduct of these hearings exist and it may be in the licensee's best interest to obtain a copy; and f. That the Board, or its designee, shall preside at the hearing and following the conclusion of the hearing shall make findings of facts, conclusions of law and recommendations, separately stated, to the Board as to what disciplinary action, if any, should be imposed on the licensee. 4. The Board or its designee shall hear evidence produced in support of the formal charges and contrary evidence produced by the licensee. At the conclusion of the hearing, the Board shall issue an order within sixty (60) days. 5. Disposition of any complaints may be made by consent order or stipulation between the Board and the licensee. 6. All proceedings pursuant to this section are matters of public record and shall be preserved pursuant to state law.

**History**
- *SOURCE: Miss. Code Ann. §73-57-13.*

##### **15 Miss. Admin. Code Pt. 19, R. 9.8.6** Rule 9.8.6 {#sec-19-9.8.6 omnilex-key=us-ms-regs-official--title-15--19#9.8.6}

Board Sanctions: The Board may impose any of the following sanctions, singly or in combination, when it finds that a licensee is guilty of any of the above offenses: 1. Revocation of the license; 2. Suspension of the license, for any period of time; 3. Issue a letter of reprimand to the licensee; 4. Place a license on probationary status and require the licensee to submit to any of the following: a. report regularly to the board upon matters which are the basis of probation; b. continue to renew professional education until a satisfactory degree of skill has been attained in those areas which are the basis of probation; or c. such other reasonable requirements or restrictions as are proper; 5. Refuse to renew a license; or 6. Revoke probation which has been granted and impose any other disciplinary action in this subsection when the requirements of probation have not been fulfilled or have been violated.

**History**
- *SOURCE: Miss. Code Ann. §73-57-13.*

##### **15 Miss. Admin. Code Pt. 19, R. 9.8.7** Rule 9.8.7 {#sec-19-9.8.7 omnilex-key=us-ms-regs-official--title-15--19#9.8.7}

Appeal: Any person aggrieved by a decision of the Board shall have a right of appeal to the Circuit Court of the county of the residence of the licensee as it appears on the record, in the manner provided for in the Act and the Laws of the State of Mississippi.

Subchapter 9: Exceptions and Exemptions Rule 9.9.1 Exceptions: No person shall practice respiratory care or represent himself to be a respiratory care practitioner unless he is licensed by the Board, except as otherwise provided in this section.

1. The person is involved in the practice of respiratory care which is an integral part of the program of study by students enrolled in a respiratory care education program recognized by the Joint Review Committee for Respiratory Therapy Education and the American Medical Association Council on Allied Health Education or their successors. Unlicensed students enrolled in respiratory therapy education programs shall be identified as "Student-RCP" and shall only provide respiratory care under direct clinical supervision. Direct Clinical Supervision shall mean under the direct control of a clinical instructor of the respiratory care education program in which the unlicensed student is enrolled, or his designee. The clinical instructor or his designee shall be a Licensed Respiratory Care Practitioner in the State of Mississippi, who shall be readily accessible and accountable at all times when

respiratory care is being provided by the unlicensed student.

2. Second-year Respiratory Care Practitioner (RCP) students enrolled in an accredited respiratory care program are allowed to be employed, to provide, and to be compensated for the performance of limited low-risk respiratory therapy procedures in licensed hospitals. The RCP student must be issued a hospital identification badge and be identified as an “RCP Student” on the hospital identification badge. Said badge shall be worn in clear sight when the RCP student is on the premises of the hospital. They must also be identified as an “RCP Student” on their employment application and any job description maintained in the hospital’s human resources department. Second-year RCP students shall work under the direct supervision of a licensed RCP, and the employing institution shall complete and retain all documentation of the competency, proficiency, and ability of the RCP students to perform the procedures authorized below. The procedures authorized to be performed are to be performed exclusively outside a critical care area and are as follows: • Set up and monitoring of low-flow oxygen (e.g., less than or equal to 6 LPM) • Non-exotic aerosol therapy (bronchodilators, anticholinergics, etc.) • Hyperinflation and airway clearance therapy • Electrocardiograms • Equipment cleaning, stocking, transporting, etc. • Once an RCP student is certified in Basic Life Support, they may assist in cardiorespiratory arrests at the discretion of the employing institution.

3. Self-care by a patient, or gratuitous care by a friend or family member who does not represent or hold himself out to be a respiratory care practitioner.

4. Respiratory care services rendered in the course of an emergency.

5. Persons in the military services or working in federal facilities shall be exempted from the provisions of this act when functioning in the course of their assigned duties.

6. The respiratory care practitioner is engaged in performing advances in the art and techniques of respiratory care learned through formalized or specialized training.

7. Nothing in these regulations is intended to limit, preclude, or otherwise interfere with the practices of other persons and health providers licensed by appropriate agencies of the State of Mississippi.

8. An individual, who, by passing an examination which

includes content in one or more of the functions included in these regulations, shall not be prohibited from performing such procedures for which he was tested, so long as the testing body offering the examination is certified by the National Commission for Health Certifying Agencies or its equivalent, so long as the individual is a licensed health care provider in the state of Mississippi.

**History**
- *SOURCE: Miss. Code Ann. §73-57-13.*
- *SOURCE: Miss. Code Ann. §73-57-13.*

##### **15 Miss. Admin. Code Pt. 19, R. 9.9.2** Rule 9.9.2 {#sec-19-9.9.2 omnilex-key=us-ms-regs-official--title-15--19#9.9.2}

Good Samaritan Act: Licensee's regulated pursuant to these rules and regulations are covered by the "Good Samaritan Act" of the State of Mississippi.

Subchapter 10: [Reserved]

Subchapter 11: Criminal Offenses and Punishment Rule 9.11.1 Offenses: It is a misdemeanor for any person to: 1. Sell, fraudulently obtain, or furnish any respiratory care permit, license, record, or aid or abet therein. 2. Practice respiratory care under cover of any respiratory care diploma, permit, license, or record illegally or fraudulently obtained or issued. 3. Practice respiratory care unless duly licensed to do so by the Mississippi State Board of Health. 4. Impersonate in any manner or pretend to be a respiratory care practitioner or use the title "Licensed Respiratory Care Practitioner," the letters "L.R.C.P." or any other words, letters, signs, symbols or devices to indicate the person using them is a licensed respiratory care practitioner, unless duly authorized by license or permit. 5. Practice respiratory care during the time his license or permit is suspended, revoked, lapsed, or expired. 6. Fail to notify the board of the suspension, probation or revocation of any past or currently held licenses, required to practice respiratory care in this or any other jurisdiction.

7. Make false representations, impersonate, act as a proxy for another person, allow, or aid any person to impersonate him in connection with any examination or application for licensing or request to be examined or licensed. 8. Otherwise violate any provisions of the Mississippi Respiratory Care Practice Act.

**History**
- *SOURCE: Miss. Code Ann. §73-57-13.*
- *SOURCE: Miss. Code Ann. §73-57-13.*
- *SOURCE: Miss. Code Ann. §73-57-13.*

##### **15 Miss. Admin. Code Pt. 19, R. 9.11.2** Rule 9.11.2 {#sec-19-9.11.2 omnilex-key=us-ms-regs-official--title-15--19#9.11.2}

Punishment: Such misdemeanor shall, upon conviction, be punishable by a fine of not more than One Thousand Dollars ($1,000.00) or by imprisonment for not more than six (6) months or by both fine and imprisonment for each offense.

Subchapter 12: Fees Rule 9.12.1 Method of Payment: In accordance with the enabling statute, the following fees, where applicable, are payable to the State Board of Health by certified check, cashiers check, or money order. Fees paid to the State Board of Health are non- refundable.

**History**
- *SOURCE: Miss. Code Ann. §73-57-13.*
- *SOURCE: Miss. Code Ann. §73-57-13.*

##### **15 Miss. Admin. Code Pt. 19, R. 9.12.2** Schedule of Fees: 1 {#sec-19-9.12.2 omnilex-key=us-ms-regs-official--title-15--19#9.12.2}

Application and Initial Licensure Fee-$75.00 2. Renewal Fee-$100.00 3. Temporary Permit Fee - $50.00 4. Reinstatement Fee - $200.00 5. Replacement Fee - $50.00 6. License Verification Fee - $25.00

**History**
- *SOURCE: Miss. Code Ann. §73-57-13.*

##### **15 Miss. Admin. Code Pt. 19, R. 9.12.3** Examination Fee: Fees for examination are to be paid directly to the appropriate testing organization {#sec-19-9.12.3 omnilex-key=us-ms-regs-official--title-15--19#9.12.3}

Subchapter 13: ADMINISTRATIVE GRIEVANCE PROCEDURE Rule 9.13.1 Administrative Appeals: All persons aggrieved by a decision regarding the initial application for licensure or the renewal of licensure shall have the right of

administrative appeal and a hearing to be conducted according to the policy of the Department of Health.

**History**
- *SOURCE: Miss. Code Ann. §73-57-13.*
- *SOURCE: Miss. Code Ann. §73-57-13.*

##### **15 Miss. Admin. Code Pt. 19, R. 9.13.2** Rule 9.13.2 {#sec-19-9.13.2 omnilex-key=us-ms-regs-official--title-15--19#9.13.2}

Notification: Written notice will be provided to all applicants regarding denial of an original license or a renewal license. Such notice shall contain the reason thereof and shall offer the applicant an opportunity to submit additional information pertinent to their application for a second review by the Department.

**History**
- *SOURCE: Miss. Code Ann. §73-57-13.*

##### **15 Miss. Admin. Code Pt. 19, R. 9.13.3** Hearing: 1 {#sec-19-9.13.3 omnilex-key=us-ms-regs-official--title-15--19#9.13.3}

If requested in writing within the specified time frame a hearing will be provided in which the applicant may show cause why the license should be granted or renewed. 2. Within sixty (60) days of the hearing, or other such time frame as determined during the hearing, written findings of fact, together with a recommendation for action on the license in question, shall be forwarded to the State Health Officer. The State Health Officer shall decide what action will be taken on the recommendation within five days of its receipt. Written notice shall be provided to the applicant.

**History**
- *SOURCE: Miss. Code Ann. §73-57-13.*

#### **Chapter 10** REGULATIONS GOVERNING LICENSURE OF SPEECH- LANGUAGE PATHOLOGISTS AND AUDIOLOGISTS Subchapter 1: General Rule 10.1.1 Purpose: The purpose of these regulations is to safeguard the public's health, safety, and welfare by establishing minimum qualifications and creating exclusive titles corresponding to the level of qualifications for individuals who wish to offer speech-language pathology or audiology services to the public. Further, in order to insure the highest degree of professional conduct by those engaged in offering speech-language pathology or audiology services to the public, it is the purpose of these regulations to provide and impose disciplinary sanctions, be they civil or criminal, against persons who do not meet or adhere to the procedures, qualifications, and standards set out in these regulations.

##### **15 Miss. Admin. Code Pt. 19, R. 10.1.2** Legal Authority: {#sec-19-10.1.2 omnilex-key=us-ms-regs-official--title-15--19#10.1.2}

1. The Mississippi State Board of Health shall be empowered under Title 73, Chapter 38, Mississippi Code of 1972 Annotated, to license qualified applicants in the practice of speech-language pathology and audiology. 2. The Mississippi State Board of Health shall promulgate such rules as are necessary to provide for the licensing of speech-language pathologists, audiologists, speech-language pathology aides, and audiology aides. 3. The principal offices of the Mississippi State Board of Health and the Mississippi Council of Advisors in Speech-Language Pathology and Audiology are located in the Mississippi State Department of Health building, 570 East Woodrow Wilson, Jackson, Mississippi 39216.

**History**
- *SOURCE: Miss. Code Ann. §73-38-13.*

##### **15 Miss. Admin. Code Pt. 19, R. 10.1.3** Definitions: 1 {#sec-19-10.1.3 omnilex-key=us-ms-regs-official--title-15--19#10.1.3}

Board means the Mississippi State Board of Health. 2. Council means the Mississippi Council of Advisors in Speech-Language Pathology and Audiology. 3. ASHA means the American Speech-Language Hearing Association. 4. Department is the Mississippi State Department of Health.

**History**
- *SOURCE: Miss. Code Ann. §73-38-13.*

##### **15 Miss. Admin. Code Pt. 19, R. 10.1.4** Rule 10.1.4 {#sec-19-10.1.4 omnilex-key=us-ms-regs-official--title-15--19#10.1.4}

Publication: The Department shall publish, annually, a list of the names and addresses of all persons licensed by the Board as speech-language pathologists and audiologists and a list of all persons whose licenses have been suspended, revoked, denied renewal, put on probationary status, censured, or reprimanded.

Subchapter 2: Speech-Language Pathology/Audiology Advisory Council (“Council”) Rule 10.2.1 Council Structure and Purpose: The Council shall consist of seven (7) members as set forth in §73-38-11 of the Code, for the terms indicated therein, and shall serve under the jurisdiction of the State Board of Health. The purpose of the Council is to serve in an advisory capacity to the Department in matters relating to the administration and interpretation of the Speech Pathologists and Audiologists Act.

**History**
- *SOURCE: Miss. Code Ann. §73-38-13.*
- *SOURCE: Miss. Code Ann. §73-38-13*

##### **15 Miss. Admin. Code Pt. 19, R. 10.2.2** Meetings: The Council shall meet at least twice each year, with the first meeting being in January {#sec-19-10.2.2 omnilex-key=us-ms-regs-official--title-15--19#10.2.2}

Additional meetings may be held, at the discretion of the

chairperson of the Council or any two council members. A quorum shall consist of four (4) members of the Council, including one speech-language pathologist and one audiologist present, and shall be necessary for the Council to take action by vote. A notice of meeting shall be published in a newspaper of general circulation in the state not less than ten (10) days prior to any meeting.

Subchapter 3: State Board of Health (“Board”) Rule 10.3.1 Responsibilities: The Board, with the advice of the council, shall: 1. establish examination, licensing, and renewal of license criteria for applicants; 2. maintain an up-to-date list of all individuals licensed to practice speech-language pathology or audiology, with such list being available, upon request, to the public; 3. conduct disciplinary hearings, upon specified charges, of a licensee; 4. refer disciplinary actions of any individual engaged in the practice of speech- language pathology or audiology to the appropriate government agency for prosecution, whether licensed or otherwise, or, in its discretion, refer same to the appropriate committee or council; 5. maintain an up-to-date list of all individuals whose license has been suspended, revoked, or denied and make such list available to public inspection and supply such list to similar regulatory boards in other states or jurisdictions; 6. keep a record of all proceedings of the Board, and make said record available to the public; and 7. direct the Department to promulgate and implement rules and procedures to carry out the purpose of the Speech Pathologists and Audiologists Act.

Subchapter 4: Licensure Rule 10.4.1 General Requirements: 1. An application for a license as a speech-language pathologist or audiologist shall be submitted to the State Board of Health at its principal office in Jackson on an application form provided by the State Board of Health. 2. Every application shall be typed or written in ink, signed under the penalty of perjury, and accompanied by the appropriate fee and by such evidence, statements, or documents as therein required.

3. Approved applications and all documents filed in support thereof shall be retained by the State Board of Health. 4. Licenses issues under these regulations shall expire and become invalid at midnight of the expiration date.

**History**
- *SOURCE: Miss. Code Ann. §73-38-13.*
- *SOURCE: Miss. Code Ann. §73-38-13.*
- *SOURCE: Miss. Code Ann. §73-38-13.*

##### **15 Miss. Admin. Code Pt. 19, R. 10.4.2** Qualifications for Licensure: 1 {#sec-19-10.4.2 omnilex-key=us-ms-regs-official--title-15--19#10.4.2}

Education a. Education qualifications deemed equivalent to those specified in Section 73-38-9 shall be at least a master's degree, e.g., M.S., M.A., or M.Ed., in speech-language pathology, communicative disorders, or speech and hearing science, or a doctoral degree in audiology from an institution recognized by the State Board of Health. Licensees currently licensed as an audiologist with a master’s degree will be “grandfathered” in and will remain licensed so long as they maintain their national certification. In addition, applicants for an audiology license who are already licensed as an audiologist in another state with only a master’s degree will be accepted for licensure in Mississippi if they are currently nationally certified. b. Institutions recognized by the State Board of Health within the meaning of Section 73-38-9 shall be those institutions with academic programs accredited by the American Speech-Language-Hearing Association or any other national accrediting body deemed appropriate by the Board. 2. Supervised Professional Employment a. The applicant must have obtained the equivalent of nine (9) months of full-time professional experience (the Supervised Professional Employment) in which bona fide clinical work has been accomplished in the major professional area (speech-language pathology or audiology) in which the license is being sought. Full-time employment is defined as a minimum of thirty (30) clock hours of work a week. For applicants awarded a master’s degree, the Supervised Professional Employment Plan (SPEP) must begin after the degree has been awarded. For applicants awarded a doctoral degree, the Supervised Professional Employment Plan requirement may be met prior to awarding of the degree, provided the equivalent of the Supervised Professional Employment Plan is an integral part of the course of study which leads to the awarding of a doctoral degree. For applicants awarded a doctoral degree from institutions that do not incorporate the equivalent of the Supervised Professional Employment Plan into the degree-granting process, the Supervised Professional Employment Plan must begin after the degree has been awarded.

b. Professional experience is construed to mean direct clinical work with patients, consultations, record keeping, or any other duties relevant to a bona fide program of clinical work. Eighty percent (80%) of full-time clinical experience and one hundred percent (100%) of part-time clinical experience will be in direct clinical contact with persons who have communication handicaps. Time spent in supervision of students, academic teaching, and research, as well as administrative activity that does not deal directly with management programs of specific patients or clients will not be counted as professional experience in this context. c. An applicant desiring to complete the Supervised Professional Employment Experience must apply to the Board for a temporary license on a form available from the Board and must demonstrate that he is or will be supervised according to Rule 10.4.5 of these regulations. 3. The National Examinations In Speech-Language Pathology and Audiology: a. The applicant must have passed a National Examination in Speech- Language Pathology and Audiology, either the National Examination in Speech-Language Pathology or the National Examination in Audiology. Each year at its first meeting, the Advisory Council will recommend to the State Board of Health a passing score for the coming year.

**History**
- *SOURCE: Miss. Code Ann. §73-38-13.*

##### **15 Miss. Admin. Code Pt. 19, R. 10.4.3** Rule 10.4.3 {#sec-19-10.4.3 omnilex-key=us-ms-regs-official--title-15--19#10.4.3}

Licensure by Reciprocity: An applicant for licensure by reciprocity shall submit to the Department, verified by oath, written evidence in form and content satisfactory to the Department that the applicant has met all requirements set forth in Rule 10.4.1 and 10.4.2 of these regulations.

**History**
- *SOURCE: Miss. Code Ann. §73-38-13.*

##### **15 Miss. Admin. Code Pt. 19, R. 10.4.4** Temporary License: 1 {#sec-19-10.4.4 omnilex-key=us-ms-regs-official--title-15--19#10.4.4}

A temporary license to practice as a speech-language pathologist or audiologist may be granted to an applicant for licensure meeting the requirements of Rule 10.4.1 and Rule 10.4.2 who has or has not taken the approved examination or who is entering the supervised professional employment plan subject to the conditions of Rule 10.4.5. 2. A temporary license must be issued prior to the beginning of the supervised professional employment plan.

**History**
- *SOURCE: Miss. Code Ann. §73-38-13.*

##### **15 Miss. Admin. Code Pt. 19, R. 10.4.5** Conditions of Temporary Licensure: {#sec-19-10.4.5 omnilex-key=us-ms-regs-official--title-15--19#10.4.5}

1. A temporary license shall be issued for one 2-year period only beginning on the date of issuance. All regular license requirements must be completed and submitted to the department during the temporary licensure period. Supervision must be maintained according to the Supervised Professional Employment Plan (SPEP) agreement until the temporary license is upgraded to a regular license by the department. 2. A temporary licensee shall restrict his practice setting to the State of Mississippi. a. A temporary licensee in a department approved SPEP shall practice under the supervision of a current licensee holding a corresponding, regular license issued by the department. b. A temporary licensee in an employment setting that is exempt from licensure under §73-38-7 of the Code and who is engaged in a department approved SPEP shall practice under the supervision of a current, licensee holding a corresponding, regular license issued by the department. c. A temporary licensee may practice only in the practice setting listed in the department approved SPEP. d. A temporary licensee may not supervise any other licensee or registered aide. 3. Documentation in form and substance acceptable to the Department that the conditions of Rule 10.4.5(2) have been met must be on file with the Department before a temporary license will be issued. 4. A temporary license will not be issued to any individual who has had a temporary license revoked pursuant to the provisions of these regulations. 5. Any person who has completed the Supervised Employment Experience and who has taken but not passed the required examination in another jurisdiction shall not be eligible for a license of any type until an approved examination is passed.

**History**
- *SOURCE: Miss. Code Ann. §73-38-13.*

##### **15 Miss. Admin. Code Pt. 19, R. 10.4.6** Conditions of a Universal Occupational License: {#sec-19-10.4.6 omnilex-key=us-ms-regs-official--title-15--19#10.4.6}

5. Notwithstanding any other provision of law, the Department shall issue a license in speech-language pathology and audiology and at the same practice level to a person who establishes residence in this state if, upon application to the Department: a. The applicant holds a current and valid license in good standing in another state in an occupation with a similar scope of practice, as determined by the Department, and has held this license from the occupational licensing board in the other state for at least one (1) year; and

b. There were minimum education requirements and, if applicable, work experience, examination, and clinical supervision requirements in effect, and the other state verifies that the applicant met those requirements in order to be licensed in that state; and c. The applicant has not committed any act in the other state that would have constituted grounds for refusal, suspension, or revocation of a license to practice that occupation in Mississippi at the time the act was committed, and the applicant does not have a disqualifying criminal record as determined by the Department under Mississippi law; and b. The applicant did not surrender a license because of negligence or intentional misconduct related to the applicant's work in the occupation in another state; and e. The applicant does not have a complaint, allegation, or investigation pending before an occupational licensing board or other board in another state that relates to unprofessional conduct or an alleged crime. If the applicant has a complaint, allegation, or investigation pending, the Department shall not issue or deny a license to the applicant until the complaint, allegation, or investigation is resolved, or the applicant otherwise satisfies the criteria for licensure in Mississippi to the satisfaction of the Department; and f. The applicant pays all applicable fees in Mississippi. 2. Notwithstanding any other law, the Department shall issue a license to an applicant in speech-language pathology or audiology and at the same practice level, as determined by the Department, to a person who establishes residence in this state based on work experience in another state, if all the following apply: j. The applicant worked in a state that does not use a license to regulate a lawful occupation, but Mississippi uses a license to regulate a lawful occupation with a similar scope of practice, as determined by the Department; k. The applicant worked for at least three (3) years in the lawful occupation; and l. The applicant satisfies the provisions of paragraphs (c) through (f) of Rule 10.4.6(1). 12. The Department may require an applicant to pass a jurisprudential examination specific to relevant state laws in Mississippi that regulate speech-language pathologists and audiologists if the issuance of a license in Mississippi requires an applicant to pass a jurisprudential examination specific to relevant state statutes and administrative rules in Mississippi that regulate speech-language pathologists and audiologists. 13. The Department may require proof of residency. Residency may be established by demonstrating proof of a state-issued identification card or one (1) of the following:

i. Current Mississippi residential utility bill with the applicant's name and address; j. Documentation of the applicant's current ownership, or current lease of a residence in Mississippi; k. Documentation of current in-state employment or a notarized letter of the promise of employment of the applicant or his or her spouse; or l. Any verifiable documentation demonstrating Mississippi residency. 14. A license issued under this section is valid only in this state and does not make the person eligible to be part of an interstate compact. 15. The Department shall issue or deny the license to the applicant within one hundred twenty (120) days after receiving an application. 16. If the application requires longer than two (2) weeks to process, the Department shall issue a temporary practice permit within thirty (30) days after receiving the application if the applicant submits an affidavit, under penalties of perjury, affirming that he or she satisfies the provisions of Rule 10.4.6(3) or Rule 10.4.6(4) and pays all applicable fees as required by Rule 10.4.6(1)(f). a. The applicant may practice under the temporary permit until a license is granted, or until a notice to deny the license is issued, in accordance with rules adopted by the Department. A temporary license will expire in three hundred sixty-five (365) days after its issuance if the applicant fails to satisfy the requirement for licensure in Rule 10.4.6(1) through Rule 10.4.6(3), as applicable. 17. The Department may waive the examination for licensure of any applicant who presents proof of current licensure in another state, including the District of Columbia, or territory of the United States which maintains professional standards considered by the Department to be equivalent to those set forth in this chapter. The issuance of a license by reciprocity to a military-trained applicant, military spouse, or person who establishes residence in this state shall be subject to the provisions of Section §73-50-1 or §73-50-2 of the Mississippi Code of 1972, as applicable. 18. The Department shall waive the examination for licensure of any person certified as clinically competent by ASHA in the area for which such person is applying for licensure. 19. Denial of Universal License a. The applicant may appeal any of the following decisions of the Department to a court of general jurisdiction: (xiii) Denial of a license;

(xiv) Determination of the occupation; (xv) Determination of the similarity of the scope of practice of the license issued; or (xvi) Other determinations under this section. b. The court shall determine all questions of law, including the interpretation of a constitutional or statutory provision or a rule adopted by the Department, without regard to any previous determination that may have been made on the question in any action before the Department.

**History**
- *SOURCE: Miss. Code Ann. §73-38-13.*

##### **15 Miss. Admin. Code Pt. 19, R. 10.4.7** Rule 10.4.7 {#sec-19-10.4.7 omnilex-key=us-ms-regs-official--title-15--19#10.4.7}

Abandonment: An application shall be deemed abandoned by the Department if, after six (6) months from the date of filing, the requirements for licensing have not been completed and submitted to the Department.

Subchapter 5: Professional Identification Rule 10.5.1 Production and Display of License; A person licensed to practice speech- language pathology or audiology in Mississippi shall be issued a "Certificate of Licensure" and "License Identification Card.” The licensee shall prominently display the "Certificate of Licensure" or copy thereof at their place(s) of employment. The licensee shall carry the "License Identification Card" when providing services and show said ID card when requested.

2. The licensure period shall be construed as July 1 through June 30 with all regular licenses expiring at midnight on June 30 of even-numbered years.

**History**
- *SOURCE: Miss. Code Ann. §73-38-13.*
- *SOURCE: Miss. Code Ann. §73-38-13 Subchapter 6: Renewal of License Rule 10.6.1 General Provisions: 1. The Board shall issue regular licenses which shall be renewed prior to the expiration date of the license.*
- *SOURCE: Miss. Code Ann. §73-38-13.*

##### **15 Miss. Admin. Code Pt. 19, R. 10.6.2** Rule 10.6.2 {#sec-19-10.6.2 omnilex-key=us-ms-regs-official--title-15--19#10.6.2}

Procedure for Renewal of License: The Department shall mail notices approximately sixty (60) days prior to the license expiration date to the last home address registered with the Department, to the persons to whom licenses were issued or renewed during the preceding licensure period. The licensee shall:

1. complete the renewal form; 2. submit proof of continuing education credit as detailed in Subchapter 7 of these regulations; 3. enclose the renewal fee; and 4. file the above with the Department prior to the licensure expiration date. 5. Renewal applications filed or postmarked after the licensure expiration date are subject to a late renewal penalty of $50.00.

**History**
- *SOURCE: Miss. Code Ann. §73-38-13.*

##### **15 Miss. Admin. Code Pt. 19, R. 10.6.3** Rule 10.6.3 {#sec-19-10.6.3 omnilex-key=us-ms-regs-official--title-15--19#10.6.3}

Failure to Renew: A licensee who does not file, with the Department, renewal requirements prior to licensure expiration will be deemed to have allowed his license to lapse. Failure to submit all renewal requirements postmarked on or before September 30 shall result in the necessity of the payment of a “renewal”, the “late renewal penalty”, and the “license issued after the expiration date” fee. Said license may be reinstated by the Department, in its discretion, by the payment of the "renewal,” the "late renewal penalty", and the "license issued after expiration date" fees, and the required continuing education hours provided said application for reinstatement is made within two (2) years after its last expiration date. A license may not be reinstated after having lapsed for two (2) consecutive years. A new application must be made and the licensure regulations in effect at the time of application must be met.

1. Continuing education is defined as education beyond the basic preparation required for entry into the profession, directly related to the performance and practice of speech-language pathology or audiology. Relevancy of continuing education hours will be determined by the department with the advice of the council. 2. Pursuant to §73-38-33 of the Mississippi Code 1972 Annotated, continuing education is mandatory.

**History**
- *SOURCE: Miss. Code Ann. §73-38-13 Subchapter 7: Continuing Education Rule 10.7.1 Definition and philosophy: Each individual licensed as a speech-language pathologist or audiologist is responsible for optimum service to the consumer and is accountable to the consumer, the employer, and the profession for evidence of maintaining high levels of skill and knowledge.*
- *SOURCE: Miss. Code Ann. §73-38-13.*

##### **15 Miss. Admin. Code Pt. 19, R. 10.7.2** Requirements: {#sec-19-10.7.2 omnilex-key=us-ms-regs-official--title-15--19#10.7.2}

1. Regulations set the requirement of 20 contact hours (CH) or 2 Continuing Education Units (CEU) to be accrued during the licensing term. No carryover of continuing education hours from one licensure period to another shall be allowed. At least fifty (50) percent (10 Contact Hours or 1 CEU) of the continuing education requirement must be directly related to the clinical practice of speech- language pathology or audiology. 2. Individuals applying for initial licensure within a licensing term must accrue continuing education hours on a prorated scale. Written notification of required hours will be sent to the applicant at the time of licensure. 3. Individuals holding a temporary license must meet the same CEU requirements as regularly licensed practitioners. 4. Persons who fail to accrue the required continuing education hours shall be issued a CE probationary license for the licensure term. Failure to accrue the required hours during the CE probationary period will result in the revocation of the license. Hours accrued are first credited for the delinquent hours lacking from the previous licensure period, and then applied to the current (CE probationary) licensing period. CE probationary licenses will be issued for one licensure term only. No ensuing license may be CE probationary as a result of not meeting continuing education requirements. 5. NOTE: Reinstatement of a license revoked for failure to meet continuing education requirements is subject to the discretion of the Department. If said license is permitted to be reinstated, payment of the "renewal,” the "late renewal payment penalty", and the "license issued after expiration date" fees as stated in Subchapter 11 of these regulations will be required before licensure may be reinstated.

**History**
- *SOURCE: Miss. Code Ann. §73-38-13.*

##### **15 Miss. Admin. Code Pt. 19, R. 10.7.3** Rule 10.7.3 {#sec-19-10.7.3 omnilex-key=us-ms-regs-official--title-15--19#10.7.3}

Content Criteria: The content must apply to the field of speech-language pathology or audiology and performance and must be designed to meet one of the following goals: 1. Update knowledge and skills required for competent performance beyond entry level as described in current legislation and regulations. 2. Allow the licensee to enhance his knowledge and skills. 3. Provide opportunities for interdisciplinary learning. 4. Extend limits of professional capabilities and opportunities. 5. Facilitate personal contributions to the advancement of the profession.

**History**
- *SOURCE: Miss. Code Ann. §73-38-13*

##### **15 Miss. Admin. Code Pt. 19, R. 10.7.4** Rule 10.7.4 {#sec-19-10.7.4 omnilex-key=us-ms-regs-official--title-15--19#10.7.4}

Sources of Continuing Education (Revised 1/14/09): Only courses/providers of CE courses approved by one of the organizations listed in Rule 10.7.4(1) (a) will be accepted as continuing education for licensure renewal purposes. A course not approved by an organization listed in this section of the regulations may be reviewed by the department prior to attendance at the course. Contact the department for information. Continuing education hours may be accrued from the following sources, when the content of the programs relates to the profession of speech-language pathology or audiology: 1. Attendance at educational programs: a. attendance at educational programs where continuing education credit is given and approved by the American Speech-Language Hearing Association (ASHA), including other state association educational programs; b. attendance at educational programs where continuing education credit is given and approved by the American Medical Association (AMA) and its components; c. attendance at educational programs where continuing education credit is given and approved by accredited universities. d. attendance at educational programs where continuing education credit is given and approved by the Academy of Dispensing Audiologists. e. attendance at educational programs where continuing education credit is given and approved by the American Academy of Audiology. f. attendance at educational programs where continuing education credit is given and approved by the American Auditory Society. g. attendance at educational programs where continuing education credit is given and approved by licensure authorities for speech-language pathology or audiology of other states or territories of the United States or the District of Columbia. h. attendance at other programs approved for continuing education credit by ASHA, AMA, or their components. 2. Presentations, made before recognized groups of speech-language pathologists or audiologists, medical practitioners, or other health related professionals, rather than civic groups, and directly related to the profession of speech-language pathology or audiology. To be considered for continuing education credit, material outline and a synopsis must be submitted to the Department thirty (30) days prior to the presentation date. Notice of approval or disapproval will be sent following a review by the Department. For approved presentations, the presenter may accrue one (1) hour of continuing education credit for each hour of the actual

presentation, and one (1) hour of preparation time, for a total of (2) two hours. Presenter credit is given one (1) time only, even though the session may be presented multiple times. No more than 30% of total required hours may be accrued through presentations. 3. Academic course work taken after successful completion of the master’s degree licensure requirement and taken for credit from a regionally accredited college or university. The courses must relate to the clinical practice of speech-language pathology or audiology. One academic semester hour shall be equivalent to fifteen (15) clock hours for continuing education credit. Courses must be on the graduate level. A minimum grade of "C" is needed for CE purposes 4. Online or Home Study Courses: a. One hundred percent (100%) of the total required hours may be accrued through online or home study courses. b. Correspondence courses are not considered self-study. c. Courses must be approved by one of the organizations listed in Rule 10.7.4(1)(a) of these regulations. 5. Teleconferences approved by a provider listed under Rule 10.7.4(1)(a) of these regulations. Viewing of taped teleconferences is not acceptable unless authorized by the provider in writing. 6. Publication in a professional, refereed journal. Licensee must be the principal author. A maximum of 30% of the total CE requirement may be accrued through publication. 7. Specific UNACCEPTABLE activities include: a. All in-service programs not approved under Rule 10.7.4(1)(a) of these regulations. b. Orientation to specific work-site programs dealing with organizational structures, processes, or procedures. c. Meetings for purposes of policy decision. d. Non-educational meetings at annual conferences, chapter, or organizational meetings. e. Entertainment or recreational meetings or activities. f. Committee meetings, holding of office, serving as an organizational delegate.

g. Visiting exhibits. h. CPR education. i. Self-directed studies other than those previously outlined.

**History**
- *SOURCE: Miss. Code Ann. §73-38-13.*

##### **15 Miss. Admin. Code Pt. 19, R. 10.7.5** Rule 10.7.5 {#sec-19-10.7.5 omnilex-key=us-ms-regs-official--title-15--19#10.7.5}

Reporting Procedures for Continuing Education: Continuing education credit must be awarded by the approved program provider on a form furnished by the program provider. Proof of program approval by an organization listed in section 106.0(1) (a) must be submitted with the certificate if a recognized approval source is not evident on the CE certificate. 1. It is the responsibility of the licensee to insure that the following criteria are met with respect to continuing education credit: Attendance at seminars, workshops, presentations, etc., approved by one of the providers listed in Rule 10.7.4(1)(a): Certificate of attendance or completion must be submitted during the licensure renewal period (must include source, number of continuing education hours and date of attendance). 2. Credit for presentations: Submit a copy of the Department's approval letter. 3. Academic course work credits must meet the content criteria in Rule 10.7.3, and must be accompanied by a course description from the college or university catalog and a copy of the transcript or final grade report. A minimum course grade of "C" is required for CE credit. 4. Home Study Course: A certificate of completion must be submitted to receive continuing education credit. 5. Teleconferences: A certificate of completion from the approved provider of the teleconference. 6. Publication: A copy of the article and the name, volume, page number, etc. of the journal in which the article was published.

Subchapter 8: Revocation, Suspension and Denial of License Rule 10.8.1 Standards of Conduct: Licensees subject to these regulations shall conduct their activities, services, and practice in accordance with this section. Licensees may be subject to the exercise of the disciplinary sanctions enumerated in Rule 10.8.6 of these regulations if the Board finds that a licensee is guilty of any of the following: 1. Negligence in the practice or performance of professional services or activities.

2. Engaging in dishonorable, unethical, or unprofessional conduct of a character likely to deceive, defraud, or harm the public in the course of professional services or activities. 3. Perpetrating or cooperating in fraud or material deception in obtaining or renewing a license or attempting the same. 4. Being convicted of any crime which has a substantial relationship to the licensee's activities and services or an essential element of which is misstatement, fraud, or dishonesty. 5. Being convicted of any crime which is a felony under the laws of this state or the United States. 6. Engaging in or permitting the performance of unacceptable services personally or by others working under the licensee's supervision due to the licensee's deliberate or negligent act or acts or failure to act, regardless of whether actual damage or damages to the public is established. 7. Continued practice although the licensee has become unfit to practice as a speech language-pathologist or audiologist due to: a. failure to keep abreast of current professional theory or practice; or b. physical or mental disability; the entry of an order or judgment by a court of competent jurisdiction that a licensee is in need of mental treatment or is incompetent shall constitute mental disability; or c. addiction or severe dependency upon alcohol or other drugs which may endanger the public by impairing the licensee's ability to practice. 8. Having disciplinary action taken against the licensee's license in another state. 9. Making differential, detrimental treatment against any person because of race, color, creed, sex, religion, or national origin. 10. Engaging in lewd conduct in connection with professional services or activities. 11. Engaging in false or misleading advertising. 12. Contracting, assisting, or permitting unlicensed persons to perform services for which a license is required under these regulations. 13. Violation of any probation requirements placed on a license by the Board. 14. Revealing confidential information except as may be required by law. 15. Failing to inform clients of the fact that the client no longer needs the services or professional assistance of the licensee.

16. Charging excessive or unreasonable fees or engaging in unreasonable collection practices. 17. For treating or attempting to treat ailments or other health conditions of human beings other than by speech or audiology therapy as authorized by these regulations. 18. For applying or offering to apply speech or audiology, exclusive of initial evaluation or screening and exclusive of education or consultation for the prevention of physical and mental disability within the scope of speech or audiology therapy, or for acting as a speech- language pathologist or audiologist, or speech-language pathologist or audiologist aide other than under the direct, on- site supervision of a licensed speech-language pathologist or audiologist. 19. Violations of the current codes for speech-language pathologists or audiologists, and speech-language pathologist or audiologist assistants adopted by the American Speech-Language-Hearing Association. 20. Violations of any rules or regulations promulgated pursuant to these regulations. 21. Has engaged in any conduct considered by the Board to be detrimental to the profession of speech-language pathology or audiology. 22. The Board may order a licensee to submit to a reasonable physical or mental examination if the licensee's physical or mental capacity to practice safely is at issue in a disciplinary proceeding. Failure to comply with a board order to submit to a physical or mental examination shall render a licensee subject to the summary suspension procedures described in Rule 10.8.0 of these regulations.

**History**
- *SOURCE: Miss. Code Ann. §73-38-13.*
- *SOURCE: Miss. Code Ann. §73-38-13.*

##### **15 Miss. Admin. Code Pt. 19, R. 10.8.2** Rules For Professional Conduct: 1 {#sec-19-10.8.2 omnilex-key=us-ms-regs-official--title-15--19#10.8.2}

Preamble: The preservation of the highest standards of integrity and ethical principles is vital to the successful discharge of the professional responsibilities of all speech-language pathologists and audiologists. These Rules of Professional Conduct have been promulgated by the State Board of Health in an effort to stress the fundamental rules considered essential to this basic purpose. Any action that is in violation of the spirit and purpose of these Rules shall be considered unethical. Failure to specify any particular responsibility or practice in these Rules should not be construed as denial of the existence of other responsibility or practices. The fundamental rules of ethical conduct are described in three categories: Principles of Ethics, Ethical Proscriptions, and Matters of Professional Propriety. 2. Principles of Ethics: Five Principles serve as a basis for the ethical evaluation of professional conduct and form the underlying moral basis for these Rules.

Individuals subscribing to these Rules shall observe these principles as affirmative obligations under all conditions of professional activity. 3. Ethical Proscriptions: Ethical Proscriptions are formal statements of prohibitions that are derived from the Principles of Ethics. 4. Matters of Professional Propriety: Matters of Professional Propriety represent guidelines of conduct designed to promote the public interest and thereby better inform the public and particularly the persons in need of speech-language pathology and audiology services as to the availability and the rules regarding the delivery of those services. 5. Principles of Ethics I: a. Individuals shall hold paramount the welfare of persons served professionally. b. Individuals shall use every resource available, including referral to other specialists as needed, to provide the best service possible. c. Individuals shall fully inform persons served of the nature and possible effects of the services. d. Individuals shall fully inform persons participating in research or teaching activities of the nature and possible effects of these activities. e. Individuals' fees shall be commensurate with services rendered. f. Individuals shall provide appropriate access to records of persons served professionally. g. Individuals shall take all reasonable precautions to avoid injuring persons in the delivery of professional services. h. Individuals shall evaluate services rendered to determine effectiveness. 6. Ethical Proscriptions: a. Individuals must not exploit persons in the delivery of professional services, including accepting persons for treatment when benefit cannot reasonably be expected or continuing treatment unnecessarily. b. Individuals must not guarantee the results of any therapeutic procedures, directly or by implication. A reasonable statement of prognosis may be made, but caution must be exercised not to mislead persons served professionally to expect results that cannot be predicted from sound evidence.

c. Individuals must not use persons for teaching or research in a manner that constitutes invasion of privacy or fails to afford informed free choice to participate. d. Individuals must not evaluate or treat speech, language, or hearing disorders except in a professional relationship. They must not evaluate or treat solely by correspondence. This does not preclude follow-up correspondence with persons previously seen, or providing them with general information of an educational nature. e. Individuals must not reveal to unauthorized persons any professional or personal information obtained from the person served professionally, unless required by law or unless necessary to protect the welfare of the person or the community. f. Individuals must not discriminate in the delivery of professional services on any basis that is unjustifiable or irrelevant to the need for and potential benefit from such services, such as race, sex, or religion. g. Individuals must not charge for services not rendered. 7. Principle of Ethics II: a. Individuals shall maintain high standards of professional competence. b. Individuals engaging in clinical practice shall possess appropriate qualifications as stated in Section 73-38-9. c. Individuals shall continue their professional development throughout their careers. d. Individuals shall identify competent, dependable referral sources for persons served professionally. e. Individuals shall maintain adequate records of professional services rendered. 8. Ethical Proscriptions: a. Individuals must provide neither services nor supervision of services for which they have not been properly prepared, not permit services to be provided by any of their staff who are not properly prepared. b. Individuals must not provide clinical services by prescription of anyone who does not hold a license in speech-language pathology or audiology. c. Individuals must not delegate any service requiring the professional competence of a licensed clinician to anyone unqualified.

d. Individuals must not offer clinical services by supportive personnel for whom they do not provide appropriate supervision and assume full responsibility. e. Individuals must not require anyone under their supervision to engage in any practice that is a violation of the Rules for Professional Conduct. 9. Principle of Ethics III: Individuals' statements to persons served professionally and to the public shall provide accurate information about the nature and management of communicative disorders, and about the profession and services rendered by its practitioners. 10. Ethical Proscriptions: a. Individuals must not misrepresent their training or competence. b. Individuals' public statements providing information about professional services and products must not contain representations or claims that are false, deceptive, or misleading. c. Individuals must not use professional or commercial affiliations in any way that would mislead or limit services to persons served professionally. 11. Matters of Professional Propriety: Individuals should announce services in a manner consonant with highest professional standards in the community. 12. Principle of Ethics IV: a. Individuals shall maintain objectivity in all matters concerning the welfare of persons served professionally. b. Individuals who dispense products to persons served professionally shall observe the following standards: i. Products associated with professional practice must be dispensed to the person served as a part of program of comprehensive habilitative care. ii. Fees established for professional services must be independent of whether a product is dispensed. iii. Persons served must be provided freedom of choice for the source of services and products. iv. Price information about professional services rendered and products dispensed must be disclosed by providing to or posting for persons served a complete schedule of fees and charges in advance of rendering services, which schedule differentiates

between fees for professional services and charges for products dispensed. v. Products dispensed to the person served must be evaluated to determine effectiveness. 13. Ethical Proscriptions: Individuals must not participate in activities that constitute a conflict of professional interest. 14. Matters of Professional Propriety: a. Individuals should not accept compensation for supervision or sponsorship of a person holding a temporary license who is completing the supervised professional employment requirement for licensure as stated in Section 73-38-5. He may, however, accept reasonable reimbursement for expenses incurred during this supervision or a consultant fee from the employer of the temporary licensee. b. Individuals should present products they have developed to their colleagues in a manner consonant with highest professional standards. 15. Principle of Ethics V: Individuals shall honor their responsibilities to the public, their profession, and their relationships with colleagues and members of allied professions. 16. Matters of Professional Propriety: a. Individuals should seek to provide and expand services to persons with speech, language, and hearing handicaps as well as to assist in establishing high professional standards for such programs. b. Individuals should educate the public about speech, language, and hearing processes, speech, language, and hearing problems, and matters related to professional competence. c. Individuals should strive to increase knowledge within the profession and share research with colleagues. d. Individuals should establish harmonious relations with colleagues and members of other professions, and endeavor to inform members of related professions of services provided by speech-language pathologists and audiologists, as well as seek information from them. e. Individuals should assign credit to those who have contributed to a publication in proportion to their contribution.

**History**
- *SOURCE: Miss. Code Ann. §73-38-13.*

##### **15 Miss. Admin. Code Pt. 19, R. 10.8.3** Summary Suspension: 1 {#sec-19-10.8.3 omnilex-key=us-ms-regs-official--title-15--19#10.8.3}

The Department may summarily suspend a license without a hearing, simultaneously with the filing of a formal complaint and notice of hearing, if the Department determines that: a. the health, safety, or welfare of the general public is in immediate danger; or b. the licensee's physical capacity to practice his/her profession is in issue; or c. the licensee's mental capacity to practice his/her profession is in issue. 2. If the Board summarily suspends a license, a hearing must begin within twenty (20) days after such suspension begins, unless continued at the request of the licensee.

**History**
- *SOURCE: Miss. Code Ann. §73-38-13.*

##### **15 Miss. Admin. Code Pt. 19, R. 10.8.4** Rule 10.8.4 {#sec-19-10.8.4 omnilex-key=us-ms-regs-official--title-15--19#10.8.4}

Complaints: All complaints concerning a licensee, his business, or professional practice, shall be reviewed by the Department. Each complaint received shall be logged, recording at a minimum the following information: 1. licensee's name 2. name of the complaining party, if known; 3. date of complaint; 4. brief statement of complaint; and 5. disposition.

**History**
- *SOURCE: Miss. Code Ann. §73-38-13.*

##### **15 Miss. Admin. Code Pt. 19, R. 10.8.5** Investigation: All complaints will be investigated and evaluated by Department {#sec-19-10.8.5 omnilex-key=us-ms-regs-official--title-15--19#10.8.5}

**History**
- *SOURCE: Miss. Code Ann. §73-38-13.*

##### **15 Miss. Admin. Code Pt. 19, R. 10.8.6** Notice of Charges and Hearing: 1 {#sec-19-10.8.6 omnilex-key=us-ms-regs-official--title-15--19#10.8.6}

Following the investigative process, the Department may file formal charges against the licensee. Such formal complaint shall, at a minimum, inform the licensee of the facts which are the basis of the charge and which are specific enough to enable the licensee to defend against the charges. 2. Each licensee, whose conduct is the subject of a formal charge which seeks to impose disciplinary action against the licensee, shall be served notice of the formal charge at least twenty (20) days before the date of hearing. A hearing shall

be presided over by the Board or the Board's designee. Service shall be considered to have been given if the notice was personally received by the licensee, or the notice was mailed certified, return receipt requested, to the licensee at the licensee's last known address as listed with the Department. The notice of the formal hearing shall consist at a minimum of the following information: a. the time, place and date of hearing; b. that the licensee shall appear personally at the hearing and may be represented by counsel; c. that the licensee shall have the right to produce witnesses and evidence in the licensee's behalf and shall have the right to cross-examine adverse witnesses and evidence; d. that the hearing could result in disciplinary action being taken against the licensee's license; e. that rules for the conduct of these hearings exist and it may be in the licensee's best interest to obtain a copy; and f. that the Board, or its designee, shall preside at the hearing and following the conclusion of the hearing shall make findings of facts, conclusions of law and recommendations, separately stated, to the Board as to what disciplinary action, if any, should be imposed on the licensee. 3. The Board may order a licensee to submit to a reasonable physical or mental examination if the licensee's physical or mental capacity to practice safely is at issue in a disciplinary proceeding. Failure to comply with a board order to submit to a physical or mental examination shall render a licensee subject to the summary suspension procedures described in Rule 10.8.2 of these regulations. 4. The Board or its designee shall hear evidence produced in support of the formal charges and contrary evidence produced by the licensee. At the conclusion of the hearing, the Board shall issue an order, within sixty (60) days. 5. Disposition of any complaints may be made by consent order or stipulation between the Board and the licensee. 6. All proceedings pursuant to this section are matters of public record and shall be preserved pursuant to state law.

**History**
- *SOURCE: Miss. Code Ann. §73-38-13.*

##### **15 Miss. Admin. Code Pt. 19, R. 10.8.7** Rule 10.8.7 {#sec-19-10.8.7 omnilex-key=us-ms-regs-official--title-15--19#10.8.7}

Sanctions: The Board may impose any of the following sanctions, singly or in combination, when it finds that a licensee or applicant for license is guilty of any

violations of the practice act or any lawful order, rule or regulation rendered or adopted by the Board: 1. Revoke the license. 2. Suspend the license, for any period of time. 3. Censure the licensee. 4. Impose a monetary penalty of not more than Two Hundred Dollars ($200.00). 5. Place a licensee on probationary status and require the licensee to submit to any of the following: a. report regularly to the Department, or its designee, upon matters which are the basis of probation; b. continue to renew professional education until a satisfactory degree of skill has been attained in those areas which are the basis of probation; or c. such other reasonable requirements or restrictions as are proper. 6. Refuse to renew a license. 7. Revoke probation which has been granted and impose any other disciplinary action in this subsection when the requirements of probation have not been fulfilled or have been violated. 8. The Board may reinstate any licensee to good standing under this chapter if, after hearing, the board is satisfied that the applicant's renewed practice is in the public interest. 9. The Board may seek the counsel of the Council regarding disciplinary actions.

**History**
- *SOURCE: Miss. Code Ann. §73-38-13.*

##### **15 Miss. Admin. Code Pt. 19, R. 10.8.8** Rule 10.8.8 {#sec-19-10.8.8 omnilex-key=us-ms-regs-official--title-15--19#10.8.8}

Criteria For Rehabilitation; Upon the suspension or revocation of a license on the grounds that the licensee has been convicted of a crime, the Board, in evaluating the rehabilitation of such person and his eligibility for licensure, will consider the following: 1. The nature and severity of the act(s) which resulted in the suspension or revocation of his license. 2. The extent of time elapsed since the commission of the act(s) which resulted in the suspension or revocation.

3. Whether he has committed any act(s) which if done by a licensee would be grounds for suspension or revocation of a license since the date of suspension or revocation. 4. Whether he has done any act(s) involving dishonesty, fraud, or deceit with the intent to substantially benefit himself or another, or substantially injure another since the date of the suspension or revocation. 5. Whether he has complied with any or all conditions or probation or restitution, or any other civil or criminal sanction imposed against him as a result of the act(s) including such administrative penalties and conditions or probation as have been imposed on him by the Board; and 6. Such other evidence of rehabilitation as the person may submit.

**History**
- *SOURCE: Miss. Code Ann. §73-38-13.*

##### **15 Miss. Admin. Code Pt. 19, R. 10.8.9** Rule 10.8.9 {#sec-19-10.8.9 omnilex-key=us-ms-regs-official--title-15--19#10.8.9}

Appeals: Any person aggrieved by a decision of the Board shall have a right of appeal in the manner provided for in the Act and the Laws of the State of Mississippi.

2. Any person licensed as a hearing aid dispenser from measuring and testing hearing in relation to the fitting, usage and dispensing of hearing aids or rendering post fitting services to his clients or using any title provided in Sections 73-14-1 through 73-14-47; 3. Any person licensed in this state by any other law from engaging in the profession or occupation for which he is licensed; 4. A person from being employed or working in a volunteer capacity without a license, as provided in this chapter, as a speech-language pathologist or audiologist by the government of the United States or by the governing authority of any school district or private or parochial school in this state, if such person performs speech-language pathology or audiology services solely within the confines or under the jurisdiction of the organization by which he is employed, or

working in a volunteer capacity; however, such person may, without obtaining a license under this chapter, consult with or disseminate his research findings and other scientific information to speech-language pathologists and audiologists outside the jurisdiction of the organization by which he is employed; such person may also offer lectures to the public for a fee, monetary or other, without being licensed under this chapter; such person may additionally elect to be subject to this chapter. 5. The activities and services of persons pursuing a course of study leading to a degree in speech-language pathology at a college or university if such activities and services constitute a part of the supervised course of study and that such person is designated speech-language pathology intern, speech-language pathology trainee, or by other such titles clearly indicating the training status appropriate to his level of training; 6. The activities and services of a person pursuing a course of study leading to a degree in audiology at a college or university if such activities and services constitute a part of a supervised course of study and such person is designated audiology intern, audiology trainee, or by any other such titles clearly indicating the training status appropriate to his level of training; or 7. The performance of speech-language pathology or audiology services in this state by any person not a resident of this state who is not licensed under this chapter if such services are performed for no more than five (5) days in any calendar year and in cooperation with a speech-language pathologist or audiologist licensed under this chapter, and if such person meets the qualifications and requirements for application for licensure described in subsections (a) through (c) of Section 73-38-9; however, a person not a resident of this state who is not licensed under this chapter, but who is licensed under the law of another state which has established licensure requirements at least equivalent to those established by Section 73-38-9, or who is the holder of the ASHA Certificate of Clinical Competence in Speech-Language Pathology or Audiology or its equivalent, may offer speech-language pathology or audiology services in this state for no more than thirty (30) days in any calendar year if such services are performed in cooperation with a speech-language pathologist or audiologist licensed under this chapter; or 8. Any person employed by a private industry or firm for the purpose of conducting hearing tests incident to the operations of such firm or industry relative to its employees and employment practices.

**History**
- *SOURCE: Miss. Code Ann. §73-38-13 Subchapter 9: Exceptions and Exemptions Rule 10.9.1 Persons and Practices Exempt: Nothing in this chapter shall be construed as preventing or restricting: 1. A physician from engaging in the practice of medicine in this state, or a person using an audiometer to test hearing under the direct supervision of a licensed physician, provided such person does not present himself to the public by any title or description of services incorporating the words "audiologist," "hearing clinician," "hearing therapist," or any similar title or description of services;*
- *SOURCE: Miss. Code Ann. §73-38-13.*

##### **15 Miss. Admin. Code Pt. 19, R. 10.9.2** Good Samaritan Act: [LEFT BLANK ON PURPOSE] {#sec-19-10.9.2 omnilex-key=us-ms-regs-official--title-15--19#10.9.2}

Subchapter 10: Regulations Governing Registration of Speech-Language Pathology Aides/Audiology Aides Rule 10.10.1 Purpose: The purpose of these regulations is to set minimum qualifications for the registration of speech-language pathology and audiology aides by the State Board of Health; to provide qualifications for registration; to provide the method of supervision of aides by speech-language pathologists or audiologists; to provide for the denial, suspension and revocation of such registration; to provide for the denial, suspension and revocation of licenses of speech-language pathologists and audiologists employing or supervising speech-language pathology or audiology aides; and for related purposes.

**History**
- *SOURCE: Miss. Code Ann. §73-38-13.*
- *SOURCE: Miss. Code Ann. §73-38-13*

##### **15 Miss. Admin. Code Pt. 19, R. 10.10.2** Rule 10.10.2 {#sec-19-10.10.2 omnilex-key=us-ms-regs-official--title-15--19#10.10.2}

Legal Authority: The Legislation Governing Speech-Language Pathologists/Audiologists, Section 73-38-1, et seq., of the Mississippi Code of 1972, provides the legal authority under which the State Board of Health, established and empowered by Section 41-3-1, et seq., Mississippi Code of 1972, and the State Department of Health, established by section 41-3-15, Mississippi Code of 1972, are authorized to establish regulations necessary to carry out the mandates of the Legislation Governing Speech-Language Pathologists/Audiologists.

**History**
- *SOURCE: Miss. Code Ann. §73-38-13.*

##### **15 Miss. Admin. Code Pt. 19, R. 10.10.3** Definitions: 1 {#sec-19-10.10.3 omnilex-key=us-ms-regs-official--title-15--19#10.10.3}

Board means the Mississippi State Board of Health. 2. Department means the Mississippi State Department of Health. 3. Council means the Mississippi Council of Advisors in Speech-Language Pathology and Audiology as established in Section 73-38-11. 4. Person means any individual, organization, or corporate body. However, only an individual may be registered under the Legislation Governing Speech-Language Pathologists/Audiologists. 5. Speech-language pathologist means an individual who practices speech- language pathology and who presents oneself to the public by any title or description of services incorporating the words "speech-language pathologist," "speech pathologist," "speech therapist," "speech correctionist," "speech clinician," "language pathologist," "language therapist," "logopedist," "communicologist," "voice therapist," "voice pathologist," or any similar title or description of services. 6. Speech-language pathology means the application of principles, methods and procedures for the measurement, testing, evaluation, prediction, counseling,

instruction, habilitation or rehabilitation related to the development and disorders of speech, voice, language, swallowing or feeding, or for the purpose of evaluating, preventing, ameliorating or modifying such disorders and conditions in individuals and/or groups of individuals. 7. Audiologist means an individual who practices audiology and who presents oneself to the public by any title or description of services incorporating the words "audiologist," "hearing clinician," "hearing therapist," or any similar title or description of service. 8. Audiology means the application of principles, methods and procedures of measurement, testing, evaluation, prediction, consultation, counseling, instruction, habilitation or rehabilitation related to disorders of hearing and balance for the purpose of evaluating, identifying, preventing, ameliorating or modifying such disorders and conditions in individuals and/or groups of individuals; and for the purpose of this subsection the words "habilitation" and "rehabilitation" include, but are not limited to, hearing aid dispensing and evaluation, auditory training, and speech reading. 9. Speech-language pathology aide means an individual who meets minimum qualifications set in these regulations, and who works under the supervision of a licensed speech-language pathologist. 10. Audiology aide means an individual who meets minimum qualifications set in these regulations, and who works under the supervision of a licensed audiologist. 11. Licensed means licensed by the Mississippi State Department of Health to practice speech-language pathology or audiology. 12. Registrant means an individual registered as a speech-language pathology or audiology aide. 13. Supervising Licensee means the licensed speech-language pathologist or licensed audiologist authorized to supervise a registered aide as stated on the aide registration form filed with the Department.

**History**
- *SOURCE: Miss. Code Ann. §73-38-13.*

##### **15 Miss. Admin. Code Pt. 19, R. 10.10.4** Powers and Duties of the Department: 1 {#sec-19-10.10.4 omnilex-key=us-ms-regs-official--title-15--19#10.10.4}

To aid the state's attorneys of the various counties in the enforcement of the provisions of the Legislation Governing Speech-Language Pathologists/Audiologists and the prosecution of any violations thereof. In addition to the criminal penalties provided by the Legislation Governing Speech- Language Pathologists/Audiologists, the civil remedy of injunction shall be available to restrain and enjoin violations of any provisions of that law without proof of actual damages sustained by any person.

2. To determine the qualifications and eligibility of applicants for registration as speech-language pathology and audiology aides in this state. 3. To issue, renew, deny, suspend, or revoke registration of speech-language pathology and audiology aides in this state or otherwise discipline registered speech-language pathology and audiology aides. 4. To deny, suspend or revoke licensure of speech-language pathologists and audiologists or otherwise discipline licensed speech-language pathologists and audiologists who employ or supervise speech-language pathology or audiology aides, and who engage in unethical or questionable practices, or who fail to provide appropriate supervision of aides or who have encouraged or participated in any intentional act or omission that caused or assisted their aides to violate these regulations and/or any law, including but not limited to, Section 73-14-1, et seq. of the Mississippi Code of 1972 as amended which is generally known as the "Hearing Aid Dealers Licensing Act". 5. To investigate alleged or suspected violations of the provisions of the Legislation Governing Speech-Language Pathologists/Audiologists or other laws of this state pertaining to speech-language pathology and audiology aides and these regulations. 6. To maintain a register listing the name of every speech-language pathology and audiology aide registered in this state, his/her last known place of business and last known place of residence, and the date and number of his/her registration. Such a list shall be available to any person upon application to the department and payment of such charges as may be fixed by it. 7. To be responsible for all disputed matters involving whether an applicant shall be registered.

**History**
- *SOURCE: Miss. Code Ann. §73-38-13.*

##### **15 Miss. Admin. Code Pt. 19, R. 10.10.5** Registration: 1 {#sec-19-10.10.5 omnilex-key=us-ms-regs-official--title-15--19#10.10.5}

Application for Registration: An application for registration for a speech- language pathology or audiology aide shall be submitted by the supervising licensee to the State Department of Health at its principal office in Jackson, Mississippi, on an application form provided by the Department. Every application shall be typed or written in ink, the signatures notarized and accompanied by the appropriate fee and by such evidence, statements, or documents as herein required. 2. Abandonment of Application: If the application process for registration is not completed within 6 months, the application shall be considered abandoned, and a new application must be submitted before registration may be granted.

3. Education Requirements: The educational requirements for registration as a speech-language pathology or audiology aide shall be a minimum of a high school diploma or the equivalent. 4. General Requirements: The licensed speech-language pathologist or audiologist who registers aides must determine that the applicant: a. Is at least 18 years of age; b. Is of good moral character; c. Has met the minimum educational requirements; d. Has adequate communication skills and the ability to relate to the clinical population; e. Has paid an application fee; f. Works under the supervision of a licensed speech-language pathologist or audiologist according to a supervision plan approved by the department; and g. Shall be registered by the department. No examination shall be required for registration. 5. Supervision Requirements: A licensed speech-language pathologist or audiologist may not supervise more than three aides. a. The licensee who supervises aides is responsible for the services provided to the client by said aides. The supervising licensee is also responsible for: b. The institution of a training program for each aide under his supervision encompassing all the procedures to be performed by the aide. Documentation of such training in form and substance acceptable to the Department shall be retained in the aide's personnel file. c. Documentation in form and substance acceptable to the Department of competency in each task performed shall be retained in the aide's personnel file. The competency in this task shall be observed and verified by the licensee. d. Insuring that the extent, kind, and quality of functions performed by each aide under supervision are consistent with the training and experience of the aide. e. The supervising licensee shall directly observe the first five (5) hours while the aide works with clients. Thereafter, the supervising licensee

shall directly observe the aide during twenty percent (20%) of the time that the aide works with clients per week, to be documented weekly in the aide's personnel file. At all other times that the aide is working, the licensee must be accessible and available to the aide. f. Insuring that each aide under his supervision complies with the provisions of the Regulations Governing Licensure of Speech-Language Pathologists and Audiologists.

**History**
- *SOURCE: Miss. Code Ann. §73-38-13.*

##### **15 Miss. Admin. Code Pt. 19, R. 10.10.6** Renewal of Registration: 1 {#sec-19-10.10.6 omnilex-key=us-ms-regs-official--title-15--19#10.10.6}

Report: Prior to the expiration date of an aide's registration, every licensed speech-language pathologist or audiologist who is supervising or who has supervised any aide during the registration period shall submit to the State Department of Health, on a form provided by the Department: (1) a report for the previous registration period showing the nature and extent of the functions performed by each aide supervised; and (2) the renewal fee for aide registration. 2. Notice of Termination: Within 7 days after the termination of the supervision of a speech-language pathology or audiology aide, the supervising licensee shall notify the State Department of Health, in writing, of such termination and the date of termination and return the certificate of registration to the department. Failure of a supervising licensee to comply with the provisions of this section may result in disciplinary action pursuant to these regulations. 3. Fees: The supervising licensee shall be responsible for ensuring that the aide's renewal application and the prescribed fee have been submitted to the Department for each aide supervised. a. The following fees are payable to the State Department of Health: i. Initial registration - $50.00 ii. Renewal of registration - $50.00

**History**
- *SOURCE: Miss. Code Ann. §73-38-1.*

##### **15 Miss. Admin. Code Pt. 19, R. 10.10.7** Rule 10.10.7 {#sec-19-10.10.7 omnilex-key=us-ms-regs-official--title-15--19#10.10.7}

Roles and Responsibilities of Licensees and Registrants: Within the provision of speech-language pathology or audiology service there are two recognized levels of personnel: the professional speech-language pathologist or audiologist who is licensed to practice speech-language pathology and audiology; and the speech-language pathology or audiology aide who is registered, but is usually an on-job-trained individual who provides support activities for the speech-language pathologist or audiologist. The speech-language pathologist or audiologist shall assume primary responsibility for speech-language pathology and audiology care rendered by the licensee and his/her aide.

**History**
- *SOURCE: Miss. Code Ann. §73-38-13.*

##### **15 Miss. Admin. Code Pt. 19, R. 10.10.8** Duties of the Speech-Language Pathology or Audiology Aide: 1 {#sec-19-10.10.8 omnilex-key=us-ms-regs-official--title-15--19#10.10.8}

Aides shall be clearly identified as aides by means of a nametag or other appropriate identification at all times. The supervising licensee shall obtain the written consent of the consumer prior to client services being performed by an aide as part of a treatment plan. The consent form shall also be signed by the aide and the licensee and retained together in one (1) clearly marked file in the principal business office of the licensee and available for review and inspection by the Department. All documents signed by an aide must clearly identify the individual as an aide. Training in professional behavior must be completed. For example, the confidentiality of patient information should be discussed. 2. Duties of the speech-language pathology aide may include the following (other activities are considered the practice of the licensed speech-language pathologist): a. Routine paperwork (case history, permission to test, insurance, scheduling, billing, etc.). b. Administer self-questionnaires to clients (paper and pencil or computerized). c. Demonstrate any computerized testing/therapy materials the clinician utilizes. d. Set up office room for therapy or testing (this includes any equipment assembly as for a nasometer, visipitch or IBM speech viewer. e. Biologically calibrate equipment. f. Display knowledge of universal body precautions and use of personal protective barriers. g. Except for the purposes of dispensing hearing aids, do mass auditory screening (such as those done in a public school with an audiometer). h. Record keeping during therapy procedures. i. Disinfect materials or items used in testing or therapy (equipment, furniture, etc.) after every client/patient visit. j. Assist client in use of augmentative communication devices. k. Demonstrate communication boards. This includes client interaction. l. Some speech-language activities such as repetitive drills are routinely assigned to a parent, caretaker, or significant other for

stabilization/generalization purposes. This is done after the speech- language pathologist has introduced and taught the client the target sound or language concept. These types of drill activities are allowed. m. Demonstrate an electrolarynx. The aide is restricted to self demonstration. n. Participate in behavior modification programming. o. Speech-language pathology aides may not be responsible for or perform diagnostic or evaluative procedures nor those activities listed as "Speech- language pathology" in Section 73-38-3 of the Mississippi Code of 1972 Annotated. 3. Duties of the audiology aide may include the following (other activities are considered the practice of the licensed audiologist): a. Routine paper work (case history, permission to test, insurance, scheduling, billing, etc.). b. Demonstrate assistive listening devices. c. Perform minor troubleshooting on hearing aids/assistive listening devices. d. Except for the purpose of dispensing hearing aids, make ear molds/impressions after ears are "visually inspected" by the physician or the licensed audiologist. e. Administer self-questionnaires to clients (paper and pencil or computerized). f. Demonstrate any computerized testing/therapy materials that the clinician utilizes. g. Set up office room or prepare client/patient for therapy or testing (this includes any equipment assembly as for an otoscope), or patient preparation work for electrophysiological measures. h. Biologically calibrate equipment. i. Display knowledge of universal body precautions and use of personal protective barriers. j. Record keeping during audiometric or therapy procedures. k. Provide assistance to the audiologist who shall perform the pediatric auditory testing or sound field testing. l. Disinfect materials or items used in testing or therapy (equipment, furniture, specula, etc.) after every client/patient visit.

m. Take sound intensity readings as with a sound level meter. n. Audiology aides shall not be responsible for or perform a) diagnostic or evaluative procedures and/or b) any activities listed as "Audiology" in Section 73-38-3 of the Mississippi Code 1972 Annotated and/or c) any procedures that deal with the fitting of hearing aids.

**History**
- *SOURCE: Miss. Code Ann. §73-38-13*

##### **15 Miss. Admin. Code Pt. 19, R. 10.10.9** Revocation, Suspension, and Denial of Registration: 1 {#sec-19-10.10.9 omnilex-key=us-ms-regs-official--title-15--19#10.10.9}

Standards of Conduct: Aides may, at the discretion of the Board, have their registration suspended, revoked, or denied at the time of renewal if the Board determines that the Aide: a. Was convicted of an offense involving moral turpitude. The record of such conviction, or certified copy thereof from the clerk of the court where such conviction occurred or by the judge of that court, shall be sufficient evidence to warrant revocation or suspension. b. Is guilty of securing, or attempting to secure a registration or certificate through fraud or deceit. c. Is guilty of unethical conduct, or gross ignorance, or inefficiency in the conduct of his practice. d. Is guilty of knowingly practicing while suffering with a contagious or infectious disease. e. Has used a false name or alias in the practice of his profession. f. Is unfit or incompetent by reason of negligence, habits, or other causes of incompetence. g. Is habitually intemperate in the use of alcoholic beverages. h. Is addicted to, or has improperly obtained, possessed, used or distributed, habit-forming drugs or narcotics. i. Has practiced as an aide after his registration or permit has expired or has been suspended. j. Has practiced as an aide under cover of any permit or registration illegally or fraudulently obtained or issued. k. Has violated or aided or abetted others in violation of any provision of the Act or regulations promulgated thereto.

l. Has engaged in any conduct considered by the Board to be detrimental to the profession of speech-language pathology or audiology. m. Has violated the provisions of any applicable federal laws or regulations. n. Has been disciplined by another jurisdiction if at least one (1) of the grounds for the discipline is the same or substantially equivalent to those set forth in the Act or rules and regulations promulgated pursuant to the Act. 2. Summary Suspensions a. The Department may summarily suspend a registration without a hearing, simultaneously with the filing of a formal complaint and notice of hearing, if the Department determines that: i. The health, safety, or welfare of the general public is in immediate danger; or ii. The aide's physical capacity to practice his profession is in issue; or iii. The aide's mental capacity to practice his profession is in issue. b. If the Department summarily suspends a registration, a hearing must begin within twenty (20) days after such suspension begins, unless continued at the request of the Aide. 3. Complaints: All complaints concerning an Aide, his business, or professional practice, shall be reviewed by the Department. Each complaint received shall be logged, recording at a minimum the following information: a. Aide's and supervisor's name; b. Name of the complaining party, if known; c. Date of complaint; d. Brief statement of complaint; and e. Disposition. 4. Investigations: All complaints will be investigated and evaluated by the Department, or its designee(s). 5. Notice of Charges and Hearing a. Following the investigative process, the Department may file formal charges against the aide and/or the supervising licensee. Such formal

complaint shall, at a minimum, inform the accused of the facts which are the basis of the charge and which are specific enough to enable the accused to defend against the charges. b. Each aide and/or supervising licensee, whose conduct is the subject of a formal charge which seeks to impose disciplinary action against the accused, shall be served notice of the formal charge at least twenty (20) days before the date of hearing. A hearing shall be presided over by the Board or the Board's designee. Service shall be considered to have been given if the notice was personally received by the accused, or the notice was mailed certified, return receipt requested, to the accused at the last known address as listed with the Department. The notice of the formal hearing shall consist at a minimum of the following information: i. The time, place and date of hearing; ii. That the accused shall appear personally at the hearing and may be represented by counsel; iii. That the accused shall have the right to produce witnesses and evidence in his behalf and shall have the right to cross-examine adverse witnesses and evidence; iv. That the hearing could result in disciplinary action being taken against the aide's registration and/or the licensee's license; v. That rules for the conduct of these hearings exist and it may be in the accused's best interest to obtain a copy; and vi. That the Board, or its designee, shall preside at the hearing and following the conclusion of the hearing shall make findings of facts, conclusions of law and recommendations, separately stated, to the Board as to what disciplinary action, if any, should be imposed on the aide and/or licensee. c. The Department may order an aide to submit to a reasonable physical or mental examination if the aide's physical or mental capacity to practice safely is at issue in a disciplinary proceeding. Failure to comply with a Department order to submit to a physical or mental examination shall render an aide subject to the summary suspension procedures described in these regulations. d. The Board or its designee shall hear evidence produced in support of the formal charges and contrary evidence produced by the accused. At the conclusion of the hearing, the Board shall issue an order, within sixty (60) days.

e. Disposition of any complaints may be made by consent order or stipulation between the Board and the accused. f. All proceedings pursuant to this section are matters of public record and shall be preserved pursuant to state law. 6. Board Sanctions: The Board may impose any of the following sanctions, singularly or in combination, when it finds that an aide is guilty of any of the above offenses: a. Revoke the registration; b. Suspend the registration, for any period of time; c. Censure the aide; d. Impose a monetary penalty of not more than two hundred dollars ($200.00); e. Place an aide on probationary status and require the Aide to submit to any of the following: i. report regularly to the Department, or its designee, upon matters which are the basis of probation; ii. continue to renew professional education until a satisfactory degree of skill has been attained in those areas which are the basis of probation; or iii. such other reasonable requirements or restrictions as are proper; f. Refuse to renew a registration; or g. Revoke probation which has been granted and impose any other disciplinary action in this subsection when the requirements of probation have not been fulfilled or have been violated. h. The Board may reinstate any aide to good standing under these regulations if, after hearing, the Board is satisfied that the aide's renewed practice is in the public interest. i. The Board may seek the advice of the Council regarding disciplinary actions. 7. Appeal: Any person aggrieved by a decision of the Board shall have a right of appeal in the manner provided for in the Act and the Laws of the State of Mississippi.

Subchapter 11: Fees: Rule 10.11.1 Method of Payment: In accordance with the Act, the following non-refundable fees, where applicable, are payable to the Department of Health by check or money order.

**History**
- *SOURCE: Miss. Code Ann. §73-38-13.*
- *SOURCE: Miss. Code Ann. §73-38-13.*

##### **15 Miss. Admin. Code Pt. 19, R. 10.11.2** Schedule of Fees: 1 {#sec-19-10.11.2 omnilex-key=us-ms-regs-official--title-15--19#10.11.2}

Initial Application ........................................................................................$100.00 2. Initial License ...............................................................................................$100.00 3. Licensure Renewal .......................................................................................$100.00 4. Late Renewal Penalty ...................................................................................$ 50.00 5. License Issued After Expiration Date ...........................................................$ 60.00 6. Initial Temporary License .............................................................................$ 75.00 7. Duplicate License Certificate Fee .................................................................$ 25.00 8. ID Card Replacement Fee .............................................................................$ 10.00 9. License Certificate Replacement Fee ............................................................$ 25.00 10. Verification of Licensure Fee .......................................................................$ 25.00 11. Examination Fee: Contact the Educational Testing Service, National Teachers Examination, in Princeton, NJ, for information regarding the examination and fee.

Subchapter 12: Administrative Grievance Procedure Rule 10.12.1 Administrative Appeals: 1. Any person aggrieved by a decision regarding the initial application for licensure or the renewal of licensure shall have the right of a second review by the Director of Professional Licensure and the Council or a designated member of the Council. 2. Any person aggrieved by a decision rendered after the second review shall have the right of administrative appeal and a public hearing to be conducted in accordance with the policies of the Department of Health.

**History**
- *SOURCE: Miss. Code Ann. §73-38-13.*
- *SOURCE: Miss. Code Ann. §73-38-13.*

##### **15 Miss. Admin. Code Pt. 19, R. 10.12.2** Rule 10.12.2 {#sec-19-10.12.2 omnilex-key=us-ms-regs-official--title-15--19#10.12.2}

Notification: Written notice will be provided to all applicants regarding denial of an original license or a renewal license. Such notice shall contain the reason thereof.

**History**
- *SOURCE: Miss. Code Ann. §73-38-13.*

##### **15 Miss. Admin. Code Pt. 19, R. 10.12.3** Rule 10.12.3 {#sec-19-10.12.3 omnilex-key=us-ms-regs-official--title-15--19#10.12.3}

Hearing: If requested in writing within the specified time frame a hearing will be provided in which the applicant may show cause why the license should be granted or renewed. Within sixty (60) days of the hearing, or other such time frame as determined during the hearing, written findings of fact, together with a recommendation for action on the license in question, shall be forwarded to the State Health Officer. The State Health Officer shall decide what action will be taken on the recommendation within five days of its receipt. Written notice shall be provided to the applicant.

Subchapter 13: Suspension for Failure to Pay Child Support Rule 10.13.1 In addition, the Department is authorized to suspend the license of any licensee for being out of compliance with an order for support, as defined in Section 93-11-153. The procedure for suspension of a license for being out of compliance with an order for support, and the procedure for reissuance or reinstatement of a license suspended for that purpose, and the payment of any fees for the reissuance or reinstatement of a license suspended for that purpose, shall be governed by Section 93-11-157 or 93-11-163, as the case may be. If there is any conflict between any provision of Section 93-11-157 or 93-11-163 and any provision of this chapter, the provisions of Section 93-11-157 or 93-11-163, as the case may be, shall control.

**History**
- *SOURCE: Miss. Code Ann. §73-38-13*
- *SOURCE: Miss. Code Ann. §73-38-13.*

#### **Chapter 11** REGULATIONS GOVERNING THE REGISTRATION OF INDIVIDUALS PERFORMING TATTOOING AND INDIVIDUALS PERFORMING BODY PIERCING Subchapter 1: General Rule 11.1.1 Legal Authority: The Mississippi Department of Health is authorized to establish, adopt, and enforce these rules and regulations by virtue of Sections 73- 61-1 and 3 et seq. of Mississippi Code of 1972, annotated.

##### **15 Miss. Admin. Code Pt. 19, R. 11.1.2** Definitions: {#sec-19-11.1.2 omnilex-key=us-ms-regs-official--title-15--19#11.1.2}

1. "Autoclave" shall mean a steam sterilizer, which operates at a minimum of 250 degrees Fahrenheit (121 degrees Celsius) at pressure of at least 15 pounds per square inch for not less than 30 minutes for the purpose of killing all organisms and spores, or other such sterilizing unit as approved by the Department. 2. "Board" shall mean the Mississippi State Board of Health. 3. "Tattoo", "tattooed", " tattooing" shall mean any means to make indelible marks or designs on or visible through the skin of a human by puncturing or pricking the skin with a needle or other instrument and inserting ink or other pigments. 4. "Body Piercing" shall mean the creation of an opening in any part of the human body, other than the outer perimeter or lobe of the ear, for the purpose of inserting jewelry or other decorative object, or for some other non-medical purpose. 5. "Department" shall mean the Mississippi Department of Health. 6. "Direct on-site supervision" shall mean face-to-face oversight, at regular intervals, by a tattooist or body piercer registered pursuant to these regulations, who shall be present in the establishment at all times that the provisional registrant is performing a procedure, and shall co-sign the consent form for each procedure. 7. "Establishment" shall mean a location that has passed inspection by the Department, wherein tattooing and/or body piercing is performed, and to which an individual is registered to perform tattooing and/or body piercing. 8. "Provisional Certificate of Registration" shall mean the certificate issued by the Department certifying that a particular individual is registered to perform tattooing and/or body piercing at a specific establishment, only under the on-site direct technical supervision of an individual with a "Regular Certificate of Registration." 9. "Regular Certificate of Registration" shall mean the certificate issued by the Department certifying that a particular individual is registered to perform tattooing and/or body piercing at a specific establishment. 10. "Sterilization" shall mean sterilization by means of an autoclave. 11. "Work Area" shall mean the area or section of the establishment in which the tattooing and/or body piercing is performed. 12. "Act" shall mean Sections 73-61-1 and 3 et seq. Of Mississippi Code of 1972, annotated

**History**
- *SOURCE: Miss. Code Ann. §73-61-1 and Miss. Code Ann. §73-61-3.*

##### **15 Miss. Admin. Code Pt. 19, R. 11.1.3** Rule 11.1.3 {#sec-19-11.1.3 omnilex-key=us-ms-regs-official--title-15--19#11.1.3}

Age Of Consent: It shall be unlawful for any person to perform tattooing and/or body piercing upon any person under the age of eighteen (18) years.

Subchapter 2: Certificate of Registration Rule 11.2.1 It shall be unlawful for any individual to perform tattooing and/or body piercing upon any person for compensation within the State of Mississippi without possessing a current and valid Certificate of Registration issued by the Mississippi Department of Health. The Certificate of Registration shall contain the name of the person registered to do the tattooing and/or body piercing, and the name and location of the establishment, and shall indicate whether the registrant has a "Regular" or "Provisional" status.

**History**
- *SOURCE: Miss. Code Ann. §73-61-1 and Miss. Code Ann. §73-61-3.*
- *SOURCE: Miss. Code Ann. §73-61-1 and Miss. Code Ann. §73-61-3.*

##### **15 Miss. Admin. Code Pt. 19, R. 11.2.2** Rule 11.2.2 {#sec-19-11.2.2 omnilex-key=us-ms-regs-official--title-15--19#11.2.2}

Display Of Certificate Of Registration; The Certificate of Registration shall be displayed in a conspicuous location within the establishment.

Subchapter 3: Requirements for Certificate of Registration Rule 11.3.1 Regular Certificate of Registration; An applicant for a Regular Certificate of Registration shall submit to the Department, verified by oath, written evidence in form and substance satisfactory to the Department, that the applicant: 1. is over the age of eighteen (18) years; and; 2. has successfully completed the American Red Cross "Preventing Disease Transmission" course or a similar course acceptable to the Department, and; 3. has successfully worked in the State of Mississippi under a Provisional Certificate of Registration for a period of not less than nine (9) months, and the holder of the Regular Certificate of Registration who supervised the applicant attests to the competency of the applicant; or 4. has been registered or licensed within eighteen (18) months in Mississippi or in another state performing the discipline of the registration being applied for, and no disciplinary action was filed against said registration or license, or; 5. is employed in a physician's office or clinic and acting under the direct orders of a physician licensed by the Mississippi State Board of Medical Licensure.

**History**
- *SOURCE: Miss. Code Ann. §73-61-1 and Miss. Code Ann. §73-61-3.*
- *SOURCE: Miss. Code Ann. §73-61-1 and Miss. Code Ann. §73-61-3.*

##### **15 Miss. Admin. Code Pt. 19, R. 11.3.2** Rule 11.3.2 {#sec-19-11.3.2 omnilex-key=us-ms-regs-official--title-15--19#11.3.2}

Provisional Certificate of Registration; An applicant for a Provisional Certificate of Registration shall submit to the Department, verified by oath, written evidence in form and substance satisfactory to the Department, that the applicant: 1. is over the age of eighteen (18) years; and 2. will work under the direct on-site supervision of an individual with a "Regular Certificate of Registration" at a registered establishment, and; 3. has successfully completed the American Red Cross "Preventing Disease Transmission" course or a similar course acceptable to the Department.

Subchapter 4: Renewal of Registration Rule 11.4.1 General Provisions: 1. Initial Certificates of Registration issued during the course of a licensure term shall expire at the end of the term in which issued. 2. Certificates of Registration shall be renewed on an annual basis after the initial period, and shall require that the individual registered complete a renewal form prepared by the Department, and that the establishment pass an inspection conducted by the Department. 3. The registration year shall be construed as June 1st through May 31st. 4. The renewal period shall be construed as ending on May 31st of each year.

**History**
- *SOURCE: Miss. Code Ann. §73-61-1 and Miss. Code Ann. §73-61-3.*
- *SOURCE: Miss. Code Ann. §73-61-1 and Miss. Code Ann. §73-61-3.*

##### **15 Miss. Admin. Code Pt. 19, R. 11.4.2** Rule 11.4.2 {#sec-19-11.4.2 omnilex-key=us-ms-regs-official--title-15--19#11.4.2}

Procedure for Renewal of Registration: The Department shall mail notices, at least thirty (30) days prior to the renewal date, to the last home address registered with the Department, to the persons to whom registrations were issued or renewed during the preceding renewal period. The registrant shall: 1. complete the renewal form; 2. file the above with the Department prior to the end of the renewal period with the appropriate fee.

**History**
- *SOURCE: Miss. Code Ann. §73-61-1 and Miss. Code Ann. §73-61-3.*

##### **15 Miss. Admin. Code Pt. 19, R. 11.4.3** Rule 11.4.3 {#sec-19-11.4.3 omnilex-key=us-ms-regs-official--title-15--19#11.4.3}

Failure to Renew: A registrant who does not file, with the Department, his renewal application within the renewal period will be deemed to have allowed his registration to lapse. Said registration may be reinstated by the Department, in its discretion, by the payment of the renewal fee and a reinstatement fee, provided

said application for reinstatement is made within one (1) year of the end of the renewal period.

Subchapter 5: Establishment Rule 11.5.1 No Certificate of Registration shall be issued or renewed to any individual, unless the establishment meets the following minimum standards: 1. The establishment shall be maintained in a clean and sanitary manner. 2. A working toilet shall be located within the establishment and shall be accessible to the customers of the establishment. 3. A lavatory with running hot and cold water, soap, and single use paper towels shall be located within the establishment and shall be accessible to the customers of the establishment. 4. The establishment shall meet all local zoning laws and business requirements. 5. All registrations issued to a specific establishment shall be automatically suspended, until such time as the Department is satisfied that sufficient safeguards have been adopted, upon a criminal or administrative finding that: a. an unregistered individual has performed tattooing and/or piercing within the establishment: or b. an individual under the age of eighteen (18) has been tattooed and/or pierced within the establishment. 6. All registrations issued to a specific establishment shall be automatically suspended, until such time as the Department is satisfied that sufficient safeguards have been adopted, upon a written finding by the District Epidemiology Nurse or District Health Officer, or his/her designee, that: a. the establishment does not meet the sterilization of equipment standards as set forth in these Regulations: or b. the establishment does not meet the sanitation standards as set forth in these Regulations. 7. All registrations issued to a specific establishment shall be automatically suspended, until such time as the Department is satisfied that sufficient safeguards have been adopted, upon a written finding by the District Epidemiology Nurse or District Health Officer that: the establishment is not maintaining the consent forms as required pursuant to these regulations.

8. A mobile establishment shall meet the all the requirements set forth in these regulations.

**History**
- *SOURCE: Miss. Code Ann. §73-61-1 and Miss. Code Ann. §73-61-3.*
- *SOURCE: Miss. Code Ann. §73-61-1 and Miss. Code Ann. §73-61-3.*

##### **15 Miss. Admin. Code Pt. 19, R. 11.5.2** Rule 11.5.2 {#sec-19-11.5.2 omnilex-key=us-ms-regs-official--title-15--19#11.5.2}

Work Area: No Certificate of Registration shall be issued or renewed to any individual, unless the work area meets the following minimum standards: 1. The work area shall be capable of being separated from waiting customers by walls, or other configuration, that shall assure privacy for the person to be tattooed and/or pierced. 2. The floor and walls of the work area shall be constructed of easily cleanable material, and shall be maintained in clean condition and good repair. Carpeting is prohibited. 3. All surfaces in the work area, including but not limited to counters, tables, equipment, chairs, recliners, shelving, and cabinets, shall be made of easily cleanable material, shall be painted, enameled or otherwise imperviously finished, with a smooth washable finish, and shall be maintained in clean condition and good repair. 4. The work area shall be well lighted and ventilated. 5. It shall be unlawful to smoke, eat, or drink in the work area, at any time.

**History**
- *SOURCE: Miss. Code Ann. §73-61-1 and Miss. Code Ann. §73-61-3.*

##### **15 Miss. Admin. Code Pt. 19, R. 11.5.3** Rule 11.5.3 {#sec-19-11.5.3 omnilex-key=us-ms-regs-official--title-15--19#11.5.3}

Tattoo Equipment: No Certificate of Registration shall be issued or renewed to any individual, unless the tattooing equipment meets the following minimum standards: 1. All needles used for tattooing shall be designated as "single use disposable tattooing needles" by the manufacturer, and contained in a self sealing sterilization pouch with indicator, shall be dated with the sterilization date and shall have a shelf life of at least one (1) year before requiring re-sterilization, or shall be disposed of in accordance with the manufacturer's instructions. 2. Sanitary, single service or individual containers of dye or ink, commercially produced specifically for use in tattooing and obtained from professional suppliers, shall be used for each patron or customer, and the container therefore shall be discarded immediately after completing work on a patron. Any dye in which the needles were dipped shall not be used on another person.

**History**
- *SOURCE: Miss. Code Ann. §73-61-1 and Miss. Code Ann. §73-61-3.*

##### **15 Miss. Admin. Code Pt. 19, R. 11.5.4** Rule 11.5.4 {#sec-19-11.5.4 omnilex-key=us-ms-regs-official--title-15--19#11.5.4}

Piercing Equipment: No Certificate of Registration shall be issued or renewed to any individual, unless the piercing equipment meets the following minimum standards: 1. All needles used for body piercing shall be designated as "piercing needles" or "medical needles" by the manufacturer, shall be single use disposable needles and contained in a self sealing sterilization pouch with indicator, shall be dated with the sterilization date and shall have a shelf life of one (1) year before requiring re- sterilization, or shall be disposed of in accordance with the manufacturer's instructions. 2. All jewelry used in the performance of the body piercing procedure shall be single use, shall be in self-sealing sterilization pouch with indicators which shall be dated with the date of sterilization, and shall have a shelf life of one (1) year before requiring re-sterilization. All sterilizations shall be in accordance with these regulations. The jewelry inserted as part of a body piercing procedure shall be made of surgical steel (316 L grade or better), implant grade stainless steel (ASTM F138 and ISO 5832-1), solid 14K through 24K gold, niobium, or titanium. Ear studs or other jewelry designed for ears shall not be used in other parts of the body.

**History**
- *SOURCE: Miss. Code Ann. §73-61-1 and Miss. Code Ann. §73-61-3.*

##### **15 Miss. Admin. Code Pt. 19, R. 11.5.5** Rule 11.5.5 {#sec-19-11.5.5 omnilex-key=us-ms-regs-official--title-15--19#11.5.5}

Sanitation And Sterilization Of Tattoo And Piercing Equipment: No Certificate of Registration shall be issued or renewed to any individual, unless the establishment meets the following minimum standards: 1. All non-disposable tattoo and body piercing equipment shall be sanitized after each use by scrubbing thoroughly with a blood dissolving chemical and disinfectant solution, and then by being placed in an ultrasonic unit, which shall be operated in accordance with the manufacturer's instructions. After sanitizing the non-disposable equipment, each item shall be placed in an individual self- sealing sterilization pouch with indicators which shall be dated with the date of sterilization and sterilized in an autoclave. 2. All single use tattoo and body piercing equipment or jewelry requiring sterilization shall be placed in an individual self-sealing sterilization pouch with indicators which shall be dated with the date of sterilization and sterilized in an autoclave. 3. All sterilizing and sanitizing equipment, and all chemicals, must be kept in a room separate and apart from any work area, separated by walls or other configuration. All sterilizing and sanitizing equipment, and all chemicals, shall be cleaned, maintained, and stored in accordance with the manufacturer's instructions, which shall be kept available at the establishment.

4. Sterile equipment may not be used if the individual self-sealing sterilization pouch has been breached or after the expiration date, without re-sterilizing as required in these regulations. 5. After sterilization, all tattoo and body piercing equipment shall be stored in secure, dry, clean cabinets, or other secure covered containers reserved for the storage of such equipment. 6. Performance of the autoclave shall checked once per month using Bacillus Stereothermophilus spore strips or suspensions and results recorded and maintained for a period of three years. If the autoclave fails a performance check, the autoclave must be immediately checked for proper use and function and the spore test repeated. If the spore test remains positive, use of the autoclave shall be discontinued until it is repaired, and a repeat spore test is negative.

**History**
- *SOURCE: Miss. Code Ann. §73-61-1 and Miss. Code Ann. §73-61-3.*

##### **15 Miss. Admin. Code Pt. 19, R. 11.5.6** Rule 11.5.6 {#sec-19-11.5.6 omnilex-key=us-ms-regs-official--title-15--19#11.5.6}

Tattoo Procedures: No Certificate of Registration shall be issued or renewed to any individual, unless the following tattoo procedures are followed: 1. Before beginning any tattoo procedure, the tattooist shall discuss the risks and responsibilities required in the particular procedure with the client. The tattooist shall also explain aftercare instructions prior to the tattoo procedure. The client shall then fill out and sign a client consent form for the tattoo, indicating that he consents to the procedure, understands the risks, understands the aftercare requirements, and has received written aftercare instructions. The original of the client consent form, along with a photocopy of a government-issued identification, shall be retained at the establishment as required in these regulations. 2. The tattooist shall thoroughly wash hands and forearms with antibacterial soap and warm water before and after each procedure. After thorough washing, the hands shall be dried using clean, single use paper towels. 3. The tattooist shall wear new, clean, single use, disposable sanitary latex examination gloves, or other type gloves approved by the Department, for every client during the procedure. If a glove is pierced, torn, or contaminated by coming into contact with any other person or non-clean surface, both gloves must be properly removed and discarded. Hands shall be washed prior to donning a new pair of disposable examination gloves. Gloves shall be discarded after the completion of each procedure on an individual client. Under no circumstances shall a pair of gloves be used on more than one person. The use of disposable gloves does not preclude the need for, or substitute for, the hand washing procedure. 4. Immediately before the procedure is to begin, the work procedure area shall be wiped down with a product classified by the United States Environmental Protection Agency (EPA) as a hospital disinfectant without label claim for

tuberculocidal activity (low level disinfection) or greater, and covered with an uncontaminated paper towel or tray cover. All instruments and supplies needed for the procedure shall then be arranged on the paper. 5. Before beginning the tattooing procedure, the immediate and surrounding area of the skin which is to be tattooed shall be washed with an EPA-approved antiseptic solution, applied with a clean, single use paper product. 6. If shaving is necessary, single use disposable razors shall be used and discarded. Following shaving, the skin and surrounding area shall be washed with an EPA- approved antiseptic solution, applied with a clean, single use paper product. 7. Upon completion of the tattoo procedure, the tattooist shall review the verbal and printed aftercare instructions with the client on the care of the tattoo. 8. If A&D ointment or other lubricant is utilized, it shall be from a collapsible or plastic tube or single-dosage unit, and shall be applied using sanitary procedures. 9. Transfer of Design. a. Acetate stencil - No acetate stencil shall be used to transfer a design to the skin unless the acetate stencil is first thoroughly cleaned and rinsed in an approved surface disinfectant for at least twenty minutes, dried with a single use sponge, gauze pad or cotton ball(s) and placed in a sanitized package. An approved disinfectant for environmental surfaces and instrument shall mean an FDA approved high-level hospital grade disinfectant such as CIDEX b. Paper stencil - If a paper stencil is used to transfer a design to the skin, the paper stencil shall be single use, disposable, and shall be used only once and then discarded. c. Direct drawing - If the design is drawn directly onto the skin, the design shall be applied with a single use article only, which shall then be discarded. 10. Excess dye or ink shall be removed from the skin only with a single use sponge, towel, gauze pad or cotton ball, which shall be used only on one patron or customer, and then immediately discarded in a sanitary fashion. If there is blood combined with the excess dye or ink, then the sponge, towel, gauze pad or cotton ball shall be discarded in a bio-hazard bag. 11. After completing work on any person, the tattooed area shall be washed with a single use sponge, towel, gauze pad or cotton ball saturated with an EPA- approved antiseptic solution. The tattooed area shall be allowed to dry and A&D ointment or similar skin lubricant from a collapsible or plastic tube or single- dosage unit shall be applied, using sterile gauze. A sanitary dressing shall then be fastened to the tattooed area with adhesive, adhesive tapes, or strips.

12. Only A&D ointment or other lubricant in collapsible metal or plastic tubes, or single-dosage unit shall be used on the area subsequent to tattooing. 13. The use of styptic pencils, alum blocks, or other solid styptic to check the flow of blood is prohibited, unless the styptic is single use, used only once, and then properly disposed of.

**History**
- *SOURCE: Miss. Code Ann. §73-61-1 and Miss. Code Ann. §73-61-3.*

##### **15 Miss. Admin. Code Pt. 19, R. 11.5.7** Rule 11.5.7 {#sec-19-11.5.7 omnilex-key=us-ms-regs-official--title-15--19#11.5.7}

Body Piercing Procedure: No Certificate of Registration shall be issued or renewed to any individual, unless the following piercing procedures are followed: 1. Before beginning any body piercing procedure, the body piercer shall discuss the risks and responsibilities required in the particular piercing with the client. The body piercer shall also explain aftercare instructions prior to the performance of the piercing. The client shall then fill out and sign a client consent form for the body piercing, indicating that he consents to the body piercing, understands the risks, understands the aftercare requirements, and has received written aftercare instructions. The original of the client consent form, along with a photocopy of a government-issued identification, shall be retained at the establishment as required in these regulations. 2. The body piercer shall thoroughly wash hands and forearms with antibacterial soap and warm water before and after each procedure. After thoroughly washing, the hands shall be dried using clean, single use paper towels. 3. The body piercer shall wear new, clean, single use, disposable sanitary latex examination gloves, or other type gloves approved by the Department, for every client during the procedure. If a glove is pierced, torn, or contaminated by coming into contact with any other person or non-clean surface, both gloves must be properly removed and discarded. Hands shall be washed prior to donning a new pair of disposable examination gloves. Gloves shall be discarded after the completion of each procedure on an individual client. Under no circumstances shall a pair of gloves be used on more than one person. The use of disposable gloves does not preclude the need for, or substitute for, the hand washing procedure. 4. Immediately before the procedure is to begin, the work procedure area shall be wiped down with a product classified by the United States Environmental Protection Agency (EPA) as a hospital disinfectant without label claim for tuberculocidal activity (low level disinfection) or greater, and covered with an uncontaminated paper towel or tray cover. All instruments and supplies needed for the procedure shall then be arranged on the paper. 5. Before beginning the piercing procedure, the immediate and surrounding area of the skin which is to be pierced shall be washed with an EPA-approved antiseptic solution, applied with a clean, single use paper product.

6. If shaving is necessary, single use disposable razors shall be used and discarded. Following shaving, the skin and surrounding area shall be washed with an EPA- approved antiseptic solution, applied with a clean, single use paper product. Upon completion of the procedure, the body piercer shall review the verbal and printed aftercare instructions with the client on the care of the body opening. 7. Gloves shall be worn when cleaning blood spills. 8. A piercing gun may only be used on the outer perimeter or lobe of the ear, and may not be used on any other part of the body.

**History**
- *SOURCE: Miss. Code Ann. §73-61-1 and Miss. Code Ann. §73-61-3.*

##### **15 Miss. Admin. Code Pt. 19, R. 11.5.8** Rule 11.5.8 {#sec-19-11.5.8 omnilex-key=us-ms-regs-official--title-15--19#11.5.8}

Disposal Of Equipment: No Certificate of Registration shall be issued or renewed to any individual, unless the establishment meets the following minimum standards: 1. Contaminated needles and other sharps shall be disposed of in a Department approved sharps container, and disposed of in accordance with the Department "Medical Waste Management Plan." 2. Used disposable dental bibs or drapes, paper towels, gauze pads, or other disposable items other than those listed above, shall be placed in a closed container that is lined with a plastic bag for disposal and shall be removed from the establishment at the end of the day. 3. Used linens shall be placed in a laundry hamper that is lined with a plastic bag and shall be laundered or removed from the establishment at the end of the day.

**History**
- *SOURCE: Miss. Code Ann. §73-61-1 and Miss. Code Ann. §73-61-3.*

##### **15 Miss. Admin. Code Pt. 19, R. 11.5.9** Restrictions 1 {#sec-19-11.5.9 omnilex-key=us-ms-regs-official--title-15--19#11.5.9}

No person shall perform a tattoo or body piercing procedure while under the influence of alcohol or drugs. 2. No person shall perform a tattoo or body piercing procedure if exhibiting an exposed rash, skin lesion, boil, or infection. 3. No person shall perform a tattoo or body piercing procedure unless attired in clean, washable, outer clothing. 4. No person shall perform a tattoo or body piercing procedure upon any individual who appears to be under the influence of drugs or alcohol. 5. No person shall perform a tattoo or body piercing procedure upon any individual exhibiting an exposed rash, skin lesion, pimple, boil, infection, or manifest any evidence of unhealthy condition in the area to be tattooed and/or pierced..

6. No skin area shall be penetrated, abraded, or treated with chemicals for the purpose of removing, camouflaging, or altering any blemish, birthmark, scar, or tattoo.

**History**
- *SOURCE: Miss. Code Ann. §73-61-1 and Miss. Code Ann. §73-61-3.*

##### **15 Miss. Admin. Code Pt. 19, R. 11.5.10** Consent Forms: 1 {#sec-19-11.5.10 omnilex-key=us-ms-regs-official--title-15--19#11.5.10}

A photocopy of an original government-issued identification containing the date of birth of the client shall be attached to the consent form. Consent forms shall be maintained at the establishment for a minimum of two (2) years, shall be produced and be made available at the request of the Department, and shall contain, at a minimum, the following information: a. Name of Tattooist or Body Piercer and Department Certificate of Registration Number; b. Name of supervisor, if the Tattooist or Body Piercer has a Provisional Certificate of Registration; c. Name and address of Establishment; d. Date of tattoo or body piercing; e. Name of client; f. Home address of client; g. Home telephone number of client; h. Sex of Client; i. Date of Birth of client; j. Description of location on the body to be tattooed or pierced; k. Acknowledgment of the risks involved in a tattoo or body piercing; l. Acknowledgment of the receipt of the printed aftercare responsibilities of the client; m. Statement that the client is not under the influence of drugs or alcohol; n. Signature of the client; o. Signature of the Tattooist or Body Piercer; and

p. Signature of supervisor if required. 2. The consent form must contain a recommendation to the patron which states the Mississippi State Board of Health recommends that any tattooing or piercing involving the mucous membranes, such as the tongue or genitalia, be performed by a licensed physician or oral surgeon as appropriate. 3. The consent form must contain a warning to persons who are diabetic, HIV infected, or have End Stage Renal Disease that they are at higher risk of complications and should consult their personal physician prior to being tattooed or pierced. 4. The consent form must contain a warning to patrons that tattooing or piercing of persons with preexisting cardiac conditions, especially when piercing occurs on areas of the body involving the mucous membranes, may result in bacteria in the blood stream which can further damage the heart, and that such persons should seek permission from their physician prior to the tattooing or piercing procedure.

**History**
- *SOURCE: Miss. Code Ann. §73-61-1 and Miss. Code Ann. §73-61-3.*

##### **15 Miss. Admin. Code Pt. 19, R. 11.5.11** Rule 11.5.11 {#sec-19-11.5.11 omnilex-key=us-ms-regs-official--title-15--19#11.5.11}

Tattoo Aftercare Instructions: Every client, prior to the tattooing procedure beginning, shall be given a printed statement of instructions for care of the tattoo, and must contain, at a minimum, the following information: 1. Care and cleaning of the specific area tattooed. 2. Signs and symptoms of infections. 3. Instructions to consult with a medical professional, if there are signs or symptoms of infection.

**History**
- *SOURCE: Miss. Code Ann. §73-61-1 and Miss. Code Ann. §73-61-3.*

##### **15 Miss. Admin. Code Pt. 19, R. 11.5.12** Rule 11.5.12 {#sec-19-11.5.12 omnilex-key=us-ms-regs-official--title-15--19#11.5.12}

Body Piercing Aftercare Instructions: Every client, prior to the piercing procedure beginning, shall be given a printed statement of instructions for care of the piercing. The instructions must be specific for the area pierced, and must contain, at a minimum, the following information: 1. Care and cleaning of the specific area pierced. 2. Information regarding the care and cleaning of the jewelry inserted, including any restrictions. 3. Signs and symptoms of infections. 4. Instructions to consult with a medical professional, if there are signs or symptoms of infection.

**History**
- *SOURCE: Miss. Code Ann. §73-61-1 and Miss. Code Ann. §73-61-3.*

##### **15 Miss. Admin. Code Pt. 19, R. 11.5.13** Rule 11.5.13 {#sec-19-11.5.13 omnilex-key=us-ms-regs-official--title-15--19#11.5.13}

Follow-Up Log: Any reports or complaints to the Establishment concerning a tattoo and/or piercing performed at the establishment, whether such complaint be delivered in person, by telephone or other electronic means, shall be recorded in a log which must include, at a minimum, the name of the complainant, sufficient identifying information to cross reference to the identification attached to the consent form, a summary of the complaint, a summary of any advice provided by the establishment, and change in contact information which is different from the original consent form.

**History**
- *SOURCE: Miss. Code Ann. §73-61-1 and Miss. Code Ann. §73-61-3.*

##### **15 Miss. Admin. Code Pt. 19, R. 11.5.14** Rule 11.5.14 {#sec-19-11.5.14 omnilex-key=us-ms-regs-official--title-15--19#11.5.14}

Exemption: These regulations do not apply to physicians licensed to practice medicine in the State of Mississippi in the performance of their professional duties.

**History**
- *SOURCE: Miss. Code Ann. §73-61-1 and Miss. Code Ann. §73-61-3.*

##### **15 Miss. Admin. Code Pt. 19, R. 11.5.15** Rule 11.5.15 {#sec-19-11.5.15 omnilex-key=us-ms-regs-official--title-15--19#11.5.15}

Summary Suspension: The Department may summarily suspend a Certificate of Registration prior to a hearing, simultaneously with the filing of a formal complaint and notice of hearing, if the Department determines that: 1. The health, safety, or welfare of the general public is in immediate danger; or 2. The Registrant's physical capacity to practice his profession is in issue; or 3. The Registrant's mental capacity to practice his profession is in issue. 4. Any hearing held pursuant to this provision shall be held within 20 days of service of the formal complaint and notice of hearing.

Subchapter 6: Standards of Conduct Rule 11.6.1 The Department may, in its discretion, deny an initial application for registration, deny an application for renewal, or file formal charges against a registrant during a licensure term seeking to have the Certificate of Registration suspended, revoked, or otherwise disciplined if the Department determines that the Registrant: 1. Is guilty of fraud, misrepresentation, concealment of material facts, or deceit in procuring or attempting to procure a Certificate of Registration. 2. Is unfit or incompetent by reason of negligence, habits, or other causes of incompetency.

3. Is addicted to, or has improperly obtained, possessed, used, or distributed habit- forming drugs or narcotics. 4. Has performed tattooing or body piercing without possessing a Certificate of Registration from the Department. 5. Has performed tattooing or body piercing after the Certificate of Registration has expired or has been suspended. 6. Has performed tattooing or body piercing under cover of any permit or registration illegally or fraudulently obtained or issued. 7. Has violated, aided, or abetted others in violation of any provision of these regulations, rules of the Board or Department, or the Act. 8. Has engaged in any conduct considered by the Department to be detrimental to the practice of tattooing or body piercing. 9. Is performing tattooing or body piercing procedures in an Establishment that violates any provision of these regulations, rules of the Board or Department, or the Act.

**History**
- *SOURCE: Miss. Code Ann. §73-61-1 and Miss. Code Ann. §73-61-3.*
- *SOURCE: Miss. Code Ann. §73-61-1 and Miss. Code Ann. §73-61-3.*

##### **15 Miss. Admin. Code Pt. 19, R. 11.6.2** Rule 11.6.2 {#sec-19-11.6.2 omnilex-key=us-ms-regs-official--title-15--19#11.6.2}

Complaints: All verifiable complaints concerning a Registrant or Establishment shall be investigated by the Department to determine what action, if any, shall be initiated.

**History**
- *SOURCE: Miss. Code Ann. §73-61-1 and Miss. Code Ann. §73-61-3.*

##### **15 Miss. Admin. Code Pt. 19, R. 11.6.3** Rule 11.6.3 {#sec-19-11.6.3 omnilex-key=us-ms-regs-official--title-15--19#11.6.3}

Notice of Charges and Hearing: Following the investigative process, the Department may file formal charges against the Registrant. Such formal complaint shall, at a minimum, inform the Registrant of the facts which are the basis of the charge and which are specific enough to enable the Registrant to defend against the charges.

**History**
- *SOURCE: Miss. Code Ann. §73-61-1 and Miss. Code Ann. §73-61-3.*

##### **15 Miss. Admin. Code Pt. 19, R. 11.6.4** Rule 11.6.4 {#sec-19-11.6.4 omnilex-key=us-ms-regs-official--title-15--19#11.6.4}

Each Registrant, whose conduct is the subject of a formal charge which seeks to impose disciplinary action against the Registrant, shall be served notice of the formal charge at least fifteen (15) days before the date of hearing. A hearing shall be presided over by the State Health Officer, or a designee. Service shall be considered to have been given if the notice was personally received by the Registrant, or the notice was mailed certified, return receipt requested, to the Registrant at the Registrant's last known home address as listed with the Department.

**History**
- *SOURCE: Miss. Code Ann. §73-61-1 and Miss. Code Ann. §73-61-3.*

##### **15 Miss. Admin. Code Pt. 19, R. 11.6.5** The notice of the formal hearing shall consist at a minimum of the following information: 1 {#sec-19-11.6.5 omnilex-key=us-ms-regs-official--title-15--19#11.6.5}

The time, place, and date of hearing; 2. That the Registrant shall appear personally at the hearing and may be represented by counsel; 3. That the Registrant shall have the right to produce witnesses and evidence in the Registrant's behalf, and shall have the right to cross-examine adverse witnesses and evidence; 4. That the hearing could result in disciplinary action being taken against the Registrant's Certificate of Registration. 5. That rules for the conduct of these hearings exist and it may be in the Registrant's best interest to obtain a copy; and 6. After the conclusion of the hearing, the hearing officer shall, within forty-five (45) days, make findings of fact and conclusions of law, and shall issue judgment, separately stated, as to what disciplinary action, if any, should be imposed on the Registrant.

**History**
- *SOURCE: Miss. Code Ann. §73-61-1 and Miss. Code Ann. §73-61-3.*

##### **15 Miss. Admin. Code Pt. 19, R. 11.6.6** Disposition of any complaints may be made by consent order or stipulation between the Department and the Registrant {#sec-19-11.6.6 omnilex-key=us-ms-regs-official--title-15--19#11.6.6}

**History**
- *SOURCE: Miss. Code Ann. §73-61-1 and Miss. Code Ann. §73-61-3.*

##### **15 Miss. Admin. Code Pt. 19, R. 11.6.7** All proceedings pursuant to this section are matters of public record and shall be preserved pursuant to state law {#sec-19-11.6.7 omnilex-key=us-ms-regs-official--title-15--19#11.6.7}

Subchapter 7: Department Sanctions Rule 11.7.1 The Department may impose any of the following sanctions, singly or in combination, when it finds that a Registrant is guilty of any of the above offenses, or in violation of any section of the Regulations: 1. Revocation of the Registration. 2. Suspension of the Registration for not more than 12 months. 3. Censure the Registrant.

4. Issue a letter of reprimand to the Registrant. 5. Place a Registrant on probationary status and require the Registrant to submit to any of the following: a. report regularly to the Department upon matters which are the basis of probation; b. practice tattooing or body piercing only under the on-site direct technical supervision of an individual with a "Regular Certificate of Registration" c. such other reasonable requirements or restrictions as are proper; 6. Refuse to renew a Registration. 7. Revoke probation which has been granted and impose any other disciplinary action in this subsection when the requirements of probation have not been fulfilled or have been violated. 8. Impose a monetary fine not to exceed five hundred ($500.00) dollars.

**History**
- *SOURCE: Miss. Code Ann. §73-61-1 and Miss. Code Ann. §73-61--3.*
- *SOURCE: Miss. Code Ann. §73-61-1 and Miss. Code Ann. §73-61-3.*

##### **15 Miss. Admin. Code Pt. 19, R. 11.7.2** Rule 11.7.2 {#sec-19-11.7.2 omnilex-key=us-ms-regs-official--title-15--19#11.7.2}

Appeal: Any person aggrieved by a decision of the Department shall have a right of appeal in the manner provided for under in the Act and the Laws of the State of Mississippi.

**History**
- *SOURCE: Miss. Code Ann. §73-61-1 and Miss. Code Ann. §73-61-3.*

##### **15 Miss. Admin. Code Pt. 19, R. 11.7.3** Criminal Offenses And Punishment: 1 {#sec-19-11.7.3 omnilex-key=us-ms-regs-official--title-15--19#11.7.3}

Any person who violates any provision of Sections 73-61-1 of Mississippi Code of 1972, annotated shall be guilty of a misdemeanor, and upon conviction, be punishable by a fine of not less than One Hundred Dollars ($100.00) nor more than Five Hundred Dollars ($500.00) for each offense. 2. Any person who violates any provision of Sections 73-61-3 of Mississippi Code of 1972, annotated shall be guilty of a misdemeanor, and upon conviction, be punishable by a fine of not less than One Hundred Dollars ($100.00) nor more than Five Hundred Dollars ($500.00) for each offense. 3. Any person who violates these regulations as adopted by the Board of Health shall, pursuant to the provision of Sections 41-3-59 of Mississippi Code of 1972, be guilty of a misdemeanor, and upon conviction shall be punishable by fine not exceeding five hundred dollars ($500.00), or by imprisonment in the county jail for not more than six (6) months, or by both.

**History**
- *SOURCE: Miss. Code Ann. §73-61-1 and Miss. Code Ann. §73-61-3.*

##### **15 Miss. Admin. Code Pt. 19, R. 11.7.4** Administrative Grievance Procedure 1 {#sec-19-11.7.4 omnilex-key=us-ms-regs-official--title-15--19#11.7.4}

All persons aggrieved by a decision regarding the initial application for a Certificate of Registration, or the renewal of a Certificate of Registration, shall have the right of administrative appeal and a hearing to be conducted according to the policy of the Department. 2. Written notice will be provided to all applicants regarding denial of an initial Certificate of Registration, or a renewal Certificate of Registration. Such notice shall contain the reason thereof and shall offer the applicant an opportunity to submit additional information pertinent to their application for a second review by the Department. 3. If requested in writing within the specified time frame, a hearing will be provided in which the aggrieved party may show cause why the Certificate of Registration should be granted or renewed. The hearing shall be presided over by the State Health Officer, or a designee. 4. After the conclusion of the hearing, the hearing officer shall make findings of facts and conclusions of law, and shall issue judgment, separately stated, as to whether the initial Certificate of Registration shall be issued, or whether the renewal of a Certificate of Registration shall be granted.

Subchapter 8: Fees Rule 11.8.1 The following fees are payable to the Mississippi Department of Health by certified check, cashier’s check, or money order. Fees paid are non-refundable. 1. Initial Certificate of Registration - $150.00 2. Renewal of Certificate of Registration - $150.00 3. Renewal of Certificate of Registration for individual holding multiple Registrations - $125.00 for each Registration 4. Reinstatement Fee - $200.00 5. Certificate of Registration Replacement Fee - $50.00 6. Change of Location Fee (not requiring establishment inspection) - $25.00 7. Change of Location Fee (requiring establishment inspection) - $100.00 8. Verification of Registration Fee - $25.00

**History**
- *SOURCE: Miss. Code Ann. §73-61-1 and Miss. Code Ann. §73-61-3.*
- *SOURCE: Miss. Code Ann. §73-61-1 and Miss. Code Ann. §73-61-3.*

#### **Chapter 12** REGULATIONS GOVERNING REGISTRATION OF HEMODIALYSIS TECHNICIANS Subchapter 1: General provisions Rule 12.1.1 Legal Authority: The Mississippi Department of Health is authorized to establish, adopt, and enforce these rules and regulations by virtue of Section 41-3- 15 of Mississippi Code of 1972, annotated.

##### **15 Miss. Admin. Code Pt. 19, R. 12.2.2** Definitions 1 {#sec-19-12.2.2 omnilex-key=us-ms-regs-official--title-15--19#12.2.2}

Board shall mean the Mississippi State Board of Health. 2. Department shall mean the Mississippi State Department of Health. 3. Hemodialysis Technician or registrant shall mean a person who has obtained certification from an organization approved by the Department and has a current registration from the Department, who is not a nurse, physician assistant or physician and who has received special training in the operation of hemodialysis equipment and treatment of patients with renal failure and provides dialysis care in a renal dialysis facility under the direct, on-site supervision of a registered nurse or physician.

1. A completed application containing such information as the Department reasonably requires. 2. Evidence that the individual holds one of the following certifications. a. Certified Clinical Hemodialysis Technician (CCHT) by the Nephrology Nursing Certification Commission (NNCC). b. Certified Hemodialysis Technician (CHT) by the Board of Nephrology Examiners Nursing and Technology (BONENT). c. Certified in Clinical Nephrology Technology (CCNT) by the National Nephrology Certification Organization (NNCO). d. Certification or licensure as a dialysis technician or similar title by another jurisdiction in the United States provided the standards for certification or licensure are substantially equivalent to those in Mississippi. 3. A registration fee as set by the board made payable to the MS State Department of Health either by check or electronic means. The fee shall be non-refundable.

1. Is guilty of fraud or deceit in procuring or attempting to procure a registration or renewal of a registration as a hemodialysis technician.

2. Is unfit or incompetent to function as a hemodialysis technician by reason of negligence or other causes of incompetency.

**History**
- *SOURCE: Miss. Code Ann. §41-3-15 Subchapter 2: Scope of Practice Rule 12.2.1 Hemodialysis technicians may administer hemodialysis under the authority of a registered nurse licensed under the Mississippi Nursing Practice Law who may delegate tasks based on nursing judgement to a hemodialysis technician based on the technician’s education, knowledge and training skills. A hemodialysis technician who has completed or is currently in a training program recognized by the Board may perform as a hemodialysis technician under the authority of a registered nurse before obtaining national certification; however, the national certification must be obtained within eighteen (18) months of the hiring of the hemodialysis technician, and evidence of the national certification must be provided to the Department.*
- *SOURCE: Miss. Code Ann. §41-3-15 Subchapter 3: Requirements for Registration Rule 12.3.1 Applicants for registration as a hemodialysis technician shall submit the following to the Department:*
- *SOURCE: Miss. Code Ann. §41-3-15 Subchapter 4: Revocation, Suspension and Denial of Registration Rule 12.4.1 Standards of Conduct: Registrants may, at the discretion of the Department, have their registration placed on probation, suspended or revoked, or denied at the time of application or renewal, or have such other disciplinary action taken as deemed appropriate, if the Department determines that the registrant:*
- *SOURCE: Miss. Code Ann. §41-3-15*

##### **15 Miss. Admin. Code Pt. 19, R. 12.4.2** Notice of Charges and Hearing: 1 {#sec-19-12.4.2 omnilex-key=us-ms-regs-official--title-15--19#12.4.2}

Following the investigative process, the Department may file formal charges against the registrant. Such formal complaint shall, at a minimum, inform the registrant of the facts which are the basis of the charge and which are specific enough to enable the registrant to defend against the charges. 2. Each registrant, whose conduct is the subject of a formal charge which seeks to impose disciplinary action against the registrant, shall be served notice of the

formal charge at least fifteen (15) days before the date of hearing. A hearing shall be presided over by the Department’s designee. Service shall be considered to have been given if the notice was personally received by the registrant, or the notice was mailed certified, return receipt requested, to the registrant at the registrant’s last known address as listed with the Department. 3. The notice of the formal hearing shall consist at a minimum of the following information: a. The time, place and date of hearing; b. That the registrant shall appear personally at the hearing and may be represented by counsel; c. That the registrant shall have the right to produce witnesses and evidence on the registrant’s behalf and shall have the right to cross-examine adverse witnesses and evidence; d. That the hearing could result in disciplinary action being taken against the registrant’s registration; e. That rules for the conduct of the hearing exist and it may be in the registrant’s best interest to obtain a copy; and f. That the Department’s designee shall preside at the hearing and following the conclusion of the hearing shall make findings of facts, conclusions of law and recommendations, separately stated to the State Health Officer as to what disciplinary action, if any, should be imposed on the registration. 4. The Department’s designee shall hear evidence produced in support of the formal charges and contrary evidence produced by the registrant. At the conclusion of the hearing, the State Health Officer shall issue an order, within sixty (60) days. 5. Disposition of any complaints may be made by consent order or stipulation between the Department and the registrant. 6. All proceedings pursuant to this section are matters of public record and shall be preserved pursuant to state law.

**History**
- *SOURCE: Miss. Code Ann. §41-3-15*

##### **15 Miss. Admin. Code Pt. 19, R. 12.4.3** Rule 12.4.3 {#sec-19-12.4.3 omnilex-key=us-ms-regs-official--title-15--19#12.4.3}

Department Sanctions: The Department may impose any of the following sanctions, singly or in combination, when it finds that a registrant is guilty of any of the offenses set forth in Rule 12.4.1 or Rule 12.4.2 above: 1. Revocation of the registration; 2. Suspension of the registration, for any period of time;

3. Issuance of a letter of reprimand to the registrant; 4. Placement of the registrant on probationary status with a requirement that the registrant submit to any of the following: a. Report regularly to the Board upon matters which are the basis of probation; or b. Such other reasonable requirements or restrictions as are proper; or 5. Revoke probation which has been granted and impose any other disciplinary action in this subsection when the requirements of probation have not been fulfilled or have been violated.

**History**
- *SOURCE: Miss. Code Ann. §41-3-15*

##### **15 Miss. Admin. Code Pt. 19, R. 12.4.4** Rule 12.4.4 {#sec-19-12.4.4 omnilex-key=us-ms-regs-official--title-15--19#12.4.4}

Appeal: Any person aggrieved by a decision of the Board shall have a right of appeal to the Hinds County Chancery Court, in the manner provided for in the Laws of the State of Mississippi.

**History**
- *SOURCE: Miss. Code Ann. §41-3-15 CHAPTER 13 GENETIC COUNSELORS*

##### **15 Miss. Admin. Code Pt. 19, R. 13.1.1** Legal Authority {#sec-19-13.1.1 omnilex-key=us-ms-regs-official--title-15--19#13.1.1}

The Mississippi Genetic Counselor Practice Act, established by 2025 Miss. Laws S.B. 2699 §§ 15-25, Mississippi Legislature Regular Session 2025 (eff. March 28, 2025), authorizes the Mississippi State Board of Health to adopt, amend, promulgate and enforce such rules, regulations and standards governing genetic counselors as may be necessary to further the accomplishment of the purpose of Act.

**History**
- *Source: 2025 Miss. Laws S.B. 2699, Miss. Leg. Reg. Session 2025 (eff. March 28, 2025)*

##### **15 Miss. Admin. Code Pt. 19, R. 13.1.2** Purpose {#sec-19-13.1.2 omnilex-key=us-ms-regs-official--title-15--19#13.1.2}

The purpose of these regulations is to safeguard the public’s health, safety, and welfare by establishing minimum qualifications and creating exclusive titles corresponding to the level of qualifications for individuals who wish to offer genetic counseling services to the public. Further, to ensure the highest degree of professional conduct by those engaged in offering genetic counseling services to the public, it is the purpose of these regulations to impose disciplinary sanctions against any licensee who does not meet or adhere to the procedures, qualifications, and standards set out in this Chapter.

**History**
- *Source: 2025 Miss. Laws S.B. 2699, Miss. Leg. Reg. Session 2025 (eff. March 28, 2025)*

##### **15 Miss. Admin. Code Pt. 19, R. 13.1.3** Licensure Required {#sec-19-13.1.3 omnilex-key=us-ms-regs-official--title-15--19#13.1.3}

A license issued under this Chapter is required to engage in the practice of genetic counseling. No person shall hold himself or herself out as a genetic counselor unless he or she is licensed in accordance with the Act and this Chapter. No person who is not so licensed may use, in connection with his or her name or place of business, the title “genetic counselor”, “licensed genetic counselor”, “gene counselor”, “genetic consultant”, “genetic associate” or any words, letters, abbreviations or insignia indicating or implying that he/she holds a genetic counseling license.

Rule 13.1.4

Scope of Practice. The practice of “genetic counseling” means the provision of services by an individual who qualifies for a license under the Act and regulations in this Chapter, and includes the following activities:

1. Obtaining and interpreting individual, family, medical, and developmental histories;

2. Determining the mode of inheritance and risk of transmission of genetic conditions and birth defects;

3. Discussing the inheritance, features, natural history, means of diagnosis, and management of these conditions;

4. Identifying, ordering, coordinating, and explaining the clinical implications of genetic laboratory tests and other diagnostic studies;

5. Assessing psychosocial factors, and recognizing social, educational and cultural issues;

6. Evaluating the client's or family's responses to the condition or risk of recurrence and provide client-centered counseling and anticipatory guidance;

7. Communicating information to their clients in an understandable manner;

8. Facilitating informed decision making about testing and management;

9. Identifying and effectively using community resources that provide medical, educational, financial, and psychosocial support and advocacy; and

10. Providing accurate written documentation of medical, genetic, and counseling information for families and health care professionals.

**History**
- *Source: 2025 Miss. Laws S.B. 2699, Miss. Leg. Reg. Session 2025 (eff. March 28, 2025)*
- *Source: 2025 Miss. Laws S.B. 2699, Miss. Leg. Reg. Session 2025 (eff. March 28, 2025)*

##### **15 Miss. Admin. Code Pt. 19, R. 13.1.5** Definitions {#sec-19-13.1.5 omnilex-key=us-ms-regs-official--title-15--19#13.1.5}

The following terms shall have the meaning set forth below for purposes of this Chapter, unless the context otherwise requires:

1. Board means the State Board of Health.

2. Department means the State Department of Health.

3. Advisory Council means the Mississippi Council of Advisors in Genetic Counseling established in this Chapter.

4. ABGC means the American Board of Genetic Counseling, its successor or equivalent.

5. ABMG means the American Board of Medical Genetics, its successor or equivalent.

6. NSGC means the National Society of Genetic Counselors, its successor or equivalent.

7. ACGC means the Accreditation Council for Genetic Counseling, its successor or equivalent.

8. Association shall mean the Mississippi Genetic Counselor Association (MGCA).

9. Active Candidate Status (ACS) means a person who has met the requirements established by the ABGC to take the ABGC certification examination in general genetics and genetic counseling and has been granted this designation by ABGC.

10. Licensed Genetic Counselor (LGC) means a person licensed under this Chapter.

11. Provisionally Licensed Genetic Counselor means a person provisionally licensed under this Chapter.

12. Genetic Counseling Intern means a student enrolled in a genetic counseling program accredited by ACGC.

13. CEU means continuing education unit as defined by the NSGC.

14. Examination for licensure means the ABGC or ABMG certification exam.

15. License means the document of licensure issued by the Board.

16. Code of Ethics for genetic counselor means the “Code of Ethics for the Profession of Genetic Counselors” prepared and approved by the National Society of Genetic Counselors (NSGC).

**History**
- *Source: 2025 Miss. Laws S.B. 2699, Miss. Leg. Reg. Session 2025 (eff. March 28, 2025)*

##### **15 Miss. Admin. Code Pt. 19, R. 13.1.6** Publication {#sec-19-13.1.6 omnilex-key=us-ms-regs-official--title-15--19#13.1.6}

The Department shall make available, upon request and payment of a fee, a list of the names and addresses of all persons licensed by the Department as Genetic Counselors, and a list of all persons whose licenses have been suspended, revoked, denied renewal, put on probationary status, censured, or reprimanded during the current licensure term.

Subchapter 2 Licensure.

**History**
- *Source: 2025 Miss. Laws S.B. 2699, Miss. Leg. Reg. Session 2025 (eff. March 28, 2025)*

##### **15 Miss. Admin. Code Pt. 19, R. 13.2.1** Qualifications for Licensure {#sec-19-13.2.1 omnilex-key=us-ms-regs-official--title-15--19#13.2.1}

To obtain a license under this Chapter, an applicant shall:

1. Submit an online application;

2. Pay the license fee in the amount and manner required;

3. Provide satisfactory evidence of having certification as a:

a. Genetic counselor by the ABGC or ABMG; or

b. Geneticist by the ABMG;

4. Provide satisfactory evidence that he/she holds, at minimum, a master’s degree from a genetic counseling training program that is accredited by the ACGC, or an equivalent as determined by the ABGC or the ABMG; and

5. Submit Mississippi State Department of Health comprehensive background check.

**History**
- *Source: 2025 Miss. Laws S.B. 2699, Miss. Leg. Reg. Session 2025 (eff. March 28, 2025)*

##### **15 Miss. Admin. Code Pt. 19, R. 13.2.2** Licensure by Reciprocity or Endorsement; Qualifications {#sec-19-13.2.2 omnilex-key=us-ms-regs-official--title-15--19#13.2.2}

1. Reciprocity. The Board may issue a license by reciprocity to an applicant who provides proof that he or she is licensed or registered as a genetic counselor in another state, territory or jurisdiction of the United States if the licensure requirements in that state, territory or jurisdiction are substantially the same as the requirements imposed by the Act and this Chapter.

a. The issuance of a license by reciprocity to a military-trained applicant or military spouse shall be subject to the provisions of Miss. Code § 73- 50-1.

b. The issuance of a license by reciprocity to a person who establishes residence in this state shall be subject to the provisions of Miss. Code § 73-50-2.

2. Endorsement. An individual who does not otherwise qualify for licensure under this Chapter but who has worked as a genetic counselor for a minimum of ten (10) years prior to July 1, 2025, may apply for licensure by endorsement under this Rule. The Board may issue a license by endorsement to an applicant who:

a. Submits an online application;

b. Pays the application fee in the amount and manner required by the Department;

c. Provides the following documentation:

i. Proof that he/she holds a master’s or higher degree in genetics or related field of study;

ii. Proof that he/she has never failed the ABMG/ABGC certification examination;

iii. Three (3) letters of recommendation from at least one (1) genetic counselor who qualifies for licensure under this Chapter, and either a clinical geneticist certified by ABMG or medical geneticist certified by ABMG. All individuals submitting letters of recommendation must have worked with the applicant in an employment setting during the last five (5) years and can attest to the applicant's competency in providing genetic counseling services;

iv. Proof of attendance of NSGC/ABGC approved CEU programs within the last five (5) years; and

d. Completes a Mississippi State Department of Health comprehensive background check.

**History**
- *Source: 2025 Miss. Laws S.B. 2699, Miss. Leg. Reg. Session 2025 (eff. March 28, 2025)*

##### **15 Miss. Admin. Code Pt. 19, R. 13.2.3** Provisional Licensure {#sec-19-13.2.3 omnilex-key=us-ms-regs-official--title-15--19#13.2.3}

The Board may issue a provisional license for the practice of genetic counseling for a period of one (1) year to an applicant who

meets all of the requirements for licensure except for the certification component and who has been granted Active Candidate Status by the ABGC or the ABMG.

1. To obtain a provisional license under this Rule, an applicant shall:

a. Submit the following to the Department:

i. Online application;

ii. Proof of having been granted active candidate status (ACS); and

iii. A Mississippi State Department of Health comprehensive background check;

b. Pay the required application fee; and

c. Work under the general supervision of a licensed genetic counselor or a licensed physician at all times during which the provisionally licensed genetic counselor performs genetic counseling; and

2. In its discretion, the Board may allow a provisional license to be renewed for an additional one (1) year if an applicant fails the ABGC or ABMG certification exam.

3. A provisional license shall expire automatically upon the earliest of the following:

a. Issuance of a regular license;

b. Thirty (30) days after the applicant fails to pass the certification examination; or

c. The date printed on the provisional license.

**History**
- *Source: 2025 Miss. Laws S.B. 2699, Miss. Leg. Reg. Session 2025 (eff. March 28, 2025)*

##### **15 Miss. Admin. Code Pt. 19, R. 13.2.4** Biennial License Renewal Required {#sec-19-13.2.4 omnilex-key=us-ms-regs-official--title-15--19#13.2.4}

Except in the case of a provisional genetic counselor license issued under Rule 13.2.3, licenses issued under this Chapter shall expire two (2) years from the date of issuance.

**History**
- *Source: 2025 Miss. Laws S.B. 2699, Miss. Leg. Reg. Session 2025 (eff. March 28, 2025)*

##### **15 Miss. Admin. Code Pt. 19, R. 13.2.5** Procedure for Renewal of Licensure {#sec-19-13.2.5 omnilex-key=us-ms-regs-official--title-15--19#13.2.5}

Approximately sixty (60) days prior to the expiration of a license, the Department shall send an electronic renewal

notice to the email address registered by the licensee with the Department. For purposes of renewal, prior to expiration of the license, an applicant shall:

1. Complete the online renewal form;

2. Submit proof of current certification or continuing education credit as detailed in Subchapter 3 of these regulations or current certification; and

3. Pay the renewal fee online.

**History**
- *Source: 2025 Miss. Laws S.B. 2699, Miss. Leg. Reg. Session 2025 (eff. March 28, 2025)*

##### **15 Miss. Admin. Code Pt. 19, R. 13.2.6** Failure to Renew {#sec-19-13.2.6 omnilex-key=us-ms-regs-official--title-15--19#13.2.6}

The licensee is responsible for renewing the license prior to its expiration. Failure of the licensee to receive notice does not relieve the licensee of responsibility for renewing that license. If a licensee fails to submit a renewal application and renewal fee prior to expiration of his/her license, the license will be deemed forfeited by the Department. A forfeited license may be reinstated if the licensee submits a reinstatement application and pays both the renewal fee and a reinstatement fee. This application must be received by the Department within one (1) year following expiration of the forfeited license. If the forfeited license is not reinstated within this one-year period, it will be automatically terminated, and the individual must apply for a new license as a first-time applicant.

**History**
- *Source: 2025 Miss. Laws S.B. 2699, Miss. Leg. Reg. Session 2025 (eff. March 28, 2025)*

##### **15 Miss. Admin. Code Pt. 19, R. 13.2.7** Abandonment {#sec-19-13.2.7 omnilex-key=us-ms-regs-official--title-15--19#13.2.7}

An application for licensure or renewal shall be considered abandoned if the applicant fails to submit all required materials to the Department within six (6) months of the initial submission date.

**History**
- *Source: 2025 Miss. Laws S.B. 2699, Miss. Leg. Reg. Session 2025 (eff. March 28, 2025)*

##### **15 Miss. Admin. Code Pt. 19, R. 13.2.8** Notification of Denial {#sec-19-13.2.8 omnilex-key=us-ms-regs-official--title-15--19#13.2.8}

Written notice will be provided to all applicants regarding denial of an application for licensure or renewal. Such notice shall contain the reason(s) therefore and provide the applicant an opportunity to cure the deficiency for a second review by the Department.

**History**
- *Source: 2025 Miss. Laws S.B. 2699, Miss. Leg. Reg. Session 2025 (eff. March 28, 2025)*

##### **15 Miss. Admin. Code Pt. 19, R. 13.2.9** Exemptions from Licensure {#sec-19-13.2.9 omnilex-key=us-ms-regs-official--title-15--19#13.2.9}

The provisions of the Act and this Chapter shall not apply to the following:

1. Any person licensed by the state to practice in a profession other than that of genetic counseling, such as a licensed physician or nurse practitioner, when acting within the scope of the person’s profession and doing work of

a nature consistent with the person’s training. However, the person shall not hold himself or herself out to the public as a genetic counselor;

2. Any person employed as a genetic counselor by the federal government or an agency thereof if such person provides genetic counseling services solely under the direction and control of the organization by which he or she is employed; or

3. A student or intern enrolled in an ABGC accredited genetic counseling educational program if genetic counseling services performed by the student are an integral part of the student’s course of study and are performed under the direct supervision of a licensed genetic counselor assigned to supervise the student and who is on duty and available in the assigned patient care area, and if the person is designated by a title “genetic counseling intern”.

4. A nonresident genetic counselor may practice genetic counseling in Mississippi for no more than a total of five (5) days per calendar year with current licensure from another state.

Subchapter 3 Fees.

**History**
- *Source: 2025 Miss. Laws S.B. 2699, Miss. Leg. Reg. Session 2025 (eff. March 28, 2025)*

##### **15 Miss. Admin. Code Pt. 19, R. 13.3.1** Schedule of Fees {#sec-19-13.3.1 omnilex-key=us-ms-regs-official--title-15--19#13.3.1}

The following non-refundable fees apply to this Chapter and are payable to the Department

1. Initial Application & Licensure Fee..................................................$250.00

2. Provisional Application & Licensure Fee..........................................$250.00

3. Renewal Application & Licensure Fee ...............................................150.00

4. Provisional Renewal Fee ..................................................................$150.00

5. Reinstatement Fee ............................................................................$100.00

6. Verification Fee...................................................................................$25.00

7. Monetary Penalty......................................................................$200.00

**History**
- *Source: 2025 Miss. Laws S.B. 2699, Miss. Leg. Reg. Session 2025 (eff. March 28, 2025)*

##### **15 Miss. Admin. Code Pt. 19, R. 13.3.2** Examination Fee {#sec-19-13.3.2 omnilex-key=us-ms-regs-official--title-15--19#13.3.2}

Fees for examination are to be paid directly to the appropriate testing organization.

Subchapter 4 Continuing Education.

**History**
- *Source: 2025 Miss. Laws S.B. 2699, Miss. Leg. Reg. Session 2025 (eff. March 28, 2025)*

##### **15 Miss. Admin. Code Pt. 19, R. 13.4.1** Requirements {#sec-19-13.4.1 omnilex-key=us-ms-regs-official--title-15--19#13.4.1}

Licensed genetic counselors must comply with the following continuing education rules as a prerequisite to licensure renewal:

1. The LGC shall remain in good standing with ABGC regarding CEUs and other requirements for recertification, according to their 5-year cycle.

2. Licensees certified and in good standing with NSGC, ABGC, or ABMG may submit proof, in form and content satisfactory to the Department, of having met the continuing education requirements of the NSGC, ABGC, or ABMG, in lieu of the provisions of this section.

3. Proof of compliance with continuing education requirements shall be submitted to the Department with an LGC’s renewal application.

4. Licensees who fail to accrue the required CEUs during the two-year licensure period shall be placed on continuing education (CE) probationary status for the next licensure period. Failure to complete the required CEUs during the CE probationary period will result in license revocation at the end of that period.

5. CE probationary status may be granted only once and is limited to a single licensure period. A licensee is not eligible for CE probationary status in consecutive or subsequent renewal cycles.

6. Reinstatement of a license revoked for failure to meet continuing education requirements is subject to the discretion of the Department. If said license is permitted to be reinstated, the renewal fee and the late renewal/reinstatement fee as stated in Subchapter 6 of these regulations will be required.

**History**
- *Source: 2025 Miss. Laws S.B. 2699, Miss. Leg. Reg. Session 2025 (eff. March 28, 2025)*

##### **15 Miss. Admin. Code Pt. 19, R. 13.4.2** Content Criteria {#sec-19-13.4.2 omnilex-key=us-ms-regs-official--title-15--19#13.4.2}

The content of CEUs must apply to the field of genetic counseling and performance and must be designed to meet one of the following goals:

1. Update knowledge and skills required for competent performance beyond entry level as described in current legislation and regulations;

2. Allow the licensee to enhance his knowledge and skills;

3. Provide opportunities for interdisciplinary learning;

4. Extend limits of professional capabilities and opportunities; and

5. Facilitate personal contributions to the advancement of the profession.

**History**
- *Source: 2025 Miss. Laws S.B. 2699, Miss. Leg. Reg. Session 2025 (eff. March 28, 2025)*

##### **15 Miss. Admin. Code Pt. 19, R. 13.4.3** Sources of Continuing Education {#sec-19-13.4.3 omnilex-key=us-ms-regs-official--title-15--19#13.4.3}

Continuing education units may be accrued from the following sources:

1. American Board of Genetic Counseling (ABGC)

2. American Board of Medical Genetics (ABMG)

3. National Society of Genetic Counselors (NSGC)

4. American Board of Medical Genetics and Genomics (ABMGG)

5. American College of Medical Genetics (ACMG)

6. Mississippi Genetic Counselor Association (MGCA)

7. Mississippi Hospital Association (MHA)

8. Joint Commission on Accreditation of Healthcare Organizations (JCAHO)

9. Regulatory boards for genetic counseling in any jurisdiction in the United States.

**History**
- *Source: 2025 Miss. Laws S.B. 2699, Miss. Leg. Reg. Session 2025 (eff. March 28, 2025)*

##### **15 Miss. Admin. Code Pt. 19, R. 13.4.4** Emergency and/or Hardship Exceptions {#sec-19-13.4.4 omnilex-key=us-ms-regs-official--title-15--19#13.4.4}

An exception to the continuing education requirements, including waiver of all or a portion of these requirements or the granting of an extension of time in which to complete these requirements, shall be granted to a licensee upon a finding of good cause by the Department following receipt of a written request for exception based upon emergency and/or hardship including, but are not limited to, the following:

1. Long-term personal illness or illness involving a close relative or person for whom the licensee has caregiving responsibilities;

2. Where the licensee can demonstrate that the required course(s) are not reasonably available; and

3. Other demonstrated economic, technological or legal hardships that substantially relate to the ability to perform or complete the continuing education requirements.

Subchapter 5 Professional Conduct Standards.

**History**
- *Source: 2025 Miss. Laws S.B. 2699, Miss. Leg. Reg. Session 2025 (eff. March 28, 2025)*

##### **15 Miss. Admin. Code Pt. 19, R. 13.5.1** Code of Ethics {#sec-19-13.5.1 omnilex-key=us-ms-regs-official--title-15--19#13.5.1}

1. All genetic counselors shall comply with the current Code of Ethics adopted by the National Society of Genetic Counselors except to the extent that they conflict with the laws of the state of Mississippi or the rules in this Chapter. If the Code of Ethics conflicts with state law or rules, the state law or rules govern the matter.

2. Each applicant or licensee is responsible for being familiar and complying with the Code of Ethics.

3. A copy of the Code of Ethics may be obtained by writing the National Society of Genetic Counselors, 401 N. Michigan Avenue, Chicago, IL 60611 or by visiting the website at www.nsgc.org.

**History**
- *Source: 2025 Miss. Laws S.B. 2699, Miss. Leg. Reg. Session 2025 (eff. March 28, 2025)*

##### **15 Miss. Admin. Code Pt. 19, R. 13.5.2** Unprofessional Conduct {#sec-19-13.5.2 omnilex-key=us-ms-regs-official--title-15--19#13.5.2}

“Unprofessional conduct” includes but is not limited to the following acts or practices:

1. Practicing, condoning, facilitating, collaborating with or engaging in discrimination against prospective or current clients, students, employees, supervisees, or research participants based on age, culture, disability, ethnicity, race, religion, sex, gender identity, sexual orientation, marital status/partnership, language preference, socioeconomic status, immigration status, or any basis proscribed by law;

2. Being convicted of any crime an essential element of which is larceny, embezzlement, obtaining money, property or credit by false pretenses or by means of a confidence game, dishonesty, fraud, misstatement or moral turpitude (e.g., unauthorized disclosure of patient information; improper alteration of a patient record; inappropriate or unlawful use of drugs or alcohol; assault, battery, or abuse of a patient; sexual contact with a patient; gross or repeated malpractice or negligence; improper professional financial dealings);

3. Performing, or pretending to be able to perform, professional services beyond one’s scope of practice and one’s competency as defined by

education, training, supervised experience, State and national professional credentials, and appropriate professional experience;

4. Procuring, attempting to procure or renewing a license by bribery or by fraudulent misrepresentation;

5. Aiding or assisting another person in violating any provision of the Act or this Chapter;

6. Misrepresenting educational background, training, credentials, competence, or staff memberships;

7. Exploiting a client for personal advantage, profit, or interest, including engaging in the sexual exploitation of clients;

8. Failing to maintain the confidentiality of any information received from a client, unless otherwise authorized or required by law;

9. Advertising in a matter that is deceptive, misleading, or false. Genetic counselors may only claim or imply professional credentials possessed and are responsible for correcting any misrepresentations of their credentials by others;

10. Submitting fraudulent claims for services to any person or entity including, but not limited to, health insurance companies or health service plans or third party payors;

11. Habitual or excessive use or addiction to alcohol, narcotics, stimulants, or any other chemical agent or drug which results in inability to practice with reasonable skill, judgment, or safety;

12. Receiving discipline by another governmental agency or unit of government, by any jurisdiction of the United States, or by a foreign nation, if at least one of the grounds for the discipline is the same or substantially equivalent to those set forth in the Act or this Chapter; and

13. Committing any other conduct that is violative of the NSGC Code of Ethics, adopted and incorporated by reference into this Chapter.

**History**
- *Source: 2025 Miss. Laws S.B. 2699, Miss. Leg. Reg. Session 2025 (eff. March 28, 2025)*

##### **15 Miss. Admin. Code Pt. 19, R. 13.6.1** Grounds for Discipline {#sec-19-13.6.1 omnilex-key=us-ms-regs-official--title-15--19#13.6.1}

The Board may deny, refuse to renew, suspend, revoke, or otherwise discipline a licensee, including issuing cease-and-desist orders, reprimands, fines, or probation, upon proof that the licensee has engaged

in unlawful or unprofessional conduct that endangers, or is likely to endanger, the health, welfare, or safety of the public. Grounds include, but are not limited to:

1. Obtaining or attempting to obtain a license by fraud, misrepresentation, or concealment of material facts;

2. Engaging in unprofessional conduct as defined by this Chapter or the Code of Ethics of the ABGC, ABMG, or NSGC;

3. Conviction of any crime other than a misdemeanor;

4. Violating any lawful order, rule, or regulation adopted by the Board; or

5. Violating any provision of this Chapter or the Act.

**History**
- *Source: 2025 Miss. Laws S.B. 2699, Miss. Leg. Reg. Session 2025 (eff. March 28, 2025)*

##### **15 Miss. Admin. Code Pt. 19, R. 13.6.2** Complaints {#sec-19-13.6.2 omnilex-key=us-ms-regs-official--title-15--19#13.6.2}

Any person may file a complaint against an LGC or a person practicing genetic counseling who is not otherwise exempt from the LGC Act. A person wishing to report a complaint or alleged violation against a licensee or person practicing genetic counseling may notify the Department. Complaints will be reviewed and evaluated by the Department. The Department shall determine whether the complaint alleges a possible violation of the Act or this Chapter. Each complaint received shall be logged, recording at a minimum the following information:

1. Name of the licensed individual;

2. Name of the complaining party, if known;

3. Date of complaint;

4. Brief description of complaint; and

5. Disposition.

**History**
- *Source: 2025 Miss. Laws S.B. 2699, Miss. Leg. Reg. Session 2025 (eff. March 28, 2025)*

##### **15 Miss. Admin. Code Pt. 19, R. 13.6.3** Investigations {#sec-19-13.6.3 omnilex-key=us-ms-regs-official--title-15--19#13.6.3}

1. The Board shall have full authority to investigate all applicants and licensees for compliance with the Act and this Chapter.

2. In conducting investigations, the Board may:

a. Issue subpoenas;

b. Examine witnesses;

c. Administer oaths; and

d. Seek injunctive relief against unlicensed practice.

3. The Department may commence an investigation whenever it has reason to believe that a violation of the Act or this Chapter has occurred.

4. If grounds for discipline are established, the Board may impose sanctions as provided under Rule 13.6.4 (Sanctions).

**History**
- *Source: 2025 Miss. Laws S.B. 2699, Miss. Leg. Reg. Session 2025 (eff. March 28, 2025)*

##### **15 Miss. Admin. Code Pt. 19, R. 13.6.4** Sanctions {#sec-19-13.6.4 omnilex-key=us-ms-regs-official--title-15--19#13.6.4}

Upon finding that a violation of the Act or these Rules has occurred, the Board may impose one or more of the following sanctions:

1. Denial or refusal to renew a license;

2. Suspension or revocation of a license;

3. Issuance of a cease-and-desist order;

4. Issuance of a warning, reprimand, or censure;

5. Placement of the licensee on probation with conditions, which may include:

a. Regular reporting to the Department;

b. Completion of continuing education to achieve competency; or

c. Compliance with other reasonable requirements or restrictions.

**History**
- *Source: 2025 Miss. Laws S.B. 2699, Miss. Leg. Reg. Session 2025 (eff. March 28, 2025)*

##### **15 Miss. Admin. Code Pt. 19, R. 13.6.5** Administrative Appeals {#sec-19-13.6.5 omnilex-key=us-ms-regs-official--title-15--19#13.6.5}

Any person aggrieved by a decision regarding the initial application for licensure, the renewal of licensure, or the imposition of sanctions shall have the right of administrative appeal as follows:

1. Right to Hearing.

a. Any applicant or licensee aggrieved by denial, refusal of renewal, suspension, revocation, or other disciplinary action may request a

hearing by filing a written request with the Department within fourteen (14) days of receipt of notice of the action.

b. If requested in writing within the specified time frame, a hearing shall be provided at which the applicant or licensee may show cause why the license should be granted, renewed, or not disciplined.

2. Scheduling and Procedure.

a. Upon receipt of a timely request, the State Health Officer shall appoint a Hearing Officer within thirty (30) days, who shall schedule the hearing at a time and place convenient to all parties.

b. Hearings shall be conducted in accordance with due process requirements and may be confidential unless otherwise required by law.

c. The licensee may appear personally, may be represented by counsel at their own expense, and shall have the right to present witnesses and evidence, and to cross-examine opposing witnesses.

d. A court reporter shall attend and transcribe the proceeding.

3. Burden of Proof. The burden shall rest with the applicant or licensee to demonstrate that the Department’s decision was:

a. Arbitrary or capricious;

b. Unsupported by substantial evidence;

c. Beyond the Department’s legal authority; or

d. In violation of statutory or constitutional rights.

4. Findings and Recommendation. Within sixty (60) days of the hearing, or such other period as determined during the hearing, the Hearing Officer shall submit written findings of fact and a recommendation for action on the license in question to the State Health Officer.

5. Final Decision. The State Health Officer shall decide what action will be taken on the recommendation within ten (10) days of its receipt. The decision of the State Health Officer shall constitute the Department’s Final Order. a. Written notice of the decision shall be provided to the applicant or licensee at the address or email on record with the Department. It is the duty of each licensee to maintain current contact information with the Department.

b. Right to Appeal Final Order. An appeal of the Final Order shall be in accordance with applicable state law. Failure to timely appeal shall render the decision final and unappealable.

**History**
- *Source: 2025 Miss. Laws S.B. 2699, Miss. Leg. Reg. Session 2025 (eff. March 28, 2025)*

##### **15 Miss. Admin. Code Pt. 19, R. 13.6.6** Summary Suspension {#sec-19-13.6.6 omnilex-key=us-ms-regs-official--title-15--19#13.6.6}

The Board may summarily suspend a license issued under this Chapter without a hearing, simultaneously with the filing of a formal complaint and notice of hearing, if the Board determines that:

1. The health, safety, or welfare of the general public is in immediate danger; or

2. The individual’s physical capacity to practice his/her profession is in issue; or

3. The individual’s mental capacity to practice his/her profession is in issue.

**History**
- *Source: 2025 Miss. Laws S.B. 2699, Miss. Leg. Reg. Session 2025 (eff. March 28, 2025)*

##### **15 Miss. Admin. Code Pt. 19, R. 13.6.7** Surrender of License {#sec-19-13.6.7 omnilex-key=us-ms-regs-official--title-15--19#13.6.7}

1. A license certificate issued under this Chapter is the property of the Board and must be surrendered on demand.

2. An LGC whose license is suspended or revoked or whose surrender of license with or without prejudice has been accepted by the Board shall promptly deliver the original license and current biennial registration to the Board.

**History**
- *Source: 2025 Miss. Laws S.B. 2699, Miss. Leg. Reg. Session 2025 (eff. March 28, 2025)*

##### **15 Miss. Admin. Code Pt. 19, R. 13.6.8** Suspension for Failure to Pay Child Support {#sec-19-13.6.8 omnilex-key=us-ms-regs-official--title-15--19#13.6.8}

In addition, the Department is authorized to suspend the license of any licensee for being out of compliance with an order for support, as defined in Section 93-11-153. The procedure for suspension of a license for being out of compliance with an order for support, and the procedure for reissuance or reinstatement of a license suspended for that purpose, and the payment of any fees for the reissuance or reinstatement of a license suspended for that purpose, shall be governed by Section 93-11-157 or 93-11-163, as the case may be. If there is any conflict between any provision of Section 93-11-157 or 93-11-163 and any provision of this Chapter, the provisions of Section 93-11-157 or 93-11-163, as the case may be, shall control.

Reg. Session 2025 (eff. March 28, 2025)

Subchapter 7 Criminal Offenses and Punishment.

**History**
- *Source: Miss. Code Ann. § 93-11-157, §93-11-163, and 2025 Miss. Laws S.B. 2699, Miss. Leg.*

##### **15 Miss. Admin. Code Pt. 19, R. 13.7.1** Offenses {#sec-19-13.7.1 omnilex-key=us-ms-regs-official--title-15--19#13.7.1}

It is a violation of the law for any person to:

1. Sell, fraudulently obtain or furnish any license, or aid or abet therein.

2. Use the title, “genetic counselor”, “licensed genetic counselor”, “gene counselor”, “genetic consultant”, “genetic associate” or any words, letters, abbreviations or insignia indicating or implying that a person holds a genetic counseling license to indicate the person using them has received a license from the Mississippi Department of Health.

3. Fail to notify the Board of the suspension, probation or revocation of any past or currently held licenses or certifications required to practice as a genetic counselor in this or any other jurisdiction.

4. Make false representations, impersonate, act as a proxy for another person, allow, or aid any person to impersonate him in connection with any examination or application for license or request to be examined or licensed.

5. Make a material, false statement in an application for licensure, or in a response to any inquiry by the Department or the Board.

6. Otherwise violate any provisions of the Act, or regulations of the Board.

**History**
- *Source: 2025 Miss. Laws S.B. 2699, Miss. Leg. Reg. Session 2025 (eff. March 28, 2025)*

##### **15 Miss. Admin. Code Pt. 19, R. 13.7.2** Punishment {#sec-19-13.7.2 omnilex-key=us-ms-regs-official--title-15--19#13.7.2}

1. Any person who violates any provision of these regulations, upon conviction, shall be guilty of a misdemeanor and shall be fined not more than One Thousand Dollars ($1,000.00) for each violation, or imprisoned in the county jail for a period not exceeding six (6) months, or both.

2. Any person who knowingly shall make a material false statement in his application for license under these regulations or in response to any inquiry by the department or the board shall be fined not less than One Hundred Dollars ($100.00) nor more than Five Hundred Dollars ($500.00) or imprisoned for not less than ten (10) days nor more than sixty (60) days, or both such fine and imprisonment.

CHAPTER 14 MUSIC THERAPISTS

**History**
- *Source: 2025 Miss. Laws S.B. 2699, Miss. Leg. Reg. Session 2025 (eff. March 28, 2025)*

##### **15 Miss. Admin. Code Pt. 19, R. 14.1.1** Legal Authority {#sec-19-14.1.1 omnilex-key=us-ms-regs-official--title-15--19#14.1.1}

2025 Miss. Laws S.B. 2741 § 1-10, Mississippi Legislature Regular Session 2025 (eff. July 1, 2025) provides for the licensure of professional music therapists be the Mississippi State Department of Health, authorizing the Mississippi State Board of Health to adopt, amend, promulgate and enforce such rules, regulations and standards governing the professional licensure of music therapists as may be necessary to further the accomplishment of that purposes.

**History**
- *Source: 2025 Miss. Laws S.B. 2741, Miss. Leg. Reg. Session 2025 (eff. July 1, 2025)*

##### **15 Miss. Admin. Code Pt. 19, R. 14.1.2** Purpose {#sec-19-14.1.2 omnilex-key=us-ms-regs-official--title-15--19#14.1.2}

The purpose of these regulations is to safeguard the public’s health, safety, and welfare by establishing minimum qualifications and creating exclusive titles corresponding to the level of qualifications for individuals who wish to offer music therapy to the public. Further, in order to ensure the highest degree of professional conduct by those engaged in the profession of music therapy, it is the purpose of these regulations to impose disciplinary sanctions, be they civil or criminal, against persons who do not meet or adhere to the procedures, qualifications, and standards set out in this Chapter.

The intent of this Chapter is to recognize that music therapy affects public health, safety and welfare and that the practice of music therapy should be subject to regulation; to assure the highest degree of professional conduct on the part of music therapists; to guarantee the availability of music therapy services provided by a qualified professional to persons in need of those services; and to protect the public from the practice of music therapy by unqualified individuals.

Rule 14.1.3

Licensure Required. 1. A license issued under this Chapter is required to engage in the professional practice of music therapy.

2. Beginning on January 1, 2026, no person without a license as a professional music therapist shall use the title “licensed professional music therapist,” “LPMT” or similar title that implies that the person is a professional music therapist.

Rule 14.1.4

Definitions. The following terms shall have the meaning set forth below, unless the context otherwise requires:

1. Advisory committee means the means the Music Therapy Advisory Committee (“Council”).

2. Board means the State Board of Health.

3. Board-certified Music Therapist means an individual who holds current board certification from the Certification Board for Music Therapists.

4. Department means the State Department of Health.

5. Director means the Executive Director of the State Department of Health or his or her designee.

6. Licensed Professional Music Therapist (LPMT) means a person licensed to practice music therapy under this Chapter.

7. Music Therapy means the clinical and evidence-based use of music interventions to accomplish individualized goals for people of all ages and ability levels within a therapeutic relationship by a board-certified music therapist. Music therapists develop music therapy treatment plans specific to the needs and strengths of the client, who may be seen individually or in groups. Music therapy treatment plans are individualized for each client. The goals, objectives and potential strategies of the music therapy services are appropriate for the client and setting. The music therapy interventions may include, but are not limited to, music improvisation, receptive music listening, song writing, lyric discussion, music and imagery, singing, music performance, learning through music, music combined with other arts, music-assisted relaxation, music-based patient education, electronic music technology, adapted music intervention and movement to music. The practice of music therapy does not include the screening, diagnosis or assessment of any physical, mental or communication disorder. The term “music therapy” may include, but is not limited to:

a. Accepting referrals for music therapy services from medical, developmental, mental health or education professionals, family members, clients, caregivers or others involved and authorized with provision of client services;

b. Conducting a music therapy assessment of a client to determine if treatment is indicated. If treatment is indicated, the licensee collects systematic, comprehensive and accurate information to determine the appropriateness and type of music therapy services to provide for the client;

c. Developing an individualized music therapy treatment plan for the client that is based upon the results of the music therapy assessment. The music therapy treatment plan includes individualized goals and objectives that focus on the assessed needs and strengths of the client

and specify music therapy approaches and interventions to be used to address these goals and objectives;

d. Implementing an individualized music therapy treatment plan that is consistent with any other developmental, rehabilitative, habilitative, medical, mental health, preventive, wellness care or educational services being provided to the client;

e. Evaluating the client's response to music therapy and the music therapy treatment plan, documenting change and progress and suggesting modifications, as appropriate;

f. Developing a plan for determining when the provision of music therapy services is no longer needed in collaboration with the client, physician or other provider of health care or education of the client, family members of the client and any other appropriate person upon whom the client relies for support;

g. Minimizing any barriers to ensure that the client receives music therapy services in the least restrictive environment;

h. Collaborating with and educating the client and the family, caregiver of the client or any other appropriate person regarding the needs of the client that are being addressed in music therapy and the manner in which the music therapy treatment addresses those needs; and

i. Using appropriate knowledge and skills to inform practice, including use of research, reasoning and problem-solving skills to determine appropriate actions in the context of each specific clinical setting.

8. License shall mean the document of licensure issued by the Board.

9. Licensee means a Licensed Professional Music Therapist licensed under the provisions of this Chapter.

10. Association shall mean the Southeastern Region of the American Music Therapy Association (SER-AMTA).

11. Accredited Institution means a university or college accredited by a nationally recognized accrediting agency of institutions of higher education, or an institution and clinical program approved by the American Music Therapy Association.

**History**
- *Source: 2025 Miss. Laws S.B. 2741, Miss. Leg. Reg. Session 2025 (eff. July 1, 2025)*
- *Source: 2025 Miss. Laws S.B. 2741, Miss. Leg. Reg. Session 2025 (eff. July 1, 2025)*
- *Source: 2025 Miss. Laws S.B. 2741, Miss. Leg. Reg. Session 2025 (eff. July 1, 2025)*

##### **15 Miss. Admin. Code Pt. 19, R. 14.1.5** Publication {#sec-19-14.1.5 omnilex-key=us-ms-regs-official--title-15--19#14.1.5}

The Department shall make available, upon request and payment of a fee, a list of the names and addresses of all persons licensed by the Department as Music Therapists, and a list of all persons whose licenses have been suspended, revoked, denied renewal, put on probationary status, censured, or reprimanded during the current licensure term.

Subchapter 2 Licensure.

**History**
- *Source: 2025 Miss. Laws S.B. 2741, Miss. Leg. Reg. Session 2025 (eff. July 1, 2025)*

##### **15 Miss. Admin. Code Pt. 19, R. 14.2.1** Qualifications for Licensure {#sec-19-14.2.1 omnilex-key=us-ms-regs-official--title-15--19#14.2.1}

To obtain a license under this Chapter, an applicant shall:

1. Submit an online application;

2. Pay the license fee in the amount and manner required;

3. Provide proof that Applicant:

a. Is at least eighteen (18) years of age;

b. Holds a bachelor’s degree or higher in music therapy, or its equivalent, including clinical training hours, from a music therapy program within an accredited college or university; and

c. Has passed the examination for board certification offered by the Certification Board for Music Therapists or any successor organization or provides proof of being transitioned into board certification, and provides proof that the applicant is currently a board-certified music therapist;

4. Be in good standing based on a review of the applicant’s music therapy licensure history in other jurisdictions, including a review of any alleged misconduct or neglect in the practice of music therapy on the part of the applicant; and

5. Submit Mississippi State Department of Health comprehensive background check.

**History**
- *Source: 2025 Miss. Laws S.B. 2741, Miss. Leg. Reg. Session 2025 (eff. July 1, 2025)*

##### **15 Miss. Admin. Code Pt. 19, R. 14.2.2** Licensure by Reciprocity or Endorsement; Qualifications {#sec-19-14.2.2 omnilex-key=us-ms-regs-official--title-15--19#14.2.2}

1. Reciprocity. The Board may issue a license by reciprocity to an applicant who provides proof that he or she is licensed and in good standing as a music therapist in another state, territory or jurisdiction of the United States if the

licensure requirements in that state, territory or jurisdiction are substantially the same as the requirements imposed by the Act and this Part.

a. The issuance of a license by reciprocity to a military-trained applicant or military spouse shall be subject to the provisions of Miss. Code § 73- 50-1.

b. The issuance of a license by reciprocity to a person who establishes residence in this state shall be subject to the provisions of Miss. Code § 73-50-2.

2. Endorsement. An individual who does not otherwise qualify for licensure under this Part but who has practiced music therapy for ten (10) or more years prior to July 1, 2025 with at least five (5) years practice immediately preceding July 1, 2025, may apply for licensure by endorsement under this Rule. The Board may issue a license by endorsement to an applicant who:

a. Submits an online application prior to January 1, 2026;

b. Pays the application fee in the amount and manner required by the Department;

c. Provides proof that he/she holds a bachelor’s degree or higher in music therapy, or its equivalent, including clinical training hours, from a music therapy program within an accredited college or university;

d. Completes a Mississippi State Department of Health comprehensive background check.

**History**
- *Source: 2025 Miss. Laws S.B. 2741, Miss. Leg. Reg. Session 2025 (eff. July 1, 2025)*

##### **15 Miss. Admin. Code Pt. 19, R. 14.2.3** Biennial License Renewal Required {#sec-19-14.2.3 omnilex-key=us-ms-regs-official--title-15--19#14.2.3}

1. Licenses issued under this Chapter shall expire two (2) years from the date of issuance.

2. The licensure period shall be construed as December 1 through November 30 of even- numbered years.

3. Licenses issued under these regulations shall expire and become invalid at midnight of the expiration date.

**History**
- *Source: 2025 Miss. Laws S.B. 2741, Miss. Leg. Reg. Session 2025 (eff. July 1, 2025)*

##### **15 Miss. Admin. Code Pt. 19, R. 14.2.4** Procedure for Renewal of Licensure {#sec-19-14.2.4 omnilex-key=us-ms-regs-official--title-15--19#14.2.4}

Approximately sixty (60) days prior to the expiration of a license, the Department shall send an electronic renewal

notice to the email address registered by the licensee with the Department. For purposes of renewal, prior to expiration of the license, an applicant shall:

1. Complete the online renewal form;

2. Submit proof of continuing education credit as detailed in Subchapter 4 of these regulations; and

3. Pay the renewal fee online.

**History**
- *Source: 2025 Miss. Laws S.B. 2741, Miss. Leg. Reg. Session 2025 (eff. July 1, 2025)*

##### **15 Miss. Admin. Code Pt. 19, R. 14.2.5** Failure to Renew {#sec-19-14.2.5 omnilex-key=us-ms-regs-official--title-15--19#14.2.5}

1. Responsibility for Renewal. Each licensee is responsible for renewing their license prior to its expiration. Failure to receive a renewal notice shall not relieve the licensee of this responsibility.

2. Forfeiture. A license shall be deemed forfeited if the licensee fails to submit a complete renewal application and pay the renewal fee prior to the license’s expiration date.

3. Reinstatement of Forfeited License.

a. A forfeited license may be reinstated if the licensee submits a reinstatement application and pays both the renewal fee and the reinstatement fee.

b. The reinstatement application must be received by the Department within one (1) year of the license’s expiration date.

4. Termination. If a forfeited license is not reinstated within one (1) year of expiration, the license shall be automatically terminated. The individual must then apply as a new applicant and meet all requirements for initial licensure.

**History**
- *Source: 2025 Miss. Laws S.B. 2741, Miss. Leg. Reg. Session 2025 (eff. July 1, 2025)*

##### **15 Miss. Admin. Code Pt. 19, R. 14.2.6** Inactive Status {#sec-19-14.2.6 omnilex-key=us-ms-regs-official--title-15--19#14.2.6}

Upon written request of a licensee, the department may place an active license on an inactive status subject to an inactive status fee established by the board. The licensee, upon request and payment of the inactive license fee, may continue on inactive status for a period up to two (2) years. An inactive license may be reactivated at any time by making a written request to the department and by fulfilling requirements established by the department.

**History**
- *Source: 2025 Miss. Laws S.B. 2741, Miss. Leg. Reg. Session 2025 (eff. July 1, 2025)*

##### **15 Miss. Admin. Code Pt. 19, R. 14.2.7** Abandonment {#sec-19-14.2.7 omnilex-key=us-ms-regs-official--title-15--19#14.2.7}

An application for licensure or renewal shall be considered abandoned if the applicant fails to submit all required materials to the Department within six (6) months of the initial submission date.

**History**
- *Source: 2025 Miss. Laws S.B. 2741, Miss. Leg. Reg. Session 2025 (eff. July 1, 2025)*

##### **15 Miss. Admin. Code Pt. 19, R. 14.2.8** Notification of Denial {#sec-19-14.2.8 omnilex-key=us-ms-regs-official--title-15--19#14.2.8}

Written notice will be provided to all applicants regarding denial of an application for licensure or renewal. Such notice shall contain the reason(s) therefore and provide the applicant an opportunity to cure the deficiency for a second review by the Department.

**History**
- *Source: 2025 Miss. Laws S.B. 2741, Miss. Leg. Reg. Session 2025 (eff. July 1, 2025)*

##### **15 Miss. Admin. Code Pt. 19, R. 14.2.9** Exemptions from Licensure {#sec-19-14.2.9 omnilex-key=us-ms-regs-official--title-15--19#14.2.9}

The provisions of the Act and this Part shall not apply to the following:

1. Any person licensed, certified or regulated under the laws of this state in another profession or occupation, including physicians, psychologists, psychoanalysts, registered nurses, marriage and family therapists, social workers, occupational therapy practitioners, professional or rehabilitation counselors, speech-language pathologists or audiologists or personnel supervised by a licensed professional, performing work, including the use of music, incidental to the practice of his or her licensed, certified or regulated profession or occupation, if that person does not represent himself or herself as a professional music therapist; or

2. Any person whose training and national certification attests to the individual’s preparation and ability to practice his or her certified profession or occupation, if that person does not represent himself or herself as a professional music therapist; or

3. Any practice of music therapy as an integral part of a program of study for students enrolled in an accredited music therapy program, if the student does not represent himself or herself as a professional music therapist; or

4. Any person who practices music therapy under the supervision of a licensed professional music therapist, if the person does not represent himself or herself as a professional music therapist.

Subchapter 3 Fees.

**History**
- *Source: 2025 Miss. Laws S.B. 2741, Miss. Leg. Reg. Session 2025 (eff. July 1, 2025)*

##### **15 Miss. Admin. Code Pt. 19, R. 14.3.1** Schedule of Fees {#sec-19-14.3.1 omnilex-key=us-ms-regs-official--title-15--19#14.3.1}

The following non-refundable fees apply to this Part and are payable to the Department

1. Application and Initial Licensure Fee...............................................$100.00

2. Licensure Fee ...................................................................................$150.00

3. Renewal Fee .....................................................................................$150.00

4. Late Renewal Fee .............................................................................$100.00

5. Reinstatement Fee ............................................................................$100.00

6. Verification Fee..................................................................................$25.00

Subchapter 4 Continuing Education.

**History**
- *Source: 2025 Miss. Laws S.B. 2741, Miss. Leg. Reg. Session 2025 (eff. July 1, 2025)*

##### **15 Miss. Admin. Code Pt. 19, R. 14.4.1** Requirements {#sec-19-14.4.1 omnilex-key=us-ms-regs-official--title-15--19#14.4.1}

Licensed music therapists shall comply with the following continuing education rules as a prerequisite to licensure renewal:

1. General Requirement. Licensed music therapists who are not certified and in good standing with the Certification Board for Music Therapists (CBMT) shall complete forty (40) clock hours of continuing education during each licensure term.

2. Ethics Requirement. Each licensee shall complete at least one (1) contact hour in an ethics course related to the practice of music therapy. Acceptable ethics topics include, but are not limited to, cultural competency, end-of- life care, ethical supervision, sexual harassment, confidentiality (HIPAA), informed consent, business practices, academic integrity, citizenship, and client/civil rights.

3. Certified Music Therapists. Licensees certified and in good standing with CBMT may satisfy the continuing education requirement by submitting proof, in form and content acceptable to the Department, of compliance with CBMT continuing education standards.

4. Prorated Requirement for New Licensees. Individuals licensed during a licensure term shall complete continuing education hours on a prorated basis. Written notice of the required hours shall be provided at the time of licensure.

5. Failure to Comply.

a. A licensee who fails to complete the required continuing education hours shall be issued a CE probationary license for one (1) licensure term.

b. Failure to complete the required hours during the probationary term shall result in license revocation.

6. Limitation on Probationary Status. CE probationary status may be granted only once and is limited to a single licensure period. A licensee shall not be eligible for probationary status in consecutive or subsequent renewal cycles.

7. Reinstatement. A license revoked for failure to meet continuing education requirements may be reinstated at the discretion of the Department. Reinstatement shall require payment of the renewal fee and the late renewal/reinstatement fee as set forth in Subchapter 3 of these regulations.

**History**
- *Source: 2025 Miss. Laws S.B. 2741, Miss. Leg. Reg. Session 2025 (eff. July 1, 2025)*

##### **15 Miss. Admin. Code Pt. 19, R. 13.4.2** Content Criteria {#sec-19-13.4.2 omnilex-key=us-ms-regs-official--title-15--19#13.4.2}

The content must apply to the field of music therapy and performance and must be designed to meet one of the following goals:

1. Update knowledge and skills required for competent performance beyond entry level as described in current legislation and regulations;

2. Allow the licensee to enhance his knowledge and skills;

3. Provide opportunities for interdisciplinary learning;

4. Extend limits of professional capabilities and opportunities; and

5. Facilitate personal contributions to the advancement of the profession.

**History**
- *Source: 2025 Miss. Laws S.B. 2741, Miss. Leg. Reg. Session 2025 (eff. July 1, 2025)*

##### **15 Miss. Admin. Code Pt. 19, R. 13.4.3** Sources of Continuing Education {#sec-19-13.4.3 omnilex-key=us-ms-regs-official--title-15--19#13.4.3}

Continuing education units may be accrued through attendance at programs sponsored or approved for continuing education by the following groups:

1. The Certification Board for Music Therapists (CBMT);

2. The American Music Therapy Association (AMTA);

3. Southeastern Region of the American Music Therapy Association (SER- AMTA); or

4. Regulatory boards for music therapy in any jurisdiction in the United States.

Subchapter 5 Professional Standards.

**History**
- *Source: 2025 Miss. Laws S.B. 2741, Miss. Leg. Reg. Session 2025 (eff. July 1, 2025)*

##### **15 Miss. Admin. Code Pt. 19, R. 14.5.1** 1 {#sec-19-14.5.1 omnilex-key=us-ms-regs-official--title-15--19#14.5.1}

Before an LPMT provides music therapy services to a client for an identified clinical or developmental need, the licensee shall review the client’s diagnosis, treatment needs and treatment plan with the health care providers involved in the client’s care.

2. Before an LPMT provides music therapy services to a student for an identified educational need in a special education setting, the licensee shall review with the individualized family service plan or individualized education program team the student's diagnosis, treatment needs and treatment plan.

3. During the provision of music therapy services to a client, the LPMT shall collaborate, as applicable, with the client’s treatment team, including the client’s physician, psychologist, licensed clinical social worker or other mental health professional.

4. During the provision of music therapy services to a client with a communication disorder, the LPMT shall collaborate and discuss the music therapy treatment plan with the client’s audiologist or speech-language pathologist so that a music therapist may work with the client and address communication skills.

5. When providing educational or health care services, an LPMT may not replace the services provided by an audiologist, a speech-language pathologist or an occupational therapy practitioner. Unless authorized to practice speech-language pathology, music therapists may not evaluate, examine, instruct or counsel on speech, language, communication and swallowing disorders and conditions. An individual licensed as a professional music therapist may not represent to the public that the individual is authorized to treat a communication disorder. This does not prohibit an LPMT from representing to the public that the individual may work with clients who have a communication disorder and address communication skills.

**History**
- *Source: 2025 Miss. Laws S.B. 2741, Miss. Leg. Reg. Session 2025 (eff. July 1, 2025)*

##### **15 Miss. Admin. Code Pt. 19, R. 13.5.2** Unprofessional Conduct {#sec-19-13.5.2 omnilex-key=us-ms-regs-official--title-15--19#13.5.2}

“Unprofessional conduct” includes but is not limited to the following acts or practices:

1. Practicing, condoning, facilitating, collaborating with or engaging in discrimination against prospective or current clients, students, employees, supervisees, or research participants based on age, culture, disability, ethnicity, race, religion, sex, gender identity, sexual orientation, marital

status/partnership, language preference, socioeconomic status, immigration status, or any basis proscribed by law;

2. Being convicted of any crime an essential element of which is larceny, embezzlement, obtaining money, property or credit by false pretenses or by means of a confidence game, dishonesty, fraud, misstatement or moral turpitude (e.g., unauthorized disclosure of patient information; improper alteration of a patient record; inappropriate or unlawful use of drugs or alcohol; assault, battery, or abuse of a patient; sexual contact with a patient; gross or repeated malpractice or negligence; improper professional financial dealings);

3. Performing, or pretending to be able to perform, professional services beyond one’s scope of practice and one’s competency as defined by education, training, supervised experience, State and national professional credentials, and appropriate professional experience;

4. Procuring, attempting to procure or renewing a license by bribery or by fraudulent misrepresentation;

5. Aiding or assisting another person in violating any provision of the Act or this Chapter;

6. Misrepresenting educational background, training, credentials, competence, or staff memberships;

7. Exploiting a client for personal advantage, profit, or interest, including engaging in the sexual exploitation of clients;

8. Failing to maintain the confidentiality of any information received from a client, unless otherwise authorized or required by law;

9. Advertising in a matter that is deceptive, misleading, or false. LPMTs may only claim or imply professional credentials possessed and are responsible for correcting any misrepresentations of their credentials by others;

10. Submitting fraudulent claims for services to any person or entity including, but not limited to, health insurance companies or health service plans or third party payors;

11. Habitual or excessive use or addiction to alcohol, narcotics, stimulants, or any other chemical agent or drug which results in inability to practice with reasonable skill, judgment, or safety; and

12. Receiving discipline by another governmental agency or unit of government, by any jurisdiction of the United States, or by a foreign nation,

if at least one of the grounds for the discipline is the same or substantially equivalent to those set forth in this Chapter.

**History**
- *Source: 2025 Miss. Laws S.B. 2741, Miss. Leg. Reg. Session 2025 (eff. July 1, 2025)*

##### **15 Miss. Admin. Code Pt. 19, R. 14.6.1** Grounds for Discipline {#sec-19-14.6.1 omnilex-key=us-ms-regs-official--title-15--19#14.6.1}

Individuals who are licensed may, at the discretion of the Board, have their licenses suspended, revoked, or denied if the Board determines that the individual is guilty of any of the following:

1. Ineligibility for licensure, including, but not limited to, falsification of information submitted for licensure or failure to maintain status as a board- certified music therapist;

2. Failure to pay fees when due;

3. Failure to provide requested information in a timely manner;

4. Conviction of a felony;

5. Conviction of any crime that reflects an inability to practice music therapy with due regard for the health and safety of clients and patients, or with due regard for the truth in filing claims with Medicare, Medicaid or any third- party payor;

6. Inability or failure to practice music therapy with reasonable skill and consistent with the welfare of clients and patients, including, but not limited to, negligence in the practice of music therapy; intoxication; incapacity; and abuse of or engaging in sexual contact with a client or patient;

7. Disciplinary action by another jurisdiction;

8. Violating any lawful order, rule, or regulation adopted by the Board; and/or

9. Violating any provision of this Chapter.

**History**
- *Source: 2025 Miss. Laws S.B. 2741, Miss. Leg. Reg. Session 2025 (eff. July 1, 2025)*

##### **15 Miss. Admin. Code Pt. 19, R. 14.6.2** Complaints {#sec-19-14.6.2 omnilex-key=us-ms-regs-official--title-15--19#14.6.2}

Any person may file a complaint against an LPMT or a person practicing music therapy who is not otherwise exempt from the Act and this Chapter. A person wishing to report a complaint or alleged violation of the rules in this Chapter may notify the Department. Complaints shall be reviewed and evaluated by the Department to determine whether they state a possible violation. Each complaint received shall be logged, recording at a minimum the following information:

1. Name of the licensed individual;

2. Name of the complaining party, if known;

3. Date of complaint;

4. Brief description of complaint; and

5. Disposition.

**History**
- *Source: 2025 Miss. Laws S.B. 2741, Miss. Leg. Reg. Session 2025 (eff. July 1, 2025)*

##### **15 Miss. Admin. Code Pt. 19, R. 14.6.3** Investigations {#sec-19-14.6.3 omnilex-key=us-ms-regs-official--title-15--19#14.6.3}

1. The Board is authorized to conduct investigations into allegations of misconduct under this Chapter and may commence an investigation whenever it has reason to believe that a violation of the Act or this Chapter has occurred.

2. If grounds for discipline are established, the Board may impose sanctions as provided under Rule 14.6.4 (Sanctions).

**History**
- *Source: 2025 Miss. Laws S.B. 2741, Miss. Leg. Reg. Session 2025 (eff. July 1, 2025)*

##### **15 Miss. Admin. Code Pt. 19, R. 14.6.4** Sanctions {#sec-19-14.6.4 omnilex-key=us-ms-regs-official--title-15--19#14.6.4}

Upon finding that a violation of the Act or rules in this Chapter has occurred, the Board may impose one or more of the following sanctions:

1. Denial or refusal to renew a license;

2. Suspension or revocation of a license;

3. Issuance of a warning or reprimand;

4. Placement of the licensee on probation with conditions, which may include:

a. Regular reporting to the Department;

b. Completion of continuing education to achieve competency; or

c. Compliance with other reasonable requirements or restrictions; and/or

5. A fine of not less than One Hundred Dollars ($100.00) or more than One Thousand Dollars ($1,000.00) for each violation.

**History**
- *Source: 2025 Miss. Laws S.B. 2741, Miss. Leg. Reg. Session 2025 (eff. July 1, 2025)*

##### **15 Miss. Admin. Code Pt. 19, R. 14.6.5** Administrative Appeals {#sec-19-14.6.5 omnilex-key=us-ms-regs-official--title-15--19#14.6.5}

Any person aggrieved by a decision regarding the initial application for licensure, the renewal of licensure, or the imposition of sanctions shall have the right of administrative appeal as follows:

1. Right to Hearing.

a. Any applicant or licensee aggrieved by denial, refusal of renewal, suspension, revocation, or other disciplinary action may request a hearing by filing a written request with the Department within fourteen (14) days of receipt of notice of the action.

b. If requested in writing within the specified time frame, a hearing shall be provided at which the applicant or licensee may show cause why the license should be granted, renewed, or not disciplined.

2. Scheduling and Procedure.

a. Upon receipt of a timely request, the State Health Officer shall appoint a Hearing Officer within thirty (30) days, who shall schedule the hearing at a time and place convenient to all parties.

b. Hearings shall be conducted in accordance with due process requirements and may be confidential unless otherwise required by law.

c. The licensee may appear personally, may be represented by counsel at their own expense, and shall have the right to present witnesses and evidence, and to cross-examine opposing witnesses.

d. A court reporter shall attend and transcribe the proceeding.

3. Burden of Proof. The burden shall rest with the applicant or licensee to demonstrate that the Department’s decision was:

a. Arbitrary or capricious;

b. Unsupported by substantial evidence;

c. Beyond the Department’s legal authority; or

d. In violation of statutory or constitutional rights.

4. Findings and Recommendation. Within sixty (60) days of the hearing, or such other period as determined during the hearing, the Hearing Officer shall submit written findings of fact and a recommendation for action on the license in question to the State Health Officer.

5. Final Decision. The State Health Officer shall decide what action will be taken on the recommendation within ten (10) days of its receipt. The decision of the State Health Officer shall constitute the Department’s Final Order. a. Written notice of the decision shall be provided to the applicant or licensee at the address or email on record with the Department. It is the duty of each licensee to maintain current contact information with the Department.

b. Right to Appeal Final Order. An appeal of the Final Order shall be in accordance with applicable state law. Failure to timely appeal shall render the decision final and unappealable.

**History**
- *Source: 2025 Miss. Laws S.B. 2741, Miss. Leg. Reg. Session 2025 (eff. July 1, 2025)*

##### **15 Miss. Admin. Code Pt. 19, R. 14.6.6** Summary Suspension {#sec-19-14.6.6 omnilex-key=us-ms-regs-official--title-15--19#14.6.6}

The Board may summarily suspend a license issued under this Part without a hearing, simultaneously with the filing of a formal complaint and notice of hearing, if the Board determines that:

1. The health, safety, or welfare of the general public is in immediate danger; or

2. The individual’s physical capacity to practice his/her profession is in issue; or

3. The individual’s mental capacity to practice his/her profession is in issue.

**History**
- *Source: 2025 Miss. Laws S.B. 2741, Miss. Leg. Reg. Session 2025 (eff. July 1, 2025)*

##### **15 Miss. Admin. Code Pt. 19, R. 14.6.7** Suspension for Failure to Pay Child Support {#sec-19-14.6.7 omnilex-key=us-ms-regs-official--title-15--19#14.6.7}

In addition, the Department is authorized to suspend the license of any licensee for being out of compliance with an order for support, as defined in Section 93-11-153. The procedure for suspension of a license for being out of compliance with an order for support, and the procedure for reissuance or reinstatement of a license suspended for that purpose, and the payment of any fees for the reissuance or reinstatement of a license suspended for that purpose, shall be governed by Section 93-11-157 or 93-11-163, as the case may be. If there is any conflict between any provision of Section 93-11-157 or 93-11-163 and any provision of this Part, the provisions of Section 93-11-157 or 93-11-163, as the case may be, shall control.

Reg. Session 2025 (eff. July 1, 2025)

**History**
- *Source: Miss. Code Ann. § 93-11-157, §93-11-163, and 2025 Miss. Laws S.B. 2741, Miss. Leg.*

#### **Chapter 15** COMMUNITY HEALTH WORKERS Subchapter 1 — General Rule 15.1.1 Legal Authority. The Mississippi Community Health Worker Certification Program, established by Miss. Code Ann. § 41-140-1 et seq., as enacted by 2025 Miss. Laws H.B. 1401, §§ 1–4, Mississippi Legislature Regular Session 2025 (eff. July 1, 2025), authorizes the Mississippi State Board of Health to adopt, amend, promulgate, and enforce such rules, regulations, and standards governing the certification of community health workers as may be necessary to further the accomplishment of the purpose of this act. The Mississippi State Department of Health shall administer the Community Health Worker Certification Program and may adopt policies, procedures, and forms necessary to implement this Chapter. Moreover, the Department may issue guidance, policies, and interpretive statements consistent with this Chapter.

##### **15 Miss. Admin. Code Pt. 19, R. 15.1.2** Purpose {#sec-19-15.1.2 omnilex-key=us-ms-regs-official--title-15--19#15.1.2}

These regulations safeguard public health, safety, and welfare by establishing minimum qualifications, standards of practice, and disciplinary procedures for Certified Community Health Workers (CCHWs). A CCHW is a frontline public health paraprofessional who is a trusted member of, or has an unusually close understanding of, the community served and who applies the Core Competencies defined in Rule 15.1.3 to provide non-clinical community health services, including outreach, health education, system navigation, advocacy, and support services. These regulations govern the use of the title “Community Health Worker” and “Certified Community Health Worker” and do not prohibit individuals from performing similar non-clinical services under other job titles as provided in this Chapter. These regulations do not create a clinical license and do not authorize the practice of any profession requiring licensure under Mississippi law.

**History**
- *Source: Miss. Code Ann. § 41-140-1 et seq.*

##### **15 Miss. Admin. Code Pt. 19, R. 15.1.3** Definitions {#sec-19-15.1.3 omnilex-key=us-ms-regs-official--title-15--19#15.1.3}

The following terms shall have the meaning set forth below for purposes of this Part, unless the context otherwise requires: A. Applicant means an individual applying to be certified or recertified as a community health worker. B. Board means the State Board of Health. C. Care Team means a coordinated group of individuals, which may include Licensed Healthcare Providers, public health professionals, and support personnel, working collaboratively to deliver services to a client or population.

D. Certificate means the document issued by the Department to a qualified applicant evidencing certification as a Certified Community Health Worker. E. Certification means the process by which the Department grants recognition and use of a credential to individuals who are certified community health workers. F. Certified Community Health Worker (CCHW) means an individual who holds a current, valid certification issued by the Department in accordance with Miss. Code Ann. § 41-140-1 et seq. and this Chapter. The terms “Certified Community Health Worker,” “CCHW,” “Community Health Worker,” and “CHW” are synonymous for purposes of this Chapter and refer to the same individual. The titles “Certified Community Health Worker,” “CCHW,” “Community Health Worker,” and “CHW” are protected titles under Mississippi law and may be used only by individuals holding a current, valid certification issued by the Department. G. CHW Specialty Designation means a notation recorded on a Certified Community Health Worker certificate and in the Department registry indicating successful completion of a Department-approved specialty training pathway established under Rule 15.4.1(C). A CHW Specialty Designation is not a separate certification, license, or credential and does not expand the scope of practice established under Rule 15.1.5. H. Community Health Worker Services means non-clinical services delivered using the Core Competencies defined in this Chapter. Community Health Worker Services do not include diagnosing, prescribing, providing clinical treatment, or providing psychotherapy, except as otherwise authorized under other Mississippi professional licensure laws. I. Core Competencies means the knowledge and skills that Certified Community Health Workers are expected to demonstrate to carry out the missions and goals as defined by the Department in this Chapter, and includes: 1. Communication; 2. Use of public health concepts and approaches; 3. Organizational and community outreach; 4. Advocacy and community capacity building; 5. Care coordination and system navigation; 6. Health coaching; 7. Documentation, reporting, and outcome management; and

8. Legal, ethical, and professional conduct. J. Days means calendar days unless otherwise specified in this Chapter. K. Department means the Mississippi State Department of Health. L. Department-Approved Competency-Based Training Program means an education and training program approved by the Department under Subchapters 4 and 7 that includes a curriculum aligned with the Department’s Core Competencies and includes a documented method for assessing competency. M. Direct Services means non-clinical assistance and support services that do not require a professional license under Mississippi law (e.g., basic health education, screening for basic needs, support with appointments, reinforcement of care plans, and delivery of supplies), and that are performed within the CCHW scope of activities and training. N. Endorsement means the issuance of a certificate by the Department to an applicant who holds a current certification in good standing as a community health worker from another U.S. jurisdiction or a Department-recognized private certifying body, in accordance with Subchapter 2. O. Grandfathering means a time-limited pathway to certification, in lieu of standard certification requirements, based on an applicant’s documented prior practice and experience as a community health worker before January 1, 2026, in accordance with Subchapter 2. P. Inactive, Lapsed, and Reinstatement refer to certificate statuses and processes as defined and governed in Subchapter 2. Q. Licensed Healthcare Provider means an individual who is licensed, certified, or otherwise authorized to provide clinical health care services under the laws of the State of Mississippi and who is acting within the scope of such licensure or authorization. R. Paraprofessional means an individual who is trained to perform non-clinical services in support of licensed or credentialed professionals and who does not independently diagnose, treat, or provide clinical care. S. Perinatal Community Health Worker (PCHW) means a Certified Community Health Worker who has successfully completed the Department-approved Perinatal Community Health Worker specialty training pathway established under Rule 15.4.1(C)(2) and holds the corresponding CHW Specialty Designation. T. Supervision means oversight by an individual or entity designated by the Department for purposes of CHW practice settings, including supervision required for Medicaid reimbursement, and includes review of documentation and periodic performance feedback.

U. Verifiable Employment means employment that can be confirmed by the Department and that demonstrates, to the satisfaction of the Department, proficiency in the Core Competencies.

**History**
- *Source: Miss. Code Ann. § 41-140-1 et seq.*

##### **15 Miss. Admin. Code Pt. 19, R. 15.1.4** Certification Required {#sec-19-15.1.4 omnilex-key=us-ms-regs-official--title-15--19#15.1.4}

A. From and after January 1, 2026, no person shall represent himself or herself as a “Community Health Worker,” “CHW,” “Certified Community Health Worker,” or “CCHW,” or use other words, letters, abbreviations, insignia, or designations indicating or implying that the person is a community health worker certified by the Department unless the person holds a current, valid certificate issued under this Chapter. B. Nothing in this Part authorizes a certified community health worker to engage in or perform any act or service for which a license issued by another Mississippi professional licensing board is required. C. Nothing in this Part shall be construed to prohibit individuals from performing community outreach, navigation, or education activities under other job titles, provided they do not hold themselves out to the public as certified under this Part.

**History**
- *Source: Miss. Code Ann. § 41-140-1 et seq.*

##### **15 Miss. Admin. Code Pt. 19, R. 15.1.5** Scope of Practice; Prohibited Acts {#sec-19-15.1.5 omnilex-key=us-ms-regs-official--title-15--19#15.1.5}

A Certified Community Health Worker is a paraprofessional who shall function as a member of a care team and shall not practice independently. A. A CCHW shall provide services in accordance with care plans, program protocols, or directives established by the employing or contracting entity. A CCHW’s scope of practice is limited to the following: 1. Providing cultural mediation among individuals, communities, and health and social systems; 2. Providing culturally appropriate health education and information; 3. Providing care coordination, case coordination, and system navigation; 4. Providing supportive coaching and social support; 5. Advocating for individuals and communities; 6. Building individual and community capacity; 7. Providing non-clinical direct services consistent with this Chapter;

8. Implementing non-clinical individual and community assessments based on standardized tools and primarily focused on social determinants of health; 9. Conducting outreach; and 10. Participating in evaluation and research by supporting participant outreach, administration of surveys, and data collection. B. In addition to the Core Competencies defined in this Chapter, a Certified Community Health Worker’s roles and activities may include: 1. Diabetes education; 2. Blood pressure education; 3. Supporting disease prevention and management activities; 4. Nutrition, specifically food preparation and purchasing; 5. Parenting education; 6. Community wellness partner; 7. Connecting clients to health education and community resources; 8. Delivery of medical supplies and equipment to assist client’s needs; 9. Outreach to clients who are out of care; and 10. Other similar health and social services provided on behalf of healthcare providers, behavioral health providers, public health agencies, or community-based organizations. C. All activities must be completed with appropriate training and under defined protocols. D. Care Team Requirement. A Certified Community Health Worker shall provide services only as part of an integrated care team or public health delivery system and shall not practice independently. 1. A CCHW must be: a. Employed by; or b. Contracted with; or c. Formally affiliated, through a written two-party agreement, with a healthcare provider, healthcare organization, public health agency, or community-based organization.

2. A CCHW shall provide services only when the following conditions exist: a. Under the direction, coordination, or oversight of the employing or contracting entity; and b. In collaboration with other members of a care team, which may include licensed healthcare professionals, social service providers, or public health personnel. 3. A CCHW shall not: a. Independently advertise or offer services to the public as a standalone provider; b. Independently bill or receive direct compensation from clients for services; or c. Operate an independent practice as a Community Health Worker. 4. A Certified Community Health Worker shall provide services only as part of a care team or organizational program that includes a licensed healthcare provider, public health entity, or community-based organization. E. Prohibited Acts. A certified community health worker shall not: 1. Diagnose a medical, dental, or behavioral health condition; 2. Prescribe medications or alter medication regimens; 3. Provide clinical treatment or perform clinical procedures that require licensure; 4. Provide psychotherapy or other services that require independent behavioral health licensure; 5. Represent that the CCHW is a licensed nurse, physician, mental health professional, or other licensed clinician; or 6. Administer medications.

**History**
- *Source: Miss. Code Ann. § 41-140-1 et seq.*

##### **15 Miss. Admin. Code Pt. 19, R. 15.1.6** Supervision and Oversight {#sec-19-15.1.6 omnilex-key=us-ms-regs-official--title-15--19#15.1.6}

A. A Certified Community Health Worker shall operate under the direction and oversight of the employing or contracting organization. B. The employing or contracting organization shall: 1. Ensure that the CCHW performs only duties within the scope as defined by the Department;

2. Provide orientation, training, and ongoing supervision appropriate to the services provided; 3. Maintain policies and procedures governing CCHW activities; 4. Ensure coordination of CCHW services with other members of the care team; 5. Be responsible for the quality and appropriateness of services delivered by the CCHW; and 6. Ensure compliance with applicable laws and regulations. C. A CCHW shall not provide services without such organizational oversight.

**History**
- *Source: Miss. Code Ann. § 41-140-1 et seq.*

##### **15 Miss. Admin. Code Pt. 19, R. 15.1.7** Confidentiality and Client Information {#sec-19-15.1.7 omnilex-key=us-ms-regs-official--title-15--19#15.1.7}

A. A certificate-holder shall maintain confidentiality of information in accordance with applicable federal and state law and employing-entity policies. B. Information obtained in the course of CHW activities and services shall not be disclosed except as permitted by law and shall be treated as confidential for purposes of public records disclosure, consistent with applicable state and federal laws, inclusive of the Health Insurance Portability and Accountability Act. C. A certificate-holder shall not access records without authorization and shall complete training on confidentiality and boundaries as required by Rule 15.4.1 and Rule 15.5.2.

**History**
- *Source: Miss. Code Ann. § 41-140-1 et seq.*

##### **15 Miss. Admin. Code Pt. 19, R. 15.1.8** Publication {#sec-19-15.1.8 omnilex-key=us-ms-regs-official--title-15--19#15.1.8}

The Department shall make available, upon request and payment of a fee, a list of Certified Community Health Workers that includes the individual’s name, certificate number, status (active, inactive, or lapsed), expiration date, county or region of practice or employing organization, and any CHW Specialty Designation held by the certificate-holder. The Department shall not include information regarding disciplinary actions or outcomes unless specifically requested. Upon such request, the Department may provide information regarding disciplinary actions or outcomes (e.g., suspension, revocation, or denial of renewal) but shall not disclose confidential investigative materials except as required by law.

Subchapter 2 — Certification Rule 15.2.1 Qualifications for Initial Certification. A. General Qualifications. An applicant shall:

1. Be at least eighteen (18) years of age; 2. Hold a high school diploma or its equivalent; 3. Submit a complete application in the manner prescribed by the Department; 4. Pay the applicable fee in the amount and manner prescribed in this Chapter; 5. Complete the background check requirements in Rule 15.2.3; and 6. Meet at least one (1) of the eligibility pathways in subsection B. B. Eligibility Pathways. 1. Training Pathway. Provide documentation of successful completion, within five (5) years prior to application, of a Department-approved competency-based training program that: a. Meets minimum training hours and curriculum requirements in Subchapter 4; and b. Includes documented competency assessments as described in Subchapter 4. 2. Experience Pathway. Provide documentation of at least two thousand (2,000) hours of community health worker services or comparable volunteer experience obtained within the five (5) years preceding application, verified under Subchapter 2, and completion of a Department-approved bridge module on Mississippi CCHW law, ethics, and confidentiality (minimum of six (6) hours). 3. Endorsement (Reciprocity) Pathway. Meet the requirements of Rule 15.2.5. 4. Grandfathering (Transitional) Pathway. Meet the requirements of Rule 15.2.6. C. Additional Requirements for Experience and Endorsement Pathways. Applicants qualifying through a pathway other than the Training Pathway shall provide: 1. Employer or supervisor verification using a Department-approved form; 2. A competency mapping attestation demonstrating experience across each Department Core Competency; and 3. At least two references, including one employer or supervisor and one community partner or client-facing collaborator.

**History**
- *Source: Miss. Code Ann. § 41-140-1 et seq.*
- *Source: Miss. Code Ann. § 41-140-1 et seq.*

##### **15 Miss. Admin. Code Pt. 19, R. 15.2.2** Competency Verification {#sec-19-15.2.2 omnilex-key=us-ms-regs-official--title-15--19#15.2.2}

A. Training Pathway. For applicants qualifying through the Training Pathway, a Department- approved training program shall provide verification directly to the Department that the applicant has successfully completed the program and demonstrated competency in each Core Competency. B. Experience and Endorsement Pathways. For applicants qualifying through the Experience or Endorsement Pathway, the applicant shall submit a Department-approved competency mapping attestation, signed by a supervisor or other qualified verifier, demonstrating experience across each Core Competency.

**History**
- *Source: Miss. Code Ann. § 41-140-1 et seq.*

##### **15 Miss. Admin. Code Pt. 19, R. 15.2.3** Criminal History Screening {#sec-19-15.2.3 omnilex-key=us-ms-regs-official--title-15--19#15.2.3}

A. Prior to issuing an initial certificate, the Department shall require each applicant to submit to state and national criminal history screening through fingerprints or other Department- approved method. The results shall be received and approved by the Department before a certificate can be issued. B. The Department shall require rescreening for: 1. Reinstatement of a lapsed certificate; and 2. Recertification every four (4) years (i.e., every other biennial renewal), unless waived for good cause. C. Applicants with criminal history shall receive individualized review. Grounds for denial shall be limited to convictions directly related to CCHW duties and public protection, with written notice of reasons and an opportunity to be heard under Subchapter 7.

**History**
- *Source: Miss. Code Ann. § 41-140-1 et seq.*

##### **15 Miss. Admin. Code Pt. 19, R. 15.2.4** Application Processing {#sec-19-15.2.4 omnilex-key=us-ms-regs-official--title-15--19#15.2.4}

A. The Department shall notify applicants of approval, denial, or incompleteness within thirty (30) business days of receipt of a complete application. B. If approved, the Department shall issue the certificate within ten (10) business days after completion and receipt of required background check results, unless further review is required. However, no certificate shall be issued until the Department has received criminal history screening results in accordance with Subchapter 2. C. The Department may grant one (1) extension of up to ninety (90) days for renewal documentation upon written request submitted prior to expiration.

**History**
- *Source: Miss. Code Ann. § 41-140-1 et seq.*

##### **15 Miss. Admin. Code Pt. 19, R. 15.2.5** Certification by Endorsement (Reciprocity) {#sec-19-15.2.5 omnilex-key=us-ms-regs-official--title-15--19#15.2.5}

A. The Department may issue a Mississippi CHW certificate by endorsement to an applicant who: 1. Holds a current, in-good-standing CHW certification from another U.S. jurisdiction or a Department-recognized private certification; 2. Was required to satisfy minimum education, training, or experience requirements or pass a competency assessment to obtain that certification; 3. Meets Mississippi background check requirements; 4. Has held the out-of-state credential for at least one (1) year immediately preceding the application; and 5. Has been actively engaged in the provision of Community Health Worker Services, as defined in this Chapter, for at least one (1) year within the five (5) years immediately preceding application. 6. Verification of certification status and active practice shall be submitted directly to the Department by the issuing authority and/or employer on Department-approved forms and shall include, at a minimum: a. Dates of employment or engagement; b. Description of duties demonstrating provision of Community Health Worker Services; c. Average hours worked or level of engagement; and d. Attestation by a supervisor or authorized representative that the applicant performed such services in a competent and ethical manner. B. The Department may require completion of a Mississippi-specific orientation module on Mississippi CHW law/rules, confidentiality, and available referral systems.

**History**
- *Source: Miss. Code Ann. § 41-140-1 et seq.*

##### **15 Miss. Admin. Code Pt. 19, R. 15.2.6** Grandfathering (Transitional Certification) {#sec-19-15.2.6 omnilex-key=us-ms-regs-official--title-15--19#15.2.6}

A. For applications submitted on or before December 31, 2027, an applicant may qualify through transitional certification if the applicant: 1. Demonstrates CHW practice prior to January 1, 2026, through written employer/supervisor verification on Department-approved forms; 2. Documents at least 2,000 hours of CHW work or volunteer experience during the five (5) years prior to application;

3. Submits two references (one supervisor/employer; one community partner); and 4. Completes a Department-approved bridge module covering Mississippi CCHW law/rules, ethics, confidentiality, and documentation standards. B. Transitional certificates shall be subject to the same renewal and continuing education requirements as standard certificates.

**History**
- *Source: Miss. Code Ann. § 41-140-1 et seq.*

##### **15 Miss. Admin. Code Pt. 19, R. 15.2.7** Denial of Certification {#sec-19-15.2.7 omnilex-key=us-ms-regs-official--title-15--19#15.2.7}

The Department may deny certification based on criminal history that is directly related to the duties of a Community Health Worker, including but not limited to offenses involving fraud, abuse, neglect, or exploitation.

**History**
- *Source: Miss. Code Ann. § 41-140-1 et seq.*

##### **15 Miss. Admin. Code Pt. 19, R. 15.2.8** Conditional/Restricted Certification {#sec-19-15.2.8 omnilex-key=us-ms-regs-official--title-15--19#15.2.8}

The Department may issue a certificate subject to conditions, limitations, or probationary status as necessary to protect the public.

**History**
- *Source: Miss. Code Ann. § 41-140-1 et seq.*

##### **15 Miss. Admin. Code Pt. 19, R. 15.2.9** Biennial Certification {#sec-19-15.2.9 omnilex-key=us-ms-regs-official--title-15--19#15.2.9}

Certifications issued under this Chapter shall expire two (2) years from the date of issuance.

**History**
- *Source: Miss. Code Ann. § 41-140-1 et seq.*

##### **15 Miss. Admin. Code Pt. 19, R. 15.2.10** Procedure for Renewal of Certificate {#sec-19-15.2.10 omnilex-key=us-ms-regs-official--title-15--19#15.2.10}

Approximately sixty (60) days prior to the expiration of a certificate, an electronic renewal notice shall be sent to the email address registered by the certificate-holder with the Department. For purposes of renewal, prior to expiration of the certificate an applicant shall: A. Complete the online renewal form; B. Submit proof of continuing education units as required under Subchapter 5; and C. Pay the required renewal fee online.

**History**
- *Source: Miss. Code Ann. § 41-140-1 et seq.*

##### **15 Miss. Admin. Code Pt. 19, R. 15.2.11** Abandonment {#sec-19-15.2.11 omnilex-key=us-ms-regs-official--title-15--19#15.2.11}

An application for certification or renewal shall be considered abandoned if the applicant fails to submit all required materials to the Department within six (6) months of the initial submission

date. Upon abandonment, the application shall be closed without further action by the Department. An applicant whose application is abandoned must submit a new application and pay all applicable fees to be considered for certification or renewal.

**History**
- *Source: Miss. Code Ann. § 41-140-1 et seq.*

##### **15 Miss. Admin. Code Pt. 19, R. 15.2.12** Notification of Denial {#sec-19-15.2.12 omnilex-key=us-ms-regs-official--title-15--19#15.2.12}

Written notice will be provided to all applicants regarding denial of an application for certification or renewal. Such notice shall contain the reason(s) therefor and provide the applicant an opportunity to cure the deficiency for a second review by the Department.

**History**
- *Source: Miss. Code Ann. § 41-140-1 et seq.*

##### **15 Miss. Admin. Code Pt. 19, R. 15.2.13** Reinstatement {#sec-19-15.2.13 omnilex-key=us-ms-regs-official--title-15--19#15.2.13}

A. Lapsed certificate (expired 12 months or less): Reinstatement upon payment of reinstatement fee and completion of continuing education required for the prior term. B. Lapsed certificate (expired more than 12 months): Requires reapplication under initial certification rules, unless the Department grants a waiver for good cause.

**History**
- *Source: Miss. Code Ann. § 41-140-1 et seq.*

##### **15 Miss. Admin. Code Pt. 19, R. 15.2.14** Duty to Report Changes {#sec-19-15.2.14 omnilex-key=us-ms-regs-official--title-15--19#15.2.14}

A certificate-holder shall notify the Department within thirty (30) days of any of the following: A. Change in name; B. Change in contact information; C. Change in employment or affiliation, including a change of employer or qualifying entity; D. Termination of employment or affiliation with a qualifying entity; or E. Any criminal conviction.

Subchapter 3 — Fees Rule 15.3.1 Schedule of Fees. The following non-refundable fees are established under this Chapter and shall be paid to the Department in the manner prescribed by the Department, including electronic payment: A. Initial Application Fee: $40.00.

B. Renewal Fee: $25.00. C. Reinstatement Fee (lapsed certificate): $25.00. D. Training Program Approval Fee (if applicable): $300.00. E. Fee Waiver/Reduction: The Department may waive or reduce fees for applicants demonstrating financial hardship, as defined in Department policy.

Subchapter 4 — Training Program Approval and Standards Rule 15.4.1 Minimum Training Standards. A. A Department-approved training program shall include at least: 1. At least one hundred sixty (160) total hours, including eighty (80) contact hours of classroom or synchronous distance-learning instruction, and eighty (80) hours of supervised practicum/field experience; and 2. An examination or objective competency assessment component for each Department core competency. B. Training programs shall maintain competency checklists or equivalent records for each trainee and shall retain such records for six (6) years, subject to Department audit. C. The curriculum shall, at minimum, cover: 1. Communication and cross-cultural communication; 2. Outreach and relationship building; 3. Individual and community assessment based on standardized tools and primarily focused on social determinants of health; 4. Navigation of public and private health and human service systems; 5. Advocacy and community capacity building; 6. Health coaching, adult learning principles, and behavior change strategies; 7. Documentation, reporting, and outcome management; 8. Confidentiality, privacy, and professional boundaries; 9. Legal and ethical responsibilities;

10. Social determinants of health and health equity; 11. Trauma-informed care principles and minimizing re-traumatization; 12. Crisis identification and safety planning appropriate to CHW scope, including suicide risk identification and overdose/intoxication response referral protocols; 13. Self-care and burnout prevention; and 14. Behavioral health and substance use basics (warning signs, when to escalate to licensed providers). D. Faculty requirements. At least forty percent (40%) of training hours shall be taught or co- taught by experienced CCHWs or CCHW trainers approved by the Department. E. CHW Specialty Training Pathways. 1. General. The Department may establish specialty training pathways for Certified Community Health Workers serving defined populations or specialty practice areas. Completion of a Department-approved specialty training pathway shall result in the applicable CHW Specialty Designation being recorded on the certificate-holder’s certificate and in the Department registry. A CHW Specialty Designation supplements, but does not replace, Certified Community Health Worker certification, does not expand the scope of practice established under Rule 15.1.5, and does not authorize the holder to perform any act requiring professional licensure under Mississippi law. A specialty designation shall remain valid only while the certificate-holder maintains an active Certified Community Health Worker certificate. The Department may establish additional specialty designations through rulemaking. Each specialty designation shall identify: a. The specialty designation title; b. The population served or specialty practice area; c. Required specialty training content; and d. Any specialty-specific continuing education requirements. 2. Perinatal Community Health Worker Specialty Training Pathway. A Department- approved Perinatal Community Health Worker specialty training pathway shall prepare Certified Community Health Workers to provide non-clinical education, outreach, care coordination, and support services for pregnant, postpartum, and infant populations within the Community Health Worker scope of practice established under Rule 15.1.5. The specialty curriculum shall include instruction in at least the following subject areas: a. Maternal-child health;

b. Pregnancy, childbirth, postpartum, and interconception support; c. Infant feeding support awareness and referral; d. Perinatal mental health awareness and referral; e. Maternal warning signs and emergency referral; f. Care coordination and escalation protocols; and g. Available maternal and infant community resources. 3. Acceptance of Existing Curricula. The Department may accept nationally recognized evidence-informed maternal support curricula, including DONA International or equivalent programs, toward satisfaction of specialty pathway requirements upon determining that the curriculum substantially addresses the subject areas required by this Rule. The Department may require supplemental instruction to address identified deficiencies. 4. Specialty pathway requirements supplement, and do not replace, the minimum training standards established by this Rule.

**History**
- *Source: Miss. Code Ann. § 41-140-1 et seq.*
- *Source: Miss. Code Ann. § 41-140-1 et seq.*
- *Source: Miss. Code Ann. § 41-140-1 et seq.*

##### **15 Miss. Admin. Code Pt. 19, R. 15.4.2** CHW Specialty Designations {#sec-19-15.4.2 omnilex-key=us-ms-regs-official--title-15--19#15.4.2}

A. Issuance. The Department shall record the applicable CHW Specialty Designation on a certificate-holder’s certificate and in the Department registry upon verification that the certificate-holder has successfully completed the requirements of a Department-approved specialty training pathway established under Rule 15.4.1(C). B. Maintenance; Effect of Lapse, Suspension, or Revocation of Underlying Certificate. A CHW Specialty Designation shall remain valid only while the certificate-holder maintains an active Certified Community Health Worker certificate in good standing. If a certificate-holder’s CCHW certificate lapses, is suspended, or is revoked, all CHW Specialty Designations held by that certificate-holder shall be simultaneously suspended or removed, as applicable, for the duration of the lapse, suspension, or revocation. A certificate-holder whose CCHW certificate has lapsed, been suspended, or been revoked shall not represent themselves as holding a CHW Specialty Designation during such period. C. Reinstatement. Upon reinstatement of a lapsed or suspended CCHW certificate in accordance with Rule 15.2.13, any CHW Specialty Designation that was in good standing at the time of the lapse or suspension shall be simultaneously reinstated, provided that the certificate-holder has satisfied any applicable specialty-specific continuing education requirements for the period of the lapse.

D. Independent Disciplinary Action. Disciplinary action may be taken against a CHW Specialty Designation independently of the underlying CCHW certificate pursuant to Subchapter 7 if the certificate-holder has engaged in conduct violating this Chapter within the applicable specialty practice area. Such independent disciplinary action shall not preclude concurrent or subsequent disciplinary action against the underlying CCHW certificate. E. Establishment of Additional Specialty Designations. The Department may establish additional CHW Specialty Designations through rulemaking conducted pursuant to the Mississippi Administrative Procedures Act, Miss. Code Ann. §§ 25-43-1.101 et seq. Each rulemaking establishing a new CHW Specialty Designation shall specify the requirements enumerated in Rule 15.4.1(C)(1).

**History**
- *Source: Miss. Code Ann. § 41-140-1 et seq.*

##### **15 Miss. Admin. Code Pt. 19, R. 15.4.3** Training Program Approval; Reapproval; Site Visits {#sec-19-15.4.3 omnilex-key=us-ms-regs-official--title-15--19#15.4.3}

A. Initial Approval. A training program seeking approval shall submit: 1. A Department training program approval application; 2. A program approval fee under Rule 15.3.1 (if applicable); 3. Curriculum materials and assessment instruments; 4. Policies on attendance, grading/competency thresholds, remediation, and record retention; 5. A description of the method of final examination/competency assessment (written, skills- based, or mixed), including passing thresholds and remediation; 6. A list of instructors, including experienced CCHWs/CCHW trainers, and their qualifications; 7. Practicum site standards and supervision plan; 8. A plan for recruiting and enrolling a diverse student population and reducing barriers to enrollment (cost, schedule, language, disability access); and 9. Attendee recordkeeping and graduation verification process used to report completions to the Department. B. Approval Term. Program approval shall extend for two (2) years from the date of the initial approval. C. Reapproval. Programs shall apply for reapproval not later than ninety (90) days before expiration.

D. Monitoring. The Department may conduct site visits, desk audits, or records audits at any time during the approval term. E. Deficiency Correction; Provisional Approval; Withdrawal. If deficiencies are identified, the Department shall issue a written deficiency report and allow remedy through a plan of correction accepted by the Department. The Department may grant provisional approval, deny approval, or withdraw approval consistent with due process.

**History**
- *Source: Miss. Code Ann. § 41-140-1 et seq.*

##### **15 Miss. Admin. Code Pt. 19, R. 15.4.4** Publication of Approved Training Providers {#sec-19-15.4.4 omnilex-key=us-ms-regs-official--title-15--19#15.4.4}

The Department shall publish and maintain a public list of Department-approved training program providers.

Subchapter 5 — Continuing Education Rule 15.5.1 Requirements. A CCHW shall complete fifteen (15) hours of continuing education during each two-year certification term.

**History**
- *Source: Miss. Code Ann. § 41-140-1 et seq.*
- *Source: Miss. Code Ann. § 41-140-1 et seq.*

##### **15 Miss. Admin. Code Pt. 19, R. 15.5.2** Required CE Topics {#sec-19-15.5.2 omnilex-key=us-ms-regs-official--title-15--19#15.5.2}

Of the fifteen (15) hours required: A. At least one (1) hour shall address Mississippi CCHW law/rules and ethics; B. At least one (1) hour shall address confidentiality/privacy and professional boundaries; C. At least two (2) hours shall address social determinants of health and cultural responsiveness and health equity; and D. At least one (1) hour of the required continuing education during each biennial renewal period shall address mandatory reporting obligations applicable to Certified Community Health Workers under Mississippi law, including recognition of suspected abuse, neglect, exploitation, applicable reporting requirements, legal protections, and documentation responsibilities. This requirement shall be satisfied within, and shall not increase, the fifteen (15) hours of continuing education required under Rule 15.5.1.

**History**
- *Source: Miss. Code Ann. § 41-140-1 et seq.*

##### **15 Miss. Admin. Code Pt. 19, R. 15.5.3** Content Criteria {#sec-19-15.5.3 omnilex-key=us-ms-regs-official--title-15--19#15.5.3}

Continuing education shall: A. Directly relate to CHW core competencies including services, skills, and knowledge that: 1. Facilitates access to quality of care delivery and health outcomes for individuals receiving services; and 2. Expands health and wellness in diverse communities to reduce health disparities; B. Have educational objectives that exceed an introductory level of knowledge related to health and community services; and C. Consist of courses related to core competencies, such as: 1. Health and social service systems; 2. Disease prevention to help manage health conditions; 3. Health promotion education; 4. Health literacy and cross-cultural communication; 5. Referrals and providing follow-up; 6. Individual support and coaching; 7. Outreach methods and strategies; 8. Client and community assessment; 9. Health education for behavior change; 10. Provision of direct services; 11. Home visits to provide education, assessment, and social support; and 12. Support, advocacy, and health system navigation. D. CE Content Requirements for Certificate-Holders Holding CHW Specialty Designations. 1. A certificate-holder holding a CHW Specialty Designation shall complete continuing education relevant to the applicable specialty during each biennial renewal period. Such continuing education shall satisfy the general content standards of this Rule and shall count toward the fifteen (15) hours required under Rule 15.5.1.

2. For holders of the Perinatal Community Health Worker Specialty Designation, specialty continuing education shall include topics related to: a. Prenatal and postpartum support; b. Infant feeding support awareness and referral; c. Perinatal mental health awareness; d. Maternal warning signs; e. Newborn care education and referral; f. Trauma-informed care in the perinatal setting; and g. Maternal and infant resource navigation. 3. Unless otherwise established by Department guidance, at least three (3) of the fifteen (15) required continuing education hours shall address the applicable specialty designation. 4. The Department may establish specialty-specific continuing education requirements and approve specialty continuing education providers through published guidance or rulemaking.

**History**
- *Source: Miss. Code Ann. § 41-140-1 et seq.*

##### **15 Miss. Admin. Code Pt. 19, R. 15.5.4** Sources of Continuing Education {#sec-19-15.5.4 omnilex-key=us-ms-regs-official--title-15--19#15.5.4}

The Department may approve or deny continuing education providers and courses. Continuing education shall be earned through Department-approved CE providers or CE programs meeting Rule 15.5.3. The Department shall maintain and publish a list of approved CE providers/programs and approval terms.

**History**
- *Source: Miss. Code Ann. § 41-140-1 et seq.*

##### **15 Miss. Admin. Code Pt. 19, R. 15.5.5** CE Provider Approval; Audits; Record Retention {#sec-19-15.5.5 omnilex-key=us-ms-regs-official--title-15--19#15.5.5}

A. The Department shall approve CE providers or CE programs for purposes of satisfying renewal requirements, including the criteria and approval term for CE providers. B. Certificate-holders shall retain documentation of CE completion for at least six (6) years and shall produce documentation upon Department auditing request. C. The Department may audit continuing education compliance and require documentation. Failure to comply may result in disciplinary action.

**History**
- *Source: Miss. Code Ann. § 41-140-1 et seq.*

##### **15 Miss. Admin. Code Pt. 19, R. 15.5.6** Emergency and/or Hardship Exceptions {#sec-19-15.5.6 omnilex-key=us-ms-regs-official--title-15--19#15.5.6}

An exception to the continuing education requirements, including waiver of all or a portion of these requirements or an extension of time in which to complete these requirements, shall be

granted to a certificate-holder upon a finding of good cause by the Department following receipt of a written request for exception based upon emergency and/or hardship including, but not limited to, the following: A. Long-term personal illness or illness involving a close relative or person for whom the certificate-holder has caregiving responsibilities; B. Where the certificate-holder can demonstrate that the required course(s) are not reasonably available; and C. Other demonstrated hardships that substantially relate to the ability to perform or complete the continuing education requirements.

**History**
- *Source: Miss. Code Ann. § 41-140-1 et seq.*

##### **15 Miss. Admin. Code Pt. 19, R. 15.5.7** Recordkeeping and Audit {#sec-19-15.5.7 omnilex-key=us-ms-regs-official--title-15--19#15.5.7}

A certificate-holder shall: A. Maintain documentation of certification, continuing education, and employment or affiliation; B. Retain records for a period of not less than six (6) years; and C. Provide such records to the Department upon request.

Subchapter 6 — Conduct Standards Rule 15.6.1 Code of Ethics. A. All CCHWs shall comply with the American Association of Community Health Workers Code of Ethics (effective 2008), as adopted by the Department and incorporated by reference. If the Code of Ethics conflicts with the laws of the State of Mississippi or the rules in this Chapter, the state law or rules govern the matter. B. Each applicant or certificate-holder is responsible for familiarity and compliance with the Code of Ethics.

**History**
- *Source: Miss. Code Ann. § 41-140-1 et seq.*
- *Source: Miss. Code Ann. § 41-140-1 et seq.*

##### **15 Miss. Admin. Code Pt. 19, R. 15.6.2** Unprofessional Conduct {#sec-19-15.6.2 omnilex-key=us-ms-regs-official--title-15--19#15.6.2}

Unprofessional Conduct includes but is not limited to the following acts or practices: A. Practicing, condoning, facilitating, collaborating with, or engaging in discrimination against prospective or current clients, students, employees, supervisees, or research participants based on age, culture, disability, ethnicity, race, religion, sex, gender identity, sexual orientation,

marital status/partnership, language preference, socioeconomic status, immigration status, or any basis proscribed by law; B. Being convicted of any crime an essential element of which is larceny, embezzlement, obtaining money, property, or credit by false pretenses, or other offenses involving dishonesty, fraud, or moral turpitude (e.g., unauthorized disclosure of patient information; improper alteration of a patient record; inappropriate or unlawful use of drugs or alcohol; assault, battery, or abuse of a patient; sexual contact with a patient; gross or repeated malpractice or negligence; improper professional financial dealings); C. Performing, or pretending to be able to perform, professional services beyond one’s scope of practice and one’s competency as defined by education, training, supervised experience, state and national professional credentials, and appropriate professional experience; D. Procuring, attempting to procure, or renewing a Certificate by bribery or by fraudulent misrepresentation; E. Aiding or assisting another person in violating any provision of the Act or this Chapter; F. Misrepresenting educational background, training, credentials, competence, or professional memberships; G. Exploiting a client for personal advantage, profit, or interest, including engaging in the sexual exploitation of clients; H. Failing to maintain the confidentiality of any information received from a client, unless otherwise authorized or required by law; I. Advertising in a matter that is deceptive, misleading, or false; J. Submitting fraudulent claims for services to any person or entity including, but not limited to, health insurance companies or health service plans or third-party payors; K. Habitual or excessive use or addiction to alcohol, narcotics, stimulants, or any other chemical agent or drug which results in inability to practice with reasonable skill, judgment, or safety; and L. Receiving discipline by another governmental agency or unit of government, by any jurisdiction of the United States, or by a foreign nation, if at least one of the grounds for the discipline is the same or substantially equivalent to those set forth in this Chapter.

Subchapter 7 — Disciplinary and Administrative Proceedings Rule 15.7.1 Complaints. Any person may file a complaint against a Certified Community Health Worker (CCHW). A person wishing to report a complaint or alleged violation shall notify the Department in writing in the manner prescribed by the Department. The Department may accept anonymous complaints; however, the absence of identifying information may limit the Department’s ability to investigate or take disciplinary action. Complaints will be reviewed and evaluated by the Department to determine whether the complaint alleges a possible violation of this Chapter. Each complaint received shall be logged, recording at a minimum the following information: A. Name of the individual CCHW; B. Name of the CCHW’s employer, if known; C. Name of the complaining party, if provided; D. Date of complaint; and E. Brief description of the complaint.

**History**
- *Source: Miss. Code Ann. § 41-140-1 et seq.*
- *Source: Miss. Code Ann. § 41-140-1 et seq.*

##### **15 Miss. Admin. Code Pt. 19, R. 15.7.2** Investigations {#sec-19-15.7.2 omnilex-key=us-ms-regs-official--title-15--19#15.7.2}

The Department shall have full authority to investigate all applicants and certificate-holders for compliance with this Chapter. A. The Department may commence an investigation whenever it has reason to believe that a violation of this Chapter has occurred. B. In conducting investigations, the Department may: 1. Issue subpoenas; 2. Examine witnesses; 3. Administer oaths; and 4. Seek injunctive relief against unlicensed practice. C. If grounds for discipline are established, the Department may impose sanctions as provided under Rule 15.7.3.

**History**
- *Source: Miss. Code Ann. § 41-140-1 et seq.*

##### **15 Miss. Admin. Code Pt. 19, R. 15.7.3** Sanctions {#sec-19-15.7.3 omnilex-key=us-ms-regs-official--title-15--19#15.7.3}

Upon finding that a violation of this Chapter has occurred, the Department may impose one or more of the following sanctions: A. Denial or refusal to renew a certificate; B. Suspension or revocation of a certificate; C. Issuance of a warning or reprimand; D. Placement of the certificate on probation with conditions, which may include: 1. Regular reporting to the Department; 2. Completion of continuing education to achieve competency; or 3. Compliance with other reasonable requirements or restrictions; and/or E. A fine of not less than One Hundred Dollars ($100.00) or more than One Thousand Dollars ($1,000.00) for each violation.

**History**
- *Source: Miss. Code Ann. § 41-140-1 et seq.*

##### **15 Miss. Admin. Code Pt. 19, R. 15.7.4** Administrative Proceedings {#sec-19-15.7.4 omnilex-key=us-ms-regs-official--title-15--19#15.7.4}

Any person aggrieved by a decision regarding the initial application for certification, the renewal of certification, or the imposition of sanctions shall have the right of administrative appeal as set forth in this Rule. A. Right to Hearing. 1. Any applicant or certificate-holder aggrieved by denial, refusal of renewal, suspension, revocation, or other disciplinary action may request a hearing by filing a written request with the Department within fourteen (14) days of receipt of notice of the action. 2. If requested in writing within the specified time frame, a hearing shall be provided at which the applicant or certificate-holder may show cause why the certificate should be granted, renewed, or that sanctions would be improper. B. Scheduling and Procedure. 1. Within thirty (30) days of receipt of a timely request for hearing, the State Health Officer shall appoint a Hearing Officer who shall schedule the hearing at a time and place convenient to all parties.

2. Hearings shall be conducted in accordance with due process requirements and may be confidential unless otherwise required by law. 3. The certificate-holder may appear personally, may be represented by counsel at their own expense, and shall have the right to present witnesses and evidence, and to cross-examine opposing witnesses. 4. A court reporter shall attend and transcribe the proceeding. C. Burden of Proof and Standard of Evidence. 1. Applicant Proceedings. An applicant bears the burden of establishing, by a preponderance of the evidence, that the applicant meets the requirements for certification, endorsement, grandfathering, renewal, or reinstatement under this Chapter. 2. Disciplinary Proceedings. In any proceeding seeking denial, suspension, revocation, reprimand, or other disciplinary action against a certificate-holder, the Department bears the burden of proving, by a preponderance of the evidence, that grounds for the proposed action exist under this Chapter. 3. Affirmative Defenses. A certificate-holder asserting an affirmative defense bears the burden of proving such defense by a preponderance of the evidence. 4. Standard of Proof. Unless otherwise specified by law, the standard of proof in all proceedings under this Chapter shall be a preponderance of the evidence. 5. Judicial Review. Nothing in this Rule alters the standard of judicial review applicable to final agency actions under Mississippi law. D. Findings and Recommendation. Within sixty (60) days of the hearing, or such other period as determined during the hearing, the Hearing Officer shall submit written findings of fact and a recommendation for action on the certificate in question to the State Health Officer. E. Final Decision. The State Health Officer shall decide what action will be taken on the recommendation within ten (10) days of its receipt. The decision of the State Health Officer shall constitute the Department’s Final Order. 1. Written notice of the decision shall be provided to the applicant or certificate-holder at the address or email on record with the Department. It is the duty of each certificate-holder to maintain current contact information with the Department. 2. An appeal of the Final Order shall be in accordance with applicable state law. Failure to timely appeal shall render the decision final and unappealable.

**History**
- *Source: Miss. Code Ann. § 41-140-1 et seq.*

##### **15 Miss. Admin. Code Pt. 19, R. 15.7.5** Summary Suspension {#sec-19-15.7.5 omnilex-key=us-ms-regs-official--title-15--19#15.7.5}

The Department may summarily suspend a certificate issued under this Chapter without a hearing, simultaneously with the filing of a formal complaint and notice of hearing, if it determines that: A. The health, safety, or welfare of the general public is in immediate danger; or B. The individual’s physical capacity to practice his/her profession is in issue; or C. The individual’s mental capacity to practice his/her profession is in issue.

**History**
- *Source: Miss. Code Ann. § 41-140-1 et seq.*

##### **15 Miss. Admin. Code Pt. 19, R. 15.7.6** Right to Appeal {#sec-19-15.7.6 omnilex-key=us-ms-regs-official--title-15--19#15.7.6}

An appeal of a Final Order of the Department shall be in accordance with applicable state law. Failure to timely appeal shall render the decision final and unappealable.

**History**
- *Source: Miss. Code Ann. § 41-140-1 et seq.*

### **Part 20** Bureau of Public Water Supply

##### **15 Miss. Admin. Code Pt. 20, R. 3.1.1** Coverage {#sec-20-3.1.1 omnilex-key=us-ms-regs-official--title-15--20#3.1.1}

1. This regulation shall only apply to community water systems (CWS) serving a population of at least two thousand (2,000).

2. Each CWS shall be required to acquire and install fluoridation treatment equipment capable of maintaining fluoride levels within the optimal range as defined in this regulation, and shall comply with all requirements of this regulation for the purpose of protecting the dental health of the citizens of this State. No System shall be required to comply unless sufficient funds are identified by the Department, whether by appropriation, capital outlay, grants or similar means or source of funds, as available to that system for the cost of acquiring and installing fluoridation equipment, and the cost of material required to fluoridate said system for at least one year from the date of initial installation.

3. A CWS that changes treatment to include fluoridation shall maintain optimal fluoridation as specified by the Bureau of Public Water Supply.

4. Any CWS that fluoridates and wishes to discontinue community water fluoridation must provide a written request to the Director of the Bureau of Public Water Supply; comply with the Bureau of Public Water Supply policy for Discontinuation of Community Water Fluoridation for a Public Water Supply and receive written approval from the Director of the Bureau of Public Water Supply.

**History**
- *SOURCE: Miss. Code Ann. § 41-26-6*

##### **15 Miss. Admin. Code Pt. 20, R. 3.1.2** Definitions {#sec-20-3.1.2 omnilex-key=us-ms-regs-official--title-15--20#3.1.2}

1. Adjusted fluoridated water system shall mean a public water system that adjusts the fluoride concentration in the drinking water to the optimal level for consumption (within the recommended control range). 2. Community Water System (CWS) shall mean any water system serving piped water for human consumption to fifteen (15) or more individual service connections used year- round by consumers or regularly serving twenty-five (25) or more individual consumers year-round, including, but not limited to, any collection, pretreatment, treatment, storage and/or distribution facilities or equipment used primarily as part of, or in connection with such system, regardless of whether or not such components are under the ownership or control of the operator of such system. 3. Department shall mean the Mississippi State Department of Health. 4. Entry point shall mean a location following one or more finished (fluoridated) water sampling points but prior to the beginning of the distribution system of the public water system. 5. Natural fluoride content shall mean the concentration of fluoride in milligrams per liter (mg/L) that is present in the water source from naturally occurring fluoride sources. 6. Optimal fluoride level in Mississippi shall mean the amount of fluoride in water that is found naturally or adjusted should be within a recommended control range of 0.6-1.2 parts per million fluoride (ppm) with the optimal fluoride level being 0.7 ppm. 7. Parts per million shall mean a unit of measurement that is equivalent to 1 milligram per liter (mg/L) where the density of the liquid measured is 1.0 gram per cubic centimeter (the density of water is 1.0). 8. Public water system (CWS) means a system for the provision to the public of water for human consumption through pipes or, after August 5, 1998, other constructed

conveyances, if such system has at least fifteen service connections or regularly serves an average of at least twenty-five individuals daily at least 60 days out of the year. 9. Raw water is defined as water that has not been treated or had fluoride injected into it by the CWS and that contains only naturally occurring levels of fluoride.

**History**
- *SOURCE: Miss. Code Ann. § 41-26-6*

##### **15 Miss. Admin. Code Pt. 20, R. 3.2.1** Testing {#sec-20-3.2.1 omnilex-key=us-ms-regs-official--title-15--20#3.2.1}

: A minimum number of samples shall be collected by designated CWS personnel based on the water supply’s classification on different days each week at all entry points and analyzed for fluoride content. At least once each month at each entry point, designated CWS personnel shall divide (split) one sample (hereinafter referred to as the split sample) and have one portion analyzed for fluoride by designated CWS personnel and the other portion analyzed by the Department’s laboratory or a private lab certified by the Department for fluoride testing.

**History**
- *SOURCE: Miss. Code Ann. § 41-26-6*

##### **15 Miss. Admin. Code Pt. 20, R. 3.2.2** Verification {#sec-20-3.2.2 omnilex-key=us-ms-regs-official--title-15--20#3.2.2}

: Designated CWS personnel shall use water sample fluoride content results to compare with a calculated fluoride dosage to verify fluoridation program operation. The calculated dosage is defined as the calculated amount of fluoride that has been added to a water system. The calculation is based on the total amount of fluoride (weight) that was added to the water system and the total amount of water (volume) that was produced plus the naturally occurring fluoride at the source.

Subchapter 3 Optimal Fluoridation Requirements Rule 3.3.1 Monitoring 1. The monthly average fluoride content of all water samples requested in Rule 3.2.1 shall have fluoride content within the optimal fluoride control range defined in Rule 3.1.2. 2. The designated CWS personnel shall collect no less than no less than 13 water samples per month from each entry point for analysis for fluoride from each entry point for analysis for fluoride and at least 90% of collected samples shall have fluoride content within the optimal fluoride control range defined in Rule 3.1.2. Results from that analysis shall be recorded in the public water system’s Operations Record. 3. The split sample result determined through analysis by designated CWS personnel shall agree with the result analyzed by the Department within a range of +/- 0.2 ppm in at least nine of 12 months during the calendar year.

4. Designated CWS personnel shall submit a report of the results of required water sample testing each month to the Department and shall include the type of fluoride chemical used.

**History**
- *SOURCE: Miss. Code Ann. § 41-26-6*
- *SOURCE: Miss. Code Ann. § 41-26-6*

##### **15 Miss. Admin. Code Pt. 20, R. 3.3.2** Quality Assurance {#sec-20-3.3.2 omnilex-key=us-ms-regs-official--title-15--20#3.3.2}

1. MSDH Bureau of Water Supply will assess each system’s compliance with this policy on a monthly basis and send letters to the Responsible Official and Operator if the system is not compliant.

2. MSDH will prepare a compliance progress report on a monthly basis that will be made available to interested parties.

3. Each CWS that complies with the optimal fluoridation requirements during the calendar year to the satisfaction of the Department shall be recognized by the Department pursuant to its health promotion policies and guidelines.

**History**
- *SOURCE: Miss. Code Ann. § 41-26-6*

##### **15 Miss. Admin. Code Pt. 20, R. 3.4.1** Compliance {#sec-20-3.4.1 omnilex-key=us-ms-regs-official--title-15--20#3.4.1}

1. CWS that fluoridate shall list in the Consumer Confidence Report the number of months in the previous calendar year that average sample results from a certified laboratory were within the optimal range.

2. Each CWS that fluoridates shall list in the Consumer Confidence Report the percentage of all samples collected in the previous calendar year that sample results were within the optimal range.

**History**
- *SOURCE: Miss. Code Ann. § 41-26-6*

##### **15 Miss. Admin. Code Pt. 20, R. 3.5.1** Verification {#sec-20-3.5.1 omnilex-key=us-ms-regs-official--title-15--20#3.5.1}

: The Department shall have the authority to request samples of the CWS raw water source seasonally for fluoride content analysis at the Department’s laboratory.

Chapter 4 REGULATION GOVERNING DRINKING WATER QUALITY ANALYSIS FUND

Subchapter 1 General Provisions:

Rule 4.1.1. Legal Authority. This regulation has been promulgated under the authority of and pursuant to the Mississippi Safe Drinking Water Act of 1997 (Section 41-26-1 through Section 41-26-101, Mississippi Code of 1972, Annotated).

Rule 4.2.1. Fees. The department annually shall assess and collect fees for water quality analysis and related activities as required by the federal Safe Drinking Water Act, as amended, which shall not exceed the amount authorized by the Mississippi State Legislature and approved by the State Board of Health per connection or Forty Thousand Dollars ($40,000.00) per system, whichever is less. The department annually shall adopt by rule, in accordance with the Administrative Procedures Law and following a public hearing, a fee schedule to cover all reasonable direct and indirect costs of water quality analysis and related activities as required by the federal Safe Drinking Water Act, as amended. In adopting a fee schedule, the department shall consider the recommendations of the advisory committee created in this section, if those recommendations are made in a timely manner as provided.

Any person making sales to customers of water for residential, noncommercial or nonagricultural use and who recovers the fee required by this section or any portion

thereof from any customer shall indicate on each statement rendered to customers that these fees are for water quality analyses required by the federal government under the Safe Drinking Water Act, as amended.

**History**
- *SOURCE: Miss. Code Ann. § 41-26-6*
- *SOURCE: Miss. Code Ann. §41-26-23 Subchapter 2 Assessment and Collection of Fees*
- *SOURCE: Miss. Code Ann. §41-26-23 Rule 4.2.2. Advisory Committee. An advisory committee is created to study the program needs and costs for the implementation of the water quality analysis program and to conduct an annual review of the needs and costs of administering that program. The annual review shall include an independent recommendation on an equitable fee schedule for the succeeding fiscal year. Each annual review report shall be due to the department by May 1. The advisory committee shall consist of one (1) member appointed by the Mississippi Rural Water Association, one (1) member appointed by the Mississippi Municipal Association, one (1) member appointed by the Mississippi Association of Supervisors and one (1) member appointed by the Mississippi Water and Pollution Control Operators Association, Inc.*
- *SOURCE: Miss. Code Ann. §41-26-23 Rule 4.2.3. Payments and Penalties. All suppliers of water for which water quality analysis and related activities as required by the federal Safe Drinking Water Act, as amended, are performed by the State Department of Health shall pay the water quality analysis fee within forty-five (45) days following receipt of an invoice from the department. In the discretion of the department, any supplier of water required to pay the fee shall be liable for a penalty equal to a maximum of two (2) times the amount of fees due and payable plus an amount necessary to reimburse the costs of delinquent fee collection for failure to pay the fee within ninety (90) days following the receipt of the invoice.*
- *SOURCE: Miss. Code Ann. §41-26-23 Chapter 5 REGULATIONS GOVERNING AMERICAN RESCUE PLAN ACT RURAL WATER ASSOCIATIONS INFRASTRUCTURE GRANT PROGRAM*

##### **15 Miss. Admin. Code Pt. 20, R. 5.1.1** Legal Authority {#sec-20-5.1.1 omnilex-key=us-ms-regs-official--title-15--20#5.1.1}

These regulations are adopted pursuant to House Bill 1421 of the Mississippi Legislature’s 2022 Regular Session and SB 2444 of the Mississippi Legislature’s 2023 Regular Session shall govern the American Rescue Plan Act Rural Water Associations Infrastructure Grant (ARPA RWAIG) Program. These regulations may be superseded by the grant agreement when a variance or exception is made by the Board of Health (Board) and when not in conflict with any state or federal laws or executive orders.

**History**
- *Source: House Bill 1421, 2022 Regular Session and Senate Bill 2444, 2023 Regular Session of the MS Legislature*

##### **15 Miss. Admin. Code Pt. 20, R. 5.1.2** Definitions {#sec-20-5.1.2 omnilex-key=us-ms-regs-official--title-15--20#5.1.2}

The following words and terms, when used in these regulations, will have the following meanings, unless the context clearly indicates otherwise:

1. Act - The Mississippi House Bill 1421 of 2022

2. Allowable Costs - Those project costs that are eligible, reasonable, necessary, allocable to the project, within the established project scope and budget, in conformance with the ARPA RWAIG program regulations and as approved by the Mississippi State Department of Health (Department).

3. Authorized Representative - The signatory agent of the applicant authorized and directed by the applicant's governing body to make application for assistance and to sign documents, on behalf of the applicant, required to undertake and complete the project. The signatory agent shall be a member or an employee of the applicant's governing body and may not be under a separate contract with the applicant at any time during the execution of the project.

4. Board - The Mississippi State Board of Health.

5. Change Order - The documents executed by the grant recipient and the construction contractor, upon recommendation of the licensed engineer if required by the contract documents, authorizing a change, alteration, or variance in the plans, specifications, and contract documents, including, but not

limited to, additions or deletions of work to be performed pursuant to the contract or a change in costs or time for work performed pursuant to the contract.

6. Construction - Any one or more of the following: erection, building, acquisition, alteration, remodeling, improvement, or extension of drinking water systems.

7. Department - Mississippi State Department of Health and staff, and their designated representatives.

8. ARPA RWAIGP (Program) - The ARPA Rural Water Associations Infrastructure Grant Program.

9. Rural Water Association - a non-profit corporation or organized not for profit with a primary function to finance, construct, operate and maintain a rural water distribution system, which has the authority to collect, treat, store, and distribute piped water for human consumption.

10. Eligible Applicant - entity that meets one of the following criteria:

A. is a Rural Water Association B. or is operating as rural water association regardless of whether such entities were user created, were initially organized not for profit, or have been granted tax-exempt status under state or federal law; C. or is a nonprofit water or sewer provider not owned by a municipality or county and is not a Rural Water Association; and is currently operating as a not-for-profit entity; and has the authority under state law to receive ARPA RWAI grant assistance; and did not receive funding under this program or the Mississippi Municipality and County Water Infrastructure Grant Program Act; and has the ability to comply with these regulations and the requirements of the grant agreement.

11. Ineligible Applicant – state agency, county, incorporated municipality, or other water organization eligible for ARPA funding through other programs.

12. Eligible Cost - Eligible costs are those costs in which ARPA RWAI grant participation is authorized pursuant to applicable statute.

13. Financial Assistance - Grants by the Department from the ARPA RWAIG Program.

14. Grant Agreement - An agreement between the Department and the grant recipient through which the Program provides ARPA RWAI grant funds for eligible assistance and the recipient promises to follow the rules and regulations of the ARPA RWAI grant period over a period of the grant

agreement. Also referred to as Sub-grant Agreement.

15. Grant Applicant - A Rural Water Association that makes application for assistance from the ARPA RWAI grant program.

16. Grant Recipient - A Rural Water Association that receives a Grant from the ARPA RWAI grant program. Also referred to as Sub-grantee.

17. May - whenever used in the context of an action to be taken by the grant applicant/recipient the word will be interpreted as optional but is not mandatory.

18. Shall - whenever used in the context of an action to be taken by the grant applicant/recipient the word will be interpreted as mandatory.

19. Shall Not - whenever used in the context of an action by the grant applicant/recipient such action is prohibited by these regulations.

20. Plans, Specifications and Contract Documents - The engineering description of the project including engineering drawings, maps, technical specifications, design reports and construction contract documents in sufficient detail to allow contractors to bid on and construct the work.

21. Schedule of Awards - The schedule of awards established by the Department to ensure all funds are obligated by the deadline established by the rules and guidelines of the United States Department of the Treasury for ARPA funds.

22. Project - The scope of work for which assistance is offered under the ARPA RWAIG program.

23. Project Completion - The date of the final construction observation as performed by the Department for the purpose of an allowability determination.

24. Protest - A written complaint to the grant recipient concerning the grant recipient’s solicitation or award of a contract. The protest shall be filed with the grant recipient by a party with a direct financial interest adversely affected by a grant recipient’s procurement action.

25. Public Water System - A system for the provision to the public of piped water for human consumption, if such a system has at least fifteen service connections or regularly serves at least twenty-five individuals. This includes any collection, treatment, storage and distribution facilities under the control of the operator of a PWS or used primarily in connection with

a PWS.

26. Licensed Engineer - The engineer, licensed by the Mississippi State Board of Registration for Professional Engineers and Land Surveyors, retained or employed by the grant recipient to provide professional engineering services during the planning, design, and/or construction of the project.

**History**
- *Source: House Bill 1421, 2022 Regular Session & Senate Bill 2444, 2023 Regular Session of the MS Legislature*

##### **15 Miss. Admin. Code Pt. 20, R. 5.2.1** Eligible Applicant Determination and Sub-Grant Agreement {#sec-20-5.2.1 omnilex-key=us-ms-regs-official--title-15--20#5.2.1}

1. Eligible Applicant Determination. To be eligible for financial assistance, an applicant shall meet the definition of an eligible applicant as described in Rule 5.1.3. of these regulations, as determined by the Department.

2. Sub-Grant Agreement. Eligible Recipients will be required to execute a sub-grant agreement with the Department and certify that the reimbursement for a rural water association drinking water infrastructure project is for allowable expenditures under the American Rescue Plan Act (ARPA) of 2021, Public Law 117-2, which amends Title VI of the Social Security Act; and its implementing guidelines, guidance, rules, regulations and/or other criteria, as may be amended or supplemented from time to time, by the United States Department of the Treasury.

**History**
- *Source: House Bill 1421, 2022 Regular Session & Senate Bill 2444, 2023 Regular Session of the MS Legislature*

##### **15 Miss. Admin. Code Pt. 20, R. 5.2.2** Obligation Period {#sec-20-5.2.2 omnilex-key=us-ms-regs-official--title-15--20#5.2.2}

Funds allotted to the Program will be available for obligation for the period of July 1, 2022, to December 31, 2024, or as otherwise established by Sub-Grant Agreement, State or federal law.

**History**
- *Source: House Bill 1421, 2022 Regular Session & Senate Bill 2444, 2023 Regular Session of the MS Legislature*

##### **15 Miss. Admin. Code Pt. 20, R. 5.2.3** Reserves {#sec-20-5.2.3 omnilex-key=us-ms-regs-official--title-15--20#5.2.3}

Up to five percent of the State's ARPA Rural Water Associations Infrastructure Grant Funds will be reserved for the administration of the program consistent with the Act and state law.

**History**
- *Source: House Bill 1421, 2022 Regular Session*

##### **15 Miss. Admin. Code Pt. 20, R. 5.2.4** ARPA RWAIG Uses {#sec-20-5.2.4 omnilex-key=us-ms-regs-official--title-15--20#5.2.4}

The ARPA RWAIG funds may be used for the following purposes:

1. To make grants for eligible infrastructure improvements on the conditions that the recipient of a grant shall establish a plan for asset management; 2. For the reasonable costs of administering the ARPA RWAIG program and conducting activities under this Act, subject to any limitations established in the state or federal law; and,

3. For other uses as allowed under the ARPA

**History**
- *Source: House Bill 1421, 2022 Regular Session & Senate Bill 2444, 2023 Regular Session of the MS Legislature*

##### **15 Miss. Admin. Code Pt. 20, R. 5.2.5** Federal Requirements {#sec-20-5.2.5 omnilex-key=us-ms-regs-official--title-15--20#5.2.5}

All projects which receive grant assistance from the ARPA RWAIG fund shall meet the requirements of the Final Rule for the Coronavirus State and Local Fiscal Recovery Funds as established by the federal American Rescue Plan Act (ARPA).

**History**
- *Source: House Bill 1421, 2022 Regular Session*

##### **15 Miss. Admin. Code Pt. 20, R. 5.2.6** Grant Award Cycles {#sec-20-5.2.6 omnilex-key=us-ms-regs-official--title-15--20#5.2.6}

The Department will prepare a schedule for award cycles to make awards to projects eligible and ready to begin construction. In the first fiscal year after the effective date of the Act, twenty percent (20%) of the funds appropriated to the Department for the program shall be obligated to projects that have completed plans and specifications, acquired all necessary land and/or easements, and are ready to proceed to construction. Award Cycles shall be created at the Departments discretion until such time that all funds are obligated but not to exceed December 31, 2024. Awards occurring during the award cycle will be a product of an applicants’ eligibility, the proposed projects eligibility, and the projects ranking score produced by the Program’s Application Ranking System.

If the Department determines the available funds for award are not adequate to justify an additional award cycle, the Department shall allow funded Round 1 and 2 projects, awarded less than $1M to request no more than 100% of their original grant in additional grant funding for the original scope, provided that does not exceed $1.5M. This shall be awarded based on funding availability at the time of the request and at the discretion of the Department.

**History**
- *Source: House Bill 1421, 2022 Regular Session*

##### **15 Miss. Admin. Code Pt. 20, R. 5.2.7** Application Ranking System {#sec-20-5.2.7 omnilex-key=us-ms-regs-official--title-15--20#5.2.7}

The department shall use the following system for ranking the grant applications received. The ranking system includes the following factors:

1. The environmental impact of the proposed project;

2. The proposed project's ability to address noncompliance with state/federal requirements;

3. The extent to which the project promotes economic development;

4. The number of people served by the project (both new and existing users);

5. Impacts of the proposed project on disadvantaged/ overburdened communities; 6. The grant applicant's prior efforts to secure funding to address the proposed project's objectives;

7. The grant applicant's proposed contribution of other funds or in-kind cost- sharing to the proposed project;

8. The grant applicant's long-term plans for the financial and physical operation and maintenance of the project; and

9. The grant applicant's capacity to initiate construction in a timely manner and complete the proposed project by the deadline specified by rules and guidelines of the United States Department of the Treasury (USDT) for ARPA funds.

These factors will be quantified based on the point allocations within each of the ranking categories defined below. A maximum of 100 points can be received by the combined total points within the nine ranking categories. As Item B. notes, an additional 10 points may be obtained if consolidation/regionalization of systems are involved.

A. The environmental impact of the proposed project will be quantified based on a High (1), Moderate (3), or Low (5) assessment with a maximum of 5 points in this category.

B. The proposed project's ability to address noncompliance with state/federal requirements project will receive up to 30 points based on project category. For the first round of funding, an additional ten points will be added to any project combining

consolidation/regionalization of public water systems with one of the other categories listed.

For projects submitted in the second round of funding, an additional fifteen points will be added to any project combining consolidation/regionalization of public water systems with one of the other categories listed. In order to receive the additional weight, the systems that will consolidate shall be in a proximity of each other as determined by the department. In addition to these additional consolidation points, an additional 10 points shall be added to any application with at least one system that has consolidated after January 1, 2018, and before application to this program and is otherwise eligible.

RANK PROJECT CATEGORY

Primary Drinking Water Standards Project facilitates compliance with Primary Drinking Water Standards. Project must correct deficiencies resulting in non- compliance with the primary drinking water standards.

One Well Project to provide additional water supply to systems that have neither a backup well nor an MSDH-approved emergency tie-in to another system to ensure safe drinking water; thereby protecting the health of the existing population.

Pressure Deficiencies Project to correct documented deficiencies that result in existing systems routinely failing to maintain minimum acceptable dynamic pressure.

RANK PROJECT CATEGORY

Source Water Protection Projects Project to manage potential sources of contaminants/pollutants and/or prevent contaminants/pollutants from reaching sources of drinking water.

Capacity Expansion to Serve the Unserved Project to either expand existing system capacity or construct a new drinking water system to serve existing residences/businesses in currently unserved areas safe drinking water (source, treatment and/or distribution).

Back-up Water Supply Sources Projects Project to provide additional supply to systems with insufficient back-up water supply sources to ensure safe drinking water, and thereby protect the health of the existing population. 18 Existing Facilities Upgrades (Meeting Primary Standards) Project to rehabilitate, replace, protect or upgrade deteriorated, worn, aged or obsolete equipment, facilities, etc., to assure continued, dependable operation of water systems where such systems are already meeting Primary Drinking Water Standards.

Secondary Drinking Water Standards Projects Project to provide treatment that brings systems into compliance with Secondary Drinking Water Regulations.

Consolidation Projects Project to consolidate separate systems into a single system for purposes other than those related to meeting primary standards.

Fluoride Addition This category is for projects that either rehabilitate existing fluoride treatment facilities at well or treatment plant sites or add new facilities to existing well or treatment plants.

Other Project does not meet the criteria of any category listed above.

C. The extent to which the project promotes economic development will be

quantified based on assessment of yes (5) or no (0) with a maximum of 5 points within this category. D. The number of people served by the project will be quantified based on population range.

Population Range Ranking 0 - 3,300 15 3,300 - 6,600 12 6,600 - 9,900 10 9,900 - 13,200 8 13,200 - 16,500 4 16,500 - 19,800 3 19,800 - 23,100 3 23,100 - 26,400 4 26,400 - 29,700 8 29,700 - 33,000 10 33,000 - 36,300 12 36,300 - Above 15

E. Impacts of the proposed project on disadvantaged communities will be quantified based on Median Household Income (MHI).

MHI Range Ranking $0.00 - $20,144.00 15 $20,144.00 - $23,073.67 13 $23,073.67 - $26,003.33 11 $26,003.33 - $28,933.00 8 $28,933.00 - $31,862.67 7 $31,862.67 - $34,792.34 6 $34,792.34 - $37,722.00 5 $37,722.00 - $40,651.67 4 $40,651.67 - $43,581.34 3 $43,581.34 - $46,511.00 2 $46,511.00 - Above 1

F. The grant applicant's prior efforts to fund the project will be quantified based on assessment of yes (5) or no (0) with a maximum of 5 points within this category.

G. The grant applicant's proposed contribution will be quantified based on a percentage range of the projects total cost with a maximum of 5 points within this category.

Percentage Range Ranking 1% - 4% 1 5% - 9% 3 10% - Above 5

H. The grant applicant's long-term plans for the financial and physical operation and maintenance of the project will be quantified based on an assessment. Applicants with no plan will receive a zero (0). Applicants with a long-term plan will receive five (5). Applicants certifying the development of an asset management plan by the end of the project will receive ten (10) with a maximum of 10 points within this category.

I. The grant applicant's capacity to complete the proposed project by the deadline specified by rules and guidelines of the USDT for ARPA funds will be quantified based on an assessment. Applicants able to meet this requirement will be quantified at 10 with a maximum of 10 points within this category. Applicants unable to meet this requirement will be disqualified.

J. If necessary, the following will be used as the basis for breaking any ties that occur.

a) Projects to primarily correct a MSDH documented failure to meet primary drinking water standards or a MSDH documented significant deficiency will be given preference. b) If there are no projects to correct a MSDH documented failure to meet primary drinking water standards or a MSDH documented significant deficiency, projects primarily for consolidation will be given preference. c) If there are no projects primarily for consolidation, projects with the lowest Median Household Income Range will be given preference. d) If all projects have the same Median Household Income Range, projects with the lowest Population will be given preference. e) If all projects have the same Population Range, projects extending potable water service to new users will be given preference.

**History**
- *Source: House Bill 1421, 2022 Regular Session & Senate Bill 2444, 2023 Regular Session of the MS Legislature*

##### **15 Miss. Admin. Code Pt. 20, R. 5.2.8** ARPA RWAIG Financing {#sec-20-5.2.8 omnilex-key=us-ms-regs-official--title-15--20#5.2.8}

The ARPA RWAIG fund has been established to provide grants to assist and encourage rural water associations to pursue projects to address drinking water system infrastructure needs. Conditions of these Grants are itemized in Rule 5.2.4 of these regulations. Basic ARPA RWAIG financing requirements are as follows:

1. ARPA RWAI grants may be limited at the discretion of the Department based on funds availability or as otherwise stated under state law.

2. For the first round, the maximum amount of funds that may be provided to any rural water association from all grants under the program is Two Million Five Hundred Thousand Dollars ($2,500,000.00). For the second round, the maximum amount of funds that may be provided to any rural water association from all grants under the program is Two Million Dollars ($2,000,000.00).

3. The applicant's project shall be able to initiate construction in a timely manner and complete the proposed project by the deadline specified by rules and guidelines of the United States Department of the Treasury for ARPA funds and set forth in House Bill 1421 of the Mississippi Legislature’s 2022 Regular Session.

4. Terms of any ARPA RWAIG assistance will be as established in the Grant agreement.

5. The applicant shall comply with the requirements of the ARPA and all applicable state and federal laws, requirements, and regulations. 6. The applicant shall not be in violation of any provision of a previously awarded grant of state or federal funds.

7. The applicant shall comply with any technical assistance recommendations provided by the Department.

8. Except for program administration expenses, funds will not be disbursed from the ARPA RWAIG until a Grant recipient has entered into a Grant agreement with the Board.

**History**
- *Source: House Bill 1421, 2022 Regular Session & Senate Bill 2444, 2023 Regular Session of the MS Legislature*

##### **15 Miss. Admin. Code Pt. 20, R. 5.2.9** Responsibility {#sec-20-5.2.9 omnilex-key=us-ms-regs-official--title-15--20#5.2.9}

The applicant/Grant recipient is responsible for the proper planning, design, construction, operation, maintenance, replacement, performance, and fiscal integrity of the project. The Department's approval of any document does not relieve the applicant/Grant recipient or any others of any liabilities or responsibilities. Department approval of any document is for Grant eligibility/allowability purposes only and does not establish or transfer any such liability or responsibility.

**History**
- *Source: House Bill 1421, 2022 Regular Session*

##### **15 Miss. Admin. Code Pt. 20, R. 5.2.10** Other Approvals {#sec-20-5.2.10 omnilex-key=us-ms-regs-official--title-15--20#5.2.10}

The applicant (or Grant recipient) shall obtain approval of all necessary documents from each state, local, and federal agency having jurisdiction over or funding in the project, if so required by that agency.

**History**
- *Source: House Bill 1421, 2022 Regular Session*

##### **15 Miss. Admin. Code Pt. 20, R. 5.3.1** Application for ARPA RWAI Grant {#sec-20-5.3.1 omnilex-key=us-ms-regs-official--title-15--20#5.3.1}

1. Pre-application Guidance and Conference.

Upon request the Department will provide a Grant application package to the potential Grant applicant and/or its licensed engineer. The potential Grant applicant and/or its licensed engineer may request a pre- application conference with the Department as early in the application process as practical.

2. Contents of Applications

All documents listed below shall be complete when submitted to the Department. When forms are provided by the Department, these forms shall be used, and they shall not be altered. The ARPA RWAI Grant application may request assistance only for costs that are allowable in accordance with Subchapter 4 of these regulations and may include a construction contingency, as determined by the Department, in the project budget. The application shall include a Project Cost Breakdown. A complete application package shall conform to these regulations and shall include the following:

A. A complete ARPA RWAI Grant application form with original signature with associated attachments.

B. A procurement certification from the Grant applicant and the Grant applicant's legal counsel.

C. A legal certification from the Grant applicant and the Grant applicant's legal counsel.

D. A certified copy of a resolution by the Grant applicant's governing body which, 1) authorizes the submission of the application and 2) designates an authorized representative or officer to make application for assistance and to sign documents on behalf of the applicant.

E. A certification regarding debarment, suspension, in accordance with Subchapter 7 Rule 5.7.2 of these regulations.

F. Documentation of its tax-exempt status under either federal or state law.

G. An Internal Revenue Service Form W-9.

H. All waste disposal permit applications, if applicable.

I. All other forms, documents, and supporting information required by the Department.

**History**
- *Source: House Bill 1421, 2022 Regular Session & Senate Bill 2444, 2023 Regular Session of the MS Legislature*

##### **15 Miss. Admin. Code Pt. 20, R. 5.3.2** Submission of Application {#sec-20-5.3.2 omnilex-key=us-ms-regs-official--title-15--20#5.3.2}

By the date specified on the MSDH website the applicant shall submit the application to the Department to be considered for the award cycle. Award cycles will be quarterly until allocated funding has been fully obligated or the legislative deadline of December 31, 2024, has been reached.

**History**
- *Source: House Bill 1421, 2022 Regular Session & Senate Bill 2444, 2023 Regular Session of the MS Legislature*

##### **15 Miss. Admin. Code Pt. 20, R. 5.3.3** Offer of ARPA RWAI Grant {#sec-20-5.3.3 omnilex-key=us-ms-regs-official--title-15--20#5.3.3}

Upon determination by the Department that (a) all applicable requirements of the ARPA RWAI Grant application have been met, (b) the application deadlines have been met for the award cycle, and (c) funds are available for the amount of the ARPA RWAI Grant application, the State Health Officer or his designee will execute and transmit an ARPA RWAI Grant offer to the Grant recipient. In addition to the estimated allowable project costs as described in Appendices A and B

of these regulations, the Grant offer may include a construction contingency, as determined by the Department, in the project budget.

**History**
- *Source: House Bill 1421, 2022 Regular Session & Senate Bill 2444, 2023 Regular Session of the MS Legislature*

##### **15 Miss. Admin. Code Pt. 20, R. 5.3.4** Execution of Grant Offer {#sec-20-5.3.4 omnilex-key=us-ms-regs-official--title-15--20#5.3.4}

Upon receipt of the ARPA RWAI Grant offer, the Grant recipient shall execute the acceptance of the Grant offer and return it to the Department within the time frame established in the Grant Offer Letter. The Grant offer becomes void if not executed and returned within the time frame specified, unless extended by the State Health Officer or his designee, for good cause.

**History**
- *Source: House Bill 1421, 2022 Regular Session & Senate Bill 2444, 2023 Regular Session of the MS Legislature*

##### **15 Miss. Admin. Code Pt. 20, R. 5.3.5** Engineering Design {#sec-20-5.3.5 omnilex-key=us-ms-regs-official--title-15--20#5.3.5}

1. Predesign Guidance and Conference.

The Department will provide design guidance to the Grant applicant, or its licensed engineer as requested. The applicant/engineer may request a pre-design conference with the Department.

2. General Requirements for plans, specifications and contract documents.

A. Plans, specifications, and contract documents shall be prepared for all appropriate elements of the project. These documents shall conform to Department requirements, to these regulations, and to the requirements of the most recent version of the Departmental document "Recommended Minimum Design Criteria for Community Water Supplies. or their successor(s). Other recognized engineering publications may be used for unit processes or technologies not described therein.

B. Plans, specifications, and contract documents shall also conform to such contract language, conditions, and forms as may be required by the Department. The plans, specifications, and contract documents shall bear the seal of the licensed engineer responsible for preparation of these documents.

3. Contents of plans specifications and contract documents.

In addition to the above general requirements, the plans, specifications, and contract documents shall contain the following:

A. Provisions assuring compliance with these regulations and all relevant federal and state laws.

B. Forms by which the bid bond, performance bond and payment bonds will be provided.

C. A contractor's assurance which shall warrant compliance by the contractor with all applicable federal laws and regulations and all laws of the State of Mississippi and all regulations and published policies of the Board.

D. Provisions providing for the applicant to retain a certain percentage of the progress payments otherwise due to the contractor, in accordance with state law.

E. Provisions requiring the contractor to obtain and maintain the appropriate insurance coverage.

F. Provisions giving authorized representatives of the Department access to all such construction activities, books, records, documents, and other evidence of the contractor for the purpose of inspection, audit, and copying during normal business and/or working hours.

G. Provisions for change orders.

H. Those conditions, specifications, and other provisions set forth or required by the Department.

I. Provisions for liquidated damages.

J. Provisions for including water meters on new distribution systems.

**History**
- *Source: House Bill 1421, 2022 Regular Session*

##### **15 Miss. Admin. Code Pt. 20, R. 5.3.6** Submission of Plans, Specifications, Contract Documents and Related Items {#sec-20-5.3.6 omnilex-key=us-ms-regs-official--title-15--20#5.3.6}

By the dates specified in the Grant agreement, the recipient shall submit the following items to the Department:

1. Complete plans, specifications, and contract documents.

2. Certification from Licensed Engineer of the environmental impact, either low, moderate, or high of the project. If the Licensed Engineers

determination is moderate or high, the Licensed Engineer should complete an Environmental and Intergovernmental Review as defined in Subchapter 6 and 8.

3. A copy of the issued National Pollutant Discharge Elimination System (NPDES) permit or the state operating permit, if required.

4. A copy of the issued solid waste disposal permit, if required.

5. Written waivers from all adjoining property owners when it is not possible to provide required buffer zones if the project includes drinking water sludge treatment facilities.

6. For all Grant eligible real property acquisitions all applicable state law must be followed. Prior to advertisement for construction bids, the Grant recipient shall secure approval of the purchase price by the Department, shall complete purchase of all Grant eligible real property and easements, and shall submit clear title certificates from the Grant recipient and title counsel for all such Grant eligible property. Clear site certificates will also be required for Grant ineligible property.

7. A copy of all necessary interlocal agreements related to the project, if applicable. Such agreements shall be executed by all appropriate parties and shall be verified by the Department prior to any construction expenditures. If the project is unable to be completed due to failure to execute the necessary interlocal agreements, Grant Recipient shall be required to repay any funds expended for the project.

**History**
- *Source: House Bill 1421, 2022 Regular Session & Senate Bill 2444, 2023 Regular Session of the MS Legislature*

##### **15 Miss. Admin. Code Pt. 20, R. 5.3.7** Approval of Plans, Specifications, and Contract Documents {#sec-20-5.3.7 omnilex-key=us-ms-regs-official--title-15--20#5.3.7}

The Department will approve the plans, specifications, and contract documents upon determining that these documents appear to conform to the requirements of these regulations and are consistent with the approved planning documents and environmental determinations required by these regulations.

**History**
- *Source: House Bill 1421, 2022 Regular Session*

##### **15 Miss. Admin. Code Pt. 20, R. 5.3.8** Construction Bidding and Grant Amendment {#sec-20-5.3.8 omnilex-key=us-ms-regs-official--title-15--20#5.3.8}

1. Grant Agreement Timeframe

Within the timeframe established in the Grant agreement, the Grant recipient shall secure Department approval of the plans, specifications, and contract documents.

A. For all Grant ineligible real property and easements (including power and other utilities), submit clear site certification forms from both the Grant recipient and the title counsel which indicate that all such Grant ineligible real property and easements for the entire project have been secured by clear title.

B. Secure all local funds necessary for the project and submit proof of such.

C. Upon approval of PSCD, submittal of all clear site certificates, and issuance of any other permits or clearances required for the project, advertise the project for construction bids. All procurement actions by the Grant recipient shall comply with applicable law and these regulations.

2. Process following Receipt of Construction Bids

Upon receipt of construction bids, the Grant recipient shall then submit:

A. The completed bid package;

B. A Budget modification consistent with as-bid construction costs, a construction contingency as determined by the Department, and any professional services contracts and amendments.

C. If additional funds are necessary for the project, A Grant agreement amendment request outlining the source of the additional funds will be submitted.

3. Review of Documents

Upon receipt of the items listed above, the Department will review them to determine whether any request for an increased Grant amount is justified and allowable and whether funds are available. If necessary, a budget modification to move funds between allowable categories may be required. After determining that all documents are approvable, the Department will transmit to the Grant recipient approval to execute the construction contracts. After approval of the bid package, the Grant Recipient shall then submit all necessary executed contracts and amendments as described these regulations.

**History**
- *Source: House Bill 1421, 2022 Regular Session & Senate Bill 2444, 2023 Regular Session of the MS Legislature*

##### **15 Miss. Admin. Code Pt. 20, R. 5.3.9** Budget Modifications, Schedule Modifications, and Amended Grant Offer {#sec-20-5.3.9 omnilex-key=us-ms-regs-official--title-15--20#5.3.9}

1. Budget Modifications. Grant recipients can request to move funds between eligible categories in the Grant Agreement by completing a budget modification. This modification will be required prior to approval of reimbursement of any costs where the costs exceed the available budget. The contingency fund can be spent for construction costs only without a budget modification, however these funds should be moved to the construction category prior to the project closeout. Grant recipients can also add additional local funds to the project as needed. After determining that the budget modification is approvable, the Department will transmit to the Grant recipient for approval of the modification.

2. Schedule Modification. To amend the schedule in the Grant Agreement, Grant Recipient should submit a letter detailing the need for schedule revision. After determining if the schedule modification is approvable, the Department will transmit to the Grant recipient for approval of the modification. Schedule modifications to construction contract should be submitted in the form of a change order.

3. Process after Grant Agreement Amendment Request

If the budget and schedule modifications cannot address the needed changes to the Grant Agreement, the Grant Recipient can submit a Grant Agreement Amendment Request. After receipt, review, and approval of the Grant agreement amendment request, the Department may prepare and transmit an amended ARPA RWAI Grant offer to the Grant recipient. The Grant offer will include in the project budget:

A. The approved as-bid amounts for construction;

B. The final allowance amounts for professional services in accordance with Subchapter 5 of these regulations;

C. A construction contingency as determined by the Department; and,

D. Required local funds, if any.

Upon receipt of the amended ARPA RWAI Grant offer, the Grant recipient shall completely execute and return it to the Department within the timeframe established in the offer letter. After execution of the amended ARPA RWAI Grant offer. Any increased project costs in excess of the amended ARPA RWAI Grant amount shall be paid by the Grant recipient from sources other than ARPA RWAIG funds.

**History**
- *Source: House Bill 1421, 2022 Regular Session & Senate Bill 2444, 2023 Regular Session of the MS Legislature 3. Execution of Amended Grant Offer*
- *Source: House Bill 1421, 2022 Regular Session & Senate Bill 2444, 2023 Regular Session of the MS Legislature*

##### **15 Miss. Admin. Code Pt. 20, R. 5.3.10** Awarding Construction Contracts and Preconstruction Conference {#sec-20-5.3.10 omnilex-key=us-ms-regs-official--title-15--20#5.3.10}

Upon receipt of the approval to execute the construction contracts and to issue the notice to proceed, the Grant recipient shall do so and shall transmit a copy of the executed construction contracts and the notice to proceed to the Department within the time frame specified in the Grant agreement.

**History**
- *Source: House Bill 1421, 2022 Regular Session*

##### **15 Miss. Admin. Code Pt. 20, R. 5.3.11** Grant Recipient Responsibility {#sec-20-5.3.11 omnilex-key=us-ms-regs-official--title-15--20#5.3.11}

The Grant recipient will be responsible for assuring that every appropriate procedure and incidental legal requirement are observed in procurement of services, advertisement for bids, and awarding the construction contracts. The plans, specifications, and executed contract documents shall not vary from those approved by the Department.

**History**
- *Source: House Bill 1421, 2022 Regular Session & Senate Bill 2444, 2023 Regular Session of the MS Legislature*

##### **15 Miss. Admin. Code Pt. 20, R. 5.3.12** Preconstruction Conference {#sec-20-5.3.12 omnilex-key=us-ms-regs-official--title-15--20#5.3.12}

The Grant recipient may arrange and hold a preconstruction conference and shall allow attendance and participation by the Department if such is held.

**History**
- *Source: House Bill 1421, 2022 Regular Session*

##### **15 Miss. Admin. Code Pt. 20, R. 5.3.13** Observation During Construction {#sec-20-5.3.13 omnilex-key=us-ms-regs-official--title-15--20#5.3.13}

1. Resident Observation

During construction work being performed, the Grant recipient shall provide for resident observation of the project by the licensed engineer or his staff and shall require the licensed engineer's assurance that the work is being performed in a satisfactory manner in accordance with the Grant agreement and the approved plans, specifications, contract documents, and approved change orders.

2. Department Observation

The Department is authorized to observe the building of any project at any time for compliance with the terms of the Grant agreement and to determine if the Grant recipient is assuring that plans, specifications, and contract documents are being followed. Such observation will not subject the Department to any legal action for claims, damages, or any other liability.

Also, such observation shall not release the contractor from any obligation to perform the work in accordance with the requirements of the contract documents or the licensed engineer from determining compliance with the requirements of the contract documents or the Grant recipient from insuring compliance with the terms of the Grant agreement.

3. Assurance of Work

The contractor, licensed engineer, and the Grant recipient shall furnish the Department with every reasonable opportunity and means for determining whether the Grant recipient and licensed engineer are assuring that the work is in accordance with the requirements of the approved plans, specifications, and contract documents. The Department is authorized to observe and require submission by the Grant recipient of daily logs, full scale record drawings, file notes, and any other documents prepared by any party in relation to the ARPA RWAI funded project.

**History**
- *Source: House Bill 1421, 2022 Regular Session & Senate Bill 2444, 2023 Regular Session of the MS Legislature*

##### **15 Miss. Admin. Code Pt. 20, R. 5.3.14** Observation of Materials and Equipment {#sec-20-5.3.14 omnilex-key=us-ms-regs-official--title-15--20#5.3.14}

The Department is also authorized to observe all equipment and materials furnished, including observation of the preparation or manufacture of the equipment and materials to be used.

**History**
- *Source: House Bill 1421, 2022 Regular Session*

##### **15 Miss. Admin. Code Pt. 20, R. 5.3.15** Construction Deficiencies {#sec-20-5.3.15 omnilex-key=us-ms-regs-official--title-15--20#5.3.15}

Nonconformity with Plans and Specifications. In the event that it appears to the Department that the Grant recipient and licensed engineer are not assuring that the construction work, materials, equipment or supplies are in conformity with approved plans and specifications the Department may determine such work unallowable for ARPA RWAI Grant participation, unless the Grant recipient takes such action, through the licensed engineer if applicable, in the manner provided for in the construction contract to correct any deficiencies.

**History**
- *Source: House Bill 1421, 2022 Regular Session & Senate Bill 2444, 2023 Regular Session of the MS Legislature*

##### **15 Miss. Admin. Code Pt. 20, R. 5.3.16** Withholding of Grant Payment {#sec-20-5.3.16 omnilex-key=us-ms-regs-official--title-15--20#5.3.16}

The Department may immediately withhold ARPA RWAI Grant payments for such time that it appears that the Grant recipient and licensed engineer are not assuring that construction work, materials, equipment, or supplies are in accordance with the approved plans, specifications, and contract documents, and may require the Grant recipient to repay any previously paid amounts related to such work within 30 days of such notification.

**History**
- *Source: House Bill 1421, 2022 Regular Session & Senate Bill 2444, 2023 Regular Session of the MS*

##### **15 Miss. Admin. Code Pt. 20, R. 5.3.17** Change Orders {#sec-20-5.3.17 omnilex-key=us-ms-regs-official--title-15--20#5.3.17}

1. General.

A. In the event a determination is made by a Grant recipient after a construction contract is executed that changes or modifications to the original contract are necessary or would better serve the purpose of the Grant recipient, such Grant recipient may, at its discretion, execute such change orders pertaining to the construction that are necessary under the circumstances, as provided in the contract documents and when in accordance with applicable law.

B. Change orders shall not change, vary, or alter the basic purpose or effect of the project unless allowed by the Department. Change orders shall be technically adequate, the costs shall be necessary and reasonable, and eligible/ineligible costs shall be appropriately separated.

2. Change Order Submissions.

A. After completion of the claims resolution and/or change order negotiation process between the Grant recipient and the contracting party, a fully executed change order shall be submitted to the Department for review and approval, in order to obtain an ARPA RWAI Grant eligibility/allowability determination. If any change order is submitted to the Department that is not complete and fully executed by the Grant recipient, the contracting party, and the licensed engineer if appropriate, the Department may return such change order without review.

B. The Grant recipient may submit a complete and fully executed change order which has been executed conditional upon an ARPA RWAI Grant eligibility/allowability determination by the Department.

C. All change orders shall be submitted to the Department for review and approval in a timely manner.

D. If possible, approval of a change order should be secured from the Department before the work is started, particularly for change orders including time extensions as per Rule 5.3.17.4 below. Approval may also be secured after the work is started; however, the Grant recipient shall bear the cost if the work is determined to

be ineligible or unallowable.

E. When the eligible cost of a project will be significantly reduced by a change order or change orders, the Department may issue an amendment to the budget modification decreasing the Grant amount, and the Grant recipient shall execute such modification within the time frame established by the Department.

3. Department Review.

In order to allow the Department to perform a technical and Grant allowability review, requests for change order approvals shall conform to Department guidance, requirements, and regulations.

4. Time Extensions.

Change orders which include time extensions exceeding 30 days beyond the original contract completion date, and/or documentation that the Grant recipient is implementing all legal remedies provided in the contract documents for failure to complete construction when required, shall be submitted to the Department as specified in these regulations. Justification for contract time extensions included in a change order shall be prepared but need not be submitted to the Department unless the total time extensions for the contract exceeds 30 days after the original contract completion date, in which case justification for all time extensions shall be submitted to the Department for an allowability determination. The deadline of September 30, 2026 ends the period of performance to liquidate all obligations. The contract completion date should not exceed August 15, 2026.

**History**
- *Source: House Bill 1421, 2022 Regular Session & Senate Bill 2444, 2023 Regular Session of the MS Legislature*

##### **15 Miss. Admin. Code Pt. 20, R. 5.3.19** Construction Phase Submissions, Approvals, and Actions -Timeline {#sec-20-5.3.19 omnilex-key=us-ms-regs-official--title-15--20#5.3.19}

The following submittals, approvals, and actions will be required during the construction phase of the project. The Department may establish other time frames within the Grant agreement when properly justified.

1. Prior to payment of any reimbursement requests for construction contracts, the following shall be submitted and approved by the Department, as appropriate: • Plans, specifications, contract documents • Bid package, including procurement documentation • Executed construction contract

2. By 50% completion of the last contract, Grant recipient shall submit a completed asset management plan for all drinking water facilities to be constructed in whole or in part with ARPA RWAI Grant funds.

3. By 90% completion of the last contract, the Grant recipient shall secure approval of the asset management plan.

4. Within 10 days after construction completion of each construction contract, the Grant recipient shall notify the Department of construction completion.

5. The Department will perform a final construction observation after the final contract has reached 90% completion. The final construction observation by the Department is only for the purpose of determining final Grant allowable costs.

6. Within 30 days after the current construction contract completion date, all change orders which include time extensions exceeding 30 days beyond the original contract completion date, and/or documentation showing the Grant recipient is implementing all legal remedies provided in the contract documents for failure to complete construction when required, shall be submitted to the Department for an allowability determination

7. Within 60 days of final contract completion, the Grant recipient shall submit: the final payment request for the awarded grant; approvable summary change orders for all construction contracts; full scale record drawings with all revisions shown and noted for the entire project funded in whole or in part with ARPA RWAI Grant funds; the licensed engineer's certification of compliance with plans, specifications, and contract documents; appropriate bacteriological test results; final construction phase professional services contract amendments, if any; and all other administrative forms and documents required by the Grant agreement.

8. Any other submittals or actions required by the Grant agreement shall be performed when so required and are subject to review and approval by the Department.

**History**
- *Source: House Bill 1421, 2022 Regular Session & Senate Bill 2444, 2023 Regular Session of the MS Legislature*

##### **15 Miss. Admin. Code Pt. 20, R. 5.3.20** Post Construction Phase {#sec-20-5.3.20 omnilex-key=us-ms-regs-official--title-15--20#5.3.20}

##### **15 Miss. Admin. Code Pt. 20, R. 5.3.20.1** Audits {#sec-20-5.3.20.1 omnilex-key=us-ms-regs-official--title-15--20#5.3.20.1}

Following final payment of ARPA RWAI Grant funds to the Grant recipient, or upon expiration of any deadlines established by the Grant agreement or the Department, the Department or other designated parties may perform an audit of the ARPA RWAI Grant project for the purpose of determining compliance with the Grant agreement and to determine final allowable costs, payments made to date, and any additional payments due the Grant recipient or repayment due

the Department.

**History**
- *Source: House Bill 1421, 2022 Regular Session*

##### **15 Miss. Admin. Code Pt. 20, R. 5.3.20.2** Final Determination of Allowable Costs and Payments {#sec-20-5.3.20.2 omnilex-key=us-ms-regs-official--title-15--20#5.3.20.2}

Upon completion of the ARPA RWAIG audit (or if an audit is not performed, following final payment of ARPA RWAI Grant funds to the Grant recipient, or upon expiration of any deadlines established by the Grant agreement or the Department), the Department will transmit to the Grant recipient a copy of the audit report, if performed, a final determination of allowable costs and payments due the Grant recipient or repayments due the State.

**History**
- *Source: House Bill 1421, 2022 Regular Session*

##### **15 Miss. Admin. Code Pt. 20, R. 5.3.20.3** Final Determination Letter {#sec-20-5.3.20.3 omnilex-key=us-ms-regs-official--title-15--20#5.3.20.3}

Unless, within 30 days after the date of the above final determination, the Grant recipient submits a written appeal of the final determination, including a written justification of the reason for the appeal, and supporting documentation for any disputed costs of the final determination, the final determination of allowable costs will become the final allowable costs for purposes of ARPA RWAI Grant payments and the Grant agreement, and the Grant recipient shall receive a final determination letter from the department.

**History**
- *Source: House Bill 1421, 2022 Regular Session*

##### **15 Miss. Admin. Code Pt. 20, R. 5.3.20.4** Final Determination Letter following Appeal {#sec-20-5.3.20.4 omnilex-key=us-ms-regs-official--title-15--20#5.3.20.4}

Should an appeal be submitted in accordance with Rule 5.3.20.3 above, the disputes procedures established in Subchapter 9 of these regulations will be followed in order to resolve the dispute and establish the final allowable costs. Upon resolution of a dispute of the final determination, the Department will transmit to the Grant recipient a revised final determination letter.

**History**
- *Source: House Bill 1421, 2022 Regular Session*

##### **15 Miss. Admin. Code Pt. 20, R. 5.3.21.1** Payments to ARPA RWAI Grant recipients {#sec-20-5.3.21.1 omnilex-key=us-ms-regs-official--title-15--20#5.3.21.1}

Payments from the ARPA RWAIG Fund may be made to ARPA RWAI Grant recipients under the following conditions:

1. Payments may be requested by and made only to Grant recipients, in accordance with the Grant agreement and the Grant recipient's contracts for eligible and allowable services and construction for work performed within the project scope and budget period.

2. Payments may be requested only on project completed work, except as

required by state law or as allowed by the Department.

3. The Grant recipient shall deduct from all ARPA RWAIG Fund payment requests the amount of funds provided or to be provided from all other state and federal agency funding sources for allowable ARPA RWAIG Fund project costs.

**History**
- *Source: House Bill 1421, 2022 Regular Session*

##### **15 Miss. Admin. Code Pt. 20, R. 5.3.21.2** Payment Request Submissions {#sec-20-5.3.21.2 omnilex-key=us-ms-regs-official--title-15--20#5.3.21.2}

Payment requests shall be submitted by the Grant recipient to the Department and shall include the following: 1. ARPA RWAIG Fund payment request form with original signature;

2. Cumulative invoices for all allowable costs for which payment is requested; and

3. Any other documents required by the Grant agreement.

Rule 5.3.21.3. Timing of Payments

Provided the Grant recipient is in compliance with the requirements of these regulations and all provisions of the Grant agreement, the timing of ARPA RWAIG payments will be upon submission of a reimbursement request by the grant recipient for eligible and allowable services and construction for work performed within the project scope and grant award period. Payments may be requested no more often than on a monthly basis.

Rule 5.3.21.4. Repayments

Any payments made to the Grant recipient which are at any time determined by the Department to be for costs not in accordance with the Grant agreement, for ineligible or unallowable costs, or for costs related to waste, fraud, abuse, or illegal acts under state or federal law shall be repaid to the ARPA RWAI grant fund within 30 days of such notification by the Department. Interest may be charged on delinquent repayments after expiration of the 30-day period at a rate of ten (10) percent per annum, compounded monthly. Alternatively, the Department may withhold such amounts from subsequent payment requests.

Subchapter 4 Costs

Rule 5.4.1. General

Eligible costs are those costs in which ARPA RWAI Grant participation is authorized pursuant to applicable statute. Allowable costs are eligible costs that meet the following criteria:

1. Are necessary and reasonable for the proper and efficient administration and construction of the project, are allocable to and within the defined scope of the project and are not a general expense required to carry out the overall responsibilities of the Grant recipient.

2. Are authorized or not prohibited under federal, state, or local laws or regulations. 3. Conform to any limitations or exclusions set forth in state laws or other governing limitations as to types or amounts of cost items.

4. Are consistent with policies, regulations, and procedures that apply uniformly to both state assisted and other activities of the Grant recipient.

5. Are accorded consistent treatment through the application of generally accepted accounting principles appropriate to the circumstances.

6. Are not allocable to or included as a cost of any other Federal or State financed program in either the current, prior, or future period.

7. Are approved as allowable by the Department.

8. Are within the scope and budget period of the project as per the Grant agreement. However, the budget period does not apply to the planning and design allowance.

9. Notwithstanding this Subchapter, are eligible and allowable under the ARPA and any implementing federal regulations.

10. Are procured in accordance with Subchapter 7 of these regulations.

Rule 5.4.2. Construction

1. Allowable Construction Costs include the costs for:

A. The following types of projects, and as further described or limited

in the Grant Agreement under which the project is funded:

(i) projects that will facilitate compliance with national primary drinking water regulations;

(ii) projects that will facilitate consolidation of public water systems or the use of an alternative water supply. Consolidation between rural water associations and municipalities is eligible if one party is an eligible grant applicant.

(iii) projects that will upgrade a drinking water system; or

(iv) development of a public water system to replace private drinking water supplies if the water poses a significant threat to human health.

B. Subagreements for construction work on drinking water systems improvements. These subagreements are the prime contracts (including any subcontracts) for such construction work and any necessary contracts for purchase of equipment, materials and supplies by the Grant recipient. Should any costs for such contracts be incurred prior to Grant offer, said costs will be allowable provided that the Grant recipient has requested and obtained Department approval of said costs and provided that the Grant agreement budget period includes the time period these costs are incurred.

C. Drinking water distribution lines on drinking water distribution projects which provide drinking water to previously unserved areas, and the service lines between the public water main and the water meter.

D. Drinking water distribution system rehabilitation and replacement (including rehabilitation and replacement of eligible service lines) necessary to eliminate water loss or to preserve/restore the safety or integrity of the system, as determined in an approved facilities plan.

E. Water system capacity equal to all water distribution system leaks that will remain in the system, as determined in an approved facilities plan.

F. Drinking water systems which include service to industrial or commercial users when such works are owned by an eligible applicant.

G. Buildings that house or protect water production, treatment or distribution facilities.

H. Replacement of existing service lines from a water main up to a building (which includes any privately owned portion) if an identified public health threat exists (such as lead in the drinking water) that can be reduced by the replacement of the existing

service line.

2. Unallowable costs include:

A. Costs for the following types of projects:

(i) Projects primarily for growth, development, or fire protection;

(ii) Projects that can be consolidated (except for projects to implement such consolidation); (iii) Projects for systems without adequate financial or managerial support necessary to comply with ARPA requirements and all requirements of the Grant agreement; and

(iv) Projects for drinking water systems which serve federal users exclusively, or almost exclusively.

B. Construction and construction related costs which are incurred after the Department approved eligible contract completion date (including approved time extension change orders), unless approved by the Department pursuant to Rule 3.7.5.4 of these regulations.

C. Bonus payments that are part of the construction contract for completion of building before a contractual completion date, unless required by state law.

D. Administration buildings.

**History**
- *Source: House Bill 1421, 2022 Regular Session*
- *Source: House Bill 1421, 2022 Regular Session*
- *Source: House Bill 1421, 2022 Regular Session*
- *Source: House Bill 1421, 2022 Regular Session & Senate Bill 2444, 2023 Regular Session of the MS Legislature*
- *Source: House Bill 1421, 2022 Regular Session*

##### **15 Miss. Admin. Code Pt. 20, R. 5.4.3** Equipment, Materials and Supplies {#sec-20-5.4.3 omnilex-key=us-ms-regs-official--title-15--20#5.4.3}

1. Allowable costs include the costs of:

A. A reasonable inventory of chemicals and supplies necessary to initiate plant operations and laboratory items necessary to conduct tests required for plant operation.

B. Necessary and reasonable safety equipment, provided the equipment meets applicable federal, state, local or industry safety requirements.

C. Constructing or installing water flow metering devices for the primary purpose of monitoring and/or billing inter-municipal or other flows or serving and billing individual residential, commercial or industrial users.

D. Backflow preventers.

E. Computers, display monitors, and computer software which are designed into the control system for the daily operation of the water system, used for the operational control and analysis of the water system, or specifically designed for the operation and maintenance (including the cost of developing unique operating programs for the specific Grant funded project) of the treatment works.

F. Specialized mobile equipment for the operation of the water system, or for the maintenance of equipment. These items include, but are not limited to:

(i) Portable stand-by generators.

(ii) Portable emergency pumps to provide "pump-around" capability in the event of booster station failure or pipeline breaks. 2. Unallowable costs include the costs of:

A. Vehicles for the transportation of the Grant recipient's employees, including buses, trucks, cars, motorcycles, ATVs, golf carts, bicycles, etc.

B. Items of routine "programmed" maintenance such as filters, couplings, hoses, belts, etc.

C. Radios, televisions, VCRs, camcorders, and other items of a similar nature.

D. Shop equipment installed at the treatment works or elsewhere.

E. Distribution system maintenance equipment.

F. Replacement parts.

G. Furnishings, office equipment, and maintenance equipment, including chairs, desks, file cabinets, typewriters, coffee tables, telephones, office supplies, calculators, copiers, bookcases, shelves, lamps, etc.

H. Ordinary site and building maintenance equipment such as lawn mowers, rakes, shovels, brooms, picks, hedge trimmers, and other such equipment.

I. Hand tools such as screw drivers, pliers, socket wrenches, electric drills or saws, etc.

J. Computers for non-operational purposes, such as for the scheduling of equipment maintenance and replacement and for accounting and billing services.

1. Change orders are allowable provided the costs are:

A. Necessary and reasonable.

B. Within the scope of the project.

C. Not caused by the Grant recipient's mismanagement.

D. Not caused by the Grant recipient's vicarious liability for the improper actions of others.

E. In conformance with the ARPA RWAIG regulations.

2. Provided the above requirements are met, the following are examples of allowable change orders.

A. Construction costs resulting from defects in the plans, design drawings and specifications, or other contract documents only to the extent that the costs would have been incurred if the contract documents on which the bids were based had been free of the defects, and excluding the costs of any rework, delay, acceleration, or disruption caused by such defects.

If the defect is realized after substantial construction work has been completed, and therefore requires rework, delay, or additional work beyond that which would have been required by defect-free drawings, the cost would still be allowable, but the additional cost of rework or delay is unallowable.

The additional cost is measured as the difference between the cost which would have been included

in the bid based on defect free drawings and the actual cost of the change order.

B. Equitable adjustments for differing site conditions.

Rule 5.4.5. Professional Services The term professional services refers to engineering, legal, administrative, and similar services.

1. Allowable costs include the costs of/for:

A. Planning, application, and design. These costs include all engineering and other costs that are incurred in planning and designing the project, as well as applying for the Grant. These costs include but are not necessarily limited to the following services, as determined allowable in Subchapter 5 of these regulations.

(i) Preparing the plans, specifications, and contract documents.

(ii) Preparing interlocal agreements necessary for the project.

(iii) Surveys and all other work needed to obtain clearance or permits from all intergovernmental review agencies.

(iv) Preparing the Grant application, preparing applications for permits required by federal, state or local regulations or procedures.

B. Construction Phase Professional Services

(i) Services incurred during the advertisement, award and construction of a project to ensure compliance with applicable purchasing laws and to ensure that the project is built in conformance with the design plans and specifications. These services are primarily engineering, and construction management services provided during the advertisement, award and building of the project, including observation services, materials testing (e.g., concrete strength, soil compaction, etc.) required by the specifications, inspecting and expediting the delivery of equipment and material purchased directly by the Grant recipient, reviewing shop drawings and full-scale record drawings, preparing change

orders, payment processing, etc.

(i) Legal, engineering, and other services incurred by the Grant recipient in deciding procurement protests and defending their decisions in protest appeals under Subchapter 7 are allowable regardless of the outcome of the protest, provided there was not an attempt by the Grant recipient to violate or circumvent applicable purchase laws.

(ii) Asset management plan for constructed components of the funded project

(iii) Accounting services for preparation of the Single Audit or Program Specific Audit

(iv) Development of an operation and maintenance manual.

(v) Start-up services for onsite training of operating personnel in operation and control of specific treatment processes, laboratory procedures, and maintenance and records management, provided these costs are incurred prior to the end of the 60-day period established in Rule 5.3.19. of these regulations.

(vi) Administrative services associated with the construction project and administering the ARPA RWAIG.

(vii) Services, other than engineering services during construction/repairs, such as railway or highway flagmen or utility or highway inspectors, required during the building of the project, provided that a. The entity responsible for the affected railway, highway, or utility requires such services for all parties conducting similar types of work, regardless of the source of construction funding for the project, or the services are required by law.

b. The cost of such services has not been included in the construction contractor's bid price.

(viii) Engineering or other services necessary to correct defects in the grant applications plan, design drawings and specifications or other documents to the extent that such costs would have been allowable for preparing defect free documents.

2. Unallowable costs include the costs of:

A. Public liaison services. B. Local travel (i.e., commuting expenses) between living quarters and the construction site for persons working at the site.

**History**
- *Source: House Bill 1421, 2022 Regular Session Rule 5.4.4. Change Orders*
- *Source: House Bill 1421, 2022 Regular Session & Senate Bill 2444, 2023 Regular Session of the MS Legislature*
- *Source: House Bill 1421, 2022 Regular Session & Senate Bill 2444, 2023 Regular Session of the MS Legislature*

##### **15 Miss. Admin. Code Pt. 20, R. 5.4.6** Claims {#sec-20-5.4.6 omnilex-key=us-ms-regs-official--title-15--20#5.4.6}

1. Allowable costs, provided the costs are properly documented, incurred and requested prior to the end of the 60-day period established Rule 5.3.19.11 of these regulations, include:

A. Change orders to the construction contract as a result of settlements, arbitration awards, or court judgements, to the extent that they would have been allowable had there not been a claim.

B. The costs of assessing the merits of, negotiating, or defending a claim against the Grant recipient are allowable, regardless of the outcome, provided that the matter under dispute is not the result of fraudulent or illegal actions or mismanagement on the part of the Grant recipient.

C. Alterations in engineering, legal, contracts etc. as a result of settlements, arbitration awards, or court judgements are allowable to the same extent that they would have been allowable had there not been a claim.

2. Unallowable costs include the costs of:

A. Claims arising from work outside the scope of the Grant.

B. Claims resulting from fraudulent or illegal activities.

C. Claims resulting from mismanagement by the Grant recipient.

D. Claims resulting from the Grant recipient's vicarious liability for the improper action of others.

E. Settlements, arbitration awards or court judgements over the allowable costs as established in these regulations.

**History**
- *Source: House Bill 1421, 2022 Regular Session*

##### **15 Miss. Admin. Code Pt. 20, R. 5.4.7** Mitigation {#sec-20-5.4.7 omnilex-key=us-ms-regs-official--title-15--20#5.4.7}

1. Allowable costs include the costs of: A. Mitigation of only direct adverse physical impacts resulting from construction of the project.

B. Reasonable site screening necessary to comply with required environmental review and necessary to screen adjacent properties.

C. Groundwater monitoring facilities necessary to determine the possibility of groundwater deterioration, depletion or modification resulting from construction of the project. The extent of the allowable costs for groundwater monitoring facilities is decided on a case-by-case basis and depends on the size and complexity of the project and the present and potential future use of the groundwater.

2. Unallowable costs include the costs of:

A. Solutions to aesthetic problems, including design details which require expensive building techniques and architectural features and hardware, that are unreasonable or substantially higher in cost than approvable alternatives and that neither enhance the function or appearance of the treatment works nor reflect regional architectural tradition.

B. Land acquired for the mitigation of adverse environmental effects identified pursuant to an environmental review.

Rule 5.4.8. Real Property

1. Allowable costs include the costs of:

A. Land acquired in fee simple title or by easement, from a willing seller, for:

(i) Water supply and/or storage purposes;

(ii) A consolidation project; and

(iii) Protection of the source water of the system from

contamination.

B. Preparation of the treatment works site before, during and, to the extent agreed on in the Grant agreement, after building. These include the cost of:

(i) Demolition of existing structures on the treatment works site (including rights-of-way) if building cannot be undertaken without such demolition. Demolition of existing structures on the treatment works site (including rights-of- way), when not required for building the project, will be considered to be an allowable cost only if the existing structures constitute a real and present hazard to safety, public health, or water quality and when the hazard can best be abated by the removal of the existing structures.

(ii) Removal, relocation, or replacement of utilities, provided the Grant recipient is legally obligated to pay for such as a result of the ARPA RWAIG project under state or local law.

(iii) Restoration of streets and rights-of-way to their original condition. The need for such restoration shall result directly from the construction of the ARPA RWAIG project and is generally limited to repaving the width of trench.

2. Unallowable costs include the costs of:

A. Any amount paid by the Grant recipient for eligible land in excess of the appraised value or the Grant recipient's record of negotiation.

An amount higher than the appraised value may be found allowable if the Grant recipient provides sufficient written documentation to the Department and receives allowability approval prior to the actual acquisition.

B. Removal, relocation or replacement of utilities located on land by privilege, such as a franchise, unless the Grant recipient is required to pay such costs under state or local law.

C. Land acquired in fee simple title or by easements for land other than that described under H.(1)(a) above, such as easements for the purpose of water distribution system expansion or improvement.

D. The demolition of an existing structure for the convenience of the owner as a means of increasing property value or property use.

Rule 5.4.9. Miscellaneous Costs 1. Allowable costs include the costs of:

A. Equipment rental and material costs necessary for the construction project.

B. Meeting specific legal requirements directly related to the project unless otherwise specified in these regulations.

C. Royalties associated with the procurement of the right to use, or the rights in, a patented product, apparatus, or process, provided that they are based on a published fee schedule or on reasonable fees charged to other users under similar conditions.

D. Training workshops/seminars for Grant recipient employees that are necessary to provide instruction in operational, administrative, fiscal or contracting procedures required to complete the construction of the project. Attendance at such training workshops or seminars shall occur after Grant offer but before the end of the Grant agreement budget period.

E. A reasonable project sign.

2. Unallowable costs include the costs of:

A. Salaries and benefits for the Grant recipient’s employees.

B. Ordinary operating expenses of the Grant recipient, including salaries and expenses of elected and appointed officials and preparation of routine financial reports and studies.

C. Administrative, engineering, and legal activities associated with the creation of special departments, agencies, commissions, regions, districts, associations, or other entities.

D. Approval, preparation, issuance and sale of bonds or other forms of indebtedness required to finance any portion of the project and the interest on them.

E. Personal injury compensation or damages arising out of the project.

F. Fines and penalties due to violations of or failure to comply with federal, state or local laws, regulations or procedures, and related legal expenses. G. Operation and maintenance of the water system, which include but are not limited to, labor, utilities, chemicals, materials and supplies, monitoring, testing, equipment replacement, periodic payment of royalties for the right to operate under a patent, etc.

H. Lease payments.

I. Travel, by the Grant recipient, unless included under an indirect cost agreement, and except as allowed under Rule 5.4.9(1)(d) above.

Rule 5.4.10. Project Income

1. Bid bond forfeitures will have no effect on the determination of allowable and unallowable costs. The Grant recipient shall make the determination of whether or not a bid bond will be forfeited.

2. The amount of liquidated damages collected will have no effect on the determination of allowable and unallowable costs, except as described by Rule 5.3.17.4 of these regulations.

3. Interest income on ARPA RWAIG Fund payments to Grant recipients will have no effect on the determination of allowable and unallowable costs.

4. The Grant recipient shall receive all income generated from use of the project facilities.

Rule 5.4.11. PWS Acquisition

1. Allowable costs include the costs of:

A. Purchase of a public or private Public Water System to consolidate system with Grant Applicant.

B. Cost of appraisal of water system infrastructure by a licensed engineer

C. Legal costs associated with negotiation of acquisition and preparation of acquisition documents

D. Real property costs as outlined in these regulations, including

purchase of existing water distribution system easements

2. Unallowable costs include the costs of:

A. Any amount paid by the Grant recipient for eligible PWS infrastructure or real property in excess of the appraised value or the Grant recipient's record of negotiation.

An amount higher than the appraised value may be found allowable if the Grant recipient provides sufficient written documentation to the Department and receives allowability approval prior to the actual acquisition.

Subchapter 5. Recommended Allowances for Planning, Design and Construction Phase Professional Services

Rule 5.5.1. Recommended Allowances for Planning and Design.

The recommended allowance for planning and design will be determined using Table 1 in this Subchapter. This table is not intended to be used to determine the consulting engineer's allowable costs for planning and design services. Compensation for these services should be based upon the nature, scope, and complexity of the services required for the project.

Table 1 includes a recommended range for engineering costs during planning and design, which the Grant applicant/recipient should consider while evaluating the engineer's proposal. If the engineer's proposal exceeds the normal range the Grant applicant/recipient should consider requiring the engineer to justify why the project is more difficult than normal. The actual compensation justified for a particular project may be more or less than the suggested range of the allowance for these services shown in Table 1.

If the consulting engineer and Grant applicant/recipient determine that the maximum recommended allowance calculated using Table 1 in this Subchapter does not adequately reflect the nature, scope, and complexity of the services required for the project, the consulting engineer may submit a detailed cost proposal, in such format as required by the Department, justifying a compensation amount greater than Table 1 recommends. If, in the Department's opinion, the detailed cost proposal justifies such, the Department will approve an allowance for facilities planning and design greater than those recommended in Table 1. The decision of the Department in this matter will be final.

Projects for which the Grant applicant/recipient shall acquire easements or real property may receive an additional 1% above the recommended maximum percentages shown in Table 1 for planning and design allowances. Also, projects for which a value engineering study is conducted may receive an additional 3% above the recommended maximum percentages shown in Table 1 for the planning and design allowance.

Rule 5.5.2. Recommended Allowance for Construction Phase Professional Services.

The Allowance for Construction Phase Professional Services includes costs for engineering services during bidding, construction, and post-construction phases, observation during construction, Grant administration and other services (i.e. legal, audit, etc.) that are associated with the construction of the ARPA RWAIG project. The recommended allowance for construction phase professional services will be determined using Table 2 in this Subchapter.

This table is not intended to be used to determine the actual compensation for construction phase professional services. Compensation for these professional services should be based upon the nature, scope, and complexity of the services required for the project.

Table 2 separates the Total Recommended Allowance for Construction Phase Professional Services shown in the far-right hand column into three types of services: engineering, Grant administration, and other services and provides suggested ranges for each of these services depending upon the complexity of the project. The Grant applicant/recipient should consider these recommended ranges when evaluating proposals for these services. If the proposals exceed the normal ranges for any of these services, the Grant applicant/recipient should consider requiring the professional to justify why the project is more difficult than normal. The actual compensation justified for a particular project may be more or less than the suggested range of the allowance for these services shown in Table 2.

If the consulting engineer and Grant applicant/recipient determine that the maximum recommended allowance calculated using Table 2 in this Subchapter does not adequately reflect the nature, scope, and complexity of the services required for the project, the consulting engineer may submit a detailed cost proposal, in such format as required by the Department, justifying a compensation amount greater than Table 2 recommends. If in the Department's opinion the detailed cost proposal justifies such, the Department will approve an allowance for construction phase professional services greater than those recommended in Table 2. The decision of the Department in this matter will be final.

Although Table 2 shows engineering and Grant administration as separate costs, the Grant applicant/recipient is not required by these regulations to contract for these services separately. The Grant applicant/recipient may wish to have the consulting engineer provide both scopes of services, and under such an arrangement, the engineer's contract should not exceed the total of the suggested ranges for both services.

Rule 5.5.3. General Guidance for Use of the Allowance Tables.

The estimated and final allowances will be determined in accordance with this Subchapter. All allowance percentages will be calculated to four decimal places

using linear interpolation.

The estimated allowances are to be based on the estimate of the initial allowable building cost from the Subgrant Agreement, Attachment B.

Following execution of the Grant agreement, the Grant recipient may request and receive payment for the facilities planning and design allowance and the allowance for construction phase professional services, in accordance with the procedures described in Rule 5.3.21.3 of these regulations. Advances of allowances will not be provided.

Table 1

Recommended Allowances for Facilities Planning and Design

Allowable Building Cost Allowances as a Percentage of Building Cost Based Upon the Difficulty of the Project

Normal to Difficult $50,000 or less 11.7500% to 13.2000% $100,000 10.7500% to 12.2000% $150,000 10.0700% to 11.2519% $200,000 9.4000% to 10.5000% $300,000 8.7000% to 9.8042% $400,000 8.3000% to 9.6312% $500,000 8.0000% to 9.4417% $600,000 7.8000% to 9.1467% $700,000 7.7000% to 9.0297% $800,000 7.5000% to 8.8089% $900,000 7.4000% to 8.7472% $1,000,000 7.2500% to 8.5673% $1,100,000 7.1030% to 8.3911% $1,200,000 6.9600% to 8.2185% $1,300,000 6.8200% to 8.0495%

$1,400,000 6.6800% to 7.8840% $1,500,000 or greater 6.5400% to 7.7219%

Table 2

Recommended Allowances for Construction Phase Professional Services Allowances as a Percentage of Building Cost Based Upon the Difficulty of the Project

Estimated Building Cost Engineering Services Grant Administration Other Services Total Allowance for Professional Services Normal to Difficult Normal to Difficult Normal to Difficult Normal to Difficult $50,000 or less 6.4400% to 11.7250% 2.0700% to 3.7688% 0.6900% to 1.2563% 9.2000% to 16.7500% $100,000 5.7400% to 11.725% 1.8450% to 3.7688% 0.6150% to 1.2563% 8.2000% to 16.7500% $150,000 5.2850% to 11.725% 1.6988% to 3.7688% 0.5663% to 1.2563% 7.5500% to 16.7500% $200,000 4.8300% to 9.9400% 1.5525% to 3.1950% 0.5175% to 1.0650% 6.9000% to 14.2000% $300,000 4.4100% to 8.1690% 1.4175% to 2.6258% 0.4725% to 0.8753% 6.3000% to 11.6700% $400,000 4.0600% to 7.2800% 1.3050% to 2.3400% 0.4350% to 0.7800% 5.8000% to 10.4000% $500,000 3.8150% to 6.5800% 1.2263% to 2.1150% 0.4088% to 0.7050% 5.4500% to 09.4000% $600,000 3.5700% to 5.9500% 1.1475% to 1.9125% 0.3825% to 0.6375% 5.1000% to 08.5000% $700,000 3.4300% to 5.4600% 1.1025% to 1.7550% 0.3675% to 0.5850% 4.9000% to 07.8000% $800,000 3.2900% to 5.0400% 1.0575% to 1.6200% 0.3525% to 0.5400% 4.7000% to 07.2000% $900,000 3.2200% to 4.6690% 1.0350% to 1.5008% 0.3450% to 0.5003% 4.6000% to 06.6700% $1,000,000 3.1500% to 4.4800% 1.0125% to 1.4400% 0.3375% to 0.4800% 4.5000% to 06.4000% $1,100,000 3.0815% to 4.2986% 0.9905% to 1.3817% 0.3302% to 0.4606% 4.4022% to 06.1409% $1,200,000 3.0146% to 4.1246% 0.9690% to 1.3258% 0.3230% to 0.4419% 4.3066% to 5.8923% $1,300,000 2.9492% to 3.9577% 0.9479% to 1.2721% 0.3160% to 0.4240% 4.2131% to 5.6538% $1,400,000 2.8852% to 3.7975% 0.9274% to 1.2206% 0.3091% to 0.4069% 4.1217% to 5.4250% $1,500,000 or greater 2.8226% to 3.6438% 0.9073% to 1.1712% 0.3024% to 0.3904% 4.0323% to 5.2054%

Subchapter 6. Environmental Review Process

Rule 5.6.1. Description of Environmental Impacts

The Licensed Engineer is required to certify the environmental impact of the project as either low, moderate, or high. If the Licensed Engineer determines that there is either a moderate or high impact, the Licensed Engineer shall prepare an Environmental Review Report. The report shall bear the seal of the licensed engineer responsible for preparation of the report and shall contain a description of the environmental impacts of the proposed project and any corresponding mitigative measures including, but not necessarily limited to, the following:

(1) Surface and groundwater resources;

(2) Archaeological/historical/cultural resources; (3) Vegetative/wildlife resources;

(4) Wetlands and navigable waterways;

(5) Floodplains;

(6) Prime or important farmlands;

(7) Coastal zones;

(8) Wild and scenic rivers; and

(9) Air Quality.

Rule 5.6.2. Environmental Review.

The Licensed Engineer will take one or more of the following actions pursuant to the review of the of Environmental Impacts:

1. Previously Disturbed Certification Complete certification that all work to be performed as a part of this project will be performed on previously disturbed sites, easements, and/or rights-of-way. Certify that no new sites, easements and/or rights-of-way will be disturbed as a result of this construction/repair project, and therefore, no comments or responses are required from the state or federal agencies listed below in order to ensure compliance with the state or federal laws or regulations under the jurisdiction of these agencies.

2. Environmental Impacts Resolved Certification Complete certification that comments and responses have been solicited and resolved from the state and federal agencies listed below regarding all work to be performed under this project on new sites, easements, and/or rights-of-way.

3. No Further Action

The Licensed Engineer will complete the appropriate certification on all ARPA RWAIG projects. If there are significant changes in the project after the issuance of the environmental documents, those changes will be described in an Amendment to the certification. Some changes are minor, however, and the Department may determine that a separate Amendment need not be issued. Such minor changes may include but are not limited to:

A. Adding work that would otherwise qualify for a previously disturbed certification.

B. Changes in the size of pump stations, storage facilities, wells, distribution lines, etc.

C. Minor changes in the size of water treatment unit processes.

D. Minor rerouting of distribution lines when the new route

i) will be mostly on public property and

ii) will not adversely affect cultural resources, habitats of endangered or threatened species, or environmentally important natural resource areas.

All affected property owners shall be notified by the Grant recipient.

Rule 5.6.3. Issuance of the Environmental Certification Copies of all necessary environmental review and certification documentation should be issued to the appropriate intergovernmental review agencies listed in Subchapter 8; other agencies shall be contacted as needed. Copies shall also be sent to any individuals or groups requesting them. All environmental review documentation shall be maintained at the grant recipient’s office location for review upon request.

Rule 5.6.4. Resolution of Adverse Comments.

Adverse comments received as a result of the environmental review process should be addressed in the following manner:

1. The Grant recipient should resolve the adverse comments

2. If the Grant recipient is unable to resolve the adverse comments and secure approval, the Department may comment on the unresolved issues and suggest a course of action.

Subchapter 7. Miscellaneous Requirements for ARPA RWAIG recipients

Rule 5.7.1. Within this subchapter, Grant recipients should have an understanding of various miscellaneous elements that could affect the project(s) ability to proceed from application to design to construction to grant payment.

Procurement Requirements.

1. In the procurement of all construction, equipment, materials, supplies, professional services and non-professional services and all other costs related to the ARPA RWAIG project, all Grant recipients shall comply with federal procurement regulations and state purchasing laws as they apply to local governments.

2. The procurement and conduct of all professional engineering and land surveying services shall also be in accordance with the Code of Conduct a and other guidance and interpretations established by the Mississippi State Board of Registration for Professional Engineers and Land Surveyors.

3. The procurement of all construction contracts shall also be in accordance with the rules and regulations of the State Board of Contractors and other guidance and interpretations established by the Mississippi State Board of Contractors.

4. All Grant recipients shall submit a procurement certification, as required by the Department, indicating that all the above referenced requirements have been met. Should it be determined that any of the above procurement requirements are violated, the Department may determine that the related costs are unallowable and may require repayment of all ARPA RWAIG funds paid for such costs, in accordance with Rule 5.3.21.4 of these regulations.

Rule 5.7.2. Debarment and Suspension

The Department is prohibited from entering into Grant agreements with Grant applicants that have been debarred or suspended by any state or federal agency.

Grant recipients are prohibited from entering into contractual agreements with individuals, businesses, organizations, or any other entities that have been debarred or suspended by any state or federal agency. Additionally, grant recipients are responsible for ensuring that prime contractors utilized on the project are not debarred or suspended. Likewise, prime contractors are responsible for ensuring that subcontractors utilized on the project are not debarred or suspended.

Anyone may contact the Board concerning the existence of a cause for debarment or suspension. The Department may refer the matter to the State Attorney General or other appropriate office for further investigation. If, after review or investigation, the Board reasonably believes that a cause for debarment exists, the Board may propose debarment or suspension and may initiate procedures similar to, but not necessarily identical to, federal regulation 40 CFR Part 32: Debarment and Suspension Under EPA Assistance Programs.

Such above-described debarment or suspension actions will not affect existing executed contractual agreements, unless such agreements have been terminated or suspended under the terms of the agreement by the Grant recipient.

Rule 5.7.3. ARPA RWAIG Dispute Procedures Only ARPA RWAIG recipients may submit a notice of dispute (disagreement) with a decision made by the Department, with the exception of decisions regarding Subchapter 6, Environmental Review Process, of these regulations. The following procedures will be used to resolve disputes between the Grant recipient and the Department.

1. The Grant recipient shall submit a written notice of dispute with a Department decision, including a summary of the dispute and reasons the Grant recipient believes the Department decision should be reversed.

2. The Department will then render a written decision on the dispute and will include reasons for the decision.

3. Should the Grant recipient desire to appeal the second Department decision, a request for an informal hearing shall be received by the Department within 30 days after the date of that decision. Upon receipt of such a request, an informal hearing will be held with staff members, as designated by the State Health Officer, and the affected parties. The State Health Officer, or his designee, will render a decision on the appeal as a result of the informal hearing.

4. Appeals of the above formal hearing decision may be made to the Chancery Court in accordance with state law.

Rule 5.7.4. Waste Fraud and Abuse

The Grant recipient is responsible for preventing, detecting, and prosecuting waste, fraud, abuse, and all other corrupt practices which occur in relation to the ARPA RWAIG project.

If the Grant recipient becomes aware of allegations, evidence, or the appearance of corrupt practices, the Grant recipient shall:

1. Immediately inform the Department in writing; and

2. Promptly pursue available state and local legal, administrative, and contractual remedies.

The Department may disallow costs under the Grant agreement where it is determined that such costs are related to waste, fraud, abuse or other corrupt practices. The Department may also require repayment of ARPA RWAI Grant funds paid for such costs in accordance with Rule 5.3.21.4 of these regulations.

Rule 5.7.5. ARPA RWAIG Recipient Accounting and Auditing Requirements

All ARPA RWAIG recipients shall maintain project accounts in accordance with generally accepted government accounting standards, as defined by the Guidelines of the Municipal Accounting and Audit Manual, as prescribed by the State Auditor's Office. Charges to the project account shall be properly supported, related to eligible construction costs, and documented by appropriate records. These project accounts shall be maintained as separate accounts.

All contracts for professional services, construction, equipment, and supplies shall include an access to audit clause which gives the Department and its representatives access to and the right to audit, inspect, copy and examine books, financial records and other documents relating directly to the receipt and disbursement of ARPA RWAIG funds.

Rule 5.7.6. ARPA RWAIG Procurement Protest Procedures

1. Prior to advertisement for bids, the Grant recipient should consider

establishing its own procedures for prompt consideration of initial protests concerning solicitations or contract awards. A "protest" is a written complaint concerning the Grant recipient's solicitation or award of a contract. The protest shall be filed with the Grant recipient by a party with a direct financial interest adversely affected by a Grant recipient's procurement action and shall be filed in accordance with and within the time frame established by the Grant recipient's protest procedures.

2. Any delay due to a protest or protest resolution will not relieve the Grant recipient of the requirement to meet the project schedule established in the Grant agreement, nor will such delays prevent the Department from pursuing the remedies for default established in the Grant agreement.

Rule 5.7.7. Related State Laws and Regulations

The Grant recipient shall comply with the applicable related state laws and regulations regarding Mississippi Safe Drinking Water Act and Operator Certification during the planning, design, construction, and operation of the project.

Rule 5.7.8. National Pollutant Discharge Elimination System (NPDES) and Siting Criteria Regulations

The following requirements apply to those drinking water treatment facilities that have or will construct wastewater treatment facilities necessary to treat waste generated by their drinking water treatment facilities.

The Grant recipient shall ensure that all current applicable regulations of the Commission on Environmental Quality and the Environmental Quality Permit Board are complied with during the planning, design, and construction of any wastewater treatment facilities associated with this ARPA RWAIG project. It is the Grant recipient's responsibility to ensure that the project is in compliance with these regulations and all future amendments.

Subchapter 8. Intergovernmental Review Process

The following outlines the Department's guidance for compliance with the Intergovernmental Review concerns for ARPA RWAIG projects.

Rule 5.8.1. Intergovernmental Review Agencies:

1. Mississippi Department of Archives and History (for archaeological/cultural review)

2. Mississippi Natural Heritage Program (for vegetative/wildlife review)

3. U.S. Army Corps of Engineers, Regulatory Functions Branch [for Section 404 (wetlands), Section 10 (navigable waterways), and floodplain impact review]

4. Mississippi Department of Marine Resources (Jackson, Harrison, and Hancock County Projects Only; for shellfish review and Mississippi Coastal Program review)

5. U.S. Fish and Wildlife Service (Jackson, Harrison, and Hancock County projects only; for Coastal Barriers Resources Act review)

6. U.S. Forest Service (projects located in a designated Wild and Scenic River Basin only, for Wild and Scenic Rivers review)

Rule 5.8.2. Planning and Design

During preparation of the plans and specifications, the Licensed Engineer will ensure that the appropriate intergovernmental review agencies have been consulted about the proposed project area concerning the existence of any known or possible archaeological/cultural sites, endangered vegetation/wildlife, wetlands, floodplain impacts, wild/scenic river impacts, shellfish/coastal program impacts, or coastal barriers resources impact. The Licensed Engineer will certify during the plans, specifications, and contract documents phase, that the proposed project components have been evaluated through a intergovernmental review process and that no concerns have been discovered that would prevent the project from moving forward and that the project has been cleared. If feasible, the project should avoid negative impacts on areas for which a concern has been expressed by an intergovernmental review agency. If it is not feasible to avoid negative impacts on these areas, the appropriate intergovernmental review agency should be consulted concerning the probability of obtaining clearance to construct the selected plan.

For projects submitted in the second round of funding, an additional ten points will be added to any project combining consolidation/regionalization of public water systems with one of the other categories listed. In order to receive the additional weight, the systems that will consolidate shall be in a proximity of each other as determined by the department. In addition to these additional consolidation points, an additional 10 points shall be added to any application with at least one system that has consolidated after January 1, 2018, and before application to this program and is otherwise eligible.

RANK PROJECT CATEGORY

Primary Drinking Water Standards Project facilitates compliance with Primary Drinking Water Standards. Project must correct deficiencies resulting in non- compliance with the primary drinking water standards.

One Well Project to provide additional water supply to systems that have neither a backup well nor an MSDH-approved emergency tie-in to another system to ensure safe drinking water; thereby protecting the health of the existing population.

Pressure Deficiencies Project to correct documented deficiencies that result in existing systems routinely failing to maintain minimum acceptable dynamic pressure.

Source Water Protection Projects Project to manage potential sources of contaminants/pollutants and/or prevent contaminants/pollutants from reaching sources of drinking water.

Capacity Expansion to Serve the Unserved Project to either expand existing system capacity or construct a new drinking water system to serve existing residences/businesses in currently unserved areas safe drinking water (source, treatment and/or distribution).

Back-up Water Supply Sources Projects Project to provide additional supply to systems with insufficient back-up water supply sources to ensure safe drinking water, and thereby protect the health of the existing population.

RANK PROJECT CATEGORY 18 Existing Facilities Upgrades (Meeting Primary Standards) Project to rehabilitate, replace, protect or upgrade deteriorated, worn, aged or obsolete equipment, facilities, etc., to assure continued, dependable operation of water systems where such systems are already meeting Primary Drinking Water Standards.

Secondary Drinking Water Standards Projects Project to provide treatment that brings systems into compliance with Secondary Drinking Water Regulations.

Consolidation Projects Project to consolidate separate systems into a single system for purposes other than those related to meeting primary standards.

Fluoride Addition This category is for projects that either rehabilitate existing fluoride treatment facilities at well or treatment plant sites or add new facilities to existing well or treatment plants.

Other Project does not meet the criteria of any category listed above.

K. The extent to which the project promotes economic development will be quantified based on assessment of yes (5) or no (0) with a maximum of 5 points within this category.

L. The number of people served by the project will be quantified based on population range.

Population Range Ranking 0 - 3,300 15 3,300 - 6,600 12 6,600 - 9,900 10 9,900 - 13,200 8 13,200 - 16,500 4 16,500 - 19,800 3 19,800 - 23,100 3 23,100 - 26,400 4

26,400 - 29,700 8 29,700 - 33,000 10 33,000 - 36,300 12 36,300 - Above 15

M. Impacts of the proposed project on disadvantaged communities will be quantified based on Median Household Income (MHI).

MHI Range Ranking $0.00 - $20,144.00 15 $20,144.00 - $23,073.67 13 $23,073.67 - $26,003.33 11 $26,003.33 - $28,933.00 8 $28,933.00 - $31,862.67 7 $31,862.67 - $34,792.34 6 $34,792.34 - $37,722.00 5 $37,722.00 - $40,651.67 4 $40,651.67 - $43,581.34 3 $43,581.34 - $46,511.00 2 $46,511.00 - Above 1

N. The grant applicant's prior efforts to fund the project will be quantified based on assessment of yes (5) or no (0) with a maximum of 5 points within this category.

O. The grant applicant's proposed contribution will be quantified based on a percentage range of the projects total cost with a maximum of 5 points within this category.

Percentage Range Ranking 1% - 4% 1 5% - 9% 3 10% - Above 5

P. The grant applicant's long-term plans for the financial and physical operation and maintenance of the project will be quantified based on an assessment. Applicants with no plan will receive a zero (0). Applicants with a long-term plan will receive five (5). Applicants certifying the development of an asset management plan by the end of the project will receive ten (10) with a maximum of 10 points within this category.

Q. The grant applicant's capacity to complete the proposed project by the

deadline specified by rules and guidelines of the USDT for ARPA funds will be quantified based on an assessment. Applicants able to meet this requirement will be quantified at 10 with a maximum of 10 points within this category. Applicants unable to meet this requirement will be disqualified.

R. If necessary, the following will be used as the basis for breaking any ties that occur.

a) Projects to primarily correct a MSDH documented failure to meet primary drinking water standards or a MSDH documented significant deficiency will be given preference. b) If there are no projects to correct a MSDH documented failure to meet primary drinking water standards or a MSDH documented significant deficiency, projects primarily for consolidation will be given preference. c) If there are no projects primarily for consolidation, projects with the lowest Median Household Income Range will be given preference. d) If all projects have the same Median Household Income Range, projects with the lowest Population will be given preference. e) If all projects have the same Population Range, projects extending potable water service to new users will be given preference.

**History**
- *Source: House Bill 1421, 2022 Regular Session & Senate Bill 2444, 2023 Regular Session of the MS Legislature*
- *Source: House Bill 1421, 2022 Regular Session & Senate Bill 2444, 2023 Regular Session of the MS Legislature*
- *Source: House Bill 1421, 2022 Regular Session*
- *Source: House Bill 1421, 2022 Regular Session & Senate Bill 2444, 2023 Regular Session of the MS Legislature*
- *Source: House Bill 1421, 2022 Regular Session*
- *Source: House Bill 1421, 2022 Regular Session*
- *Source: House Bill 1421, 2022 Regular Session*
- *Source: House Bill 1421, 2022 Regular Session & Senate Bill 2444, 2023 Regular Session of the MS Legislature*
- *Source: House Bill 1421, 2022 Regular Session & Senate Bill 2444, 2023 Regular Session of the MS Legislature*
- *Source: House Bill 1421, 2022 Regular Session & Senate Bill 2444, 2023 Regular Session of the MS Legislature*
- *Source: House Bill 1421, 2022 Regular Session*
- *Source: House Bill 1421, 2022 Regular Session & Senate Bill 2444, 2023 Regular Session of the MS Legislature*
- *Source: House Bill 1421, 2022 Regular Session*
- *Source: House Bill 1421, 2022 Regular Session*
- *Source: House Bill 1421, 2022 Regular Session*
- *Source: House Bill 1421, 2022 Regular Session*
- *Source: House Bill 1421, 2022 Regular Session*
- *Source: House Bill 1421, 2022 Regular Session*
- *Source: House Bill 1421, 2022 Regular Session*
- *Source: House Bill 1421, 2022 Regular Session*
- *Source: House Bill 1421, 2022 Regular Session*
- *Source: House Bill 1421, 2022 Regular Session & Senate Bill 2444, 2023 Regular Session of the MS Legislature*
- *Source: House Bill 1421, 2022 Regular Session & Senate Bill 2444, 2023 Regular Session of the MS Legislature*

##### **15 Miss. Admin. Code Pt. 20, R. 5.2.8** ARPA RWAIG Financing {#sec-20-5.2.8 omnilex-key=us-ms-regs-official--title-15--20#5.2.8}

The ARPA RWAIG fund has been established to provide grants to assist and encourage rural water associations to pursue projects to address drinking water system infrastructure needs. Conditions of these Grants are itemized in Rule 5.2.4 of these regulations. Basic ARPA RWAIG financing requirements are as follows:

9. ARPA RWAI grants may be limited at the discretion of the Department based on funds availability or as otherwise stated under state law.

10. For the first round, the maximum amount of funds that may be provided to any rural water association from all grants under this round is Two Million Five Hundred Thousand Dollars ($2,500,000.00). For the second round, the maximum amount of funds that may be provided to any rural water association from the program is Two Million Dollars ($2,000,000.00).

11. The applicant's project shall be able to initiate construction in a timely manner and complete the proposed project by the deadline specified by rules and guidelines of the United States Department of the Treasury for ARPA funds and set forth in House Bill 1421 of the Mississippi Legislature’s 2022 Regular Session.

12. Terms of any ARPA RWAIG assistance will be as established in the Grant agreement.

13. The applicant shall comply with the requirements of the ARPA and all applicable state and federal laws, requirements, and regulations. 14. The applicant shall not be in violation of any provision of a previously awarded grant of state or federal funds.

15. The applicant shall comply with any technical assistance recommendations provided by the Department.

16. Except for program administration expenses, funds will not be disbursed from the ARPA RWAIG until a Grant recipient has entered into a Grant agreement with the Board.

**History**
- *Source: House Bill 1421, 2022 Regular Session & Senate Bill 2444, 2023 Regular Session of the MS Legislature*

##### **15 Miss. Admin. Code Pt. 20, R. 5.2.9** Responsibility {#sec-20-5.2.9 omnilex-key=us-ms-regs-official--title-15--20#5.2.9}

The applicant/Grant recipient is responsible for the proper planning, design, construction, operation, maintenance, replacement, performance, and fiscal integrity of the project. The Department's approval of any document does not relieve the applicant/Grant recipient or any others of any liabilities or responsibilities. Department approval of any document is for Grant eligibility/allowability purposes only and does not establish or transfer any such liability or responsibility.

**History**
- *Source: House Bill 1421, 2022 Regular Session*

##### **15 Miss. Admin. Code Pt. 20, R. 5.2.10** Other Approvals {#sec-20-5.2.10 omnilex-key=us-ms-regs-official--title-15--20#5.2.10}

The applicant (or Grant recipient) shall obtain approval of all necessary documents from each state, local, and federal agency having jurisdiction over or funding in the project, if so required by that agency.

**History**
- *Source: House Bill 1421, 2022 Regular Session*

##### **15 Miss. Admin. Code Pt. 20, R. 5.3.1** Application for ARPA RWAI Grant {#sec-20-5.3.1 omnilex-key=us-ms-regs-official--title-15--20#5.3.1}

3. Pre-application Guidance and Conference.

Upon request the Department will provide a Grant application package to the potential Grant applicant and/or its licensed engineer. The potential Grant applicant and/or its licensed engineer may request a pre- application conference with the Department as early in the application process as practical.

4. Contents of Applications

All documents listed below shall be complete when submitted to the Department. When forms are provided by the Department, these forms shall be used, and they shall not be altered. The ARPA RWAI Grant application may request assistance only for costs that are allowable in accordance with Subchapter 4 of these regulations and may include a construction contingency, as determined by the Department, in the project budget. The application shall include a Project Cost Breakdown. A complete application package shall conform to these regulations and shall include the following:

A. A complete ARPA RWAI Grant application form with original signature with associated attachments.

B. A procurement certification from the Grant applicant and the Grant applicant's legal counsel.

C. A legal certification from the Grant applicant and the Grant applicant's legal counsel.

D. A certified copy of a resolution by the Grant applicant's governing body which, 1) authorizes the submission of the application and 2) designates an authorized representative or officer to make application for assistance and to sign documents on behalf of the applicant.

E. A certification regarding debarment, suspension, in accordance with Subchapter 7 Rule 5.7.2 of these regulations.

F. Documentation of its tax-exempt status under either federal or state law.

G. An Internal Revenue Service Form W-9.

H. All waste disposal permit applications, if applicable.

I. All other forms, documents, and supporting information required by the Department.

**History**
- *Source: House Bill 1421, 2022 Regular Session & Senate Bill 2444, 2023 Regular Session of the MS Legislature*

##### **15 Miss. Admin. Code Pt. 20, R. 5.3.2** Submission of Application {#sec-20-5.3.2 omnilex-key=us-ms-regs-official--title-15--20#5.3.2}

By the date specified on the MSDH website the applicant shall submit the application to the Department to be considered for the award cycle. Award cycles will be quarterly until allocated funding has been fully obligated or the legislative deadline of December 31, 2024, has been reached.

**History**
- *Source: House Bill 1421, 2022 Regular Session & Senate Bill 2444, 2023 Regular Session of the MS Legislature*

##### **15 Miss. Admin. Code Pt. 20, R. 5.3.3** Offer of ARPA RWAI Grant {#sec-20-5.3.3 omnilex-key=us-ms-regs-official--title-15--20#5.3.3}

Upon determination by the Department that (a) all applicable requirements of the ARPA RWAI Grant application have been met, (b) the application deadlines have been met for the award cycle, and (c) funds are available for the amount of the ARPA RWAI Grant application, the State Health Officer or his designee will execute and transmit an ARPA RWAI Grant offer to the Grant recipient. In addition to the estimated allowable project costs as described in Appendices A and B of these regulations, the Grant offer may include a construction contingency, as determined by the Department, in the project budget.

**History**
- *Source: House Bill 1421, 2022 Regular Session & Senate Bill 2444, 2023 Regular Session of the MS Legislature*

##### **15 Miss. Admin. Code Pt. 20, R. 5.3.4** Execution of Grant Offer {#sec-20-5.3.4 omnilex-key=us-ms-regs-official--title-15--20#5.3.4}

Upon receipt of the ARPA RWAI Grant offer, the Grant recipient shall execute the acceptance of the Grant offer and return it to the Department within the time frame established in the Grant Offer Letter. The Grant offer becomes void if not executed and returned within the time frame specified, unless extended by the State Health Officer or his designee, for good cause. The Grant Recipient shall provide copies of all proposed or executed contracts for professional services with the executed Grant.

**History**
- *Source: House Bill 1421, 2022 Regular Session & Senate Bill 2444, 2023 Regular Session of the MS Legislature*

##### **15 Miss. Admin. Code Pt. 20, R. 5.3.5** Engineering Design {#sec-20-5.3.5 omnilex-key=us-ms-regs-official--title-15--20#5.3.5}

4. Predesign Guidance and Conference.

The Department will provide design guidance to the Grant applicant, or its licensed engineer as requested. The applicant/engineer may request a pre-design conference with the Department.

5. General Requirements for plans, specifications and contract documents.

A. Plans, specifications, and contract documents shall be prepared for all appropriate elements of the project. These documents shall conform to Department requirements, to these regulations, and to the requirements of the most recent version of the Departmental document "Recommended Minimum Design Criteria for Community Water Supplies. or their successor(s). Other recognized engineering publications may be used for unit processes or technologies not described therein.

B. Plans, specifications, and contract documents shall also conform to such contract language, conditions, and forms as may be required by the Department. The plans, specifications, and contract documents shall bear the seal of the licensed engineer responsible for preparation of these documents.

6. Contents of plans specifications and contract documents.

In addition to the above general requirements, the plans, specifications, and contract documents shall contain the following:

A. Provisions assuring compliance with these regulations and all relevant federal and state laws.

B. Forms by which the bid bond, performance bond and payment bonds will be provided.

C. A contractor's assurance which shall warrant compliance by the contractor with all applicable federal laws and regulations and all laws of the State of Mississippi and all regulations and published policies of the Board.

D. Provisions providing for the applicant to retain a certain percentage of the progress payments otherwise due to the contractor, in accordance with state law.

E. Provisions requiring the contractor to obtain and maintain the

appropriate insurance coverage.

F. Provisions giving authorized representatives of the Department access to all such construction activities, books, records, documents, and other evidence of the contractor for the purpose of inspection, audit, and copying during normal business and/or working hours.

G. Provisions for change orders.

H. Those conditions, specifications, and other provisions set forth or required by the Department.

I. Provisions for liquidated damages.

J. Provisions for including water meters on new distribution systems.

**History**
- *Source: House Bill 1421, 2022 Regular Session*

##### **15 Miss. Admin. Code Pt. 20, R. 5.3.6** Submission of Plans, Specifications, Contract Documents and Related Items {#sec-20-5.3.6 omnilex-key=us-ms-regs-official--title-15--20#5.3.6}

By the dates specified in the Grant agreement, the recipient shall submit the following items to the Department:

8. Complete plans, specifications, and contract documents.

9. Certification from Licensed Engineer of the environmental impact, either low, moderate, or high of the project. If the Licensed Engineers determination is moderate or high, the Licensed Engineer should complete an Environmental and Intergovernmental Review as defined in Subchapter 6 and 8.

10. A copy of the issued National Pollutant Discharge Elimination System (NPDES) permit or the state operating permit, if required.

11. A copy of the issued solid waste disposal permit, if required.

12. Written waivers from all adjoining property owners when it is not possible to provide required buffer zones if the project includes drinking water sludge treatment facilities.

13. For all Grant eligible real property acquisitions all applicable state law must be followed. Prior to advertisement for construction bids, the Grant recipient shall secure approval of the purchase price by the Department, shall complete purchase of all Grant eligible real property and easements,

and shall submit clear title certificates from the Grant recipient and title counsel for all such Grant eligible property. Clear site certificates will also be required for Grant ineligible property.

14. A copy of all necessary interlocal agreements related to the project, if applicable. Such agreements shall be executed by all appropriate parties and shall be verified by the Department prior to any construction expenditures. If the project is unable to be completed due to failure to execute the necessary interlocal agreements, Grant Recipient shall be required to repay any funds expended for the project.

**History**
- *Source: House Bill 1421, 2022 Regular Session & Senate Bill 2444, 2023 Regular Session of the MS Legislature*

##### **15 Miss. Admin. Code Pt. 20, R. 5.3.7** Approval of Plans, Specifications, and Contract Documents {#sec-20-5.3.7 omnilex-key=us-ms-regs-official--title-15--20#5.3.7}

The Department will approve the plans, specifications, and contract documents upon determining that these documents appear to conform to the requirements of these regulations and are consistent with the approved planning documents and environmental determinations required by these regulations.

**History**
- *Source: House Bill 1421, 2022 Regular Session*

##### **15 Miss. Admin. Code Pt. 20, R. 5.3.8** Construction Bidding and Grant Amendment {#sec-20-5.3.8 omnilex-key=us-ms-regs-official--title-15--20#5.3.8}

4. Grant Agreement Timeframe

Within the timeframe established in the Grant agreement, the Grant recipient shall secure Department approval of the plans, specifications, and contract documents.

A. For all Grant ineligible real property and easements (including power and other utilities), submit clear site certification forms from both the Grant recipient and the title counsel which indicate that all such Grant ineligible real property and easements for the entire project have been secured by clear title.

B. Secure all local funds necessary for the project and submit proof of such.

C. Upon approval of PSCD, submittal of all clear site certificates, and issuance of any other permits or clearances required for the project, advertise the project for construction bids. All procurement actions by the Grant recipient shall comply with applicable law and these regulations. 5. Process following Receipt of Construction Bids

Upon receipt of construction bids, the Grant recipient shall then submit:

A. The completed bid package;

B. A Budget modification consistent with as-bid construction costs, a construction contingency as determined by the Department, and any professional services contracts and amendments.

C. If additional funds are necessary for the project, A Grant agreement amendment request outlining the source of the additional funds will be submitted.

6. Review of Documents

Upon receipt of the items listed above, the Department will review them to determine whether any request for an increased Grant amount is justified and allowable and whether funds are available. If necessary, a budget modification to move funds between allowable categories may be required. After determining that all documents are approvable, the Department will transmit to the Grant recipient approval to execute the construction contracts. After approval of the bid package, the Grant Recipient shall then submit all necessary executed contracts and amendments as described these regulations.

**History**
- *Source: House Bill 1421, 2022 Regular Session & Senate Bill 2444, 2023 Regular Session of the MS Legislature*

##### **15 Miss. Admin. Code Pt. 20, R. 5.3.9** Budget Modifications, Schedule Modifications, and Amended Grant Offer {#sec-20-5.3.9 omnilex-key=us-ms-regs-official--title-15--20#5.3.9}

4. Budget Modifications. Grant recipients can request to move funds between eligible categories in the Grant Agreement by completing a budget modification. This modification will be required prior to approval of reimbursement of any costs where the costs exceed the available budget. The contingency fund can be spent for construction costs only without a budget modification, however these funds should be moved to the construction category prior to the project closeout. After determining that the budget modification is approvable, the Department will transmit to the Grant recipient for approval of the modification.

5. Schedule Modification. To amend the schedule in the Grant Agreement, Grant Recipient should submit a letter detailing the need for schedule revision. After determining if the schedule modification is approvable, the Department will transmit to the Grant recipient for approval of the modification. Schedule modifications to construction contract should be submitted in the form of a change order.

6. Process after Grant Agreement Amendment Request

If the budget and schedule modifications cannot address the needed changes to the Grant Agreement or if additional local funds are needed for the project, the Grant Recipient can submit a Grant Agreement Amendment Request. After receipt, review, and approval of the Grant agreement amendment request, the Department may prepare and transmit an amended ARPA RWAI Grant offer to the Grant recipient. The Grant offer will include in the project budget:

A. The approved as-bid amounts for construction;

B. The final allowance amounts for professional services in accordance with Subchapter 5 of these regulations;

C. A construction contingency as determined by the Department; and,

D. Required local funds, if any.

7. Execution of Amended Grant Offer

Upon receipt of the amended ARPA RWAI Grant offer, the Grant recipient shall completely execute and return it to the Department within the timeframe established in the offer letter. After execution of the amended ARPA RWAI Grant offer. Any increased project costs in excess of the amended ARPA RWAI Grant amount shall be paid by the Grant recipient from sources other than ARPA RWAIG funds.

**History**
- *Source: House Bill 1421, 2022 Regular Session & Senate Bill 2444, 2023 Regular Session of the MS Legislature*

##### **15 Miss. Admin. Code Pt. 20, R. 5.3.10** Awarding Construction Contracts and Preconstruction Conference {#sec-20-5.3.10 omnilex-key=us-ms-regs-official--title-15--20#5.3.10}

Upon receipt of the approval to execute the construction contracts and to issue the notice to proceed, the Grant recipient shall do so and shall transmit a copy of the executed construction contracts and the notice to proceed to the Department within the time frame specified in the Grant agreement.

**History**
- *Source: House Bill 1421, 2022 Regular Session*

##### **15 Miss. Admin. Code Pt. 20, R. 5.3.11** Grant Recipient Responsibility {#sec-20-5.3.11 omnilex-key=us-ms-regs-official--title-15--20#5.3.11}

The Grant recipient will be responsible for assuring that every appropriate procedure and incidental legal requirement are observed in procurement of services, advertisement for bids, and awarding the construction contracts. The plans, specifications, and executed contract documents shall not vary from those approved by the Department.

**History**
- *Source: House Bill 1421, 2022 Regular Session & Senate Bill 2444, 2023 Regular Session of the MS Legislature*

##### **15 Miss. Admin. Code Pt. 20, R. 5.3.12** Preconstruction Conference {#sec-20-5.3.12 omnilex-key=us-ms-regs-official--title-15--20#5.3.12}

The Grant recipient may arrange and hold a preconstruction conference and shall allow attendance and participation by the Department if such is held.

**History**
- *Source: House Bill 1421, 2022 Regular Session*

##### **15 Miss. Admin. Code Pt. 20, R. 5.3.13** Observation During Construction {#sec-20-5.3.13 omnilex-key=us-ms-regs-official--title-15--20#5.3.13}

4. Resident Observation

During construction work being performed, the Grant recipient shall provide for resident observation of the project by the licensed engineer or his staff and shall require the licensed engineer's assurance that the work is being performed in a satisfactory manner in accordance with the Grant agreement and the approved plans, specifications, contract documents, and approved change orders.

5. Department Observation

The Department is authorized to observe the building of any project at any time for compliance with the terms of the Grant agreement and to determine if the Grant recipient is assuring that plans, specifications, and contract documents are being followed. Such observation will not subject the Department to any legal action for claims, damages, or any other liability.

Also, such observation shall not release the contractor from any obligation to perform the work in accordance with the requirements of the contract documents or the licensed engineer from determining compliance with the requirements of the contract documents or the Grant recipient from insuring compliance with the terms of the Grant agreement.

6. Assurance of Work

The contractor, licensed engineer, and the Grant recipient shall furnish the Department with every reasonable opportunity and means for determining whether the Grant recipient and licensed engineer are assuring that the work is in accordance with the requirements of the approved plans, specifications, and contract documents. The Department is authorized to observe and require submission by the Grant recipient of daily logs, full scale record drawings, file notes, and any other documents prepared by any party in relation to the ARPA RWAI funded project.

**History**
- *Source: House Bill 1421, 2022 Regular Session & Senate Bill 2444, 2023 Regular Session of the MS Legislature*

##### **15 Miss. Admin. Code Pt. 20, R. 5.3.14** Observation of Materials and Equipment {#sec-20-5.3.14 omnilex-key=us-ms-regs-official--title-15--20#5.3.14}

The Department is also authorized to observe all equipment and materials furnished, including observation of the preparation or manufacture of the equipment and materials to be used.

**History**
- *Source: House Bill 1421, 2022 Regular Session*

##### **15 Miss. Admin. Code Pt. 20, R. 5.3.15** Construction Deficiencies {#sec-20-5.3.15 omnilex-key=us-ms-regs-official--title-15--20#5.3.15}

Nonconformity with Plans and Specifications. In the event that it appears to the Department that the Grant recipient and licensed engineer are not assuring that the construction work, materials, equipment or supplies are in conformity with approved plans and specifications the Department may determine such work unallowable for ARPA RWAI Grant participation, unless the Grant recipient takes such action, through the licensed engineer if applicable, in the manner provided for in the construction contract to correct any deficiencies.

**History**
- *Source: House Bill 1421, 2022 Regular Session & Senate Bill 2444, 2023 Regular Session of the MS Legislature*

##### **15 Miss. Admin. Code Pt. 20, R. 5.3.16** Withholding of Grant Payment {#sec-20-5.3.16 omnilex-key=us-ms-regs-official--title-15--20#5.3.16}

The Department may immediately withhold ARPA RWAI Grant payments for such time that it appears that the Grant recipient and licensed engineer are not assuring that construction work, materials, equipment, or supplies are in accordance with the approved plans, specifications, and contract documents, and may require the Grant recipient to repay any previously paid amounts related to such work within 30 days of such notification.

**History**
- *Source: House Bill 1421, 2022 Regular Session & Senate Bill 2444, 2023 Regular Session of the MS Legislature*

##### **15 Miss. Admin. Code Pt. 20, R. 5.3.17** Change Orders {#sec-20-5.3.17 omnilex-key=us-ms-regs-official--title-15--20#5.3.17}

5. General.

A. In the event a determination is made by a Grant recipient after a construction contract is executed that changes or modifications to the original contract are necessary or would better serve the purpose of the Grant recipient, such Grant recipient may, at its discretion, execute such change orders pertaining to the construction that are necessary under the circumstances, as provided in the contract documents and when in accordance with applicable law.

B. Change orders shall not change, vary, or alter the basic purpose or effect of the project unless allowed by the Department. Change orders shall be technically adequate, the costs shall be necessary and reasonable, and eligible/ineligible costs shall be appropriately separated.

6. Change Order Submissions.

A. After completion of the claims resolution and/or change order negotiation process between the Grant recipient and the contracting party, a fully executed change order shall be submitted to the Department for review and approval, in order to obtain an ARPA RWAI Grant eligibility/allowability determination. If any change order is submitted to the Department that is not complete and fully executed by the Grant recipient, the contracting party, and the licensed engineer if appropriate, the Department may return such change order without review.

B. The Grant recipient may submit a complete and fully executed change order which has been executed conditional upon an ARPA RWAI Grant eligibility/allowability determination by the Department.

C. All change orders shall be submitted to the Department for review and approval in a timely manner.

D. If possible, approval of a change order should be secured from the Department before the work is started, particularly for change orders including time extensions as per Rule 5.3.17.4 below. Approval may also be secured after the work is started; however, the Grant recipient shall bear the cost if the work is determined to be ineligible or unallowable.

E. When the eligible cost of a project will be significantly reduced by a change order or change orders, the Department may issue a budget modification decreasing the Grant amount, and the Grant recipient shall execute such modification within the time frame established by the Department.

7. Department Review.

In order to allow the Department to perform a technical and Grant allowability review, requests for change order approvals shall conform to Department guidance, requirements, and regulations.

8. Time Extensions.

Change orders which include time extensions exceeding 30 days beyond the original contract completion date, and/or documentation that the Grant recipient is implementing all legal remedies provided in the contract documents for failure to complete construction when required, shall be submitted to the Department as specified in these regulations. Justification for contract time extensions included in a change order shall be prepared but need not be submitted to the

Department unless the total time extensions for the contract exceeds 30 days after the original contract completion date, in which case justification for all time extensions shall be submitted to the Department for an allowability determination. The deadline of September 30, 2026, ends the period of performance to liquidate all obligations. The contract completion date should not exceed August 15, 2026.

**History**
- *Source: House Bill 1421, 2022 Regular Session & Senate Bill 2444, 2023 Regular Session of the MS Legislature*

##### **15 Miss. Admin. Code Pt. 20, R. 5.3.19** Construction Phase Submissions, Approvals, and Actions -Timeline {#sec-20-5.3.19 omnilex-key=us-ms-regs-official--title-15--20#5.3.19}

The following submittals, approvals, and actions will be required during the construction phase of the project. The Department may establish other time frames within the Grant agreement when properly justified.

1. Within 30 days after approval of plans, specifications, and contract documents by the Department (1) all construction related contracts shall be advertised for bids and proof of such advertisement shall be submitted, (2) all local funds necessary for the project shall be secured, and proof of such local funds shall be submitted, and (3) clear site certificates from the Grant recipient and title counsel for all real property shall be submitted.

2. Within 45 days after advertisement, the Grant recipient shall open bids on all construction related contracts.

3. Within 14 days after receipt of bids for new construction, the Grant recipient shall submit all bid packages.

4. Within 60 days after receipt of bids, the Grant recipient shall execute all construction contract documents, shall submit a copy of all executed contract documents, and shall issue and submit a copy of the notice to proceed on all such contracts.

5. By the date initially established in the Grant agreement (which is based upon approximately 50% of contract time) the Grant recipient shall submit a completed asset management plan for all drinking water facilities to be constructed in whole or in part with ARPA RWAI Grant funds.

6. By the date initially established in the Grant agreement (which is based upon approximately 90% of contract time) the Grant recipient shall secure approval of the asset management plan.

7. Within 10 days after construction completion of each construction contract, the Grant recipient shall notify the Department of construction completion.

8. The Department will perform a final construction observation within 30 days after the current construction contract completion date, unless further delayed by the Department pursuant to review of the Grant recipient's request and justification for such delay. Should the Department decide that the construction completion is being unreasonably delayed, a final construction observation may be immediately performed by the Department. The final construction observation by the Department is only for the purpose of determining final Grant allowable costs.

9. Within 30 days after the current construction contract completion date, all change orders which include time extensions exceeding 30 days beyond the original contract completion date, and/or documentation showing the Grant recipient is implementing all legal remedies provided in the contract documents for failure to complete construction when required, shall be submitted to the Department for an allowability determination

10. Within 60 days after the final construction observation performed by the Department, the Grant recipient shall submit: the final payment request for the awarded grant; approvable summary change orders for all construction contracts; full scale record drawings with all revisions shown and noted for the entire project funded in whole or in part with ARPA RWAI Grant funds; the licensed engineer's certification of compliance with plans, specifications, and contract documents; appropriate bacteriological test results; final construction phase professional services contract amendments, if any; and all other administrative forms and documents required by the Grant agreement. Grant payment requests submitted after this date are not allowable, regardless of when the costs were incurred.

11. Any other submittals or actions required by the Grant agreement shall be performed when so required and are subject to review and approval by the Department.

**History**
- *Source: House Bill 1421, 2022 Regular Session & Senate Bill 2444, 2023 Regular Session of the MS Legislature*

##### **15 Miss. Admin. Code Pt. 20, R. 5.3.20** Post Construction Phase {#sec-20-5.3.20 omnilex-key=us-ms-regs-official--title-15--20#5.3.20}

##### **15 Miss. Admin. Code Pt. 20, R. 5.3.20.1** Audits {#sec-20-5.3.20.1 omnilex-key=us-ms-regs-official--title-15--20#5.3.20.1}

Following final payment of ARPA RWAI Grant funds to the Grant recipient, or upon expiration of any deadlines established by the Grant agreement or the Department, the Department or other designated parties may perform an audit of the ARPA RWAI Grant project for the purpose of determining compliance with the Grant agreement and to determine final allowable costs, payments made to date, and any additional payments due the Grant recipient or repayment due

the Department.

**History**
- *Source: House Bill 1421, 2022 Regular Session*

##### **15 Miss. Admin. Code Pt. 20, R. 5.3.20.2** Final Determination of Allowable Costs and Payments {#sec-20-5.3.20.2 omnilex-key=us-ms-regs-official--title-15--20#5.3.20.2}

Upon completion of the ARPA RWAIG audit (or if an audit is not performed, following final payment of ARPA RWAI Grant funds to the Grant recipient, or upon expiration of any deadlines established by the Grant agreement or the Department), the Department will transmit to the Grant recipient a copy of the audit report, if performed, a final determination of allowable costs and payments due the Grant recipient or repayments due the State.

**History**
- *Source: House Bill 1421, 2022 Regular Session*

##### **15 Miss. Admin. Code Pt. 20, R. 5.3.20.3** Final Determination Letter {#sec-20-5.3.20.3 omnilex-key=us-ms-regs-official--title-15--20#5.3.20.3}

Unless, within 30 days after the date of the above final determination, the Grant recipient submits a written appeal of the final determination, including a written justification of the reason for the appeal, and supporting documentation for any disputed costs of the final determination, the final determination of allowable costs will become the final allowable costs for purposes of ARPA RWAI Grant payments and the Grant agreement, and the Grant recipient shall receive a final determination letter from the department.

**History**
- *Source: House Bill 1421, 2022 Regular Session*

##### **15 Miss. Admin. Code Pt. 20, R. 5.3.20.4** Final Determination Letter following Appeal {#sec-20-5.3.20.4 omnilex-key=us-ms-regs-official--title-15--20#5.3.20.4}

Should an appeal be submitted in accordance with Rule 5.3.20.3 above, the disputes procedures established in Subchapter 9 of these regulations will be followed in order to resolve the dispute and establish the final allowable costs. Upon resolution of a dispute of the final determination, the Department will transmit to the Grant recipient a revised final determination letter.

**History**
- *Source: House Bill 1421, 2022 Regular Session*

##### **15 Miss. Admin. Code Pt. 20, R. 5.3.21.1** Payments to ARPA RWAI Grant recipients {#sec-20-5.3.21.1 omnilex-key=us-ms-regs-official--title-15--20#5.3.21.1}

Payments from the ARPA RWAIG Fund may be made to ARPA RWAI Grant recipients under the following conditions:

4. Payments may be requested by and made only to Grant recipients, in accordance with the Grant agreement and the Grant recipient's contracts for eligible and allowable services and construction for work performed within the project scope and budget period.

5. Payments may be requested only on project completed work, except as

required by state law or as allowed by the Department.

6. The Grant recipient shall deduct from all ARPA RWAIG Fund payment requests the amount of funds provided or to be provided from all other state and federal agency funding sources for allowable ARPA RWAIG Fund project costs.

**History**
- *Source: House Bill 1421, 2022 Regular Session*

##### **15 Miss. Admin. Code Pt. 20, R. 5.3.21.2** Payment Request Submissions {#sec-20-5.3.21.2 omnilex-key=us-ms-regs-official--title-15--20#5.3.21.2}

Payment requests shall be submitted by the Grant recipient to the Department and shall include the following: 4. ARPA RWAIG Fund payment request form with original signature;

5. Cumulative invoices for all allowable costs for which payment is requested; and

6. Any other documents required by the Grant agreement.

Rule 5.3.21.3. Timing of Payments

Provided the Grant recipient is in compliance with the requirements of these regulations and all provisions of the Grant agreement, the timing of ARPA RWAIG payments will be upon submission of a reimbursement request by the grant recipient for eligible and allowable services and construction for work performed within the project scope and grant award period. Payments may be requested no more often than on a monthly basis.

Rule 5.3.21.4. Repayments

Any payments made to the Grant recipient which are at any time determined by the Department to be for costs not in accordance with the Grant agreement, for ineligible or unallowable costs, or for costs related to waste, fraud, abuse, or illegal acts under state or federal law shall be repaid to the ARPA RWAI grant fund within 30 days of such notification by the Department. Interest may be charged on delinquent repayments after expiration of the 30-day period at a rate of ten (10) percent per annum, compounded monthly. Alternatively, the Department may withhold such amounts from subsequent payment requests.

Subchapter 4 Costs

Rule 5.4.1. General

Eligible costs are those costs in which ARPA RWAI Grant participation is authorized pursuant to applicable statute. Allowable costs are eligible costs that meet the following criteria:

11. Are necessary and reasonable for the proper and efficient administration and construction of the project, are allocable to and within the defined scope of the project and are not a general expense required to carry out the overall responsibilities of the Grant recipient.

12. Are authorized or not prohibited under federal, state, or local laws or regulations. 13. Conform to any limitations or exclusions set forth in state laws or other governing limitations as to types or amounts of cost items.

14. Are consistent with policies, regulations, and procedures that apply uniformly to both state assisted and other activities of the Grant recipient.

15. Are accorded consistent treatment through the application of generally accepted accounting principles appropriate to the circumstances.

16. Are not allocable to or included as a cost of any other Federal or State financed program in either the current, prior, or future period.

17. Are approved as allowable by the Department.

18. Are within the scope and budget period of the project as per the Grant agreement. However, the budget period does not apply to the planning and design allowance.

19. Notwithstanding this Subchapter, are eligible and allowable under the ARPA and any implementing federal regulations.

20. Are procured in accordance with Subchapter 7 of these regulations.

Rule 5.4.2. Construction

3. Allowable Construction Costs include the costs for:

A. The following types of projects, and as further described or limited in the Grant Agreement under which the project is funded:

(i) projects that will facilitate compliance with national primary drinking water regulations;

(ii) projects that will facilitate consolidation of public water systems or the use of an alternative water supply. Consolidation between rural water associations and municipalities is eligible if one party is an eligible grant applicant.

(iii) projects that will upgrade a drinking water system; or

(iv) development of a public water system to replace private drinking water supplies if the water poses a significant threat to human health.

B. Subagreements for construction work on drinking water systems improvements. These subagreements are the prime contracts (including any subcontracts) for such construction work and any necessary contracts for purchase of equipment, materials and supplies by the Grant recipient. Should any costs for such contracts be incurred prior to Grant offer, said costs will be allowable provided that the Grant recipient has requested and obtained Department approval of said costs and provided that the Grant agreement budget period includes the time period these costs are incurred.

C. Drinking water distribution lines on drinking water distribution projects which provide drinking water to previously unserved areas, and the service lines between the public water main and the water meter.

D. Drinking water distribution system rehabilitation and replacement (including rehabilitation and replacement of eligible service lines) necessary to eliminate water loss or to preserve/restore the safety or integrity of the system, as determined in an approved facilities plan.

E. Water system capacity equal to all water distribution system leaks that will remain in the system, as determined in an approved facilities plan.

F. Drinking water systems which include service to industrial or commercial users when such works are owned by an eligible applicant.

G. Buildings that house or protect water production, treatment or distribution facilities.

H. Replacement of existing service lines from a water main up to a building (which includes any privately owned portion) if an identified public health threat exists (such as lead in the drinking water) that can be reduced by the replacement of the existing service line.

4. Unallowable costs include:

A. Costs for the following types of projects:

(i) Projects primarily for growth, development, or fire protection;

(ii) Projects that can be consolidated (except for projects to implement such consolidation); (iii) Projects for systems without adequate financial or managerial support necessary to comply with ARPA requirements and all requirements of the Grant agreement; and

(iv) Projects for drinking water systems which serve federal users exclusively, or almost exclusively.

B. Construction and construction related costs which are incurred after the Department approved eligible contract completion date (including approved time extension change orders), unless approved by the Department pursuant to Rule 3.7.5.4 of these regulations.

C. Bonus payments that are part of the construction contract for completion of building before a contractual completion date, unless required by state law.

D. Administration buildings.

**History**
- *Source: House Bill 1421, 2022 Regular Session*
- *Source: House Bill 1421, 2022 Regular Session*
- *Source: House Bill 1421, 2022 Regular Session*
- *Source: House Bill 1421, 2022 Regular Session & Senate Bill 2444, 2023 Regular Session of the MS Legislature*
- *Source: House Bill 1421, 2022 Regular Session*

##### **15 Miss. Admin. Code Pt. 20, R. 5.4.3** Equipment, Materials and Supplies {#sec-20-5.4.3 omnilex-key=us-ms-regs-official--title-15--20#5.4.3}

2. Allowable costs include the costs of:

A. A reasonable inventory of chemicals and supplies necessary to initiate plant operations and laboratory items necessary to conduct tests required for plant operation.

B. Necessary and reasonable safety equipment, provided the equipment meets applicable federal, state, local or industry safety requirements.

C. Constructing or installing water flow metering devices for the

primary purpose of monitoring and/or billing inter-municipal or other flows or serving and billing individual residential, commercial or industrial users.

D. Backflow preventers.

E. Computers, display monitors, and computer software which are designed into the control system for the daily operation of the water system, used for the operational control and analysis of the water system, or specifically designed for the operation and maintenance (including the cost of developing unique operating programs for the specific Grant funded project) of the treatment works.

F. Specialized mobile equipment for the operation of the water system, or for the maintenance of equipment. These items include, but are not limited to:

(i) Portable stand-by generators.

(ii) Portable emergency pumps to provide "pump-around" capability in the event of booster station failure or pipeline breaks. 2. Unallowable costs include the costs of:

A. Vehicles for the transportation of the Grant recipient's employees, including buses, trucks, cars, motorcycles, ATVs, golf carts, bicycles, etc.

B. Items of routine "programmed" maintenance such as filters, couplings, hoses, belts, etc.

C. Radios, televisions, VCRs, camcorders, and other items of a similar nature.

D. Shop equipment installed at the treatment works or elsewhere.

E. Distribution system maintenance equipment.

F. Replacement parts.

G. Furnishings, office equipment, and maintenance equipment, including chairs, desks, file cabinets, typewriters, coffee tables, telephones, office supplies, calculators, copiers, bookcases, shelves, lamps, etc.

H. Ordinary site and building maintenance equipment such as lawn

mowers, rakes, shovels, brooms, picks, hedge trimmers, and other such equipment.

I. Hand tools such as screw drivers, pliers, socket wrenches, electric drills or saws, etc.

J. Computers for non-operational purposes, such as for the scheduling of equipment maintenance and replacement and for accounting and billing services.

3. Change orders are allowable provided the costs are:

A. Necessary and reasonable.

B. Within the scope of the project.

C. Not caused by the Grant recipient's mismanagement.

D. Not caused by the Grant recipient's vicarious liability for the improper actions of others.

E. In conformance with the ARPA RWAIG regulations.

4. Provided the above requirements are met, the following are examples of allowable change orders.

A. Construction costs resulting from defects in the plans, design drawings and specifications, or other contract documents only to the extent that the costs would have been incurred if the contract documents on which the bids were based had been free of the defects, and excluding the costs of any rework, delay, acceleration, or disruption caused by such defects.

If the defect is realized after substantial construction work has been completed, and therefore requires rework, delay, or additional work beyond that which would have been required by defect-free drawings, the cost would still be allowable, but the additional cost of rework or delay is unallowable.

The additional cost is measured as the difference between the cost which would have been included in the bid based on defect free drawings and the actual cost of the change order.

B. Equitable adjustments for differing site conditions.

Rule 5.4.5. Professional Services The term professional services refers to engineering, legal, administrative, and similar services.

3. Allowable costs include the costs of/for:

A. Planning, application, and design. These costs include all engineering and other costs that are incurred in planning and designing the project, as well as applying for the Grant. These costs include but are not necessarily limited to the following services, as determined allowable in Subchapter 5 of these regulations.

(i) Preparing the plans, specifications, and contract documents.

(ii) Preparing interlocal agreements necessary for the project.

(iii) Surveys and all other work needed to obtain clearance or permits from all intergovernmental review agencies.

(iv) Preparing the Grant application, preparing applications for permits required by federal, state or local regulations or procedures.

B. Construction Phase Professional Services

(i) Services incurred during the advertisement, award and construction of a project to ensure compliance with applicable purchasing laws and to ensure that the project is built in conformance with the design plans and specifications. These services are primarily engineering, and construction management services provided during the advertisement, award and building of the project, including observation services, materials testing (e.g., concrete strength, soil compaction, etc.) required by the specifications, inspecting and expediting the delivery of equipment and material purchased directly by the Grant recipient, reviewing shop drawings and full-scale record drawings, preparing change orders, payment processing, etc.

(ii) Legal, engineering, and other services incurred by the Grant

recipient in deciding procurement protests and defending their decisions in protest appeals under Subchapter 9 are allowable regardless of the outcome of the protest, provided there was not an attempt by the Grant recipient to violate or circumvent applicable purchase laws.

(iii) Asset management plan for constructed components of the funded project

(iv) Accounting services for preparation of the Single Audit or Program Specific Audit

(v) Development of an operation and maintenance manual.

(vi) Start-up services for onsite training of operating personnel in operation and control of specific treatment processes, laboratory procedures, and maintenance and records management, provided these costs are incurred prior to the end of the 60-day period established in Rule 5.3.19. of these regulations.

(vii) Administrative services associated with the construction project and administering the ARPA RWAIG.

(viii) Services, other than engineering services during construction/repairs, such as railway or highway flagmen or utility or highway inspectors, required during the building of the project, provided that a. The entity responsible for the affected railway, highway, or utility requires such services for all parties conducting similar types of work, regardless of the source of construction funding for the project, or the services are required by law.

b. The cost of such services has not been included in the construction contractor's bid price.

(ix) Engineering or other services necessary to correct defects in the grant applications plan, design drawings and specifications or other documents to the extent that such costs would have been allowable for preparing defect free documents.

4. Unallowable costs include the costs of:

A. Public liaison services. B. Local travel (i.e., commuting expenses) between living quarters and the construction site for persons working at the site.

**History**
- *Source: House Bill 1421, 2022 Regular Session Rule 5.4.4. Change Orders*
- *Source: House Bill 1421, 2022 Regular Session & Senate Bill 2444, 2023 Regular Session of the MS Legislature*
- *Source: House Bill 1421, 2022 Regular Session & Senate Bill 2444, 2023 Regular Session of the MS Legislature*

##### **15 Miss. Admin. Code Pt. 20, R. 5.4.6** Claims {#sec-20-5.4.6 omnilex-key=us-ms-regs-official--title-15--20#5.4.6}

3. Allowable costs, provided the costs are properly documented, incurred and requested prior to the end of the 60-day period established Rule 5.3.19.11 of these regulations, include:

A. Change orders to the construction contract as a result of settlements, arbitration awards, or court judgements, to the extent that they would have been allowable had there not been a claim.

B. The costs of assessing the merits of, negotiating, or defending a claim against the Grant recipient are allowable, regardless of the outcome, provided that the matter under dispute is not the result of fraudulent or illegal actions or mismanagement on the part of the Grant recipient.

C. Alterations in engineering, legal, contracts etc. as a result of settlements, arbitration awards, or court judgements are allowable to the same extent that they would have been allowable had there not been a claim.

4. Unallowable costs include the costs of:

A. Claims arising from work outside the scope of the Grant.

B. Claims resulting from fraudulent or illegal activities.

C. Claims resulting from mismanagement by the Grant recipient.

D. Claims resulting from the Grant recipient's vicarious liability for the improper action of others.

E. Settlements, arbitration awards or court judgements over the allowable costs as established in these regulations.

**History**
- *Source: House Bill 1421, 2022 Regular Session*

##### **15 Miss. Admin. Code Pt. 20, R. 5.4.7** Mitigation {#sec-20-5.4.7 omnilex-key=us-ms-regs-official--title-15--20#5.4.7}

3. Allowable costs include the costs of: A. Mitigation of only direct adverse physical impacts resulting from construction of the project.

B. Reasonable site screening necessary to comply with required environmental review and necessary to screen adjacent properties.

C. Groundwater monitoring facilities necessary to determine the possibility of groundwater deterioration, depletion or modification resulting from construction of the project. The extent of the allowable costs for groundwater monitoring facilities is decided on a case-by-case basis and depends on the size and complexity of the project and the present and potential future use of the groundwater.

4. Unallowable costs include the costs of:

A. Solutions to aesthetic problems, including design details which require expensive building techniques and architectural features and hardware, that are unreasonable or substantially higher in cost than approvable alternatives and that neither enhance the function or appearance of the treatment works nor reflect regional architectural tradition.

B. Land acquired for the mitigation of adverse environmental effects identified pursuant to an environmental review.

Rule 5.4.8. Real Property

3. Allowable costs include the costs of:

A. Land acquired in fee simple title or by easement, from a willing seller, for:

(i) Water supply and/or storage purposes;

(ii) A consolidation project; and

(iii) Protection of the source water of the system from contamination.

B. Preparation of the treatment works site before, during and, to the extent agreed on in the Grant agreement, after building. These include the cost of:

(i) Demolition of existing structures on the treatment works site (including rights-of-way) if building cannot be undertaken without such demolition. Demolition of existing structures on the treatment works site (including rights-of- way), when not required for building the project, will be considered to be an allowable cost only if the existing structures constitute a real and present hazard to safety, public health, or water quality and when the hazard can best be abated by the removal of the existing structures.

(ii) Removal, relocation, or replacement of utilities, provided the Grant recipient is legally obligated to pay for such as a result of the ARPA RWAIG project under state or local law.

(iii) Restoration of streets and rights-of-way to their original condition. The need for such restoration shall result directly from the construction of the ARPA RWAIG project and is generally limited to repaving the width of trench.

4. Unallowable costs include the costs of:

A. Any amount paid by the Grant recipient for eligible land in excess of the appraised value or the Grant recipient's record of negotiation.

An amount higher than the appraised value may be found allowable if the Grant recipient provides sufficient written documentation to the Department and receives allowability approval prior to the actual acquisition.

B. Removal, relocation or replacement of utilities located on land by privilege, such as a franchise, unless the Grant recipient is required to pay such costs under state or local law.

C. Land acquired in fee simple title or by easements for land other than that described under H.(1)(a) above, such as easements for the purpose of water distribution system expansion or improvement.

D. The demolition of an existing structure for the convenience of the owner as a means of increasing property value or property use.

Rule 5.4.9. Miscellaneous Costs 3. Allowable costs include the costs of:

A. Equipment rental and material costs necessary for the construction project.

B. Meeting specific legal requirements directly related to the project unless otherwise specified in these regulations.

C. Royalties associated with the procurement of the right to use, or the rights in, a patented product, apparatus, or process, provided that they are based on a published fee schedule or on reasonable fees charged to other users under similar conditions.

D. Training workshops/seminars for Grant recipient employees that are necessary to provide instruction in operational, administrative, fiscal or contracting procedures required to complete the construction of the project. Attendance at such training workshops or seminars shall occur after Grant offer but before the end of the Grant agreement budget period.

E. A reasonable project sign.

4. Unallowable costs include the costs of:

A. Salaries and benefits for the Grant recipient’s employees.

B. Ordinary operating expenses of the Grant recipient, including salaries and expenses of elected and appointed officials and preparation of routine financial reports and studies.

C. Administrative, engineering, and legal activities associated with the creation of special departments, agencies, commissions, regions, districts, associations, or other entities.

D. Approval, preparation, issuance and sale of bonds or other forms of indebtedness required to finance any portion of the project and the interest on them.

E. Personal injury compensation or damages arising out of the project.

F. Fines and penalties due to violations of or failure to comply with federal, state or local laws, regulations or procedures, and related legal expenses. G. Operation and maintenance of the water system, which include but are not limited to, labor, utilities, chemicals, materials and supplies, monitoring, testing, equipment replacement, periodic

payment of royalties for the right to operate under a patent, etc.

H. Lease payments.

I. Travel, by the Grant recipient, unless included under an indirect cost agreement, and except as allowed under Rule 5.4.9(1)(d) above.

Rule 5.4.10. Project Income

5. Bid bond forfeitures will have no effect on the determination of allowable and unallowable costs. The Grant recipient shall make the determination of whether or not a bid bond will be forfeited.

6. The amount of liquidated damages collected will have no effect on the determination of allowable and unallowable costs, except as described by Rule 5.3.17.4 of these regulations.

7. Interest income on ARPA RWAIG Fund payments to Grant recipients will have no effect on the determination of allowable and unallowable costs.

8. The Grant recipient shall receive all income generated from use of the project facilities.

Rule 5.4.11. Water System Acquisition

The terms of water system acquisition must be provided to the Department prior to the acquisition to ensure cost allowability under federal regulations and applicable state law.

3. Allowable costs include the costs of:

E. Purchase of a public or private Public Water System with a PWS ID number to consolidate system with Grant Applicant.

F. Cost of appraisal of water system infrastructure by a licensed engineer

G. Legal costs associated with negotiation of acquisition and preparation of acquisition documents

H. Real property costs as outlined in these regulations, including purchase of existing water distribution system easements

4. Unallowable costs include the costs of:

B. Any amount paid by the Grant recipient for eligible PWS infrastructure or real property in excess of the appraised value or the Grant recipient's record of negotiation.

An amount higher than the appraised value may be found allowable if the Grant recipient provides sufficient written documentation to the Department and receives allowability approval prior to the actual acquisition.

Subchapter 5. Recommended Allowances for Planning, Design and Construction Phase Professional Services

Rule 5.5.1. Recommended Allowances for Planning and Design.

The recommended allowance for planning and design will be determined using Table 1 in this Subchapter. This table is not intended to be used to determine the consulting engineer's allowable costs for planning and design services. Compensation for these services should be based upon the nature, scope, and complexity of the services required for the project.

Table 1 includes a recommended range for engineering costs during planning and design, which the Grant applicant/recipient should consider while evaluating the engineer's proposal. If the engineer's proposal exceeds the normal range the Grant applicant/recipient should consider requiring the engineer to justify why the project is more difficult than normal. The actual compensation justified for a particular project may be more or less than the suggested range of the allowance for these services shown in Table 1.

If the consulting engineer and Grant applicant/recipient determine that the maximum recommended allowance calculated using Table 1 in this Subchapter does not adequately reflect the nature, scope, and complexity of the services required for the project, the consulting engineer may submit a detailed cost proposal, in such format as required by the Department, justifying a compensation amount greater than Table 1 recommends. If, in the Department's opinion, the detailed cost proposal justifies such, the Department will approve an allowance for facilities planning and design greater than those recommended in Table 1. The decision of the Department in this matter will be final.

Projects for which the Grant applicant/recipient shall acquire easements or real property may receive an additional 1% above the recommended maximum percentages shown in Table 1 for planning and design allowances. Also, projects for which a value engineering study is conducted may receive an additional 3% above the recommended maximum percentages shown in Table 1 for the planning and design allowance.

Rule 5.5.2. Recommended Allowance for Construction Phase Professional Services.

The Allowance for Construction Phase Professional Services includes costs for engineering services during bidding, construction, and post-construction phases, observation during construction, Grant administration and other services (i.e. legal, etc.) that are associated with the construction of the ARPA RWAIG project. The recommended allowance for construction phase professional services will be determined using Table 2 in this Subchapter.

This table is not intended to be used to determine the actual compensation for construction phase professional services. Compensation for these professional services should be based upon the nature, scope, and complexity of the services required for the project.

Table 2 separates the Total Recommended Allowance for Construction Phase Professional Services shown in the far-right hand column into three types of services: engineering, Grant administration, and other services and provides suggested ranges for each of these services depending upon the complexity of the project. The Grant applicant/recipient should consider these recommended ranges when evaluating proposals for these services. If the proposals exceed the normal ranges for any of these services, the Grant applicant/recipient should consider requiring the professional to justify why the project is more difficult than normal. The actual compensation justified for a particular project may be more or less than the suggested range of the allowance for these services shown in Table 2.

If the consulting engineer and Grant applicant/recipient determine that the maximum recommended allowance calculated using Table 2 in this Subchapter does not adequately reflect the nature, scope, and complexity of the services required for the project, the consulting engineer may submit a detailed cost proposal, in such format as required by the Department, justifying a compensation amount greater than Table 2 recommends. If in the Department's opinion the detailed cost proposal justifies such, the Department will approve an allowance for construction phase professional services greater than those recommended in Table 2. The decision of the Department in this matter will be final.

Although Table 2 shows engineering and Grant administration as separate costs, the Grant applicant/recipient is not required by these regulations to contract for these services separately. The Grant applicant/recipient may wish to have the consulting engineer provide both scopes of services, and under such an arrangement, the engineer's contract should not exceed the total of the suggested ranges for both services.

Rule 5.5.3. General Guidance for Use of the Allowance Tables.

The estimated and final allowances will be determined in accordance with this Subchapter. All allowance percentages will be calculated to four decimal places using linear interpolation. The allowance amount is computed by applying the resulting total allowance percentage to the initial allowable building cost, which is the initial award amount of all prime contracts for construction, equipment, supplies, and testing of the project.

The estimated allowances are to be based on the estimate of the initial allowable building cost from the Subgrant Agreement, Attachment B.

Following execution of the Grant agreement, the Grant recipient may request and receive payment for the facilities planning and design allowance and the allowance for construction phase professional services, in accordance with the procedures described in Rule 5.3.21.3 of these regulations. Advances of allowances will not be provided.

Table 1

Recommended Allowances for Facilities Planning and Design

Allowable Building Cost Allowances as a Percentage of Building Cost Based Upon the Difficulty of the Project

Normal to Difficult $50,000 or less 11.7500% to 13.2000% $100,000 10.7500% to 12.2000% $150,000 10.0700% to 11.2519% $200,000 9.4000% to 10.5000% $300,000 8.7000% to 9.8042% $400,000 8.3000% to 9.6312% $500,000 8.0000% to 9.4417% $600,000 7.8000% to 9.1467% $700,000 7.7000% to 9.0297% $800,000 7.5000% to 8.8089% $900,000 7.4000% to 8.7472% $1,000,000 7.2500% to 8.5673% $1,100,000 7.1030% to 8.3911% $1,200,000 6.9600% to 8.2185% $1,300,000 6.8200% to 8.0495% $1,400,000 6.6800% to 7.8840%

$1,500,000 or greater 6.5400% to 7.7219%

Table 2

Recommended Allowances for Construction Phase Professional Services Allowances as a Percentage of Building Cost Based Upon the Difficulty of the Project

Estimated Building Cost Engineering Services Grant Administration Other Services Total Allowance for Professional Services Normal to Difficult Normal to Difficult Normal to Difficult Normal to Difficult $50,000 or less 6.4400% to 11.7250% 2.0700% to 3.7688% 0.6900% to 1.2563% 9.2000% to 16.7500% $100,000 5.7400% to 11.725% 1.8450% to 3.7688% 0.6150% to 1.2563% 8.2000% to 16.7500% $150,000 5.2850% to 11.725% 1.6988% to 3.7688% 0.5663% to 1.2563% 7.5500% to 16.7500% $200,000 4.8300% to 9.9400% 1.5525% to 3.1950% 0.5175% to 1.0650% 6.9000% to 14.2000% $300,000 4.4100% to 8.1690% 1.4175% to 2.6258% 0.4725% to 0.8753% 6.3000% to 11.6700% $400,000 4.0600% to 7.2800% 1.3050% to 2.3400% 0.4350% to 0.7800% 5.8000% to 10.4000% $500,000 3.8150% to 6.5800% 1.2263% to 2.1150% 0.4088% to 0.7050% 5.4500% to 09.4000% $600,000 3.5700% to 5.9500% 1.1475% to 1.9125% 0.3825% to 0.6375% 5.1000% to 08.5000% $700,000 3.4300% to 5.4600% 1.1025% to 1.7550% 0.3675% to 0.5850% 4.9000% to 07.8000% $800,000 3.2900% to 5.0400% 1.0575% to 1.6200% 0.3525% to 0.5400% 4.7000% to 07.2000% $900,000 3.2200% to 4.6690% 1.0350% to 1.5008% 0.3450% to 0.5003% 4.6000% to 06.6700% $1,000,000 3.1500% to 4.4800% 1.0125% to 1.4400% 0.3375% to 0.4800% 4.5000% to 06.4000% $1,100,000 3.0815% to 4.2986% 0.9905% to 1.3817% 0.3302% to 0.4606% 4.4022% to 06.1409% $1,200,000 3.0146% to 4.1246% 0.9690% to 1.3258% 0.3230% to 0.4419% 4.3066% to 5.8923% $1,300,000 2.9492% to 3.9577% 0.9479% to 1.2721% 0.3160% to 0.4240% 4.2131% to 5.6538% $1,400,000 2.8852% to 3.7975% 0.9274% to 1.2206% 0.3091% to 0.4069% 4.1217% to 5.4250% $1,500,000 or greater 2.8226% to 3.6438% 0.9073% to 1.1712% 0.3024% to 0.3904% 4.0323% to 5.2054%

Subchapter 6. Environmental Review Process

Rule 5.6.1. Description of Environmental Impacts

The Licensed Engineer is required to certify the environmental impact of the project as either low, moderate, or high. If the Licensed Engineer determines that there is either a moderate or high impact, the Licensed Engineer shall prepare an Environmental Review Report. The report shall bear the seal of the licensed engineer responsible for preparation of the report and shall contain a description of the environmental impacts of the proposed project and any corresponding mitigative measures including, but not necessarily limited to, the following:

(10) Surface and groundwater resources;

(11) Archaeological/historical/cultural resources; (12) Vegetative/wildlife resources;

(13) Wetlands and navigable waterways;

(14) Floodplains;

(15) Prime or important farmlands;

(16) Coastal zones;

(17) Wild and scenic rivers; and

(18) Air Quality.

Rule 5.6.2. Environmental Review.

The Licensed Engineer will take one or more of the following actions pursuant to the review of the of Environmental Impacts:

4. Previously Disturbed Certification Complete certification that all work to be performed as a part of this project will be performed on previously disturbed sites, easements, and/or rights-of-way. Certify that no new sites, easements and/or rights-of-way will be disturbed as a result of this construction/repair project, and therefore, no comments or responses are required from the state or federal agencies listed below in order to ensure compliance with the state or federal laws or regulations under the jurisdiction of these agencies.

5. Environmental Impacts Resolved Certification Complete certification that comments and responses have been solicited and resolved from the state and federal agencies listed below regarding all work to be performed under this project on new sites, easements, and/or rights-of-way.

6. No Further Action

The Licensed Engineer will complete the appropriate certification on all ARPA RWAIG projects. If there are significant changes in the project after the issuance of the environmental documents, those changes will be described in an Amendment to the certification. Some changes are minor, however, and the Department may determine that a separate Amendment need not be issued. Such minor changes may include but are not limited to:

A. Adding work that would otherwise qualify for a previously disturbed certification.

B. Changes in the size of pump stations, storage facilities, wells, distribution lines, etc.

C. Minor changes in the size of water treatment unit processes.

D. Minor rerouting of distribution lines when the new route

i) will be mostly on public property and

ii) will not adversely affect cultural resources, habitats of endangered or threatened species, or environmentally important natural resource areas.

All affected property owners shall be notified by the Grant recipient.

Rule 5.6.3. Issuance of the Environmental Certification Copies of all necessary environmental review and certification documentation should be issued to the appropriate intergovernmental review agencies listed in Subchapter 8; other agencies shall be contacted as needed. Copies shall also be sent to any individuals or groups requesting them. All environmental review documentation shall be maintained at the grant recipient’s office location for review upon request.

Rule 5.6.4. Resolution of Adverse Comments.

Adverse comments received as a result of the environmental review process should be addressed in the following manner:

3. The Grant recipient should resolve the adverse comments

4. If the Grant recipient is unable to resolve the adverse comments and secure approval, the Department may comment on the unresolved issues and suggest a course of action.

Subchapter 7. Miscellaneous Requirements for ARPA RWAIG recipients

Rule 5.7.1. Within this subchapter, Grant recipients should have an understanding of various miscellaneous elements that could affect the project(s) ability to proceed from application to design to construction to grant payment.

Procurement Requirements.

5. In the procurement of all construction, equipment, materials, supplies, professional services and non-professional services and all other costs related to the ARPA RWAIG project, all Grant recipients shall comply with federal procurement regulations and applicable state and local laws. • All procurements must comply with the requirements of 2 CFR 200.317-327. • All procurements must follow the affirmative outreach steps required in 2 CFR 200.321. • Compliance with the 2 CFR 200 rules and regulations must be documented and such documents retained for the ARPA/SLFRF record retention (i.e., for five years after date of final ARPA/SLFRF disbursed or returned to Treasury, whichever is later).

6. The procurement and conduct of all professional engineering and land surveying services shall also be in accordance with the Code of Conduct a and other guidance and interpretations established by the Mississippi State Board of Registration for Professional Engineers and Land Surveyors.

7. The procurement of all construction contracts shall also be in accordance with the rules and regulations of the State Board of Contractors and other guidance and interpretations established by the Mississippi State Board of Contractors.

8. All Grant recipients shall submit a procurement certification, as required by the Department, indicating that all the above referenced requirements

have been met. Should it be determined that any of the above procurement requirements are violated, the Department may determine that the related costs are unallowable and may require repayment of all ARPA RWAIG funds paid for such costs, in accordance with Rule 5.3.21.4 of these regulations.

Rule 5.7.2. Debarment and Suspension

The Department is prohibited from entering into Grant agreements with Grant applicants that have been debarred or suspended by any state or federal agency.

Grant recipients are prohibited from entering into contractual agreements with individuals, businesses, organizations, or any other entities that have been debarred or suspended by any state or federal agency. Additionally, grant recipients are responsible for ensuring that prime contractors utilized on the project are not debarred or suspended. Likewise, prime contractors are responsible for ensuring that subcontractors utilized on the project are not debarred or suspended.

Anyone may contact the Board concerning the existence of a cause for debarment or suspension. The Department may refer the matter to the State Attorney General or other appropriate office for further investigation. If, after review or investigation, the Board reasonably believes that a cause for debarment exists, the Board may propose debarment or suspension and may initiate procedures similar to, but not necessarily identical to, federal regulation 40 CFR Part 32: Debarment and Suspension Under EPA Assistance Programs.

Such above-described debarment or suspension actions will not affect existing executed contractual agreements, unless such agreements have been terminated or suspended under the terms of the agreement by the Grant recipient.

Rule 5.7.3. ARPA RWAIG Dispute Procedures Only ARPA RWAIG recipients may submit a notice of dispute (disagreement) with a decision made by the Department, with the exception of decisions regarding Subchapter 6, Environmental Review Process, of these regulations. The following procedures will be used to resolve disputes between the Grant recipient and the Department.

5. The Grant recipient shall submit a written notice of dispute with a Department decision, including a summary of the dispute and reasons the Grant recipient believes the Department decision should be reversed.

6. The Department will then render a written decision on the dispute and will include reasons for the decision.

7. Should the Grant recipient desire to appeal the second Department decision, a request for an informal hearing shall be received by the Department within 30 days after the date of that decision. Upon receipt of such a request, an informal hearing will be held with staff members, as designated by the State Health Officer, and the affected parties. The State Health Officer, or his designee, will render a decision on the appeal as a result of the informal hearing.

8. Appeals of the above formal hearing decision may be made to the Chancery Court in accordance with state law.

Rule 5.7.4. Waste Fraud and Abuse

The Grant recipient is responsible for preventing, detecting, and prosecuting waste, fraud, abuse, and all other corrupt practices which occur in relation to the ARPA RWAIG project.

If the Grant recipient becomes aware of allegations, evidence, or the appearance of corrupt practices, the Grant recipient shall:

3. Immediately inform the Department in writing; and

4. Promptly pursue available state and local legal, administrative, and contractual remedies.

The Department may disallow costs under the Grant agreement where it is determined that such costs are related to waste, fraud, abuse or other corrupt practices. The Department may also require repayment of ARPA RWAI Grant funds paid for such costs in accordance with Rule 5.3.21.4 of these regulations.

Rule 5.7.5. ARPA RWAIG Recipient Accounting and Auditing Requirements

All ARPA RWAIG recipients shall maintain project accounts in accordance with generally accepted government accounting standards, as defined by the Guidelines of the Municipal Accounting and Audit Manual, as prescribed by the State Auditor's Office. Charges to the project account shall be properly supported, related to eligible construction costs, and documented by appropriate records. These project accounts shall be maintained as separate accounts.

All contracts for professional services, construction, equipment, and supplies shall include an access to audit clause which gives the Department and its representatives access to and the right to audit, inspect, copy and examine books, financial records and other documents

relating directly to the receipt and disbursement of ARPA RWAIG funds.

Rule 5.7.6. ARPA RWAIG Procurement Protest Procedures

3. Prior to advertisement for bids, the Grant recipient should consider establishing its own procedures for prompt consideration of initial protests concerning solicitations or contract awards. A "protest" is a written complaint concerning the Grant recipient's solicitation or award of a contract. The protest shall be filed with the Grant recipient by a party with a direct financial interest adversely affected by a Grant recipient's procurement action and shall be filed in accordance with and within the time frame established by the Grant recipient's protest procedures.

4. Any delay due to a protest or protest resolution will not relieve the Grant recipient of the requirement to meet the project schedule established in the Grant agreement, nor will such delays prevent the Department from pursuing the remedies for default established in the Grant agreement.

Rule 5.7.7. Related State Laws and Regulations

The Grant recipient shall comply with the applicable related state laws and regulations regarding Mississippi Safe Drinking Water Act and Operator Certification during the planning, design, construction, and operation of the project.

Rule 5.7.8. National Pollutant Discharge Elimination System (NPDES) and Siting Criteria Regulations

The following requirements apply to those drinking water treatment facilities that have or will construct wastewater treatment facilities necessary to treat waste generated by their drinking water treatment facilities.

The Grant recipient shall ensure that all current applicable regulations of the Commission on Environmental Quality and the Environmental Quality Permit Board are complied with during the planning, design, and construction of any wastewater treatment facilities associated with this ARPA RWAIG project. It is the Grant recipient's responsibility to ensure that the project is in compliance with these regulations and all future amendments.

Subchapter 8. Intergovernmental Review Process

The following outlines the Department's guidance for compliance with the Intergovernmental Review concerns for ARPA RWAIG projects.

Rule 5.8.1. Intergovernmental Review Agencies: 7. Mississippi Department of Archives and History (for archaeological/cultural review)

8. Mississippi Natural Heritage Program (for vegetative/wildlife review)

9. U.S. Army Corps of Engineers, Regulatory Functions Branch [for Section 404 (wetlands), Section 10 (navigable waterways), and floodplain impact review]

10. Mississippi Department of Marine Resources (Jackson, Harrison, and Hancock County Projects Only; for shellfish review and Mississippi Coastal Program review)

11. U.S. Fish and Wildlife Service (Jackson, Harrison, and Hancock County projects only; for Coastal Barriers Resources Act review)

12. U.S. Forest Service (projects located in a designated Wild and Scenic River Basin only, for Wild and Scenic Rivers review)

Rule 5.8.2. Planning and Design

During preparation of the plans and specifications, the Licensed Engineer will ensure that the appropriate intergovernmental review agencies have been consulted about the proposed project area concerning the existence of any known or possible archaeological/cultural sites, endangered vegetation/wildlife, wetlands, floodplain impacts, wild/scenic river impacts, shellfish/coastal program impacts, or coastal barriers resources impact. The Licensed Engineer will certify during the plans, specifications, and contract documents phase, that the proposed project components have been evaluated through a intergovernmental review process and that no concerns have been discovered that would prevent the project from moving forward and that the project has been cleared. If feasible, the project should avoid negative impacts on areas for which a concern has been expressed by an intergovernmental review agency. If it is not feasible to avoid negative impacts on these areas, the appropriate intergovernmental review agency should be consulted concerning the probability of obtaining clearance to construct the selected plan.

**History**
- *Source: House Bill 1421, 2022 Regular Session & Senate Bill 2444, 2023 Regular Session of the MS Legislature*
- *Source: House Bill 1421, 2022 Regular Session & Senate Bill 2444, 2023 Regular Session of the MS Legislature*
- *Source: House Bill 1421, 2022 Regular Session*
- *Source: House Bill 1421, 2022 Regular Session & Senate Bill 2444, 2023 Regular Session of the MS Legislature*
- *Source: House Bill 1421, 2022 Regular Session*
- *Source: House Bill 1421, 2022 Regular Session*
- *Source: House Bill 1421, 2022 Regular Session*
- *Source: House Bill 1421, 2022 Regular Session & Senate Bill 2444, 2023 Regular Session of the MS Legislature*
- *Source: House Bill 1421, 2022 Regular Session & Senate Bill 2444, 2023 Regular Session of the MS Legislature*
- *Source: House Bill 1421, 2022 Regular Session & Senate Bill 2444, 2023 Regular Session of the MS Legislature*
- *Source: House Bill 1421, 2022 Regular Session*
- *Source: House Bill 1421, 2022 Regular Session & Senate Bill 2444, 2023 Regular Session of the MS Legislature*
- *Source: House Bill 1421, 2022 Regular Session*
- *Source: House Bill 1421, 2022 Regular Session*
- *Source: House Bill 1421, 2022 Regular Session*
- *Source: House Bill 1421, 2022 Regular Session*
- *Source: House Bill 1421, 2022 Regular Session*
- *Source: House Bill 1421, 2022 Regular Session*
- *Source: House Bill 1421, 2022 Regular Session*
- *Source: House Bill 1421, 2022 Regular Session*
- *Source: House Bill 1421, 2022 Regular Session*
- *Source: House Bill 1421, 2022 Regular Session & Senate Bill 2444, 2023 Regular Session of the MS Legislature*

##### **15 Miss. Admin. Code Pt. 20, R. 5.1.1** Legal Authority {#sec-20-5.1.1 omnilex-key=us-ms-regs-official--title-15--20#5.1.1}

These regulations are adopted pursuant to House Bill 1421 of the Mississippi Legislature’s 2022 Regular Session and Senate Bill 2444 of the Mississippi Legislature’s 2023 Regular Session shall govern the American Rescue Plan Act Rural Water Associations Infrastructure Grant (ARPA RWAIG) Program. These regulations may be superseded by the grant agreement when a variance or exception is made by the Board of Health (Board) and when not in conflict with any state or federal laws or executive orders.

**History**
- *Source: House Bill 1421, 2022 Regular Session and Senate Bill 2444, 2023 Regular Session*

##### **15 Miss. Admin. Code Pt. 20, R. 5.1.2** Definitions {#sec-20-5.1.2 omnilex-key=us-ms-regs-official--title-15--20#5.1.2}

The following words and terms, when used in these regulations, will have the following meanings, unless the context clearly indicates otherwise:

1. Act - The Mississippi House Bill 1421 of 2022 Regular Session and Senate Bill 2444 of 2023 Regular Session

2. Allowable Costs - Those project costs that are eligible, reasonable, necessary, allocable to the project, within the established project scope and budget, in conformance with the ARPA RWAIG program regulations and as approved by the Mississippi State Department of Health (Department).

3. Authorized Representative - The signatory agent of the applicant authorized and directed by the applicant's governing body to make application for assistance and to sign documents, on behalf of the applicant, required to undertake and complete the project. The signatory agent shall be a member or an employee of the applicant's governing body and may not be under a separate contract with the applicant at any time during the execution of the project.

Binding Commitment – An ARPA RWAI grant offer, as described in these regulations.

4. Board - The Mississippi State Board of Health.

5. Change Order - The documents executed by the grant recipient and the construction contractor, upon recommendation of the registered licensed engineer if required by the contract documents, authorizing a change,

alteration, or variance in the plans, specifications, and contract documents, including, but not limited to, additions or deletions of work to be performed pursuant to the contract or a change in costs or time for work performed pursuant to the contract.

6. Construction - Any one or more of the following: erection, building, acquisition, alteration, remodeling, improvement, or extension of drinking water systems.

7. Department - Mississippi State Department of Health and staff, and their designated representatives.

8. ARPA RWAIGP (Program) - The ARPA Rural Water Associations Infrastructure Grant Program.

9. Rural Water Association - a non-profit corporation or organized not for profit with a primary function to finance, construct, operate and maintain a rural water distribution system, which has the authority to collect, treat, store, and distribute piped water for human consumption.

10. Eligible Applicant - entity that meets one of the following criteria:

A. is a Rural Water Association OR B. is operating as rural water association regardless of whether such entities were user created, were initially organized not for profit, or have been granted tax-exempt status under state or federal law OR C. is a nonprofit water or sewer provider not owned by a municipality or county and is not a Rural Water Association

AND is currently operating as a not-for-profit entity AND has the authority under state law to receive ARPA RWAI grant assistance AND did not receive funding under this program in Round 1 or the Mississippi Municipality and County Water Infrastructure Grant Program Act AND has the ability to comply with these regulations and the requirements of the grant agreement.

Eligible Applicant – A Rural Water Association or water organization that is user member created and has been granted tax exempt status under either federal or state law; has the authority under stat law to receive ARPA RWAI grant assistance; and has the ability to comply with these regulations and the requirement of the grant agreements.

11. Ineligible Applicant – state agency, county, incorporated municipality, district, or other water organization eligible for ARPA funding through other programs.

12. Eligible Cost - Eligible costs are those costs in which ARPA RWAI grant participation is authorized pursuant to applicable statute.

13. Financial Assistance - Grants by the Department from the ARPA RWAIG Program.

14. Grant Agreement - An agreement between the Department and the grant recipient through which the Program provides ARPA RWAI grant funds for eligible assistance and the recipient promises to follow the rules and regulations of the ARPA RWAI grant period over a period of the grant agreement. Also referred to as Sub-grant Agreement.

15. Grant Applicant - A Rural Water Association that makes application for assistance from the ARPA RWAI grant program.

16. Grant Recipient - A Rural Water Association that receives a Grant from the ARPA RWAI grant program. Also referred to as Sub- grantee.

17. May - whenever used in the context of an action to be taken by the grant applicant/recipient the word will be interpreted as optional but is not mandatory.

18. Shall - whenever used in the context of an action to be taken by the grant applicant/recipient the word will be interpreted as mandatory.

19. Shall Not - whenever used in the context of an action by the grant applicant/recipient such action is prohibited by these regulations

PWSS – Public Water System Supervision.

20. Plans, Specifications and Contract Documents - The engineering description of the project including engineering drawings, maps, technical specifications, design reports and construction contract documents in sufficient detail to allow contractors to bid on and construct the work.

21. Schedule of Awards - The schedule of awards established by the Department to ensure all funds are obligated by the deadline established by the rules and guidelines of the United States Department of the Treasury for ARPA funds.

22. Project - The scope of work for which assistance is offered under the ARPA RWAIG program.

23. Project Completion - The date of the final construction observation as performed by the Department for the purpose of an

allowability determination.

24. Protest - A written complaint to the grant recipient concerning the grant recipient’s solicitation or award of a contract. The protest shall be filed with the grant recipient by a party with a direct financial interest adversely affected by a grant recipient’s procurement action.

25. Public Water System (PWS) - A system for the provision to the public of piped water for human consumption, if such a system has at least fifteen service connections or regularly serves at least twenty-five individuals. This includes any collection, treatment, storage and distribution facilities under the control of the operator of a PWS or used primarily in connection with a PWS.

26. Registered Licensed Engineer - The engineer, registered licensed by the Mississippi State Board of Registration for Professional Engineers and Land Surveyors, retained or employed by the grant recipient to provide professional engineering services during the planning, design, and/or construction of the project.

**History**
- *Source: House Bill 1421, 2022 Regular Session & Senate Bill 2444, 2023 Regular Session*

##### **15 Miss. Admin. Code Pt. 20, R. 5.2.1** Eligible Applicant Determination and Sub-Grant Agreement {#sec-20-5.2.1 omnilex-key=us-ms-regs-official--title-15--20#5.2.1}

3. Eligible Applicant Determination. To be eligible for financial assistance, an applicant shall meet the definition of an eligible applicant as described in Rule 5.1.3. of these regulations, as determined by the Department.

4. Sub-Grant Agreement. Eligible Recipients will be required to execute a sub-grant agreement with the Department and certify that the reimbursement for a rural water association drinking water infrastructure project is for allowable expenditures under the American Rescue Plan Act (ARPA) of 2021, Public Law 117-2, which amends Title VI of the Social Security Act; and its implementing guidelines, guidance, rules, regulations and/or other criteria, as may be amended or supplemented from time to time, by the United States Department of the Treasury.

**History**
- *Source: House Bill 1421, 2022 Regular Session & Senate Bill 2444, 2023 Regular Session*

##### **15 Miss. Admin. Code Pt. 20, R. 5.2.2** Obligation Period {#sec-20-5.2.2 omnilex-key=us-ms-regs-official--title-15--20#5.2.2}

Funds allotted to the Program will be available for obligation for the period of July 1, 2022, to

December 31, 2024, or as otherwise established by Sub-Grant Agreement, State or federal law.

**History**
- *Source: House Bill 1421, 2022 Regular Session & Senate Bill 2444, 2023 Regular Session*

##### **15 Miss. Admin. Code Pt. 20, R. 5.2.3** Reserves {#sec-20-5.2.3 omnilex-key=us-ms-regs-official--title-15--20#5.2.3}

Up to five percent of the State's ARPA Rural Water Associations Infrastructure Grant Funds will be reserved for the administration of the program consistent with the Act and state law.

**History**
- *Source: House Bill 1421, 2022 Regular Session*

##### **15 Miss. Admin. Code Pt. 20, R. 5.2.4** ARPA RWAIG Uses {#sec-20-5.2.4 omnilex-key=us-ms-regs-official--title-15--20#5.2.4}

The ARPA RWAIG funds may be used for the following purposes:

4. To make grants for eligible infrastructure improvements on the conditions that the recipient of a grant shall establish a plan for asset management; 5. For the reasonable costs of administering the ARPA RWAIG program and conducting activities under this Act, subject to any limitations established in the state or federal law; and,

6. For other uses as allowed under the ARPA

**History**
- *Source: House Bill 1421, 2022 Regular Session & Senate Bill 2444, 2023 Regular Session*

##### **15 Miss. Admin. Code Pt. 20, R. 5.2.5** Federal Requirements {#sec-20-5.2.5 omnilex-key=us-ms-regs-official--title-15--20#5.2.5}

All projects which receive grant assistance from the ARPA RWAIG fund shall meet the requirements of the Final Rule for the Coronavirus State and Local Fiscal Recovery Funds as established by the federal American Rescue Plan Act (ARPA).

**History**
- *Source: House Bill 1421, 2022 Regular Session*

##### **15 Miss. Admin. Code Pt. 20, R. 5.2.6** Grant Award Cycles {#sec-20-5.2.6 omnilex-key=us-ms-regs-official--title-15--20#5.2.6}

The Department will prepare a schedule for award cycles to make awards to projects eligible and ready to begin construction. In the first fiscal year after the effective date of the Act, twenty percent (20%) of the funds appropriated to the Department for the program shall be obligated to projects that have completed plans and specifications, acquired all necessary land and/or easements, and are ready to proceed to construction. Award Cycles shall be created at the Departments discretion until such time that all funds are obligated but not to exceed December 31, 2024. Awards occurring during the award cycle will be a product of an applicants’ eligibility, the proposed projects eligibility, and the projects ranking score produced by the Program’s Application Ranking System.

**History**
- *Source: House Bill 1421, 2022 Regular Session*

##### **15 Miss. Admin. Code Pt. 20, R. 5.2.7** Application Ranking System {#sec-20-5.2.7 omnilex-key=us-ms-regs-official--title-15--20#5.2.7}

The department shall use the following has developed a system for ranking the grant applications received. The ranking system includes the following factors:

10. The environmental impact of the proposed project;

11. The proposed project's ability to address noncompliance with state/federal requirements;

12. The extent to which the project promotes economic development;

13. The number of people served by the project (both new and existing users);

14. Impacts of the proposed project on disadvantaged/ overburdened communities; 15. The grant applicant's prior efforts to secure funding to address the proposed project's objectives;

16. The grant applicant's proposed contribution of other funds or in-kind cost- sharing to the proposed project;

17. The grant applicant's long-term plans for the financial and physical operation and maintenance of the project; and

18. The grant applicant's capacity to initiate construction in a timely manner and complete the proposed project by the deadline specified by rules and guidelines of the United States Department of the Treasury (USDT) for ARPA funds.

These factors will be quantified based on the point allocations within each of the ranking categories defined below. A maximum of 100 points can be received by the combined total points within the nine ranking categories. As Item B. notes, an additional 10 points may be obtained if consolidation/regionalization of systems are involved.

A. The environmental impact of the proposed project will be quantified based on a High (1), Moderate (3), or Low (5) assessment with a maximum of 5 points in this category.

B. The proposed project's ability to address noncompliance with state/federal requirements project will receive up to 30 points based on project category. For the first round of funding, an additional ten

points will be added to any project combining consolidation/regionalization of public water systems with one of the other categories listed.

For projects submitted in the second round of funding, an additional fifteen points will be added to any project combining consolidation/regionalization of public water systems with one of the other categories listed. In order to receive the additional weight, the systems that will consolidate shall be in a proximity of each other as determined by the department. In addition to these additional consolidation points, an additional 10 points shall be added to any application with at least one system that has consolidated after January 1, 2018, and before application to this program and is otherwise eligible.

RANK PROJECT CATEGORY

Primary Drinking Water Standards Project facilitates compliance with Primary Drinking Water Standards. Project must correct deficiencies resulting in non- compliance with the primary drinking water standards.

One Well Project to provide additional water supply to systems that have neither a backup well nor an MSDH-approved emergency tie-in to another system to ensure safe drinking water; thereby protecting the health of the existing population.

Pressure Deficiencies Project to correct documented deficiencies that result in existing systems routinely failing to maintain minimum acceptable dynamic pressure.

RANK PROJECT CATEGORY

Source Water Protection Projects Project to manage potential sources of contaminants/pollutants and/or prevent contaminants/pollutants from reaching sources of drinking water.

Capacity Expansion to Serve the Unserved Project to either expand existing system capacity or construct a new drinking water system to serve existing residences/businesses in currently unserved areas safe drinking water (source, treatment and/or distribution).

Back-up Water Supply Sources Projects Project to provide additional supply to systems with insufficient back-up water supply sources to ensure safe drinking water, and thereby protect the health of the existing population.

Existing Facilities Upgrades (Meeting Primary Standards) Project to rehabilitate, replace, protect or upgrade deteriorated, worn, aged or obsolete equipment, facilities, etc., to assure continued, dependable operation of water systems where such systems are already meeting Primary Drinking Water Standards.

Secondary Drinking Water Standards Projects Project to provide treatment that brings systems into compliance with Secondary Drinking Water Regulations.

Consolidation Projects Project to consolidate separate systems into a single system for purposes other than those related to meeting primary standards.

Fluoride Addition This category is for projects that either rehabilitate existing fluoride treatment facilities at well or treatment plant sites or add new facilities to existing well or treatment plants.

Other Project does not meet the criteria of any category listed above.

C. The extent to which the project promotes economic development will be quantified based on assessment of yes (5) or no (0) with a

maximum of 5 points within this category. D. The number of people served by the project will be quantified based on population range.

Population Range Ranking 0 - 3,300 15 3,300 - 6,600 12 6,600 - 9,900 10 9,900 - 13,200 8 13,200 - 16,500 4 16,500 - 19,800 3 19,800 - 23,100 3 23,100 - 26,400 4 26,400 - 29,700 8 29,700 - 33,000 10 33,000 - 36,300 12 36,300 - Above 15

E. Impacts of the proposed project on disadvantaged communities will be quantified based on Median Household Income (MHI).

MHI Range Ranking $0.00 - $20,144.00 15 $20,144.00 - $23,073.67 13 $23,073.67 - $26,003.33 11 $26,003.33 - $28,933.00 8 $28,933.00 - $31,862.67 7 $31,862.67 - $34,792.34 6 $34,792.34 - $37,722.00 5 $37,722.00 - $40,651.67 4 $40,651.67 - $43,581.34 3 $43,581.34 - $46,511.00 2 $46,511.00 - Above 1

F. The grant applicant's prior efforts to fund the project will be quantified based on assessment of yes (5) or no (0) with a maximum of 5 points within this category.

G. The grant applicant's proposed contribution will be quantified based on a percentage range of the projects total cost with a maximum of 5 points within this category.

Percentage Range Ranking 1% - 4% 1 5% - 9% 3 10% - Above 5

H. The grant applicant's long-term plans for the financial and physical operation and maintenance of the project will be quantified based on an assessment. Applicants with no plan will receive a zero (0). Applicants with a long-term plan will receive five (5). Applicants certifying the development of an asset management plan by the end of the project will receive ten (10) with a maximum of 10 points within this category.

I. The grant applicant's capacity to complete the proposed project by the deadline specified by rules and guidelines of the USDT for ARPA funds will be quantified based on an assessment. Applicants able to meet this requirement will be quantified at 10 with a maximum of 10 points within this category. Applicants unable to meet this requirement will be disqualified.

J. If necessary, the following will be used as the basis for breaking any ties that occur.

a) Projects to primarily correct a MSDH documented failure to meet primary drinking water standards or a MSDH documented significant deficiency will be given preference. b) If there are no projects to correct a MSDH documented failure to meet primary drinking water standards or a MSDH documented significant deficiency, projects primarily for consolidation will be given preference. c) If there are no projects primarily for consolidation, projects with the lowest Median Household Income Range will be given preference. d) If all projects have the same Median Household Income Range, projects with the lowest Population will be given preference. e) If all projects have the same Population Range, projects extending potable water service to new users will be given

preference.

**History**
- *Source: House Bill 1421, 2022 Regular Session & Senate Bill 2444, 2023 Regular Session*

##### **15 Miss. Admin. Code Pt. 20, R. 5.2.8** ARPA RWAIG Financing {#sec-20-5.2.8 omnilex-key=us-ms-regs-official--title-15--20#5.2.8}

The ARPA RWAIG fund has been established to provide grants to assist and encourage rural water associations to pursue projects to address drinking water system infrastructure needs. Conditions of these Grants are itemized in Rule 5.2.4 of these regulations. Basic ARPA RWAIG financing requirements are as follows:

17. ARPA RWAI grants may be limited at the discretion of the Department based on funds availability or as otherwise stated under state law.

18. For the first round, the maximum amount of funds that may be provided to any rural water association from all grants under this round is Two Million Five Hundred Thousand Dollars ($2,500,000.00). For the second round, the maximum amount of funds that may be provided to any rural water association from the program is Two Million Dollars ($2,000,000.00).

19. The applicant's project shall be able to initiate construction in a timely manner and complete the proposed project by the deadline specified by rules and guidelines of the United States Department of the Treasury for ARPA funds and set forth in House Bill 1421 of the Mississippi Legislature’s 2022 Regular Session.

20. Terms of any ARPA RWAIG assistance will be as established in the Grant agreement.

21. The applicant shall comply with the requirements of the ARPA and all applicable state and federal laws, requirements, and regulations. 22. The applicant shall not be in violation of any provision of a previously awarded grant of state or federal funds.

23. The applicant shall comply with any technical assistance recommendations provided by the Department.

24. Except for program administration expenses, funds will not be disbursed from the ARPA RWAIG until a Grant recipient has entered into a Grant agreement with the Board.

**History**
- *Source: House Bill 1421, 2022 Regular Session & Senate Bill 2444, 2023 Regular Session*

##### **15 Miss. Admin. Code Pt. 20, R. 5.2.9** Responsibility {#sec-20-5.2.9 omnilex-key=us-ms-regs-official--title-15--20#5.2.9}

The applicant/Grant recipient is responsible for the proper planning, design, construction, operation, maintenance, replacement, performance, and fiscal integrity of the project. The Department's approval of any document does not relieve the applicant/Grant recipient or any others of any liabilities or responsibilities. Department approval of any document is for Grant eligibility/allowability purposes only and does not establish or transfer any such liability or responsibility.

**History**
- *Source: House Bill 1421, 2022 Regular Session*

##### **15 Miss. Admin. Code Pt. 20, R. 5.2.10** Other Approvals {#sec-20-5.2.10 omnilex-key=us-ms-regs-official--title-15--20#5.2.10}

The applicant (or Grant recipient) shall obtain approval of all necessary documents from each state, local, and federal agency having jurisdiction over or funding in the project, if so required by that agency.

**History**
- *Source: House Bill 1421, 2022 Regular Session*

##### **15 Miss. Admin. Code Pt. 20, R. 5.3.1** Application for ARPA RWAI Grant {#sec-20-5.3.1 omnilex-key=us-ms-regs-official--title-15--20#5.3.1}

5. Pre-application Guidance and Conference.

Upon request the Department will provide a Grant application package to the potential Grant applicant and/or its registered licensed engineer. The potential Grant applicant and/or its registered licensed engineer may request a pre- application conference with the Department as early in the application process as practical.

6. Contents of Applications

All documents listed below shall be complete when submitted to the Department. When forms are provided by the Department, these forms shall be used, and they shall not be altered. The ARPA RWAI Grant application may request assistance only for costs that are allowable in accordance with Subchapter 4 of these regulations and may include a construction contingency, as determined by the Department, in the project budget. The application shall include a Project Cost Breakdown. A complete application package shall conform to these regulations and shall include the following:

A. A complete ARPA RWAI Grant application form with original signature with associated attachments.

All proposed or executed contracts for planning, design, bidding, and construction phase

professional services.

B. A procurement certification from the Grant applicant and the Grant applicant's legal counsel.

C. A legal certification from the Grant applicant and the Grant applicant's legal counsel.

D. A certified copy of a resolution by the Grant applicant's governing body which, agrees to develop an asset management plan for all facilities being funded, 1) authorizes the submission of the application and 2) designates an authorized representative or officer to make application for assistance and to sign documents on behalf of the applicant.

A copy of all existing or proposed interlocal agreements related to the project, if applicable. Such agreements shall be executed by all appropriate parties and shall be verified by the Department prior to any Grant offer.

E. A certification regarding debarment, suspension, in accordance with Subchapter 7 Rule 5.7.2 of these regulations.

F. Documentation of its tax-exempt status under either federal or state law.

G. An Internal Revenue Service Form W-9.

H. All waste disposal permit applications, if applicable.

I. All other forms, documents, and supporting information required by the Department.

**History**
- *Source: House Bill 1421, 2022 Regular Session & Senate Bill 2444, 2023 Regular Session*

##### **15 Miss. Admin. Code Pt. 20, R. 5.3.2** Submission of Application {#sec-20-5.3.2 omnilex-key=us-ms-regs-official--title-15--20#5.3.2}

By the date specified on the MSDH website in the Schedule of Awards the applicant shall submit the application to the Department to be considered for the award cycle. Award cycles will be quarterly until allocated funding has been fully obligated or the legislative deadline of December 31, 2024, has been reached.

**History**
- *Source: House Bill 1421, 2022 Regular Session & Senate Bill 2444, 2023 Regular Session*

##### **15 Miss. Admin. Code Pt. 20, R. 5.3.3** Offer of ARPA RWAI Grant {#sec-20-5.3.3 omnilex-key=us-ms-regs-official--title-15--20#5.3.3}

Upon determination by the Department that (a) all applicable requirements of the ARPA RWAI Grant application have been met, (b) the application Schedule of Award’s deadlines have been met for the award cycle, and (c) funds are available for the amount of the ARPA RWAI Grant application, the State Health Officer or his designee will execute and transmit an ARPA RWAI Grant offer to the Grant recipient. In addition to the estimated allowable project costs as described in Appendices A and B of these regulations, the Grant offer may include a construction contingency, as determined by the Department, in the project budget.

**History**
- *Source: House Bill 1421, 2022 Regular Session & Senate Bill 2444, 2023 Regular Session*

##### **15 Miss. Admin. Code Pt. 20, R. 5.3.4** Execution of Grant Offer {#sec-20-5.3.4 omnilex-key=us-ms-regs-official--title-15--20#5.3.4}

Upon receipt of the ARPA RWAI Grant offer, the Grant recipient shall execute the acceptance of the Grant offer and return it to the Department within the time frame established in the Schedule of Awards Grant Offer Letter. The Grant offer becomes void if not executed and returned within the time frame specified, unless extended by the State Health Officer or his designee, for good cause. The Grant Recipient shall provide copies of all proposed or executed contracts for professional services with the executed Grant.

**History**
- *Source: House Bill 1421, 2022 Regular Session & Senate Bill 2444, 2023 Regular Session*

##### **15 Miss. Admin. Code Pt. 20, R. 5.3.5** Engineering Design {#sec-20-5.3.5 omnilex-key=us-ms-regs-official--title-15--20#5.3.5}

7. Predesign Guidance and Conference.

The Department will provide design guidance to the Grant applicant, or its registered licensed engineer as requested. The applicant/engineer may request a pre-design conference with the Department.

8. General Requirements for plans, specifications and contract documents.

A. Plans, specifications, and contract documents shall be prepared for all appropriate elements of the project. These documents shall conform to Department requirements, to Subchapters 4-8, of these regulations, and to the requirements of the most recent version of the Departmental document "Recommended Minimum Design Criteria for Community Water Supplies. or their successor(s). Other recognized engineering publications may be used for unit processes or technologies not described therein.

B. Plans, specifications, and contract documents shall also conform to such contract language, conditions, and forms as may be required by the Department. The plans, specifications,

and contract documents shall bear the seal of the registered licensed engineer responsible for preparation of these documents.

9. Contents of plans specifications and contract documents.

In addition to the above general requirements, the plans, specifications, and contract documents shall contain the following:

A. Provisions assuring compliance with these regulations and all relevant federal and state laws.

B. Forms by which the bid bond, performance bond and payment bonds will be provided.

C. A contractor's assurance which shall warrant compliance by the contractor with all applicable federal laws and regulations and all laws of the State of Mississippi and all regulations and published policies of the Board.

D. Provisions providing for the applicant to retain a certain percentage of the progress payments otherwise due to the contractor, in accordance with state law.

E. Provisions requiring the contractor to obtain and maintain the appropriate insurance coverage.

F. Provisions giving authorized representatives of the Department access to all such construction activities, books, records, documents, and other evidence of the contractor for the purpose of inspection, audit, and copying during normal business and/or working hours.

G. Provisions for change orders.

H. Those conditions, specifications, and other provisions set forth or required by the Department.

I. Provisions for liquidated damages.

J. Provisions for including water meters on new distribution systems.

**History**
- *Source: House Bill 1421, 2022 Regular Session & Senate Bill 2444, 2023 Regular Session*

##### **15 Miss. Admin. Code Pt. 20, R. 5.3.6** Submission of Plans, Specifications, Contract Documents and Related Items {#sec-20-5.3.6 omnilex-key=us-ms-regs-official--title-15--20#5.3.6}

By the dates specified in the Grant agreement, the recipient shall submit the following items to the Department:

15. Complete plans, specifications, and contract documents.

16. Certification from Registered Licensed Engineer of the environmental impact, either low, moderate, or high of the project. If the Registered Licensed Engineers determination is moderate or high, the Registered Licensed Engineer should complete an Environmental and Intergovernmental Review as defined in Subchapter 6 and 8.

17. A copy of the issued National Pollutant Discharge Elimination System (NPDES) permit or the state operating permit, if required.

18. A copy of the issued solid waste disposal permit, if required.

19. Written waivers from all adjoining property owners when it is not possible to provide required buffer zones if the project includes drinking water sludge treatment facilities.

20. For all Grant eligible real property acquisitions all applicable state law must be followed. Prior to advertisement for construction bids, the Grant recipient shall secure approval of the purchase price by the Department, shall complete purchase of all Grant eligible real property and easements, and shall submit clear title certificates from the Grant recipient and title counsel for all such Grant eligible property. Clear site certificates will also be required for Grant ineligible property.

21. A copy of all necessary interlocal agreements related to the project, if applicable. Such agreements shall be executed by all appropriate parties and shall be verified by the Department prior to any construction expenditures. If the project is unable to be completed due to failure to execute the necessary interlocal agreements, Grant Recipient shall be required to repay any funds expended for the project.

**History**
- *Source: House Bill 1421, 2022 Regular Session & Senate Bill 2444, 2023 Regular Session*

##### **15 Miss. Admin. Code Pt. 20, R. 5.3.7** Approval of Plans, Specifications, and Contract Documents {#sec-20-5.3.7 omnilex-key=us-ms-regs-official--title-15--20#5.3.7}

The Department will approve the plans, specifications, and contract documents upon determining that these documents appear to conform to the requirements of these regulations and are consistent with the approved planning documents and environmental determinations

required by these regulations.

**History**
- *Source: House Bill 1421, 2022 Regular Session*

##### **15 Miss. Admin. Code Pt. 20, R. 5.3.8** Construction Bidding and Grant Amendment {#sec-20-5.3.8 omnilex-key=us-ms-regs-official--title-15--20#5.3.8}

7. Grant Agreement Timeframe

Within the timeframe established in the Grant agreement, the Grant recipient shall secure Department approval of the plans, specifications, and contract documents.

A. For all Grant ineligible real property and easements (including power and other utilities), submit clear site certification forms from both the Grant recipient and the title counsel which indicate that all such Grant ineligible real property and easements for the entire project have been secured by clear title.

B. Secure all local funds necessary for the project and submit proof of such.

C. Upon completion of (1) through (3) approval of PSCD, submittal of all clear site certificates, above and issuance of any other permits or clearances required for the project, advertise the project for construction bids. All procurement actions by the Grant recipient shall comply with applicable state law and these regulations.

8. Process following Receipt of Construction Bids

Upon receipt of construction bids, the Grant recipient shall then submit:

A. The completed bid package;

All necessary executed contracts and amendments as described in Rule 5.2.4 (2B) of these regulation; and

B. A Budget modification consistent with as-bid construction costs, a construction contingency as determined by the Department, and any professional services contracts and amendments.

C. If additional funds are necessary for the project, a Grant agreement amendment request (consistent with as bid- construction costs, a construction contingency as determined by the Department, and any professional services contracts

and amendments) to the Department within the time frame established in the Grant agreement outlining the source of the additional funds will be submitted.

9. Review of Documents

Upon receipt of the items listed above, the Department will review them to determine whether any request for an increased Grant amount is justified and allowable and whether funds are available. If necessary, a budget modification to move funds between allowable categories may be required. After determining that all documents are approvable, the Department will transmit to the Grant recipient approval to execute the construction contracts. After approval of the bid package, the Grant Recipient shall then submit all necessary executed contracts and amendments as described these regulations.

**History**
- *Source: House Bill 1421, 2022 Regular Session & Senate Bill 2444, 2023 Regular Session*

##### **15 Miss. Admin. Code Pt. 20, R. 5.3.9** Budget Modifications, Schedule Modifications, and Amended Grant Offer {#sec-20-5.3.9 omnilex-key=us-ms-regs-official--title-15--20#5.3.9}

8. Budget Modifications. Grant recipients can request to move funds between eligible categories in the Grant Agreement by completing a budget modification. This modification will be required prior to approval of reimbursement of any costs where the costs exceed the available budget. Funds can be spent from The contingency fund can be spent for construction costs only without a budget modification, however these funds should be moved to the construction category prior to the project closeout. After determining that the budget modification is approvable, the Department will transmit to the Grant recipient for approval of the modification.

9. Schedule Modification. To amend the schedule in the Grant Agreement, Grant Recipient should submit a letter detailing the need for schedule revision. After determining if the schedule modification is approvable, the Department will transmit to the Grant recipient for approval of the modification. Schedule modifications to construction contract should be submitted in the form of a change order.

10. Process after Grant Agreement Amendment Request

If the budget and schedule modifications cannot address the needed changes to the Grant Agreement or if additional local funds are needed for the project, the Grant Recipient can submit a Grant Agreement Amendment Request. After receipt, review, and approval of the Grant agreement amendment request, the Department may prepare and transmit an amended ARPA RWAI Grant offer to the Grant recipient. The Grant offer will include in the project budget:

A. The approved as-bid amounts for construction;

B. The final allowance amounts for professional services in accordance with Subchapter 5 of these regulations;

C. A construction contingency as determined by the Department; and,

D. Required local funds, if any.

11. Execution of Amended Grant Offer

Upon receipt of the amended ARPA RWAI Grant offer, the Grant recipient shall completely execute and return it to the Department within the timeframe established in the offer letter. After execution of the amended ARPA RWAI Grant offer. Any increased project costs in excess of the amended ARPA RWAI Grant amount shall be paid by the Grant recipient from sources other than ARPA RWAIG funds.

**History**
- *Source: House Bill 1421, 2022 Regular Session & Senate Bill 2444, 2023 Regular Session*

##### **15 Miss. Admin. Code Pt. 20, R. 5.3.10** Awarding Construction Contracts and Preconstruction Conference {#sec-20-5.3.10 omnilex-key=us-ms-regs-official--title-15--20#5.3.10}

Upon receipt of the approval to execute the construction contracts and to issue the notice to proceed, the Grant recipient shall do so and shall transmit a copy of the executed construction contracts and the notice to proceed to the Department within the time frame specified in the Grant agreement.

**History**
- *Source: House Bill 1421, 2022 Regular Session*

##### **15 Miss. Admin. Code Pt. 20, R. 5.3.11** Grant Recipient Responsibility {#sec-20-5.3.11 omnilex-key=us-ms-regs-official--title-15--20#5.3.11}

The Grant recipient will be responsible for assuring that every appropriate procedure and incidental legal requirement are observed in procurement of services, advertisement for bids, and awarding the construction contracts. The plans, specifications, and executed contract documents shall not vary from those approved by the Department.

**History**
- *Source: House Bill 1421, 2022 Regular Session & Senate Bill 2444, 2023 Regular Session*

##### **15 Miss. Admin. Code Pt. 20, R. 5.3.12** Preconstruction Conference {#sec-20-5.3.12 omnilex-key=us-ms-regs-official--title-15--20#5.3.12}

The Grant recipient may arrange and hold a preconstruction conference and shall allow attendance and participation by the Department if such is held.

**History**
- *Source: House Bill 1421, 2022 Regular Session*

##### **15 Miss. Admin. Code Pt. 20, R. 5.3.13** Observation During Construction {#sec-20-5.3.13 omnilex-key=us-ms-regs-official--title-15--20#5.3.13}

7. Resident Observation

During construction work being performed, the Grant recipient shall provide for resident observation of the project by the registered licensed engineer or his staff and shall require the registered licensed engineer's assurance that the work is being performed in a satisfactory manner in accordance with the Grant agreement and the approved plans, specifications, contract documents, and approved change orders.

8. Department Observation

The Department is authorized to observe the building of any project at any time for compliance with the terms of the Grant agreement and to determine if the Grant recipient is assuring that plans, specifications, and contract documents are being followed. Such observation will not subject the Department to any legal action for claims, damages, or any other liability.

Also, such observation shall not release the contractor from any obligation to perform the work in accordance with the requirements of the contract documents or the registered licensed engineer from determining compliance with the requirements of the contract documents or the Grant recipient from insuring compliance with the terms of the Grant agreement.

9. Assurance of Work

The contractor, registered licensed engineer, and the Grant recipient shall furnish the Department with every reasonable opportunity and means for determining whether the Grant recipient and registered licensed engineer are assuring that the work is in accordance with the requirements of the approved plans, specifications, and contract documents. The Department is authorized to observe and require submission by the Grant recipient of daily logs, full scale record drawings, file notes, and any other documents prepared by any party in relation to the ARPA RWAI funded project.

**History**
- *Source: House Bill 1421, 2022 Regular Session & Senate Bill 2444, 2023 Regular Session*

##### **15 Miss. Admin. Code Pt. 20, R. 5.3.14** Observation of Materials and Equipment {#sec-20-5.3.14 omnilex-key=us-ms-regs-official--title-15--20#5.3.14}

The Department is also authorized to observe all equipment and materials furnished, including observation of the preparation or manufacture of the equipment and materials to be used.

**History**
- *Source: House Bill 1421, 2022 Regular Session*

##### **15 Miss. Admin. Code Pt. 20, R. 5.3.15** Construction Deficiencies {#sec-20-5.3.15 omnilex-key=us-ms-regs-official--title-15--20#5.3.15}

Nonconformity with Plans and Specifications. In the event that it appears to the Department that the Grant recipient and registered licensed engineer are not assuring that the construction work, materials, equipment or supplies are in conformity with approved plans and specifications

the Department may determine such work unallowable for ARPA RWAI Grant participation, unless the Grant recipient takes such action, through the registered licensed engineer if applicable, in the manner provided for in the construction contract to correct any deficiencies.

**History**
- *Source: House Bill 1421, 2022 Regular Session & Senate Bill 2444, 2023 Regular Session*

##### **15 Miss. Admin. Code Pt. 20, R. 5.3.16** Withholding of Grant Payment {#sec-20-5.3.16 omnilex-key=us-ms-regs-official--title-15--20#5.3.16}

The Department may immediately withhold ARPA RWAI Grant payments for such time that it appears that the Grant recipient and registered licensed engineer are not assuring that construction work, materials, equipment, or supplies are in accordance with the approved plans, specifications, and contract documents, and may require the Grant recipient to repay any previously paid amounts related to such work within 30 days of such notification.

**History**
- *Source: House Bill 1421, 2022 Regular Session & Senate Bill 2444, 2023 Regular Session*

##### **15 Miss. Admin. Code Pt. 20, R. 5.3.17** Change Orders {#sec-20-5.3.17 omnilex-key=us-ms-regs-official--title-15--20#5.3.17}

9. General.

A. In the event a determination is made by a Grant recipient after a construction contract is executed that changes or modifications to the original contract are necessary or would better serve the purpose of the Grant recipient, such Grant recipient may, at its discretion, execute such change orders pertaining to the construction that are necessary under the circumstances, as provided in the contract documents and when in accordance with state applicable law.

B. Change orders shall not change, vary, or alter the basic purpose or effect of the project unless allowed by the Department. Change orders shall be technically adequate, the costs shall be necessary and reasonable, and eligible/ineligible costs shall be appropriately separated.

10. Change Order Submissions.

A. After completion of the claims resolution and/or change order negotiation process between the Grant recipient and the contracting party, a fully executed change order shall be submitted to the Department for review and approval, in order to obtain an ARPA RWAI Grant eligibility/allowability determination. If any change order is submitted to the Department that is not complete and fully executed by the Grant recipient, the contracting party, and the registered licensed engineer if appropriate, the Department may return

such change order without review. However, unilateral change orders executed by the Grant recipient, and the registered engineer if appropriate, and identified as such, that are issued in accordance with the contract documents may be submitted to the Department for review and approval, in order to obtain a ARPA RWAI Grant eligibility/allowability determination.

B. The Grant recipient may submit a complete and fully executed change order which has been executed conditional upon an ARPA RWAI Grant eligibility/allowability determination by the Department.

C. All change orders shall be submitted to the Department for review and approval in a timely manner.

D. If possible, approval of a change order should be secured from the Department before the work is started, particularly for change orders including time extensions as per Rule 5.3.17.4 below. Approval may also be secured after the work is started; however, the Grant recipient shall bear the cost if the work is determined to be ineligible or unallowable.

E. When the eligible cost of a project will be significantly reduced by a change order or change orders, the Department may issue a Grant agreement budget modification decreasing the Grant amount, and the Grant recipient shall execute such amendment modification within the time frame established by the Department.

11. Department Review.

In order to allow the Department to perform a technical and Grant allowability review, requests for change order approvals shall conform to Department guidance, requirements, and regulations.

12. Time Extensions.

Change orders which include time extensions exceeding 30 days beyond the original contract completion date, and/or documentation that the Grant recipient is implementing all legal remedies provided in the contract documents for failure to complete construction when required, shall be submitted to the Department as specified in Rule 5.3.19.8 of these regulations. Justification for contract time extensions included in a change order shall be prepared but need not be submitted to the Department unless the total time extensions for the contract exceeds 30 days after the original contract completion date, in which case justification for all time extensions shall be submitted to the Department for an allowability determination. The statutory deadline of December 31 September 30, 2026, ends the period of performance to liquidate all obligations. The contract completion date should not exceed November August 15,

2026.

**History**
- *Source: House Bill 1421, 2022 Regular Session & Senate Bill 2444, 2023 Regular Session*

##### **15 Miss. Admin. Code Pt. 20, R. 5.3.19** Construction Phase Submissions, Approvals, and Actions -Timeline {#sec-20-5.3.19 omnilex-key=us-ms-regs-official--title-15--20#5.3.19}

The following submittals, approvals, and actions will be required during the construction phase of the project. The Department may establish other time frames within the Grant agreement when properly justified.

12. Within 30 days after approval of plans, specifications, and contract documents by the Department (1) all construction related contracts shall be advertised for bids and proof of such advertisement shall be submitted, (2) all local funds necessary for the project shall be secured, and proof of such local funds shall be submitted, and (3) clear site certificates from the Grant recipient and title counsel for all real property shall be submitted.

13. Within 60 days after approval of plans, specifications, and contract documents by the Department 45 days after advertisement, the Grant recipient shall open bids on all construction related contracts.

14. Within 14 days after receipt of bids for new construction, the Grant recipient shall submit all bid packages.

15. Within 60 days after receipt of bids, the Grant recipient shall execute all construction contract documents, shall submit a copy of all executed contract documents, and shall issue and submit a copy of the notice to proceed on all such contracts.

16. By the date initially established in the Grant agreement (which is based upon approximately 50% of contract time) the Grant recipient shall submit a completed asset management plan for all drinking water facilities to be constructed in whole or in part with ARPA RWAI Grant funds.

17. By the date initially established in the Grant agreement (which is based upon approximately 90% of contract time) the Grant recipient shall secure approval of the asset management plan.

18. Within 10 days after construction completion of each construction contract, the Grant recipient shall notify the Department of construction completion.

19. The Department will perform a final construction observation within 30 days after the current construction contract completion date, unless

further delayed by the Department pursuant to review of the Grant recipient's request and justification for such delay. Should the Department decide that the construction completion is being unreasonably delayed, a final construction observation may be immediately performed by the Department. The final construction observation by the Department is only for the purpose of determining final Grant allowable costs.

20. Within 30 days after the current construction contract completion date, all change orders which include time extensions exceeding 30 days beyond the original contract completion date, and/or documentation showing the Grant recipient is implementing all legal remedies provided in the contract documents for failure to complete construction when required, shall be submitted to the Department for an allowability determination

21. Within 60 days after the final construction observation performed by the Department, the Grant recipient shall submit: the final payment request for the awarded grant; approvable summary change orders for all construction contracts; full scale record drawings with all revisions shown and noted for the entire project funded in whole or in part with ARPA RWAI Grant funds; the registered licensed engineer's certification of compliance with plans, specifications, and contract documents; appropriate bacteriological test results; final construction phase professional services contract amendments, if any; and all other administrative forms and documents required by the Grant agreement. Grant payment requests submitted after this date are not allowable, regardless of when the costs were incurred.

22. Any other submittals or actions required by the Grant agreement shall be performed when so required and are subject to review and approval by the Department.

**History**
- *Source: House Bill 1421, 2022 Regular Session & Senate Bill 2444, 2023 Regular Session*

##### **15 Miss. Admin. Code Pt. 20, R. 5.3.20.1** Audits {#sec-20-5.3.20.1 omnilex-key=us-ms-regs-official--title-15--20#5.3.20.1}

Following final payment of ARPA RWAI Grant funds to the Grant recipient, or upon expiration of any deadlines established by the Grant agreement or the Department, the Department or other designated parties may perform an audit of the ARPA RWAI Grant project for the purpose of determining compliance with the Grant agreement and to determine final allowable costs, payments made to date, and any additional payments due the Grant recipient or repayment due the Department.

**History**
- *Source: House Bill 1421, 2022 Regular Session*

##### **15 Miss. Admin. Code Pt. 20, R. 5.3.20.2** Final Determination of Allowable Costs and Payments {#sec-20-5.3.20.2 omnilex-key=us-ms-regs-official--title-15--20#5.3.20.2}

Upon completion of the ARPA RWAIG audit (or if an audit is not performed, following final payment of ARPA RWAI Grant funds to the Grant recipient, or upon expiration of any deadlines established by the Grant agreement or the Department), the Department will transmit to the Grant recipient a copy of the audit report, if performed, a final determination of allowable costs and payments due the Grant recipient or repayments due the State.

**History**
- *Source: House Bill 1421, 2022 Regular Session*

##### **15 Miss. Admin. Code Pt. 20, R. 5.3.20.3** Final Determination Letter {#sec-20-5.3.20.3 omnilex-key=us-ms-regs-official--title-15--20#5.3.20.3}

Unless, within 30 days after the date of the above final determination, the Grant recipient submits a written appeal of the final determination, including a written justification of the reason for the appeal, and supporting documentation for any disputed costs of the final determination, the final determination of allowable costs will become the final allowable costs for purposes of ARPA RWAI Grant payments and the Grant agreement, and the Grant recipient shall receive a final determination letter from the department.

**History**
- *Source: House Bill 1421, 2022 Regular Session*

##### **15 Miss. Admin. Code Pt. 20, R. 5.3.20.4** Final Determination Letter following Appeal {#sec-20-5.3.20.4 omnilex-key=us-ms-regs-official--title-15--20#5.3.20.4}

Should an appeal be submitted in accordance with Rule 5.3.20.3 above, the disputes procedures established in Subchapter 9 of these regulations will be followed in order to resolve the dispute and establish the final allowable costs. Upon resolution of a dispute of the final determination, the Department will transmit to the Grant recipient a revised final determination letter.

**History**
- *Source: House Bill 1421, 2022 Regular Session*

##### **15 Miss. Admin. Code Pt. 20, R. 5.3.21.1** Payments to ARPA RWAI Grant recipients {#sec-20-5.3.21.1 omnilex-key=us-ms-regs-official--title-15--20#5.3.21.1}

Payments from the ARPA RWAIG Fund may be made to ARPA RWAI Grant recipients under the following conditions:

7. Payments may be requested by and made only to Grant recipients, in accordance with the Grant agreement and the Grant recipient's contracts for eligible and allowable services and construction for work performed within the project scope and budget period.

8. Payments may be requested only on project completed work, except as required by state law or as allowed by the Department.

9. The Grant recipient shall deduct from all ARPA RWAIG Fund

payment requests the amount of funds provided or to be provided from all other state and federal agency funding sources for allowable ARPA RWAIG Fund project costs.

**History**
- *Source: House Bill 1421, 2022 Regular Session*

##### **15 Miss. Admin. Code Pt. 20, R. 5.3.21.2** Payment Request Submissions {#sec-20-5.3.21.2 omnilex-key=us-ms-regs-official--title-15--20#5.3.21.2}

Payment requests shall be submitted by the Grant recipient to the Department and shall include the following: 7. ARPA RWAIG Fund payment request form with original signature;

8. Cumulative invoices for all allowable costs for which payment is requested; and

9. Any other documents required by the Grant agreement.

Rule 5.3.21.3. Timing of Payments

Provided the Grant recipient is in compliance with the requirements of these regulations and all provisions of the Grant agreement, the timing of ARPA RWAIG payments will be upon submission of a reimbursement request by the grant recipient for eligible and allowable services and construction for work performed within the project scope and grant award period. Payments may be requested no more often than on a monthly basis.

Rule 5.3.21.4. Repayments

Any payments made to the Grant recipient which are at any time determined by the Department to be for costs not in accordance with the Grant agreement, for ineligible or unallowable costs, or for costs related to waste, fraud, abuse, or illegal acts under state or federal law shall be repaid to the ARPA RWAI grant fund within 30 days of such notification by the Department. Interest may be charged on delinquent repayments after expiration of the 30-day period at a rate of ten (10) percent per annum, compounded monthly. Alternatively, the Department may withhold such amounts from subsequent payment requests.

Subchapter 4 Costs

Rule 5.4.1. General

Eligible costs are those costs in which ARPA RWAI Grant participation is authorized pursuant to applicable statute. Allowable costs are eligible costs that meet the following criteria:

21. Are necessary and reasonable for the proper and efficient administration and construction of the project, are allocable to and within the defined scope of the project and are not a general expense required to carry out the overall responsibilities of the Grant recipient.

22. Are authorized or not prohibited under federal, state, or local laws or regulations. 23. Conform to any limitations or exclusions set forth in state laws or other governing limitations as to types or amounts of cost items.

24. Are consistent with policies, regulations, and procedures that apply uniformly to both state assisted and other activities of the Grant recipient.

25. Are accorded consistent treatment through the application of generally accepted accounting principles appropriate to the circumstances.

26. Are not allocable to or included as a cost of any other Federal or State financed program in either the current, prior, or future period.

27. Are approved as allowable by the Department.

28. Are within the scope and budget period of the project as per the Grant agreement. However, the budget period does not apply to the planning and design allowance.

29. Notwithstanding this Subchapter, are eligible and allowable under the ARPA and any implementing federal regulations.

30. Are procured in accordance with Subchapter 7 of these regulations.

Rule 5.4.2. Construction

5. Allowable Construction Costs include the costs for:

A. The following types of projects, and as further described or limited in the Grant Agreement under which the project is

funded:

(i) projects that will facilitate compliance with national primary drinking water regulations;

(ii) projects that will facilitate consolidation of public water systems or the use of an alternative water supply. Consolidation between rural water associations and municipalities is eligible if one party is an eligible grant applicant.

(iii) projects that will upgrade a drinking water system; or

(iv) development of a public water system to replace private drinking water supplies if the water poses a significant threat to human health.

B. Subagreements for construction work on drinking water systems improvements. These subagreements are the prime contracts (including any subcontracts) for such construction work and any necessary contracts for purchase of equipment, materials and supplies by the Grant recipient. Should any costs for such contracts be incurred prior to Grant offer, said costs will be allowable provided that the Grant recipient has requested and obtained Department approval of said costs and provided that the Grant agreement budget period includes the time period these costs are incurred.

C. Drinking water distribution lines on drinking water distribution projects which provide drinking water to previously unserved areas, and the service lines between the public water main and the water meter.

D. Drinking water distribution system rehabilitation and replacement (including rehabilitation and replacement of eligible service lines) necessary to eliminate water loss or to preserve/restore the safety or integrity of the system, as determined in an approved facilities plan.

E. Water system capacity equal to all water distribution system leaks that will remain in the system, as determined in an approved facilities plan.

F. Drinking water systems which include service to industrial or commercial users when such works are owned by an eligible applicant.

G. Buildings that house or protect water production, treatment or distribution facilities.

H. Replacement of existing service lines from a water main up to a building (which includes any privately owned portion) if an identified public health

threat exists (such as lead in the drinking water) that can be reduced by the replacement of the existing service line.

6. Unallowable costs include:

A. Costs for the following types of projects:

(i) Projects primarily for growth, development, or fire protection;

(ii) Projects that can be consolidated (except for projects to implement such consolidation); (iii) Projects for systems without adequate financial or managerial support necessary to comply with ARPA requirements and all requirements of the Grant agreement; and

(iv) Projects for drinking water systems which serve federal users exclusively, or almost exclusively.

B. Construction and construction related costs which are incurred after the Department approved eligible contract completion date (including approved time extension change orders), unless approved by the Department pursuant to Rule 3.7.5.4 of these regulations.

C. Bonus payments that are part of the construction contract for completion of building before a contractual completion date, unless required by state law.

D. Administration buildings.

**History**
- *Source: House Bill 1421, 2022 Regular Session*
- *Source: House Bill 1421, 2022 Regular Session*
- *Source: House Bill 1421, 2022 Regular Session*
- *Source: House Bill 1421, 2022 Regular Session & Senate Bill 2444, 2023 Regular Session*
- *Source: House Bill 1421, 2022 Regular Session & Senate Bill 2444, 2023 Regular Session*

##### **15 Miss. Admin. Code Pt. 20, R. 5.4.3** Equipment, Materials and Supplies {#sec-20-5.4.3 omnilex-key=us-ms-regs-official--title-15--20#5.4.3}

3. Allowable costs include the costs of:

A. A reasonable inventory of chemicals and supplies necessary to initiate plant operations and laboratory items necessary to conduct tests required for plant operation.

B. Necessary and reasonable safety equipment, provided the equipment meets applicable federal, state, local or industry

safety requirements.

C. Constructing or installing water flow metering devices for the primary purpose of monitoring and/or billing inter- municipal or other flows or serving and billing individual residential, commercial or industrial users.

D. Backflow preventers.

E. Computers, display monitors, and computer software which are designed into the control system for the daily operation of the water system, used for the operational control and analysis of the water system, or specifically designed for the operation and maintenance (including the cost of developing unique operating programs for the specific Grant funded project) of the treatment works.

F. Specialized mobile equipment for the operation of the water system, or for the maintenance of equipment. These items include, but are not limited to:

(i) Portable stand-by generators.

(ii) Portable emergency pumps to provide "pump-around" capability in the event of booster station failure or pipeline breaks. 2. Unallowable costs include the costs of:

A. Vehicles for the transportation of the Grant recipient's employees, including buses, trucks, cars, motorcycles, ATVs, golf carts, bicycles, etc.

B. Items of routine "programmed" maintenance such as filters, couplings, hoses, belts, etc.

C. Radios, televisions, VCRs, camcorders, and other items of a similar nature.

D. Shop equipment installed at the treatment works or elsewhere.

E. Distribution system maintenance equipment.

F. Replacement parts.

G. Furnishings, office equipment, and maintenance equipment, including chairs, desks, file cabinets,

typewriters, coffee tables, telephones, office supplies, calculators, copiers, bookcases, shelves, lamps, etc.

H. Ordinary site and building maintenance equipment such as lawn mowers, rakes, shovels, brooms, picks, hedge trimmers, and other such equipment.

I. Hand tools such as screw drivers, pliers, socket wrenches, electric drills or saws, etc.

J. Computers for non-operational purposes, such as for the scheduling of equipment maintenance and replacement and for accounting and billing services.

5. Change orders are allowable provided the costs are:

A. Necessary and reasonable.

B. Within the scope of the project.

C. Not caused by the Grant recipient's mismanagement.

D. Not caused by the Grant recipient's vicarious liability for the improper actions of others.

E. In conformance with the ARPA RWAIG regulations.

F. Asset management plan for constructed components of the funded project.

6. Provided the above requirements are met, the following are examples of allowable change orders.

A. Construction costs resulting from defects in the plans, design drawings and specifications, or other contract documents only to the extent that the costs would have been incurred if the contract documents on which the bids were based had been free of the defects, and excluding the costs of any rework, delay, acceleration, or disruption caused by such defects.

If the defect is realized after substantial construction work has been completed, and therefore

requires rework, delay, or additional work beyond that which would have been required by defect-free drawings, the cost would still be allowable, but the additional cost of rework or delay is unallowable.

The additional cost is measured as the difference between the cost which would have been included in the bid based on defect free drawings and the actual cost of the change order.

B. Equitable adjustments for differing site conditions.

Rule 5.4.5. Professional Services The term professional services refers to engineering, legal, administrative, and similar services.

5. Allowable costs include the costs of/for:

A. Planning, application, and design. These costs include all engineering and other costs that are incurred in planning and designing the project, as well as applying for the Grant. These costs include but are not necessarily limited to the following services, as determined allowable in Subchapter 5 of these regulations. Contracts for planning, application and design costs need not be submitted to the Department.

(i) Preparing the plans, specifications, and contract documents.

(ii) Preparing interlocal agreements necessary for the project.

(iii) Surveys and all other work needed to obtain clearance or permits from all intergovernmental review agencies.

(iv) Preparing the Grant application, preparing applications for permits required by federal, state or local regulations or procedures.

B. Construction Phase Professional Services

(i) Services incurred during the advertisement, award and construction of a project to ensure compliance with state applicable purchasing laws and to ensure that the project is built in conformance with the design plans and specifications. These services are primarily engineering, and construction management services provided during

the advertisement, award and building of the project, including observation services, materials testing (e.g., concrete strength, soil compaction, etc.) required by the specifications, inspecting and expediting the delivery of equipment and material purchased directly by the Grant recipient, reviewing shop drawings and full-scale record drawings, preparing change orders, payment processing, etc.

(ii) Legal, engineering, and other services incurred by the Grant recipient in deciding procurement protests and defending their decisions in protest appeals under Subchapter 9 are allowable regardless of the outcome of the protest, provided there was not an attempt by the Grant recipient to violate or circumvent applicable purchase laws.

(iii) Asset management plan for constructed components of the funded project

(iv) Accounting services for preparation of the Single Audit or Program Specific Audit

(v) Development of an operation and maintenance manual.

(vi) Start-up services for onsite training of operating personnel in operation and control of specific treatment processes, laboratory procedures, and maintenance and records management, provided these costs are incurred prior to the end of the 60-day period established in Rule 5.3.19. of these regulations.

(vii) Administrative services associated with the construction project and administering the ARPA RWAIG.

(viii) Services, other than engineering services during construction/repairs, such as railway or highway flagmen or utility or highway inspectors, required during the building of the project, provided that a. The entity responsible for the affected railway, highway, or utility requires such services for all parties conducting similar types of work, regardless of the source of construction funding for the project, or the services are required by

law.

b. The cost of such services has not been included in the construction contractor's bid price.

(ix) Engineering or other services necessary to correct defects in the grant applications plan, design drawings and specifications or other documents to the extent that such costs would have been allowable for preparing defect free documents.

6. Unallowable costs include the costs of:

A. Public liaison services. B. Local travel (i.e., commuting expenses) between living quarters and the construction site for persons working at the site.

**History**
- *Source: House Bill 1421, 2022 Regular Session Rule 5.4.4. Change Orders*
- *Source: House Bill 1421, 2022 Regular Session & Senate Bill 2444, 2023 Regular Session*
- *Source: House Bill 1421, 2022 Regular Session & Senate Bill 2444, 2023 Regular Session*

##### **15 Miss. Admin. Code Pt. 20, R. 5.4.6** Claims {#sec-20-5.4.6 omnilex-key=us-ms-regs-official--title-15--20#5.4.6}

5. Allowable costs, provided the costs are properly documented, incurred and requested prior to the end of the 60-day period established Rule 5.3.19.11 of these regulations, include:

A. Change orders to the construction contract as a result of settlements, arbitration awards, or court judgements, to the extent that they would have been allowable had there not been a claim.

B. The costs of assessing the merits of, negotiating, or defending a claim against the Grant recipient are allowable, regardless of the outcome, provided that the matter under dispute is not the result of fraudulent or illegal actions or mismanagement on the part of the Grant recipient.

C. Alterations in engineering, legal, contracts etc. as a result of settlements, arbitration awards, or court judgements are allowable to the same extent that they would have been allowable had there not been a claim.

6. Unallowable costs include the costs of:

A. Claims arising from work outside the scope of the Grant.

B. Claims resulting from fraudulent or illegal activities.

C. Claims resulting from mismanagement by the Grant recipient.

D. Claims resulting from the Grant recipient's vicarious liability for the improper action of others.

E. Settlements, arbitration awards or court judgements over the allowable costs as established in these regulations.

**History**
- *Source: House Bill 1421, 2022 Regular Session*

##### **15 Miss. Admin. Code Pt. 20, R. 5.4.7** Mitigation {#sec-20-5.4.7 omnilex-key=us-ms-regs-official--title-15--20#5.4.7}

5. Allowable costs include the costs of: A. Mitigation of only direct adverse physical impacts resulting from construction of the project.

B. Reasonable site screening necessary to comply with facilities plan required environmental review and necessary to screen adjacent properties.

C. Groundwater monitoring facilities necessary to determine the possibility of groundwater deterioration, depletion or modification resulting from construction of the project. The extent of the allowable costs for groundwater monitoring facilities is decided on a case-by-case basis and depends on the size and complexity of the project and the present and potential future use of the groundwater.

6. Unallowable costs include the costs of:

A. Solutions to aesthetic problems, including design details which require expensive building techniques and architectural features and hardware, that are unreasonable or substantially higher in cost than approvable alternatives and that neither enhance the function or appearance of the treatment works nor reflect regional architectural tradition.

B. Land acquired for the mitigation of adverse environmental effects identified pursuant to an environmental review.

Rule 5.4.8. Real Property

5. Allowable costs include the costs of:

A. Land acquired in fee simple title or by easement, from a willing seller, for:

(i) Water supply and/or storage purposes;

(ii) A consolidation project; and

(iii) Protection of the source water of the system from contamination.

B. Preparation of the treatment works site before, during and, to the extent agreed on in the Grant agreement, after building. These include the cost of:

(i) Demolition of existing structures on the treatment works site (including rights-of-way) if building cannot be undertaken without such demolition. Demolition of existing structures on the treatment works site (including rights-of- way), when not required for building the project, will be considered to be an allowable cost only if the existing structures constitute a real and present hazard to safety, public health, or water quality and when the hazard can best be abated by the removal of the existing structures.

(ii) Removal, relocation, or replacement of utilities, provided the Grant recipient is legally obligated to pay for such as a result of the ARPA RWAIG project under state or local law.

(iii) Restoration of streets and rights-of-way to their original condition. The need for such restoration shall result directly from the construction of the ARPA RWAIG project and is generally limited to repaving the width of trench.

6. Unallowable costs include the costs of:

A. Any amount paid by the Grant recipient for eligible land in excess of the appraised value or the Grant recipient's record of negotiation.

An amount higher than the appraised value may be found allowable if the Grant recipient

provides sufficient written documentation to the Department and receives allowability approval prior to the actual acquisition.

B. Removal, relocation or replacement of utilities located on land by privilege, such as a franchise, unless the Grant recipient is required to pay such costs under state or local law.

C. Land acquired in fee simple title or by easements for land other than that described under H.(1)(a) above, such as easements for the purpose of water distribution system expansion or improvement.

Acquiring all or part of an existing publicly or privately owned drinking water treatment works.

D. The demolition of an existing structure for the convenience of the owner as a means of increasing property value or property use.

Rule 5.4.9. Miscellaneous Costs 5. Allowable costs include the costs of:

A. Equipment rental and material costs necessary for the construction project.

B. Meeting specific legal requirements directly related to the project unless otherwise specified in these regulations.

C. Royalties associated with the procurement of the right to use, or the rights in, a patented product, apparatus, or process, provided that they are based on a published fee schedule or on reasonable fees charged to other users under similar conditions.

D. Training workshops/seminars for Grant recipient employees that are necessary to provide instruction in operational, administrative, fiscal or contracting procedures required to complete the construction of the project. Attendance at such training workshops or seminars shall occur after Grant offer but before the end of the Grant agreement budget period.

E. A reasonable project sign.

6. Unallowable costs include the costs of:

A. Salaries and benefits for the Grant recipient’s employees.

B. Ordinary operating expenses of the Grant recipient, including salaries and expenses of elected and appointed officials and preparation of routine financial reports and studies.

C. Administrative, engineering, and legal activities associated with the creation of special departments, agencies, commissions, regions, districts, associations, or other entities.

D. Approval, preparation, issuance and sale of bonds or other forms of indebtedness required to finance any portion of the project and the interest on them.

E. Personal injury compensation or damages arising out of the project.

F. Fines and penalties due to violations of or failure to comply with federal, state or local laws, regulations or procedures, and related legal expenses. G. Operation and maintenance of the water system, which include but are not limited to, labor, utilities, chemicals, materials and supplies, monitoring, testing, equipment replacement, periodic payment of royalties for the right to operate under a patent, etc.

H. Lease payments.

I. Travel, by the Grant recipient, unless included under an indirect cost agreement, and except as allowed under Rule 5.4.9(1)(d) above.

Rule 5.4.10. Project Income

9. Bid bond forfeitures will have no effect on the determination of allowable and unallowable costs. The Grant recipient shall make the determination of whether or not a bid bond will be forfeited.

10. The amount of liquidated damages collected will have no effect on the determination of allowable and unallowable costs, except as described by Rule 5.3.17.4 of these regulations.

11. Interest income on ARPA RWAIG Fund payments to Grant recipients will have no effect on the determination of allowable and unallowable costs.

12. The Grant recipient shall receive all income generated from use of the project facilities.

Rule 5.4.11. PWS Water System Acquisition

The terms of water system acquisition must be provided to the Department prior to the acquisition to ensure cost allowability under federal regulations and applicable state law.

5. Allowable costs include the costs of:

I. Purchase of a public or private Public Water System with a PWS ID number to consolidate system with Grant Applicant.

J. Cost of appraisal of water system infrastructure by a licensed engineer

K. Legal costs associated with negotiation of acquisition and preparation of acquisition documents

L. Real property costs as outlined in these regulations, including purchase of existing water distribution system easements

6. Unallowable costs include the costs of:

C. Any amount paid by the Grant recipient for eligible PWS infrastructure or real property in excess of the appraised value or the Grant recipient's record of negotiation.

An amount higher than the appraised value may be found allowable if the Grant recipient provides sufficient written documentation to the Department and receives allowability approval prior to the actual acquisition.

Subchapter 5. Recommended Allowances for Planning, Design and Construction Phase Professional Services

Rule 5.5.1. Recommended Allowances for Planning and Design.

The recommended allowance for planning and design will be determined using Table 1 in this Subchapter. This table is not intended to be used to determine the consulting engineer's allowable costs for planning and design services. Compensation for these services should be based upon

the nature, scope, and complexity of the services required for the project.

Table 1 includes a recommended range for engineering costs during planning and design, which the Grant applicant/recipient should consider while evaluating the engineer's proposal. If the engineer's proposal exceeds the normal range the Grant applicant/recipient should consider requiring the engineer to justify why the project is more difficult than normal. The actual compensation justified for a particular project may be more or less than the suggested range of the allowance for these services shown in Table 1.

If the consulting engineer and Grant applicant/recipient determine that the maximum recommended allowance calculated using Table 1 in this Subchapter does not adequately reflect the nature, scope, and complexity of the services required for the project, the consulting engineer may submit a detailed cost proposal, in such format as required by the Department, justifying a compensation amount greater than Table 1 recommends. If, in the Department's opinion, the detailed cost proposal justifies such, the Department will approve an allowance for facilities planning and design greater than those recommended in Table 1. The decision of the Department in this matter will be final.

Projects for which the Grant applicant/recipient shall acquire easements or real property may receive an additional 1% above the recommended maximum percentages shown in Table 1 for planning and design allowances. Also, projects for which a value engineering study is conducted may receive an additional 3% above the recommended maximum percentages shown in Table 1 for the planning and design allowance.

Rule 5.5.2. Recommended Allowance for Construction Phase Professional Services.

The Allowance for Construction Phase Professional Services includes costs for engineering services during bidding, construction, and post-construction phases, observation during construction, Grant administration and other services (i.e. legal, etc.) that are associated with the construction of the ARPA RWAIG project. The recommended allowance for construction phase professional services will be determined using Table 2 in this Subchapter.

This table is not intended to be used to determine the actual compensation for construction phase professional services. Compensation for these professional services should be based upon the nature, scope, and complexity of the services required for the project.

Table 2 separates the Total Recommended Allowance for Construction Phase Professional Services shown in the far-right hand column into three types of services: engineering, Grant administration, and other services and provides suggested ranges for each of these services depending upon the complexity of the project. The Grant applicant/recipient should consider these recommended ranges when evaluating proposals for these services. If the proposals exceed the normal ranges for any of these services, the Grant applicant/recipient should consider requiring the professional to justify why the project is more difficult than normal. The actual compensation justified for a particular project may be more or less than the

suggested range of the allowance for these services shown in Table 2.

If the consulting engineer and Grant applicant/recipient determine that the maximum recommended allowance calculated using Table 2 in this Subchapter does not adequately reflect the nature, scope, and complexity of the services required for the project, the consulting engineer may submit a detailed cost proposal, in such format as required by the Department, justifying a compensation amount greater than Table 2 recommends. If in the Department's opinion the detailed cost proposal justifies such, the Department will approve an allowance for construction phase professional services greater than those recommended in Table 2. The decision of the Department in this matter will be final.

Although Table 2 shows engineering and Grant administration as separate costs, the Grant applicant/recipient is not required by these regulations to contract for these services separately. The Grant applicant/recipient may wish to have the consulting engineer provide both scopes of services, and under such an arrangement, the engineer's contract should not exceed the total of the suggested ranges for both services.

Rule 5.5.3. General Guidance for Use of the Allowance Tables.

The estimated and final allowances will be determined in accordance with this Subchapter. All allowance percentages will be calculated to four decimal places using linear interpolation. The allowance amount is computed by applying the resulting total allowance percentage to the initial allowable building cost, which is the initial award amount of all prime contracts for construction, equipment, supplies, and testing of the project.

The estimated allowances are to be based on the estimate of the initial allowable building cost from the facilities plan Subgrant Agreement, Attachment B. The final allowances will be determined one time only for each project, based on the initial allowable as bid cost, and will not be adjusted for subsequent cost increases or decreases.

Following execution of the Grant agreement, the Grant recipient may request and receive payment for the facilities planning and design allowance and the allowance for construction phase professional services, in accordance with the procedures described in Rule 5.3.21.3 of these regulations. Advances of allowances will not be provided.

Table 1

Recommended Allowances for Facilities Planning and Design

Allowable Building Cost Allowances as a Percentage of Building Cost Based Upon the Difficulty of the Project

Normal to Difficult

$50,000 or less 11.7500% to 13.2000% $100,000 10.7500% to 12.2000% $150,000 10.0700% to 11.2519% $200,000 9.4000% to 10.5000% $300,000 8.7000% to 9.8042% $400,000 8.3000% to 9.6312% $500,000 8.0000% to 9.4417% $600,000 7.8000% to 9.1467% $700,000 7.7000% to 9.0297% $800,000 7.5000% to 8.8089% $900,000 7.4000% to 8.7472% $1,000,000 7.2500% to 8.5673% $1,100,000 7.1030% to 8.3911% $1,200,000 6.9600% to 8.2185% $1,300,000 6.8200% to 8.0495% $1,400,000 6.6800% to 7.8840% $1,500,000 or greater 6.5400% to 7.7219%

Table 2

Recommended Allowances for Construction Phase Professional Services Allowances as a Percentage of Building Cost Based Upon the Difficulty of the Project

Estimated Building Cost Engineering Services Grant Administration Other Services Total Allowance for Professional Services Normal to Difficult Normal to Difficult Normal to Difficult Normal to Difficult $50,000 or less 6.4400% to 11.7250% 2.0700% to 3.7688% 0.6900% to 1.2563% 9.2000% to 16.7500% $100,000 5.7400% to 11.725% 1.8450% to 3.7688% 0.6150% to 1.2563% 8.2000% to 16.7500% $150,000 5.2850% to 11.725% 1.6988% to 3.7688% 0.5663% to 1.2563% 7.5500% to 16.7500% $200,000 4.8300% to 9.9400% 1.5525% to 3.1950% 0.5175% to 1.0650% 6.9000% to 14.2000% $300,000 4.4100% to 8.1690% 1.4175% to 2.6258% 0.4725% to 0.8753% 6.3000% to 11.6700% $400,000 4.0600% to 7.2800% 1.3050% to 2.3400% 0.4350% to 0.7800% 5.8000% to 10.4000% $500,000 3.8150% to 6.5800% 1.2263% to 2.1150% 0.4088% to 0.7050% 5.4500% to 09.4000% $600,000 3.5700% to 5.9500% 1.1475% to 1.9125% 0.3825% to 0.6375% 5.1000% to 08.5000% $700,000 3.4300% to 5.4600% 1.1025% to 1.7550% 0.3675% to 0.5850% 4.9000% to 07.8000% $800,000 3.2900% to 5.0400% 1.0575% to 1.6200% 0.3525% to 0.5400% 4.7000% to 07.2000% $900,000 3.2200% to 4.6690% 1.0350% to 1.5008% 0.3450% to 0.5003% 4.6000% to 06.6700% $1,000,000 3.1500% to 4.4800% 1.0125% to 1.4400% 0.3375% to 0.4800% 4.5000% to 06.4000% $1,100,000 3.0815% to 4.2986% 0.9905% to 1.3817% 0.3302% to 0.4606% 4.4022% to 06.1409% $1,200,000 3.0146% to 4.1246% 0.9690% to 1.3258% 0.3230% to 0.4419% 4.3066% to 5.8923% $1,300,000 2.9492% to 3.9577% 0.9479% to 1.2721% 0.3160% to 0.4240% 4.2131% to 5.6538% $1,400,000 2.8852% to 3.7975% 0.9274% to 1.2206% 0.3091% to 0.4069% 4.1217% to 5.4250% $1,500,000 or greater 2.8226% to 3.6438% 0.9073% to 1.1712% 0.3024% to 0.3904% 4.0323% to 5.2054%

Subchapter 6. Environmental Review Process

Rule 5.6.1. Description of Environmental Impacts

The Registered Licensed Engineer is required to certify the environmental impact of the project as either low, moderate, or high. If the Registered Licensed Engineer determines that there is either a moderate or high impact, the Registered Licensed Engineer shall prepare an Environmental Review Report. The report shall bear the seal of the Registered Licensed engineer responsible for preparation of the report and shall contain a description of the environmental impacts of the proposed project and any corresponding mitigative measures including, but not necessarily limited to, the following:

(19) Surface and groundwater resources;

(20) Archaeological/historical/cultural resources; (21) Vegetative/wildlife resources;

(22) Wetlands and navigable waterways;

(23) Floodplains;

(24) Prime or important farmlands;

(25) Coastal zones;

(26) Wild and scenic rivers; and

(27) Air Quality.

Rule 5.6.2. Environmental Review.

The Registered Licensed Engineer will take one or more of the following actions pursuant to the review of the Environmental Review Report of Environmental Impacts:

7. Previously Disturbed Certification Complete certification that all work to be performed as a part of this project will be performed on previously disturbed sites, easements, and/or rights-of-way. Certify that no new sites, easements and/or rights-of-way will be disturbed as a result of this construction/repair project, and therefore, no comments or responses are required from the state or federal agencies listed below in order to ensure compliance with the state or federal laws or regulations under the jurisdiction of these agencies. Categorical Exclusion

8. Environmental Impacts Resolved Certification Complete certification that comments and responses have been solicited and resolved from the state and federal agencies listed below regarding all work to be performed under this project on new sites, easements, and/or rights-of-way.

The Registered Engineer will issue a Categorical Exclusion (CE) from environmental review if a project meets all of the following criteria:

A. The project includes minor rehabilitation of existing facilities, functional replacement of equipment, or construction of new ancillary facilities adjacent or appurtenant to existing facilities.

B. The project will not have a significant adverse effect on the environment.

C. The project will not adversely affect cultural resources, habitats of endangered or threatened species, or environmentally important natural resource areas.

D. The project is not expected to cause significant public controversy. The Department may revoke a categorical exclusion at any time if significant adverse information becomes available.

Finding of No Significant Impact (FONSI) on the Environment

The Registered Engineer will issue a Finding of No Significant Impact (FONSI) and an Environmental Assessment (EA) when, based upon review of the environmental impacts in the Environmental Review Report, it appears that a project will not have a significant adverse environmental impact, but does not qualify for a CE.

Amendment to a Finding of No Significant Impact FONSI to the Environment FONSI amendments are occasionally needed to describe changes to proposed facilities that have already been described in a FONSI.

Environmental Impact Statement (EIS) If the Registered Engineer determines that an environmental impact statement (EIS) is needed, the document will be prepared in general conformance as deemed appropriate by the Department.

9. No Further Action

The Registered Licensed Engineer will issue a CE, FONSI, or EIS complete the appropriate certification on all ARPA RWAIG projects. If there are significant changes in the project after the issuance of the environmental documents, those changes will be described in an Amendment to a FONSI the certification. Some changes are minor, however, and the Department may determine that a separate Amendment need not be issued. Such minor changes

may include but are not limited to:

A. Adding work that would otherwise qualify for a categorical exclusion previously disturbed certification.

B. Changes in the size of pump stations, storage facilities, wells, distribution lines, etc.

C. Minor changes in the size of water treatment unit processes.

D. Minor rerouting of distribution lines when the new route

i) will be mostly on public property and

ii) will not adversely affect cultural resources, habitats of endangered or threatened species, or environmentally important natural resource areas.

All affected property owners shall be notified by the Grant recipient.

Rule 5.6.3. Issuance of the Environmental Action Certification Copies of all necessary environmental actions review and certification documentation should be issued to the appropriate intergovernmental review agencies listed in Subchapter 8; other agencies shall be contacted as needed. Copies shall also be sent to any individuals or groups requesting them. All environmental actions will also be published in an appropriate local newspaper or review documentation shall be maintained at the grant recipients recipient’s office location for review upon request.

All environmental actions should provide for at least a 30-day period from the day of issuance to receive comments from agencies, groups, or individuals. All such comments will be evaluated by the Registered Engineer before finalizing any environmental action.

Rule 5.6.4. Resolution of Adverse Comments.

Adverse comments received as a result of the environmental review process should be addressed in the following manner:

5. The Grant recipient should resolve the adverse comments

6. If the Grant recipient is unable to resolve the adverse comments and secure approval, the Department may comment on the unresolved

issues and suggest a course of action.

Subchapter 7. Miscellaneous Requirements for ARPA RWAIG recipients

Rule 5.7.1. Within this subchapter, Grant recipients should have an understanding of various miscellaneous elements that could affect the project(s) ability to proceed from application to design to construction to grant payment.

Procurement Requirements.

9. In the procurement of all construction, equipment, materials, supplies, professional services and non-professional services and all other costs related to the ARPA RWAIG project, all Grant recipients shall comply with federal procurement regulations and state purchasing laws as they applicable state and local laws. 10. • All procurements must comply with the requirements of 2 CFR 200.317-327.

• All procurements must follow the affirmative outreach steps required in 2 CFR 200.321.

• Compliance with the 2 CFR 200 rules and regulations must be documented and such documents retained for the ARPA/SLFRF record retention (i.e., for five years after date of final ARPA/SLFRF disbursed or returned to Treasury, whichever is later).

11. The procurement and conduct of all professional engineering and land surveying services shall also be in accordance with the Code of Conduct a and other guidance and interpretations established by the Mississippi State Board of Registration for Professional Engineers and Land Surveyors.

12. The procurement of all construction contracts shall also be in accordance with the rules and regulations of the State Board of Contractors and other guidance and interpretations established by the Mississippi State Board of Contractors.

13. All Grant recipients shall submit a procurement certification, as required by the Department, indicating that all the above referenced requirements have been met. Should it be determined that any of the above procurement requirements are violated, the Department may

determine that the related costs are unallowable and may require repayment of all ARPA RWAIG funds paid for such costs, in accordance with Rule 5.3.21.4 of these regulations.

Rule 5.7.2. Debarment and Suspension

The Department is prohibited from entering into Grant agreements with Grant applicants that have been debarred or suspended by any state or federal agency.

Grant recipients are prohibited from entering into contractual agreements with individuals, businesses, organizations, or any other entities that have been debarred or suspended by any state or federal agency. Additionally, grant recipients are responsible for ensuring that prime contractors utilized on the project are not debarred or suspended. Likewise, prime contractors are responsible for ensuring that subcontractors utilized on the project are not debarred or suspended.

Anyone may contact the Board concerning the existence of a cause for debarment or suspension. The Department may refer the matter to the State Attorney General or other appropriate office for further investigation. If, after review or investigation, the Board reasonably believes that a cause for debarment exists, the Board may propose debarment or suspension and may initiate procedures similar to, but not necessarily identical to, federal regulation 40 CFR Part 32: Debarment and Suspension Under EPA Assistance Programs.

Such above-described debarment or suspension actions will not affect existing executed contractual agreements, unless such agreements have been terminated or suspended under the terms of the agreement by the Grant recipient.

Rule 5.7.3. ARPA RWAIG Dispute Procedures Only ARPA RWAIG recipients may submit a notice of dispute (disagreement) with a decision made by the Department, with the exception of decisions regarding Subchapter 6, Environmental Review Process, of these regulations. The following procedures will be used to resolve disputes between the Grant recipient and the Department.

9. The Grant recipient shall submit a written notice of dispute with a Department decision, including a summary of the dispute and reasons the Grant recipient believes the Department decision should be reversed.

10. The Department will then render a written decision on the dispute and will include reasons for the decision.

11. Should the Grant recipient desire to appeal the second Department

decision, a request for an informal hearing shall be received by the Department within 30 days after the date of that decision. Upon receipt of such a request, an informal hearing will be held with staff members, as designated by the State Health Officer, and the affected parties. The State Health Officer, or his designee, will render a decision on the appeal as a result of the informal hearing.

12. Appeals of the above formal hearing decision may be made to the Chancery Court in accordance with state law.

Rule 5.7.4. Waste Fraud and Abuse

The Grant recipient is responsible for preventing, detecting, and prosecuting waste, fraud, abuse, and all other corrupt practices which occur in relation to the ARPA RWAIG project.

If the Grant recipient becomes aware of allegations, evidence, or the appearance of corrupt practices, the Grant recipient shall:

5. Immediately inform the Department in writing; and

6. Promptly pursue available state and local legal, administrative, and contractual remedies.

The Department may disallow costs under the Grant agreement where it is determined that such costs are related to waste, fraud, abuse or other corrupt practices. The Department may also require repayment of ARPA RWAI Grant funds paid for such costs in accordance with Rule 5.3.21.4 of these regulations.

Rule 5.7.5. ARPA RWAIG Recipient Accounting and Auditing Requirements

All ARPA RWAIG recipients shall maintain project accounts in accordance with generally accepted government accounting standards, as defined by the Guidelines of the Municipal Accounting and Audit Manual, as prescribed by the State Auditor's Office. Charges to the project account shall be properly supported, related to eligible construction costs, and documented by appropriate records. These project accounts shall be maintained as separate accounts.

All contracts for professional services, construction, equipment, and supplies shall include an access to audit clause which gives the Department and its representatives access to and the right to audit, inspect, copy and examine books, financial records and other documents relating directly to the receipt and disbursement of ARPA RWAIG funds.

Rule 5.7.6. ARPA RWAIG Procurement Protest Procedures

5. Prior to advertisement for bids, the Grant recipient should consider establishing its own procedures for prompt consideration of initial protests concerning solicitations or contract awards. A "protest" is a written complaint concerning the Grant recipient's solicitation or award of a contract. The protest shall be filed with the Grant recipient by a party with a direct financial interest adversely affected by a Grant recipient's procurement action and shall be filed in accordance with and within the time frame established by the Grant recipient's protest procedures.

6. Any delay due to a protest or protest resolution will not relieve the Grant recipient of the requirement to meet the project schedule established in the Grant agreement, nor will such delays prevent the Department from pursuing the remedies for default established in the Grant agreement.

Rule 5.7.7. Related State Laws and Regulations

The Grant recipient shall comply with the applicable related state laws and regulations regarding Mississippi Safe Drinking Water Act and Operator Certification during the planning, design, construction, and operation of the project.

Rule 5.7.8. National Pollutant Discharge Elimination System (NPDES) and Siting Criteria Regulations

The following requirements apply to those drinking water treatment facilities that have or will construct wastewater treatment facilities necessary to treat waste generated by their drinking water treatment facilities.

The Grant recipient shall ensure that all current applicable regulations of the Commission on Environmental Quality and the Environmental Quality Permit Board are complied with during the planning, design, and construction of any wastewater treatment facilities associated with this ARPA RWAIG project. It is the Grant recipient's responsibility to ensure that the project is in compliance with these regulations and all future amendments.

Subchapter 8. Intergovernmental Review Process

The following outlines the Department's guidance for compliance with the Intergovernmental Review concerns for ARPA RWAIG projects.

Rule 5.8.1. Intergovernmental Review Agencies: 13. Mississippi Department of Archives and History (for archaeological/cultural review)

14. Mississippi Natural Heritage Program (for vegetative/wildlife review)

15. U.S. Army Corps of Engineers, Regulatory Functions Branch [for Section 404 (wetlands), Section 10 (navigable waterways), and floodplain impact review]

16. Mississippi Department of Marine Resources (Jackson, Harrison, and Hancock County Projects Only; for shellfish review and Mississippi Coastal Program review)

17. U.S. Fish and Wildlife Service (Jackson, Harrison, and Hancock County projects only; for Coastal Barriers Resources Act review)

18. U.S. Forest Service (projects located in a designated Wild and Scenic River Basin only, for Wild and Scenic Rivers review)

Rule 5.8.2. Planning and Design

During preparation of the plans and specifications, the Registered Licensed Engineer will ensure that the appropriate intergovernmental review agencies have been consulted about the proposed project area concerning the existence of any known or possible archaeological/cultural sites, endangered vegetation/wildlife, wetlands, floodplain impacts, wild/scenic river impacts, shellfish/coastal program impacts, or coastal barriers resources impact. The Registered Licensed Engineer will certify during the plans, specifications, and contract documents phase, that the proposed project components have been evaluated through a intergovernmental review process and that no concerns have been discovered that would prevent the project from moving forward and that the project has been cleared. If feasible, the project should avoid negative impacts on areas for which a concern has been expressed by an intergovernmental review agency. If it is not feasible to avoid negative impacts on these areas, the appropriate intergovernmental review agency should be consulted concerning the probability of obtaining clearance to construct the selected plan.

A. 0.. B. C. D. E. F. G. H. I. J. K. L. M. N. O. P. Q. R. S. T. U. V. W. X. Y. Z. AA. BB. CC. DD. EE. FF. GG. HH. 0Plans, specifications, and contract documents shall also conform to such contract language, conditions, and forms as may be required by the Department. The plans, specifications, and contract documents shall bear the seal of the registered engineer responsible for preparation of these documents. 3. Contents of plans specifications and contract documents. In addition to the above general requirements, the plans, specifications, and contract documents shall contain the following: A. Provisions assuring compliance with these regulations and all relevant federal and state laws.

B. Forms by which the bid bond, performance bond and payment bonds will be provided. C. A contractor's assurance which shall warrant compliance by the contractor with all applicable federal laws and regulations and all laws of the State of Mississippi and all regulations and published policies of the Board. D. Provisions providing for the applicant to retain a certain percentage of the progress payments otherwise due to the contractor, in accordance with state law. E. Provisions requiring the contractor to obtain and maintain the appropriate insurance coverage. F. Provisions giving authorized representatives of the Department access to all such construction activities, books, records, documents, and other evidence of the contractor for the purpose of inspection, audit, and copying during normal business and/or working hours. G. Provisions for change orders. H. Those conditions, specifications, and other provisions set forth or required by the Department. I. Provisions for liquidated damages. J. Provisions for including water meters on new distribution systems.

**History**
- *Source: House Bill 1421, 2022 Regular Session & Senate Bill 2444, 2023 Regular Session*
- *Source: House Bill 1421, 2022 Regular Session & Senate Bill 2444, 2023 Regular Session*
- *Source: House Bill 1421, 2022 Regular Session*
- *Source: House Bill 1421, 2022 Regular Session & Senate Bill 2444, 2023 Regular Session*
- *Source: House Bill 1421, 2022 Regular Session*
- *Source: House Bill 1421, 2022 Regular Session*
- *Source: House Bill 1421, 2022 Regular Session & Senate Bill 2444, 2023 Regular Session*
- *Source: House Bill 1421, 2022 Regular Session & Senate Bill 2444, 2023 Regular Session*
- *Source: House Bill 1421, 2022 Regular Session & Senate Bill 2444, 2023 Regular Session*
- *Source: House Bill 1421, 2022 Regular Session & Senate Bill 2444, 2023 Regular Session*
- *Source: House Bill 1421, 2022 Regular Session*
- *Source: House Bill 1421, 2022 Regular Session & Senate Bill 2444, 2023 Regular Session*
- *Source: House Bill 1421, 2022 Regular Session*
- *Source: House Bill 1421, 2022 Regular Session*
- *Source: House Bill 1421, 2022 Regular Session*
- *Source: House Bill 1421, 2022 Regular Session*
- *Source: House Bill 1421, 2022 Regular Session*
- *Source: House Bill 1421, 2022 Regular Session*
- *Source: House Bill 1421, 2022 Regular Session*
- *Source: House Bill 1421, 2022 Regular Session*
- *Source: House Bill 1421, 2022 Regular Session*
- *Source: House Bill 1421, 2022 Regular Session*
- *Source: House Bill 1421, 2022 Regular Session*

##### **15 Miss. Admin. Code Pt. 20, R. 5.3.6** Submission of Plans, Specifications, Contract Documents and Related Items {#sec-20-5.3.6 omnilex-key=us-ms-regs-official--title-15--20#5.3.6}

By the dates specified in the Grant agreement, the recipient shall submit the following items to the Department: 1. Complete plans, specifications, and contract documents. 2. Certification from Registered Engineer of the environmental impact, either low, moderate, or high of the project. If the Registered Engineers determination is moderate or high, the Registered Engineer should complete an Environmental and Intergovernmental Review as defined in Subchapter 6 and 8. 3. A copy of the issued National Pollutant Discharge Elimination System (NPDES) permit or the state operating permit, if required. 4. A copy of the issued solid waste disposal permit, if required.

5. Written waivers from all adjoining property owners when it is not possible to provide required buffer zones if the project includes drinking water sludge treatment facilities. 6. For all Grant eligible real property acquisitions all applicable state law must be followed. Prior to advertisement for construction bids, the Grant recipient shall secure approval of the purchase price by the Department, shall complete purchase of all Grant eligible real property and easements, and shall submit clear title certificates from the Grant recipient and title counsel for all such Grant eligible property.

**History**
- *Source: House Bill 1421, 2022 Regular Session*

##### **15 Miss. Admin. Code Pt. 20, R. 5.3.7** Approval of Plans, Specifications, and Contract Documents {#sec-20-5.3.7 omnilex-key=us-ms-regs-official--title-15--20#5.3.7}

The Department will approve the plans, specifications, and contract documents upon determining that these documents appear to conform to the requirements of these regulations and are consistent with the approved planning documents and environmental determinations required by these regulations.

**History**
- *Source: House Bill 1421, 2022 Regular Session*

##### **15 Miss. Admin. Code Pt. 20, R. 5.3.8** Construction Bidding and Grant Amendment {#sec-20-5.3.8 omnilex-key=us-ms-regs-official--title-15--20#5.3.8}

1. Grant Agreement Timeframe Within the timeframe established in the Grant agreement, the Grant recipient shall secure Department approval of the plans, specifications, and contract documents. A. For all Grant ineligible real property and easements (including power and other utilities), submit clear site certification forms from both the Grant recipient and the title counsel which indicate that all such Grant ineligible real property and easements for the entire project have been secured by clear title. B. Secure all local funds necessary for the project and submit proof of such. C. Upon completion of (1) through (3) above and issuance of any other permits or clearances required for the project, advertise the project for construction bids. All procurement actions by the Grant recipient shall comply with state law and these regulations. 2. Process following Receipt of Construction Bids Upon receipt of construction bids, the Grant recipient shall then submit:

A. The completed bid package; B. All necessary executed contracts and amendments as described in Rule 5.3.4 (2B) of these regulations; and C. A Grant agreement amendment request (consistent with as-bid construction costs, a construction contingency as determined by the Department, and any professional services contracts and amendments) to the Department within the time frame established in the Grant agreement. 3. Review of Documents Upon receipt of the items listed above, the Department will review them to determine whether any request for an increased Grant amount is justified and allowable and whether funds are available. After determining that all documents are approvable, the Department will transmit to the Grant recipient approval to execute the construction contracts.

**History**
- *Source: House Bill 1421, 2022 Regular Session*

##### **15 Miss. Admin. Code Pt. 20, R. 5.3.9** Amended Grant offer 1 {#sec-20-5.3.9 omnilex-key=us-ms-regs-official--title-15--20#5.3.9}

Process after Grant Agreement Amendment Request After receipt, review and approval of the Grant agreement amendment request, the Department may prepare and transmit an amended ARPA RWAI Grant offer to the Grant recipient. The Grant offer will include in the project budget: A. The approved as-bid amounts for construction; B. The final allowance amounts for professional services in accordance with Subchapter 5 of these regulations; and C. A construction contingency as determined by the Department. 2. Execution of Amended Grant Offer Upon receipt of the amended ARPA RWAI Grant offer, the Grant recipient shall completely execute and return it to the Department within the timeframe established in the offer letter. After execution of the amended ARPA RWAI Grant offer. Any increased project costs in excess of the amended ARPA RWAI Grant amount shall be paid by the Grant recipient from sources other than ARPA RWAIG funds.

**History**
- *Source: House Bill 1421, 2022 Regular Session*

##### **15 Miss. Admin. Code Pt. 20, R. 5.3.10** Awarding Construction Contracts and Preconstruction Conference {#sec-20-5.3.10 omnilex-key=us-ms-regs-official--title-15--20#5.3.10}

Upon receipt of the approval to execute the construction contracts and to issue the notice to proceed, the Grant recipient shall do so and shall transmit a copy of the executed construction contracts and the notice to proceed to the Department within the time frame specified in the Grant agreement.

**History**
- *Source: House Bill 1421, 2022 Regular Session*

##### **15 Miss. Admin. Code Pt. 20, R. 5.3.11** Rule 5.3.11 {#sec-20-5.3.11 omnilex-key=us-ms-regs-official--title-15--20#5.3.11}

Grant Recipient Responsibility The Grant recipient will be responsible for assuring that every appropriate procedure and incidental legal requirement are observed in advertisement for bids and awarding the construction contracts. The plans, specifications, and executed contract documents shall not vary from those approved by the Department.

**History**
- *Source: House Bill 1421, 2022 Regular Session*

##### **15 Miss. Admin. Code Pt. 20, R. 5.3.12** Rule 5.3.12 {#sec-20-5.3.12 omnilex-key=us-ms-regs-official--title-15--20#5.3.12}

Preconstruction Conference The Grant recipient may arrange and hold a preconstruction conference and shall allow attendance and participation by the Department if such is held.

**History**
- *Source: House Bill 1421, 2022 Regular Session*

##### **15 Miss. Admin. Code Pt. 20, R. 5.3.13** Observation During Construction {#sec-20-5.3.13 omnilex-key=us-ms-regs-official--title-15--20#5.3.13}

1. Resident Observation During construction work being performed, the Grant recipient shall provide for resident observation of the project by the registered engineer or his staff and shall require the registered engineer's assurance that the work is being performed in a satisfactory manner in accordance with the Grant agreement and the approved plans, specifications, contract documents, and approved change orders. 2. Department Observation The Department is authorized to observe the building of any project at any time for compliance with the terms of the Grant agreement and to determine if the Grant recipient is assuring that plans, specifications, and contract documents are being followed. Such observation will not subject the Department to any legal action for claims, damages, or any other liability. Also, such observation shall not release the contractor from any obligation to perform the work in accordance with the requirements of the contract documents or the registered engineer from determining compliance with

the requirements of the contract documents or the Grant recipient from insuring compliance with the terms of the Grant agreement. 3. Assurance of Work The contractor, registered engineer, and the Grant recipient shall furnish the Department with every reasonable opportunity and means for determining whether the Grant recipient and registered engineer are assuring that the work is in accordance with the requirements of the approved plans, specifications, and contract documents. The Department is authorized to observe and require submission by the Grant recipient of daily logs, full scale record drawings, file notes, and any other documents prepared by any party in relation to the ARPA RWAI funded project.

**History**
- *Source: House Bill 1421, 2022 Regular Session*

##### **15 Miss. Admin. Code Pt. 20, R. 5.3.14** Observation of Materials and Equipment {#sec-20-5.3.14 omnilex-key=us-ms-regs-official--title-15--20#5.3.14}

The Department is also authorized to observe all equipment and materials furnished, including observation of the preparation or manufacture of the equipment and materials to be used.

**History**
- *Source: House Bill 1421, 2022 Regular Session*

##### **15 Miss. Admin. Code Pt. 20, R. 5.3.15** Construction Deficiencies {#sec-20-5.3.15 omnilex-key=us-ms-regs-official--title-15--20#5.3.15}

Nonconformity with Plans and Specifications In the event that it appears to the Department that the Grant recipient and registered engineer are not assuring that the construction work, materials, equipment or supplies are in conformity with approved plans and specifications, the Department may determine such work unallowable for ARPA RWAI Grant participation, unless the Grant recipient takes such action, through the registered engineer if applicable, in the manner provided for in the construction contract to correct any deficiencies.

**History**
- *Source: House Bill 1421, 2022 Regular Session*

##### **15 Miss. Admin. Code Pt. 20, R. 5.3.16** Withholding of Grant Payment {#sec-20-5.3.16 omnilex-key=us-ms-regs-official--title-15--20#5.3.16}

The Department may immediately withhold ARPA RWAI Grant payments for such time that it appears that the Grant recipient and registered engineer are not assuring that construction work, materials, equipment, or supplies are in accordance with the approved plans, specifications, and contract documents, and may require the Grant recipient to repay any previously paid amounts related to such work within 30 days of such notification.

**History**
- *Source: House Bill 1421, 2022 Regular Session*

##### **15 Miss. Admin. Code Pt. 20, R. 5.3.17** Change Orders {#sec-20-5.3.17 omnilex-key=us-ms-regs-official--title-15--20#5.3.17}

1. General. A. In the event a determination is made by a Grant recipient after a construction contract is executed that changes or modifications to the original contract are necessary or would better serve the purpose of the Grant recipient, such Grant recipient may, at its discretion, execute such change orders pertaining to the construction that are necessary under the circumstances, as provided in the contract documents and when in accordance with state law.

B. Change orders shall not change, vary, or alter the basic purpose or effect of the project unless allowed by the Department. Change orders shall be technically adequate, the costs shall be necessary and reasonable, and eligible/ineligible costs shall be appropriately separated. 2. Change Order Submissions. A. After completion of the claims resolution and/or change order negotiation process between the Grant recipient and the contracting party, a fully executed change order shall be submitted to the Department for review and approval, in order to obtain an ARPA RWAI Grant eligibility/allowability determination. If any change order is submitted to the Department that is not complete and fully executed by the Grant recipient, the contracting party, and the registered engineer if appropriate, the Department may return such change order without review. However, unilateral change orders executed by the Grant recipient, and the registered engineer if appropriate, and identified as such, that are issued in accordance with the contract documents may be submitted to the Department for review and approval, in order to obtain an ARPA RWAI Grant eligibility/allowability determination.

B. The Grant recipient may submit a complete and fully executed change order which has been executed conditional upon an ARPA RWAI Grant eligibility/allowability determination by the Department.

C. All change orders shall be submitted to the Department for review and approval in a timely manner.

D. If possible, approval of a change order should be secured from the Department before the work is started, particularly for change orders including time extensions as per Rule 5.3.17.4 below. Approval may also be secured after the work is started; however,

the Grant recipient shall bear the cost if the work is determined to be ineligible or unallowable. E. When the eligible cost of a project will be significantly reduced by a change order or change orders, the Department may issue an amendment to the Grant agreement decreasing the Grant amount, and the Grant recipient shall execute such amendment within the time frame established by the Department. 3. Department Review. In order to allow the Department to perform a technical and Grant allowability review, requests for change order approvals shall conform to Department guidance, requirements, and regulations. 4. Time Extensions. Change orders which include time extensions exceeding 30 days beyond the original contract completion date, and/or documentation that the Grant recipient is implementing all legal remedies provided in the contract documents for failure to complete construction when required, shall be submitted to the Department as specified in Rule 5.3.19.8 of these regulations. Justification for contract time extensions included in a change order shall be prepared but need not be submitted to the Department unless the total time extensions for the contract exceeds 30 days after the original contract completion date, in which case justification for all time extensions shall be submitted to the Department for an allowability determination. The statutory deadline of December 31, 2026 ends the period of performance to liquidate all obligations. The contract completion date should not exceed November 15, 2026.

**History**
- *Source: House Bill 1421, 2022 Regular Session*

##### **15 Miss. Admin. Code Pt. 20, R. 5.3.19** Rule 5.3.19 {#sec-20-5.3.19 omnilex-key=us-ms-regs-official--title-15--20#5.3.19}

Construction Phase Submissions, Approvals, and Actions -Timeline The following submittals, approvals, and actions will be required during the construction phase of the project. The Department may establish other time frames within the Grant agreement when properly justified. 1. Within 30 days after approval of plans, specifications, and contract documents by the Department (1) all construction related contracts shall be advertised for bids and proof of such advertisement shall be submitted, (2) all local funds necessary for the project shall be secured, and proof of such local funds shall be submitted, and (3) clear site certificates from the Grant recipient and title counsel for all real property shall be submitted. 2. Within 60 days after approval of plans, specifications, and contract documents by the Department, the Grant recipient shall open bids on all construction related contracts.

3. Within 14 days after receipt of bids for new construction, the Grant recipient shall submit all bid packages. 4. Within 60 days after receipt of bids, the Grant recipient shall execute all construction contract documents, shall submit a copy of all executed contract documents, and shall issue and submit a copy of the notice to proceed on all such contracts. 5. By the date initially established in the Grant agreement (which is based upon approximately 50% of contract time) the Grant recipient shall submit a completed asset management plan for all drinking water facilities to be constructed in whole or in part with ARPA RWAI Grant funds. 6. By the date initially established in the Grant agreement (which is based upon approximately 90% of contract time) the Grant recipient shall secure approval of the asset management plan. 7. Within 10 days after construction completion of each construction contract, the Grant recipient shall notify the Department of construction completion. 8. The Department will perform a final construction observation within 30 days after the current construction contract completion date, unless further delayed by the Department pursuant to review of the Grant recipient's request and justification for such delay. Should the Department decide that the construction completion is being unreasonably delayed, a final construction observation may be immediately performed by the Department. The final construction observation by the Department is only for the purpose of determining final Grant allowable costs. 9. Within 30 days after the current construction contract completion date, all change orders which include time extensions exceeding 30 days beyond the original contract completion date, and/or documentation showing the Grant recipient is implementing all legal remedies provided in the contract documents for failure to complete construction when required, shall be submitted to the Department for an allowability determination 10. Within 60 days after the final construction observation performed by the Department, the Grant recipient shall submit: the final payment request for the awarded grant; approvable summary change orders for all construction contracts; full scale record drawings with all revisions shown and noted for the entire project funded in whole or in part with ARPA RWAI Grant funds; the registered engineer's certification of compliance with plans, specifications, and contract documents; appropriate bacteriological test results; final construction phase professional services contract amendments, if any; and all other administrative forms and documents required by the Grant agreement. Grant payment requests

submitted after this date are not allowable, regardless of when the costs were incurred. 11. Any other submittals or actions required by the Grant agreement shall be performed when so required and are subject to review and approval by the Department.

**History**
- *Source: House Bill 1421, 2022 Regular Session*

##### **15 Miss. Admin. Code Pt. 20, R. 5.3.20** Post Construction Phase {#sec-20-5.3.20 omnilex-key=us-ms-regs-official--title-15--20#5.3.20}

Rule 5.3.20.1 Audits Following final payment of ARPA RWAI Grant funds to the Grant recipient, or upon expiration of any deadlines established by the Grant agreement or the Department, the Department or other designated parties may perform an audit of the ARPA RWAI Grant project for the purpose of determining compliance with the Grant agreement and to determine final allowable costs, payments made to date, and any additional payments due the Grant recipient or repayment due the Department.

**History**
- *Source: House Bill 1421, 2022 Regular Session*

##### **15 Miss. Admin. Code Pt. 20, R. 5.3.20.2** Rule 5.3.20.2 {#sec-20-5.3.20.2 omnilex-key=us-ms-regs-official--title-15--20#5.3.20.2}

Final Determination of Allowable Costs and Payments Upon completion of the ARPA RWAIG audit (or if an audit is not performed, following final payment of ARPA RWAI Grant funds to the Grant recipient, or upon expiration of any deadlines established by the Grant agreement or the Department), the Department will transmit to the Grant recipient a copy of the audit report, if performed, a final determination of allowable costs and payments due the Grant recipient or repayments due the State.

**History**
- *Source: House Bill 1421, 2022 Regular Session*

##### **15 Miss. Admin. Code Pt. 20, R. 5.3.20.3** Rule 5.3.20.3 {#sec-20-5.3.20.3 omnilex-key=us-ms-regs-official--title-15--20#5.3.20.3}

Final Determination Letter Unless, within 30 days after the date of the above final determination, the Grant recipient submits a written appeal of the final determination, including a written justification of the reason for the appeal, and supporting documentation for any disputed costs of the final determination, the final determination of allowable costs will become the final allowable costs for purposes of ARPA RWAI Grant payments and the Grant agreement, and the Grant recipient shall receive a final determination letter from the department.

**History**
- *Source: House Bill 1421, 2022 Regular Session*

##### **15 Miss. Admin. Code Pt. 20, R. 5.3.20.4** Final Determination Letter following Appeal {#sec-20-5.3.20.4 omnilex-key=us-ms-regs-official--title-15--20#5.3.20.4}

Should an appeal be submitted in accordance with Rule 5.3.20.3 above, the disputes procedures established in Subchapter 9 of these regulations will be followed in order to resolve the dispute and establish the final allowable costs. Upon resolution of a dispute of the final determination, the Department will transmit to the Grant recipient a revised final determination letter.

**History**
- *Source: House Bill 1421, 2022 Regular Session*

##### **15 Miss. Admin. Code Pt. 20, R. 5.3.21.1** Payments to ARPA RWAI Grant recipients {#sec-20-5.3.21.1 omnilex-key=us-ms-regs-official--title-15--20#5.3.21.1}

Payments from the ARPA RWAIG Fund may be made to ARPA RWAI Grant recipients under the following conditions: 1. Payments may be requested by and made only to Grant recipients, in accordance with the Grant agreement and the Grant recipient's contracts for eligible and allowable services and construction for work performed within the project scope and budget period. 2. Payments may be requested only on project completed work, except as required by state law or as allowed by the Department. 3. The Grant recipient shall deduct from all ARPA RWAIG Fund payment requests the amount of funds provided or to be provided from all other state and federal agency funding sources for allowable ARPA RWAIG Fund project costs.

**History**
- *Source: House Bill 1421, 2022 Regular Session*

##### **15 Miss. Admin. Code Pt. 20, R. 5.3.21.2** Rule 5.3.21.2 {#sec-20-5.3.21.2 omnilex-key=us-ms-regs-official--title-15--20#5.3.21.2}

Payment Request Submissions Payment requests shall be submitted by the Grant recipient to the Department and shall include the following: 1. ARPA RWAIG Fund payment request form with original signature;

2. Cumulative invoices for all allowable costs for which payment is requested; and

3. Any other documents required by the Grant agreement.

performed within the project scope and grant award period. Payments may be requested no more often than on a monthly basis.

Rule 5.4.1. General

Eligible costs are those costs in which ARPA RWAI Grant participation is authorized pursuant to applicable statute. Allowable costs are eligible costs that meet the following criteria:

1. Are necessary and reasonable for the proper and efficient administration and construction of the project, are allocable to and within the defined scope of the project and are not a general expense required to carry out the overall responsibilities of the Grant recipient.

2. Are authorized or not prohibited under state or local laws or regulations.

3. Conform to any limitations or exclusions set forth in state laws or other governing limitations as to types or amounts of cost items.

4. Are consistent with policies, regulations, and procedures that apply uniformly to both state assisted and other activities of the Grant recipient.

5. Are accorded consistent treatment through the application of generally accepted accounting principles appropriate to the circumstances.

6. Are not allocable to or included as a cost of any other Federal or State financed program in either the current, prior, or future period.

7. Are approved as allowable by the Department.

8. Are within the scope and budget period of the project as per the Grant agreement. However, the budget period does not apply to the planning and design allowance.

9. Notwithstanding this Subchapter, are eligible and allowable under the ARPA and any implementing federal regulations.

10. Are procured in accordance with Subchapter 7 of these regulations.

1. Allowable Construction Costs include the costs for:

A. The following types of projects, and as further described or limited in the Grant Agreement under which the project is funded:

(i) projects that will facilitate compliance with national primary drinking water regulations;

(ii) projects that will facilitate consolidation of public water systems or the use of an alternative water supply

(iii) projects that will upgrade a drinking water system; or

(iv) development of a public water system to replace private drinking water supplies if the water poses a significant threat to human health.

B. Subagreements for construction work on drinking water systems improvements. These subagreements are the prime contracts (including any subcontracts) for such construction work and any necessary contracts for purchase of equipment, materials and supplies by the Grant recipient. Should any costs for such contracts be incurred prior to Grant offer, said costs will be allowable provided that the Grant recipient has requested and obtained Department approval of said costs and provided that the Grant agreement budget period includes the time period these costs are incurred.

C. Drinking water distribution lines on drinking water distribution projects which provide drinking water to previously unserved areas, and the service lines between the public water main and the water meter.

D. Drinking water distribution system rehabilitation and replacement (including rehabilitation and replacement of eligible service lines) necessary to eliminate water loss or to preserve/restore the safety or integrity of the system, as determined in an approved facilities plan.

E. Water system capacity equal to all water distribution system leaks that will remain in the system, as determined in an approved facilities plan.

F. Drinking water systems which include service to industrial or commercial users when such works are owned by an eligible applicant.

G. Buildings that house or protect water production, treatment or distribution facilities.

H. Replacement of existing service lines from a water main up to a building (which includes any privately owned portion) if an identified public health threat exists (such as lead in the drinking water) that can be reduced by the replacement of the existing service line.

2. Unallowable costs include:

A. Costs for the following types of projects:

(i) Projects primarily for growth, development, or fire protection; (ii) Projects that can be consolidated (except for projects to implement such consolidation); (iii) Projects for systems without adequate financial or managerial support necessary to comply with ARPA requirements and all requirements of the Grant agreement; and (iv) Projects for drinking water systems which serve federal users exclusively, or almost exclusively. B. Construction and construction related costs which are incurred after the Department approved eligible contract completion date (including approved time extension change orders), unless approved by the Department pursuant to Rule 3.7.5.4 of these regulations.

C. Bonus payments that are part of the construction contract for completion of building before a contractual completion date, unless required by state law.

D. Administration buildings.

**History**
- *Source: House Bill 1421, 2022 Regular Session Rule 5.3.21.3. Timing of Payments Provided the Grant recipient is in compliance with the requirements of these regulations and all provisions of the Grant agreement, the timing of ARPA RWAIG payments will be upon submission of a reimbursement request by the grant recipient for eligible and allowable services and construction for work*
- *Source: House Bill 1421, 2022 Regular Session Rule 5.3.21.4. Repayments Any payments made to the Grant recipient which are at any time determined by the Department to be for costs not in accordance with the Grant agreement, for ineligible or unallowable costs, or for costs related to waste, fraud, abuse, or illegal acts under state or federal law shall be repaid to the ARPA RWAI grant fund within 30 days of such notification by the Department. Interest may be charged on delinquent repayments after expiration of the 30-day period at a rate of ten (10) percent per annum, compounded monthly. Alternatively, the Department may withhold such amounts from subsequent payment requests.*
- *Source: House Bill 1421, 2022 Regular Session Subchapter 4 Costs*
- *Source: House Bill 1421, 2022 Regular Session Rule 5.4.2. Construction*
- *Source: House Bill 1421, 2022 Regular Session*

##### **15 Miss. Admin. Code Pt. 20, R. 5.4.3** Equipment, Materials and Supplies {#sec-20-5.4.3 omnilex-key=us-ms-regs-official--title-15--20#5.4.3}

1. Allowable costs include the costs of:

A. A reasonable inventory of chemicals and supplies necessary to initiate plant operations and laboratory items necessary to conduct tests required for plant operation.

B. Necessary and reasonable safety equipment, provided the equipment meets applicable federal, state, local or industry safety requirements.

C. Constructing or installing water flow metering devices for the primary purpose of monitoring and/or billing inter-municipal or other flows or serving and billing individual residential, commercial or industrial users.

D. Backflow preventers.

E. Computers, display monitors, and computer software which are designed into the control system for the daily operation of the water system, used for the operational control and analysis of the water system, or specifically designed for the operation and maintenance (including the cost of developing unique operating programs for the specific Grant funded project) of the treatment works.

F. Specialized mobile equipment for the operation of the water system, or for the maintenance of equipment. These items include, but are not limited to:

(i) Portable stand-by generators.

(ii) Portable emergency pumps to provide "pump-around" capability in the event of booster station failure or pipeline breaks.

2. Unallowable costs include the costs of:

A. Vehicles for the transportation of the Grant recipient's employees, including buses, trucks, cars, motorcycles, ATVs, golf carts, bicycles, etc.

B. Items of routine "programmed" maintenance such as filters, couplings, hoses, belts, etc.

C. Radios, televisions, VCRs, camcorders, and other items of a similar nature.

D. Shop equipment installed at the treatment works or elsewhere.

E. Distribution system maintenance equipment.

F. Replacement parts.

G. Furnishings, office equipment, and maintenance equipment, including chairs, desks, file cabinets, typewriters, coffee tables, telephones, office supplies, calculators, copiers, bookcases, shelves, lamps, etc.

H. Ordinary site and building maintenance equipment such as lawn mowers, rakes, shovels, brooms, picks, hedge trimmers, and other such equipment.

I. Hand tools such as screw drivers, pliers, socket wrenches, electric drills or saws, etc.

J. Computers for non-operational purposes, such as for the scheduling of equipment maintenance and replacement and for accounting and billing services.

Rule 5.4.4. Change Orders

1. Change orders are allowable provided the costs are:

A. Necessary and reasonable.

B. Within the scope of the project.

C. Not caused by the Grant recipient's mismanagement.

D. Not caused by the Grant recipient's vicarious liability for the improper actions of others.

E. In conformance with the ARPA RWAIG regulations.

F. Asset management plan for constructed components of the funded project

2. Provided the above requirements are met, the following are examples of allowable change orders.

A. Construction costs resulting from defects in the plans, design drawings and specifications, or other contract documents only to the extent that the costs would have been incurred if the contract documents on which the bids were based had been free of the defects, and excluding the costs of any rework, delay, acceleration, or disruption caused by such defects.

If the defect is realized after substantial construction work has been completed, and therefore requires rework, delay, or additional work beyond that which would have been required by defect-free drawings, the cost would still be allowable, but the additional cost of rework or delay is unallowable.

The additional cost is measured as the difference between the cost which would have been included in the bid based on defect free drawings and the actual cost of the change order.

B. Equitable adjustments for differing site conditions.

The term professional services refers to engineering, legal, administrative, and similar services.

1. Allowable costs include the costs of/for:

A. Planning, application, and design. These costs include all engineering and other costs that are incurred in planning and designing the project, as well as applying for the Grant. These costs include but are not necessarily limited to the following services, as determined allowable in Subchapter 5 of these regulations. Contracts for planning, application and design costs need not be submitted to the Department.

(i) Preparing the plans, specifications, and contract documents.

(ii) Preparing interlocal agreements necessary for the project.

(iii) Surveys and all other work needed to obtain clearance or permits from all intergovernmental review agencies.

(iv) Preparing the Grant application, preparing applications for permits required by federal, state or local regulations or procedures.

B. Construction Phase Professional Services

(i) Services incurred during the advertisement, award and construction of a project to ensure compliance with state purchasing laws and to ensure that the project is built in conformance with the design plans and specifications. These services are primarily engineering, and construction management services provided during the advertisement, award and building of the project, including observation services, materials testing (e.g., concrete strength, soil compaction, etc.) required by the specifications, inspecting and expediting the delivery of equipment and material purchased directly by the Grant recipient, reviewing shop drawings and full-scale record drawings, preparing change orders, payment processing, etc. (ii) Legal, engineering, and other services incurred by the Grant recipient in deciding procurement protests and defending their decisions in protest appeals under Subchapter 9 are allowable regardless of the outcome of the protest, provided there was not an attempt by the Grant recipient to violate or circumvent state purchase laws. (iii) Development of an operation and maintenance manual. (iv) Start-up services for onsite training of operating personnel in operation and control of specific treatment processes, laboratory procedures, and maintenance and records management, provided these costs are incurred prior to the end of the 60-day period established in Rule 5.3.19.11 of these regulations. (v) Professional liability or other insurance premiums for a provider of professional services only for insurance which the provider maintains in connection with the general conduct of its business. The types and extent of coverage

shall be in accordance with sound business practice, and the rates and premiums shall be reasonable under the circumstances but only as part of an indirect cost agreement. (vi) Administrative services associated with the construction project and administering the ARPA RWAIG. (vii) Services, other than engineering services during construction/repairs, such as railway or highway flagmen or utility or highway inspectors, required during the building of the project, provided that

a. The entity responsible for the affected railway, highway, or utility requires such services for all parties conducting similar types of work, regardless of the source of construction funding for the project, or the services are required by law.

b. The cost of such services has not been included in the construction contractor's bid price.

(viii) Engineering or other services necessary to correct defects in the grant applications plan, design drawings and specifications or other documents to the extent that such costs would have been allowable for preparing defect free documents.

2. Unallowable costs include the costs of:

A. Public liaison services.

B. Local travel (i.e., commuting expenses) between living quarters and the construction site for persons working at the site.

**History**
- *Source: House Bill 1421, 2022 Regular Session*
- *Source: House Bill 1421, 2022 Regular Session Rule 5.4.5. Professional Services*
- *Source: House Bill 1421, 2022 Regular Session*

##### **15 Miss. Admin. Code Pt. 20, R. 5.4.6** Claims {#sec-20-5.4.6 omnilex-key=us-ms-regs-official--title-15--20#5.4.6}

1. Allowable costs, provided the costs are properly documented, incurred and requested prior to the end of the 60-day period established Rule 5.3.19.11 of these regulations, include:

A. Change orders to the construction contract as a result of settlements, arbitration awards, or court judgements, to the extent that they would have been allowable had there not been a claim.

B. The costs of assessing the merits of, negotiating, or defending a claim against the Grant recipient are allowable, regardless of the outcome, provided that the matter under dispute is not the result of fraudulent or illegal actions or mismanagement on the part of the Grant recipient.

C. Alterations in engineering, legal, contracts etc. as a result of settlements, arbitration awards, or court judgements are allowable to the same extent that they would have been allowable had there not been a claim.

2. Unallowable costs include the costs of:

A. Claims arising from work outside the scope of the Grant.

B. Claims resulting from fraudulent or illegal activities.

C. Claims resulting from mismanagement by the Grant recipient.

D. Claims resulting from the Grant recipient's vicarious liability for the improper action of others.

E. Settlements, arbitration awards or court judgements over the allowable costs as established in these regulations.

**History**
- *Source: House Bill 1421, 2022 Regular Session*

##### **15 Miss. Admin. Code Pt. 20, R. 5.4.7** Mitigation {#sec-20-5.4.7 omnilex-key=us-ms-regs-official--title-15--20#5.4.7}

1. Allowable costs include the costs of:

A. Mitigation of only direct adverse physical impacts resulting from construction of the project.

B. Reasonable site screening necessary to comply with facilities plans and necessary to screen adjacent properties.

C. Groundwater monitoring facilities necessary to determine the possibility of groundwater deterioration, depletion or modification resulting from construction of the project. The extent of the allowable costs for groundwater monitoring facilities is decided on a case-by-case basis and depends on the size and complexity of the project and the present and potential future use of the groundwater.

2. Unallowable costs include the costs of:

A. Solutions to aesthetic problems, including design details which require expensive building techniques and architectural features and hardware, that are unreasonable or substantially higher in cost than approvable alternatives and that neither enhance the function or appearance of the treatment works nor reflect regional architectural tradition.

B. Land acquired for the mitigation of adverse environmental effects identified pursuant to an environmental review.

1. Allowable costs include the costs of:

A. Land acquired in fee simple title or by easement, from a willing seller, for:

(i) Water supply and/or storage purposes;

(ii) A consolidation project; and

(iii) Protection of the source water of the system from contamination.

B. Preparation of the treatment works site before, during and, to the extent agreed on in the Grant agreement, after building. These include the cost of:

(i) Demolition of existing structures on the treatment works site (including rights-of-way) if building cannot be undertaken without such demolition. Demolition of existing structures on the treatment works site (including rights-of- way), when not required for building the project, will be considered to be an allowable cost only if the existing structures constitute a real and present hazard to safety, public health, or water quality and when the hazard can best be abated by the removal of the existing structures.

(ii) Removal, relocation, or replacement of utilities, provided the Grant recipient is legally obligated to pay for such as a result of the ARPA RWAIG project under state or local law.

(iii) Restoration of streets and rights-of-way to their original condition. The need for such restoration shall result directly

from the construction of the ARPA RWAIG project and is generally limited to repaving the width of trench.

2. Unallowable costs include the costs of:

A. Any amount paid by the Grant recipient for eligible land in excess of the appraised value or the Grant recipient's record of negotiation.

An amount higher than the appraised value may be found allowable if the Grant recipient provides sufficient written documentation to the Department and receives allowability approval prior to the actual acquisition.

B. Removal, relocation or replacement of utilities located on land by privilege, such as a franchise, unless the Grant recipient is required to pay such costs under state or local law.

C. Land acquired in fee simple title or by easements for land other than that described under H.(1)(a) above, such as easements for the purpose of water distribution system expansion or improvement.

D. Acquiring all or part of an existing publicly or privately owned drinking water treatment works.

E. The demolition of an existing structure for the convenience of the owner as a means of increasing property value or property use.

1. Allowable costs include the costs of:

A. Equipment rental and material costs necessary for the construction project.

B. Meeting specific legal requirements directly related to the project unless otherwise specified in these regulations.

C. Royalties associated with the procurement of the right to use, or the rights in, a patented product, apparatus, or process, provided that they are based on a published fee schedule or on reasonable fees charged to other users under similar conditions.

D. Training workshops/seminars for Grant recipient employees that are necessary to provide instruction in operational, administrative,

fiscal or contracting procedures required to complete the construction of the project. Attendance at such training workshops or seminars shall occur after Grant offer but before the end of the Grant agreement budget period.

E. A reasonable project sign.

2. Unallowable costs include the costs of:

A. Salaries and benefits for the Grant recipient’s employees.

B. Ordinary operating expenses of the Grant recipient, including salaries and expenses of elected and appointed officials and preparation of routine financial reports and studies.

C. Administrative, engineering, and legal activities associated with the creation of special departments, agencies, commissions, regions, districts, associations, or other entities.

D. Approval, preparation, issuance and sale of bonds or other forms of indebtedness required to finance any portion of the project and the interest on them.

E. Personal injury compensation or damages arising out of the project.

F. Fines and penalties due to violations of or failure to comply with federal, state or local laws, regulations or procedures, and related legal expenses.

G. Operation and maintenance of the water system, which include but are not limited to, labor, utilities, chemicals, materials and supplies, monitoring, testing, equipment replacement, periodic payment of royalties for the right to operate under a patent, etc.

H. Lease payments.

I. Travel, by the Grant recipient, unless included under an indirect cost agreement, and except as allowed under Rule 5.4.9(1)(d) above.

1. Bid bond forfeitures will have no effect on the determination of allowable and unallowable costs. The Grant recipient shall make the determination of whether or not a bid bond will be forfeited.

2. The amount of liquidated damages collected will have no effect on the determination of allowable and unallowable costs, except as described by Rule 5.3.17.4 of these regulations.

3. Interest income on ARPA RWAIG Fund payments to Grant recipients will have no effect on the determination of allowable and unallowable costs.

4. The Grant recipient shall receive all income generated from use of the project facilities.

Rule 5.5.1. Recommended Allowances for Planning and Design.

The recommended allowance for planning and design will be determined using Table 1 in this Subchapter. This table is not intended to be used to determine the consulting engineer's allowable costs for planning and design services. Compensation for these services should be based upon the nature, scope, and complexity of the services required for the project.

Table 1 includes a recommended range for engineering costs during planning and design, which the Grant applicant/recipient should consider while evaluating the engineer's proposal. If the engineer's proposal exceeds the normal range the Grant applicant/recipient should consider requiring the engineer to justify why the project is more difficult than normal. The actual compensation justified for a particular project may be more or less than the suggested range of the allowance for these services shown in Table 1.

If the consulting engineer and Grant applicant/recipient determine that the maximum recommended allowance calculated using Table 1 in this Subchapter does not adequately reflect the nature, scope, and complexity of the services required for the project, the consulting engineer may submit a detailed cost proposal, in such format as required by the Department, justifying a compensation amount greater than Table 1 recommends. If, in the Department's opinion the detailed cost proposal justifies such, the Department will approve an allowance for facilities planning and design greater than those recommended in Table 1. The decision of the Department in this matter will be final.

Projects for which the Grant applicant/recipient shall acquire easements or real property may receive an additional 1% above the recommended maximum

percentages shown in Table 1 for planning and design allowances. Also, projects for which a value engineering study is conducted may receive an additional 3% above the recommended maximum percentages shown in Table 1 for the planning and design allowance.

The Allowance for Construction Phase Professional Services includes costs for engineering services during bidding, construction, and post-construction phases, observation during construction, Grant administration and other services (i.e. legal, audit, etc.) that are associated with the construction of the ARPA RWAIG project. The recommended allowance for construction phase professional services will be determined using Table 2 in this Subchapter.

This table is not intended to be used to determine the actual compensation for construction phase professional services. Compensation for these professional services should be based upon the nature, scope, and complexity of the services required for the project.

Table 2 separates the Total Recommended Allowance for Construction Phase Professional Services shown in the far-right hand column into three types of services: engineering, Grant administration, and other services and provides suggested ranges for each of these services depending upon the complexity of the project. The Grant applicant/recipient should consider these recommended ranges when evaluating proposals for these services. If the proposals exceed the normal ranges for any of these services, the Grant applicant/recipient should consider requiring the professional to justify why the project is more difficult than normal. The actual compensation justified for a particular project may be more or less than the suggested range of the allowance for these services shown in Table 2.

If the consulting engineer and Grant applicant/recipient determine that the maximum recommended allowance calculated using Table 2 in this Subchapter does not adequately reflect the nature, scope, and complexity of the services required for the project, the consulting engineer may submit a detailed cost proposal, in such format as required by the Department, justifying a compensation amount greater than Table 2 recommends. If in the Department's opinion the detailed cost proposal justifies such, the Department will approve an allowance for construction phase professional services greater than those recommended in Table 2. The decision of the Department in this matter will be final.

Although Table 2 shows engineering and Grant administration as separate costs, the Grant applicant/recipient is not required by these regulations to contract for these services separately. The Grant applicant/recipient may wish to have the consulting engineer provide both scopes of services, and under such an

arrangement, the engineer's contract should not exceed the total of the suggested ranges for both services.

The estimated and final allowances will be determined in accordance with this Subchapter. All allowance percentages will be calculated to four decimal places using linear interpolation. The allowance amount is computed by applying the resulting total allowance percentage to the initial allowable building cost, which is the initial award amount of all prime contracts for construction, equipment, supplies, and testing of the project.

The estimated allowances are to be based on the estimate of the initial allowable building cost from the facilities plan. The final allowances will be determined one time only for each project, based on the initial allowable as-bid cost, and will not be adjusted for subsequent cost increases or decreases.

Following execution of the Grant agreement, the Grant recipient may request and receive payment for the facilities planning and design allowance and the allowance for construction phase professional services, in accordance with the procedures described in Rule 5.3.21.3 of these regulations. Advances of allowances will not be provided.

Table 1

Recommended Allowances for Facilities Planning and Design

Allowable Building Cost Allowances as a Percentage of Building Cost Based Upon the Difficulty of the Project

Normal to Difficult $50,000 or less 11.7500% to 13.2000% $100,000 10.7500% to 12.2000% $150,000 10.0700% to 11.2519% $200,000 9.4000% to 10.5000% $300,000 8.7000% to 9.8042% $400,000 8.3000% to 9.6312% $500,000 8.0000% to 9.4417%

$600,000 7.8000% to 9.1467% $700,000 7.7000% to 9.0297% $800,000 7.5000% to 8.8089% $900,000 7.4000% to 8.7472% $1,000,000 7.2500% to 8.5673% $1,100,000 7.1030% to 8.3911% $1,200,000 6.9600% to 8.2185% $1,300,000 6.8200% to 8.0495% $1,400,000 6.6800% to 7.8840% $1,500,000 or greater

6.5400% to 7.7219%

Table 2

Recommended Allowances for Construction Phase Professional Services

Allowances as a Percentage of Building Cost

Based Upon the Difficulty of the Project

Estimated Building Cost Engineering Services Grant Administration Other Services Total Allowance for Professional Services

Normal to Difficult Normal to Difficult Normal to Difficult Normal to Difficult

$50,000 or less 6.4400% to 11.7250% 2.0700% to 3.7688% 0.6900% to 1.2563% 9.2000% to 16.7500% $100,000 5.7400% to 11.725% 1.8450% to 3.7688% 0.6150% to 1.2563% 8.2000% to 16.7500% $150,000 5.2850% to 11.725% 1.6988% to 3.7688% 0.5663% to 1.2563% 7.5500% to 16.7500% $200,000 4.8300% to 9.9400% 1.5525% to 3.1950% 0.5175% to 1.0650% 6.9000% to 14.2000% $300,000 4.4100% to 8.1690% 1.4175% to 2.6258% 0.4725% to 0.8753% 6.3000% to 11.6700% $400,000 4.0600% to 7.2800% 1.3050% to 2.3400% 0.4350% to 0.7800% 5.8000% to 10.4000% $500,000 3.8150% to 6.5800% 1.2263% to 2.1150% 0.4088% to 0.7050% 5.4500% to 09.4000% $600,000 3.5700% to 5.9500% 1.1475% to 1.9125% 0.3825% to 0.6375% 5.1000% to 08.5000% $700,000 3.4300% to 5.4600% 1.1025% to 1.7550% 0.3675% to 0.5850% 4.9000% to 07.8000%

$800,000 3.2900% to 5.0400% 1.0575% to 1.6200% 0.3525% to 0.5400% 4.7000% to 07.2000% $900,000 3.2200% to 4.6690% 1.0350% to 1.5008% 0.3450% to 0.5003% 4.6000% to 06.6700% $1,000,000 3.1500% to 4.4800% 1.0125% to 1.4400% 0.3375% to 0.4800% 4.5000% to 06.4000% $1,100,000

3.0815% to 4.2986%

0.9905% to 1.3817%

0.3302% to 0.4606%

4.4022% to 06.1409%

$1,200,000 3.0146% to 4.1246% 0.9690% to 1.3258% 0.3230% to 0.4419% 4.3066% to 5.8923% $1,300,000 2.9492% to 3.9577% 0.9479% to 1.2721% 0.3160% to 0.4240% 4.2131% to 5.6538% $1,400,000 2.8852% to 3.7975% 0.9274% to 1.2206% 0.3091% to 0.4069% 4.1217% to 5.4250% $1,500,000 or greater 2.8226% to 3.6438% 0.9073% to 1.1712% 0.3024% to 0.3904% 4.0323% to 5.2054%

Rule 5.6.1. Description of Environmental Impacts

The Registered Engineer is required to certify the environmental impact of the project as either low, moderate, or high. If the Registered Engineer determines that there is either a moderate or high impact, the Registered Engineer shall prepare an Environmental Review Report. The report shall bear the seal of the registered engineer responsible for preparation of the report and shall contain a description of the environmental impacts of the proposed project and any corresponding mitigative measures including, but not necessarily limited to, the following:

(1) Surface and groundwater resources; (2) Archaeological/historical/cultural resources; (3) Vegetative/wildlife resources; (4) Wetlands and navigable waterways; (5) Floodplains; (6) Prime or important farmlands; (7) Coastal zones; (8) Wild and scenic rivers; and (9) Air Quality.

Rule 5.6.2. Environmental Review.

The Registered Engineer will take one or more of the following actions pursuant to the review of the Environmental Review Report of Environmental Impacts:

1. Categorical Exclusion

The Registered Engineer will issue a Categorical Exclusion (CE) from environmental review if a project meets all of the following criteria:

A. The project includes minor rehabilitation of existing facilities, functional replacement of equipment, or construction of new ancillary facilities adjacent or appurtenant to existing facilities. B. The project will not have a significant adverse effect on the environment. C. The project will not adversely affect cultural resources, habitats of endangered or threatened species, or environmentally important natural resource areas. D. The project is not expected to cause significant public controversy. The Department may revoke a categorical exclusion at any time if significant adverse information becomes available.

2. Finding of No Significant Impact (FONSI) on the Environment

The Registered Engineer will issue a Finding of No Significant Impact (FONSI) and an Environmental Assessment (EA) when, based upon review of the environmental impacts in the Environmental Review Report, it appears that a project will not have a significant adverse environmental impact, but does not qualify for a CE.

3. Amendment to a Finding of No Significant Impact FONSI to the Environment FONSI amendments are occasionally needed to describe changes to proposed facilities that have already been described in a FONSI.

4. Environmental Impact Statement (EIS)

If the Registered Engineer determines that an environmental impact statement (EIS) is needed, the document will be prepared in general conformance as deemed appropriate by the Department.

5. No Further Action

The Registered Engineer will issue a CE, FONSI, or EIS on all ARPA RWAIG projects. If there are significant changes in the project after the issuance of the environmental documents, those changes will be described in an Amendment to a FONSI. Some changes are minor, however, and the Department may determine that a separate Amendment need not be issued. Such minor changes may include but are not limited to:

A. Adding work that would otherwise qualify for a categorical exclusion.

B. Changes in the size of pump stations, storage facilities, wells, distribution lines, etc.

C. Minor changes in the size of water treatment unit processes.

D. Minor rerouting of distribution lines when the new route

i) will be mostly on public property and

ii) will not adversely affect cultural resources, habitats of endangered or threatened species, or environmentally important natural resource areas.

All affected property owners shall be notified by the Grant recipient.

Copies of all necessary environmental actions should be issued to the appropriate intergovernmental review agencies listed in Subchapter 8; other agencies shall be contacted as needed. Copies shall also be sent to any individuals or groups requesting them. All environmental actions will also be published in an appropriate local newspaper or maintained at the grant recipients office location for review upon request.

All environmental actions should provide for at least a 30-day period from the day of issuance to receive comments from agencies, groups, or individuals. All such comments will be evaluated by the Registered Engineer before finalizing any environmental action.

Adverse comments received as a result of the environmental review process should be addressed in the following manner:

1. The Grant recipient should resolve the adverse comments

2. If the Grant recipient is unable to resolve the adverse comments and secure approval, the Department may comment on the unresolved issues and suggest a course of action.

Rule 5.7.1. Within this subchapter, Grant recipients should have an understanding of various miscellaneous elements that could affect the project(s) ability to proceed from application to design to construction to grant payment.

Procurement Requirements.

1. In the procurement of all construction, equipment, materials, supplies, professional services and non-professional services and all other costs related to the ARPA RWAIG project, all Grant recipients shall comply with state purchasing laws as they apply to local governments. Procurement of professional services exceeding the Simplified Acquisition Threshold (SAT) of $250,000 will require the grant recipient to seek those services under the federal procurement requirements as outlined in the federal Uniform Grant Guidance as distributed by the Office of Management and Budget.

2. The procurement and conduct of all professional engineering and land surveying services shall also be in accordance with the Code of Conduct and other guidance and interpretations established by the Mississippi State Board of Registration for Professional Engineers and Land Surveyors.

3. The procurement of all construction contracts shall also be in accordance with the rules and regulations of the State Board of Contractors and other guidance and interpretations established by the Mississippi State Board of Contractors.

4. All Grant recipients shall submit a procurement certification, as required by the Department, indicating that all the above referenced requirements have been met. Should it be determined that any of the above procurement requirements are violated, the Department may determine that the related costs are unallowable and may require repayment of all ARPA RWAIG funds paid for such costs, in accordance with Rule 5.3.21.4 of these regulations.

The Department is prohibited from entering into Grant agreements with Grant applicants that have been debarred or suspended by any state or federal agency.

Grant recipients are prohibited from entering into contractual agreements with individuals, businesses, organizations, or any other entities that have been debarred or suspended by any state or federal agency. Additionally, grant recipients are responsible for ensuring that prime contractors utilized on the project are not debarred or suspended. Likewise, prime contractors are responsible for ensuring that subcontractors utilized on the project are not debarred or suspended.

Anyone may contact the Board concerning the existence of a cause for debarment or suspension. The Department may refer the matter to the State Attorney General or other appropriate office for further investigation. If, after review or investigation, the Board reasonably believes that a cause for debarment exists, the Board may propose debarment or suspension and may initiate procedures similar to, but not necessarily identical to, federal regulation 40 CFR Part 32: Debarment and Suspension Under EPA Assistance Programs.

Such above-described debarment or suspension actions will not affect existing executed contractual agreements, unless such agreements have been terminated or suspended under the terms of the agreement by the Grant recipient.

Only ARPA RWAIG recipients may submit a notice of dispute (disagreement) with a decision made by the Department, with the exception of decisions regarding Subchapter 6, Environmental Review Process, of these regulations. The following procedures will be used to resolve disputes between the Grant recipient and the Department.

1. The Grant recipient shall submit a written notice of dispute with a Department decision, including a summary of the dispute and reasons the Grant recipient believes the Department decision should be reversed. 2. The Department will then render a written decision on the dispute and will include reasons for the decision. 3. Should the Grant recipient desire to appeal the second Department decision, a request for an informal hearing shall be received by the Department within 30 days after the date of that decision. Upon receipt of

such a request, an informal hearing will be held with staff members, as designated by the State Health Officer, and the affected parties. The State Health Officer, or his designee, will render a decision on the appeal as a result of the informal hearing. 4. Appeals of the above formal hearing decision may be made to the Chancery Court in accordance with state law.

The Grant recipient is responsible for preventing, detecting, and prosecuting waste, fraud, abuse, and all other corrupt practices which occur in relation to the ARPA RWAIG project.

If the Grant recipient becomes aware of allegations, evidence, or the appearance of corrupt practices, the Grant recipient shall:

1. Immediately inform the Department in writing; and

2. Promptly pursue available state and local legal, administrative, and contractual remedies.

The Department may disallow costs under the Grant agreement where it is determined that such costs are related to waste, fraud, abuse or other corrupt practices. The Department may also require repayment of ARPA RWAI Grant funds paid for such costs in accordance with Rule 5.3.21.4 of these regulations.

All ARPA RWAIG recipients shall maintain project accounts in accordance with generally accepted government accounting standards, as defined by the Guidelines of the Municipal Accounting and Audit Manual, as prescribed by the State Auditor's Office. Charges to the project account shall be properly supported, related to eligible construction costs, and documented by appropriate records. These project accounts shall be maintained as separate accounts.

All contracts for professional services, construction, equipment, and supplies shall include an access to audit clause which gives the Department and its representatives access to and the right to audit, inspect, copy and examine books, financial records and other documents relating directly to the receipt and disbursement of ARPA RWAIG funds.

contract. The protest shall be filed with the Grant recipient by a party with a direct financial interest adversely affected by a Grant recipient's procurement action and shall be filed in accordance with and within the time frame established by the Grant recipient's protest procedures.

2. Any delay due to a protest or protest resolution will not relieve the Grant recipient of the requirement to meet the project schedule established in the Grant agreement, nor will such delays prevent the Department from pursuing the remedies for default established in the Grant agreement.

The Grant recipient shall comply with the applicable related state laws and regulations regarding Mississippi Safe Drinking Water Act and Operator Certification during the planning, design, construction, and operation of the project.

The following requirements apply to those drinking water treatment facilities that have or will construct wastewater treatment facilities necessary to treat waste generated by their drinking water treatment facilities.

The Grant recipient shall ensure that all current applicable regulations of the Commission on Environmental Quality and the Environmental Quality Permit Board are complied with during the planning, design, and construction of any wastewater treatment facilities associated with this ARPA RWAIG project. It is the Grant recipient's responsibility to ensure that the project is in compliance with these regulations and all future amendments.

The following outlines the Department's guidance for compliance with the Intergovernmental Review concerns for ARPA RWAIG projects.

1. Mississippi Department of Archives and History (for archaeological/cultural review)

2. Mississippi Natural Heritage Program (for vegetative/wildlife review)

3. U.S. Army Corps of Engineers, Regulatory Functions Branch [for Section 404 (wetlands), Section 10 (navigable waterways), and floodplain impact review]

4. Mississippi Department of Marine Resources (Jackson, Harrison, and Hancock County Projects Only; for shellfish review and Mississippi Coastal Program review)

5. U.S. Fish and Wildlife Service (Jackson, Harrison, and Hancock County projects only; for Coastal Barriers Resources Act review)

6. U.S. Forest Service (projects located in a designated Wild and Scenic River Basin only; for Wild and Scenic Rivers review)

During preparation of the plans and specifications, the Registered Engineer will ensure that the appropriate intergovernmental review agencies have been consulted about the proposed project area concerning the existence of any known or possible archaeological/cultural sites, endangered vegetation/wildlife, wetlands, floodplain impacts, wild/scenic river impacts, shellfish/coastal program impacts, or coastal barriers resources impact. The Registered Engineer will certify during the plans, specifications, and contract documents phase, that the proposed project components have been evaluated through a intergovernmental review process and that no concerns have been discovered that would prevent the project from moving forward and that the project has been cleared. If feasible, the project should avoid negative impacts on areas for which a concern has been expressed by an intergovernmental review agency. If it is not feasible to avoid negative impacts on these areas, the appropriate intergovernmental review agency should be consulted concerning the probability of obtaining clearance to construct the selected plan.

**History**
- *Source: House Bill 1421, 2022 Regular Session Rule 5.4.8. Real Property*
- *Source: House Bill 1421, 2022 Regular Session Rule 5.4.9. Miscellaneous Costs*
- *Source: House Bill 1421, 2022 Regular Session Rule 5.4.10. Project Income*
- *Source: House Bill 1421, 2022 Regular Session Subchapter 5. Recommended Allowances for Planning, Design and Construction Phase Professional Services*
- *Source: House Bill 1421, 2022 Regular Session Rule 5.5.2. Recommended Allowance for Construction Phase Professional Services.*
- *Source: House Bill 1421, 2022 Regular Session Rule 5.5.3. General Guidance for Use of the Allowance Tables.*
- *Source: House Bill 1421, 2022 Regular Session Subchapter 6. Environmental Review Process*
- *Source: House Bill 1421, 2022 Regular Session*
- *Source: House Bill 1421, 2022 Regular Session Rule 5.6.3. Issuance of the Environmental Action.*
- *Source: House Bill 1421, 2022 Regular Session Rule 5.6.4. Resolution of Adverse Comments.*
- *Source: House Bill 1421, 2022 Regular Session Subchapter 7. Miscellaneous Requirements for ARPA RWAIG recipients*
- *Source: House Bill 1421, 2022 Regular Session Rule 5.7.2. Debarment and Suspension*
- *Source: House Bill 1421, 2022 Regular Session Rule 5.7.3. ARPA RWAIG Dispute Procedures*
- *Source: House Bill 1421, 2022 Regular Session Rule 5.7.4. Waste Fraud and Abuse*
- *Source: House Bill 1421, 2022 Regular Session Rule 5.7.5. ARPA RWAIG Recipient Accounting and Auditing Requirements*
- *Source: House Bill 1421, 2022 Regular Session Rule 5.7.6. ARPA RWAIG Procurement Protest Procedures 1. Prior to advertisement for bids, the Grant recipient should consider establishing its own procedures for prompt consideration of initial protests concerning solicitations or contract awards. A "protest" is a written complaint concerning the Grant recipient's solicitation or award of a*
- *Source: House Bill 1421, 2022 Regular Session Rule 5.7.7. Related State Laws and Regulations*
- *Source: House Bill 1421, 2022 Regular Session Rule 5.7.8. National Pollutant Discharge Elimination System (NPDES) and Siting Criteria Regulations*
- *Source: House Bill 1421, 2022 Regular Session Subchapter 8. Intergovernmental Review Process*
- *Source: House Bill 1421, 2022 Regular Session Rule 5.8.1. Intergovernmental Review Agencies:*
- *Source: House Bill 1421, 2022 Regular Session Rule 5.8.2. Planning and Design*
- *Source: House Bill 1421, 2022 Regular Session*

### **Part 21** Division of Radiological Health

##### **15 Miss. Admin. Code Pt. 21, R. 1.1.2** Definitions {#sec-21-1.1.2 omnilex-key=us-ms-regs-official--title-15--21#1.1.2}

As used in these regulations, these terms have the definitions set forth below. Additional definitions used only in a certain section will be found in that section.

1. "A

" means the maximum activity of special form radioactive material permitted in a Type A package. "A

" means the maximum activity of radioactive material, other than special form, LSA and SCO material, permitted in a Type A package. These values are either listed in Appendix A, Table A-1 of Subchapter 13 of these regulations or may be derived in accordance with the procedure prescribed in Appendix A of Subchapter 13 of these regulations.

2. "Absorbed dose" means the energy imparted to matter by ionizing radiation per unit mass of irradiated material at the place of interest. The units of absorbed dose are the rad and the gray (Gy).

3. "Accelerator" means any machine capable of accelerating electrons, protons, deuterons, or other charged particles in a vacuum and of discharging the resultant particulate or other radiation into a medium at energies usually in excess of 1 MeV. For purposes of this definition, "particle accelerator" is an equivalent term.

4. "Accelerator-produced radioactive material" means any material made radioactive by a particle accelerator.

5. “Acute” as used in this part, means a single radiation dose or multiple radiation dose occurring within a short time (24 hours or less).

6. "Act" means the Mississippi Radiation Protection Law of 1976.

Attention is directed to the fact that regulation by the State of source material, byproduct material, and special nuclear material in quantities not sufficient to form a critical mass is subject to the provisions of the agreement between State and the U.S. Nuclear Regulatory Commission and to 10 CFR Part 150 of the Commission’s regulations.

7. "Activity" means the rate of disintegration (transformation) or decay of radioactive material. The units of activity are the curie (Ci) and the becquerel (Bq).

8. "Adult" means an individual 18 or more years of age.

9. "Agency" means the Mississippi State Department of Health.

10. "Agreement State" means any State with which the U.S. Nuclear Regulatory Commission or the U.S. Atomic Energy Commission has entered into an effective agreement under Subchapter 274b. of the Atomic Energy Act of 1954, as amended (73 Stat. 689).

11. "Airborne radioactive material" means any radioactive material dispersed in the air in the form of dusts, fumes, particulates, mists, vapors, or gases.

12. "Airborne radioactivity area" means a room, enclosure, or area in which airborne radioactive materials exist in concentrations:

a. in excess of the derived air concentrations (DACs) specified in Subchapter 4 (10 CFR Part 20, Appendix B, Table 1) of these regulations; or

b. to such a degree that an individual present in the area without respiratory protective equipment could exceed, during the hours an individual is present in a week, an intake of 0.6 percent of the annual limit on intake (ALI) or 12 DAC- hours.

13. "Alert" means events may occur, are in progress, or have occurred that could lead to a release of radioactive material but that the release is not expected to require a response by offsite response organizations to protect persons offsite.

14. "As low as is reasonably achievable" (ALARA) means making every reasonable effort to maintain exposures to radiation as far below the dose limits in these regulations as is practical, consistent with the purpose for which the licensed or registered activity is undertaken, taking into account the state of technology, the economics of improvements in relation to state of technology, the economics of improvements in relation to benefits to the public health and safety, and other societal and socioeconomic considerations, and in relation to utilization of nuclear energy and licensed or registered sources of radiation in the public interest.

15. "Becquerel" (Bq) means the SI unit of activity. One becquerel is equal to 1 disintegration or transformation per second (dps or tps).

16. "Bioassay" means the determination of kinds, quantities or concentrations, and, in some cases, the locations of radioactive material in the human body, whether by direct measurement, in vivo counting, or by analysis and evaluation of materials excreted or removed from the human body. For purposes of these regulations, "radiobioassay" is an equivalent term.

17. "Brachytherapy" means a method of radiation therapy in which sealed sources are utilized to deliver a radiation dose at a distance of up to a few centimeters, by surface, intracavitary, or interstitial application.

18. "Byproduct material" means:

a. Any radioactive material, except special nuclear material, yielded in or made radioactive by exposure to the radiation incident to the process of producing or utilizing special nuclear material;

b. The tailings or wastes produced by the extraction or concentration of uranium or thorium from ore processed primarily for its source material content, including discrete surface wastes resulting from uranium solution extraction processes. Underground ore bodies depleted by these solution extraction operations do not constitute "byproduct material" within this definition;

c. Any discrete source of radium-226 that is produced, extracted, or converted after extraction, for use for a commercial, medical, or research activity;

d. Any material that has been made radioactive by use of a particle accelerator; and is produced, extracted, or converted after extraction, for use for a commercial, medical, or research activity; and

e. Any discrete source of naturally occurring radioactive material, other than source material, that the Nuclear Regulatory Commission, in consultation with the Administrator of the Environmental Protection Agency, the Secretary of Energy, the Secretary of Homeland Security, and the head of any other appropriate Federal agency, determines would pose a threat similar to the threat posed by a discrete source of radium-226 to the public health and safety or the common defense and security; and is extracted or converted after extraction for use in a commercial, medical, or research activity.

19. "Calendar quarter" means not less than 12 consecutive weeks nor more than 14 consecutive weeks. The first calendar quarter of each year shall begin in January and subsequent calendar quarters shall be so arranged such that no day is included in more than one calendar quarter and no day in any one year is omitted from inclusion within a calendar quarter. No licensee or registrant shall change the method observed by him of determining calendar quarters for purposes of these regulations except at the beginning of a year.

20. "Calibration" means the determination of (1) the response or reading of an instrument relative to a series of known radiation values over the range of the instrument, or (2) the strength of a source of radiation relative to a standard.

21. "CFR" means Code of Federal Regulations”

22. "Chelating agent" means amine polycarboxylic acids, hydroxycarboxylic acids, gluconic acid, and polycarboxylic acids.

23. "Collective dose" means the sum of the individual doses received in a given period of time by a specified population from exposure to a specified source of radiation.

24. "Committed dose equivalent" (HT,50) means the dose equivalent to organs or tissues of reference (T) that will be received from an intake of radioactive material by an individual during the 50-year period following the intake. "Committed

effective dose equivalent" (H E, 50 ) is the sum of the products of the weighting factors applicable to each of the body organs or tissues that are irradiated and the committed dose equivalent to each of these organs or tissues (H E,50 = Σ w T H T,50 ).

25. “Consortium” means an association of medical use licensees and a PET radionuclide production facility in the same geographical area that jointly own or share in the operation and maintenance cost of the PET radionuclide production facility that produces PET radionuclides for use in producing radioactive drugs within the consortium for noncommercial distributions among its associated members for medical use. The PET radionuclide production facility within the consortium must be located at an educational institution or a Federal facility or a medical facility.

26. "Controlled area" means an area, outside of a restricted area but inside the site boundary, access to which can be limited by the licensee or registrant for any reason.

27. “Critical Group” means the group of individuals reasonably expected to receive the greatest exposure to residual radioactivity for any applicable set of circumstances.

28. "Curie" means a unit of quantity of radioactivity. One curie (Ci) is that quantity of radioactive material which decays at the rate of 3.7E+10 transformations per second (tps). Commonly used submultiples of the curie are the millicurie and the microcurie. One millicurie (mCi) = 0.001 curie = 3.7E+7 tps. One microcurie (Ci) = 0.000001 curie = 3.7E+4 tps (See 1.1.16 for SI equivalent becquerel).

29. "Decommission" means to remove a facility or site safely from service and reduce residual radioactivity to a level that permits:

a. Release of the property for unrestricted use and termination of the license; or

b. Release of the property under restricted conditions and termination of the license.

30. "Deep dose equivalent" (H d ), which applies to external whole body exposure, means the dose equivalent at a tissue depth of 1 centimeter (1000 mg/cm

).

31. "Depleted uranium" means the source material uranium in which the isotope uranium-235 is less than 0.711 weight percent of the total uranium present. Depleted uranium does not include special nuclear material.

32. “Discrete source” means a radionuclide that has been processed so that its concentration within a material has been purposely increased for use for commercial, medical, or research activities.

33. “Distinguishable from background” means that the detectable concentration of a radionuclide is statistically different from the background concentration of that radionuclide in the vicinity of the site or, in the case of structures, in similar materials using adequate measurements technology, survey, and statistical techniques.

34. "Dose" is a generic term that means absorbed dose, dose equivalent, effective dose equivalent, committed dose equivalent, committed effective dose equivalent, total

organ dose equivalent, or total effective dose equivalent. For purposes of these regulations, "radiation dose" is an equivalent term.

35. “Dose Commitment” means the total radiation dose to a part of the body that will result from retention in the body of radioactive material. For purposes of estimating the dose commitment, it is assumed that from the time of intake the period of exposure to retained material will not exceed 50 years.

36. "Dose equivalent (H T )" means the product of the absorbed dose in tissue, quality factor, and all other necessary modifying factors at the location of interest. The units of dose equivalent are the rem and the sievert (Sv).

37. "Dose limits" means the permissible upper bounds of radiation doses established in accordance with these regulations. For purposes of these regulations, "limits" is an equivalent term.

38. "Effective dose equivalent (H E )" means the sum of the products of the dose equivalent to each organ or tissue (H T ) and the weighting factor (w T ) applicable to each of the body organs or tissues that are irradiated (H E = Σ w T H T ).

39. "Embryo/fetus" means the developing human organism from conception until the time of birth.

40. "Entrance or access point" means any opening through which an individual or extremity of an individual could gain access to radiation areas or to sources of radiation. This includes entry or exit portals of sufficient size to permit human entry, irrespective of their intended use.

41. "Explosive material" means any chemical compound, mixture, or device which produces a substantial instantaneous release of gas and heat spontaneously or by contact with sparks or flame.

42. "Exposure" means being exposed to ionizing radiation or to radioactive material.

43. "Exposure" means the quotient of dQ by dm where "dQ" is the absolute value of the total charge of the ions of one sign produced in air when all the electrons (negatrons and positrons) liberated by photons in a volume element of air having mass "dm" are completely stopped in air. The SI unit of exposure is the coulomb per kilogram (C/kg). The special unit of exposure is the roentgen (R) (See 1.1.15 for SI equivalent coulomb per kilogram).

"When not underlined as above or indicated as 'exposure' (x), the term 'exposure' has a more general meaning in these regulations."

44. "Exposure rate" means the exposure per unit of time, such as roentgen per minute and milliroentgen per hour.

45. "External dose" means that portion of the dose equivalent received from any source of radiation outside the body.

46. "Extremity" means hand, elbow, arm below the elbow, foot, knee, and leg below the knee.

47. "Former U.S. Atomic Energy Commission (AEC) or U.S. Nuclear Regulatory Commission (NRC) licensed facilities" means nuclear reactors, nuclear fuel reprocessing plants, uranium enrichment plants, or critical mass experimental facilities where AEC or NRC licenses have been terminated.

48. "Generally applicable environmental radiation standards" means standards issued by the U.S. Environmental Protection Agency (EPA) under the authority of the Atomic Energy Act of 1954, as amended, that impose limits on radiation exposures or levels, or concentrations or quantities of radioactive material, in the general environment outside the boundaries of locations under the control of persons possessing or using radioactive material.

49. "Gray" (Gy) means the SI unit of absorbed dose. One gray is equal to an absorbed dose of 1 joule per kilogram (100 rads).

50. "Hazardous waste" means those wastes designated as hazardous by the U.S. Environmental Protection Agency regulations in 40 CFR Part 261.

51. "Healing arts" means the professional disciplines authorized by the laws of this state to use sources of radiation in the diagnosis or treatment of human or animal diseases.

52. "High radiation area" means an area, accessible to individuals, in which radiation levels from radiation sources external to the body could result in an individual receiving a dose equivalent in excess of 0.1 rem (1 millisievert) in 1 hour at 30 centimeters from any source of radiation or 30 centimeters from any surface that the radiation penetrates.

53. "Human use" means the internal or external administration of radiation or radioactive material to human beings.

54. "Individual" means any human being.

55. "Individual monitoring" means the assessment of:

a. Dose equivalent: (a) by the use of individual monitoring devices, or (b) by the use of survey data; or

b. Committed effective dose equivalent: (a) by bioassay, or (b) by determination of the time-weighted air concentrations to which an individual has been exposed, that is, DAC-hours. (See the definition of DAC-hours in Subchapter 4).

56. "Individual monitoring devices" (individual monitoring equipment) means devices designed to be worn by a single individual for the assessment of dose equivalent such as film badges, thermoluminescence dosimeters (TLDs), optically stimulated luminescence dosimeters (OSLs), pocket ionization chambers, and personal (“lapel”) air sampling devices

57. "Inspection" means an official examination or observation including, but not limited to, tests, surveys, and monitoring to determine compliance with rules, regulations, orders, requirements, and conditions of the Agency.

58. "Interlock" means a device arranged or connected such that the occurrence of an event or condition is required before a second event or condition can occur or continue to occur.

59. "Internal dose" means that portion of the dose equivalent received from radioactive material taken into the body

60. “Lens dose equivalent” (LDE) applies to the external exposure of the lens of the eye and is taken as the dose equivalent at a tissue depth of 0.3 centimeter (300 mg/cm

).

61. "License" means a license issued by the Agency in accordance with the regulations adopted by the Agency.

62. "Licensed material" means radioactive material received, possessed, used, transferred or disposed of under a general or specific license issued by the Agency.

63. "Licensee" means any person who is licensed by the Agency in accordance with these regulations and the Act.

64. "Licensing State" means any State with regulations equivalent to the Suggested State Regulations for Control of Radiation relating to, and an effective program for, the regulatory control of NARM and which has been granted final designation by the Conference of Radiation Control Program Directors, Inc.

65. "Limits" See "Dose limits".

66. "Lost or missing source of radiation" means a source of radiation whose location is unknown. This definition includes licensed material that has been shipped but has not reached its planned destination and whose location cannot be readily traced in the transportation system.

67. “Lot Tolerance Percent Defective” means the poorest quality in an individual inspection lot that should be accepted, expressed in percent defective.

68. "Major processor" means a user processing, handling, or manufacturing radioactive material exceeding Type A quantities as unsealed sources or material, or exceeding 4 times Type B quantities as sealed sources, but does not include nuclear medicine programs, universities, industrial radiographers, or small industrial programs. Type A and B quantities are defined in Subchapter 13 (10 CFR 71.4) of these regulations.

69. "Member of the public" means any individual except when that individual is receiving an occupational dose.

70. "Minor" means an individual less than 18 years of age.

71. "NARM" means any naturally occurring or accelerator-produced radioactive material. It does not include byproduct, source, or special nuclear material.

72. “Nationally tracked source” means a sealed source containing a quantity equal to or greater than Category 1 or Category 2 levels of any radioactive material listed in Subchapter 4 (10 CFR Part 20, Appendix E) of these regulations. In this context a sealed source is defined as radioactive material that is sealed in a capsule or closely bonded, in a solid form and which is not exempt from regulatory control. It does not mean material encapsulated solely for disposal, or nuclear material contained in any fuel assembly, subassembly, fuel rod, or fuel pellet. Category 1 nationally tracked sources are those containing radioactive material at a quantity equal to or greater than the Category 1 threshold. Category 2 nationally tracked sources are those containing radioactive material at a quantity equal to or greater than the Category 2 threshold but less than the Category 1 threshold.

73. "Natural radioactivity" means radioactivity of naturally occurring nuclides.

74. "Nuclear Regulatory Commission" (NRC) means the U.S. Nuclear Regulatory Commission or its duly authorized representatives.

75. "Occupational dose" means the dose received by an individual in the course of employment in which the individual's assigned duties involve exposure to radiation and/or radioactive material from licensed and unlicensed sources of radiation, whether in the possession of the licensee, registrant, or other person. Occupational dose does not include doses from background radiation, from any medical administration the individual has received, from exposure to individuals administered radioactive material and released in accordance with Subchapter 7 (10 CFR 35.75) of these regulations, from voluntary participation in medical research programs, or as a member of the public.

76. “Offshore Waters” means that area of land and water, beyond Agreement States' Submerged Lands Act jurisdiction, on or above the U.S. Outer Continental Shelf.

77. "Package" means the packaging together with its radioactive contents as presented for transport.

78. "Particle accelerator" See "Accelerator".

79. "Person" means any individual, corporation, partnership, firm, association, trust, estate, public or private institution, group, agency, political subdivision of this State, any other State or political subdivision or agency thereof, and any legal successor, representative, agent, or agency of the foregoing, other than the NRC and federal government agencies licensed or exempted by the NRC.

80. "Personnel monitoring equipment" See "Individual monitoring devices".

81. "Pharmacist" means an individual licensed by this State to compound and dispense drugs, prescriptions, and poisons.

82. "Physician" means an individual licensed by this State to dispense drugs in the practice of medicine.

83. "Principal activities" means activities authorized by the license which are essential to achieving the purpose(s) for which the license was issued or amended. Storage

during which no licensed material is accessed for use or disposal and activities incidental to decontamination or decommissioning are not principal activities.

84. "Public dose" means the dose received by a member of the public from exposure to radiation and/or radioactive material released by a licensee, or to any other source of radiation under the control of the licensee or registrant. Public dose does not include occupational dose or doses received from background radiation, from any medical administration the individual has received, from exposure to individuals administered radioactive material and released in accordance with Subchapter 7 (10 CFR 35.75) of these regulations, or from voluntary participation in medical research programs.

85. "Pyrophoric liquid" means any liquid that ignites spontaneously in dry or moist air at or below 130 ºF (54.4 ºC). A pyrophoric solid is any solid material, other than one classed as an explosive, which under normal conditions is liable to cause fires through friction, retained heat from manufacturing or processing, or which can be ignited readily and, when ignited, burns so vigorously and persistently as to create a serious transportation, handling, or disposal hazard. Included are spontaneously combustible and water-reactive materials.

86. "Qualified expert" means an individual having the knowledge and training to measure ionizing radiation, to evaluate safety techniques, and to advise regarding radiation protection needs, for example, individuals certified in the appropriate field by the American Board of Radiology or the American Board of Health Physics, or those having equivalent qualifications. With reference to the calibration of radiation therapy equipment, an individual having, in addition to the above qualifications, training and experience in the clinical applications of radiation physics to radiation therapy, for example, individuals certified in Therapeutic Radiological Physics or X-Ray and Radium Physics by the American Board of Radiology, or those having equivalent qualifications.

87. "Quality factor" (Q) means the modifying factor, listed in Tables I and II of 1.1.15, that is used to derive dose equivalent from absorbed dose.

88. "Rad" means the special unit of absorbed dose. One rad is equal to an absorbed dose of 100 ergs per gram or 0.01 joule per kilogram (0.01 gray).

89. "Radiation" means gamma rays and x-rays, alpha and beta particles, high speed electrons, neutrons, high speed protons and other atomic particles and electromagnetic radiation consisting of associated and interacting electric and magnetic waves and ultrasonic waves.

90. "Radiation area" means any area, accessible to individuals, in which radiation levels could result in an individual receiving a dose equivalent in excess of 0.005 rem (0.05 millisievert) in 1 hour at 30 centimeters from the source of radiation or from any surface that the radiation penetrates.

91. "Radiation dose" See "Dose".

92. "Radiation machine" means any device capable of producing radiation except, those devices with radioactive material as the only source of radiation.

93. "Radioactive material" means any solid, liquid, or gas which emits radiation spontaneously.

94. "Radioactivity" means the transformation of unstable atomic nuclei by the emission of radiation.

95. "Radiobioassay" See "Bioassay".

96. "Registrant" means any person who is registered with the Agency and is legally obligated to register with the Agency pursuant to these regulations and the Act.

97. "Registration" means registration with the Agency in accordance with the regulations adopted by the Agency.

98. "Regulations of the U.S. Department of Transportation" means the regulations in 49 CFR Parts 100-189.

99. “Residual radioactivity” means radioactivity in structures, materials, soils, groundwater, and other media at a site resulting from activities under the licensee(s control. This includes radioactivity from all licensed and unlicensed sources used by the licensee, but excludes background radiation. It also includes radioactive materials remaining at the site as a result of routine or accidental releases of radioactive material at the site and previous burials at the site, even if those burials were made in accordance with the provisions of Subchapter 4 of these regulations.

100. "Rem" means the special unit of any of the quantities expressed as dose equivalent. The dose equivalent in rem is equal to the absorbed dose in rad multiplied by the quality factor (1 rem = 0.01 sievert).

101. "Research and development" means (1) theoretical analysis, exploration, or experimentation; or (2) the extension of investigative findings and theories of a scientific or technical nature into practical application for experimental and demonstration purposes, including the experimental production and testing of models, devices, equipment, materials, and processes. Research and development does not include the internal or external administration of radiation or radioactive material to human beings.

102. "Roentgen" means the special unit of exposure. One roentgen (R) equals 2.58E-4 coulomb per kilogram of air (see "Exposure" and 1.1.15).

103. "Sealed source" means any radioactive material that is encased in a capsule designed to prevent leakage or escape of the radioactive material.

104. "Shallow dose equivalent" (H s ), which applies to the external exposure of the skin of the whole body or the skin of an extremity, means the dose equivalent at a tissue depth of 0.007 centimeter (7 mg/cm

).

105. "SI" means the abbreviation for the International System of Units

106. "Sievert" (Sv) means the SI unit of any of the quantities expressed as dose equivalent. The dose equivalent in sievert is equal to the absorbed dose in gray multiplied by the quality factor (1 sievert = 100 rems).

107. "Site area emergency" means events may occur, are in progress, or have occurred that could lead to a significant release of radioactive material and that could require a response by offsite response organizations to protect persons offsite.

108. "Site boundary" means that line beyond which the land or property is not owned, leased, or otherwise controlled by the licensee or registrant.

109. "Source material" means:

a. Uranium or thorium, or any combination thereof, in any physical or chemical form; or

b. Ores that contain by weight one-twentieth of 1 percent (0.05 percent) or more of uranium, thorium or any combination of uranium and thorium. Source material does not include special nuclear material.

110. "Source material milling" means any activity that results in the production of byproduct material as defined by definition (2) of byproduct material.

111. "Source of radiation" means any radioactive material or any device or equipment emitting, or capable of producing, radiation.

112. "Special form radioactive material" means radioactive material that satisfies the following conditions:

a. It is either a single solid piece or is contained in a sealed capsule that can be opened only by destroying the capsule;

b. The piece or capsule has at least one dimension not less than 5 millimeters (0.2 inch); and

c. It satisfies the test requirements specified by the U.S. Nuclear Regulatory Commission. A special form encapsulation designed in accordance with the U.S. Nuclear Regulatory Commission requirements in effect on June 30, 1983, and constructed prior to July 1, 1985, may continue to be used. A special form encapsulation designed in accordance with the Nuclear Regulatory Commission requirements in effect on March 31, 1996, and constructed prior to April 1, 1998, may continue to be used. A special form encapsulation either designed or constructed after April 1, 1998, must meet requirements of this definition applicable at the time of its design or construction.

113. "Special nuclear material" means:

a. Plutonium, uranium-233, uranium enriched in the isotope 233 or in the isotope 235, and any other material that the U.S. Nuclear Regulatory Commission, pursuant to the provisions of section 51 of the Atomic Energy Act of 1954, as amended, determines to be special nuclear material, but does not include source material; or

b. Any material artificially enriched by any of the foregoing but does not include source material.

114. "Special nuclear material in quantities not sufficient to form a critical mass" means uranium enriched in the isotope U-235 in quantities not exceeding 350 grams of contained U-235; uranium-233 in quantities not exceeding 200 grams; plutonium in quantities not exceeding 200 grams; or any combination of them in accordance with the following formula: For each kind of special nuclear material, determine the ratio between the quantity of that special nuclear material and the quantity specified above for the same kind of special nuclear material. The sum of such ratios for all of the kinds of special nuclear material in combination shall not exceed 1. For example, the following quantities in combination would not exceed the limitation and are within the formula:

175(grams contained U - 235)

##### **15 Miss. Admin. Code Pt. 21, R. 50** (grams U - 233) {#sec-21-50 omnilex-key=us-ms-regs-official--title-15--21#50}

##### **15 Miss. Admin. Code Pt. 21, R. 50** (grams Pu) {#sec-21-50 omnilex-key=us-ms-regs-official--title-15--21#50}

##### **15 Miss. Admin. Code Pt. 21, R. 350** 200 200 {#sec-21-350 omnilex-key=us-ms-regs-official--title-15--21#350}

115. "Survey" means an evaluation of the radiological conditions and potential hazards incident to the production, use, transfer, release, disposal, or presence of sources of radiation. When appropriate, such evaluation includes, but is not limited to, tests, physical examinations, calculations, and measurements of levels of radiation or concentrations of radioactive material present.

116. "Test" means the process of verifying compliance with an applicable regulation.

117. "These regulations" mean all sections of the Mississippi State Department of Health Regulations for Control of Radiation, Subpart 78 – Radiological Health.

118. "Total effective dose equivalent" (TEDE) means the sum of the effective dose equivalent for external exposures and the committed effective dose equivalent for internal exposures.

119. "Total organ dose equivalent" (TODE) means the sum of the deep dose equivalent and the committed dose equivalent to the organ receiving the highest dose as described in Subchapter 4 (10 CFR 20.2104) of these regulations.

120. "U.S. Department of Energy" means the Department of Energy established by Public Law 95-91, August 4, 1977, 91 Stat. 565, 42 U.S.C. 7101 et seq., to the extent that the Department exercises functions formerly vested in the U.S. Atomic Energy Commission, its Chairman, members, officers and components and transferred to the U.S. Energy Research and Development Administration and to the Administrator thereof pursuant to sections 104(b), (c) and (d) of the Energy Reorganization Act of 1974 (Public Law 93-438, October 11, 1974, 88 Stat. 1233 at 1237, 42 U.S.C. 5814, effective January 19, 1975) and retransferred to the Secretary of Energy pursuant to section 301(a) of the Department of Energy Organization Act (Public Law 95-91, August 4, 1977, 91 Stat. 565 at 577-578, 42 U.S.C. 7151, effective October 1, 1977).

121. "Unrefined and unprocessed ore" means ore in its natural form prior to any processing, such as grinding, roasting, beneficiating, or refining.

122. "Unrestricted area" means any area access to which is neither limited nor controlled by the licensee or registrant for purposes of protection of individuals from exposure to radiation and radioactive material. For purposes of these regulations, "uncontrolled area" is an equivalent term.

123. "Very high radiation area" means an area, accessible to individuals, in which radiation levels from radiation sources external to the body could result in an individual receiving an absorbed dose in excess of 500 rads (5 grays) in 1 hour at 1 meter from a source of radiation or from any surface that the radiation penetrates.

"Very high radiation area" means an area, accessible to individuals, in which radiation levels from radiation sources external to the body could result in an individual receiving an absorbed

124. "Waste" means those low-level radioactive wastes containing source, special nuclear, or byproduct material that are acceptable for disposal in a land disposal facility. For the purposes of this definition, low-level radioactive waste means

radioactive waste not classified as high-level radioactive waste, transuranic waste, spent nuclear fuel, or byproduct material as defined in paragraphs (b.), (c.), (d.) and (e.) of the definition of byproduct material set forth in this section.

125. "Waste handling licensees" mean persons licensed to receive and store radioactive wastes prior to disposal and/or persons licensed to dispose of radioactive waste.

126. "Week" means 7 consecutive days starting on Sunday.

127. "Whole body" means, for purposes of external exposure, head, trunk including male gonads, arms above the elbow, or legs above the knee.

128. "Worker" means an individual engaged in work under a license or registration issued by the Agency and controlled by a licensee or registrant, but does not include the licensee or registrant.

129. "Working level" (WL) means any combination of short-lived radon daughters in 1 liter of air that will result in the ultimate emission of 1.3E+5 MeV of potential alpha particle energy. The short-lived radon daughters are -- for radon-222: polonium- 218, lead-214, bismuth-214, and polonium-214; and for radon-220: polonium- 216, lead-212, bismuth-212, and polonium-212.

130. "Working level month" (WLM) means an exposure to 1 working level for 170 hours (2,000 working hours per year divided by 12 months per year is approximately equal to 170 hours per month).

131. "Year" means the period of time beginning in January used to determine compliance with the provisions of these regulations. The licensee or registrant may change the starting date of the year used to determine compliance by the licensee or registrant provided that the change is made at the beginning of the year and that no day is omitted or duplicated in consecutive years.

**History**
- *SOURCE: Miss. Code Ann. §45-14-11*

##### **15 Miss. Admin. Code Pt. 21, R. 1.1.3** Exemptions {#sec-21-1.1.3 omnilex-key=us-ms-regs-official--title-15--21#1.1.3}

1. The Agency may, upon application or upon its own initiative, grant such exemptions or exceptions from the requirements of these regulations as it determines are authorized by law and will not result in undue hazard to public health and safety or property. 2. U.S. Department of Energy Contractors and U.S. Nuclear Regulatory Commission Contractors. Any U.S. Department of Energy contractor or subcontractor and any U.S. Nuclear Regulatory Commission contractor or subcontractor of the following categories operating within this State is exempt from these regulations to the extent

that such contractor or subcontractor under his contract receives, possesses, uses, transfers, or acquires sources of radiation: a. prime contractors performing work for the U.S. Department of Energy at U.S. Government-owned or -controlled sites, including the transportation of sources of radiation to or from such sites and the performance of contract services during temporary interruptions of such transportation; b. prime contractors of the U.S. Department of Energy performing research in, or development, manufacture, storage, testing, or transportation of, atomic weapons or components thereof; c. prime contractors of the U.S. Department of Energy using or operating nuclear reactors or other nuclear devices in a United States Government- owned vehicle or vessel; and d. any other prime contractor or subcontractor of the U.S. Department of Energy or of the U.S. Nuclear Regulatory Commission when the State and the U.S. Nuclear Regulatory Commission jointly determine: i. that the exemption of the prime contractor or subcontractor is authorized by law; and ii. that, under the terms of the contract or subcontract, there is adequate assurance that the work thereunder can be accomplished without undue risk to the public health and safety.

**History**
- *SOURCE: Miss. Code Ann. §45-14-11*

##### **15 Miss. Admin. Code Pt. 21, R. 1.1.4** Records {#sec-21-1.1.4 omnilex-key=us-ms-regs-official--title-15--21#1.1.4}

Each licensee and registrant shall maintain records showing the receipt, transfer, and disposal of all sources of radiation. Additional record requirements are specified elsewhere in these regulations.

**History**
- *SOURCE: Miss. Code Ann. §45-14-11*

##### **15 Miss. Admin. Code Pt. 21, R. 1.1.5** Inspections {#sec-21-1.1.5 omnilex-key=us-ms-regs-official--title-15--21#1.1.5}

1. Each licensee and registrant shall afford the Agency at all reasonable times opportunity to inspect sources of radiation and the premises and facilities wherein such sources of radiation are used or stored. 2. Each licensee and registrant shall make available to the Agency for inspection, upon reasonable notice, records maintained pursuant to these regulations.

**History**
- *SOURCE: Miss. Code Ann. §45-14-11*

##### **15 Miss. Admin. Code Pt. 21, R. 1.1.6** Tests {#sec-21-1.1.6 omnilex-key=us-ms-regs-official--title-15--21#1.1.6}

Each licensee and registrant shall perform upon instructions from the Agency, or shall permit the Agency to perform, such reasonable tests as the Agency deems appropriate or necessary including, but not limited to, tests of: 1. sources of radiation; 2. facilities wherein sources of radiation are used or stored; 3. radiation detection and monitoring instruments; and 4. other equipment and devices used in connection with utilization or storage of licensed or registered sources of radiation.

**History**
- *SOURCE: Miss. Code Ann. §45-14-11*

##### **15 Miss. Admin. Code Pt. 21, R. 1.1.7** Reports {#sec-21-1.1.7 omnilex-key=us-ms-regs-official--title-15--21#1.1.7}

Notwithstanding any other requirements for notification: 1. Immediate Report. Each licensee shall notify the Agency as soon as possible but not later than 4 hours after the discovery of an event that prevents immediate protective actions necessary to avoid exposures to radiation or radioactive materials that could exceed regulatory limits or releases of licensed material that could exceed regulatory limits (events may include fires, explosions, toxic gas releases, etc.). 2. Twenty-Four Hour Report. Each licensee shall notify the Agency within 24 hours after the discovery of any of the following events involving licensed material: a. An unplanned contamination event that: i. requires access to the contaminated area, by workers or the public, to be restricted for more than 24 hours by imposing additional radiological controls or by prohibiting entry into the area; ii. involves a quantity of material greater than five times the lowest annual limit on intake specified in Appendix B of Subchapter 4 of these regulations for the material; and iii. has access to the area restricted for a reason other than to allow isotopes with a half-life of less than 24 hours to decay prior to decontamination. b. An event that requires unplanned medical treatment at a medical facility of an individual with spreadable radioactive contamination on the individual's clothing or body. c. An unplanned fire or explosion damaging any licensed material or any device, container, or equipment containing licensed material when:

i. the quantity of material involved is greater than five times the lowest annual limit on intake specified in Appendix B of Subchapter 4 of these regulations for the material; and ii. the damage affects the integrity of the licensed material or its container. 3. Twenty-Four Hour Report. Each licensee or registrant shall notify the Agency within 24 hours after the discovery of an event in which equipment is disabled or fails to function as designed when: a. The equipment is required by regulation or license condition to prevent releases exceeding regulatory limits, to prevent exposures to radiation and radioactive materials exceeding regulatory limits, or to mitigate the consequences of an accident; b. The equipment is required to be available and operable when it is disabled or fails to function; and c. No redundant equipment is available and operable to perform the required safety function. 4. Preparation and Submission of Reports. Reports made by licensees or registrants in response to the requirements of this section must be made as follows: a. Licensees or registrants shall make reports required by 1.1.7(1), (2), and (3) by telephone to the Agency. To the extent that the information is available at the time of notification, the information provided in these reports must include: i. the caller's name and call back telephone number; ii. a description of the event, including the manufacturer and model number (if applicable) of any equipment that failed or malfunctioned; iii. the exact location of the event; iv. the date and time of the event; v. the isotopes, quantities, and chemical and physical form of the licensed material involved; and vi. any personnel radiation exposure data available. b. Written Report. Each licensee or registrant who makes a report required by 1.1.7(1), (2), or (3) shall submit a written follow-up report within 30 days of the initial report. Written reports prepared pursuant to other regulations

may be submitted to fulfill this requirement if the reports contain all of the necessary information and the appropriate distribution is made. The reports must include the following: i. a description of the event, including the probable cause and the manufacturer and model number (if applicable) of any equipment that failed or malfunctioned; ii. the exact location of the event; iii. the isotopes, quantities and chemical and physical form of the licensed material involved; iv. date and time of the event; v. corrective actions taken or planned and the results of any evaluations or assessments; and vi. the extent of exposure of individuals to radiation or to radioactive materials without identification of individuals by name.

**History**
- *SOURCE: Miss. Code Ann. §45-14-11*

##### **15 Miss. Admin. Code Pt. 21, R. 1.1.8** Additional Requirements {#sec-21-1.1.8 omnilex-key=us-ms-regs-official--title-15--21#1.1.8}

The Agency may, by rule, regulation, or order, impose upon any licensee or registrant such requirements in addition to those established in these regulations as it deems appropriate or necessary to minimize danger to public health and safety or property.

**History**
- *SOURCE: Miss. Code Ann. §45-14-11*

##### **15 Miss. Admin. Code Pt. 21, R. 1.1.9** Enforcement Requirements Violations {#sec-21-1.1.9 omnilex-key=us-ms-regs-official--title-15--21#1.1.9}

An injunction or other court order may be obtained prohibiting any violation of any provision of the Act or any regulation or order issued thereunder. Any person who willfully violates any provision of the Act or any regulation or order issued thereunder may be guilty of a misdemeanor and, upon conviction, may be punished by fine or imprisonment or both, as provided by Section 45-14-37 of the Act.

**History**
- *SOURCE: Miss. Code Ann. §45-14-11*

##### **15 Miss. Admin. Code Pt. 21, R. 1.1.10** Enforcement Requirements Impounding {#sec-21-1.1.10 omnilex-key=us-ms-regs-official--title-15--21#1.1.10}

Sources of radiation shall be subject to impounding pursuant to Section 45-14-23 of the Act.

**History**
- *SOURCE: Miss. Code Ann. §45-14-11*

##### **15 Miss. Admin. Code Pt. 21, R. 1.1.11** Enforcement Requirements Prohibited Uses {#sec-21-1.1.11 omnilex-key=us-ms-regs-official--title-15--21#1.1.11}

1. A hand-held fluoroscopic screen shall not be used with x-ray equipment unless it has been listed in the Registry of Sealed Sources and Devices maintained by the

Agency or accepted for certification by the U.S. Food and Drug Administration, Center for Devices and Radiological Health. 2. A shoe-fitting fluoroscopic device shall not be used. 3. Sources of radiation shall not be used to expose any individual solely for training or demonstration purposes.

**History**
- *SOURCE: Miss. Code Ann. §45-14-11*

##### **15 Miss. Admin. Code Pt. 21, R. 1.1.12** Deliberate Misconduct {#sec-21-1.1.12 omnilex-key=us-ms-regs-official--title-15--21#1.1.12}

1. Any licensee, certificate holder, quality assurance program approval holder, or registrant; applicant for a license, certificate, quality assurance program approval, or registration; employee of a licensee, certificate holder, quality assurance program approval holder, registrant or applicant; or any contractor (including a supplier or consultant), subcontractor, employee of a contractor or subcontractor of any licensee, certificate holder, quality assurance program approval holder, or registrant or applicant, who knowingly provides to any licensee, certificate holder, quality assurance program approval holder, registrant, applicant, contractor, or subcontractor, any components, equipment, materials, or other goods or services that relate to a licensee's, certificate holder’s, quality assurance program approval holder’s, registrant’s or applicant's activities in these regulations, may not: a. Engage in deliberate misconduct that causes or would have caused, if not detected, a licensee, certificate holder, quality assurance program approval holder, registrant, or applicant to be in violation of any rule, regulation, or order; or any term, condition, or limitation of any license, certificate, approval or registration issued by the Agency; or b. Deliberately submit to the Agency, a licensee, certificate holder, quality assurance program approval holder, registrant, an applicant, or a licensee's, certificate holder’s, quality assurance program approval holder’s registrant’s or applicant's, contractor or subcontractor, information that the person submitting the information knows to be incomplete or inaccurate in some respect material to the Agency. 2. A person who violates 1.1.12(1)(a) or (1)(b) of this section may be subject to enforcement action in accordance with the procedures in 1.1.17 and Chapter 45-14- 37 of the Act. 3. For the purposes of 1.1.12(1)(a) of this section, deliberate misconduct by a person means an intentional act or omission that the person knows: a. Would cause a licensee, certificate holder, quality assurance program approval holder, registrant or applicant to be in violation of any rule,

regulation, or order; or any term, condition, or limitation, of any license or registration issued by the Agency; or b. Constitutes a violation of a requirement, procedure, instruction, contract, purchase order, or policy of a licensee, certificate holder, quality assurance program approval holder, registrant, applicant, contractor, or subcontractor.

**History**
- *SOURCE: Miss. Code Ann. §45-14-11*

##### **15 Miss. Admin. Code Pt. 21, R. 1.1.13** Interpretations {#sec-21-1.1.13 omnilex-key=us-ms-regs-official--title-15--21#1.1.13}

Except as specifically authorized by the Agency in writing, no interpretation of these regulations by an officer or employee of the Agency other than a written interpretation by the legal counsel will be recognized to be binding upon the Agency.

**History**
- *SOURCE: Miss. Code Ann. §45-14-11*

##### **15 Miss. Admin. Code Pt. 21, R. 1.1.14** Communications {#sec-21-1.1.14 omnilex-key=us-ms-regs-official--title-15--21#1.1.14}

All communications and reports concerning these regulations, and applications filed thereunder, should be addressed to the Division of Radiological Health at its office located at 3150 Lawson Street, P.O. Box 1700, Jackson, Mississippi, 39215-1700.

**History**
- *SOURCE: Miss. Code Ann. §45-14-11*

##### **15 Miss. Admin. Code Pt. 21, R. 1.1.15** Units of Exposure and Dose {#sec-21-1.1.15 omnilex-key=us-ms-regs-official--title-15--21#1.1.15}

1. As used in these regulations, the unit of Exposure is the coulomb per kilogram (C/kg) of air. One roentgen is equal to 2.58E-4 coulomb per kilogram of air. 2. As used in these regulations, the units of dose are: a. Gray (Gy) is the SI unit of absorbed dose. One gray is equal to an absorbed dose of 1 joule per kilogram (100 rads). b. Rad is the special unit of absorbed dose. One rad is equal to an absorbed dose of 100 ergs per gram or 0.01 joule per kilogram (0.01 gray). c. Rem is the special unit of any of the quantities expressed as dose equivalent. The dose equivalent in rem is equal to the absorbed dose in rad multiplied by the quality factor (1 rem = 0.01 sievert). d. Sievert is the SI unit of any of the quantities expressed as dose equivalent. The dose equivalent in sievert is equal to the absorbed dose in gray multiplied by the quality factor (1 sievert = 100 rems). 3. As used in these regulations, the quality factors for converting absorbed dose to dose equivalent are shown in Table I.

TABLE I

QUALITY FACTORS AND ABSORBED DOSE EQUIVALENCIES

Quality Factor Absorbed Dose Equal to TYPE OF RADIATION (Q) a Unit Dose Equivalent a

X-ray, gamma, or beta radiation and 1 1 high-speed electrons

Alpha particles, multiple-charged particles, fission fragments and heavy particles of unknown charge 20 0.05

Neutrons of unknown energy 10 0.1

High-energy protons 10 0.1

a Absorbed dose in rad equal to 1 rem or the absorbed dose in gray equal to 1 sievert.

4 If it is more convenient to measure the neutron fluence rate than to determine the neutron dose equivalent rate in rem per hour or sievert per hour, as provided in 1.1.15(3), 1 rem (0.01 sievert) of neutron radiation of unknown energies may, for purposes of these regulations, be assumed to result from a total fluence of 25 million neutrons per square centimeter incident upon the body. If sufficient information exists to estimate the approximate energy distribution of the neutrons, the licensee or registrant may use the fluence rate per unit dose equivalent or the appropriate Q value from Table II to convert a measured tissue dose in rad or gray to dose equivalent in rem or sievert. TABLE II

MEAN QUALITY FACT0RS, Q, AND FLUENCE PER UNIT DOSE EQUIVALENT FOR MONOENERGETIC NEUTRONS

Neutron Quality Fluence per Unit Fluence per Unit Energy Factor a Dose Equivalent b Dose Equivalent b

(MeV) (Q) (neutrons cm-2rem-1) (neutrons cm-2Sv-1)

(thermal) 2.5E-8 2 980E+6 980E+8 1E-7 2 980E+6 980E+8 1E-6 2 810E+6 810E+8 1E-5 2 810E+6 810E+8 1E-4 2 840E+6 840E+8 1E-3 2 980E+6 980E+8 1E-2 2.5 1010E+6 1010E+8 1E-1 7.5 170E+6 170E+8 5E-1 11 39E+6 39E+8 1 11 27E+6 27E+8 2.5 9 29E+6 29E+8 5 8 23E+6 23E+8 7 7 24E+6 24E+8 10 6.5 24E+6 24E+8 14 7.5 17E+6 17E+8 20 8 16E+6 16E+8 40 7 14E+6 14E+8 60 5.5 16E+6 16E+8 1E+2 4 20E+6 20E+8 2E+2 3.5 19E+6 19E+8 3E+2 3.5 16E+6 16E+8 4E+2 3.5 14E+6 14E+8

a Value of quality factor (Q) at the point where the dose equivalent is maximum in a 30-centimeter diameter cylinder tissue-equivalent phantom.

b Monoenergetic neutrons incident normally on a 30-centimeter diameter cylinder tissue-equivalent phantom.

**History**
- *SOURCE: Miss. Code Ann. §45-14-11*

##### **15 Miss. Admin. Code Pt. 21, R. 1.1.16** Units of Activity {#sec-21-1.1.16 omnilex-key=us-ms-regs-official--title-15--21#1.1.16}

For purposes of these regulations, activity is expressed in the special unit of curie (Ci), or in the SI unit of becquerel (Bq) or their multiples, or disintegrations or transformations per unit of time. 1. One becquerel (Bq) = 1 disintegration or transformation per second (dps or tps). 2. One curie (Ci) = 3.7E+10 disintegrations or transformations per second (dps or tps) = 3.7E+10 becquerel (Bq) = 2.22E+12 disintegrations or transformations per minute (dpm or tpm).

**History**
- *SOURCE: Miss. Code Ann. §45-14-11*

##### **15 Miss. Admin. Code Pt. 21, R. 1.1.17** Hearings and Judicial Review {#sec-21-1.1.17 omnilex-key=us-ms-regs-official--title-15--21#1.1.17}

In any proceedings under these regulations for granting, denying, suspending, revoking, or amending any license or registration,

or for determining compliance with rules and regulations of the Agency, the Agency shall afford an opportunity for a hearing upon the request of any person whose interest may be affected by the proceeding, and shall admit any such person as a party to such a hearing. Any order or decision of the Agency regarding the granting, denying, suspending, revoking or amending any license or registration as provided by these regulations, shall be subject to review by writ of certiorari to the Circuit Court of Hinds County, Mississippi, at the instance of any party in interest. The filing of the appeal shall, in all cases, be with a bond, with security for all costs, as approved by the judge or clerk of the court, and shall operate as a stay of any such order or decision until the court directs otherwise. The court may review all the facts and, in disposing of the issue before it, may modify, affirm or reverse the order or decision of the Agency in whole or in part.

**History**
- *SOURCE: Miss. Code Ann. §45-14-11*

##### **15 Miss. Admin. Code Pt. 21, R. 1.1.18** Fees {#sec-21-1.1.18 omnilex-key=us-ms-regs-official--title-15--21#1.1.18}

1. Application Fees

a. Each applicant or amendment thereto for which a fee is prescribed shall be accompanied by a remittance in the full amount of the fee. No application or amendment thereto shall be accepted or processed prior to payment of the full amount specified. No license, registration, or variance shall be issued, unless otherwise authorized by the Director of Radiological Health

b. Payment of the prescribed annual fee does not automatically renew the license or registration, or approval for which the fee is paid. License renewal applications must be filed in accordance with Rule 1.2.6 and/or Subchapter 3 (10 CFR 30.37).

2. Annual Fees

a. All activities for which an annual fee is provided shall be subject to the payment of such fee by the due date indicated on the invoice.

3. Reciprocal Agreements—Licenses and Registrants

a. Persons operating within Mississippi under the provision of Rule 1.2.10 and/or Subchapter 17 (10 CFR 150.20) shall submit to the Mississippi State Department of Health Division of Radiological Health the annual fee of the applicable category before the first entry into the state. The fee will allow reciprocal recognition of the license or registration for one year from the date of receipt.

4. Determination of Fee

a. The fee for each applicable category is listed in Appendix A.

b. In the case of licenses that authorize more than one activity, the total fee will be for the activity assigned the higher fee.

c. Licenses that are amended and that result in a change in the Appendix A category to a higher fee category license shall be assessed the entire fee for that type of license effective with the amendment.

d. Electronic products that are in storage are subject to the same initial application fee and annual fee unless the X-ray unit is rendered permanently incapable of producing radiation and this fact is documented in writing to the Mississippi State Department of Health Division of Radiological Health.

e. Electronic products that are no longer possessed by the registrant (e.g., sold, donated, or transferred) shall not be subject to the annual fee, provided written documentation is received by the invoice due date, which includes the name address, and telephone number to whom possession was transferred.

5. Methods of Payment

a. All payments must be made by electronic methods of payment.

b. Electronic Methods of Payment

1. Persons wishing to make payments using the electronic pay method shall access the department’s website and follow the instructions provided on the website.

2. Persons wishing to make payments using the electronic funds transfer (EFB) method shall contact the Office of Finance and Administration for further instructions.

c. Cash is not an acceptable form of payment.

6. Payments and Penalties.

a. All fees due to Radiological Health are required to be paid in full within forty- five (45) days of the invoiced fee due date.

b. Failure to pay all fees due within the forty-five (45) days shall cause the licensee/registrant to be in violation of these regulations and subject to a penalty fee equal to a maximum of two (2) times the amount of the fee due and payable plus an amount necessary to reimburse the costs of delinquent fee collection which may include administrative hearings for failure to pay the fee within ninety (90) days of the invoice due date.

7. Effective Date

a. The schedule of fees prescribed herein shall be effective on June 1, 2019.

8. Multiple Locations

a. Those persons possessing licenses or registrations that name multiple locations where sources of radiation are stored, used, or otherwise possessed, shall be subject to an additional fee of 10 percent of the annual fee for each such location within the state of Mississippi, not to exceed an amount equal to the annual fee.

Appendix A Schedule of Fees License Category 1 Application/Annual Fee Industrial Radiography Broad Scope Medical Nuclear Pharmacy NORM Decontamination General License Distribution Broad Scope Industrial Waste Compaction/transfer Waste Repackaging

$4,593.75 $4,593.75 $4,593.75 $4,593.75 $4,593.75 $4,593.75 $4,593.75 $4,593.75

License Category 2

Broad Scope Educational Environmental Tracer Studies Research & Development Educational Research & Development Medical Therapeutic Teletherapy Gamma-Knife/Stereotactic Radio Surgery Waste Receipt/Transfer

$2,362.50 $2,362.50 $2,362.50 $2,362.50 $2,362.50 $2,362.50 $2,362.50 $2,362.50

Specific License Fees Civil Defense Other Specific Well logging Radioactive markers/collars Irradiator (self-shielded) $826.25 $991.25 $4,132.50 $575.00 $1,487.50 $8,265.00

Irradiator (Panoramic pool or source exposed) Fixed In-Plant Gauges Pipe wall thickness Gauges Portable densitometer gauge Portable Industrial Gauge (Troxler) Gauge Services (Repair, Installation, Removal, etc.) Medical Nuclear Medicine (Diagnostic only) Medical Eye Applicator/Bone Mineral Analyzer Medical Mobile Nuclear Services Medical Satellite Facility Gas Chromatograph NORM Removal (Pipe cleaning) Waste Disposal

Specific License Fees (continued) $1,581.25 $1,581.25 $1,581.25 $991.25 $1,581.25 $1,817.50 $826.25 $3,306.25 $991.25 $495.00 $1,652.50 $575,000.00

Waste Incineration Nuclear Laundry $9,918.75 $6,612.50 Licenses that authorize the possession, use and/or processing of source material for extraction of metals other than uranium or thorium. (greater than or equal to 150 kilograms) $15,812.50 Licenses that authorize the possession, use and/or processing of source material for extraction of metals other than uranium or thorium. (less than 150 kilograms) $7,187.50

Reciprocal License Fee Same as Fees Above Each Additional Storage and/or Use Area 10% of Licensing Fee General Licenses Gauges/certain measuring Gas Chromatographs Static Eliminators/ion generating Source material/Depleted Uranium In Vitro/clinical All other General Licenses

$243.75 $165.00 $165.00 $165.00 $165.00 $165.00 Registrations X-Ray Fees Industrial/non-healing arts Educational Healing Arts/Veterinary

$143.75/tube $121.25/tube $143.75/tube

Computed tomography, fluoroscopic, and mammographic X-Ray Industrial Radiography X-Ray Services Accelerators Therapeutic X-Ray Neutron Generators

$187.50

$991.25 $495.00 $1,236.25 $718.75 $862.50

Nuclear Reactor

Possessing a Nuclear Regulatory Commission license or permit authorizing a nuclear reactor in the State of Mississippi for commercial production of electrical energy utilizing special nuclear material sufficient to form a critical mass, shall pay an annual fee of $182,173.75 for each such reactor so licensed or permitted.

$182,173.75 Subchapter 2 Registration of Radiation Machines Facilities And Services Rule 1.2.1 Purpose and Scope. 1. This section provides for the registration of radiation machines and facilities and for the registration of persons providing radiation machine installation, servicing, and/or services. 2. In addition to the requirements of this section, all registrants are subject to the applicable provisions of other sections of these regulations.

**History**
- *SOURCE: Miss. Code Ann. §45-14-31*
- *Source: MS Code Ann. §45-14-3*

##### **15 Miss. Admin. Code Pt. 21, R. 1.2.2** Definitions {#sec-21-1.2.2 omnilex-key=us-ms-regs-official--title-15--21#1.2.2}

1. "Facility" means the location at which one or more devices or sources are installed and are under the same administrative control. 2. "Storage" means a condition in which a device or source is not being used for an extended period of time, and has been made inoperable.

**History**
- *Source: MS Code Ann. §45-14-3*

##### **15 Miss. Admin. Code Pt. 21, R. 1.2.3** Exemptions {#sec-21-1.2.3 omnilex-key=us-ms-regs-official--title-15--21#1.2.3}

1. Electronic equipment that produces radiation incidental to its operation for other purposes is exempt from the registration and notification requirements of this section, providing dose equivalent rate averaged over an area of 10 square centimeters does not exceed 0.5 millirem (5 μ Sv) per hour at 5 centimeters from

any accessible surface of such equipment. The production, testing, or factory servicing of such equipment shall be exempt. 2. Radiation machines while in transit or storage incident thereto are exempt from the requirements of this section. 3. Domestic television receivers are exempt from the requirements of this section.

**History**
- *Source: MS Code Ann. §45-14-3*

##### **15 Miss. Admin. Code Pt. 21, R. 1.2.4** Shielding Plan Review {#sec-21-1.2.4 omnilex-key=us-ms-regs-official--title-15--21#1.2.4}

1. Prior to construction, the floor plans, shielding specifications and equipment arrangement of all new installations, or modifications of existing installations, utilizing ionizing radiation for diagnostic or therapeutic purposes shall be submitted to the Agency for review and approval. The required information is denoted in Appendices A and B of this Subchapter. 2. The Agency may require the applicant to uti1ize the services of a qualified expert to determine the shielding requirements prior to the plan review and approval. 3. The approval of such plans shall not preclude the requirement of additional modifications should a subsequent analysis of operating conditions indicate the possibility of an individual receiving a dose in excess of the limits prescribed in 1.4.1, of these regulations. 4. After installation of a radiation machine, the registrant shall maintain for inspection by the Agency: a. the maximum rated technique factors of each x-ray system control panel; b. scale drawing of the room in which a stationary radiation machine system is located with such drawing indicating the use of areas adjacent to the room and an estimation of the extent of occupancy by an individual in such areas. In addition, the drawing shall include: i. the results of a survey for radiation levels present at the operator's position and at pertinent points outside the room at specified test conditions, or ii. the type and thickness of materials, or lead equivalency, of each protective barrier.

**History**
- *Source: MS Code Ann. §45-14-3*

##### **15 Miss. Admin. Code Pt. 21, R. 1.2.2** Registration of Radiation Machines and Facilities {#sec-21-1.2.2 omnilex-key=us-ms-regs-official--title-15--21#1.2.2}

Each person having a radiation machine facility shall:

1. Apply for registration of such facility with the Agency prior to the operation of a radiation machine facility. Application for registration shall be completed on forms furnished by the Agency and shall contain all the information required by the form and accompanying instructions. 2. Designate on the application form an individual to be responsible for radiation protection. 3. Each registrant shall prohibit any person from furnishing radiation machine servicing or services as described in 1.2.6(4) to his radiation machine facility until such person provides evidence that he has been registered with the Agency as a provider of services in accordance with 1.2.6.

**History**
- *Source: MS Code Ann. §45-14-3*

##### **15 Miss. Admin. Code Pt. 21, R. 1.2.3** Application for Registration of Servicing and Services {#sec-21-1.2.3 omnilex-key=us-ms-regs-official--title-15--21#1.2.3}

1. Each person who is engaged in the business of installing or offering to install radiation machines or is engaged in the business of furnishing or offering to furnish radiation machine servicing or services in this State shall apply for registration of such services with the Agency prior to furnishing or offering to furnish any such services. 2. Application for registration shall be completed on forms furnished by the Agency and shall contain all information required by the Agency as indicated on the forms and accompanying instructions. 3. Each person applying for registration under this section shall specify: a. that he has read and understands the requirements of these regulations; b. the services for which he is applying for registration; c. the training and experience that qualify him to discharge the services for which he is applying for registration; d. the type of measurement instruments to be used, frequency of calibration, and source of calibration; and e. the type of personnel dosimeters supplied, frequency of reading, and replacement or exchange schedule. 4. For the purpose of 1.2.6, services may include but shall not be limited to: a. installation and/or servicing of radiation machines and associated radiation machine components,

b. calibration of radiation machines or radiation measurement instruments or devices, c. radiation protection or health physics consultations or surveys, and d. personnel dosimetry services. 5. No individual shall perform services which are not specifically stated for that individual on the notice of registration issued by the Agency.

**History**
- *Source: MS Code Ann. §45-14-3*

##### **15 Miss. Admin. Code Pt. 21, R. 1.2.4** Issuance of Notice of Registration {#sec-21-1.2.4 omnilex-key=us-ms-regs-official--title-15--21#1.2.4}

1. Upon a determination that an applicant meets the requirements of the regulations, the Agency shall issue a notice of registration. 2. The Agency may incorporate in the notice of registration at the time of issuance or thereafter by appropriate rule, regulation, or order, such additional requirements and conditions with respect to the registrant's receipt, possession, use, and transfer of radiation machines as it deems appropriate or necessary.

**History**
- *Source: MS Code Ann. §45-14-3*

##### **15 Miss. Admin. Code Pt. 21, R. 1.2.5** Expiration of Notice of Registration {#sec-21-1.2.5 omnilex-key=us-ms-regs-official--title-15--21#1.2.5}

Except as provided by 1.2.9(2), each notice of registration shall expire at the end of the specified day in the month and year stated therein.

**History**
- *Source: MS Code Ann. §45-14-3*

##### **15 Miss. Admin. Code Pt. 21, R. 1.2.6** Renewal of Notice of Registration {#sec-21-1.2.6 omnilex-key=us-ms-regs-official--title-15--21#1.2.6}

1. Application for renewal of registration shall be filed in accordance with 1.2.5 or 1.2.6. 2. In any case in which a registrant not less than 30 days prior to the expiration of his existing notice of registration has filed an application in proper form for renewal, such existing notice of registration shall not expire until the application status has been finally determined by the Agency.

**History**
- *Source: MS Code Ann. §45-14-3*

##### **15 Miss. Admin. Code Pt. 21, R. 1.2.7** Report of Changes {#sec-21-1.2.7 omnilex-key=us-ms-regs-official--title-15--21#1.2.7}

The registrant shall notify the Agency in writing before making any change which would render the information contained in the application for registration and/or the notice of registration no longer accurate.

**History**
- *Source: MS Code Ann. §45-14-3*

##### **15 Miss. Admin. Code Pt. 21, R. 1.2.8** Approval Not Implied {#sec-21-1.2.8 omnilex-key=us-ms-regs-official--title-15--21#1.2.8}

No person, in any advertisement, shall refer to the fact that he or his facility is registered with the Agency pursuant to the provisions of 1.2.5 or 1.2.6. and no person shall state or imply that any activity under such registration has been approved by the Agency.

**History**
- *Source: MS Code Ann. §45-14-3*

##### **15 Miss. Admin. Code Pt. 21, R. 1.2.9** Assembler and/or Transfer Obligation {#sec-21-1.2.9 omnilex-key=us-ms-regs-official--title-15--21#1.2.9}

1. Any person who sells, leases, transfers, lends, disposes, assembles, or installs radiation machines in this State shall notify the Agency within 15 days of:

a. the name and address of persons who have received these machines; b. the manufacturer, model, and serial number of each radiation machine transferred; and c. the date of transfer of each radiation machine. 2. No person shall make, sell, lease, transfer, lend, assemble, or install radiation machines or the supplies used in connection with such machines unless such supplies and equipment when properly placed in operation and used shall meet the requirements of these regulations.

**History**
- *Source: MS Code Ann. §45-14-3*

##### **15 Miss. Admin. Code Pt. 21, R. 1.2.10** Out-Of-State Radiation Machines {#sec-21-1.2.10 omnilex-key=us-ms-regs-official--title-15--21#1.2.10}

1. Whenever any radiation machine is to be brought into the State, for any temporary use, the person proposing to bring such machine into the State shall give written notice to the Agency at least 3 days before such machine is to be used in the State. The notice shall include: a. the type of radiation machine; b. the nature, duration, and scope of use; c. the exact location(s) where the radiation machine is to be used; and d. states in which this machine is registered.

In the case of diagnostic x-ray systems which contain certified components, a copy of the assembler's report prepared in compliance with requirements of the Federal diagnostic x-ray standard (21 CFR 1020.30(d)) shall be submitted to the Agency within 15 days following completion of the assembly. Such report shall suffice in lieu of any other report by the assembler.

2. If, for a specific case, the 3 day period would impose an undue hardship on the person, upon application to the Agency, permission to proceed sooner may be granted. 3. The person referred to in 1.2.13(1) shall: a. comply with all applicable regulations of the Agency; b. supply the Agency with such other information as the Agency may reasonably request; and c. not operate within the State on a temporary basis in excess of 180 calendar days per year.

APPENDIX A Information On Radiation Shielding Required For Plan Reviews In order for the Agency to provide an evaluation, technical advice, and official approval on shielding requirements for a radiation installation, the following information must be submitted. I. The plans should show, as a minimum, the following: a. The normal location of the x-ray system's radiation port; the port's travel and traverse limits; general direction(s) of the useful beam; locations of any windows and doors; the location of the operator's booth; and the location of the x-ray control panel. b. The structural composition and thickness or lead equivalent of all walls, doors, partitions, floor, and ceiling of the room(s) concerned. c. The dimensions of the room(s) concerned. d. The type of occupancy of all adjacent areas inclusive of space above and below the room(s) concerned. If there is an exterior wall, show distance to the closest area(s) where it is likely that individuals may be present. e. The make and model of the x-ray equipment and the maximum technique factors, and the energy waveform (single phase, three phase, etc.). f. The type of examination(s) or treatment(s) which will be performed with the equipment. II. Information on the anticipated workload of the x-ray system(s) in mA-minutes per week. III. A report showing all basic assumptions used in the development of the shielding specifications.

APPENDIX B Design Requirements For An Operator’s Booth I. Space Requirements: a. The operator shall be allotted not less than 7.5 square feet (0.70m²) of unobstructed floor space in the booth. b.The operator's booth may be any geometric configuration with no dimension of less than 2 feet (0.61 m). c. The space shall be allotted excluding any encumbrance by the x-ray control panel, such as overhang, cables, or other similar encroachments. d.The booth shall be located or constructed such that unattenuated direct scatter radiation originating from the examination table or at the wall cassette holder will not reach the operator's position in the booth. II. Structural Requirements: a. The booth walls shall be permanently fixed barriers of at least 7 feet (2.1 m) high. b.When a door or movable panel is used as an integral part of the booth structure, it must have an interlock which will prevent an exposure when the door or panel is not closed. c. Shielding shall be provided to meet the requirements of Subchapter 4 of these regulations. III. X-Ray Exposure Control Placement: a. The x-ray exposure control for the system shall be fixed within the booth and: b.Shall be at least 40 inches (1.0 m) from any open edge of the booth wall which is nearest to the examining table. c. Shall allow the operator to use the majority of the available viewing windows. IV. Viewing System Requirements: a. Each booth shall have at least one viewing device which will: i. Be so placed that the operator can view the patient during any exposure, and ii. Be so placed that the operator can have full view of any occupant of the room and should be so placed that the operator can view any entry into the room. If any door which allows access to the room cannot be seen from the booth, then outside that door there shall be an "x-ray on" warning sign that will be

lighted anytime the rotor of the x-ray tube is activated. Alternatively, an interlock must be present such that exposures are prevented unless the door is closed. b.When the viewing system is a window, the following requirements also apply: i. It shall have a viewing area of at least 1 square foot (0.093 m

). ii. Regardless of size or shape, at least 1 square foot of the window area must be centered no less than 2 feet (0.61 m) from the open edge of the booth and no less than 5 feet (1.52 m) from the floor. iii. The window shall have at least the same lead equivalence as that required in the booth's wall in which it is mounted. c. When the viewing system is by mirrors, the mirror(s) shall be so located as to accomplish the general requirements of Appendix B.IV(A). d.When the viewing system is by electronic means: i. The camera shall be so located as to accomplish the general requirements of Appendix B.IV(A), and ii. There shall be an alternate viewing system as a backup for the primary system

Subchapter 3 Licensing of Radioactive Material Rule 1.3.1 Purpose and Scope. This Regulation adopts by reference the current revision of the following sections in Title 10 Code of Federal Regulations Part 30: 30.1, 30.2, 30.3, 30.4 (with the exception referenced in No. 1 below), 30.7, 30.9, 30.10, 30.11, 30.12, 30.13, 30.14, 30.15, 30.18, 30.19, 30.20, 30.21, 30.22, 30.31, 30.32, 30.33, 30.34, 30.35, 30.36, 30.37, 30.38, 30.39, 30.41, 30.50, 30.51, 30.52, 30.53, 30.61, 30.62, 30.70, 30.71, and 30.72 and Appendix A through Appendix E to Part 30, with the following exceptions and additions:

1. Not adopted by reference is Title 10 Code of Federal Regulations 30.4 Paragraph (2) Common defense and security, in the definition of “Commencement of Construction”, Paragraph 9(ii) Common defense and security, in the definition of “Construction”, 30.21(c), 30.34(d), 30.34(e)(1), 30.34(e)(3), and 30.41(b)(6).

2. Requirements in Title 10 Code of Federal Regulations Part 30 that apply to "byproduct material" also apply to naturally occurring or accelerator- produced radioactive material.

3. Where the words "NRC", "commission", "nuclear regulatory commission", "United States Nuclear Regulatory Commission", "NRC regional office", or "administrator of the appropriate regional office" appear in Title 10 Code of Federal Regulations Part 30, substitute the words "Mississippi State Department of Health" except when used in Title 10 Code of Federal Regulations 30.12, 30.21(c), 30.34(h)(1), and 30.50(c)(1).

4. Title 10 Code of Federal Regulations 30.7 employee protection also applies to violations of Mississippi State Department of Health Regulations for the Control of Radiation Subchapter 10.

5. "Act" includes Mississippi Radiation Protection Law of 1976.

6. Mississippi State Department of Health form number 707 E , "Application for Radioactive Material License" (Medical Uses) or form number 844 E "Application for Radioactive Material License" (Other Uses), must be used instead of NRC form 313 as specified in Title 10 Code of Federal Regulations Part 30.

7. Mississippi State Department of Health form number 935, "Notice to Employees", must be posted instead of NRC form 3 that is specified in Title 10 Code of Federal Regulations Part 30.

8. Mississippi State Department of Health form number 843 must be used instead of NRC form 244 that is specified in Title 10 Code of Federal Regulations Part 30.

9. Mississippi State Department of Health form number 1061, "Certificate of Disposition of Radioactive Materials", must be used instead of NRC form 314 as specified in Title 10 Code of Federal Regulations Part 30.

10. For references to Title 10 Code of Federal Regulations Parts 170 and 171, see Mississippi State Department of Health Regulations for the Control of Radiation in Mississippi Rule 1.1.18 for applicable fee.

Subchapter 4 Standards For Protection Against Radiation Rule 1.4.1 This Regulation adopts by reference the current revision of the following sections in Title 10 Code of Federal Regulations Part 20: 20.1001, 20.1002, 20.1003, 20.1004, 20.1005, 20.1008, 20.1101, 20.1201, 20.1202, 20.1203, 20.1204, 20.1206, 20.1207, 20.1208, 20.1301, 20.1302, 20.1401, 20.1402, 20.1403, 20.1404, 20.1405, 20.1406, 20.1501, 20.1502, 20.1601, 20.1602, 20.1701, 20.1702, 20.1703, 20.1704, 20.1705, 20.1801, 20.1802, 20.1901, 20.1902, 20.1903, 20.1904, 20.1905, 20.1906, 20.2001, 20.2002, 20.2003, 20.2004, 20.2005, 20.2006, 20.2007, 20.2008, 20.2101, 20.2102, 20.2103, 20.2104, 20.2105, 20.2106, 20.2107, 20.2108, 20.2110, 20.2201, 20.2202, 20.2203, 20.2204, 20.2205, 20.2206, 20.2207, 20.2301, and 20.2302, Appendix A through C to Part 20, Appendix E to Part 20, and Appendix G to Part 20, with the following exceptions:

1. Not adopted by reference are 20.1406 (b), 20.1905(g), 20.2203(c), and 20.2206(a)(1), (a)(3), (a)(4), and (a)(5).

2. All of the requirements in Subchapter 4 apply to both licensees and registrants. A reference in Title 10 Code of Federal Regulations Part 20 to "license" includes "registration", a reference to "licensee" includes "registrant", a reference to "licensed" includes "registered", a reference to "licensed material(s)" includes "registered source of radiation", and a reference to "licensed radioactive material" includes "registered source of radiation". "Registrant" means any person who is registered with the department and is legally obligated to register with the department pursuant to Regulations for Control of Radiation in Mississippi and Mississippi Code Annotated § 45-14-13. "Registration" means the notification of the Mississippi State Department of Health of possession of a source of radiation and the furnishing of information with respect thereto, in accordance with Mississippi State Department of Health Regulations for the Control of Radiation in Mississippi Rule 1.2.5.

3. Where the words "NRC", "commission", "administrator of the appropriate NRC regional office", "administrator of the nearest commission regional office", or "NRC regional office" appear in Title 10 Code of Federal Regulations Part 20, substitute the words " Mississippi State Department of Health".

4. Requirements in Title 10 Code of Federal Regulations Part 20 that apply to "byproduct material" also apply to naturally occurring or accelerator- produced radioactive material.

5. "Act" includes the Mississippi Radiation Protection Law of 1976.

6. Mississippi State Department of Health form number 933, "cumulative occupational exposure history", must be used instead of NRC form 4 as specified in Title 10 Code of Federal Regulations Part 20.

7. Mississippi State Department of Health form number 934, "occupational radiation exposure for a monitoring period", must be used instead of NRC form 5 as specified in Title 10 Code of Federal Regulations Part 20.

8. NRC form 748 shall not be used as described in Title 10 Code of Federal Regulations Part 20.

9. The words "in the Federal Register and" shall be omitted from Title 10 Code of Regulations 20.1405(b).

Subchapter 5. Radiation Safety Requirements For Industrial Radiographic Operations

**History**
- *Source: MS Code Ann. §45-14-3*
- *SOURCE: Miss. Code Ann. §45-14-11*
- *SOURCE: Miss. Code Ann. §45-14-11*

##### **15 Miss. Admin. Code Pt. 21, R. 1.5.1** Purpose {#sec-21-1.5.1 omnilex-key=us-ms-regs-official--title-15--21#1.5.1}

This Regulation adopts by reference the current revision of the following sections in Title 10 Code of Federal Regulations Part 34: 34.1, 34.3, 34.11, 34.13, 34.20, 34.21, 34.23, 34.25, 34.27, 34.29, 34.31, 34.33, 34.35, 34.41, 34.42, 34.43, 34.45, 34.46, 34.47, 34.49, 34.51, 34.53, 34.61, 34.63, 34.65, 34.67, 34.69, 34.71, 34.73, 34.75, 34.79, 34.81, 34.83, 34.85, 34.87, 34.89, 34.101, and 34.111 and Appendix A to Part 34, with the following exceptions:

1. All of the requirements in Subchapter 5 apply to both licensees and registrants. A reference in Title 10 Code of Federal Regulations Part 34 to "license" includes "registration", a reference to "licensee" includes "registrant", a reference to "licensed" includes "registered", and a reference to "licensed material" includes "registered source of radiation". "Registrant" means any person who is registered with the Mississippi State Department of Health and is legally obligated to register with the department pursuant to Section 45-14-13 of the Mississippi Code of 1972, Annotated. "Registration" means the notification of the Mississippi State Department of Health of possession of a source of radiation and the furnishing of information with respect thereto, in accordance with Mississippi State Department of Health Regulations for the Control of Radiation in Mississippi Rule 1.2.5.

2. Where the words "NRC", "commission", "Nuclear Regulatory Commission", "United States Nuclear Regulatory Commission", "NRC Regional Administrator", "NRC regional office", "administrator of the appropriate Nuclear Regulatory Commission’s regional office", or "NRC’s Office of Nuclear Material Safety and Safeguards, Division of Industrial and Medical Nuclear Safety" appear in Title 10 Code of Federal Regulations Part 34, substitute the words "Mississippi State Department of Health".

3. Requirements in Title 10 Code of Federal Regulations Part 34 that apply to “byproduct material” also apply to naturally occurring or accelerator- produced radioactive material.

4. Mississippi State Department of Health form number 844 E "Application for Radioactive Material License", or form number 802 “Application for Ionizing Radiation” must be used instead of NRC form 313 as specified in Title 10 Code of Federal Regulations Part 34.

5. For references to Title 10 Code of Federal Regulations Parts 170 and 171, see Mississippi State Department of Health Regulations for the Control of Radiation in Mississippi Rule 1.1.18 for applicable fee.

**History**
- *SOURCE: Miss. Code Ann. §45-14-11 SubChapter 6 X-Rays In The Healing Arts Rule 1.6.1 Scope. This section establishes requirements, for which a registrant is responsible, for use of x-ray equipment by or under the supervision of an individual authorized by and licensed in accordance with Mississippi statutes to engage in the healing arts or veterinary medicine. The provisions of this section are in addition to, and not in substitution for, other applicable provisions of these regulations.*
- *SOURCE: Miss. Code Ann. §45-14-11*

##### **15 Miss. Admin. Code Pt. 21, R. 1.6.2** Definitions {#sec-21-1.6.2 omnilex-key=us-ms-regs-official--title-15--21#1.6.2}

As used in this section, the following definitions apply: 1. "Accessible surface" means the external surface of the enclosure or housing provided by the manufacturer. 2. "Added filtration" means any filtration which is in addition to the inherent filtration. 3. "Aluminum equivalent" means the thickness of type 1100 aluminum alloy

affording the same attenuation, under specified conditions, as the material in question. 4. "Assembler" means any person engaged in the business of assembling, replacing, or installing one or more components into an x-ray system or subsystem. The term includes the owner of an x-ray system or his or her employee or agent who assembles components into an x-ray system that is subsequently used to provide professional or commercial services. 5. "Attenuation block" means a block or stack, having dimensions 20 centimeters by 20 centimeters by 3.8 centimeters, of type 1100 aluminum alloy or other materials having equivalent attenuation. 6. "Automatic exposure control" means a device which automatically controls one or more technique factors in order to obtain at a preselected location(s) a required quantity of radiation (See also "Phototimer"). 7. "Barrier" (See "Protective barrier"). 8. "Beam axis" means a line from the source through the centers of the x-ray fie1ds. 9. "Beam-limiting device" means a device which provides a means to restrict the dimensions of the x-ray field.

The nominal chemical composition of type 1100 aluminum alloy is 99.00 percent minimum aluminum, 0.12 percent copper.

10. "C-Arm x-ray system" means an x-ray system in which the image receptor and x-ray tube housing assembly are connected by a common mechanical support system in order to maintain a desired spatial relationship. This system is designed to allow a change in the projection of the beam through the patient without a change in the position of the patient. 11. "Cephalometric device" means a device intended for the radiographic visualization and measurement of the dimensions of the human head. 12. "Certified components" means components of x-ray systems which are subject to regulations promulgated under Public Law 90-602, the Radiation Control for Health and Safety Act of 1968. 13. "Certified system" means any x-ray system comprised totally of certified components. 14. "Changeable filters" means any filter, exclusive of inherent filtration, which can be removed from the useful beam through any electronic, mechanical, or physical process. 15. "Coefficient of variation" or "C" means the ratio of the standard deviation to the mean value of a sample population of observations. It is estimated using the following equation:

where s = Estimated standard deviation of the population. X = Mean Value of observations in sample. X i = i th observation in sample. n = Number of observations in sample.

16. "Computed tomography" means the production of a tomogram by the acquisition and computer processing of x-ray transmission data. 17. "Control panel" means that part of the x-ray control upon which are mounted the switches, knobs, pushbuttons, and other hardware necessary for setting the technique factors. 18. "Cooling curve" means the graphical relationship between heat units stored and cooling time. 19. "CT" (See "Computed tomography").

20. "Dead-man switch" means a switch so constructed that a circuit closing contact can be maintained only by continuous pressure on the switch by the operator. 21. "Detector" (See "Radiation detector"). 22. "Diagnostic source assembly" means the tube housing assembly with a beam-limiting device attached. 23. "Diagnostic x-ray imaging system" means an assemblage of components for the generation, emission and reception of x-rays and the transformation, storage and visual display of the resultant x-ray image. 24. "Diagnostic x-ray system" means an x-ray system designed for irradiation of any part of the human or animal body for the purpose of diagnosis or visualization. 25. "Direct scattered radiation" means that scattered radiation which has been deviated in direction only by materials irradiated by the useful beam (See "Scattered radiation"). 26. "Entrance exposure rate" means the exposure free in air per unit time at the point where the center of the useful beam enters the patient. 27. "Equipment" (See "X-ray equipment"). 28. "Field emission equipment" means equipment which uses an x-ray tube in which electron emission from the cathode is due solely to the action of an electric field." 29. "Filter" means material placed in the useful beam to absorb preferentially selected radiations. 30. "Fluoroscopic imaging assembly" means a subsystem in which x-ray photons produce a fluoroscopic image. It includes the image receptor(s) such as the image intensifier and spot-film device, electrical interlocks, if any, and structural material providing linkage between the image receptor and diagnostic source assembly. 31. "Focal spot" means the area projected on the anode of the x-ray tube by the electrons accelerated from the cathode and from which the useful beam originates. 32. "General purpose radiographic x-ray system" means any radiographic x-ray system which, by design, is not limited to radiographic examination of specific anatomical regions. 33. "Gonad shield" means a protective barrier for the testes or ovaries. 34. "Half-value layer" means the thickness of specified material which attenuates the beam of radiation to an extent such that the exposure rate is reduced to one-half of its original value. In this definition, the contribution of all scattered radiation, other

than any which might be present initially in the beam concerned, is deemed to be excluded. 35. "Healing arts screening" means the testing of human beings using x-ray machines for the detection or evaluation of health indications when such tests are not specifically and individually ordered by a licensed practitioner of the healing arts legally authorized to prescribe such x-ray tests for the purpose of diagnosis or treatment. 36. "HVL" (See "Half-value layer"). 37. "Image intensifier" means a device, installed in its housing, which instantaneously converts an x-ray pattern into a corresponding light image of higher energy density. 38. "Image receptor" means any device, such as a fluorescent screen or radiographic film, which transforms incident x-ray photons either into a visible image or into another form which can be made into a visible image by further transformations. 39. "Image receptor support" means, for mammographic systems, that part of the system designed to support the image receptor during mammography. 40. "Inherent filtration" means the filtration of the useful beam provided by the permanently installed components of the tube housing assembly. 41. "Irradiation" means the exposure of a living being or matter to ionizing radiation. 42. "Kilovolt (kV) [kilo electron volt (keV)]" means the energy equal to that acquired by a particle with one electron charge in passing through a potential difference of one thousand volts in a vacuum. [Note: current convention is to use kV for photons and keV for electrons]. 43. "Kilovolts peak" (See "Peak tube potential"). 44. "kVp" (See "Peak tube potential"). 45. "kWs" means kilowatt second. 46. "Lead equivalent" means the thickness of the material in question affording the same attenuation, under specified conditions as lead. 47. "Leakage radiation" means radiation emanating from the diagnostic source assembly except for: a. the useful beam; and b. radiation produced when the exposure switch or timer is not activated.

48. "Leakage technique factors" means the technique factors associated with the diagnostic source assembly which are used in measuring leakage radiation. They are defined as follows: a. For diagnostic source assemblies intended for capacitor energy storage equipment, the maximum-rated peak tube potential and the maximum-rated number of exposures in an hour for operation at the maximum-rated peak tube potential with the quantity of charge per exposure being 10 millicoulombs, i.e., 10 milliampere seconds, or the minimum obtainable from the unit, whichever is larger. b. For diagnostic source assemblies intended for field emission equipment rated for pulsed operation, the maximum-rated peak tube potential and the maximum-rated number of x-ray pulses in an hour for operation at the maximum-rated peak tube potential. c. For all other diagnostic source assemblies, the maximum-rated peak tube potential and the maximum-rated continuous tube current for the maximum-rated peak tube potential. 49. "Light field" means the area illuminated by light, being the locus of points at which the illumination exceeds a specific or specified level, simulating the radiation field. 50. "Line-voltage regulation" means the difference between the no-load and the load line potentials expressed as a percent of the load line potential. It is calculated using the following equation: Percent line-voltage regulation = 100 (V n -V

)/V

where

V n = No-load line potential and V

= Load line potential.

51. "mA" means milliampere. 52. "mAs" means milliampere second. 53. "Maximum line current" means the root-mean-square current in the supply line of an x-ray machine operating at its maximum rating. 54. "Mobile x-ray equipment" (See "X-ray equipment"). 55. "Patient" means an individual or animal subjected to healing arts examination, diagnosis, or treatment. 56. "PBL" See "Positive beam limitation."

57. "Peak tube potential" means the maximum value of the potential difference across the x-ray tube during an exposure. 58. "Phantom" means a volume of material behaving in a manner similar to tissue with respect to the attenuation and scattering of radiation. 59. "Phototimer" means a method for controlling radiation exposures to image receptors by measuring the amount of radiation which reaches a radiation monitoring device(s). The radiation monitoring device(s) is part of an electronic circuit which controls the duration of time the tube is activated (See "Automatic exposure control"). 60. "PID" (See "Position indicating device"). 61. "Portable x-ray equipment" (See "X-ray equipment"). 62. "Position indicating device" means a device on dental x-ray equipment used to indicate the beam position and to establish a definite source surface (skin) distance. It may or may not incorporate or serve as a beam-limiting device. 63. "Positive beam limitation" means the automatic or semiautomatic adjustment of an x-ray beam to the selected image receptor size, whereby exposures cannot be made without such adjustment. 64. "Primary protective barrier" (See "Protective barrier"). 65. "Protective apron" means an apron made of radiation absorbing materials used to reduce radiation exposure. 66. "Protective barrier" means a barrier of radiation absorbing material(s) used to reduce radiation exposure. The types of protective barriers are as follows: a. "Primary protective barrier" means the material, excluding filters, placed in the useful beam, to protect anyone other than the patient from radiation exposure. b. "Secondary protective barrier" means a barrier sufficient to attenuate the stray radiation to the required degree. c. "Protective glove" means a glove made of radiation absorbing materials used to reduce radiation exposure. 67. "Qualified expert" means an individual who has demonstrated to the satisfaction of the Agency that such individual possesses the knowledge, training, and experience to measure ionizing radiation, to evaluate safety techniques, and to advise regarding radiation protection needs.

68. "Radiation detector" means a device which in the presence of radiation provides a signal or other indication suitable for use in measuring one or more quantities of incident radiation. 69. "Radiation therapy simulation system" means a radiographic or fluoroscopic x-ray system intended for localizing the volume to be exposed during radiation therapy and confirming the position and size of the therapeutic irradiation field. 70. "Radiograph" means an image receptor on which the image is created directly or indirectly by an x-ray pattern and results in a permanent record. 71. "Radiographic imaging system" means any system whereby a permanent or temporary image is recorded on an image receptor by the action of ionizing radiation. 72. "Rating" means the operating limits as specified by the component manufacturer. 73. "Recording" means producing a permanent form of an image resulting from x-ray photons. 74. "Scattered radiation" means radiation that, during passage through matter, has been deviated in direction (See "Direct scattered radiation"). 75. "Secondary protective barrier" (See "Protective barrier"). 76. "Shutter" means a device attached to the tube housing assembly which can totally intercept the entire cross section area of the useful beam and which has a lead equivalency not less than that of the tube housing assembly. 77. "SID" (See "Source-image receptor distance"). 78. "Source" means the focal spot of the x-ray tube. 79. "Source-image receptor distance" means the distance from the source to the center of the input surface of the image receptor. 80. "Spot film" means a radiograph which is made during a fluoroscopic examination to permanently record conditions which exist during that fluoroscopic procedure. 81. "Spot-film device" means a device intended to transport and/or position a radiographic image receptor between the x-ray source and fluoroscopic image receptor. It includes a device intended to hold a cassette over the input end of an image intensifier for the purpose of making a radiograph. 82. "SSD" means the distance between the source and the skin entrance plane of the patient. 83. "Stationary x-ray equipment" (See "X-ray equipment").

84. "Stray radiation" means the sum of leakage and scattered radiation. 85. "Technique factors" means the following conditions of operation: a. for capacitor energy storage equipment, peak tube potential in kV and quantity of charge in mAs; b. for field emission equipment rated for pulsed operation, peak tube potential in kV and number of x-ray pulses; c. for CT x-ray systems designed for pulsed operation, peak tube potential in kV, scan time in seconds, and either tube current in mA, x-ray pulse width in seconds, and the number of x-ray pulses per scan, or the product of tube current, x-ray pulse width, and the number of x-ray pulses in mAs; d. for CT x-ray systems not designed for pulsed operation, peak tube potential in kV, and either tube current in mA and scan time in seconds, or the product of tube current and exposure time in mAs and the scan time when the scan time and exposure time are equivalent; and e. for all other equipment, peak tube potential in kV, and either tube current in mA and exposure time in seconds, or the product of tube current and exposure time in mAs. 86. "Termination of irradiation" means the stopping of irradiation in a fashion which will not permit continuance of irradiation without the resetting of operating conditions at the control panel. 87. "Tomogram" means the depiction of the x-ray attenuation properties of a section through a body. 88. "Tube" means an x-ray tube, unless otherwise specified. 89. "Tube housing assembly" means the tube housing with tube installed. It includes high-voltage and/or filament transformers and other appropriate elements when such are contained within the tube housing. 90. "Tube rating chart" means the set of curves which specify the rated limits of operation of the tube in terms of the technique factors. 91. "Useful beam" means the radiation emanating from the tube housing port or the radiation head and passing through the aperture of the beam-limiting device when the exposure controls are in a mode to cause the system to produce radiation. 92. "Variable-aperture beam-limiting device" means a beam-limiting device which has capacity for stepless adjustment of the x-ray field size at a given SID.

93. "Visible area" means that portion of the input surface of the image receptor over which incident x-ray photons are producing a visible image. 94. "X-ray exposure control" means a device, switch, button, or other similar means by which an operator initiates and/or terminates the radiation exposure. 95. "X-ray equipment" means an x-ray system, subsystem, or component thereof. Types of x-ray equipment are as follows: a. "Mobile x-ray equipment" means x-ray equipment mounted on a permanent base with wheels and/or casters for moving while completely assembled. b. "Portable x-ray equipment" means x-ray equipment designed to be hand carried. c. "Stationary x-ray equipment" means x-ray equipment which is installed in a fixed location. 96. "X-ray field" means that area of the intersection of the useful beam and any one of the set of planes parallel to and including the plane of the image receptor, whose perimeter is the locus of points at which the exposure rate is one-fourth of the maximum in the intersection. 97. "X-ray high-voltage generator" means a device which transforms electrical energy from the potential supplied by the x-ray control to the tube operating potential. The device may also include means for transforming alternating current to direct current, filament transformers for the x-ray tube(s), high-voltage switches, electrical protective devices, and other appropriate elements. 98. "X-ray system" means an assemblage of components for the controlled production of x-rays. It includes minimally an x-ray high-voltage generator, an x-ray control, a tube housing assembly, a beam-limiting device, and the necessary supporting structures. Additional components which function with the system are considered integral parts of the system. 99. "X-ray subsystem" means any combination of two or more components of an x-ray system. 100. "X-ray tube" means any electron tube which is designed to be used primarily for the production of x-rays.

**History**
- *SOURCE: Miss. Code Ann. §45-14-11*

##### **15 Miss. Admin. Code Pt. 21, R. 1.6.3** General and Administrative Requirements {#sec-21-1.6.3 omnilex-key=us-ms-regs-official--title-15--21#1.6.3}

1. Radiation Safety Requirements. The registrant shall be responsible for directing the operation of the x-ray system(s) under his administrative control. The registrant or the registrant's agent shall assure that the requirements of these regulations are met in the operation of the x-ray system(s).

a. An x-ray system which does not meet the provisions of these regulations shall not be operated for diagnostic purposes (if so directed by the Agency). b. Individuals who will be operating the x-ray systems shall be adequately instructed in the safe operating procedures and be competent in the safe use of the equipment. See Appendix A for a list of subject matters pertinent to this requirement. The Agency may use interview, observation and/or testing to determine compliance. c. A chart shall be provided in the vicinity of the diagnostic x-ray system's control panel which specifies, for all examinations performed with that system, the following information: i. patient's body part and anatomical size, or body part thickness, or age (for pediatrics), versus technique factors to be utilized; ii. type and size of the film or screen-film combination to be used; iii. type and focal distance of the grid to be used, if any; iv. source to image receptor distance to be used (except for dental intraoral radiography); and v. type and location of placement of patient shielding (i.e., gonad, etc.) to be used. d. The registrant of a facility shall establish and make available to x-ray operators written safety procedures, including patient holding and any restrictions of the operating technique required for the safe operation of the particular x-ray system. The operator shall be able to demonstrate familiarity with these procedures. e. Except for human patients who cannot be moved out of the room, only the staff and ancillary personnel, or other persons, required for the medical procedure or training shall be in the room during the radiographic exposure. Other than the patient being examined: i. All individuals shall be positioned such that no part of the body will be struck by the useful beam unless protected by not less than 0.5 millimeter lead equivalent material. ii. The x-ray operator, other staff, ancillary personnel, and other persons required for the medical procedure shall be protected from the direct scatter radiation by protective aprons or whole body protective barriers of not less than 0.25 millimeter lead equivalent material.

iii. Human patients who cannot be removed from the room shall be protected from the direct scatter radiation by whole body protective barriers of not less than 0.25 millimeter lead equivalent material, or shall be so positioned that the nearest portion of the body is at least 2 meters from both the tube head and the nearest edge of the image receptor. f. Gonad shielding of not less than 0.5 millimeter lead equivalent material shall be used for human patients, who have not passed the reproductive age, during radiographic procedures in which the gonads are in the useful beam, except for cases in which this would interfere with the diagnostic procedure. g. Individuals shall not be exposed to the useful beam except for healing arts purposes and unless such exposure has been authorized by a licensed practitioner of the healing arts. This provision specifically prohibits deliberate exposure for the following purposes: i. exposure of an individual for training, demonstration, or other non-healing-arts purposes; and ii. exposure of an individual for the purpose of healing arts screening except as authorized by 1.6.3(1)(k). h. When a patient or film must be provided with auxiliary support during a radiation exposure: i. mechanical holding devices shall be used when the technique permits. The written safety procedures, required by 1.6.3(1)(d), shall list individual projections where holding devices cannot be utilized; ii. written safety procedures, as required by 1.6.3(1)(d), shall indicate the requirements for selecting a holder and the procedure the holder shall follow; iii. the human holder shall be instructed in personal radiation safety and protected as required by 1.6.3(1)(e); iv. no individual shall be used routinely to hold film or patients; v. in those cases where the patient must hold the film, except during intraoral examinations, any portion of the body other than the area of clinical interest struck by the useful beam shall be protected by not less than 0.5 millimeter lead equivalent material; vi. when an animal must be held by an individual during an exposure, that individual shall be protected with appropriate shielding devices,

such as leaded aprons and gloves, and shall be positioned such that no part of his or her body shall be struck by the useful beam; and vii. each facility must have leaded aprons and gloves available in sufficient numbers to provide protection to all personnel who are involved with x-ray operations and who are otherwise not shielded. i. Procedures and auxiliary equipment designed to minimize patient and personnel exposure commensurate with the needed diagnostic information shall be utilized. i. The speed of the screen and film combinations used shall be the fastest speed consistent with the diagnostic objective of the examinations. Film cassettes without intensifying screens shall not be used for any routine diagnostic radiological imaging, with the exception of standard film packets for intraoral use in dental radiography. ii. The radiation exposure to the patient shall be the minimum exposure required to produce images of good diagnostic quality. iii. Portable or mobile x-ray equipment shall be used only for examinations where it is impractical to transfer the patient(s) to a stationary x-ray installation. iv. X-ray systems subject to 1.6.6 shall not be utilized in procedures where the source to patient distance is less than 30 centimeters except for veterinary systems. v. If grids are used between the patient and the image receptor to decrease scatter to the film and improve contrast the grid shall: vi. Be positioned properly, i.e., tube side facing the right direction, and grid centered to the central ray. vii. If of the focused type, be of the proper focal distance for the SIDs being used. j. All individuals who are associated with the operation of an x-ray system are subject to the requirements of 1.4.5 and 1.4.7 of these regulations. In addition: i. When protective clothing or devices are worn on portions of the body and a personnel monitoring device(s) is required, at least one such monitoring device shall be utilized as follows: i. When an apron is worn, the monitoring device shall be worn at the collar outside of the apron.

ii. The dose to the whole body based on the maximum dose attributed to the most critical organ shall be recorded in the reports required by 1.4.6 of these regulations. If more than one device is used and a record is made of the data, each dose shall be identified with the area where the device was worn on the body. ii. Exposure of a personnel monitoring device to deceptively indicate a dose delivered to an individual is prohibited. k. Healing Arts Screening. Any person proposing to conduct a healing arts screening program shall not initiate such a program without prior approval of the Agency. When requesting such approval, that person shall submit the information outlined in Appendix B of this Subchapter. If any information submitted to the Agency becomes invalid or outdated, the Agency shall be immediately notified. l. Information and Maintenance Record and Associated Information. The registrant shall maintain the following information for each x-ray system for inspection by the Agency: i. model and serial numbers of all major components, and user's manuals for those components; ii. tube rating charts and cooling curves; iii. records of surveys, calibrations, maintenance, and modifications performed on the x-ray system(s); and iv. a copy of all correspondence with this Agency regarding that x-ray system. m. X-Ray Log. Each facility shall maintain an x-ray log containing the patient's name, the type of examinations, and the dates the examinations were performed. When the patient or film must be provided with human auxiliary support, the name of the human holder shall be recorded. n. A sign shall be posted in a conspicuous area so as to be easily seen by the patient to the effect that if there is a pregnancy or the possibility of a pregnancy, the physician should be notified. Prescription of x-ray examinations of pregnant or possibly pregnant patients shall assure that medical consideration has been given to possible fetal exposure and appropriate protective measures are taken. 2. X-ray Film Processing Facilities and Practices. Each installation using a radiographic x-ray system and using analog image receptors (radiographic film) shall have available suitable equipment for handling and processing radiographic film in accordance with the following provisions:

a. Manually developed film: i. Processing tanks shall be constructed of mechanically rigid, corrosion resistant material; and ii. The temperature of solutions in the tanks shall be maintained within the range of 60ºF to 80ºF (16ºC to 27ºC). Film shall be developed in accordance with the time-temperature relationships recommended by the film manufacturer, or, in the absence of such recommendations, with the time-temperature chart below:

Time-Temperature Chart Thermometer Reading (Degrees) Minimum Developing Time (Minutes) o C o F 26.7 80 2 26.1 79 2 25.6 78 2 ½ 25.0 77 2 ½ 24.4 76 3 23.9 75 3 23.3 74 3 ½ 22.8 73 3 ½ 22.2 72 4 21.7 71 4 21.1 70 4 ½ 20.6 69 4 ½ 20.0 68 5 19.4 67 5 ½ 18.9 66 5 ½ 18.3 65 6 17.8 64 6 ½ 17.2 63 7 16.7 62 8 16.1 61 8 ½ 15.6 60 9 ½

iii. Devices shall be utilized which will: i. Indicate the actual temperature of the developer; and ii. Signal the passage of a preset time appropriate to the developing time required.

b. Automatic Processors and Other Closed Processing Systems: i. Films shall be developed in accordance with the time-temperature relationships recommended by the film manufacturer; in the absence of such recommendations, the film shall be developed using the chart below:

Developer Temperature (Degrees)

Minimum Immersion Time:* (Seconds) o C o F 35.5 96 19 35 95 20 34.5 94 21 34 93 22 33.5 92 23 33 91 24 32 90 25 31.5 89 26 31 88 27 30.5 87 28 30 86 29 29.5 85 30

*Immersion time only, no crossover time included.

ii. The specified developer temperature and immersion time shall be posted in the darkroom or on the automatic processor. c. Other Requirements i. Pass boxes, if provided, shall be so constructed as to exclude light from the darkroom when cassettes are placed in or removed from the boxes, and shall incorporate adequate shielding from stray radiation to prevent exposure of undeveloped film. ii. The darkroom shall be light tight and use proper safelighting such that any film type in use exposed in a cassette to x-radiation sufficient to produce an optical density from 1 to 2 when processed shall not suffer an increase in density greater than 0.1 (0.02 for mammography) when exposed in the darkroom for 2 minutes with all safelights on. If used, daylight film handling boxes shall preclude fogging of the film.

iii. Darkrooms typically used by more than one individual shall be provided a positive method to prevent accidental entry while undeveloped films are being handled or processed. iv. Film shall be stored in a cool, dry place and shall be protected from exposure to stray radiation. Film in open packages shall be stored in a light tight container. i. Film cassettes and intensifying screens shall be inspected periodically and shall be cleaned and replaced as necessary to best assure radiographs of good diagnostic quality. ii. Outdated x-ray film shall not be used for human diagnostic radiographs, unless the film has been stored in accordance with the manufacturer's recommendations and a sample of the film passes a sensitometric test for normal ranges of base plus fog and speed. iii. Film developing solutions shall be prepared in accordance with the directions given by the manufacturer, and shall be maintained in strength by replenishment or renewal so that full development is accomplished within the time specified by the manufacturer.

**History**
- *SOURCE: Miss. Code Ann. §45-14-11*

##### **15 Miss. Admin. Code Pt. 21, R. 1.6.4** General Requirements for all Diagnostic X-Ray Systems {#sec-21-1.6.4 omnilex-key=us-ms-regs-official--title-15--21#1.6.4}

In addition to other requirements of this section, all diagnostic x-ray systems shall meet the following requirements: 1. Warning Label. The control panel containing the main power switch shall bear the warning statement, legible and accessible to view: "WARNING: This x-ray unit may be dangerous to patient and operator unless safe exposure factors and operating instructions are observed." 2. Battery Charge Indicator. On battery-powered x-ray generators, visual means shall be provided on the control panel to indicate whether the battery is in a state of charge adequate for proper operation. 3. Leakage Radiation from the Diagnostic Source Assembly. The leakage radiation from the diagnostic source assembly measured at a distance of 1 meter in any direction from the source shall not exceed 100 milliroentgens (25.8 μC/kg) in 1 hour when the x-ray tube is operated at its leakage technique factors. Compliance shall be determined by measurements averaged over an area of 100 square centimeters with no linear dimension greater than 20 centimeters. If leakage technique factors cannot be set on the control panel, then compliance shall be determined by measuring leakage at maximum kVp and an appropriate mAs.

4. Radiation from Components Other Than the Diagnostic Source Assembly. The radiation emitted by a component other than the diagnostic source assembly shall not exceed 2 milliroentgens (0.516 μC/kg) in 1 hour at 5 centimeters from any accessible surface of the component when it is operated in an assembled x-ray system under any conditions for which it was designed. Compliance shall be determined by measurements averaged over an area of 100 square centimeters with no linear dimension greater than 20 centimeters. 5. Beam Quality. a. Half-value Layer. i. The half-value layer of the useful beam for a given x-ray tube potential shall not be less than the values shown in Table I. If it is necessary to determine such half-value layer at an x-ray tube potential which is not listed in Table I, linear interpolation or extrapolation may be made. TABLE I

X-ray tube voltage (kilovolt peak) Minimum HVL (mm of Al) Designed Operating Range Measured Operating Potential Dental Systems Medical X-ray Systems Manufactured before 06/10/2006 Medical X-ray Systems Manufactured after 06/10/2006

Below 50 30 1.5 0.3 0.3 40 1.5 0.4 0.4 50 1.5 0.5 0.5 50 to 70 51 1.5 1.3 1.3 60 1.5 1.5 1.5 70 1.5 2.1 1.8 Above 70 71 2.1 2.1 2.5 80 2.3 2.3 2.9 90 2.5 2.5 3.2 100 2.7 2.7 3.6 110 3.0 3.0 3.9 120 3.2 3.2 4.3 130 3.5 3.5 4.7 140 3.8 3.8 5.0 150 4.1 4.1 5.4

ii. For capacitor energy storage equipment, compliance with the requirements of 1.6.4(5) shall be determined with the maximum

quantity of charge per exposure. This will be deemed to have been met if a mAs of 5-10 has been used. iii. The required minimal half-value-layer of the useful beam shall include the filtration contributed by all materials which are permanently between the source and the patient. b. Filtration Controls. For x-ray systems which have variable kVp and variable filtration for the useful beam, a device shall link the kVp selector with the filter(s) and shall prevent an exposure unless the minimum amount of filtration necessary to produce the HVL required by 1.6.4(5)(a) is in the useful beam for the given kVp which has been selected. 6. Multiple Tubes. Where two or more radiographic tubes are controlled by one exposure switch, the tube or tubes which have been selected shall be clearly indicated prior to initiation of the exposure. This indication shall be both on the x-ray control panel and at or near the tube housing assembly which has been selected. 7. Mechanical Support of Tube Head. The tube housing assembly supports shall be adjusted such that the tube housing assembly will remain stable during an exposure unless tube housing movement is a designed function of the x-ray system. 8. Technique Indicators. a. The technique factors to be used during an exposure shall be indicated before the exposure begins. If automatic exposure controls are used, the technique factors which are set prior to the exposure shall be indicated. b. The requirements of 1.6.4(8)(a) may be met by permanent markings on equipment having fixed technique factors. Indication of technique factors shall be visible from the operator's position except in the case of spot films made by the fluoroscopist. 9. Locks. All position locking, holding, and centering devices on x-ray system components shall function as intended.

**History**
- *SOURCE: Miss. Code Ann. §45-14-11*

##### **15 Miss. Admin. Code Pt. 21, R. 1.6.5** Fluoroscopic X-Ray Systems {#sec-21-1.6.5 omnilex-key=us-ms-regs-official--title-15--21#1.6.5}

All fluoroscopic x-ray systems shall be image intensified and meet the following requirements: 1. Limitation of Useful Beam. a. Primary Barrier.

i. The fluoroscopic imaging assembly used shall be provided with a primary protective barrier which intercepts the entire cross section of the useful beam at any SID. ii. The x-ray tube used for fluoroscopy shall not produce x-rays unless the barrier is in position to intercept the entire useful beam. b. Fluoroscopic Beam Limitation. i. For certified fluoroscopic systems, neither the length nor the width of the x-ray field in the plane of the image receptor shall exceed that of the visible area of the image receptor by more than 3 percent of the SID. The sum of the excess length and the excess width shall be no greater than 4 percent of the SID. ii. For uncertified fluoroscopic systems with a spot film device, the x-ray beam with the shutters fully opened (during fluoroscopy or spot filming) shall be no larger than the largest spot film size for which the device is designed. Measurements shall be made at the minimum SID available but at no less than 20 centimeters table top to the film plane distance. iii. For uncertified fluoroscopic systems without a spot film device, the requirements of 1.6.5(1)(b)(i) apply. iv. Other requirements for fluoroscopic beam limitation: i. Means shall be provided to permit further limitation of the field. Beam-limiting devices manufactured after May 22, 1979, and incorporated in equipment with a variable SID and/or a visible area of greater than 300 square centimeters shall be provided with means for stepless adjustments of the x-ray field. ii. All equipment with a fixed SID and a visible area of 300 square centimeters or less shall be provided with either stepless adjustment of the x-ray field or with means to further limit the x-ray field size at the plane of the image receptor to 125 square centimeters or less. iii. If provided, stepless adjustment shall provide continuous field sizes from the maximum obtainable to a field size of 5 centimeters by 5 centimeters or less. iv. For equipment manufactured after February 25, 1978, when the angle between the image receptor and beam axis is variable, means shall be provided to indicate when the axis of the x-ray beam is perpendicular to the plane of the image

receptor; compliance shall be determined with the beam axis indicated to be perpendicular to the plane of the image receptor. v. For rectangular x-ray fields used with circular image reception, the error in alignment shall be determined along the length and width dimensions of the x-ray field which pass through the center of the visible area of the image receptor. c. Spot Film Beam Limitation. Spot-film devices which are certified components shall meet the following additional requirements: i. Means shall be provided between the source and the patient for adjustment of the x-ray field size in the plane of the film to the size of that portion of the film which has been selected on the spot film selector. Such adjustment shall be automatically accomplished except when the x-ray field size in the plane of the film is smaller than that of the selected portion of the film. For spot film devices manufactured after June 21, 1979, if the x-ray field size is less than the size of the selected portion of the film, the means for adjustment of the field size shall be only at the operator's option. d. It shall be possible to adjust the x-ray field size in the plane of the film to a size smaller than the selected portion of the film. The minimum field size at the greatest SID shall be equal to, or less than, 5 centimeters by 5 centimeters. e. The center of the x-ray field in the plane of the film shall be aligned with the center of the selected portion of the film to within 2 percent of the SID. f. On spot-film devices manufactured after February 25, 1978, if the angle between the plane of the image receptor and beam axis is variable, means shall be provided to indicate when the axis of the x-ray beam is perpendicular to the plane of the image receptor, and compliance shall be determined with the beam axis indicated to be perpendicular to the plane of the image receptor. g. Override. If a means exists to override any of the automatic x-ray field size adjustments required in 1.6.5(1)(b), and (c) that means: i. shall be designed for use only in the event of system failure; ii. shall incorporate a signal visible at the fluoroscopist's position which will indicate whenever the automatic field size adjustment is overridden; and iii. shall be clearly and durably labeled as follows:

FOR X-RAY FIELD LIMITATION SYSTEM FAILURE 2. Activation of the Fluoroscopic Tube. X-ray production in the fluoroscopic mode shall be controlled by a device which requires continuous pressure by the fluoroscopist for the entire time of any exposure. When recording serial fluoroscopic images, the fluoroscopist shall be able to terminate the x-ray exposure(s) at any time, but means may be provided to permit completion of any single exposure of the series in process. 3. Exposure Rate Limits. a. Entrance Exposure Rate Allowable Limits. i. Fluoroscopic equipment which is provided with automatic exposure rate control shall not be operable at any combination of tube potential and current which will result in an exposure rate in excess of 10 roentgens (2.58 mC/kg) per minute at the point where the center of the useful beam enters the patient, except: i. During recording of fluoroscopic images, or ii. When an optional high level control is provided. When so provided, the equipment shall not be operable at any combination of tube potential and current which will result in an exposure rate in excess of 5 roentgens (1.29 mC/kg) per minute at the point where the center of the useful beam enters the patient unless the high level control is activated. Special means of activation of high level controls shall be required. The high level control shall only be operable when continuous manual activation is provided by the operator. A continuous signal audible to the fluoroscopist shall indicate that the high level control is being employed. ii. Fluoroscopic equipment which is not provided with automatic exposure rate control shall not be operable at any combination of tube potential and current which will result in an exposure rate in excess of 5 roentgens (1.29 mC/kg) per minute at the point where the center of the useful beam enters the patient, except: i. During recording of fluoroscopic images, or ii. When an optional high level control is activated. Special means of activation of high level controls shall be required. The high level control shall only be operable when continuous manual activation is provided by the operator. A

continuous signal audible to the fluoroscopist shall indicate that the high level control is being employed. iii. Compliance with the requirements of 1.6.5(3) shall be determined as follows: i. If the source is below the x-ray table, the exposure rate shall be measured 1 centimeter above the tabletop or cradle. ii. If the source is above the x-ray table, the exposure rate shall be measured at 30 centimeters above the tabletop with the end of the beam-limiting device or spacer positioned as closely as possible to the point of measurement. iii. For a C-arm type of fluoroscope, the exposure rate shall be measured 30 centimeters from the input surface of the fluoroscopic imaging assembly, with the source positioned at any available SID, provided that the end of the beam-limiting device or spacer is no closer than 30 centimeters from the input surface of the fluoroscopic imaging assembly. iv. For a lateral type fluoroscope, the exposure rate shall be measured at a point 15 centimeters from the center line of the x-ray table and in the direction of the x-ray source with the end of the beam-limiting device or spacer positioned as closely as possible to the point of measurement. If the tabletop is movable, it shall be positioned as closely as possible to the lateral x-ray source, with the end of the beam limiting device or spacer no closer than 15 centimeters to the center line of the x-ray table. b. Periodic measurement of entrance exposure rate shall be performed by a qualified expert for both maximum and typical values, as follows.

i. Such measurements shall be made annually or after any maintenance of the system which might affect the exposure rate. ii. Results of these measurements shall be posted where any fluoroscopist may have ready access to such results while using the fluoroscope and in the record required in 1.6.3(1)(l)(iii) The measurement results shall be stated in roentgens per minute and include the technique factors used in determining such results. The name of the person performing the measurements and the date the measurements were performed shall be included in the results.

Materials should be placed in the useful beam to protect the imaging system when conducting these periodic measurements.

iii. Conditions of periodic measurement of maximum entrance exposure rate are as follows: i. the measurement shall be made under the conditions that satisfy the requirements of 1.6.5(3)(a)(iii); ii. the kVp, mA, and/or other selectable parameters shall be adjusted to those settings which give the maximum entrance exposure rate; and iii. the x-ray system that incorporates automatic exposure rate control shall have sufficient attenuative material placed in the useful beam to produce the maximum output of that system. iv. Conditions of periodic measurement of typical entrance exposure rate are as follows: i. the measurement shall be made under the conditions that satisfy the requirements of 1.6.5(3)(a)(iii); ii. the kVp and mA shall be typical of clinical use of the x-ray system; and iii. the x-ray system(s) that incorporates automatic exposure rate control shall have an appropriate phantom placed in the useful beam to produce a milliamperage and/or kilovoltage typical of the use of the x-ray system. 4. Barrier Transmitted Radiation Rate Limits. a. The exposure rate due to transmission through the primary protective barrier with the attenuation block in the useful beam, combined with radiation from the image intensifier shall not exceed 2 milliroentgens (0.516 μC/kg) per hour at 10 centimeters from any accessible surface of the fluoroscopic imaging assembly beyond the plane of the image receptor for each roentgen per minute of entrance exposure rate. b. Measuring Compliance of Barrier Transmission. i. The exposure rate due to transmission through the primary protective barrier combined with radiation from the image intensifier shall be determined by measurements averaged over an area of 100 square centimeters with no linear dimension greater than 20 centimeters.

ii. If the source is below the tabletop, the measurement shall be made with the input surface of the fluoroscopic imaging assembly positioned 30 centimeters above the tabletop. iii. If the source is above the tabletop and the SID is variable, the measurement shall be made with the end of the beam-limiting device or spacer as close to the tabletop as it can be placed, provided that it shall not be closer than 30 centimeters. iv. Compression devices and movable grids shall be removed from the useful beam during the measurement. 5. Indication of Potential and Current. During fluoroscopy and cinefluorography, the kV and the mA shall be continuously indicated. 6. Source-to-Skin Distance. The SSD shall not be less than: a. 38 centimeters on stationary fluoroscopic systems manufactured on or after August 1, 1974; b. 35.5 centimeters on stationary fluoroscopic systems manufactured prior to August 1, 1974; c. 30 centimeters on all mobile fluoroscopes; and d. 20 centimeters for all mobile fluoroscopes used for specific surgical procedures. 7. Fluoroscopic Timer. a. Means shall be provided to preset the cumulative on-time of the fluoroscopic x-ray tube. The maximum cumulative time of the timing device shall not exceed 5 minutes without resetting. b. A signal audible to the fluoroscopist shall indicate the completion of any preset cumulative on-time. Such signal shall continue to sound while x-rays are produced until the timing device is reset. 8. Control of Scattered Radiation. a. Fluoroscopic table designs when combined with procedures utilized shall be such that no unprotected part of any staff or ancillary individual's body shall be exposed to unattenuated scattered radiation which originates from under the table. The attenuation required shall be not less than 0.25 millimeter lead equivalent. b. Equipment configuration when combined with procedures shall be such that no portion of any staff or ancillary individual's body, except the extremities,

shall be exposed to the unattenuated scattered radiation emanating from above the table top unless that individual: i. is at least 120 centimeters from the center of the useful beam; or ii. the radiation has passed through not less than 0.25 millimeter lead equivalent material including, but not limited to, drapes, Bucky-slot cover panel, or self-supporting curtains, in addition to any lead equivalency provided by the protective apron referred to in 1.6.3(1)(h)(vii). c. The Agency may grant exemptions to 1.6.5(8)(b) where a sterile field will not permit the use of the normal protective barriers. Where the use of prefitted sterilized covers for the barriers is practical, the Agency shall not permit such exemption. See Appendix C for a suggested list of fluoroscopic procedures where such exemptions will be automatically granted. 9. Spot Film Exposure Reproducibility. Fluoroscopic systems equipped with spot film (radiographic) mode shall meet the exposure reproducibility requirements of 1.6.6(4) when operating in the spot film mode. 10. Radiation Therapy Simulation Systems. Radiation therapy simulation systems shall be exempt from all the requirements of 1.6.5(1), 1.6.5(3), 1.6.5(4), and 1.6.5(7) provided that: a. such systems are designed and used in such a manner that no individual other than the patient is in the x-ray room during periods of time when the system is producing x-rays; and b. systems which do not meet the requirements of 1.6.5(7) are provided with a means of indicating the cumulative time that an individual patient has been exposed to x-rays. Procedures shall require in such cases that the timer be reset between examinations.

**History**
- *SOURCE: Miss. Code Ann. §45-14-11*

##### **15 Miss. Admin. Code Pt. 21, R. 1.6.6** Rule 1.6.6 {#sec-21-1.6.6 omnilex-key=us-ms-regs-official--title-15--21#1.6.6}

Radiographic Systems Other Than Fluoroscopic, Dental Intraoral, Veterinarian, Computed Tomography, or Mammography Systems. 1. Beam Limitation. The useful beam shall be limited to the area of clinical interest. This shall be deemed to have been met if a positive beam-limiting device has been properly used or if evidence of collimation is shown on at least three sides or three corners of the film, (for example, projections from the shutters of the collimator, cone cutting at the corners, or borders at the film's edge). a. General Purpose Stationary and Mobile X-Ray Systems.

i. The use of a variable-field beam limiting device providing stepless, independent adjustment of at least two dimensions of the x-ray field is required. ii. A method shall be provided for visually defining the perimeter of the x-ray field. The total misalignment of the edges of the visually defined field with the respective edges of the x-ray field along either the length or width of the visually defined field shall not exceed 2 percent of the distance from the source to the center of the visually defined field when the surface upon which it appears is perpendicular to the axis of the x-ray beam. iii. The Agency may grant an exemption on noncertified x-ray systems to 1.6.6(1)(a)(i) and (ii) provided the registrant makes a written application for such exemption and in that application: i. demonstrates it is impractical to comply with 1.6.6(1)(a)(i) and (ii); and ii. the purpose of 1.6.6(1)(a)(i) and (ii) will be met by other methods. b. Additional Requirements for Stationary General Purpose X-Ray Systems. In addition to the requirements of 1.6.6(1)(a), all stationary general purpose x-ray systems shall meet the following requirements: i. A method shall be provided to indicate when the axis of the x-ray beam is perpendicular to the plane of the image receptor, to align the center of the x-ray field with respect to the center of the image receptor to within 2 percent of the SID, and to indicate the SID to within 2 percent. ii. The beam-limiting device shall indicate numerically the field size in the plane of the image receptor to which it is adjusted. iii. Indication of field size dimension and SID's shall be specified in inches and/or centimeters, and shall be such that aperture adjustments result in x-ray field dimensions in the plane of the image receptor which correspond to those indicated by the beam-limiting device to within 2 percent of the SID when the beam axis is indicated to be perpendicular to the plane of the image receptor. c. X-Ray Systems Designed for One Image Receptor Size. Radiographic equipment designed for only one image receptor size at a fixed SID shall be provided with means to limit the field at the plane of the image receptor to dimensions no greater than those of the image receptor, and to align the center of the x-ray field with the center of the image receptor to within 2

percent of the SID, or shall be provided with means to both size and align the x-ray field such that the x-ray field at the plane of the image receptor does not extend beyond any edge of the image receptor. d. Radiographic Systems Other Than Those Designated in 1.6.6(1)(a),(b), and (c). i. Means shall be provided to limit the x-ray field in the plane of the image receptor so that such field does not exceed each dimension of the image receptor by more than 2 percent of the SID when the axis of the x-ray beam is perpendicular to the plane of the image receptor. ii. Means shall be provided to align the center of the x-ray field with the center of the image receptor to within 2 percent of the SID, or means shall be provided to both size and align the x-ray field such that the x-ray field at the plane of the image receptor does not extend beyond any edge of the image receptor. Compliance shall be determined with the axis of the x-ray beam perpendicular to the plane of the image receptor. iii. 1.6.6(1)(d)(i) and (ii) may be met with a system that meets the requirements for a general purpose x-ray system as specified in 1.6.6(1)(a) or, when alignment means are also provided, may be met with either: i. an assortment of removable, fixed-aperture, beam-limiting devices sufficient to meet the requirement for each combination of image receptor size and SID for which the unit is designed with each such device having clear and permanent markings to indicate the image receptor size and SID for which it is designed; or ii. a beam-limiting device having multiple fixed apertures sufficient to meet the requirement for each combination of image receptor size and SID for which the unit is designed. Permanent, clearly legible markings shall indicate the image receptor size and SID for which each aperture is designed and shall indicate which aperture is in position for use. 2. Radiation Exposure Control a. Exposure Initiation. Means shall be provided to initiate the radiation exposure by a positive action on the part of the operator, such as the depression of a switch. Radiation exposure shall not be initiated without such a positive action. In addition, it shall not be possible to initiate an exposure when the timer is set to a "zero" or "off" position if either position is provided.

b. Exposure Termination. Means shall be provided to terminate the exposure at a preset time interval, preset product of current and time, a preset number of pulses, or a preset radiation exposure to the image receptor. Termination of an exposure shall cause automatic resetting of the timer to its initial setting or to "zero." i. Manual exposure control. An x-ray exposure control shall be incorporated into each x-ray system such that an exposure can be terminated by the operator at any time ("dead-man" switch) except for: i. exposure of 1/2 second or less; or ii. during serial radiography when means shall be provided to permit completion of any single exposure of the series in process. ii. Automatic exposure control. When an automatic exposure control is provided: i. indication shall be made on the control panel when this mode of operation is selected; ii. if the x-ray tube potential is equal to or greater than 50 kVp, the minimum exposure time for field emission equipment rated for pulsed operation shall be equal to or less than a time interval equivalent to two pulses; iii. the minimum exposure time for all equipment other than that specified in 1.6.6(2)(b)(ii)(ii) shall be equal to or less than 1/60 second or a time interval required to deliver 5 mAs, whichever is greater; iv. either the product of peak x-ray tube potential, current, and exposure time shall be limited to not more than 60 kWs per exposure, or the product of x-ray tube current and exposure time shall be limited to not more than 600 mAs per exposure, except that when the x-ray tube potential is less than 50 kVp, the product of x-ray tube current and exposure time shall be limited to not more than 2000 mAs per exposure; and v. a visible signal shall indicate when an exposure has been terminated at the limits required by 1.6.6(2)(ii)(iv), and manual resetting shall be required before further automatically timed exposures can be made. c. Exposure Indication. Means shall be provided for visual indication of x-ray production observable at or from the operator's protected position

whenever x-rays are produced. In addition, a signal audible to the operator shall indicate that the exposure has terminated. d. Exposure Duration (Timer) Reproducibility. With a timer setting of 0.5 seconds or less, the difference between the maximum exposure time (T max ) and the minimum exposure time (T min ) shall be less than or equal to 10% of the average exposure time ( T ), when four timer tests are performed:

e. Exposure Control Location. The x-ray exposure control shall be so placed that the operator can view the patient while making any exposure. f. Operator Protection, Except Veterinary Systems. i. Stationary systems. Stationary x-ray systems shall be required to have the x-ray exposure control permanently mounted in a protected area so that the operator is required to remain in that protected area during the entire exposure. ii. Mobile and portable systems. Mobile and portable x-ray systems which are: i. used continuously for greater than one week in the same location, i.e., a room or suite shall be considered as stationary systems under 1.6.6(2)(f)(i); and ii. used for less than one week in the same location shall be provided with either a protective barrier at least 6.5 feet (2 m) high for operator protection during exposures, or means shall be provided to allow the operator to be at least 12 feet (3.7 m) from the tube housing assembly during the exposure. iii. Operation Protection for Veterinary Systems. All stationary, mobile or portable x-ray systems used for veterinary work shall be provided with either a 6.5 foot (2 m) high protective barrier for operator protection during exposures, or shall be provided with means to allow the operator to be at least 12 feet (3.7 m) from the tube housing assembly during exposures. 3. Source-to-Skin Distance. All mobile or portable radiographic systems shall be provided with means to limit the source-to-skin distance to equal to or greater than 30 centimeters, except for veterinary systems. 4. Exposure Reproducibility. When all technique factors are held constant, including control panel selections associated with automatic exposure control (phototiming) systems, the coefficient of variation of exposure for both manual and phototimed

systems shall not exceed 0.05. This requirement shall be deemed to have been met, if, when four exposures are made at identical technique factors, the difference between the maximum exposure (E max ) and the minimum exposure ( E min ) shall be less than or equal to 10% of the average exposure( ):

5. Radiation from Capacitor Energy Storage Equipment in Standby Status. Radiation emitted from the x-ray tube when the exposure switch or timer is not activated shall not exceed a rate of 2 milliroentgens (0.516 μC/kg) per hour at 5 centimeters from any accessible surface of the diagnostic source assembly, with the beam-limiting device fully open. 6. Accuracy. Deviation of technique factors from indicated values shall not exceed the limits specified for that system by its manufacturer. In the absence of manufacturer's specifications, the deviation shall not exceed 10% of the indicated value. 7. Linearity, Uncertified X-Ray Systems Only. The following requirements apply when the equipment is operated on a power supply as specified by the manufacturer for any fixed x-ray tube potential within the range of 40 percent to 100 percent of the maximum rated. a. Equipment having independent selection of x-ray tube current (mA). The average ratios of exposure to the indicated milliampere-seconds product mR/mAs (C/kg/mAs) obtained at any two tube current settings shall not differ by more than 0.10 times their sum. This is:

where

and are the average mR/mAs (C/kg/mAs) values obtained at any two tube current settings. b. Equipment having a combined x-ray tube current-exposure time product (mAs) selector, but not a separate tube current (mA) selector. The average ratios of exposure to the indicated milliampere-seconds product mR/mAs (C/kg/mAs) obtained at any two mAs selector settings shall not differ by more than 0.10 times their sum. This is:

where

and are the average mR/mAs (C/kg/mAs) values obtained at any two mAs selector settings.

c. Measuring compliance. Determination of compliance shall be based on 4 exposures, of no less than 0.05 seconds each, taken within a time period of one hour, at each of the two settings. These two settings may include any two focal spot sizes provided that neither focal spot size is equal to or less than 0.45 millimeter, in which case the two settings shall be restricted to the same focal spot size. For purposes of this requirement, focal spot size is the nominal focal spot size specified by the x-ray tube manufacturer. 8. Additional Requirements Applicable to Certified Systems Only. Diagnostic x-ray systems incorporating one or more certified component(s) shall be required to comply with the following additional requirement(s) which relate to that certified component(s).

a. Linearity. When the equipment allows a choice of x-ray tube current settings and is operated on a power supply as specified by the manufacturer in accordance with the requirements of applicable Federal standards, for any fixed x-ray tube potential within the range of 40 to 100 percent of the maximum rating, the average ratios of exposure to the indicated milliampere-seconds product obtained at any 2 consecutive tube current settings shall not differ by more than 0.10 times their sum:

where

and are the average mR/mAs (C/kg/mAs) values obtained at each of 2 consecutive tube current settings. b. Beam Limitation for Stationary and Mobile General Purpose X-Ray Systems. i. There shall be provided a means of stepless adjustment of the size of the x-ray field. The minimum field size at an SID of 100 cm shall be equal to or less than 5 centimeters by 5 centimeters. ii. When a light localizer is used to define the x-ray field, it shall provide an average illumination of not less than 160 lux or 15 footcandles at 100 centimeters or at the maximum SID, whichever is less. The average illumination shall be based upon measurements made in the approximate center of each quadrant of the light field. Radiation therapy simulation systems manufactured on and after May 27, 1980, are exempt from this requirement. c. Beam Limitation for Portable X-Ray Systems. Beam limitation for portable x-ray systems shall meet the beam limitation requirements of 1.6.6(1)(a) and 1.6.6(7)(b).

d. Field Limitation and Alignment on Stationary General Purpose X-Ray Systems. For stationary, general purpose x-ray systems which contain a tube housing assembly, an x-ray control, and, for those systems so equipped, a table, all certified in accordance with 21 CFR 1020.30(c): i. Positive beam limitation (PBL) shall be provided whenever all the following conditions are met: i. The image receptor is inserted into a permanently mounted cassette holder; ii. The image receptor length and width are each less than 50 centimeters; iii. The x-ray beam axis is within plus or minus 3 degrees of vertical and the SID is 90 centimeters to 130 centimeters inclusive; or the x-ray beam axis is within plus or minus 3 degrees of horizontal and the SID is 90 centimeters to 205 centimeters inclusive; iv. The x-ray beam axis is perpendicular to the plane of the image receptor to within plus or minus 3 degrees; v. Neither tomographic nor stereoscopic radiography is being performed; and vi. The PBL system has not been intentionally overridden. This override provision is subject to 1.6.6(8)(d)(iii). ii. Positive beam limitation (PBL) shall prevent the production of x-rays when: i. Either the length or width of the x-ray field in the plane of the image receptor differs, except as permitted by 1.6.6(8)(d)(v), from the corresponding image receptor dimensions by more than 3 percent of the SID; or ii. The sum of the length and width differences as stated in 1.6.6 (8)(d)(ii)(i) without regard to sign exceeds 4 percent of the SID. iii. If a means of overriding the positive beam limitation (PBL) system exists, that means: i. Shall be designed for use only in the event of PBL system failure or if the system is being serviced; and

ii. If in a position that the operator would consider it part of the operational controls or if it is referenced in the operator's manual or in other materials intended for the operator, i. shall require that a key be utilized to defeat the PBL; ii. shall require that the key remain in place during the entire time the PBL system is overridden; and iii. shall require that the key or key switch be clearly and durably labeled as follows: FOR X-RAY FIELD LIMITATION SYSTEM FAILURE iv. Compliance with 1.6.6(8)(d)(ii) shall be determined when the equipment indicates that the beam axis is perpendicular to the plane of the image receptor and the provisions of 1.6.6(8)(d)(i) are met. Compliance shall be determined no sooner than 5 seconds after insertion of the image receptor. v. The positive beam limitation system shall be capable of operation, at the discretion of the operator, such that the size of the field may be made smaller than the size of the image receptor through stepless adjustment of the field size. The minimum field size at a SID of 100 centimeters shall be equal to or less than 5 centimeters by 5 centimeters. vi. The positive beam limitation system shall be designed such that if a change in image receptor does not cause an automatic return to positive beam limitation function as described in 1.6.6(8)(d)(ii), then any change of image receptor size or SID must cause the automatic return. e. Timers. Except for dental panoramic systems, termination of exposure shall cause automatic resetting of the timer to its initial setting or to "zero." 9. Tube Stands for Portable X-Ray Systems. A tube stand or other mechanical support shall be used for portable x-ray systems so that the x-ray tube housing assembly need not be hand-held during exposures.

**History**
- *SOURCE: Miss. Code Ann. §45-14-11*

##### **15 Miss. Admin. Code Pt. 21, R. 1.6.7** Intraoral Dental Radiographic Systems {#sec-21-1.6.7 omnilex-key=us-ms-regs-official--title-15--21#1.6.7}

In addition to the provisions of 1.6.3and 1.6.4, the requirements of 1.6.7 apply to x-ray equipment and associated facilities used for dental radiography. Requirements for extraoral dental radiographic systems are covered in 1.6.6.

1. Source-to-Skin Distance (SSD). X-ray systems designed for use with an intraoral image receptor shall be provided with means to limit SSD, to not less than: a. 18 centimeters if operable above 50 kVp; or b. 10 centimeters if not operable above 50 kVp. 2. Field Limitation. a. Radiographic systems designed for use with an intraoral image receptor shall be provided with means to limit the x-ray field such that the x-ray field at the minimum SSD shall be containable in a circle having a diameter of no more than 7 centimeters; and b. An open ended PID (position indicating device) shall be used on new dental x-ray equipment purchased after the effective date of these regulations. 3. Radiation Exposure Control for Certified and Noncertified Systems. a. Exposure Initiation. i. Means shall be provided to initiate the radiation exposure by a deliberate action on the part of the operator, such as the depression of a switch. Radiation exposure shall not be initiated without such an action; and ii. It shall not be possible to make an exposure when the timer is set to a "zero" or "off" position if either position is provided. b. Exposure Termination. i. Means shall be provided to terminate the exposure at a preset time interval, preset product of current and time, a preset number of pulses, or a preset radiation exposure to the image receptor. ii. An x-ray exposure control shall be incorporated into each x-ray system such that an exposure can be terminated by the operator at any time, except for exposures of 1/2 second or less. iii. Termination of an exposure shall cause automatic resetting of the timer to its initial setting or to "zero". c. Exposure Indication. Means shall be provided for visual indication observable at or from the operator's protected position whenever x-rays are produced. In addition, a signal audible to the operator shall indicate that the exposure has terminated.

d. Exposure Duration (Timer) Reproducibility. With a timer setting of 0.5 seconds or less, the difference between the maximum exposure time (T max ) and the minimum exposure time (T min ) shall be less than or equal to 10% of the average exposure time ( ), when four timer test are performed:

e. Exposure Control Location and Operation Protection. i. Stationary x-ray systems shall be required to have the x-ray exposure control permanently mounted in a protected area, so that the operator is required to remain in that protected area during the entire exposure; and ii. Mobile and portable x-ray systems which are: i. used for greater than one week in the same location, i.e., a room or suite, shall meet the requirements of 1.6.7(3)(e)(i); and ii. used for less than one week in the same location, shall be provided with either a protective barrier at least 6.5 feet (2m) high for operator protection, or means to allow the operator to be at least 12 feet (3.7 m) from the tube housing assembly while making exposures. 4. Exposure Reproducibility. The coefficient of variation shall not exceed 0.05 when all technique factors are held constant. This requirement shall be deemed to have been met if, when 4 exposures are made within a period of one hour at identical technique factors, the difference between the maximum exposure value (E max ) and the minimum exposure value (E min ) shall be less than or equal to 10% of the average exposure ( ):

5. Linearity. When the equipment allows a choice of x-ray tube current settings and is operated on a power supply as specified by the manufacturer in accordance with any fixed x-ray tube potential within the range of 40 to 100 percent of the maximum rating, the average ratios of exposure to the indicated millampere-seconds product obtained at any 2 consecutive tube current settings shall not differ by more than 0.10 times their sum:

where

and are the average mR/mAs (C/kg/mAs) values obtained at each of 2 consecutive tube current settings. 6. Accuracy. Deviation of technique factors from indicated values shall not exceed the limits specified for that system by its manufacturer. In the absence of manufacturer's specifications, the deviation shall not exceed 10% of the indicated value. 7. kVp Limitations. Dental x-ray machines with a nominal fixed kVp of less than 50 kVp shall not be used to make diagnostic dental radiographs of humans. 8. Administrative Controls. a. Patient and film holding devices shall be used when the techniques permit. b. The tube housing and the PID shall not be hand held during an exposure. c. The x-ray system shall be operated in such a manner that the useful beam at the patient's skin does not exceed the requirements of 1.6.7(2). d. Dental fluoroscopy without image intensification shall not be used.

**History**
- *SOURCE: Miss. Code Ann. §45-14-11*

##### **15 Miss. Admin. Code Pt. 21, R. 1.6.8** Veterinary Medicine Radiographic Installations {#sec-21-1.6.8 omnilex-key=us-ms-regs-official--title-15--21#1.6.8}

1. Equipment. a. The protective tube housing shall be equivalent to the requirements of 1.6.4(3). b. Diaphragms or cones shall be provided for collimating the useful beam to the area of clinical interest and shall provide the same degree of protection as is required of the housing. c. The total filtration permanently in the useful beam shall not be less than 0.5 millimeters aluminum equivalent for machines operating up to 50 kVp, 1.5 millimeters aluminum equivalent for machines operating between 50 and 70 kVp, and 2.5 millimeters aluminum equivalent for machines operating above 70 kVp. d. A device shall be provided to terminate the exposure after a preset time or exposure. e. A dead-man type of exposure switch shall be provided, together with an electrical cord of sufficient length, so that the operator can stand out of the useful beam and at least 6 feet (1.83 m) from the animal during all x-ray exposures.

2. Structural Shielding. All wall, ceiling, and floor areas shall be equivalent to or provided with applicable protective barriers to assure compliance with 1.4.5 of these regulations. 3. Operating Procedures. a. The operator shall stand well away from the useful beam and the animal during radiographic exposures. b. No individual other than the operator shall be in the x-ray room while exposures are being made unless such individual's assistance is required. c. When an animal must be held in position during radiography, mechanical supporting or restraining devices should be used. If the animal must be held by an individual, that individual shall be protected with appropriate shielding devices, such as protective gloves and apron, and he shall be so positioned that no part of his body will be struck by the useful beam. The exposure of any individual used for this purpose shall be monitored.

**History**
- *SOURCE: Miss. Code Ann. §45-14-11*

##### **15 Miss. Admin. Code Pt. 21, R. 1.6.9** Computed Tomography X-Ray Systems {#sec-21-1.6.9 omnilex-key=us-ms-regs-official--title-15--21#1.6.9}

1. Definitions. In addition to the definitions provided in 1.1.2 and 1.6.2 of these regulations, the following definitions shall be applicable to 1.6.9: a. "Computed tomography dose index" means the integral from -7T to +7T of the dose profile along a line perpendicular to the tomographic plane divided by the product of the nominal tomographic section thickness and the number of tomograms produced in a single scan, that is:

where: z = Position along a line perpendicular to the tomographic plane. D(z) = Dose at position z. T = Nominal tomographic section thickness. n = Number of tomograms produced in a single scan.

This definition assumes that the dose profile is centered around z = 0 and that, for a multiple tomogram system, the scan increment between adjacent scans is nT.

b. "Contrast scale" means the change in the linear attenuation coefficient per CTN relative to water, that is:

where: μ x = Linear attenuation coefficient of the material of interest. μ w = Linear attenuation coefficient of water. (CTN) x = CTN of the material of interest. (CTN) w = CTN of water.

c. "CS" (See "Contrast scale"). d. "CT conditions of operation" means all selectable parameters governing the operation of a CT x-ray system including, but not limited to, nominal tomographic section thickness, filtration, and the technique factors as defined in 1.6.2. e. "CTDI" (See "Computed tomography dose index"). f. "CT gantry" means the tube housing assemblies, beam-limiting devices, detectors, and the supporting structures and frames which hold these components. g. "CTN" (See "CT number"). h. "CT number" means the number used to represent the x-ray attenuation associated with each elemental area of the CT image.

where: k = A constant

μ x = Linear attenuation coefficient of the material of interest. μ w = Linear attenuation coefficient of water.

i. "Dose profile" means the dose as a function of position along a line. j. "Elemental area" means the smallest area within a tomogram for which the x-ray attenuation properties of a body are depicted. (See also "Picture element").

The constant has a normal value of 1,000 when the Houndsfield scale of CTN is used.

k. "Multiple tomogram system" means a computed tomography x-ray system which obtains x-ray transmission data simultaneously during a single scan to produce more than one tomogram. l. "Noise" means the standard deviation of the fluctuations in CTN expressed as a percentage of the attenuation coefficient of water. Its estimate (S n ) is calculated using the following expression:

where: CS = Contract scale. μ w = Linear attenuation coefficient of water. s = Estimated standard deviation of the CTN of picture elements in a specified area of the CT image.

m. "Nominal tomographic section thickness" means the full width at half-maximum of the sensitivity profile taken at the center of the cross-sectional volume over which x-ray transmission data are collected. n. "Picture element" means an elemental area of a tomogram. o. "Reference plane" means a plane which is displaced from and parallel to the tomographic plane. p. "Scan" means the complete process of collecting x-ray transmission data for the production of a tomogram. Data can be collected simultaneously during a single scan for the production of one or more tomograms. q. "Scan increment" means the amount of relative displacement of the patient with respect to the CT x-ray system between successive scans measured along the direction of such displacement. r. "Scan sequence" means a preselected set of two or more scans performed consecutively under preselected CT conditions of operation. s. "Scan time" means the period of time between the beginning and end of x-ray transmission data accumulation for a single scan. t. "Single tomogram system" means a CT x-ray system which obtains x-ray transmission data during a scan to produce a single tomogram. u. "Tomographic plane" means that geometric plane which is identified as corresponding to the output tomogram.

v. "Tomographic section" means the volume of an object whose x-ray attenuation properties are imaged in a tomogram. 2. Requirement for Equipment. a. Termination of Exposure. i. Means shall be provided to terminate the x-ray exposure automatically by either de-energizing the x-ray source or shuttering the x-ray beam in the event of equipment failure affecting data collection. Such termination shall occur within an interval that limits the total scan time to no more than 110 percent of its preset value through the use of either a backup timer or devices which monitor equipment function. ii. A visible signal shall indicate when the x-ray exposure has been terminated through the means required by 1.6.9(2)(a)(i). iii. The operator shall be able to terminate the x-ray exposure at any time during a scan, or series of scans under CT x-ray system control, of greater than one-half second duration. b. Tomographic Plane Indication and Alignment. i. For any single tomogram system, means shall be provided to permit visual determination of the tomographic plane or a reference plan offset from the tomographic plane. ii. For any multiple tomogram system, means shall be provided to permit visual determination of the location of a reference plane. This reference plane can be offset from the location of the tomographic planes. iii. If a device using a light source is used to satisfy 1.6.9(2)(b)(i) or (ii), the light source shall provide illumination levels sufficient to permit visual determination of the location of the tomographic plane or reference plane under ambient light conditions of up to 500 lux. c. Beam-On and Shutter Status Indicators and Control Switches. i. The CT x-ray control and gantry shall provide visual indication whenever x-rays are produced and, if applicable, whether the shutter is open or closed. ii. Each emergency button or switch shall be clearly labeled as to its function.

d. Indication of CT Conditions of Operation. The CT x-ray system shall be designed such that the CT conditions of operation to be used during a scan or a scan sequence shall be indicated prior to the initiation of a scan or a scan sequence. On equipment having all or some of these conditions of operation at fixed values, this requirement may be met by permanent markings. Indication of CT conditions of operation shall be visible from any position from which scan initiation is possible. e. Extraneous Radiation. When data are not being collected for image production, the radiation adjacent to the tube port shall not exceed that permitted by 1.6.4(3). f. Maximum Surface CTDI Identification. The angular position where the maximum surface CTDI occurs shall be identified to allow for reproducible positioning of a CT dosimetry phantom. g. Additional Requirements Applicable to CT X-Ray Systems Containing a Gantry Manufactured After September 3, 1985. i. The total error in the indicated location of the tomographic plane or reference plane shall not exceed 5 millimeters. ii. If the x-ray production period is less than one-half second, the indication of x-ray production shall be actuated for at least one-half second. Indicators at or near the gantry shall be discernible from any point external to the patient opening where insertion of any part of the human body into the primary beam is possible. iii. The deviation of indicated scan increment versus actual increment shall not exceed plus or minus 1 millimeter with any mass from 0 to 100 kilograms resting on the support device. The patient support device shall be incremented from a typical starting position to the maximum incremented distance or 30 centimeters, whichever is less, and then returned to the starting position. Measurement of actual versus indicated scan increment may be taken anywhere along this travel. iv. Premature termination of the x-ray exposure by the operator shall necessitate resetting of the CT conditions of operation prior to the initiation of another scan. 3. Facility Design Requirements. a. Aural Communication. Provision shall be made for two-way aural communication between the patient and the operator at the control panel. b. Viewing Systems.

i. Windows, mirrors, closed-circuit television, or an equivalent shall be provided to permit continuous observation of the patient during irradiation and shall be so located that the operator can observe the patient from the control panel. ii. When the primary viewing system is by electronic means, an alternate viewing system (which may be electronic) shall be available for use in the event of failure of the primary viewing system. 4. Surveys, Measurements, Spot Checks and Operating Procedures. a. Surveys. i. All CT x-ray systems installed after the effective date of these regulations and those systems not previously surveyed shall have a survey made by, or under the direction of, a qualified expert. In addition, such surveys shall be done after any change in the facility or equipment which might cause a significant increase in radiation hazard. ii. The registrant shall obtain a written report of the survey from the qualified expert, and a copy of the report shall be made available to the Agency upon request. b. Radiation Measurements. i. The measurements of the radiation output of the CT x-ray system shall be performed by, or under the direction of, a qualified expert. ii. The measurement of the radiation output of the CT x-ray system shall be performed annually and after any change or replacement of components which could cause a change in the radiation output. iii. The measurement of the radiation output of the CT x-ray system shall be performed with a calibrated dosimetry system. The calibration of such system shall be traceable to a national standard. The dosimetry system shall have been calibrated within the preceding 2 years. iv. CT dosimetry phantom(s) shall be used in determining the radiation output of a CT x-ray system. Such phantom(s) shall meet the following specifications and conditions of use: i. CT dosimetry phantom(s) shall be right circular cylinders of polymethyl-methacrylate of density 1.19 plus or minus 0.01 grams per cubic centimeter. The phantom(s) shall be at least 14 centimeters in length and shall have diameters of 32.0

centimeters for testing CT x-ray systems designed to image any section of the body and 16.0 centimeters for systems designed to image the head or for whole body scanners operated in the head scanning mode. ii. CT dosimetry phantom(s) shall provide means for the placement of a dosimeter(s) along the axis of rotation and along a line parallel to the axis of rotation 1.0 centimeter from the outer surface and within the phantom. Means for the placement of dosimeters or alignment devices at other locations may be provided. iii. Any effects on the doses measured to the removal of phantom material to accommodate dosimeters shall be accounted for through appropriate corrections to the reported data or included in the statement of maximum deviation for the values obtained using the phantom. iv. All dose measurements shall be performed with the CT dosimetry phantom placed on the patient couch or support device without additional attenuation materials present. v. The measurement of the radiation output shall be required for each type of head, body, or whole-body scan performed at the facility. vi. Measurement of the radiation output shall meet the following requirements: i. The dose profile along the center axis of the CT dosimetry phantom for the minimum, maximum, and midrange values of the nominal tomographic section thickness used by the registrant shall be measurable. Where less than three nominal tomographic thicknesses can be selected, the dose profile determination shall be performed for each available nominal tomographic section thickness. ii. The CTDI

along the two axes specified in 1.6.9(4)(b)(iv)(ii) shall be measured. The CT dosimetry phantom shall be oriented so that the measurement point 1.0 centimeter from the outer surface and within the phantom is in the same angular position within the gantry as the point of

For the purpose of determining the CTDI, the manufacturer's statements as to the nominal tomographic section thickness for that particular system may be utilized.

maximum surface CTDI identified. The CT conditions of operation shall correspond to typical values used by the registrant. iii. The spot checks specified in 1.6.9(4)(c) shall be made. vii. Procedures for the measurement of radiation output shall be in writing. Records of measurements performed shall be maintained for inspection by the Agency. c. Spot Checks. i. The spot-check procedures shall be in writing and shall have been developed by a qualified expert. ii. The spot-check procedures shall incorporate the use of a CT dosimetry phantom which has a capability of providing an indication of contrast scale, noise, nominal tomographic section thickness, the resolution capability of the system for low and high contrast objects, and measuring the mean CTN for water or other reference material. iii. All spot checks shall be included in the measurement required by 1.6.9(4)(b) and at time intervals and under system conditions specified by a qualified expert. iv. Spot checks shall include acquisition of images obtained with the CT dosimetry phantom(s) using the same processing mode and CT conditions of operation as are used to perform measurements required by 1.6.9(4)(b). The images shall be retained, until a new measurement is performed, in two forms as follows: i. photographic copies of the images obtained from the image display device; and ii. images stored in digital form on a storage medium compatible with the CT x-ray system. v. Written records of the spot checks performed shall be maintained for inspection by the Agency. d. Operating Procedures. i. The CT x-ray system shall not be operated except by an individual who has been specifically trained in its operation.

ii. Information shall be available at the control panel regarding the operation of the system and measurements of radiation output. Such information shall include the following: i. dates of the latest measurements and spot checks and the location within the facility where the results of those tests may be obtained; ii. instructions on the use of the CT dosimetry phantom(s) including a schedule of spot checks appropriate for the system, allowable variations for the indicated parameters, and the results of at least the most recent spot checks conducted on the system; iii. the distance in millimeters between the tomographic plane and the reference plane if a reference plane is utilized; and iv. a current technique chart available at the control panel which specifies for each routine examination the CT conditions of operation and the number of scans per examination. iii. If the measurement or spot check of the CT x-ray system identifies that a system operating parameter has exceeded a tolerance established by the qualified expert, use of the CT x-ray system on patients shall be limited to those permitted by established written instructions of the qualified expert.

**History**
- *SOURCE: Miss. Code Ann. §45-14-11*

##### **15 Miss. Admin. Code Pt. 21, R. 1.6.10** Rule 1.6.10 {#sec-21-1.6.10 omnilex-key=us-ms-regs-official--title-15--21#1.6.10}

Mammography X-Ray Systems – Adoption by reference of several sections in 21 Code of Federal Regulations Part 900 Subpart B §900.12. 21 Code of Federal Regulations §900.12(b), §900.12(c), §900.12(d), §900.12(e)(1), §900.12(e)(2), §900.12(e)(3), §900.12(e)(4), §900.12(e)(5), §900.12(e)(6), §900.12(e)(7), §900.12(e)(8), §900.12(e)(9), §900.12(e)(10), §900.12(e)(11), §900.12(e)(12), §900.12(f)(1), §900.12(f)(2), and §900.12(i) are adopted by reference as they exist on May 11, 2017, with the following exceptions: 1. Medical Records and Mammography Reports. In addition to the requirements of 21 Code of Federal Regulations §900.12(c), a. Language in mammography reports and lay letters provided to patients receiving mammogram services furnished by the entity performing the mammography services directly to patients under the federal Mammography Quality Standards Act, 42 USC Section 263b shall be in compliance with the U.S. Food & Drug Administration’s Mammography Quality Standards Act.

b. Entities providing mammogram services shall consult guidelines and standards developed by the American College of Radiology, the American College of Obstetricians and Gynecologists and the American Cancer Society when developing any additional information the entity deems necessary for inclusion in mammography reports and lay letters. Any additional information provided in the report shall be evidence-based, consistent with accepted medical standards, and with the U.S. Food & Drug Administration’s Mammography Quality Standards Act. Entities shall conduct an annual review of any forms provided to ensure compliance with FDA requirements.

APPENDIX A Determination Of Competence The following are areas in which the agency considers it important that an individual have expertise for the competent operation of x-ray equipment. I. Familiarization With Equipment. a. Identification of controls. b. Function of each control. c. How to use a technique chart. II. Radiation Protection. a. Collimation. b. Filtration. c. Gonad shielding and other patient protection devices if used. d. Restriction of x-ray tube radiation to the image receptor. e. Personnel protection. f. Grids. III. Film Processing. a. Film speed as related to patient exposure. b. Film processing parameters. c. Quality Assurance Program. IV. Emergency Procedures. a. Termination of exposure in event of automatic timing device failure. V. Proper use of Personnel Dosimetry, if Required. VI. Understanding Units of Radiation.

APPENDIX B Information To Be Submitted By Persons Proposing To Conduct Healing Arts Screening Persons requesting that the Agency approve a healing arts screening program shall submit the following information and evaluation: I. Name and address of the applicant and, where applicable, the names and addresses of agents within this State. II. Diseases or conditions for which the x-ray examinations are to be used in diagnoses. III. A detailed description of the x-ray examinations proposed in the screening program. IV. Description of the population to be examined in the screening program, i.e., age, sex, physical condition, and other appropriate information. V. An evaluation of any known alternate methods not involving ionizing radiation which could achieve the goals of the screening program and why these methods are not used instead of the x-ray examinations. VI. An evaluation by a qualified expert of the x-ray system(s) to be used in the screening program. The evaluation by the qualified expert shall show that such system(s) do satisfy all requirements of these regulations. The evaluation shall include a measurement of patient exposures for the x-ray examinations to be performed. VII. A description of the diagnostic x-ray quality control program. VIII. A copy of the technique chart for the x-ray examination procedures to be used. IX. The qualifications of each individual who will be operating the x-ray system(s). X. The qualifications of the individual who will be supervising the operators of the x-ray system(s). The extent of supervision and the method of work performance evaluation shall be specified. XI. The name and address of the individual who will interpret the radiograph(s). XII. A description of the procedures to be used in advising the individuals screened and their private practitioners of the healing arts of the results of the screening procedure and any further medical needs indicated. XIII. A description of the procedures for the retention or disposition of the radiographs and other records pertaining to the x-ray examinations. XIV. An indication of the frequency of screening and the duration of the entire screening program.

APPENDIX C Exemptions From Shielding For Certain Fluoroscopic Procedures I. Myelograms II. Arthrograms III. Angiograms IV. Percutaneous nephrostomies V. Biliary drainage procedures VI. Percutaneous cholangiograms VII. T-tube cholangiograms VIII. Sinograms or fistulograms IX. Fluoroscopic biopsy procedures

APPENDIX D Actual (f eff ) and Nominal (f nom ) Focal Spot Sizes necessary to achieve an Object Plan Spatial Resolution of 12.5 cycles/mm at the Chest Wall SID Magnification f eff f nom

**History**
- *SOURCE: Miss. Code Ann. §45-14-11*

##### **15 Miss. Admin. Code Pt. 21, R. 80** 1.07 1.2 0.6 {#sec-21-80 omnilex-key=us-ms-regs-official--title-15--21#80}

##### **15 Miss. Admin. Code Pt. 21, R. 65** 1.08 1.1 0.5 {#sec-21-65 omnilex-key=us-ms-regs-official--title-15--21#65}

##### **15 Miss. Admin. Code Pt. 21, R. 50** 1.11 0.85 0.4 {#sec-21-50 omnilex-key=us-ms-regs-official--title-15--21#50}

-- 1.5 0.23 0.15

-- 2.0 0.15 0.10

Subchapter 7 Medical Use of Byproduct Material Subchapter 7 Medical Use of Byproduct Material

##### **15 Miss. Admin. Code Pt. 21, R. 1.7.1** Purpose {#sec-21-1.7.1 omnilex-key=us-ms-regs-official--title-15--21#1.7.1}

This Regulation adopts by reference the current revision of the following

sections in Title 10 Code of Federal Regulations Part 35: 35.1, 35.2, 35.5, 35.6,

35.7, 35.10, 35.11, 35.12, 35.13, 35.14, 35.15, 35.18, 35.19, 35.24, 35.26, 35.27,

35.40, 35.41, 35.49, 35.50, 35.51, 35.55, 35.57, 35.59, 35.60, 35.61, 35.63, 35.65,

35.67, 35.69, 35.70, 35.75, 35.80, 35.92, 35.100, 35.190, 35.200, 35.204, 35.290,

35.300, 35.310, 35.315, 35.390, 35.392, 35.394, 35.396, 35.400, 35.404, 35.406,

35.410, 35.415, 35.432, 35.433, 35.457, 35.490, 35.491, 35.500, 35.590, 35.600,

35.604, 35.605, 35.610, 35.615, 35.630, 35.632, 35.633, 35.635, 35.642, 35.643,

35.645, 35.647, 35.652, 35.655, 35.657, 35.690, 35.1000, 35.2024, 35.2026,

35.2040, 35.2041, 35.2060, 35.2061, 35.2063, 35.2067, 35.2070, 35.2075, 35.2080,

35.2092, 35.2204, 35.2310, 35.2404, 35.2406, 35.2432, 35.2433, 35.2605, 35.2610,

35.2630, 35.2632, 35.2642, 35.2643, 35.2645, 35.2647, 35.2652, 35.2655, 35.3045,

35.3047, 35.3067, and 35.3204 with the following exceptions:

1. Not adopted by reference are Title 10 Code of Federal Regulations 35.11(c)(1) and 35.13(a)(1).

2. Requirements in Title 10 Code of Federal Regulations Part 35 that apply to "byproduct material" also apply to naturally occurring or accelerator- produced radioactive material.

3. Where the words "NRC", "commission", "NRC regional office", or "director, office of nuclear material safety and safeguards" appear in Title 10 Code of Federal Regulations Part 35, substitute the words "Mississippi State Department of Health".

4. "Act" includes the Mississippi Radiation Protection Law of 1976.

5. Mississippi State Department of Health form number 707 E , "Application for Radioactive Material License" (Medical Uses) or form number 844 E "Application for Radioactive Material License" (Other Uses), must be used instead of NRC form 313 as specified in Title 10 Code of Federal Regulations Part 35.

6. For references to Title 10 Code of Federal Regulations Parts 170 and 171, see Mississippi State Department of Health Regulations for the Control of Radiation in Mississippi Rule 1.1.18 for applicable fee.

Subchapter 8 Radiation Safety Requirements For Analytical X-Ray Equipment Rule 1.8.1 Purpose and Scope. This section provides special requirements for analytical x- ray equipment. The requirements of this section are in addition to, and not in substitution for, applicable requirements in other sections of these regulations.

**History**
- *SOURCE: Miss. Code Ann. §45-14-11*
- *SOURCE: Miss. Code Ann. §45-14-11*

##### **15 Miss. Admin. Code Pt. 21, R. 1.8.2** Definitions {#sec-21-1.8.2 omnilex-key=us-ms-regs-official--title-15--21#1.8.2}

As used in this section, the following definitions apply: 1. "Analytical x-ray equipment" means equipment used for x-ray diffraction or fluorescence analysis. 2. "Analytical x-ray system" means a group of components utilizing x- or gamma-rays to determine the elemental composition or to examine the microstructure of materials. 3. "Fail-safe characteristics" mean a design feature which causes beam port shutters to close, or otherwise prevents emergence of the primary beam, upon the failure of a safety or warning device. 4. "Local components" mean part of an analytical x-ray system and include areas that are struck by x-rays such as radiation source housings, port and shutter assemblies, collimators, sample holders, cameras, goniometers, detectors, and shielding, but do not include power supplies, transformers, amplifiers, readout devices, and control panels. 5. "Normal operating procedures" mean step-by-step instructions necessary to accomplish the analysis. These procedures shall include sample insertion and manipulation, equipment alignment, routine maintenance by the registrant, and data recording procedures, which are related to radiation safety. 6. "Open-beam configuration" means an analytical x-ray system in which an individual could accidentally place some part of his body in the primary beam path during normal operation. 7. "Primary beam" means radiation which passes through an aperture of the source housing by a direct path from the x-ray tube or a radioactive source located in the radiation source housing.

Rule 1.8.3 Equipment Requirements.

1. Safety Device. A device which prevents the entry of any portion of an individual's body into the primary x-ray beam path or which causes the beam to be shut off upon entry into its path shall be provided on all open- beam configurations. A registrant may apply to the Agency for an exemption from the requirements of a safety device. Such application shall include: a. a description of the various safety devices that have been evaluated; b. the reason each of these devices cannot be used; and c. a description of the alternative methods that will be employed to minimize the possibility of an accidental exposure, including procedures to assure that operators and others in the area will be informed of the absence of safety devices. 2. Warning Devices a. Open-beam configurations shall be provided with a readily discernible indication of: i. x-ray tube "on-off" status located near the radiation source housing, if the primary beam is controlled in this manner; and/or ii. shutter "open-closed" status located near each port on the radiation source housing, if the primary beam is controlled in this manner. b. An easily visible warning light labeled with the words "X-RAY ON", or words having a similar intent, shall be located: i. near any switch that energizes an x-ray tube and shall be illuminated only when the tube is energized; or ii. in the case of a radioactive source, near any switch that opens a housing shutter and shall be illuminated only when the shutter is open. c. Warning devices shall be labeled so that their purpose is easily identified. On e q u i p m e n t i n s t a l l e d a f t e r J u n e 30, 1978, w a r n i n g devices shall have fail-safe characteristics. 3. Ports. Unused ports on radiation source housings shall be secured in the closed position in a manner which will prevent casual opening. 4. Labeling. All analytical x-ray equipment shall be labeled with a readily discernible sign or signs bearing the radiation symbol and the words:

a. "CAUTION - HIGH INTENSITY X-RAY BEAM", or words having a similar intent, on the x-ray source housing; and b. "CAUTION RADIATION - THIS EQUIPMENT PRODUCES RADIATION WHEN ENERGIZED", or words having a similar intent, near any switch that energizes an x-ray tube if the radiation source is an x-ray tube; or c. "CAUTION - RADIOACTIVE MATERIAL", or words having a similar intent, on the source housing in accordance with 1.4.29 of these regulations if the radiation source is a radionuclide. 5. Shutters. On open-beam configurations installed after January 12, 1980, each port on the radiation source housing shall be equipped with a shutter that cannot be opened unless a collimator or a coupling has been connected to the port. 6. Radiation Source Housing. Each radiation source housing shall be subject to the following requirements: a. Each x-ray tube housing shall be equipped with an interlock that shuts off the tube if it is removed from the radiation source housing or if the housing is disassembled. b. Each radioactive source housing or port cover or each x-ray tube housing shall be so constructed that, with all shutters closed, the radiation measured at a distance of 5 centimeters from its surface is not capable of producing a dose in excess of 2.5 millirems (0.025 mSv) in one hour. For systems utilizing x-ray tubes, this limit shall be met at any specified tube rating. 7. Generator C a b i n e t. Each x-ray g e n e r a t o r s h a l l be s u p p l i e d w i t h a protective cabinet which limits leakage radiation measured at a distance of 5 centimeters from its surface such that it is not capable of producing a dose in excess of 0.25 millirem (2.5 μSv) in one hour.

1. Radiation Levels. The local components of an analytical x-ray system shall be located and arranged and shall include sufficient shielding or access control such that no radiation levels exist in any area surrounding the local component group which could result in a dose to an individual present therein in excess of the dose limits given in 1.4.14 of these regulations. For systems utilizing x-ray tubes, these levels shall be met at any specified tube rating. 2. Surveys

a. Radiation surveys, as required by 1.4.17 of these regulations, of all analytical x-ray systems sufficient to show compliance with 1.8.4(1) shall be performed: i. upon installation of the equipment, and at least once every 12 months thereafter; ii. following any change in the initial arrangement, number, or type of local components in the system; iii. following any maintenance requiring the disassembly or removal of a local component in the system; iv. during the performance of maintenance and alignment procedures if the procedures require the presence of a primary x-ray beam when any local component in the system is disassembled or removed; v. any time a visual inspection of the local components in the system reveals an abnormal condition; and vi. whenever personnel monitoring devices show a significant increase over the previous monitoring period or the readings are approaching the limits specified in 1.4.6 of these regulations. b. Radiation survey measurements shall not be required if a registrant can demonstrate compliance with 1.8.4(1) to the satisfaction of the Agency. 3. Posting. Each area or room containing analytical x-ray equipment shall be conspicuously posted with a sign or signs bearing the radiation symbol and the words "CAUTION - X-RAY EQUIPMENT" or words having a similar intent in accordance with 1.4.29 of these regulations.

1. Procedures. Normal operating procedures shall be written and available to all analytical x-ray equipment workers. No individual shall be permitted to operate analytical x-ray equipment in any manner other than that specified in the procedures unless such individual has obtained written approval of the radiation safety officer. 2. Bypassing. No individual shall bypass a safety device or interlock unless such individual has obtained the approval of the radiation safety officer. Such approval shall be for a specified period of time. When a safety device or interlock has been bypassed, a readily discernible sign bearing the words "SAFETY DEVICE NOT WORKING", or words having a similar intent, shall be placed

on the radiation source housing. 3. Repair or Modification of X-Ray Tube Systems. Except as specified in 1.8.5(2), no operation involving removal of covers, shielding materials or tube housings or modifications to shutters, collimators, or beam stops shall be performed without ascertaining that the tube is off and will remain off until safe conditions have been restored. The main switch, rather than interlocks, shall be used for routine shutdown in preparation for repairs. 4. Radioactive Source Replacement, Testing, or Repair. Radioactive source housings shall be opened for source replacement, leak testing, or other maintenance or repair procedures only by individuals authorized to specifically conduct such procedures under a license issued by the U.S. Nuclear Regulatory Commission (NRC), an Agreement State, or a Licensing State.

1. Instruction. No individual shall be permitted to operate or maintain analytical x- ray equipment unless such individual has received instruction in and demonstrated competence as to: a. identification of radiation hazards associated with the use of the equipment; b. significance of the various radiation warning, safety devices, and interlocks incorporated into the equipment, or the reasons they have not been installed on certain pieces of equipment and the extra precautions required in such cases; c. proper operating procedures for the equipment; d. recognition of symptoms of an acute localized exposure; and e. proper procedures for reporting an actual or suspected exposure. 2. Personnel Monitoring a. Finger or wrist dosimetric devices shall be provided to and shall be used by: i. analytical x-ray equipment workers using systems having an open- beam configuration and not equipped with a safety device; and ii. personnel maintaining analytical x-ray equipment if the maintenance procedures require the presence of a primary x-ray beam when any local component in the analytical x-ray system

is disassembled or removed. b. Reported dose values shall not be used for the purpose of determining compliance with 1.4.6 of these regulations unless evaluated by a qualified expert.

2. In addition to the requirements of this section, all registrants are subject to the requirements of Subchapters 1, 2, 4, and 10 of these regulations. Registrants engaged in industrial radiographic operations are subject to the requirements of Subchapter 5 of these regulations, and registrants and/or licensees engaged in the healing arts are subject to the requirements of Subchapters 6, 7 and 15 of these regulations. Registrants whose operations result in the production of radioactive material are subject to the requirements of Subchapter 3 of these regulations.

**History**
- *SOURCE: Miss. Code Ann. §45-14-11 General Regulatory Provisions and Specific Requirements*
- *SOURCE: Miss. Code Ann. §45-14-11 Rule 1.8.4 Area Requirements*
- *SOURCE: Miss. Code Ann. §45-14-11 Rule 1.8.5 Operating Requirements.*
- *SOURCE: Miss. Code Ann. §45-14-11 Rule 1.8.6 Personnel Requirements.*
- *SOURCE: Miss. Code Ann. §45-14-11 Subchapter 9 Radiation Safety Requirements for Particle Accelerators Rule 1.9.1 Purpose and Scope 1. This Section establishes procedures for the registration and the use of particle accelerators.*
- *SOURCE: Miss. Code Ann. §45-14-11*

##### **15 Miss. Admin. Code Pt. 21, R. 1.9.2** Registration Requirements {#sec-21-1.9.2 omnilex-key=us-ms-regs-official--title-15--21#1.9.2}

No person shall receive, possess, use, transfer, own, or acquire a particle accelerator except as authorized in a registration issued pursuant to Subchapter 2 of these regulations.

**History**
- *SOURCE: Miss. Code Ann. §45-14-11*

##### **15 Miss. Admin. Code Pt. 21, R. 1.9.3** General Requirements for the Issuance of a Registration for Particle Accelerators {#sec-21-1.9.3 omnilex-key=us-ms-regs-official--title-15--21#1.9.3}

In addition to the requirements of Subchapter 2 of these regulations, a registration application for use of a particle accelerator will be approved only if the Agency determines that: 1. the applicant is qualified by reason of training and experience to use the accelerator in question for the purpose requested in accordance with this section and Subchapters 4 and 10 of these regulations in such a manner as to minimize danger to public health and safety or property; 2. the applicant's proposed or existing equipment, facilities, and operating and emergency procedures are adequate to protect health and minimize danger to public health and safety or property;

3. the issuance of the registration will not be inimical to the health and safety of the public, and the applicant satisfies any applicable special requirement in 1.9.4; 4. the applicant has appointed a radiation safety officer; 5. the applicant and the applicant's staff has substantial experience in the use of particle accelerators and training sufficient for application to its intended uses; 6. the applicant has established a radiation safety committee to approve, in advance, proposals for uses of particle accelerators, whenever deemed necessary by the Agency; and 7. the applicant has an adequate training program for operators of particle accelerators.

**History**
- *SOURCE: Miss. Code Ann. §45-14-11*

##### **15 Miss. Admin. Code Pt. 21, R. 1.9.4** Reserved {#sec-21-1.9.4 omnilex-key=us-ms-regs-official--title-15--21#1.9.4}

Rule 1.9.5 Reserved. Rule 1.9.6 Limitations. 1. No registrant shall permit any individual to act as an operator of a particle accelerator until such individual: a. has been instructed in radiation safety and shall have demonstrated an understanding thereof; b. has received copies of and instruction in this section and the applicable requirements of Subchapters 4 and 10 of these regulations, pertinent registration conditions and the registrant's operating and emergency procedures, and shall have demonstrated understanding thereof; and c. has demonstrated competence to use the particle accelerator, related equipment, and survey instruments which will be employed. 2. The radiation safety committee or the radiation safety officer shall have the authority to terminate the operations at a particle accelerator facility if such action is deemed necessary to minimize danger to public health and safety or property.

**History**
- *SOURCE: Miss. Code Ann. §45-14-11*

##### **15 Miss. Admin. Code Pt. 21, R. 1.9.7** Shielding and Safety Design Requirements {#sec-21-1.9.7 omnilex-key=us-ms-regs-official--title-15--21#1.9.7}

1. A qualified expert, acceptable to the Agency, shall be consulted in the design of a particle accelerator installation and called upon to perform a radiation survey when the accelerator is first capable of producing radiation. 2. Each particle accelerator installation shall be provided with such primary and secondary barriers as are necessary to assure compliance with 1.4.6 and 1.4.14 of these regulations.

**History**
- *SOURCE: Miss. Code Ann. §45-14-11*

##### **15 Miss. Admin. Code Pt. 21, R. 1.9.8** Particle Accelerator Controls and Interlock Systems {#sec-21-1.9.8 omnilex-key=us-ms-regs-official--title-15--21#1.9.8}

1. Instrumentation, readouts, and controls on the particle accelerator control console shall be clearly identified and easily discernible. 2. Each entrance into a target room or other high radiation area shall be provided with a safety interlock that shuts down the machine under conditions of barrier penetration. 3. Each safety interlock shall be on a circuit which shall allow it to operate independently of all other safety interlocks. 4. All safety interlocks shall be designed so that any defect or component failure in the safety interlock system prevents operation of the accelerator. 5. When a safety interlock system has been tripped, it shall only be possible to resume operation of the accelerator by manually resetting controls at the position where the safety interlock has been tripped and, lastly, at the main control console. 6. A scram button or other emergency power cutoff switch shall be located and easily identifiable in all high radiation areas. Such a cutoff switch shall include a manual reset so that the accelerator cannot be restarted from the accelerator control console without resetting the cutoff switch.

**History**
- *SOURCE: Miss. Code Ann. §45-14-11*

##### **15 Miss. Admin. Code Pt. 21, R. 1.9.9** Warning Devices 1 {#sec-21-1.9.9 omnilex-key=us-ms-regs-official--title-15--21#1.9.9}

Each location designated as high radiation area, and each entrance to such location, shall be equipped with easily observable warning lights that operate when, and only when, radiation is being produced. 2. Except in facilities designed for human exposure, each high radiation area shall have an audible warning device which shall be activated for 15 seconds prior

to the possible creation of such high radiation area. Such warning device shall be clearly discernible in all high radiation areas. 3. Barriers, temporary or otherwise, and pathways leading to high radiation areas shall be posted in accordance with 1.4.30 of these regulations.

**History**
- *SOURCE: Miss. Code Ann. §45-14-11*

##### **15 Miss. Admin. Code Pt. 21, R. 1.9.10** Operating Procedures {#sec-21-1.9.10 omnilex-key=us-ms-regs-official--title-15--21#1.9.10}

1. Particle accelerators, when not in operation, shall be secured to prevent unauthorized use. 2. The safety interlock system shall not be used to turn off the accelerator beam except in an emergency. 3. All safety and warning devices, including interlocks, shall be checked for proper operation at intervals not to exceed three months. Results of such tests shall be maintained at the accelerator facility for inspection by the Agency. 4. Electrical circuit diagrams of the accelerator and the associated safety interlock systems shall be kept current and maintained for inspection by the Agency and shall be available to the operator at each accelerator facility. 5. If, for any reason, it is necessary to intentionally bypass a safety interlock or interlocks, such action shall be: a. authorized by the radiation safety committee and/or radiation safety officer; b. recorded in a permanent log and a notice posted at the accelerator control console; and c. terminated as soon as possible. 6. A copy of the current operating and the emergency procedures shall be maintained at the accelerator control panel.

**History**
- *SOURCE: Miss. Code Ann. §45-14-11*

##### **15 Miss. Admin. Code Pt. 21, R. 1.9.11** Radiation Monitoring Requirements {#sec-21-1.9.11 omnilex-key=us-ms-regs-official--title-15--21#1.9.11}

1. There shall be available, at each particle accelerator facility, appropriate portable monitoring equipment which is operable and has been appropriately calibrated for the radiations being produced at the facility. Such equipment shall be tested for proper operation daily and calibrated at intervals not to exceed one year and after each servicing and repair.

2. A radiation protection survey shall be performed and documented by a qualified expert, acceptable to the Agency, when changes have been made in shielding, operation, equipment, or occupancy of adjacent areas. 3. Radiation levels in all high radiation areas shall be continuously monitored. The monitoring devices shall be electrically independent of the accelerator control and safety interlock systems and capable of providing a read- out at the control panel. 4. All area monitors shall be calibrated at intervals not to exceed one year and after each servicing and repair. 5. Whenever applicable, periodic surveys shall be made to determine the amount of airborne particulate radioactivity present. 6. Whenever applicable, periodic smear surveys shall be made to determine the degree of contamination. 7. All surveys shall be made in accordance with the written procedures established by a qualified expert, acceptable to the Agency, or the radiation safety officer. 8. Records of all radiation protection surveys, calibrations, and instrumentation tests shall be maintained at the accelerator facility for inspection by the Agency.

**History**
- *SOURCE: Miss. Code Ann. §45-14-11*

##### **15 Miss. Admin. Code Pt. 21, R. 1.9.12** Ventilation Systems {#sec-21-1.9.12 omnilex-key=us-ms-regs-official--title-15--21#1.9.12}

1. Ventilation systems shall be provided to ensure that personnel entering any area where airborne radioactivity may be produced will not be exposed to airborne radioactive material in excess of those limits specified in Subchapter 4, Appendix B, Table I of these regulations. 2. A registrant, as required by 1.4.15 of these regulations, shall not vent, release, or otherwise discharge airborne radioactive material to an unrestricted area which exceeds the limits specified in Subchapter 4, Appendix B, Table I of these regulations, except as authorized pursuant to 1.4.15(3) of these regulations. For purposes of 1.9.12(2), concentrations may be averaged over a period not greater than one year. Every effort should be made to maintain releases of radioactive material to unrestricted areas as far below these limits as is reasonably achievable.

19.3, 19.5, 19.11, 19.12, 19.13, 19.14, 19.15, 19.16, 19.17, 19.18, 19.20, 19.31, and 19.32, with the following exceptions:

1. Not adopted by reference is Title 10 Code of Federal Regulations 19.11(a), where it references “except for a holder of an early site permit under subpart A of part 52 of this chapter, or a holder of a manufacturing license under subpart F of part 52 of this chapter”, (b), (e) where it references “each applicant for or holder of a standard design approval under subpart E of part 52 of this chapter, each applicant for an early site permit under subpart A of part 52 of this chapter, and each applicant for a standard design certification under subpart B of part 52 of this chapter” and 19.14(a).

2. All of the requirements in Subchapter 10 apply to both licensees and registrants. A reference in Title 10 Code of Federal Regulations Part 19 to "license" includes "registration", a reference to "licensee" includes "registrant", a reference to "licensed" includes registered", and a reference to "licensed radioactive material" includes "registered source of radiation". "Registrant" means any person who is registered with the Mississippi State Department of Health and is legally obligated to register with the department pursuant to Section 45-14-13 of the Mississippi Code of 1972, Annotated. "Registration" means the notification of the Mississippi State Department of Health of possession of a source of radiation and the furnishing of information with respect thereto, in accordance with Mississippi State Department of Health Regulations for the Control of Radiation in Mississippi Rule 1.2.5.

3. Where the words "NRC", "commission", "nuclear regulatory commission", "United States Nuclear Regulatory Commission", "administrator of the appropriate commission regional office", "administrator of the appropriate regional office", "regional office administrator", "executive director for operations", "regional administrator of the appropriate United States Nuclear Regulatory Commission regional office", or "agency" appear in Title 10 Code of Federal Regulations Part 19, substitute the words "Mississippi State Department of Health".

4. "Act" includes Mississippi Radiation Protection Law of 1976.

5. Mississippi State Department of Health form number 935, "Notice to Employees", must be posted in place of NRC form 3 that is specified in Title 10 Code of Federal Regulations Part 19.

6. Where Title 10 Code of Federal Regulations Part 19 specifies contacting the United States Nuclear Regulatory Commission, contact the Division of Radiological Health, Mississippi State Department of Health.

**History**
- *SOURCE: Miss. Code Ann. §45-14-11 Subchapter 10 Notices, Instructions, and Reports to Workers; Inspections Rule 1.10.1 Purpose. This Regulation adopts by reference the current revision of the following sections in Title 10 Code of Federal Regulations Part 19: 19.1, 19.2,*
- *Source: Miss. Code Ann. §45-14-11 Subchapter 11 Licensing of Naturally Occurring Radioactive Materials (Norm)*

##### **15 Miss. Admin. Code Pt. 21, R. 1.11.1** Purpose {#sec-21-1.11.1 omnilex-key=us-ms-regs-official--title-15--21#1.11.1}

This section establishes radiation protection standards for the possession, use, transfer, transport, storage and disposal of naturally occurring radioactive materials, NORM, not subject to regulation under the Atomic Energy Act of 1954, as amended.

**History**
- *SOURCE: Miss. Code Ann. §45-14-3*

##### **15 Miss. Admin. Code Pt. 21, R. 1.11.2** Scope {#sec-21-1.11.2 omnilex-key=us-ms-regs-official--title-15--21#1.11.2}

These regulations apply to any person who engages in the extraction, mining, beneficiating, processing, use, transfer, transport, storage, waste generation or disposal of NORM in such a manner as to alter the chemical properties or physical state of the NORM or its potential exposure pathways to humans. 1. The regulations in this section address the introduction of NORM into materials or products in which neither the NORM nor the radiation emitted from the NORM is considered to be beneficial to the materials or products. The manufacture and distribution of materials or products containing NORM in which the NORM and/or its associated radiation(s) is considered to be a beneficial attribute are licensed under the provisions of Subchapter 3. 2. These regulations also apply to sludges and scale deposits in tubulars and equipment and to soil or water contaminated by the cleaning of scale deposits. These regulations include the contamination of soil from produced waters. 3. This section also addresses waste generation, waste management, transfer, and disposal with regard to both inactive and active sites and facilities involved in storage and/or cleaning of tubulars and contaminated equipment. In the case of closed or inactive pits, surveys are required only at the time of transfer for unrestricted use.

**History**
- *SOURCE: Miss. Code Ann. §45-14-3*

##### **15 Miss. Admin. Code Pt. 21, R. 1.11.3** Definitions {#sec-21-1.11.3 omnilex-key=us-ms-regs-official--title-15--21#1.11.3}

As used in this section, the following definitions apply: 1. "Beneficial attribute" or "beneficial to the product" means the radioactivity of the product is necessary to the use of the product. 2. "Beneficiating" means the processing of materials for the purpose of altering the chemical or physical properties to improve the quality, purity or assay grade. 3. "Decontamination" means the removal of NORM contaminants from surfaces or equipment to reduce levels of radiation. 4. "Decontamination facility" means a facility that provides services to reduce

levels of NORM contamination. 5. "Equipment" means tubulars, wellheads, separators, condensers, or any other related apparatus associated with the potential enhancement of NORM. 6. "Facility" means all contiguous land and structures, other appurtenances, and improvements on land or water that contain NORM. 7. "Fluid" means any material or substance which flows or moves, whether in a semi- solid, liquid, sludge, gas, or any other form or state. 8. "Naturally occurring radioactive material (NORM)" means any nuclide which is radioactive in its natural physical state (i.e., not man-made), but does not include byproduct, source or special nuclear material. 9. "Product" means something produced, made, manufactured, refined, or beneficiated. 10. "Storage" means the containment of NORM waste in such a manner as not to constitute disposal of NORM waste. 11. "Technologically enhanced" means natural sources of radiation which would not normally appear without some technological activity not expressly designed to produce radiation.

**History**
- *SOURCE: Miss. Code Ann. §45-14-3*

##### **15 Miss. Admin. Code Pt. 21, R. 1.11.4** Exemptions {#sec-21-1.11.4 omnilex-key=us-ms-regs-official--title-15--21#1.11.4}

1. Persons who receive, possess, use, process, transfer, transport, store, distribute, and dispose of NORM are exempt from the requirements of these regulations if:

a. The materials contain, or are contaminated at, concentrations less than 5 picocuries per gram of radium - 226 or radium - 228 above background; or, concentrations less than 30 picocuries per gram (1.11 kBq/kg) of technologically enhanced radium-226 or radium-228, averaged over any 100 square meters, provided the radon emanation rate does not exceed 20 picocuries (740 mBq) per square meter per second, or 150 picocuries per gram (5.55 kBq/kg) of any other NORM radionuclide, provided that these concentrations are not exceeded at any time; or

b. Equipment does not exceed 25 microroentgens per hour above background radiation at any accessible point.

2. Persons who receive products or materials containing NORM distributed in accordance with a specific license issued by the Agency pursuant to 1.11.15(1) or an equivalent license issued by another Licensing State are exempt from these regulations.

3. The manufacturing, distribution, use, transportation, and disposal of potassium and potassium compounds which have not been isotopically enriched in the radionuclide K-40 are exempt from the requirements of these regulations.

4. The wholesale and retail distribution (including custom blending), possession, and use of the following products or materials are exempt from the requirements of these regulations;

a. Phosphate and potash fertilizer; and

b. Phosphogypsum for agricultural uses provided such commercial distribution and uses meet the requirements of 40 CFR 61.204.

5. The possession, use, and transportation of natural gas, and natural gas products, and crude oil, and crude oil products as a fuel are exempt from the requirements of these regulations. The manufacturing and distribution of natural gas and crude oil and natural gas and crude oil products are exempt from the specific license requirements of this section but are subject to the general license requirements in 1.11.10, 1.11.11, and 1.11.12.

6. Produced waters from crude oil and natural gas production are exempt from the requirements of these regulations if the produced waters are reinjected in a well approved by the Mississippi State Oil and Gas Board and Mississippi Department of Environmental Quality and as a Class II Injection and Disposal well.

**History**
- *SOURCE: Miss. Code Ann. §45-14-3*

##### **15 Miss. Admin. Code Pt. 21, R. 1.11.5** Reserved {#sec-21-1.11.5 omnilex-key=us-ms-regs-official--title-15--21#1.11.5}

##### **15 Miss. Admin. Code Pt. 21, R. 1.11.6** Radiation Survey Instruments {#sec-21-1.11.6 omnilex-key=us-ms-regs-official--title-15--21#1.11.6}

1. Radiation survey instruments used to determine exposure rates pursuant to this section shall be capable of measuring 1 microroentgen per hour through at least 500 microroentgens per hour.

2. Radiation survey instruments used to make surveys required by this section shall be calibrated and operable.

3. Each radiation survey instrument shall be calibrated:

a. by person licensed by the Agency, another Agreement State, or the U.S. Nuclear Regulatory Commission to perform such service;

b. at energies and radiation levels appropriate for the licensee's use;

c. at intervals not to exceed six months and after each instrument

servicing other than battery replacement; and

d. to demonstrate an accuracy within plus or minus 20 percent of the true radiation level on each scale.

4. Records of these calibrations shall be maintained for 3 years after the calibration date for inspection by the Agency.

**History**
- *SOURCE: Miss. Code Ann. §45-14-3*

##### **15 Miss. Admin. Code Pt. 21, R. 1.11.7** Reserved {#sec-21-1.11.7 omnilex-key=us-ms-regs-official--title-15--21#1.11.7}

##### **15 Miss. Admin. Code Pt. 21, R. 1.11.8** Reserved {#sec-21-1.11.8 omnilex-key=us-ms-regs-official--title-15--21#1.11.8}

##### **15 Miss. Admin. Code Pt. 21, R. 1.11.9** Reserved {#sec-21-1.11.9 omnilex-key=us-ms-regs-official--title-15--21#1.11.9}

##### **15 Miss. Admin. Code Pt. 21, R. 1.11.10** General Licenses {#sec-21-1.11.10 omnilex-key=us-ms-regs-official--title-15--21#1.11.10}

1. A general license is hereby issued to mine, extract, receive, possess, own, use, process, and transfer NORM not exempted in 1.11.4 without regard to quantity. This general license does not authorize the manufacturing or distribution of products containing NORM in concentrations greater than those specified in 1.11.4(1) nor the disposal of wastes from other persons.

2. Facilities and equipment contaminated with NORM in excess of the levels set forth in Appendix A of this section shall not be released for unrestricted use. The decontamination of equipment, facilities and land shall be performed only by persons specifically licensed by the Agency or another Licensing State to conduct such work. Each general licensee shall establish and submit to this Agency written procedures for performing on- site maintenance on contaminated equipment, components and facilities and for surveying (or screening) equipment, components and facilities prior to release for unrestricted use to ensure that the levels in Appendix A of this section are not exceeded.

3. person shall transfer land for unrestricted use contaminated with technologically enhanced radium-226 or radium-228, averaged over any 100 square meters, in which the radon emanation rate is less than 20 picocuries (740 mBq) per square meter per second and in which the concentrations of technologically enhanced radium-226 or radium-228 are in excess of 30 picocuries per gram (1.11 kBq/kg), averaged over a maximum depth of 15 cm of soil below the surface. No person shall transfer land contaminated with technologically enhanced radium- 226 or radium-228, averaged over any 100 square meters, in which the radon emanation rate is 20 picocuries (740 mBq) per square meter per second or more and in which concentrations of technologically enhanced radium-226 or radium- 228 are in excess of:

a. 5 pCi/g (185 Bq/kg), averaged over the first 15 cm of soil below the

surface; and

b. 15 pCi/g (555 Bq/kg), averaged over 15 cm thick layers of soil more than 15 cm below the surface.

4. Equipment contaminated with NORM in excess of the levels set forth in Appendix A of this section may be released for maintenance and/or overhaul provided the recipient is specifically licensed to perform the activity on contaminated equipment.

5. The decontamination of equipment and facilities, as described in 1.11.13(2), shall only be performed by persons specifically licensed by the Agency or another Licensing State to conduct such work.

6. The transfer of NORM not exempt from these regulations from one general licensee to another general licensee shall be authorized by the Agency if:

a. The equipment and facilities contaminated with NORM are to be used by the recipient for the same purpose or at the same site; b. The transfer of control or ownership of land contaminated with NORM includes an annotation of the deed records to indicate the presence of NORM; or c. The materials being transferred are ores or raw materials for processing or refinement.

7. Transfers made under 1.11.10(6)(i) do not relieve the general licensee who makes the transfer from the responsibilities of assessing the extent of NORM contamination or material present, evaluating the hazards of the NORM, informing the general licensee receiving the NORM of these assessments and evaluations, and maintaining records required by these regulations prior to and up to the time of documented transfers.

**History**
- *SOURCE: Miss. Code Ann. §45-14-3*

##### **15 Miss. Admin. Code Pt. 21, R. 1.11.11** Protection of Workers and the General Population {#sec-21-1.11.11 omnilex-key=us-ms-regs-official--title-15--21#1.11.11}

Each person subject to the general license in 1.11.10 or a specific license shall conduct operations in compliance with the standards for radiation protection set out in Subchapters 4 and 10, except for disposal, which shall be governed by 1.11.12.

**History**
- *SOURCE: Miss. Code Ann. §45-14-3*

##### **15 Miss. Admin. Code Pt. 21, R. 1.11.12** Disposal and Transfer of Waste for Disposal {#sec-21-1.11.12 omnilex-key=us-ms-regs-official--title-15--21#1.11.12}

1. Each person subject to the general license in 1.11.10 or a specific license shall manage and dispose of wastes containing NORM:

a. in accordance with the applicable requirements of the U.S. Environmental Protection Agency for disposal of such wastes;

b. in a manner equivalent to the requirements for uranium and thorium byproduct materials in 40 CFR 192;

c. by transfer of the wastes for disposal to a land disposal facility licensed by the U.S. Nuclear Regulatory Commission, an Agreement State, or a Licensing State; or

d. in accordance with alternate methods authorized by the Agency upon application or upon the Agency's initiative.

2. Records of disposal, including manifests, shall be maintained pursuant to the provisions of Subchapter 4 of these regulations.

3. Transfers of waste containing NORM for disposal shall be made only to a person specifically authorized to receive such waste.

**History**
- *SOURCE: Miss. Code Ann. §45-14-3*

##### **15 Miss. Admin. Code Pt. 21, R. 1.11.13** Specific Licenses {#sec-21-1.11.13 omnilex-key=us-ms-regs-official--title-15--21#1.11.13}

1. Unless otherwise exempted under the provisions of 1.11.4 or licensed under the provisions of Subchapter 3 of the regulations, the manufacturing and distribution of any material or product containing NORM shall be specifically licensed pursuant to the requirements of this section or pursuant to equivalent regulations of another Licensing State.

2. Persons conducting the following activities involving equipment or facilities contaminated with NORM in excess of the levels set forth in Appendix A of this section and land contaminated with radium-226 or radium-228 in excess of the limits set forth in 1.11.10(3) shall be specifically licensed pursuant to the requirements of this section:

a. Decontamination of equipment, facilities, and land; or

b. Disposal of the resulting waste.

**History**
- *SOURCE: Miss. Code Ann. §45-14-3*

##### **15 Miss. Admin. Code Pt. 21, R. 1.11.14** Filing Application for Specific Licenses {#sec-21-1.11.14 omnilex-key=us-ms-regs-official--title-15--21#1.11.14}

Applications for specific licenses shall be filed in accordance with 1.3.8 of these regulations.

**History**
- *SOURCE: Miss. Code Ann. §45-14-3*

##### **15 Miss. Admin. Code Pt. 21, R. 1.11.15** Requirements for the Issuance of Specific Licenses {#sec-21-1.11.15 omnilex-key=us-ms-regs-official--title-15--21#1.11.15}

1. In addition to the requirements set forth in 1.3.9, and application for a specific license to decontaminate equipment, land, or facilities contaminated with NORM in excess of the levels set forth in 1.11.4(1), 1.11.10(3), or Appendix A of this section, as applicable and to dispose of the resulting waste will be approved if:

a. The applicant has adequately addressed the following items in the application:

i. Procedures and equipment for protection of workers;

ii. An evaluation of the radiation levels and concentrations of contamination expected during normal operations;

iii. Operating and emergency procedures, including procedures for waste reduction and quality assurance of items released for unrestricted use; and

iv. Method of disposing of the NORM removed from contaminated equipment, facilities, and/or land.

2. An application for a specific license to manufacture and/or initially transfer products or materials containing NORM to persons exempted from these regulations pursuant to 1.11.4(2), will be approved if:

a. The NORM is not contained in any food, beverage, cosmetic, drug, or other commodity designed for ingestion or inhalation by, or application to, a human being; and

b. The applicant submits sufficient information relating to the design, manufacture, prototype testing, quality control procedures, labeling or marking, and conditions of handling, storage, use, and disposal of the NORM material or product to demonstrate that the material or product will meet the safety criteria set forth in 1.11.16. The information shall include:

i. A description of the material or product and its intended use or uses;

ii. The type, quantity, and concentration of NORM in each material or product;

iii. The chemical and physical form of the NORM in the material or product, and changes in chemical and physical form that may occur during the useful life of the material or product;

iv. An analysis of the solubility in water and body fluids of the NORM in the material or product;

v. The details of manufacture and design of the material or product relating to containment and shielding of the NORM and other safety features under normal and severe conditions of handling, storage, use, reuse, and disposal of the material or product;

vi. The degree of access of human beings to the material or product during normal handling, use, and disposal;

vii. The total quantity of NORM expected to be distributed annually in the material or product;

viii. The expected useful life of the material or product;

ix. The proposed method of labeling or marking each unit of the material or product with identification of the manufacturer and/or initial transferor of the product and the radionuclide(s) and quantity of NORM in the material or product;

x. The procedures for prototype testing of the material or product to demonstrate the effectiveness of the containment, shielding, and other safety features under both normal and severe conditions of handling, storage, use, reuse, and disposal;

xi. The results of the prototype testing of the material or product, including any change in the form of the NORM contained in it, the extent to which the NORM may be released to the environment, any change in radiation levels, and any other changes in safety features;

xii. The estimated external radiation doses and dose commitments relevant to the safety criteria in 1.11.16 and the basis for such estimates;

xiii. A determination that the probabilities with respect to doses referred to 1.11.16 meet the safety criteria;

xiv. The quality control procedures to be followed in the production of production lots of the material or product, and the quality control standards the material or product will be required to meet; and

xv. Any additional information, including experimental studies and tests, required by the Agency to facilitate a determination of the radiation safety of the material or product.

3. Notwithstanding the provisions of 1.11.16(2), the Agency may deny an application for a specific license if the end uses of the product are frivolous or cannot

be reasonably foreseen.

**History**
- *SOURCE: Miss. Code Ann. §45-14-3*

##### **15 Miss. Admin. Code Pt. 21, R. 1.11.16** Safety Criteria {#sec-21-1.11.16 omnilex-key=us-ms-regs-official--title-15--21#1.11.16}

An applicant for a license under 1.11.15(2) shall demonstrate that the product is designed and will be manufactured so that:

1. In normal use and disposal, it is unlikely that the external radiation dose in any one year, or the dose commitment resulting from the intake of NORM, excluding radon and radon decay products, in any one year, to a suitable sample of the group of individuals expected to be most highly exposed to radiation or NORM from the material or product, will exceed the doses in Column I of 1.11.17

2. In normal handling and storage of the quantities of the material or product likely to accumulate in one location during marketing, distribution, installation, and servicing of the material or product, it is unlikely that the external radiation dose in any one year, or the dose commitment resulting from the intake of NORM, excluding radon, in any one year, to a suitable sample of the group of individuals expected to be most highly exposed to radiation or NORM from the material or product, will exceed the doses in Column II of 1.11.17

3. In normal use, disposal, handling, and storage, it is unlikely that the radon released from the material or product will result in an increase in the average concentration in air of more than 0.4 picocurie per liter (14.8Bq/m3).

4. It is unlikely that there will be a significant reduction in the effectiveness of the containment, shielding, or other safety features of the material or product from wear and abuse likely to occur in normal handling and use of the material or product during its useful life.

Table of Organ Doses.

Column I*

Column II*

Part of Body

Dose in Rem

Dose in Rem

Whole body; head and trunk;

active blood-forming organs;

gonads; or lens of eye 0.005 (0.05 mSv) 0.5 (5 mSv)

Hands and forearms; feet and ankles; localized areas of skin

averaged over areas no larger

than 1 square centimeter 0.075 (0.75 mSv) 7.5 (75 mSv)

Other organs 0.015 (0.15 mSv) 1.5 (15 mSv)

*Dose limit is the dose above background from the product.

**History**
- *SOURCE: Miss. Code Ann. §45-14-3*

##### **15 Miss. Admin. Code Pt. 21, R. 1.11.17** Issuance of Specific Licenses {#sec-21-1.11.17 omnilex-key=us-ms-regs-official--title-15--21#1.11.17}

The Agency will issue a specific license in accordance with 1.3.14 of these regulations.

**History**
- *SOURCE: Miss. Code Ann. §45-14-3*

##### **15 Miss. Admin. Code Pt. 21, R. 1.11.18** Conditions of Licenses Issued Under 1.11.15 {#sec-21-1.11.18 omnilex-key=us-ms-regs-official--title-15--21#1.11.18}

1. Each license issued pursuant to this section shall be subject to all the requirements set forth in 1.3.15.

2. Each person licensed by the Agency pursuant to this section is subject to the general license provisions of 1.11.11.

3. In addition to the requirements set forth in 1.3.15 each person listed under 1.11.15(2) shall:

a. Carry out adequate control procedures in the manufacture of the material or product to assure that each production lot meets the quality control standards approved by the Agency;

b. Label or mark each unit to identify the manufacturer, processor, producer, or initial transferor of the material or product and the NORM in the material or product; and

c. Maintain records identifying, by name and address, each person to whom NORM is transferred for use under 1.11.4(2) or the equivalent regulations of another Licensing State, and stating the kinds, quantities and uses of NORM transferred. An annual summary report stating the total quantity of each radionuclide transferred under the specific license shall be filed with the Agency. Each report shall cover the year ending December 31, and shall be filed within 30 days thereafter. If no transfers of NORM have been made pursuant to 1.11.15(2) during the reporting period, the report shall so indicate.

**History**
- *SOURCE: Miss. Code Ann. §45-14-3*

##### **15 Miss. Admin. Code Pt. 21, R. 1.11.19** Expiration and Termination of Licenses {#sec-21-1.11.19 omnilex-key=us-ms-regs-official--title-15--21#1.11.19}

Each licensee shall comply with the provisions in 1.3.16 of these regulations.

**History**
- *SOURCE: Miss. Code Ann. §45-14-3*

##### **15 Miss. Admin. Code Pt. 21, R. 1.11.20** Renewal of License {#sec-21-1.11.20 omnilex-key=us-ms-regs-official--title-15--21#1.11.20}

Applications for renewal of specific licenses shall be filed in accordance with 1.3.17 of these regulations.

**History**
- *SOURCE: Miss. Code Ann. §45-14-3*

##### **15 Miss. Admin. Code Pt. 21, R. 1.11.21** Amendment of Licenses at Request of Licensee {#sec-21-1.11.21 omnilex-key=us-ms-regs-official--title-15--21#1.11.21}

Applications for amendment of a license shall be filed in accordance with 1.3.18 of these regulations.

**History**
- *SOURCE: Miss. Code Ann. §45-14-3*

##### **15 Miss. Admin. Code Pt. 21, R. 1.11.22** Agency Action on Application to Renew and Amend {#sec-21-1.11.22 omnilex-key=us-ms-regs-official--title-15--21#1.11.22}

In considering an application by a licensee to renew or amend the license, the Agency will apply the criteria set forth in 1.3.19 of these regulations.

**History**
- *SOURCE: Miss. Code Ann. §45-14-3*

##### **15 Miss. Admin. Code Pt. 21, R. 1.11.23** Modification and Revocation of Licenses {#sec-21-1.11.23 omnilex-key=us-ms-regs-official--title-15--21#1.11.23}

The terms and conditions of all licenses shall be subject 1.3.25 of these regulations.

**History**
- *SOURCE: Miss. Code Ann. §45-14-3*

##### **15 Miss. Admin. Code Pt. 21, R. 1.11.24** Reciprocal Recognition of Licenses {#sec-21-1.11.24 omnilex-key=us-ms-regs-official--title-15--21#1.11.24}

The out-of-state licensee shall comply with the provisions of 1.3.26 of these regulations.

APPENDIX A

Acceptable Surface Contamination Levels For Norm

RADIONUCLIDE a

U-nat, U-235, AVERAGE bcf MAXIMUM bdfg REMOVABLE bcef

U-238, and asso-

ciated products

(including Po-210),

except Ra-226,

Th-230, Ac-227, and Pa-231 5,000 dpm alpha/100 cm

15,000 dpm alpha/100 cm

1,000 dpm alpha/100 cm

Transuranics, Ra-226,

Ra-228, Th-230

**History**
- *SOURCE: Miss. Code Ann. §45-14-3*

##### **15 Miss. Admin. Code Pt. 21, R. 300** dpm/ {#sec-21-300 omnilex-key=us-ms-regs-official--title-15--21#300}

cm

##### **15 Miss. Admin. Code Pt. 21, R. 20** pm/ {#sec-21-20 omnilex-key=us-ms-regs-official--title-15--21#20}

cm

Th-nat, Th-232,

Ra-223, Ra-224, U-232 1,000 dpm/

cm

3,000 dpm/

cm

##### **15 Miss. Admin. Code Pt. 21, R. 200** dpm/ {#sec-21-200 omnilex-key=us-ms-regs-official--title-15--21#200}

cm

Beta-gamma emitters

(radionuclides with decay

modes other than alpha

emission or spontaneous

fission, including

Pb-210), except others noted above. 5,000 dpm beta, gamma/100 cm

15,000 dpm beta, gamma/100 cm

1,000 dpm beta, gamma/100 cm

(a) Where surface contamination by both alpha and beta-gamma emitting radionuclides exists, the limits established for alpha and beta-gamma emitting radionuclides should apply independently.

(b) As used in this table, dpm (disintegrations per minute) means the rate of emission by radioactive material as determined by correcting the counts per minute observed by an appropriate detector for background, efficiency, and geometric factors associated with the instrumentation.

(c) Measurements of average contamination levels should not be averaged over more than one square meter. For objects of less surface area, the average should be derived for each object.

(d) The maximum contamination level applies to an area of not more than 100 cm2.

(e) The amount of removable radioactive material per 100 cm2 of surface area should be determined by wiping that area with dry filter or soft absorbent paper, applying moderate pressure, and assessing the amount of radioactive material on the wipe with an appropriate instrument of known efficiency. When removable contamination on objects of less surface area is determined, the pertinent levels should be reduced proportionally and the entire surface should be wiped.

(f) The average and maximum radiation levels associated with surface contamination resulting from beta-gamma emitters should not exceed 0.2 mrad/hr (2 μGy/hr) at 1 cm and 1.0 mrad/hr (10 μGy/hr) at 1 cm respectively, measured through not more than 7 milligrams per square centimeter of total absorber.

(g) Equipment containing NORM shall not exceed a maximum radiation exposure level of 25 microroentgens per hour above background radiation at any accessible point.

Subchapter 12 Licensing And Radiation Safety Requirements For Irradiators

##### **15 Miss. Admin. Code Pt. 21, R. 1.12.1** Purpose {#sec-21-1.12.1 omnilex-key=us-ms-regs-official--title-15--21#1.12.1}

This Regulation adopts by reference the current revision of the following sections in Title 10 Code of Federal Regulations Part 36: 36.1, 36.2 (with the exception referenced in No. 1 below), 36.11, 36.13, 36.15, 36.17, 36.19, 36.21, 36.23, 36.25, 36.27, 36.29, 36.31, 36.33, 36.35, 36.37, 36.39, 36.41, 36.51, 36.53, 36.55, 36.57, 36.59, 36.61, 36.63, 36.65, 36.67, 36.69, 36.81, and 36.83, with the following exceptions:

1. Not adopted by reference is Title 10 Code of Federal Regulations 36.2 Paragraph (2) Common defense and security, in the definition of “Commencement of Construction” and Paragraph 9(ii) Common defense and security, in the definition of “Construction.”

2. Requirements in Title 10 Code of Federal Regulations Part 36 that apply to "byproduct material" also apply to naturally occurring or accelerator- produced radioactive material.

3. Where the words "NRC", "commission", or "NRC regional office" appear in Title 10 Code of Federal Regulations Part 36, substitute the words "Mississippi State Department of Health".

4. "Act" includes Mississippi Radiation Protection Law of 1976.

5. Mississippi State Department of Health form number 844 E "Application for Radioactive Material License" must be used instead of NRC form 313 as specified in Title 10 Code of Federal Regulations Part 36.

6. For references to Title 10 Code of Federal Regulations Parts 170 and 171, see Mississippi State Department of Health Regulations for the Control of Radiation in Mississippi Rule 1.1.18 for applicable fee.

Subchapter 13 Packaging and Transportation of Radioactive Materials Rule 1.13.1 Purpose. This Regulation adopts by reference the current revision of the following sections in Title 10 Code of Federal Regulations Part 71: 71.0, 71.3, 71.4, 71.5, 71.7, 71.8, 71.9, 71.10, 71.12, 71.13, 71.14, 71.15, 71.17, 71.21, 71.22, 71.23, 71.47, 71.81, 71.83, 71.85, 71.87, 71.88, 71.89, 71.91, 71.93, 71.95, 71.97, 71.101, 71.103, 71.105, 71.106, 71.127, 71.129, 71.131, 71.133, 71.135, and 71.137 and Appendix A to Part 71, with the following exceptions:

1. Not adopted by reference are Title 10 Code of Federal Regulations 71.0(d), 71.14(b), 71.85(a), (b), and (c), 71.91(b), and 71.101(c)(2), (d), and (e).

2. The terms “certificate of compliance”, “certificate holder”, and “applicant” in the provisions of Title 10 Code of Federal Regulations Part 71 are used only in relation to the Nuclear Regulatory Commission as the Nuclear Regulatory Commission is the sole authority for approving and issuing a Part 71 package Certificate of Compliance.

3. Requirements in Title 10 Code of Federal Regulations Part 71 that apply to "licensed material" or "byproduct material" also apply to naturally occurring or accelerator-produced radioactive material.

4. Where the words "NRC", "commission", "nuclear regulatory commission", "United States Nuclear Regulatory Commission", or "administrator of the appropriate regional office" appear in Title 10 Code of Federal Regulations Part 71, substitute the words "Mississippi State Department of Health" except when used in Title 10 Code of Federal Regulations 71.5(b), 71.10, 71.17 (c)(3), and (e), 71.85(c), 71.88(a)(4), 71.93(c), 71.95, and 71.97(c), (c)(3)(iii), and (f).

5. Title 10 Code of Federal Regulations 71.9 employee protection also applies to violations of Mississippi State Department of Health Regulations for Control of Radiation in Mississippi Subchapter 10.

6. Mississippi State Department of Health form number 935, "notice to employees", must be posted instead of NRC form 3 that is specified in Title 10 Code of Federal Part 71.

**History**
- *SOURCE: Miss. Code Ann. §45-14-11*
- *SOURCE: Miss. Code Ann. §45-14-11*

##### **15 Miss. Admin. Code Pt. 21, R. 1.14.1** Purpose {#sec-21-1.14.1 omnilex-key=us-ms-regs-official--title-15--21#1.14.1}

This Regulation adopts by reference the current revision of the following sections in Title 10 Code of Federal Regulations Part 39: 39.1, 39.2, 39.11, 39.13, 39.15, 39.17, 39.31, 39.33, 39.35, 39.37, 39.39, 39.41, 39.43, 39.45, 39.47, 39.49, 39.51, 39.53, 39.55, 39.61, 39.63, 39.65, 39.67, 39.69, 39.71, 39.73, 39.75, 39.77, and 39.91, with the following exceptions:

1. All of the requirements in Subchapter 14 apply to both licensees and registrants. A reference in Title 10 Code of Federal Regulations Part 39 to "license" includes "registration", a reference to "licensee" includes "registrant", a reference to "licensed" includes "registered", and a reference to "licensed material" includes "registered source of radiation". "Registrant" means any person who is registered with the Mississippi State Department of Health and is legally obligated to register with the department pursuant to Section 45-14-13 of the Mississippi Code of 1972, Annotated. "Registration" means the notification of the Mississippi State Department of Health of possession of a source of radiation and the furnishing of information with respect thereto, in accordance with Mississippi State Department of Health Regulations for the Control of Radiation in Mississippi Rule 1.2.5.

2. Where the words "NRC", "commission", or "NRC regional office" appear in Title 10 Code of Federal Regulations Part 39, substitute the words "Mississippi State Department of Health".

3. Requirements in Title 10 Code of Federal Regulations Part 39 that apply to "byproduct material" also apply to naturally occurring or accelerator- produced radioactive material.

4. Mississippi State Department of Health form number 844 E "Application for Radioactive Material License", or form number 802 “Application for Ionizing Radiation” must be used instead of NRC form 313 as specified in Title 10 Code of Federal Regulations Part 39.

5. For references to Title 10 Code of Federal Regulations Parts 170 and 171, see Mississippi State Department of Health Regulations for the Control of Radiation in Mississippi Rule 1.1.18 for applicable fee.

Subchapter 15 Therapeutic Radiation Machines Rule 1.15.1 Scope and Applicability. 1. This section establishes requirements, for which the registrant is responsible, for use of therapeutic radiation machines. The provisions of this section are in addition to, and not in substitution for, other applicable provisions of these regulations. 2. The use of therapeutic radiation machines shall be by, or under the supervision of, a licensed practitioner of the healing arts who meets the training/experience criteria established by 1.15.3.(3)

**History**
- *SOURCE: Miss. Code Ann. §45-14-11*
- *SOURCE: Miss. Code Ann. §45-14-11*

##### **15 Miss. Admin. Code Pt. 21, R. 1.15.2** Definitions {#sec-21-1.15.2 omnilex-key=us-ms-regs-official--title-15--21#1.15.2}

As used in this section, the following definitions apply: 1. "Absorbed dose" is the energy imparted to matter by ionizing radiation per unit mass of irradiated material at the place of interest. The special unit of absorbed dose is the rad (see "Rad"). 2. "Absorbed dose rate" means absorbed dose per unit time, for machines with timers, or dose monitor unit per unit time for linear accelerators. 3. "Accessible surface" means the external surface of the enclosure or housing provided by the manufacturer. 4. "Added filtration" means any filtration which is in addition to the inherent filtration. 5. "Air kerma (K)" means the kinetic energy released in air by ionizing radiation. Kerma is determined as the quotient of dE by dM, where dE is the sum of the initial kinetic energies of all the charged ionizing particles liberated by uncharged ionizing particles in air of mass dM. Kerma is measured in the same unit as absorbed dose. 6. "Barrier" (See "Protective barrier"). 7. "Beam axis" means the central ray of the useful radiation beam that passes through the isocenter and the source of radiation. 8. "Beam-limiting device" means a field defining collimator which provides a means to restrict the dimensions of the useful beam. 9. "Beam monitoring system" means a system designed and installed in the radiation head to detect and measure the radiation present in the useful beam. 10. "Beam scattering foil" means a thin piece of material (usually metallic) placed in the beam to scatter a beam of electrons in order to provide a more uniform electron distribution in the useful beam.

11. "Bent beam linear accelerator" means a linear accelerator geometry in which the accelerated electron beam must change direction by passing through a bending magnet. 12. "Changeable filters" means any filter, exclusive of inherent filtration, which can be removed from the useful beam through any electronic, mechanical, or physical process. 13. "Contact therapy system" means a therapeutic radiation machine with a short source to skin distance (SSD), usually less than 5 centimeters. 14. "Detector" (See "Radiation detector"). 15. "Dose monitor unit (DMU)" means a unit response from the beam monitoring system from which the absorbed dose can be calculated. 16. "External beam radiation therapy" means therapeutic irradiation in which the source of radiation is at a distance from the body. 17. "Field-flattening filter" means a filter used to homogenize the absorbed dose rate over the radiation field. 18. "Filter" means material placed in the useful beam to change beam quality in therapeutic radiation machines subject to1.15.6. 19. "Gantry" means that part of a system supporting and allowing movements of the radiation head about a center of rotation. 20. "Gray (Gy)" means the special name for the SI unit of absorbed dose, kerma, and specific energy imparted equal to 1 joule per kilogram. The previous unit of absorbed dose (rad) is being replaced by the gray. [1 Gy=100 rad]. 21. "Half-value layer (HVL)" means the thickness of a specified material which attenuates under narrow beam conditions, x-radiation or gamma radiation to an extent such that the air kerma rate, exposure rate or absorbed dose rate is reduced to one-half of the value measured without the material. 22. "Interlock" means a device preventing the start or continued operation of equipment unless certain predetermined conditions prevail. 23. "Interruption of irradiation" means the stopping of irradiation with the possibility of continuing irradiation without resetting of operating conditions at the control panel. 24. "Irradiation" means the exposure of a living being or matter to ionizing radiation. 25. "Isocenter" means the center of the smallest sphere through which the useful beam axis passes.

26. "Kilovolt (kV) [kilo electron volt (keV)]" means the energy equal to that acquired by a particle with one electron charge in passing through a potential difference of one thousand volts in a vacuum. [Note: current convention is to use kV for photons and keV for electrons.] 27. "Lead equivalent" means the thickness of the material in question affording the same attenuation, under specified conditions, as lead. 28. "Leakage radiation" means radiation emanating from the therapeutic source assembly except for the useful beam. 29. "Light field" means the area illuminated by light, being the locus of points at which the illumination exceeds a specific or specified level, simulating the radiation field. 30. "mA" means milliampere. 31. "Megavolt (MV) [mega electron volt (MeV)]" means the energy equal to that acquired by a particle with one electron charge in passing through a potential difference of one million volts in a vacuum. [Note: current convention is to use MV for photons and MeV for electrons.] 32. "Monitor unit (MU)" (See "Dose monitor unit"). 33. "Moving beam radiation therapy" means radiation therapy with continuous displacement of the radiation source relative to the patient during irradiation. It includes arc therapy, skip therapy, conformal therapy and rotational therapy. 34. "Nominal treatment distance" means: a. For electron irradiation, the distance from the scattering foil, virtual source, or exit window of the electron beam to the entrance surface of the irradiated object along the central axis of the useful beam. b. For x-ray irradiation, the virtual source or target to isocenter distance along the central axis of the useful beam. For non-isocentric equipment, this distance shall be that specified by the manufacturer. 35. "Patient" means an individual subjected to machine produced external beam radiation for the purposes of medical therapy. 36. "Peak tube potential" means the maximum value of the potential difference across the x-ray tube during an exposure. 37. "Periodic quality assurance check" means a procedure which is performed to ensure that a previous calibration continues to be valid. 38. "Phantom" means an object behaving in essentially the same manner as tissue, with respect to absorption or scattering of the ionizing radiation in question.

39. "Practical range of electrons" corresponds to classical electron range where the only contribution to dose is from bremsstrahlung x-rays. Precise definition may be found in "Clinical Electron Beam Dosimetry: Report of AAPM Radiation Therapy Committee Task Group 25" [Medical Physics 18(1): 73-109, Jan/Feb 1991] and ICRU Report 35, "Radiation Dosimetry: Electron Beams with Energies Between 1 and 50 MeV", International Commission on Radiation Units and Measurements, September 15, 1984. 40. “Primary dose monitoring system" means a system which will monitor the useful beam during irradiation and which will terminate irradiation when a preselected number of dose monitor units have been acquired. 41. "Primary protective barrier" (See "Protective barrier"). 42. "Protective barrier" means a barrier of radiation absorbing material(s) used to reduce radiation exposure. The types of protective barriers are as follows: a. "Primary protective barrier" means the material, excluding filters, placed in the useful beam, to protect anyone other than the patient from radiation exposure. b. "Secondary protective barrier" means a barrier sufficient to attenuate the stray radiation to the required degree. 43. "Radiation detector" means a device which, in the presence of radiation provides, by either direct or indirect means a signal or other indication suitable for use in measuring one or more quantities of incident radiation. 44. "Radiation head" means the structure from which the useful beam emerges. 45. "Radiation Therapy Physicist" means an individual qualified in accordance with 1.15.3(4). 46. "Redundant dose monitoring combination" means a combination of two dose monitoring systems in which both systems are arranged to terminate irradiation in accordance with a preselected number of dose monitor units. 47. "Response time" means the time required for an instrument system to reach 90 percent of its final reading when the radiation-sensitive volume of the instrument system is exposed to a step change in radiation flux from zero sufficient to provide a steady state midscale reading. 48. "Scattered radiation" means ionizing radiation emitted by interaction of ionizing radiation with matter, the interaction being accompanied by a change in direction of the radiation. Scattered primary radiation means that scattered radiation which has been deviated in direction only by materials irradiated by the useful beam.

49. "Secondary dose monitoring system" means a system which will terminate irradiation in the event of failure of the primary dose monitoring system. 50. "Secondary protective barrier" (See "Protective barrier"). 51. "Shadow tray" means a device attached to the radiation head to support auxiliary beam blocking material. 52. "Shutter" means a device attached to the tube housing assembly which can totally intercept the useful beam and which has a lead equivalency not less than that of the tube housing assembly. 53. "Sievert (Sv)" means the special name for the SI unit of dose equivalent. The unit of dose equivalent is the joule per kilogram. The previous unit of dose equivalent (rem) is being replaced by the sievert [1 Sv=100 rem]. 54. "Simulator (radiation therapy simulation system)" means a radiographic or fluoroscopic x-ray system intended for localizing the volume to be exposed during radiation therapy and confirming the position and size of the therapeutic irradiation field. 55. "Source" means the region and/or material from which the radiation emanates. 56. "Source-skin distance (SSD)" means the distance measured along the central ray from the center of the front surface of the radiation source to the surface of the irradiated object or patient. [See also Target-skin distance] 57. "Stationary beam radiation therapy" means radiation therapy without displacement of the radiation source relative to the patient during irradiation. 58. "Stray radiation" means the sum of leakage and scattered radiation. 59. "Target" means that part of an x-ray tube or particle accelerator onto which is directed a beam of accelerated particles to produce ionizing radiation or other particles. 60. "Target-skin distance (TSD)" means the distance measured along the central ray from the center of the front surface of the x-ray target to the surface of the irradiated object or patient. [See also Source-skin distance] 61. "Tenth-value layer (TVL)" means the thickness of a specified material which attenuates under broad beam conditions, x-radiation or gamma radiation to an extent such that the air kerma rate, exposure rate or absorbed dose rate is reduced to one-tenth of the value measured without the material. 62. "Termination of irradiation" means the stopping of irradiation in a fashion which will not permit continuance of irradiation without the resetting of operating conditions at the control panel.

63. "Therapeutic radiation machine" means x-ray or electron-producing equipment designed and used for external beam radiation therapy. 64. "Tube" means an x-ray tube, unless otherwise specified. 65. "Tube housing assembly" means the tube housing with tube installed. It includes high-voltage and/or filament transformers and other appropriate elements when such are contained within the tube housing. 66. "Useful beam" means the radiation emanating from the tube housing port or the radiation head and passing through the aperture of the beam-limiting device when the exposure controls are in a mode to cause the therapeutic radiation machine to produce radiation. 67. "Virtual source" means a point from which radiation appears to originate. 68. "Wedge filter" means a filter which effects continuous change in transmission over all or a part of the radiation field. 69. "X-ray tube" means any electron tube which is designed to be used primarily for the production of x-rays.

**History**
- *Source: Miss. Code Ann. §45-14-11*

##### **15 Miss. Admin. Code Pt. 21, R. 1.15.3** General Administrative Requirements for Facilities Using Therapeutic Radiation Machines {#sec-21-1.15.3 omnilex-key=us-ms-regs-official--title-15--21#1.15.3}

1. Administrative Controls. The registrant shall be responsible for directing the operation of the therapeutic radiation machines which have been registered with the Agency. The registrant or the registrant's agent shall ensure that the requirements of Subchapter 15 are met in the operation of the therapeutic radiation machine(s). 2. A therapeutic radiation machine which does not meet the provisions of these regulations shall not be used for irradiation of patients. 3. Training for External Beam Radiation Therapy Authorized User. The registrant for any therapeutic radiation machine subject to 1.15.6 or 1.15.7 shall require the authorized user to be a physician who: a. Is certified in: i. Radiology or therapeutic radiology by the American Board of Radiology; ii. Radiation oncology by the American Osteopathic Board of Radiology;

iii. Radiology, with specialization in radiotherapy, as a British "Fellow of the Faculty of Radiology" or "Fellow of the Royal College of Radiology"; or iv. Therapeutic Radiology by the Canadian Royal College of Physicians and Surgeons; or b. Is in the active practice of therapeutic radiology, and has completed 200 hours of instruction in basic radiation techniques applicable to the use of an external beam radiation therapy unit, 500 hours of supervised work experience, and a minimum of 3 years of supervised clinical experience.To satisfy the requirement for instruction, the classroom and laboratory training shall include: i. Radiation physics and instrumentation; i Radiation protection; ii Mathematics pertaining to the use and measurement of radioactivity; and iii Radiation biology. ii. To satisfy the requirement for supervised work experience, training shall be under the supervision of an authorized user and shall include: i. Review of the full calibration measurements and periodic quality assurance checks; ii. Preparing treatment plans and calculating treatment times; iii. Using administrative controls to prevent misadministrations; iv. Implementing emergency procedures to be followed in the event of the abnormal operation of an external beam radiation therapy unit or console; and v. Checking and using survey meters. iii. To satisfy the requirement for a period of supervised clinical experience, training shall include 1 year in a formal training program approved by the Residency Review Committee for Radiology of the Accreditation Council for Graduate Medical Education or the Committee on Postdoctoral Training of the American Osteopathic Association and an additional 2 years of clinical experience in therapeutic radiology under the supervision of an authorized user. The supervised clinical experience shall include:

i. Examining individuals and reviewing their case histories to determine their suitability for external beam radiation therapy treatment, and any limitations/contraindications; ii. Selecting proper dose and how it is to be administered; iii. Calculating the external beam radiation therapy doses and collaborating with the authorized user in the review of patients' progress and consideration of the need to modify originally prescribed doses as warranted by patients' reaction to radiation; and iv. Post administration follow-up and review of case histories. c. Notwithstanding the requirements of 1.15.3(3)(a) and 1.15.3(3)(b), the registrant for any therapeutic radiation machine subject to 1.15.6 may also submit the training of the prospective authorized user physician for Agency review on a case-by-case basis. d. A physician shall not act as an authorized user for any therapeutic radiation machine until such time as said physician's training has been reviewed and approved by the Agency. 4. Training for Radiation Therapy Physicist. The registrant for any therapeutic radiation machine subject to 1.15.6 or 1.15.7 shall require the Radiation Therapy Physicist to: a. Be registered with the Agency, under the provisions of Subchapter 2 of these regulations, as a provider of radiation services in the area of calibration and compliance surveys of external beam radiation therapy units. b. Be certified by the American Board of Radiology in: i. Therapeutic radiological physics; ii. Roentgen-ray and gamma-ray physics; iii. X-ray and radium physics; or iv. Radiological physics; or c. Be certified by the American Board of Medical Physics in Radiation Oncology Physics; or d. Be certified by the Canadian College of Medical Physics; or

e. Hold a master's or doctor's degree in physics, biophysics, radiological physics, or health physics, and have completed 1 year of full-time training in therapeutic radiological physics and also 1 year of full-time work experience under the supervision of a Radiation Therapy Physicist at a medical institution. To meet this requirement, the individual shall have performed the tasks listed in 1.15.4(1), 1.15.6(16), 1.15.6(17), 1.15.7(20), and 1.15.7(21) under the supervision of a Radiation Therapy Physicist during the year of work experience; or f. Hold a bachelor's degree in a physical science and have completed 1 additional year of full-time training in therapeutic radiological physics and also 2 years of full-time work experience under the supervision of a Radiation Therapy Physicist at a medical institution. To meet this requirement, the individual shall have performed the tasks listed in 1.15.4(1), 1.15.6(16), 1.15.6(17), 1.15.7(20), and 1.15.7(21) under the supervision of a Radiation Therapy Physicist during the 2 years of work experience. Agency review of applicants in this category will only be on a case-by-case basis and additional information may be required for the Agency to determine if the applicant is qualified to function as a Radiation Therapy Physicist. 5. Qualifications of Operators a. Individuals who will be operating a therapeutic radiation machine for medical use shall be American Registry of Radiologic Technologists (ARRT) Registered Radiation Therapy Technologists. Individuals who are not ARRT Registered Radiation Therapy Technologists shall submit evidence that they have satisfactorily completed a radiation therapy technologist training program that complies with the requirements of the Joint Review Committee on Education in Radiologic Technology. ARRT Registered Radiologic Technologists, who have been working for two years or more in radiation therapy, will be allowed three years from the effective date of these regulations to fulfill the above listed requirements.

b. The names and training of all personnel currently operating a therapeutic radiation machine shall be kept on file at the facility. Information on former operators shall be retained for a period of 2 years beyond the last date they were authorized to operate a therapeutic radiation machine at that facility. 6. Written safety procedures and rules shall be developed by a Radiation Therapy Physicist and shall be provided to each individual operating a therapeutic radiation machine, including any restrictions of the operating technique required for the safe

“Essentials and Guidelines of an Accredited Educational Program for the Radiation Therapy Technologist", Joint Review Committee on Education in Radiologic Technology, 1988.

operation of the particular therapeutic radiation machine. The operator shall be able to demonstrate familiarity with these rules. 7. Individuals shall not be exposed to the useful beam except for medical therapy purposes and unless such exposure has been ordered in writing by a licensed practitioner of the healing arts who is specifically identified on the Certificate of Registration. This provision specifically prohibits deliberate exposure of an individual for training, demonstration or other non-healing-arts purposes. 8. All individuals associated with the operation of a therapeutic radiation machine shall be instructed in and shall comply with the provisions of the registrant's quality management program. In addition to the requirements of Subchapter 15, these individuals are also subject to the requirements of 1.4.5, 1.4.10, and 1.4.18. 9. Information and Maintenance Record and Associated Information. The registrant shall maintain the following information in a separate file or package for each therapeutic radiation machine, for inspection by the Agency: a. Report of acceptance testing; b. Records of surveys, calibrations, and periodic quality assurance checks of the therapeutic radiation machine required by Subchapter 15, as well as the name(s) of person(s) who performed such activities; c. Records of major maintenance and modifications performed on the therapeutic radiation machine after the effective date of these regulations, as well as the name(s) of person(s) who performed such services; and d. Signature of person authorizing the return of therapeutic radiation machine to clinical use after service, repair, or upgrade. 10. Records Retention. All records required by Subchapter 15 shall be retained until disposal is authorized by the Agency unless another retention period is specifically authorized in Subchapter 15. All required records shall be retained in an active file from at least the time of generation until the next Agency inspection. Any required record generated prior to the last Agency inspection may be microfilmed or otherwise archived as long as a complete copy of said record can be retrieved until such time as the Agency authorizes final disposal.

**History**
- *Source: Miss. Code Ann. §45-14-11*

##### **15 Miss. Admin. Code Pt. 21, R. 1.15.4** General Technical Requirements for Facilities Using Therapeutic Radiation Machines {#sec-21-1.15.4 omnilex-key=us-ms-regs-official--title-15--21#1.15.4}

1. Protection Surveys. a. The registrant shall ensure that radiation protection surveys of all new facilities, and existing facilities not previously surveyed are performed with

an operable radiation measurement survey instrument calibrated in accordance with1.15.8. The radiation protection survey shall be performed by, or under the direction of, a Radiation Therapy Physicist or a Certified Health Physicist and shall verify that, with the therapeutic radiation machine in a "BEAM-ON" condition, with the largest clinically available treatment field and with a scattering phantom in the primary beam of radiation: i. Radiation levels in restricted areas are not likely to cause personnel exposures in excess of the limits specified in 1.4.6(1); and ii. Radiation levels in unrestricted areas do not exceed the limits specified in 1.4.14(1) and 1.4.14(2). b. In addition to the requirements of 1.15.4(1)(a), a radiation protection survey shall also be performed prior to any subsequent medical use and: i. After making any change in the treatment room shielding; ii. After making any change in the location of the therapeutic radiation machine within the treatment room; iii. After relocating the therapeutic radiation machine; or iv. Before using the therapeutic radiation machine in a manner that could result in increased radiation levels in areas outside the external beam radiation therapy treatment room. c. The survey record shall indicate all instances where the facility, in the opinion of the Radiation Therapy Physicist or a Certified Health Physicist, is in violation of applicable regulations. The survey record shall also include the date of the measurements, the reason the survey is required, the manufacturer's name, model number and serial number of the therapeutic radiation machine, the instrument(s) used to measure radiation levels, a plan of the areas surrounding the treatment room that were surveyed, the measured dose rate at several points in each area expressed in millirems (microsieverts) per hour, the calculated maximum level of radiation over a period of 1 week for each restricted and unrestricted area, and the signature of the individual responsible for conducting the survey; d. If the results of the surveys required by 1.15.4(1)(a) or 1.15.4(1)(b) indicate any radiation levels in excess of the respective limit specified in1.15.4(1)(a), the registrant shall lock the control in the "OFF" position and not use the unit: i. Except as may be necessary to repair, replace, or test the therapeutic radiation machine, the therapeutic radiation machine shielding, or the treatment room shielding; or

ii. Until the registrant has received a specific exemption from the Agency. 2. Modification of Radiation Therapy Unit or Room Before Beginning a Treatment Program. If the survey required by 1.15.4(1) indicates that an individual in an unrestricted area may be exposed to levels of radiation greater than those permitted by 1.4.14(1) of these regulations, before beginning the treatment program the registrant shall: a. Either equip the unit with beam direction interlocks or add additional radiation shielding to ensure compliance with 1.4.14(1) of these regulations; b. Perform the survey required by 1.15.4(1) again; and c. Include in the report required by 1.15.4(4) the results of the initial survey, a description of the modification made to comply with 1.15.4(2)(a), and the results of the second survey; or d. Request and receive a registration amendment under 1.4.14(3) of these regulations that authorizes radiation levels in unrestricted areas greater than those permitted by 1.4.14(1) of these regulations. 3. Dosimetry Equipment. a. The registrant shall have a calibrated dosimetry system available for use. The system shall have been calibrated for Cobalt-60 by the National Institute for Standards and Technology (NIST) or by an American Association of Physicists in Medicine (AAPM) Accredited Dosimetry Calibration Laboratory (ADCL). The calibration shall have been performed within the previous 24 months and after any servicing that may have affected system calibration; b. The registrant shall have available for use a dosimetry system for quality assurance check measurements. To meet this requirement, the system may be compared with a system that has been calibrated in accordance with 1.15.4(3)(a). This comparison shall have been performed within the previous 12 months (6 months if the dosimetry system is an ionization chamber) and after each servicing that may have affected system calibration. The quality assurance check system may be the same system used to meet the requirement in 1.15.4(3)(a); and c. The registrant shall maintain a record of each dosimetry system calibration, intercomparison, and comparison for the duration of the license and/or registration. For each calibration, intercomparison, or comparison, the record shall include the date, the model numbers and serial numbers of the instruments that were calibrated, intercompared, or compared as required by 1.15.4(3)(a) and 1.15.4(3)(b), the correction factors that were determined, the names of the individuals who performed the calibration,

intercomparison, or comparison, and evidence that the intercomparison was performed by, or under the direct supervision of, a Radiation Therapy Physicist. 4. Reports of External Beam Radiation Therapy Surveys and Measurements. The registrant for any therapeutic radiation machine subject to 1.15.6 or 1.15.7 shall furnish a copy of the records required in 1.15.4(1) and 1.15.4(2) to the Agency within 30 days following completion of the action that initiated the record requirement.

**History**
- *Source: Miss. Code Ann. §45-14-11*

##### **15 Miss. Admin. Code Pt. 21, R. 1.15.5** Quality Management Program {#sec-21-1.15.5 omnilex-key=us-ms-regs-official--title-15--21#1.15.5}

1. In addition to the definitions in 1.15.2, the following definitions are applicable to a quality management program: a. "Prescribed dose" means the total dose and dose per fraction as documented in the written directive. b. "Misadministration" means the administration of an external beam radiation therapy dose: i. Involving the wrong patient, wrong treatment modality, or wrong treatment site; ii. When the treatment consists of three (3) or fewer fractions and the calculated total administered dose differs from the total prescribed dose by more than 10 percent of the total prescribed dose; iii. When the calculated weekly administered dose is 30 percent greater than the weekly prescribed dose; or iv. When the calculated total administered dose differs from the total prescribed dose by more than 20 percent of the total prescribed dose. c. "Recordable event" means the administration of an external beam radiation therapy dose when the calculated weekly administered dose is 15 percent greater than the weekly prescribed dose. d. "Written directive" means an order in writing for a specific patient, dated and signed by an authorized user prior to the administration of radiation, containing the following information: total dose, dose per fraction, treatment site and overall treatment period. 2. Scope and Applicability. Each applicant or registrant subject to 1.15.6 or 1.15.7 shall establish and maintain a written quality management program to provide high confidence that radiation will be administered as directed by the authorized user.

The quality management program shall include written policies and procedures to meet the following specific objectives: a. Prior to administration, a written directive is prepared for any external beam radiation therapy dose; i. Notwithstanding 1.15.5(2)(a), a written revision to an existing written directive may be made provided that the revision is dated and signed by an authorized user prior to administration of the external beam radiation therapy dose or the next external beam radiation therapy fractional dose; ii. Notwithstanding 1.15.5(2)(a), if, because of the patient's condition, a delay in order to provide a written revision to an existing written directive would jeopardize the patient's health, an oral revision to an existing written directive shall be acceptable, provided that the oral revision is documented immediately in the patient's record and a revised written directive is signed by an authorized user within 48 hours of the oral revision; or iii. Notwithstanding 1.15.5(2)(a), if, because of the emergent nature of the patient's condition, a delay in order to provide a written directive would jeopardize the patient's health, an oral directive shall be acceptable, provided that the information contained in the oral directive is documented immediately in the patient's record and a written directive is prepared and signed by an authorized user within 24 hours of the oral directive. b. Prior to each administration, the patient's identity is verified, by more than one method, as the individual named in the written directive; c. External beam radiation therapy final plans of treatment and related calculations are in accordance with the respective written directives; d. Each administration is in accordance with the written directive; and e. Any unintended deviation from the written directive is identified and evaluated, and appropriate action is taken. 3. Submission of Quality Management Program a. Each applicant subject to 1.15.6 or 1.15.7 shall submit a quality management program to the Agency as part of the application required by Subchapter 2 of these regulations. The registrant shall implement the program upon issuance of a Certificate of Registration by the Agency. b. Each existing registrant subject to 1.15.6 or 1.15.7 shall, within 30 days of the effective date of these regulations, submit to the Agency a written

certification that a quality management program has been implemented, as well as a copy of said program. 4. As a part of the quality management program, the registrant shall: a. Develop procedures for, and conduct a review of, the quality management program including, since the last review, an evaluation of a representative sample of patient administrations, all recordable events, and all misadministrations to verify compliance with all aspects of the quality management program; b. Conduct these reviews at intervals not to exceed 12 months; c. Evaluate each of these reviews to determine the effectiveness of the quality management program and, if required, make modifications to meet the requirements of 1.15.5(2); and d. Maintain records of each review, including the evaluations and findings of the review, in an auditable form, for 3 years. 5. The registrant shall evaluate and respond, within 30 days after discovery of the recordable event, to each recordable event by: a. Assembling the relevant facts including the cause; b. Identifying what, if any, corrective action is required to prevent recurrence; and c. Retaining a record, in an auditable form, for 3 years, of the relevant facts and what corrective action, if any, was taken. 6. The registrant shall retain: a. Each written directive; and b. A record of each administered radiation dose, in an auditable form, for 3 years after the date of administration. 7. The registrant may make modifications to the quality management program to increase the program's efficiency provided the program's effectiveness is not decreased. The registrant shall furnish the modifications to the Agency within 30 days after the modification has been made. 8. The registrant shall evaluate each misadministration and shall take the following actions in response to a misadministration: a. Notify the Agency by telephone no later than the next calendar day after discovery of the misadministration;

b. Submit a written report to the Agency within 15 days after discovery of the misadministration. The written report shall include: the registrant's name; the prescribing physician's name; a brief description of the event; why the event occurred; the effect on the patient; what improvements are needed to prevent recurrence; actions taken to prevent recurrence; whether the registrant notified the patient or the patient's responsible relative or guardian (this person will subsequently be referred to as "the patient"), and if not, why not, and if the patient was notified, what information was provided to the patient. The report shall not include the patient's name or other information that could lead to identification of the patient; c. Notify the referring physician and also notify the patient of the misadministration no later than 24 hours after its discovery, unless the referring physician personally informs the registrant either that he/she will inform the patient or that, based on medical judgment, telling the patient would be harmful. The registrant is not required to notify the patient without first consulting the referring physician. If the referring physician or patient cannot be reached within 24 hours, the registrant shall notify the patient as soon as possible thereafter. The registrant shall not delay any appropriate medical care for the patient, including any necessary remedial care as a result of the misadministration, because of any delay in notification; d. Retain a record of each misadministration for 5 years. The record shall contain the names of all individuals involved (including the prescribing physician, allied health personnel, the patient, and the patient's referring physician), the patient's social security number or identification number if one has been assigned, a brief description of the event, why it occurred, the effect on the patient, what improvements are needed to prevent recurrence, and the actions taken to prevent recurrence; and e. If the patient was notified, furnish, within 15 days after discovery of the misadministration, a written report to the patient by sending either a copy of the report that was submitted to the Agency, or a brief description of both the event and the consequences as they may effect the patient, provided a statement is included that the report submitted to the Agency can be obtained from the registrant. 9. Aside from the notification requirement, nothing in 1.15.5(8) affects any rights or duties of registrants and physicians in relation to each other, patients, or the patient's responsible relatives or guardians.

**History**
- *Source: Miss. Code Ann. §45-14-11*

##### **15 Miss. Admin. Code Pt. 21, R. 1.15.6** Therapeutic Radiation Machines of Less Than 500 kV {#sec-21-1.15.6 omnilex-key=us-ms-regs-official--title-15--21#1.15.6}

1. Leakage Radiation. When the x-ray tube is operated at its maximum rated tube current for the maximum kV, the leakage kerma rate shall not exceed the value specified at the distance specified for that classification of therapeutic radiation machine: a. 5-50 kV Systems. The leakage air kerma rate measured at any position 5 centimeters from the tube housing assembly shall not exceed 100 mrad (1 mGy) in any one hour. b. >50 and <500 kV Systems. The leakage air kerma rate measured at a distance of 1 meter from the source in any direction shall not exceed 1 rad (1 cGy) in any one hour. This air kerma rate measurement may be averaged over areas no larger than 100 square centimeters. In addition, the air kerma rate at a distance of 5 centimeters from the surface of the tube housing assembly shall not exceed 30 rad (3O cGy) per hour. 2. Permanent Beam-Limiting Devices. Permanent diaphragms or cones used for limiting the useful beam shall provide at least the same degree of attenuation as required for the tube housing assembly. 3. Adjustable or Removable Beam-Limiting Devices. a. All adjustable or removable beam-limiting devices, diaphragms, cones or blocks shall not transmit more than 5 percent of the useful beam for the most penetrating beam used. b. When adjustable beam-limiting devices are used, the position and shape of the radiation field shall be indicated by a light beam. 4. Filter System. The filter system shall be so designed that: a. Filters cannot be accidentally displaced at any possible tube orientation; b. For equipment installed after the effective date of these regulations, an interlock system prevents irradiation if the proper filter is not in place; c. The air kerma rate escaping from the filter slot shall not exceed 1 rad (1 cGy) per hour under any operating conditions; and d. Each filter shall be marked as to its material of construction and its thickness. 5. Tube Immobilization. a. The x-ray tube shall be so mounted that it cannot accidentally turn or slide with respect to the housing aperture; and

b. The tube housing assembly shall be capable of being immobilized for stationary portal treatments. 6. Source Marking. The tube housing assembly shall be so marked that it is possible to determine the location of the source to within 5 millimeters, and such marking shall be readily accessible for use during calibration procedures. 7. Beam Block. Contact therapy tube housing assemblies shall have a removable shield of material, equivalent in attenuation to 0.5 millimeters of lead at 100 kV, which can be positioned over the entire useful beam exit port during periods when the beam is not in use. 8. Timer. A suitable irradiation control device shall be provided to terminate the irradiation after a preset time interval. a. A timer which has a display shall be provided at the treatment control panel. The timer shall have a preset time selector and an elapsed time indicator; b. The timer shall be a cumulative timer which activates with an indication of "BEAM-ON" and retains its reading after irradiation is interrupted or terminated. After irradiation is terminated and before irradiation can be reinitiated, it shall be necessary to reset the elapsed time indicator; c. The timer shall terminate irradiation when a preselected time has elapsed, if any dose monitoring system present has not previously terminated irradiation; d. The timer shall permit accurate presetting and determination of exposure times as short as 1 second; e. The timer shall not permit an exposure if set at zero; f. The timer shall not activate until the shutter is opened when irradiation is controlled by a shutter mechanism unless calibration includes a timer error correction to compensate for mechanical lag; and g. The timer shall be accurate to within 1 percent of the selected value or 1 second, whichever is greater. 9. Control Panel Functions. The control panel, in addition to the displays required by other provisions in 1.15.6 shall have: a. An indication of whether electrical power is available at the control panel and if activation of the x-ray tube is possible; b. An indication of whether x-rays are being produced; c. Means for indicating x-ray tube potential and current;

d. The means for terminating an exposure at any time; e. A locking device which will prevent unauthorized use of the therapeutic radiation machine; and f. For therapeutic radiation machines manufactured after the effective date of these regulations, a positive display of specific filter(s) in the beam. 10. Multiple Tubes. When a control panel may energize more than one x-ray tube: a. It shall be possible to activate only one x-ray tube at any time; b. There shall be an indication at the control panel identifying which x-ray tube is activated; and c. There shall be an indication at the tube housing assembly when that tube is energized. 11. Source-to-Skin Distance (SSD). There shall be a means of determining the central axis SSD to within 1 centimeter and of reproducing this measurement to within 2 millimeters thereafter. 12. Shutters. Unless it is possible to bring the x-ray output to the prescribed exposure parameters within 5 seconds after the x-ray "ON" switch is energized, the beam shall be attenuated by a shutter having a lead equivalency not less than that of the tube housing assembly. In addition, after the unit is at operating parameters, the shutter shall be controlled electrically by the operator from the control panel. An indication of shutter position shall appear at the control panel. 13. Low Filtration X-ray Tubes. Each therapeutic radiation machine equipped with a beryllium or other low-filtration window shall be clearly labeled as such upon the tube housing assembly and shall be provided with a permanent warning device on the control panel that is activated when no additional filtration is present to indicate that the dose rate is very high. 14. Facility Design Requirements for Therapeutic Radiation Machines Capable of Operating in the Range 50 kV to 500 kV. In addition to shielding adequate to meet requirements of 1.15.9, the treatment room shall meet the following design requirements: a. Aural Communication. Provision shall be made for continuous two-way aural communication between the patient and the operator at the control panel. b. Viewing Systems. Provision shall be made to permit continuous observation of the patient during irradiation and shall be so located that the operator can observe the patient from the control panel. The therapeutic

radiation machine shall not be used for patient irradiation unless at least one viewing system is operational. 15. Additional Requirements. Treatment rooms which contain a therapeutic radiation machine capable of operating above 150 kV shall meet the following additional requirements: a. All protective barriers shall be fixed except for entrance doors or beam interceptors; b. The control panel shall be located outside the treatment room or in a totally enclosed booth, which has a ceiling, inside the room; c. Interlocks shall be provided such that all entrance doors, including doors to any interior booths, shall be closed before treatment can be initiated or continued. If the radiation beam is interrupted by any door opening, it shall not be possible to restore the machine to operation without closing the door and reinitiating irradiation by manual action at the control panel; and d. When any door referred to in 1.15.6(15)(c) is opened while the x-ray tube is activated, the air kerma rate at a distance of 1 meter from the source shall be reduced to less than 100 mrad (1 mGy) per hour. 16. Full Calibration Measurements. a. Full calibration of a therapeutic radiation machine subject to 1.15.6 shall be performed by, or under the direct supervision of, a Radiation Therapy Physicist: i. Before the first medical use following installation or reinstallation of the therapeutic radiation machine; ii. At intervals not exceeding 1 year; and iii. Before medical use under the following conditions: i. Whenever quality assurance check measurements indicate that the radiation output differs by more than 5 percent from the value obtained at the last full calibration and the difference cannot be easily discerned; and ii. Following any component replacement, major repair, or modification of components that could significantly affect the characteristics of the radiation beam. b. To satisfy the requirement of 1.15.6(16)(a), full calibration shall include all measurements recommended for annual calibration by NCRP Report 69,

"Dosimetry of X-Ray and Gamma Ray Beams for Radiation Therapy in the Energy Range 10 keV to 50 MeV" (1981). c. A registrant shall maintain a record of each calibration for the duration of the registration. The record shall include the date of the calibration, the manufacturer's name, model number, and serial number for both the therapeutic radiation machine and the x-ray tube, the model numbers and serial numbers of the instruments used to calibrate the therapeutic radiation machine, and the signature of the Radiation Therapy Physicist responsible for performing the calibration. 17. Periodic Quality Assurance Checks. a. Periodic quality assurance checks shall be performed on therapeutic radiation machines subject to 1.15.6, which are capable of operation at greater than 150 kV. b. To satisfy the requirement of 1.15.6(17)(a), quality assurance checks shall meet the following requirements: i. The registrant shall perform quality assurance checks in accordance with written procedures established by the Radiation Therapy Physicist; and ii. The quality assurance check procedures shall specify the frequency at which tests or measurements are to be performed. The quality assurance check procedures shall specify that the quality assurance check shall be performed during the calibration specified 1.15.6(16)(a). The acceptable tolerance for each parameter measured in the quality assurance check, when compared to the value for that parameter determined in the calibration specified in 1.15.6(16)(a) shall be stated. c. The cause for a parameter exceeding a tolerance set by the Radiation Therapy Physicist shall be investigated and corrected before the system is used for patient irradiation. d. Whenever a quality assurance check indicates a significant change in the operating characteristics of a system, as specified in the Radiation Therapy Physicist's quality assurance check procedures, the system shall be recalibrated as required in 1.15.6(16)(a). e. The registrant shall use the dosimetry system described in 1.15.4(3) to make the quality assurance check required in 1.15.6(17)(b). f. The registrant shall have the Radiation Therapy Physicist review and sign the results of each radiation output quality assurance check at intervals not to exceed 1 month. The Radiation Therapy Physicist shall promptly notify

the registrant in writing of the results of each radiation output quality assurance check. The registrant shall keep a copy of each written notification for 3 years. g. Therapeutic radiation machines subject to 1.15.6 shall have safety quality assurance checks of each external beam radiation therapy facility performed at intervals not to exceed 1 month. h. To satisfy the requirement of 1.15.6(17)(g), safety quality assurance checks shall ensure proper operation of: i. Electrical interlocks at each external beam radiation therapy room entrance; ii. Proper operation of the "BEAM-ON" and termination switches; iii. Beam condition indicator lights on the access door(s), control console, and in the radiation therapy room; iv. Viewing systems; and v. Electrically operated treatment room doors from inside and outside the treatment room. i. The registrant shall promptly repair any system identified in 1.15.6(17)(h) that is not operating properly. j. The registrant shall maintain a record of each quality assurance check required by 1.15.6(17)(a) and 1.15.6(17)(g) for 3 years. The record shall include the date of the quality assurance check, the manufacturer's name, model number, and serial number for the therapeutic radiation machine, the manufacturer's name, model number and serial number of the instrument(s) used to measure the radiation output of the therapeutic radiation machine, and the signature of the individual who performed the periodic quality assurance check. 18. Operating Procedures. a. The therapeutic radiation machine shall not be used for irradiation of patients unless the requirements of 1.15.6(16) and 1.15.6(17) have been met; b. Therapeutic radiation machines shall not be left unattended unless it is secured pursuant to 1.15.6(9)(e); c. When a patient must be held in position for radiation therapy, mechanical supporting or restraining devices shall be used;

d. The tube housing assembly shall not be held by an individual during operation unless the assembly is designed to require such holding and the peak tube potential of the system does not exceed 50 kV. In such cases, the holder shall wear protective gloves and apron of not less than 0.5 millimeters lead equivalency at 100 kV; e. A copy of the current operating and emergency procedures shall be maintained at the therapeutic radiation machine control console; and f. No individual other than the patient shall be in the treatment room during exposures from therapeutic radiation machines operating above 150 kV. At energies less than or equal to 150 kV, any individual, other than the patient, in the treatment room shall be protected by a barrier sufficient to meet the requirements of 1.4.6 of these regulations. 19. Possession of Survey Instrument(s). The registrant authorized to use a therapeutic radiation machine in accordance with 1.15.6 shall possess appropriately calibrated portable monitoring equipment. As a minimum, such equipment shall include a portable radiation measurement survey instrument capable of measuring dose rates over the range 1 mrem (10 Sv) per hour to 1000 mrem (10 mSv) per hour. The survey instrument(s) shall be operable and calibrated in accordance with 1.15.8.

**History**
- *Source: Miss. Code Ann. §45-14-11*

##### **15 Miss. Admin. Code Pt. 21, R. 1.15.7** Rule 1.15.7 {#sec-21-1.15.7 omnilex-key=us-ms-regs-official--title-15--21#1.15.7}

Therapeutic Radiation Machines - Photon Therapy Systems (500 kV and Above) and Electron Therapy Systems (500 keV and Above). 1. Possession of Survey Instrument(s). A registrant authorized to use a therapeutic radiation machine in accordance with 1.15.7 shall possess appropriately calibrated portable monitoring equipment. As a minimum, such equipment shall include a portable radiation measurement survey instrument capable of measuring dose rates over the range 1 mrem (10 Sv) per hour to 1000 mrem (10 mSv) per hour. The survey instrument(s) shall be operable and calibrated in accordance with 1.15.8. 2. Leakage Radiation Outside the Maximum Useful Beam in Photon and Electron Modes. a. The absorbed dose rate due to leakage radiation (excluding neutrons) at any point outside the maximum sized useful beam, but within a circular plane of radius 2 meters which is perpendicular to and centered on the central axis of the useful beam at the nominal treatment distance (i.e., patient plane), shall not exceed a maximum of 0.2 percent and an average of 0.1 percent of the absorbed dose rate on the central axis of the beam at the nominal treatment distance. Measurements shall be averaged over an area up to but not exceeding 100 square centimeters at the positions specified;

b. Except for the area defined in 1.15.7(2)(a), the absorbed dose rate in tissue (excluding that from neutrons) at I meter from the electron path between the source and the target or electron window shall not exceed 0.5 percent of the absorbed dose rate in tissue on the central axis of the beam at the nominal treatment distance. Measurements shall be averaged over an area up to but not exceeding 100 square centimeters at the positions specified; c. The neutron absorbed dose rate outside the useful beam shall be kept as low as practicable. Measurements of the portion of the leakage radiation dose contributed by neutrons shall be averaged over an area up to but not exceeding 800 square centimeters; and d. For each therapeutic radiation machine, the registrant shall determine, or obtain from the manufacturer, the leakage radiation existing at the positions specified in 1.15.7(2)(a) through 1.15.7(2)(c) for the specified operating conditions. Records on leakage radiation measurements shall be maintained at the installation for inspection by the Agency. 3. Leakage Radiation Through Beam-Limiting Devices. a. Photon Radiation. All adjustable or interchangeable beam-limiting devices shall attenuate the useful beam such that: i. At the nominal treatment distance, the maximum absorbed dose anywhere in the area shielded by the beam-limiting device(s) shall not exceed 2 percent of the maximum absorbed dose on the central axis of the useful beam measured in a 10 centimeters by 10 centimeters radiation field. ii. For fields of any size in which the maximum area shielded by the beam-limiting devices exceeds 500 square centimeters, the product of the average absorbed dose due to leakage radiation through the beam-limiting devices and the maximum area protectable by the beam-limiting devices shall not exceed one tenth (0.1) of the product of the maximum absorbed dose on the central axis of the useful beam and the area of the useful beam for a radiation field of 10 centimeters by 10 centimeters. All values of absorbed dose and area are referred to the nominal treatment distance. b. Electron Radiation. All adjustable or interchangeable electron applicators shall attenuate the radiation, including but not limited to photon radiation generated by electrons incident on the beam-limiting device and electron applicator and other parts of the radiation head, such that the following limits apply: i. The absorbed dose in a plane perpendicular to the central axis of the useful beam at the nominal treatment distance shall not exceed:

i. An average of 2 percent of the absorbed dose on the central axis of the useful beam at the nominal treatment distance. This limit shall apply in the area between a line 4 centimeters outside the periphery of the geometrical radiation field and the border of the maximum area protectable by the electron applicator; and ii. A maximum of 10 percent of the absorbed dose on the central axis of the useful beam at the nominal treatment distance. This limit shall apply in the area between a line 2 centimeters outside the periphery of the geometrical radiation field and the border of the maximum area protectable by the electron applicator. ii. For fields of any size in which the maximum area shielded by the electron applicator exceeds 1000 square centimeters, the product of the average absorbed dose due to leakage radiation through the electron applicators and the maximum area protectable by the electron applicators shall not exceed two tenths (0.2) of the product of the maximum absorbed dose on the central axis of the useful beam and the area of the useful beam for a radiation field of 10 centimeters by 10 centimeters. All values of absorbed dose and area are referred to the nominal treatment distance. c. Measurement of Leakage Radiation. i. Photon Radiation. Measurements of leakage radiation through the beam-limiting devices shall be made with the beam-limiting devices closed and any residual aperture blocked by at least two (2) tenth value layers of suitable absorbing material. In the case of overlapping beam-limiting devices, the leakage radiation through each set shall be measured independently, and the leakage radiation from each set shall not exceed a maximum of 2 percent anywhere in the area protectable by that beam-limiting device. ii. Electron Radiation. Measurements of leakage radiation through the electron applicators shall be made with the electron beam directed into the air and using a radiation detector of area up to but not exceeding 1 square centimeter suitably protected against radiation which has been scattered from material beyond the radiation detector. Measurements shall be made using 1 centimeter of tissue equivalent build up material. d. When adjustable beam-limiting devices are used, the position and shape of the radiation field shall be indicated by a light field.

4. Filters/Wedges. a. Each filter and/or wedge which is removable from the system shall be clearly marked with an identification number. For removable wedge filters, the nominal wedge angle shall appear on the wedge or wedge tray (if permanently mounted to the tray). If the wedge or wedge tray is damaged, the wedge transmission factor shall be redetermined; b. If the absorbed dose rate information required by 1.15.7(9) relates exclusively to operation with a field flattening or beam scattering filter in place, such filter shall be removable only by the use of tools; c. For equipment manufactured after the effective date of these regulations which utilize a system of wedge filters, interchangeable field flattening filters, or interchangeable beam scattering foils: i. Irradiation shall not be possible until a selection of a filter or a positive selection to use "no filter" has been made at the treatment control panel, either manually or automatically; ii. An interlock system shall be provided to prevent irradiation if the filter selected is not in the correct position; iii. A display shall be provided at the treatment control panel showing the wedge filter(s), interchangeable field flattening filter(s), and/or interchangeable beam scattering foil(s) in use; and iv. An interlock shall be provided to prevent irradiation if any filter and/or beam scattering foil selection operation carried out in the treatment room does not agree with the filter and/or beam scattering foil selection operation carried out at the treatment control panel. 5. X-Ray Stray Radiation in the Useful Electron Beam. For equipment manufactured after the effective date of these regulations, the registrant shall determine during acceptance testing, or obtain from the manufacturer, data sufficient to ensure that x-ray stray radiation in the useful electron beam, absorbed dose at the surface during x-ray irradiation and stray neutron radiation in the useful x-ray beam are in compliance with International Electrotechnical Commission (IEC) Document 601-2-1 (most current revision). 6. Beam Monitors. All therapeutic radiation machines subject to 1.15.7 shall be provided with beam monitoring devices. The sensors for this device shall be fixed in the useful beam during treatment, (or interlocked) to indicate the air kerma rate or dose rate. a. Equipment manufactured after the effective date of these regulations shall be provided with at least two independently powered integrating dose

meters. Alternatively, a common power supply may be used if the production of radiation is terminated upon failure of any common element. b. Equipment manufactured on or before the effective date of these regulations shall be provided with at least one radiation detector. This detector shall be incorporated into a primary beam monitoring system; c. The detector and the system into which that detector is incorporated shall meet the following requirements: i. Each detector shall be removable only with tools and, if movable, shall be interlocked to prevent incorrect positioning; ii. Each detector shall form part of a beam monitoring system from whose readings in dose monitor units the absorbed dose at a reference point in the treatment volume can be calculated; iii. Each beam monitoring system shall be capable of independently monitoring, interrupting, and terminating irradiation; and iv. For equipment manufactured after the effective date of these regulations, the design of the beam monitoring systems shall ensure that the: i. Malfunctioning of one system shall not affect the correct functioning of the secondary system; and ii. Failure of any element common to both systems which could affect the correct function of both systems shall terminate irradiation or prevent the initiation of radiation. v. Each beam monitoring system shall have a legible display at the treatment control panel. For equipment manufactured after the effective date of these regulations, each display shall: i. maintain a reading until intentionally reset; ii. have only one scale and no electrical or mechanical scale multiplying factors; iii. utilize a design such that increasing dose is displayed by increasing numbers; and iv. In the event of power failure, the beam monitoring information required in 1.15.7(6)(c)(v)(iii) displayed at the control panel at the time of failure shall be retrievable in at least one system for a 20 minute period of time.

7. Beam Symmetry. a. Bent-beam linear accelerators subject to 1.15.7 shall be provided with auxiliary device(s) to monitor beam symmetry; b. The device(s) referenced in 1.15.7(7)(a) shall be able to detect field asymmetry greater than 10 percent; and c. The device(s) referenced in 1.15.7(7)(a) shall be configured to terminate irradiation if the specifications in 1.15.7(7)(b) cannot be maintained. 8. Selection and Display of Dose Monitor Units. a. Irradiation shall not be possible until a selection of a number of dose monitor units has been made at the treatment control panel; b. The preselected number of dose monitor units shall be displayed at the treatment control panel until reset manually for the next irradiation; c. After termination of irradiation, it shall be necessary to reset the dosimeter display before subsequent treatment can be initiated; and d. For equipment manufactured after the effective date of these regulations, after termination of irradiation, it shall be necessary for the operator to reset the preselected dose monitor units before irradiation can be initiated. 9. Air Kerma Rate/Absorbed Dose Rate. For equipment manufactured after the effective date of these regulations, a system shall be provided whose readings the air kerma rate or absorbed dose rate at a reference point in the treatment volume can be calculated. [The radiation detectors specified in 1.15.7(6) may form part of this system.] In addition: a. The dose monitor unit dose rate shall be displayed at the treatment control panel; b. If the equipment can deliver under any conditions, an air kerma rate or absorbed dose rate at the nominal treatment distance more than twice the maximum value specified by the manufacturer, a device shall be provided which terminates irradiation when the air kerma rate or absorbed dose rate exceeds a value twice the specified maximum. The dose rate at which the irradiation will be terminated shall be a record maintained by the registrant; and c. For equipment manufactured after the effective date of these regulations, if the equipment can deliver under any conditions an air kerma rate or absorbed dose rate at the nominal treatment distance more than ten (10) times the maximum value specified by the manufacturer, a device shall be provided to prevent the air kerma rate or absorbed dose rate anywhere in the

radiation field from exceeding twice the specified maximum value and to terminate irradiation if the excess absorbed dose at the nominal treatment distance exceeds 400 rad (4 Gy). 10. Termination of Irradiation by the Beam Monitoring System or Systems During Stationary Beam Radiation Therapy. a. Each primary system shall terminate irradiation when the preselected number of dose monitor units has been detected by the system; b. If original design of the equipment included a secondary dose monitoring system, that system shall be capable of terminating irradiation when not more than 15 percent or 40 dose monitor units above the preselected number of dose monitor units set at the control panel has been detected by the secondary dose monitoring system; and c. For equipment manufactured after the effective date of these regulations, an indicator on the control panel shall show which monitoring system has terminated irradiation. 11. Termination Switches. It shall be possible to terminate irradiation and equipment movement or go from an interruption condition to termination condition at any time from the operator's position at the treatment control panel. 12. Interruption Switches. If a therapeutic radiation machine has an interrupt mode, it shall be possible to interrupt irradiation and equipment movements at any time from the treatment control panel. Following an interruption, it shall be possible to restart irradiation by operator action without any reselection of operating conditions. If any change is made of a preselected value during an interruption, irradiation and equipment movements shall be automatically terminated. 13. Timer. A suitable irradiation control device shall be provided to terminate the irradiation after a preset time interval. a. A timer shall be provided which has a display at the treatment control panel. The timer shall have a preset time selector and an elapsed time indicator; b. The timer shall be a cumulative timer which activates with an indication of "BEAM-ON" and retains its reading after irradiation is interrupted or terminated. After irradiation is terminated and before irradiation can be reinitiated, it shall be necessary to reset the elapsed time indicator; c. For equipment manufactured after the effective date of these regulations, after termination of irradiation and before irradiation can be reinitiated, it shall be necessary for the operator to reset the preset time selector; and d. The timer shall terminate irradiation when a preselected time has elapsed, if the dose monitoring systems have not previously terminated irradiation.

14. Selection of Radiation Type. Equipment capable of both x-ray therapy and electron therapy shall meet the following additional requirements: a. Irradiation shall not be possible until a selection of radiation type (x-rays or electrons) has been made at the treatment control panel; b. The radiation type selected shall be displayed at the treatment control panel before and during irradiation; c. An interlock system shall be provided to ensure that the equipment can principally emit only the radiation type which has been selected; d. An interlock system shall be provided to prevent irradiation with x-rays except to obtain a verification film, when electron applicators are fitted; e. An interlock system shall be provided to prevent irradiation with electrons when accessories specific for x-ray therapy are fitted; and f. An interlock system shall be provided to prevent irradiation if any selected operations carried out in the treatment room do not agree with the selected operations carried out at the treatment control panel. 15. Selection of Energy. Equipment capable of generating radiation beams of different energies shall meet the following requirements: a. Irradiation shall not be possible until a selection of energy has been made at the treatment control panel; b. The measured energy value selected shall be displayed (MV for photons and MeV for electrons) at the treatment control panel before and during irradiation; and c. Irradiation shall not be possible until the appropriate flattening filter or scattering foil for the selected energy is in its proper location. 16. Selection of Stationary Beam Radiation Therapy or Rotational Arc Radiation Therapy. Therapeutic radiation machines capable of both stationary beam radiation therapy and rotational arc radiation therapy shall meet the following requirement: a. Irradiation shall not be possible until a selection of stationary beam radiation therapy or rotational arc radiation therapy has been made at the treatment control panel; b. The mode of operation shall be displayed at the treatment control panel; c. An interlock system shall be provided to ensure that the equipment can operate only in the mode which has been selected;

d. An interlock system shall be provided to prevent irradiation if any selected parameter in the treatment room does not agree with the selected parameter at the treatment control panel; e. Rotational arc radiation therapy shall be controlled to obtain the selected relationships between incremental dose monitor units and incremental angle of movement: i. For equipment manufactured after the effective date of these regulations, an interlock system shall be provided to terminate irradiation if the number of dose monitor units delivered in any 15 degrees of arc differs by more than 20 percent from the selected value; ii. For equipment manufactured after the effective date of these regulations, where gantry angle terminates the irradiation in rotational arc radiation therapy, the dose monitor units shall differ by less than 5 percent from the value calculated from the absorbed dose per unit angle and total angle relationship; iii. For equipment manufactured after the effective date of these regulations, an interlock shall be provided to prevent the gantry moving more than 5 degrees beyond the selected angular limits during rotational arc radiation therapy; and iv. For equipment manufactured after the effective date of these regulations, an interlock shall be provided to require that a selection of direction be made at the treatment control panel in all units which are capable of both clockwise and counter-clockwise rotational arc radiation therapy. f. Where the beam monitor system terminates the irradiation in rotational arc radiation therapy, the termination of irradiation shall be as required by 1.15.7(10); and g. For equipment manufactured after the effective date of these regulations, an interlock system shall be provided to terminate irradiation if movement of the gantry: i. occurs during stationary beam radiation therapy; or ii. stops during rotational arc radiation therapy unless such stoppage is a preplanned function. 17. Facility Design Requirements for Therapeutic Radiation Machines Operating above 500 kV. In addition to shielding adequate to meet requirements of 1.15.9, the following design requirements are made:

a. Protective Barriers. All protective barriers shall be fixed, except for access doors to the treatment room or movable beam interceptors; b. Control Panel. In addition to other requirements specified in Subchapter 15, the control panel shall also: i. Be located outside the treatment room; ii. Provide an indication of whether electrical power is available at the control panel and if activation of the radiation is possible; iii. Provide an indication of whether radiation is being produced; and iv. Include an access control (locking) device which will prevent unauthorized use of the therapeutic radiation machine; c. Viewing Systems. Windows, mirrors, closed-circuit television or an equivalent viewing system shall be provided to permit continuous observation of the patient following positioning and during irradiation and shall be so located that the operator may observe the patient from the treatment control panel. The therapeutic radiation machine shall not be used for patient irradiation unless at least one viewing system is operational; d. Aural Communications. Provision shall be made for continuous two-way aural communication between the patient and the operator at the control panel. The therapeutic radiation machine shall not be used for irradiation of patients unless continuous two-way aural communication is possible; e. Room Entrances. Treatment room entrances shall be provided with warning lights in a readily observable position near the outside of all access doors, which will indicate when the useful beam is "ON" and when it is "OFF"; f. Entrance Interlocks. Interlocks shall be provided such that all entrance doors must be closed before treatment can be initiated or continued. If the radiation beam is interrupted by any door opening, it shall not be possible to restore the machine to operation without closing the door and reinitiating irradiation by manual action at the control panel; g. Beam Interceptor Interlocks. If the shielding material in any protective barrier requires the presence of a beam interceptor to ensure compliance with 1.4.14(1), and 1.4.14(2) of these regulations, interlocks shall be provided to prevent the production of radiation, unless the beam interceptor is in place, whenever the useful beam is directed at the designated barrier(s); h. Emergency Cutoff Switches. At least one (1) "scram button" or other emergency power cutoff switch shall be located in the radiation therapy room and shall terminate all equipment electrical power including radiation

and mechanical motion. This switch is in addition to the termination switch required by 1.15.7(11). All emergency power cutoff switches shall include a manual reset so that the therapeutic radiation machine cannot be restarted from the unit's control console without resetting the emergency cutoff switch; i. Safety Interlocks. All safety interlocks shall be designed so that any defect or component failure in the safety interlock system prevents or terminates operation of the therapeutic radiation machine; and j. Surveys for Residual Radiation. Surveys for residual activity, shall be conducted on all therapeutic radiation machines capable of generating photon and electron energies above 10 MV prior to machining, removing, or working on therapeutic radiation machine components which may have become activated due to photo-neutron production. 18. Radiation Therapy Physicist Support. a. The services of a Radiation Therapy Physicist shall be utilized in facilities having therapeutic radiation machines with energies of 500 kV and above. The Radiation Therapy Physicist shall be responsible for: i. Full calibration(s) required by 1.15.7(20) and protection surveys required by 1.15.4(1); ii. Supervision and review of dosimetry; iii. Beam data acquisition and storage for computerized dosimetry, and supervision of its use; iv. Quality assurance, including quality assurance check review required by 1.15.7(21)(e) of these regulations; v. Consultation with the authorized user in treatment planning, as needed; and vi. Perform calculations/assessments regarding misadministrations. b. If the Radiation Therapy Physicist is not a full-time employee of the registrant, the operating procedures required by 1.15.7(19) shall also specifically address how the Radiation Therapy Physicist is to be contacted for problems or emergencies, as well as the specific actions, if any, to be taken until the Radiation Therapy Physicist can be contacted. 19. Operating Procedures.

a. No individual other than the patient shall be in the treatment room during treatment of a patient or during any irradiation for testing or calibration purposes; b. Therapeutic radiation machines shall not be made available for medical use unless the requirements of 1.15.4(1), 1.15.7(20), and 1.15.7(21) have been met; c. Therapeutic radiation machines, when not in operation, shall be secured to prevent unauthorized use; d. If a patient must be held in position during treatment, mechanical supporting or restraining devices shall be used; and e. A copy of the current operating and emergency procedures shall be maintained at the therapeutic radiation machine control console. 20. Full Calibration Measurements. a. Full calibration of a therapeutic radiation machine subject to 1.15.7 shall be performed by, or under the direct supervision of, a Radiation Therapy Physicist: i. Before the first medical use following installation or reinstallation of the therapeutic radiation machine; ii. At intervals not exceeding 1 year; and iii. Before medical use under the following conditions: i. Whenever quality assurance check measurements indicate that the radiation output differs by more than 5 percent from the value obtained at the last full calibration and the difference cannot be easily discerned; and ii. Following any component replacement, major repair, or modification of components that could significantly affect the characteristics of the radiation beam. iv. Notwithstanding the requirements of 1.15.7(20)(a)(iii): i. Full calibration of therapeutic radiation machines with multi-energy and/or multi-mode capabilities is required only for those modes and/or energies that are not within their acceptable range; and ii. If the repair, replacement or modification does not affect all modes and/or energies, full calibration shall be performed on

the affected mode/energy that is in most frequent clinical use at the facility. The remaining energies/modes may be validated with quality assurance check procedures against the criteria in 1.15.7(20)(a)(iii)(i). b. To satisfy the requirement of 1.15.7(1)(a), full calibration shall include all measurements required for annual calibration by American Association of Physicists in Medicine (AAPM) Report 13, "Physical Aspects of Quality Assurance in Radiation Therapy"; c. The registrant shall use the dosimetry system described in 1.15.4(3) to measure the radiation output for one set of exposure conditions. The remaining radiation measurements required in 1.15.7(20)(b) may then be made using a dosimetry system that indicates relative dose rates; and d. The registrant shall maintain a record of each calibration for the duration of the registration. The record shall include the date of the calibration, the manufacturer's name, model number, and serial number for the therapeutic radiation machine, the model numbers and serial numbers of the instruments used to calibrate the therapeutic radiation machine, and the signature of the Radiation Therapy Physicist responsible for performing the calibration. 21. Periodic Quality Assurance Checks. a. Periodic quality assurance checks shall be performed on all therapeutic radiation machines subject to 1.15.7 at intervals not to exceed 1 week; b. To satisfy the requirement of 1.15.7(21)(a), quality assurance checks shall include determination of all parameters for periodic quality assurance checks contained in American Association of Physicists in Medicine (AAPM) Report 13, "Physical Aspects of Quality Assurance in Radiation Therapy"; c. The registrant shall use a dosimetry system which has been intercompared within the previous 6 months with the dosimetry system described in 1.15.4(3) to make the periodic quality assurance checks required in 1.15.7(21)(b); d. The registrant shall perform periodic quality assurance checks required by 1.15.7(21)(a) in accordance with procedures established by the Radiation Therapy Physicist; e. The registrant shall review the results of each periodic radiation output check according to the following procedures: i. The authorized user and Radiation Therapy Physicist shall be immediately notified if any parameter is not within its acceptable

range. The therapeutic radiation machine shall not be made available for subsequent medical use until the Radiation Therapy Physicist has determined that all parameters are within their acceptable range; ii. If all quality assurance check parameters appear to be within their acceptable range, the quality assurance check shall be reviewed and signed by either the authorized user or Radiation Therapy Physicist within 3 treatment days; and iii. The Radiation Therapy Physicist shall review and sign the results of each radiation output quality assurance check at intervals not to exceed 1 month; f. Therapeutic radiation machines subject to 1.15.7 shall have safety quality assurance checks of each radiation therapy facility performed at intervals not to exceed 1 week; g. To satisfy the requirement of 1.15.7(21)(f), safety quality assurance checks shall ensure proper operation of: i. Electrical interlocks at each external beam radiation therapy room entrance; ii. Proper operation of the "BEAM-ON", interrupt and termination switches; iii. Beam condition indicator lights on the access doors, control console, and in the radiation therapy room; iv. Viewing systems; v. Electrically operated treatment room door(s) from inside and outside the treatment room; and vi. At least one emergency power cutoff switch. If more than one emergency power cutoff switch is installed and not all switches are tested at once, each switch shall be tested on a rotating basis. Safety quality assurance checks of the emergency power cutoff switches may be conducted at the end of the treatment day in order to minimize possible stability problems with the therapeutic radiation machine. h. The registrant shall promptly repair any system identified in 1.15.7(21)(g) that is not operating properly; and i. A registrant shall maintain a record of each quality assurance check required by 1.15.7(21)(a) and 1.15.7(21)(g) for 3 years. The record shall include the

date of the quality assurance check, the manufacturer's name, model number, and serial number for the therapeutic radiation machine, the manufacturer's name, model number and serial number of the instrument(s) used to measure the radiation output of the therapeutic radiation machine, and the signature of the individual who performed the periodic quality assurance check.

**History**
- *Source: Miss. Code Ann. §45-14-11*

##### **15 Miss. Admin. Code Pt. 21, R. 1.15.8** Calibration and Check of Survey Instruments {#sec-21-1.15.8 omnilex-key=us-ms-regs-official--title-15--21#1.15.8}

1. A registrant shall ensure that the survey instruments used to show compliance with this Subchapter have been calibrated before first use, annually, and following repair. 2. To satisfy the requirements of 1.15.8(1), the registrant shall: a. Calibrate all required scale readings up to 1000 mrem (10 mSv) per hour with an appropriate radiation source; b. Calibrate at least two points on each scale to be calibrated. These points should be at approximately 1/3 and 2/3 of scale rating; and c. Conspicuously note on the instrument the apparent dose rate from a dedicated check source as determined at the time of calibration, and the date of calibration. 3. To satisfy the requirements of 1.15.8(2), the registrant shall: a. Consider a point as calibrated if the indicated dose rate differs from the calculated dose rate by not more than 10 percent; and b. Consider a point as calibrated if the indicated dose rate differs from the calculated dose rate by not more than 20 percent if a correction factor or graph is conspicuously attached to the instrument. 4. A registrant shall check each survey instrument for proper operation with the dedicated check source each day of use. The registrant is not required to keep records of these checks. 5. The registrant shall retain a record of each calibration required in 1.15.8(1) for 3 years. The record shall include: a. A description of the calibration procedure; and b. A description of the source used and the certified dose rates from the source, and the rates indicated by the instrument being calibrated, the correction

factors deduced from the calibration data, the signature of the individual who performed the calibration, and the date of calibration. 6. The registrant may obtain the services of individuals licensed by the Agency, the U.S. Nuclear Regulatory Commission, an Agreement State, or a Licensing State to perform calibrations of survey instruments. Records of calibrations which contain information required by 1.15.8(5) shall be maintained by the registrant.

**History**
- *Source: Miss. Code Ann. §45-14-11*

##### **15 Miss. Admin. Code Pt. 21, R. 1.15.9** Shielding and Safety Design Requirements {#sec-21-1.15.9 omnilex-key=us-ms-regs-official--title-15--21#1.15.9}

1. Each therapeutic radiation machine subject to 1.15.6 or 1.15.7 shall be provided with such primary and/or secondary barriers as are necessary to ensure compliance with 1.4.6 and 1.4.14 of these regulations. 2. Facility design information for all new installations of a therapeutic radiation machine or installations of a therapeutic radiation machine of higher energy into a room not previously approved for that energy shall be submitted for Agency approval prior to actual installation of the therapeutic radiation machine. The minimum facility design information that must be submitted is contained in Appendix A.

APPENDIX A INFORMATION ON RADIATION SHIELDING REQUIRED FOR PLAN REVIEWS I. ALL THERAPEUTIC RADIATION MACHINES A. Basic facility information including: name, telephone number and Agency registration number of the individual responsible for preparation of the shielding plan; name and telephone number of the facility supervisor; and the street address [including room number] of the external beam radiation therapy facility. The plan should also indicate whether this is a new structure or a modification to existing structure(s). B. All wall, floor, and ceiling areas struck by the useful beam shall have primary barriers. C. Secondary barriers shall be provided in all wall, floor, and ceiling areas not having primary barriers. II. THERAPEUTIC RADIATION MACHINES UP TO 150 kV (PHOTONS ONLY) In addition to the requirements listed in Section I. above, therapeutic radiation machine facilities which produce only photons with a maximum energy less than or equal to 150 kV shall submit shielding plans which contain, as a minimum, the following additional information: A. Equipment specifications, including the make, model and serial number of the therapeutic radiation machine, as well as the maximum technique factors. B. The maximum design workload for the facility, including the total anticipated number of exposures/films per day and/or week, as well as the type of treatment(s) or examination(s) which will be performed with the therapeutic radiation machine. C. A facility blueprint/drawing indicating: scale [0.25 inch = 1 foot is typical]; direction of North; normal location of the therapeutic radiation machine's radiation port(s); the port's travel and traverse limits; general direction(s) of the useful beam; locations of any windows and doors; and the location of the therapeutic radiation machine control panel. If the control panel is located inside the external beam radiation therapy treatment room, the location of the operator's booth shall be noted on the plan and the operator's station at the control panel shall be behind a protective barrier sufficient to ensure compliance with 400.06 of these regulations. D. The structural composition and thickness or lead/concrete equivalent of all walls, doors, partitions, floor, and ceiling of the room(s) concerned. E. The type of occupancy of all adjacent areas inclusive of space above and below the room(s) concerned. If there is an exterior wall, show distance to the closest area(s) where it is likely that individuals may be present.

F. At least one example calculation which shows the methodology used to determine the amount of shielding required for each physical condition [i.e., primary and secondary/leakage barriers, restricted and unrestricted areas, entry door(s) and shielding material in the facility.] (1) If commercial software is used to generate shielding requirements, identify the software used and the version/revision date. (2) If the software used to generate shielding requir. ements is not in the open literature, submit quality control sample calculations to verify the result obtained with the software. III. THERAPEUTIC RADIATION MACHINES OVER 150 kV In addition to the requirements listed in Section I. above, therapeutic radiation machine facilities which produce photons with a maximum energy in excess of 150 kV and/or electrons and/or protons or other subatomic particles shall submit shielding plans which contain, as a minimum, the following additional information: A. Equipment specifications including manufacturer, model number, and serial number of the therapeutic radiation machine, rad/gray or rem/sievert per minute at the isocenter and the energy(s) and type(s) of radiation produced [i.e., photon, electron]. The source to isocenter distance shall be specified. B. Maximum design workload for the facility including total weekly radiation output, [expressed in rad/gray or rem/sievert per minute at 1 meter], total beam-on time per day or week, the average treatment time per patient, along with the anticipated number of patients to be treated per day or week. C. Facility blueprint/drawing [including both floor plan and elevation views] indicating relative orientation of the therapeutic radiation machine, scale [0.25 inch = 1 foot is typical], type(s) and thickness of shielding material(s), direction of North, the locations and size of all penetrations through each shielding barrier [ceiling, walls and floor], as well as details of the door(s) and maze. D. The structural composition and thickness or concrete equivalent of all walls, doors, partitions, floor, and ceiling of the room(s) concerned E. The type of occupancy of all adjacent areas inclusive of space above and below the room(s) concerned. If there is an exterior wall, show distance to the closest area(s) where it is likely that individuals may be present. F. Description of all assumptions that were in shielding calculations including, but not limited to, design energy [i.e., room may be designed for 6 MV unit although only a 4 MV unit is currently proposed], workload, presence of integral beam-stop in unit, occupancy and use(s) of adjacent areas, fraction of time that primary beam will intercept each permanent barrier [walls, floor and ceiling] and "allowed" radiation exposure in both restricted and unrestricted areas.

G. At least one example calculation which shows the methodology used to determine the amount of shielding required for each physical condition [i.e., primary and secondary/leakage barriers, restricted and unrestricted areas, small angle scatter, entry door(s) and maze] and shielding material in the facility. (1) If commercial software is used to generate shielding requirements, identify the software used and the version/revision date. (2) If the software used to generate shielding requirements is not in the open literature, submit quality control sample calculations to verify the result obtained with the software. IV. NEUTRON SHIELDING In addition to the requirements listed in Section III above, therapeutic radiation machine facilities which are capable of operating above 10 MV shall submit shielding plans which contain, as a minimum, the following additional information: A. The structural composition, thickness and location of all neutron shielding material. B. Description of all assumptions that were used in neutron shielding calculations including, but not limited to, neutron spectra as a function of energy, neutron fluence rate, absorbed dose and dose equivalent (due to neutrons) in both restricted and unrestricted areas. C. At least one example calculation which shows the methodology used to determine the amount of neutron shielding required for each physical condition [i.e. restricted and unrestricted areas, entry door(s) and maze] and neutron shielding material utilized in the facility. (1) If commercial software is used to generate shielding requirements, identify the software used and the version/revision date. (2) If the software used to generate shielding requirements is not in the open literature, submit quality control sample calculations to verify the result obtained with the software. D. The method(s) and instrumentation which will be used to verify the adequacy of all neutron shielding installed in the facility. V. REFERENCES A. NCRP Report 49, "Structural Shielding Design and Evaluation for Medical Use of X-Rays and Gamma Rays of Energies Up to 10 MeV" (1976). B. NCRP Report 51, "Radiation Protection Design Guidelines for 0.1-100 MeV Particle Accelerator Facilities" (1977).

C. NCRP Report 79, "Neutron Contamination from Medical Electron Accelerators" (1984). Subchapter 16 Physical Protection of Category 1 and Category 2 Quantities of Radioactive Material

**History**
- *Source: Miss. Code Ann. §45-14-11*

##### **15 Miss. Admin. Code Pt. 21, R. 1.16.1** Purpose {#sec-21-1.16.1 omnilex-key=us-ms-regs-official--title-15--21#1.16.1}

This Regulation adopts by reference the current revision of the following sections in Title 10 Code of Federal Regulations Part 37: 37.1, 37.3, 37.5, 37.11, 37.21, 37.23, 37.25, 37.27, 37.29, 37.31, 37.33, 37.41, 37.43, 37.45, 37.47, 37.49, 37.51, 37.53, 37.55, 37.57, 37.71, 37.73, 37.75, 37.77, 37.79, 37.81, 37.101, 37.103, 37.105, with the following exceptions:

1. Not incorporated by reference is Title 10 Code of Federal Regulations 37.11(b).

2. Where the word "NRC" appears in Title 10 Code of Federal Regulations 37.31(d), 37.43(c)(3)(iii), 37.57(a), 37.57(c), 37.77 [with the exception of "the NRC's Web site" in 37.77(a)(1), and 37.81(g)], substitute the words " Division of Radiological Health, Mississippi State Department of Health".

3. Where the word "Commission" appears in Title 10 Code of Federal Regulations 37.5 (definitions of "byproduct material" and "person"), 37.11(a), 37.43(a)(3), 37.43(c)(1)(ii), 37.101, 37.103, and 37.105, substitute the words " Division of Radiological Health, Mississippi State Department of Health".

4. Where the words "NRC regional office" appear in Title 10 Code of Federal Regulations 37.41(a)(3) and 37.81, substitute the words " Director, Division of Radiological Health, Mississippi State Department of Health, 3150 Lawson Street, Jackson, Mississippi 39213".

5. Where the words "appropriate NRC regional office listed in § 30.6(a)(2) of this chapter" appear in Title 10 Code of Federal Regulations 37.45(b), substitute the words "Director, Division of Radiological Health, Mississippi State Department of Health, 3150 Lawson Street, Jackson, Mississippi 39213".

6. Where the words "NRC's Operational Center (301-816-5100)" appear in Title 10 Code of Federal Regulations 37.57(a), 37.57(b), and 37.81, substitute the words "Division of Radiological Health, Mississippi State Department of Health (601) 987-6893".

7. Where the words "NRC's Operational Center" appear in Title 10 Code of Federal Regulations 37.81, substitute the words "Division of Radiological Health, Mississippi State Department of Health (601) 987- 6893".

8. Where the words "NRC's Director, Division of Security Policy, Office of Nuclear Security and Incident Response, U.S. Nuclear Regulatory Commission, Washington, D.C. 20555-0001. The notification to the NRC may be made by email to RAMQC_SHIPMENTS@nrc.gov or by fax to 301-816-5151" appear in Title 10 Code of Federal Regulations 37.77(a)(1), substitute the words "Director, Division of Radiological Health, Mississippi State Department of Health, 3150 Lawson Street, Jackson, Mississippi 39213, (fax) 601-987-6887".

9. Where the words "NRC's Director of Nuclear Security, Office of Nuclear Security and Incident Response, U.S. Nuclear Regulatory Commission, Washington, D.C. 20555-0001" appear in Title 10 Code of Federal Regulations 37.77(c)(1), substitute the words "Director, Division of Radiological Health, Mississippi State Department of Health, 3150 Lawson Street, Jackson, Mississippi 39213".

10. Where the words "NRC's Director, Division of Security Policy, Office of Nuclear Security and Incident Response, U.S. Nuclear Regulatory Commission, Washington, D.C. 20555-0001" appear in Title 10 Code of Federal Regulations 37.77(c)(2) and 37.77(d), substitute the words “Director, Division of Radiological Health, Mississippi State Department of Health, 3150 Lawson Street, Jackson, Mississippi 39213".

11. Where the words "Director, Division of Security Policy, Office of Nuclear Security and Incident Response, U.S. Nuclear Regulatory Commission, Washington, D.C. 20555-0001" appear in Title 10 Code of Federal Regulations 37.81(g), substitute the words "Director, Division of Radiological Health, Mississippi State Department of Health, 3150 Lawson Street, Jackson, Mississippi 39213".

12. Requirements in Title 10 Code of Federal Regulations Part 37 that apply to "byproduct material" also apply to naturally occurring or accelerator- produced radioactive material.

13. "Act" includes Mississippi Radiation Protection Law of 1976.

**History**
- *SOURCE: Miss. Code Ann. §45-14-11*

##### **15 Miss. Admin. Code Pt. 21, R. 1.17.1** Purpose {#sec-21-1.17.1 omnilex-key=us-ms-regs-official--title-15--21#1.17.1}

This Regulation adopts by reference the current revision of the following sections in Title 10 Code of Federal Regulations Part 150: 10 Code of Federal Regulations 150.1, 150.2, 150.3, 150.11, 150.20, 150.31, and 150.32 are adopted by reference as they exist in its most current revision, with the following exceptions:

1. Not adopted by reference is Title 10 Code of Federal Regulations 150.3 definition of foreign obligations.

2. Requirements in Title 10 Code of Federal Regulations Part 150 that apply to "byproduct material" also apply to naturally occurring or accelerator- produced radioactive material.

3. Where the words "NRC", "commission", "nuclear regulatory commission", "regional administrator", "United States Nuclear Regulatory Commission", "region", or "regional administrator of the United States Nuclear Regulatory Commission regional office" appear in Title 10 Code of Federal Regulations Part 150, substitute the words "Mississippi State Department of Health" except when used in section 150.5.

4. "Act" includes Mississippi Radiation Protection Law of 1976.

5. Mississippi State Department of Health form number 1043, "Notice of Intent” radioactive material (and radiation source registration) reciprocity request, must be used instead of nuclear regulatory commission form 241 as specified in Title 10 Code of Federal Regulations Part 150.

6. Where the words "non-agreement states", "areas of exclusive federal jurisdiction within agreement states", or "offshore waters" are used in Title 10 Code of Federal Regulations 150.20(a)(1)(i), (ii), (iii), (b), (b)(3), and (b)(4) substitute the words "state of Mississippi”.

7. Where the words "agreement states license" are used in Title 10 Code of Federal Regulations 150.20 also add the words "nuclear regulatory commission license". Where the words "license issued by an agreement state" are used in Title 10 Code of Federal Regulations 150.20 also add the words "license issued by the nuclear regulatory commission". Where the words "license from an agreement state" are used in Title 10 Code of Federal Regulations 150.20 also add the words "license from the nuclear regulatory commission".

8. The words "for the first time in a calendar year" are stricken from Title 10 Code of Federal Regulations 150.20(b)(1).

9. For references to Title 10 Code of Federal Regulations Parts 170 and 171, see Mississippi State Department of Health Regulations for the Control of Radiation in Mississippi Rule 1.1.18 for applicable fee.

**History**
- *SOURCE: Miss. Code Ann. §45-14-11 Subchapter 18 Domestic Licensing of Source Materials*

##### **15 Miss. Admin. Code Pt. 21, R. 1.18.1** Purpose {#sec-21-1.18.1 omnilex-key=us-ms-regs-official--title-15--21#1.18.1}

This Regulation adopts by reference the current revision of the following sections in Title 10 Code of Federal Regulations Part 40: 40.1, 40.2, 40.3, 40.4 (with exception referenced in No. 1 below), 40.7, 40.9, 40.10, 40.11, 40.12, 40.13, 40.14, 40.20, 40.21, 40.22, 40.25, 40.26, 40.31, 40.32, 40.34, 40.35, 40.36, 40.41, 40.42, 40.43, 40.44, 40.45, 40.46, 40.51, 40.54, 40.55(a), (b),(c), (d), and (e), 40.60, 40,61, 40.62, 40.63, 40.65, and 40.71 and Appendix A to Part 40, with the following exceptions:

1. Not adopted by reference are Title 10 Code of Federal Regulations 40.4 Paragraph (2) Common defense and security, in the definition of “Commencement of Construction”, Paragraph 9(ii) Common defense and security, in the definition of “Construction”, the definition of “Foreign obligations”, and the definition of “Reconciliation”; 40.12(b); 40.13(c)(5)(iv); 40.31(j), (k), (l); and (m); and 40.32(d) and (g) and those portions of paragraph (e) which apply to uranium enrichment and uranium hexafluoride facilities, 40.41(d),(e)(1), (e)(3), (g) and (h); and 40.51(b)(6); and Appendix A, criterion 11A through F and criterion 12.

2. Requirements in Title 10 Code of Federal Regulations Part 40 that apply to "byproduct material" also apply to naturally occurring or accelerator- produced radioactive material.

3. Where the words "NRC", "commission", "nuclear regulatory commission", "United States Nuclear Regulatory Commission", "NRC regional administrator", or "administrator of the appropriate regional office" appear in Title 10 Code of Federal Regulations Part 40, substitute the words "Mississippi State Department of Health" except when used in Title 10 Code of Federal Regulations 40.11.

4. Title 10 Code of Federal Regulations Part 40 employee protection also applies to violations of Mississippi State Department of Health Regulations for the Control of Radiation Subchapter 10.

5. "Act" includes Mississippi Radiation Protection Law of 1976.

6. Mississippi State Department of Health form number 935, "Notice to Employees", must be posted instead of NRC form 3 that is specified in Title 10 Code of Federal Regulations Part 40.

7. Mississippi State Department of Health radioactive material license form number 843 must be used instead of NRC form 244 that is specified in Title 10 Code of Federal Regulations Part 40.

8. Mississippi State Department of Health form number 844 E "Application for Radioactive Material License" must be used instead of NRC form 313 as specified in Title 10 Code of Federal Regulations Part 40.

9. Mississippi State Department of Health form number 1061, "Certificate of Disposition of Radioactive Materials", must be used instead of NRC form 314 as specified in Title 10 Code of Federal Regulations Part 40.

10. For references to Title 10 Code of Federal Regulations Parts 170 and 171, see Mississippi State Department of Health Regulations for the Control of Radiation in Mississippi Rule 1.1.18 for applicable fee.

**History**
- *SOURCE: Miss. Code Ann. §45-14-11 Subchapter 19 Domestic Licensing of Special Nuclear Material*

##### **15 Miss. Admin. Code Pt. 21, R. 1.19.1** Purpose {#sec-21-1.19.1 omnilex-key=us-ms-regs-official--title-15--21#1.19.1}

This Regulation adopts by reference the current revision of the following sections in Title 10 Code of Federal Regulations Part 70: 70.1, 70.2, 70.3, 70.4 (with the exception referenced in No. 1 below), 70.7, 70.9, 70.10, 70.11, 70.12, 70.17, 70.18, 70.19, 70.20, 70.21, 70.22, 70.23, 70.25, 70.31, 70.32, 70.33, 70.34, 70.35, 70.36, 70.38, 70.39, 70.41, 70.42, 70.50, 70.51, 70.56, and 70.81, with the following exceptions:

1. The following are not adopted by reference: Title 10 Code of Federal Regulations 70.1(c), (d), and (e); 70.4 Paragraph (2) Common defense and security, in the definition of “Commencement of Construction”, and Paragraph 9(ii) Common defense and security, in the definition of “Construction”; 70.20a; 70.20b; 70.21(a)(1), (c), (f), (g), and (h); 70.22(b), (c), (f), (g), (h), (i), (j), (k), (l), (m), and (n); 70.23(a)(6), (a)(7), (a)(8), (a)(9), (a)(10), (a)(11), (a)(12), and (b); 70.23a; 70.25(a)(1); 70.31(c), (d), and (e); 70.32(a)(1), (a)(4), (a)(5), (a)(6), (a)(7), (b)(1), (b)(3), (b)(4), (c), (d), (e), (f), (g), (h), (i), (j), and (k); 70.42(b)(6); and 70.51(c).

2. Requirements in Title 10 Code of Federal Regulations Part 70 that apply to "byproduct material" also apply to naturally occurring or accelerator- produced radioactive material.

3. Where the words "NRC", "commission", "nuclear regulatory commission", "United States Nuclear Regulatory Commission", "NRC regional administrator", "NRC regional office", "administrator of the appropriate nuclear regulatory commission’s regional office", "administrator of the appropriate regional office", or "nuclear regulatory commission’s office of nuclear material safety and safeguards, division of

industrial and medical nuclear safety" appear in Title 10 Code of Federal Regulations Part 70, substitute the words "Mississippi State Department of Health".

4. Title 10 Code of Federal Regulations 70.7 employee protection also applies to violations of Mississippi State Department of Health Regulations for Control of Radiation in Mississippi Subchapter 10.

5. "Act" includes the Mississippi Radiation Protection Law of 1976.

6. Mississippi State Department of Health form number 844 E "Application for Radioactive Material License" (Other Uses), must be used instead of NRC form 313 as specified in Title 10 Code of Federal Regulations Part 70.

7. Mississippi State Department of Health form number 935, "notice to employees", must be posted instead of NRC form 3 that is specified in Title 10 Code of Federal Regulations Part 70.

8. For references to Title 10 Code of Federal Regulations Parts 170 and 171, see Mississippi State Department of Health Regulations for the Control of Radiation in Mississippi Rule 1.1.18 for applicable fee.

**History**
- *SOURCE: Miss. Code Ann. §45-14-11 Subchapter 20 General Domestic Licenses for Byproduct Material*

##### **15 Miss. Admin. Code Pt. 21, R. 1.20.1** Purpose {#sec-21-1.20.1 omnilex-key=us-ms-regs-official--title-15--21#1.20.1}

This Regulation adopts by reference the current revision of the following sections in Title 10 Code of Federal Regulations Part 31: 31.1, 31.2, 31.5, 31.6, 31.7, 31.8, 31.9, 31.10, 31.11, and 31.12, with the following exceptions:

1. Not adopted by reference is Title 10 Code of Federal Regulations 31.6(a).

2. Requirements in Title 10 Code of Federal Regulations Part 31 that apply to "byproduct material" also apply to naturally occurring or accelerator- produced radioactive material.

3. Where the words "NRC", "commission", "nuclear regulatory commission", "United States Nuclear Regulatory Commission", or "director of nuclear material safety and safeguards" appear in Title 10 Code of Federal Regulations Part 31, substitute the words "Mississippi State Department of Health" except when used in Title 10 Code of Federal Regulations 31.8(c)(2) and 31.11(d)(2).

4. Mississippi State Department of Health radioactive material license form number 1096 must be used instead of NRC form 483 that is specified in Title 10 Code of Federal Regulations Part 31.

5. References in Title 10 Code of Federal Regulations Part 31 to specific licenses issued by an agreement state also include specific licenses issued by the United States Nuclear Regulatory Commission.

**History**
- *SOURCE: Miss. Code Ann. §45-14-11 Subchapter 21 Specific Domestic Licenses to Manufacture or Transfer Certain Items Containing Byproduct Material*

##### **15 Miss. Admin. Code Pt. 21, R. 1.21.1** Purpose {#sec-21-1.21.1 omnilex-key=us-ms-regs-official--title-15--21#1.21.1}

This Regulation adopts by reference the current revision of the following sections in Title 10 Code of Federal Regulations Part 32: 32.1, 32.2, 32.3, 32.13, 32.24, 32.51, 32.51(a), 32.52, 32.53, 32.54, 32.55, 32.56, 32.57, 32.58, 32.59, 32.61, 32.62, 32.71, 32.72, 32.74, 32.201, 32.210, 32.211, and 32.301, with the following exceptions:

1. Not adopted by reference is Title 10 Code of Federal Regulations 32.1(c)(1).

2. Requirements in Title 10 Code of Federal Regulations Part 32 that apply to "byproduct material" also apply to naturally occurring or accelerator- produced radioactive material.

3. Where the words "NRC", "commission", "NRC regional office", or "director of nuclear material safety and safeguards" appear in Title 10 Code of Federal Regulations Part 32, substitute the words "Mississippi State Department of Health" except when used in 32.51(a)(3)(iii), 32.54(a), 32.58, 32.71(d), 32.72(b)(5), and 32.74(a)(3).

4. Mississippi State Department of Health form number 844 E "Application for Radioactive Material License" must be used instead of NRC form 313 as specified in Title 10 Code of Federal Regulations Part 32.

5. For references to Title 10 Code of Federal Regulations Parts 170 and 171, see Mississippi State Department of Health Regulations for the Control of Radiation in Mississippi Rule 1.1.18 for applicable fee.

**History**
- *SOURCE: Miss. Code Ann. §45-14-11 Subchapter 22 Specific Domestic Licenses of Broad Scope for Byproduct Material*

##### **15 Miss. Admin. Code Pt. 21, R. 1.22.1** Purpose {#sec-21-1.22.1 omnilex-key=us-ms-regs-official--title-15--21#1.22.1}

This Regulation adopts by reference the current revision of the following sections in Title 10 Code of Federal Regulations Part 33: 33.1, 33.11,

33.12, 33.13, 33.14, 33.15, 33.16, 33.17, and 33.100, with the following exceptions:

1. Requirements in Title 10 Code of Federal Regulations Part 33 that apply to "byproduct material" also apply to naturally occurring or accelerator- produced radioactive material.

2. Where the word "commission" appears in Title 10 Code of Federal Regulations Part 33, substitute the words "Mississippi State Department of Health".

3. "Act" includes the Mississippi Radiation Protection Law of 1976.

4. Mississippi State Department of Health form number 844 E "Application for Radioactive Material License", must be used instead of NRC form 313 as specified in Title 10 Code of Federal Regulations Part 33.

5. For references to Title 10 Code of Federal Regulations Parts 170 and 171, see Mississippi State Department of Health Regulations for the Control of Radiation in Mississippi Rule 1.1.18 for applicable fee.

Chapter 2 REGULATIONS FOR TANNING FACILITIES

**History**
- *SOURCE: Miss. Code Ann. §45-14-11*

##### **15 Miss. Admin. Code Pt. 21, R. 2.1.1** Purpose and Scope {#sec-21-2.1.1 omnilex-key=us-ms-regs-official--title-15--21#2.1.1}

1. This Chapter provides for the registration of tanning equipment and tanning facilities and regulation of the maintenance and operation of tanning facilities. 2. In addition to the requirements of this Chapter, all registrants are subject to the applicable provision of other Chapters of these regulations. 3. Nothing in this Chapter shall be interpreted as limiting the intentional exposure of patients to ultraviolet radiation for the purpose of treatment or use commensurate with the licensed practitioner's use of a healing art.

**History**
- *Source: Miss. Code Ann. §45-14-11*

##### **15 Miss. Admin. Code Pt. 21, R. 2.1.2** Definitions {#sec-21-2.1.2 omnilex-key=us-ms-regs-official--title-15--21#2.1.2}

The following terms are defined for purposes of this Chapter. 1. "Act" means the Mississippi Radiation Protection Law of 1976. 2. "Agency" means the Mississippi Department of Health. 3. "CFR" means Code of Federal Regulations. 4. "Consumer" means any member of the public who is provided access to a tanning facility in exchange for a fee or other compensation, or any individual who, in exchange for a fee or other compensation, is afforded use of a tanning facility as a condition or benefit of membership or access. 5. "FDA" means U.S. Food and Drug Administration. 6. "Healing arts" means the professional disciplines authorized by the laws of this state to use sources of radiation in the diagnosis or treatment of human or animal diseases. 7. "Individual" means any human being. 8. "Inspection" means an official examination or observation including but not limited to tests, surveys, and monitoring to determine compliance with rules, regulations, orders, requirements, and conditions of the Agency. 9. "Operator" means an individual designated by the Registrant to control operation of the tanning facility and to instruct and assist the consumer in the proper operation of the tanning equipment.

10. "Person" means any individual, corporation, partnership, firm, association, trust, estate, public or private institution, group, agency, political subdivision of this State, any other State or political subdivision or agency thereof, and any legal successor, representative, agent, or agency of the foregoing. 11. "Radiation" means ultraviolet radiation in these regulations. 12. "Radiation machine" means any device capable of producing radiation. 13. “Registrant" means any person who is registered with the Agency and is legally obligated to register with the Agency pursuant to these regulations and the Act. 14. “Registration" means registration with the Agency in accordance with regulations adopted by the Agency. 15. "Tanning equipment" means ultraviolet lamps and equipment containing ultraviolet lamps intended to induce skin tanning through the irradiation of any part of the living human body. 16. "Tanning facility" means any location, place, area, structure or business which provides consumers access to tanning equipment. 17. "These regulations" means all chapters of the Mississippi State Board of Health Environmental Regulations Division 800-Radiological Health, Subpart 78-Radiation, Chapter 2, Regulations For Tanning Facilities. 18. "Ultraviolet radiation" means electromagnetic radiation with wavelengths in air between two hundred (200) nanometers and four hundred (400) nanometers.

**History**
- *Source: Miss. Code Ann. §45-14-11*

##### **15 Miss. Admin. Code Pt. 21, R. 2.1.3** Exemptions {#sec-21-2.1.3 omnilex-key=us-ms-regs-official--title-15--21#2.1.3}

1. General: The Agency may, upon application therefore or upon its own initiative, grant such exemptions or exceptions from the requirements of these regulations as it determines are authorized by law and will not result in undue hazard to public health and safety. 2. Equipment intended for purposes other than the deliberate exposure of parts of the living body to ultraviolet radiation, and which produce or emit ultraviolet radiation incidental to its proper operation are exempt from the provisions of this Chapter. 3. Radiation machines while in transit or storage incidental thereto are exempt from the provisions of this Chapter.

**History**
- *Source: Miss. Code Ann. §45-14-11*

##### **15 Miss. Admin. Code Pt. 21, R. 2.1.4** Application for Registration of Tanning Facilities {#sec-21-2.1.4 omnilex-key=us-ms-regs-official--title-15--21#2.1.4}

1. Each person having a tanning facility shall apply for registration of such facility with the Agency within thirty (30) days following the effective date of these regulations or thereafter prior to the operation of a tanning facility. Application for registration shall be completed on forms furnished by the Agency and shall contain all the information required by the form and the accompanying instructions. 2. The Agency shall require at least the following information on the Application for Registration of Tanning Facilities form: a. Name, address and telephone number of the following: i. the tanning facility; ii. the owner(s) of the tanning facility. b. The manufacturer, model number, and type of each ultraviolet lamp or tanning equipment located within the facility. c. The geographic areas within the State to be covered, if the facility is mobile. d. Name of the tanning equipment supplier, installer, and service agent. e. A signed and dated certification that the applicant has read and understands the requirements of these regulations. f. A copy of operating and safety procedures unique to facility operation. 3. Each applicant shall provide such additional information as the Agency may reasonably require.

**History**
- *Source: Miss. Code Ann. §45-14-11*

##### **15 Miss. Admin. Code Pt. 21, R. 2.1.5** Issuance of Certificate of Registration {#sec-21-2.1.5 omnilex-key=us-ms-regs-official--title-15--21#2.1.5}

1. Upon determination that an applicant meets the requirements of these regulations, the Agency shall issue a certificate of registration. 2. The Agency may incorporate in the certificate of registration at the time of issuance or thereafter by appropriate rule, regulation or order, such additional requirements and conditions with respect to the registrant's receipt, possession, use, and transfer of tanning equipment and tanning facilities as it deems appropriate or necessary. 3. No person shall operate a tanning facility until the Agency has issued the certificate of registration.

**History**
- *Source: Miss. Code Ann. §45-14-11*

##### **15 Miss. Admin. Code Pt. 21, R. 2.1.6** Expiration of Certificate of Registration {#sec-21-2.1.6 omnilex-key=us-ms-regs-official--title-15--21#2.1.6}

Except as provided in 2.1.7 (2), each certificate of registration shall expire at the end of the specified day in the month and year stated therein.

**History**
- *Source: Miss. Code Ann. §45-14-11*

##### **15 Miss. Admin. Code Pt. 21, R. 2.1.7** Renewal of Certificate of Registration {#sec-21-2.1.7 omnilex-key=us-ms-regs-official--title-15--21#2.1.7}

1. Application for renewal of registration shall be filed in accordance with 2.1.4. 2. In any case in which a registrant, not less than 30 days prior to the expiration of his existing certificate of registration, has filed an application in proper form for renewal, such existing certificate of registration shall not expire until the application status has been finally determined by the Agency.

**History**
- *Source: Miss. Code Ann. §45-14-11*

##### **15 Miss. Admin. Code Pt. 21, R. 2.1.8** Report of Changes {#sec-21-2.1.8 omnilex-key=us-ms-regs-official--title-15--21#2.1.8}

The registrant shall notify the Agency in writing before making any change which would render the information reported pursuant to 2.1.4 (2) (a), (b), (c) and (g), contained in the application for registration and/or the certificate of registration, no longer accurate. This requirement shall not apply to changes involving replacement of designated original equipment lamp types with lamps which have been certified with the FDA as "equivalent (lamps under the FDA regulations and policies applicable at the time of replacement of the lamps. The facility owner shall maintain manufacturer's literature demonstrating the equivalency of any replacement lamps.

**History**
- *Source: Miss. Code Ann. §45-14-11*

##### **15 Miss. Admin. Code Pt. 21, R. 2.1.9** Transfer of Certificate of Registration {#sec-21-2.1.9 omnilex-key=us-ms-regs-official--title-15--21#2.1.9}

No certificate of registration shall be transferable from one person to another or from one tanning facility to another.

**History**
- *Source: Miss. Code Ann. §45-14-11*

##### **15 Miss. Admin. Code Pt. 21, R. 2.1.10** Approval Not Implied {#sec-21-2.1.10 omnilex-key=us-ms-regs-official--title-15--21#2.1.10}

No person, in any advertisement, shall refer to the fact that he or his facility is registered with the Agency pursuant to the provisions of 2.1.4, and no person shall state or imply that any activity under such registration has been approved by the Agency.

**History**
- *Source: Miss. Code Ann. §45-14-11*

##### **15 Miss. Admin. Code Pt. 21, R. 2.1.11** Denial, Suspension, or Revocation of Certificate of Registration {#sec-21-2.1.11 omnilex-key=us-ms-regs-official--title-15--21#2.1.11}

The Agency may, for good cause shown, deny, suspend or revoke a certificate of registration sought or issued pursuant to these regulations for any of the following reasons: 1. Failure of reports, plans or specifications to show that the tanning facility will be constructed, operated or maintained in accordance with the requirements of these regulations;

2. Submission of incorrect, false or misleading information in the application, reports, plans, or specifications; 3. Failure to construct, operate or maintain the tanning facility in accordance with the application, plans and specifications approved by the Agency except as such maintenance may involve the replacement of lamps by "equivalent" lamps which have been defined in 2.1. 8; 4. Operation of the tanning facility in a way that causes or created a nuisance or hazard to the public health or safety; 5. Violation of any rules, regulations, standards, or requirements adopted by the Agency; 6. Violation of any condition upon which the certificate of registration was issued; 7. Failure to allow duly authorized agents of the Agency to conduct inspections at reasonable hours and in a reasonable manner; 8. Failure to pay any registration or inspection fees. 9. Failure of the tanning equipment to comply with the Federal Performance Standard for Sunlamp Products and Ultraviolet Lamps intended for use in Sunlamp Products 21 CFR 1040.20. Rule 2.1.12 Hearing: If any certificate of registration is denied, suspended, or revoked, the applicant or registrant may request a hearing in accordance with Chapter 45-14-21, Mississippi Code of 1972, Annotated.

**History**
- *Source: Miss. Code Ann. §45-14-11*

##### **15 Miss. Admin. Code Pt. 21, R. 2.1.13** Construction and Operation of Tanning Facilities {#sec-21-2.1.13 omnilex-key=us-ms-regs-official--title-15--21#2.1.13}

Unless otherwise ordered or approved by the Agency, each tanning facility shall be constructed, operated, and maintained to meet the following minimum requirements: 1. Physical facilities a. The following warning sign shall be posted in the immediate proximity (within 1 meter) of each piece of tanning equipment and it shall be readily legible, clearly visible, and not obstructed by any barrier, equipment, or other item present so that the user can easily view the warning sign before energizing the ultraviolet light generating equipment: DANGER - ULTRAVIOLET RADIATION b. Follow instructions.

c. Avoid overexposure. As with natural sunlight, overexposure can cause eye and skin injury and allergic reactions. Repeated exposure may cause premature aging of the skin and skin cancer. d. Wear protective eyewear. e. FAILURE TO USE PROTECTIVE EYEWEAR MAY RESULT IN SEVERE BURNS OR LONG-TERM INJURY TO THE EYES. f. Medications or cosmetics may increase your sensitivity to the ultraviolet radiation. Consult a physician before using sunlamp if you are using medications or have a history of skin problems or believe yourself especially sensitive to sunlight. g. If you do not tan in the sun, you are unlikely to tan from the use of this product. h. The lettering on each warning sign shall be at least ten (10) millimeters high for all words showing in capital letters and at least five (5) millimeters high for all lowercase letters. i. Only tanning equipment manufactured and certified to comply with 21 CFR Part 1040, Chapter j. 1040.20, "Sunlamp products and ultraviolet lamps intended for use in sunlamp products", shall be used in tanning facilities. Compliance shall be based on the standard in effect at the time of manufacture as shown on the device identification label required by 21 CFR Part 1010, Chapter 1010.3. k. Each tanning equipment shall have a timer which complies with the requirements of 21 CFR Part 1040, Chapter 1040.20(c) (2). The maximum timer interval shall not exceed the manufacturer's maximum recommended exposure time. No timer interval shall have an error greater than ± 10% of the maximum timer interval for the product. l. Tanning equipment shall meet the National Fire Protection Association's National Electrical Code. m. There shall be physical barriers to protect consumers from injury induced by touching or breaking the lamps. n. Additional requirements for stand-up booths: i. there shall be physical barriers or other means such as handrails or floor markings to indicate the proper exposure distance between ultraviolet lamps and the consumer's skin.

ii. the construction of the booth shall be such that it will withstand the stress of use and the impact of a falling person. iii. access to the booth shall be of rigid construction. Doors shall open outwardly. Handrails and nonslip floors shall be provided. o. Tanning equipment electrical circuit shall be approved by the Underwriter Laboratories (UL) or Electrical Testing Laboratories (ETL). 2. Protective goggles a. Each consumer shall be provided with protective goggles and instructions for the use. b. Protective goggles shall meet the requirements of 21 CFR Part 1040, Section 1040.20 (c) (5). c. Protective goggles shall be properly sanitized before each use. Exposure to the ultraviolet radiation produced by the tanning equipment itself is not considered a sanitizing agent. d. Each consumer shall wear the protective goggles as instructed. 3. Operation a. An operator must be present when tanning equipment is operated. b. Prior to initial exposure each consumer shall be provided the opportunity to read a copy of the warning specified in 2.1.12 (1) (a). The operator shall then request that the consumer sign a statement that the information has been read and understood. For illiterate or visually handicapped persons, the warning statement shall be read by the operator in the presence of a witness. Both the witness and the operator shall sign the statement. c. A record shall be kept by the facility operator of each consumer's total number of tanning visits and tanning times. d. A written report of any tanning injury shall be forwarded to the Agency within five [5] working days of the occurrence or knowledge thereof. The report shall include: i. the name of the affected individual; ii. the name and location of the tanning facility involved; iii. the nature of the injury; and iv. name and address of health care provider, if any;

v. any other information considered relevant to the situation. e. No consumer under sixteen years of age shall be allowed to use the tanning facility unless he or she provides a consent form signed by the parent or legal guardian. The parent or guardian shall have been provided with the basic information required under 2.1.12. f. Defective or burned-out lamps or filters shall be replaced with a type intended for use in that device as specified on the product label on the tanning equipment, or, with lamps or filters that are "equivalent" under the FDA regulations and policies applicable at the time of lamp manufacture. g. Each operator must be adequately trained. Proof of training must be maintained in the facility and available for inspection. Training shall include: i. the requirements of these regulations; ii. procedures for correct operation of the facility; iii. recognition of injury or overexposure; iv. manufacturer's procedures for operation and maintenance of tanning equipment; v. emergency procedures in case of injury. vi. A list of operators trained in accordance with 2.1.12 (3) (g) shall be maintained and available at the facility.

**History**
- *Source: Miss. Code Ann. §45-14-11*

##### **15 Miss. Admin. Code Pt. 21, R. 2.1.14** Enforcement and Penalties {#sec-21-2.1.14 omnilex-key=us-ms-regs-official--title-15--21#2.1.14}

An injunction or other court order may be obtained prohibiting any violation of any provision of the Act or any regulation or order issued there under. Any person who willfully violates any provisions of the Act, or any regulation, or order issued there under, may be guilty of a misdemeanor and, upon conviction, may be punished by fine or imprisonment or both, as provided by Section 45-14-37 of the Act.

**History**
- *Source: Miss. Code Ann. §45-14-11*

##### **15 Miss. Admin. Code Pt. 21, R. 2.1.15** Communications {#sec-21-2.1.15 omnilex-key=us-ms-regs-official--title-15--21#2.1.15}

All communications and reports concerning these regulations, and applications filed there under, should be addressed to the Division of Radiological Health at its office located at 3150 Lawson Street, P. 0. Box 1700, Jackson, Mississippi, 39215-1700.

**History**
- *Source: Miss. Code Ann. §45-14-11*

### **Part 22** Part 22: Medical Cannabis Program

##### **15 Miss. Admin. Code Pt. 22, R. 17043** Rule 17043 {#sec-22-17043 omnilex-key=us-ms-regs-official--title-15--22#17043}

accreditation, where the concentration and identity of an analyte is known to the independent party but is unknown to the testing laboratory and testing laboratory employees. 1.2.114 Program – The term “program” means the Mississippi Medical Cannabis Program. 1.2.115 Provisional License – The term “provisional license” means a license issued by the Mississippi State Department of Health when a temporary condition of non- compliance with the regulations contained in this Part exists. A provisional license shall be issued only if the Mississippi State Department of Health is satisfied that preparations are being made to qualify for a regular license and that the health and safety of patients and the public will not be endangered. Business activities and operations can be limited by the Department for this licensure category. 1.2.116 Public Place – The term “public place” means a church or any area to which the general public is invited or in which the general public is permitted, regardless of the ownership of the area, and any area owned or controlled by a municipality, county, state or federal government, including, but not limited to, streets, sidewalks or other forms of public transportation. Such term shall not mean a private residential dwelling. 1.2.117 Raw Pre-Roll – The term “raw pre-roll” means a medical cannabis product that is produced by rolling, filling, or stuffing harvested cannabis flower, shake, and/or trim into paper, leaves or an equivalent wrapper and is intended for consumption by inhalation. 1.2.118 Registry Identification Card – The term “registry identification card” means a document issued by the Department that identifies a person as a registered qualifying patient, nonresident registered qualifying patient or registered designated caregiver. 1.2.119 Regular License – The term “regular license” means a license issued by the Mississippi State Department of Health when there is evidence of compliance with all applicable rules and regulations in this Part and components of the Mississippi Medical Cannabis Act. 1.2.120 Research and Development Testing – The term “research and development (R&D) testing” means optional testing performed before final compliance testing. 1.2.121 Residency – The term “residency” means a person’s dwelling where a person typically stays or stays more often than other locations. Residency may be determined by the Department with submission of two (2) of the following: Mississippi Tax Return Form 80-105; ownership, lease or rental documents for

primary residence; utility bills (electric, water, gas bills) for primary residence; and/or vehicle registration. 1.2.122 Revocation – The term “revocation” means the Department's final decision to revoke a license in accordance with Mississippi law. 1.2.123 Restricted Area – The term “restricted area” means a building, room or other contiguous area upon the permitted premises where cannabis is grown, cultivated, harvested, stored, weighed, packaged, processed for sale or sold (to other medical cannabis establishments, not directly to an individual), under control of the licensed cannabis cultivator. 1.2.124 Sanitize – The term “sanitize” means to adequately treat cleaned equipment, containers, utensils, or any other cleaned contact surface by a process that is effective in destroying vegetative cells of pathogens, and in substantially reducing numbers of other microorganisms, but without adversely affecting the product or its safety for the end-user/consumer. 1.2.125 School – The term “school” means an institution for the teaching of children, consisting of a physical location, whether owned or leased, including instructional staff members and students, and which is in session each school year. This definition shall include, but not be limited to, public, private, church and parochial programs for kindergarten, elementary, junior high and high schools. Such term shall not mean a home instruction program. 1.2.126 Scope of Practice – The term “scope of practice” means the defined parameters of various duties, services or activities that may be provided or performed by a certified nurse practitioner as authorized under Miss. Code. §§ 73-15-5 and 73- 15-20, by an optometrist as authorized under § 73-19-1, by a physician as authorized under § 73-25-33, or by a physician assistant under § 73-26-5, and rules and regulations adopted by the respective licensing boards for those practitioners. 1.2.127 Secure – The term “secure” means protected from danger or risk. 1.2.128 Seedling – The term “seedling” means a cannabis plant that has no flowers. 1.2.129 Seed-to-Sale System – The term “seed-to-sale system” means the specialized inventory management system utilized throughout the medical cannabis program that allows for the tracking of cannabis from early life cycle until final sale to a qualified patient or caregiver or disposal/destruction by a cannabis disposal entity. 1.2.130 THC – The terms “THC” or “Tetrahydrocannabinol” mean any and all forms of tetrahydrocannabinol that are contained naturally in the cannabis plant, as well as synthesized forms of THC and derived variations, derivatives, isomers and allotropes that have similar molecular and physiological characteristics of

tetrahydrocannabinol, including, but not limited to, THCA, THC Delta 5, THC Delta 8, THC Delta 10 and THC Delta 6. 1.2.131 Tincture – The term “tincture” means a liquid edible cannabis product with a concentration of greater than 1 mg of THC per ounce of liquid. 1.2.132

Topical Cannabis Product – The term “topical cannabis product” means a THC- infused product intended for external application to human body surfaces and/or absorption through the skin, does not cross the blood-brain barrier and is not intended for consumption by oral ingestion. 1.2.133 Total CBD – The term “Total CBD” means the sum of CBD and CBDA. Total CBD is calculated using the following equation: Total CBD = CBD + (CBDA*0.877). 1.2.134 Total THC – The term “Total THC” means the sum of THC and THCA. Total THC is calculated using the following equation: Total THC = delta-9 THC + (THCA*0.877). 1.2.135 Total Yeast and Mold Count (TYMC) – The term “Total Yeast and Mold Count (TYMC)” means the total combined yeast and mold count in standardized planting methodologies and is usually expressed in number of colony-forming units (CFU). 1.2.136 Unique Identification Number – The term “unique identification number” means a unique number generated by the seed-to-sale system and assigned to all usable medical cannabis for the purpose of tracking cannabis from early life cycle until final sale to a qualified patient or caregiver or disposal/destruction by a cannabis disposal entity. 1.2.137 Unusable and Unrecognizable – The term “unusable and unrecognizable” means that anything containing THC shall be destroyed to prevent THC-containing material(s) from being accessed or consumed. 1.2.138 Usable Medical Cannabis – The term “usable medical cannabis” means any medical cannabis product that has completed all required growing/processing steps, is in the final form intended for sale or distribution and intended for use or consumption by qualifying patients as defined in the Mississippi Medical Cannabis Act. The term “retail-ready medical cannabis” may also be used. 1.2.139 Validation – The term “validation” means the confirmation by examination and objective evidence that the requirements for a specific intended use or analytical method are fulfilled. 1.2.140 Variance – The term “variance” means a Department granted exception to the rules contained in this Part.

1.2.141 Water Activity – The term “water activity” means the measure of the quantity of water in a product that is available and therefore capable of supporting bacteria, yeasts, and fungi and which is reported in units a w . 1.2.142 Work Permit – The term “work permit” means the official document issued by the Department that authorizes a person to function as a Medical Cannabis Establishment. 1.2.143 Written Certification – The term “written certification” means a form approved by the Department, signed and dated by a practitioner, certifying that a person has a debilitating medical condition. This written certification may also be referred to as a “practitioner certification”. 1.3 Severability. The provisions of this Part are severable. If a court of competent jurisdiction declares any section, subsection, paragraph, or provision unconstitutional or invalid, the validity of the remaining provisions shall not be affected.

Subpart 2 PRACTITIONERS, CERTIFICATION, REGISTRATION CARDS & CAREGIVERS 2.1 Types of Medical Cannabis Registries and Associated Fees. 2.1.1 The following types of medical cannabis registry identification cards (may also be referred to as patient cards) will be issued, in a form and manner set by the Department, upon satisfaction of all application criteria: 1. Registered Qualifying Patient Identification Card; 2. Nonresident Qualifying Patient Identification Card (i.e., temporary patient card or nonresident cardholder); and, 3. Registered Designated Caregiver Identification Card. 4. Practitioner Registration.

2.1.2 At a minimum, identification cards issued by the Department will identify: A. Type of card; B. Valid dates of the card; C. Legal name of the cardholder; D. Date of birth of the cardholder;

E. Photograph (headshot) of the cardholder; F. Unique identification number; G. MMCEU allotment and limitations; and, H. How the card may be verified.

2.1.3 The initial fees for Registered Qualifying Patient Identification Card are as follows: 1. The standard nonrefundable fee is $25.00. 2. The nonrefundable fee for a 100% disabled veteran or disabled first responder is waived. A disabled veteran or disabled first responder may prove their disability by providing written documentation to the Department from the Social Security Disability Office or documentation that attests the applicant is a 100% disabled veteran as determined by the U.S. Department of Veteran Affairs. 3. The nonrefundable fee for a Mississippi Medicaid participant shall be $15.00. Medicaid status will be verified at the time of application. 4. All fees are nonrefundable. Fees shall be paid in the manner set forth by the Department at the time of application.

2.1.4 The renewal fees for Registered Qualifying Patient Identification Cards are as follows: A. The standard nonrefundable fee is $25.00. B. The nonrefundable fee for a 100% disabled veteran or disabled first responder is waived. A disabled veteran or disabled first responder may prove their disability by providing written documentation to the Department from the Social Security Disability Office or documentation that attests the applicant is a 100% disabled veteran as determined by the U.S. Department of Veteran Affairs. C. The nonrefundable fee for a Mississippi Medicaid participant shall be $15.00. Medicaid status will be verified at the time of renewal. D. All renewal fees are nonrefundable. Fees shall be paid in the manner set forth by the Department at the time of renewal.

2.1.5 The initial fees for a Designated Caregiver Registry Identification Card are as follows: A. The standard nonrefundable fee is $25.00. B. The designated caregiver criminal background check nonrefundable fee is $37.00 to be paid to the Department for conducting the required background checks. C. All fees are nonrefundable. Fees shall be paid in the manner set forth by the Department at the time of application.

2.1.6 The renewal fees for a Designated Caregiver Registry Identification Card are as follows: A. The standard nonrefundable fee is $25.00. B. The designated caregiver criminal background check nonrefundable fee is $37.00. C. All fees are nonrefundable. Fees shall be paid in the manner set forth by the Department at the time of application.

2.1.7 Both initial and renewal fees for all medical cannabis identification cards may be waived by the Department in the event of extenuating circumstances approved by the Department.

2.2 Registered Qualifying Patient Identification Cards. 2.2.1 Registered Qualifying Patient Identification Cards will only be issued by the Department when all application and practitioner certification criteria are met. Upon issuance of the identification card, the applicant is recognized as a qualified patient, or cardholder, of the medical cannabis program.

2.2.2 Registered Qualifying Patient Identification Cards issued by the Department are valid for one (1) year from the date of issuance unless a lesser timeframe is otherwise imposed through the written certification or circumstances determined by the Department.

2.2.3 Utilizing the same process outlined in Rule 2.3.1, Qualified Patients may apply for renewal of their identification card no later than one (1) year from the date of issuance or last renewal of the identification card. For purposes of renewal, a registered practitioner may conduct a registered cardholder’s recertification assessment via telehealth if he/she previously evaluated the registered cardholder in person.

2.2.4 When there is a change in the cardholder’s name, address, designated caregiver, or if the registered qualifying patient ceases to have his or her diagnosed debilitating medical condition (as determined by the practitioner issuing the patient’s written certification) that qualified him/her for the medical cannabis program, the patient is responsible for notifying the Department within twenty (20) calendar days of the change. If the patient is unable to make these notifications, the patient’s registered designated caregiver with the program or legal representative shall make these notifications to the Department on behalf of the patient in the same required timeframes as stated above in this Rule.

2.2.5 Reporting of changes required in Rule 2.2.4 shall be done in a format required by the Department.

2.2.6 Registered Qualifying Patient Identification Cards may be denied or revoked for the following: 1. The cardholder provided false or incomplete information to the Department during application or renewal; 2. The cardholder uses his/her card to obtain medical cannabis or medical cannabis products for another individual; and/or, 3. The certifying practitioner has terminated the written certification.

2.2.7 In addition to Rule 2.2.6, if the cardholder is under the age of eighteen (18), the Registered Qualifying Patient Identification Card may be denied or revoked if the custodial parent or legal guardian with responsibility for health care decisions doesn’t provide written consent to the patient’s use of medical cannabis, agree to serve as the patient’s designated caregiver; and control the acquisition, dosage and frequency of use of the patient’s medical cannabis.

2.3 Application to Participate in the Medical Cannabis Program as a Registered Qualifying Patient. 2.3.1 To obtain a Registered Qualifying Patient Identification Card, an applicant shall submit (in a form and manner determined by the Department) the following information: A. Full legal name and any aliases, such as a nickname (e.g., Bill as a nickname for William); B. Date of birth; C. Current physical address; D. Current mailing address; E. Current telephone number and/or email address; F. Identification issued by the State of MS – (driver’s license or ID card issued by the Mississippi Department of Motor Vehicles); G. Current photograph, meeting the following requirements: 1. clear, color photograph of the head and top of shoulders (headshot); 2. in a .jpg, .png, or .gif digital image format; 3. taken in the last six months to reflect the applicant’s appearance; 4. taken in front of a plain white or off-white background; 5. taken in full-face view directly facing the camera at eye level with nothing obscuring the face; 6. shall not be digitally enhanced to change the appearance of the applicant (e.g., use of “filters”); H. Written certification (as set forth by the Department); I. Identification card nonrefundable fee (see Rules 2.1.3 and 2.1.4); J. An attestation, signed and dated by the applicant, that the information provided is true and correct; K. An attestation, signed and dated by the applicant, pledging not to divert medical cannabis or medical cannabis products to any individual or entity; and, L. Any other information that may be required by the Department.

2.3.2 To obtain a Qualified Patient Identification Card for a Minor (under the age of 18), a legal guardian or custodial parent with responsibility for health care decisions, on behalf of the minor applicant, shall submit (in a form and manner determined by the Department) the following information: A. The full legal name and aliases, such as a nickname (e.g., Bill as a nickname for William) of the minor applicant; B. The minor applicant’s date of birth; C. A copy of the minor applicant’s birth certificate; D. A copy of any court orders pertaining to custody of the minor applicant (including, but not limited to custody order through chancery or youth court); E. The minor applicant’s current physical address; F. Proof of minor’s residency in the State of Mississippi provided by the custodial parent and/ or legal guardian (see Rule 2.4.1 for sources required); G. The minor applicant’s telephone number and/or email address if the applicant has a telephone number and/or email address and that telephone number and/or email address is different from one provided by the applicant’s parent(s) or legal guardian(s); H. The full legal name(s) of the minor applicant’s parent(s) or legal guardian(s); I. The date(s) of birth of the minor applicant’s parent(s) or legal guardian(s); J. The current physical address(es) of the minor applicant’s parent(s) or legal guardian(s); K. The current telephone number(s) and/or email address(es) of the minor applicant’s parent(s) or legal guardian(s); L. Identification issued by the State of MS (if applicable based on minor applicant) MS – (driver’s license or ID card issued by the Mississippi Department of Motor Vehicles); M. Current photograph of minor applicant: 1. clear, color photograph of the head and top of shoulders (headshot); 2. in a .jpg, .png, or .gif digital image format 3. taken in the last six months to reflect the applicant’s appearance; 4. taken in front of a plain white or off-white background; 5. taken in full-face view directly facing the camera at eye level with

nothing obscuring the face; 6. shall not be digitally enhanced to change the appearance of the applicant (e.g., use of “filters”); N. Written certifications (as set forth by the Department); O. Identification card nonrefundable fee (see Rules 2.1.3 and 2.1.4); P. An attestation that the information provided is true and correct; Q. Parental or legal guardian consent for the minor to participate in the medical cannabis program; R. An attestation, signed and dated by the applicant and parent(s)/legal guardian(s), pledging not to divert medical cannabis or medical cannabis products to any individual or entity; and, S. Any other information that may be required by the Department.

2.3.3 A certification issued for an individual between the ages of eighteen (18) and twenty-five (25) must meet the following conditions: 1. The debilitating condition is confirmed by two practitioners from separate practices after an in-person consultation (this isn’t required if the person is homebound or had an identification card before the age of 18); and, 2. One of the practitioners must be a physician (MD/DO).

2.3.4 The following limitations apply to resident cardholders: A. A resident card is valid for a maximum of one (1) year from the date of issuance of the card; B. A maximum of six (6) MMCEUs of medical cannabis in a week can be dispensed to a resident cardholder; C. A maximum of twenty-four (24) MMCEUs of medical cannabis in a thirty (30) day period can be dispensed to a resident cardholder; and D. A maximum of twenty-eight (28) MMCEUs is the possession limit for resident cardholders.

2.4 Nonresident Qualifying Patients (i.e., Nonresident Cardholders).

2.4.1 In order to participate in the program as a nonresident cardholder the following conditions shall be met: A. The individual has been diagnosed with a debilitating medical condition by a practitioner (licensed to prescribe medicine under the respective occupational board of the state of residence) in his or her respective state of residence; B. The individual is not a resident of the State of Mississippi or has been a resident of the State of Mississippi for less than forty-five (45) days; C. The individual has an active identification card for the use of medical cannabis in his/her state of residence; and, D. The individual has met the application criteria in Rule 2.4.2 below.

2.4.2 To obtain a Nonresident Qualifying Patient Identification Card, an applicant shall submit (in a form and manner determined by the Department) the following information: A. Full legal name and any aliases, such as a nickname (e.g., Bill as a nickname for William); B. Date of birth; C. Current physical address and mailing address; D. Current telephone number and/or email address; E. Identification issued by the applicant’s state of residence – (driver’s license, or state-issued ID card); F. Current photograph: 1. clear, color photograph of the head and top of shoulders (headshot); 2. in a .jpg, .png, or .gif digital image format; 3. taken in the last six months to reflect the applicant’s appearance; 4. taken in front of a plain white or off-white background; 5. taken in full-face view directly facing the camera at eye level with nothing obscuring the face; 6. shall not be digitally enhanced to change the appearance of the applicant (e.g., use of “filters”); G. Proof of active (current) participation in the medical cannabis program of the individual’s state of residence (as set forth by the Department);

H. Identification card nonrefundable fee of $75.00; I. An attestation, signed and dated by the applicant, that the information provided is true and correct; J. An attestation, signed and dated by the applicant, pledging not to divert medical cannabis or medical cannabis products to any individual or entity; and, K. Any other information that may be required by the Department.

2.4.3 In compliance with Rule 2.4.2 above, an individual seeking to participate in the program as a nonresident cardholder may apply to receive his/her nonresident identification card up to thirty (30) days before arriving in Mississippi.

2.4.4 The following limitations apply to nonresident cardholders: A. A nonresident card is valid for a maximum of two (2) fifteen (15) day periods in a 365-day year from the date of issuance of the card; B. The first consecutive fifteen (15) day period is the initial approval period; C. The second consecutive fifteen (15) day period is the renewal period; D. A maximum of six (6) MMCEUs of medical cannabis shall be dispensed per week to a nonresident cardholder; E. A maximum of twelve (12) MMCEUs of medical cannabis shall be dispensed to a nonresident cardholder in a consecutive fifteen (15) day period; and F. The maximum possession limit for nonresident cardholders shall be fourteen (14) MMCEUs.

2.5 Registered Designated Caregiver Cards. 2.5.1 Registered Designated Caregiver Cards will only be issued by the Department when all application criteria are met. Upon issuance of the designated caregiver card, the applicant is recognized as a designated caregiver to a qualified patient or patients (inclusive of nonresident patients) of the medical cannabis program. The Department will not issue a designated caregiver identification card before the Department issues the designated caregiver’s qualifying patient’s identification card.

2.5.2 Caregiver applicants are prohibited from having a disqualifying felony offense.

2.5.3 Caregivers shall be at least twenty-one (21) years of age unless the person is the parent or legal guardian of the qualified patient cardholder that the designated caregiver assists.

2.5.4 Registered Designated Caregiver Cards issued by the Department are valid for one (1) year from the date of issuance or lesser timeframe if assisting a nonresident patient.

2.5.5 Utilizing the same process outlined in Rule 2.4.2, Caregivers may apply for renewal of their identification card no later than one (1) year from the date of issuance or last renewal of the Caregiver Identification Card.

2.5.6 Caregiver Cards may be suspended or revoked for the following: A. The caregiver provided false information to the Department; B. The caregiver uses his/her card to obtain medical cannabis for an individual who has not designated them as their caregiver or who is not a qualified patient; and/or, C. The caregiver uses the medical cannabis of the patient for whom he/she is providing care.

2.6 Application to Participate in the Medical Cannabis Program as a Caregiver. 2.6.1 To obtain a Registered Designated Caregiver Card, an applicant shall submit (in a form and manner determined by the Department) the following information: A. Full legal name and any aliases, such as a nickname (e.g., “Bill” as a nickname for “William”); B. Date of birth; C. Current physical address and mailing address; D. Current telephone number and/or email address; E. Identification issued by the State of Mississippi – (driver’s license or ID card issued by the Mississippi Department of Motor Vehicles);

F. Current photograph, meeting the following requirements: 1. clear, color photograph of the head and top of shoulders (headshot); 2. in a .jpg, .png, or .gif digital image format; 3. taken in the last six months to reflect the applicant’s appearance; 4. taken in front of a plain white or off-white background; 5. taken in full-face view directly facing the camera at eye level with nothing obscuring the face; 6. shall not be digitally enhanced to change the appearance of the applicant (e.g., use of “filters”). G. Name(s), date(s) of birth, and identification number(s) (if available at the time of application) of the patient(s) to whom services are being provided; H. Identification card nonrefundable fee of $25.00; I. Fingerprints on a fingerprint card or a live scan fingerprint to be submitted to the Department to conduct a criminal background check; J. Authorization to conduct state and federal criminal records checks; K. Caregiver criminal background check nonrefundable fee of $37.00 paid at the time of application to complete the required background check; L. An attestation that the information provided is true and correct; M. An attestation, signed and dated by the applicant, pledging not to divert medical cannabis or medical cannabis products to any individual or entity; N. Designation of Caregiver Form; and, O. Any other documentation required by the Department such as an acknowledgement of caregiver responsibilities.

2.6.2 In the event that an applicant is applying to become a registered designated caregiver for a qualified patient who is a minor and the caregiver applicant is not the patient’s parent and/or legal guardian, the caregiver applicant shall also submit authorization from the patient’s parent and/or legal guardian to serve in a caregiver capacity. The form of the authorization may be determined by the Department.

2.7 Application to Obtain a Caregiver Entity Card.

2.7.1 The following entities, licensed by the applicable state authority, may facilitate the use of medical cannabis by a qualified patient after registering with the Department as a Caregiver Entity: A. Hospitals; B. Hospice Programs; C. Assisted Living Programs; D. ICF/IDD Institutions; E. Nursing Homes; F. Personal Care Homes; G. Adult day care facilities; and H. Adult foster care facilities.

2.7.2 To register as a Caregiver Entity, the facility/program shall submit, in a form and manner determined by the Department, the following information: A. The name, address, and telephone number of the facility/program, as well as the contact information for a primary contact person at that facility/program; B. A copy of the facility/program’s current facility license; and, C. An attestation that the information provided is true and correct and shall be signed and dated by an authorized signatory of the facility/program.

2.7.3 The Caregiver Entity shall update the Department with any changes to the facility/program’s primary contact person within three (3) business days of the change and shall file a copy of their license(s) each time that license is renewed or updated.

2.7.4 A Caregiver Entity card shall remain valid unless or until the facility’s/program’s state license or certification (whichever is applicable) is no longer valid or the registration with the medical cannabis program is suspended, revoked, or restricted by the Department.

2.7.5 The Department shall provide a single card to a Caregiver Entity. The Caregiver Entity will be notified by the Department of each qualifying patient’s designation of that entity as his/her caregiver.

2.7.6 Individual caregivers employed by registered Caregiver Entities are subject to all other Caregiver requirements included in this Part.

2.8 Practitioner Certification for Registered Qualifying Patients (Mississippi Residents). 2.8.1 A practitioner’s written certification (in a manner set forth by the Department) is required for a person, residing in the State of Mississippi, to apply to become a qualified patient of the Medical Cannabis Program.

2.8.2 The purpose of the practitioner certification is to determine and certify that a person suffers from a debilitating medical condition for which the use of medical cannabis may mitigate the symptoms and/or effects.

2.8.3 Before issuing a Practitioner Certification for an individual seeking to participate in the medical cannabis program, a Practitioner shall: A. Have a bona fide practitioner-patient relationship with the individual; B. Examine the individual in person in Mississippi; C. Determine that the individual suffers from a Debilitating Medical Condition for which the use of medical cannabis may mitigate the symptoms and/or the effects.

2.8.4 A bona fide practitioner-patient relationship must include the following: 1. A treatment or consulting relationship between the practitioner and the individual seeking the practitioner certification; 2. A practitioner certification is included in the individual’s medical record; 3. The practitioner is available to provide follow-up care and treatment to the individual seeking certification; and, 4. Any other requirements related to the practitioner’s scope of practice put in place by the practitioner’s respective occupational/licensing board or the Department.

2.8.5 A practitioner certification is valid for twelve (12) months from the date of issuance unless a shorter time is specified by the certifying practitioner.

2.8.6 A practitioner certification shall not exceed the allowable amount of medical cannabis. A practitioner can place restrictions on the allowable amount of medical cannabis by stating the maximum amount of medical cannabis and/or the method(s) of administration permissible on the practitioner certification.

2.8.7 A practitioner shall not issue a written certification for any individual with whom he/she does not have a bona fide practitioner-patient relationship.

2.8.8 A practitioner issuing a written certification is prohibited from being a medical cannabis dispensary representative or employee.

2.8.9 A certification issued for an individual eighteen (18) to twenty-five (25) years old shall meet the following conditions: A. The debilitating condition is confirmed by two practitioners from separate practices after an in-person consultation (this isn’t required if the person is homebound or had an identification card before the age of 18); and, B. One of the practitioners shall be a physician (MD/DO).

2.8.10 A certification issued for a minor (under the age of 18) may only be issued by a physician (MD/DO).

2.8.11 A registered practitioner is prohibited from the following: A. Referring patients to a specific medical cannabis establishment; B. Referring patients to a specific caregiver; C. Advertising in medical cannabis establishments; and, D. Issuing a written certification for a qualifying patient while holding a financial interest in any medical cannabis establishment.

2.8.12 A registered practitioner shall conduct the evaluation, consultation, diagnosis, and certification processes under this part in a manner consistent with all

professional and medical standards of care, including the rules of professional conduct adopted by the practitioner’s respective board of licensure, and document all information related to those processes in the patient’s records.

2.8.13 After a registered practitioner issues a written certification to a qualifying patient, he/she may assist that patient in applying for a registry identification card via the Department’s Licensing Portal.

2.9 Practitioner Registration. 2.9.1 Practitioners shall register annually with the Department to participate in the medical cannabis program for purposes of issuing written certifications on behalf of qualifying patients.

2.9.2 The collaborating physician (MD/DO), for both physician assistants and certified nurse practitioners, shall be registered with the Department in order for the physician assistant or nurse practitioner in collaboration with that physician (MD/DO) to subsequently register with the Department.

2.9.3 In order to register with the Department, the practitioner (i.e., applicant) shall submit the following to the Department: A. Evidence of unrestricted licensure in Mississippi by the Mississippi State Board of Medical Licensure; Mississippi State Board of Nursing; or Mississippi State Board of Optometry; B. Issue date and expiration date of licensure in Mississippi; C. Area of specialty; D. Physical address of practice; E. Current telephone number and email address; F. Evidence of completion of continuing medical education approved by the Department; G. A waiver, signed and dated by the practitioner, allowing, and authorizing the Department to fully communicate with the Mississippi State Board of Medical Licensure, Mississippi State Board of Nursing; or Mississippi State Board of Optometry and receive licensure information; and, H. An attestation that the applicant has no direct or indirect financial interest in

any licensed medical cannabis establishment.

2.9.4 Practitioner Registration may be suspended or revoked for the following: A. The practitioner provided false information to the Department; and/or B. The practitioner is the subject of disciplinary action from the Mississippi State Board of Medical Licensure, Mississippi State Board of Nursing, or Mississippi State Board of Optometry.

2.10 Requirements of Practitioners Participating in the Medical Cannabis Program. 2.10.1 Practitioners shall complete eight (8) hours of initial training related to the use of medical cannabis in order to enroll in the program. Annual training in the amount of five (5) hours related to the use of medical cannabis shall also be completed in order to annually renew participation in the program. All training shall be approved by the Department. Failure to meet these training requirements will negatively impact a practitioner’s ability to participate in the Program.

2.10.2 Practitioners are prohibited from sharing office space with a medical cannabis establishment.

2.10.3 Participation in the program does not negate the authority of the Mississippi State Board of Medical Licensure, Mississippi State Board of Nursing or Mississippi State Board of Optometry to investigate practitioners and freely communicate with the Department should those instances occur. Practitioners registered with the Program agree to the additional regulatory requirements related to the MS Medical Cannabis Act and the rules contained in this Part. Practitioners participating in the Program agree that MSDH is authorized to freely communicate with the practitioner’s professional licensing board if violations are alleged.

2.10.4 Practitioners shall utilize the Prescription Monitoring Program in order to complete an assessment of the patient prior to issuing an initial or renewal certification qualifying his/her condition for the medical cannabis program.

2.10.5 All patients shall be advised of their freedom of choice as to the medical cannabis dispensary they wish to utilize. Evidence of this shall be maintained in the patient’s medical record.

2.10.6 In addition to the requirements set forth in this Part, practitioners shall also follow the rules, regulations, and policies set forth by the Mississippi State Board of Medical Licensure, Mississippi State Board of Nursing, or the Mississippi State Board of Optometry in order to maintain an unrestricted license from the respective licensing boards.

2.10.7 A certifying practitioner may determine that a patient no longer meets the requirements related to a debilitating medical condition; no longer believes that the patient receives therapeutic benefit from the use of medical cannabis; or does not believe the patient is using the medical cannabis for medical purposes. The practitioner shall notify the Department of that determination and intent to terminate the physician certification. Termination of physician certification renders the patient identification card null and void.

2.10.8 Notification of termination of practitioner certification to the Department and patient shall include, but isn’t limited to: 1. The practitioner’s identification number issued by the MS Medical Cannabis Program; 2. The patient’s identification number issued by the MS Medical Cannabis Program; 3. The reason the certification is being revoked; 4. The date of revocation; 5. The signature of the practitioner; 6. The date of notification to the Department; 7. The date of notification to the patient; and, 8. The official letterhead and/or email account of the practitioner.

2.11 Advertising Restrictions for Registered Practitioners. 2.11.1 Advertising for cannabis certification(s) shall be professional in nature and may not be designed in such a way as to suggest that patients will obtain certification

regardless of their condition or compliance with the requirements of the Act, or in any way that entices minors.

2.11.2 A practitioner or affiliated clinic/entity shall not publish or cause to be published any advertisement that: A. Contains false or misleading statements about medical cannabis or about the Program; B. Uses colloquial terms to refer to medical cannabis, including but not limited to pot, weed, dope or grass; C. States or implies the health care practitioner is endorsed by the Department or by the Program, including use of the Department’s Medical Cannabis Program logo; D. Includes images of cannabis in its plant or leaf form or of cannabis-smoking paraphernalia; or E. Contains medical symbols that could reasonably be confused with symbols of established medical associations or groups.

2.11.3 A practitioner found by the Department to have violated this Part is prohibited from certifying that patients have a qualifying medical condition for purposes of patient participation in the Program. The Department’s decision that a practitioner has violated this subdivision is a final decision of the Department which may be appealed by an aggrieved party in accordance with Subpart 11 of this Part.

Subpart 3 MEDICAL CANNABIS ESTABLISHMENT LICENSES, BACKGROUND CHECKS, & WORK PERMITS 3.1 Application for Medical Cannabis Establishment License. 3.1.1 An application and all required documentation shall be completed by the applicant and submitted to the Department using the Department’s Online Licensing Portal.

3.1.2 At a minimum, an application for licensure as a medical cannabis establishment shall include the following:

1. The names and other required information for all individuals and legal entities who are applicants; 2. The proposed physical location of the cannabis facility; 3. A map or sketch of the premises proposed for licensure, including the defined boundaries of the premises and a scaled floorplan sketch of all enclosed areas with clear identification of the main entrance, walls, all areas of ingress and egress, and all limited access areas. This map shall provide accurate measurements that allow the Department, at a minimum, to determine the precise main entrance location in reference to the rest of the premises. This map shall also clearly identify the distinct areas utilized for commercial cannabis activities (i.e., cultivation activities, processing activities, storage, etc.). This map shall identify all locations of security cameras, exterior lighting, secure access areas and fencing; 4. If the application is based on proposed construction not completed at the time of application, the applicant shall submit construction plans for the proposed building which will be the basis for the application investigation. These plans shall, at a minimum, provide accurate measurements that allow the Department to determine the precise main entrance location in reference to the rest of the building. If the application is based on an existing building, photos of the interior, exterior and the surrounding property should be submitted at the time of application; 5. An operating plan that demonstrates the following at a minimum: 1. The applicant’s organization chart; 2. Job descriptions and minimum qualifications for each position; 3. An explanation of whether the applicant has experience operating businesses in highly-regulated industries, including but not limited to the cannabis industry under the laws of Mississippi or any other state or jurisdiction within the United States; 4. Employee training plan; and 5. Hours of operation. 6. Standard Operating Procedures that demonstrate at a minimum how the applicant’s proposed premises and business will comply with applicable laws and rules regarding: A. Security; B. Employment practices adhering to state and federal law;

C. Record-keeping systems; D. Preventing diversion of cannabis and/or cannabis products; E. Types and quantities of cannabis products that will be produced at the facility; F. Methods of cultivation or processing of cannabis and/or cannabis products, as applicable based on category of license applied for; G. Inventory control and tracking; H. Procedures for proper labeling and packaging; I. Transportation of cannabis and/or cannabis products, as applicable based on category of license applied for; J. Waste disposal; and, K. Recall of cannabis and/or cannabis products; 7. If the municipality or county where the proposed cannabis facility will be located has enacted zoning restrictions, a sworn attestation by the applicant certifying that the proposed cannabis facility is in compliance with the restrictions; 8. If the municipality or county where the proposed cannabis facility will be located requires a local registration, license, or permit, then the applicant shall include a copy of such registration, license or permit issued to the applicant with the application submitted to the Department. If construction is still underway at the time of application, then the applicant shall include a signed attestation containing the following information: A. A list of all local requirements not yet obtained; B. Anticipated dates that the applicant will obtain each location registration, license and/or permit; C. An attestation that acknowledges that the applicant is aware of the outstanding need for local registrations, licenses and/or permits and will provide delinquent documents within 10 business days of their receipt as a condition of licensure; 9. The names and other required information for all persons and/or entities who directly or indirectly own ten percent (10%) or more of the medical cannabis establishment applicant entity;

10. If the applicant is a business entity, the names and other required information for each principal officer and board member of the medical cannabis establishment applying for licensure; 11. Fingerprint cards or electronic fingerprints collected by a live scan (or like) vendor for any person who directly or indirectly owns ten percent (10%) or more of the medical cannabis establishment applicant in order to perform a criminal background check to determine whether a disqualifing felony offense is present. The signed and notarized Background Check Affidavit for each applicant should also be submitted at the time of application; and, 12. Other information that may be required by the Department.

3.1.3 All information and documents required by the Department including but not limited to the following shall accompany an application for licensing as a cannabis testing entity: A. Initial applications for regular and/or provisional licensing as a cannabis testing entity shall require: 1. The legal name of the prospective cannabis testing entity; 2. The physical address of the prospective cannabis testing entity’s facility, which shall not be within one thousand (1,000) feet of the nearest property boundary line of a school, church, or child care facility which exists or has acquired necessary real property for the operation of such facility before the date of the cannabis testing facility application unless the proposed entity has received approval from the school, church or child care facility and received the applicable waiver from the entity that licenses or accredits any such school or child care facility, provided that the main point of entry of the cannabis testing facility is not located within five hundred (500) feet of the nearest property boundary line of any school, church or child care facility; 3. The name of each owner, principal officer, board member, and lab director of the proposed cannabis testing entity; 4. An attestation that the information provided to the Department to apply for a cannabis testing entity license is true and correct; 5. The signatures of the owners of the cannabis testing entity and the technical laboratory director and the date each signed; 6. For each owner: a. An attestation signed and dated by the owner that the owner has not been

convicted of an excluded felony offense; b. An attestation signed and dated by the owner that the owner does not have a direct or indirect familial or financial relationship with or interest in a cannabis dispensary, cannabis cultivation entity, cannabis processing entity, cannabis disposal entity or cannabis research entity; c. An attestation signed and dated by the owner pledging not to divert cannabis to any individual who or entity that is not allowed to possess cannabis; and, 7. Verification for each principal officer or board member that they are at least twenty-one (21) years of age. 8. Verification for each principal officer or board member that they are at least twenty-one (21) years of age; 9. A valid certificate of accreditation, issued by an accreditation body, as defined in this Chapter, that attests to the laboratory’s competence to perform testing, including all the required analytes for the relevant test methods: a. Cannabinoids; b. Heavy metals; c. Microbial impurities; d. Mycotoxins; e. Residual pesticides; f. Residual solvents and processing chemicals; g. Terpenoids (if performed); and, h. Foreign Material; 10. A copy of the cannabis testing facility’s most recent assessment by the laboratory’s accreditation body, the laboratory’s responses to any findings of non-compliance with standards or recommendations, and the corrective actions taken by the laboratory to address the findings or recommendations; 11. Laboratory standard operating procedures for all testing methods; 12. Laboratory test method verification and validation documentation for all testing methods, including final data reports approved by the laboratory director, validation material package inserts and all supporting data including instrument raw data and calculation tools; 13. Laboratory standard operating procedures for security measures;

14. Laboratory standard operating procedures for the sampling of cannabis or cannabis products; 15. Laboratory standard operating procedures for the transportation of cannabis or cannabis products; 16. Laboratory standard operating procedures for the reporting of test results for cannabis or cannabis products; 17. Laboratory standard operating procedures for the disposal of samples, digestates, leachates and extracts or other sample preparation products; 18. Testing staff initial and/or ongoing demonstration of capability for all applicable tests. 19. All completed proficiency testing. For new applications, a testing entity shall successfully analyze one set of proficiency testing samples for all required analytes prior to being licensed. B. In addition to the above, applications for renewal of a cannabis testing entity license shall also include: 1. A valid certificate of accreditation, issued by an accreditation body, as defined in this Part, that attests to the laboratory’s competence to perform testing, including all the required analytes for the relevant test methods: a. Cannabinoids; b. Heavy metals; c. Microbial impurities; d. Mycotoxins; e. Residual pesticides; f. Residual solvents and processing chemicals; g. Foreign Material; h. Terpenoids, if performed. 2. A copy of the cannabis testing entity’s most recent assessment by the laboratory's accreditation body, the laboratory's responses to any findings of non-compliance with standards or recommendations, and the corrective actions taken by the laboratory to address the findings or recommendations; 3. Any new or updated laboratory standard operating procedures for all testing methods; 4. Any new or updated laboratory test method verification and validation documentation for all testing methods, including final data reports approved

by the laboratory director, validation material package inserts and all supporting data including instrument raw data and calculation tools; 5. Any new or updated laboratory standard operating procedures for security measures; 6. Any new or updated laboratory standard operating procedures for the sampling of cannabis or cannabis products; 7. Any new or updated laboratory standard operating procedures for the transportation of cannabis or cannabis products; 8. Any new or updated laboratory standard operating procedures for the reporting of test results for cannabis or cannabis products; 9. Any new or updated laboratory standard operating procedures for the disposal of samples, digestates, leachates and extracts or other sample preparation products; and, 10. Testing staff initial demonstration of capability for all applicable tests.

3.1.4 The Department will review an application for licensure to determine if it is complete. An application will not be considered complete if the applicant does not provide all information required by the application form, the full application and license fees have not been paid, or all of the additional information required under these rules is not submitted. If items are missing/require correction/require additional information, the Department will send notification to the applicant that the application has been returned for action and provide a description of the requisite information. The applicant will need to resubmit an amended application and/or supporting documents for a license if the application is returned for action.

3.1.5 Upon review, the Department may return an application for action, an applicant will have three opportunities for correction. If an applicant is unable to present a complete and correct application, as determined by the Department, after these three attempts, the application will be denied. Upon denial, if the entity chooses to apply again, a new application and supporting documents meeting the requirements of this Part shall be submitted.

3.1.6 Once all required information is received and the fees have been paid, the Department will send notification to the applicant that it has received a completed application. Once the application has been deemed complete, the Department will

review the application and issue a determination within thirty (30) days of receiving the completed application. Applications will be processed in the order in which a completed application is filed by the applicant. Review will be initiated based on the order in which a complete application is filed; however, the duration of the review will depend upon the information provided by the applicant.

3.2 Categories and Fees. 3.2.1 Categories of Medical Cannabis Establishment Licenses. The following categories of medical cannabis establishment licenses may be issued by the Department consistent with the Mississippi Medical Cannabis Act: A. Cannabis Cultivation License. Establishments licensed as cannabis cultivation facilities/entities or micro-cultivation facilities may engage in the following commercial cannabis activities: acquisition and possession of medical cannabis, production of cannabis (e.g., grow, cultivate, harvest, dry, cure, trim) in accordance with the rules contained in this Part; storage of cannabis and/or raw pre-roll cannabis products; packaging and labeling of cannabis and/or cannabis products; production of raw pre-roll cannabis products, the sale of cannabis and raw pre-roll cannabis products to medical cannabis establishments authorized by this Part or medical cannabis dispensaries licensed by MDOR. Additionally, establishments licensed as micro-cultivation facilities/entities shall meet the ownership requirement established in Miss. Code § 41-137-35(12). B. Cannabis Processing License. Establishments licensed as cannabis processing facilities/entities or micro-processing facilities may engage in the following commercial cannabis activities: acquisition of cannabis from licensed cultivation and/or micro-cultivation facilities/entities; possession of cannabis with the intent to manufacture cannabis products; manufacture of cannabis products from unprocessed cannabis and/or a cannabis extract; storage of cannabis and/or cannabis products, packaging and labeling of cannabis and/or cannabis products, the sale of cannabis products to medical cannabis establishments authorized by this Part or medical cannabis dispensaries licensed by MDOR. Additionally, establishments licensed as micro-processing facilities/entities shall meet the ownership requirement established in Miss. Code § 41-137-35(12). C. Cannabis Transportation License. Establishments licensed as cannabis transportation entities in accordance with the rules in this Part may engage in the transportation (e.g., transfer) and storage of cannabis and/or cannabis products to other licensed medical cannabis establishments authorized by this Part and/or medical cannabis dispensaries licensed by MDOR.

D. Cannabis Disposal License. Establishments licensed as cannabis disposal entities may engage in the following commercial cannabis activities: disposal or destruction of medical cannabis, cannabis products, and/or cannabis waste. E. Cannabis Testing Facility License. Establishments licensed as medical cannabis testing facilities/entities may engage in the following commercial cannabis activities: collection and transportation of medical cannabis test samples, testing of medical cannabis test samples for purposes of analyzing the safety and potency of cannabis and cannabis products. F. Cannabis Research License. Establishments licensed as medical cannabis research facilities/entities may engage in the following commercial cannabis activities: acquisition of cannabis or cannabis products from licensed cannabis cultivation facilities and licensed cannabis processing facilities in order to research cannabis, develop best practices for specific medical conditions, develop medicines and provide commercial access for medical use.

3.2.2 License Fees. The following nonrefundable fees are required at the time of initial application and renewal: A. Micro-cultivators. 1. Tier 1 (canopy of 1,000 square feet or less) - one-time application fee of $1,500.00. Annual license fee of $2,000.00. 2. Tier II (canopy of more than 1,000 square feet but not more than 2,000 square feet) - one-time application fee of $2,500.00. Annual license fee of $3,500.00. B. Cultivators. 1. Tier I (canopy of not less than 2,000 square feet but not more than 5,000 square feet) – one-time application fee of $5,000.00. Annual license fee of $15,000.00. 2. Tier II (canopy of not less than 5,000 square feet but not more than 15,000.00 square feet) – one-time application fee of $10,000.00. Annual license fee of $25,000.00. 3. Tier III (canopy of not less than 15,000 square feet but not more than 30,000 square feet) – one-time application fee of $20,000.00. Annual license fee of $50,000.00. 4. Tier IV (canopy of not less than 30,000 square feet but not more than 60,000 square feet) - one time application fee of $30,000.00. Annual license fee of

$75,000.00. 5. Tier V (canopy of not less than 60,000 square feet but not more than 100,000 square feet) – one time application fee of $40,000.00. Annual license fee of $100,000.00. 6. Tier VI (canopy of not less than100,000 square feet but no more than 150,000 square feet with up to two locations) – one time application fee $60,000.00. Annual license fee of $150,000.00. C. Micro-Processors. 1. Tier 1 (processes less than two thousand (2,000) pounds of dried biomass annually) - one-time application fee of $2,000.00. Annual license fee of $3,500.00. 2. Tier II (processes not less than two thousand (2,000) pounds but not more than three thousand (3,000) pounds of dried biomass annually) - one-time application fee of $2,500.00. Annual license fee of $5,000.00. D. Processors (processes no less than three thousand (3,000) pounds of dried biomass annually) - one time application fee of $15,000.00. Annual license fee of $20,000.00. E. Transportation Entity. One time application fee of $5,000.00. Annual license fee of $7,500.00. F. Waste Disposal Entity. One-time application fee of $5,000.00. Annual license fee of $7,500.00. G. Testing Entity. One-time application fee of $10,000.00. Annual license fee of $15,000.00. H. Research Entity. One-time application fee of $10,000.00. Annual license fee of $15,000.00.

3.2.3 All application and license fees shall be paid in a manner set forth by the Department.

3.2.4 The one-time application fee and license fee shall be paid in order for an initial application to be determined complete and move forward in the Department’s review.

3.2.5 A fee for a status change from provisional license to regular license is not required. The application and license fees shall be paid as stated in Rule 3.2.2.

3.2.6 Should fees be returned to the Department as insufficient; the Department will cease the application review process. The applicant will be notified of the activity and the application will be denied at that time. If a license has been issued when the Department is notified of insufficient funds associated with the payment of fee, the medical cannabis establishment will be notified, and its license will be suspended until the fee payments are remedied. Remediation of the insufficient funds shall occur within thirty (30) days.

3.3. Background Checks. 3.3.1 Fingerprinting and criminal history record checks are required for each applicant applying to obtain a medical cannabis work permit.

3.4 Licensure: Regular and Provisional 3.4.1 A license, issued by the Department, shall be obtained for each medical cannabis establishment prior to the commencement of any commercial cannabis activities authorized by this Part and the Mississippi Medical Cannabis Act. Activities outside of the authority granted to medical cannabis establishments by virtue of these rules, licensure and registration with the Department and the Mississippi Medical Cannabis Act may be considered suspected illegal activities and reported to proper authorities as such.

3.4.2 All operational medical cannabis establishments shall be currently licensed and registered by the Department and adhere to all regulations set forth by the Department.

3.4.3 To be licensed and registered by the Department, cannabis testing entities shall be accredited as defined in this Part.

3.4.4 To be licensed and registered by the Department, cannabis testing entities shall test at least one analyte required by the Department.

3.4.5 To maintain an active license and registration certificate, cannabis testing entities shall maintain accreditation, as defined in this Part.

3.4.6 Any loss of accreditation status by a cannabis testing entity will result in immediate revocation of the license and registration of the cannabis testing facility.

3.4.7 Any cannabis testing entity that has a license revoked for failure to maintain accreditation, as defined in this Part, may file a written petition to the Department to reinstate the cannabis testing entity’s license once the cannabis testing entity submits proof of accreditation, as defined in this Part. A reinstatement of a license is required prior to the cannabis testing entity resuming cannabis testing operations.

3.4.8 A medical cannabis establishment shall not be within 1,000 feet of the nearest property boundary line of a school, church or child care facility that exists or has acquired necessary real property for the operation of such facility before the date of the medical cannabis establishment application unless the entity has received approval from the school, church or child care facility and received the applicable waiver from their licensing agency, provided that the main point of entry of the cannabis establishment is not located within five hundred (500) feet of the nearest property boundary line of any school, church or child care facility.

3.4.9 Regular Licensure. A license shall be issued for the specific business/entity identified on the application, and is valid only for the owner, premises and name designated on the application and Department issued license and the location for which it is issued. Upon issuance of a license, the licensee may begin operations; provided that it may not commence cultivating, producing or dispensing cannabis or cannabis products until it receives a written notice authorizing commencement from the Department, following the Department’s initial inspection to determine compliance with this Part.

3.4.10 Provisional Licensure. Within its discretion, the Department may issue a provisional license when a temporary condition of non-compliance with the regulations contained in this Part exists. A provisional license shall be issued only if the Department is satisfied that preparations are being made to qualify for a regular license and that the health and safety of patients and the public will not be

endangered. The Department identifies opportunities for diversion, such as a lack of plant/package tags and insufficient security measures, as dangers to the health and safety of patients and the public.

3.4.11 A provisional license may be issued when the following conditions exist: A. Prior to the medical cannabis establishment’s start date of operations and subsequent to meeting the licensure requirements for the development of all required standard operating procedures. The license issued under this provision shall be valid until the issuance of a regular license but shall generally not exceed four (4) months following date of issuance, whichever may be sooner. B. When a temporary issue of non-compliance with these regulations exists that does not endanger the health and safety of patients and the public (at the discretion of the Department). The license issued under this provision shall be valid until the issues of non-compliance are remedied and evidence of compliance is submitted to the Department. The license issued under this provision shall be valid until the issuance of a regular license but shall generally not exceed four (4) months following date of issuance, whichever may be sooner.

3.4.12 Upon acceptance of a license issued by the Department to operate as a medical cannabis establishment pursuant to this Part and the Medical Cannabis Act, the licensee shall: A. Post the license or permit in a location in the medical cannabis establishment that is conspicuous; B. Comply with the provisions of the Act and the rules and regulations contained in this Part; C. Comply with directives of the Department including time frames for corrective actions specified in inspection reports, audit reports, notices, orders, warnings, and other directives issued by the Department in regard to the license holder’s medical cannabis business or in response to community emergencies; D. Be subject to the administrative, civil, injunctive, and criminal remedies authorized in law for failure to comply with rules in this Part or a directive of the Department, including time frames for corrective actions specified in inspection reports, audit reports, notices, orders, warnings, and other directives; and, E. Bear the financial responsibility for all compliance and inventory tracking

obligations and responsibilities set forth in Mississippi statutes and rules in this Part.

3.4.13 Licensees shall register with the Mississippi Department of Revenue for tax purposes.

3.5 Oversight and Inspections. 3.5.1 The physical location of medical cannabis establishments, all general business (inclusive of employee records) of the establishments, all financial records of the establishments, and vehicles utilized to transport cannabis and/or cannabis products (which requires a cannabis transportation entity license) are subject to reasonable inspection by the Department.

3.5.2 The Department shall conduct at least one on-site inspection of all medical cannabis establishments. Inspections by the Department may be scheduled or unannounced but generally shall occur during the reported hours of operation included in the licensee’s operating plan submitted as a requisite component of the application for licensure.

3.5.3 Cannabis testing facilities are subject to inspection by the Department during business hours, including but not limited to, inspection of the physical cannabis testing facility, interviews of personnel, review, inspection, and audit of records and documents related to the analyses of dispensary samples to verify compliance with this Part.

3.5.4 Medical cannabis licensees shall cooperate with the Department during any inspections, requests to resolve complaints, requests for information/data, etc. in order to verify compliance with this Part, the Mississippi Medical Cannabis Act and any subsequent versions of the rules and regulations in this Part and the Act.

3.5.5 If the Department discovers what it reasonably believes to be criminal activity or other violations of Mississippi law during an inspection, the Department may refer the matter to appropriate Mississippi state or local law enforcement or regulatory authorities for further investigation.

3.6 Authority Relating to Inspections and Investigations; Administration of Provisions of Program. 3.6.1 Except for license information concerning licensed patients, the Department may share confidential information to assist other agencies in ensuring compliance with applicable laws, rules, and regulations.

3.7 Term of License. 3.7.1 Regular licenses issued by the Department under this Part are valid for one year from the date of issuance.

3.8 Renewal of Licensure. 3.8.1 Regular licenses issued by the Department under this Part require annual renewal.

3.8.2 The Department shall send notification to each licensee of the duty to renew at least sixty (60) days prior to the expiration date of an active license. Notification will be to the email address of the primary contact person designated by the licensee on its application or latest renewal, as applicable.

3.8.3 License Renewal Process. A. A license issued under this Part may be renewed annually if the medical cannabis establishment: 1. Submits to the Department a renewal application in the manner prescribed by the Department within thirty (30) days prior to the expiration date on the license that includes as applicable: a. Copy of current Certificate of Good Standing from the Mississippi Secretary of State’s Office; b. New, updated or revised service agreements; c. Any new or updated Standard Operating Procedures; d. Updated and/or revised diagram of the licensee’s premises; e. Copy of licensee’s current insurance policy; f. Updated vehicle information (transportation and disposal licensees); 2. Continues to meet all the requirements of this Part; and,

3. Submits proof that the licensee remains in compliance with all requisite local permits and licenses; and, 4. Submits the renewal fee for the license to the Department as required in Rule 3.2.2. B. Before renewing a license, the Department may require further information and documentation and may conduct additional background checks to determine that the licensee continues to meet the requirements of this Part. C. A licensee whose license is not renewed shall cease all operations immediately upon expiration of the license, schedule a close out inspection with the Department, and destroy all cannabis and cannabis products in the licensee’s possession in a manner approved by the Department.

3.8.4 At the time of renewal, the licensee shall ensure that all material changes to the required plans and/or standard operating procedures have been communicated in writing to the Department.

3.8.5 An inspection by the Department within sixty (60) days prior to expiration of a license issued under this Part may be required at the Department’s discretion for renewal of the license.

3.8.6 A license may be suspended, revoked, and shall not be renewed by the Department if: A. Outstanding fines are owed to the Department; B. An owner has been convicted of a disqualifying felony; C. The medical cannabis establishment has not engaged in licensed activity at the licensed premises for a period of one (1) year, unless the medical cannabis establishment submits evidence of reasonable justification, including without limitation death, illness, natural disaster, or other circumstances beyond the medical cannabis establishment’s control; D. Renewal will result in any person having a direct or indirect ownership or economic interest of greater than ten percent (10%) in more than one (1) Mississippi cannabis cultivation entity license; more than one (1) Mississippi cannabis processing entity license; and more than five (5) Mississippi cannabis dispensary licenses;

E. The licensed entity owes delinquent taxes. Applicants who have completed an agreed upon payment plan and/or are following an agreed upon payment plan are not considered to be delinquent; F. The licensed entity no longer meets all eligibility requirements for the issuance of a medical cannabis establishment license; G. The licensed entity does not meet regulatory requirements set by the Department; and/or, H. The licensed entity provides of misleading, incorrect, false or fraudulent information.

3.8.7 The application for renewal of a medical cannabis establishment license may be denied after consideration by the Department of the licensee’s demonstrated history of violations of the rules in this Part. The number and severity of violations will be considered by the Department.

3.8.8 If the license of a medical cannabis establishment expires (by date), isn’t renewed, or is suspended or revoked, operations of that establishment that are authorized by rules and regulations in this Part and the MS Medical Cannabis Act must cease as instructed by the Department.

3.9 Procedure for Termination of License. 3.9.1 Licensees who permanently abandon the licensed premises or otherwise permanently cease all activities relating to the operation of a medical cannabis establishment under its license, whether a result of revocation, voluntary surrender or other reasons, shall follow the following procedures for terminating the license: A. Provide written notice of abandoning the licensed premises or ceasing operations at least forty-eight (48) hours in advance to the Department stating the reason for surrender of the license; name(s) and contact information of the person(s) responsible for closing of all business operations; and the address where business records will be retained. B. Provide the Department with a full accounting of all cannabis plants, cannabis and cannabis products located within the licensed premises; and, C. Destroy all cannabis plants, cannabis and cannabis products in its possession as instructed by the Department.

The annual licensing fee paid at the time of application is non-refundable. No portion of the annual licensing fee shall be returned to the licensee.

3.10 Transfer of Ownership Requirements. 3.10.1 A licensee may transfer ownership interests, including without limitation partial ownership, only after the application for a transfer of an ownership interest has been approved by the Department.

3.10.2 An application for the transfer of ownership interests in a medical cannabis establishment shall: 1. Be completed on forms and/or a system made available by the Department; 2. Be submitted to the Department; and, 3. Contain all required supplemental information provided by the person or entity seeking to assume an ownership interest, similar to that which is required in an application for a cannabis cultivation license, to demonstrate compliance with all applicable requirements for licensure, including but not limited to fingerprinting and background check requirements.

3.10.3 The Department may revoke or suspend a license upon discovery of any effort or attempt to transfer an ownership interest in a license without complying with the requirements of this Part.

3.10.4 All information and documents required by the Department, including but not limited to, the following must accompany an application for change of ownership for a cannabis testing entity: 1. The legal name of the cannabis testing entity; 2. The name of each principal officer and board member of the cannabis testing entity; 3. An attestation that the information provided to the Department regarding the change of ownership for a cannabis testing entity is true and correct; 4. The signatures of the owners of the cannabis testing entity and the technical laboratory director and the date each signed; 5. For each owner:

A. An attestation signed and dated by the owner that the owner has not been convicted of an excluded felony offense; B. An attestation signed and dated by the owner that the owner does not have a direct or indirect familial or financial relationship with or interest in a dispensary, cannabis cultivation entity, cannabis processing entity, cannabis disposal entity or cannabis research entity; and, C. An attestation signed and dated by the owner pledging not to divert cannabis to any individual or entity that is not allowed to possess cannabis; 6. Verification for each principal officer or board member that they are at least twenty-one (21) years of age.

3.11 Work Permit Licenses. 3.11.1 A medical cannabis establishment representative as defined in this Part shall register for and obtain a work permit license issued by the Department before the individual may work for, volunteer at, or maintain his/her ownership interest of ten percent (10%) or greater, whether direct or indirect, in a medical cannabis establishment licensed by the Department.

3.11.2 To be eligible to obtain a work permit, an individual shall be at least twenty-one (21) years of age.

3.11.3 An applicant for an initial work permit or renewal of a work permit shall complete a fingerprint-based background check of the Mississippi Central Criminal Database and the Federal Bureau of Investigation Criminal History Database and shall not have a disqualifying felony offense.

3.11.4 A work permit license shall be valid for five (5) years from the date of issuance by the Department.

3.11.5 A medical cannabis work permit shall be the property of the licensed individual and non-transferrable.

3.11.6 Anyone holding a valid work permit shall provide written notification to the

Department within ten (10) business days of a name change.

3.11.7 All applicants for a Work Permit shall complete the application required by the Department and include all documentation set forth in this Part, pay the appropriate nonrefundable application and fingerprinting/background fees to the Department, and be approved as a valid work permit license-holder by the Department prior to beginning work at/for a medical cannabis establishment licensed by the Department or the MDOR.

3.11.8 All information and documents required by the Department, including but not limited to, the following shall accompany an initial or renewal application for a medical cannabis work permit: A. Current photograph, meeting the following requirements: 1. Clear, color photograph of the head and top of shoulders (headshot); 2. In a .jpg, .png, or .gif digital image format; 3. Taken in the last six (6) months to reflect the applicant’s appearance; 4. Taken in front of a plain white or off-white background; 5. Taken in full-face view directly facing the camera at eye level with nothing obscuring the face; 6. With a neutral facial expression and both eyes open; 7. No hat or head covering that obscures the hair or hairline, unless worn daily for a religious purpose. Full face shall be visible, and the head covering shall not cast any shadows on the face; 8. Shall not be digitally enhanced to change the appearance of the applicant (e.g., use of “filters”); 9. Other photo requirements as specified by the Department; B. Copy of a current driver’s license or state-issued ID card issued by the state department of motor vehicles; C. Copies of all current state issued professional licenses; D. Authorization for the Department to perform a criminal history records check; E. An attestation that the information provided to the Department to apply for a medical cannabis establishment employee work permit and registration is true and correct;

F. Fees as required by the Department.

3.11.9 Application and Permit Fees: Initial and Renewal. The following nonrefundable fees are due and payable at the time of initial registration for a work permit and at the time of renewal of such permit: A. Medical Cannabis Work Permit registration fee of $25.00. B. Fingerprinting and Department background records check fee(s) in addition to the work permit registration fee. C. All payments shall be made through the Department’s electronic payment system(s) found on the Department’s website.

3.11.10 Medical cannabis establishments shall not employ any person who has been convicted of a disqualifying felony offense as defined in this Part.

3.11.11 The Department may deny an application for registration or renewal of a work permit for any of the following reasons: A. Failure to provide the information required in this Part; B. Failure to meet the requirements set forth in this Part; C. Provision of misleading, incorrect, false or fraudulent information; D. Failure to pay all applicable fees as required; and/or, E. Any other grounds that serve the purposes of this Part.

3.11.12 If the Department denies an application for registration or renewal of a work permit, the Department shall notify the applicant in writing of the Department’s decision, including the reason for denial.

3.11.13 If an individual does not complete the continuing education required by this Part, the Department may revoke the individual’s work permit or suspend the work permit until such time as the education requirements are completed.

3.11.14 The Department may fine, suspend or revoke the work permit issued by the Department for a violation of any rules and/or regulations in this Part or any

disqualifying felony offense.

3.11.15 A medical cannabis work permit applicant or registered permit-holder aggrieved by a decision of the Department denying, suspending or revoking registration of a medical cannabis work permit or imposing a fine or other penalty, the applicant permit-holder may file an administrative appeal in writing with the Department within twenty (20) days of receipt of the initial notice of the decision. If an applicant permit-holder fails to appeal within twenty (20) days of receipt of the initial notice, the Department’s decision becomes final.

3.11.16 The hearing decision of the Department on the denial of an application for registration or renewal of a work permit, or the revocation or suspension of a work permit, is a final decision of the Department. Any person or entity aggrieved by a final decision of the Department under the provisions of this Part may petition for judicial review of the decision as provided in Miss. Code § 41-137-59.

Subpart 4 Operational & Recordkeeping Requirements 4.1 General. 4.1.1 All medical cannabis establishments, including cannabis testing facility laboratory operations, shall be physically located within the State of Mississippi.

4.1.2 Licensed medical cannabis establishments may produce and possess usable medical cannabis in an amount reasonably necessary to meet the demand for and needs of qualifying patients as demand and needs may be determined by the Department. At a minimum, the Department will utilize the following data sources to make such determinations: patient registry, medical cannabis establishment licensing data, and data produced by the statewide seed-to-sale system.

4.1.3 Cannabis processing entities that process edible cannabis products shall also comply with any and all Department regulations for Mississippi Food Manufacture and Sale with fees and inspection schedules associated with risk level 4 for the related manufactured food permit.

4.1.4 Commencement of Operations. Medical cannabis licensees shall notify the Department (in a format approved by the Department) of their intent to commence operations for which authority is granted by the licensure status, along with the date of the commencement. Notification to the Department shall include, but is not limited to: A. Verification of an operational alarm and video surveillance system meeting requirements in Rules 4.5.2 and 4.5.3; B. Verification of secure locks throughout the facility; C. Verification of implementation of biosecurity measures; D. Verification of access controls throughout the facility; E. Verification of initial inventory of cannabis and/or cannabis products; F. Verification of functional operation capacity; G. Verification of employment records (at the time); and, H. Verification of connection to the state’s seed-to-sale system.

4.1.5 A medical cannabis licensee that fails to maintain operations for any reason for more than six (6) months from the date of licensure after it has commenced business activities shall be notified in writing and given thirty (30) days from the date of notification from the Department to submit a written explanation why it so failed and, if it plans on continuing to operate as a licensee, a description of how it will correct the problem and prevent it from occurring again.

4.1.6 Licensed medical cannabis establishments shall only purchase, grow, cultivate, and use cannabis that is grown, cultivated, processed, and dispensed in this state. No medical cannabis that is grown, cultivated or processed in this state shall be transported outside of this state. No cannabis product shall be brought into the State of Mississippi for the purpose of converting, transforming, chemically engineering, or otherwise altering it into a compound or substance which would constitute cannabis and/or a cannabis product under this Part.

4.1.7 Medical cannabis establishments shall not acquire, possess, store, grow, cultivate, harvest, manufacture, produce, or transport cannabis or cannabis products for any person or entity other than those authorized by this Part.

4.2 Personnel. 4.2.1 An individual shall not begin work at a medical cannabis establishment until after he or she obtains a work permit license issued by the Department. An individual is required to renew his or her permit every five (5) years.

4.2.2 Medical cannabis establishments shall complete a criminal history background check on each employee to verify that the employee does not have a disqualifying felony.

4.2.3 Medical cannabis establishments shall ensure that any and all persons who are employed by, volunteer for, and/or engaged in activities or operations under the direction of the licensee are qualified to perform their assigned duties.

4.2.4 All employees of a medical cannabis establishment shall be entered into the state’s seed-to-sale system within seven (7) calendar days of employment by the licensed entity.

4.2.5 A cannabis testing entity shall not employ an individual who also is employed or has ownership at any other medical cannabis establishment other than a licensed cannabis transportation entity. Further, when a cannabis testing entity owns a transport entity or any part thereof, the transport entity cannot have any ownership that creates a conflict of interest.

4.2.6 Test samples shall only be collected and transported by qualified lab employees Test samples shall not be transported between facilities in the same vehicle at the same time as any other cannabis product (e.g. retail-ready cannabis products) due to the potential for cross-contamination.

4.2.7 Cannabis testing entities shall employ a full-time supervisor or management employee who shall be responsible for the following: A. Overseeing and directing the scientific methods of the cannabis testing facility; B. Ensuring that the cannabis testing facility achieves and maintains a cannabis

testing facility quality assurance program; and, C. Providing ongoing and appropriate training to cannabis testing facility employees. D. To be considered qualified, the supervisor or management employee shall have at minimum: 1. A doctoral degree in biological, chemical, agricultural, environmental, or related sciences from an accredited college or university; 2. A master’s degree in biological, chemical, agricultural, environmental, or related sciences from an accredited college or university, plus at least 2 years of full-time practical experience; 3. A bachelor’s degree in biological, chemical, agricultural, environmental, or related sciences from an accredited college or university, plus at least 4 years of full-time practical experience; or 4. A bachelor’s degree in any field from an accredited college or university, plus at least 8 years of full-time practical experience, four (4) years of which shall have been in a supervisory or management position.

4.2.8 Cannabis testing entities shall employ a full-time analyst who, at minimum shall have: A. Earned a master’s degree or a bachelor’s degree in biological, chemical, agricultural, environmental, or related sciences from an accredited college or university; or B. Completed two (2) years of college or university education that included coursework in biological, chemical, agricultural, environmental, or related sciences from an accredited college or university, plus at least 3 years of full- time practical experience; and C. Demonstrated the analyst’s ability to perform a preparation and/or analytical method through: 1. A documented training program that includes a training checklist that is signed by the trainer and the analyst; and 2. A documented attestation that the analyst has read and understands the methods Standard Operating Procedure. D. Demonstrated an initial display of competency prior to analyzing any compliance sample. An initial display of competency for a method includes: 1. Obtaining quality control samples from an outside source or preparing the

samples using stock standards that are prepared independently from those used in instrument calibration. 2. Preparing four (4) aliquots at the concentration specified, or if unspecified, to a concentration of one (1) to four (4) times the LOQ for low-concentration analytes either concurrently or over a period of days. For higher-concentration analytes (such as potency), the concentration may be greater than four (4) times the LOQ. 3. Analyzing the aliquots either concurrently or over a period of days. 4. Using all results, assess the results against established and documented method acceptance criteria. E. Complete a continuing demonstration of competency annually thereafter for all methods performed. One of the following options shall be performed and documented: 1. Another initial demonstration of competency (as described above), or 2. Participation in a proficiency test study offered by an ISO/IEC 17043 proficiency test provider (if available); or 3. Analysis of one (1) sample of clean matrix that is fortified with a known quantity of the target analyte, with the result compared to method acceptance criteria. F. If an analyst has not run a specific analysis within one calendar year, he or she shall successfully complete an initial display of competency for this analysis and shall not run such analysis until competency has been demonstrated. G. If a method Standard Operating Procedure is significantly amended, an analyst must be retrained on the procedure, and the training documented.

4.2.9 Cannabis testing facilities entities shall employ designated sample collector who, at minimum, shall have: 1. Documented attestation that the designated sample collector has read and understands the Sampling Standard Operating Procedure; 2. A documented sampling training program that includes principles, procedures, and policies of sampling and was provided by a qualified instructor who has demonstrated competency in performing the sampling methods referenced with all training documented on a training checklist for each sample matrix type that will be collected;

3. At least 8 hours of documented field training on various sampling techniques with a qualified instructor; 4. Documentation of an initial demonstration of capability (IDOC) through the comparison of replicate samples within a defined Relative Standard Deviation (%RSD) or the comparison of a sample collected to that of one collected by personnel with an existing IDOC within a defined RPD; 5. Thereafter, continuing demonstration of capability (CDOC) is required annually. The cannabis testing entity shall have a documented procedure for performing the CDOC. The cannabis testing entity shall retain documentation verifying CDOC for each designated sample collector and make this documentation available to the Department upon request; and, 6. If the Sampling SOP is significantly amended, all designated sample collectors shall be retrained on the procedure, and the training documented.

4.2.10 A cannabis testing entity must maintain a master of list of all controlled quality system documents and a signature log that includes the names, initials and signatures for all individuals who are responsible for signing or initialing any cannabis testing entity record.

4.2.11 Each licensed medical cannabis establishment is required to create an identification badge for its representatives/employees. This badge shall be conspicuously worn by all representatives /employees at all times while they are on the licensed premises or during transport of cannabis and/or cannabis products. Representatives/employees shall also maintain a copy of the Department issued work permit on their person while present at a medical cannabis establishment.

4.2.12 Within thirty (30) calendar days of the date of hire, licensed medical cannabis establishments shall ensure all employees are trained in at least the following for a minimum of eight (8) hours of initial training and five (5) hours of annual training: A. The rules and regulations contained in this Part; B. The use of security measures and controls that have been adopted by the facility for the prevention of diversion, inversion, theft, or loss of cannabis and/or cannabis products;

C. Proper use of the statewide seed-to-sale system; D. Response to an emergency, including severe weather, fire, natural disasters, and unauthorized intrusions; and, E. The facility’s safety and sanitation procedures.

4.2.13 Medical cannabis licensees shall take reasonable measures and precautions to ensure the following measures for personnel: A. Disease control. Any person who, by medical examination or supervisory observation, is shown to have, or appears to have, an illness, open lesion, including boils, sores, or infected wounds, or any other abnormal source of microbial contamination by which there is a reasonable possibility of cannabis, cannabis products, components, contact surfaces, or packaging materials becoming contaminated, shall be excluded from any operations which may be expected to result in such contamination until the condition is corrected, unless conditions such as open lesions, boils, and infected wounds are adequately covered (e.g., by an impermeable cover). Personnel shall be instructed to report such health conditions to their supervisors. B. Cleanliness. All persons working in direct contact with cannabis, cannabis products, components, contact surfaces, and packaging materials shall conform to hygienic practices while on duty to the extent necessary to protect against allergen cross-contact and against contamination of cannabis or cannabis products. The methods for maintaining cleanliness include: 1. Wearing outer garments suitable to the operation in a manner that protects against allergen cross-contact and against the contamination of cannabis, cannabis products, components, contact surfaces, or packaging materials; 2. Maintaining adequate personal cleanliness; 3. Washing hands thoroughly (and sanitizing if necessary to protect against contamination with undesirable microorganisms) in an adequate handwashing facility before starting work, after each absence from the workstation, and at any other time when the hands may have become soiled or contaminated; 4. Removing all unsecured jewelry and other objects that might fall into cannabis, cannabis products, components, equipment, or containers, and removing hand jewelry that cannot be adequately sanitized during periods in which cannabis, cannabis products, or components are manipulated by hand. If such hand jewelry cannot be removed, it may be covered by gloves or material which can be maintained in an intact, clean, and

sanitary condition and which effectively protects against the contamination by these objects of the cannabis, cannabis products, components, contact surfaces, or packaging materials; 5. Maintaining gloves, if they are used in handling cannabis, cannabis products, or components, in an intact, clean, and sanitary condition; 6. Wearing, where appropriate, in an effective manner, hair nets, headbands, caps, beard covers, or other effective hair restraints; 7. Storing clothing or other personal belongings in areas other than where cannabis, cannabis products, or components are exposed or where equipment or utensils are washed; 8. Confining the following to areas other than where cannabis, cannabis products, or components may be exposed or where equipment or utensils are washed: eating food, chewing gum, drinking beverages, or using tobacco; and 9. Taking any other necessary precautions to protect against allergen cross contact and against contamination of cannabis, cannabis products, components, contact surfaces, or packaging materials with microorganisms or foreign substances (including perspiration, hair, cosmetics, tobacco, chemicals, and medicines applied to the skin). C. Responsibility for ensuring compliance by individuals with the requirements of this subchapter shall be clearly assigned to supervisory personnel who have the education, training, or experience (or a combination thereof) necessary to supervise the production of clean and safe cannabis and/or cannabis products.

4.2.14 Licensees shall not permit the consumption of cannabis and/or cannabis products on its licensed premises or by employees during working hours.

4.2.15 Contractors and Other Authorized Visitors. A. Contractors and other authorized visitors permitted access to a licensee’s premises who will not handle cannabis plants, cannabis or cannabis products, including but not limited to electricians, plumbers, engineers and alarm technicians, do not require an individual identification card issued by the licensed medical cannabis establishment. B. A contractor may enter a limited access area only if wearing a visitor identification badge, signed in and recorded on a visitor entry log and

prevented from accessing cannabis plants, cannabis or cannabis products. 1. If the contractor is working in an area with immediate access to cannabis plants, cannabis or cannabis products, a licensee or employee shall supervise the contractor at all times. 2. If the contractor is working in an area in which locked doors, compartments or other physical security measures prevent the contractor from accessing cannabis plants, cannabis or cannabis products, a licensee or employee shall take reasonable precautions to ensure that the contractor remains in such areas and does not attempt to gain access to cannabis plants, cannabis or cannabis products. C. At all times while in a limited access area, the contractor shall display in a conspicuous place on their person a visitor identification badge. 1. The visitor identification badge shall display an identifying mark, which may be a clearly identifiable letter, number or symbol or combination thereof. 2. The visitor identification badge may be displayed on a sticker, a card on a lanyard, a card pinned to the clothing of the visitor, or by other effective means. D. A visitor entry log shall include, at a minimum: 1. The date and time of the visitor’s entry; 2. The date and time of the visitor’s departure; 3. The full name of the visitor; 4. The identifying number of the visitor’s state- or federally-issued identification; 5. The identifying mark on the visitor identification badge; 6. The individual identification card number of the person who will accompany the contractor, if required, while the contractor is in the limited access areas of the premises; and, 7. The purpose for which the contractor is accessing the limited access area(s). E. Any incident of noncompliance with the licensee’s authorized conduct that occurred while the contractor or visitor was in a limited access area of the premises shall be reported in writing to the Department within twenty-four (24) hours, including all information required by the visitor entry log.

4.3 Facility and Grounds. 4.3.1 Medical cannabis establishments may be located in any area in a municipality or county that is zoned as agricultural or industrial or for which agricultural or industrial use is otherwise authorized or not prohibited, provided that it being there does not violate any other provision of this Part.

4.3.2 Medical cannabis establishments may be located in any area in a municipality or county that is zoned as commercial or for which commercial use is otherwise authorized or not prohibited, provided that the municipality or county has authorized the entity to be located in such area and that it being there does not violate any other provision of this chapter. The municipality or county may authorize this by granting a variance to an existing zoning ordinance or by adopting a change in the zoning ordinance that allows for those entities to be located in specific commercial areas.

4.3.3 A municipality or county may require a medical cannabis establishment to obtain a local license, permit or registration to operate, and may charge a reasonable fee for the local license, permit or registration, provided that this fee is consistent with fees charged to businesses that are not involved in the cannabis industry.

4.3.4 No individuals may reside at the same address and/or live on the same property where a medical cannabis establishment is located. Should a prospective owner of a medical cannabis establishment reside on an adjoining property, a separate address for the medical cannabis establishment shall be obtained from the county (e.g., 123 County Road and 123 A County Road). The medical cannabis establishment shall have a separate, independent address from any residential premises.

4.4 Facility Construction and Design. 4.4.1 All commercial cannabis activities shall take place in indoor, enclosed, locked and secure facilities with controls over environmental conditions such as humidity, temperature, and light and that preclude unfiltered air exchange with the outdoors. Condition changes outside of the facility should not significantly alter or affect environmental conditions inside the facility Outdoor cultivation of

cannabis and processing of cannabis products are prohibited. “Home grow” of cannabis is prohibited.

4.4.2 Indoor, enclosed, and secure facilities. All operations and activities shall take place within a building or secure structure that meets all state and local electrical, fire, plumbing and building codes and specification(s) in addition to the following requirements: A. Has a complete roof enclosure supported by connecting permanent walls, constructed of solid materials extending from the ground to the roof; that: 1. Provides a sealed environment that prevents unfiltered air exchange with the outdoors; 2. Provides control over the environment (i.e., temperature, humidity, light, carbon dioxide levels, etc.); and, 3. Protects commercial cannabis activities from all external elements; B. Is secure against unauthorized entry; C. Has a foundation, slab, or equivalent base to which the floor is securely attached; D. Has commercial-grade door locks on all external doors that are locked at all times; E. Restricts access to only authorized personnel to locked and secure areas identified with signage and daily records of entry and exit; F. Plumbing is adequate to carry sufficient quantities of water to locations through the facility and convey sewage and waste from the facility without cross-contamination of potable water and waste; G. Water supplies should be sufficient for commercial cannabis activities; H. Toxic cleaning compounds, sanitizing agents, solvents, and pesticides shall be identified and stored in a manner that is in accordance with applicable local, state or federal law, rule, or regulation; and, I. A pest control management plan shall be implemented on the premises; J. Biosecurity measures shall be implemented and adhered to at all times.

4.4.3 Cannabis facilities shall be constructed in such a manner that: A. Ensure floors, walls, and ceilings may be adequately cleaned, kept clean, and

kept in good repair; B. Prevent drip or condensate from fixtures, ducts, and pipes from contaminating cannabis, cannabis products, components, contact surfaces, or packaging materials; and C. Ensure Aisles or working spaces are provided between equipment and walls and are adequately unobstructed and of adequate width to permit employees to perform their duties and to protect against contaminating cannabis, cannabis products, components, contact surfaces, or packaging materials with clothing or personal contact; D. Provide adequate lighting in hand-washing areas, dressing and locker rooms, and toilet rooms and in all areas where cannabis, cannabis products, or components are examined, produced, packed, or stored and where equipment or utensils are cleaned; E. Provide shatter-resistant light bulbs, fixtures, skylights, or other glass suspended over exposed cannabis, cannabis products, or components in any step of preparation, or otherwise protect against contamination in case of glass breakage; F. Provide adequate ventilation or control equipment to minimize dust, odors, and vapors (including steam and noxious fumes) in areas where they may cause allergen cross contact or contaminate cannabis, cannabis products, or components; G. Ensure fans and other air blowing equipment are located and operate in a manner that minimizes the potential for allergen cross-contact and for contaminating cannabis, cannabis products, components, contact surfaces, and packaging materials; and, H. Provide adequate screening or other protection against pests.

4.4.4 The perimeter of all licensed medical cannabis establishments shall be designed and maintained to discourage theft and diversion of cannabis and/or cannabis products. In addition to any local zoning requirements, all cannabis licensees shall: 1. Maintain adequate lighting to facilitate video surveillance at all times (24 hours per day/7 days per week); 2. Have landscaping that prevents the concealment of any person(s) from sight or video surveillance;

3. Have fencing that ensures secure perimeter access and points of entry onto the premises including but not limited to around the grounds and that all stages of commercial cannabis activities are inaccessible to and hidden from view of the public. Licensed testing entities are exempt from this requirement. 4. Post signage in a conspicuous location at each entrance of the cannabis cultivation facility that reads “PERSONS UNDER 21 YEARS OF AGE NOT PERMITTED ON THESE PREMISES”; and, 5. Post signage in a conspicuous location at each entrance of the cannabis facility that reads “THESE PREMISES ARE UNDER CONSTANT VIDEO SURVEILLANCE”.

4.4.5 Cannabis cultivation licensees shall maintain physical access to their stock of cannabis plant(s) for safe and easy observation and inventory of each plant group. Aisles shall be open and accessible so as to allow inspection of the plants by the Department and shall provide a safe means for access and viewing of plants if plants are located/placed on an upper rack.

4.4.6 Separation of Functions. If a medical cannabis establishment is licensed as a cultivation entity and processing entity with both functions in the same physical space, there shall be physical separation between the two by connecting permanent walls, constructed of solid materials extending from the ground to the roof with separate means of entrance and exit.

4.5 Security and Surveillance. 4.5.1 Licensees shall designate a security manager with responsibility for overall facility security to include, but not limited to: adherence to security requirements; conducting semiannual audits of security measures to identify areas of needed improvements/corrective actions; employee training on security measures and controls; and, prevention of diversion/theft of cannabis and/or cannabis products.

4.5.2 Alarm Systems. All licensees and locations shall have alarm systems that meet the following: 1. Upon unauthorized entry, or attempted unauthorized entry, the alarm system shall transmit a signal directly to a central protection company or a law

enforcement agency that has legal authority to respond. A designated employee of the licensee shall also be notified; 2. Provide continuous, uninterrupted coverage (24 hours/7 days) for all points of ingress and egress to the facility, including without limitation doorways, windows, loading areas; 3. Provide continuous, uninterrupted coverage (24 hours/7 days) of any room with an exterior wall, any room containing cannabis (of any type or stage of growth) and any room used for cannabis production operations and activities of any type; 4. Be equipped with failure notification systems to notify the licensee and law enforcement of any failure in the alarm system; and, 5. Have the ability to remain operational during a power outage.

4.5.3 Video Surveillance. All licensees and locations shall have video surveillance that meets the following: 1. Provide continuous, uninterrupted coverage (24 hours/7 days) for all points of ingress and egress to the facility, including without limitation doorways, windows, loading areas, and parking areas; 2. Provide continuous, uninterrupted coverage (24 hours/7 days) of any room with an exterior wall, any room containing cannabis (of any type or stage of growth), and any room used for cannabis production operations and activities of any type; 3. Digital archiving capabilities for a minimum of (120) days; 4. On-site and off-site monitoring capabilities; 5. At least one on-site display monitor, of at least twelve inches, connected to the system at all times shall be available; 6. Have the date and time embedded on all surveillance recordings without significantly obscuring the picture; and, 7. Use cameras that are capable of recording in both high and low lighting conditions. 8. Have the ability to remain operational during a power outage. 9. Licensing entities should undertake a vulnerability assessment of their standby power systems, to include: all system components and hazards likely to impact the facility, conduct a detailed accounting of what electrical devices are and are not supplied by the backup power, identify systems that should

not go down during a power outage event. 10. Licensees should have a backup power system/generator for backup power supply for up to a minimum of forty-eight (48) hours for portions of the facility that should be supplied with standby power during a power interruption. Licensees should have a safe and secure location for a digital backup archiving system in the facility located in a locked and secure area to prevent any unauthorized access or theft of video/recording system monitors or video footage.

4.5.4 Upon request, licensees shall make all information related to security alarm systems and video surveillance, monitoring, and recordings available to the Department within the timeframe requested.

4.5.5 Licensed medical cannabis establishments shall notify local law enforcement and the Department of any theft, robbery, break-in, or security breach that occurs on the premises, no later than twenty-four (24) hours after the licensee first becomes aware of the event. Notice to the Department shall include at minimum a description of any property that was stolen or destroyed, and the quantity of any usable cannabis that was stolen.

4.6 Health and Safety Standards. 4.6.1 General. A. Each licensee shall ensure that all cannabis and cannabis products it dispenses are safe for use or consumption by registered patient cardholders. B. Each licensee shall comply with State and county health, safety, and sanitation laws and regulations and will be subject to unannounced inspections to confirm that no health or safety concerns are present which may contaminate the cannabis or cannabis products.

4.6.2 General Sanitation Requirements. All medical cannabis establishment licensees shall maintain sanitary conditions at their respective facilities and locations that include the following: 1. Any employee who, by medical examination or supervisory observation, is shown to have, or appears to have, an illness, open lesion, including boils, sores, or infected wounds, or any other abnormal source of microbial

contamination for whom there is a reasonable possibility of contact with cannabis and/or cannabis products shall be excluded from any operations which may be expected to result in such contamination until the condition is resolved. 2. Hand-washing areas that are adequate and convenient to employees. Hand washing or sanitizing areas shall include running water at a suitable temperature and a sanitary towel service or suitable drying device. 3. Any person working in direct contact with cannabis and/or cannabis products shall: 1. Maintain adequate personal cleanliness; 2. Wash hands and exposed portions of his or her arms thoroughly in an adequate hand-washing area before starting work and at any other time when the hands may have become soiled or contaminated, including but not limited to: a. Any time after handling possibly soiled equipment or utensils; b. After leaving the initial room in which he or she was working, and before resuming work in any room, including the initial room; D. Litter and waste shall be properly removed so they do not contribute to potential sources of contamination in areas where cannabis plants or products are located; E. Floors, walls, and ceilings shall be adequately cleaned and kept in good repair; and, F. There shall be adequate screen or other protection against the entry of pests.

4.6.3 Sanitary Operations. A. General maintenance. Buildings, fixtures, and other physical facilities shall be maintained in a clean and sanitary condition and shall be kept in repair adequate to prevent cannabis or cannabis products from becoming contaminated. Cleaning and sanitizing of utensils and equipment shall be conducted in a manner that protects against allergen cross-contact and against contamination of cannabis, cannabis products, components, contact surfaces, or packaging materials. B. Substances used in cleaning and sanitizing; storage of toxic materials. Cleaning compounds and sanitizing agents used in cleaning and sanitizing procedures shall be free from undesirable microorganisms and shall be safe

and adequate under the conditions of use. Compliance with this requirement may be verified by any effective means, including purchase of these substances under a letter of guarantee or certification or examination of these substances for contamination. Only the following toxic materials may be used or stored in a medical cannabis production center: 1. Those required to maintain clean and sanitary conditions; 2. Those necessary for use in laboratory testing procedures; 3. Those necessary for facility and equipment maintenance and operation; and, 4. Those necessary for use in the facility’s operations. C. Toxic cleaning compounds, sanitizing agents, and pesticide chemicals shall be identified and stored in a manner that protects against contamination of cannabis, cannabis products, components, contact surfaces, or packaging materials. D. Pest control. Pests shall not be allowed in any area of a production center. Guard, guide, or pest-detecting dogs may be allowed in some areas of a production center if the presence of the dogs is unlikely to result in contamination of cannabis, cannabis products, components, contact surfaces, or packaging materials. Effective measures shall be taken to exclude pests from the production and storage areas and to protect against the contamination of cannabis, cannabis products, or components on the premises by pests. The use of pesticides to control pests in the production center is permitted only under precautions and restrictions that will protect against the contamination of cannabis, cannabis products, components, contact surfaces, and packaging materials. E. Sanitation of contact surfaces. All contact surfaces, including utensils and contact surfaces of equipment, shall be cleaned as frequently as necessary to protect against allergen cross-contact and against contamination of cannabis, cannabis products, or components. 1. Contact surfaces used for producing and storing cannabis or low-moisture cannabis products or components shall be in a clean, dry, sanitary condition before use. When the surfaces are wet cleaned, they shall, when necessary, be sanitized and thoroughly dried before subsequent use. 2. In wet processing, when cleaning is necessary to protect against allergen cross contact or the introduction of microorganisms into cannabis, cannabis products, or components, all contact surfaces shall be cleaned and sanitized before use and after any interruption during which the

contact surfaces may have become contaminated. Where equipment and utensils are used in a continuous production operation, the utensils and contact surfaces of the equipment shall be cleaned and sanitized as necessary. 3. Single-service articles (such as utensils intended for one-time use, paper cups, and paper towels) shall be stored, handled, and disposed of in a manner that protects against allergen cross-contact and against contamination of cannabis, cannabis products, components, contact surfaces, or packaging materials. F. Sanitation of non-contact surfaces. Noncontact surfaces of equipment used in the operation of a production center shall be cleaned in a manner and as frequently as necessary to protect against allergen cross-contact and against contamination of cannabis, cannabis products, components, contact surfaces, and packaging materials. G. Storage and handling of cleaned portable equipment and utensils. Cleaned and sanitized portable equipment with contact surfaces and utensils shall be stored in a location and manner that protects contact surfaces from allergen cross-contact and from contamination.

4.6.4 Sanitary Facilities and Controls. Each medical cannabis establishment shall be equipped with adequate sanitary facilities and accommodations including: A. Water supply. The water supply shall be adequate for the operations intended and shall be derived from an adequate source. Any water that contacts cannabis, cannabis products, components, contact surfaces, or packaging materials shall be safe and of adequate sanitary quality. Running water at a suitable temperature, and under pressure as needed, shall be provided in all areas where required for the production of cannabis and cannabis products, for the cleaning of equipment, utensils, and packaging materials, or for employee sanitary facilities; B. Plumbing. Plumbing shall be of adequate size and design and adequately installed and maintained to: 1. Carry adequate quantities of water to required locations throughout the facility; 2. Properly convey sewage and liquid disposable waste from the facility; 3. Avoid constituting a source of contamination to cannabis, cannabis products, components, water supplies, equipment, or utensils or creating

an unsanitary condition; 4. Provide adequate floor drainage in all areas where floors are subject to flooding-type cleaning or where normal operations release or discharge water or other liquid waste on the floor; and 5. Provide that there is not backflow from, or cross-connection between, piping systems that discharge wastewater or sewage and piping systems that carry water for cannabis or cannabis product production; C. Sewage disposal. Sewage shall be disposed of into an adequate sewerage system or disposed of through other adequate means; D. Toilet facilities. Licensees shall provide employees with adequate, readily accessible toilet facilities. Toilet facilities shall be kept clean and shall not be a potential source of contamination of cannabis, cannabis products, components, contact surfaces, or packaging materials; E. Hand-washing facilities. Licensees shall provide hand-washing facilities designed to ensure that an employee’s hands are not a source of contamination of cannabis, cannabis products, components, contact surfaces, or packaging materials, by providing facilities that are adequate, convenient, and furnish running water at a suitable temperature; and rubbish disposal. Rubbish shall be so conveyed, stored, and disposed of as to minimize the development of odor, minimize the potential for the waste becoming an attractant and harborage or breeding place for pests, and protect against contamination of cannabis, cannabis products, components, contact surfaces, packaging materials, water supplies, and ground surfaces.

4.6.5 Each production area designated and/or used for commercial cannabis activities shall be maintained free of debris.

4.6.6 Potable water sources shall be utilized in processing/ manufacturing of cannabis and/or cannabis products.

4.7 Extraction/Processing. 4.7.1 Cannabis processing licensees may utilize chemical extraction processes using a nonhydrocarbon-based, or other solvent such as water, vegetable glycerin, vegetable oils, animal fats, steam distillation, food-grade ethanol. Nonhydrocarbon-based solvents shall be food grade.

4.7.2 Cannabis processing licensees may use chemical extraction processes using hydrocarbon-based solvents that are at least ninety-nine percent (99%) purity.

4.7.3 Extraction processes shall take place in an environment with proper ventilation, controlling all sources of ignition where a flammable atmosphere is, or could be, present.

4.7.4 Cannabis processing licensees are prohibited from using pressurized canned flammable fuel such as butane intended for use in outdoor/camp like activities, handheld torch devise, refillable cigarette letters, etc.

4.7.5 Cannabis processing licensees using carbon dioxide shall have equipment and facilities approved by local fire code officials, if applicable.

4.7.6 Manufacturing processes using flammable gas or flammable liquid shall have leak or gas detection measures, or both.

4.8 Storage of Cannabis and/or Cannabis Products. 4.8.1 Storage of cannabis, cannabis products, and components shall be under conditions that will protect against allergen cross-contact and against biological, chemical (including radiological), and physical contamination of cannabis, cannabis products, or components as well as against deterioration of the cannabis, cannabis product, or component and the container.

4.9 General Recordkeeping Requirements. 4.9.1 Medical cannabis establishments shall participate in and utilize the state’s seed- to-sale system for inventory control and tracking purposes. All associated costs for their participation are the financial responsibility of the medical cannabis establishments.

4.9.2 Medical cannabis establishments are required to maintain the following for a minimum period of five (5) years:

1. All books and records necessary to fully account for each business transaction conducted under its license; 2. A copy of each transportation manifest for each transport of cannabis and/or cannabis products shall be maintained (a separate license as a cannabis transportation entity is required if cannabis is being transported); 3. Employment records; 4. Record of all pesticides and chemical applications to cannabis and/or cannabis products; and, 5. Records of any theft, loss, or other unaccountability of any cannabis and/or cannabis products.

4.9.3 Records of all pesticides and chemical applications to cannabis plants and/or cannabis products shall include the following: 1. The date of application; 2. The name of the individual making the application; 3. The product that was applied; 4. The section, including the square footage, that receives the application; 5. The amount of product that was applied; and, 6. A copy of the label of the product that was applied.

4.9.4 All records shall be maintained on-site or electronically (virtually) and available for Department review at the address of the licensee.

4.9.5 All cannabis plants, cannabis and cannabis products shall be physically inventoried on a weekly basis and records maintained for a minimum of five (5) years. Any removal, including but not limited to disposal or destruction, of cannabis plants, cannabis or cannabis products shall be recorded.

4.10 Employment Records. 4.10.1 A medical cannabis establishment shall keep an individual employment record for all employees, including, but not limited to: 1. Full legal name and any nicknames;

2. Detailed job description; 3. Record of all training received or acquired by the employee; 4. Dates of employment; 5. Records of days and hours worked; 6. Records of time worked; and, 7. Any disciplinary actions taken.

4.10.2 Employment records shall be maintained, either electronically or in hard copy, for at least five (5) years after the employee’s last date of employment with the cannabis cultivation facility.

4.10.3 Licensees shall ensure, document, and provide to the Department upon request, documentation that each medical cannabis establishment representative, as defined by this Part, meets the requirements of the Mississippi Medical Cannabis Act, and Department regulations.

4.11 Statewide Seed-to-Sale System and Inventory Control. 4.11.1 Licensees shall use the Department-designated seed-to-sale system directly for inventory tracking or may use an approved third-party integrator for interface into the Department-designated seed-to-sale system.

4.11.2 Licensees shall identify an employee with primary responsibility for seed-to-sale tracking (e.g., seed-to-sale system administrator).

4.11.3 Licensees shall ensure that all reporting into the Department approved statewide seed-to-sale system is clear, accurate, and transparent.

4.11.4 Licensees shall ensure its inventories are properly tagged and labeled in any manner which is compatible with the state seed-to-sale tracking program for tracking purposes and such tags may include bar codes, RFID tags, NFC tags, or other equivalent system for assigning unique numbers to cannabis plants, products, and packages:

A. Tags shall contain the legal name and correct license number of the licensed medical cannabis establishment. B. Prior to a cannabis plant reaching a point where it is able to support the weight of a tag (8 inches in height), a tag may be securely fastened to the stalk or other similarly situated position approved by the Department. The tag shall remain affixed for the entire life of the plant until disposal. C. Cannabis shall be continuously and properly tagged (individually or as packages) at all stages of production, including all cultivation phases and/or production steps. D. Mother plants shall be tagged before any cuttings or clones are generated therefrom. Cuttings or clones taken from the mother plant for a plant batch shall be recorded in the state seed-to-sale program as being derived from that mother plant’s tag. E. If a tag is destroyed, stolen, or falls off of a cannabis plant or package, the licensee shall ensure a new tag is placed on the cannabis plant or package and the change is properly reflected in the State seed-to-sale system. F. Licensees shall not reuse any tags that have already been affixed to any cannabis plant or cannabis products. G. Each wholesale package of cannabis and/or cannabis products shall have a tag during storage and transfer and may only contain one batch of cannabis and/or cannabis products. This is inclusive of packages awaiting testing. H. Prior to transfer, licensees shall ensure that each immature plant batch is assigned a package tag in accordance with seed-to-sale system protocol and the rules in this Part. I. Licensees’ inventory shall have a tag properly affixed to all cannabis and/or cannabis products during storage and transfer in one of the following manners: A. Individual units of cannabis product(s) shall be individually affixed with a tag; B. Cannabis products may only be combined in a single wholesale package using one tag if all units are from the same production batch. C. If any cannabis and/or cannabis products are removed from a wholesale package, each individual unit or new wholesale package shall be separately tagged.

4.11.5 All locations related to the commercial production of cannabis and cannabis products shall be distinguishable in the statewide seed-to-sale system. Locations identified in the system shall be designed and labeled in accordance with the licensee’s approved site plan and in a manner that identifies the position of inventory within the facility at all times.

Subpart 5 PRODUCT TESTING AND SAFETY 5.1 General. 5.1.1 Cannabis testing entities shall test for cannabis-related analytes for which they are licensed and registered by the Department.

5.1.2 Cannabis testing entities shall develop and implement an employee training program to ensure competency of cannabis testing entity employees for their assigned function and shall document each employee’s qualifications.

5.1.3 Licensees shall not treat or otherwise adulterate a cannabinoid product, concentrate, cannabinoid extract, or extract with any non-cannabinoid additive that would increase potency, toxicity or addictive potential, or that would create an unsafe combination, with caffeine or other chemical that may increase carcinogenicity or cardiac effects.

5.1.4 All edible cannabis products shall be homogenized to ensure uniform disbursement of cannabinoids throughout the product(s).

5.1.5 Every medical cannabis establishment licensee shall comply with the testing requirements for cannabis and cannabis products in this Part.

5.2 Batch Requirements. 5.2.1 A medical cannabis establishment shall separate each harvest batch of usable medical cannabis into no larger than twenty-five pound (25 lb) harvest batch packages for testing purposes.

5.2.2 Notwithstanding Rule 5.2.1 of this section, a medical cannabis establishment may combine harvest batch packages for purposes of test sampling if intended for use by a licensed processing entity to make a cannabinoid concentrate or extract

5.2.3 A medical cannabis establishment may not combine harvest batch packages for purposes of sampling and testing for THC or CBD.

5.2.4 A medical cannabis establishment shall assign each harvest and production batch a unique batch number as defined in this Part and that unique batch number shall be: A. Documented and maintained in the licensee’s records for at least two years and available to the Department upon request; B. Provided to the individual responsible for taking samples; and C. Included on the batch label.

5.3 Sample Size, Handling, Storage and Disposal. 5.3.1 An employee of a licensed testing facility will obtain and analyze test samples only from usable medical cannabis. Cannabis products shall be sampled and tested in final form in accordance with the rules in this Part.

5.3.2 Sampling shall be conducted on-site at the cannabis cultivation or processing entity. Testing entity personnel shall have access to the entire batch for the purposes of sampling.

5.3.3 Sampling Requirements for Mandatory Testing. A. All samples must be collected, stored, and transported in a way that mitigates contamination and degradation. B. Sampling of each harvest batch or production batch shall be conducted with representative samples such that there is assurance that all harvest or process lots are adequately assessed for contaminants and that the cannabinoid profile is consistent throughout.

C. For mandatory harvest/production batch sampling, the total batch weight or count to be sampled shall be verified by the testing licensee. A testing licensee shall not pull samples for mandatory testing if there is reasonable belief the full batch is not present for sampling. D. A representative sample shall be taken from each container or area holding the harvest/production batch, from the top, middle, and bottom of the total contents. E. The sampling shall be video-recorded, with the batch number stated verbally or in writing on the video at the beginning of the video and a visible time and date indication on the video recording footage. A facility employee must be present but not involved nor assisting with the sampling. The video recordings shall be maintained for 90 calendar days.

5.3.4 The maximum harvest batch package is twenty-five pounds (25 lbs). For harvest batch sampling a licensed testing entity shall take a minimum of fifteen (15) sample increments of half a gram (0.5 g) each. Additional increments may be collected to ensure that the samples obtained are representative and sufficient to perform required testing.

5.3.5 The production batch for infused cannabis products (edible, non-edible liquids, non-edible solids) shall not contain more than 150,000 units. For infused and edible cannabis products, the test sample collected by a licensed testing entity for product testing shall comply with the minimum number of units set forth below based upon the production batch size. Additional increments may be collected to ensure that the samples obtained are representative. A. 3 units for a production batch of up to 100 units. B. 6 units for a production batch of 101 to 500 units. C. 9 units for a production batch of 501 to 1000 units. D. 12 units for a production batch of 1001 to 5000 units. E. 15 units for a production batch of 5001 to 10,000 units. F. 20 units for a production batch 10,001 to 35,000 units. G. 30 units for a production batch of 35,001 to 100,000 units. H. 50 units for a production batch of 100,001 to 150,000 units.

5.3.6 For a cannabis concentrate, each sample increment taken by a licensed testing entity for product testing shall be one-quarter gram (0.25 g). The test sample collected by a licensed testing entity for product testing shall comply with the minimum number of increments set forth below based upon the production batch size. Additional increments may be collected to ensure that the samples obtained are representative. A. 12 increments for a production batch of 1 to 2 pounds. B. 15 increments for a production batch of 2.01 to 3 pounds. C. 18 increments for a production batch of 3.01 to 4 pounds. D. 23 increments for a production batch of 4.01 to 10 pounds. E. 30 increments for a production batch greater than 10 pounds.

5.3.7 A production batch of raw or infused pre-rolls shall contain no more than 150,000 units. The test sample collected by a licensed testing entity for product testing shall comply with the minimum number of increments relative to the batch size as set forth below. Additional increments may be collected at the discretion of the licensed testing entity to ensure that the samples obtained are representative. Each sample increment consists of one packaged unit. A. 2 units for a production batch of up to 50 units. B. 3 units for a production batch of 51 to 100 units. C. 4 units for a production batch of 101 to 500 units. D. 8 units for a production batch of 501 to 1500 units. E. 12 units for a production batch of 1501 to 3000 units. F. 20 units for a production batch of 3001 to 10,000 units. G. 30 units for a production batch of 10,001 units- 35,000 units. H. 50 units for a production batch of 35,001 units – 150,000 units.

5.3.8 A production batch of inhalable concentrate products shall contain no more than 150,000 units. The test sample collected by a licensed testing entity for product testing shall comply with the minimum number of increments relative to the batch size as set forth below. Additional increments may be collected at the discretion of the licensed testing entity to ensure that the samples obtained are representative. Each sample increment consists of one packaged unit.

A. 2 units for a production batch of up to 50 units. B. 3 units for a production batch of 51 to 100 units. C. 4 units for a production batch of 101 to 500 units. D. 8 units for a production batch of 501 to 1500 units. E. 12 units for a production batch of 1501 to 3000 units. F. 20 units for a production batch of 3001 to 10,000 units. G. 30 units for a production batch of 10,001 units- 35,000 units. H. 50 units for a production batch of 35,001 units – 150,000 units.

5.3.9 A licensed testing entity shall not do any of the following: A. Desiccate samples; B. Test compliance samples without homogenization where required by the rules in this Part; or C. Select only the most desirable material from a batch or sample for testing; or D. Manipulate samples in any way that would alter the sample integrity or homogeneity of the sample. All sample increments must have the same genesis.

5.3.10 Only qualified employees/representatives of a licensed testing entity may collect and transport test samples and shall follow the testing entity’s accredited sampling and transportation policies and procedure when collecting samples for testing. A. A licensed testing entity shall prepare medical cannabis sampling policies and procedures that contain all of the information necessary for collecting and transporting samples from usable medical cannabis in a manner that does not endanger the integrity of the sample for any analysis required by this rule. These policies and procedures shall be appropriate to the matrix being sampled. B. Care shall be taken to avoid contamination of the non-sampled material. Sample containers shall be free of analytes of interest and appropriate for the analyses requested. C. A sufficient sample size shall be taken for analysis of all requested tests and

the quality control performed by the testing laboratory for these tests. D. A licensed testing entity shall comply with any recording requirements for samples and subsamples in the policies and procedures and at a minimum: 1. Record the location of each sample and subsample taken. 2. Subsamples collected from the same batch shall be combined into a single sample by a laboratory prior to testing. 3. Subsamples and samples collected from different batches may not be combined. 4. Field duplicates may not be combined with the primary samples. 5. Assign a field identification number for each sample, subsample and field duplicate that have an unequivocal link to the laboratory identification number. 6. Assign a unique identification number for each test batch. 7. Have a documented system for uniquely identifying the samples to be tested to ensure there can be no confusion regarding the identity of such samples at any time. This system shall include identification for all samples, subsamples, preservations, sample containers, tests, and subsequent extracts or digestates. 8. Place the licensed testing entity identification code as a durable mark on each sample container. 9. Enter a unique sample identification number into the laboratory records. This number shall be the link that associates the sample with related laboratory activities such as sample preparation. In cases where the sample collector and analyst are the same individual, or the laboratory pre-assigns numbers to sample containers, the unique identification number may be the same as the field identification code. E. The test sample(s) shall be transported in one or more sealed containers and not be accessible while in transit. F. The vehicle a testing facility employee uses to transport medical cannabis test samples shall not bear markings or other indication that it is carrying cannabis or a cannabis product. G. All test samples shall be transported by a qualified employee of a licensed testing facility and shall not be transported in the same vehicle as other products. H. An employee of the medical cannabis establishment from which a test sample

is being collected shall be physically present to observe the testing facility employee collect the test sample and ensure that the sample increments are taken from throughout the batch. I. No employee of the medical cannabis establishment from which a test sample is being collected shall assist the testing facility employee nor touch the harvest and/or production batch package or sampling equipment while the testing facility employee is obtaining the test sample. J. After test samples have been selected, both the employee of the medical cannabis establishment having the test samples collected and the employee of the testing facility shall sign and date the chain of custody form, attesting to the following sample information: 1. Product name; 2. Weight of product; 3. All products and test samples are correctly identified in the statewide seed-to-sale system; and, 4. If the test sample is obtained for a retest, the testing facility confirms that it is not accepting a test sample that is prohibited from being retested. K. The medical cannabis establishment from which the test sample is collected shall enter in the statewide seed-to-sale system the test sample that is collected by a licensed testing facility, including the date and time the test sample is collected and transferred. L. When a test sample is collected from a medical cannabis establishment for testing, that licensee shall quarantine the product that is undergoing the testing from any other product at the facility. The quarantined product may not be packaged, transferred, or sold until passing test results are entered into the statewide monitoring system. M. Any cannabis or cannabis product collected for testing shall not be transferred or sold to any person or entity other than the licensee from whom the sample was collected. This provision does not apply to a testing facility that engages another testing facility to perform certain safety tests on a subcontracted basis. N. A testing facility may collect additional sample material from the same licensee from which the original sample was collected for the purposes of completing the required safety tests as long as the requirements of this Rule are met.

5.3.11 An approved testing entity shall store each test sample under the appropriate conditions to protect the physical and chemical integrity of the sample. A. Analyzed test samples consisting of cannabis or cannabis-derived product shall be appropriately segregated, controlled, and held in a controlled access area pending destruction or other disposal. B. Any portion of a cannabis or cannabis-derived test sample that is not destroyed during analysis shall be: 1. Returned to the licensed producer who provided the sample under chain of custody; or 2. Destroyed in accordance with the disposal requirements of this Part.

5.3.12 A testing entity shall maintain the documentation required in these rules for at least five years and shall provide that information to the Department upon request.

5.4 Testing Requirements and Standards. 5.4.1 Testing Requirements for Cannabis and Cannabis Products. A. All sample increments collected must be homogenized prior to sample analyses, notwithstanding foreign material testing. B. Every harvest batch of cannabis flower shall be tested for the following prior to sale or distribution to a qualified patient or caregiver: 1. Pesticides in accordance with Rule 5.4.3 of this Part; 2. Water activity and moisture content in accordance with Rule 5.4.5 of this Part; 3. THC and CBD concentration in accordance with Rule 5.4.6 of this Part; 4. Heavy Metals in accordance with Rule 5.4.7 of this Part; 5. Mycotoxins in accordance with Rule 5.4.8 of this Part; 6. Microbiological contaminants in accordance with Rule 5.4.2 of this Part; 7. Terpenes, if performed, in accordance with Rule 5.4.9 of this Part; 8. Foreign material in accordance with Rule 5.4.10 of this Part. C. Every production batch of raw pre-rolls shall be tested in the final form intended for sale or distribution to a qualified patient or caregiver, for the

following prior to sale or transfer: 1. Pesticides in accordance with Rule 5.4.3 of this Part; 2. Water activity and moisture content in accordance with Rule 5.4.5 of this Part; 3. THC and CBD concentration in accordance with Rule 5.4.6 of this Part; 4. Heavy Metals in accordance with Rule 5.4.7 of this Part; 5. Mycotoxins in accordance with Rule 5.4.8 of this Part; 6. Microbiological contaminants in accordance with Rule 5.4.2 of this Part; 7. Terpenes, if performed, in accordance with Rule 5.4.9 of this Part; 8. Foreign material in accordance with Rule 5.4.10 of this Part. D. Every production batch of cannabinoid concentrate, and extract shall be tested in the final form intended for sale or distribution to a qualified patient or caregiver for the following prior to sale or transfer: 1. Pesticides in accordance with Rule 5.4.3 of this Part; 2. Water activity and moisture content in accordance with Rule 5.4.5 of this Part; 3. THC and CBD concentration in accordance with Rule 5.4.6 of this Part; 4. Heavy Metals in accordance with Rule 5.4.7 of this Part; 5. Mycotoxins in accordance with Rule 5.4.8 of this Part; 6. Microbiological contaminants in accordance with Rule 5.4.2 of this Part; 7. Terpenes, if performed, in accordance with Rule 5.4.9 of this Part; 8. Foreign material in accordance with Rule 5.4.10 of this Part. 9. A processing entity is exempt from testing concentrates for solvents under this Rule if the processing entity: a. Did not use any solvent listed in Appendix A, Table 2 1; and, b. Solvents in Used a mechanical extraction process to separate cannabinoids from the cannabis; or c. Used only water, animal fat or vegetable oil as a solvent to separate the cannabinoids from the cannabis. E. Every production batch of infused cannabis products shall be tested in the final form intended for sale or distribution to a qualified patient or caregiver for the following prior to sale or transfer:

1. Pesticides in accordance with Rule 5.4.3 of this Part; 2. Water activity and moisture content in accordance with Rule 5.4.5 of this Part; 3. THC and CBD concentration in accordance with Rule 5.4.6 of this Part; 4. Heavy Metals in accordance with Rule 5.4.7 of this Part; 5. Mycotoxins in accordance with Rule 5.4.8 of this Part; 6. Microbiological contaminants in accordance with Rule 5.4.2 of this Part; 7. Terpenes, if performed, in accordance with Rule 5.4.9 of this Part; 8. Foreign material in accordance with Rule 5.4.10 of this Part; and 9. Homogeneity. 10. Final form edible cannabis products shall meet the following additional requirements: a. Produced and sold with a standardized concentration of cannabinoids not to exceed ten milligrams (10 mg) of total tetrahydrocannabinol (THC) per serving with an allowable variance of ±10% when testing. b. Must demonstrate uniform disbursement of cannabinoids throughout the product when sampled and tested. 11. Infused non-edible products and beverages are exempt from water activity and moisture content testing. F. Every production batch of Kief shall be tested in the final form intended for sale or distribution to a qualified patient or caregiver for the following prior to sale or transfer: 1. Pesticides in accordance with Rule 5.4.3 of this Part; 2. Water activity and moisture content in accordance with Rule 5.4.5 of this Part; 3. THC and CBD concentration in accordance with Rule 5.4.6 of this Part; 4. Heavy Metals in accordance with Rule 5.4.7 of this Part; 5. Mycotoxins in accordance with Rule 5.4.8 of this Part; 6. Microbiological contaminants in accordance with Rule 5.4.2 of this Part; 7. Terpenes, if performed, in accordance with Rule 5.4.9 of this Part; and 8. Foreign material in accordance with Rule 5.4.10 of this Part; and G. Every production batch of infused pre-rolls and inhalable compound

concentrate products shall be tested in the final form intended for sale or distribution to a qualified patient or caregiver for the following prior to sale or transfer: 1. Pesticides in accordance with Rule 5.4.3 of this Part; 2. Water activity and moisture content in accordance with Rule 5.4.5 of this Part; 3. THC and CBD concentration in accordance with Rule 5.4.6 of this Part; 4. Heavy Metals in accordance with Rule 5.4.7 of this Part; 5. Mycotoxins in accordance with Rule 5.4.8 of this Part; 6. Microbiological contaminants in accordance with Rule 5.4.2 of this Part; 7. Terpenes, if performed, in accordance with Rule 5.4.9 of this Part; and 8. Foreign material in accordance with Rule 5.4.10 of this Part. H. Testing Standards: All compliance testing requirements by product type are summarized in Appendix D and all compliance testing requirements by final packaging are summarized in Appendix E.

5.4.2 Standards for Testing Microbiological Contaminants. A. Medical cannabis and medical cannabis products required to be tested for microbiological contaminants shall be sampled using appropriate aseptic technique and tested by a Mississippi licensed and registered cannabis testing entity for microbial impurities. B. The cannabis testing entity shall report the result of the microbial impurities testing by indicating “pass” or “fail” on the Certificate of Analysis. C. All cannabis products shall be deemed to have passed the microbial impurities testing if all of the following conditions are met: 1. Total coliform is not detected above 100 colony forming units/gram. 2. Shiga toxin-producing Escherichia coli is not detected in 1 gram; 3. Salmonella spp. is not detected in 1 gram; and 4. Pathogenic Aspergillus species A. fumigatus, A. flavus, A. niger, and A. terreus are not detected in 1 gram. 5. Total Yeast and Mold is not detected above 10,000 colony-forming units/gram. D. Microbial impurities testing shall include an optimized incubation period for

all plating-based methods used to report total coliform and total yeast and mold results. E. If the sample fails microbial impurities testing, the batch from which the sample was collected fails microbial impurities testing and shall not be released for retail sale. F. The testing entity shall follow the protocol or product instructions provided by the equipment manufacturer, including any enrichment steps. If enrichment is recommended but not required, the enrichment shall be performed. G. The testing entity shall enter all test results into the seed-to-sale system within three (3) business days of test completion.

5.4.3 Standards for Testing Pesticides A. Medical cannabis and medical cannabis products required to be tested for pesticides shall be tested by a Mississippi licensed, and registered cannabis testing entity approved for the analytes listed in Appendix A, Table 1. B. The cannabis testing entity shall report whether any Residual Pesticides are detected above the limit of detection (LOD) and shall report the result of the testing in ppms on the Certificate of Analysis. The cannabis testing facility shall indicate “pass” or “fail” on the Certificate of Analysis. C. A batch fails pesticide testing if a cannabis testing entity detects the presence of a pesticide above the action levels listed in Appendix A, Table 1 in a sample: 1. During an initial test where no reanalysis is requested; or 2. Upon reanalysis as described in Rule 5.5.1 of this Part.

5.4.4 Standards for Testing Solvents. A. Medical cannabis products required to be tested for solvents shall be tested by a Mississippi licensed, and registered cannabis testing entity approved for the analytes listed in Appendix A, Table 1. B. The cannabis testing entity shall report the result of the residual solvents testing in ppm on the Certificate of Analysis and indicate “pass” or “fail” on the Certificate of Analysis. C. A batch fails solvent testing if a cannabis testing entity, during an initial test where no reanalysis is requested or upon reanalysis as described in section

5.5 of this Part: 1. Detects the presence of a solvent above the action level listed in Appendix A, Table 1; or 2. Calculates a RPD of more than twenty percent (20%) between the field primary result of the sample and the field duplicate result.

5.4.5 Standards for Testing Water Activity and Moisture Content. A. Medical cannabis and medical cannabis products required to be tested for water activity and moisture content shall be tested by a currently Mississippi licensed and registered cannabis testing entity. If a sample has a water activity rate of more than 0.65 a w the sample fails except for an edible infused cannabis product. B. An edible cannabis-infused product fails water activity testing if the water activity rate of more than 0.85 a w . C. Non-edible infused products are not subject to water activity testing.

D. The cannabis testing entity shall report the result of the water activity test on the COA and indicate “pass” or “fail” on the COA. E. If a sample has a moisture content of more than fifteen percent (15%), the sample fails. The cannabis testing entity shall report the result of the moisture content on the COA and indicate “pass” or “fail” on the COA. F. The testing entity shall enter all test results into the seed-to-sale system within three (3) business days of test completion.

5.4.6 Standards for Potency (THC and CBD) Testing. A. In the preparation of samples intended for potency analysis, the testing entity may not adulterate or attempt to manipulate the total potency of the sample by any means, including by the addition of trichomes that were removed during the grinding and homogenization process. B. All flower material used for potency testing shall be representative of the product used by the end consumer and homogenized in such a way that it is representative of the way a consumer would be using the product. Kief shall not be reintroduced to the flower sample during the homogenization process. C. A licensed cannabis testing entity shall test for the following at a minimum when testing medical cannabis and medical cannabis products for potency

without any corrective factor taken for moisture content: 1. Delta-8- tetrahydrocannabinol; 2. Delta-8- tetrahydrocannabinolic acid; 3. Delta-9-tetrahydrocannabinol; 4. Delta-9-tetrahydrocannabinolic acid; 5. Cannabidiol (CBD); 6. Cannabidiolic acid (CBDA); 7. THC content; 8. Cannabinol (CBN); and 9. Any other cannabinoid determined by the department. D. A cannabis testing entity shall establish a limit of quantitation of 1.0 mg/g or lower for all cannabinoids analyzed and reported. E. A cannabis testing entity shall report the result of the cannabinoid testing on the Certificate of Analysis, including, at minimum: 1. A percentage for THC, THCA, CBD, and CBDA. The dry-weight percent shall be calculated using the below equation: Dry-weight percent cannabinoid = wet-weight percent cannabinoid/(1 − percent moisture/100); 2. A percentage for Total THC and Total CBD, if applicable; 3. Milligrams per gram (mg/g) if by dry-weight or milligrams per milliliter (mg/mL) if by volume for THC, THCA, CBD, and CBDA; 4. Milligrams per gram (mg/g) if by dry-weight or milligrams per milliliter (mg/mL) if by volume for Total THC and Total CBD, if applicable; 5. Total cannabinoid concentration shall be calculated for concentration expressed in weight: Total cannabinoid concentration (mg/g) = (cannabinoid acid form concentration (mg/g) x 0.877) + cannabinoid concentration (mg/g); 6. Milligrams per package for THC and CBD; 7. Milligrams per package for Total THC and Total CBD, if applicable; 8. Milligrams per serving for THC and CBD, if any; 9. Milligrams per serving for Total THC and Total CBD, if any and if applicable;

10. For edible cannabis products, the cannabis testing entity shall also report, the concentration in milligrams per serving (mg/serving) and milligrams per package (mg/package). 11. The results of all other cannabinoids analyzed on the COA both as a percentage and in either milligrams per gram (mg/g) if by weight or milligrams per milliliter (mg/mL) if by volume. 12. The sample shall be deemed to have passed the cannabinoid testing if the amount of THC does not exceed the limits below: a. Cannabis flower or trim potency ≤ 30% total THC; b. Cannabis tinctures, oils or concentrates ≤ 60% total THC. F. A cannabis testing entity shall report the test results and indicate an overall “pass” or “fail” for the cannabinoid testing on the Certificate of Analysis. G. Total THC, and/or Total CBD claimed to be present on a label shall not be considered inaccurate if the difference in percentage on the certificate of analysis is plus or minus 10.0%. H. A production batch of cannabinoid concentrate or extract fails potency testing if, based on an initial test where no reanalysis is requested or upon reanalysis, the amount of THC, as calculated pursuant to Rule 5.4.6 of this Part, between samples taken from the batch exceeds twenty percent (20%) RSD. I. The testing facility shall enter all test results into the seed-to-sale system within three (3) business days of test completion.

5.4.7 Standards for Testing for Heavy Metals. A. Medical cannabis and medical cannabis products shall be tested by a current Mississippi licensed and registered cannabis testing entity for the metals listed in Appendix A. B. A cannabis testing entity shall report the result of the heavy metals test on the Certificate of Analysis and indicate “pass” or “fail” on the COA. C. A batch fails metals testing if a cannabis testing entity, during an initial test where no reanalysis is requested or upon reanalysis as described in section 5.5 of this Part detects the presence of metals above the action level listed in Appendix A, Table 1. D. The testing entity shall enter all test results into the seed-to-sale system within three (3) business days of test completion.

5.4.8 Standards for Mycotoxin Testing. A. Medical cannabis and medical cannabis products shall be tested by a Mississippi licensed and registered cannabis testing entity for the following mycotoxins: Aflatoxin B1, B2, G1, and G2 Ochratoxin A. B. A batch shall be deemed to have passed mycotoxin testing if both the following conditions are met: 1. Total of aflatoxin B1, B2, G1, and G2 does not exceed 20 μg/kg of substance, and 2. Ochratoxin A does not exceed 20 μg/kg of substance. C. A cannabis testing entity shall report the result of the mycotoxin testing on the Certificate of Analysis and indicate “pass” or “fail” on the COA. D. A batch fails mycotoxin testing if a cannabis testing entity, during an initial test where no reanalysis is requested or upon reanalysis as described in section 5.5 of this Part detects the presence of mycotoxins above the action level listed in Appendix A, Table 1. E. The testing facility shall enter all test results into the seed-to-sale system within three (3) business days of test completion.

5.4.9 Standards for Terpenoid Testing. A. Terpene analysis is not required. However, if terpene content is listed on product packaging or label, a terpene analysis from a Mississippi licensed and registered cannabis testing entity shall be performed to confirm the product label. B. A cannabis testing facility shall report the result of the terpenoid testing on the COA both as a percentage and in either milligrams per gram (mg/g) if by weight or milligrams per milliliter (mg/mL) if by volume. C. The terpenoid testing results on the label of any one terpenoid claimed to be present shall not be considered inaccurate if the difference in percentage on the COA is plus or minus 10.0%. D. The testing entity shall enter all test results into the seed-to-sale system within three (3) business days of test completion.

5.4.10 Standards for Foreign Material Testing.

A. Medical cannabis and medical cannabis products shall be tested by a Mississippi licensed and registered cannabis testing entity to determine whether foreign material is present. B. A cannabis testing entity shall report the result of the foreign material test by indicating “pass” or “fail” on the COA. C. A cannabis testing entity shall perform foreign material testing on the total representative sample prior to sample homogenization. D. When the licensed testing entity performs foreign material testing, at minimum, it shall do all of the following: 1. Examine both the exterior and interior of the dried flower sample and; 2. Examine the exterior of the cannabis product sample. E. The sample shall be deemed to have passed the foreign material testing if the presence of foreign material does not exceed: 1. One-fourth (1/4) of the total sample area covered by sand, soil, cinders, or dirt; 2. One-fourth (1/4) of the total sample area covered by mold; 3. One (1) insect fragment, 1 hair, or 1 count mammalian excreta per 3.0 grams; or 4. One-fourth (1/4) of the total sample area covered by an embedded foreign material. F. If the sample fails foreign material testing, the batch from which the sample was collected fails foreign material testing and shall not be released for retail sale. G. The testing entity shall enter all test results into the seed-to-sale system within three (3) business days of test completion.

5.4.11 Standards for Homogeneity Testing. A. Infused cannabis products must be homogenous, with the THC and CBD content evenly distributed throughout. B. Infused cannabis products shall only be considered homogenous if the concentration of total THC and/or CBD in milligrams per serving for three (3) units from the batch is +/- 15% of the stated THC/CBD per serving. C. Each type of infused product shall be tested every six (6) months and any time the manufacturing process or ingredient(s) change.

D. An infused cannabis product that fails homogeneity testing shall not be released for retail sale. All subsequent production batches of the failed item type shall undergo homogeneity testing until three (3) consecutive batches pass. E. The testing entity shall enter all test results into the seed-to-sale system within three (3) business days of test completion. F. The processor shall maintain copies of the test results for each product type for at least one (1) year after the specific item is discontinued.

5.4.12 If a testing entity is not accredited for the full scope of state-required tests, the testing facility will need to subcontract with another Department-licensed testing facility for the relevant tests needed. All subcontracted testing shall be documented in the seed-to-sale system and be transferred using appropriate transport processes and chain of custody.

5.4.13 If a testing entity performs research and development testing, the laboratory shall comply with these rules. A. Punitive action shall not be taken against a licensed medical cannabis establishment for conducting research and development testing when permitted. B. The Department may publish guidance for research and development testing that shall be followed by all licensed medical cannabis establishments. C. Research and development testing is only permitted BEFORE compliance testing for all analytes except Terpenes, which shall always be ordered as an R&D test. D. All research and development testing shall be fully completed and reported into the seed-to-sale system by the testing entity BEFORE the final compliance testing can be ordered by the licensee. E. Research and development testing shall not replace the Department’s required safety compliance testing.

5.4.14 The Department shall take immediate disciplinary action, including sanctions, fines, or both, against any testing entity that falsifies records or fails to comply with the provisions of this Part.

5.4.15 A testing entity shall comply with random compliance checks at the request of the Department. The Department or its authorized agents may collect a random sample of a medical cannabis product from a testing entity or designate another testing entity to collect a random sample of a medical cannabis product in a secure manner to test that sample for compliance pursuant to these Rules.

5.5 Failed Test Samples. 5.5.1 If a sample fails any initial test, the cannabis testing entity that did the testing may reanalyze the sample. If the sample passes, another cannabis testing entity shall resample the batch and confirm that result in order for the batch to pass testing.

5.5.2 If a sample fails a test or a reanalysis under Rule 5.5.1of this Chapter, the batch: A. May be remediated or sterilized in accordance with this subchapter; or B. If it is not or cannot be remediated or sterilized under this rule, it shall be destroyed in a manner specified by the Department.

5.5.3 If a cultivation entity is permitted under this Part to sell or transfer a harvest batch that has failed a test, the cultivation entity shall notify the processing entity to whom the harvest batch is sold or transferred of the failed test within twenty-four (24) hours of receipt of the COA.

5.5.4 Failed Microbiological Contaminant Testing. A. If a sample from a batch of usable medical cannabis fails microbiological contaminant testing, the batch may be used to make a cannabinoid concentrate or extract if the processing method effectively sterilizes the batch, such as a method using a hydrocarbon-based solvent, or a CO

closed loop system. B. If a sample from a batch of a cannabinoid concentrate or extract fails microbiological contaminant testing, the batch may be further processed, if the processing method effectively sterilizes the batch, such as a method using a hydrocarbon-based solvent, or a CO

closed loop system. C. A batch that is sterilized in accordance with subsection (A) or (B) of this rule shall be sampled and tested in accordance with this Chapter and must be tested, if not otherwise required for that product, for microbiological

contaminants, solvents and pesticides. D. A batch that fails microbiological contaminant testing after undergoing a sterilization process in accordance with subsection (A) or (B) of this rule shall be destroyed in a manner specified by the Department.

5.5.5 Failed Solvent Testing. A. If a sample from a batch fails solvent testing, the batch may be remediated using procedures that would reduce the concentration of solvents to less than the action level. B. A batch that is remediated in accordance with subsection (A) of this rule shall be sampled and tested in accordance with this Chapter and shall be tested if not otherwise required for that product under this Chapter, for solvents and pesticides. C. A batch that fails solvent testing that is not remediated or that if remediated fails testing shall be destroyed in a manner specified by the Department.

5.5.6 Failed Water Activity Testing and Moisture Testing. A. If a sample from a batch of usable medical cannabis fails for water activity or moisture activity, the batch from which the sample was taken may: 1. Be used to make a cannabinoid concentrate or extract; or 2. Continue to dry or cure. B. A batch that undergoes additional drying or curing as described in subsection (A) of this rule shall be sampled and tested in accordance with this Part.

5.5.7 Failed pesticide testing. If a sample from a batch fails pesticide testing, the batch may not be remediated and shall be destroyed in a manner permitted under this Part and/or approved by the Department.

5.5.8 Failed Potency Testing. A. Usable medical cannabis that fails potency testing under Rule 5.4.7 of this Part may be repackaged in a manner that enables the item to meet the standard in Rule 5.4.7 of this Part. B. Usable medical cannabis that is repackaged in accordance with this section

shall be sampled and tested in accordance with these Rules.

5.5.9 Failed Remediation. A. If a sample fails a test after undergoing remediation or sterilization as permitted under this rule, the batch shall be destroyed in a manner approved by the Department. B. A cultivation or processing entity shall inform a cannabis testing facility prior to samples being taken that the batch has failed a test and is being retested after undergoing remediation or sterilization. C. A cultivation or processing entity shall, as applicable: 1. Have detailed procedures for sterilization processes to remove microbiological contaminants and for reducing the concentration of solvents. 2. Document all sampling, testing, sterilization, remediation and destruction that are a result of failing a test under these rules. D. A cannabis or cannabis product batch may only be remediated twice. If the batch fails after a second remediation attempt and the second retesting, the entire batch shall be destroyed in a manner approved by the Department. E. Within one (1) business day of completing the required analyses of a representative sample obtained from a remediated cannabis or cannabis product batch, the cannabis testing entity shall upload the COA information into the seed-to-sale system.

5.6 Tentative Identification of Compounds. 5.6.1 Tentatively Identified Compounds (TICs) are compounds detected in a sample using gas chromatography mass spectrometry that are not among the target analytes for the residual solvent analysis.

5.6.2 The Department may initiate an investigation of a cultivation or processing entity upon receipt of a TICs report from a cannabis testing entity and may require a cultivation or processing entity to submit samples for additional testing, including testing for analytes that are not required by these rules, at the cultivation or processing entity’s expense.

5.7 Certificate of Analysis (COA). 5.7.1 The cannabis testing entity shall generate a Certificate of Analysis for each representative sample that the cannabis testing entity analyzes.

5.7.2 The cannabis testing entity shall ensure that the COA contains the results of all required analyses performed for the representative sample.

5.7.3 The cannabis testing entity shall, within three (3) business day of completing all analyses of a sample, upload the COA into the seed-to-sale system. Passed test results shall be in the Department’s seed-to-sale system for a batch to be released for immediate processing, packaging, and labeling for transfer or sale in accordance with these Rules.

5.7.4 The cannabis testing entity shall not release to any person any cumulative or individual test results prior to completing all analyses and providing the COA to the Department.

5.7.5 The COA shall contain, at minimum, the following information: A. The term “Regulatory Compliance Testing” in font no smaller than 14- point, which shall appear in the upper-right corner of each page of the COA. No text or images shall appear above the term “Regulatory Compliance Testing” on any page of the COA. B. The cannabis testing entity’s name, premises address, and license number; cultivator’s, or processor’s name, premises address, and license number; C. Batch number of the batch from which the sample was obtained. For cannabis and cannabis products that are already packaged at the time of sampling, the labeled batch number on the packaged cannabis and cannabis products shall match the batch number on the COA; D. Sample identifying information, including matrix type and unique sample identifiers; E. Sample history, including the date collected, the date received by the cannabis testing entity, and the date(s) of sample analyses and corresponding testing results; F. A picture of the sample of cannabis and cannabis products. If the sample

is pre-packaged, the picture shall include an unobstructed image of the packaging; G. For dried flower samples, the total weight of the batch in grams and the total weight of the representative sample in grams; H. For cannabis product or pre-rolls samples, the total unit count of both the representative sample and the total batch size; I. Measured of the cannabis and cannabis products; J. The analytical methods, analytical instrumentation used, and corresponding Limits of Detection (“LOD)” and Limits of Quantitation (“LOQ”); K. An attestation on the COA from the cannabis testing entity supervisory or management employee that all LQC samples required by this Part were performed and met the acceptance criteria; and, L. Analytes detected during the analyses of the sample that are unknown, unidentified, or injurious to human health if consumed, if any.

5.7.6 The cannabis testing entity shall report test results for each representative sample on the COA as follows: Indicate an overall “pass” or “fail” for the entire batch; A. When reporting qualitative results for each analyte, the cannabis testing entity shall indicate “pass” or “fail”; B. When reporting quantitative results for each analyte, the cannabis testing entity shall use the appropriate units of measurement as required under this Part; C. When reporting results for each test method, the cannabis testing entity shall indicate “pass” or “fail”; D. When reporting results for any analytes that were detected below the analytical method LOQ, indicate “<LOQ”, notwithstanding cannabinoid results; E. When reporting results for any analytes that were not detected or detected below the LOD, indicate “ND”; and, F. Indicate “NT” for any test that the cannabis testing entity did not perform.

5.7.7 The cannabis testing entity supervisory or management employee shall validate the accuracy of the information contained on the COA and sign and date the COA.

5.7.8 The cannabis testing entity supervisory or management employee may request to amend a COA to correct minor errors and upload into the seed-to-sale system.

5.8 Post-Testing Sample Requirements. 5.8.1 The cannabis testing entity shall retain the reserve sample, consisting of any portion of a sample that was not used in the testing process. The reserve sample shall be kept at minimum, for forty-five (45) business days after the analyses, after which time it may be destroyed and denatured to the point the material is rendered unrecognizable and unusable.

5.8.2 The cannabis testing entity shall securely store the reserve sample in a manner that prohibits sample degradation, contamination, and tampering.

5.8.3 The cannabis testing entity shall provide the reserve sample to the Department upon request.

5.9 Transportation of Samples. 5.9.1 Qualified employees of a licensed cannabis testing entity are responsible for the collection and transportation of testing samples. Only qualified employees of a licensed cannabis testing entity shall collect and transport medical cannabis test samples. Medical cannabis test samples shall not be transported in the same vehicle with any other usable cannabis or cannabis products.

5.9.2 Licensed cannabis testing entities that transport medical cannabis test samples shall also comply with all applicable rules and regulations set forth in Subpart 7 of this Part.

5.9.3 Qualified employees/representatives of a licensed cannabis testing entity shall utilize an electronic inventory management system to create and maintain

transportation manifests documenting all transport of medical cannabis and medical cannabis products throughout the State of Mississippi.

5.9.4 When transporting medical cannabis test samples, all cannabis testing entities and their employees/representatives shall provide copies of the inventory manifests to each originating and receiving medical cannabis establishment at the time the product changes possession.

5.9.5 The copy of the inventory manifest to be left with the originating medical cannabis establishment shall include, at a minimum: A. The license number, business name, address, and contact information of the originating medical cannabis establishment; B. A complete inventory of the medical cannabis test samples to be transported, including the quantities by weight or unit of each type of medical cannabis and medical cannabis products and the batch number(s); C. The date of transportation and the approximate time of departure; D. Printed names, signatures, and identification card numbers of testing entity personnel accompanying the transport; E. The license number(s), business name(s), address(es), and contact information for all end point recipients.

5.9.6 The copy of the inventory manifest to be left with the receiving medical cannabis establishment shall include, at a minimum: A. The license number, business name, address, and contact information for the receiving medical cannabis establishment; B. The license number, business name, address, and contact information of the originating medical cannabis establishment; C. A complete inventory of the medical cannabis test samples delivered to the receiving medical cannabis establishment, including the quantities by weight or unit of each type of medical cannabis test sample and the batch number(s); D. The date and estimated time of arrival; E. The printed names, signatures, and identification card numbers of the personnel accompanying the transport; and F. The printed names, titles, and signatures of any personnel accepting delivery

on behalf of the receiving medical cannabis establishment.

5.9.7 Transportation manifests should reflect a complete chain of custody of all medical cannabis test samples being transported, including all instances in which the medical cannabis test samples are stored.

5.9.8 Originating and receiving licensed entities shall maintain copies of transportation manifests and inventory records logging the quantity of medical cannabis test samples received for at least three (3) years from the date of receipt.

5.9.9 A transportation manifest shall not be altered after departing from the originating medical cannabis establishment’s premises, except for the addition of the printed names, titles, and signatures of any personnel accepting delivery on behalf of the receiving cannabis testing entity.

5.10 Quality Assurance Measures for Cannabis Testing Entities. 5.10.1 The cannabis testing entity shall develop and implement a Quality Assurance (QA) program to assure the reliability and validity of the analytical data produced by the cannabis testing entity. The QA program shall, at minimum, include a written QA manual that addresses the following: A. Quality control procedures; B. Cannabis testing entity organization and employee training and responsibilities, including good laboratory practice (GLP); C. QA objectives for measurement data; D. Traceability of data and analytical results; E. Instrument maintenance, calibration procedures, and frequency; F. Performance and system audits, G. Corrective action procedures; H. Steps to change processes when necessary; I. Record retention and document control; J. Test procedure standardization; and K. Method validation;

L. Chain of custody protocols; M. Premise and sample security; N. Sample handling, including sample receipt, identification, rejection, storage and destruction; O. Contingency plans for data that is not within control limits, or is otherwise unacceptable for analysis; and P. Disposal of cannabis and laboratory waste.

5.10.2 The supervisory or management cannabis testing entity employee shall annually review, amend if necessary, and approve the QA program and manual both when they are created and when there is a change in methods, testing entity equipment, or the supervisory or management testing entity employee.

5.10.3 The cannabis testing entity’s standard operating procedures for testing methods shall include the following: A. The name of the testing method; B. A list of all analytes used in the testing method; C. The applicable matrix or matrices; D. Sample receipt and acceptance; E. Method sensitivity; F. Potential interferences; G. Analytical instrument and equipment used; H. Consumable supplies, reagents, and standards; I. Sample preservation and hold time; J. Type, frequency, and acceptable criteria for quality control samples; K. Type, frequency, and acceptable criteria for calibration standards; L. Procedures for analyzing batch samples; M. Data quality assessment and acceptance criteria; N. Calibration of results; and, O. Reagent solution and reference material preparation.

P. Current step-by-step instructions with sufficient detail to perform the assay to include equipment operation and any abbreviated versions used by a testing analyst.

5.10.4 Each cannabis testing entity shall maintain a consumables log or inventory for all reagents, reference standards and media purchased and received. All reagents and reference standards, including any working standards, must be: A. Labeled to indicate identity, batch number, date received or prepared, expiration date, and where applicable, concentration or purity, and date opened; B. Stored under appropriate conditions to minimize degradation or deterioration of the material; C. Within their expiration or re-qualification dates at the time of use; and, D. Documented on records for each analysis.

5.10.5 Each cannabis testing entity shall calibrate and maintain its equipment as specified below, and the calibration, verification and/or check and maintenance must be documented. A. Trend testing space temperatures and humidity daily using NIST-certified temperature devices. Record corrective action if temperatures are out-of- range. B. Check autoclaves performance with bioindicator monthly and use heat- indicating tape with each cycle. C. Check automatic Pipettes or Micropipettors and Pipette Tips dispensing accuracy and precision quarterly and calibrate annually. D. Check balances daily with a documented zero before use and service and recalibrate annually. E. Inspect Biosafety cabinet airflow with each use and have certified annually. F. Clean blenders as required by manufacturer after each homogenization of submitted cannabis or cannabis products. G. Verify centrifuge speeds and temperatures daily and have certified annually. H. Calibrate conductivity monthly.

I. Trend freezer and refrigerator temperatures daily using NIST-certified temperature devices. Record corrective action if temperatures are out-of- range. J. Inspect glassware for chemistry cannabis testing entity with each use for cleanliness, chips, and etching with each use. Use class A when specified by the approved method and keep certificate of conformance per each piece of class A glassware. If class B or class A without a certificate of conformance, perform verification check upon purchase or prior to first use. K. Inspect glassware for microbiological cannabis testing entity with each use for cleanliness, chips, and etching. L. Trend incubator temperatures daily using NIST-certified temperature devices. Record corrective action if temperatures are out-of-range. M. Trend water bath temperatures daily using NIST-certified temperature devices. Record corrective action if temperatures are out-of-range. N. Trend Laminar Flow Hoods daily and service annually. O. Clean Microscope optics and stage daily and check alignment with each use. Service annually. P. Follow Microwave digestors manufacturer’s instructions. Q. Check Muffle furnaces temperature accuracy at least annually. R. Standardize pH meters with at least 2 buffer solutions daily before use. S. Check Spectrophotometers wavelength. T. Check Timers and stop watches at least annually. U. Certify reference weights annually. V. Follow Analytical Instrumentation manufacturer’s instructions for cleaning and maintenance and document all cleaning, calibrations, maintenance, and repairs. W. Maintain all service records for the life of equipment.

5.10.6 The cannabis testing entities shall develop, implement, and validate test methods for the analyses of samples as follows: A. To the extent practicable, methods shall compart with the following guidelines: B. The Bacteriological Analytical Manual (BAM), 2019, which is incorporated by reference, includes no future editions or amendments, and is available at

https://www.fda.gov/food/laboratory-methods-food/bacteriological- analytical-manualbam; C. AOAC Official Methods of Analysis, 21st Edition, 2019, which is incorporated by reference, includes no future editions or amendments, and is available at https://www.aoac.org/official-methods-of-analysis-21st-edition- 2019; and D. To the extent practicable, methods shall be validated in accordance with the following guidelines: 1. AOAC - Appendix J: Guidelines for Validation of Microbiological Methods for Food and Environmental Surfaces, 2012, which is incorporated by reference, includes no future editions or amendments, and is available at http://www.eoma.aoac.org/app_j.pdf; 2. AOAC - Appendix K: Guidelines for Dietary Supplements and Botanicals, 2013, which is incorporated by reference, includes no future editions or amendments, and is available at http://www.eoma.aoac.org/app_k.pdf; 3. ICH – Validation of Analytical Procedures: Text and Methodology Q2(R1) 2005, which is incorporated by reference, includes no future editions or amendments, and is available at https://database.ich.org/sites/default/files/Q2_R1__Guideline.pdf or Unofficial version of the Rules in 9 A.A.C. 17, effective September 8, 2022 Page 115 https://www.fda.gov/regulatory-information/search-fda- guidance-documents/q2-r1- validation-analytical-procedures-text-and- methodology. E. Method validation should, at a minimum, verify accuracy, precision, analytical sensitivity, analytical specificity, limit of detection, limit of quantification, reportable range and the identification of interfering substances. F. Methods adopted from a matrix specific standard method, inclusivity and exclusivity do not require a comprehensive reassessment, provided that there were no modifications to the methods, including, but not limited to, all of the following: 1. Referenced media. 2. Primers. 3. Probes. 4. Antibodies.

5. Critical chemistries that were not modified. 6. Microbial methods shall include environmental monitoring and quality control of all buffers, media, primers, and incubators. G. The licensed laboratory shall generate a validation report for each test method. Each validation report shall include the following information: 1. Instrument calibration data, if any; 2. Raw data, including instrument raw data scanned as a PDF, for each test method, if any; 3. Cannabis reference materials or certified reference material results; 4. Data and calculations pertaining to LOD and LOQ determinations, if any; 5. Quality Control Sample report; 6. Worksheets, forms, pictures, or copies of laboratory notebook pages H. The laboratory director shall review, approve, sign, and date the validation report for each test method. I. Validations shall be submitted to the agency for approval with an acceptable and graded external proficiency test by a third party, where all required analytes are shown to have passed. J. Upon new test methods or altered test methods being used in the laboratory, the new validation report shall be submitted to the Department within 5 business days.

5.11 Cannabis Testing Entity Quality Control Samples. 5.11.1 The cannabis testing entity shall use Quality Control samples (QC) and adhere to good, approved laboratory practice (“GLP”) in the performance of each analysis according to the specifications of this Part.

5.11.2 The cannabis testing entity shall analyze QC samples in the same manner as the cannabis testing entity analyzes cannabis and cannabis products samples.

5.11.3 The cannabis testing entity shall use at least one negative control, one positive control, and one cannabis testing entity replicate sample in each analytical batch for each target organism during microbial testing. If one of the controls

produces unexpected results, the samples shall be re- prepped and reanalyzed with a new set of controls.

5.11.4 If the result of the microbial analyses is outside the specified acceptance criteria in Appendix A, Table 2, the cannabis testing entity shall determine the cause and take steps to remedy the problem until the result is within the specified acceptance criteria. Microbiology Culture Methods – Qualitative and Quantitative The quality control (QC) samples that are required for culturing of cannabis and cannabis products using qualitative and quantitative methods are included in Appendix A, Table 2. Molecular Assays/Methods The QC samples that are required for molecular (i.e., polymerase chain reaction (PCR), gel electrophoresis and probe-based qPCR with or without melting curve analyses) analysis of cannabis and cannabis products are listed in Appendix A, Table 3. PCR positive DNA controls are used to verify that the PCR master mix and reagents were prepared correctly to produce amplification of the target nucleic acid. This type of positive control is analyzed with each PCR run. A PCR run is defined as a group of samples that are analyzed at the same time under the same amplification conditions, using the same PCR master mix, and in the same thermocycler. A PCR run may contain more than one extracted sample batches. A PCR run with multiple assays must have a DNA positive control for each assay. Inhibition controls are used to verify that interfering constituents from a cannabis form, which may be carried over during isolation of nucleic acids or organisms during sample processing, do not inhibit the PCR. Because cannabis forms are constantly changing, inhibition positive controls must be performed in every extracted sample. PCR DNA negative controls are used to verify that the PCR master mix and reagents were prepared correctly to produce amplification of the target nucleic acid. This type of negative control is analyzed with each PCR run. A PCR run is defined as a group of samples that are analyzed at the same time under the same amplification conditions, using the same PCR master mix, and in the same thermocycler. A PCR run may contain more than one extracted sample batches.

A PCR run with multiple assays must have a DNA negative control for each assay to verify that the amplification conditions are working properly. No template controls are used to verify no contaminating nucleic acid has been introduced into the master mix. These controls are prepared when template is added to the master mix. They are prepared as separate PCR reactions to which aliquots of molecular-grade water or buffer are added to the master mix in place of target nucleic acid or sample. A negative result with this control indicates that the master mix and final processing reagents are not contaminated. This type of negative control is analyzed with each PCR run. A PCR run is defined as a group of samples that are analyzed at the same time under the same amplification conditions, using the same PCR master mix, and in the same thermocycler. A PCR run may contain more than one extracted sample batch. A PCR run with multiple assays must have not template controls for each assay to verify that the sterility of the assays. One duplicate sample is required per run. A duplicate sample is subjected to all of the same steps as the original sample. For qualitative analyses, if the duplicate sample does not equal the sample result, the sample and its duplicate must be reanalyzed. Consideration should also be given to possibility of re-preparing and reanalyzing all associated samples. For quantitative analyses, if the RPD of the sample and duplicate is greater than 100, the parent sample and duplicate sample must be reanalyzed. Consideration should also be given to possibility of re- preparing and reanalyzing all associated samples. When data are accepted, the result for the sample portion designated as the “original sample” is reported.

5.11.5 Chemistry – Analytical, Organic and Inorganic (Metals). Quality control must be performed for each analytical, organic and metal chemistry method. Each cannabis testing entity shall maintain sufficient raw data records to ensure the QC was performed at the frequency specified. ‘Bracketing’ of QC samples, rotating from across the calibration curve range, is required. QC samples must follow the first twenty (20) samples after an initial calibration, every twenty (20) samples thereafter, and at the end of testing samples. This would also apply to a continuing calibration. Initial Calibration

A. Samples results must be associated with an acceptable initial calibration. If the initial calibration is not acceptable, corrective actions must be performed and all associated samples re-analyzed. B. No sample results are to be reported nor data qualified for a failed initial calibration. C. Samples must be analyzed under an initial calibration that was performed no more than one month prior. D. The following items are required elements of an initial calibration: 1. The details of the initial calibration procedures including calculations, integrations, acceptance criteria, and associated statistics must be included or referenced in the method SOP. When initial calibration procedures are referenced in the method SOP, then the referenced material must be retained by the cannabis testing entity and be available for review; 2. Sufficient raw data records must be retained to permit reconstruction of the initial calibration (e.g., calibration date, method, instrument, analysis date, each analyte name, and analyst or technician’s initials or signature; concentration and response, calibration curve or response factor; or unique equation or coefficient used to reduce instrument responses to concentration); 3. The cannabis testing entity must use the most recent initial calibration analyzed prior to the analytical batch; 4. Standards used for calibration must be traceable to an international or national standard, when commercially available; and 5. The cannabis testing entity must have a written procedure addressing removal and replacement of calibration standards. E. The lowest calibration standard must be at or below the lowest concentration for which quantitative data are to be reported without qualification. F. The highest calibration standard shall be at or above the highest concentration for quantitative data are to be reported without qualification. G. Sample results must be quantitated from the initial calibration and may not be quantitated from any continuing calibration verification. H. Criteria for the acceptance of an initial calibration must be established including any calculations (e.g., relative error, relative standard deviation). 1. R2 ≥ 0.990, and

2. Curve recovery of ±20% (and ±30% for the lowest point) for all points must be maintained. I. The cannabis testing entity must use and document a measure of relative error in the calibration as specified in the method SOP. Initial Calibration Verification A. All initial calibrations must be verified with a standard obtained from a second manufacturer or a separate lot prepared independently by the same manufacturer. B. Initial calibration verification is performed by analyzing a test solution of known analyte concentration(s) after initial calibration and prior to sample analysis. C. In general, the check must be ± 20% (± 30% for the lowest point) of the known value. Some individual methods may require tighter tolerances (±10% of the known value). Continuing Calibration Verification A. The validity of the initial calibration must be verified prior to sample analyses by a continuing calibration verification with each analytical batch. B. A CCV is performed by analyzing a test solution of known analyte concentration(s) prior to sample testing on each testing day and continued periodically during the analytical batch run, no less frequently than once after each set of 20 samples, and at the end of each run. C. The CCV must be a standard that is from the same vendor/lot that is used for the calibration curve. D. In general, the check must be ± 20% (and ± 30% for the lowest point) of the known value. E. Calibration must be verified for each compound, element, or other discrete chemical analyte, except for multi-component analytes where a representative chemical, related substance or mixture can be used. F. Instrument continuing calibration verification must be performed at the beginning and end of each analytical batch, and at the frequency defined in the method. G. Sufficient raw data records must be retained to permit reconstruction of the continuing instrument calibration verification (e.g., method, instrument, analysis date, each analyte name, concentration and response, calibration

curve or response factor, or unique equations or coefficients used to convert instrument responses into concentrations). H. Continuing calibration verification records must explicitly connect the continuing calibration verification data to the initial calibration. I. If the continuing instrument calibration verification results obtained are outside the established acceptance criteria, the following steps must be taken: 1. If a cause for the calibration verification failure is identified that impacts only the calibration verification sample (e.g., a missed autosampler injection), then analysis may proceed if a second calibration verification sample is analyzed immediately and the result is within acceptance criteria. Samples analyzed previously must be considered valid if bracketed by a passing calibration verification sample. The cause for the failure of the first calibration verification result must be documented; and 2. If the cause for the calibration verification failure is not identifiable or has impacted other samples, then corrective action must be performed and documented. Prior to analyzing samples, the cannabis testing entity must demonstrate acceptable performance after corrective action with calibration verification or a new initial calibration must be performed. Samples analyzed prior to the calibration verification failure must be reanalyzed. J. Data associated with an unacceptable calibration verification must not be reported with a qualifier. Qualifying the data is not an acceptable approach. Low Level Continuing Calibration Verification A. A LLCCV will be run at the end of each analytical batch. B. The measured value must be within ± 30 % of the prepared value. C. The cannabis testing facility entity shall prepare and analyze at least one of each of the following QC samples for each analytical batch: 1. Negative Control, Method Blank; and 2. Positive Control, Laboratory Control Sample (LCS); 3. Matrix spike sample; 4. Duplicate matrix spike sample; and 5. Duplicate sample. D. The required QC is summarized in Appendix 2, Table 4. Negative Control – Method Blank (MB)

A. A method blank must be analyzed at a minimum of one (1) per preparation batch. B. The MB must be processed along with and under the same conditions as the associated samples to include all steps of the preparation and analytical procedure. C. The MB is used to assess the samples in the preparation batch for possible contamination during the preparation and processing steps. D. The measured concentration of each analyte in the MB or LRB must be < LOQ or MRL. E. Procedures must be in place to determine if a MB or LRB is contaminated. While the goal is to have no detectable contaminants, each method blank must be critically evaluated as to the nature of the interference and the effect on the analysis of each sample within the batch. F. The source of contamination must be investigated and measures taken to minimize or eliminate the problem and affected samples reprocessed if the concentration of a targeted analyte in the blank is at or above the LOQ, if the blank contamination otherwise affects the sample results as per the method requirements or the individual project data quality objectives, and a blank is determined to be contaminated. Samples associated with a contaminated blank must be evaluated as to the best corrective action for the samples (e.g., reprocessing or data qualifying codes). In all cases, the corrective action must be documented. G. Any affected samples associated with a contaminated MB or LRB must be reprocessed for analysis. Positive Control – Laboratory Control Sample (LCS) A. The LCS is used to evaluate the performance of the total analytical system, including all preparation and analysis steps. B. The LCS must be carried through the entire sample preparation process and analyzed. C. The LCS must be spiked with all target analytes at a mid-level concentration in the curve. D. The LCS must be analyzed at a minimum of one (1) per preparation batch. E. The LCS is a quality system matrix, known to be free of analytes of interest, spiked with known concentrations of analytes that are within the calibration range.

1. A laboratory control sample (LCS) may be used in place of a continuing calibration verification (CCV) (but not as a replacement for a failing CCV) for methods where the calibration goes through the same process as the LCS. Note that the more stringent acceptance criteria must be met. 2. The matrix spike may be used in place of this control as long as the acceptance criteria are as stringent as for the LCS. 3. The lab may use commercially available or pre-prepared standards (separate from calibrators) for QC. F. All analyte concentrations must be within the calibration range of the methods. G. The individual LCS must be compared to the acceptance criteria stated in the standard operating procedure. The results of the individual batch LCS are calculated in percent recovery or other appropriate statistical technique that allows comparison to established acceptance criteria. The cannabis testing entity must document the calculation. H. When the acceptance criteria for the positive control are exceeded, those sample results must be investigated, and a corrective action implemented. Matrix Spikes and Matrix Spike Duplicates A. Analyze an actual sample with a known amount of standard added (matrix spike. MS). A second portion of the actual sample used to prepare the MS that is spiked and processed in the same manner as the MS (matrix spike duplicate, MSD). 1. For potency testing, a “representative matrix” may be used to prepare the MS/MSD. 2. MS/ MSD shall be spiked at a midlevel concentration with the target analytes. B. Calculate the relative percent difference (RPD) between first sample and replicate. The calculations must be documented, and the target value must be close to the first value and have a RPD of less than 20%. C. Matrix-specific QC samples indicate the effect of the sample matrix on the precision and accuracy of the results generated using the selected method. The information from these controls is sample/matrix specific and would not normally be used to determine the validity of the entire batch. D. For methods that include one (1) to twenty (20) targets, spike all components.

E. For methods with more than twenty (20) targets, randomly spike at least sixteen (16) components. Sample Duplicate A. Analyze the same sample twice, using two separate preparations. The sample should be chosen at random and run together on the same analytical run. B. Calculate the relative percent difference (RPD) between first sample and replicate. Calculations must be documented, and the target value must be close to the first value and have a RPD of less than twenty percent (20%). Variability may be introduced during sample preparation. To account for this, if more than one staff member is prepping samples, each staff must also prepare and analyze a sample matrix duplicate for each set of prepared samples.

5.11.6 Physical Chemistry. Water Activity: A. Sample Duplicates. Analyze the same sample twice, using two separate preparations. The sample should be chosen at random and run together on the same analytical run. Calculate the relative percent difference (RPD) between first sample and replicate. Calculations must be documented, and the target value must be close to the first value and have a RPD of less than twenty percent (20%). Variability may be introduced during sample preparation. To account for this, if more than one staff member is prepping samples, each staff must also prepare and analyze a sample matrix duplicate for each set of prepared samples. B. Calibration. If the aw instrument is being used in a single location at the same temperature (61°C) and humidity (65% relative humidity), calibrate if it has been more than seven consecutive days since the last calibration. If the aw instrument is physically moved from one location to another, calibrate immediately following the move and prior to analyzing samples. If the aw instrument has been cleaned, then calibrate immediately following the cleaning. Follow any other calibration procedures listed in a consensus method and manufacturer’s instructional manual. C. Monitor temperature and humidity daily or on day of use and keep a record of the check.

5.12 Required Formulas.

5.12.1 The cannabis testing entity shall prepare and analyze at least one of each of the following QC samples for each analytical batch: A. Method Blank; and B. Laboratory control sample (LCS); and C. Matrix spike sample; and D. Duplicate matrix spike sample.

5.12.2 The cannabis testing entity shall analyze, at minimum, a continuing calibration verification (“CCV”) sample prior to sample testing on each testing day and continued periodically during the analytical batch run no less frequently than once after each set of twenty (20) samples and at the end of each run. The CCV shall be a standard that is not from the same vendor/lot that is used for the calibration curve.

5.12.3 If the result of the chemical analyses is outside the specified minimum acceptance criteria in Appendix A, Table 3, the cannabis testing entity shall determine the cause and take steps to remedy the problem until the result is within the specified acceptance criteria.

5.12.4 A cannabis testing entity shall use the following calculation for determining Relative Percentage Difference (RPD): RPD = (|Num1-Num2|/((Num1+Num2)/2)) x 100 Where: Num1= Original Number Num2= Second Number

5.12.5 A cannabis testing entity shall use the following calculation for determining Relative Standard Deviation (RSD):

5.12.6 For calculating both RPD and RSD if any results are less than the LOQ, the absolute value of the LOQ is used in the equation.

5.12.7 If any analyte is detected above any action level, as described in this Part, the sample shall be re-prepped and reanalyzed in replicate within another analytical batch.

5.12.8 For quantitative analyses, the re-prepped sample and its associated replicate shall meet the acceptance criteria of RPD ≤20%.

5.12.9 For qualitative analyses, the re-prepped sample and its associated replicate results shall concur.

5.12.10 If any quality control sample produces a result outside of the acceptance criteria, the cannabis testing entity cannot report the result and the entire batch cannot be released for retail sale. The cannabis testing entity shall determine the cause and take steps to remedy the problem until the result is within the specified acceptance criteria.

5.12.11 If the cannabis testing entity determines that the result is a false-positive or a false- negative, the Department may ask for the cannabis testing entity to re- sample or re-test.

5.12.12 The cannabis testing entity shall compile and generate one LQC sample report for each analytical batch that includes LQC acceptance criteria, measurements, analysis date, and matrix.

5.13 Limits of Detection (LOD) and Limits of Quantitation (LOQ) for Quantitative Analyses. 5.13.1 The cannabis testing entity shall calculate the LOD for chemical method analyses according to any of the following methods: A. Signal-to-noise ratio of between 3:1 and 2:1; B. Standard deviation of the response and the slope of calibration curve using a minimum of seven (7) spiked blank samples calculated as follows: LOD = (3.3 x standard deviation of the response)/slope of the calibration curve; or C. A method published by the United States Food and Drug Administration (USFDA) or the United States Environmental Protection Agency (USEPA).

5.13.2 The cannabis testing entity shall calculate the LOQ for chemical method analyses according to any of the following methods: A. Signal-to-noise ratio of 10:1, at minimum; B. Standard deviation of the response and the slope using a minimum of seven (7) spiked Blank samples calculated as follows: LOQ = (10 × standard deviation of the response)/slope of the calibration curve; or C. A method published by the USFDA or the USEPA.

5.14 Cannabis Testing Entity Data Package. 5.14.1 The cannabis testing entity shall compile and generate one data package for each representative sample that the cannabis testing facility analyzes. A. All data generated during the testing of a test sample, except data generated by automated data collection systems, is recorded directly, promptly, and legibly in ink. All data shall be annotated with the date of entry and signed or initialed by the person recording the data. Any change in entries shall be made so as not to obscure the original entry, shall indicate the reason for such

change, and shall be dated and signed or initialed at the time of the change. B. In automated data collection systems, the individual responsible for direct data input shall be identified at the time of data input. Any change in an entry shall be made so as not to obscure the original entry, shall indicate the reason for such change, and shall be dated and signed or initialed at the time of the change. A corrective action report shall accompany such change and shall be made available to the department, a non-profit producer, and a manufacturer upon their request for up to two years after the analysis is completed. C. For each final result reported, an approved testing entity shall verify that: 1. Any calculations or other data processing steps were performed correctly; 2. The data meet any data quality requirements such as for accuracy, precision, linearity, etc.; 3. Any reference standards used were of the appropriate purity and within their expiration or requalification dates; 4. Any volumetric solutions were properly standardized before use; and, 5. Any test or measuring equipment used has been properly tested, verified, and calibrated, and is within its verification or calibration period.

5.14.2 The cannabis testing entity shall provide requested data packages to the Department immediately upon request.

5.15 Required Proficiency Testing. 5.15.1 A cannabis testing entity shall participate in a proficiency testing program for all methods available from an organization that operates in conformance with the requirements of ISO/IEC 17043 at least once every six (6) months.

5.15.2 The cannabis testing entity shall annually, successfully participate in a proficiency testing program for each test method performed for the below: A. Cannabinoids; B. Heavy metals; C. Microbial impurities ; D. Mycotoxins; E. Residual pesticides;

F. Residual solvents and processing chemicals; G. Foreign Material; and H. Terpenoids, if performed.

5.15.3 The cannabis testing entity shall report all analytes available by the proficiency testing program provider and for which the licensee is required to test under the rules in this Part.

5.15.4 The cannabis testing entity shall participate in the proficiency testing program by following the cannabis testing entity’s existing SOPs for testing cannabis and cannabis products.

5.15.5 The cannabis testing entity shall rotate the proficiency testing program among the cannabis testing entity employees who perform the test methods.

5.15.6 Cannabis testing entity employees who participate in a proficiency testing program shall sign the corresponding analytical reports or attestation statements to certify that the proficiency testing program was conducted in the same manner as the cannabis testing entity tests of cannabis and cannabis products.

5.15.7 A supervisory or management cannabis testing entity employee shall review and verify the accuracy of results reported for all proficiency testing program samples analyzed.

5.15.8 The cannabis testing entity shall request the proficiency testing program provider to send results concurrently to the Department, if available, or the cannabis testing entity shall provide the proficiency testing program results to the Department within three (3) business days after the cannabis testing entity receives notification of their test results from the proficiency testing program provider.

5.16 Proficiency Testing Performance. 5.16.1 The cannabis testing entity shall be deemed to have successfully participated in a proficiency testing program for an analyte tested in a specific method if the test

results demonstrate a “satisfactory” or otherwise proficient performance determination by the proficiency testing program provider.

5.16.2 The cannabis testing entity may not report test results for analytes that are deemed by the proficiency testing program provider as “unacceptable,” “questionable,” “unsatisfactory”, or otherwise deficient. Testing with the deficient method shall stop immediately upon receiving deficient proficiency testing results.

5.16.3 The cannabis testing entity may resume reporting test results for analytes that were deemed “unacceptable,” “questionable,” “unsatisfactory”, or otherwise deficient, only if both of the following conditions are met: A. The cannabis testing entity satisfactorily remedies the cause of the failure for each analyte; and B. The cannabis testing entity submits to the Department a written corrective action report demonstrating how the cannabis testing entity has fixed the cause of the failure.

5.16.4 The cannabis testing entity shall immediately perform a follow-up proficiency test on any method associated with a deficient report until the testing entity obtains an acceptable result for all analytes.

5.16.5 The Department shall take immediate disciplinary action against any cannabis testing entity that is unable to successfully participate in a proficiency program for any available method/analyte every six (6) months.

5.17 Cannabis Testing Entity Audits. 5.17.1 The cannabis testing entity shall conduct an internal audit at least once per year or in accordance with the ISO/IEC 17025 accrediting body’s requirement, whichever is more frequent.

5.17.2 The internal audit shall include all the components required by the ISO/IEC 17025 internal-audit standards.

5.17.3 Within three (3) business days of completing the internal audit, the cannabis testing entity shall submit the results of the internal audit to the Department.

5.17.4 A cannabis testing entity shall contract with an independent, third-party auditor certified to conduct on-site audits at least annually or in accordance with ISO/IEC 17025 accrediting body’s requirements standards.

5.17.5 Within three (3) business days of receiving the accrediting body on-site audit findings, the cannabis testing facility shall submit the report to the Department.

5.17.6 The Department reserves the rights to perform additional audits as needed and without advance notice.

5.18 Recalls. 5.18.1 The Department may issue public notice of a medical cannabis recall if, in its judgment, any particular cannabis and/or cannabis product presents a threat to the health and safety of qualifying patients. All medical cannabis establishments are responsible for complying with recall notices. Recalled items shall be immediately pulled from production or inventory and held until such time as the Department determines the item is safe, may be remediated, or shall be destroyed.

Subpart 6 PACKAGING AND LABELING 6.1 General Requirements. 6.1.1 Licensees shall not sell, or otherwise transfer cannabis and/or cannabis products to other medical cannabis establishments licensed by the Department and/or MDOR that are not packaged and labeled in accordance with these regulations.

6.1.2 Medical cannabis establishments receiving a sale or transfer from another medical cannabis establishment shall refuse to accept or shall return to the medical cannabis establishment transferring cannabis and/or cannabis products, any cannabis and/or cannabis products that are not packaged and labeled in accordance with these

regulations. The medical cannabis establishment that sold or otherwise transferred the nonconforming cannabis and/or cannabis products shall accept such return.

6.1.3 Medical cannabis establishments shall document any such return, nonacceptance, or disposal, and such documentation shall include at a minimum: 1. The license number, name, contact information, and address of the medical cannabis establishment that sold or otherwise transferred the nonconforming cannabis and/or cannabis products; 2. A complete inventory of the cannabis and/or cannabis products to be returned or disposed, including the batch number; 3. The reason for the nonacceptance, return, or disposal; and, 4. The date of the nonacceptance, return, or disposal.

6.1.4 The following packaging requirements apply to all usable medical cannabis (retail- ready) being transferred to or sold to a medical cannabis dispensary for sale to a qualified patient and/or caregiver. Packaging and labelling, meeting the following requirements, shall be in place when transferred or sold to a medical cannabis dispensary: 1. Labels, packages, and containers shall not be attractive to minors and shall not contain any content that reasonably appears to target children, including toys, cartoon characters, or any color scheme, image, graphic, or feature that might reasonably be expected to make the product label, package, or container entice or appealing to children. 2. Packages should be designed to minimize appeal to children and shall not depict images other than the business name and logo of the medical cannabis establishment. 3. Packaging shall contain a label that reads: “Keep out of reach of children”. 4. All usable medical cannabis and cannabis products shall be packaged in child- resistant containers at the point of sale or other transfer to a patient, a patient's parent, or legal guardian if patient is a minor, or a caregiver. 5. Packages and labels shall not contain product names related to candy or candies or any spellings thereof (e.g., kandy, kandies, etc.) or feature images that look like candy. 6. No cannabis and/or cannabis products shall be intentionally or knowingly packaged or labeled to cause a reasonable patient confusion as to whether the

medical cannabis or medical cannabis product is a trademarked product or any commercially available candy, snack, baked good or beverage. 7. Packages and labels shall not make any claims or statements that the medical cannabis or medical cannabis products provide health or physical benefits to the patient. 8. Shall not contain the logo of the Department or any seal, flag, crest, coat of arms, or other insignia that could reasonably mislead any person to believe the product has been endorsed, manufactured, or used by any state, county, or municipality or any agency thereof. 9. Cannabis products that have a potency of over thirty percent (30%) total THC shall be labeled as “extremely potent”. 10. Edible cannabis products shall be labeled in a manner which indicates the number of servings of THC in the product and include a statement that the product’s potency was tested with an allowable variance of plus or minus 10%. Potency of all products shall test +/- 10% of label claim or be repackaged to meet actual concentration. The single serving size shall also be included on the label. All edible cannabis product shall be labeled. 11. Usable medical cannabis shall include the following on the label: a. Name of the cannabis and/or cannabis product; b. Batch number of the cannabis and/or cannabis product; c. Unique identifier number created by the seed to sale system; d. Net quantity or weight of contents; e. The length of time it typically takes for the product to take affect; f. Disclosure of ingredients and possible allergens; g. A nutritional fact panel (applicable to cannabis products meant to be ingested); h. The total amount of THC and CBD in the product as verified by the cannabis testing facility; i. Terpenoid profile in the product as verified by the cannabis testing facility (if applicable); j. A notice of the potential harm caused by consuming medical cannabis; and, k. For edible cannabis products, when practicable, the Mississippi standard symbol indicating the product contains cannabis. This symbol is required

on packaging as of July 1, 2023. The required symbol will be available for download from the Department.

6.1.5 All usable medical cannabis and/or cannabis products shall be in compliant packaging upon entering the medical cannabis dispensary space.

6.1.6 All labeling shall be in plain font that can be easily read.

6.1.7 All labeling on topical products shall also state “For Topical Application – Do Not Eat or Smoke”.

6.1.8 Labels and packaging for food containing cannabis shall comply with all applicable requirements in existing Mississippi law, rules and regulations.

6.1.9 In addition to the labeling requirements in this Part, all usable (retail-ready) cannabis and/or cannabis products shall be packaged to meet the following: 1. Packaging shall be opaque and light resistant. The Department does not specify package coloring. 2. Packing shall fully enclose the product so that it cannot be seen from outside the packaging. 3. Packaging shall protect the product from contamination; 4. Not impart any toxic or deleterious substance to the medical cannabis product; 5. Shall be in child-resistant packages or containers; and, 6. Shall be in a resealable package or container that meets the effectiveness specifications outlined in 16 CFR 1700.15, to the extent that such laws, rules, regulations do not conflict with the Mississippi Medical Cannabis Act, if the product contains more than one serving.

6.1.10 All cannabis and/or cannabis products sold or transferred between cannabis cultivation facilities and/or cannabis processing facilities shall be labeled (in addition to the required seed-to-sale tagging), and the label shall contain, at a minimum, the following information: 1. Name and license number of the cultivator/grower or processor/manufacturer who is selling or otherwise transferring the medical cannabis or medical cannabis product; 2. The batch number of the medical cannabis or medical cannabis product; 3. Date of harvest or production; and, 4. Unique identifier number generated by the seed-to-sale system.

Subpart 7 TRANSPORTATION 7.1 General Requirements. 7.1.1 Cannabis transportation entities shall comply with any and all motor vehicle laws in the State of Mississippi.

7.1.2 All employees shall possess a valid, unrestricted driver’s license issued by the State of Mississippi and a valid work permit issued by the Department. The cannabis transportation entity shall also issue each employee an identification badge, with picture. All documents referenced in this Rule shall be in the employee’s possession when in a vehicle transporting cannabis and/or cannabis products.

7.1.3 A cannabis transportation entity shall be responsible for any and all cannabis and/or cannabis products within its custody, control, or possession.

7.1.4 A cannabis transportation entity may transport cannabis and/or cannabis products to medical cannabis establishments during the hours of 5:00 a.m. until 9:00 p.m.

7.1.5 Prior to the transport of cannabis and/or cannabis products, the cannabis transportation entity shall ensure a trip plan has been created for each transportation event. At a minimum, a trip plan shall include the following: 1. Names of employees transporting the cannabis and/or cannabis products; 2. State issued work permits of the employees transporting the cannabis and/or cannabis products; 3. Date and start time of the transport; 4. Physical location of the originating medical cannabis establishment; 5. Physical location of the receiving medical cannabis establishment; 6. A description of the cannabis and cannabis products to be transported to include: quantities by weight or unit of each type of cannabis and/or cannabis products contained in the transport, along with the unique identifying numbers issued by the seed to sale system for each item; 7. Any anticipated stops during the trip, including the locations of the stop and arrival and departure time from the location; 8. The anticipated route of transportation; 9. Any and all instances in which cannabis and/or cannabis products are stored at cannabis transportation entity’s facilities; and, 10. Estimated date and time of arrival at the receiving medical cannabis establishment. 11. The make, model, color and license plate number of the vehicles transporting cannabis and/or cannabis products.

7.1.6 A copy of the trip plan shall be provided to the originating medical cannabis establishment and maintained by the cannabis transportation entity. A copy of the applicable trip plan shall be kept in the vehicle during transport.

7.1.7 A cannabis transportation entity may make reasonable deviations from the anticipated routes identified on the trip plan when needed (for example, unanticipated mandatory detours for construction, traffic accidents, etc.). All deviations shall be reflected in the transportation entity’s vehicle GPS system at all times.

7.1.8 Should a cannabis transportation entity possess cannabis and/or cannabis products outside of the approved transportation hours, the licensee shall immediately go to its facility and store the cannabis and/or cannabis products in accordance with the rules in this Part.

7.1.9 To maintain the independence required, cannabis transportation entities are prohibited from the following activities related to the medical cannabis program: 1. Growing/cultivating cannabis; 2. Manufacturing/processing cannabis and/or cannabis products; 3. Retail sales of cannabis and/or cannabis products; 4. The resale of cannabis and/or cannabis products to other entities and medical cannabis establishments; 5. Transportation, storage, and/or delivery of cannabis and/or cannabis products to entities who are not licensed by the Department as medical cannabis establishments or the MDOR as cannabis dispensaries; and, 6. Provision of cannabis and/or cannabis products directly to qualifying patients and/or caregivers as defined in this Part.

7.1.10 A cannabis transportation entity shall have inventory tracking processes and procedures in place that include, but are not limited to, the following: 1. Prior to the transport of cannabis and/or cannabis products, the originating medical cannabis establishment shall provide the transporter with a copy of the inventory/transportation manifest generated from the seed-to-sale system. At a minimum, the manifest shall include the following: a. License number of the originating medical cannabis establishment; b. Name and contact information of the originating medical cannabis establishment; c. License number of the receiving medical cannabis establishment; d. Name and contact information of the receiving medical cannabis establishment; e. Physical address of the receiving medical cannabis establishment where cannabis and/or cannabis products are being delivered;

f. Quantities by weight or unit of each type of cannabis and/or cannabis products contained in the transport, along with the unique identifying numbers issued by the seed-to-sale system for each item; g. The date of transport to include the time of departure and approximate arrival time; h. Names and work permit numbers issued by the Department of the individuals accompanying the transport; i. The make, model, color, and license plate number of the vehicles providing transport of cannabis and/or cannabis products.

7.1.11 An inventory/transportation manifest shall be included with each transport.

7.1.12 An inventory/transportation manifest shall not be altered after departing the originating medical cannabis establishment. Such manifest made be made available to law enforcement, if requested.

7.1.13 There shall not be any passenger or operator in a vehicle transporting cannabis and/or cannabis products that is not employed by the cannabis transportation entity while cannabis and/or cannabis products are present.

7.1.14 Transportation of Cannabis or Cannabis Products to Retail Dispensary Locations. A. Cannabis and/or cannabis products that have undergone and passed regulatory compliance testing and have an accompanying COA may be transferred to one or more licensed dispensaries via a licensed cannabis transportation entity. B. Cannabis that has not been transported to a licensed dispensary for retail sale within twelve (12) months of the date on the COA shall be destroyed or retested by the licensee in possession thereof. Retesting pursuant to this subsection shall only be conducted if the cannabis has not been modified in any way.

7.2 Vehicle Requirements. 7.2.1 Prior to use, a licensed cannabis transportation entity shall submit to the Department the license plate numbers, proof of insurance, and vehicle

identification numbers for each vehicle being used to transport cannabis or cannabis-infused products.

7.2.2 Vehicles used to transport cannabis and/or cannabis products shall be insured at or above the legal requirements in Mississippi.

7.2.3 Vehicles used to transport cannabis and/or cannabis products shall be equipped with the following: 1. An alarm system; 2. A global positioning system (GPS) to monitor location, routes, etc. at all times with the ability to grant the Department and/or state and local law enforcement access to the system; and, 3. Locked storage container as defined in Rule 1.2.73.

7.2.4 With the exception of test samples, all vehicles used to transport cannabis and/or cannabis products shall meet one of the following requirements for video surveillance or staffing required during transport of cannabis and/or cannabis products: 1. Staffed with a minimum of two (2) employees when a vehicle contains cannabis and/or cannabis products. At least one (1) employee shall remain with the vehicle any time it contains cannabis and/or cannabis products; or 2. Utilize video surveillance of the vehicle (meeting video surveillance requirements in Rule 7.3.5) to include: a. Installation of video cameras in the interior of vehicles transporting cannabis and/or cannabis products; and, b. Video surveillance of the interior of the vehicle, particularly the locked storage areas where cannabis and/or cannabis products are located.

7.2.5 All vehicles used for the purpose of transporting cannabis and/or cannabis products shall be maintained in a sanitary condition.

7.2.6 A vehicle transporting cannabis and/or cannabis products shall not bear any markings to indicate the vehicle contains cannabis or bear the name or logo of the medical cannabis establishment.

7.3 Storage Requirements – During and Outside of Transport. 7.3.1 A transporter shall not transport cannabis and/or cannabis product(s) unless it is first packed in a cannabis container by the originating medical cannabis establishment.

7.3.2 A cannabis container for transport shall be: 1. Sealable and sealed during transport; 2. Locked during transport; 3. Clearly labeled as medical cannabis and/or medical cannabis product; 4. Maintained in a locked and secure storage compartment that is part of the vehicle or a locked storage container with a separate key or combination lock.

7.3.3 A transporter shall not open a cannabis container. Once a cannabis container is packed and sealed for delivery, only the following may open a cannabis container: 1. The originating medical cannabis establishment; 2. The medical cannabis establishment intended for delivery; 3. Local, State, or federal law enforcement; 4. An employee of the Department or the MDOR.

7.3.4 Cannabis and/or cannabis-products shall be transported so it is not visible or recognizable from outside the vehicle.

7.3.5 If a cannabis transportation entity is required to store cannabis and/or cannabis products, the storage location shall, at a minimum, meet the following requirements: 1. Approved by the Department during the application process as part of the cannabis transportation entity’s license; 2. Be secure, enclosed with permanent walls, and controls for temperature and relative humidity to ensure storage in a manner that prevents the cannabis and cannabis products from becoming adulterated.;

3. Be locked at all times; 4. Be accessible only to specifically identified employees of the cannabis transportation entity; 5. Have an alarm system that meets the following: a. Upon attempted unauthorized entry, the alarm system shall transmit a signal directly to a central protection company or a law enforcement agency that has a legal authority to respond. A designated employee of the cannabis transportation entity shall also be notified. b. Provide continuous, uninterrupted coverage (24 hours/7 days) for all points of ingress and egress to the facility, including without limitation doorways, windows, loading areas; c. Provide continuous, uninterrupted coverage (24 hours/7 days) of any room with an exterior wall, any room containing a safe, and any room used to store cannabis and/or cannabis products; d. Be equipped with failure notification systems to notify the transporter and law enforcement of any failure in the alarm system; and, e. Have the ability to remain operational during a power outage. 6. Have continuous, uninterrupted video surveillance that meets the following: A. Provide continuous, uninterrupted coverage (24 hours/7 days) for all points of ingress and egress to the facility, including without limitation doorways, windows, loading areas, and parking areas; B. Provide continuous, uninterrupted coverage (24 hours/7 days) of any room with an exterior wall, any room containing a safe, and any room used to store cannabis and/or cannabis products; C. Digital archiving capabilities for a minimum of (120) days; D. On-site and off-site monitoring capabilities; E. Have the date and time embedded on all surveillance recordings without significantly obscuring the picture; and, F. Use cameras that are capable of recording in both high and low lighting conditions.

7.3.6 Upon request, a medical cannabis establishment shall make all information related to security alarm systems and video surveillance, monitoring, and recordings available to the Department within the timeframe requested.

Subpart 8 WASTE DISPOSAL 8.1.1 Cannabis disposal entities shall also comply with all applicable rules and regulations in this Part to include, but not limited to, licensure and registration as a cannabis transportation entity if the cannabis disposal entity transports cannabis and/or cannabis products.

8.1.2 All employees shall possess a valid, unrestricted driver’s license issued by the State of Mississippi and a valid work permit issued by the Department. The cannabis disposal entity shall also issue each employee an identification badge, with picture. All documents referenced in this Rule shall be in the employee’s possession when in a vehicle transporting cannabis and/or cannabis products.

8.1.3 A cannabis disposal entity shall be responsible for any and all cannabis and/or cannabis products within its custody, control, or possession.

8.1.4 Unless specifically licensed by the Department to do so, cannabis disposal entities are prohibited from the following activities related to the medical cannabis program: 1. Growing/cultivating cannabis; 2. Manufacturing/processing cannabis and/or cannabis products; 3. Retail sales of cannabis and/or cannabis products; 4. The resale of cannabis and/or cannabis products to other entities and medical cannabis establishments; 5. Transportation, storage, and delivery of cannabis and/or cannabis products (outside of the purposes of disposal and/or destruction of cannabis waste); and, 6. Provision of cannabis and/or cannabis products directly to qualifying patients and/or caregivers as defined in this Part.

8.1.5 If a cannabis disposal entity is required to store cannabis and/or cannabis products, the storage location shall, at a minimum, meet the following requirements: 1. Cannabis and/or cannabis products shall be stored at location licensed by the Department as part of the cannabis disposal entity’s license; 2. Be secure and enclosed with permanent walls; 3. Be locked at all times; 4. Be accessible only to specifically identified employees of the cannabis transportation entity; 5. Have an alarm system that meets the following: A. Upon attempted unauthorized entry, the alarm system shall transmit a signal directly to a central protection company or a law enforcement agency that has a legal authority to respond. A designated employee of the cannabis transportation entity shall also be notified; B. Provide continuous, uninterrupted coverage (24 hours/7 days) for all points of ingress and egress to the facility, including without limitation doorways, windows, loading areas; C. Provide continuous, uninterrupted coverage (24 hours/7 days) of any room with an exterior wall, any room containing a safe, and any room used to store cannabis and/or cannabis products; D. Be equipped with failure notification systems to notify the transporter and law enforcement of any failure in the alarm system; and, E. Have the ability to remain operational during a power outage. 6. Have continuous, uninterrupted video surveillance that meets the following: A. Provide continuous, uninterrupted coverage (24 hours/7 days) for all points of ingress and egress to the facility, including without limitation doorways, windows, loading areas, and parking areas; B. Provide continuous, uninterrupted coverage (24 hours/7 days) of any room with an exterior wall, any room containing a safe, and any room used to store cannabis and/or cannabis products; C. Digital archiving capabilities for a minimum of (120) days; D. On-site and off-site monitoring capabilities; E. Have the date and time embedded on all surveillance recordings without significantly obscuring the picture; and,

F. Use cameras that are capable of recording in both high and low lighting conditions.

8.1.6 All cannabis waste designated for disposal shall be properly weighed and recorded in the state’s seed-to-sale system at the following points at minimum: 1. On-site at the medical cannabis establishment for which the cannabis disposal entity is providing services; and, 2. At the final destination where disposal/destruction occurs.

8.1.7 Cannabis waste shall be disposed of either via a process which renders the waste unusable and unrecognizable through physical destruction or a recycling process that the waste disposal facility is authorized by Mississippi law to carry out.

8.1.8 The disposal/destruction of cannabis waste shall be done under video surveillance by video surveillance and made available to the Department upon request.

8.1.9 Medical cannabis and/or cannabis products shall be rendered unusable by grinding and incorporating the cannabis waste with other ground materials, so the resulting mixture is at least fifty percent 50% non-cannabis waste by volume. This includes compostable mixed waste and non-compostable mixed waste meeting the requirements below.

8.1.10 Grinding and incorporating the cannabis waste into compostable mixed waste until it is unusable and unrecognizable: Cannabis waste to be disposed of as compost or in another organic waste method may be mixed with the following types of waste materials: 1. Food waste; 2. Yard waste; 3. Vegetable based grease oils; 4. Agricultural Materials; 5. Biodegradable products and paper; 6. Clean wood;

7. Fruits and vegetables; or 8. Plant matter. 9. Bokashi or other compost activators; or, 10. Other materials or methods approved by the Department that will render the cannabis waste unusable and unrecognizable.

8.1.11 Grinding and incorporating the cannabis waste into non-compostable mixed waste until it is unusable and unrecognizable: Cannabis waste to be disposed of in a landfill or another disposal method, such as incineration, may be mixed with the following types of waste materials: 1. Paper waste; 2. Cardboard waste; 3. Plastic waste; 4. Soil; 5. Nonrecyclable plastic; 6. Broken glass; 7. Sawdust; or 8. Other materials or methods approved by the Department that will render the cannabis waste unusable and unrecognizable.

8.1.12 Licensure and/or permitting may also be required through the Mississippi Department of Environmental Quality for cannabis disposal entities as well as local permitting, dependent upon the location of the cannabis disposal entity.

Subpart 9 ADVERTISING AND MARKETING 9.1 Prohibition Against Advertising and Marketing. 9.1.1 Medical cannabis establishments licensed by the Department pursuant to this Part, and/or entities acting on their behalf, are prohibited from advertising and marketing in any media, including but not limited to: A. Broadcast or electronic media:

1. Radio 2. Television 3. Unsolicited internet pop-up advertising 4. Social media B. Print media: 1. Newspaper C. Other forms: 1. Mass text/messaging communications. 2. Mass email communications. 3. Medical cannabis or medical cannabis products shall not be displayed in windows or public view. 4. Advertisement in any manner that can be viewable or otherwise perceived as a public space, including, but not limited to, adopt a highway signs, and electronic interstate signs. 5. Solicited/paid patient and/or caregiver reviews/testimonies/endorsements. 6. Solicited/paid practitioner reviews/testimonies/endorsements.

9.1.2 Licensees shall not engage in advertising that contains any statement or illustration that: A. Depicts the actual consumption of cannabis or cannabis products; B. Promotes the overconsumption of cannabis or cannabis products; C. Makes any health, medicinal, or therapeutic claims about cannabis or cannabis products; D. Makes safety claims of any type; E. Includes the image of a cannabis leaf or bud; or F. Includes any image designed or likely to appeal to minors, including cartoons, toys, animals, or children or any other likeness, images, characters, or phrases that are designed in any manner to be appealing to children and/or youth.

9.2 Branding Requirements.

9.2.1 Medical cannabis establishments licensed by the Department pursuant to this Part are permitted to participate in branding activities as described in Rules 9.2.2 and 9.2.3 in order to publicize their businesses. Additionally, the business name and contact information of all licensed medical cannabis establishments will be made available by the Department through a public website.

9.2.2 Permissible branding activities include: 1. Establishment of a website and/or social media presence that provides general information on the licensed entity’s contact information, retail dispensing locations, and a list of products available.; 2. Listings in business directories (inclusive of phone books, cannabis-related or medical publications);. 3. Display of cannabis in company logos and other branding activities; and, 4. Sponsorships of health or not-for-profit charity or advocacy events.

9.2.3 Branding shall not target minors, pregnant women, breastfeeding women, or promote non-medical use of cannabis.

9.2.4 Branding, in the form of business signage, for all licensed medical cannabis establishments is subject to local zoning and permitting requirements.

9.3 Use of Inducements. 9.3.1 Licensees may utilize inducements to assist qualified patients. Inducements shall not persuade or influence the use of medical cannabis outside of practitioner recommendations and/or limitations or the amounts allowed by the Mississippi Medical Cannabis Act. Examples of inducements include, but are not limited to: 1. The use of discount cards; 2. The use of coupons; 3. The use of “punch cards” to offer discounts/free products; 4. Promotion of sales/discounts on medical cannabis of any type; 5. The use of “buy one, get one” discount approaches; and, 6. The use of any type of “daily deal”, “weekly deal”, “monthly deal”, etc.

9.3.2 Any medical cannabis and medical cannabis products that are part of an inducement program as defined in Rule 9.3.1, remain subject to seed-to-sale tracking requirements, any practitioner limitation included on the qualified patient’s written certification, and MMCEU allotment limitations set forth in the Mississippi Medical Cannabis Act.

9.4 Education Regarding the Risks and Benefits of Medical Cannabis. 9.4.1 Education on the risks and benefits of the use of medical cannabis between a registered practitioner and/or medical cannabis establishment and a qualified patient, caregiver, parent, or legal guardian is permissible. This education is not considered advertising or marketing.

9.4.2 Education on the risks and benefits of the use of medical cannabis between a registered practitioner and/or medical cannabis establishment and a qualified patient, caregiver, parent, or legal guardian can also include written or video educational materials that are inclusive of the medical cannabis establishment’s brand.

9.4.3 Education provided to a qualified patient, caregiver, parent, or legal guardian by a registered practitioner and/or medical cannabis establishment that includes instruction/direction on the safe use of medical cannabis and/or medical cannabis products is permissible.

9.4.4 Except as otherwise provided in this Part the use of pictures and/or images of cannabis and/or cannabis products shall be limited to patient education materials.

9.4.5 A registered practitioner or medical cannabis establishment may provide educational materials about cannabis to qualifying patients and/or their designated caregivers, parents and/or legal guardians. Educational materials shall adhere to the following: A. Information about the potential risks and side effects of medical cannabis use, including the risk of poisoning and the number for the closest poison control center shall be included; B. Information to assist in the selection of cannabis, describing the potential

differing effects of various strains of cannabis, as well as various forms and routes of administration, purported effectiveness of various methods, and the differences in the anticipated time frames for the forms to take affect may be included; C. Materials offered to registered qualifying patients and their personal caregivers to enable them to track the strains used and their associated effects may be included; D. Information on tolerance, dependence, and withdrawal may be included; E. Information regarding substance abuse signs and symptoms, as well as referral information for substance abuse treatment programs; and, F. Other warnings, instructions, and/or directions on the safe use of medical cannabis and/or medical cannabis products which the registered practitioner and/or medical cannabis establishment deems appropriate.

Subpart 10 VARIANCE REQUESTS 10.1.1 Through a variance, the Department may waive provisions of this Part on its own initiative or by request from licensed medical cannabis establishments. The Department shall not consider Variance Requests related to provisions that are purely statutory.

**History**
- *Source: Miss. Code Ann. §§ 41-137-1 – 41-137-67.*
- *Source: Miss. Code Ann. §§ 41-137-1 – 41-137-67.*
- *Source: Miss. Code Ann. §§ 41-137-1 – 41-137-67.*
- *Source: Miss. Code Ann. §§ 41-137-1 – 41-137-67.*
- *Source: Miss. Code Ann. §§ 41-137-1 – 41-137-67.*
- *Source: Miss. Code Ann. §§ 41-137-1 – 41-137-67.*
- *Source: Miss. Code Ann. §§ 41-137-1 – 41-137-67.*
- *Source: Miss. Code Ann. §§ 41-137-1 – 41-137-67.*
- *Source: Miss. Code Ann. §§ 41-137-1 – 41-137-67.*

##### **15 Miss. Admin. Code Pt. 22, R. 10.1.2** Rule 10.1.2 {#sec-22-10.1.2 omnilex-key=us-ms-regs-official--title-15--22#10.1.2}

Requests for variance from the rules of any provision of this Part shall be made in writing and will be granted or denied by the State Health Officer. Variance Requests shall include: 1. A list of each rule for which a variance is requested, with citation to the specific rule(s); 2. An explanation of why the rule cannot be met at the time of the request or why meeting the rule would impose an undue burden on the licensed medical cannabis establishment; and, 3. The requested relief. Denial of variance requests shall be issued by the Department in writing and shall include the specific reasons for the denial.

##### **15 Miss. Admin. Code Pt. 22, R. 10.1.3** Rule 10.1.3 {#sec-22-10.1.3 omnilex-key=us-ms-regs-official--title-15--22#10.1.3}

The Variance Request shall be submitted by the primary contact of the licensed medical cannabis establishment in a format approved by the Department.

##### **15 Miss. Admin. Code Pt. 22, R. 10.1.4** Rule 10.1.4 {#sec-22-10.1.4 omnilex-key=us-ms-regs-official--title-15--22#10.1.4}

Variance Requests are not guaranteed for approval and will not be approved to circumvent any relevant rule, regulation or standards promulgated under the Act or any portion thereof. The medical cannabis establishment making the Variance Request should continue to meet Department-published rules in this Part while the Request is under consideration and pending.

Subpart 11 ENFORCEMENT AND PENALTIES 11.1 Suspension or Revocation of License, Fines or Other Penalties. 11.1.1 The Department may take the following actions against licensees, alone or in combination, in any case in which it finds that a licensee has failed to comply with the requirements established by the Mississippi Medical Cannabis Act and/or the rules, regulations or standards promulgated in furtherance of such act: A. Impose monetary penalties; B. Issue an Administrative Hold; C. Suspend a license; D. Revoke a license; E. Accept the voluntary surrender of a license; F. Confiscate or seize cannabis plants, cannabis and/or cannabis products; G. Order destruction of cannabis plants, cannabis and/or cannabis products; H. Recall cannabis and/or cannabis products; or I. Accept the voluntary surrender of cannabis plants, cannabis and/ cannabis products. The schedule of disciplinary actions included as APPENDIX B to this Part shall be used when administratively disciplining medical cannabis establishments for violating statutory and/or regulatory requirements. The Department reserves the right to increase penalties based on aggravating circumstances and/or the medical cannabis establishment’s history of violations and corrective actions.

**History**
- *Source: Miss. Code Ann. §§ 41-137-1 – 41-137-67.*

##### **15 Miss. Admin. Code Pt. 22, R. 11.1.2** Rule 11.1.2 {#sec-22-11.1.2 omnilex-key=us-ms-regs-official--title-15--22#11.1.2}

Suspension. In addition to the schedule of disciplinary actions included as APPENDIX B to this Part, the Department may suspend the license of a medical cannabis establishment if necessary to protect public health, safety, or welfare. A suspension shall not exceed a period longer than six (6) months. A medical cannabis establishment may continue to possess and cultivate cannabis as otherwise authorized to do so under its license during a suspension, but it may not dispense, transfer or sell cannabis.

##### **15 Miss. Admin. Code Pt. 22, R. 11.1.3** Rule 11.1.3 {#sec-22-11.1.3 omnilex-key=us-ms-regs-official--title-15--22#11.1.3}

The Department may seize, destroy, confiscate or place an administrative hold on any cannabis plants, cannabis and/or cannabis products under, but not limited to, the following circumstances: A. Failure to log and/or tag in the seed-to-sale system; B. Alteration of cannabis and/or cannabis products in a manner that fails to comply with this Part; C. Failure to package and label in accordance with this Part in general and Section 11 specifically; D. Such items are cultivated, harvested, manufactured or transferred in a manner, or otherwise in a form, not compliant with the rules/regulations in this Part or the Mississippi Medical Cannabis Act Use; or E. Improper use, handling, storage, transport, transfer or other possession of such items.

##### **15 Miss. Admin. Code Pt. 22, R. 11.1.4** Rule 11.1.4 {#sec-22-11.1.4 omnilex-key=us-ms-regs-official--title-15--22#11.1.4}

Administrative Holds. The Department may order an administrative hold of cannabis plants, cannabis and/or cannabis products to prevent destruction of evidence, diversion or other threats to public safety, while permitting a licensee to retain its inventory pending further investigation, pursuant to the following procedure: A. If during an investigation or inspection of a licensee, an employee or agent of the Department develops reasonable grounds to believe certain cannabis plants, cannabis or cannabis products constitute evidence of acts in violation of the rules/regulations in this Part, the Mississippi Medical Cannabis Act or constitute a threat to the public health or safety, the Department may issue a notice of administrative hold of any such cannabis plants, cannabis or cannabis products. The notice of administrative hold shall provide a documented description of the cannabis plants, cannabis and/or cannabis products subject to the administrative hold and a concise statement regarding

the reasons for issuing the administrative hold. B. The Department will identify the cannabis plants, cannabis and/or cannabis products subject to the administrative hold in the seed-to-sale system. The licensee shall continue to comply with all inventory tracking requirements of the seed-to-sale system. C. The licensee shall completely and physically segregate the cannabis plants, cannabis and/or cannabis products subject to the administrative hold in a limited access area of the licensed premises under investigation, where it shall be safeguarded by the licensee. D. While the administrative hold is in effect, the licensee is prohibited from selling, giving away, transferring, transporting or destroying the cannabis plants, cannabis and/or cannabis products subject to the administrative hold, except as otherwise authorized by this Part. E. While the administrative hold is in effect, the licensee must safeguard the cannabis plants, cannabis and/or cannabis products subject to the administrative hold, must maintain the licensed premises in reasonable condition according to health, safety and sanitary standards, and must fully comply with all security requirements, including but not limited to all surveillance, lock and alarm requirements in this Part. F. Nothing herein shall prevent a licensee from voluntarily surrendering cannabis plants, cannabis and/or cannabis products that is subject to an administrative hold, except that the licensee shall follow the procedure authorized by the Department to complete the voluntary surrender. G. Nothing herein shall prevent a licensee from the continued possession, cultivation or harvesting of the cannabis plants, cannabis and/or cannabis products subject to the administrative hold. H. At any time after the initiation of the administrative hold, the Department may lift the administrative hold or seek other appropriate relief.

##### **15 Miss. Admin. Code Pt. 22, R. 11.1.5** Rule 11.1.5 {#sec-22-11.1.5 omnilex-key=us-ms-regs-official--title-15--22#11.1.5}

Notice. At the time of denial of an application for licensure or the imposition of any monetary penalty and prior to imposition of non-monetary sanctions, suspension or revocation of a license, written notice of the contemplated action shall be given to the applicant or licensee specifying the reason(s) for the proposed action and shall notify the licensee of the right to a hearing on the matter. The Department shall provide its initial notice of denial, suspension, revocation, fine or other sanction by personal delivery, mailing by certified mail, signature

required, or by electronic mail to the applicant or licensee, at the address on record with the Department.

##### **15 Miss. Admin. Code Pt. 22, R. 11.1.6** Rule 11.1.6 {#sec-22-11.1.6 omnilex-key=us-ms-regs-official--title-15--22#11.1.6}

Request for an Administrative Appeal/Hearing. The Mississippi State Department of Health will provide to a licensee/aggrieved party an opportunity for a prompt and fair appeal process when the licensee/aggrieved party is dissatisfied with an administrative decision imposing fines and/or other penalties/sanctions, denial, suspension, or revocation of a license and wishes to appeal the administrative decision. A. Upon written request by the licensee/aggrieved party and within twenty (20) days of receipt of the initial notice of administrative action, the licensee/aggrieved party may file a request for an appeal which is handled through the means of an administrative hearing with the Department. Once a licensee/aggrieved party requests an appeal, the State Health Officer shall be notified by the Department and shall appoint a qualified Hearing Officer within thirty (30) days to set a date, time and place for the administrative hearing convenient for all parties. B. If the licensee/aggrieved party fails to appeal the initial notice within the prescribed time, the decision becomes final and cannot be further appealed. C. A court reporter shall attend and transcribe the proceeding. D. Hearings before a Hearing Officer are considered confidential and are not open to the public. E. An informal review may be granted for any situation, but is not required before seeking an administrative appeal, and if requested, does not toll the time limit to request an appeal/administrative hearing. F. The parties may continue to attempt to resolve issues informally once the formal appeals process has begun. G. The licensee/aggrieved party shall be entitled to legal representation at the hearing at his/her own expense but may also choose to represent himself/herself. The burden shall be on the licensee/aggrieved party at the hearing to prove that the Department’s decision was: (a) arbitrary or capricious; (b) unsupported by evidence; (c) beyond the power of the Department to make; or (d) violated a statutory or constitutional right of the aggrieved party. H. A continuance for an administrative hearing may only be requested by a showing of good cause and may be granted at the discretion of the Hearing Officer. A request for a continuance shall be made within ten (10) days of the

date for which it is needed unless it is due to an emergency. 1. Within thirty (30) calendar days of the hearing, or such period as determined during the hearing, written findings of fact together with a recommendation from the Hearing Officer shall be forwarded to the State Health Officer for review. The State Health Officer may adopt, modify, or reject the Hearing Officer’s recommendation or decide what, if any, action is to be taken on the matter. The decision by the State Health Officer will be made within fourteen (14) calendar days of receipt of the recommendation from the Hearing Officer and will be considered the Final Decision or Final Order by the Department. 2. Written notice of the decision shall be provided to the licensee/aggrieved party at the address on record with the Department. Licensee/aggrieved party has a duty to update his/her address as necessary to receive correspondence in a timely manner. 3. Appeal of the Department’s Final Order shall be accomplished as provided by the appropriate statute. 4. If the licensee/aggrieved party fails to appeal the Final Order within the prescribed time, the decision becomes final and cannot be further appealed. 5. For the Rules and Procedures for State Level Administrative Hearings refer to APPENDIX C of this Part.

##### **15 Miss. Admin. Code Pt. 22, R. 11.2** Rule 11.2 {#sec-22-11.2 omnilex-key=us-ms-regs-official--title-15--22#11.2}

Appeal of Final Decisions or Orders. 11.2.1 Any person or entity who disagrees with or is aggrieved by the Final Decision or Final Order of the Department concerning the imposition of fine(s) and/or other sanction(s), including but not limited to, denial of an application for licensure, suspension, or revocation of a license may appeal same in the circuit court of the county in which he/she resides. If the aggrieved party is a nonresident of this state, he/she may appeal to the Circuit Court of the First Judicial District of Hinds County, Mississippi. The appeal shall be filed no later than twenty (20) calendar days after the issuance of the Final Decision or Order by the Department.

##### **15 Miss. Admin. Code Pt. 22, R. 11.2.2** Rule 11.2.2 {#sec-22-11.2.2 omnilex-key=us-ms-regs-official--title-15--22#11.2.2}

The review by the circuit court shall be based on the record made before the Department. Before filing an appeal petition in circuit court, the appellant shall obtain from the Department an estimate of the cost to prepare the entire record of the Department and shall pay to the Department the amount of the estimate. The circuit court shall dismiss with prejudice any petition filed where it is shown

that the petitioner failed to pay prior to filing the petition the estimated cost for preparation of the record. On appeal to the circuit court, appellant shall have the burden of proving that the decision of the Department was: (a) arbitrary or capricious; (b) unsupported by substantial evidence; (c) beyond the power of the administrative agency to make; or (d) violated some statutory or constitutional right of the licensee/aggrieved party.

##### **15 Miss. Admin. Code Pt. 22, R. 11.2.3** Rule 11.2.3 {#sec-22-11.2.3 omnilex-key=us-ms-regs-official--title-15--22#11.2.3}

Any person or entity aggrieved by the decision of the circuit court may appeal to the Mississippi Supreme Court.

##### **15 Miss. Admin. Code Pt. 22, R. 11.2.4** Rule 11.2.4 {#sec-22-11.2.4 omnilex-key=us-ms-regs-official--title-15--22#11.2.4}

If a medical cannabis establishment is allowed to continue to operate during the appeal process, it will remain under the regulation of the Department and will be subject to all current licensure regulations to include, but not limited to, inspection of the facility, review of facility and/or records, submission of all required or requested documents, and payment of all applicable fees and/or monetary penalties. However, the medical cannabis establishment may not dispense, transfer or sell cannabis during this period.

##### **15 Miss. Admin. Code Pt. 22, R. 11.2.5** Rule 11.2.5 {#sec-22-11.2.5 omnilex-key=us-ms-regs-official--title-15--22#11.2.5}

A cannabis testing entity may continue to possess cannabis under its license during a suspension but shall not receive, transfer or test cannabis during the suspension period.

APPENDIX A Table 1 Key to Table 1: • CAS Number = Chemical Abstract Services Registry number • CFU = Colony-forming unit, a method to estimate the number of viable bacteria or fungal cells in a sample. A. Microbial Contaminants Analyte Maximum Allowable Contaminants Required Action Total coliform 100 CFU/g Use to make a concentrate or extract if the processing method effectively sterilizes the batch and retested or destroy Shiga toxin- producing Escherichia coli Detectable in 1 gram Destroy Salmonella spp. Detectable in 1 gram Destroy Aspergillus flavus, Aspergillus fumigatus, Aspergillus niger, and Aspergillus terreus Inhalable: Detectable in 1 gram Use to make a concentrate or extract if the processing method effectively sterilizes the batch and retest or destroy Mycotoxins: Aflatoxin B1, B2, G1, and G2 Ochratoxin A Cannabis product, except a cannabis product intended for topical application, prepared from an extract or concentrate of medical cannabis Destroy Total Mold and Yeast 10,000 CFU/g Use to make a concentrate or extract if the processing method effectively sterilizes the batch and retest or destroy

B. Heavy Metals Analyte Maximum Allowable Concentration (ppm) Required Action Inhaled Flower Inhaled Concentrates Other Arsenic 0.4 0.2 1.5 Remediate and retest, or Destroy

*Copper is required for vaping products only Cadmium 0.4 0.2 0.5 Lead 1.0 0.5 0.5 Mercury 0.2 0.1 3.0 Total Chromium 1.2 0.6 2.0 Nickel 1.0 0.5 N/A Copper N/A 3.0* N/A C. Residual Solvents Analyte CAS Number Maximum Allowable Concentration Required Action Acetone 67-64-1 1,000 ppm

Remediate and retest, or Destroy Acetonitrile 75-05-8 410 ppm Benzene 71-43-2 2 ppm Butanes (measured as the cumulative residue of n-butane and isobutane) respectively 106-97-8 and 75- 28-5, 5,000 ppm Chloroform 67-66-3 60 ppm Dichloromethane 75-09-2 600 ppm Ethanol 64-17-5 5,000 ppm Ethyl Acetate 141-78-6 5,000 ppm Ethyl Ether 60-29-7 5,000 ppm Heptane 142-82-5 5,000 ppm Hexanes (measured as the cumulative residue of n-hexane, 2- methylpentane, 3- methylpentane, 2,2- dimethylbutane, and 2,3- dimethylbutane) 110-54-3, 107- 83-5, and 79-29-8 290 ppm Isopropyl Acetate 108-21-4 5,000 ppm Methanol 67-56-1 3,000 ppm

Pentanes (measured as the cumulative residue of n-pentane, iso- pentane, and neo- pentane) 109-66-0, 78-78- 4, and 463-82-1 5,000 ppm 2-Propanol (IPA) 67-63-0 5,000 ppm Propane 74-98-6 5,000 ppm Toluene 108-88-3 890 ppm Xylenes (measured as the cumulative residue of 1,2- dimethylbenzene, 1,3- dimethylbenzene, and 1,4- dimethylbenzene, And the non-xylene, ethyl benzene) 1330-20-7 (95- 47-6,108- 38-3, and 106- 42- 3, and 100-41-4) 2,170 ppm Dimethylbenzene, and 1,4- dimethylbenzene, and the non- xylene, ethyl benzene) D. Pesticides, Fungicides, Growth Regulators

Analyte

CAS Number Maximum Allowable Concentration

Required Action Abamectin 71751-41-2 0.5 ppm

Destroy

Acephate 30560-19-1 0.4 ppm Acequinocyl 57960-19-7 2.0 ppm Acetamiprid 135410-20-7 0.2 ppm Aldicarb 116-06-3 0.4 ppm Azoxystrobin 131860-33-8 0.2 ppm Bifenazate 149877-41-8 0.2 ppm Bifenthrin 82657-04-3 0.2 ppm Boscalid 188425-85-6 0.4 ppm Carbaryl 63-25-2 0.2 ppm Carbofuran 1563-66-2 0.2 ppm Chlorantraniliprole 500008-45-7 0.2 ppm Chlorfenapyr 122453-73-0 1.0 ppm Chlormequat chloride 7003-89-6 0.2 ppm Chlorpyrifos 2921-88-2 0.2 ppm Clofentezine 74115-24-5 0.2 ppm Cyfluthrin 68359-37-5 1.0 ppm Cypermethrin 52315-07-8 1.0 ppm Daminozide 1596-84-5 1.0 ppm DDVP (Dichlorvos) 62-73-7 0.1 ppm

Diazinon 333-41-5 0.2 ppm

Destroy Dimethoate 60-51-5 0.2 ppm Ethoprophos 13194-48-4 0.2 ppm Etofenprox 80844-07-1 0.4 ppm Etoxazole 153233-91-1 0.2 ppm Fenoxycarb 72490-01-8 0.2 ppm Fenpyroximate 134098-61-6 0.4 ppm Fipronil 120068-37-3 0.4 ppm Flonicamid 158062-67-0 1.0 ppm Fludioxonil 131341-86-1 0.4 ppm Hexythiazox 78587-05-0 1.0 ppm Imazalil 35554-44-0 0.2 ppm Imidacloprid 138261-41-3 0.4 ppm Kresoxim-methyl 143390-89-0 0.4 ppm Malathion 121-75-5 0.2 ppm Metalaxyl 57837-19-1 0.2 ppm Methiocarb 2032-65-7 0.2 ppm Methomyl 16752-77-5 0.4 ppm Methyl parathion 298 -00 - 0 0.2 ppm Myclobutanil 88671-89-0 0.2 ppm Naled 300-76-5 0.5 ppm Oxamyl 23135-22-0 1.0 ppm Paclobutrazol 76738-62-0 0.4 ppm Permethrins (measured as the cumulative residue of cis- and trans-isomers) 52645-53- 1(54774-45-7 and 51877-74-8) 0.2 ppm Phosmet 732-11-6 0.2 ppm Piperonyl_butoxide 51-03-6 2.0 ppm Prallethrin 23031-36-9 0.2 ppm Propiconazole 60207-90-1 0.4 ppm Propoxur 114-26-1 0.2 ppm Pyrethrins (measured as the cumulative residue of pyrethrin 1, cinerin 1 and jasmolin 1) 8003-34-7(121- 21-1, 25402-06-6, and 4466-14-2) 1.0 ppm Pyridaben 96489-71-3 0.2 ppm Spinosad 168316-95-8 0.2 ppm Spiromesifen 283594-90-1 0.2 ppm

Spirotetramat 203313-25-1 0.2 ppm Spiroxamine 118134-30-8 0.4 ppm Tebuconazole 107534-96-3 0.4 ppm Thiacloprid 111988-49-9 0.2 ppm Thiamethoxam 153719-23-4 0.2 ppm Trifloxystrobin 141517-21-7 0.2 ppm E. Potency Analyte Labeling Required Action Tetrahydro- cannabinolic acid (THC-A) Label claim is not within ±10 % of tested value Revise label as necessary Delta-9- tetrahydrocannabinol (Δ9- THC) Cannabidiolic acid (CBD-A) Cannabidiol (CBD) Terpenoids (primary and secondary) Label claim is not within ±10 % of tested value Revise label as necessary F. Moisture Content and Water Activity Testing Measurement Allowable Measurement Required Action Water activity ˃ 0.65 A w Destroy Moisture content ˃ than 15% Remediate and retest

Table 2 Quality Control Sample Acceptance Criteria Frequency Positive control Produces expected result, positive result Per Batch Negative control Produces expected result, negative result Per Batch Duplicate sample Results shall concur Per Run Analyst or technician Quantitative Performance Plate count comparisons monthly Within 10% for all analysts Monthly Table 3 Quality Control Sample Acceptance Criteria Corrective Action Positive control Produces expected result, positive result Re-prep and reanalyze the entire analytical batch, once. If problem persists, locate and remedy the source of unexpected result, then re- prep samples and reanalyze with a new set of controls. Negative control Produces expected result, negative result Re-prep and reanalyze the entire analytical batch, once. If problem persists, locate and remedy the source of unexpected result, then re- prep samples and reanalyze with a new set of controls. Laboratory replicate sample Sample results shall concur Reanalyze sample and associated replicate sample once. If problem persists, re-prep samples and reanalyze.

Table 4 Quality Control Sample Acceptance Criteria Corrective Action Method Blank Sample Not to exceed LOQ Reanalyze entire analytical batch once. If method blank is still greater than the LOQ for any analyte, locate the source of contamination then re-prep samples and reanalyze. Laboratory Control Sample RPD ≤20% Reanalyze the entire analytical batch, once. If problem persists, re-prep samples and reanalyze or re-run the initial calibration curve. Duplicate Sample RPD ≤20% Reanalyze sample and associated replicate sample once. If problem persists, re-prep samples and reanalyze. Matrix Spike Sample/Matrix Spike Duplicate RPD ≤20% Reanalyze sample and associated matrix spike sample once. If problem persists, re-prep samples and reanalyze. CCV RPD ≤20% except for lowest point, which can be ±30% Reanalyze all samples that followed the last CCV that met the acceptance criteria. If CCV still fails, re-run the initial calibration curve and all samples in the analytical sequence.

APPENDIX B SCHEDULE OF DISCIPLINARY ACTIONS Violation Penalty Unit of Measurement Failure of an employee to possess an active work permit $5,000 Each employee found without an active work permit. Employment of person under the age of

$5,000 Each employee found under the age of 21. Failure to assist Department during recall of product $5,000 Each directive from the Department regarding recall. Failure to comply with security requirements $5,000 Each security deficiency related to Rules in this Part. On-site use of cannabis by employee(s) of medical cannabis establishment $5,000 Each employee using cannabis on premises of the medical cannabis establishment. Failure to sufficiently maintain records $10,000 Each deficiency/finding related to recordkeeping to Rules in this Part. Unlawful acquisition, transfer, purchase or sale of cannabis and/or cannabis product(s) $10,000 Each instance of acquisition, transfer, purchase or sale. Failure to accurately track inventory $10,000 and/or one-week suspension and/or destruction of product Each untagged plant, package and/or batch at the time of the Department’s finding. Falsification of records $10,000 and/or one week suspension Each instance of falsification of records required under Rules in this Part. Refusal to permit access by Department staff as required by law Two-week suspension Instance/Occurrence documented at the time of requested access. Threat against law enforcement and/or Department staff Two-week suspension Instance/Occurrence documented at the time of the threat. Cultivation activities during a license suspension period Revocation Cultivation activities that would include (but not limited to) any planting, drying, harvesting, and/or packaging during the dates of suspension and any administrative appeal.

Processing activities during a license suspension period Revocation Activities related to processing during the dates of suspension and any administrative appeals. Transportation activities during a license suspension period Revocation Transportation activities that would include during the dates of suspension and any administrative appeal. Disposal/Destruction activities during a license suspension period Revocation Any disposal activities during the dates of suspension and any administrative appeal. General penalty for any violation/infraction not specifically listed in this Table $5,000 Each instance and/or finding to be specifically identified by the Department.

APPENDIX C RULES AND PROCEDURES FOR ADMINISTRATIVE HEARINGS 1. Hearing Officer: The Hearing Officer shall be appointed by the State Health Officer or his/her designee. The Hearing Officer shall preside at the hearing, shall be charged with maintaining order at the hearing, and shall rule on all questions of evidence and procedure in accordance with the provisions of these rules. 2. Appearance by Licensee/Aggrieved party: The licensee/aggrieved party shall appear at the date and time set for the hearing, and failure to do so without reasonable notice to the Department may result in admission of the charges and adverse action taken against the licensee. 3. Representation by Counsel: The licensee/aggrieved party may, but is not required to be, represented by counsel at the hearing at his/her own expense and shall have the right to cross- examine all witnesses, present evidence, written or oral, on his/her own behalf, and to refute any testimony or evidence presented by the Department. 4. Confidentiality of Hearings: Administrative hearings before a Hearing Officer are considered confidential and are not open to the public. 5. Rules of Evidence and Discovery: Formal rules of evidence and procedure, including Discovery, do not apply in administrative hearings; however, the rules of evidence may be used as a guide during the hearing. A record of the hearing shall be made by a court reporter. 6. Attendance of Witnesses: The licensee/aggrieved party or counsel for the Department may make a written request to the Hearing Officer at least ten (10) days prior to the hearing to ensure the attendance of a witness or the production of documents through the issuance of an administrative subpoena. The issuance of the subpoena shall be at the discretion of the Hearing Officer. 7. Order of Proceedings: The Department shall present its case first, followed by the licensee/aggrieved party, and any rebuttal evidence by either party. At the request of either party, all prospective witnesses shall be excluded from the proceedings except while actually testifying. 8. Standard of Proof: In order for the Department’s decision to be overturned, the Hearing Officer shall find that the regulatory violation and/or disciplinary action is (a) arbitrary or capricious;

(b) unsupported by substantial evidence; (c) beyond the power of the administrative agency to make; or (d) violated some statutory or constitutional right of the aggrieved party. 9. Recommendation and Final Decision/Final Order: Within thirty (30) days of the hearing, or such period as determined at the hearing considering the amount of testimony and evidence and the complexity of the issues, the Hearing Officer shall submit his/her “Findings of Fact, Conclusions of Law and Recommendation” to the State Health Officer, outlining the proof presented and containing his/her recommendation to the State Health Officer as to the appropriate action to be taken. The State Health Officer shall issue his/her Final Order adopting, modifying, or rejecting the Recommendation within fourteen (14) days of receipt of the recommendation. This Final Order becomes the final appealable order of the Mississippi State Department of Health as to those proceedings. 10. Appeal of the Department’s Final Order shall be accomplished as provided by the appropriate statute. 11. Any person or entity who disagrees with or is aggrieved by the Final Decision or Final Order of the Department concerning the imposition of fine(s) and/or other sanction(s). suspension, or revocation of a license may appeal same in the circuit court of the county in which he/she resides. If the aggrieved party is a nonresident of this state, he/she may appeal to the Circuit Court of the First Judicial District of Hinds County, Mississippi. The appeal shall be filed no later than twenty (20) calendar days after the issuance of the Final Decision or Order by the Department. 12. Any person or entity aggrieved by the decision of the circuit court may appeal to the Mississippi Supreme Court. 13. If the licensee/aggrieved party fails to appeal the Final Order within the prescribed time, the decision becomes final and cannot be further appealed.

APPENDIX D Medical Cannabis Testing Requirements by Product Type Product Type Potency Pesticides &Chemical Residue Residual Solvents Heavy Metals Microbiological Impurities Water Activity Foreign Matter Homogeneity Bud/Flower, Shake/Trim or Raw Pre-roll ✓ ✓

✓ ✓ ✓ ✓

Non-Solvent Concentrate* ✓ ✓ ✓ ✓ ✓ Concentrate or Kief ✓ ✓ ✓ ✓ ✓

✓

Infused Beverages ✓ ✓ ✓ ✓ ✓

✓ ✓ Infused Non-Edible Solids ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ Infused Edible ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ Inhalable Concentrates, Infused Pre-Roll or Other Compound Concentrate Products*** ✓ ✓ ✓ ✓ ✓ ✓ ✓

* Extraction using ice water, rosin press or dry ice ** Moonrock, Caviar joint, tarantula, etc.

APPENDIX E Product Type Description Test Sample Packaging Cannabis Flower Loose cannabis flower whole or ground. Batch can be packaged after passing compliance testing. Raw and Infused Pre-roll products Cannabis flower loaded, rolled and ready for consumption. Samples must be in final form. Pre-roll lots in their entirety must be rolled prior to testing and shall be stored in a manner to ensure general sanitary practices and product stability. Remainder of the batch can be packaged after passing compliance testing. Oil for Vaporization Pre-filled vape cartridges and prefilled disposable pens. Samples shall be in the cartridge or container. Remainder of the batch shall be stored in a manner to ensure general sanitary practices and product stability. Remainder of the batch can be packaged after passing compliance testing. Topicals All products intended for topical use. Some examples are balms, lotions, and body oils. Samples shall be in final form. Remainder of the batch shall be stored in a manner to ensure general sanitary practices and product stability. Remainder of the batch can be packaged after passing compliance testing. Wax, Shatter, Resin Concentrated cannabis extracted using a solvent. Some examples are budder, crumble, sauce, shatter, crystals, and crumble. Samples shall be in final form. Remainder of the batch shall be stored in a manner to ensure general sanitary practices and product stability. Remainder of the batch can be packaged after passing compliance testing.

Product Type Description Test Sample Packaging Gel-based foods, Water- Soluble Edibles, Tablets, Capsules, Solid Chocolates, and Lozenges Includes: • Any cannabis edible product that is intended to be chewed and relies upon a gelling agent such as, but not limited to, gelatin, agar, or pectin to maintain its shape or texture. Some examples are fruit chews, gummies, and chewable gel capsules. • Tablets, capsules, and lozenges. • Edible products which are intended to be dissolved in water before consumption. Some examples are dissolving powders and effervescent tablets. Samples shall be in final form. Remainder of the batch shall be stored in a manner to ensure general sanitary practices and product stability. Remainder of the batch can be packaged after passing compliance testing. Oral Liquids Homogeneous oral liquids including tinctures, oral solutions, syrups, and oral emulsions. Samples shall be in final form. Remainder of the batch shall be stored in a manner to ensure general sanitary practices and product stability. Remainder of the batch can be packaged after passing compliance testing. Beverages All beverages and syrups. Samples shall be in final form. Remainder of the batch shall be stored in a manner to ensure general sanitary practices and product stability. Remainder of the batch can be packaged after passing compliance testing.

**History**
- *Source: Miss. Code Ann. §§ 41-137-1 – 41-137-67.*
- *Source: Miss. Code Ann. §§ 41-137-1 – 41-137-67.*

### **Part 23** Office Against Interpersonal Violence-Repealed

##### **15 Miss. Admin. Code Pt. 23** Office Against Interpersonal Violence-Repealed {#sec-23 omnilex-key=us-ms-regs-official--title-15--23}

1

Title 15: Mississippi Department of Health
Part 23: Office Against Interpersonal Violence
Subpart 100: State Victim Services Grant Program
REPEALED. Effective 05/23/2025