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Palliative-care physician asks Mississippi medical board for exceptions to in‑state practice rules to allow Louisiana nurse practitioners to do home visits
Summary
Dr. Simeon Kwan, representing national palliative-care company Carillon, asked the State Board of Medical Licensure to grant exceptions to a 75‑mile rule and the board's 80/20 in‑state practice requirement so two Louisiana nurse practitioners could provide in‑home care in north Mississippi while Kwan provides virtual oversight.
Dr. Simeon Kwan, a palliative‑care physician with the national company Carillon, asked the State Board of Medical Licensure during a board meeting to grant two exceptions so the group's Louisiana nurse practitioners can provide occasional in‑home visits in north Mississippi while the group provides virtual care from out of state.
Kwan told the board he and his colleagues “only practice in patients' homes and do about 50% virtual, 50% in person” nationally, and that Carillon seeks an “extended mileage exception to allow us to collaborate” so two nurse practitioners based in the New Orleans area can enter Mississippi for in‑person visits. Kwan said the company would meet oversight requirements including monthly chart reviews, a quality‑improvement program and quarterly in‑person meetings.
The request concerns two board rules referenced in the meeting: a 75‑mile geographic rule and an 80/20 in‑state practice requirement. Kwan confirmed he is based in Houston, Texas, that the two nurse practitioners (identified only as Holly and Catherine in the record) work in Louisiana, and that the company has no physician who resides in Mississippi.
Board members pressed for details about the model of care, scope of practice, and billing. Kwan described Carillon's target patients as frail, often geriatric people with multiple chronic conditions who are frequently hospitalized; he said payers refer the sickest patients and Carillon contracts with Medicare Advantage plans. “We only bill the payers directly on a per member per month” basis, he said, adding the company does not bill patients directly.
Board members also asked how much of the care would be in person versus virtual. Kwan initially gave several figures used in different markets — “50% virtual, 50% in person” and “about 70/30” in saturated areas — and then said for this Mississippi practice the care would likely be predominantly virtual: “Probably 90–95 to 5, only really going into Mississippi if they really need to.”
The board asked whether the Louisiana nurse practitioners make diagnoses and prescribe medications; Kwan said yes, and that they would generally consult patients' primary care physicians before making significant changes to chronic medication regimens but could prescribe for acute problems. He said the team uses Epic as its electronic medical record and telemedicine platform.
After questioning, the board voted to close the public meeting and go into executive session “to consider matters that may have an application.” The motion to enter executive session passed with board members voting in the affirmative; the board then conducted its closed deliberations.
No final licensure decision or formal grant of the requested exceptions was announced in the public record before the meeting moved into executive session.
The discussion underscores how licensure and geographic limits can affect delivery models that combine telemedicine with periodic in‑person visits across state lines. Board members sought details about supervision, frequency of in‑person visits, the relationship to patients' primary care physicians, and the billing arrangement with Medicare Advantage plans.
