The AAMA Protects the Medical Assisting Right to Practice

The American Association of Medical Assistants® (AAMA) engages in state and federal advocacy to protect patients from substandard medical assisting services. This objective is achieved by drafting legislation and regulations that ensure that potentially patient-jeopardizing tasks are delegable to only knowledgeable and competent medical assistants who meet the following three standards:

• Have completed education of appropriate and adequate depth, breadth, and rigor
• Have been awarded an accredited credential—such as the CMA (AAMA)®—that measures required medical assisting knowledge and its application
• Have demonstrated continuing competence by periodic recertification

As a result of accomplishing this objective, knowledgeable and competent medical assistants are differentiated in law from other medical assistants.

As part of the AAMA mission, AAMA staff monitor and pursue advocacy opportunities on the federal and state levels that are most strategically advantageous. The following are some examples of AAMA advocacy that have increased patient protection by requiring medical assistants to have appropriate as well as adequate education and/or credentialing.

Arizona

In 2017, AAMA staff urged the Arizona Medical Board (AMB) to more precisely define approved medical assistant program in its delegation rules. The AMB saw the wisdom of the AAMA position and changed the wording of its regulations.

North Dakota

Because of a 2004 ruling by the North Dakota attorney general, medical assistants were no longer permitted to be delegated and perform medication administration. Partly through the efforts of AAMA staff, medication assistant regulations were amended to permit medical assistants who had completed an accredited program and held an accredited medical assisting credential to be delegated certain types of medication administration.

CMS meaningful use requirements of the Medicare and Medicaid Electronic Health Record (EHR) Incentive Programs

The initial set of proposed rules published by the Centers for Medicare & Medicaid Services (CMS) in 2010 to implement the computerized provider order entry (CPOE) requirements of the Medicare and Medicaid EHR Incentive Programs allowed only “licensed health care professionals” to enter orders into the CPOE system for meaningful use calculation purposes. Staff of the AAMA petitioned CMS to recognize “credentialed medical assistants,” as well as licensed professionals, for meaningful use order entry. In 2012, CMS was persuaded and changed the wording of its final rule to include “credentialed medical assistants.” This was the first time that credentialed medical assistants were distinguished from noncredentialed medical assistants in federal law.

For more information on these achievements, read the Public Affairs articles “Comments to the Arizona Medical Board” (November/December 2017), “North Dakota CMAs regain injections” (September/October 2005), and “AAMA triumphs in CMS order entry rule” (November/December 2012) in past CMA Today issues.

Is Medical Assisting Governed by State Law or Federal Law?

Like most other health professions, medical assisting is governed primarily by state law. This is due to the wording of the Tenth Amendment to the United States Constitution:

The powers not delegated to the United States by the Constitution, nor prohibited by it to the States, are reserved to the States respectively, or to the people.

Because the power to regulate professions and occupations is not delegated to the United States Congress in Article I of the Constitution, it remains within the sovereign authority of each state. This authority includes establishing education and credentialing prerequisites for the practice of a profession, delineating legal and ethical responsibilities for the professionals, and issuing and enforcing disciplinary standards for breaches of these responsibilities.

Therefore, the legal scope of practice of medical assistants (which is coterminous with the legal authority of licensed health care providers to delegate to medical assistants) is established by state legislation, regulations and policies of state boards that regulate health professionals who delegate to medical assistants, and common law principles arising from court decisions and usual and customary practice. Federal law, however, sometimes impacts medical assisting scope of practice. The meaningful use regulations of the Centers for Medicare & Medicaid Services (CMS) are a current and significant example. Federal statute and CMS rule require a certain percentage of medication/prescription, laboratory, and diagnostic imaging orders to be entered into the computerized provider order entry (CPOE) system by licensed health care professionals or “credentialed medical assistants” in order for a licensed eligible professional to receive incentive payments under the Medicaid Electronic Health Record (EHR) Incentive Program.

Congressional Action on the ACA

As our government transitions to a new administration, the following question has become increasingly common:

Would amendments to or repeal of the Affordable Care Act (ACA) affect medical assistants’ scope of practice?

The answer? Almost certainly not.  The scope of practice of medical assistants is determined primarily by state law.  An exception is the meaningful use order entry requirements of the Medicaid Electronic Health Record Incentive Program.  The Medicaid Incentive Program was not created by the ACA and would not be impacted by any amendments to or repeal of the Affordable Care Act.  Consequently, it is highly unlikely that the scope of practice for medical assistants will be impacted by congressional action on the ACA.