Two State Nursing Boards Recognize Educated and Credentialed Medical Assistants

Earlier this year, Connecticut and South Carolina enacted legislation that empowered medical assistants in these states to perform tasks for which they are educated, credentialed, and competent. Recently, nursing boards in Delaware and South Dakota have similarly revised existing legislation to differentiate duties delegable to educated and credentialed medical assistants from tasks delegable to all other medical assistants.

Specifically, the Delaware Board of Nursing and the South Dakota Board of Nursing issued proposed regulations that allow licensed nurses to delegate to formally educated and credentialed medical assistants the administration of medications by speci­fied routes. Like the Connecticut and South Carolina legislation, these newer revisions speak to the ongoing demand for knowledgeable and competent medical assistants to perform a greater number of advanced functions.

Learn more about this trend and read supporting documentation in the November/December 2022 Public Affairs article, “Two State Nursing Boards Recognize Educated and Credentialed Medical Assistants,” on the “Public Affairs Articles” webpage.

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.

Medical Assistants and Limited Scope Radiography

I receive fewer questions than I did seven or 10 years ago about the legalities of medical assistants performing limited scope radiography. However, in some states medical assistants are called upon to expose patients to ionizing radiation, as specifically directed by the overseeing/delegating provider.

The legality of this task is governed by state law. In some states unlicensed professionals such as medical assistants are forbidden from doing any limited scope radiography. Only licensed radiologic technologists are permitted to perform radiography. In other states medical assistants are required to complete a short course and pass a test in order to be delegated limited scope radiography. In other states limited scope radiography under direct/on-site provider supervision is not regulated. Physicians are permitted to delegate limited scope radiography to knowledgeable and competent employees.

Ohio Passes Senate Bill 110

I am happy to report that the Ohio Legislature has passed Senate Bill (SB) 110, which has now been signed into law by Governor John Kasich. The bill becomes effective 90 days after signing.

This bill gives nurse practitioners (NPs) and physician assistants (PAs) the ability to delegate medication administration to unlicensed allied health professionals, such as medical assistants working under their supervision in outpatient settings.

See the following relevant passages from SB 110, the first from page 20 of the attached, which is the version that has passed both Houses of the Ohio legislature:

Sec. 4723.48. (A) A clinical nurse specialist, certified nurse-midwife, or certified nurse practitioner seeking authority to prescribe drugs and therapeutic devices shall file with the board of nursing a written application for a certificate to prescribe. The board of nursing shall issue a certificate to prescribe to each applicant who meets the requirements specified in section 4723.482 or 4723.485 of the Revised Code. …

(C)(1) The holder of a certificate issued under this section may delegate to a person not otherwise authorized to administer drugs the authority to administer to a specified patient a drug, other than a controlled substance, listed in the formulary established in rules adopted under section 4723.50 of the Revised Code. The delegation shall be in accordance with division (C)(2) of this section and standards and procedures established in rules adopted under division (Q) of section 4723.07 of the Revised Code.

(2) Prior to delegating the authority, the certificate holder shall do both of the following:

(a) Assess the patient and determine that the drug is appropriate for the patient;

(b) Determine that the person to whom the authority will be delegated has met the conditions specified in division (D) of section 4723.489 of the Revised Code.

Note also the following on pages 22 and 23:

Sec. 4723.489. A person not otherwise authorized to administer drugs may administer a drug to a specified patient if all of the following conditions are met:

(A) The authority to administer the drug is delegated to the person by an advanced practice registered nurse who is a clinical nurse specialist, certified nurse-midwife, or certified nurse practitioner and holds a certificate to prescribe issued under section 4723.48 of the Revised Code.

(B) The drug is listed in the formulary established in rules adopted under section 4723.50 of the Revised Code but is not a controlled substance and is not to be administered intravenously.

(C) The drug is to be administered at a location other than a hospital inpatient care unit, as defined in section 3727.50 of the Revised Code; a hospital emergency department or a freestanding emergency department; or an ambulatory surgical facility, as defined in section 3702.30 of the Revised Code.

(D) The person has successfully completed education based on a recognized body of knowledge concerning drug administration and demonstrates to the person’s employer the knowledge, skills, and ability to administer the drug safely.

(E) The person’s employer has given the advanced practice registered nurse access to documentation, in written or electronic form, showing that the person has met the conditions specified in division (D) of this section.Sub. S. B. No. 110 131st G.A. 23

(F) The advanced practice registered nurse is physically present at the location where the drug is administered.

Note the following from pages 36 and 37:

Sec. 4730.203. (A) Acting pursuant to a supervision agreement, a physician assistant may Sub. S. B. No. 110 131st G.A. 37

delegate performance of a task to implement a patient’s plan of care or, if the conditions in division (C) of this section are met, may delegate administration of a drug. Subject to division (D) of section 4730.03 of the Revised Code, delegation may be to any person. The physician assistant must be physically present at the location where the task is performed or the drug administered.

(B) Prior to delegating a task or administration of a drug, a physician assistant shall determine that the task or drug is appropriate for the patient and the person to whom the delegation is to be made may safely perform the task or administer the drug.

(C) A physician assistant may delegate administration of a drug only if all of the following conditions are met:

(1) The physician assistant has been granted physician-delegated prescriptive authority.

(2) The drug is included in the formulary established under division (A) of section 4730.39 of the Revised Code.

(3) The drug is not a controlled substance.

(4) The drug will not be administered intravenously.

(5) The drug will not be administered in a hospital inpatient care unit, as defined in section 3727.50 of the Revised Code; a hospital emergency department; a freestanding emergency department; or an ambulatory surgical facility licensed under section 3702.30 of the Revised Code.

(D) A person not otherwise authorized to administer a drug or perform a specific task may do so in accordance with a physician assistant’s delegation under this section.

“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.