New Law: Action Required
| To: | Rural Chief Executive Officers, Chief Medical Officers, Chief Nursing Officers, Human Resources, Legal, Quality and Risk, and Government Affairs Staff. Please forward to clinic managers and other interested staff |
| Staff Contact: | Katerina LaMarche, JD, Policy Director katerinal@wsha.org | (206) 216-2505 |
| Subject: | Certification, scope of practice, and supervision changes for certain medical assistants – Effective April 20, 2023 |
Purpose
The purpose of this bulletin is to provide hospitals information about ESHB 1073, which makes changes to certification, scope of practice, and supervision for certain medical assistants. WSHA supported ESHB 1073 during the 2023 legislative session and is pleased it was enacted.
Applicability/Scope
Effective April 20, 2023, ESHB 1073 contains provisions that apply to those who are medical assistant-certified (MA-certified), medical assistant-registered (MA-registered), medical assistant-phlebotomist (MA-phlebotomist), or medical assistant-hemodialysis (MA-hemodialysis).
Recommendation
- Hospitals should review rules and policies related to medical assistants.
- Rules and policies related to supervision, interim permit work, and scope of practice may need to be revised and updated to accommodate the changes allowed for by the new law.
Overview
Relating to certification:
- An interim permit for a MA-certified now expires upon passage of the examination and issuance of a certification, or after one year, whichever occurs first. An interim permit may be issued to any person who has met all the required qualifications for certification except for passing the examination. A person holding an interim permit possesses the full scope of practice of a MA-certified.
- Applicants for a MA-hemodialysis technician certification who have completed their training program may work at dialysis facilities, under the level of supervision required for the training program, for up to 180 days after filing their application for certification.
- Applicants for a MA-phlebotomist certification who have completed their training program may work, under the level of supervision required for the training program, for up to 180 days after filing their application for certification.
Relating to scope and supervision:
ESHB 1073 changes the supervision standard
- For all medical assistant types/positions, a supervising health care practitioner is no longer required to be present for procedures to administer vaccines, obtain specimens for diagnostic testing, or perform diagnostic testing, but must be immediately available.
MA-Certified
- A MA-certified may establish intravenous lines for diagnostic or therapeutic purposes, without administering medications, under the supervision of a health care practitioner if they meet minimum standards established by the Secretary in rule. (Current law still requires administration of intravenous injections for diagnostic or therapeutic agents by a MA-certified to be done under the direct visual supervision of a health care practitioner.)
MA-Registered
- A MA-registered may prepare patients for, and assist with, routine and specialty examinations, procedures, treatments, and minor office surgeries, including those with minimal sedation, under the supervision of a health care practitioner.
- A MA-registered may perform diagnostic testing and electrocardiography, under the supervision of a health care practitioner.
- A MA-registered may administer intramuscular injections for diagnostic or therapeutic agents under the immediate supervision of a health care practitioner if they meet minimum standards established by the Secretary in rule.
- Note that “immediate supervision” is not the same as “direct visual supervision,” as required for MA-certified. “Immediate supervision” is not defined in ESHB 1073 or the MA statute, but it is defined in the MA rules (WAC 246-827-0010), as “…the supervising health care practitioner is on the premises and available for immediate response as needed.” This is materially the same as the definition of “supervision” in the MA statute (RCW 360.010), “…supervision of procedures permitted pursuant to this chapter by a health care practitioner who is physically present and is immediately available in the facility.” Our understanding behind the intent to specify “immediate” was to emphasize that the supervising health care practitioner should be immediately available.
- A MA-registered may administer medications for intramuscular injections if the medications are:
- Administered only by unit or single dosage, or by a dosage calculated and verified by a health care practitioner. A combination or multidose vaccine is considered a unit dose;
- Limited to legend drugs, vaccines, and Schedule III through V controlled substances as authorized by a health care practitioner under the scope of their license and consistent with rules adopted by the Secretary; and
- Administered pursuant to a written order from a health care practitioner.
Background
WSHA supported ESHB 1073 in response to members’ concerns about medical assistant staffing shortages and retention issues. We are hopeful these changes will help alleviate the staffing challenges that were exacerbated by the COVID-19 pandemic, improve retention of trained health care workers, and facilitate continuity of care. WSHA will continue to work with members to address these and other workforce challenges.
Next Steps
The Department of Health will hold a rulemaking to determine the minimum standards required and other requirements necessary to effectuate the changes made in ESHB 1073.
WSHA’s 2023 New Law Implementation Guide
Please visit WSHA’s new law implementation guide online. The Government Affairs team is hard at work preparing resources and information on the high priority bills that passed in 2023 to help members implement these new laws, as well as links to resources such as this bulletin. In addition, you will find the Government Affairs team’s schedule for release of upcoming resources on other laws and additional resources for implementation.
References
ESHB 1073 – Concerning medical assistants
WAC 246-827-0010 – Definitions
RCW 18.360.010 – Definitions
