Scope of Practice

The AAMA Achieves Legislative Victories in Maryland and Washington

During the COVID-19 pandemic, medical assistants have risen to the occasion by undertaking expanded duties. As a result, they have been given opportunities to join in combatting the pandemic because of favorable federal and state legislation, executive orders, and official rules and interpretations by federal agencies. These developments have been chronicled on the “State Scope of Practice Laws” webpage of the AAMA website, via this blog, and in CMA Today

Notably, two such bills from Maryland and Washington will have precedential weight and influence on future medical assisting laws and create a lasting impact extending well beyond the pandemic. 

To learn more about these momentous bills and related trends in medical assisting, read the July/August 2021 Public Affairs article in CMA Today, “The AAMA Achieves Legislative Victories in Maryland and Washington.” 

Scope of Practice

Multi-State Scope of Practice for Medical Assistants

I recently received an inquiry regarding medical assisting scope of practice laws across the U.S.:

I am a CMA (AAMA) residing in Washington. I am trying to find all the scope of practice laws for my current job. I work for a start-up health care/technology company [that] serves all 50 states. All our physicians are licensed in each state, and we are trying to implement the use of CMAs (AAMA) to better serve our patient load. Would I need to follow each state’s rules, or because the company is in Washington, would I just follow Washington’s rules?

I feel as though Washington [law] is the strictest. [Do you think] any other states seem to be a little stricter?

To find the medical assisting laws of all states, go to the “State Scope of Practice Laws” webpage on the AAMA website

Because medical assistants employed by this company work under the authority of physicians in all states, they are required to abide by the laws of all states.

Washington has more requirements that medical assistants must meet to work as medical assistants than any other state. Further, Washington law requires medical assistants to meet specified requirements for a category of medical assistants and register with the Washington State Department of Health in that category in order to work.

However, some states have more limitations on tasks that medical assistants are permitted to be delegated and to perform.

Two of my Public Affairs articles published in CMA Today, “What Tasks Are Delegable to—and Performable by—Medical Assistants?” part I and part II, contain legal principles generally applicable in all U.S. jurisdictions. Note the following excerpt from the handout that served as the source material for those articles:

7. General legal principles—

• It is not permissible for medical assistants to perform tasks that constitute the practice of medicine, or require the skill and knowledge of physicians or other licensed providers;

• It is not permissible for medical assistants to perform tasks that are restricted in state law to other health professionals—often licensed health professionals;

• It is not permissible for medical assistants to perform tasks that require the exercise of independent clinical judgment, and/or the making of clinical assessments, evaluations, or interpretations;

On the Job, Scope of Practice

Legal Requirements for Venipuncture in Washington

I recently received the following question regarding the legality of medical assistants performing venipuncture in Washington:

I am licensed as a medical assistant-certified (MA-C) under Washington law. Do I need to obtain the Washington state medical assistant-phlebotomist credential in order to perform venipuncture?

To answer this question, note the following excerpt from the Washington State Department of Health’s Frequently Asked Questions webpage:

The scope of practice of a medical assistant-phlebotomist includes capillary, venous, and arterial invasive procedures for blood withdrawal, CLIA [Clinical Laboratory Improvement Amendments] waived, moderate and high complexity tests, and [(electrocardiogram (ECG)]. A medical assistant-certified may perform capillary and venous blood withdrawals, CLIA waived and moderated complexity tests, and [ECG] but may not perform arterial invasive procedures for blood withdrawal or high complexity designated CLIA tests. If you hold a medical assistant-certified credential, you need only to retain your medical assistant-phlebotomist credential if you’re required to perform arterial invasive procedures for blood withdrawal or high complexity tests.

delegation, Scope of Practice

The Delegation of Off-Site Blood Draws in WA

In-home patient visits necessitated by COVID-19 raise questions about the scope of practice for medical assistants working off-site. For example, I received the following email from a Washington chief of primary care regarding delegation during off-site visits:

We are instituting programs where medical assistants see patients in their homes and help set them up for video visits [in response to COVID-19]. Many of our providers are requesting [laboratory work] from these appointments. [Can] a phlebotomy-certified medical assistant draw blood if a provider is not in attendance and the patient is doing a video visit with the provider?

To answer this question, note the following excerpt from the Washington statutes, especially the italicized, underlined language at the end of this excerpt:

RCW 18.360.010

Definitions. (Effective until July 1, 2022.)

The definitions in this section apply throughout this chapter unless the context clearly requires otherwise.

(1) “Administer” means the retrieval of medication, and its application to a patient, as authorized in RCW 18.360.050.

(2) “Delegation” means direct authorization granted by a licensed health care practitioner to a medical assistant to perform the functions authorized in this chapter which fall within the scope of practice of the health care provider and the training and experience of the medical assistant.

(3) “Department” means the department of health.

(4) “Forensic phlebotomist” means a police officer, law enforcement officer, or employee of a correctional facility or detention facility, who is certified under this chapter and meets any additional training and proficiency standards of [their] employer to collect a venous blood sample for forensic testing pursuant to a search warrant, a waiver of the warrant requirement, or exigent circumstances.

(5) “Health care practitioner” means:

(a) A physician licensed under chapter 18.71 RCW;

(b) An osteopathic physician and surgeon licensed under chapter 18.57 RCW; or

(c) Acting within the scope of their respective licensure, a podiatric physician and surgeon licensed under chapter 18.22 RCW, a registered nurse or advanced registered nurse practitioner licensed under chapter 18.79 RCW, a naturopath licensed under chapter 18.36A RCW, a physician assistant licensed under chapter 18.71A RCW, an osteopathic physician assistant licensed under chapter 18.57A RCW, or an optometrist licensed under chapter 18.53 RCW.

(6) “Medical assistant-certified” means a person certified under RCW 18.360.040 who assists a health care practitioner with patient care, executes administrative and clinical procedures, and performs functions as provided in RCW 18.360.050 under the supervision of the health care practitioner.

(7) “Medical assistant-hemodialysis technician” means a person certified under RCW 18.360.040 who performs hemodialysis and other functions pursuant to RCW 18.360.050 under the supervision of a health care practitioner.

(8) “Medical assistant-phlebotomist” means a person certified under RCW 18.360.040 who performs capillary, venous, and arterial invasive procedures for blood withdrawal and other functions pursuant to RCW 18.360.050 under the supervision of a health care practitioner.

(9) “Medical assistant-registered” means a person registered under RCW 18.360.040 who, pursuant to an endorsement by a health care practitioner, clinic, or group practice, assists a health care practitioner with patient care, executes administrative and clinical procedures, and performs functions as provided in RCW 18.360.050 under the supervision of the health care practitioner.

(10) “Secretary” means the secretary of the department of health.

(11) “Supervision” means supervision of procedures permitted pursuant to this chapter by a health care practitioner who is physically present and is immediately available in the facility. The health care practitioner does not need to be present during procedures to withdraw blood, but must be immediately available [emphasis added].

My legal opinion is that the above language permits licensed providers to assign to medical assistants who are off-site in the homes of patients the performing of phlebotomy/venipuncture as long as the delegating/overseeing provider is immediately available, such as by video or audio means.

On the Job

Continuing Education Requirements for Medical Assistant-Certified Credential in WA

In 2020, a bill (HB 2351) was introduced in the Washington State House of Representatives that would establish continuing education requirements for the medical assistant-certified credential.

I teamed up with the Washington State Society of Medical Assistants to submit comments in support of the bill to the House Health Care & Wellness Committee on January 27, 2020. These comments are presented in the May/June 2020 Public Affairs article, “Continuing Education Requirements for Medical Assistant-Certified Credential in WA,” on the AAMA website.

Information on the bill’s status is available on a dedicated webpage of the Washington State Legislature website.