Mississippi PA Collaboration Requirements Summary

Mississippi requires every PA to practice under a supervising (collaborating) physician, working from a written protocol the PA and physician agree on together. Physician involvement is high: the physician oversees and accepts responsibility for the medical services the PA provides, must be on site for the PA’s first 120 days or 960 hours, and afterward must generally stay within 75 miles of the PA’s practice site. PAs cannot practice independently in Mississippi; finishing 960 hours ends the on-site requirement but does not reduce supervision otherwise. Monthly chart review and quarterly quality-assurance meetings continue for as long as the relationship lasts. This page covers Mississippi’s rules on supervision, the collaborative agreement, board filing, ongoing compliance, prescribing, and specialty and telehealth requirements.

Source: Miss. Code Regs. 30-17-2615-1.5

Type of Collaborative Relationship

Mississippi requires PAs to practice under a supervising physician at all times, following a written protocol the two of them agree on. Physician involvement is high — the physician must be on site for the PA’s first 120 days or 960 hours, then remain within 75 miles of the practice site in most cases, and must always be reachable through some adequate means of communication. There is no route to independent practice; completing 960 hours lifts the on-site presence requirement but supervision continues.

Source: Miss. Code Regs. 30-17-2615-1.6

What is a PA’s scope of practice in Mississippi?

A PA’s scope of practice is set by the written protocol agreed on with the supervising physician. The protocol is prepared with the physician’s specialty in mind and must spell out the diagnostic and therapeutic procedures the PA may perform, along with the categories of medications the PA may order, administer, dispense, or prescribe for the diagnoses the PA identifies.

Do PAs need a collaborating physician in Mississippi?

Yes. A PA must practice under a supervising physician and cannot begin practice until they report that physician and their practice information to the Mississippi State Board of Medical Licensure.

Can PAs practice independently in Mississippi?

No. Mississippi requires ongoing physician supervision, and the physician oversees and accepts responsibility for the medical services the PA provides. Completing 960 hours ends the on-site presence requirement but does not create independent or autonomous practice.

How many PAs can a physician collaborate with in Mississippi?

Mississippi sets no limit on the number of PAs a physician may supervise. There is no ratio cap in the state’s rules.

Who can be a collaborating physician in Mississippi?

A supervising physician must be an MD or DO holding an unrestricted Mississippi license who practices in Mississippi at least 20 hours per week or 80 hours per month. Telemedicine and chart review time do not count toward those hours. The Board may grant an exception to the in-state practice requirement where good cause is shown, weighing factors such as the physician’s location relative to the PA, the patient population served, the need for the services, and the experience and disciplinary history of both clinicians.

Are there proximity or in-person requirements in Mississippi?

Yes. New graduate PAs and any PA whose Mississippi license is their first license require the on-site presence of a supervising physician for 120 days or 960 hours; that period may be shortened if the PA’s clerkship was completed with the same physician. After that, the PA’s practice must stay within the physician’s primary office or a facility within 75 miles of it, and practicing farther away requires the Board’s approval of the protocol — though PAs in licensed hospitals, state health department facilities, federally qualified community health clinics, and volunteer clinics are excluded from that approval requirement, and primary care PAs face no mileage limit when the protocol is with a compatible primary care physician who has direct access to the PA’s EMR and meets the in-state hours requirement.

Collaboration Agreement Requirements

Mississippi’s written agreement is called a protocol, and the state does not provide a template. It must describe what the PA may do clinically, what categories of medications the PA may use and for which diagnoses, and how coverage works when the physician is away. Mississippi does not require signatures or set a review schedule, but the protocol must be mutually agreed on by the PA and the physician.

Source: Miss. Code Regs. 30-17-2615-1.5

What must be included in a PA collaborative agreement in Mississippi?

The protocol must cover the diagnostic and therapeutic procedures the PA may perform, the categories of medications the PA may order, administer, dispense, or prescribe and the diagnoses they apply to, and a detailed description of back-up coverage when the supervising physician is away from the primary office. It must be prepared taking the supervising physician’s specialty into account. Separately, every supervisory relationship must have a formal quality improvement program in place — monthly chart review and quarterly quality-assurance meetings — even though the rules do not expressly require that program to sit inside the protocol document.

What is the collaborative agreement called in Mississippi?

It is called a protocol.

Who has to sign the collaborative agreement in Mississippi?

Mississippi does not require signatures on the protocol. The rules do require that the protocol be mutually agreed on by the PA and the supervising physician.

How often must the agreement be reviewed or renewed in Mississippi?

Mississippi sets no review or renewal schedule for the protocol.

Is a backup physician required in Mississippi?

No, Mississippi does not require a named backup physician. The protocol must still contain a detailed description of back-up coverage for times when the supervising physician is away from the primary office.

Board Filing Requirements

Mississippi does not require the protocol to be filed with the Board in the ordinary case, but a PA cannot practice until they report their supervising physician and practice information to the Mississippi State Board of Medical Licensure. Once that report is made, the PA may begin practicing. Any change in the arrangement — including termination — must be reported to the Board in writing immediately.

Source: Miss. Code Regs. 30-17-2615-1.5

Do you have to file the collaborative agreement with the board in Mississippi?

No, the protocol does not have to be filed routinely. The PA must report their supervising physician and practice information to the Board through its online licensing system before practicing. A protocol does have to be presented to the Board for approval before a PA practices more than 75 miles from the supervising physician’s primary office, unless the PA works in a licensed hospital, state health department facility, federally qualified community health clinic, or volunteer clinic.

Can a PA start practicing as soon as they file in Mississippi?

Yes. Once the PA has reported their supervising physician and practice information to the Board, they may begin practicing — separate Board approval of the relationship is not required in the ordinary case.

What are the termination and notice requirements in Mississippi?

The PA must notify the Board in writing immediately. This applies to the PA’s termination, the physician’s retirement or withdrawal from active practice, and any other change in employment, functions, or activities. Mississippi allows no grace period for an unanticipated termination, and failing to notify the Board can lead to disciplinary action.

Collaboration Compliance

Once the relationship is active, Mississippi requires monthly chart review, a quarterly face-to-face quality-assurance meeting, and documentation of both. The supervising physician must also provide an adequate means of communication with the PA, which can be by phone, fax, or other telecommunication technology. The formal quality improvement program must be kept on site and available for Board inspection.

Source: Miss. Code Regs. 30-17-2615-1.6

How many charts must a collaborating physician review in Mississippi?

Every month, the supervising physician must review a random sample of 10% of the PA’s patient charts or 20 charts, whichever is less. The sample should reflect the variety of patient types the PA sees. A patient the PA and physician consulted on together during the month counts as one chart review.

How often must a PA and collaborating physician meet in Mississippi?

Once per quarter, face to face — either in person or by video conference. The meeting is for quality assurance and must be documented.

How long must collaboration records be kept in Mississippi?

Mississippi sets no specific retention period. The PA must maintain a log of the charts reviewed, including the chart identifier, the reviewer’s name, and the date of review, and the formal quality improvement program must be kept on site and available for inspection by the Mississippi State Board of Medical Licensure. Quarterly quality-assurance meetings must also be documented.

Prescribing Rules

PAs in Mississippi may prescribe, including controlled substances, but controlled-substance authority must be granted by the Mississippi State Board of Medical Licensure and requires federal DEA registration. Prescribing runs through the protocol: the categories of medications a PA may use, and the diagnoses they apply to, are defined there. Mississippi adds no separate state controlled-substance registration and sets no prescription pad requirements.

Source: Miss. Code Regs. 30-17-2615-1.5(B)

Can a PA prescribe controlled substances in Mississippi?

Yes, with controlled-substance prescribing authority granted by the Board. To obtain it, the PA must complete a Board-approved educational program before applying and then submit a Board-approved application. The PA must also be registered with the U.S. Drug Enforcement Administration.

Can a PA prescribe Schedule II drugs in Mississippi?

Mississippi’s PA rules do not limit controlled-substance prescribing by schedule. The Board grants authority to prescribe controlled substances in any schedule once the PA completes the required education and the Board approves the application.

What schedule drugs can a PA prescribe in Mississippi?

Any schedule the Board has authorized for that PA. Mississippi’s rules address controlled substances in any schedule rather than carving out specific ones, and what the PA may actually prescribe is also bounded by the categories of medications and diagnoses set out in the protocol.

Does a PA need a DEA license in Mississippi?

Yes. Every PA authorized to practice in Mississippi who prescribes any controlled substance must be registered with the U.S. Drug Enforcement Administration in compliance with federal law. Mississippi does not add a separate state controlled-substance registration, though PAs in a registered pain management practice must also register with the Mississippi Prescription Monitoring Program.

Can a PA prescribe independently (without physician sign-off) in Mississippi?

No. A PA’s prescribing is bounded by the categories of medications and diagnoses in the protocol agreed on with the supervising physician, and the physician accepts responsibility for the medical services the PA provides. Mississippi does not require the physician to co-sign individual prescriptions or charts.

Specialty & Telehealth Requirements

Mississippi sets no telehealth-specific requirements for PAs, but it does impose extra requirements on PAs working in a registered pain management practice, including prescription monitoring program registration and additional continuing education. Standard supervision, protocol, and prescribing rules apply otherwise.

Source: Miss. Code Regs. 30-17-2640-1.14(J),(K)

Are there telehealth or telemedicine requirements for PAs in Mississippi?

No, Mississippi sets no telehealth-specific requirement for PAs. Telemedicine does affect supervision math, though: hours a physician spends on telemedicine do not count toward the 20 hours per week or 80 hours per month of in-state practice required to serve as a supervising physician, and they do not count toward the in-state hours needed for the primary care mileage exemption.

Are there specialty-specific requirements for PAs in Mississippi?

Yes, PAs working in a registered pain management medical practice face additional requirements. The PA must have a Board-approved pain management protocol with a physician whose license is not limited, restricted, retired, temporary, or in-training; must be registered with the Mississippi Prescription Monitoring Program and obtain a report at the initial visit and every subsequent visit for each patient; and, if the PA has prescriptive authority, must complete 5 additional hours of Category 1 CME on prescribing and pain management each two-year CME cycle and follow the Board’s rules on prescribing, administering, and dispensing medication.