Scope of Practice

New Jersey Prescription Monitoring Program: Medical Assistants as Delegates

Does New Jersey allow medical assisting access to the state prescription drug monitoring program?

Medical assistants are recognized as “delegates” under the New Jersey Prescription Monitoring Program (NJPMP). Because I have not written previously about these programs, I will explain in detail.

Note the following from the NJPMP frequently asked questions webpage:

The New Jersey Prescription Monitoring Program (NJPMP) is an important component of the New Jersey Division of Consumer Affairs’ (Division) effort to halt the abuse and diversion of prescription drugs.

The NJPMP … is a statewide database that collects prescription data on Controlled Dangerous Substances (CDS), Human Growth Hormone (HGH) and gabapentin dispensed in outpatient settings in New Jersey, and by out-of-State pharmacies dispensing into New Jersey.

Access to the NJPMP is granted to prescribers and pharmacists who are licensed by the State of New Jersey and are in good standing with their respective licensing boards. Registered prescribers may delegate their authority to access the NJPMP to certain other healthcare professionals.

Patient information in the NJPMP is intended to help prescribers and pharmacists provide better-informed patient care. The information will help supplement patient evaluations, confirm patient drug histories, and document compliance with therapeutic regimens. When prescribers, delegates, or pharmacists identify a patient as potentially having an issue of concern regarding drug use, they are encouraged to help the patient locate assistance and take any other action the prescriber or pharmacist deems appropriate.

Medical assistants who (a) meet the education requirements of New Jersey law and (b) hold a current medical assisting credential from a certifying body approved by the New Jersey State Board of Medical Examiners are authorized to be appointed as “delegates” by practitioners.

A “practitioner” is defined as an individual “currently licensed, registered, or otherwise authorized by this State or another state to prescribe drugs in the course of professional practice,” according to the administrative rules governing the NJPMP. A practitioner may “designate a delegate or delegates for the purpose of accessing PMP [prescription monitoring program] information for a new or current patient, or a prescriber.”

The NJPMP requires a “mandatory look-up” in certain situations. Note the following excerpt from the administrative rules governing the NJPMP:

a) … [A] practitioner or the practitioner’s delegate shall access prescription monitoring information for a new or current patient consistent with the following:

1) The first time the practitioner prescribes a Schedule II controlled dangerous substance or any opioid to a new or current patient for acute or chronic pain; …

2) The first time the practitioner prescribes a benzodiazepine drug that is a Schedule III or Schedule IV controlled dangerous substance;

3) If the practitioner has a reasonable belief that the person may be seeking a controlled dangerous substance, in whole or in part, for any purpose other than the treatment of an existing medical condition, such as for purposes of misuse, abuse, or diversion, the first time the practitioner or other person prescribes a non-opioid drug other than a benzodiazepine drug that is a Schedule III or Schedule IV controlled dangerous substance;

4) Any time the practitioner prescribes a Schedule II controlled dangerous substance for acute or chronic pain to a patient receiving care or treatment in the emergency department of a general hospital;

5) On a quarterly basis during the period of time a current patient continues to receive a prescription for a Schedule II controlled dangerous substance or for an opioid drug for acute or chronic pain, or for a benzodiazepine that is a Schedule III or Schedule IV controlled dangerous substance.

Each provider must establish written processes to document in each patient’s record the information obtained from the prescription monitoring program. The disclosure of prescription monitoring program information is determined by state and federal law.

delegation, On the Job, Scope of Practice

Suicide Safety Plan Delegation

Is it appropriate for a nurse practitioner to delegate patient follow-up that will establish a suicide safety plan to a medical assistant?

My legal opinion is that nursing law of some states allows nurse practitioners to assign to knowledgeable and competent unlicensed professionals such as medical assistants the interacting by telephone with chronically suicidal patients to establish a suicide safety plan as long as both of the following conditions are met:

  1. The medical assistant adheres strictly to the information guidelines provided by the licensed therapist and approved by the nurse practitioner
  2. The medical assistant’s interaction with the patient does not require the exercise of any degree of independent clinical judgment or the making of clinical assessments or evaluations 

These principles are especially important in interacting with psychiatric patients—even more so for those who are chronically suicidal.

I would also suggest that delegating nurse practitioners check with their malpractice insurance carrier to make sure that the insurance would cover any negligence by a medical assistant in assisting a patient in establishing a suicide safety plan. The opinion from the malpractice carrier should be in writing and kept on file.

Centers for Medicare & Medicaid Services, CMS Rule, Scope of Practice

Testing Period Extension for the AUC Program

Note the recent update via the Centers for Medicare & Medicaid Services on the appropriate use criteria (AUC) program:

NOTICE: The EDUCATIONAL AND OPERATIONS TESTING PERIOD for the AUC Program has been extended through CY 2021. There are no payment consequences associated with the AUC program during CY 2020 and CY 2021. We encourage stakeholders to use this period to learn, test and prepare for the AUC program.

The following describes the intended AUC program timeline, according to the Centers for Medicare & Medicaid Services:

Program Timeline

Currently, the program is set to be fully implemented on January 1, 2022 which means AUC consultations with qualified CDSMs [clinical decision support mechanism] are required to occur along with reporting of consultation information on the furnishing professional and furnishing facility claim for the advanced diagnostic imaging service. Claims that fail to append this information will not be paid. Prior to this date the program will operate in an Education and Operations Testing Period starting January 1, 2020 during which claims will not be denied for failing to include proper AUC consultation information. Beginning July 1, 2018 the program is operating under a voluntary participation period during which time consultations with AUC may occur and may be reported on furnishing professional and facility claims using HCPCS [Healthcare Common Procedure Coding System] modifier QQ.

As a reminder, I provide supporting evidence for my position that CMAs (AAMA) are clinical staff according to the Centers for Medicare & Medicaid Services rule regarding the AUC program in my Public Affairs article of the September/October 2019 CMA Today. As a result of their clinical staff status, I assert that CMAs (AAMA) are permitted to do the following:

  1. Consult a clinical decision support mechanism (CDSM) about the appropriateness of ordering a particular advanced diagnostic imaging service
  2. Report findings to their overseeing or delegating licensed providers

Find the article, as well as all my other Public Affairs articles, on the AAMA website.

On the Job, Scope of Practice

Medical Assistants Answer the Call to Work in Acute Care Settings

Many medical assistants have been asked to work in acute care environments because of the enormous need to deploy skilled and dedicated health professionals to where they are most needed during the COVID-19 pandemic.

But because medical assistants have not typically worked in acute care settings, inevitable questions about the legal parameters of medical assisting scope of practice have arisen. Notably, answering these questions requires a close review because state laws usually address medical assistants’ scope of practice within only the typical ambulatory setting.

My analysis of three state examples was published in the July/August 2020 Public Affairs article, “Medical Assistants Answer the Call to Work in Acute Care Settings: What Is Their Scope of Practice?” on the AAMA website.

education

USDE Regulations on Institutional Information

Regulations of the United States Department of Education (USDE) that address the recognition of accrediting agencies (and other matters) went into effect July 1, 2020. The regulations apply to institutions and schools accredited by USDE-recognized accrediting bodies. A school must comply with USDE regulations to be eligible for federal funding, including financial assistance for students under Title IV of the Higher Education Act.

The provisions of the regulations relevant to the medical assisting education community are about education in fields that require completion of a program as a prerequisite for employment. Note the following from the regulations:

(v) If an educational program is designed to meet educational requirements for a specific professional license or certification that is required for employment [emphasis added] in an occupation, or is advertised as meeting such requirements, information regarding whether completion of that program would be sufficient to meet licensure requirements in a State for that occupation [must be provided].

Currently, the following U.S. states require the completion of some sort of medical assisting education program to work as a medical assistant or to be delegated certain tasks while working as a medical assistant:

  • Arizona
  • Massachusetts
  • New Jersey
  • North Dakota
  • South Dakota
  • Washington

Medical assisting program directors and educators who have questions about the impact of the USDE regulations on their programs and schools should email me at dbalasa@aama-ntl.org.