delegation, On the Job, Scope of Practice

Nasopharyngeal Swabbing for COVID-19 Testing in New York

May medical assistants be delegated nasopharyngeal swabbing to check for COVID-19 in New York? Consider the following excerpt from an executive order issued by New York Governor Andrew Cuomo on declaring a state disaster emergency:

I hereby temporarily suspend or modify, from the date of this Executive Order through April 6, 2020,* the following:

Sections 6521 and 6902 of the Education Law, to the extent necessary to permit unlicensed individuals, upon completion of training deemed adequate by the Commissioner of Health, to collect throat or nasopharyngeal swab specimens from individuals suspected of being infected by COVID-19, for purposes of testing; and to the extent necessary to permit non-nursing staff, upon completion of training deemed adequate by the Commissioner of Health, to perform tasks, under the supervision of a nurse, otherwise limited to the scope of practice of a licensed or registered nurse;

*Note: The above executive order has been extended to June 21, 2020, and is subject to further extension by the governor (New York State Education Department).

My legal opinion is that this executive order applies to medical assistants because they are not licensed under New York law.

If your state has similar executive orders or legislation, this New York example can apply to you. Check with the AAMA State Scope of Practice Laws webpage to find key legislative materials for your state.

On the Job, Scope of Practice

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.

delegation, On the Job, Scope of Practice

Medical Assistants and Vaccination Administration under Pharmacists

Improving vaccination rates and lessening vaccination hesitancy is a top priority for all health care professionals. Medical assistants are in a prime position to help, but the exact nature of their role requires some legal considerations.

Consider the following situation:

I own a pharmacy in which pharmacists administer influenza vaccinations. Could I hire a medical assistant to help us administer these influenza shots, or is it required that medical assistants work only under the supervision of a physician?

Most often, medical assistants work under the authority and supervision of licensed providers such as physicians (doctors of medicine or osteopathic medicine), nurse practitioners, and physician assistants in outpatient settings. However, state laws generally do not prohibit other licensed health care professionals (such as podiatrists, dentists, optometrists, and pharmacists) from employing medical assistants and delegating legally permitted tasks to them.

In response to your specific question, it is necessary to check the pharmacy practice act of your state—and the regulations and policies of the state board of pharmacy—to ascertain which allied health professionals (if any) may be delegated the administration of influenza vaccinations by a pharmacist. It is also necessary to determine the degree of supervision pharmacists must exercise over allied health professionals who are administering influenza vaccinations. I suspect the pharmacy law of your state requires delegating pharmacists to exercise on-site supervision over professionals who are administering influenza vaccinations.

If you’d like to know more about your specific state laws, visit the State Scope of Practice Laws webpage on the AAMA website.

dental assistant, On the Job, Scope of Practice

Medical Assistants Working with Dually Licensed Providers

The following question is not asked frequently. However, it raises important legal considerations:

I work for an oral surgeon who is both a licensed physician and a licensed dentist. Is my scope of practice determined by the state medical practice act or the state dental practice act?

Many oral surgeons have both an MD/DO degree (doctor of medicine or osteopathy) and a DDS/DMD degree (doctor of dental surgery or dental medicine) and are licensed as both physicians and dentists.

When medical assistants perform a dental task, they function as dental assistants. Thus, the state dental practice act and the regulations and policies of the state board of dental examiners determine the legal scope of practice—including supervision requirements by the delegating oral surgeon. If state law allows delegation of certain dental tasks only to individuals who meet dental assisting education and credentialing requirements, medical assistants must meet these requirements or obtain a waiver from the board of dental examiners to perform such tasks.

When medical assistants perform a medical task, the scope of practice is established by the state medical practice act and the regulations and policies of the state board of medical examiners. Go to the State Scope of Practice Laws webpage on the AAMA website to find the medical assisting law of all states.

delegation, On the Job, Scope of Practice

Medical Assistants and Fetal Nonstress Test Monitors

State laws are the best place to look for guidance on medical assisting scope of practice, but they are sometimes less thorough than desired. For cases such as those, consider the following:

We have some CMAs (AAMA) and RMAs(AMT) assisting physicians who are providing obstetrical services. The physicians delegate to the medical assistants the hooking up of patients to fetal nonstress test monitors. The medical assistants do not interpret the results of the fetal nonstress test. Is this delegation permitted by Minnesota law?

Based on my research, hooking up a patient to a fetal nonstress test monitor is a straightforward, repeatable process that does not require (1) the knowledge or skill or a licensed health care professional, (2) the exercise of independent clinical judgment, or (3) the making of clinical assessments. Therefore, my legal opinion is that this task is likely delegable to knowledgeable and competent unlicensed allied health professionals such as medical assistants working under direct/onsite physician supervision.

The delegating physicians should reverify periodically (perhaps every 12 months) the knowledge and skill of the medical assistants performing this task and should document in writing each medical assistant’s current competence in this task.

It may also be advisable to request a written opinion from the practice’s malpractice insurance carrier stating that it would cover any negligence by a medical assistant in hooking up a patient to a fetal nonstress test monitor.