Why Professional Regulation Laws Vary from State to State

Why do medical assisting laws vary—sometimes greatly—from state to state? Some may even argue that it would make more sense—and be better public policy—for the U.S. Congress to enact laws for each regulated profession that are nationally applicable and consistently interpreted in all U.S. jurisdictions.

However, even though national regulation of the professions has great intuitive appeal, the plain language of the U.S. Constitution would make broad federal regulation of the professions unconstitutional.

In the 2023 January/February Public Affairs article, “Why Professional Regulation Laws Vary from State to State,” I further expand on the reasons professional regulation laws vary across the nation. Read the article to learn more about how the Tenth Amendment limits laws governing professions, why the Medicare and Medicaid Electronic Health Record Incentive Programs were constitutional, how state licensing laws can become more uniform, and more.

The full article is available via the “Public Affairs Articles” webpage.  

Proposed Delaware Regulation Expands APRN Delegation to Medical Assistants

On June 9, 2022, I sent a letter to the executive director of the Delaware Board of Nursing regarding proposed regulations that would allow advanced practice registered nurses (APRNs), including nurse practitioners, to delegate to educated and credentialed medical assistants the administration of medication.

Read the full letter here:

I am writing on behalf of the American Association of Medical Assistants® (AAMA), the national professional society for medical assistants, in regard to the following proposed addition to the regulations of the Delaware Board of Nursing (BON):

8.7.15.1 APRNs are authorized to assign and supervise medication administration to a medical assistant if the medical assistant has successfully completed a medical assistant training program and possesses current national medical assistant certification.

8.7.15.1.1 If a practice is solely operated by APRNs, the APRN must be present in the building when the medical assistant is administering medications and assumes liability for the actions of the medical assistant.

8.7.15.2 When a physician delegates to a medical assistant, and an organizational policy exists to allow the APRN to assign and supervise the medical assistant, the physician retains responsibility and accountability for the actions of the medical assistant and will be notified of unsafe or improper practices.

It is the position of the AAMA that medical assistants who have completed a medical assistant training program that includes medication administration theory and technique, and who have a current national medical assistant certification such as the CMA (AAMA)® that tests knowledge needed to safely administer medication, should be permitted to administer medication under the authority of APRNs—including nurse practitioners—and other licensed independent practitioners such as physicians.

The AAMA commends the Delaware BON for increasing the availability of safe and accessible health care for the residents of Delaware by proposing this revision to the BON regulations.

New Utah Regulations Permit Increased Medical Assisting Scope of Service

On February 1, 2022, the Utah Department of Commerce Division of Occupational and Professional Licensing issued regulations that permit medical assistants to complete a formal or on-the-job dispensing training program and become dispensing medical practitioner (DMP) designees. Note the following excerpts from the Pharmacy Practice Act Rule:

(3) The duties of the consulting pharmacist, [pharmacist in charge], [remote dispensing pharmacist-in-charge], or [dispensing medical practitioner in charge] shall include:

(a) assuring that a pharmacist, pharmacy intern, DMP, or DMP designee dispenses drugs or devices, including:

(i) packaging, preparation, compounding and labeling; and

(ii) ensuring that drugs are dispensed safely and accurately as prescribed;

…

In accordance with Subsection 58-17b-601(1), the following shall apply to prescriptions:

…

(3) A prescription issued by a licensed prescribing practitioner, if electronically communicated by an agent of that practitioner, upon that practitioner’s specific instruction and authorization, may be accepted by a pharmacist, pharmacy intern, pharmacy technician, pharmacy technician trainee, DMP, or DMP designee. [Emphasis added.]

Medical assistants are included in the list of health professionals eligible to meet the requirements and become DMP designees, according to the regulation:

(22) “DMP designee” means an individual, acting under the direction of a DMP, who:

(a) (i) holds an active health care professional license under one of the following chapters:

(A) Chapter 67, Utah Medical Practice Act;

(B) Chapter 68, Utah Osteopathic Medical Practice Act;

(C) Chapter 70a, Physician Assistant Act;

(D) Chapter 31b, Nurse Practice Act;

(E) Chapter 16a, Utah Optometry Practice Act;

(F) Chapter 44a, Nurse Midwife Practice Act; or

(G) Chapter 17b, Pharmacy Practice Act; or

(ii) is a medical assistant [emphasis added] as defined in Subsection 58-67-102(12);

(b) meets requirements established in Subsection 58-17b-803 (4)(c); and

(c) can document successful completion of a formal or on-the-job dispensing training program under Section R156-17b-622.

 Questions about the Utah regulation may be directed to me at DBalasa@aama-ntl.org.