The CMS Rule and “Grandfathering” in Washington

Following my last post, I received a question about medical assistants in the state of Washington who may have been “grandfathered” into the Washington MA-C credential, and thus have never passed a national certification exam. Would such medical assistants be considered properly “credentialed” by the Centers for Medicare and Medicaid Services (CMS) for entering orders into the computerized provider order entry system for meaningful use purposes under the Medicare and Medicaid Incentive Programs?

It is my opinion that, under Washington law, Medical Assistants-Certified (MA-Cs) who were grandfathered in because they were previously Health Care Assistants (HCAs) would not be considered “credentialed medical assistants” under the CMS Incentive Programs rule. Likewise, Medical Assistants-Registered (MA-Rs) would not be considered credentialed, because they did not take and pass an examination given by a third-party credentialing body.

In addition, the question also raised concern that many medical assistants would only earn a credential to satisfy the initial CMS requirement, and not keep that credential current. Remember, any medical assistant whose CMA (AAMA) credential is not current cannot use the credential for any purposes, including order entry. A CMA (AAMA) who is not current, therefore, would not be considered “credentialed” under the CMS rule.

About Donald A. Balasa

Donald A. Balasa, JD, MBA, chief executive officer and legal counsel for the American Association of Medical Assistants, keeps his eye on what is happening in the profession.
This entry was posted in Certification and the CMA (AAMA) Credential, On the Job and tagged , , , . Bookmark the permalink.

25 Responses to The CMS Rule and “Grandfathering” in Washington

  1. Clare Ley says:

    This posting states “… under Washington law …”. Does that mean this could be interpreted differently from state to state. If so, I am sure there are many of us who would like to know what applies in our own state.

  2. Erin says:

    I was not currently working as an MA, and thus not granfathered in. I tested with AAMA in 2008 due to recert. in March 2014. However, WA dept of health is saying that I can’t be certified in the state till I recert with AAMA? Can I recert early?

    • Thank you for your question. I am happy to help.

      May I assume because you were not working as medical assistant you did not have a health care assistant (HCA) permit from the Washington Department of Health?

      I will send to your e-mail some information about the WA law that will help you understand what you need to do.

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

      American Association of Medical Assistants
      Ph: 800/228-2262  |  Fax: 312/899-1259  |  http://www.aama-ntl.org

      Visit us on Facebook! http://www.aama-ntl.org/facebook  

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

  3. Megan Burdick says:

    Good morning,

    We are in the process of having our final MA’s become certified when we came across a couple of questions:

    Q: We have 2 phlebotomists at our clinic who are not MA’s or CMA’s, they do on occasion order labs when the provider tells them to add additional ones. Does this meet the requirements or will they too have to certified in one way or another?

    Q: What is the process if a Medical Assistant has failed the CMA exam through the AAMA and is not able to resit until a scheduled date of 2/2014?

    Thank you,
    Megan Burdick, CMA

    • Thank you for your question. I have checked the website of the Washington State Department of Health and have noticed that phlebotomists are not recognized specifically under WA law. Therefore, it is my opinion that these two phlebotomists would have to meet the requirements and become MA-Ps in order to be delegated venipuncture under WA law. I will send the MA-P law to your e-mail address.

      If the individual has met the requirements and has been granted interim MA-C status, she/he has twelve months in which to pass an examination recognized by the WA Department of Health, such as the CMA (AAMA) Certification Examination.

      I hope this is helpful.

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

      American Association of Medical Assistants
      Ph: 800/228-2262  |  Fax: 312/899-1259  |  http://www.aama-ntl.org

      Visit us on Facebook! http://www.aama-ntl.org/facebook  

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

  4. Megan Burdick says:

    I am from Michigan not Washington, sorry for the confusion.

    • Q: We have 2 phlebotomists at our clinic who are not MA’s or CMA’s, they do on occasion order labs when the provider tells them to add additional ones. Does this meet the requirements or will they too have to certified in one way or another?

      No problem, and I am sorry! Michigan law does not require phlebotomists or medical assistants to have any credentials. Michigan law does permit physicians to delegate to competent and knowledgeable medical assistants working under their direct supervision in outpatient settings the ordering of laboratory work as specifically directed by the physician.

      If the phlebotomists have some sort of phlebotomy credential, they would be able to enter such orders into the EHR and have such entry count toward meeting the meaningful use requirements. If they do not have phlebotomy credentials, they would not be able to do so.

      I hope this is helpful.

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

      American Association of Medical Assistants
      Ph: 800/228-2262  |  Fax: 312/899-1259  |  http://www.aama-ntl.org

      Visit us on Facebook! http://www.aama-ntl.org/facebook  

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

  5. Jordan says:

    I am asking a question in statement form. I have had a few other people who are more educated in reading more legal documents that I, and I have found that currently there is a law stating that HCA’ s if certified before July 1, 2013 or who had the training and certification of that job like an NAC would be able to recertify as an MA. The importance of that was that in order to get your MA…you start off as MA registered when you apply for the certification, but you are MA-registered and after getting the certification you have 365 days to take the state licensure test and pass to continue along with your MA-C. I am currently in this process. I have applied for the certification today, and am now trying to prep for the test (aside for the studying) what is the documentation that would be required for Washington HCA’s/NAC’s? I have looked, but would like to double check.

    Thank you

    • Thank you for your questions. I will be sending to your e-mail address two documents from the Washington Department of Health:

      Note the following from one of the documents I will be attaching regarding the interim MA-C status recognized under WA law:
      Interim Certification Requirements:
      • You have met all requirements except
      passage of the examination.
      • You can provide the full scope of practice
      of a medical assistant-certified.
      • Your interim certification will expire upon
      issuance of the medical assistant certified
      credential or after one year issuance of
      the interim certification.
      • You cannot renew an interim certification.
      • You are only eligible for an interim
      certification upon initial application.

      In other words, if an individual meets all of the requirements of the MA-C under WA law except the testing requirement, an individual can register with the WA Department of Health, work as an MA-C for 365 days, and must take and pass one of the four examinations recognized by the WA law in order to move from interim MA-C status to full MA-C status.

      I hope this is helpful. I will be sending two documents to your e-mail.

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

      American Association of Medical Assistants
      Ph: 800/228-2262  |  Fax: 312/899-1259  |  http://www.aama-ntl.org

      Visit us on Facebook! http://www.aama-ntl.org/facebook  

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

  6. Pingback: News From AAMA!! | Washington State Society of Medical Assistants

  7. Shirley Pack, RMA says:

    I have been a AAMT Registered Medical Assistant for 25 yrs, currently unemployed, and am trying to get certified thru the WADOH. However, after submitting the proper documents I am being told that certification cannot be issued because there is no graduation date on my transcripts. I have contacted Everest College, the institution that took over Eton Technical College where I attended, and there is no other documentation available. I am now unable to find employment because of someone’s poor record keeping. What recourse do I have

    • Thank you for your comment. I am very sorry that you are having these difficulties. I would suggest you contact Brett Cain of the Washington Department of Health and indicate that I recommended that you contact him. Mr. Cain’s e-mail address is as follows:

      Brett.Cain@DOH.WA.GOV

      I hope this proves to be helpful.

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

      American Association of Medical Assistants
      Ph: 800/228-2262 | Fax: 312/899-1259 | http://www.aama-ntl.org

      Visit us on Facebook! http://www.aama-ntl.org/facebook

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

  8. jakenolte says:

    I have worked as a CNA since 1998, and also as a HUC and an HCA under a doctor’s license that expired in 5/172013. Is there some way that I can qualify as a Medical assistant like the grandfathered providers were 2 months after me? I currently am working in an ER as a tech and an MA would allow me to perform phlebotomy again—which is of more use to the unit.

    • Thank you for your question. It might be best for you to contact directly the Washington Department of Health. Here is the e-mail address of Brett Cain, the chief staff person for this program at the WA Department of Health:
      Cain, Brett A (DOH)

      I am confident that Mr. Cain will be able to provide you a definitive and authoritative answer to your question.

      Thank you again.

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

      American Association of Medical Assistants
      Ph: 800/228-2262 | Fax: 312/899-1259 | http://www.aama-ntl.org

      Visit us on Facebook! http://www.aama-ntl.org/facebook

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

  9. Jasmine says:

    Are there any refresher courses for the certified medical assistant exam in Seattle,wa

  10. Yulia says:

    Under this new law, are CMAs able to call in prescriptions if they have a written order?

    • Thank you for your question. The Washington State regulations specifically states that it does not address the delegation of administrative tasks to administrative personnel. Please note the following from the WA regulation:
      WAC 246-827-0100 Applicability. A person shall obtain a
      medical assistant credential from the secretary in order to
      practice as a medical assistant. “Practice as a medical assistant”
      means the person assists a health care practitioner by providing
      direct patient health care including treatment, self-care
      instruction, patient education, and administration of medication.
      A person employed by a health care practitioner or facility is not
      practicing as a medical assistant as defined in this chapter if he
      or she only performs the following tasks:
      (1) Accounting;
      (2) Insurance reimbursement;
      (3) Maintaining medication and immunization records;
      (4) Obtaining and recording patient history;
      (5) Preparing and maintaining examination and treatment areas;
      (6) Reception;
      (7) Scheduling;
      (8) Telephone and in person screening limited to intake and
      gathering of information; or
      (9) Similar administrative tasks.

      Based on the above language, it is my legal opinion that WA law permits physicians to delegate to competent and knowledgeable employees the verbatim transmission to a pharmacy of the provider’s prescription orders.

      However, keep in mind the CMS rule. Regardless of the WA law, the CMS rule states that only “credentialed medical assistants” (in addition to licensed health care professionals) are permitted to enter medication, laboratory, and radiology orders into the CPOE system and have such entry count toward meeting the meaningful use requirements of the Medicare and Medicaid Incentive Programs.

      I hope this is helpful.

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

      American Association of Medical Assistants
      Ph: 800/228-2262 | Fax: 312/899-1259 | http://www.aama-ntl.org

      Visit us on Facebook! http://www.aama-ntl.org/facebook

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

      • Stacie says:

        What if there is a person that is not credentialed and is doing shots and other things within the charts now?

  11. victoria hutson says:

    I have worked as a medical assistant in several states over the last 30 years. I at one time did have a Washington State Health Care Assistant license. it has since expired as I moved to another state. 10 years later I am back in Washington state and need to get certified to keep my job. I was told that with out an official transcript from the now, debunked, school I went to I can not get certified. Given my history and past license can I be grandfathered in? Thanks

    • Thank you for your question. I will send to your e-mail address the requirements of Washington State law.

      Donald A. Balasa, JD, MBA
      Chief Executive Officer, Legal Counsel
      American Association of Medical Assistants
      Ph: 800/228-2262 | Fax: 312/899-1259 | http://www.aama-ntl.org
      The CMA (AAMA): Health Care’s Most Versatile Professional®

      • Patricia Evans says:

        I have worked as a medical assistant for the last 20 years. I was a phlebotomist and acquired my Medical Assistant Certification in Anchorage, AK in 1998 through the AAMA. I challenged the test and passed it. My employer at the time transitioned me from a phlebotomist to a CMA. And I have been one since then. I am currently registered through the WA department of health. I am working in OR, but reside in WA. My current employer will schedule me to work in WA if I become WA state certified. So I took the CMA test offered through AAMA and passed it. I submitted the application with my passing scores. Unfortunately they are requesting official transcripts which I am not able to provide.
        I am wondering if given my extensive experience, having passed the test and also being currently registered I would qualify to be grandfathered.

        Thank you,

      • Thank you for your question. I and some of my staff colleagues are quite familiar with the Washington State medical assisting law. The WA law requires a medical assistant to have passed an accredited examination such as the CMA (AAMA) within five (5) years of registering as an MA-C. Please e-mail me at dbalasa@aama-ntl.org and I will provide you additional information.

        Donald A. Balasa, JD, MBA
        Chief Executive Officer, Legal Counsel
        American Association of Medical Assistants
        Ph: 800/228-2262 | Fax: 312/899-1259 | http://www.aama-ntl.org
        The CMA (AAMA): Health Care’s Most Versatile Professional®

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