Levels of Medical Assisting

Here is an interesting question about “levels” of medical assisting:

I work for a very large cardiology practice in North Carolina. Is it permissible to establish tiers of medical assistants based on their skill sets? For example, are we permitted under North Carolina law to have categories such as Medical Assistant I, Medical Assistant II, Medical Assistant III based on the medical assistant’s education, credentialing, and skill sets?

North Carolina law does not forbid employers from establishing tiers or levels of medical assistants. An employer is allowed to determine what elements of knowledge and skill are required for each category of medical assistants and what tasks should be assigned to medical assistants in the respective categories.

However, these levels should not have “CMA” in their titles. The American Association of Medical Assistants (AAMA) has intellectual property rights to the phrase “certified medical assistant” and the initialisms “CMA (AAMA)” and “CMA.”

Titling these classifications as Medical Assistant I, II, III is permitted under North Carolina law and does not infringe on the trademark and intellectual property rights of the AAMA. See the State Scope of Practice Laws webpage on the AAMA website to access key state legislative materials pertaining to medical assisting.

CMAs (AAMA), CNAs, and Medication Aides

I recently received the following question:

Does the law permit a CMA (AAMA) to work as a certified nursing assistant (CNA) in a nursing home without meeting the state requirements for registering as a CNA?

The answer is no. A medical assistant—even a CMA (AAMA) who has graduated from a programmatically accredited medical assisting program—must meet the state requirements for CNAs and register with the state as a CNA in order to perform clinical tasks in a skilled nursing facility or other inpatient settings.

Some states have a category of “medication aides (or assistants).” Medication aides are permitted to distribute medications to patients in an inpatient setting, usually under registered nurse authority and supervision. CMAs (AAMA) must also meet state requirements in order to work as a medication aide.

For more discussion on this topic, read my previous blog post “Medical Assistants and Medication Aides/Assistants/Technicians: Differences and Clarifications.”

Medical Assistants and Medication Aides/Assistants/Technicians: Differences and Clarifications

Although I have written about the difference between medical assistants and medication aides/assistants/technicians in Public Affairs articles in CMA Today, I continue to receive questions about the topic. Here are the basics:

Medical assistants work in outpatient settings under direct provider supervision, and may be delegated clinical and administrative tasks. Medication aides/assistants/technicians work in inpatient settings, usually under registered nurse supervision. A primary task of medication aides is to pass medications as directed by the RN supervisor.

Medication aides do not exist under the laws of some states. The laws of other states refer to these health workers by a designation other than medication aide. In some states an individual must first meet the requirements and register with the state as a certified nursing assistant (CNA) in order to be eligible to receive additional training and become a medication aide.

Medical assistants do not work in a clinical capacity in inpatient settings as medical assistants per se. Medical assistants must meet the requirements and register with the state as a CNA and/or a medication aide in order to work in a clinical capacity in inpatient settings.

Some state laws refer to medication aides as “certified medication aides.” The initialism associated with this phrase can cause confusion between medical assistants and medication aides. To help minimize such confusion, the National Council of State Boards of Nursing refers to medication aides as “MA-Cs” and encourages states to use this initialism. This change was made at the request of the American Association of Medical Assistants.