24 LC 54 0288
House Bill 1046
By: Representatives Clark of the 100
th
, Jones of the 47
th
, Powell of the 33
rd
, Barrett of the
24
th
, Mathiak of the 74
th
, and others
A BILL TO BE ENTITLED
AN ACT
To amend Code Section 16-13-72, Code Section 31-6-2, and Article 7 of Chapter 7 of
1
Title 31 of the Official Code of Georgia Annotated, relating to the sale, distribution, or2
possession of dangerous drugs, definitions relative to state health planning and development,3
and home health agencies, respectively, so as to authorize advanced practice registered4
nurses and physician assistants to order home healthcare services; to amend Title 43 of the5
Official Code of Georgia Annotated, relating to professions and businesses, so as to authorize6
the Georgia Composite Board of Professional Counselors, Social Workers, and Marriage and7
Family Therapists to establish a professional health program to provide for monitoring and8
rehabilitation of impaired healthcare professionals; to authorize the Georgia Board of9
Nursing to establish a professional health program to provide for monitoring and10
rehabilitation of impaired healthcare professionals; to repeal the prohibition on delegating11
to advanced practice registered nurses the authority to sign death certificates; to provide for12
related matters; to repeal conflicting laws; and for other purposes.13
BE IT ENACTED BY THE GENERAL ASSEMBLY OF GEORGIA:14
H. B. 1046
- 1 - 24 LC 54 0288
SECTION 1.
15
Code Section 16-13-72 of the Official Code of Georgia Annotated, relating to the sale,16
distribution, or possession of dangerous drugs, is amended by revising paragraph (4.2) as17
follows:18
"(4.2) A registered professional nurse licensed under Article 1 of Chapter 26 of Title 4319
who is employed or engaged by a licensed home health agency may possess sterile saline,20
sterile water, and diluted heparin for use as intravenous maintenance for use in a home21
health setting, and such nurse may administer such items to patients of the home health22
agency upon the order of a licensed physician, advanced practice registered nurse acting
23
pursuant to the authority of Code Section 43-34-25, or licensed physician assistant acting24
pursuant to the authority of subsection (e.1) of Code Section 43-34-103. The State Board25
of Pharmacy shall be authorized to adopt regulations governing the storage, quantity, use,26
and administration of such items; provided, however, nothing in this paragraph or in such27
regulations shall be construed to restrict any authority of nurses existing under other28
provisions of law;"29
SECTION 2.30
Code Section 31-6-2 of the Official Code of Georgia Annotated, relating to the definitions31
relative to state health planning and development, is amended by revising paragraph (20) as32
follows:33
"(20) 'Home health agency' means a public agency or private organization, or a34
subdivision of such an agency or organization, which is primarily engaged in providing35
to individuals who are under a written plan of care of a physician, advanced practice36
registered nurse acting pursuant to the authority of Code Section 43-34-25, or licensed37
physician assistant acting pursuant to the authority of subsection (e.1) of Code Section38
43-34-103, on a visiting basis in the places of residence used as such individuals' homes,39
H. B. 1046
- 2 - 24 LC 54 0288
part-time or intermittent nursing care provided by or under the supervision of a registered
40
professional nurse, and one or more of the following services:41
(A) Physical therapy;42
(B) Occupational therapy;43
(C) Speech therapy;44
(D) Respiratory therapy;
45
(E) Skilled nursing care;46
(F) Medical social services under the direction of a physician, advanced practice47
registered nurse acting pursuant to the authority of Code Section 43-34-25, or licensed48
physician assistant acting pursuant to the authority of subsection (e.1) of Code Section49
43-34-103; or50
(E)(G) Part-time or intermittent services of a home health aide."51
SECTION 3.52
Article 7 of Chapter 7 of Title 31 of the Official Code of Georgia Annotated, relating to53
home health agencies, is amended by revising Code Section 31-7-150, relating to definitions,54
as follows:55
"31-7-150.56
As used in this article, the term:57
(1) 'Advanced practice registered nurse' has the same meaning as provided in Code58
Section 43-26-3.59
(2) 'Branch office' means a location or site, identified in the application or endorsement60
thereto, from which a home health agency provides services within a portion of the total61
geographic area served by the parent agency and which is part of the home health agency62
and is located sufficiently close to share administration, supervision, and services in a63
manner that renders it unnecessary for the branch independently to meet the requirements64
of this article.65
H. B. 1046
- 3 - 24 LC 54 0288
(1.1)(3) 'Department' means the Department of Community Health.66
(2)(4) 'Home health agency' means a public, nonprofit, or proprietary organization,67
whether owned or operated by one or more persons or legal entities, which is engaged in68
furnishing home health services.69
(3)(5) 'Home health services' means those items and services furnished to an individual70
according to a written plan of treatment signed by the patient's physician, an advanced71
practice registered nurse, or a physician assistant; by a home health agency,; or by others72
under arrangement with the home health agency, on a visit or hourly basis, in a place of73
temporary or permanent residence used as the individual's home, as follows:74
(A) Part-time or intermittent skilled nursing care as ordered by a physician, advanced75
practice registered nurse, or physician assistant and provided by or under the76
supervision of a registered nurse and at least one other service listed in77
subparagraphs (B) through (D) of this paragraph;78
(B) Physical, occupational, or speech therapy;79
(C) Medical social services; and80
(D) Home health aide services.81
(4)(6) 'License' means a license issued by the department.82
(5)(7) 'Licensee' means the individual, corporation, or public entity with whom rests the83
ultimate responsibility for maintaining approved standards for the home health agency.84
(6)(8) 'Parent home health agency' means the agency that develops and maintains85
administrative controls of subunits or branch offices.86
(7)(9) 'Physician' means an individual currently licensed or authorized to practice87
medicine, surgery, or osteopathy in this state.88
(10) 'Physician assistant' means an individual licensed pursuant to Article 4 of89
Chapter 34 of Title 43 and acting pursuant to the authority of subsection (e.1) of Code90
Section 43-34-103.91
H. B. 1046
- 4 - 24 LC 54 0288
(8)(11) 'Plan of treatment' means a plan written, signed, and reviewed at least every two92
months by the patient's physician, an advanced practice registered nurse, or a physician93
assistant prescribing items and services for the patient's condition.94
(9)(12) 'Registered nurse' means an individual who is currently licensed as a registered95
professional nurse in this state.96
(10)(13) 'Subunit' means a semiautonomous organization which serves patients in a97
geographic area different from that of the parent agency and which, by virtue of the98
distance between it and the parent agency, is judged incapable of sharing administration,99
supervision, and services on a daily basis with the parent agency and must, therefore,100
independently meet the licensing requirements for a home health agency and shall be101
separately licensed."102
SECTION 4.103
Said article is further amended by revising Code Section 31-7-153, relating to standards for104
patient care and agency operation, regulations as to issuance, denial, suspension, or105
revocation of licenses, and hearings, as follows:106
"31-7-153.107
The department shall promulgate regulations which define standards for the care, treatment,108
health, safety, welfare, and comfort of patients served by home health agencies and for the109
maintenance and operation of home health agencies which will promote safe and adequate110
care and treatment of the patients. These regulations shall be no less stringent than those111
required for participation of home health agencies in the Title XVIII medicare Medicare112
program and shall include, but not be limited to, a provision requiring the agency to have113
policies established by a professional group which includes at least one physician and one114
registered nurse and appropriate representation from other professional disciplines;115
provisions governing the services the agency provides; provisions for the supervision of116
services by a physician, advanced practice registered nurse, physician assistant, or117
H. B. 1046
- 5 - 24 LC 54 0288
registered nurse, as appropriate, and maintenance of clinical records on all patients,
118
including a plan of treatment prescribed by a physician
. The department is authorized to119
issue, deny, suspend, or revoke licenses in accordance with regulations promulgated120
pursuant to this Code section. Such regulations shall also include hearing procedures121
related to denial, suspension, or revocation of licenses."122
SECTION 5.123
Said article is further amended by revising Code Section 31-7-154, relating to inspections,124
as follows:125
"31-7-154.126
Each home health agency for which a license has been issued shall be periodically127
inspected by an authorized representative of the department. Such inspections shall be for128
the purpose of ensuring that this article is being followed. The department is directed to129
ensure by inspection that the licensee is providing quality care to its patients in accordance130
with the orders of the patient's physician, an advanced practice registered nurse, or a131
physician assistant; provided, however, that an agency shall be exempt from an additional132
on-site licensure inspection if certified in a federal program for reimbursement of medicare133
Medicare or Medicaid services."134
SECTION 6.135
Title 43 of the Official Code of Georgia Annotated, relating to professions and businesses,136
is amended in Chapter 10A, relating to professional counselors, social workers, and marriage137
and family therapists, by adding a new Code section to read as follows:138
"43-10A-24.139
(a) As used in this Code section, the term:140
(1) 'Entity' means an organization or medical professional association which conducts141
professional health programs.142
H. B. 1046
- 6 - 24 LC 54 0288
(2) 'Healthcare professional' means any individual licensed, certified, or permitted by the143
board under this chapter.144
(3) 'Impaired' means the inability of a healthcare professional to practice with reasonable145
skill and safety to patients by reason of illness or use of alcohol, drugs, narcotics,146
chemicals, or any other type of material, or as a result of any mental or physical147
condition.148
(4) 'Professional health program' means a program established for the purposes of149
monitoring and rehabilitation of impaired healthcare professionals.150
(b) The board shall be authorized to conduct a professional health program to provide151
monitoring and rehabilitation of impaired healthcare professionals in this state. To this152
end, the board shall be authorized to enter into a contract with an entity for the purpose of153
establishing and conducting such professional health program, including, but not limited154
to:155
(1) Monitoring and rehabilitation of impaired healthcare professionals for the purpose156
of ensuring the fitness of each such healthcare professional to resume or continue the157
practice of his or her healthcare profession while maintaining the safety of the public;158
(2) Performing duties related to paragraph (10) of subsection (a) of Code159
Section 43-10A-17; and160
(3) Performing such other related activities as determined by the board.161
(c) Notwithstanding subsection (k) of Code Section 43-1-2 and Code Section 43-10A-17,162
the board shall be authorized to provide pertinent information regarding healthcare163
professionals, as determined by the board and in its sole discretion, to an entity for its164
purposes in conducting a professional health program pursuant to this Code section.165
(d) All information, interviews, reports, statements, memoranda, or other documents166
furnished to an entity by the board or other source or produced by an entity and any167
findings, conclusions, recommendations, or reports resulting from the monitoring or168
rehabilitation of healthcare professionals pursuant to this Code section are declared to be169
H. B. 1046
- 7 - 24 LC 54 0288
privileged and confidential and shall not be subject to Article 4 of Chapter 18 of Title 50,170
relating to open records. All such records of an entity shall be confidential and shall be171
used by such entity and its employees and agents only in the exercise of the proper function172
of the entity pursuant to its contract with the board. Such information, interviews, reports,173
statements, memoranda, or other documents furnished to or produced by an entity and any174
findings, conclusions, recommendations, or reports resulting from the monitoring or175
rehabilitation of healthcare professionals shall not be available for court subpoenas or for176
discovery proceedings.177
(e) An impaired healthcare professional who participates in a professional health program178
conducted pursuant to this Code section shall bear all costs associated with such179
participation.180
(f) Any entity that contracts with the board pursuant to this Code section shall be immune181
from any liability, civil or criminal, that might otherwise be incurred or imposed for the182
performance of any functions or duties under the contract, if performed in accordance with183
the terms of such contract and the provisions of this Code section."184
SECTION 7.185
Said title is further amended in Chapter 26, relating to nurses, by adding a new article to read186
as follows:187
"ARTICLE 5188
43-26-70.189
As used in this article, the term:190
(1) 'Board' means the Georgia Board of Nursing.191
(2) 'Entity' means an organization or medical professional association which conducts192
professional health programs.193
H. B. 1046
- 8 - 24 LC 54 0288
(3) 'Healthcare professional' means any individual licensed, certified, or permitted by the194
board under this chapter.195
(4) 'Impaired' means the inability of a healthcare professional to practice with reasonable196
skill and safety to patients by reason of illness or use of alcohol, drugs, narcotics,197
chemicals, or any other type of material, or as a result of any mental or physical198
condition.199
(5) 'Professional health program' means a program established for the purposes of200
monitoring and rehabilitation of impaired healthcare professionals.201
43-26-71.202
(a) The board shall be authorized to conduct a professional health program to provide203
monitoring and rehabilitation of impaired healthcare professionals in this state. To this204
end, the board shall be authorized to enter into a contract with an entity for the purpose of205
establishing and conducting such professional health program, including, but not limited206
to:207
(1) Monitoring and rehabilitation of impaired healthcare professionals for the purpose208
of ensuring the fitness of each such healthcare professional to resume or continue the209
practice of his or her healthcare profession while maintaining the safety of the public;210
(2) Performing duties related to paragraph (2) of Code Section 43-26-11; and211
(3) Performing such other related activities as determined by the board.212
(b) Notwithstanding subsection (k) of Code Section 43-1-2 and Code Section 43-26-11,213
the board shall be authorized to provide pertinent information regarding healthcare214
professionals, as determined by the board and in its sole discretion, to an entity for its215
purposes in conducting a professional health program pursuant to this Code section.216
(c) All information, interviews, reports, statements, memoranda, or other documents217
furnished to an entity by the board or other source or produced by an entity and any218
findings, conclusions, recommendations, or reports resulting from the monitoring or219
H. B. 1046
- 9 - 24 LC 54 0288
rehabilitation of healthcare professionals pursuant to this Code section are declared to be220
privileged and confidential and shall not be subject to Article 4 of Chapter 18 of Title 50,221
relating to open records. All such records of an entity shall be confidential and shall be222
used by such entity and its employees and agents only in the exercise of the proper function223
of the entity pursuant to its contract with the board. Such information, interviews, reports,224
statements, memoranda, or other documents furnished to or produced by an entity and any225
findings, conclusions, recommendations, or reports resulting from the monitoring or226
rehabilitation of healthcare professionals shall not be available for court subpoenas or for227
discovery proceedings.228
43-26-72.229
An impaired healthcare professional who participates in a professional health program230
conducted pursuant to Code Section 43-26-71 shall bear all costs associated with such231
participation.232
43-26-73.233
Any entity that contracts with the board pursuant to Code Section 43-26-71 shall be234
immune from any liability, civil or criminal, that might otherwise be incurred or imposed235
for the performance of any functions or duties under the contract if performed in236
accordance with the terms of such contract and the provisions of this article."237
SECTION 8.238
Said title is further amended in Chapter 34, relating to physicians, acupuncture, physician239
assistants, cancer and glaucoma treatment, respiratory care, clinical perfusionists, and240
orthotics and prosthetics practice, by revising subsection (b) of Code Section 43-34-23,241
relating to delegation of authority to nurse or physician assistant, as follows:242
H. B. 1046
- 10 - 24 LC 54 0288
"(b)(1)(A) A physician may delegate the authority contained in subparagraph (B) of
243
this paragraph to:244
(i) A physician assistant in accordance with a job description; or245
(ii) A nurse recognized by the Georgia Board of Nursing as a certified nurse midwife,246
certified registered nurse anesthetist, certified nurse practitioner, or clinical nurse247
specialist in psychiatric/mental health in accordance with a nurse protocol.248
(B) A physician may delegate to those health care
healthcare professionals identified249
in subparagraph (A) of this paragraph:250
(i) The authority to order controlled substances selected from a formulary of such251
drugs established by the board and the authority to order dangerous drugs, medical252
treatments, and diagnostic studies;253
(ii) The authority to request, receive, and sign for professional samples and to254
distribute professional samples to patients. The office or facility at which the health255
care healthcare professional identified in subparagraph (A) of this paragraph is256
working shall maintain a general list of the professional samples approved by the257
delegating physician for request, receipt, and distribution by the health care healthcare258
professional identified in subparagraph (A) of this paragraph as well as a complete list259
of the specific number and dosage of each professional sample and medication260
voucher received. Professional samples that are distributed by a health care261
healthcare professional identified in subparagraph (A) of this paragraph shall be so262
noted in the patient's medical record. In addition to the requirements of this Code263
section, all professional samples shall be maintained as required by applicable state264
and federal laws and regulations; and265
(iii) The authority to sign, certify, and endorse all documents relating to health care266
healthcare provided to a patient within his or her scope of authorized practice,267
including, but not limited to, documents relating to physical examination forms of all268
state agencies and verification and evaluation forms of the Department of Human269
H. B. 1046
- 11 - 24 LC 54 0288
Services, the State Board of Education, local boards of education, the Department of
270
Community Health, and the Department of Corrections; provided, however, that a271
health care
healthcare professional identified in subparagraph (A) of this paragraph272
shall not have the authority to sign death certificates or assign a percentage of a273
disability rating."274
SECTION 9.275
Said title is further amended in said chapter by revising subsection (e.1) of Code Section276
43-34-25, relating to delegation of certain medical acts to advanced practice registered nurse,277
construction and limitations of such delegation, definitions, conditions of nurse protocol, and278
issuance of prescription drug orders, as follows:279
"(e.1) Except for death certificates and assigning a percentage of a disability rating, an280
advanced practice registered nurse may be delegated the authority to sign, certify, and281
endorse all documents relating to health care healthcare provided to a patient within his or282
her scope of authorized practice, including, but not limited to, documents relating to283
physical examination forms of all state agencies and verification and evaluation forms of284
the Department of Human Services, the State Board of Education, local boards of285
education, the Department of Community Health, and the Department of Corrections."286
SECTION 10.287
All laws and parts of laws in conflict with this Act are repealed.288
H. B. 1046
- 12 -