The Centers for Medicare & Medicaid Services (CMS) Conditions of Participation (CoPs) do not preempt or override state scope of practice laws. Moreover, state laws regarding provider delegation to medical assistants are not altered or nullified when medical offices and clinics are owned, operated, or on the premises of a hospital that is required to meet CMS CoPs.
If you have been told that different health care professionals share identical authority to delegate to medical assistants, consider the following situation:
A practice management consultant is telling us that medical assistants working under the authority of a nurse practitioner (NP) have the identical scope of practice as medical assistants working under a physician assistant (PA). Is that legally accurate? The consultant is saying that this is the case because the educational and licensing requirements for NPs and PAs are the same.
The medical assisting scope of practice under nurse practitioner authority is not necessarily the same as the scope of practice under physician assistant authority. Nurse practitioners are governed by the state nurse practice act and the regulations of the state board of nursing, whereas physician assistants are governed by the physician assistant practice act (which is sometimes part of the medical practice act) and the regulations of the state board of medical examiners. Consequently, the NP legal delegation authority in a state often differs significantly from the PA legal delegation authority in the same state.
And although the educational and testing requirements for NPs and PAs are similar, they are not identical. I have read articles asserting that the “nursing model” under which NPs are trained is very different from the “medical model” under which PAs are trained. This is a debatable point. However, it is indisputable that the tasks delegable to unlicensed allied health professionals such as medical assistants by NPs and PAs practicing in the same state are sometimes very different.
Determining whether you are successfully working within your legal scope of practice as a medical assistant requires recognizing some situational nuances, especially on the matter of delegation. The following demonstrates one such instance:
I work in an outpatient practice setting. At times, I work under the authority and supervision of a physician. At other times, I work under the authority of a nurse practitioner or a physician assistant. I have been informed that my legal scope of practice is the same regardless of which licensed provider is assigning tasks to me. Is this correct?
Not necessarily. Under the laws of most states, the medical assistants’ scope of practice is determined by the practice act and regulations of the delegating provider.
For example, the nurse practice act and the regulations and policies of the state’s board of nursing determine which tasks nurses (including advanced practice registered nurses [APRNs], such as nurse practitioners) are permitted to delegate to medical assistants.
On the other hand, the medical practice act and the regulations and policies of the state’s board of medical examiners delineate which duties physicians are allowed to assign to medical assistants. And physician assistant delegation authority is established by other state statutes, regulations, and policies.
There are legal nuances that must be taken into consideration. Some states permit nurse practitioners to work autonomously and without a collaborative practice agreement with a physician. In these states the delegation authority of autonomous nurse practitioners is determined by the nurse practice act and the rules of the board of nursing.
However, nurse practitioners in an independent-practice state may choose to work under physician authority and supervision, and physicians may assign nurse practitioners to oversee medical assistants who are performing tasks delegated to them by a physician. In such a case, both the medical practice act and the nurse practice act may have a bearing on the scope of practice of a medical assistant.
In the effort to protect patients in Montana from substandard medical assisting services, the Montana Society of Medical Assistants (MSMA) and the American Association of Medical Assistants (AAMA) wrote to the Montana Board of Medical Examiners on the proposed New Rule I “Medical Assistant—Delegation and Supervision.” Read the comments as well as an excerpt from the proposed new rules in the latest Public Affairs article. Access “Comments to the Montana Board of Medical Examiners” in the September/October 2018 issue of CMA Today on the AAMA website.
The role of medical assistants—especially CMAs (AAMA)—in the Medicare Annual Wellness Visit (AWV) continues to be a topic of interest and inquiry for health care professionals. The latest Public Affairs article attempts to clarify what AWV tasks are and are not delegable to medical assistants. Read “The Role of Medical Assistants in the Medicare Annual Wellness Visit” in the July/August 2018 issue of CMA Today on the AAMA website.