delegation, medication administration, On the Job, SB 110, Scope of Practice

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 131st 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

Certification and the CMA (AAMA) Credential, On the Job, Professional Identity, Scope of Practice

Medical Assistants as Home Health Aides

Because of the great versatility of medical assistants, questions have arisen about whether medical assistants—especially CMAs (AAMA)—are permitted to work as home health aides (HHAs).

Most states have laws defining what qualifications an individual must have in order to work as a home health aide.  These laws also assign responsibility for the HHA program to an existing state agency, such as the department of health.  CMAs (AAMA) would have the opportunity to ask this agency whether their education in a CAAHEP or ABHES accredited medical assisting program, and their demonstration of didactic knowledge by passing the CMA (AAMA) Certification Examination, would meet or exceed the requirements of the home health aide law.  If the agency accepts the CMA (AAMA) credential in lieu of home health aide training, the CMA (AAMA) would then be able to work as an HHA.

Certification and the CMA (AAMA) Credential, On the Job, Professional Identity, Scope of Practice

Medical Assistants as Scribes

Recently I received the following first-time question:

Is it illegal for a medical assistant to also function as the physician’s scribe? The office manager told me that a new law states that a medical assistant either can function as a scribe or as a medical assistant, but cannot assume both roles.

I am not aware of any state or federal laws that forbid a medical assistant from also functioning as the physician’s scribe. Medical assistants who have graduated from a CAAHEP or ABHES accredited medical assisting program and who hold a current CMA (AAMA) credential should be knowledgeable in scribing for the physician or other provider.

Certification and the CMA (AAMA) Credential, Computerized Provider Order Entry (CPOE), EHR Incentive Programs, On the Job, Scope of Practice

Breaking News: Proposed CMS Rule is Favorable for CMAs (AAMA)

On March 20, 2015, the Centers for Medicare and Medicaid Services (CMS) issued a notice of proposed rulemaking (NPRM) for Stage 3 of the Medicare and Medicaid Electronic Health Record (EHR) Incentive Programs.  I am pleased to report that the Proposed Objective for computerized provider order entry (CPOE) in the NPRM is very favorable for credentialed medical assistants such as CMAs (AAMA).  Note the following excerpts from the Notice of Proposed Rulemaking:

Proposed Objective: Use computerized provider order entry (CPOE) for medication, laboratory, and diagnostic imaging orders directly entered by any licensed healthcare professional, credentialed medical assistant, or a medical staff member credentialed to and performing the equivalent duties of a credentialed medical assistant; who can enter orders into the medical record per state, local, and professional guidelines.…

In Stage 3, we propose to continue the policy from the Stage 2 final rule at

77 FR 53986 that orders entered by any licensed healthcare professional or credentialed medical assistant would count toward this objective. A credentialed medical assistant may enter orders if they are credentialed to perform the duties of a medical assistant by a credentialing body other than the employer. If a staff member of the eligible provider is appropriately credentialed and performs assistive services similar to a medical assistant, but carries a more specific title due to either specialization of their duties or to the specialty of the medical professional they assist, orders entered by that staff member would be included in this objective. We further note that medical staff whose organizational or job title, or the title of their credential, is other than medical assistant may enter orders if these staff are credentialed to perform the equivalent duties of a credentialed medical assistant by a credentialing body other than their employer and perform such duties as part of their organizational or job title. We defer to the provider’s discretion to determine the appropriateness of the credentialing of staff to ensure that any staff entering orders have the clinical training and knowledge required to enter orders for CPOE.…

However, as stated in the Stage 2 final rule at 77 FR 53986, it is apparent that the prevalent time when CDS [Clinical Decision Support] interventions are presented is when the order is entered into CEHRT [Certified Electronic Health Record Technology], and that not all EHRs also present CDS when the order is authorized (assuming such a multiple step ordering process is in place). This means that the person entering the order would be required to enter the order correctly, evaluate a CDS intervention either using their own judgment or through accurate relay of the information to the ordering provider, and then either make a change to the order based on the information provided by the CDS intervention or bypass the intervention. The execution of this role represents a significant impact on patient safety; therefore, we continue to maintain for Stage 3 that a layperson is not qualified to perform these tasks. [Emphasis added]

The full document can be found here. I will provide further excerpts and summaries later this week and next week.

On the Job, Scope of Practice

Scope of Practice With Nurse Practitioners

I have been receiving an increasing number of questions about the scope of practice for medical assistants when they are working under the supervision of nurse practitioners (NPs) or physician assistants (PAs), and not under the direct supervision of a physician. This scenario will become more frequent because of the Affordable Care Act and the anticipated increase in demand for primary care, which is often provided by NPs and PAs.

Because physician assistants always work under physician authority and supervision—although, in some states, very general physician supervision—the scope of practice for medical assistants working under PAs is usually very similar to their scope of practice when working under physician supervision. However, there are some state laws that do not permit medical assistants to administer medication unless a physician (MD) or osteopath (DO) is on the premises.

Medical assistants’ scope of practice when working under nurse practitioners (or other advanced practice nurses) is usually more difficult to ascertain from state law. The controlling law is the state nurse practice act and the regulations and policies of the state board of nursing. Often, the legal analysis is complicated.

If you work under the direct supervision of a nurse practitioner or a physician assistant and have questions about scope of practice, please feel free to direct your questions to me.