HB981: HB981 Professions and businesses; expand certain advanced practice registered nurse and physician assistant prescriptive authorizations

26 LC 46 1327 House Bill 981 By: Representatives Powell of the 33rd, Ehrhart of the 36th, O’Steen of the 169th, Jackson of the 128th, and Jones of the 47th A BILL TO BE ENTITLED AN ACT To amend Chapter 34 of Title 43 of the Official Code of Georgia Annotated, relating to1 physicians, assistants, and others, so as to expand certain advanced practice registered nurse2 and physician assistant prescriptive authorizations; to provide for a definition; to increase3 certain prescriptive authorizations from five-day to 30 day sup plies; to remove certain4 prohibitions on writing prescriptions for minors; to provide fo r certain prescriptive5 authorization to order stimulants; to provide for related matters; to repeal conflicting laws;6 and for other purposes.7 BE IT ENACTED BY THE GENERAL ASSEMBLY OF GEORGIA:8 SECTION 1.9 Chapter 34 of Title 43 of the Official Code of Georgia Annotate d, relating to physicians,10 assistants, and others, is amended by adding a new paragraph to subsection (a) of and by11 revising subsection (d.1), paragraph (10) of subsection (g), and paragraph (2) of subsection12 (m) of Code Section 43-34-25, relating to delegation of certain medical acts to advanced13 practice registered nurse, construction and limitations of such delegation, definitions,14 conditions of nurse protocol, and issuance of prescription drug orders, to read as follows:15 H. B. 981 - 1 - 26 LC 46 1327 "(16) 'Stimulant' means any material, compound, mixture, or preparation that increases16 heart rate, breathing, or brain function as provided in paragra ph (3) of Code Section17 16-13-26."18 "(d.1) An advanced practice registered nurse who has at least o ne year of post-licensure19 clinical experience and is in good standing with the board may be authorized under a nurse20 protocol agreement to issue prescription drug orders for stimul ants, hydrocodone,21 oxycodone, or compounds thereof in emergency situations pursuan t to the following22 requirements:23 (1) The authorization is specifically included in the nurse protocol agreement;24 (2) The advanced practice registered nurse has directly evaluated the patient;25 (3) The prescription drug order is limited to an initial presc ription, not to exceed a26 five-day 30 day supply; and27 (4) The prescription drug order is for an individual 18 years of age or older; and28 (5)(4) The advanced practice registered nurse completes one hour of continuing29 education biennially in the appropriate ordering and use of sti mulants, hydrocodone,30 oxycodone, and compounds thereof."31 "(10) Notwithstanding the provisions of subsection (d.1) of thi s Code section, in any32 emergency medical services system operated by, or on behalf of, any county,33 municipality, or hospital authority with a full-time physician medical director who does34 not order drugs, except that he or she may order up to a 14 day supply of drugs as35 necessary in an emergency situation, excluding benzodiazepines and all Schedule II36 controlled substances except hydrocodone, oxycodone, or compounds thereof; provided,37 however, that an advanced practice registered nurse shall not order radiographic imaging,38 diagnostic studies, or medical devices pursuant to this paragraph; and provided, further,39 that a patient shall be referred to a physician, a dentist, or a federally qualified health40 center."41 "(2)(A) Further, the board shall be authorized to:42 H. B. 981 - 2 - 26 LC 46 1327 (i) Require that a nurse protocol agreement shall be filed by the delegating physician43 with the board within a reasonable time from the date of execution;44 (ii) Determine, after review of a filed nurse protocol agreeme nt, if such nurse45 protocol agreement fails to meet accepted standards of medical practice as established46 by the board; and47 (iii) Require the delegating physician to amend any such noncompliant nurse protocol48 agreement in order to meet such accepted standards.49 (B) If a medical practice has an existing approved nurse proto col agreement and an50 alternate delegating physician or a change in the delegating physician within the same51 or similar specialty, such new nurse protocol agreement for the new alternate delegating52 physician or a change in the delegating physician, upon submiss ion, shall be53 automatically deemed approved authorized by the board.54 (C) If a delegating physician submits a nurse protocol agreement for a new advanced55 practice registered nurse and such nurse protocol agreement has substantially the same56 terms and provisions as a nurse protocol agreement previously s ubmitted by such57 delegating physician for another advanced practice registered nurse and approved by58 the board, the nurse protocol agreement for the new advanced practice registered nurse,59 upon submission, shall be automatically deemed approved authorized by the board."60 SECTION 2.61 Said chapter is further amended by revising paragraphs (1) and (10) of subsection (e.1) of62 Code Section 43-34-103, relating to delegation of authority to physician assistants, as63 follows:64 "(e.1)(1)(A) In addition to and without limiting the authority granted by Code Section65 43-34-23, a physician may delegate to a physician assistant, in accordance with a job66 description, the authority to issue a prescription drug order or orders for any device as67 defined in Code Section 26-4-5 or to issue any dangerous drug a s defined in Code68 H. B. 981 - 3 - 26 LC 46 1327 Section 16-13-71, stimulants, hydrocodone, oxycodone, or compounds thereof in69 accordance with subparagraph (B) of this paragraph, or any Sche dule III, IV, or V70 controlled substance as defined in Code Section 16-13-21 on a prescription drug order71 or prescription device order form as specified in paragraph (3) of this subsection. 72 Delegation of such authority shall be contained in the job description required by this73 Code section. The delegating physician shall remain responsible for the medical acts74 of the physician assistant performing such delegated acts and shall adequately supervise75 the physician assistant. If an existing job description for a physician assistant does not76 contain such authority to order a prescription drug or device order as provided by this77 subsection, that physician assistant may not issue any such prescription drug or device78 order until a new job description delegating such authority is submitted to and approved79 by the board. Nothing in this Code section shall be construed to authorize the written80 prescription drug order of a Schedule I or II controlled substance, except as authorized81 pursuant to subparagraph (B) of this paragraph.82 (B) A physician may delegate to a physician assistant who has at least one year of83 post-licensure clinical experience and is in good standing with the board the authority84 to issue prescription drug orders for stimulants, hydrocodone, oxycodone, or85 compounds thereof in emergency situations pursuant to the following requirements:86 (i) The authorization is specifically included in the job description;87 (ii) The physician assistant has directly evaluated the patient; and88 (iii) The drug order is limited to an initial prescription not to exceed a five-day 3089 day supply; and90 (iv) The prescription drug order is for an individual 18 years of age or older."91 "(10)(A) A physician assistant delegated the authority by the p rimary supervising92 physician to issue a prescription drug or device order shall be required to complete a93 minimum of three hours of continuing education biennially in pr actice specific94 pharmaceuticals in which the physician assistant has prescriptive order privileges.95 H. B. 981 - 4 - 26 LC 46 1327 (B) A physician assistant delegated the authority by the primary supervising physician96 to issue a prescription drug or device order for stimulants, hydrocodone, oxycodone,97 or compounds thereof shall be required to complete one additional hour of continuing98 education biennially in the appropriate ordering and use of sti mulants, hydrocodone,99 oxycodone, or compounds thereof."100 SECTION 3.101 All laws and parts of laws in conflict with this Act are repealed.102 H. B. 981 - 5 -