Key Scope of Practice Legislation Is Enacted in Connecticut and South Carolina

In May 2022, Connecticut and South Carolina legislatures passed two significant bills that empower medical assistants in these states to perform tasks for which they are educated, credentialed, and competent.

In Connecticut, “An Act Concerning the Department of Public Health’s Recommendations Regarding Various Revisions to the Public Health Statutes” will allow medical assistants to administer vaccinations (effective October 1, 2022).

In South Carolina, new legislation permits medical assistants to be delegated injections by not only physicians but also advanced practice registered nurses (including nurse practitioners) and physician assistants (effective July 14, 2022).   

Learn more about these legislative victories by reading the July/August 2022 Public Affairs article, “Key Scope of Practice Legislation Is Enacted in Connecticut and South Carolina,” on the “Public Affairs Articles” webpage.

Supervision Requirements in Federally Qualified Health Centers

I recently received the following query from a South Carolina medical assistant:

I have a question regarding medical assistants working with a physician assistant or nurse practitioner in an office without a physician on the premises. I currently work for an organization that is termed a federally qualified health center [FQHC]. I have been told the medical assistants are not allowed to go to some of our small satellites if a nurse is not there, [because] we cannot work with a physician assistant or nurse practitioner without a nurse on the premises. Have you heard of such? Is this because we are noted as an FQHC?

In the Health Center Compliance Manual from 2018, I see no requirements stating that medical assistants are permitted to work under the authority of a nurse practitioner or a physician assistant only if a registered nurse is on the premises.

Further, I have not found anything in federal law about FQHCs requiring registered nurses to be present when medical assistants are working under the authority of nurse practitioners and physician assistants.

Additionally, the July/August 2022 Public Affairs article, “Key Scope of Practice Legislation Is Enacted in Connecticut and South Carolina,” offers information about the legislation that was recently enacted in South Carolina. However, nothing in the article speaks to the question raised in the email quoted in this blog post. And the recently enacted legislation doesn’t alter any requirements noted in the 2018 Health Center Compliance Manual.

Permissible Delegation of Catheterization Tasks in Iowa

I recently received the following question from a medical assisting educator regarding scope of service for Iowa medical assistants:

Regarding urinary catheterization, we have been told that a Certified Medical Assistant^® cannot insert a straight catheter, but they can remove the catheter. Our [medical assisting] course does not include performing this task, but I have had a few students who would be doing their externship in urology, and the question is always presented because the urinary [practices] allow medical assistants to insert catheters. But, we have been informed that it is out of our scope.

Are you able to provide some insight on this subject and possibly some documentation so we can correctly advise our externship sites as well as provide accurate information for our students?

Iowa law neither specifically authorizes nor forbids medical assistants being delegated and performing catheterization tasks.

The Commission on Accreditation of Allied Health Education Programs and the Medical Assisting Education Review Board recently issued new Standards and Guidelines for the Accreditation of Educational Programs in Medical Assisting, which includes a revised “Core Curriculum for Medical Assistants.” The Medical Assisting Education Review Board has also updated Educational Competencies for Medical Assistants. Note the following from this document:

Catheterization: Catheterization may not be a common day-to-day task of a medical assistant; however, some communities of interest may see a need for training in this area due to local physician office needs. Laws for catheterization performed by medical assistants will vary by state. It is important to know and follow the specific state regulations for medical assistants performing catheterization procedures.

Note the following from my handout on federal and state updates to medical assisting scope of practice:

30. … It may be prudent to ask the malpractice insurance carrier for the practice/clinic/health system whether it would cover any negligence by a medical assistant in performing [certain tasks.] The insurance carrier should be asked to put its opinion in writing.

31. To formulate a legal opinion on whether a particular task is delegable to medical assistants when state law does not address the legality or when state law is ambiguous, … I often begin my analysis by evaluating whether the task is usually and customarily delegated to medical assistants in the state and in other states. I also determine whether the task is contained in the “Core Curriculum” of the current CAAHEP [Standards]. [The “Core Curriculum” of the CAAHEP Standards takes into account the results of the most recent occupational analysis of the medical assisting profession.]

Thus, in such cases, I suggest that educators or practitioners contact the malpractice insurance carrier for their school and program or medical practice and ask whether it would cover any negligence by a medical assistant in performing these catheterization tasks.

Utilizing Medical Assistants to the Top of Their Training

Medical assistants’ scope of service has greatly expanded during the last 18 months due to changes in federal and state law. To help clinicians and managers utilize medical assistants to the top of their education or training and credentialing, I presented on some of these major changes during the Medical Group Management Association (MGMA) Medical Practice Excellence: Leaders Conference on October 25, 2021.

The March/April 2022 Public Affairs article, “Utilizing Medical Assistants to the Top of Their Training,” summarizes this presentation, covering important facets of health care such as telehealth, remote physiologic monitoring, and post-discharge medication reconciliation.

Find the article on the “Public Affairs Articles” webpage.

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.