As reported in a previous issue of CMA Today, the National Council of State Boards of Nursing (NCSBN) greatly assisted the American Association of Medical Assistants (AAMA) by changing references in its Model Nursing Practice Act and Model Nursing Administrative Rules from “certified medication assistant” to “medication assistant-certified.”1 This was done in response to the AAMA pointing out to the NCSBN that state legislation creating the title of “certified medication aide/assistant” was causing confusion between Certified Medical Assistants, or CMAs (AAMA), and medication aides/assistants.

Because of the growing need for health personnel who are capable of passing medications in hospitals, skilled nursing facilities, assisted living environments, correctional institutions, and similar settings, an increasing number of states have created a category of medication aides/assistants, either as a pilot or permanent program. Approximately 33 states and the District of Columbia have medication aides/assistants of some sort. Such titles include the following: certified medication technician; medication assistive person; certified unlicensed personnel; qualified medication aide; medication aide credentialed; certified residential care medication aide; trained medication aide; nonlicensed staff person; unlicensed assistive personnel; registered medication aide; and approved medication assistive personnel. Most of these medication aide/assistant laws require the completion of a short training course, and some require applicants to pass a test.

In very recent months, however, a new threat seems to have arisen in a small number of states. Medical assistants, even CMAs (AAMA), are being told that they must become medication aides/assistants in order to be delegated the administration of medication by physicians. This article is being written to prevent this alarming development from becoming an issue in a larger number of states.

What is a medication aide/assistant? The following language from the National Council of State Boards of Nursing’s Model Nursing Practice Act and Model Nursing Administrative Rules is instructive [emphasis added]:

Section 3. Nursing Assistive Personnel Registry. Each individual who successfully meets all requirements for certification shall be entitled to be listed on the Nursing Assistive Personnel Registry as a certified nursing assistant (CNA), certified nursing assistant II (CNA-II), or medication assistant-certified (MA-C).

Section 6. MA-C Range of Functions. A CNA or CNA-II with additional education and training as set forth in rule may administer medications as prescribed by an authorized provider within the parameters set forth in rule. A licensed nurse shall supervise the MA-C.

8.6 Medication Administration by an MA-C
a. An MA-C may perform a task involving the administration of medications if:

   1. The MA-C’s assignment is to administer medications under the supervision of a licensed nurse in accordance with provisions of this Act and rules; and
   2. The delegation is not prohibited by any provision of this Act and rules.

(MA-Cs may work under the supervision of another professional in some limited settings. Most, however, work in facilities where licensed nurses provide supervision.)

Note well that medication aides/assistants are nursing assistive personnel, most often working under the direction of nurses. Medical assistants are not nursing assistive personnel. Although in some states medical assistants may work under the direct supervision of independent and autonomous nurse practitioners (i.e., nurse practitioners who are not practicing under a collaboration agreement with a physician), medical assistants nevertheless are not nursing assistive personnel.

Medical assistants work primarily under the direct supervision of physicians, most often in outpatient settings. Therefore, except in rare instances in which the scope of medical assisting practice is addressed in a different statute, medical assistants work under the Medical Practice Act of each state, and the regulations, policies, and rulings of the Board of Medical Examiners of each state. The Medical Practice Act and/or the regulations of the Board of Medical Examiners control what duties physicians are permitted to delegate to allied health professionals such as medical assistants.

All nurses function under the Nurse Practice Act of each state, and the regulations, policies, and rulings of the Board of Nursing of each state. The Nurse Practice Act and/or the regulations of the Board of Nursing delineate what duties nurses are permitted to delegate to other nurses and to nursing assistive personnel, such as certified nursing assistants and medication aides/assistants. (In some states, certified nursing assistants and medication aides/assistants are addressed in statutes other than the Nurse Practice Act, and fall under state agencies other than the Board of Nursing—such as the Department of Health or the Department of Public Health.)

The dispositive legal principle is that as long as medical assistants work under direct physician supervision, they do not have to become medication aides/assistants in order to be delegated by the physician(s) the administration of medication (including by intramuscular, subcutaneous, and intradermal injections, which include vaccines/immunizations). As stated above, delegation of duties by physicians is determined by the state Medical Practice Act and its attendant regulations, not by the Nurse Practice Act and its regulations.

As reinforcement of this legal principle, it is noteworthy that there is no reference to medication aides/assistants in the Medical Practice Acts and regulations of any American jurisdiction, or in the Essentials of a Modern Medical Practice Act of the Federation of State Medical Boards.

It is the position of the American Association of Medical Assistants that state and federal laws must ensure that all patients receive good quality health care in all delivery settings. A necessary corollary of this position is that all health personnel should be appropriately educated, trained, and suitably credentialed. The AAMA does not object to states enacting legislation that creates a category of medication aides/assistants to work under nurse supervision in residential or inpatient settings. However, the AAMA does object strenuously to any attempts to misinterpret and misapply medication aide/assistant laws by requiring medical assistants working under direct physician supervision in outpatient delivery settings to complete medication aide/assistant training and pass a medication aide/assistant test.

Any medical assistants being asked to become medication aides/assistants should contact Executive Director Donald A. Balasa, JD, MBA, at dbalasa@aama-ntl.org or 800/228-2262.