BILL REQ. #:  H-1694.1 

READ FIRST TIME 02/22/13.   

     AN ACT Relating to medical assistants; amending RCW 18.360.005, 18.360.040, 18.360.050, 18.360.060, and 18.360.080; creating a new section; providing an effective date; and declaring an emergency.

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

Sec. 1   RCW 18.360.005 and 2012 c 153 s 1 are each amended to read as follows:
     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 intends that individuals performing specialized functions be trained and supervised in a manner that will not pose an undue risk to patient safety. The legislature further finds that rural and small medical practices and clinics may have limited access to formally trained medical assistants. The legislature further intends that the secretary of health develop recommendations for a career ladder that includes medical assistants.

Sec. 2   RCW 18.360.040 and 2012 c 153 s 5 are each amended to read as follows:
     (1)(a) The secretary shall issue a certification as a medical assistant-certified to any person who has satisfactorily completed a medical assistant training program approved by the secretary, passed an examination approved by the secretary, and met any additional qualifications established under RCW 18.360.030.
     (b) The secretary shall issue an interim certification to any person who has met all of the qualifications in (a) of this subsection, except for the passage of the examination. A person holding an interim permit possesses the full scope of practice of a medical assistant-certified. The interim permit expires upon passage of the examination or after one year, whichever occurs first, and may not be renewed.
     (2) The secretary shall issue a certification as a medical assistant-hemodialysis technician to any person who meets the qualifications for a medical assistant-hemodialysis technician established under RCW 18.360.030.
     (3) The secretary shall issue a certification as a medical assistant-phlebotomist to any person who meets the qualifications for a medical assistant-phlebotomist established under RCW 18.360.030.
     (4)(a) The secretary shall issue a registration as a medical assistant-registered to any person who has a current endorsement from a health care practitioner, clinic, or group practice.
     (b) In order to be endorsed under this subsection (4), a person must:
     (i) Be endorsed by a health care practitioner, clinic, or group practice that meets the qualifications established under RCW 18.360.030; and
     (ii) Have a current attestation of his or her endorsement to perform specific medical tasks signed by a supervising health care practitioner filed with the department. A medical assistant-registered may only perform the medical tasks listed in his or her current attestation of endorsement.
     (c) A registration based on an endorsement by a health care practitioner, clinic, or group practice is not transferrable to another health care practitioner, clinic, or group practice.
     (d) An applicant for registration as a medical assistant-registered who applies to the department within seven days of employment by the endorsing health care practitioner, clinic, or group practice may work as a medical assistant-registered for up to sixty days while the application is processed. The applicant must stop working on the sixtieth day of employment if the registration has not been granted for any reason.
     (5) A certification issued under subsections (1) through (3) of this section is transferrable between different practice settings.

Sec. 3   RCW 18.360.050 and 2012 c 153 s 6 are each amended to read as follows:
     (1) A medical assistant-certified may perform the following duties delegated by, and under the supervision of, a health care practitioner:
     (a) Fundamental procedures:
     (i) Wrapping items for autoclaving;
     (ii) Procedures for sterilizing equipment and instruments;
     (iii) Disposing of biohazardous materials; and
     (iv) Practicing standard precautions.
     (b) Clinical procedures:
     (i) Performing aseptic procedures in a setting other than a hospital licensed under chapter 70.41 RCW;
     (ii) Preparing of and assisting in sterile procedures in a setting other than a hospital under chapter 70.41 RCW;
     (iii) Taking vital signs;
     (iv) Preparing patients for examination;
     (v) Capillary blood withdrawal, venipuncture, and intradermal, subcutaneous, and intramuscular injections; and
     (vi) Observing and reporting patients' signs or symptoms.
     (c) Specimen collection:
     (i) Capillary puncture and venipuncture;
     (ii) Obtaining specimens for microbiological testing; and
     (iii) Instructing patients in proper technique to collect urine and fecal specimens.
     (d) Diagnostic testing:
     (i) Electrocardiography;
     (ii) Respiratory testing; and
     (iii)(A) Tests waived under the federal clinical laboratory improvement amendments program on July 1, 2013. The department shall periodically update the tests authorized under this subsection (1)(d) based on changes made by the federal clinical laboratory improvement amendments program; and
     (B) Moderate complexity tests if the medical assistant-certified meets standards for personnel qualifications and responsibilities in compliance with federal regulation for nonwaived testing.
     (e) Patient care:
     (i) Telephone and in-person screening limited to intake and gathering of information without requiring the exercise of judgment based on clinical knowledge;
     (ii) Obtaining vital signs;
     (iii) Obtaining and recording patient history;
     (iv) Preparing and maintaining examination and treatment areas;
     (v) Preparing patients for, and assisting with, routine and specialty examinations, procedures, treatments, and minor office surgeries;
     (vi) Maintaining medication and immunization records; and
     (vii) Screening and following up on test results as directed by a health care practitioner.
     (f)(i) Administering medications. A medical assistant-certified may only administer medications if the drugs are:
     (A) Administered only by unit or single dosage, or by a dosage calculated and verified by a health care practitioner. For purposes of this section, a combination or multidose vaccine shall be considered a unit dose;
     (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 and consistent with rules adopted by the secretary under (f)(ii) of this subsection; and
     (C) Administered pursuant to a written order from a health care practitioner.
     (ii) A medical assistant-certified may not administer experimental drugs or chemotherapy agents. The secretary may, by rule, further limit the drugs that may be administered under this subsection (1)(f). The rules adopted under this subsection must limit the drugs based on risk, class, or route.
     (g) Intravenous injections. A medical assistant-certified may administer intravenous injections for diagnostic or therapeutic agents under the direct visual supervision of a health care practitioner if ((he or she)) the medical assistant-certified meets minimum standards established by the secretary in rule. The minimum standards must be substantially similar to the qualifications for category D and F health care assistants as they exist on July 1, 2013.
     (h) Urethral catheterization when appropriately trained.
     (2) A medical assistant-hemodialysis technician may perform hemodialysis when delegated and supervised by a health care practitioner. A medical assistant-hemodialysis technician may also administer drugs and oxygen to a patient when delegated and supervised by a health care practitioner and pursuant to rules adopted by the secretary.
     (3) A medical assistant-phlebotomist may perform capillary, venous, or arterial invasive procedures for blood withdrawal when delegated and supervised by a health care practitioner and pursuant to rules adopted by the secretary.
     (4) A medical assistant-registered may perform the following duties delegated by, and under the supervision of, a health care practitioner:
     (a) Fundamental procedures:
     (i) Wrapping items for autoclaving;
     (ii) Procedures for sterilizing equipment and instruments;
     (iii) Disposing of biohazardous materials; and
     (iv) Practicing standard precautions.
     (b) Clinical procedures:
     (i) Preparing for sterile procedures;
     (ii) Taking vital signs;
     (iii) Preparing patients for examination; and
     (iv) Observing and reporting patients' signs or symptoms.
     (c) Specimen collection:
     (i) Obtaining specimens for microbiological testing; and
     (ii) Instructing patients in proper technique to collect urine and fecal specimens.
     (d) Patient care:
     (i) Telephone and in-person screening limited to intake and gathering of information without requiring the exercise of judgment based on clinical knowledge;
     (ii) Obtaining vital signs;
     (iii) Obtaining and recording patient history;
     (iv) Preparing and maintaining examination and treatment areas;
     (v) Preparing patients for, and assisting with, routine and specialty examinations, procedures, treatments, and minor office surgeries. The department may, by rule, prohibit duties authorized under this subsection (4)(d)(v) if performance of those duties by a medical assistant-registered would pose an unreasonable risk to patient safety;
     (vi) Maintaining medication and immunization records; and
     (((vi))) (vii) Screening and following up on test results as directed by a health care practitioner.
     (e)(i) Tests waived under the federal clinical laboratory improvement amendments program on July 1, 2013. The department shall periodically update the tests authorized under subsection (1)(d) of this section based on changes made by the federal clinical laboratory improvement amendments program.
     (ii) Moderate complexity tests if the medical assistant-registered meets standards for personnel qualifications and responsibilities in compliance with federal regulation for nonwaived testing.
     (f) Administering eye drops, topical ointments, and vaccines, including combination or multidose vaccines.
     (g) Urethral catheterization when appropriately trained.

Sec. 4   RCW 18.360.060 and 2012 c 153 s 7 are each amended to read as follows:
     (1) Prior to delegation of any of the functions in RCW 18.360.050, a health care practitioner shall determine to the best of his or her ability each of the following:
     (a) That the task is within that health care practitioner's scope of licensure or authority;
     (b) That the task is indicated for the patient;
     (c) The appropriate level of supervision;
     (d) That no law prohibits the delegation;
     (e) That the person to whom the task will be delegated is competent to perform that task; and
     (f) That the task itself is one that should be appropriately delegated when considering the following factors:
     (i) That the task can be performed without requiring the exercise of judgment based on clinical knowledge;
     (ii) That results of the task are reasonably predictable;
     (iii) That the task can be performed without a need for complex observations or critical decisions;
     (iv) That the task can be performed without repeated clinical assessments; and
     (v)(A) For a medical assistant other than a medical assistant-hemodialysis technician, that the task, if performed improperly, would not present life-threatening consequences or the danger of immediate and serious harm to the patient; and
     (B) For a medical assistant-hemodialysis technician, that the task, if performed improperly, is not likely to present life-threatening consequences or the danger of immediate and serious harm to the patient.
     (2) Nothing in this section prohibits the use of protocols that do not involve clinical judgment and do not involve the administration of medications, other than vaccines.

Sec. 5   RCW 18.360.080 and 2012 c 153 s 9 are each amended to read as follows:
     (1) The department may not issue new certifications for category C, D, E, or F health care assistants on or after July 1, 2013. The department shall certify a category C, D, E, or F health care assistant whose certification is in good standing and who was certified prior to July 1, 2013, as a medical assistant-certified when he or she renews his or her certification.
     (2) The department may not issue new certifications for category G health care assistants on or after July 1, 2013. The department shall certify a category G health care assistant whose certification is in good standing and who was certified prior to July 1, 2013, as a medical assistant-hemodialysis technician when he or she renews his or her certification.
     (3) The department may not issue new certifications for category A or B health care assistants on or after July 1, 2013. The department shall certify a category A or B health care assistant whose certification is in good standing and who was certified prior to July 1, 2013, as a medical assistant-phlebotomist when he or she renews his or her certification.

NEW SECTION.  Sec. 6   The department of health may delay the implementation of the medical assistant-registered credential to the extent necessary to comply with this act.

NEW SECTION.  Sec. 7   This act is necessary for the immediate preservation of the public peace, health, or safety, or support of the state government and its existing public institutions, and takes effect July 1, 2013.