24 HB 1046/AP
House Bill 1046 (AS PASSED HOUSE AND SENATE)
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 31-10-15 and Chapter 34 of Title 43 of the Official Code of Georgia
1
Annotated, relating to death certificates and physicians, physician assistants, and others,2
respectively, so as to revise regulations concerning advanced practice registered nurses and3
physician assistants; to authorize advanced practice registered nurses and physician assistants4
to sign death certificates; to revise provisions relating to the number of advanced practice5
registered nurses and physician assistants that a physician can authorize and supervise at any6
one time; to amend Chapter 2A of Title 31, Chapter 16 of Title 40, and Chapter 16 of Title7
50 of the Official Code of Georgia Annotated, relating to the Department of Public Health,8
the Department of Driver Services, and public property relative to state government,9
respectively, so as to improve government efficiency by creating one commission and10
repealing provisions relating to two inactive groups; to create the Georgia Commission on11
Maternal and Infant Health; to provide for its composition, membership, duties, and12
responsibilities; to provide for a definition; to provide for funding; to provide for automatic13
repeal; to repeal provisions establishing the Governor's Commercial Transportation Advisory14
Committee; to repeal provisions creating the Commission on the Preservation of the State15
Capitol; to provide for related matters; to provide for effective dates; to repeal conflicting16
laws; and for other purposes.17
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BE IT ENACTED BY THE GENERAL ASSEMBLY OF GEORGIA:
18
PART I19
SECTION 1-1.20
Code Section 31-10-15 of the Official Code of Georgia Annotated, relating to death21
certificates, filing, medical certification, forwarding death certificate to decedent's county of22
residence, and purging voter registration list, is amended by revising subsections (c) and (e)23
as follows:24
"(c)(1) The medical certification as to the cause and circumstances of death shall be25
completed, signed, and returned to the funeral director or person acting as such within 7226
hours after death by the physician, or advanced practice registered nurse acting pursuant
27
to the authority of Code Sections 43-34-23 and 43-34-25 or licensed physician assistant28
acting pursuant to the authority of Code Sections 43-34-23 and 43-34-103, who is in29
charge of the patient's care for the illness or condition which resulted in death, except30
when inquiry is required by Article 2 of Chapter 16 of Title 45, the 'Georgia Death31
Investigation Act.' In the absence of said physician, advanced practice registered nurse,32
or licensed physician assistant or with that physician's approval, the certificate may be33
completed and signed by an associate physician, the chief medical officer of the34
institution in which death occurred, or the physician who performed an autopsy upon the35
decedent, provided that such individual has access to the medical history of the case,36
views the deceased at or after death, and death is due to natural causes. If, 30 days after37
a death, the physician, or advanced practice registered nurse acting pursuant to the38
authority of Code Sections 43-34-23 and 43-34-25 or licensed physician assistant acting39
pursuant to the authority of Code Sections 43-34-23 and 43-34-103, who is in charge of40
the patient's care for the illness or condition which resulted in death has failed to41
complete, sign, and return the medical certification as to the cause and circumstances of42
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death to the funeral director or person acting as such, the funeral director or person acting
43
as such shall be authorized to report such physician, advanced practice registered nurse,
44
or licensed physician assistant to their respective licensing boards for disciplinary action45
to the Georgia Composite Medical Board for discipline pursuant to Code46
Section 43-34-8.47
(2) In any area in this state which is in a state of emergency as declared by the Governor48
due to an influenza pandemic, in addition to any other person authorized by law to49
complete and sign a death certificate, any registered professional nurse employed by a50
long-term care facility, advanced practice nurse, physician assistant, registered nurse51
employed by a home health agency, or nursing supervisor employed by a hospital shall52
be authorized to complete and sign the death certificate, provided that such person has53
access to the medical history of the case, such person views the deceased at or after death,54
the death is due to natural causes, and an inquiry is not required under Article 2 of55
Chapter 16 of Title 45, the 'Georgia Death Investigation Act.' In such a state of56
emergency, the death certificate shall be filed by the funeral director in accordance with57
subsection (b) of this Code section; or, if the certificate is not completed and signed by58
an appropriate physician, advanced practice registered nurse acting pursuant to the59
authority of Code Sections 43-34-23 and 43-34-25, licensed physician assistant acting60
pursuant to the authority of Code Sections 43-34-23 and 43-34-103, or coroner, the public61
health director of preparedness shall cause the death certificate to be completed, signed,62
and filed by some other authorized person within ten days after death.63
(3) An authorized individual completing and signing a death certificate in good faith and64
in accordance with this subsection shall be immune from civil liability for any acts or65
omissions relating to the medical certification, absent wanton misconduct or intentional66
wrongdoing. This immunity is in addition to any other legal immunity from liability to67
which such individuals may be entitled."68
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"(e) If the cause of death cannot be determined within 48 hours after death, the medical
69
certification shall be completed as provided by regulation. The attending physician,
70
advanced practice registered nurse acting pursuant to the authority of Code71
Sections 43-34-23 and 43-34-25, licensed physician assistant acting pursuant to the72
authority of Code Sections 43-34-23 and 43-34-103, or coroner shall give the funeral73
director or person acting as such notice of the reason for the delay, and final disposition of74
the body shall not be made until authorized by the attending physician, coroner, or medical75
examiner."76
SECTION 1-2.77
Chapter 34 of Title 43 of the Official Code of Georgia Annotated, relating to physicians,78
physician assistants, and others, is amended by revising subparagraph (b)(1)(B) of Code79
Section 43-34-23, relating to delegation of authority to nurse or physician assistant, as80
follows:81
"(B) A physician may delegate to those health care healthcare professionals identified82
in subparagraph (A) of this paragraph:83
(i) The authority to order controlled substances selected from a formulary of such84
drugs established by the board and the authority to order dangerous drugs, medical85
treatments, and diagnostic studies;86
(ii) The authority to request, receive, and sign for professional samples and to87
distribute professional samples to patients. The office or facility at which the health88
care healthcare professional identified in subparagraph (A) of this paragraph is89
working shall maintain a general list of the professional samples approved by the90
delegating physician for request, receipt, and distribution by the health care healthcare91
professional identified in subparagraph (A) of this paragraph as well as a complete list92
of the specific number and dosage of each professional sample and medication93
voucher received. Professional samples that are distributed by a health care94
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healthcare professional identified in subparagraph (A) of this paragraph shall be so95
noted in the patient's medical record. In addition to the requirements of this Code96
section, all professional samples shall be maintained as required by applicable state97
and federal laws and regulations; and98
(iii) The authority to sign, certify, and endorse all documents relating to health care99
healthcare provided to a patient within his or her scope of authorized practice,100
including, but not limited to, documents relating to physical examination forms of all101
state agencies and verification and evaluation forms of the Department of Human102
Services, the State Board of Education, local boards of education, the Department of103
Community Health, and the Department of Corrections; provided, however, that a104
health care healthcare professional identified in subparagraph (A) of this paragraph105
shall not have the authority to sign death certificates or assign a percentage of a106
disability rating.107
Healthcare professionals identified in subparagraph (A) of this paragraph must108
complete biennial continuing education regarding the recognition and documentation109
of the causes of death and appropriate execution of death certificates, as approved by110
the board."111
SECTION 1-3.112
Said chapter is further amended by revising subsections (b) and (e.1) of Code113
Section 43-34-25, relating to delegation of certain medical acts to advanced practice114
registered nurse, construction and limitations of such delegation, definitions, conditions of115
nurse protocol, and issuance of prescription drug orders, as follows:116
"(b) In addition to and without limiting the authority granted pursuant to Code117
Section 43-34-23, a physician may delegate to an advanced practice registered nurse in118
accordance with a nurse protocol agreement the authority to order drugs, medical devices,119
medical treatments, diagnostic studies, or radiographic imaging tests or to sign death120
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certificates. A selection box shall be added to death certificates to be checked off by121
nonphysicians completing the form."122
"(e.1) Except for death certificates and assigning a percentage of a disability rating, an123
advanced practice registered nurse may be delegated the authority to sign, certify, and124
endorse all documents relating to health care healthcare provided to a patient within his or125
her scope of authorized practice, including, but not limited to, documents relating to126
physical examination forms of all state agencies and verification and evaluation forms of127
the Department of Human Services, the State Board of Education, local boards of128
education, the Department of Community Health, and the Department of Corrections."129
SECTION 1-4.130
Said chapter is further amended by revising subsections (j) and (l) of Code131
Section 43-34-103, relating to application for licensure as a physician assistant, authorized132
delegated authority, and prohibited acts, as follows:133
"(j) A physician assistant shall be allowed to make a pronouncement of death pursuant to134
authority delegated by the supervising physician of the physician assistant and to certify135
such pronouncement in the same manner as a physician, including by signing death136
certificates. A selection box shall be added to death certificates to be checked off by137
nonphysicians completing the form."138
"(l) Except for death certificates and assigning a percentage of a disability rating, a139
physician assistant may be delegated the authority to sign, certify, and endorse all140
documents relating to health care provided to a patient within his or her scope of authorized141
practice, including, but not limited to, documents relating to physical examination forms142
of all state agencies and verification and evaluation forms of the Department of Human143
Services, the State Board of Education, local boards of education, the Department of144
Community Health, and the Department of Corrections."145
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PART II
146
SECTION 2-1.147
Chapter 34 of Title 43 of the Official Code of Georgia Annotated, relating to physicians,148
acupuncture, physician assistants, and others, is amended in Code Section 43-34-25, relating149
to delegation of certain medical acts to advanced practice registered nurse, construction and150
limitations of such delegation, definitions, conditions of nurse protocol, and issuance of151
prescription drug orders, by revising subsections (g), (g.1), and (g.2) as follows:152
"(g) Except as otherwise provided in subsection (g.1) or (g.2) of this Code section, a153
delegating physician may not enter into a nurse protocol agreement pursuant to this Code154
section or enter into a job description with a physician assistant pursuant to Code
155
Section 43-34-103 with more than four the combined equivalent of eight advanced practice156
registered nurses or physician assistants at any one time, except this limitation shall not157
apply to an advanced practice registered nurse who is practicing:158
(1) In a hospital licensed under Title 31;159
(2) In any college or university as defined in Code Section 20-8-1;160
(3) In the Department of Public Health;161
(4) In any county board of health;162
(4.1) In any community service board;163
(5) In any free health clinic;164
(6) In a birthing center;165
(7) In any entity:166
(A) Which is exempt from federal taxes pursuant to Section 501(c)(3) of the Internal167
Revenue Code, as defined in Code Section 48-1-2, and primarily serves uninsured or168
indigent Medicaid and medicare Medicare patients; or169
(B) Which has been established under the authority of or is receiving funds pursuant170
to 42 U.S.C. Section 254b or 254c of the United States Public Health Service Act;171
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(8) In any local board of education which has a school nurse program;
172
(9) In a health maintenance organization that has an exclusive contract with a medical173
group practice and arranges for the provision of substantially all physician services to174
enrollees in health benefits of the health maintenance organization; or175
(10) In any emergency medical services system operated by, or on behalf of, any county,176
municipality, or hospital authority with a full-time physician medical director and who177
does not order drugs, except that he or she may order up to a 14 day supply of drugs as178
necessary in an emergency situation, excluding Schedule II controlled substances and179
benzodiazepines; provided, however, that an advanced practice registered nurse shall not180
order radiographic imaging, diagnostic studies, or medical devices pursuant to this181
paragraph; and provided, further, that a patient shall be referred to a physician, a dentist,182
or a federally qualified health center.183
(g.1) A delegating physician may not enter into a nurse protocol agreement pursuant to this184
Code section or enter into a job description with a physician assistant pursuant to Code
185
Section 43-34-103 with more than the combined equivalent of eight advanced practice186
registered nurses or physician assistants at any one time, may not supervise more than four187
the combined equivalent of eight advanced practice registered nurses or physician188
assistants at any one time pursuant to nurse protocol agreements or job descriptions, and189
shall not be required to conduct any meetings, observations, or review of medical records190
except as otherwise provided in this subsection, if the advanced practice registered nurses191
practice at a location that:192
(1) Maintains evidence based clinical practice guidelines;193
(2) Is accredited by an accrediting body, approved by the board, such as the Joint194
Commission or a nationally recognized accrediting organization with comparable195
standards;196
(3) Requires the delegating physician to document and maintain a record of review of197
at least 10 percent of the advanced practice registered nurses' medical records to monitor198
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quality of care being provided to patients, which may be conducted electronically or on
199
site;200
(4) Requires the delegating physician and advanced practice registered nurse to201
participate in and maintain documentation of quarterly clinical collaboration meetings,202
either by telephone, in person, or on site, for purposes of monitoring care being provided203
to patients; and204
(5) Requires the delegating physician's name, contact information, and record of the visit205
to be provided to the patient's primary care provider of choice with the patient's consent206
within 24 hours of the visit.207
(g.2) A delegating physician may not enter into a nurse protocol agreement pursuant to this208
Code section or enter into a job description with a physician assistant pursuant to Code
209
Section 43-34-103 with more than the combined equivalent of eight advanced practice210
registered nurses or physician assistants at any one time or supervise more than four the211
combined equivalent of eight advanced practice registered nurses or physician assistants212
at any one time in any emergency medical services system operated by, or on behalf of, any213
county, municipality, or hospital authority with a full-time medical director."214
SECTION 2-2.215
Said chapter is further amended in Code Section 43-34-103, relating to application for216
licensure as a physician assistant, authorized delegated authority, and prohibited acts, by217
revising subsection (b) as follows:218
"(b)(1) No primary supervising physician shall enter into a job description with a219
physician assistant pursuant to this Code section or a nurse protocol agreement with an220
advanced practice registered nurse pursuant to Code Section 43-34-25 with more than the221
combined equivalent of eight physician assistants or advanced practice registered nurses222
or supervise more than four the combined equivalent of eight physician assistants or223
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advanced practice registered nurses at a time except as provided in paragraph (3) or (4)224
of this subsection.225
(2) A primary supervising physician shall designate in writing to the board such other226
physicians who may serve as an alternate supervising physician for each physician227
assistant with which such primary supervising physician has entered into a job228
description. The board shall have authority to approve or deny such designations in229
whole or in part; provided, however, that a physician may be listed as an alternate230
supervising physician for any number of physician assistants so long as he or she only231
supervises as many physician assistants at any one time as allowed by paragraphs (1)232
and (3) of this subsection.233
(3) No primary supervising physician shall have more than eight physician assistants234
who have completed a board approved anesthesiologist assistant program licensed to him235
or her at a time or supervise more than four physician assistants who have completed a236
board approved anesthesiologist assistant program at any one time.237
(4) Except for physician assistants who have completed a board approved238
anesthesiologist assistant program, the limitation in paragraph (1) of this subsection shall239
not apply to a physician assistant who is practicing:240
(A) In a hospital licensed under Title 31;241
(B) In any college or university as defined in Code Section 20-8-1;242
(C) In the Department of Public Health;243
(D) In any county board of health;244
(E) In any community service board;245
(F) In any free health clinic;246
(G) In a birthing center;247
(H) In any entity:248
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(i) Which is exempt from federal taxes pursuant to Section 501(c)(3) of the Internal
249
Revenue Code, as defined in Code Section 48-1-2, and primarily serves uninsured or250
indigent Medicaid and Medicare patients; or251
(ii) Which has been established under the authority of or is receiving funds pursuant252
to 42 U.S.C. Section 254b or 254c of the United States Public Health Service Act; or253
(I) In a health maintenance organization that has an exclusive contract with a medical254
group practice and arranges for the provision of substantially all physician services to255
enrollees in health benefits of the health maintenance organization."256
PART III257
SECTION 3-1.258
Chapter 2A of Title 31 of the Official Code of Georgia Annotated, relating to the Department259
of Public Health, is amended in Article 1, relating to general provisions, by revising Code260
Section 31-2A-12, which is reserved, as follows:261
"31-2A-12.262
(a) As used in this Code section, the term 'perinatal care' means maternal and infant health
263
improvement services and ancillary services that are appropriate for women and infants264
during the perinatal period, which begins before conception and ends on the infant's first265
birthday.266
(b) There is created the Georgia Commission on Maternal and Infant Health to be assigned267
to the Department of Public Health for administrative purposes only as prescribed in Code268
Section 50-4-3. The commission shall consist of 14 members, who shall be appointed as269
follows:270
(1) Six members shall be appointed by the Governor. The Governor shall include among271
his or her appointees an obstetrician, either a pediatrician or neonatologist, a nurse272
midwife, either a family practice or general practice physician, and a representative of a273
perinatal facility;274
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(2) Three members of the Senate shall be appointed by the Lieutenant Governor,275
provided that at least one member shall be of the minority party; and276
(3) Three members of the House of Representatives shall be appointed by the Speaker277
of the House of Representatives, provided that at least one member shall be of the278
minority party.279
The commissioner or his or her designee and the chief executive officer of the Georgia280
Research Alliance or his or her designee shall serve as members of the commission. The281
Governor shall appoint one member to serve as the chairperson of the commission.282
(c) Members of the commission shall receive no compensation for their services but shall283
be allowed actual and necessary expenses in the performance of their duties. Any284
legislative members of the council shall receive the allowances provided for in Code285
Section 28-1-8. Citizen members shall be entitled to receive reimbursement for per diem286
and travel expenses as provided in Code Section 45-7-21.287
(d) The commission shall meet at least four times per year at the call of the chairperson or288
upon the request of at least seven of its members.289
(e) The commission shall have the following duties and responsibilities:290
(1) To solicit the views of perinatal facilities, healthcare providers, and related291
professional associations on the state of perinatal care in Georgia and give due292
consideration to the current recommendations of medical and scientific organizations in293
the field of perinatal care;294
(2) To make policy recommendations regarding programs of perinatal care with local295
communities, their physicians and perinatal facilities, and the general public;296
(3) To establish indices to measure the quality and determine the effectiveness of297
perinatal care in Georgia;298
(4) To make available to the public the records of all meetings of the commission and299
all business transacted by the commission;300
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(5) To employ such staff and to enter into such contracts as may be necessary to fulfill301
its duties and responsibilities under this chapter subject to funding by the General302
Assembly;303
(6) To consult with and advise the department on matters related to the establishment,304
maintenance, operation, and outcomes evaluation of perinatal care initiatives in this state;305
and306
(7) To make state-wide policy recommendations based on its findings.307
(f) The commission may request additional funding from any additional source including,308
but not limited to, federal and private grants.309
(g) No later than June 30, 2026, the commission shall submit a detailed written report on310
its findings and recommendations to the Governor and the General Assembly.311
(h) This Code section shall stand automatically repealed on July 1, 2026. Reserved."312
SECTION 3-2.313
Chapter 16 of Title 40 of the Official Code of Georgia Annotated, relating to the Department314
of Driver Services, is amended by repealing Code 40-16-8, relating to the Governor's315
Commercial Transportation Advisory Committee, and designating said Code section as316
reserved.317
SECTION 3-3.318
Chapter 16 of Title 50 of the Official Code of Georgia Annotated, relating to public property319
relative to state government, is amended by repealing Code Section 50-16-5.1, relating to the320
Commission on the Preservation of the State Capitol.321
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PART IV
322
SECTION 4-1.323
(a) Except as provided in subsection (b) of this section, this Act shall become effective on324
the first day of the month following the month in which it is approved by the Governor or325
becomes law without such approval.326
(b) Part I and Part III of this Act shall become effective on July 1, 2024.327
SECTION 4-2.328
All laws and parts of laws in conflict with this Act are repealed.329
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