Governor Perdue has signed HB 509 into law. HB 509, introduced by Rep. Sharon Cooper, the chair of the House Health and Human Services Committee, for the Composite State Board of Medical Examiners. HB 509 updates both the Medical Practice and Physician Assistant (PA) Acts.

As noted in the summary below, HB 509 makes it unlawful for a physician to be an "employee" of a PA whom he or she supervises. Current arrangements are grandfathered but not transferable. PAs who are currently paying physicians to supervise them must have such arrangements approved by the Medical Board before July 1, 2009. Therefore, now that the bill has been signed, the Composite State Medical Board will be mailing a postcard notice to all licensed PAs informing them of this requirement.

The term "employee of" is not defined, and the "PA ownership" provision is only expected to affect those PAs currently paying a physician to supervise him or her. However if you are a PA with any doubts whether or not this provision affects you, you should respond to the Medical Board´s postcard by the June 25 deadline.

HB 509 also simplifies the prescription form which must be used by PAs. The Medical Board will be discussing this change qnd will provide guidance to PAs as close to the July 1 effective date as is possible.

Although significant changes have been made to the PA Act since its original passage in 1972, the basic regulatory framework and definitions had not been comprehensively updated since that time. While retaining all of the significant changes- such as physician delegated prescribing, licensure, physician/PA ratio flexibility, sampling, disaster relief, job description flexibility, and practice by "temporary practice agreement" in indigent care settings- HB 509 basically reflects current PA practice under physician supervision, as regulated by the Medical Board. In addition, it contains provisions enabling the CSBME to treat PAs who prescribe medications in substantially the same manner as advanced practice nurses (APRNs), who obtained the authority to be delegated prescribing privileges just two years ago.

The effort to update the PA Act has been a point of discussion by GAPA for at least six years. A summary of the major changes proposed in PA regulation by HB 509 is provided below. The new law represents very significant progress in updating the law to reflect current Physician-PA team practice. However, despite the fact that much of the language GAPA submitted to the Medical Board is in HB 509, this is "Board" legislation and not that of GAPA. The Medical Board and Rep. Cooper were very supportive of PAs in negotiating the bill, but as is common in the legislative process, ultimately there is "give and take", and a few provisions sought by the Board or GAPA were modified or eliminated; in addition a few unexpected items were added.

If you have any questions concerning changes in the PA law, please contact Tom Bauer, GAPA legislative consultant, at TBauer23@aol.com.

SUMMARY OF MAJOR CHANGES IN PA ACT

1. Licensure- Ownership/Application
   
   The PA is considered the applicant for a license and an "independent" licensee as are other health care professionals, but with the restriction that patient services may not be provided until there is an approved job description.
   
   The apostrophe "s" has been removed from PA
   
   The PA remains "licensed to" the supervising physician
   
   
2. Definition of PA
   
   The antiquated definition of a PA is retained. However, the provision about places in which PAs may practice (see below) has been modernized.
   
   
3. Places in which PAs may practice
   
   Language referring to the supervising physician´s "principal" office is removed.
   
   PA may practice in public/private places or facilities ("health" removed).
   
   Language declaring that a physician need not be present is added to the definition.
   
   Hospital "duties" replace hospital "rounds."
   
   
4. "Additional Duties"
   
   Language upon which concept of additional duties is based has been modernized, replaced by authorization for a supervising physician to submit an "amended" job description
   
   
5. "Ordering"/"Prescribing" Nomenclature
   
   Removes "only physician can prescribe" language.
   
   Uses the same delegating language as the APRN statute
   
   
6. Temporary Practice Agreements
   
   Expands PA voluntary practice with other than "usual" supervising physician from 501(c)(3) organizations to other programs which provide indigent care in "medically underserved or critical need population" areas.
   
   
7. Prescriptions (Streamline process and make comparable to APRNs)
   
   Formulary has been eliminated.
   
   Refills authorized for up to 12 months
   
   Rx Form with language of PA issuing prescription "through" the physician has been eliminated. Update Record-keeping (Electronic)
   
   Countersign of prescription has been eliminated, replaced by a requirement that the chart be reviewed (by 50% sampling) within 30 days.
   
   Physician re-evaluation of patient- Language requiring "personal reevaluation" of the patient by the physician has been replaced by "evaluate or examine":
   
   -Quarterly for patients prescribed controlled substances
   -Eliminated for other patients
   
   "Informing the Patient"- Language requiring a PA to inform the patient of the right to see the physician has been changed to "notify" and can be done by "office staff."
   
   
8. DEA Authorization- The current statement in Georgia law has been added to the PA Act
   
   
9. PA Practice "Ownership"
   
   Language (identical to the APRN statute) added to make it unlawful for a physician to be an "employee" of a PA whom he or she supervises. The term "employee of" is not defined.
   
   
10. "Chronic Patients"
    
    Language has been added to require patient seen more than twice in a year to see the physician at least once in that period. NOTE: Since it will be difficult for the Medical Board to enforce this provision, it will need to be clarified in Board rules in order not to disrupt Physician-PA team practice.
    
    
11. Abortion
    
    Language – identical to the APRN law – was added to prevent prescribing pharmaceutical abortions.
    
    

The following are changes to the Medical Practice Act (MPA) which are of interest to or affect PAs:

1. The name of the Medical Board has been changed to the "Georgia Composite Medical Board."
   
   
2. Language has been added to allow medical assistants to perform certain tasks, such as obtaining vital signs and subcutaneous and intramuscular injections, or other tasks established by Board rule. There is also ambiguous language, to be addressed by Board rule, governing the taking of orders from PAs and APRNs.
   
   
3. Radiologist Assistants
   
   Language defining and giving a liberal scope of practice to radiologist assistants was inserted in the MPA. This is not self-executing, but is to pave the way for a (perhaps near) future licensure effort.