HB1150: HB1150 Professions and businesses; expand certain advanced practice registered nurse and physician assistant prescriptive authorizations

26 LC 46 1366 House Bill 1150 By: Representatives Powell of the 33rd, Jones of the 47th, O’Steen of the 169th, and Donatucci of the 105th 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 provide for3 certain limitations; to remove certain prohibitions on writing prescriptions for minors; to4 provide for certain prescriptive authorization to order stimula nts; to provide for related5 matters; to repeal conflicting laws; and for other purposes.6 BE IT ENACTED BY THE GENERAL ASSEMBLY OF GEORGIA:7 SECTION 1.8 Chapter 34 of Title 43 of the Official Code of Georgia Annotate d, relating to physicians,9 assistants, and others, is amended in Code Section 43-34-25, relating to delegation of certain10 medical acts to advanced practice registered nurse, constructio n and limitations of such11 delegation, definitions, conditions of nurse protocol, and issuance of prescription drug orders,12 by revising paragraph (3) of and adding a new paragraph to subs ection (a), by revising13 subsection (d.1), by revising paragraph (10) of subsection (g), by revising subsection (k), and14 by adding a new subsection to read as follows:15 H. B. 1150 - 1 - 26 LC 46 1366 "(3) 'Controlled substance' means any controlled substance as defined in Code Section16 16-13-21 but shall not include any Schedule I controlled substa nce included in Code17 Section 16-13-25 or any Schedule II controlled substance includ ed in Code Section18 16-13-26, except as authorized pursuant to subsection (d.1) subsections (d.1) and (d.2)19 of this Code section."20 "(16) 'Stimulant' means any material, compound, mixture, or preparation that increases21 heart rate, breathing, or brain function as provided in paragra ph (3) of Code22 Section 16-13-26."23 "(d.1) An advanced practice registered nurse who has at least o ne year of post-licensure24 clinical experience and is in good standing with the board may be authorized under a nurse25 protocol agreement to issue prescription drug orders in emergen cy situations f o r26 hydrocodone, oxycodone, or compounds thereof in emergency situations pursuant to the27 following requirements:28 (1) The authorization is specifically included in the nurse protocol agreement;29 (2) The advanced practice registered nurse has directly evaluated the patient;30 (3) The prescription drug order is limited to an initial presc ription, not to exceed a31 five-day supply;32 (4) The prescription drug order is for an individual 18 years of age or older; and33 (5) The advanced practice registered nurse completes one hour of continuing education34 biennially in the appropriate ordering and use of hydrocodone, oxycodone, and35 compounds thereof."36 "(d.2) An advanced practice registered nurse who has at least o ne year of post-licensure37 clinical experience and is in good standing with the board may be authorized under a nurse38 protocol agreement to issue prescription drug orders for stimul ants pursuant to the39 following requirements:40 (1) The authorization is specifically included in the nurse protocol agreement;41 (2) The advanced practice registered nurse has directly evaluated the patient; and42 H. B. 1150 - 2 - 26 LC 46 1366 (3) The advanced practice registered nurse completes one hour of continuing education43 biennially in the appropriate ordering and use of stimulants."44 "(10) Notwithstanding the provisions of subsection (d.1) subsections (d.1) and (d.2) of45 this Code section, in any emergency medical services system operated by, or on behalf46 of, any county, municipality, or hospital authority with a full -time physician medical47 director who does not order drugs, except that he or she may order up to a 14 day supply48 of drugs as necessary in an emergency situation, excluding benz odiazepines and all49 Schedule II controlled substances except hydrocodone, oxycodone , or compounds50 thereof; provided, however, that an advanced practice registere d nurse shall not order51 radiographic imaging, diagnostic studies, or medical devices pursuant to this paragraph;52 and provided, further, that a patient shall be referred to a ph ysician, a dentist, or a53 federally qualified health center."54 "(k) Nothing in this Code section shall be construed to authori ze an advanced practice55 registered nurse to issue a prescription drug order for a Sched ule I or II controlled56 substance, except as otherwise authorized pursuant to subsectio n (d.1) subsections (d.1)57 and (d.2) of this Code section, or authorize refills of any drug for mor e than 12 months58 from the date of the original order except in the case of oral contraceptives, hormone59 replacement therapy, or prenatal vitamins which may be refilled for a period of 24 months."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. 1150 - 3 - 26 LC 46 1366 Section 16-13-71, stimulants, and in emergency situations, hydrocodone, oxycodone,69 or compounds thereof in accordance with subparagraph (B) subparagraphs (B) and (C)70 of this paragraph, or any Schedule III, IV, or V controlled substance as defined in Code71 Section 16-13-21 on a prescription drug order or prescription d evice order form as72 specified in paragraph (3) of this subsection. Delegation of s uch authority shall be73 contained in the job description required by this Code section. T h e d e l e g a t i n g74 physician shall remain responsible for the medical acts of the physician assistant75 performing such delegated acts and shall adequately supervise the physician assistant. 76 If an existing job description for a physician assistant does not contain such authority77 to order a prescription drug or device order as provided by thi s subsection, that78 physician assistant may not issue any such prescription drug or device order until a new79 job description delegating such authority is submitted to and a pproved by the board. 80 Nothing in this Code section shall be construed to authorize th e written prescription81 drug order of a Schedule I or II controlled substance, except as authorized pursuant to82 subparagraph (B) subparagraphs (B) and (C) of this paragraph.83 (B) A physician may delegate to a physician assistant who has at least one year of84 post-licensure clinical experience and is in good standing with the board the authority85 to issue prescription drug orders in emergency situations for hydrocodone, oxycodone,86 or compounds thereof in emergency situations pursuant to the following requirements:87 (i) The authorization is specifically included in the job description;88 (ii) The physician assistant has directly evaluated the patient; and89 (iii) The drug order is limite d to an initial prescription not to exceed a five-day90 supply; and91 (iv) The prescription drug order is for an individual 18 years of age or older.92 (C) A physician may delegate to a physician assistant who has at least one year of93 post-licensure clinical experience and is in good standing with the board the authority94 to issue prescription drug orders for stimulants pursuant to the following requirements:95 H. B. 1150 - 4 - 26 LC 46 1366 (i) The authorization is specifically included in the job description; and96 (ii) The physician assistant has directly evaluated the patient."97 "(10)(A) A physician assistant delegated the authority by the p rimary supervising98 physician to issue a prescription drug or device order shall be required to complete a99 minimum of three hours of conti nuing education bi ennially in pr actice specific100 pharmaceuticals in which the physician assistant has prescriptive order privileges.101 (B) A physician assistant delegated the authority by the primary supervising physician102 to issue a prescription drug or device order for stimulants, hydrocodone, oxycodone,103 or compounds thereof shall be required to complete one additional hour of continuing104 education biennially in the appropriate ordering and use of sti mulants, hydrocodone,105 oxycodone, or compounds thereof."106 SECTION 3.107 All laws and parts of laws in conflict with this Act are repealed.108 H. B. 1150 - 5 -