House of Representatives
Office of Program Research
Health Care & Wellness Committee
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.
Brief Description: Concerning medical assistants.
Sponsors: Representatives Cody, Jinkins, Green, Morrell and Ryu.
Hearing Date: 2/7/13
Staff: Jim Morishima (786-7191).
I. Medical Assistants.
Last year, four new professions were created: medical assistant-certified (MA-Certified), medical assistant-registered (MA-Registered), medical assistant-hemodialysis technician (MA-Hemodialysis Technician, and medical assistant-phlebotomist (MA-Phlebotomist).
A person meets the qualifications for certification as an MA-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 an MA-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 an MA-Registered if he or she:
is endorsed by a health care practitioner, clinic, or group practice, that meets qualifications established by the Secretary; and
has a current attestation of his or her endorsement to perform specific medical tasks signed by a supervising health care practitioner filed with the Department of Health (DOH). An MA-Registered may only perform the medical tasks listed on the attestation.
A person meets the qualifications for certification as an MA-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 an MA-Phlebotomist if he or she meets qualifications adopted by the Secretary in rule.
III. Scope of Practice.
An MA-Certified may perform the following tasks delegated by, and under the supervision of, a health care practitioner:
fundamental procedures: wrapping items for autoclaving, procedures for sterilizing equipment and instruments, disposing of biohazardous materials, and practicing standard precautions;
clinical procedures: performing aseptic procedures in settings other than hospitals, preparing of and assisting in sterile procedures in settings other than hospitals, taking vital signs, preparing patients for examination, capillary blood withdrawal, venipuncture, and intradermal, subcutaneous, and intramuscular injection, and observing and reporting patients' signs or symptoms;
specimen collection: capillary puncture and venipuncture, obtaining specimens for microbiological testing, and instructing patients in the proper technique to collect urine and fecal specimens;
diagnostic testing: electrocardiography, respiratory testing, and tests waived under the federal Clinical Laboratory Improvement Amendments (CLIA) program (the DOH may update this list by rule based on changes to the CLIA program);
patient care: telephone and in-person screening limited to intake and gathering of information without requiring the exercise of judgment based on clinical knowledge, obtaining vital signs, obtaining and recording patient history, preparing and maintaining examination and treatment areas, preparing patients for, and assisting with, examinations, procedures, treatments, and minor office surgeries, maintaining medication records, and screening and following up on test results as directed by a health care practitioner; and
administering medications that are: (1) administered only by unit or single dosage or by a dosage calculated and verified by a health care practitioner; (2) administered pursuant to a written order; and (3) limited to legend drugs, vaccines (including combination vaccines), and schedule III-IV controlled substances as authorized by a health care practitioner under the scope of his or her license. The Secretary may, by rule, limit the drugs that may be administered by an MA-Certified based on risk, class, or route.
An MA-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.
An MA-Registered may perform the same tasks as an MA-Certified, except:
blood withdrawal or injections;
electrocardiography and respiratory testing;
preparing patients for, and assisting with, routine and specialty examinations, procedures, treatments, and minor office surgeries;
intravenous injections; and
the administration of medications (a medical assistant-registered may, however, administer vaccines).
An MA-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.
An MA-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:
a physician or an osteopathic physician; and
acting within the scope of his or her license:
a podiatric physician and surgeon;
a registered nurse;
an advanced registered nurse practitioner;
a physician assistant; and
an osteopathic physician assistant.
Prior to delegating a task to a medical assistant, a health care practitioner must determine:
that the task is within the scope of practice of the health care practitioner;
that the task is indicated for the patient;
the appropriate level of supervision;
that no law prohibits the delegation;
that the medical assistant is competent to perform the task; and
that the task itself is one that should be appropriately delegated considering that:
the task can be performed without the exercise of judgment based on clinical knowledge;
results of the task are reasonably predictable;
the task can be performed without a need for complex observations or critical decisions;
the task can be performed without repeated clinical assessments; and
the task, if performed improperly, would not result in life-threatening consequences or the danger of immediate and serious harm to the patient.
V. Health Care Assistants.
The existing Health Care Assistant credential will be eliminated on July 1, 2016. Persons certified as a health care assistant will be automatically converted to medical assistants upon renewal of their certifications.
Summary of Bill:
I. Scope of Practice.
The scope of practice of an MA-Certified is expanded to include:
the administration of multi-dose vaccines; and
moderate complexity tests if the MA-Certified meets standards for personnel qualifications and responsibilities in compliance for federal regulation for non-waived testing.
The scope of practice of an MA-Registered is expanded to include:
the administration of multi-dose vaccines;
moderate complexity tests if the MA-Registered meets standards for personnel qualifications and responsibilities in compliance for federal regulation for non-waived testing;
the administration of eye drops and topical ointments; and
preparing patients for, and assisting with, routine and specialty examinations, procedures, treatments, and minor office surgeries. The DOH may, by rule, prohibit any of these duties if performance of those duties by an MA-Registered would pose an unreasonable risk to patient safety.
A task may be delegated if it is not likely to present life-threatening consequences or serious harm to the patient if performed improperly (instead of if it would not present life-threatening consequences or serious harm to the patient if performed improperly).
III. Health Care Assistants.
A certified health care assistant's credential must be in good standing before it can be automatically be converted to a medical assistant credential.
IV. Delayed Implementation.
The DOH may delay the implementation of the MA-Registered credential as necessary to comply with the requirements described above.
Fiscal Note: Available.
Effective Date: The bill contains an emergency clause and takes effect on July 1, 2013.