25 HB 54/SCSFA
SENATE SUBSTITUTE TO HB 54
A BILL TO BE ENTITLED
AN ACT
To amend Titles 16, 31, 43, and 48 of the Official Code of Georgia Annotated, relating to1
crimes and offenses, health, professions and businesses, and revenue and taxation,2
respectively, so as to authorize advanced practice registered nurses and physician assistants3
to order home healthcare services to patients of home health agencies; to provide for4
definitions; to provide for the approval of continuing education regarding death certificates;5
to provide for authorizing job descriptions; to provide for tax credits for qualified caregiving6
expenses to include advanced practice registered nurses and physician assistants; to provide7
for related matters; to repeal conflicting laws; and for other purposes.8
BE IT ENACTED BY THE GENERAL ASSEMBLY OF GEORGIA:9
SECTION 1.10
Title 16 of the Official Code of Georgia Annotated, relating to crimes and offenses, is11
amended by revising paragraph (4.2) of Code Section 16-13-72, relating to the sale,12
distribution, or possession of dangerous drugs, as follows:13
"(4.2) A registered professional nurse licensed under Article 1 of Chapter 26 of Title 4314
who is employed or engaged by a licensed home health agency may possess sterile saline,15
sterile water, and diluted heparin for use as intravenous maintenance for use in a home16
health setting, and such nurse may administer such items to patients of the home health17
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agency upon the order of a licensed physician, an advanced practice registered nurse18
acting pursuant to the authority of Code Section 43-34-25, or a physician assistant19
provided that the individual ordering the home health services does not have an20
ownership interest in an entity to which they are referring. acting pursuant to the authority21
of Code Section 43-34-103. The State Board of Pharmacy shall be authorized to adopt22
regulations governing the storage, quantity, use, and administration of such items;23
provided, however, that nothing in this paragraph or in such regulations shall be24
construed to restrict any authority of nurses existing under other provisions of law;"25
SECTION 2.26
Title 31 of the Official Code of Georgia Annotated, relating to health, is amended by revising27
paragraph (20) of Code Section 31-6-2, relating to definitions relative to state health planning28
and development, as follows:29
"(20) 'Home health agency' means a public agency or private organization, or a30
subdivision of such an agency or organization, which is primarily engaged in providing31
to individuals who are under a written plan of care of a physician treatment ordered by32
a physician, an advanced practice registered nurse acting pursuant to the authority of33
Code Section 43-34-25, or a physician assistant provided that the individual ordering the34
home health services does not have an ownership interest in an entity to which they are35
referring. acting pursuant to the authority of Code Section 43-34-103, on a visiting basis36
in the places of residence used as such individuals' homes, part-time or intermittent37
nursing care provided by or under the supervision of a registered professional nurse, and38
one or more of the following services:39
(A) Physical therapy;40
(B) Occupational therapy;41
(C) Speech therapy;42
(D) Respiratory therapy;43
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(E) Skilled nursing care;44
(D)(F) Medical social services under the direction of a physician, an advanced practice45
registered nurse acting pursuant to the authority of Code Section 43-34-25, or a46
physician assistant provided that the individual ordering the home health services does47
not have an ownership interest in an entity to which they are referring. acting pursuant48
to the authority of Code Section 43-34-103; or49
(E)(G) Part-time or intermittent services of a home health aide."50
SECTION 3.51
Said title is further amended by revising Code Section 31-7-150, relating to definitions, as52
follows:53
"31-7-150.54
As used in this article, the term:55
(.5) 'Advanced practice registered nurse' has the same meaning as set forth in Code56
Section 43-26-3.57
(1) 'Branch office' means a location or site, identified in the application or endorsement58
thereto, from which a home health agency provides services within a portion of the total59
geographic area served by the parent agency and which is part of the home health agency60
and is located sufficiently close to share administration, supervision, and services in a61
manner that renders it unnecessary for the branch independently to meet the requirements62
of this article.63
(1.1)(2) 'Department' means the Department of Community Health.64
(2)(3) 'Home health agency' means a public, nonprofit, or proprietary organization,65
whether owned or operated by one or more persons or legal entities, which is engaged in66
furnishing home health healthcare services.67
(3)(4) 'Home health healthcare services' means those items and services furnished to an68
individual according to a written plan of treatment signed by the patient's physician, an69
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advanced practice registered nurse acting pursuant to the authority of Code Section70
43-34-25, or a physician assistant acting pursuant to the authority of Code Section71
43-34-103, by a home health agency, or by others under arrangement with the home72
health agency on a visit or hourly basis, in a place of temporary or permanent residence73
used as the individual's home, as follows:74
(A) Part-time or intermittent skilled nursing care as ordered by a physician, an75
advanced practice registered nurse acting pursuant to the authority of Code Section76
43-34-25, or a physician assistant provided that the individual ordering the home health77
services does not have an ownership interest in an entity to which they are referring.78
acting pursuant to the authority of Code Section 43-34-103 and provided by or under79
the supervision of a registered nurse and at least one other service listed in80
subparagraphs (B) through (D) of this paragraph;81
(B) Physical, occupational, or speech therapy;82
(C) Medical social services; and83
(D) Home health aide services.84
(4)(5) 'License' means a license issued by the department.85
(5)(6) 'Licensee' means the individual, corporation, or public entity with whom rests the86
ultimate responsibility for maintaining approved standards for the home health agency.87
(6)(7) 'Parent home health agency' means the agency that develops and maintains88
administrative controls of subunits or branch offices.89
(7)(8) 'Physician' means an individual currently licensed or authorized to practice90
medicine, surgery, or osteopathy in this state.91
(9) 'Physician assistant' means an individual licensed pursuant to Article 4 of Chapter 3492
of Title 43 and acting pursuant to the authority of Code Section 43-34-103.93
(8)(10) 'Plan of treatment' means a plan written, signed, and reviewed at least every two94
months by the patient's physician, an advanced practice registered nurse acting pursuant95
to the authority of Code Section 43-34-25, or a physician assistant provided that the96
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individual ordering the home health services does not have an ownership interest in an97
entity to which they are referring. acting pursuant to the authority of Code Section98
43-34-103 prescribing items and services for the patient's condition.99
(9)(11) 'Registered nurse' means an individual who is currently licensed as a registered100
professional nurse in this state.101
(10)(12) 'Subunit' means a semiautonomous organization which serves patients in a102
geographic area different from that of the parent agency and which, by virtue of the103
distance between it and the parent agency, is judged incapable of sharing administration,104
supervision, and services on a daily basis with the parent agency and must shall,105
therefore, independently meet the licensing requirements for a home health agency and106
shall be separately licensed."107
SECTION 4.108
Said title is further amended by revising Code Section 31-7-153, relating to standards for109
patient care and agency operation, regulations as to issuance, denial, suspension, or110
revocation of licenses, and hearings, as follows:111
"31-7-153.112
The department shall promulgate regulations which define standards for the care, treatment,113
health, safety, welfare, and comfort of patients served by home health agencies and for the114
maintenance and operation of home health agencies which will promote safe and adequate115
care and treatment of the patients. These regulations shall be no less stringent than those116
required for participation of home health agencies in the Title XVIII medicare Medicare117
program and shall include, but not be limited to, a provision requiring the agency to have118
policies established by a professional group which includes at least one physician and one119
registered nurse and appropriate representation from other professional disciplines;120
provisions governing the services the agency provides; provisions for the supervision of121
services by a physician, advanced practice registered nurse, physician assistant, or122
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registered nurse, as appropriate, and maintenance of clinical records on all patients,123
including a plan of treatment prescribed by a physician. The department is authorized to124
issue, deny, suspend, or revoke licenses in accordance with regulations promulgated125
pursuant to this Code section. Such regulations shall also include hearing procedures126
related to denial, suspension, or revocation of licenses."127
SECTION 5.128
Said title is further amended by revising Code Section 31-7-154, relating to inspections, as129
follows:130
"31-7-154.131
Each home health agency for which a license has been issued shall be periodically132
inspected by an authorized representative of the department. Such inspections shall be for133
the purpose of ensuring that this article is being followed. The department is directed to134
ensure by inspection that the licensee is providing quality care to its patients in accordance135
with the orders of the patient's physician, an advanced practice registered nurse, or a136
physician assistant; provided, however, that an agency shall be exempt from an additional137
on-site licensure inspection if certified in a federal program for reimbursement of medicare138
Medicare or Medicaid services."139
SECTION 6.140
Title 43 of the Official Code of Georgia Annotated, relating to professions and businesses,141
is amended by revising paragraph (1) of subsection (b) of Code Section 43-34-23, relating142
to the delegation of authority to nurse or physician assistant, and by adding a new paragraph143
to read as follows:144
"(b)(1)(A) A physician may delegate the authority contained in subparagraph (B) of145
this paragraph to:146
(i) A physician assistant in accordance with a job description; or147
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(ii) A nurse recognized by the Georgia Board of Nursing as a certified nurse midwife,148
certified registered nurse anesthetist, certified nurse practitioner, or clinical nurse149
specialist in psychiatric/mental health in accordance with a nurse protocol.150
(B) A physician may delegate to those healthcare professionals identified in151
subparagraph (A) of this paragraph:152
(i) The authority to order controlled substances selected from a formulary of such153
drugs established by the board and the authority to order dangerous drugs, medical154
treatments, and diagnostic studies;155
(ii) The authority to request, receive, and sign for professional samples and to156
distribute professional samples to patients. The office or facility at which the157
healthcare professional identified in subparagraph (A) of this paragraph is working158
shall maintain a general list of the professional samples approved by the delegating159
physician for request, receipt, and distribution by the healthcare professional160
identified in subparagraph (A) of this paragraph as well as a complete list of the161
specific number and dosage of each professional sample and medication voucher162
received. Professional samples that are distributed by a healthcare professional163
identified in subparagraph (A) of this paragraph shall be so noted in the patient's164
medical record. In addition to the requirements of this Code section, all professional165
samples shall be maintained as required by applicable state and federal laws and166
regulations; and167
(iii) The authority to sign, certify, and endorse all documents relating to healthcare168
provided to a patient within his or her scope of authorized practice, including, but not169
limited to, documents relating to physical examination forms of all state agencies and170
verification and evaluation forms of the Department of Human Services, the State171
Board of Education, local boards of education, the Department of Community Health,172
and the Department of Corrections; provided, however, that a healthcare professional173
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identified in subparagraph (A) of this paragraph shall not have the authority to assign174
a percentage of a disability rating.175
(1.1) Healthcare professionals identified in subparagraph (A) of this paragraph must176
paragraph (1) of this subsection shall complete biennial continuing education regarding177
the recognition and documentation of the causes of death and appropriate execution of178
death certificates, as approved by the board for a physician assistant as identified in179
division (b)(1)(A)(i) of this Code section or by the Board of Nursing for a healthcare180
professional identified in division (b)(1)(A)(ii) of this Code section."181
SECTION 7.182
Said title is further amended in Code Section 43-34-103, relating to application for licensure183
as a physician assistant, authorized delegated authority, and prohibited acts, by adding a new184
subsection to read as follows:185
"(m) In addition to and without limiting the authority granted by Code Section 43-34-23,186
a physician may delegate to a physician assistant, in accordance with a job description, the187
authority to order home healthcare services to a patient."188
SECTION 8.189
Title 48 of the Official Code of Georgia Annotated, relating to revenue and taxation, is190
amended by revising paragraph (1) of subsection (a) of Code Section 48-7-29.2, relating to191
tax credits for qualified caregiving expenses, as follows:192
"(1) 'Qualified caregiving expenses' means payments by the taxpayer for home health193
agency services, personal care services, personal care attendant services, homemaker194
services, adult day care, respite care, or healthcare equipment and supplies which195
equipment and supplies have been determined to be medically necessary by a physician,196
an advanced practice registered nurse acting pursuant to the authority of Code Section197
43-34-25, or a physician assistant provided that the individual ordering the home health198
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services does not have an ownership interest in an entity to which they are referring. acting199
pursuant to the authority of Code Section 43-34-103, which services, care, or equipment200
and supplies are:201
(A) Provided to the qualifying family member; and202
(B) Purchased or obtained from an organization or individual not related to the203
taxpayer or the qualifying family member."204
SECTION 9.205
All laws and parts of laws in conflict with this Act are repealed.206
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