New Alaska Standards for Delegation of Certain Duties

The Alaska State Medical Board has added a new section to its regulations that establishes standards and conditions under which a licensed physician (doctor of medicine or osteopathic medicine), podiatrist, or physician assistant may delegate certain medical duties to unlicensed professionals such as medical assistants.

These regulations remove any ambiguity from the assertion that knowledgeable and competent unlicensed allied health professionals such as medical assistants can legally perform intramuscular (IM), subcutaneous (subq), and intradermal (ID) injections delegated by a licensed provider under the provider’s direct/on-site supervision.

The regulations of the Alaska State Medical Board were finalized November 25, 2019, and went into effect December 25, 2019.

You can read the regulations by either accessing the December 2019 medical statues and regulations document (Page 37) via the Alaska State Medical Board webpage or the Alaska section of the AAMA State Scope of Practice Laws webpage on the AAMA website.

This is a significant scope of practice victory in Alaska, and I congratulate the Alaska Medical Assistant Society for its excellent and diligent work on strengthening and clarifying medical assistants’ right to practice!

Medical Assistants and Vaccination Administration under Pharmacists

Improving vaccination rates and lessening vaccination hesitancy is a top priority for all health care professionals. Medical assistants are in a prime position to help, but the exact nature of their role requires some legal considerations.

Consider the following situation:

I own a pharmacy in which pharmacists administer influenza vaccinations. Could I hire a medical assistant to help us administer these influenza shots, or is it required that medical assistants work only under the supervision of a physician?

Most often, medical assistants work under the authority and supervision of licensed providers such as physicians (doctors of medicine or osteopathic medicine), nurse practitioners, and physician assistants in outpatient settings. However, state laws generally do not prohibit other licensed health care professionals (such as podiatrists, dentists, optometrists, and pharmacists) from employing medical assistants and delegating legally permitted tasks to them.

In response to your specific question, it is necessary to check the pharmacy practice act of your state—and the regulations and policies of the state board of pharmacy—to ascertain which allied health professionals (if any) may be delegated the administration of influenza vaccinations by a pharmacist. It is also necessary to determine the degree of supervision pharmacists must exercise over allied health professionals who are administering influenza vaccinations. I suspect the pharmacy law of your state requires delegating pharmacists to exercise on-site supervision over professionals who are administering influenza vaccinations.

If you’d like to know more about your specific state laws, visit the State Scope of Practice Laws webpage on the AAMA website.

The CMA (AAMA)® Certification Exam Eligibility Pilot Program

The Certifying Board (CB) of the American Association of Medical Assistants® (AAMA) has approved the launch of a three-year eligibility pilot program, which temporarily opens a new education pathway for medical assistants to become eligible to sit for the CMA (AAMA)® Certification Exam.

Applicants first submit their documentation for review, free of charge, to determine their eligibility to apply for the exam. The criteria and submission requirements for the review are outlined on the Eligibility Pilot Program webpage of the AAMA website.

Before implementing the program, the CB took into account several policy priorities, including but not limited to the following:

• Maintaining global and national accreditation standards
• Heeding a recommendation from the National Commission for Certifying Agencies
• Needing to collect and evaluate empirical evidence on examination performance by candidates who are not graduates of accredited medical assisting programs

Examine all the CB’s considerations and rationale in detail by reading the November/December 2019 Public Affairs article, “The CMA (AAMA)® Certification Exam Eligibility Pilot Program: Criteria and Rationale for the Three-Year Pilot Study,” on the AAMA website.

Medical Assistants Working with Dually Licensed Providers

The following question is not asked frequently. However, it raises important legal considerations:

I work for an oral surgeon who is both a licensed physician and a licensed dentist. Is my scope of practice determined by the state medical practice act or the state dental practice act?

Many oral surgeons have both an MD/DO degree (doctor of medicine or osteopathy) and a DDS/DMD degree (doctor of dental surgery or dental medicine) and are licensed as both physicians and dentists.

When medical assistants perform a dental task, they function as dental assistants. Thus, the state dental practice act and the regulations and policies of the state board of dental examiners determine the legal scope of practice—including supervision requirements by the delegating oral surgeon. If state law allows delegation of certain dental tasks only to individuals who meet dental assisting education and credentialing requirements, medical assistants must meet these requirements or obtain a waiver from the board of dental examiners to perform such tasks.

When medical assistants perform a medical task, the scope of practice is established by the state medical practice act and the regulations and policies of the state board of medical examiners. Go to the State Scope of Practice Laws webpage on the AAMA website to find the medical assisting law of all states.

“Certified Medical Assistant” vs. “Medical Assistant-Certified” in Washington: A Review of Permissible Usage among Programs

The distinction between “certified medical assistant” and its variations can be difficult for medical assisting programs to make. Trademark registrations and state law need to be taken into consideration.

Take this question for example:

Can a Washington-based medical assisting program that meets the requirements of the Washington State Department of Health (e.g., graduates can become a “medical assistant-certified” [MA-C]) but not the CMA (AAMA)® Certification Exam use the phrase “certified medical assistant” in connection with their program?

The American Association of Medical Assistants® (AAMA) holds a trademark registration with the U.S. Patent and Trademark Office for the phrase “certified medical assistant.” Any party’s use of the phrase that is likely to confuse or mislead the public is an infringement of the AAMA’s intellectual property rights in the phrase.

Medical assisting programs that are not accredited by either the Commission on Accreditation of Allied Health Education Programs (CAAHEP) or the Accrediting Bureau of Health Education Schools (ABHES) should not use the phrase because it could be misconstrued as their graduates being eligible for the CMA (AAMA) Certification Exam.

Washington State Legislature has established several categories for medical assistants (WAC 246-827-0010), but the medical assistant-certified (MA-C) category is the one most likely to be confused with “certified medical assistant” permissible usage. Note the requirements for becoming an MA-C:

WAC 246-827-0200

Medical assistant-certified—Training and examination.

An applicant for a medical assistant-certified credential must meet the following requirements:

(1) Successful completion of one of the following medical assistant training programs:

(a) Postsecondary school or college program accredited by the Accrediting Bureau of Health Education Schools (ABHES) or the Commission of [sic] Accreditation of Allied Health Education Programs (CAAHEP);

(b) Postsecondary school or college accredited by a regional or national accrediting organization recognized by the U.S. Department of Education, which includes a minimum of seven hundred twenty clock hours of training in medical assisting skills, including a clinical externship of no less than one hundred sixty hours;

(c) A registered apprenticeship program administered by a department of the state of Washington unless the secretary determines that the apprenticeship program training or experience is not substantially equivalent to the standards of this state. The apprenticeship program shall ensure a participant who successfully completes the program is eligible to take one or more examinations identified in subsection (2) of this section; or

(d) The secretary may approve an applicant who submits documentation that he or she completed postsecondary education with a minimum of seven hundred twenty clock hours of training in medical assisting skills. The documentation must include proof of training in all of the duties identified in RCW [Revised Code of Washington] 18.360.050(1) and a clinical externship of no less than one hundred sixty hours.

(2) Pass a medical assistant certification examination, approved by the secretary, within five years of submitting an initial application. A medical assistant certification examination approved by the secretary means an examination that:

(a) Is offered by a medical assistant program that is accredited by the National Commission for Certifying Agencies (NCCA); and

(b) Covers the clinical and administrative duties under RCW 18.360.050(1).

Consequently, if the medical assisting program meets (1)(a), (b), (c), or (d), it would be permissible for the program to state that graduates meet the educational portion of the MA-C requirements. It would also be permissible to state that graduates would be eligible for one or more of the NCCA-accredited medical assisting certification programs.

For more information on whether a Washington-based MA-C can write “CMA” after their name, see my blog post “Can Washington State Medical Assistants Use the ‘CMA’ Initialism?”