Key Scope of Practice Legislation Is Enacted in Connecticut and South Carolina

In May 2022, Connecticut and South Carolina legislatures passed two significant bills that empower medical assistants in these states to perform tasks for which they are educated, credentialed, and competent.

In Connecticut, “An Act Concerning the Department of Public Health’s Recommendations Regarding Various Revisions to the Public Health Statutes” will allow medical assistants to administer vaccinations (effective October 1, 2022).

In South Carolina, new legislation permits medical assistants to be delegated injections by not only physicians but also advanced practice registered nurses (including nurse practitioners) and physician assistants (effective July 14, 2022).   

Learn more about these legislative victories by reading the July/August 2022 Public Affairs article, “Key Scope of Practice Legislation Is Enacted in Connecticut and South Carolina,” on the “Public Affairs Articles” webpage.

Connecticut COVID-19 Crisis Necessitates Medical Assistants Administering Vaccinations

On Monday, December 14, the AAMA and its Connecticut Society of Medical Assistants, in conjunction with the Fairfield and Hartford County Medical Associations, sent Connecticut Governor Ned Lamont a letter asking him to issue an executive order allowing knowledgeable and competent medical assistants to administer COVID-19 vaccinations under the authority and supervision of licensed providers. Read the full letter here: 

Dear Governor Lamont: 

I am writing on behalf of the American Association of Medical Assistants^® (AAMA), the national professional society representing over 80,000 members and CMAs (AAMA)^®, and the Connecticut Society of Medical Assistants, an affiliated state society of the AAMA. 

With COVID-19 vaccinations beginning in the United States, the Centers for Disease Control and Prevention (CDC) published the COVID-19 Vaccination Program Interim Playbook for Jurisdiction Operations. The purpose of this publication is to assist state and local public health programs “to plan and operationalize a vaccination response to COVID-19 within their jurisdictions.” Note the reference to medical assistants as “vaccinators” on page 22 of this CDC publication: 

Verify COVID-19 vaccination providers have active, valid licensure/credentials to possess and administer vaccine. This licensure verification is needed only for those with prescribing authority [e.g., MD, DO, RPh, NP, PA] who will oversee COVID-19 vaccine administration. Credential verification is not required for vaccinators who work under the authority of someone with a higher level of licensure (i.e., not required for pharmacy techs/interns, RNs, LPNs, medical assistants, etc.). [emphase​s added] 

As demand for allied health professionals to administer the COVID-19 vaccines has started to increase rapidly, state governors have issued executive orders waiving certain elements of their state law to enable knowledgeable and competent medical assistants to be delegated, and to perform, COVID-19 vaccinations. For example, on December 4, 2020, Tennessee governor Bill Lee issued Executive Order No. 68: An Order to Facilitate the Continued Response to COVID-19 By Increasing Health Care Resources and Capacity. In part, this order authorizes “medical assistants certified by the American Association of Medical Assistants [to be delegated] tasks that would normally be within the practical nurse scope of practice, including, but not limited to, administration of COVID-19 vaccinations.” Tasks delegable to certified medical assistants “are required to have been ordered and authorized by a Tennessee licensed practitioner with prescriptive authority” and “performed under the supervision of the delegating registered nurse.” 

Also, state departments of health have clarified (as necessary) the fact that COVID-19 vaccinations may be delegated to, and may be administered by, knowledgeable and competent medical assistants. For example, the Washington State Department of Health published a list of health professionals permitted to administer the COVID-19 vaccine under licensed provider authority and supervision. Note the following: 

Medical assistant-certified 

Can administer vaccines? Yes 

Requires supervision? Yes 

Task must be delegated by a provider with the activity in their scope of practice: MD/DO, RN, ARNP, Naturopathic Physician, PA/DOPA. The requirements for the supervising health care practitioner to be physically present and immediately available in the facility are waived under Governor Inslee’s Proclamation 20-32. The supervisor only has to be immediately available, which may be by remote means. 

Issuing executive orders allowing medical assistants to administer COVID-19 vaccinations is consistent with similar measures that have been taken under federal and state law in regard to medical assistants performing nasopharyngeal swabbing for COVID-19 testing. 

The Centers for Medicare & Medicaid Services (CMS) published an interim final rule with comment period entitled “Medicare and Medicaid Programs; Policy and Regulatory Revisions in Response to the COVID-19 Public Health Emergency” (85 FR 19247 through 19253) in the April 6, 2020, Federal Register. Its language supports the legal position that medical assistants are permitted to perform nasopharyngeal swabbing to test for COVID-19. Note the following excerpts from this CMS rule: 

Even if the patient is confined to the home because of a suspected diagnosis of an infectious disease as part of a pandemic event … a nasal or throat culture … could be obtained by an appropriately-trained medical assistant or laboratory technician … Services furnished by auxiliary personnel (such as nurses, medical assistants, or other clinical personnel acting under the supervision of the [rural health clinic] or [federally qualified health center] practitioner) are considered to be incident to the visit and are included in the per-visit payment. [emphases added] 

The New York State Board of Medicine has taken the position that unlicensed allied health professionals such as medical assistants may not be delegated by physicians certain invasive procedures. In response to the early crisis period of the COVID-19 pandemic, New York Governor Andrew Cuomo declared a state disaster emergency that included the following provisions: 

I hereby temporarily suspend or modify … the following: 

… 

Sections 6521 and 6902 of the Education Law, to the extent necessary to permit unlicensed individuals, upon completion of training deemed adequate by the Commissioner of Health, to collect throat or nasopharyngeal swab specimens from individuals suspected of being infected by COVID-19, for purposes of testing; and to the extent necessary to permit non-nursing staff, upon completion of training deemed adequate by the Commissioner of Health, to perform tasks, under the supervision of a nurse, otherwise limited to the scope of practice of a licensed or registered nurse; 

In light of the aforementioned federal and state precedents, and the great need to deploy competent unlicensed allied health professionals to supplement the current licensed allied health workforce in administering COVID-19 vaccinations, the American Association of Medical Assistants and the Connecticut Society of Medical Assistants urge you to issue an executive order permitting medical assistants to administer COVID-19 vaccinations under the authority of licensed providers such as physicians (MDs/DOs), nurse practitioners, physician assistants, and pharmacists. 

Thank you for your consideration, Governor Lamont. Feel free to direct questions to me at dbalasa@aama-ntl.org and 800/228-2262. 

“An Act Concerning Medical Assistants”: Raised Bill No. 459

On March 19 the Public Health Committee of the Connecticut legislature held a public hearing on General Assembly Raised Bill No. 459, “An Act Concerning Medical Assistants.”  This legislation was the result of a scope of practice request submitted by the American Association of Medical Assistants and the Connecticut Society of Medical Assistants (CSMA) on July 16, 2012, to the Connecticut Department of Public Health (as described in the March/April 2013 issue of CMA Today).

Raised Bill No. 459 would permit physicians to delegate to medical assistants who had graduated from an accredited postsecondary medical assisting program and who are certified by the Certifying Board of the AAMA “the administration of medication orally, by inhalation, or by intramuscular, intradermal, or subcutaneous injections, including, but not limited to, the administration of a vaccine.”  The bill would also require that the medication be administered “under the direct supervision, control, and responsibility of a physician who is in the outpatient clinic or office when such medication is administered.”

The AAMA and the CSMA submitted joint written testimony in support of Raised Bill No. 459, and Holly Martin, CMA (AAMA), of the CSMA, presented oral testimony at the March 19 hearing.  Legal Eye will keep readers informed about the outcome of Bill No. 459.

Favorable Report from the Connecticut Department of Public Health

In November I described the continuing scope of practice issues that exist for medical assistants in Connecticut. I also detailed my efforts in concert with the Connecticut Society of Medical Assistants (CSMA) to correct these issues and see legislation passed that allows professionally educated and suitably credentialed medical assistants to administer medication under physician supervision.

In response to our letter (the body of which will be available in the upcoming March/April issue of CMA Today), the Connecticut Department of Public Health formed a scope of practice review committee to examine the request. The committee consisted of representatives from a number of organizations—not just the AAMA and CSMA, but the Connecticut Hospital Association, the Connecticut State Medical Society, and the Connecticut Association of Optometrists, among others. All information provided in the scope of practice request was reviewed by the committee, after which a report was issued. While this report makes no recommendations as to potential legislation, there are a number of positives to be taken from it.

First, the report acknowledges the ability and education of medical assistants:

“Literature and other information reviewed and evaluated by the scope of practice review committee demonstrated that certified medical assistants are educated and trained to administer medication under the direct supervision of a licensed physician. Accredited education and training programs that lead to certification as a medical assistant … include coursework and clinical training in pharmacology and medication administration.”

The report goes on to acknowledge that certification programs like those offered by the Certifying Board of the AAMA provide powerful evidence that medical assistants possess the knowledge necessary for medication administration, and that such certification programs could potentially be used as a standard in Connecticut.

In addition, the report also states that allowing medical assistants to administer medication should allow physicians and nurses to see more patients and focus on clinical care, as our letter argues.

The report goes on to confirm that all the information provided by the AAMA and CSMA allowed the committee to thoroughly address any quality and safety risks surrounding this issue. In addition, the report recommends that a number of terms must be clarified in any proposed legislation:

• “Physician”
• “Certified medical assistant”
• “Outpatient setting”
• “Direct supervision”

In short, the report discussed necessary steps that should be taken in the event that our recommended legislation is proposed. The report itself is over 15 pages long, but nonetheless includes some very encouraging reports about the progress of our work!

As always, I will keep you informed of any further developments in this matter.

Scope of Practice Issues Persist in Connecticut

Medical assistants in Connecticut continue to face difficult challenges. At the time of this post, no scope of practice for medical assistants currently exists in Connecticut statutes or regulations. Furthermore, in an informal document entitled “Medical Assistant Information,” the Connecticut Department of Public Health (DPH) describes the duties physicians may delegate to medical assistants. The DPH in this document explicitly states that medical assistants may not be delegated “medical administration by any route (including oxygen, immunizations, and tuberculin testing).”

I have been working with the Connecticut Society of Medical Assistants (CSMA) to request that the Connecticut General Assembly enact legislation enabling licensed physicians to delegate medication administration to medical assistants who have graduated from medical assisting programs accredited by the Commission on Accreditation of Allied Health Education Programs (CAAHEP) or the Accrediting Bureau of Health Education Schools (ABHES), and possess a current medical assisting credential acceptable to—and recognized by—the Connecticut Medical Examining Board and the DPH.

Recently, CSMA Public Policy Chair, Holly Martin, CMA (AAMA), and I penned a letter to Jennifer L. Filippone, chief of the Practitioner Licensing and Investigations Section of the Connecticut DPH. In this letter, we encouraged the passing of this legislation and detailed the benefits of doing so. As is the case with other states lacking such legislation, passing legislation would enhance the availability of health care for its citizens without decreasing the quality of that care. And, because medical assistants would continue to work under direct physician supervision, such legislation would not disrupt the health care delivery system. Finally, enacting this legislation would not have to create a licensure mechanism for medical assistants, and thus avoid increasing regulatory costs for the DPH.

I will write more thoroughly on this matter in an upcoming issue of CMA Today. In the meantime, I will continue to work with the CSMA in efforts to resolve this issue, and will keep you updated as the situation changes.