Chapter 360-8 PAIN MANAGEMENT CLINICS
| (1) |
'Annual patient
population' means persons seen by a clinic or practice in a 12 month calendar
year but shall not include persons that are patients of a nursing home, home
health agency or hospice licensed pursuant to Chapter 7 of Title 31. |
| (2) |
'Board' means the Georgia Composite
Medical Board created by Code Section 98 43-34-2. |
| (3) |
'Chronic pain' means physical pain
treated for a period of 90 days or more in a year but shall not include
perioperative pain, which shall mean pain immediately preceding and immediately
following a surgical procedure, when such perioperative pain is being treated
in connection with a surgical procedure by a licensed health care professional
acting within the scope of his or her license. |
| (4) |
'License' means a valid and current
certificate of registration issued by the board pursuant to this article which
shall give the person to whom it is issued to engage in the practice prescribed
thereon. |
| (5) |
'Licensee' means any
person holding a license under this article. |
| (6) |
'Medical treatment' and 'medical
services' means the treatment of chronic pain. |
| (7) |
'Medical treatment or services' means for
purposes of Chapter 360-8, medical treatment and services include, but are not
limited to, the evaluation, diagnosis, and/or treatment of any medical
complaint or condition, including prescribing and/or ordering medication,
administering therapy, and/or any surgical procedure. |
| (8) |
'Nonterminal condition' means a medical
condition which is reversible, where there is a reasonable hope of recovery,
and where the patient's medical prognosis is a life expectancy of two years or
more. |
| (9) |
'Pain management clinic'
means a medical practice advertising 'treatment of pain' or utilizing 'pain' in
the name of the clinic or a medical practice or clinic with greater than 50
percent of its annual patient population being treated for chronic pain for
nonterminal conditions by the use of Schedule II or III controlled substances.
This term shall not include any clinic or practice owned, in whole or in part,
or operated by a hospital licensed pursuant to Chapter 7 of Title 31 or by a
health system or any ambulatory surgical center, skilled nursing facility,
hospice, or home health agency licensed pursuant to Chapter 7 of Title
31. |
| (10) |
'Proof of Ownership'
includes official documents such as incorporation papers filed with Secretary
of State, a business license issued to the location identified in the
application, lease agreements, bank accounts, information related to billing
practices of the business, evidence related to form of payment for the owners
of the clinic and physicians practicing at the clinic, and any other
documentation that the Board may need to determine actual ownership. |
| (11) |
'Person' means a natural
person. |
| (12) |
'Physician' means a
person who possesses a current, unrestricted license to practice medicine in
the State of Georgia pursuant to Article 2 of this chapter. |
| (1) |
Each location of a clinic where a physician practices pain management must be
licensed. |
| (2) |
A new pain management
clinic license must be obtained if there is a change in ownership or a change
in location. |
| (3) |
No pain management
clinic shall provide medical treatment or services unless a physician, a
physician assistant authorized to prescribe controlled substances under an
approved job description, or an advanced practice registered nurse authorized
to prescribe controlled substances pursuant to a physician protocol is on-site
at the pain management clinic. This rule shall not apply to a certified
registered nurse anesthetist practicing pursuant to Code Section 43-26-11.1, so
long as
| (a) |
the patient has previously been
examined by a physician and such physician has issued a written order for such
patient to receive medical treatment or services and |
| (b) |
the pain management clinic has obtained
written consent of the patient prior to any medical treatment or services being
provided by the certified registered nurse anesthetist regarding the medical
treatment or services to be performed, the risks of the medical treatment or
services to be performed, and that a physician may or may not be
on-site. |
|
| (4) |
No licensed
physician can own a pain management clinic if the physician, during the course
of his or her practice, has been denied the privilege of prescribing,
dispensing, administering, supplying or selling any controlled substance, or
has had board action against his or her medical license as a result of
dependency on alcohol or drugs. |
| (5) |
No person can own a pain management clinic if he or she has been convicted of a
felony. For purposes of this rule, the term "convicted of a felony" shall
include a conviction of an offense which if committed in this state would be
deemed a felony under either state or federal law, without regard to its
designation elsewhere. As used in this paragraph, the term "conviction" shall
include a finding or verdict of guilt, a plea of guilty resulting in first
offender status, or a plea of nolo contendere in a criminal proceeding,
regardless of whether the adjudication of guilt or sentence is withheld or not
entered thereon. |
| (6) |
The owner of
the clinic and the physicians practicing in the clinic shall be responsible for
compliance with all the laws and rules and regulations regulating the practice
of medicine and the laws and rules and regulations pertaining to the controlled
substances. |
| (7) |
The license issued
by the Board shall be displayed in a conspicuous place. |
| (8) |
All pain management clinics that dispense
controlled substances or dangerous drugs shall be registered with the Georgia
State Board of Pharmacy as required by Chapter 4 of Title 26. |
| (9) |
Each physician owning or practicing in a
pain management clinic must register with the Georgia Prescription Monitoring
Program ("PDMP"). See link www.gdna.ga.gov. Each physician practicing at a pain
clinic must regularly check the PDMP on all new and existing
patients. |
| (10) |
The Board shall have
the power to reprimand, cancel, suspend, revoke, or otherwise restrict any
license or permit issued by the Board. |
| (11) |
Any person who operates a pain
management clinic in the State of Georgia without a license shall be guilty of
a felony. |
| (1) |
Effective July 1, 2013, all pain
management clinics must hold a license issued by the Board to operate in this
state, and must be owned by physicians holding current licenses to practice in
this state.
| (a) |
A pain management clinic who
can present satisfactory evidence to the Board of being in existence on June
30, 2013, may also qualify for a licenses at each location if it is jointly
owned by one or more Georgia licensed physicians and one or more Georgia
licensed physician assistants or Georgia licensed advanced practice registered
nurses. However, the non-physician owners must meet all the qualifications for
licensure except being a licensed physician. |
| (b) |
A pain management clinic who can present
satisfactory evidence to the Board of being in existence on June 30, 2013, may
also qualify for a license at ONE location even though it is not wholly owned
by Georgia licensed physicians. However, the owners must meet all the
qualifications for licensure except being a licensed physician. |
|
| (2) |
All applicants for licensure
as pain management clinic must submit an application on a form approved by the
Board for each location and a non-refundable application fee for each
application, and must submit all of the following:
| (a) |
An affidavit from each owner that each
owner is a United States citizen, a legal permanent resident of the United
States, or that he/she is a qualified alien or non-immigrant under the Federal
Immigration and Nationality Act. If the applicant is not a U.S. citizen, he/she
must submit documentation that will determine his/her qualified alien status.
The Board participates in the DHS-USCIS SAVE (Systematic Alien
Verification for Entitlements or "SAVE") program for the purpose of verifying
citizenship and immigration status information of non-citizens. If the
applicant is a qualified alien or non-immigrant under the Federal Immigration
and Nationality Act, he/she must provide the alien number issued by the
Department of Homeland Security or other federal immigration agency. |
| (b) |
A secure and verifiable document from
each owner. |
| (c) |
Proof that each
licensed owner who holds a license to practice healthcare in this state and
each physician, physician assistant and advanced practice registered nurse who
practices at the clinic are in good standing with the Board or their respective
licensing board. |
| (d) |
Each owner,
principal, manager, agent, officer, and licensed health care practitioner must
pass a criminal background check and further investigation, at the Board's
discretion. |
| (e) |
Each owner must
submit an affidavit of ownership and current photograph. |
| (f) |
A National Practitioner Data Bank and
Health Integrity and Protection Data Bank Report is required for all health
care providers owning or practicing in the pain management clinic. |
| (g) |
A copy of the current Drug Enforcement
Administration (DEA) card for all owners and all health care providers
practicing in the pain management clinic that holds such license. |
|
| (3) |
Pain management clinic applications are
valid for six month from initial receipt. |
| (4) |
The Board may require the owner and/or
physician(s) practicing at the pain management clinic to appear for a personal
interview before the Licensure Committee of the Board. |
| (5) |
The physical location of the applicant
pain management clinic may be inspected before the application is considered.
In addition, if a license is granted, the pain management clinic may be
inspected at the Board's discretion at any time. The pain management clinic
must have the necessary medical equipment to provide the medical treatment or
service offered and must comply with sanitation standards. |
| (6) |
An application may be denied for any of
the reasons authorized by law, or the Board may grant a license with
restrictions. |
| (1) |
The Board will deny a pain clinic license application if a physician practicing
at the clinic has been convicted of a felony unless the Board finds through
evidence satisfactory to the Board that the felony is no longer relevant to the
physician's ability to safely practice in a pain management clinic. For
purposes of this rule, the term "convicted of a felony" shall include a
conviction of an offense which if committed in this state would be deemed a
felony under either state or federal law, without regard to its designation
elsewhere. As used in this paragraph, the term "conviction" shall include a
finding or verdict of guilt, a plea of guilty resulting in first offender
status, or a plea of nolo contendere in a criminal proceeding, regardless of
whether the adjudication of guilt or sentence is withheld or not entered
thereon. |
| (2) |
The Board will deny a
pain clinic license application if a physician practicing at the clinic, during
the course of his or her practice, has been denied the privilege of
prescribing, dispensing, administering, supplying, or selling any controlled
substance, or if the physician, during the course of his or her practice, had
board action taken against his or her medical license as a result of dependency
on drugs or alcohol unless the Board finds through evidence satisfactory to the
Board that the prior disciplinary action, denial of privileges relative to
controlled substances or impairment is no longer relevant to the physician's
ability to safely practice in a pain management clinic. |
| (3) |
The Board may deny a license for a pain
management clinic for any of the reasons set forth in O.C.G.A. Sections
43-34-8,
43-34-283 and/or
43-34-284. |
| (4) |
If the Board intends
to deny the license, the applicant shall be allowed to appear before the board,
if the applicant so requests, prior to the board making a final decision
regarding the issuance of the license. |
| (1) |
The licensee shall notify the Board
within ten business days upon the occurrence of any of the
following:
| (a) |
Permanent closing of a licensed
pain management clinic; |
| (b) |
Any
theft or loss of drugs or devices of a licensed pain management
clinic; |
| (c) |
Any known conviction of
any employee of a licensed pain management clinic of any state or federal drug
laws; |
| (d) |
Any known conviction
based upon charges of fraud of any employee of a licensed pain management
clinic; or |
| (e) |
Disasters,
accidents, theft, destruction, or loss of records of a licensed pain management
clinic required to be maintained by state or federal law or the rules of the
board. |
| (f) |
If there is a death of a
patient due to medication. |
| (g) |
Any
malpractice settlements or disciplinary actions imposed against the owners or
physicians practicing in the clinic |
| (h) |
Impairment of any physician, physician
assistant or advanced practice registered nurse practicing in the
clinic. |
| (i) |
Revocation of the
license of another pain management clinic in this or other states owned by the
same owners. |
| (j) |
Notification if
the DEA of an owner of physician, physician assistant or advanced practice
registered nurse is revoked or surrendered. |
| (k) |
Termination of employment of a physician,
physician assistant and advanced practice registered nurse from a licensed pain
management clinic; |
|
| (2) |
The licensee must notify the Board at least ten (10) days prior to the
occurrence of the following:
| (a) |
Change of ownership, name, management, or location of a licensed pain
management clinic; the license is non-transferrable so the license immediately
becomes void and inactive upon a change in ownership or location. |
| (b) |
Employment of a new physicians, physician
assistant, or advanced practice registered nurse in a licensed pain management
clinic. The notification must be on a form approved by the Board and must
include appropriate supplemental documentation including a criminal background
check. Although prior approval by the Board is not required, the employment of
a person who does not qualify for employment at a pain clinic under the law and
rules of the Board is grounds for disciplinary action against the clinic
license. A clinic license holder may voluntarily submit notification with a
request for prior Board approval to verify that a person does qualifies for
employment under the laws and rules of the Board. |
|
| (1) |
All active licenses must be renewed every
two years. This may be done through mail. A pain management clinic may not
operate after the expiration date of the license. A license must be renewed
biennially by June 30th, and the licensee must
establish satisfaction of Board-approved continuing education requirements to
be eligible for renewal. |
| (2) |
All
physicians owning and/or practicing in a pain management clinic must biennially
document competence to the Board for purposes of renewal by providing one of
the following:
| (a) |
evidence of having
obtained during the preceding two (2) years, twenty (20) hours of continuing
medical education ("CME") pertaining to pain management or palliative medicine
except as provided below. Such CME must be an AMA/AOA PRA Category I CME, a
board approved CME program, or any federally approved CME. The CME obtained
pursuant to this rule may count towards the CME required for individual
physician license renewal; or
| (i) |
All
physicians owning and/or practicing in a pain management clinic that has a pain
clinic license that has been active less than two years, must provide evidence
of having obtained during that time, at least ten (10) hours of CME pertaining
to pain management or palliative medicine. Such CME must be an AMA/AOA PRA
Category I CME, a board approved CME program, or any federally approved CME.
The CME obtained pursuant to this rule may count towards the CME required for
individual physician license renewal; |
|
| (b) |
evidence of current certification or
eligibility for certification in pain management or palliative medicine as
approved by the Board. The Board recognizes certifications in pain medicine or
palliative medicine by the American Board of Medical Specialties or the
American Osteopathic Association, the American Board of Pain Medicine and the
American Board of Interventional Pain Physicians. |
|
| (3) |
Licensees have the right to obtain a late
renewal of their licenses during the three (3) month period immediately
following the expiration date. During this period, the penalty for late renewal
applies. A pain management clinic may not operate after the expiration date of
the license. |
| (4) |
The fee for
renewals and late renewals shall be designated in the fee schedule. |
| (5) |
The Board shall administratively revoke
any license not renewed prior to the expiration of the late renewal period.
Such revocation removes all rights and privileges to operate a pain management
clinic in this State. A license that is so revoked may only be reinstated in
the sole discretion of the Board. Revocation for failure to renew may be
reported to the public and to other state licensing boards, and will be
reported as a revocation for failure to renew. Revocation for failure to renew
is not considered a disciplinary revocation. However, the license may only be
reinstated through application. |
Licensure under this Chapter shall not be required for any
clinic or practice owned, in whole or in part, or operated by a hospital
licensed pursuant to Chapter 7 of Title 31 or by a health system or any
ambulatory surgical center, skilled nursing facility, hospice, or home health
agency licensed pursuant to Chapter 7 of Title 31.
By March 1st of each year, every
hospital that operates an outpatient clinic at its main facility or at any
satellite facility with greater than 50 percent of such clinic's annual patient
population being treated for chronic pain for non-terminal conditions by the
use of Schedule II or III controlled substances shall submit a form approved by
the Board to notify the Board of such clinic. Such notification shall identify
the address of the outpatient clinic and the name or names of the physicians
practicing at such clinic.
The Board can take disciplinary action including revocation
against a licensed pain management clinic upon a finding that the owner or a
physician practicing in the clinic has engaged in conduct identified in
O.C.G.A. Section
43-34-8 as a ground for
disciplinary action or as provided in O.C.G.A. Section
43-34-284.
| (1) |
A license which
is revoked for failure to renew may be reinstated upon the discretion of the
Board upon receipt of a reinstatement application and fee. |
| (2) |
Applicants for reinstatement must be
owned by a physician. If the clinic's original license was issued under the
grandfather clause, the clinic must now meet the requirements of
360-8-.02,"Pain Management Clinic
License Requirements." |
| (3) |
The
Board may also require the applicant to meet with the Board or a committee of
the Board. |
| (4) |
Each owner,
principal, manager, agent, officer, and licensed health care practitioner must
pass a criminal background check and further investigation, at the Board's
discretion. |
| (5) |
This provision of
this rule shall not be construed to limit the ability of the Board to impose
sanctions for continuing to practice with an expired license. |
| (6) |
Reinstatement of the license is within
the discretion of the Board. |
| (7) |
The Board may deny reinstatement if it determines that the granting or renewing
of such license would not be in the public interest. |
| (8) |
The denial of reinstatement is not a
contested case, but the applicant shall be entitled to an appearance before the
Board. |
