Permissible Tasks for New Jersey Medical Assistants

I received the following question from a CMA (AAMA)^® who is also a surgical technologist:

I am a CMA (AAMA) and am also certified in surgical technology in the state in which I am currently working. I am planning to move to New Jersey, a state that does not recognize surgical technology in its law. Am I able to perform surgical technology tasks in New Jersey, based on my certification as a surgical technologist in my current state?

Thank you for this interesting question. I don’t believe I have ever received this type of question.

New Jersey law requires medical assistants to meet education and credentialing requirements to be delegated injections and venipuncture.  The New Jersey law does not address the legality of other medical assisting tasks.

As you have indicated, surgical technology is not mentioned in New Jersey law. Based on these facts, my legal opinion is that the New Jersey medical assisting law—aside from the requirements for injections and venipuncture—permits medical assistants to perform only standard medical assisting duties such as those tasks in the “Core Curriculum” of the Commission on Accreditation of Allied Health Education Programs Standards and Guidelines for the Accreditation of Education Programs in Medical Assisting. It is also my opinion that the laws of New Jersey do not permit you to perform surgical technologist tasks that are not also usually and customarily done by medical assistants.

Medical Assistants as “School Nurses”

Today I received a question about whether a medical assistant is allowed to work as a “school nurse.”

Just as medical assistants cannot use the title “nurse,” “office nurse,” or “doctor’s nurse” (see my Public Affairs article from the January/February 2011 CMA Today), under the laws of all American jurisdictions medical assistants—even CMAs (AAMA)—are not permitted to be employed as “school nurses.”  In some states medical assistants are permitted to assist registered nurses who are functioning as school nurses.  To reiterate, however, medical assistants are not allowed to work as “school nurses.”

CMS Final Rule Reaffirms Credentialing Requirement for Medical Assistants

On October 6, 2015, the Centers for Medicare and Medicaid Services (CMS) issued its final rule for the Electronic Health Record (EHR) Incentive Programs. In responding to comments urging that the “credentialed medical assistant” requirement be made less stringent, CMS reaffirmed that medical assistants must have a third-party credential (such as the CMA (AAMA)), and must have sufficient knowledge to handle properly clinical decision support (CDS) alerts.

One party commenting on the CMS notice of proposed rulemaking for the EHR Incentive Programs made the suggestion “that if a standard for medical assistant CPOE [computerized provider order entry] is required, then the standard should be that the medical assistant must be appropriately trained for CEHRT [certified electronic health record technology] use (including CPOE) by the employer or CEHRT vendor in order to be counted [toward meeting the meaningful use requirements of the Incentive Programs].” (page 322 of the attached document)

CMS responded as follows:

We [CMS] disagree that the training on the use of CEHRT is adequate for the purposes of entering an order under CPOE and executing any relevant action related to a CDS. We believe CPOE and CDS duties should be considered clinical in nature, not clerical.  Therefore, CPOE and CDS duties, as noted, should be viewed in the same category as any other clinical task, which may only be performed by a qualified medical or clinical staff. (page 323 of the attached document)

This position of CMS is a resounding affirmation of the fact that only professionally-credentialed medical assistants (such as CMAs (AAMA)) are qualified to enter orders safely into the CPOE system.

More information about the CMS final rule will be forthcoming in Legal Eye: On Medical Assisting and CMA Today.

CMS Final Rule (10/6/15), pages 322-323

Further Information on SB 110

Information regarding Senate Bill (SB) 110 continues to emerge. Please see the following missive from the Ohio Board of Nursing:

SB 110, passed by the 131^st General Assembly, authorizes CTP [Certificate to Prescribe] holders to delegate non-controlled drug administration under specified circumstances to unlicensed persons. Please click on the links below to access the statute and the Legislative Services Commission (LSC) Analysis for further details.

Effective October 15, 2015, APRNs [Advanced Practice Registered Nurses] holding prescriptive authority are authorized to delegate medication administration as specified in Sections 4723.48(C) and 4723.489, Ohio Revised Code (ORC). In doing so, APRNs must comply with standards of safe practice, including delegation, set forth in the law and rules, including Chapter 4723-13, Ohio Administrative Code (OAC). Please be aware that the new authorization in ORC Section 4723.48(C) supersedes rule language currently found in Chapter 4723-13, OAC, with respect to APRN prescribers, which previously limited the types of medication that could be delegated to an unlicensed person.

SB 110 authorizes the Board to adopt rules establishing standards and procedures for APRN delegation. The Board will convene a Board Committee on Practice meeting on January 20, 2016 at noon at the Board office to gather public input regarding the need for administrative rules.

If you have questions, please email practice@nursing.ohio.gov. To access the Ohio Revised Code and the Ohio Administrative Code, go to the Board website at www.nursing.ohio.gov.

https://www.legislature.ohio.gov/legislation/legislation-summary?id=GA131-SB-110

https://www.legislature.ohio.gov/legislation/legislation-documents?id=GA131-SB-110

Supervision in an Office Setting

I recently received the following question:

I work in a medical specialty office. We have four CMAs (AAMA) and six nurses. Is it legal for a medical assistant to supervise a nurse in an office setting?

Here is my response:

Thank you for your question. It is my legal opinion that a medical assistant is permitted to supervise a registered nurse and a licensed practical/vocational nurse in regard to non-clinical matters–such as work schedule, office attire, compliance with government regulations, and administrative protocol. A medical assistant is not permitted to supervise an RN or an LP/VN in regard to clinical matters. This is due to the fact that clinical supervision of a nurse may require the medical assistant to exercise independent professional judgment, or to make clinical assessments, evaluations, or interpretations.