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.

The Misuse of Medical Assisting Credentials May Have Legal Consequences

The roles of medical assistants have expanded and diversified during the last 10 years. So too have the number and types of medical assisting credentials. In this blog post, I will explain basic facts about medical assisting credentials and the potential legal consequences of misusing them.

Licensing and Certification

A license is a mandatory credential, usually issued by a state, without which an individual is not permitted by law to practice a profession. A certification is most frequently a voluntary credential, usually issued by a private-sector body, that provides evidence of an individual’s knowledge and competence in a profession. A license is required by law; a certification is (with limited exceptions) not required by law.

Examples of medical assisting licenses are the “medical assistant-certified (MA-C)” and the “medical assistant-registered (MA-R)” issued by the Washington State Department of Health.

Accreditation of Certification Programs

There are two accreditations available to U.S. certification programs:

• Accreditation by the National Commission for Certifying Agencies (NCCA) under its Standards for the Accreditation of Certification Programs
• Accreditation under International Standard ISO/IEC 17024:2012, Conformity Assessment—General Requirements for Bodies Operating Certification of Persons (ISO 17024)

Accreditation of the CMA (AAMA) Certification Program

The CMA (AAMA)® is a medical assisting certification issued by the Certifying Board of the American Association of Medical Assistants® (AAMA). The CMA (AAMA) certification program is the only medical assisting certification program that is accredited both by the NCCA and under ISO 17024.

Permissible Use of the CMA (AAMA) Credential

The only medical assistants permitted to use the CMA (AAMA) designation in connection with employment or seeking employment are those medical assistants who have achieved certification through the Certifying Board of the American Association of Medical Assistants (AAMA) and whose CMA (AAMA) credential is current. A medical assistant who never held the CMA (AAMA) or who formerly held the CMA (AAMA) but whose CMA (AAMA) is not current is forbidden from using the CMA (AAMA) credential. A medical assistant who violates this policy is in jeopardy of sanctions by the Certifying Board of the AAMA and sanctions under federal trademark law.

Registration of the CMA (AAMA)

The AAMA registered the “CMA (AAMA)” designation/initialism with the United States Patent and Trademark Office (USPTO) as a certification mark. This registration gives the AAMA intellectual property rights in this designation. A certification mark “is a type of trademark that is used to show consumers that particular goods and/or services, or their providers, have met certain standards,” according to the USPTO.

Registration of the “Certified Medical Assistant” Phrase

The three-word phrase “certified medical assistant” has also been registered by the AAMA with the USPTO. Consequently, this three-word phrase should not be used as a generic reference to all medical assistants. This phrase should also not be used as a generic reference to all medical assistants who hold a credential. “Certified medical assistant” should only be used when referring to medical assistants who hold a current CMA (AAMA).

The Legal Status of the “CMA” Initialism

The “CMA” initialism is not registered with the USPTO. This is because the official designation of the credential awarded by the Certifying Board of the AAMA was changed from “CMA” to “CMA (AAMA),” effective January 1, 2008. However, the AAMA retains common law rights in the initialism “CMA.” For example, if the initialism “CMA” were used in a way that would likely confuse employers or other parties into thinking that the reference to “CMA” was a reference to “CMA (AAMA),” the AAMA would likely have a cause of action against the misusing party.

State Law Authorizing the Use of “CMA” as an Abbreviation of “Certified Medication Aide/Assistant”

Statutes or regulations of some states permit or require the initialism “CMA” to be used as the designation for “certified medication aides” or “certified medication assistants.” Such state laws do not infringe the AAMA’s common law rights in the “CMA” initialism because the authority of a government to define an initialism and restrict its use supersedes the authority of a private-sector body—such as a certifying board—to do so. In fact, in some states it is a violation of state law to use “CMAs” to refer to medical assistants rather than medication aides. This is another example of negative legal consequences resulting from the misuse of a credential.

State Law Requiring Words or Initials to Be Used on Medical Assistants’ Name Tags

Some states’ laws require words or initialisms to be on the name tags of medical assistants. These laws must be obeyed. If they are not, legal sanctions may result.

The Display of Medical Assisting Credentials in EHR Platforms

Employers will sometimes tell medical assistants that the electronic health record (EHR) platform of the clinic, practice, or health system will not permit the inclusion of medical assistants’ credentials. This is usually not the case. Most EHR platforms have this capability.

Questions should be directed to me in the comments or via email at DBalasa@aama-ntl.org.

Delegation to Medical Assistants under Florida Law

The Florida Medical Practice Act defines medical assistant as “a professional multiskilled person dedicated to assisting in all aspects of medical practice under the direct supervision and responsibility of a physician.” While some medical practice consultants argue that the act’s definition means medical assistants are permitted to work under only physicians, such an argument is flawed.

In the May/June 2022 Public Affairs article, “Delegation to Medical Assistants under Florida Law,” I provide evidence—from the Florida Board of Nursing—that demonstrates that Florida law permits medical assistants to work under advanced registered nurse practitioners as well as physicians. Then, I offer insight into medical assistants’ scope of service under Florida law.

Read the article on the “Public Affairs Articles” webpage.

Proposed Delaware Regulation Expands APRN Delegation to Medical Assistants

On June 9, 2022, I sent a letter to the executive director of the Delaware Board of Nursing regarding proposed regulations that would allow advanced practice registered nurses (APRNs), including nurse practitioners, to delegate to educated and credentialed medical assistants the administration of medication.

Read the full letter here:

I am writing on behalf of the American Association of Medical Assistants® (AAMA), the national professional society for medical assistants, in regard to the following proposed addition to the regulations of the Delaware Board of Nursing (BON):

8.7.15.1 APRNs are authorized to assign and supervise medication administration to a medical assistant if the medical assistant has successfully completed a medical assistant training program and possesses current national medical assistant certification.

8.7.15.1.1 If a practice is solely operated by APRNs, the APRN must be present in the building when the medical assistant is administering medications and assumes liability for the actions of the medical assistant.

8.7.15.2 When a physician delegates to a medical assistant, and an organizational policy exists to allow the APRN to assign and supervise the medical assistant, the physician retains responsibility and accountability for the actions of the medical assistant and will be notified of unsafe or improper practices.

It is the position of the AAMA that medical assistants who have completed a medical assistant training program that includes medication administration theory and technique, and who have a current national medical assistant certification such as the CMA (AAMA)® that tests knowledge needed to safely administer medication, should be permitted to administer medication under the authority of APRNs—including nurse practitioners—and other licensed independent practitioners such as physicians.

The AAMA commends the Delaware BON for increasing the availability of safe and accessible health care for the residents of Delaware by proposing this revision to the BON regulations.

Medical Assistants Working with Multiple Providers in Wisconsin

I recently received the following question from a Wisconsin medical assistant who was concerned about the possibility of mistakes being made in the pediatric practice where they worked:

[During] the last six months, I have been assisting more than one provider at a time throughout my eight-hour shift. Is this legal?

To answer this question, go to the “State Scope of Practice Laws” webpage on the AAMA website to find the medical assisting law of all states, including Wisconsin.

I am not aware of any Wisconsin law that prohibits a medical assistant from assisting more than one provider during one work shift.

If any health professional is making mistakes, they should be investigated immediately, and appropriate action should be taken.