delegation, Scope of Practice

Duties and Delegation Abroad

I field many scope-of-practice questions in my work, some of which are highly specific to the individuals posing them. Others can be applied more broadly, however. These serve as interesting material to share with readers of this blog. The following is one such question I received recently.

I practice as a medical assistant in North Carolina. I routinely travel outside the country for medical missions. As a CMA (AAMA), when working under a physician licensed in another country, am I permitted to perform the same tasks that I am allowed to perform under North Carolina law?

I responded as follows:

Thank you for your most interesting question.  Your legal scope of practice would depend on the laws of the country in which you are working.  You would not necessarily be able to perform the same tasks you are delegated in North Carolina.

However, to take your question a step further, it is my legal opinion that—if a physician licensed in North Carolina also went on such a mission trip—the physician would be permitted to delegate to you the same tasks that he/she delegates to you under North Carolina law.  This same legal principle would apply to nurse practitioners and physician assistants licensed in North Carolina.

Note that the state in question here is largely interchangeable. Were the medical assistant and physician from Oklahoma, for example, the same legal principle would apply, only specific to Oklahoma law instead of North Carolina.

Computerized Provider Order Entry (CPOE), EHR Incentive Programs, Eligible Professionals, Medicaid, On the Job

Order Entry Requirements for Non-Physician Practitioners

I was recently asked whether non-physician practitioners (e.g., nurse practitioners and physician assistants) must meet the meaningful use order entry requirements under the Medicaid Electronic Health Record (EHR) Incentive Program.  The answer is yes.

The following are considered “eligible professionals” (EPs) who can participate in the  Medicaid EHR Incentive Program:

  • Physicians (primarily doctors of medicine and doctors of osteopathy)
  • Nurse practitioners
  • Certified nurse-midwives
  • Dentists
  • Physician assistants who furnish services in a Federally Qualified Health Center or Rural Health Clinic that is led by a physician assistant

All participating EPs must meet the computerized provider order entry (CPOE) requirements of the Incentive Program in order to receive incentive payments.

On the Job, Scope of Practice

Scope of Practice With Nurse Practitioners

I have been receiving an increasing number of questions about the scope of practice for medical assistants when they are working under the supervision of nurse practitioners (NPs) or physician assistants (PAs), and not under the direct supervision of a physician. This scenario will become more frequent because of the Affordable Care Act and the anticipated increase in demand for primary care, which is often provided by NPs and PAs.

Because physician assistants always work under physician authority and supervision—although, in some states, very general physician supervision—the scope of practice for medical assistants working under PAs is usually very similar to their scope of practice when working under physician supervision. However, there are some state laws that do not permit medical assistants to administer medication unless a physician (MD) or osteopath (DO) is on the premises.

Medical assistants’ scope of practice when working under nurse practitioners (or other advanced practice nurses) is usually more difficult to ascertain from state law. The controlling law is the state nurse practice act and the regulations and policies of the state board of nursing. Often, the legal analysis is complicated.

If you work under the direct supervision of a nurse practitioner or a physician assistant and have questions about scope of practice, please feel free to direct your questions to me.