The Impact of Federal Law on COVID-19 Vaccination in Michigan

I recently received the following concern from a Michigan medical assistant:

A provider is questioning whether medical assistants can administer the COVID-19 vaccine. Under the Public Readiness and Emergency Preparedness Act for Medical Countermeasures Against COVID-19, it does not list that a [medical assistant] is qualified.

Note the following excerpt from the Department of Health and Human Services (HHS) document:

As qualified persons, these healthcare professionals and students in healthcare profession training programs will be afforded liability protections in accordance with the PREP [Public Readiness and Emergency Preparedness] Act and the terms of this amended Declaration. Second, to the extent that any State law that would otherwise prohibit the healthcare professionals and students in healthcare profession training programs who are a “qualified person” from prescribing, dispensing, or administering COVID-19 vaccines or other Covered Countermeasures, such law is preempted. On May 19, 2020, the Office of the General Counsel issued an advisory opinion concluding that, because licensed pharmacists are “qualified persons” under this declaration, the PREP Act preempts state law that would otherwise prohibit such pharmacists from ordering and administering authorized COVID-19 diagnostic tests. The opinion relied in part on the fact that the Congressional delegation of authority to the Secretary under the PREP Act to specify a class of persons, beyond those who are authorized to administer a covered countermeasure under State law, as “qualified persons” would be rendered a nullity in the absence of such preemption. This opinion is incorporated by reference into this declaration. Based on the reasoning set forth in the May 19, 2020 advisory opinion, any State law that would otherwise prohibit a member of any of the classes of “qualified persons” specified in this declaration from administering a covered countermeasure is likewise preempted. In accordance with section 319F–3(i)(8)(A) of the Public Health Service Act, a State remains free to expand the universe of individuals authorized to administer covered countermeasures within its jurisdiction under State law [emphasis added].

The bold language permits states to expand the categories of individuals who are allowed to administer COVID-19 vaccinations beyond what is stated in the HHS document. More restrictive state laws are preempted by this federal document. However, states are permitted to be more inclusive than what the federal document indicates.

Go to the AAMA website and visit the “State Scope of Practice Laws” page to find the medical assisting law of all states, including Michigan.

Note, especially, the third link to my blog post “Permissible Delegation of Influenza Vaccination Administration in Michigan” in the Michigan subsection of the “State Scope of Practice Laws” webpage. The blog post concludes with my following legal opinion:

Therefore, my legal opinion is that Michigan law permits physicians to delegate the administration of influenza vaccinations to knowledgeable and competent unlicensed individuals such as medical assistants as long as the delegating physician is accessible to the medical assistants by radio, telephone, or telecommunication.

COVID-19 Vaccination in the District of Columbia

The District of Columbia Department of Health (DC Health) clarified the legality of medical assistants administering COVID-19 vaccinations by adding the following section to its regulations:

223 SARS-CoV-2 VACCINE ADMINISTRATION

223.1 An individual, including a medical assistant [emphasis added] or a health technician, who is not licensed, registered, or certified to practice a health occupation pursuant to Chapter 12 of Subtitle I of Chapter 3 of the District of Columbia Official Code, is authorized to administer a SARS-CoV-2 vaccine provided that:

(a) The individual has successfully completed training, provided by a licensed health professional authorized by an existing scope of practice of a health profession to administer a vaccination in the District of Columbia, on the administration of the SARS-CoV-2 vaccine;

(b) A licensed health professional authorized by an existing scope of practice of a health profession to administer a vaccination in the District of Columbia must supervise the individual at the vaccination site;

(c) The licensed health professional reasonably determines that the individual is able to administer the SARS-CoV-2 vaccine under appropriate supervision;

(d) The individual administers the SARS-CoV-2 vaccine at the vaccination site under the general supervision of a licensed health professional supervising the unlicensed person at the vaccination site; and

(e) The training, authorization, and supervision are appropriately documented in the records maintained by the vaccination site.

This rule is similar to rules and executive orders in other American jurisdictions that recognize the importance of empowering knowledgeable and competent medical assistants to administer COVID-19 vaccinations under appropriate supervision.

The AAMA Launches Order Entry Competence Outreach to Payers

On July 11, 2021, the American Association of Medical Assistants® (AAMA) launched its national Order Entry Competence (OEC) initiative in response to the ending of the Medicaid Promoting Interoperability Program (formerly the Medicaid Electronic Health Record [EHR] Incentive Program) on December 31, 2021.

The goal of the OEC outreach is to persuade third-party payers to incorporate into their agreements with licensed providers the requirement that their orders be entered into the computerized provider order entry (CPOE) system by either credentialed medi­cal assistants or licensed health care professionals who are competent in order entry. Clinical knowledge is neces­sary when a clinical order is entered, not just when the licensed provider subsequently authorizes the order.

Learn more about the OEC initiative and the related history of the Promoting Interoperability Programs in the September/October Public Affairs article in CMA Today, “The AAMA Launches Order Entry Competence Outreach to Payers.”

Then, help the OEC initiative succeed! Please email me at DBalasa@aama-ntl.org with contact information for any health insurance carriers’ executives and board members.

Montana Licensure Requirements for CMAs (AAMA)

I recently received the following question from a CMA (AAMA)® working in Montana:

As a [CMA (AAMA)], is it possible and legal for me to take a job as a medical laboratory technician or medical technologist in the state of Montana? … Or, [do] I need to take any classes to be certified to do this type of job?

To answer this question, please review the application for Montana licensure of clinical laboratory scientists, including medical laboratory technicians. Note the following excerpt:

CLINICAL LABORATORY TECHNICIAN

• Graduated with an associate degree or possess 60 semester or 90 quarter hours in a science-related discipline, or completed a military medical laboratory training program of at least 12 months in duration.

• Passed a technician examination offered by a national certifying body for clinical laboratory scientists.

There are some exemptions under federal law, such as those detailed in the Montana Code Annotated 2019. Note the following language, which states that an individual performing only Clinical Laboratory Improvement Amendments (CLIA)–waived tests does not have to become licensed:

37-34-302. Exemptions. (1) This chapter does not limit or regulate the practice of licensed physicians, including but not limited to pathologists.

(2) This chapter does not apply to:

…

(e) any person performing only waived tests as provided for in the federal clinical laboratory regulations set forth in 42 CFR part 493.

Age Requirements for Ohio Medical Assistants

I recently received the following question from an Ohio educator regarding age restrictions for medical assistants:

 Can you tell me if there is any legal implication that [a medical assistant] who has completed a high-school training program [but] is not yet 18 might [be unable] to work as a medical assistant until they turn 18? 

The medical assisting laws of all states, including Ohio, are available on the “State Scope of Practice Laws” webpage. 

Notably, Ohio law does not require medical assistants to be at least 18 years of age to work as a medical assistant. 

However, a few states ​(such as California) do require medical assistants to be at least 18 in order to work as a medical assistant.