On August 16, 2011, Donald A. Balasa, JD, MBA, executive director of the American Association of Medical Assistants (AAMA); AAMA Trustee Patricia Hightower, CMA (AAMA), who is also past president of the Washington State Society of Medical Assistants (WSSMA), and cochair of the WSSMA Legislative Committee; and Thomas Wolf, CMA (AAMA), cochair of the WSSMA Legislative Committee testified at a public hearing of the Washington State Department of Health. The purpose of the hearing was to provide information to a three-person panel of the Department of Health in regard to proposed medical assisting legislation.

The following is an excerpt and an adaptation from a Washington State Department of Health summary of the sunrise process in that state, and highlights of Executive Director Balasa’s testimony.

The sunrise process in the state of Washington

In Washington state, the Department of Health makes recommendations to the legislature on health profession credentialing proposals. The process is called a “sunrise review.”

The legislature’s intent is that all individuals should be permitted to provide health services unless there is an overwhelming need for the state to protect the interests of the public by restricting entry. Changes of practitioner’s scope of practice should benefit the public. Enhancement of professional status or qualification for third-party reimbursement alone are unacceptable justifications for regulation.

The Sunrise Act states that a health profession should be regulated or scope of practice expanded only when:

  • Unregulated practice can clearly harm or endanger the health, safety, or welfare of the public, and the potential for the harm is easily recognizable and not remote or dependent upon tenuous argument.
  • The public needs, and can reasonably be expected to benefit from, an assurance of initial and continuing professional ability.
  • The public cannot be effectively protected by other means in a more cost-beneficial manner.

If the legislature finds it necessary to regulate a health profession not previously regulated by law, the least restrictive method of regulation should be implemented, consistent with the public interest.

Testimony of AAMA Executive Director Balasa

Executive Director Balasa stated that it is the position of the AAMA and the WSSMA that there is an urgent need for medical assisting legislation in Washington state. The current legal ambiguities as to what medical assistants can be delegated are limiting access to health care for Washington residents and resulting in inefficiencies in health care delivery. Based on his familiarity with the medical assisting laws of all the states and generally-accepted health policy considerations, he maintained that the law in Washington state must be changed.

There is no other state that has a law similar to Washington’s “health care assistant” (HCA) law. “Health care assisting” is not a profession, but an ad hoc category created by the Washington state legislature in the 1980s to address a specific problem. To Balasa’s knowledge, “health care assisting” is not included in any listing of health professions, whether on the federal or state levels. Because the health care assistant law just addresses blood withdrawal and injections, the Washington State Department of Health’s interpretation has been that the legislature did not want to allow physicians to delegate to medical assistants any duties other than blood withdrawal and injections. He asserted that the Department of Health’s interpretation is not consistent with legislative intent, and must therefore be corrected by legislation.

Balasa offered the opinion that President Obama’s Patient Protection and Affordable Care Act (PPACA) will increase the demand for health care in general, and for outpatient care in particular. He also opined that this anticipated growth in the outpatient health care sector is pertinent to this hearing because medical assistants are specifically educated, trained, and credentialed in outpatient care. Passing legislation that would remove the barriers to safe and effective utilization of medical assistants—especially those who have graduated from a programmatically accredited postsecondary medical assisting program and who have a current medical assisting credential, such as the CMA (AAMA)—would enable physicians, nurse practitioners, physician assistants, and other providers to concentrate their expertise on helping patients with more complex and acute medical needs.

One of the many changes occurring simultaneously with President Obama’s health reform initiatives is a shift in emphasis toward team-based delivery of health care. Team-based care can be structured according to the patient-centered medical home (PCMH) paradigm, within accountable care organizations (ACOs)—which have been mandated by statute and are being incorporated into the regulations of the United States Department of Health and Human Services—or according to other models. As a result of the transition of ambulatory health care delivery to the team-based philosophy, there is an even greater necessity for legislation to provide rational, clear-cut guidelines as to what physicians are permitted to delegate to medical assistants.

Balasa emphasized that the primary legislative objectives of both the AAMA and the WSSMA are as follows:

  1. To enhance the quality of health care for all patients
  2. To increase the availability of high-quality health care

Balasa argued that the proposed legislation is imperative for achieving both of these vital public policy goals—ensuring greater access to care without diminishing the quality of care and the well-being of the residents of Washington. He remarked that, from his experience with medical assisting laws throughout the United States, there is an increasing number of states that are either including medical assistants by name in legislation, or authorizing the issuance of regulations delineating medical assisting educational and testing requirements. States have taken these actions to guarantee that physicians will be able to delegate a reasonable scope of duties to professionally educated and suitably credentialed medical assistants working under their direct supervision in outpatient settings.

Questions? Contact Donald A. Balasa, JD, MBA, at dbalasa@aama-ntl.org or 800/228-2262.