Massachusetts Law Outlines Delegation of Immunizations

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.

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Congressional Action on the ACA

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 , , , , , | Leave a comment

Medication Reconciliation and Scope of Practice

Recently I have been receiving a number of questions about whether the process of medication reconciliation falls within medical assistants’ scope of practice. This is an important issue worthy of discussion. The following is my position on the issue:

The Joint Commission defines medication reconciliation as follows:

The process of comparing a patient’s medication orders to all of the medications that the patient has been taking.  This reconciliation is done to avoid medication errors such as omissions, duplications, dosing errors, or drug interactions. It should be done at every transition of care in which new medications are ordered or existing orders are rewritten. Transitions in care include changes in setting, service, practitioner, or level of care.  This process comprises five steps: (1) develop a list of current medications; (2) develop a list of medications to be prescribed; (3) compare the medications on the two lists; (4) make clinical decisions based on the comparison; and (5) communicate the new list to appropriate caregivers and to the patient.

It is my legal opinion that knowledgeable and competent medical assistants can be assigned steps 1 and 2 as long as step 2 entails compiling a list of prescribed medications from the prescription orders of providers. However, steps 3 and 4 require the exercising of independent professional judgment and the making of clinical assessments. Therefore, in my judgment, medical assistants cannot be assigned 3 and 4. In regard to step 5, medical assistants can communicate verbatim new lists of medications as specifically approved by the overseeing/delegating provider, and only when the provider directs the medical assistant to do so.

 

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MACRA and Order Entry Requirements

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 , , , , , , , | 9 Comments

Physician Delegation: Standing Orders

Under the laws of most states, physicians are permitted to delegate by means of standing orders to knowledgeable and competent medical assistants as long as the following conditions are met:

  1. The standing order is understood by the medical assistant
  2. The standing order is for a task that is delegable to medical assistants under the laws of the state, and the delegating physician is exercising the degree of supervision required by the laws of the state
  3. The standing order is applicable to all patients without exception
  4. The standing order does not require the medical assistant to exercise independent professional judgment, or to make clinical assessments, evaluations, or interpretations
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