Scope of Practice
Donald A. Balasa, JD, MBA
CEO and House Legal Counsel
dbalasa@aama-ntl.org
American Association of Medical Assistants (AAMA)
June 2022
Medical assistants continue to be in high demand throughout the United States. Medical assisting scope of practice is determined primarily by state law. This paper will explain the scope of practice for medical assistants under Michigan law.
As is the case with the laws of many American jurisdictions, Michigan law classifies medical assistants as “unlicensed individuals/personnel.” Note the following excerpt from the Michigan Public Health Code:
333.16215 Delegation of acts, tasks, or functions to licensed or unlicensed individual; supervision…
…[A] [licensed physician]…may delegate to a licensed or unlicensed individual (emphasis added) who is otherwise qualified by education, training, or experience the performance of selected acts, tasks, or functions where the acts, tasks, or functions fall within the scope of practice of the [licensed physician] and will be performed under the [licensed physician’s] supervision (emphasis added). A [licensed physician] shall not delegate an act, task, or function under this section if the act, task, or function, under standards of acceptable and prevailing practice, requires the level of education, skill, and judgment required of the [licensed physician] under this article (emphasis added).
Tasks Delegable to Medical Assistants
Which tasks may be delegated by physicians to unlicensed individuals such as medical assistants under Michigan law? A legally defensible answer to this question consists of two parts:
- Medical assistants may be delegated, and may perform, only those tasks for which they are knowledgeable and competent.
- Medical assistants may be delegated, and may perform, those tasks that are included in the Core Curriculum of the CAAHEP Standards for the Accreditation of Educational Programs in Medical Assisting. The following are the tasks that students must demonstrate proficiency in to graduate from a CAAHEP-accredited medical assisting program:
- Measuring vital signs
- Performing electrocardiography
- Performing venipuncture
- Performing pulmonary function testing
- Calculating proper dosages of medication for administration
- Administering oral and parenteral (excluding IV) medications
- Obtaining specimens and performing CLIA-waived tests
- Performing wound care
- Performing dressing changes
Tasks Not Delegable to Medical Assistants
Which tasks are not delegable to medical assistants because they “require the level of education, skill, and judgment required of the [licensed physician] under this article”?
- It is not legally permissible for medical assistants to be delegated, and to perform, any task that requires the exercise of independent clinical judgment or the making of clinical assessments, evaluations, or interpretations.
- It is not legally permissible for medical assistants to be delegated, and to perform, any task reserved exclusively in Michigan law to other health professionals—often licensed health professionals.
Degree of Supervision Physicians Must Exercise over Medical Assistants
What degree of physician supervision is required under Michigan law (see line 19 above) when unlicensed individuals such as medical assistants are performing tasks delegated to them by a physician? The answer is found in another section of the Michigan Public Health Code:
333.16109 Definitions; S to T.
333.16109 Definitions; S to T.
(2) “Supervision,” except as otherwise provided in this article, means the overseeing of or participation in the work of another individual by a health professional licensed under this article in circumstances where at least all of the following conditions exist:
(a) The continuous availability of direct communication in person or by radio, telephone, or telecommunication between the supervised individual and a licensed health professional. (emphasis added)
(b) The availability of a licensed health professional on a regularly scheduled basis to review the practice of the supervised individual, to provide consultation to the supervised individual, to review records, and to further educate the supervised individual in the performance of the individual’s functions.
(c) The provision by the licensed supervising health professional of predetermined procedures and drug protocol.
Telemedicine/Telehealth
Under the laws of all states, knowledgeable and competent medical assistants are permitted to: (1) receive information by electronic means for licensed providers; and (2) convey information by electronic means as authorized by overseeing/delegating providers. Providers should specify in writing what information may be received and transmitted by medical assistants. When receiving and conveying information, medical assistants must avoid making independent clinical judgments and assessments.
Patient Education
Under the laws of all states, it is permissible for licensed providers to delegate to knowledgeable and competent unlicensed professionals such as medical assistants working under their authority and direction the providing of patient education as long as: (a) the content of such education has been approved by the delegating provider; and (b) the medical assistant is not permitted to exercise independent clinical judgment or to make clinical assessments or evaluations during the education process.
Chronic Care Management (CCM) and Transitional Care Management (TCM)
The Chronic Care Management (CCM) and Transitional Care Management (TCM) programs were created to provide reimbursement for services for Medicare recipients who have health needs not included within standard Medicare coverage. Medical assistants fall within the CPT definition of clinical staff. Medical assistants also are auxiliary personnel according to chapter 15, section 60.1, “Incident to Physician’s Professional Services” of the Medicare Benefit Policy Manual. Medical assistants may be delegated tasks that are billable incident to the provider’s services under CPT code 99490 (CCM) or CPT codes 99495 and 99496 (TCM).