delegation, On the Job, Scope of Practice

Suicide Safety Plan Delegation

Is it appropriate for a nurse practitioner to delegate patient follow-up that will establish a suicide safety plan to a medical assistant?

My legal opinion is that nursing law of some states allows nurse practitioners to assign to knowledgeable and competent unlicensed professionals such as medical assistants the interacting by telephone with chronically suicidal patients to establish a suicide safety plan as long as both of the following conditions are met:

  1. The medical assistant adheres strictly to the information guidelines provided by the licensed therapist and approved by the nurse practitioner
  2. The medical assistant’s interaction with the patient does not require the exercise of any degree of independent clinical judgment or the making of clinical assessments or evaluations 

These principles are especially important in interacting with psychiatric patients—even more so for those who are chronically suicidal.

I would also suggest that delegating nurse practitioners check with their malpractice insurance carrier to make sure that the insurance would cover any negligence by a medical assistant in assisting a patient in establishing a suicide safety plan. The opinion from the malpractice carrier should be in writing and kept on file.

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

Testing Period Extension for the AUC Program

Note the recent update via the Centers for Medicare & Medicaid Services on the appropriate use criteria (AUC) program:

NOTICE: The EDUCATIONAL AND OPERATIONS TESTING PERIOD for the AUC Program has been extended through CY 2021. There are no payment consequences associated with the AUC program during CY 2020 and CY 2021. We encourage stakeholders to use this period to learn, test and prepare for the AUC program.

The following describes the intended AUC program timeline, according to the Centers for Medicare & Medicaid Services:

Program Timeline

Currently, the program is set to be fully implemented on January 1, 2022 which means AUC consultations with qualified CDSMs [clinical decision support mechanism] are required to occur along with reporting of consultation information on the furnishing professional and furnishing facility claim for the advanced diagnostic imaging service. Claims that fail to append this information will not be paid. Prior to this date the program will operate in an Education and Operations Testing Period starting January 1, 2020 during which claims will not be denied for failing to include proper AUC consultation information. Beginning July 1, 2018 the program is operating under a voluntary participation period during which time consultations with AUC may occur and may be reported on furnishing professional and facility claims using HCPCS [Healthcare Common Procedure Coding System] modifier QQ.

As a reminder, I provide supporting evidence for my position that CMAs (AAMA) are clinical staff according to the Centers for Medicare & Medicaid Services rule regarding the AUC program in my Public Affairs article of the September/October 2019 CMA Today. As a result of their clinical staff status, I assert that CMAs (AAMA) are permitted to do the following:

  1. Consult a clinical decision support mechanism (CDSM) about the appropriateness of ordering a particular advanced diagnostic imaging service
  2. Report findings to their overseeing or delegating licensed providers

Find the article, as well as all my other Public Affairs articles, on the AAMA website.

On the Job, Scope of Practice

Medical Assistants Answer the Call to Work in Acute Care Settings

Many medical assistants have been asked to work in acute care environments because of the enormous need to deploy skilled and dedicated health professionals to where they are most needed during the COVID-19 pandemic.

But because medical assistants have not typically worked in acute care settings, inevitable questions about the legal parameters of medical assisting scope of practice have arisen. Notably, answering these questions requires a close review because state laws usually address medical assistants’ scope of practice within only the typical ambulatory setting.

My analysis of three state examples was published in the July/August 2020 Public Affairs article, “Medical Assistants Answer the Call to Work in Acute Care Settings: What Is Their Scope of Practice?” on the AAMA website.


USDE Regulations on Institutional Information

Regulations of the United States Department of Education (USDE) that address the recognition of accrediting agencies (and other matters) went into effect July 1, 2020. The regulations apply to institutions and schools accredited by USDE-recognized accrediting bodies. A school must comply with USDE regulations to be eligible for federal funding, including financial assistance for students under Title IV of the Higher Education Act.

The provisions of the regulations relevant to the medical assisting education community are about education in fields that require completion of a program as a prerequisite for employment. Note the following from the regulations:

(v) If an educational program is designed to meet educational requirements for a specific professional license or certification that is required for employment [emphasis added] in an occupation, or is advertised as meeting such requirements, information regarding whether completion of that program would be sufficient to meet licensure requirements in a State for that occupation [must be provided].

Currently, the following U.S. states require the completion of some sort of medical assisting education program to work as a medical assistant or to be delegated certain tasks while working as a medical assistant:

  • Arizona
  • Massachusetts
  • New Jersey
  • North Dakota
  • South Dakota
  • Washington

Medical assisting program directors and educators who have questions about the impact of the USDE regulations on their programs and schools should email me at

On the Job, Scope of Practice

CDC Affirms Medical Assistants’ Role in Telehealth

In a recent guidance on how to expand access to health care during the COVID-19 pandemic, the Centers for Disease Control and Prevention affirmed that medical assistants and other health care professionals are permitted to interact with patients by several means. Note the following from this guidance:

Telehealth Modalities

Several telehealth modalities allow [health care personnel] and patients to connect using technology to deliver health care:

Synchronous: This includes real-time telephone or live audio-video interaction typically with a patient using a smartphone, tablet, or computer.

In some cases, peripheral medical equipment (e.g., digital stethoscopes, otoscopes, ultrasounds) can be used by another HCP (e.g., nurse, medical assistant [italics added]) physically with the patient, while the consulting medical provider conducts a remote evaluation [emphasis added in red].

Asynchronous: This includes “store and forward” technology where messages, images, or data are collected at one point in time and interpreted or responded to later. Patient portals can facilitate this type of communication between provider and patient through secure messaging.

Remote patient monitoring: This allows direct transmission of a patient’s clinical measurements from a distance (may or may not be in real time) to their healthcare [sic.] provider.

Additionally, in its Telehealth Implementation Playbook, the American Medical Association listed ways in which medical assistants can use telehealth to help their overseeing physician/provider:


Be familiar with the conditions and situations that are appropriate for a telehealth visit

Educate patients on telehealth expectations

Support patient troubleshooting related to platform pre-visit and during visit

Let [the] doctor know when a patient has “checked in” for a telehealth appointment (if platform does not include this feature)