On the Job, Professional Identity

Only Select Professionals May Legally Use “Nurse” As a Title

I recently received the following significant question about permissible titles:

Recently [someone] was hired in my company, and she is a CMA (AAMA).

Can she call herself a “nurse”? She insisted on getting a name badge that identifies her as a nurse. … I remember being taught we cannot. I found and read the June 2019 article you wrote saying we cannot.

As stated in the 2019 Public Affairs article, the laws in all American jurisdictions continue to forbid anyone—other than registered nurses (RN), licensed practical nurses (LPN), or licensed vocational nurses (LVN)—from calling themself a nurse.

Note the following from a 2019 Advisory Opinion issued by the Kentucky Board of Nursing:

KRS 314.031(1) states: “It shall be unlawful for any person to call or hold [themself] out as or use the title of nurse or to practice or offer to practice as a nurse unless licensed or privileged under the provisions of this chapter.”

Centers for Medicare & Medicaid Services, On the Job

Supervision Requirements for Incident-To Billing

I recently received the following question about incident-to billing: 

My compliance officer asked me to reach out to … seek direction on where we could find current information about [whether] it is permitted to bill incident to when a medical assistant is supervised and billed under a PA [physician assistant] as the supervising physician.

We read your 2016 article … about [Medicare’s Chronic Care Management] and [Transitional Care Management] billing. Oregon recently passed laws where PAs enter into a collaborative agreement with providers. [Does this change whether the Centers for Medicare & Medicaid Services] will now allow incident-to billing with PAs supervising [medical assistants]?

In the Medicare Benefit Policy Manual, the definition of physician includes physician assistants and nurse practitioners. As demonstrated in the 2016 Public Affairs article, medical assistants are classified as auxiliary personnel and clinical staff under Medicare law.

Therefore, medical assistants’ services performed incident to those of a PA may be billed incident to the services of the PA in the same way that they may be billed incident to the services of an MD or DO.

Scope of Practice

Key Scope of Practice Legislation Is Enacted in Connecticut and South Carolina

In May 2022, Connecticut and South Carolina legislatures passed two significant bills that empower medical assistants in these states to perform tasks for which they are educated, credentialed, and competent.

In Connecticut, “An Act Concerning the Department of Public Health’s Recommendations Regarding Various Revisions to the Public Health Statutes” will allow medical assistants to administer vaccinations (effective October 1, 2022).

In South Carolina, new legislation permits medical assistants to be delegated injections by not only physicians but also advanced practice registered nurses (including nurse practitioners) and physician assistants (effective July 14, 2022).   

Learn more about these legislative victories by reading the July/August 2022 Public Affairs article, “Key Scope of Practice Legislation Is Enacted in Connecticut and South Carolina,” on the “Public Affairs Articles” webpage.

On the Job

Supervision Requirements in Federally Qualified Health Centers

I recently received the following query from a South Carolina medical assistant:

I have a question regarding medical assistants working with a physician assistant or nurse practitioner in an office without a physician on the premises. I currently work for an organization that is termed a federally qualified health center [FQHC]. I have been told the medical assistants are not allowed to go to some of our small satellites if a nurse is not there, [because] we cannot work with a physician assistant or nurse practitioner without a nurse on the premises. Have you heard of such? Is this because we are noted as an FQHC?

In the Health Center Compliance Manual from 2018, I see no requirements stating that medical assistants are permitted to work under the authority of a nurse practitioner or a physician assistant only if a registered nurse is on the premises.

Further, I have not found anything in federal law about FQHCs requiring registered nurses to be present when medical assistants are working under the authority of nurse practitioners and physician assistants.

Additionally, the July/August 2022 Public Affairs article, “Key Scope of Practice Legislation Is Enacted in Connecticut and South Carolina,” offers information about the legislation that was recently enacted in South Carolina. However, nothing in the article speaks to the question raised in the email quoted in this blog post. And the recently enacted legislation doesn’t alter any requirements noted in the 2018 Health Center Compliance Manual.


How National Accreditation of Health Education Programs Enhances Interstate Mobility of Health Professionals

The following post is adapted from a piece I wrote for Communiqué, a publication of the Commission on Accreditation of Allied Health Education Programs.

The negative effects of states having differing and incompatible licensing requirements for health professionals were brought to light as never before during the COVID-19 pandemic. Emergency legislation, suspension of licensing board rules, and executive orders from state governors (and, in a few instances, from federal agency heads) were necessary to deploy health professionals to areas of the United States that were being impacted most severely by the coronavirus. Legislators and regulators from both political parties were united in advocating that permanent change be made to state licensing laws for health professionals.

Many policy solutions (e.g., interstate compacts, model statutes and rules, licensing reciprocity, and universal license recognition) had been devised and implemented (to some extent) before the pandemic. Efforts to reduce barriers to interstate mobility and practice for health professionals have only intensified during the last 12 months. However, one essential aspect of this problem has not been fully recognized: the importance of education programs in each health profession being held to national standards and being accredited by a national accrediting body.

Professional regulation usually consists of three requirements: education, examination, and (for some professions) experience. I argue that education is the most foundational of these three components. If there are inconsistent education prerequisites for entry into a health profession, it becomes very difficult to even begin the discussion of state licensing reciprocity.

Another major, seemingly unprecedented, current challenge in the labor market for health professionals is the pervasive and persistent shortage of qualified individuals. Decision-makers in some states have sought to address this shortage by creating less rigorous and shorter education pathways. This may offer a minor and temporary solution to the workforce shortage. However, I assert that the short-term benefit of increasing the pool of professionals by attenuating the education requirement would (1) be outweighed by the long-term lessening in the quality of care and (2) perpetuate barriers to interstate mobility because the truncated education would differ from the national standard and from legally mandated education in other states.

In the final analysis, then, adhering to national accreditation standards of health professional education is indispensable for both safeguarding public health and removing barriers to interstate portability of professional credentials. The Commission on Accreditation of Allied Health Education Programs is proud to be a part of the programmatic accreditation community that is committed to accomplishing both policy objectives.