HOUSE BILL REPORT

ESSB 6237

This analysis was prepared by non-partisan legislative staff for the use of legislative members in their deliberations. This analysis is not a part of the legislation nor does it constitute a statement of legislative intent.

As Reported by House Committee On:

Health Care & Wellness

Health & Human Services Appropriations & Oversight

Title: An act relating to creating a career pathway for medical assistants.

Brief Description: Creating a career pathway for medical assistants.

Sponsors: Senate Committee on Health & Long-Term Care (originally sponsored by Senators Keiser, Conway, Kline, Frockt and Becker).

Brief History:

Committee Activity:

Health Care & Wellness: 2/15/12, 2/20/12 [DPA];

Health & Human Services Appropriations & Oversight: 2/22/12 [DPA(APPH w/o HCW)].

Brief Summary of Engrossed Substitute Bill

(As Amended by Committee)

  • Creates four new professions: medical assistant-certified; medical assistant-registered; medical assistant-hemodialysis technician; and medical assistant-phlebotomist.

  • Eliminates the health care assistant credential effective July 1, 2016.

HOUSE COMMITTEE ON HEALTH CARE & WELLNESS

Majority Report: Do pass as amended. Signed by 11 members: Representatives Cody, Chair; Jinkins, Vice Chair; Schmick, Ranking Minority Member; Hinkle, Assistant Ranking Minority Member; Bailey, Clibborn, Green, Harris, Kelley, Moeller and Van De Wege.

Staff: Jim Morishima (786-7191).

Background:

I. Health Care Assistants.

A certified health care assistant is authorized to provide assistance to certain licensed health care practitioners, such as physicians, nurses, and naturopaths. A licensed health practitioner may delegate certain functions to the health care assistant such as administering skin tests, injections, and performing blood withdrawals.

Each health care assistant is certified by the facility in which they are employed, or by the practitioner who delegates functions to the health care assistant, pursuant to standards adopted by the Department of Health (DOH) in rule. The facility or practitioner must submit a roster of certified health care assistants to the DOH.

Health care assistants are divided into seven different categories based on differing educational, training, and experiential requirements. The different tasks each category of health care assistant may perform are as follows (all health care assistants may administer vaccines):

II. Medical Assistants.

Medical assistants are assistive personnel who provide administrative or clinical tasks under the supervision of other health care practitioners. Although a variety of national organizations certify medical assistants, they are currently not a credentialed health profession in Washington.

In 2011 the DOH completed a sunrise review of a proposal to credential medical assistants. In its report, the DOH supported credentialing medical assistants, but also made recommendations regarding clarifying the current health care assistant credential. The DOH made the following recommendations:

III. Nursing Technicians.

A nursing technician is a person enrolled in a nursing program or a person who graduated from a nursing program within the last 30 days or within the past 60 days with permission from the Secretary of Health. A nursing technician may perform certain nursing tasks within the limits of his or her education and may only practice in a hospital or a nursing home.

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Summary of Amended Bill:

I. New Professions Created.

Four new professions are created: medical assistant-certified, medical assistant-registered, medical assistant-hemodialysis technician, and medical assistant-phlebotomist. No person may practice as one of the new professions unless he or she is appropriately certified or registered.

The Medical Quality Assurance Commission, the Board of Osteopathic Medicine and Surgery, the Podiatric Medical Board, the Nursing Care Quality Assurance Commission, the Board of Naturopathy, and the Optometry Board must each review and identify other specialty assistive personnel and the tasks they perform. The DOH must compile the information and submit it to the Legislature no later than December 15, 2012.

II. Qualifications for Certification/Registration.

A person meets the qualifications for certification as a medical assistant-certified if he or she satisfactorily completes a medical assistant training program approved by the Secretary of Health (Secretary), passes an examination approved by the Secretary, and meets any additional qualifications established by the Secretary in rule. A person who has not passed the examination may practice as a medical assistant-certified under an interim permit. The permit expires upon passage of the examination or after one year, whichever occurs first, and may not be renewed.

A person meets the qualifications for registration as a medical assistant-registered if he or she:

A person meets the qualifications for certification as a medical assistant-hemodialysis technician if he or she meets qualifications adopted by the Secretary in rule. The qualifications must be equivalent to the current qualifications for hemodialysis technicians certified as health care assistants.

A person meets the qualifications for certification as a medical assistant-phlebotomist if he or she meets qualifications adopted by the Secretary in rule.

An applicant with military training or experience satisfies the training or experience requirements of any of the new professions unless the Secretary determines that the military training or experience is not substantially equivalent to state standards.

III. Scope of Practice.

A medical assistant-certified may perform the following tasks delegated by, and under the supervision of, a health care practitioner:

A medical assistant-certified may also administer intravenous injections if he or she meets qualifications set by the Secretary. The qualifications must be substantially similar to the qualifications for category D and F health care assistants.

A medical assistant-registered may perform the same tasks as a medical assistant-certified, except a medical assistant-registered may not perform the following:

A medical assistant-hemodialysis technician may, under the delegation and supervision of a health care practitioner, perform hemodialysis and administer drugs and oxygen pursuant to rules adopted by the Secretary.

A medical assistant-phlebotomist may, under the delegation and supervision of a health care practitioner, perform capillary, venous, and arterial invasive procedures for blood withdrawal pursuant to rules adopted by the Secretary.

The following health care practitioners are authorized to delegate to, and supervise, a medical assistant:

Prior to delegating a task to a medical assistant, a health care practitioner must determine:

Protocols may be used as long as they do not involve clinical judgment and do not involve the administration of medications, other than vaccines.

IV. Portability.

A medical assistant-certified, medical assistant-hemodialysis technician, or a medical assistant-phlebotomist credential is transferable among different practice settings. A medical assistant-registered credential is not transferable to other practice settings.

V. Exemptions.

The following persons are exempt from certification or registration as a medical assistant:

Any medical assistant may perform blood withdrawal procedures in the residences of research study participants when the procedures have been authorized by the institutional review board of a comprehensive cancer center or nonprofit degree-granting institution of higher education and are conducted under the general supervision of a physician.

VI. Career Ladders.

Within existing resources, the Secretary must develop recommendations regarding a career path plan for medical assistants. When developing the recommendations, the Secretary must consult with stakeholders, including health care practitioner professional organizations, organizations representing health care workers, community colleges, career colleges, and technical colleges. The recommendations must include methods for including credit for prior learning. The purpose of the recommendations is to evaluate and map career paths for medical assistants and entry-level health care workers to transition by means of a career ladder into medical assistants or other health care professions. The recommendations must identify barriers to career advancement and career ladder training initiatives. The recommendations must be reported to the Legislature no later than December 15, 2012.

VII. Health Care Assistants.

Certified health care assistants are converted to medical assistants upon renewal of their certifications in the following manner:

The health care assistant credential is eliminated effective July 1, 2016. Until July 1, 2016, the DOH must consider medical assistants and health care assistants as one profession for purposes of calculating licensing fees.

VIII. Nursing Technicians.

Nursing technicians may practice in a clinical setting.

Amended Bill Compared to Engrossed Substitute Bill:

The amended bill:

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Appropriation: None.

Fiscal Note: Available. New fiscal note requested on February 21, 2012.

Effective Date of Amended Bill: The bill takes effect 90 days after adjournment of the session in which the bill is passed, except for sections 1 through 12, 14, 16, and 18, relating to the creation of the new medical assistant credentials, which take effect on July 1, 2013, and sections 15 and 17, relating to the elimination of the health care assistant credential, which take effect July 1, 2016.

Staff Summary of Public Testimony:

(In support) This bill comes out of the sunrise review. There are currently too many categories of health care assistants and no pathways for people to move forward in terms of skills and income.

(In support with amendments) Certifying medical assistants is a good idea. Medical assistants are entry-level professionals and a career ladder would be beneficial. There should be provisions in this bill dealing with students in internships/externships. The language in the House companion (Substitute House Bill 2227) would be preferable, once perfected.

(With concerns) Medical assistants should be regulated and health care assistants should be transitioned to the new credential. Patient safety will be supported through clear qualifications, scope, and training. Requiring a preliminary plan to be submitted to the Legislature could delay this process. The language in the House companion is preferable.

(Opposed) This scope of authority for medical assistants is too general, especially in the area of medication administration. The House and Senate versions should be merged.

Persons Testifying: (In support) Senator Keiser, prime sponsor.

(In support with amendments) Carl Nelson, Washington State Medical Association; Linda Hull, The Everett Clinic; and Gail McGaffick, Corinthian Colleges.

(With concerns) Karen Jensen, Department of Health; and Joe King, Group Health Cooperative.

(Opposed) Sofia Aragon, Washington State Nurses Association.

Persons Signed In To Testify But Not Testifying: None.

HOUSE COMMITTEE ON HEALTH & HUMAN SERVICES APPROPRIATIONS & OVERSIGHT

Majority Report: Do pass as amended by Committee on Health & Human Services Appropriations & Oversight and without amendment by Committee on Health Care & Wellness. Signed by 9 members: Representatives Dickerson, Chair; Appleton, Vice Chair; Schmick, Assistant Ranking Minority Member; Cody, Green, Harris, Kagi, Pettigrew and Walsh.

Minority Report: Do not pass. Signed by 1 member: Representative Overstreet.

Staff: Amy Skei (786-7109).

Summary of Recommendation of Committee On Health & Human Services Appropriations & Oversight Compared to Recommendation of Committee On Health Care & Wellness:

The Health and Human Services Appropriations and Oversight (APPH) Committee recommended that medications administered by a medical assistant-certified that are by a dosage calculated by a health care practitioner must also be verified by the health care practitioner. The APPH Committee also recommended technical corrections to the names of two of the health professions included in the definition of "health care practitioner."

Appropriation: None.

Fiscal Note: Available. New fiscal note requested on February 21, 2012.

Effective Date of Amended Bill: The bill takes effect 90 days after adjournment of the session in which the bill is passed, except for sections 1 through 12, 14, 16, and 18, relating to the creation of the new medical assistant credentials, which take effect on July 1, 2013, and sections 15 and 17, relating to the elimination of the health care assistant credential, which take effect July 1, 2016.

Staff Summary of Public Testimony:

(In support) Practices and clinics need a way to define what their medical assistants do in order to receive Medicaid and Medicare reimbursement. With the implementation of electronic medical records, there are grants available, and, in order to receive them, practices have to be able to define what their employees do.

The bill should be modified to deal with verification of dosages. Medical assistants are not allowed to express clinical judgment, so the bill should clarify that a health care practitioner will calculate the dose of a medication and verify that it is correct. This will make it clear that this will not be left up to the medical assistant.

(Opposed) None.

Persons Testifying: Carl Nelson, Washington State Medical Association; and Melissa Johnson, Washington State Nurses Association.

Persons Signed In To Testify But Not Testifying: None.