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. |
