Nebraska Amendment Clarifies Medical Assisting Scope of Practice

Beginning in 2018, a particular interpretation of Nebraska law has cast doubt on the legal authority of physicians to delegate to medical assistants the performing of certain tasks under direct/on-site physician supervision in outpatient settings.

In response, the Nebraska Medical Association drafted an amendment to the Medicine and Surgery Practice Act to eliminate any ambiguity about medical assistants’ scope of practice. The American Association of Medical Assistants^® and the Nebraska Society of Medical Assistants submitted written testimony supporting this legislation, and the amendment was enacted into law.

The new language clarifies the authority of physicians to delegate—and the right of medical assistants to perform—tasks within the standard scope of practice for medical assistants throughout the United States. I have incorporated this new language into my legal opinion letter for Nebraska, which is available on the AAMA State Scope of Practice webpage.

What Tasks Are Delegable to—and Performable by—Medical Assistants? Part II

The COVID-19 pandemic has created many changes in health care. Notably, medical assistants’ roles have shifted and expanded to help ensure patients continue to receive high-quality care.

The January/February 2021 Public Affairs article—adapted from the handout for my presentation of the same title for the 2020 American Academy of Ambulatory Care Nursing Annual (Virtual) Conference— discusses medical assistants’ scope of practice in terms of state law. Specifically, I examine the legality of delegating certain tasks to medical assistants:

• Performing injections and venipuncture
• Executing verbal and standing orders from licensed providers
• Enter­ing orders under the Medicaid Promoting Interoperability Program and its meaningful use provisions for electronic order entry

Review details by reading “What Tasks Are Delegable to—and Performable by—Medical Assistants? Part II” on the AAMA website. And check out “Part I,” which was published in the November/December 2020 issue of CMA Today.

Permissible Delegation of IV Infusions in Florida

I recently received the following question regarding the administration of an IV infusion: 

What are the requirements [for administering IV vitamin bags if] I completed schooling for my medical assistant certification? I thought doing an IV certification course would be a good start. What other requirements would be necessary as far as being able to administer the IV [infusion]? 

For medical assistants to be delegated an IV infusion by a physician and perform an IV infusion under the physician’s direct/onsite supervision, Florida law requires the medical assistant to be knowledgeable and competent in all aspects of IV infusion. 

Additionally, there must be written verification by the delegating physician (or another licensed provider) that the medical assistant is knowledgeable and competent in IV infusion. Completing an IV certification course is good evidence of competence. The delegating physician periodically should reverify in writing the medical assistant’s ongoing competence in IV infusion. 

COVID-19 Vaccination in New Jersey

On January 6, 2021, the New Jersey Department of Health issued an executive directive stating that health care providers, including ancillary health care personnel, are “authorized to administer COVID-19 vaccines that are approved or authorized by the FDA [U. S. Food and Drug Administration] at any vaccination site established within the state” as long as the health care providers are trained in and are competent in administering COVID-19 vaccinations. 

My legal opinion is that ancillary health care personnel, which fall within the directive’s definition of health care providers, include knowledgeable and competent medical assistants. 

COVID-19 Vaccination in Maryland

On January 1, 2021, the Maryland Department of Health issued an amended directive and order that, in part, permits certain individuals to administer COVID-19 vaccinations:

The following individuals may administer COVID-19 vaccines at vaccination sites: 

…

D. Other individuals provided that:

a. Each individual has successfully completed training on the administration ofCOVID-19 vaccines;

b. Qualified supervisory personnel at the vaccination site reasonably determine that each individual is able to administer COVID-19 vaccines under appropriate supervision; and

c. The individual administers the COVID-19 vaccine at the vaccination site under the reasonable supervision of qualified supervisory personnel. 

My legal opinion is that this category of individuals allowed to administer COVID-19 vaccinations includes knowledgeable and competent medical assistants who have completed training on the administration of COVID-19 vaccines.