How Will Medical Assistants Be Impacted by the CMS COVID-19 Vaccination Rule?

In response to the COVID-19 pandemic, the Centers for Medicare & Medicaid Services (CMS) issued its interim final rule with comment period titled “Medicare and Medicaid Programs; Omnibus COVID-19 Health Care Staff Vaccination” (CMS vaccination rule) in November 2021. This rule requires the staff of Medicare- or Medicaid-certified providers and suppliers to be vaccinated against COVID-19.

Medical assistants must be mindful of federal vaccination requirements. So, in order to combat confusion and misinformation about how this CMS vaccination rule—and other federal vaccination rules—affect medical assistants, my January/February 2022 Public Affairs article answers common questions about the rule.

This article—titled “How Will Medical Assistants Be Impacted by the CMS COVID-19 Vaccination Rule?”—covers many aspects of the CMS vaccination rule including its scope, who is and is not covered, and the effects on externing medical assisting students.

Find the article on the “Public Affairs Articles” webpage.

The Impact of Federal Law on COVID-19 Vaccination in Michigan

I recently received the following concern from a Michigan medical assistant:

A provider is questioning whether medical assistants can administer the COVID-19 vaccine. Under the Public Readiness and Emergency Preparedness Act for Medical Countermeasures Against COVID-19, it does not list that a [medical assistant] is qualified.

Note the following excerpt from the Department of Health and Human Services (HHS) document:

As qualified persons, these healthcare professionals and students in healthcare profession training programs will be afforded liability protections in accordance with the PREP [Public Readiness and Emergency Preparedness] Act and the terms of this amended Declaration. Second, to the extent that any State law that would otherwise prohibit the healthcare professionals and students in healthcare profession training programs who are a “qualified person” from prescribing, dispensing, or administering COVID-19 vaccines or other Covered Countermeasures, such law is preempted. On May 19, 2020, the Office of the General Counsel issued an advisory opinion concluding that, because licensed pharmacists are “qualified persons” under this declaration, the PREP Act preempts state law that would otherwise prohibit such pharmacists from ordering and administering authorized COVID-19 diagnostic tests. The opinion relied in part on the fact that the Congressional delegation of authority to the Secretary under the PREP Act to specify a class of persons, beyond those who are authorized to administer a covered countermeasure under State law, as “qualified persons” would be rendered a nullity in the absence of such preemption. This opinion is incorporated by reference into this declaration. Based on the reasoning set forth in the May 19, 2020 advisory opinion, any State law that would otherwise prohibit a member of any of the classes of “qualified persons” specified in this declaration from administering a covered countermeasure is likewise preempted. In accordance with section 319F–3(i)(8)(A) of the Public Health Service Act, a State remains free to expand the universe of individuals authorized to administer covered countermeasures within its jurisdiction under State law [emphasis added].

The bold language permits states to expand the categories of individuals who are allowed to administer COVID-19 vaccinations beyond what is stated in the HHS document. More restrictive state laws are preempted by this federal document. However, states are permitted to be more inclusive than what the federal document indicates.

Go to the AAMA website and visit the “State Scope of Practice Laws” page to find the medical assisting law of all states, including Michigan.

Note, especially, the third link to my blog post “Permissible Delegation of Influenza Vaccination Administration in Michigan” in the Michigan subsection of the “State Scope of Practice Laws” webpage. The blog post concludes with my following legal opinion:

Therefore, my legal opinion is that Michigan law permits physicians to delegate the administration of influenza vaccinations to knowledgeable and competent unlicensed individuals such as medical assistants as long as the delegating physician is accessible to the medical assistants by radio, telephone, or telecommunication.

COVID-19 Vaccination in the District of Columbia

The District of Columbia Department of Health (DC Health) clarified the legality of medical assistants administering COVID-19 vaccinations by adding the following section to its regulations:

223 SARS-CoV-2 VACCINE ADMINISTRATION

223.1 An individual, including a medical assistant [emphasis added] or a health technician, who is not licensed, registered, or certified to practice a health occupation pursuant to Chapter 12 of Subtitle I of Chapter 3 of the District of Columbia Official Code, is authorized to administer a SARS-CoV-2 vaccine provided that:

(a) The individual has successfully completed training, provided by a licensed health professional authorized by an existing scope of practice of a health profession to administer a vaccination in the District of Columbia, on the administration of the SARS-CoV-2 vaccine;

(b) A licensed health professional authorized by an existing scope of practice of a health profession to administer a vaccination in the District of Columbia must supervise the individual at the vaccination site;

(c) The licensed health professional reasonably determines that the individual is able to administer the SARS-CoV-2 vaccine under appropriate supervision;

(d) The individual administers the SARS-CoV-2 vaccine at the vaccination site under the general supervision of a licensed health professional supervising the unlicensed person at the vaccination site; and

(e) The training, authorization, and supervision are appropriately documented in the records maintained by the vaccination site.

This rule is similar to rules and executive orders in other American jurisdictions that recognize the importance of empowering knowledgeable and competent medical assistants to administer COVID-19 vaccinations under appropriate supervision.

Federal Policy and the Pandemic: How the Pandemic and Changes in Federal Policy Have Expanded Medical Assistants’ Scope of Practice

Medical assistants’ role and duties have been significantly impacted by the COVID-19 pandemic. During this time, federal agencies and state governors have made necessary changes to expand medical assistants’ legal scope of practice to meet new health care needs.

In the March/April 2021 Public Affairs article in CMA Today, I discuss how these government actions have changed the knowledge, skills, and professional attributes and behaviors medical assistants are now expected to have and to demonstrate, particularly in these areas:

• Telehealth
• Nasopharyngeal swabbing
• COVID-19 vaccination administration

Learn more about how recent federal policy has affected medical assistants’ scope of practice by reading “Federal Policy and the Pandemic: How the Pandemic and Changes in Federal Policy Have Expanded Medical Assistants’ Scope of Practice” on the AAMA website.

Delegation of COVID-19 Vaccinations in Oregon: Part II

In part I of this topic, I responded to a registered nurse (RN) who questioned whether language in the regulations of the Oregon Board of Nursing might prevent RNs from delegating to medical assistants the administration of COVID-19 vaccinations. The RN followed up with an additional question:

What language in the Oregon nursing law permits RNs to delegate to medical assistants the administration of intramuscular injections—including COVID-19 vaccinations?

Medical assistants are classified as unregulated assistive personnel (UAP) under the Oregon nursing law. Division 45 of the regulations of the Oregon Board of Nursing, “Standards and Scope of Practice for the Licensed Practical Nurse and the Registered Nurse,” contains the key information on medical assistants’ scope of practice:

(11) Standards related to the RN who delegates the performance of a nursing procedure to a UAP.

…

(e) The RN’s authorization of a UAP to perform a nursing procedure shall only occur when the following delegation process steps are met:

(A) Based on nursing judgment, the RN determines that:

(i) The procedure does not require interpretation or independent decision making during its performance on the client;

(ii) The results of performing the procedure are reasonably predictable;

…

(B) The RN teaches the nursing procedure to the UAP and competency validates the UAP in the safe and accurate performance of the procedure on the client.

…

(f) The RN shall provide clinical supervision of the UAP to whom the procedure has been delegated.  The clinical supervision shall include:

(A) Monitoring of the UAP’s performance of the procedure to verify the UAP’s adherence to written directions; and

(B) Engaging in ongoing evaluation of the client and associated data to determine the degree to which client outcomes related to performance of the procedure are being met.

My legal opinion is that Division 45—not Division 47, which was discussed in Part I—is the applicable Oregon nursing law for determining what tasks may be delegated by RNs to UAP such as medical assistants in outpatient settings, including vaccination clinics. Division 45 states that RNs are permitted to delegate to UAP nursing procedures as long as all of the conditions delineated in Division 45 are satisfied.

An intramuscular injection such as a COVID-19 vaccination is a nursing procedure. Therefore, my legal conclusion is that Oregon nursing law allows RNs to delegate to knowledgeable and competent medical assistants working under direct or on-site RN supervision the administration of COVID-19 vaccinations in outpatient vaccination clinics as long as all the requirements of nurse delegation in Division 45 are met.