Ohio Passes Senate Bill 110

I am happy to report that the Ohio Legislature has passed Senate Bill (SB) 110, which has now been signed into law by Governor John Kasich. The bill becomes effective 90 days after signing.

This bill gives nurse practitioners (NPs) and physician assistants (PAs) the ability to delegate medication administration to unlicensed allied health professionals, such as medical assistants working under their supervision in outpatient settings.

See the following relevant passages from SB 110, the first from page 20 of the attached, which is the version that has passed both Houses of the Ohio legislature:

Sec. 4723.48. (A) A clinical nurse specialist, certified nurse-midwife, or certified nurse practitioner seeking authority to prescribe drugs and therapeutic devices shall file with the board of nursing a written application for a certificate to prescribe. The board of nursing shall issue a certificate to prescribe to each applicant who meets the requirements specified in section 4723.482 or 4723.485 of the Revised Code. …

(C)(1) The holder of a certificate issued under this section may delegate to a person not otherwise authorized to administer drugs the authority to administer to a specified patient a drug, other than a controlled substance, listed in the formulary established in rules adopted under section 4723.50 of the Revised Code. The delegation shall be in accordance with division (C)(2) of this section and standards and procedures established in rules adopted under division (Q) of section 4723.07 of the Revised Code.

(2) Prior to delegating the authority, the certificate holder shall do both of the following:

(a) Assess the patient and determine that the drug is appropriate for the patient;

(b) Determine that the person to whom the authority will be delegated has met the conditions specified in division (D) of section 4723.489 of the Revised Code.

Note also the following on pages 22 and 23:

Sec. 4723.489. A person not otherwise authorized to administer drugs may administer a drug to a specified patient if all of the following conditions are met:

(A) The authority to administer the drug is delegated to the person by an advanced practice registered nurse who is a clinical nurse specialist, certified nurse-midwife, or certified nurse practitioner and holds a certificate to prescribe issued under section 4723.48 of the Revised Code.

(B) The drug is listed in the formulary established in rules adopted under section 4723.50 of the Revised Code but is not a controlled substance and is not to be administered intravenously.

(C) The drug is to be administered at a location other than a hospital inpatient care unit, as defined in section 3727.50 of the Revised Code; a hospital emergency department or a freestanding emergency department; or an ambulatory surgical facility, as defined in section 3702.30 of the Revised Code.

(D) The person has successfully completed education based on a recognized body of knowledge concerning drug administration and demonstrates to the person’s employer the knowledge, skills, and ability to administer the drug safely.

(E) The person’s employer has given the advanced practice registered nurse access to documentation, in written or electronic form, showing that the person has met the conditions specified in division (D) of this section.Sub. S. B. No. 110 131st G.A. 23

(F) The advanced practice registered nurse is physically present at the location where the drug is administered.

Note the following from pages 36 and 37:

Sec. 4730.203. (A) Acting pursuant to a supervision agreement, a physician assistant may Sub. S. B. No. 110 131st G.A. 37

delegate performance of a task to implement a patient’s plan of care or, if the conditions in division (C) of this section are met, may delegate administration of a drug. Subject to division (D) of section 4730.03 of the Revised Code, delegation may be to any person. The physician assistant must be physically present at the location where the task is performed or the drug administered.

(B) Prior to delegating a task or administration of a drug, a physician assistant shall determine that the task or drug is appropriate for the patient and the person to whom the delegation is to be made may safely perform the task or administer the drug.

(C) A physician assistant may delegate administration of a drug only if all of the following conditions are met:

(1) The physician assistant has been granted physician-delegated prescriptive authority.

(2) The drug is included in the formulary established under division (A) of section 4730.39 of the Revised Code.

(3) The drug is not a controlled substance.

(4) The drug will not be administered intravenously.

(5) The drug will not be administered in a hospital inpatient care unit, as defined in section 3727.50 of the Revised Code; a hospital emergency department; a freestanding emergency department; or an ambulatory surgical facility licensed under section 3702.30 of the Revised Code.

(D) A person not otherwise authorized to administer a drug or perform a specific task may do so in accordance with a physician assistant’s delegation under this section.

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Medical Assistants as Home Health Aides

Because of the great versatility of medical assistants, questions have arisen about whether medical assistants—especially CMAs (AAMA)—are permitted to work as home health aides (HHAs).

Most states have laws defining what qualifications an individual must have in order to work as a home health aide.  These laws also assign responsibility for the HHA program to an existing state agency, such as the department of health.  CMAs (AAMA) would have the opportunity to ask this agency whether their education in a CAAHEP or ABHES accredited medical assisting program, and their demonstration of didactic knowledge by passing the CMA (AAMA) Certification Examination, would meet or exceed the requirements of the home health aide law.  If the agency accepts the CMA (AAMA) credential in lieu of home health aide training, the CMA (AAMA) would then be able to work as an HHA.

Posted in Certification and the CMA (AAMA) Credential, On the Job, Professional Identity, Scope of Practice | Tagged , , , , , , , , , | Leave a comment

Medical Assistants as Scribes

Recently I received the following first-time question:

Is it illegal for a medical assistant to also function as the physician’s scribe? The office manager told me that a new law states that a medical assistant either can function as a scribe or as a medical assistant, but cannot assume both roles.

I am not aware of any state or federal laws that forbid a medical assistant from also functioning as the physician’s scribe. Medical assistants who have graduated from a CAAHEP or ABHES accredited medical assisting program and who hold a current CMA (AAMA) credential should be knowledgeable in scribing for the physician or other provider.

Posted in Certification and the CMA (AAMA) Credential, On the Job, Professional Identity, Scope of Practice | Tagged , , , , , | 4 Comments

Educational Requirements for Different Medical Assisting Credentials

I have received questions to the following effect: “Which medical assisting academic programs are ‘CMA (AAMA) programs,’ and which are ‘RMA(AMT) programs’?”

This is an imprecise way to frame the question.  It is better to ask what the eligibility pathways are for the CMA (AAMA) Certification Examination, and for the RMA(AMT) Examination.

Applicants for the CMA (AAMA) Certification Examination for initial certification must be graduates of CAAHEP (Commission on Accreditation of Allied Health Education Programs) or ABHES (Accrediting Bureau of Health Education Schools) accredited medical assisting programs, and must meet the other requirements established by the Certifying Board of the AAMA. (Information regarding such programs can be found on the AAMA website.)

There are five eligibility routes for the RMA(AMT) Examination.  One of the five is the education route.  Note the following from the website of AMT:

Graduated from an accredited MA program (ROUTE 1–Education)

  • Training programs must be accredited by an agency approved by the DOE
  • Training programs must have 720 clock hours of instruction, including at least 160 clock hours of externship
  • If graduated more than 4 years ago, must also have 3 out of the last 5 years of work experience as an MA in both clinical and administrative areas

Consequently, in addition to graduates of CAAHEP and ABHES accredited medical assisting programs, graduates of medical assisting programs in schools that are accredited by an accrediting body recognized by the United States Department of Education (DOE), and that have the required clock hours of instruction and externship specified above, are eligible for the RMA(AMT) Examination.

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OIG Initiates Audit Program of the Medicare EHR Incentive Program

As part of its Work Plan for Fiscal Year 2015, the Office of Inspector General (OIG) of the Department of Health and Human Services is initiating an audit program of the Medicare Electronic Health Record (EHR) Incentive Program. This audit program will be conducted in addition those already being performed by Figliozzi and Company, the audit contractor for the Centers for Medicare and Medicaid Services.

Any eligible professionals (EPs) who received incentive payments from Jan. 1, 2011, to June 30, 2014, are eligible to be randomly selected for auditing. The OIG will review certain meaningful use measures to determine whether selected EPs incorrectly received any incentive payments, and whether those EPs have adequately protected patients’ health information created or maintained by the EHR. As part of the auditing process, the agency will request specific information and documentation of compliance with the meaningful use measures under review.

To prepare for the possibility of an audit, all EPs should review their documentation for each meaningful use measure and for every year an incentive payment was received. For more information, visit the CMS meaningful use meaningful use audits webpage and access the Medical Group Management Association’s Meaningful Use Resource Center.

Posted in Computerized Provider Order Entry (CPOE), EHR Incentive Programs, Medicare, On the Job | Tagged , , , , , , , | 3 Comments