medication reconciliation, Scope of Practice

Medication Reconciliation Post-Discharge Measure Victory

The ability of appropriately educated and professionally credentialed medical assistants to perform—under the authority of licensed providers—medication reconciliation post-discharge has become widely recognized by providers. However, the fact that medical assistants are not explicitly mentioned in the National Committee for Quality Assurance (NCQA) post-discharge medication reconciliation measure had given rise to some uncertainty about whether medication reconciliation by medical assistants would count toward determining whether the following measure has been met:

Quality ID #46 (NQF 0097): Medication Reconciliation Post-Discharge


Medication reconciliation conducted by a prescribing practitioner, clinical pharmacist or registered nurse on or within 30 days of discharge

I asked the NCQA whether medication reconciliation by medical assistants would count toward meeting the above quality measure. An excerpt and further details about this letter are available in my November 2020 Legal Eye post. The NCQA provided the following answer:

NCQA recognizes the supervising physician as providing the service when they have signed off on the medical record/documentation. It is our understanding many licensed practical nurses (LPNs) and medical assistants work with physicians and registered nurses (RNs). With this in mind, medication reconciliation provided by the medical assistant and signed off by a physician, [nurse practitioner, physician assistant, or clinical pharmacist with prescribing privileges], or RN may be counted toward NCQA Medication Reconciliation indicators as the signature indicates additional clinical oversight for this work.

Additional updates from the NCQA will be reported in future Legal Eye blog posts.

Centers for Medicare & Medicaid Services, Computerized Provider Order Entry (CPOE)

New AAMA Initiative Urges Private Payers to Adopt CMS Order Entry Requirements

The Medicaid Promoting Interoperability Program (formerly the Medicaid Electronic Health Record Incentive Program) will be ending December 31, 2021, because of the provisions of the 2009 Health Information Technology for Economic and Clinical Health (HITECH) Act and the regulations of the Centers for Medicare & Medicaid Services (CMS). One notable requirement of the Medicaid Promoting Interoperability Program for participating licensed providers to receive an annual incentive payment is that they must attest that at least 60% of medication, 60% of laboratory, and 60% of diagnostic imaging orders have been entered into the computerized provider order entry (CPOE) system by either credentialed medical assistants or licensed health care professionals. 

Effective immediately, the Board of Trustees of the American Association of Medical Assistants® (AAMA) has authorized the AAMA to embark upon a nationwide initiative to persuade third-party payers to include the 60% order entry personnel provision in its reimbursement requirements. 

Further information will be forthcoming.


Basics of Not-for-Profit and Tax-Exempt Law

The American Association of Medical Assistants® is a not-for-profit corporation, but what does that designation mean and what are the legal requirements that accompany it?  

During telephone presentations to AAMA state societies and local chapters, I discussed various aspects of not-for-profit and tax-exempt law. In the May/June 2021 Public Affairs article in CMA Today, I have adapted these presentations into frequently asked questions. Review the article to learn specifics of not-for-profit and tax-exempt law, such as typical governance documents, tax exemption requirements, and member deductions. 

The article, “Basics of Not-for-Profit and Tax-Exempt Law,” is available on the AAMA website.  

delegation, Scope of Practice

Permissible Delegation to Montana Medical Assistants

I recently received the following appeal from a licensed practical nurse working in Montana:

I’m requesting something in writing that states that CMAs (AAMA) can still administer immunizations. The verbiage that my bosses are reading has [caused them to change] what our medical assistants can and can’t do. I depend on [medical assistants] being able to give shots (i.e., immunizations) when working with me.

For documentation related to this issue, go to the State Scope of Practice Laws webpage on the AAMA website to find the medical assisting laws of all states, including Montana.

Note the following from the Montana Code Annotated (MCA):

37-3-104. Medical assistants — guidelines. (1) The board shall adopt guidelines by administrative rule for:

(a) the performance of administrative and clinical tasks by a medical assistant that are allowed to be delegated by a physician, physician assistant, or podiatrist, including the administration of medications; and

(b) the level of physician, physician assistant, or podiatrist supervision required for a medical assistant when performing specified administrative and clinical tasks delegated by a physician, physician assistant, or podiatrist. However, the board shall adopt a rule requiring onsite supervision of a medical assistant by a physician, physician assistant, or podiatrist for invasive procedures, administration of medication, or allergy testing. [Italics added.]

Further, note the following from the Administrative Rules of Montana (ARM):


(1) A health care provider authorized by 37-3-104, MCA, may delegate administrative and clinical tasks which are within the delegating health care provider’s scope of practice to medical assistants who:

(a) work in the delegating health care provider’s office under the general supervision of the delegating health care provider; and

(3) A health care provider delegating administrative and/or clinical tasks to a medical assistant shall:

(c) personally provide onsite direct supervision as defined by ARM 24.156.501 to a medical assistant to whom the health care provider has delegated:

(i) injections other than immunizations;

(ii) invasive procedures;

(iii) conscious sedation monitoring;

(iv) allergy testing;

(v) intravenous administration of blood products; or

(vi) intravenous administration of medication [Italics added.]

The definition for direct supervision is in ARM “Definitions”:

(7) “Direct supervision” means the supervising physician is:

(a) physically present in the same building as the person under supervision; or

(b) in sufficiently close proximity to the person under supervision to be quickly available to the person under supervision. [Italics added.]

Given this language from the Montana statutes and regulations, my legal opinion is that Montana law permits physicians to delegate to medical assistants—who have the knowledge and competence outlined in the Montana rules—the administration of immunizations under the physician’s general supervision. My opinion is also that Montana law requires the delegating physician to be exercising direct supervision when medical assistants are performing the following tasks outlined in ARM:

(ii) invasive procedures;

(iii) conscious sedation monitoring;

(iv) allergy testing;

(v) intravenous administration of blood products; or

(vi) intravenous administration of medication

On the Job

CMA (AAMA) Certification Outside the United States

I received the following question about whether CMA (AAMA)® certification can be used by medical assistants who are interested in working outside the United States:

I am a medical assistant who is certified by the American Association of Medical Assistants®, and I understand that this certification is usable anywhere in the United States. Since I am interested in possibly volunteering outside of the United States as a medical missionary, is my certification usable outside of the United States? If not, what action could I take to remedy this situation?

In addition to CMA (AAMA) certification being usable throughout the United States, the CMA (AAMA) certification program is accredited under ISO 17024—an international standard of the International Organization for Standardization (ISO). ISO standards are recognized throughout the world.

Consequently, CMA (AAMA) certification should be usable in nations other than the United States.

Learn more about ISO 17024 and its significance in the CMA Today July/August 2016 Public Affairs article.