Medical Assistants Deserve COVID-19 Vaccinations as Health Care Workers

I recently received notice of difficulties scheduling COVID-19 vaccinations appointments for health care professionals:

I had an appointment [to receive] a COVID-19 vaccine [in February] and was just notified today by Publix Pharmacy per their corporate office that frontline health care workers needed to have a Florida license number.

I tried to explain that [medical assistants] in the state of Florida are not required to have a medical license and that [medical assistants] work under the supervision of the physician.

Still, my appointment was canceled due to the fact that I do not have a state license. I have already sent an email to Publix’s customer care department and included a link that explains what a medical assistant is and does.

I am not certain if any other medical assistants (credentialed or not) have encountered this same issue with trying to obtain COVID-19 vaccination appointments as frontline health care workers at Publix or other pharmacies. I am simply passing this information on in the event that others have encountered the same issues.

This was the first medical assistant to report this issue to me, and they did all the right things. Medical assistants may use this as a model for what to do if denied the COVID-19 vaccination for not having a license number.

In this situation, medical assistants may also want to suggest to the pharmacy staff that they go to the AAMA website and navigate to the State Scope of Practice Laws webpage, where they will find the medical assisting law for all states.

What Tasks Are Delegable to—and Performable by—Medical Assistants? Part I

The scope of work for most health care professionals—including medical assistants—has expanded during the COVID-19 pandemic.

In the November/December 2020 Public Affairs article, I discuss current scope of practice for medical assistants and delegation considerations. Adapted from the handout I used for my presentation of the same title for the 2020 American Academy of Ambulatory Care Nursing Annual (Virtual) Conference, this article reviews four legal axioms and how they can be applied to determine which tasks are delegable to—and performable by—medical assistants. It also debunks three pervasive myths about medical assistants’ scope of practice and proffers diagnostic questions for ascertaining the legality of a specific task.

Review details on the legality of delegating certain tasks by reading “What tasks are delegable to—and performable by—medical assistants? Part I” on the AAMA website. And stay tuned for “Part II,” which will be published in the January/February 2021 issue of CMA Today.

Medication Reconciliation Post-Discharge HEDIS Measure

In a letter to the president of the National Committee for Quality Assurance (NCQA), I urged NCQA to add “credentialed medical assistants” to the list of health professionals in its post-discharge medication reconciliation measure.

This NCQA Healthcare Effectiveness Data and Information Set (HEDIS) measure is incorporated into the Centers for Medicare & Medicaid Services (CMS) Measures Inventory Tool for “Medication Reconciliation Post-Discharge.” According to this HEDIS measure, only post-discharge medication reconciliation by a “prescribing practitioner, clinical pharmacist, or registered nurse” is counted in determining whether the measure has been met. 

The following is an excerpt from my letter to the NCQA president: 

It is the position of the American Association of Medical Assistants^® [AAMA] that professionally educated and appropriately credentialed medical assistants are capable of, and competent in, performing—under the authority of a licensed provider—post-discharge medication reconciliation. Therefore, the AAMA respectfully requests that “credentialed medical assistant” be added to the list of health professionals in the HEDIS post-discharge medication reconciliation HEDIS measure. 

Adding “credentialed medical assistant” to this list would be consistent with the provisions of the Medicaid Promoting Interoperability Program Eligible Professionals Objectives and Measures for 2020: Objective 4 of 8. Note the following from this CMS document: 

Use CPOE [computerized provider order entry] 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 [emphasis added].

Medical Assistants’ Competence in Performing Diagnostic Tests: Comments to CMS

On August 14, 2020, I submitted comments to the Centers for Medicare & Medicaid Services (CMS) of the Department of Health and Human Services regarding proposed rule CMS-1734-P.

Read those comments in the September/October 2020 Public Affairs article, “Medical Assistants’ Competence in Performing Diagnostic Tests: Comments to the CMS,” on the AAMA website.

New Jersey Prescription Monitoring Program: Medical Assistants as Delegates

Does New Jersey allow medical assisting access to the state prescription drug monitoring program?

Medical assistants are recognized as “delegates” under the New Jersey Prescription Monitoring Program (NJPMP). Because I have not written previously about these programs, I will explain in detail.

Note the following from the NJPMP frequently asked questions webpage:

The New Jersey Prescription Monitoring Program (NJPMP) is an important component of the New Jersey Division of Consumer Affairs’ (Division) effort to halt the abuse and diversion of prescription drugs.

The NJPMP … is a statewide database that collects prescription data on Controlled Dangerous Substances (CDS), Human Growth Hormone (HGH) and gabapentin dispensed in outpatient settings in New Jersey, and by out-of-State pharmacies dispensing into New Jersey.

Access to the NJPMP is granted to prescribers and pharmacists who are licensed by the State of New Jersey and are in good standing with their respective licensing boards. Registered prescribers may delegate their authority to access the NJPMP to certain other healthcare professionals.

Patient information in the NJPMP is intended to help prescribers and pharmacists provide better-informed patient care. The information will help supplement patient evaluations, confirm patient drug histories, and document compliance with therapeutic regimens. When prescribers, delegates, or pharmacists identify a patient as potentially having an issue of concern regarding drug use, they are encouraged to help the patient locate assistance and take any other action the prescriber or pharmacist deems appropriate.

Medical assistants who (a) meet the education requirements of New Jersey law and (b) hold a current medical assisting credential from a certifying body approved by the New Jersey State Board of Medical Examiners are authorized to be appointed as “delegates” by practitioners.

A “practitioner” is defined as an individual “currently licensed, registered, or otherwise authorized by this State or another state to prescribe drugs in the course of professional practice,” according to the administrative rules governing the NJPMP. A practitioner may “designate a delegate or delegates for the purpose of accessing PMP [prescription monitoring program] information for a new or current patient, or a prescriber.”

The NJPMP requires a “mandatory look-up” in certain situations. Note the following excerpt from the administrative rules governing the NJPMP:

a) … [A] practitioner or the practitioner’s delegate shall access prescription monitoring information for a new or current patient consistent with the following:

1) The first time the practitioner prescribes a Schedule II controlled dangerous substance or any opioid to a new or current patient for acute or chronic pain; …

2) The first time the practitioner prescribes a benzodiazepine drug that is a Schedule III or Schedule IV controlled dangerous substance;

3) If the practitioner has a reasonable belief that the person may be seeking a controlled dangerous substance, in whole or in part, for any purpose other than the treatment of an existing medical condition, such as for purposes of misuse, abuse, or diversion, the first time the practitioner or other person prescribes a non-opioid drug other than a benzodiazepine drug that is a Schedule III or Schedule IV controlled dangerous substance;

4) Any time the practitioner prescribes a Schedule II controlled dangerous substance for acute or chronic pain to a patient receiving care or treatment in the emergency department of a general hospital;

5) On a quarterly basis during the period of time a current patient continues to receive a prescription for a Schedule II controlled dangerous substance or for an opioid drug for acute or chronic pain, or for a benzodiazepine that is a Schedule III or Schedule IV controlled dangerous substance.

Each provider must establish written processes to document in each patient’s record the information obtained from the prescription monitoring program. The disclosure of prescription monitoring program information is determined by state and federal law.