23 SB 164/AP
S. B. 164
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Senate Bill 164
By: Senators Hufstetler of the 52nd, Dolezal of the 27th, Brass of the 28th, Walker III of the
20th, Summers of the 13th and others
AS PASSED
A BILL TO BE ENTITLED
AN ACT
To amend Title 43 of the Official Code of Georgia Annotated, relating to professions and
1
businesses, so as to provide for the licensure and regulation of healthcare providers; to2
provide for licensure of advanced practice registered nurses; to revise definitions; to provide3
for licensure requirements; to provide for renewal of licenses; to provide for a misdemeanor4
to practice advanced practice registered nursing without a license; to enact the5
"Anesthesiologist Assistant Act"; to provide for an anesthesiologist assistant to be appointed6
in an advisory capacity to the Georgia Composite Medical Board; to provide for definitions;7
to provide for powers and duties of the Georgia Composite Medical Board as they relate to8
anesthesiologist assistants; to provide for licensure rules and requirements; to define the9
scope of practice for anesthesiologist assistants; to provide for regulation of the profession;10
to provide for rules and requirements for licensure reinstatement; to provide for penalties for11
unauthorized practice; to provide for practice during emergencies; to provide for related12
matters; to repeal conflicting laws; and for other purposes.13
BE IT ENACTED BY THE GENERAL ASSEMBLY OF GEORGIA:14 23 SB 164/AP
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SECTION 1.
15
Title 43 of the Official Code of Georgia Annotated, relating to professions and businesses,16
is amended in Code Section 43-26-3, relating to definitions relative to nurses, by revising17
paragraphs (1) and (1.1) as follows:18
"(1) 'Advanced nursing practice' means practice in a population focus
by a registered19
professional nurse who is licensed by the board under this article or who holds a20
multistate license under Article 4 of this chapter who meets those educational, practice,21
certification requirements, or any combination of such requirements as specified in Code22
Section 43-26-7.1 and established by the board, and includes certified nurse midwives,23
certified nurse practitioners, certified registered nurse anesthetists, clinical nurse24
specialists and clinical nurse specialists in psychiatric/mental health, and others25
recognized by the board.26
(1.1) 'Advanced practice registered nurse' means:27
(A) A person a registered professional nurse who is licensed by the board under this28
article or who holds a multistate license under Article 4 of this chapter, who is29
recognized by the board as having met the requirements as specified in Code Section30
43-26-7.1 and established by the board to engage in advanced nursing practice, and who31
holds a master's degree or other graduate degree from an approved nursing education32
program and national board certification in his or her area of specialty, within one of33
the following roles: a certified nurse midwife, a certified nurse practitioner, a certified34
registered nurse anesthetist, or a clinical nurse specialist or clinical nurse specialist in35
psychiatric/mental health; or36
(B) A a person who was recognized as an advanced practice registered nurse by the37
board on or before June 30, 2006.38
This paragraph shall not be construed to require a certified registered nurse anesthetist39
who graduated from an approved nurse anesthetist educational program prior to January40
1, 1999, to hold a master's degree or other graduate degree. Further, this paragraph shall41 23 SB 164/AP
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not be construed to require a registered professional nurse who holds a multistate license
42
under Article 4 of this chapter authorizing such nurse to practice in another party state43
under a multistate licensure privilege to obtain a single-state license from the board as a44
condition of receiving authorization
licensure by the board to practice in this state as an45
advanced practice registered nurse."46
SECTION 2.47
Said title is further amended in Chapter 26, relating to nurses, by adding a new Code section48
to read as follows:49
"43-26-7.1.50
(a) Any applicant who meets the requirements of this Code section shall be eligible for51
licensure as an advanced practice registered nurse.52
(b) An applicant for initial licensure to practice as an advanced practice registered nurse53
shall:54
(1) Submit a completed written application and fee;55
(2) Be currently licensed by the board as a registered professional nurse or hold a56
multistate license under Article 4 of this chapter;57
(3) Have completed an accredited graduate or postgraduate level advanced practice58
registered nursing program in one of the four roles specified under subparagraph (A) of59
paragraph (1.1) of Code Section 43-26-3 and in at least one population focus;60
(4) Be currently certified by a national certifying body recognized by the board in an61
advanced practice registered nursing program in a role and population focus appropriate62
for educational preparation;63
(5) Have satisfactory results from a fingerprint record check report conducted by the64
Georgia Crime Information Center and the Federal Bureau of Investigation, as65
determined by the board. Application for licensure under this subsection shall constitute66
express consent and authorization for the board to perform a criminal background check.67 23 SB 164/AP
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Each applicant who submits an application to the board for licensure agrees to provide68
the board with any and all information necessary to run a criminal background check,69
including, but not limited to, classifiable sets of fingerprints. The applicant shall be70
responsible for all fees associated with the performance of such criminal background71
check; and72
(6) Meet such other criteria as established by the board.73
(c) An applicant for reinstatement of licensure who has previously held a valid advanced74
practice registered nurse license in Georgia shall:75
(1) Submit a completed written application and fee;76
(2) Meet continuing competency requirements as established by the board;77
(3) Have satisfactory results from a fingerprint record check report conducted by the78
Georgia Crime Information Center and the Federal Bureau of Investigation, as79
determined by the board. Application for reinstatement of licensure under this subsection80
shall constitute express consent and authorization for the board to perform a criminal81
background check. Each applicant who submits an application to the board for82
reinstatement of licensure agrees to provide the board with any and all information83
necessary to run a criminal background check, including, but not limited to, classifiable84
sets of fingerprints. The applicant shall be responsible for all fees associated with the85
performance of such criminal background check; and86
(4) Meet such other criteria as established by the board."87
SECTION 3.88
Said title is further amended by revising Code Section 43-26-9, relating to biennial renewal89
of nursing licenses, continuing competency requirements, voluntary surrender or failure to90
renew license, and restoration and reissuance of license, as follows:91 23 SB 164/AP
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"43-26-9.
92
(a) Licenses issued under this article shall be renewed biennially according to schedules93
and fees approved by the board.94
(b) A renewed license shall be issued to a registered professional nurse or licensed95
undergraduate nurse who remits the required fee and complies with requirements96
established by the board.97
(b.1)
(c) Beginning with the 2016 license renewal cycle, an applicant for license renewal98
as a registered professional under this article shall meet one of the following continuing99
competency requirements during the previous licensure period:100
(1) Completion of 30 continuing education hours by a board approved provider;101
(2) Maintenance of certification or recertification by a national certifying body102
recognized by the board;103
(3) Completion of an accredited academic program of study in nursing or a related field,104
as recognized by the board;105
(4) Verification of competency by a health care facility or entity licensed under Chapter106
7 of Title 31 or by a physician's office that is part of a health system and at least 500107
hours practiced as evidenced by employer certification on a form approved by the board;108
or109
(5) Other activities as prescribed and approved by the board that show competency in the110
nursing field.111
Failure to meet the minimum continuing competency requirement for renewal of a license112
shall be grounds for denial of a renewal application. The board may waive or modify the113
requirements contained in this subsection in cases of hardship, disability, or illness or under114
such other circumstances as the board, in its discretion, deems appropriate. An applicant115
who is renewing a license for the first time shall not be required to meet the requirements116
of this subsection until the time of the second renewal if the applicant's initial license117
period is six months or less.118 23 SB 164/AP
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(d) Advanced practice registered nurse licenses issued under this article shall be issued to119
an advanced practice registered nurse who remits the required fee and complies with120
requirements established by the board.121
(c)(e) The voluntary surrender of a license or the failure to renew a license by the end of122
an established penalty period shall have the same effect as a revocation of said license,123
subject to reinstatement at the discretion of the board. The board may restore and reissue124
a license and, as a condition thereof, may impose any disciplinary sanction provided by125
Code Section 43-1-19 or 43-26-11."126
SECTION 4.127
Said title is further amended by revising Code Section 43-26-10, relating to practicing as a128
registered professional nurse without a license prohibited, as follows:129
"43-26-10.130
It shall be a misdemeanor for any person, including any corporation, association, or131
individual, to:132
(1) Practice nursing as a registered professional nurse, or advanced practice registered133
nurse without a valid, current license, except as otherwise permitted under Code Section134
43-26-12;135
(2) Practice nursing as a registered professional nurse or advanced practice registered136
nurse under cover of any diploma, license, or record illegally or fraudulently obtained,137
signed, or issued;138
(3) Practice nursing as a registered professional nurse or advanced practice registered139
nurse during the time the license is suspended, revoked, surrendered, or administratively140
revoked for failure to renew;141
(4) Use any words, abbreviations, figures, letters, title, sign, card, or device implying that142
such person is a registered professional nurse or advanced practice registered nurse unless143 23 SB 164/AP
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such person is duly licensed or recognized by the board so to practice under the
144
provisions of this article;145
(5) Fraudulently furnish a license to practice nursing as a registered professional nurse146
or advanced practice registered nurse
;147
(6) Knowingly employ any person to practice nursing as a registered professional nurse148
or advanced practice registered nurse who is not a registered professional nurse or149
advanced practice registered nurse;150
(7) Conduct a nursing education program preparing persons to practice nursing as151
registered professional nurses unless the program has been approved by the board; or152
(8) Knowingly aid or abet any person to violate this article."153
SECTION 5.154
Said title is further amended by revising subsection (e) of Code Section 43-34-2, relating to155
creation of the Georgia Composite Medical Board, members, physician assistants advisory156
committee, review of qualifications, and required training, as follows:157
"(e)(1) The board shall appoint a Physician Assistants Advisory Committee composed158
of four physicians, at least two of whom shall be members of the board, and four licensed159
physician assistants, who shall each serve for terms of office of two years and until their160
successors are appointed and qualified. The committee shall review matters to come161
before the board which relate to physician assistants, including, but not limited to,162
applicants for physician assistant licensure and relicensure and education requirements163
therefor, and proposed board regulations concerning physician assistants. The committee164
shall periodically make recommendations to the board regarding matters reviewed. Each165
member of the advisory committee shall be entitled to the same expense allowances,166
mileage allowances, and reimbursement as members of the board as provided for in this167
chapter.168 23 SB 164/AP
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(2) The committee shall appoint a physician assistant in an advisory capacity to the
169
board. The advisory person shall serve at the pleasure of the committee as an ex officio170
adviser to the board in all matters relating to physician assistants and shall share in the171
privileges and benefits of the board without a vote.172
(3) The committee shall appoint an anesthesiologist assistant in an advisory capacity to
173
the board. The advisory person shall serve at the pleasure of the committee as an ex174
officio adviser to the board in all matters relating to anesthesiologist assistants and shall175
share in the privileges and benefits of the board without a vote."176
SECTION 6.177
Said title is further amended in Chapter 34, relating to professions and businesses, by178
enacting a new article to read as follows:179
"ARTICLE 13180
43-34-320.181
This article shall be known and may be cited as the 'Anesthesiologist Assistant Act.'182
43-34-321.183
As used in this article, the term:184
(1) 'Alternate supervising anesthesiologist' means an anesthesiologist to whom a board185
approved supervising anesthesiologist has delegated the responsibility of supervising an186
anesthesiologist assistant and who agrees to supervise the anesthesiologist assistant for187
the supervising anesthesiologist and who is on record with the board.188
(2) 'Anesthesiologist' means a physician licensed pursuant to this chapter who has189
completed a residency in anesthesiology approved by the American Board of190
Anesthesiology or the American Osteopathic Board of Anesthesiology.191 23 SB 164/AP
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(3) 'Anesthesiologist assistant' means a person who has met the requirements of Code192
Section 43-34-323 and is licensed to practice medicine under the supervision of an193
anesthesiologist.194
(4) 'Certification examination' means the initial certifying examination approved by the195
board for the certification of anesthesiologist assistants, which may include the196
examination administered by the National Commission for the Certification of197
Anesthesiologist Assistants or other national anesthesiologist assistant certifying agency198
that has been reviewed and approved by the board.199
(5) 'Immediately available' means that a supervising anesthesiologist is immediately200
available if he or she is in physical proximity that allows the anesthesiologist to201
reestablish direct contact with the patient to meet medical needs and any urgent or202
emergent clinical problems. These responsibilities may also be met through coordination203
among anesthesiologists of the same group or department.204
(6) 'Job description' means a document, signed by the supervising anesthesiologist and205
the anesthesiologist assistant whom the supervising anesthesiologist is supervising, in206
which the supervising anesthesiologist delegates to that anesthesiologist assistant207
authority to perform certain medical acts and which describes the professional208
background and specialty of the supervising anesthesiologist; describes the qualifications,209
including related experience of the anesthesiologist assistant; and includes a general210
description of how the anesthesiologist assistant will be utilized in the practice. A job211
description shall not be required to contain every activity the anesthesiologist deems the212
anesthesiologist assistant qualified to perform but shall confine the activities of the213
anesthesiologist assistant to those in the scope of practice of the supervising214
anesthesiologist.215
(7) 'Supervising anesthesiologist' means the anesthesiologist who has the primary216
responsibility for supervising the practice of an anesthesiologist assistant pursuant to that217
anesthesiologist assistant's job description.218 23 SB 164/AP
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(8) 'Supervision' means the availability of an anesthesiologist to delegate, coordinate,219
direct, and consult on the implementation of his or her intentions.220
43-34-322.221
(a) The board shall review and determine the qualifications and fitness of all persons222
applying for a license to practice as an anesthesiologist assistant.223
(b) The board shall:224
(1) Grant, deny, revoke, and reinstate licenses;225
(2) Investigate allegations regarding improper conduct by anesthesiologist assistants that226
would be grounds for revocation of licensure;227
(3) Conduct informal interviews and hearings;228
(4) Adopt rules governing the practice of anesthesiologist assistants; and229
(5) Retain jurisdiction over all licensees who receive temporary or full licenses under this230
article, regardless of whether the license has expired or lapsed, or was relinquished during231
or after any alleged occurrence of conduct.232
43-34-323.233
(a) A person shall not practice in this state as an anesthesiologist assistant or use the title234
or otherwise represent that the person is a licensed anesthesiologist assistant or use the235
credentials 'A.A.', 'C.A.A.', or anesthetist without having a license granted by the board236
pursuant to this article.237
(b) The board may grant an anesthesiologist assistant license to an applicant who:238
(1) Graduated from an anesthesiologist assistant program accredited by the Commission239
on Accreditation of Allied Health Education Programs or its predecessor or successor240
organization;241 23 SB 164/AP
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(2) Successfully completed a certification examination and that is or was certified as of242
July 1, 2023, or was licensed in this state as a physician assistant in anesthesiology as of243
July 1, 2023;244
(3) Completes an application form prescribed by the board; and245
(4) Pays the required application fees as prescribed by the board in its rules.246
(c) A license issued pursuant to this article, other than a temporary license, shall be valid247
for a period of two years. A licensee shall renew the license every other year by248
completing and submitting to the board a renewal application form as prescribed by the249
board and the prescribed renewal fee before the current license expires. The board shall250
provide renewal notices to licensees at least one month before the expiration date.251
(d) The board may reinstate a lapsed license if the applicant pays a reinstatement fee as252
prescribed by the board in rule and meets the requirements for initial licensure.253
(e) Any person who has not successfully completed a certification examination may be254
issued a temporary license by the board if such person:255
(1) Completes a temporary license application;256
(2) Pays the required temporary license fee as prescribed by the board in rule; and257
(3) Has successfully graduated from a program accredited by the Commission on258
Accreditation of Allied Health Education Programs, or another board approved program259
for educating and training anesthesiologist assistants.260
Such person shall take the next available certification examination after receiving a261
temporary license. A temporary license shall not be issued for a period of more than262
90 days and is subject to any other requirements the board adopts by rule.263
43-34-324.264
(a) This Code section shall not apply to persons who are enrolled in an anesthesiologist265
assistant education program approved by the board.266 23 SB 164/AP
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(b) An anesthesiologist assistant may practice medicine only under the supervision of an267
anesthesiologist. The anesthesiologist assistant may perform only those duties and268
responsibilities delegated to the anesthesiologist assistant by the supervising269
anesthesiologist pursuant to a job description.270
(c) The supervising anesthesiologist or an alternate supervising anesthesiologist shall be271
allowed to supervise anesthesiologist assistants in a manner consistent with federal rules272
or regulations for reimbursement for anesthesia services.273
(d) The supervising anesthesiologist or an alternate supervising anesthesiologist shall be274
immediately available to the anesthesiologist assistant such that the supervising275
anesthesiologist or an alternate supervising anesthesiologist is able to intervene if needed276
in the delivery of medical care.277
(e) An anesthesiologist assistant's practice may not exceed his or her education, training,278
or the scope of practice of the supervising anesthesiologist or an alternate supervising279
anesthesiologist.280
(f) Nothing in this article shall prevent an anesthesiologist assistant from having access to281
and being able to administer prescription drugs as directed by the supervising282
anesthesiologist or an alternate supervising anesthesiologist.283
43-34-325.284
(a) A supervising anesthesiologist or an alternate supervising anesthesiologist may285
delegate the authority contained in subsection (b) of this Code section to an286
anesthesiologist assistant in accordance with a job description.287
(b) A supervising anesthesiologist or an alternate supervising anesthesiologist may288
delegate to an anesthesiologist assistant the authority to order controlled substances289
selected from a formulary of such drugs established by the board and the authority to order290
dangerous drugs, medical treatments, and diagnostic studies.291 23 SB 164/AP
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(c) An anesthesiologist assistant authorized by a supervising anesthesiologist to order292
controlled substances pursuant to this Code section is authorized to register with the United293
States Drug Enforcement Administration.294
43-34-326.295
The board shall have all authority to impose on an anesthesiologist assistant any sanction296
authorized under Code Section 43-34-8 upon a finding of any conduct specified in Code297
Section 43-34-8.298
43-34-327.299
(a) The board may issue a new license to an anesthesiologist assistant whose license was300
previously revoked by the board if the applicant applies in writing to the board and301
demonstrates to the board's satisfaction that the applicant is completely rehabilitated with302
respect to the conduct that was the basis for the revocation. In making its decision, the303
board shall determine:304
(1) Whether the applicant has engaged in any conduct during the revocation period that305
would constitute a basis for revocation pursuant to rules adopted by the board;306
(2) If a criminal conviction was a basis of the revocation, whether the applicant's civil307
rights have been fully restored pursuant to statute or judicial or executive order;308
(3) Whether the applicant has made restitution to any aggrieved person as ordered by a309
court of competent jurisdiction; and310
(4) Whether the applicant demonstrates any other standard of rehabilitation the board311
determines is appropriate.312
(b) Except as provided in subsection (c) of this Code section, a person shall not apply for313
license reinstatement until two years after the date of revocation.314
(c) If a license revocation was based on a conviction of a felony or an offense involving315
moral turpitude and that conviction has been reversed on appeal, the board shall reverse its316 23 SB 164/AP
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previous order to revoke the license, and the anesthesiologist assistant may apply for317
reinstatement as soon as the court enters its reversal.318
(d) An application for reinstatement shall comply with all initial licensure requirements319
prescribed by this article and rules and regulations adopted by the board pursuant to this320
article.321
43-34-328.322
Any person practicing as an anesthesiologist assistant or representing that he or she is an323
anesthesiologist assistant without a license, or any person employing an unlicensed person324
to practice as an anesthesiologist assistant, is guilty of a misdemeanor and upon conviction325
shall be punished by a fine of not more than $1,000.00 or by imprisonment for not more326
than one year, or both. Each violation constitutes a separate offense for which the penalty327
in this Code section may be assessed.328
43-34-329.329
(a) Notwithstanding any provision of this article to the contrary, an anesthesiologist330
assistant licensed pursuant to this article or licensed, certified, or otherwise authorized to331
practice in any other state or federal jurisdiction and whose license, certification, or332
authorization is in good standing who responds to a need for medical care created by333
conditions which characterize those of a state of emergency or public health emergency334
may render such care that the anesthesiologist assistant is able to provide with such335
supervision as is available at the immediate scene or at the local site where such need for336
medical care exists or at a relief site established as part of a state or local safety plan337
established pursuant to Chapter 3 of Title 38. Such services shall be provided by an338
anesthesiologist assistant in response to the request of an appropriate state or local official339
implementing a state or local emergency management plan or program, and in accordance340
with applicable guidelines established by such officials or plans. The authority granted by341 23 SB 164/AP
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this Code section shall last no longer than 48 hours or such time as the board may establish342
under guidelines for supervision of the anesthesiologist assistant rendering medical care.343
(b) For the purposes of this Code section, the term 'public health emergency' has the same344
meaning as in paragraph (6) of Code Section 38-3-3, and the term 'state of emergency' has345
the same meaning as in paragraph (7) of Code Section 38-3-3."346
SECTION 7.347
All laws and parts of laws in conflict with this Act are repealed.348