This blog frequently discusses scope-of-practice issues, but health care always provides new questions to examine. This post will address the following: Are medical assistants permitted to work in a dental office under the authority/supervision of a dentist?
First of all, it is important to keep in mind the distinction between a dental hygienist and a dental assistant. Under the laws of all American jurisdictions, dental hygienists are required to be licensed. Licensure for dental hygienists requires graduation from a postsecondary dental hygiene academic program and the passing of a national (and in some cases, state) examination. Thus, medical assistants—including CMAs (AAMA)—are not permitted to work as dental hygienists.
Under the laws of some states, dental assistants are required to have formal education and pass a test in order to be delegated certain tasks by the overseeing/delegating dentist. Other states have no educational or testing requirements for dental assistants. A medical assistant should check with the state board of dental examiners (usually in the state capital) to find out whether the state has any educational or testing requirements for dental assistants, and whether any of the medical assisting education or credentialing can be used toward meeting any state requirements for dental assistants.
Posted in delegation, dental assistant, On the Job, Professional Identity, Scope of Practice
Tagged dental assistant, dental office, dentist, medical assistant, medical assisting, school, scope of practice
Under South Dakota law, medical assistants are governed jointly by the Board of Medical and Osteopathic Examiners and the Board of Nursing. Medical assistants must meet the requirements and register with the South Dakota Board of Medical and Osteopathic Examiners in order to work as a medical assistant.
As of October 20, 2016, the joint rules of the two South Dakota boards now require medical assistants to have “passed a national certifying exam approved by the boards.” For 20 years the rules have required medical assistants to have “graduated from a medical assisting program approved by the boards.” Note the following addition, emphasized below, to the joint rules:
20:84:03:01. Qualifications of applicants. An applicant for registration shall provide:
- Proof of graduation from a medical assistant program approved by the boards;
- Proof of good moral character;
- Proof the applicant has graduated from high school or passed a standard equivalency test;
- Documentation showing the applicant is at least 18 years of age; and
- Proof of having passed a national certifying exam approved by the boards.
20:84:04:01. Approved education programs. An applicant for registration shall have graduated from a medical assistant program that is approved by the boards or accredited by the Commission on Accreditation of Allied Health Education Programs (CAAHEP), or a similar accrediting institution approved by the United States Department of Education. Approved programs must provide classroom, laboratory, and clinical learning experiences that provide for student attainment of entry level competence as a registered medical assistant.
In 2016 the Massachusetts legislature passed legislation that permits primary care providers to delegate the administration of immunizations to a medical assistant who is the following:
…is a graduate of a post-secondary medical assisting education program accredited by the Committee on Allied Health Education and Accreditation of the American Medical Association, or its successor, the Accrediting Bureau of Health Education Schools, or its successor or such other certificate program as the commissioner of public health shall approve; (ii) is employed in the medical practice of a licensed primary care provider; and (iii) who performs basic administrative, clerical, and clinical duties upon the specific authorization and under the direct supervision of a licensed primary care provider.
Note the following definitions from the legislation:
Direct supervision: “Oversight of a certified medical assistant exercised by a primary care provider who is present in the facility and immediately available to furnish assistance and direction throughout the course of the performance of a delegated procedure but is not required to be present in the room when the procedure is being performed.”
Primary care provider: “A health care professional qualified to provide general medical care for common health care problems who: (i) supervises, coordinates, prescribes, or otherwise provides or proposes health care services; (ii) initiates referrals for specialist care; and (iii) maintains continuity of care within the scope of practice.”
The legislation directs the Massachusetts Department of Public Health to promulgate regulations regarding the specifics of the delegation of immunizations. The full text of the legislation can be found on the AAMA website, under State Scope of Practice Laws.
As our government transitions to a new administration, the following question has become increasingly common:
Would amendments to or repeal of the Affordable Care Act (ACA) affect medical assistants’ scope of practice?
The answer? Almost certainly not. The scope of practice of medical assistants is determined primarily by state law. An exception is the meaningful use order entry requirements of the Medicaid Electronic Health Record Incentive Program. The Medicaid Incentive Program was not created by the ACA and would not be impacted by any amendments to or repeal of the Affordable Care Act. Consequently, it is highly unlikely that the scope of practice for medical assistants will be impacted by congressional action on the ACA.
Posted in Affordable Care Act (ACA), EHR Incentive Programs, Meaningful Use, Medicaid, Medicare, Scope of Practice
Tagged ACA, Affordable Care Act, meaningful use, Medicaid EHR Incentive Program, Medicare EHR Incentive Program, scope of practice
The Medicare Access and CHIP (Children’s Health Insurance Program) Reauthorization Act of 2015 (MACRA) mandated that the Medicare Electronic Health Record (EHR) Incentive Program come to an end on December 31, 2016. One of the new payment mechanisms for Medicare established by MACRA is the Merit-Based Incentive Payment System (MIPS). Under the primary reporting method of MIPS, an eligible provider is not required to report to the Centers for Medicare & Medicaid Services (CMS) that medication, laboratory, and diagnostic imaging orders are being entered by credentialed medical assistants or licensed health care professionals.
CMS, however, offers eligible providers an alternate reporting method under MIPS. Under this method, providers are permitted to report on optional measures, such as computerized provide order entry (CPOE).
This issue will be addressed in greater detail in the upcoming January/February 2017 issue of CMA Today. In the meantime, all past Public Affairs articles by CEO Balasa can be found on the AAMA website.
Posted in Centers for Medicare & Medicaid Services, Computerized Provider Order Entry (CPOE), EHR Incentive Programs, On the Job
Tagged AAMA, CHIP, CMS, CPOE, credentialed medical assistants, licensed health care professionals, MACRA, MIPS