BILL REQ. #:  H-3274.1 

Prefiled 01/05/12. Read first time 01/09/12.   Referred to Committee on Health Care & Wellness.

     AN ACT Relating to medical assistants; amending RCW 18.130.040 and 18.135.055; and adding a new chapter to Title 18 RCW.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF WASHINGTON:

NEW SECTION.  Sec. 1   The legislature finds that medical assistants are health professionals specifically trained to work in settings, such as physicians' offices, clinics, group practices, and other health care facilities. These multiskilled personnel are trained to perform administrative and clinical procedures under the supervision of health care providers. Physicians value this unique versatility more and more because of the skills of medical assistants and their ability to contain costs and manage human resources efficiently. The demand for medical assistants is expanding rapidly. The efficient and effective delivery of health care in Washington will be improved by recognizing the valuable contributions of medical assistants, and providing statutory support for medical assistants in Washington state. The legislature further finds that rural and small medical practices and clinics may have limited access to formally trained medical assistants.

NEW SECTION.  Sec. 2   The definitions in this section apply throughout this chapter unless the context clearly requires otherwise.
     (1) "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. "Delegation" may include standing orders.
     (2) "Department" means the department of health.
     (3) "Health care practitioner" means:
     (a) A physician licensed under chapter 18.71 RCW;
     (b) An osteopathic physician or 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, or an osteopathic physician assistant licensed under chapter 18.57A RCW.
     (4) "Medical assistant" means an unlicensed person who may assist a licensed health care practitioner in all aspects of health care under the supervision of a health care practitioner pursuant to this chapter. A medical assistant assists with patient care, executes administrative and clinical procedures, and performs functions as provided in section 5 of this act.
     (5) "Secretary" means the secretary of the department of health.
     (6) "Standing orders" means a written document containing rules, policies, procedures, regulations, and orders for the conduct of patient care in various stipulated clinical situations. The standing orders may be formulated collectively by the professional members of a department in a hospital or other health care facility, clinic, or practice. Standing orders may name the condition and prescribe the action to be taken in caring for the patient pursuant to recognized standards of patient care and clinical best practices.
     (7) "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, but does not need to be present during procedures to withdraw blood. "Supervision" may include standing orders.

NEW SECTION.  Sec. 3   No person may practice as a medical assistant unless that person is registered under section 4 of this act.

NEW SECTION.  Sec. 4   (1) The secretary shall issue a registration as a medical assistant to any person who has been either certified by the department or endorsed by a health care practitioner.
     (2) In order to be certified by the department, an individual must have satisfactorily completed a medical assistant training program approved by the secretary.
     (3) In order to be endorsed by a health care practitioner, an individual must:
     (a) Be endorsed by a health care practitioner, clinic, or group practice as provided in section 7 of this act; and
     (b) Have an attestation of their endorsement to perform those medical tasks signed by a supervising health care practitioner filed with the department.
     (4) The department shall make accommodations for rural and small medical practices and clinics by providing for alternative means by which medical assistants may qualify for registration under this section.

NEW SECTION.  Sec. 5   A medical assistant may perform the following duties under the supervision of a health care practitioner:
     (1) Fundamental procedures:
     (a) Wrapping items for autoclaving;
     (b) Sterilization procedures;
     (c) Disposing of biohazardous materials; and
     (d) Practicing standard precautions.
     (2) Clinical procedures:
     (a) Performing aseptic procedures;
     (b) Preparing of and assisting in sterile procedures;
     (c) Taking vital signs;
     (d) Preparing patients for examination;
     (e) Capillary blood withdrawal, venipuncture, and nonintravenous injection; and
     (f) Observing and reporting patients' signs or symptoms.
     (3) Specimen collection:
     (a) Capillary puncture and venipuncture;
     (b) Obtaining specimens for microbiological testing; and
     (c) Instructing patients in proper technique to collect urine and fecal specimens.
     (4) Diagnostic testing:
     (a) Electrocardiography;
     (b) Respiratory testing; and
     (c) Tests waived under the federal clinical laboratory improvement amendments program on the effective date of this section. The department shall periodically update the tests authorized under this subsection (4)(c) based on changes made by the federal clinical laboratory improvement amendments program.
     (5) Patient care:
     (a) Telephone and in-person screening limited to intake and gathering of information without requiring the exercise of judgment based on medical knowledge;
     (b) Acting under established standing orders under supervision when clinically indicated and when within the scope of practice provided in this section;
     (c) Obtaining vital signs;
     (d) Obtaining and recording patient history;
     (e) Preparing and maintaining examination and treatment areas;
     (f) Preparing patients for, and assisting with, routine and specialty examinations, procedures, treatments, and minor office surgeries;
     (g) Maintaining medication and immunization records; and
     (h) Screening and following up on test results.
     (6) Administering medications. A medication assistant may only administer medications if the medications are:
     (a) Administered only by unit or single dosage, or by a dosage calculated by a health care practitioner; and
     (b) Limited to legend drugs, vaccines, and schedule III-V controlled substances as authorized by a health care practitioner under the scope of his or her license.

NEW SECTION.  Sec. 6   Prior to delegation of any of the functions in section 5 of this act to a medical assistant, a health care practitioner shall determine to the best of his or her ability each of the following:
     (1) That the task is within that health care practitioner's scope of licensure or authority;
     (2) That the task is indicated for the patient;
     (3) The appropriate level of supervision;
     (4) That no law prohibits the delegation;
     (5) That the medical assistant to whom the task will be delegated is competent to perform that task; and
     (6) That the task itself is one that should be appropriately delegated when considering the following factors:
     (a) That the task can be performed without requiring the exercise of judgment based on medical knowledge;
     (b) That results of the task are reasonably predictable;
     (c) That the task can be performed without a need for complex observations or critical decisions;
     (d) That the task can be performed without repeated medical assessments; and
     (e) That the task, if performed improperly, would not present life-threatening consequences or the danger of immediate and serious harm to the patient.

NEW SECTION.  Sec. 7   The secretary shall adopt rules that establish the minimum requirements necessary for a health care practitioner, clinic, or group practice to endorse a medical assistant as qualified to perform the duties authorized by this chapter and be able to file an attestation of that endorsement with the department.

NEW SECTION.  Sec. 8   (1) In addition to any other authority provided by law, the secretary may:
     (a) Adopt rules, in accordance with chapter 34.05 RCW, necessary to implement this chapter;
     (b) Establish forms and procedures necessary to administer this chapter;
     (c) Establish administrative procedures, administrative requirements, and fees in accordance with RCW 43.70.250 and 43.70.280. For purposes of setting fees under this section, the secretary shall consider medical assistants and health care assistants, certified under chapter 18.135 RCW, as one profession;
     (d) Issue a registration to any applicant under section 4 of this act who has met the requirements for registration and deny a registration to applicants who do not meet the minimum qualifications for registration;
     (e) Hire clerical, administrative, and investigative staff as needed to implement and administer this chapter;
     (f) Maintain the official department of health record of all applicants and registrants; and
     (g) Establish requirements and procedures for an inactive registration.
     (2) The uniform disciplinary act, chapter 18.130 RCW, governs unregistered practice, the issuance and denial of a registration, and the discipline of persons registered under this chapter.

NEW SECTION.  Sec. 9   The secretary shall adopt rules to implement this act, including rules regarding the portability of a medical assistant registration from one practice setting to another.

NEW SECTION.  Sec. 10   (1) Nothing in this chapter affects health care assistants certified under chapter 18.135 RCW or other assistive health care personnel working under the supervision of a licensed health care practitioner consistent with the standards of care and best practices of that health care practitioners' license, except that persons currently certified as health care assistants, or other assistive health care personnel are eligible to become medical assistants so long as they meet the requirements set forth in this chapter.
     (2) Nothing in this chapter prohibits or affects:
     (a) The practice of dental therapy by an individual otherwise licensed under this title and performing services within his or her scope of practice; or
     (b) The practice of dental therapy in the discharge of official duties on behalf of the United States government, including, but not limited to, the armed forces, coast guard, public health service, veterans' bureau, or bureau of Indian affairs.

Sec. 11   RCW 18.130.040 and 2011 c 41 s 11 are each amended to read as follows:
     (1) This chapter applies only to the secretary and the boards and commissions having jurisdiction in relation to the professions licensed under the chapters specified in this section. This chapter does not apply to any business or profession not licensed under the chapters specified in this section.
     (2)(a) The secretary has authority under this chapter in relation to the following professions:
     (i) Dispensing opticians licensed and designated apprentices under chapter 18.34 RCW;
     (ii) Midwives licensed under chapter 18.50 RCW;
     (iii) Ocularists licensed under chapter 18.55 RCW;
     (iv) Massage operators and businesses licensed under chapter 18.108 RCW;
     (v) Dental hygienists licensed under chapter 18.29 RCW;
     (vi) East Asian medicine practitioners licensed under chapter 18.06 RCW;
     (vii) Radiologic technologists certified and X-ray technicians registered under chapter 18.84 RCW;
     (viii) Respiratory care practitioners licensed under chapter 18.89 RCW;
     (ix) Hypnotherapists and agency affiliated counselors registered and advisors and counselors certified under chapter 18.19 RCW;
     (x) Persons licensed as mental health counselors, mental health counselor associates, marriage and family therapists, marriage and family therapist associates, social workers, social work associates--advanced, and social work associates -- independent clinical under chapter 18.225 RCW;
     (xi) Persons registered as nursing pool operators under chapter 18.52C RCW;
     (xii) Nursing assistants registered or certified under chapter 18.88A RCW;
     (xiii) Health care assistants certified under chapter 18.135 RCW;
     (xiv) Dietitians and nutritionists certified under chapter 18.138 RCW;
     (xv) Chemical dependency professionals and chemical dependency professional trainees certified under chapter 18.205 RCW;
     (xvi) Sex offender treatment providers and certified affiliate sex offender treatment providers certified under chapter 18.155 RCW;
     (xvii) Persons licensed and certified under chapter 18.73 RCW or RCW 18.71.205;
     (xviii) Denturists licensed under chapter 18.30 RCW;
     (xix) Orthotists and prosthetists licensed under chapter 18.200 RCW;
     (xx) Surgical technologists registered under chapter 18.215 RCW;
     (xxi) Recreational therapists (([under chapter 18.230 RCW])) under chapter 18.230 RCW;
     (xxii) Animal massage practitioners certified under chapter 18.240 RCW;
     (xxiii) Athletic trainers licensed under chapter 18.250 RCW;
     (xxiv) Home care aides certified under chapter 18.88B RCW; ((and))
     (xxv) Genetic counselors licensed under chapter 18.290 RCW; and
     (xxvi) Medical assistants registered under chapter 18.--- RCW (the new chapter created in section 13 of this act).
     (b) The boards and commissions having authority under this chapter are as follows:
     (i) The podiatric medical board as established in chapter 18.22 RCW;
     (ii) The chiropractic quality assurance commission as established in chapter 18.25 RCW;
     (iii) The dental quality assurance commission as established in chapter 18.32 RCW governing licenses issued under chapter 18.32 RCW and licenses and registrations issued under chapter 18.260 RCW;
     (iv) The board of hearing and speech as established in chapter 18.35 RCW;
     (v) The board of examiners for nursing home administrators as established in chapter 18.52 RCW;
     (vi) The optometry board as established in chapter 18.54 RCW governing licenses issued under chapter 18.53 RCW;
     (vii) The board of osteopathic medicine and surgery as established in chapter 18.57 RCW governing licenses issued under chapters 18.57 and 18.57A RCW;
     (viii) The board of pharmacy as established in chapter 18.64 RCW governing licenses issued under chapters 18.64 and 18.64A RCW;
     (ix) The medical quality assurance commission as established in chapter 18.71 RCW governing licenses and registrations issued under chapters 18.71 and 18.71A RCW;
     (x) The board of physical therapy as established in chapter 18.74 RCW;
     (xi) The board of occupational therapy practice as established in chapter 18.59 RCW;
     (xii) The nursing care quality assurance commission as established in chapter 18.79 RCW governing licenses and registrations issued under that chapter;
     (xiii) The examining board of psychology and its disciplinary committee as established in chapter 18.83 RCW;
     (xiv) The veterinary board of governors as established in chapter 18.92 RCW; and
     (xv) The board of naturopathy established in chapter 18.36A RCW.
     (3) In addition to the authority to discipline license holders, the disciplining authority has the authority to grant or deny licenses. The disciplining authority may also grant a license subject to conditions.
     (4) All disciplining authorities shall adopt procedures to ensure substantially consistent application of this chapter, the Uniform Disciplinary Act, among the disciplining authorities listed in subsection (2) of this section.

Sec. 12   RCW 18.135.055 and 1996 c 191 s 83 are each amended to read as follows:
     The health care facility or health care practitioner registering an initial or continuing certification pursuant to the provisions of this chapter shall comply with administrative procedures, administrative requirements, and fees determined by the secretary as provided in RCW 43.70.250 and 43.70.280. For the purposes of setting fees under this section, the secretary shall consider health care assistants and medical assistants registered under chapter 18.--- RCW (the new chapter created in section 13 of this act), as one profession.
     All fees collected under this section shall be credited to the health professions account as required in RCW 43.70.320.

NEW SECTION.  Sec. 13   Sections 1 through 10 of this act constitute a new chapter in Title 18 RCW.