Permissible Tasks for New Jersey Medical Assistants

I received the following question from a CMA (AAMA)^® who is also a surgical technologist:

I am a CMA (AAMA) and am also certified in surgical technology in the state in which I am currently working. I am planning to move to New Jersey, a state that does not recognize surgical technology in its law. Am I able to perform surgical technology tasks in New Jersey, based on my certification as a surgical technologist in my current state?

Thank you for this interesting question. I don’t believe I have ever received this type of question.

New Jersey law requires medical assistants to meet education and credentialing requirements to be delegated injections and venipuncture.  The New Jersey law does not address the legality of other medical assisting tasks.

As you have indicated, surgical technology is not mentioned in New Jersey law. Based on these facts, my legal opinion is that the New Jersey medical assisting law—aside from the requirements for injections and venipuncture—permits medical assistants to perform only standard medical assisting duties such as those tasks in the “Core Curriculum” of the Commission on Accreditation of Allied Health Education Programs Standards and Guidelines for the Accreditation of Education Programs in Medical Assisting. It is also my opinion that the laws of New Jersey do not permit you to perform surgical technologist tasks that are not also usually and customarily done by medical assistants.

Legally Delegable Tasks to Certified and Uncertified Medical Assistants in South Carolina

I recently received the following request for information from a medical group in South Carolina: 

We [need] to find out what tasks certified medical assistants can do and what uncertified medical assistants cannot do.

The South Carolina Medical Board gave us a list of tasks that certified medical assistants can do; however, [they] will not tell us [whether] uncertified medical assistants can or cannot do these tasks.

Any information you can provide is greatly appreciated.

For more information, see the 2022 South Carolina law. Note the following excerpts, particularly the bolded and italicized sections:

“(63)    ‘Unlicensed assistive personnel’ or ‘UAP’ are persons not currently licensed by the board as nurses, or persons who are not certified medical assistants as defined in Section 40-33-20( ), who perform routine nursing tasks that do not require a specialized knowledge base or the judgment and skill of a licensed nurse. Nursing tasks performed by a UAP must be performed under the supervision of a physician, physician assistant, an advanced practice registered nurse, registered nurse, or selected licensed practical nurse. Unlicensed assistive personnel must not administer medications except as otherwise provided by law.”

…

SECTION    3.    Section 40-33-42(C) of the 1976 Code is amended to read:

“(C)    Subject to the rights of licensed physicians and dentists under state law, and except as provided in Section 40-47-196 regarding the delegation of tasks to certified medical assistants, the administration of medications is the responsibility of a licensed nurse as prescribed by the licensed physician, dentist, other authorized licensed provider or as authorized in an approved written protocol or guidelines. Unlicensed assistive personnel must not administer medications, except as otherwise provided by law.”

The medical group followed up with an additional question: 

In reference to below, the South Carolina [Board of Medical Examiners] has listed the following tasks that can be delegated to a CMA (AAMA). Do you feel that an uncertified medical assistant is also able to perform these tasks? We tried to get clarification from them, but they instructed us to contact the AAMA.

• Point of Care Testing (e.g., strep test, flu swab, urine dip, etc.)
• Entering Verbal Orders
• [Preparing] and Administering Vaccines
• Administering In-Clinic Medications
• Straight Needle Blood Draw
• Performing Basic [Laboratories]
• Performing Screening Tests (ex: [ECG], vision, hearing, etc.)
• Removing Sutures and Changing Dressings
• Performing Non-Clinical Tasks via Telemedicine
• Administering Allergy Tests
• Entering Prescription Refills
• Responding to Patient Phone Calls and Messages

The listed tasks were included in documents by the South Carolina Board of Medical Examiners and the South Carolina Board of Nursing. 

These documents indicate that the South Carolina Board of Nursing and the South Carolina Board of Medical Examiners are taking the legal position that only the tasks listed under “authorized tasks that can be delegated to certified medical assistants with appropriate training” are delegable legally to CMAs (AAMA) and only CMAs (AAMA). The tasks in the list may not be delegated to UAP. The Board of Nursing document states that specifically at the bottom of the second page.

 To restate, the tasks included in the “authorized tasks” list may not be delegated to unlicensed medical assistants who are part of the UAP category, according to the South Carolina Board of Nursing and the Board of Medical Examiners.

Because both these state boards have issued their respective documents, I have no authority to override their opinions.

Categorization of Medical Assistants in Various States

A medical assistant recently sent me the following email:

I was curious about my scope of practice under the law of my state and went to your “State Scope of Practice Laws” webpage.  I could not find anything in my state’s section that mentioned “medical assistants.” Could you please explain to me why this is the case?

There are some states that do not have the two­-word phrase “medical assistant(s)” in their statutes or regulations. Medical assistants may be classified as “agents,” “assistants,” “unlicensed assistive personnel,” or “employees,” for example. In Illinois, medical assistants are included in the category of “unlicensed persons.”

If medical assistants are not named specifically in state law, the only way scope of practice can be determined is by analyzing the scope of practice of the legal categories into which medical assistants are classified.

Clarification of California Medical Assisting Law

I recently received the following question:

I have been reading and hearing conflicting information about whether California law requires medical assistants to be certified or licensed. Can you please clarify the California law for me?

California medical assisting law can seem confusing. However, I am happy to explain it in understandable terms.

California law does not require medical assistants to be certified or licensed to work as medical assistants. To put it another way, medical assistants do not have to complete specified medical assisting education, or take and pass a medical assisting exam, to work as medical assistants.

According to California law, medical assistants must be trained adequately in the tasks they are performing. Note the following from the Medical Board of California website:

A medical assistant shall receive training, as necessary, in the judgment of the supervising physician, podiatrist, or instructor to ensure the medical assistant is competent when performing [technical supportive services.]

However, California has specific training requirements for medical assistants to administer medication and perform venipuncture and skin puncture. Note the following from the Medical Board of California:

For medical assistants to administer medications by intramuscular, subcutaneous, and intradermal injections, to perform skin tests, or to perform venipuncture or skin puncture for the purposes of withdrawing blood, a medical assistant shall complete the minimum training prescribed in the regulations.

Training shall be for the duration required by the medical assistant to demonstrate to the supervising physician, podiatrist, or instructor. Where applicable, training shall include no less than:

• 10 clock hours of training in administering injections and performing skin tests;
• 10 hours of training in venipuncture and skin puncture for the purpose of withdrawing blood;
• at least 10 of each intramuscular, subcutaneous, and intradermal injections and 10 skin tests, and/or at least 10 venipuncture and 10 skin punctures;
• 10 hours of training in administering medical by inhalation; and
• Training in the above shall include instruction and demonstration in:
  • pertinent anatomy and physiology appropriate to the procedures;
  • choice of equipment;
  • proper technique including sterile technique;
  • hazards and complications;
  • patient care following treatment or tests;
  • emergency procedures; and
  • California law and regulations for medical assistants

Under California law, it can be unclear which health professionals are able to train medical assistants outside of a formal school setting.

The Medical Board of California states the following:

Medical assistants shall be trained by a licensed physician, podiatrist, registered nurse, licensed vocational nurse, a physician assistant, or a qualified medical assistant. [Emphasis added.]

California law defines a “qualified medical assistant” as follows:

Per Title 16 of the California Code of Regulations section 1366.3 (c)(1)(2)(3), a “qualified medical assistant” is a medical assistant who:

1. Is certified by a medical assistant certifying organization approved by the Board; … [or]
2. Holds a credential to teach in a medical assistant training program at a community college; or
3. Is authorized to teach medical assistants in a private postsecondary institution accredited by an accreditation agency recognized by the United States Department of Health or approved by the Bureau for Private Postsecondary Education.

The following is the current list of medical assisting certifying organizations approved by the Medical Board of California:

• The American Association of Medical Assistants
• American Medical Technologists
• American Medical Certification Association
• California Certifying Board of Medical Assistants
• Multiskilled Medical Certification Institute Inc.

However, note the following from the regulations of the Medical Board of California:

(c) A medical assistant certifying organization approved prior to the requirement for NCCA accreditation shall reapply for and obtain Board approval by meeting all of the requirements of this section by January 1, 2027, or its approval shall be terminated.

I hope this explanation has clarified the medical assisting law in California.

A Department of Education Proposed Rule Could Impact Career and Technical (Including Allied Health) Education

The United States Department of Education (USDE) issued a Notice of Proposed Rulemaking that would impose new requirements on academic programs that “prepare students for gainful employment in a recognized occupation,” which became final Oct. 31, 2023. This requirement encompasses allied health professions such as medical assisting.

Notably, programs that do not meet the requirements of the proposed rule would risk losing their eligibility to participate in programs under Title IV of the Higher Education Act (HEA). As a result, students who are in these programs may become ineligible for federal financial assistance, including scholarships.

Learn more about three particularly significant elements of the rule—gainful employment, state licensing/certification requirements, and limitations on the length of programs—in the September/October 2023 Public Affairs article, “A Department of Education Proposed Rule Could Impact Career and Technical (Including Allied Health) Education,” available via the “Public Affairs Articles” webpage.

And, stay up to date on the latest news regarding this proposed regulation by subscribing to Legal Eye. Further information will be shared, including the forthcoming Public Affairs article “States That Require Medical Assistants to Meet Education and Testing Requirements,” which will appear in the November/December 2023 issue of CMA Today.