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):

Category A: venous and capillary invasive procedures for blood withdrawal;
Category B: arterial invasive procedures for blood withdrawal;
Category C: intradermal, subcutaneous, and intramuscular injections for diagnostic agents and the administration of skin tests;
Category D: intravenous injections for diagnostic agents;
Category E: intradermal, subcutaneous, and intramuscular injections and the administration of skin tests;
Category F: intravenous injections for therapeutic agents; and
Category G: hemodialysis.

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:

Blend the existing health care assistant categories with a medical assistant certification.
- Categories C and E would be replaced with a certified medical assistant credential.
- Categories A and B would be replaced with a certified phlebotomist credential.
- Category G would be replaced with a certified hemodialysis technician credential.
Remove the requirement that a credential holder obtain a new credential every time he or she leaves a facility or delegator.
Require the following qualifications for new applicants:
- Certified medical assistants must complete a medical assistant training program and pass an examination (both the program and the exam must be approved by the Secretary of Health).
- Certified phlebotomists must meet the same qualifications as category A and B health care assistants.
- Certified hemodialysis technicians must meet the same qualifications as category G health care assistants.
"Grandfather" current health care assistants in the following manner:
- Category C or E health care assistants would become medical assistants upon renewal and submission of a practice arrangement plan.
- Category A or B health care assistants would become phlebotomists upon renewal.
- Category G health care assistants would become hemodialysis technicians upon renewal.
- More research is necessary to determine what should be done with category D and F health care assistants.
Set parameters around medication administration for medical assistants.
Set parameters around office medical equipment usage for medical assistants.
Include criteria that identify the nature of the tasks a medical assistant can perform.

Summary of Bill:

Health care assistants are renamed medical assistants. Beginning July 1, 2014, no person may represent himself or herself as a medical assistant unless he or she is certified by the DOH. In order to be certified, an applicant must:

be 18 years of age or older;
satisfactorily complete a medical assistant program approved by the Secretary of Health (Secretary);
satisfactorily complete an examination approved by the Secretary; and
demonstrate evidence of completing the education and training requirements for the category of medical assistant for which the person is seeking certification.

The Secretary may certify a person without an examination if:

the person is a certified medical assistant in another jurisdiction and the requirements of that jurisdiction are equivalent to Washington's; or
the person is practicing as a certified health care assistant and is in good standing. The Secretary must certify the person for the category of medical assistant that is appropriate for the person's education and experience and may only exempt a health care assistant from the examination until July 1, 2014.

A medical assistant may perform delegated medical tasks related to:

administering first aid;
collecting routine laboratory specimens;
assisting with patient examinations or treatment;
performing minor clinical procedures;
operating office medical equipment;
performing basic laboratory procedures; and
administering medications by unit, single, or calculated dosage, including vaccines.

The Secretary must, by rule, create categories of medical assistants that reflect an increasing level of skill and responsibility and describe the training, experience, education, or examination requirements for each category. The rules must create a category of medical assistants for hemodialysis technicians that allows the technician to be trained by the facility in which the person is employed if the training program is approved by the DOH (a hemodialysis technician trained by his or her facility is exempt from all of the requirements for other medical assistants, except the age requirement). The Secretary must also adopt rules that provide for the transition of health assistants to medical assistants and ensure that a health care assistant practicing prior to July 1, 2014, will be certified in the appropriate medical assistant category.

The following health care practitioners may delegate to a medical assistant:

physicians and osteopathic physicians and surgeons;
podiatric physicians and surgeons;
registered nurses;
advanced registered nurse practitioners;
naturopaths; and
physician assistants and osteopathic physician assistants.

The Secretary must establish a career ladder for medical assistants. The career ladder must specify the training, experience, education, or examination requirements for entry-level health care workers to transition to medical assistants, for medical assistants to transition to a higher category of medical assistant, and for medical assistants to transition to other health care professions. The career ladder must also include:

the minimum requirements for the entry-level category;
education and experience requirements that are needed for medical assistants to advance to another category (medical assistants may be trained in procedures in a higher category under the supervision of a health care practitioner);
on-the-job instruction and training;
the procedures medical assistants are able to assist with during training to assist them in advancing up the ladder;
requirements to assist entry-level health care workers in other fields, such as home care aides, to advance into a medical assistant position; and
education and experience requirements to assist medical assistants to move into other health care professions, including nursing, that would benefit from their experience and training.

Before adopting any rules, the Secretary must submit a preliminary plan to the appropriate committees of the Legislature that includes the categories of medical assistants (and their scopes of practice) and a plan for transitioning health care assistants to medical assistants.

The Secretary is given a variety of administrative duties related to the new medical assistant credential, including establishing forms, issuing and denying certifications, hiring staff, maintaining records, conducting hearings, investigating violations and complaints, issuing subpoenas and other documents relating to disciplinary proceedings, conducting disciplinary proceedings, setting fees, setting certification renewal periods, and setting continuing education requirements.