Legislative Updates

Update from the Capital

1) Legislative session began 1/14/08

2) Legislation currently under attention on the UAPRN include:

HB 1041- sponsored by Sharon Cooper and first read 1/29/08 requiring criminal background checks for licensing of RN's (which includes APRNs). This appears to require amending the Nurse Practice Act. Representative Cooper has not approached the UAPRN to request recommendations or feedback about the legislation prior to first reading/as it is written. A majority of States require baclkground checks for nurse licensing.

HB 676 and SB 253 - legislation carried over from previous legislative session. These legislations attempt to further restrict APRN practice by requiring further MD physical evaluation and chart review. they also restrict APRN/MD contractual agreements.

SR 66 - to establish a study group to evaluate medical professional shortages - including nurses, in the state of Georgia.

Meet our Lobbyist

Last September UAPRN hired a lobbying group and are now working with them regarding issues concerning APN’s Please check out their web site and meet the team.

2008 Legislation to Watch

Summary of SB 253 and HB 676

  • Provide "on-site" patient examination by the delegating physicians, with the frequency of such examination to be based on the nature, extent, and scope of the delegated act/s as determined by the delegating physician in accordance with "accepted standards of medical practice as determined by the Board".
  • 100% chart review of all patients who receive a prescription for controlled substances, and shall be examined “on site" by the delegating physician, but this does not apply to a Rx for a 10-day supply.
  • The NPA must be submitted with the required form, and the requisite non-refundable fee.
  • It shall be unlawful for a physician to be employed by "or a consultant of" the APRN if the MD is required to supervise the APRN.



Summary of SB 498

  • Cosmetic Laser Services; licensing; change certain provisions
  • - requires the MD perform the initial exam
  • - requires a supervisor on-site for anyone other than a MD
  • - requirements for minimum training requirements
  • - UAPRN does not support in its current version (3/11/08)

Links to SB 253 and HB 676 and SB498



Please go to vote-smart.org with your nine digit zip code and find all of your elected officials including your Georgia State Representative and Senator. Please take the time to write your legislators regarding the above issues and issues that are important to you as their constituent.

Past Updates



Updates from our Lobbyist
Coming soon!

April 23, 2007 - DEA Update
The DEA has started issuing DEA numbers for those who have submitted their NPA to the BOM.

Click here to view "BOME Approved" Nurse Protocol Agreement (NPA).

April 2nd, 2007
As the 2007 legislative session is coming to an end, we are all anxiously waiting for news. Believe me, I am too!

It has been an unusual session, with lots of recesses, which make it hard to get any momentum. We started off the year with amazing support for changing SB 480 to address the concerns that the Legislators, as well as many health care establishments throughout GA, had regarding the abused powers of the Board of Medicine.

February 7th, the Board of Medicine introduced a new version of their proposed Rules and Regulations. To get the Legislators off their back, the Board of Medicine made significant changes to the R&R to make it more in-line with the intent of the law. This endeavor changed a lot of the dynamics with us being able to introduce legislation, AND have to remember that we lost our passionate sponsor from last year, Rep. Sue Burmeister.

The Medical Association of GA was successful with introducing SB 253, and HB 676 which adds additional "on-site" restrictions to SB 480, and makes it illegal for an APRN to employ or contract with an MD to enter into a Nurse Protocol Agreement. These two pieces of legislation did not move out of committee, therefore will not see action this year.

In the past week, there has been a stalemate with the House and Senate over the proposed budget. Some Legislators feel we should insure the prosperity of PeachCare and find funding to rebuild Sumter Regional in Americus, where as others feel they are owed monies for pet projects, like museums, ball parks, etc. for their districts. This stalemate has stopped all bills from passing out of committees in the House, and they are only hearing bills that have already passed out of the Senate. Hopefully, the Legislators will return after the Easter break and be more willing to work around this stalemate.

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DEA Update
We have received word from the DEA that they have been waiting for the BOM to send them a list of names of APRNs who have submitted their Nurse Protocol Agreements to the BOM. The BOM says that they were unaware that the DEA wanted them to send the list to them. We hope that all parties are aware of the problem, and this glitch is fixed for those who have already submitted their NPA to the BOM.

We are also hearing that there is a major discrepancy in the number of applications that the DEA has received and the number of NPAs that the BOM has received.

You must submit your NPA to the Board of Medicine to be approved for a DEA number! Click here for information packet.

– Karen Schwartz, UAPRN Legislative Chair

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March 9th, 2007
The Board of Medicine voted unanimously to adopt their 4th version of Rules and Regulations. These are an improvement from the original version, BUT still are not consistent with the intent of the law. See the version as passed Please remain vigilant as we are approaching the end of the 2007 Legislative session.

– Karen Schwartz, UAPRN Legislative Chair

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Feb. 28th, 2007
URGENT ACTION NEEDED! Call your Senators TODAY!

Yesterday, SB 253 was dropped in the hopper and is slated to be heard tomorrow (March 1) at 1pm in the Senate Mezzanine. This bill attempts to amend the UAPRN and GNA-supported APRN prescribing bill that was passed last year. The legislation is sponsored by John Wiles of the 37th and Don Thomas, MD of the 54th. If passed, this bill would put into law some of the provisions the Composite Board of Medical Examiners has written into their new rules/regulations. Contact your senators NOW to voice your opposition to this bill! It is especially important for contacts to occur with the members of the Senate Health and Human Services Committee—the NEED to hear from their constituents! (See the list below.) GNA will be well-represented by legislative leadership. Click here to view the bill.

Senate Health and Human Services Committee Members

  • Thomas, Don (R-SS 54)Chairman
  • Unterman, Renee S (R-SS 45)Vice Chairman
  • Goggans, Greg (R-SS 07)Secretary
  • Adelman, David (D-SS 42)Member
  • Balfour, Don (R-SS 09)Member
  • Butler, Gloria S. (D-SS 55)Member
  • Carter, Joseph (R-SS 13)Ex-Officio
  • Grant, Johnny (R-SS 25)Member
  • Hawkins, Lee (R-SS 49)Member
  • Henson, Steve (D-SS 41)Member
  • Hill, Judson (R-SS 32)Member
  • Orrock, Nan (D-SS 36)Ex-Officio
  • Shafer, David (R-SS 48)Ex-Officio
  • Smith, Preston W. (R-SS 52)Member
  • Tate, Horacena (D-SS 38)Member
  • Wiles, John J. (R-SS 37)Member



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Feb. 7th, 2007
New Version of Rules and Regulations
We are in the midst of negotiations again with the BOM re: Rule & Regs. Tonight they posted a revision which is more in keeping with the spirit of the law, but we are still able to rebut it in the following ways: -written public comment will be accepted through Feb 27 OR - in person at a public hearing on March 1 with a BOM vote via teleconference on March 9.

Proposed Board of Medicine Rules and Regulations Burden Physicians

  1. If you currently have an Advanced Practice Nurse (Nurse Practitioner, Certified Nurse Midwife, or Clinical Nurse Specialist for Psychiatry/Mental Health) working for you and you DO NOT have a document that is mutually agreed upon, and signed by the physician and the Advanced Practice Nurse that legally defines how the APRN can practice, then you will first have to develop this document called a Nurse Protocol Agreement.
    1. There are many restrictions to APRN practice that are not current practice, just so the APRN can sign their name to their prescriptions.
    2. There are also excessive burdens added to the delegating physician to now have their APRNs prescribe.
    3. Please review the proposed Rules and Regulations
  2. PAPERWORK, PAPERWORK, PAPERWORK
    1. You’ll have to keep documentation each medical act the APRN is performing and maintain the APRNs pharmacology CE hours.
    2. You’ll essentially have to do 100% chart review of all prescriptions, most within 30 days, but for prescriptions for chronic illnesses you have a year to sign off on those patient charts. You even have perform chart review for 25% of the charts of patients that do not receive a prescription by the APRN.
      1. Problems: how are you going to differentiate all of these charts? The BOM essentially wants you to just do 100% chart review on everything, since that is the only way to keep in compliance with this rule.
      2. Example: if you have 1 APRN who sees 25 patients/day=500 charts a month.
      3. Example: if you have 4 APRNs who see 25 patients/day=2000 charts a month.
    3. How many times will the Nurse Protocol Agreement need to be sent to the BOM until “they” feel that it meets acceptable standards, and HOW MUCH is that going to cost the physician?
      1. You at least have to submit the Nurse Protocol Agreement annually, even if there are NO changes to the agreement. This is an unnecessary requirement and fee to the physician.
      2. If new names are added to your list of alternate delegating physicians, you must resubmit the Nurse Protocol Agreement each time to the BOM.
      3. If new drugs come out, you will have to resubmit the Nurse Protocol Agreement to the BOM to update your “formulary”.
      4. If new drug samples come out, you will have to resubmit the Nurse Protocol Agreement to the BOM to update those professional drug samples approved for request, receipt, or distribution by the APRN.
      5. Just keeping a log of drugs received, and drugs dispensed.
  3. Increased time commitment to supervise the APRN and reevaluate their patients as determined by the BOM
    1. The delegating physician shall spend 4 HOURS per month in each location where the APRN is providing medical services to monitor the quality of medical care being provided by the APRN. . The physician shall have DOCUMENATATION of compliance with this rule available to the BOM upon request by the BOM.
      1. If you have 4 practice locations = 16 hours per month monitoring the quality of care provided by the APRN. Plus, you must keep documentation of being compliant with this rule.
      2. The SB 480 law only states that the delegating physician shall “adequately supervise”, with no requirement of time.
  4. Increased costs to the physician or APRN practice as a result of more physician supervision, physician reevaluation of ARPN patients, chart review, submission of Nurse Protocol Agreements multiple times to the BOM.
    1. It is inconceivable at this time how much money this process will cost the delegating physician.
    2. To the Nurse Practitioner who operates his/her own practice in rural Georgia seeing the poorest of poor, medically underserved and uninsured these costs will be grave. Not only is it hard to get physicians to work in rural areas, but those who do are stretched to where they cannot handle the volume. Nurse practitioners often fill in these gaps to improve the accessibility of healthcare for all of Georgia. These practices operate with a minimal copay requirement of the patient of ~$40. This is usually the minimum that the clinics can handle to keep the clinic operational as well as provide a financially manageable means that these patients can receive “acute” healthcare or management of chronic illnesses without over utilizing our Emergency Departments.
  5. These proposed Rules and Regulations by the BOM, are setting our physicians up for compliance issues, and disciplinary action.
    1. Physicians are busy managing their practices and seeing their patients, they do not need this additional paperwork, time commitments, and financial burdens added to their already functioning practice where the current Nurse Protocol statute has been in existence for almost 18 years.
    2. These proposed rules and regulations only add burdens to our practice, but do not improve the quality of care or safety that APRNs are providing. Our previous 18 years of practice alone shows are safety.


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Pharmacy Update
We are receiving reports that APRNs who have made attempts to submit "written" prescriptions, even though they've done everything correctly by having a Nurse Protocol Agreement, are having their prescriptions denied by pharmacists. Some insurance companies have told pharmacists that prescriptions without a DEA number will not be reimbursed. A DEA number is not required for the ordering of dangerous drugs; yet some insurance companies are making the DEA number a condition for the reimbursement of all prescriptions. This is a "kink" that we'll have to work through, but should be amended once we have our DEA numbers.

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