HOUSE BILL REPORT

HB 2227

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

Title: An act relating to medical assistants.

Brief Description: Regarding medical assistants.

Sponsors: Representatives Cody and Jinkins.

Brief History:

Committee Activity:

Health Care & Wellness: 1/12/12, 1/26/12 [DPS].

Brief Summary of Substitute Bill

  • 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: The substitute bill be substituted therefor and the substitute bill do pass. Signed by 10 members: Representatives Cody, Chair; Jinkins, Vice Chair; Schmick, Ranking Minority Member; Hinkle, Assistant Ranking Minority Member; 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:

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Summary of Substitute 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.

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 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.

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-registered may perform the same tasks as a medical assistant-certified, except a medical assistant-registered may notperform the following:

A medical assistant-hemodialysis technician may, under the delegation and supervision of a health care practitioner, perform hemodialysis and administer vaccines, 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 and administer vaccines 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:

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. 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.

Substitute Bill Compared to Original Bill:

The substitute bill:

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Appropriation: None.

Fiscal Note: Available.

Effective Date of Substitute Bill: The bill takes effect 90 days after adjournment of the session in which the bill is passed, except for sections 1 through 11, 13, and 15, relating to the creation of the new medical assistant credentials, which take effect on July 1, 2013, and sections 12 and 14, relating to the elimination of the health care assistant credential, which take effect July 1, 2016.

Staff Summary of Public Testimony:

(In support) Medical assistants are a vital part of many medical practices—they can perform a variety of procedures that do not require medical judgment. Medical assistants are an important part of medical homes and specialty clinics. Medical assistants are one of the fastest growing professions in Washington. This bill will protect the public from sub-standard medical assistant services while increasing the availability of medical services (including primary care) without compromising quality. This bill will increase safety for Washington citizens. Medical assistants are recognized by a variety of national organizations and are becoming subject to more educational requirements. This legislation closely tracks the DOH's sunrise review. Medication administration is limited to situations that do not require clinical judgment. Another safeguard in this bill is that a delegator must be sure of the medical assistant's competency prior to delegation. Health care assistants should remain a separate profession, but they should be combined for purposes of setting fees. The scope of drugs authorized by this bill should be expanded to include certain schedule II controlled substances. The current medical assistant scope of practice has been in turmoil because of changing interpretations by the DOH—this bill does not expand this existing scope of practice. The medical assistant scope should evolve with technological changes.

(With concerns) Medical assistants, who are often confused with nurses, should be regulated, but in a manner more closely reflective of the DOH sunrise review. Delegation inflation is a concern. Medical assistants should not be able to administer medications or respiratory tests without more training.

(Opposed) There should be more education standards in this bill. The new credential should be portable. The scope of practice in this bill is broad and goes beyond low-risk tasks. The drugs that may be administered should be stated in the bill. The provisions of the bill authorizing standing orders may result in unsupervised practice by medical assistants. The difference between health care assistants and medical assistants should be clarified. This bill is confusing with respect to whether the medical assistants are registered or certified.

Persons Testifying: (In support) Representative Cody, prime sponsor; Carl Nelson and Doug Meyers, Washington State Medical Association; Donald A. Balasa, American Association of Medical Assistants and Washington State Society of Medical Assistants; Sherry Hawkins, Wenatchee Valley Medical Center; Tom Wolf, Washington State Society of Medical Assistants; Debbie Quinn, MultiCare Health System; Carl Olden, Washington Academy of Family Physicians; Stu Burger, Everett Community College; Peg Gerber, Pima Medical Institute; Judy Mitacek, Polyclinic; Gena Wikstrom, Northwest Career Colleges Federation; Kevin Haughton, Providence; Philip Lundberg, Charter College; Karen Jensen, Department of Health; and Lisa Thatcher, Washington State Hospital Association.

(With concerns) Paula Meyer, Nursing Commission; Chris Barton, Service Employees International Union 1199NW; Amber Ulvenes, Group Health Cooperative; and Nick Federici, Respiratory Care Society of Washington.

(Opposed) Sofia Aragon, Washington State Nurses Association.

Persons Signed In To Testify But Not Testifying: None.