Medical Assistants during Covid Era Webinar

Expanded Roles and Duties for Medical Assistants during the COVID-19 Era

Donald A. Balasa, JD, MBA, Chief Executive Officer and Legal Counsel of the American Association of Medical Assistants (AAMA) leads this timely and informative webinar. The medical assisting profession has risen to the occasion as the United States and the world have been dealing with the most serious health crisis in the last 100 years. Medical assistants have been asked by public health officials, managers of health systems, and licensed providers to assume expanded roles and perform tasks beyond their normal scope of work.

Because of the breadth of their education and training, medical assistants have been able to adapt quickly to these new responsibilities. Medical assistants have been called upon to work in nontraditional settings under the authority and supervision of a dedicated array of clinicians and administrators with whom they had not previously practiced (e.g., pharmacists).

The purpose of this webinar is to identity the laws that establish the scope of practice for medical assistants, and to delineate the expanded tasks that medical assistants may be delegated under these laws. The legal principles placing limitations on the scope of work for medical assistants will be explained, and the expanded functions that are not delegable to medical assistants will be set forth.

This webinar will cover the following objectives:

1. The attendee will be able to differentiate between the authority of state law over the scope of practice for
medical assistants (and all other health professions), and the authority of federal law over scope of practice

2. The attendee will be able to identify the general category of state laws that permits medical assistants to work in health care delivery settings other than ambulatory care

3. The attendee will be able to articulate the key legal principle governing tasks that are and are not delegable to medical assistants, and apply this principle in making determinations about delegable and non-delegable tasks and functions



  • 1:00:32


medical assistants, state, medical assistance, work, medical assistant, authority, laws, licensed, tasks, practice, vaccinations, licensed provider, delegated, certification, telehealth, swabbing, provider, patient, permitted


Catherine Short, Donald Balasa



Catherine Short  00:00

Welcome to our continuing 2021 educational webinar series. I am Catherine Short Partnership Marketing Manager for First Healthcare Compliance. At First Healthcare Compliance, we help you with a comprehensive compliance management solution tailored to your business, a hospital network, healthcare practice of any size billing company or skilled nursing facility, and we help manage every aspect of a compliance program and our training library provides hundreds of modules that are easy to assign and track. As part of our complimentary educational webinar series. We bring you experts from around the country to discuss relevant topics in the healthcare industry.


Catherine Short  00:43

We are so pleased to have Donald Balasa JD, MBA with us today. Mr. Balasa has served as chief executive officer and legal counsel of the American Association of Medical Assistants AMA since 1990. Don received both his baccalaureate and law degrees from Northwestern University and his MBA in economics from the University of Chicago. Mr. Balasa has taught courses at DePaul University Graduate School of Business and Trinity International University. Mr. Balasa is currently a commissioner of the Commission on Accreditation of Allied Health Education Programs, and serves on its board of directors and Governance Committee. In the past year, Don has written and spoken on the scope of practice on medical assistance in acute care settings and ambulatory surgery centers, the role of medical assistants in remote physiologic monitoring, permissible medication reconciliation by medical assistance and state laws governing nasal, nasal pharyngeal swabbing administration of COVID-19 vaccinations, vaccinations by medical assistants, and in the last 60 days he has given written and oral testimony before Connecticut and Maryland legislature’s on bills that would clarify the scope of practice for medical assistance.


Catherine Short  02:12

Before we begin, I would like to mention at First Healthcare Compliance, we strive to serve as a trusted resource for compliance professionals. And every month we strive to celebrate their hard work and dedication with our compliance super ninja recognition. For this Super Ninja, our team is turning the spotlight on Betty M. Perriman, Administrator at Southern Avenue Family Practice. Betty says I have worked with my doctor for many years and I really enjoy the interaction with the patients. We have a concierge practice and we’re able to spend more time with the patients when they come in. Our staff has been together for a long time and we work well as a team and it is a pleasure working with them. Congratulations Betty, our team is honored to have the privilege of working with you.


Catherine Short  02:59

A copy of the slides is available for download on the control panel. Feel free to submit questions into the question box on your control panel during the during the presentation. We will address questions at the conclusion. Your PAHCOM and PMI CEU certificates will be emailed to you following the broadcast. Your PAHCOM certificate will come directly from PAHCOM and your PMI certificate will come from our email. There is no need to request either one additional CEU opportunities will be available to BC advantage members following the live broadcast see their website for details.


Catherine Short  03:36

So Donald, welcome, thank you so much for being here! Very warm welcome.


Donald Balasa  03:41

Thank you, Catherine. And thank you for this opportunity. I always enjoy presenting for First Healthcare Compliance. And the topic this morning I think is particularly relevant for all of our listeners, and that is the expanded roles and duties for medical assistance during the COVID-19 era. You see my website address as well as my email address, and feel free to email me any questions about medical assisting scope of practice throughout the United States. Also, if you do go to our website, you will find the state laws for all states, as well as articles that explain some of these important concepts that I will be discussing this morning. As we talk about the expanded roles and duties for medical assistance during this COVID era, we have to keep in mind that medical assistants are an untapped resource for the healthcare system. And some of their abilities are being showcased out of necessity during the covid 19 pandemic. What we must think about is what are legal and illegal tasks for medical assistance and that’s what I’ll be talking to a great extent.


Donald Balasa  05:02

First of all, let’s look at a definition of medical assistant. medical assistants are unlicensed allied health professionals who number one work in outpatient settings. And secondly, perform both both back office clinical duties, as well as front office administrative duties. Let’s talk about the unlicensed. I’m going to define that in a few slides. But generally, if a profession is unlicensed, that means that there are no state laws that require professionals to have a certain type of formal education or to have a certain type of credentialing or certification. However, what we are seeing throughout the United States is that employers are preferring or even in some cases, insisting that their medical assistants have graduated from an accredited post secondary Medical Assisting program, and that they have an accredited certification. Some of those certifications are the CMA or certified medical assistant of the double AMA. Another one is the registered medical assistant or RMA of American Medical Technologists, and there are others as well. Referring to medical assistants as unlicensed once again means that there are no state laws requiring a certain type of education or credential. These two points really are the distinctive features of medical assistants, and they are the only allied health professionals who are specifically trained to work in outpatient settings. And also they are trained to do both back office clinical tasks as well as front office administrative tasks. That versatility and multi skilling has come in very handy during this time of COVID-19. Because as we all know, very many times it’s just sort of an all persons on deck mentality. And medical assistants, because of their versatility, are able to adjust and adapt better than some other allied health professionals who may be more narrowly focused and narrowly educated.


Donald Balasa  07:20

A point of clarification. medical assistants are much different from certified nursing assistants or CNAs. There’s a lot of confusion. But the main way of distinguishing these two is to keep in mind that certified nursing assistants work in inpatient settings, hospitals, skilled nursing facilities, assisted living facilities and the like. And they are able after completing a short course of training and passing a test to administer medications, usually under the authority of a registered nurse in one of those inpatient settings. In some states, nursing assistants are able to take an additional course and then are able to do other duties under the authority of an RN. These advanced nursing assistants are sometimes called medication aides or medication assistance. In some states, unfortunately, the statute refers to them as certified medication aides or assistance. And the confusion is that that initialism certified medication aide or CMA is sometimes confused with the initialism representing certified medical assistants, which is also CMA. So whenever you encounter the initialism CMA, it’s important to find out whether that’s a reference to medication aides who work in inpatient settings, or medical assistants who by definition work in outpatient settings.


Donald Balasa  08:57

Let’s talk about some of those traditional outpatient settings. And then we’re going to talk about how during the pandemic, medical assistants have expanded their scope and are working in many different health care delivery settings. Traditionally, medical assistants have worked in outpatient settings such as clinics medical offices, under licensed provider authority and supervision. By licensed provider we mean health professionals such as physicians, both MDS and deos, or allopathic physicians and osteopathic physicians, as well as nurse practitioners and physician assistants. It’s important to keep in mind that medical assistants do not work autonomously. As some of these licensed providers do. Rather they always work under the authority of a licensed provider. However, as we’ve seen during the pandemic, in some cases, medical assistance are now permitted to work under general supervision of a provider, which means that the provider does not necessarily have to be on the premises or in the office suite, but rather can be overseeing the work of the medical assistant by electronic means, such as video, telephone or audio telephone. But traditionally, medical assistants have worked in these environments, these outpatient environments under the direct or on site, presence of a licensed provider.


Donald Balasa  10:36

Let’s talk about some of the non traditional settings that have come into play in the last 12 months out of necessity. As I mentioned, with the all hands on deck mentality, medical assistants have been called upon to work in non traditional settings, such as vaccination centers, acute care settings or even inpatient settings. Even though medical assistants traditionally defined as allied health professionals will work in outpatient or ambulatory settings other licensed provider authority, because of their competency, their education and their versatility. They have been called upon to work in these other non traditional settings. And what I have been busy doing in the last 12 months is analyzing questions that come in about whether in a particular state a medical assistant is permitted to be delegated function a or task B. And that requires, in some cases a very complex analysis of the state law. In addition to working in different environments, the pandemic has also resulted in medical assistants working under other health care professionals, for example, pharmacists, and registered nurses, not just nurse practitioners, but generally under registered nurses. And that is quite significant because I think most of you are aware that pharmacists have been authorized by both federal and state law to administer COVID-19 vaccinations. And oftentimes, they will delegate that task to individuals who are working under their authority that often has been pharmacy technicians. But in reality, pharmacists are also employing medical assistants to administer COVID-19 vaccinations. So this is an example of both a different setting a pharmacy setting as well as different licensed providers, a pharmacist working medical assistants have worked under the authority of pharmacists in these settings.


Donald Balasa  12:56

Now let’s look at state and federal law and analyze the authority the legal authority for medical assistance to be able to practice. Even though we’re used to the federal government having more power and more authority than it did maybe 30 or 40 years ago, we still have to keep in mind that the scope of practice for all professions and not just health professions, but all professions and occupations is determined primarily by state law. It is true that Congress has various enumerated powers in Article One of the Constitution, but it does have limited legislative authority. Congress is only permitted to legislate in the areas that are set forth in Article One of the Constitution. I’d also like to direct your attention to the 10th amendment of the United States Constitution, which essentially says that any authority not assigned to Congress, particularly in Article One remains with the state governments. So it has traditionally been understood by the federal courts, including the United States Supreme Court, that the ultimate authority for regulating health professions is the state governments, the state legislatures. This is known as the police power, which is defined as the authority to legislate to protect the health, safety and welfare of residents. And of course, in the arena of health professions. It’s vitally important that these professionals have shown their knowledge and competence by completing an educational program, which can be very long in the case of the more advanced licensed providers, or can be shorter depending on the scope of practice for the Allied Health Group professionals. But the primary authority rests with state governments, not with the federal government. However, Congress does have limited authority over the Health Professions by virtue of its taxing and spending authority.


Donald Balasa  15:17

And let’s look at some of the examples that we’ve become familiar with in recent decades. Congress enacted the Nursing Home Reform Act of 1987. And one of the elements of that statute was that certified nursing assistants, as I mentioned before, who work in inpatient settings, must complete a training requirement and must pass a test before they are able to work in facilities that receive Medicare and Medicaid reimbursement. So note this connection with the spending authority. Obviously, these inpatient settings want to be able to receive Medicare and Medicaid reimbursement. But the federal government has said that in order to do that, these inpatient settings whether they be assisted living facilities, hospitals, hospices, skilled nursing facilities, must demonstrate that they are only hiring certified nursing assistants who have finished the training requirement established by Congress and its agencies. Even though the state law may not specifically address CNA educational requirements, because of the federal mandate that Medicare and Medicaid reimbursement will only be given to facilities that meet the federal requirements. In effect, Congress has established its own standards over and above the state requirements for nursing assistants. Another more recent example is the HITECH Act, which was enacted by Congress in 2009.


Donald Balasa  17:05

This was part of President Obama’s health care reforms. And one of the creations of the electronic health record act was the creation of the meaningful use program are also known as the EHR Incentive Program. Now, there is one incentive program for Medicare and one for Medicaid. The essence of these pieces of legislation were that in order for a licensed provider, and this could be either an individual or an institution to receive incentive payments from the federal government. That provider has to demonstrate that it is using electronic medical records and converting from paper medical records to electronic records. And in addition to that, there is a requirement that a certain percentage of medication, laboratory and diagnostic imaging orders must be entered by one of two categories of health professionals. Number one is credentialed medical assistants. And that’s actually written in to the federal law, and the other category is licensed health professionals. So in other words, to receive these incentive payments, which are quite significant, the provider must show that 60% of all orders, all medication orders have been entered by one of these two categories, credentialed medical assistants or licensed professionals. Likewise, 60% of all laboratory orders have to be entered by professionals in one of those two categories. And finally, 60% of diagnostic imaging orders must be entered either by credential medical assistance or licensed health professionals. Even though the HITECH act did not override state laws, it did provide a very powerful financial incentive for electronic health records to be used, and in particular, for electronic order entry to become more prominent than the old way of sending orders to a pharmacist for a prescription or a medication as well as laboratory and imaging orders. I do want to mention at this point that the Medicare EHR Incentive Program has been phased out as of 2018. However, the Medicaid EHR Incentive Program which is now known as the promoting interoperability program, referring to interoperability Electronic Health Records is still in effect. So if providers are participating in the Medicaid program for computerized provider order entry, they must still make sure that a certain percentage of orders is being entered by one of those two categories by either credentialed medical assistants or licensed healthcare professionals. I mentioned before that medical assistants are unlicensed in most states and let me define licensure and certification. Licensure may be defined generally as a mandatory state credential that is required by law in order for an individual to practice a profession. There are often criminal or quasi-criminal penalties for an individual who is practicing a licensed profession without having a license. So the key elements of a license, number one is that it is mandatory, it is not optional. It is required by state law in order for an individual to practice a profession. The other feature is that licenses are essentially created by state legislators. That’s not a federal law. As I mentioned before, Congress has only indirect authority to influence how the licensed profession it’s our practice. The primary responsibility, however, rests with state governments with state legislatures, and any agencies that they create, such as boards of pharmacy boards of dentistry boards of nursing boards of medicine.


Donald Balasa  21:50

The next point or the next definition is about certification. Certification may be defined as a voluntary national credential, usually awarded by a private sector body. So note the two differences between licensing and certification. Unlike a license which is mandatory, a certification is voluntary. In other words, it is not required by state law, although as I mentioned before, we are seeing in the medical assisting field that many employers are insisting on hiring medical assistants who have a credential who have a certification. So in reality, these credentials for medical assistance, these certifications are functioning as license, but not because of a mandate by state law or federal law rather because of the preferences of employers. So that’s the first distinction between a license and a certification. A license is mandatory, a certification is voluntary. Secondly, licenses, as I mentioned, are state credentials created by state legislators. But certifications generally are national credentials. They are not state by state credentials. And finally, another distinction of a certification is that it is usually awarded by a private sector body, not by a state agency. licenses are issued by these various state agencies that I mentioned, a Board of Accountancy, the state board, Bar Examiners for attorneys, etc. certifications, however, are issued by private sector certifying bodies. And those who have a private sector certification may refer to themselves as being certified in a certain area. They may not say that they are licensed by having certification. licensure, once again is a creature of state government. And it is mandatory, not voluntary, like certifications.


Donald Balasa  24:12

The only state that has full licensure for medical assistance is Washington State. And there are various categories under Washington law. And you can go to our website and find out the different categories. As I mentioned before, we have the laws for all American jurisdictions posted on our website. But keep in mind that licensure is not common for medical assistance. The only state that has fun licensure is Washington. There are just a handful of states that have what I call partial licensing lots. Let’s look at the legal authority to practice as a medical assistant because Again, the threshold question, when we’re talking about medical assistance being utilized in non traditional ways, and working to the top of their education, and their certification is to see what the state law says, to see whether certain tasks may be delegated to medical assistance, and performed by medical assistance. medical assistants are classified as unlicensed assistive professionals or personnel and the laws of some states. And in some state laws, you will not find the phrase medical assistant. However, medical assistants derive their authority to work from various sources. I mentioned in the second bullet that some states do have specific medical assisting laws that actually list the tasks that are delegable to medical assistance. However, in some states, the medical assisting scope of practice is determined not by a specific medical assisting act, but by the delegation language in the practice acts of licensed professionals. And what has enable Medical Assisting practice to be expanded is the fact that through a careful analysis of some of these state laws, medical assistants do fall under the category of unlicensed professionals. And that is how medical assistance have been utilized in these non traditional settings and under non traditional licensed providers. So let’s look specifically at an example of how the authority for medical assisting practices found in Acts other than State Medical Assisting acts. First of all for physicians. Every state has its own Medical Practice Act, and also has created a State Board of Medical Examiners. And that board has the authority to issue regulations or rules which are synonymous by the way. The State Board of Medical Examiners also has the authority to issue policies, and to hear any cases of alleged malpractice by any of the physicians that it regulates.


Donald Balasa  27:26

Also, in regard to the nursing realm, states have their own Nurse Practice Act, and they also have a State Board of Nursing, who also has the authority to issue regulations or rules and policies and to adjudicate any allegations of malpractice by any category of nurse. So we have been seeing that medical assistants often work under Advanced Practice registered nurses most commonly under nurse practitioners. And this again is a source of authority for medical assistants to work under a nurse practitioner or under a registered nurse. Finally, physician assistants also have licensure under all 50 states. They have a physician assistant Practice Act under each state’s law and they also have a regulation that is usually under the authority of the State Board of Medical Examiners because physician assistants are permitted to work under physicians, even though the authority of the physician is very general. Physicians all may have to in some cases, review the records of physician assistants once a month to make sure that the PA is practicing within the bounds of correct and ethical position assisting practice. And I mentioned pharmacists before each state has its own pharmacy act, and also in those acts. And in the regulations of the state boards of pharmacy. We see regulations that address what tasks may be delegated by pharmacists to allied health professionals such as pharmacy technicians, but the language in these pharmacy acts and rules sometimes is very general, and does allow for pharmacists to delegate tasks to medical assistants who would be classified as unlicensed assistive professionals under the laws of that state.


Donald Balasa  29:43

We also have to look at the common law, which means court decisions to determine what principles have an impact on the limits of medical assisting scope of practice. First of all, medical assistants are forbidden from assuming responsibilities. And performing any procedures that constitute the practice of a licensed profession. Whether that is the practice of medicine or the practice of nursing, or the practice of physician assisting medical assistants are not permitted to practice in those areas. As I stated in my definitions, in order for an individual to practice as a physician, or a nurse practitioner or physician assistant, that individual must meet certain educational requirements must pass a test and then must register with the licensing board of the state. So medical assistants are not authorized to assume the responsibilities of the licensed health profession. Secondly, medical assistants are forbidden from performing tasks that are restricted in state laws to other health professionals, usually licensed professionals. The examples that I give here are physical therapy and acupuncture. In all states, those professions are licensed. So it is not legally allowable for, let’s say a physician, to hire a medical assistant and to expect the medical assistants to perform the full range of physical therapy tasks, or to perform the full range of acupuncture. Because state laws indicate that only acupuncturists and physical therapists are permitted to do a full range of those disciplines. It wouldn’t be permissible in some cases, for a physician to hire a medical assistant to do very limited physical therapy modalities. However, that does not rise to the level of practicing physical therapy.


Donald Balasa  31:58

This next point is very important. This is a ground rule for determining what tasks are and are not delegable. To and perform rubble by medical assistance, namely, medical assistance must not perform any tasks that number one require the exercise of independent clinical judgment, or secondly, require the making of clinical assessments, or evaluations or interpretations or diagnosis. So number one, medical assistants are not permitted to perform any tasks that require the exercise of independent clinical judgment or secondly, any tasks that require the exercise of clinical evaluations or assessments or diagnoses. An example of this would be the question that I often receive, and that is whether medical assistants are permitted to perform triage. My response is that that really depends on how you define triage. I define triage as having an element of clinical judgment or clinical evaluation. Therefore, given my definition of triage, I state that medical assistants are not permitted to perform triage. If the definition is, as I have just defined, namely, interacting with a patient or a patient’s representative over the telephone or in person, and being required to make some sort of clinical judgments or assessments. If that is the definition of triage, it is my legal opinion that that is not delegable to medical assistance under the laws of any of the American jurisdictions. However, some people define triage differently. They define triage as any interaction with a patient or patient’s representatives over the telephone. If one defines triage that way, then there’s a different answer to the question. And I’d like to define that as not being triage but as being telephone screening.


Donald Balasa  34:22

So what is telephone screening that is interacting with a patient that involves conveying verbatim information to the patient that has been approved and authorized by the overseeing licensed provider? Again, we’re talking mostly about physicians, nurse practitioners or physician assistants, or receiving verbatim information from a patient that is conveyed verbatim to the licensed provider. I do not consider that to be triage I consider that to be Patient telephone screening, because again, it does not involve any clinical judgment or assessments. It’s just a matter of conveying verbatim information that’s been approved by the provider, and receiving information from the patient that is then conveyed verbatim to the provider. So when we’re looking at the issue of any type of telephone interaction, we have to determine whether there’s a clinical element in that interaction or whether it’s just verbatim transmitting or receiving of information.


Donald Balasa  35:38

Now, let’s look at some of these particular tasks that have become very popular with medical assistance really necessary for providers to delegate them to medical assistance. The first area began with testing for COVID-19. And as you know, that often involves nasal pharyngeal swabbing. It’s my legal opinion, having analyzed the laws of the states that medical assistants are permitted to perform nasal pharyngeal swabbing with the possible exception of the state of California, and that’d be that is because California law states, the medical assistants can only perform swabbing as long as it’s limited to the opening of the nasal cavity. And of course, nasal pharyngeal swabbing is a much deeper type of invasive swabbing that is not limited to the opening of the nasal cavity. I’ve been monitoring the California law to see whether the governor has issued an executive order, setting aside that restriction. To my knowledge that has not happened. However, in all other states. It is my legal opinion that medical assistance may be delegated, and may perform nasal pharyngeal swabbing, for the purposes of COVID-19 testing, which of course, which is a major step and still is a major part of responding to the pandemic, crises that we have been seeing. I also was able to find some federal authority establishing the right of medical assistance to be delegated this type of swabbing, the Centers for Medicare and Medicaid Services issued a COVID-19 rule on April 6, last year of 2020. That included the following and I am quoting, even if the patient is confined to the home because of a suspected diagnosis of an infectious disease as part of a pandemic event, a nasal or throat culture could be obtained by an appropriately trained medical assistant or laboratory technician. So we see in the CMS document specific statement that medical assistants are permitted to go to the home of a patient and collect a swab for purposes of diagnosing whether that individual tests positively for COVID-19. We have this federal authority that also supports the state authority, indicating that medical assistants may perform nasal pharyngeal swabbing under the ultimate authority of a licensed provider, but again, not necessarily under the providers on site or personal supervision. Because of the language in state law, as well as this CMS documents, more nasal pharyngeal swabbing New York State, which is traditionally a very strict state in terms of what tasks may be delegated to medical assistance. We see that Governor Cuomo did issue an executive order stating the following, and I’m calling I hereby to temporarily suspend or modify the following sections 6521 and 6902 of the New York education law, to the extent necessary to permit unlicensed individuals and remember that would include medical assistance, upon completion of training deemed adequate by the New York Commissioner of Health to collect throat or nasal pharyngeal swab specimens, from individuals suspected of being infected by covid 19 for purposes of testing this course that the Commissioner of Health of New York has set up is a very short course something that can be completed in a day. And know that this executive order says that once that course is completed, the unlicensed as individual is permitted to perform tasks under the supervision of a nurse, otherwise limited to the scope of practice of a licensed practical nurse or registered nurse. Here we have a New York law statement that medical assistants are not limited to working on to the licensed providers that we talked about the physicians, nurse practitioners, etc. but also may work under the direct supervision of a nurse of an RN. For the purposes of collecting nasal pharyngeal swabs.


Donald Balasa  40:53

Let’s look at another very key task, of course, COVID-19 vaccinations, which is a very present issue for all of us. under the laws of most states, medical assistants are permitted to administer COVID-19 vaccinations. We see for example, in Tennessee that the governor issued an executive order on December 4 of last year, specifically stating that this order authorizes medical assistance certified by the double AAMA to be delegated tasks that would normally be within the practical nurse scope of practice, including but not limited to administration of COVID-19 vaccinations unquote. So Governor Lee of Tennessee has clearly stated that medical assistants who have the CMA, double AAMA certification are permitted to be delegated the administration of COVID-19 vaccinations. We see that in other states as well. And I think it’s helpful to understand what the state laws are saying and Maryland. We have an executive order this time from the Maryland Department of Health January 1 of this year, stating, quote that other individuals, namely unlicensed professionals, such as medical assistants, are permitted to administer COVID-19 vaccinations, as long as such individual has successfully completed training and the administration of COVID-19 vaccines. Also, that there are qualified supervisory personnel at the vaccination site, boom determined that the unlicensed individual the medical assistant most commonly is competent and knowledgeable and administering COVID-19 vaccinations under appropriate supervision. And finally, that this unlicensed practice professional who has had this training, administers the COVID vaccinations at the sites under the reasonable supervision of qualified supervisory personnel, which can be registered nurses as well as other professionals. So we have some very clear authority under Maryland law. Let’s turn towards New Jersey, I’m not going to go into this in detail. But you do see that similarly to New York and Maryland. There is an executive order from the New Jersey Department of Health, authorizing ancillary healthcare personnel, which would include medical assistants who are not licensed under New Jersey law to administer COVID vaccines. Add a vaccination site under appropriate authority of a licensed health care provider, or licensed health care professional such as an RN.


Donald Balasa  44:07

There are also federal laws or federal pronouncements that address this very important document is that of the CDC the Centers for Disease Control and Prevention that was issued in 2020 classified medical assistance as vaccinators for the purpose of the CDC vaccination program. This is found in a COVID-19 vaccination program interim playbook, which is available on the CDC website. Once again, this does not override state laws. Federal laws all may can influence scope of practice indirectly. But this is a clear statement that the CDC considers medical assistants to have the knowledge and the skill, especially after they complete this short course COVID-19 vaccinations to be able to be delegated administrative ministration of COVID-19 vaccinations. And again, because of President Biden’s desire to have our population immunized as quickly as possible, it’s just essential that medical assistants be pressed into service to function as vaccinators in vaccination sites and other environments. Because there are just not enough allied health professionals to administer all of the vaccines that need to be administered in order to protect Americans from the spread of COVID. Alright, one other statement. This is from the National Council of State boards of nursing. And it’s a December 15 2020 publication a policy brief. The National Council is the professional association of all state boards of nursing as I state and it is responsible for issuing general directives to the state boards of nursing that guide the state nursing laws and the regulations of the state boards of nursing. This policy brief states the knowledgeable and competent, certified medical assistants that’s a direct quote may be delegated COVID-19 vaccine administration once again under the authority of a licensed nurse or another licensed provider.


Donald Balasa  46:49

Finally, let’s turn the page to another area of tasks that medical assistants are being delegated that they had not done as frequently prior to the COVID era. Under the laws of many states, medical assistants are permitted to perform certain telehealth tasks. And we see once again in a CDC publication guidance that medical assistants are permitted to interact with patients by several means. The issue of course is what can medical assistants do in terms of providing telehealth tasks? And what can they not do? In the CDC publication. We see this quotes in some cases peripheral medical equipment, stethoscopes auto scopes, ultrasounds can be used by another health care professional. For example, a nurse or a medical assistant, again, I’m quoting verbatim from the CDC publication, who are physically with the patient, while the consulting medical provider conducts a remote evaluation. So medical assistants are able to go out into the community to patient homes, patients who may be in assisted living facilities, etc. and actually do this remote patient monitoring, which allows direct transmission of a patient’s clinical measurements, vital signs from a distance. And also these may be transmitted to the provider in real time or synchronously so that a provider is able to make a diagnosis immediately, or they may be transmitted and may be analyzed by the licensed provider at a future point in time. So telehealth tasks once again, very significant for medical assistants.


Donald Balasa  48:54

We also see the AMA in this telehealth implementation playbook. Making these statements that a medical assistant or patient care technician may be familiar with the conditions and situations that are appropriate for our telehealth visit may educate patients on telehealth expectations once again, under the authority of a licensed provider may support patient troubleshooting related to platform pre visit and during the telehealth visit and finally may let the doctor know when a patient has checked in for a telehealth appointment. If the telehealth platform does not include this feature.


Donald Balasa  49:41

So I would close by once again pointing out the fact that there are certain limitations on what telehealth tasks, medical assistants may be delegated. Once again we come back to rule of thumb that medical assistants are forbidden from performing tasks that are restricted in state law, to other usually licensed health professionals. And most importantly, medical assistants may not perform tasks that require the exercise of independent clinical judgment, or the making of clinical assessments. You are welcome to email me with any scope of practice questions you may have and my email address that you see, please feel free to go to our website. And you will find many of the resources that I have mentioned during this presentation, you will be able to find the laws of all states in regard to medical assisting scope or practice, you will see and column that is focused on COVID-19 updates. And I go into greater detail in the various executive orders that I’ve talked about. And finally, you will be able to find some articles that I have written on these topics. Thank you again for the opportunity to present. And Catherine, I see that we have some questions that we need to address.


Catherine Short  51:20

Thank you, Don, that was fantastic, very informative and extremely, extremely on point for what we need today. So thank you so much. And we do have a few questions. Okay, very good. Okay, so the first one is how can I find the Medical Assisting scope of work laws for my state and specific information about covid 19 related tasks that are delegable under the laws of my particular state?


Donald Balasa  51:52

Thank you, once again, you would go to our website, and you would click below state scope of practice laws, which is near the left bottom of our homepage. And you’ll be taken to a web page that lists all of the states. And under each state, you will see my legal opinion letter, you will see excerpts from state statutes from state regulations. And you can see what my interpretation has been on the laws of your state. And regard to COVID-19. on our homepage, if you go to the right column, you will see all of our COVID-19 resources articles that address the issues I’ve talked about in greater detail. And you will have a very thorough treatment of the COVID-19 situation in regard to what medical assistants are permitted to do.


Catherine Short  52:54

Okay, thank you so much. Okay, so the next question is, our office employees looks like kind of an alphabet soup here. So we’ve got CMAs from RMA’s and  CCMA’s and medical assistants with other credentials. What’s the difference between all these credentials?


Donald Balasa  53:20

Thank you, Catherine. That is a question that I receive every week. Because there is a lot of confusion about this. These are all medical assisting certifications, none of the ones that you read are licenses. Sometimes there’s a confusion over the presence of the word registered or the presence of the word certification. All of these credentials are voluntary national certifications, none of this a license for medical assistance. I mentioned that Washington is the only state that licenses medical assistance and they have their own set of credentials. So the answer to that is that all of those various credentials are voluntary national certifications, they are not licenses or state requirements.


Catherine Short  54:23

Does it take longer in Washington since it’s a license than typical, typically in other states?


Donald Balasa  54:30

Yes, actually, Washington State does require some education for the highest level of medical assistance and does require the passing of an examination. So a medical assistant who may be working in one of the other states that moves to Washington State sometimes has to go through some education and pass a test in order to work so it is a little more time consuming and the law is a little more complicated.


Catherine Short  54:59

Okay. All right. Okay, we have another question here. Who is legally liable for  negligent acts by medical assistants? The delegating licensed provider or the medical assistant? That’s a good question.


Donald Balasa  55:18

Yes, indeed. And there’s a lot of confusion over this. And this is also a question that I receive very frequently. The answer is that both the delegating licensed provider, whether it’s a physician, nurse, practitioner, RN, physician assistant, as well as the medical assistant, are both potentially liable as individuals, for any negligent act by the medical assistant. Some thinking, confused thinking is that only the delegator is responsible. So the medical assistant is thought to be off the hook. That’s not correct. The medical assistant is personally liable for any acts of negligence by the medical assistant. But again, the delegating provider is also liable for that because the delegator has a legal responsibility to make sure that the medical assistant is knowledgeable and competent in the tasks which have been delegated to the medical assistant and performed by the medical assistant. So both the delegator and the delegate t so to speak the medical assistant are potentially legally liable for any negligence by the medical assistant.


Catherine Short  56:44

That’s true. Do you sometimes recommend to the people who are training to be medical assistants that they get some kind of additional umbrella type of insurance?


Donald Balasa  56:59

I do that, of course, depends on what tasks they’re performing. But yes, that’s a good point. Sometimes I do recommend that. And obviously, the more advanced the tasks that they are performing the greater need for some sort of individual professional liability coverage.


Catherine Short  57:19

Yeah, I would think so. I would think so. Okay, we have another question here. Do you think the expanded scope of work for medical assistants would continue after the covid 19 pandemic?


Donald Balasa  57:34

I definitely think that is the case. And yes, we have to look forward. As I mentioned during my talk, medical assistants are an untapped valuable resource for helping providers provide care to patients. And yes, I think the fact that medical assistants have done so well in terms of performing these telehealth tasks, and doing the nasal pharyngeal swabbing for testing and performing COVID-19 vaccinations. I think that the role of medical assistance, as the roles of just about every health care professional, have been permanently changed. And medical assistants will continue to be used in these more advanced types of responsibilities.


Catherine Short  58:26

Very good. Well, I think that that’s all the time that we have for questions. But I’m wondering, do you have any other words of advice that you’d like to leave with us today?


Donald Balasa  58:38

Yes, and to all of our people who are listening to this, I like to remind you that the utilization of medical assistants to the top of their education, the top of their certification is vitally important, because of the demands on the American health care system and the threats to public health. So I would urge all of you to find out what the Medical Assisting school from practices in your state and perhaps adjust some of your position descriptions based on the competencies that medical assistants have and the laws that allow them to perform advanced tasks.


Catherine Short  59:22

Thank you so much Don. Thank you for being here. We really appreciate you coming on today and speaking about these issues in this vital need today that we have for testing and for vaccinating. So thank you so much.


Donald Balasa  59:37

You’re welcome. Thank you for the opportunity.


Catherine Short  59:40

Yes. And attendees, we thank you also for attending and please send any other questions along to Mr. Balasa. And you have his contact right there on the screen. You can also, if you think of any later, you can send them to us and we’ll forward them on. Please remember your PAHCOM And PMI CEU certificate will be emailed to you from within two days following the broadcast there’s no need to request it. You can register for future webinars and request a demo of our compliance solution on our website at or call us at 888-543-4778. And thank you for joining us.