Can a Mississippi community hospital provide services in another state if that's part of its service area?

Plain-English summary

Magnolia Regional Medical Center's attorney asked whether a Mississippi community hospital could provide services outside the state, as long as the location was within the hospital's defined "service area."

The AG read the current statute and said yes. Section 41-13-10(f) defines "service area" as "that area in which a community hospital may provide services and perform the activities in Section 41-13-35(5), as determined by a board of trustees by its patient origin studies, and may include areas outside of the State of Mississippi" (emphasis added).

The italicized phrase was added by a 2019 amendment (S.B. 2892, 2019 Regular Session). Before that amendment, a 2011 AG opinion (Philips) had said community hospitals couldn't operate in another state. The 2019 amendment changed the law, and the 2021 opinion modified the older Philips opinion to that extent. Hospitals could now legitimately serve out-of-state patients and operate facilities (e.g., clinics, satellite locations) outside Mississippi, as long as the area was within the hospital's service area as determined by the board's patient-origin studies.

The opinion was narrow: it answered the service-area definition question only. The AG expressly offered no opinion on the applicability of any other state or federal laws to a Mississippi community hospital operating in another state.

Currency note

This opinion was issued in 2021. Subsequent statutory amendments, court decisions, or later AG opinions may have changed the analysis. Treat this page as historical context, not current legal advice. Verify current law before relying on any specific rule, deadline, or remedy mentioned here.

What the opinion said for each audience, at the time

For Mississippi community hospitals

Under the opinion, a community hospital could provide its authorized services at a location outside Mississippi, as long as that location was within the hospital's "service area." Section 41-13-10(f) ties the service-area boundary to the board's patient-origin studies, "as determined by a board of trustees by its patient origin studies."

For hospital boards of trustees

The statute makes the board's patient-origin studies the basis for determining the service area, and the amended definition says that area "may include areas outside of the State of Mississippi." The opinion did not require AG approval for an out-of-state service area; under § 41-13-10(f) the board's own determination was the operative authority.

For health-system attorneys

The opinion modified the 2011 Philips opinion, which had concluded a community hospital could not operate in another state. The substantive change was the 2019 amendment to § 41-13-10(f); the 2021 opinion read the amended text as permitting a service area that includes out-of-state areas. The AG limited the opinion to the meaning of "service area" and, in footnote 2, offered "no opinion on the applicability of any other state or federal laws to a Mississippi community hospital operating in another state."

Common questions

Q: What is a "community hospital" in Mississippi?
A: A hospital organized under Mississippi Code §§ 41-13-10 through 41-13-47. These are governed by a board of trustees, which under § 41-13-10(f) determines the hospital's "service area" through its patient-origin studies.

Q: What's a "patient origin study"?
A: The statute does not define the term beyond making it the board's tool for setting the service area. Section 41-13-10(f) ties the service area to the board's "patient origin studies," so the board uses the pattern of where its patients come from to determine the area it serves.

Q: Did the law require AG approval for the out-of-state service area?
A: No. Under § 41-13-10(f) the board of trustees determines the service area through its patient-origin studies. The AG opinion addressed only whether the statute allowed a service area outside Mississippi; once that was settled, the board's own determination was the operative authority.

Q: How was the law before the 2019 amendment?
A: Before the amendment, the 2011 Philips opinion read the enabling statute as not allowing a community hospital to operate in another state. The 2019 amendment (S.B. 2892) added the language expressly stating the service area "may include areas outside of the State of Mississippi," and the 2021 opinion modified Philips to that extent.

Q: What kinds of services count?
A: The services a community hospital is "otherwise authorized to perform" under § 41-13-35(5). The opinion did not reproduce that list; it held only that whatever services the hospital may perform, it may perform them at a location within its service area, including an out-of-state location.

Q: Could a Mississippi community hospital open a full hospital in another state?
A: The opinion did not address that. It was limited to interpreting "service area" and to a hospital "providing services" it is otherwise authorized to perform within that area. The AG offered no opinion on any other state or federal law that might apply.

Background and statutory framework

Mississippi's community hospital enabling legislation runs from § 41-13-10 through § 41-13-47 (Title 41, Chapter 13). Section 41-13-10(f) defines "service area" as the area in which a community hospital may provide the services and activities listed in § 41-13-35(5), "as determined by a board of trustees by its patient origin studies," and provides that the area "may include areas outside of the State of Mississippi."

The phrase allowing out-of-state areas was added by the 2019 amendment (S.B. 2892, 2019 Regular Session). Before that, the 2011 Philips opinion had concluded that the enabling legislation did not allow a community hospital to operate in another state. The 2021 opinion treated Philips as a correct reading of the 2011 statute and modified it to the extent it conflicted with the amended text. The opinion was expressly limited to the meaning of "service area" and offered no opinion on whether other state or federal laws would apply to a Mississippi community hospital operating in another state.

Citations and references

Statutes:

• Miss. Code Ann. § 41-13-10, definitions for community hospital chapter
• Miss. Code Ann. § 41-13-10(f), definition of "service area" (post-2019 amendment includes out-of-state areas)
• Miss. Code Ann. § 41-13-35(5), authorized activities of community hospitals
• Miss. Code Ann. § 41-13-47, end of community hospital chapter

Prior AG opinions cited:

• MS AG Op., Philips (Feb. 18, 2011), pre-2019 amendment opinion that community hospital could not operate in another state (modified)

Bill referenced:

• S.B. 2892 (Reg. Sess. 2019), amended § 41-13-10(f) to include out-of-state areas in service-area definition

Source

• Landing page: https://attorneygenerallynnfitch.com/divisions/opinions-and-policy/recent-opinions/
• Original PDF: https://attorneygenerallynnfitch.com/wp-content/uploads/2021/05/K.Gilchrist_May-14-2021-Service-area-of-community-hospital-1.pdf

Original opinion text

May 14, 2021

Kathryn R. Gilchrist, Esq.
Attorney for Magnolia Regional Medical Center
609 Steed Road
Ridgeland, Mississippi 39157

Re: Service area of community hospital

Dear Ms. Gilchrist:

The Office of the Attorney General has received your request for an official opinion.

Question Presented

Can a community hospital provide services outside of Mississippi, so long as it operates within its "service area"?

Brief Response

Yes. A community hospital may provide authorized services within the hospital's "service area," which "may include areas outside of the State of Mississippi."

Applicable Law and Discussion

Mississippi Code Annotated Sections 41-13-10 through 41-13-47 govern community hospitals. Section 41-13-10 provides, in part:

For purposes of Sections 41-13-10 through 41-13-47, the following words shall have the meanings ascribed herein, unless the context otherwise requires:
...
(f) "Service area" means that area in which a community hospital may provide services and perform the activities in Section 41-13-35(5), as determined by a board of trustees by its patient origin studies, and may include areas outside of the State of Mississippi.

Miss. Code Ann. § 41-13-10 (emphasis added).

As your request notes, our office has previously been asked to opine as to whether a community hospital could operate in another state, so long as it operates within its "service area." MS AG Op., Philips (Feb. 18, 2011). There, we found that a community hospital could not operate in another state because the community hospital enabling legislation did not allow for such operation. While Philips is a correct interpretation of the law as it existed in 2011, Section 41-13-10(f), the definition of "service area," was amended during the 2019 Regular Legislative Session to specifically state that a community hospital's authorized service area "may include areas outside of the State of Mississippi." S.B. 2892, Reg. Sess. (Miss. 2019).[1]

Based on a plain reading of Section 41-13-10(f), as currently written, a community hospital's service area may include areas outside the State. Therefore, so long as the hospital is performing services that it is otherwise authorized to perform, it may do so outside the State of Mississippi, providing such location is within the hospital's service area.[2]

If this office may be of any further assistance to you, please do not hesitate to contact us.

Sincerely,

LYNN FITCH, ATTORNEY GENERAL

By: /s/ Phil Carter
Phil Carter
Special Assistant Attorney General

[1] Our Philips opinion is modified to the extent that it is inconsistent with current law and this opinion.

[2] This opinion is limited to an interpretation of the term "service area," as was amended during the 2019 Regular Legislative Session. We offer no opinion on the applicability of any other state or federal laws to a Mississippi community hospital operating in another state.