How to Receive Guidance on Scope of Practice from State Medical Boards

I recently received the following question:

My physician employer contacted the state medical board and asked whether she could delegate a particular task to a medical assistant. The staffer at the medical board replied that the board does not regulate medical assistants and therefore he was not able to answer the question. My physician employer wants to know how she can obtain an answer from the medical board.

Your physician employer should ask the state medical board whether the medical practice act and the regulations and policies of the medical board permit her to delegate a certain task to an unlicensed employee. The question should not contain the term “medical assistant” unless this term is found in the medical practice act and/or the regulations of the medical board. By using “unlicensed employee” instead of “medical assistant,” it is more likely that your physician employer will receive an answer to her question.

Only Select Professionals May Legally Use “Nurse” As a Title

I recently received the following significant question about permissible titles:

Recently [someone] was hired in my company, and she is a CMA (AAMA).

Can she call herself a “nurse”? She insisted on getting a name badge that identifies her as a nurse. … I remember being taught we cannot. I found and read the June 2019 article you wrote saying we cannot.

As stated in the 2019 Public Affairs article, the laws in all American jurisdictions continue to forbid anyone—other than registered nurses (RN), licensed practical nurses (LPN), or licensed vocational nurses (LVN)—from calling themself a nurse.

Note the following from a 2019 Advisory Opinion issued by the Kentucky Board of Nursing:

KRS 314.031(1) states: “It shall be unlawful for any person to call or hold [themself] out as or use the title of nurse or to practice or offer to practice as a nurse unless licensed or privileged under the provisions of this chapter.”

Age Requirements for Ohio Medical Assistants

I recently received the following question from an Ohio educator regarding age restrictions for medical assistants:

 Can you tell me if there is any legal implication that [a medical assistant] who has completed a high-school training program [but] is not yet 18 might [be unable] to work as a medical assistant until they turn 18? 

The medical assisting laws of all states, including Ohio, are available on the “State Scope of Practice Laws” webpage. 

Notably, Ohio law does not require medical assistants to be at least 18 years of age to work as a medical assistant. 

However, a few states ​(such as California) do require medical assistants to be at least 18 in order to work as a medical assistant. 

Multi-State Scope of Practice for Medical Assistants

I recently received an inquiry regarding medical assisting scope of practice laws across the U.S.:

I am a CMA (AAMA) residing in Washington. I am trying to find all the scope of practice laws for my current job. I work for a start-up health care/technology company [that] serves all 50 states. All our physicians are licensed in each state, and we are trying to implement the use of CMAs (AAMA) to better serve our patient load. Would I need to follow each state’s rules, or because the company is in Washington, would I just follow Washington’s rules?

…

I feel as though Washington [law] is the strictest. [Do you think] any other states seem to be a little stricter?

To find the medical assisting laws of all states, go to the “State Scope of Practice Laws” webpage on the AAMA website. 

Because medical assistants employed by this company work under the authority of physicians in all states, they are required to abide by the laws of all states.

Washington has more requirements that medical assistants must meet to work as medical assistants than any other state. Further, Washington law requires medical assistants to meet specified requirements for a category of medical assistants and register with the Washington State Department of Health in that category in order to work.

However, some states have more limitations on tasks that medical assistants are permitted to be delegated and to perform.

Two of my Public Affairs articles published in CMA Today, “What Tasks Are Delegable to—and Performable by—Medical Assistants?” part I and part II, contain legal principles generally applicable in all U.S. jurisdictions. Note the following excerpt from the handout that served as the source material for those articles:

7. General legal principles—

• It is not permissible for medical assistants to perform tasks that constitute the practice of medicine, or require the skill and knowledge of physicians or other licensed providers;

• It is not permissible for medical assistants to perform tasks that are restricted in state law to other health professionals—often licensed health professionals;

• It is not permissible for medical assistants to perform tasks that require the exercise of independent clinical judgment, and/or the making of clinical assessments, evaluations, or interpretations;

Nebraska Amendment Clarifies Medical Assisting Scope of Practice

Beginning in 2018, a particular interpretation of Nebraska law has cast doubt on the legal authority of physicians to delegate to medical assistants the performing of certain tasks under direct/on-site physician supervision in outpatient settings.

In response, the Nebraska Medical Association drafted an amendment to the Medicine and Surgery Practice Act to eliminate any ambiguity about medical assistants’ scope of practice. The American Association of Medical Assistants^® and the Nebraska Society of Medical Assistants submitted written testimony supporting this legislation, and the amendment was enacted into law.

The new language clarifies the authority of physicians to delegate—and the right of medical assistants to perform—tasks within the standard scope of practice for medical assistants throughout the United States. I have incorporated this new language into my legal opinion letter for Nebraska, which is available on the AAMA State Scope of Practice webpage.