Centers for Medicare & Medicaid Services, CMS Rule, delegation, Scope of Practice

CMS Final Rule Supports Medical Assistants Performing Nasopharyngeal Swabbing

The Centers for Medicare & Medicaid Services (CMS) published an interim final rule with comment period entitled “Medicare and Medicaid Programs; Policy and Regulatory Revisions in Response to the COVID-19 Public Health Emergency” (85 FR 19247 through 19253) in the April 6, 2020, Federal Register. Its language supports my legal position that medical assistants are permitted to perform nasopharyngeal swabbing to test for COVID-19.

Note the following excerpts from this CMS rule:

Even if the patient is confined to the home because of a suspected diagnosis of an infectious disease as part of a pandemic event … a nasal or throat culture … could be obtained by an appropriately-trained [sic] medical assistant or laboratory technician. …

… Services furnished by auxiliary personnel (such as nurses, medical assistants, or other clinical personnel acting under the supervision of the [rural health clinic] or [federally qualified health center] practitioner) are considered to be incident to the visit and are included in the per-visit payment.

16 thoughts on “CMS Final Rule Supports Medical Assistants Performing Nasopharyngeal Swabbing”

  1. I feel we as CMA’s due not get the pay or recognition to perform the COVID Testing. Let the LPN’s and nurses get them done. We are not allowed to give injections in Ct or Ny why should we put ourselves and out families at risk. ????

  2. I guess what I am looking for clarification is, it seems that the language supports the Medical Assistant doing nasopharyngeal swabs for covid in home based care, it does not state or reflect for care in the clinic. For example my organization does covid testing, currently the medical assistants are used in the tent to help package and process the specimen before it goes to the lab. The RN or LPN collects the swab. It would be beneficial to my organization if the MA’s could collect the sample as we have an abundance of MA’s vs LPN’s and RN’s.
    Could you please clarify if this would also pertain to the clinic setting or just home bound?

        1. Thank you for your question. It is my legal opinion that New Hampshire law permits physicians to delegate to knowledgeable and competent medical assistants the performing of nasopharyngeal swabbing. I will forward documentation to your email address.

          Donald A. Balasa, JD, MBA
          CEO and Legal Counsel, AAMA
          dbalasa@aama-ntl.org

    1. Thank you for your question. Note the following from the FAQs of the Medical Board of California in the Scope of Practice Laws section of website, accessible by clicking below State Scope of Practice Laws near the left bottom of our home page:
      Are medical assistants allowed to perform nasal smears?
      Yes. Only if the procedure is limited to the opening of the nasal cavity.
      ……
      Are medical assistants allowed to swab the throat in order to preserve the specimen in a throat culture?
      Yes. Medical assistants are allowed to swab throats as long as the medical assistant has received the proper training and a physician or podiatrist is on the premises.
      According to California law, the above also applies to nurse practitioners and physician assistants delegating to medical assistants.

      The answer to the first question above would seem to not permit medical assistants to perform nasopharyngeal swabbing because this task is not “limited to the opening of the nasal cavity.”

      To my knowledge, California is the only state that has not temporarily set aside its law to allow medical assistants to perform nasopharyngeal swabbing.

      I hope this is helpful.

      Donald A. Balasa, JD, MBA
      CEO and Legal Counsel, AAMA
      dbalasa@aama-ntl.org

    1. Thank you for your question. It is my legal opinion that Tennessee law permits physicians to assign to knowledgeable and competent medical assistants the performing of nasopharyngeal swabbing. I will send documentation to your email address.

      Donald A. Balasa, JD, MBA
      CEO and Legal Counsel, AAMA
      dbalasa@aama-ntl.org

      1. Can CMA’s collet nasopharyngeal swabs in Minnesota? Our clinic is telling us we can but I didn’t think we could. Thanks in advance.

    1. Thank you for your question. It is my legal opinion that Oregon law permits physicians to delegate to knowledgeable and competent unlicensed allied health professionals such as medical assistants the performing of nasopharyngeal swabbing. I will send details to your email address.

      Donald A. Balasa, JD, MBA
      CEO and Legal Counsel, AAMA
      dbalasa@aama-ntl.org

  3. Hello,
    Does California allow Medical Assistants to perform nasal swabs? I work for a Rural Health Center and we tend to go out to the farms and test workers there.

    Thank you!

    1. Thursday, September 24, 2020

      Thank you for your question. California may be the only state that has language in its laws that do not allow medical assistants to be delegated, and to perform, nasopharyngeal swabbing. Note the following from the FAQs of the Medical Board of California accessible in the California subsection of our State Scope of Practice Laws section of our website:
      Are medical assistants allowed to perform nasal smears?
      Yes. Only if the procedure is limited to the opening of the nasal cavity.
      Of course, nasopharyngeal swabs are not “limited to the opening of the nasal cavity.”

      Governor Newsom has not issued an executive order setting aside this interpretation of California law.

      I hope this is helpful.

      Donald A. Balasa, JD, MBA
      CEO and Legal Counsel, AAMA
      dbalasa@aama-ntl.org

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