What Tasks Are Delegable to—and Performable by—Medical Assistants? Part II

The COVID-19 pandemic has created many changes in health care. Notably, medical assistants’ roles have shifted and expanded to help ensure patients continue to receive high-quality care.

The January/February 2021 Public Affairs article—adapted from the handout for my presentation of the same title for the 2020 American Academy of Ambulatory Care Nursing Annual (Virtual) Conference— discusses medical assistants’ scope of practice in terms of state law. Specifically, I examine the legality of delegating certain tasks to medical assistants:

• Performing injections and venipuncture
• Executing verbal and standing orders from licensed providers
• Enter­ing orders under the Medicaid Promoting Interoperability Program and its meaningful use provisions for electronic order entry

Review details by reading “What Tasks Are Delegable to—and Performable by—Medical Assistants? Part II” on the AAMA website. And check out “Part I,” which was published in the November/December 2020 issue of CMA Today.

Standing Orders and Supervision Requirements

I welcome further questions about my blog posts because addressing those questions allows me to dive deeper into a pertinent topic for medical assistants who wish to better understand their scope of practice.

For instance, in response to my blog post “Standing Orders from an Overseeing Provider,” I received the following question:

Does a standing order change the supervision requirements for medical assistants? For example, if our state law requires the delegating licensed provider to be on the premises when a medical assistant is performing venipuncture, is this supervision requirement changed by a standing order from the provider?

A standing order does not change the supervision requirement established by state law. The supervision requirements apply regardless of whether the licensed provider issues a standing order, verbal order, or written order. If this were not the case, a provider could circumvent supervision requirements by issuing standing orders instead of verbal orders.

The purpose of supervision requirements is patient protection.

Standing Orders from an Overseeing Provider

I receive the following question about standing orders fairly often, and it is a bit difficult to answer because state law seldom addresses it:

Our new office manager claims that it is illegal for medical assistants to perform tasks based on standing orders of our licensed providers. She states that only licensed professionals, such as registered nurses (RNs), are permitted to work under standing orders. Is this legally accurate?

Most state laws do not prohibit physicians, nurse practitioners, and physician assistants from assigning tasks to unlicensed allied health professionals such as medical assistants by means of standing orders.

However, the crucial issue is what tasks medical assistants may or may not be delegated by standing order.

It is my legal opinion that medical assistants are permitted to receive and execute standing orders from an overseeing/delegating provider as long as the following conditions are met:

1. The standing order is understood by the medical assistant.
2. The standing order is for a task that is delegable to medical assistants under the laws of the state, and the delegating provider is exercising the degree of supervision required by the laws of the state.
3. The standing order is either patient-specific or applicable to all patients without exception.
4. The standing order does not require the medical assistant to exercise independent clinical judgment or make clinical assessments, evaluations, or interpretations.

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