Scope of Practice

Stage 2 Ruling and State Regulations

I have received questions regarding the Stage 2 computerized provider order entry rule; specifically, if individual state laws could affect it.

Federal regulations impacting medical assisting are usually subject to state laws pertaining to medical assistants. However, I am not aware of any statutes or regulations in any American jurisdiction that limit what physicians are permitted to delegate to medical assistants in regard to entering orders–at the physician’s specific direction and approval–into electronic health/medical records. Therefore, my response to this question is that the entry of medication, laboratory, and radiology orders into the computerized provider order entry (CPOE) system at the direction of a licensed provider for purposes of calculating meaningful use under Stages 1 and 2 of the Medicare and Medicaid Electronic Health Record Incentive Program is not effected by state law.

5 thoughts on “Stage 2 Ruling and State Regulations”

  1. Hi Don! Can you answer a question for me? If the NP works directly under the supervision of a medical provider (this could be where my question falls apart. I’m assuming the NP does work under the supervision of the medical provider. Are they independent of the provider?), why can’t the NP delegate to us? If it’s because they are independent, then I understand. Anyway, can you help me with this question? Before Cheryl and I tackle this I want to make sure I understand it completely. This question popped up after reading your last Legal Eye posting. Thank you!

    Sherry Brewer, BS, CMA-AC(AAMA)

    Medical Assistant Program Manager/Coordinator

    Cuyahoga Community College

    2900 Community College Avenue


    Cleveland, Ohio 44115-3196

    Phone: 216-987-4439

    Fax: 216-987-4285

    1. Thank you for your good question Sherry. I am happy to respond.

      In some states NPs are permitted to work independently. In some states NPs must work under a collaboration agreement or other oversight arrangement with one or more physicians.

      In states in which NPs can work autonomously the nurse practice act and the board of nursing determine what can be delegated by an NP, and to whom. In states in which there is physician oversight of NPs it could be argued that physicians are permitted to delegate duties to medical assistants and give NPs supervisory authority over the medical assistants.

      I hope this is helpful Sherry. Don

      Sent from my iPhone

      1. Don
        Where can I find information on bylaws for MAs for the state of Pennsylvania. I have been hearing a variety of conflicting responses to the question of whether an MA in PA can conduct a foot exam for a diabetic patient, for example.

      2. Thank you for your question. I will send my legal opinion letter for Pennsylvania and other attachments to your e-mail address.

        In all states medical assistants are not permitted to do examinations for purposes of making assessments or evaluations.

        I will send you the documents immediately. After you receive them, please let me know whether you have any questions.

        Donald A. Balasa, JD, MBA
        Executive Director, Legal Counsel

        American Association of Medical Assistants
        Ph: 800/228-2262 | Fax: 312/899-1259 |

        Visit us on Facebook!

        The CMA (AAMA): Health Care’s Most Versatile Professional

Leave a Reply

Fill in your details below or click an icon to log in: Logo

You are commenting using your account. Log Out /  Change )

Google+ photo

You are commenting using your Google+ account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )


Connecting to %s