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 to
crimes and offenses, health, professions and businesses, and revenue and taxation,
respectively, so as to authorize advanced practice registered nurses and physician assistants
to order home healthcare services to patients of home health agencies; to provide for
definitions; to provide for the approval of continuing education regarding death certificates;
to provide for authorizing job descriptions; to provide for tax credits for qualified caregiving
expenses to include advanced practice registered nurses and physician assistants; to provide
for related matters; to repeal conflicting laws; and for other purposes.
BE IT ENACTED BY THE GENERAL ASSEMBLY OF GEORGIA:
SECTION 1.
Title 16 of the Official Code of Georgia Annotated, relating to crimes and offenses, is
amended by revising paragraph (4.2) of Code Section 16-13-72, relating to the sale,
distribution, or possession of dangerous drugs, as follows:
"(4.2) A registered professional nurse licensed under Article 1 of Chapter 26 of Title 43
who is employed or engaged by a licensed home health agency may possess sterile saline,
sterile water, and diluted heparin for use as intravenous maintenance for use in a home
health setting, and such nurse may administer such items to patients of the home health
agency upon the order of a licensed physician, <ins>an advanced practice registered nurse
acting pursuant to the authority of Code Section 43-34-25, or a physician assistant
provided that the individual ordering the home health services does not have an
ownership interest in an entity to which they are referring. acting pursuant to the authority
of Code Section 43-34-103.</ins> The State Board of Pharmacy shall be authorized to adopt
regulations governing the storage, quantity, use, and administration of such items;
provided, however, that nothing in this paragraph or in such regulations shall be
construed to restrict any authority of nurses existing under other provisions of law;"
SECTION 2.
Title 31 of the Official Code of Georgia Annotated, relating to health, is amended by revising
paragraph (20) of Code Section 31-6-2, relating to definitions relative to state health planning
and development, as follows:
"(20) 'Home health agency' means a public agency or private organization, or a
subdivision of such an agency or organization, which is primarily engaged in providing
to individuals who are under a written plan of <del>care of a physician</del> <ins>treatment ordered by
a physician, an advanced practice registered nurse acting pursuant to the authority of
Code Section 43-34-25, or a physician assistant provided that the individual ordering the
home health services does not have an ownership interest in an entity to which they are
referring. acting pursuant to the authority of Code Section 43-34-103,</ins> on a visiting basis
in the places of residence used as such individuals' homes, part-time or intermittent
nursing care provided by or under the supervision of a registered professional nurse, and
one or more of the following services:
(A) Physical therapy;
(B) Occupational therapy;
(C) Speech therapy;
<ins>(D) Respiratory therapy;
</ins>
<ins>(E) Skilled nursing care;
</ins> <del>(D)(F)</del> Medical social services under the direction of a physician, <ins>an advanced practice
registered nurse acting pursuant to the authority of Code Section 43-34-25, or a
physician assistant provided that the individual ordering the home health services does
not have an ownership interest in an entity to which they are referring. acting pursuant
to the authority of Code Section 43-34-103;</ins> or
<ins>(E)(G)</ins> Part-time or intermittent services of a home health aide."
SECTION 3.
Said title is further amended by revising Code Section 31-7-150, relating to definitions, as
follows:
"31-7-150.
As used in this article, the term:
<ins>(.5) 'Advanced practice registered nurse' has the same meaning as set forth in Code
Section 43-26-3.
</ins> (1) 'Branch office' means a location or site, identified in the application or endorsement
thereto, from which a home health agency provides services within a portion of the total
geographic area served by the parent agency and which is part of the home health agency
and is located sufficiently close to share administration, supervision, and services in a
manner that renders it unnecessary for the branch independently to meet the requirements
of this article.
<del>(1.1)(2)</del> 'Department' means the Department of Community Health.
<del>(2)(3)</del> 'Home health agency' means a public, nonprofit, or proprietary organization,
whether owned or operated by one or more persons or legal entities, which is engaged in
furnishing home <del>health</del> <ins>healthcare</ins> services.
<del>(3)(4)</del> 'Home <del>health</del> <ins>healthcare</ins> services' means those items and services furnished to an
individual according to a written plan of treatment signed by the patient's physician, <ins>an
</ins>
<ins>advanced practice registered nurse acting pursuant to the authority of Code Section
43-34-25, or a physician assistant acting pursuant to the authority of Code Section
43-34-103,</ins> by a home health agency, or by others under arrangement with the home
health agency on a visit or hourly basis, in a place of temporary or permanent residence
used as the individual's home, as follows:
(A) Part-time or intermittent skilled nursing care as ordered by a physician, <ins>an
advanced practice registered nurse acting pursuant to the authority of Code Section
43-34-25, or a physician assistant provided that the individual ordering the home health
services does not have an ownership interest in an entity to which they are referring.
acting pursuant to the authority of Code Section 43-34-103</ins> and provided by or under
the supervision of a registered nurse and at least one other service listed in
subparagraphs (B) through (D) of this paragraph;
(B) Physical, occupational, or speech therapy;
(C) Medical social services; and
(D) Home health aide services.
<del>(4)(5)</del> 'License' means a license issued by the department.
<del>(5)(6)</del> 'Licensee' means the individual, corporation, or public entity with whom rests the
ultimate responsibility for maintaining approved standards for the home health agency.
<del>(6)(7)</del> 'Parent home health agency' means the agency that develops and maintains
administrative controls of subunits or branch offices.
<del>(7)(8)</del> 'Physician' means an individual currently licensed or authorized to practice
medicine, surgery, or osteopathy in this state.
<ins>(9) 'Physician assistant' means an individual licensed pursuant to Article 4 of Chapter 34
of Title 43 and acting pursuant to the authority of Code Section 43-34-103.
(8)(10)</ins> 'Plan of treatment' means a plan written, signed, and reviewed at least every two
months by the patient's physician, <ins>an advanced practice registered nurse acting pursuant
to the authority of Code Section 43-34-25, or a physician assistant provided that the
</ins>
<ins>individual ordering the home health services does not have an ownership interest in an
entity to which they are referring. acting pursuant to the authority of Code Section
43-34-103</ins> prescribing items and services for the patient's condition.
<ins>(9)(11)</ins> 'Registered nurse' means an individual who is currently licensed as a registered
professional nurse in this state.
<del>(10)(12)</del> 'Subunit' means a semiautonomous organization which serves patients in a
geographic area different from that of the parent agency and which, by virtue of the
distance between it and the parent agency, is judged incapable of sharing administration,
supervision, and services on a daily basis with the parent agency and <del>must</del> <ins>shall,
</ins> therefore, independently meet the licensing requirements for a home health agency and
shall be separately licensed."
SECTION 4.
Said title is further amended by revising Code Section 31-7-153, relating to standards for
patient care and agency operation, regulations as to issuance, denial, suspension, or
revocation of licenses, and hearings, as follows:
"31-7-153.
The department shall promulgate regulations which define standards for the care, treatment,
health, safety, welfare, and comfort of patients served by home health agencies and for the
maintenance and operation of home health agencies which will promote safe and adequate
care and treatment of the patients. These regulations shall be no less stringent than those
required for participation of home health agencies in the Title XVIII <del>medicare</del> <ins>Medicare
</ins> program and shall include, but not be limited to, a provision requiring the agency to have
policies established by a professional group which includes at least one physician and one
registered nurse and appropriate representation from other professional disciplines;
provisions governing the services the agency provides; provisions for the supervision of
services by a physician, <ins>advanced practice registered nurse, physician assistant,</ins> or
registered nurse, as appropriate, and maintenance of clinical records on all patients,
including a plan of treatment <del>prescribed by a physician.</del> The department is authorized to
issue, deny, suspend, or revoke licenses in accordance with regulations promulgated
pursuant to this Code section. Such regulations shall also include hearing procedures
related to denial, suspension, or revocation of licenses."
SECTION 5.
Said title is further amended by revising Code Section 31-7-154, relating to inspections, as
follows:
"31-7-154.
Each home health agency for which a license has been issued shall be periodically
inspected by an authorized representative of the department. Such inspections shall be for
the purpose of ensuring that this article is being followed. The department is directed to
ensure by inspection that the licensee is providing quality care to its patients in accordance
with the orders of the patient's physician, <ins>an advanced practice registered nurse, or a
physician assistant;</ins> provided, however, that an agency shall be exempt from an additional
on-site licensure inspection if certified in a federal program for reimbursement of <del>medicare
</del> <ins>Medicare</ins> or Medicaid services."
SECTION 6.
Title 43 of the Official Code of Georgia Annotated, relating to professions and businesses,
is amended by revising paragraph (1) of subsection (b) of Code Section 43-34-23, relating
to the delegation of authority to nurse or physician assistant, and by adding a new paragraph
to read as follows:
"(b)(1)(A) A physician may delegate the authority contained in subparagraph (B) of
this paragraph to:
(i) A physician assistant in accordance with a job description; or
(ii) A nurse recognized by the Georgia Board of Nursing as a certified nurse midwife,
certified registered nurse anesthetist, certified nurse practitioner, or clinical nurse
specialist in psychiatric/mental health in accordance with a nurse protocol.
(B) A physician may delegate to those healthcare professionals identified in
subparagraph (A) of this paragraph:
(i) The authority to order controlled substances selected from a formulary of such
drugs established by the board and the authority to order dangerous drugs, medical
treatments, and diagnostic studies;
(ii) The authority to request, receive, and sign for professional samples and to
distribute professional samples to patients. The office or facility at which the
healthcare professional identified in subparagraph (A) of this paragraph is working
shall maintain a general list of the professional samples approved by the delegating
physician for request, receipt, and distribution by the healthcare professional
identified in subparagraph (A) of this paragraph as well as a complete list of the
specific number and dosage of each professional sample and medication voucher
received. Professional samples that are distributed by a healthcare professional
identified in subparagraph (A) of this paragraph shall be so noted in the patient's
medical record. In addition to the requirements of this Code section, all professional
samples shall be maintained as required by applicable state and federal laws and
regulations; and
(iii) The authority to sign, certify, and endorse all documents relating to healthcare
provided to a patient within his or her scope of authorized practice, including, but not
limited to, documents relating to physical examination forms of all state agencies and
verification and evaluation forms of the Department of Human Services, the State
Board of Education, local boards of education, the Department of Community Health,
and the Department of Corrections; provided, however, that a healthcare professional
identified in subparagraph (A) of this paragraph shall not have the authority to assign
a percentage of a disability rating.
<ins>(1.1)</ins> Healthcare professionals identified in subparagraph (A) of <del>this paragraph must
</del> <ins>paragraph (1) of this subsection shall</ins> complete biennial continuing education regarding
the recognition and documentation of the causes of death and appropriate execution of
death certificates, as approved by the board <ins>for a physician assistant as identified in
division (b)(1)(A)(i) of this Code section or by the Board of Nursing for a healthcare
professional identified in division (b)(1)(A)(ii) of this Code section."
</ins> SECTION 7.
Said title is further amended in Code Section 43-34-103, relating to application for licensure
as a physician assistant, authorized delegated authority, and prohibited acts, by adding a new
subsection to read as follows:
<ins>"(m) In addition to and without limiting the authority granted by Code Section 43-34-23,
a physician may delegate to a physician assistant, in accordance with a job description, the
authority to order home healthcare services to a patient."
</ins> SECTION 8.
Title 48 of the Official Code of Georgia Annotated, relating to revenue and taxation, is
amended by revising paragraph (1) of subsection (a) of Code Section 48-7-29.2, relating to
tax credits for qualified caregiving expenses, as follows:
"(1) 'Qualified caregiving expenses' means payments by the taxpayer for home health
agency services, personal care services, personal care attendant services, homemaker
services, adult day care, respite care, or healthcare equipment and supplies which
equipment and supplies have been determined to be medically necessary by a physician,
<ins>an advanced practice registered nurse acting pursuant to the authority of Code Section
43-34-25, or a physician assistant provided that the individual ordering the home health
</ins>
<ins>services does not have an ownership interest in an entity to which they are referring. acting
pursuant to the authority of Code Section 43-34-103,</ins> which services, care, or equipment
and supplies are:
(A) Provided to the qualifying family member; and
(B) Purchased or obtained from an organization or individual not related to the
taxpayer or the qualifying family member."
SECTION 9.
All laws and parts of laws in conflict with this Act are repealed.