Reports from the Chief Executive Officer

Don Balasa

The following are excerpts from the past reports of Chief Executive Officer Donald A. Balasa, JD, MBA, to the House of Delegates and the Board of Trustees:

October 2017
September 2016
September 2015
October 2014
September 2013
September 2012
September 2011

For copies of earlier reports, you may e-mail a request to Chief Executive Officer Balasa at DBalasa@aama-ntl.org.


October 2017

FEDERAL MATTERS

Modifications to CMS Meaningful Use Order Entry Requirements

Despite the phasing out of the Medicare Electronic Health Record (EHR) Incentive Program by the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), the Centers for Medicare & Medicaid Services (CMS) rule that only licensed health care professionals or “credentialed medical assistants” are permitted to enter orders into the computerized provider order entry (CPOE) system for meaningful use calculation purposes under the Medicaid EHR Incentive Program remains in effect until at least December 31, 2021.

As noted in Legal Eye: On Medical Assisting, May 26, 2017, eligible professionals (EPs) participating in the Medicaid Incentive Program who “attest directly to a state for that state’s Medicaid EHR Incentive Program”:

…will continue to attest to the measures and objectives finalized in the 2015 EHR Incentive Program Final Rule (80 FR 62762 through 62955). In 2017, Medicaid EPs have the option to report to the Modified Stage 2 or Stage 3 objectives and measures.

The following are the Modified Stage 2 Objectives and Measures for Computerized Provider Order Entry (CPOE):

Objective: Use computerized provider order entry (CPOE) for medication, laboratory, and [diagnostic imaging] orders directly entered by any licensed healthcare professional[, credentialed medical assistant, or a medical staff member credentialed to and performing the equivalent duties of a credentialed medical assistant] who can enter orders into the medical record per state, local, and professional guidelines.
An eligible professional through a combination of meeting the thresholds and exclusions (or both), must satisfy all three measures for this objective.
Measure 1: More than 60 percent of medication orders created by the EP during the EHR reporting period are recorded using computerized provider order entry.
Exclusion: Any EP who writes fewer than 100 medication orders during the EHR reporting period.
Measure 2: More than 30 percent of laboratory orders created by the EP during the EHR reporting period are recorded using computerized provider order entry.
Exclusion: Any EP who writes fewer than 100 laboratory orders during the EHR reporting period.
Measure 3: More than 30 percent of [diagnostic imaging] orders created by the EP during the EHR reporting period are recorded using computerized provider order entry.
Exclusion: Any EP who writes fewer than 100 [diagnostic imaging] orders during the EHR reporting period.

The following are the Stage 3 Objectives and Measures for Computerized Provider Order Entry (CPOE):

Objective: Use computerized provider order entry (CPOE) for medication, laboratory, and diagnostic imaging orders directly entered by any licensed healthcare professional, credentialed medical assistant, or a medical staff member credentialed to and performing the equivalent duties of a credentialed medical assistant who can enter orders into the medical record per state, local, and professional guidelines.
An eligible professional through a combination of meeting the thresholds and exclusions (or both), must satisfy all three measures for this objective.
Measure 1: More than 60 percent of medication orders created by the EP during the EHR reporting period are recorded using computerized provider order entry.
Exclusion: Any EP who writes fewer than 100 medication orders during the EHR reporting period.
Measure 2: More than 60 percent of laboratory orders created by the EP during the EHR reporting period are recorded using computerized provider order entry.
Exclusion: Any EP who writes fewer than 100 laboratory orders during the EHR reporting period.
Measure 3: More than 60 percent of diagnostic imaging orders created by the EP during the EHR reporting period are recorded using computerized provider order entry.
Exclusion: Any EP who writes fewer than 100 diagnostic imaging orders during the EHR reporting period.

 

Medicare Chronic Care Management (CCM) and Transitional Care Management (TCM)

In response to specific right-to-practice questions, Legal Counsel Balasa wrote “‘Incident-to’ Billing: Medical Assistants’ Services under the Medicare CCM Program” for the November-December 2016 CMA Today. His position on the role of medical assistants—especially CMAs (AAMA)—in Chronic Care Management and Transitional Care Management is presented in the first paragraph:

I have received numerous questions about whether medical assistants’ services can be billed incident to the services of physicians and nonphysician practitioners (i.e., physician assistants, nurse practitioners, certified nurse-midwives, and clinical nurse specialists) under Medicare’s Chronic Care Management (CCM) program. The answer to this question is generally yes. Incident-to services under the CCM program are not limited to services of licensed professionals, such as registered nurses or licensed practical/vocational nurses.

 

Mr. Balasa's article was cited as a resource in the June 12, 2017, Part B News.

CDC Fetal Alcohol Spectrum Disorders (FASDs) Prevention Initiative—Partnership With CASAT

Mr. Balasa continues to serve as the principal staff contact for the partnership between the AAMA and the Center for the Application of Substance Abuse Technologies (CASAT) of the University of Nevada, Reno (UNR) in carrying out the grant from the Centers for Disease Control and Prevention (CDC) to combat Fetal Alcohol Spectrum Disorders (FASDs). His responsibilities include reviewing and signing legal documents that enable the AAMA to receive the grant funds, and compiling and submitting a semi-yearly invoice and justification for the time spent by AAMA staff in furtherance of this initiative.

CEO Balasa attended the CDC Grantee Meeting April 24-25, 2017, in Atlanta, Georgia. He attended the plenary sessions and the breakout brainstorming sessions involving the CASAT representatives. The breakout sessions clarified the role of the AAMA during the upcoming months of this important collaboration.

Mr. Balasa thanks Directors Langley, Johnson, and Lynch for their outstanding work and invaluable assistance in all aspects of this project. Director Langley has assumed the primary responsibility for coordinating the invoice report and justification and its documentation.

PROTECTING THE RIGHT TO PRACTICE AND PURSUING STATE LAW RECOGNITION OF CMAs (AAMA)

This calendar year (2017) has brought a higher level of state legislative and rule-making activity of pertinence for the medical assisting profession and CMAs (AAMA) than any other period in recent memory. As is usually the case, some of the legislation and proposed rules have been favorable, some have been threatening, and some have been neutral. However, a trend seems to be emerging: Significant numbers of Advanced Practice Registered Nurses (APRNs)—especially nurse practitioners (NPs)—and physician assistants (PAs) want laws to be changed so they will be permitted to delegate to medical assistants (in some states, medical assistants who have received formal medical assisting education and a medical assisting credential) the administration of intramuscular, intradermal, and subcutaneous injections—including vaccinations/immunizations. This trend is positive for CMAs (AAMA) and the American health care delivery system.

NURSE PRACTITIONER AND PHYSICIAN ASSISTANT DELEGATION OF INJECTIONS

Montana—Rita Nixon, CMA (AAMA), President of the Montana Society of Medical Assistants, contacted Mr. Balasa and asked him to review pending legislation that would allow physician assistants to delegate to medical assistants both administrative and clinical tasks, including the administration of medication. He submitted a letter to President Nixon stating that the bill did not create increased legal exposure for medical assistants. In fact, the legislation was favorable for medical assistants.

Arkansas—Melinda Rhynes, M.Ed., CMA (AAMA), President of the Arkansas Society of Medical Assistants and the medical assisting program director at Arkansas Tech University, asked CEO Balasa to assist the Arkansas Society in drafting a proposed change in the rules of the Arkansas State Board of Nursing (BON) that would permit advanced practice registered nurses (APRNs)—especially nurse practitioners—to delegate to educated and credentialed medical assistants certain types of medication administration. The rationale for the proposed rule change is as follows:

The health needs in Arkansas have increased in recent years. There is a shortage of health care professionals across the state, which could jeopardize the quality of care that Arkansans receive. The Arkansas State Board of Nursing recognized this trend years ago and authorized prescriptive authority for APRNs. Now, APRNs are wanting to delegate to CMAs (AAMA) medication administration in ambulatory health care settings under direct/onsite APRN supervision. The Arkansas Society of Medical Assistants and the American Association of Medical Assistants believe this change in APRN scope of practice would increase the quality of care for Arkansans. 

Based on language that Mr. Balasa and Ms. Rhynes drafted, the Arkansas State Board of Nursing Practice Committee discussed the following proposed rule change at its May 11, 2017, meeting: 

Chapter Four—Advanced Practice Registered Nurse
Section VI—Standards of Nursing Practice

B. Standards for All Categories of Advanced Practice Registered Nursing

8. The advanced practice registered nurse may delegate medication administration to a medical assistant who has graduated from a medical assisting program accredited by either the Commission on Accreditation of Allied Health Education Programs (CAAHEP) or the Accrediting Bureau of Health Education Schools (ABHES) and holds a current certification or registration that is accredited by the National Commission for Certifying Agencies (NCCA). The routes by which medication may be administered include: oral; topical; drops for eye, ear, or nose; vaginal; rectal; transdermal; inhalation; subcutaneous; and intramuscular. The advanced practice registered nurse shall be on the premises and immediately available whenever such individual is administering medications. Such medications shall not be a controlled substance.

The proposed rule change did not move forward. However, it is likely that this matter will be addressed by the Arkansas Board of Nursing in the future.

Ohio, Alaska, West Virginia—Legislation was enacted and regulations were issued in Ohio in 2015 and 2016 that permit APRNs and physician assistants to delegate to unlicensed allied health professionals such as medical assistants the administration of certain types of medication by specified routes. For several years Alaska and West Virginia laws have allowed APRNs to delegate to credentialed medical assistants the administration of certain types of injectable medication.

Connecticut—The leaders of the Connecticut Society of Medical Assistants, especially Public Policy Chair Holly Martin, CMA (AAMA), are to be commended for their excellent and hard work in the face of both support and opposition for Connecticut House Bill (HB) 6025. The current version of the legislation would permit medical assistants who have completed a medical assisting academic program and who hold a current medical assisting credential to be delegated the administration of vaccines to patients at least eleven (11) years of age. HB 6025 did not pass during the regular session of the Connecticut legislature. However, it is possible that the bill can be addressed during the special session of the legislature.

Mr. Balasa has worked with the leaders of the Connecticut Society, the lobbying firm employed by the Connecticut Society, and American Medical Technologists (AMT), which has been fully supportive of the legislative effort and is paying half the lobbyist fees.

Massachusetts—In late 2016 the Massachusetts legislature passed legislation that permits primary care providers to delegate to “certified medical assistants” working under their direct and immediate supervision the administration of immunizations. The Massachusetts Department of Public Health has issued interim guidelines pertaining to the new law and will be promulgating regulations pursuant to this law.

Florida—The medical assisting law in Florida is complex and in a state of flux. Legal Counsel Balasa, at the request of Florida Society Public Policy Chair Betty Springer, CMA (AAMA), reviewed two pieces of legislation. It is likely that there will be more legislation of relevance to medical assistants during the next several years.

New York—It is unlikely that New York Senate Bill 1047 will move forward during this session of the New York legislature.

Arizona—Arizona law requires its regulations to be reviewed every five years. (This is a type of “sunset law.”) Mr. Balasa drafted comments to the Arizona Medical Board that were reviewed by Mary Dockall, CMA (AAMA), President of the Arizona State Society of Medical Assistants (ASSMA), and other ASSMA leaders. The comments were submitted May 10, 2017. The following are two excerpts:

Arizona physicians and physician assistants are delegating an increasing number and variety of tasks to medical assistants working under their direct supervision in outpatient settings. To protect patients from substandard medical assisting services, it is the position of the AAMA and the ASSMA that (effective January 1, 2019) only: (1) graduates of accredited postsecondary medical assisting programs (or medical assisting programs in accredited schools), or of United States Armed Forces medical services training programs; or (2) individuals holding a current CMA (AAMA) credential awarded by the American Association of Medical Assistants (AAMA) or a current RMA(AMT) credential awarded by American Medical Technologists (AMT), should be permitted to work as medical assistants under Arizona law.

The following proposed changes to the current rules offered by the AAMA and the ASSMA reflect the above policy position. 

“Approved medical assistant training program” means: (1) a program accredited by the Commission on Accreditation of Allied Health Education Programs (CAAHEP) or the Accrediting Bureau of Health Education Schools (ABHES); or (2) a program in a school institutionally accredited by an accrediting body recognized by the United States Department of Education or the Council for Higher Education Accreditation; or (3) a United States Armed Forces medical services training program.

Washington—Washington State Society Public Policy Chair Patricia Hightower, CMA (AAMA), and Mr. Balasa drafted and submitted comments to the Washington Department of Health in regard to a proposed amendment to the medical assisting rules. The following is an excerpt:

It is the position of the AAMA and the WSSMA that Option B is superior to Option A. This position is based on the wording of Option A:
(2) Pass a clinical medical assistant certification examination accredited by the National Commission for Certifying Agencies (NCCA). The examinations recognized under this section must consist of clinical and administrative duties performed by medical assistants. Examinations for other health professions accredited by the NCCA do not satisfy the examination requirement for the medical assistant-certified credential.

The AAMA and the WSSMA understand the advantages of not having to amend the Washington Administrative Code every time another medical assisting certification program and its examination are accredited by the NCCA. However, even though Option A states that the “examinations recognized under this section must consist of clinical and administrative duties performed by medical assistants,” there is no assurance that NCCA-accredited medical assisting programs/examinations will contain questions about the particular tasks for MA-Cs delineated in statute and rule, or that questions about MA-C tasks will be of sufficient depth, breadth, and rigor to provide some measure of assurance that medical assistants applying for the MA-C will have the knowledge to protect adequately the people of Washington from substandard medical assisting services.

Thus, the American Association of Medical Assistants and the Washington State Society of Medical Assistants assert that the Washington Department of Health (DOH) should review the content outlines/test blueprints of medical assisting examinations that are part of programs that become NCCA-accredited to determine whether the examinations test knowledge necessary for MA-Cs. Such NCCA-accredited medical assisting certification programs that meet this requirement (as determined by the WA DOH) should then be added to WAC 246-827-0200 through the standard process for amending the Washington Administrative Code.

South Dakota—Under South Dakota law, medical assistants are governed jointly by the Board of Medical and Osteopathic Examiners and the Board of Nursing. Medical assistants must meet the requirements and register with the SD Board of Medical and Osteopathic Examiners in order to work as a medical assistant.

As of October 20, 2016, the joint rules now require medical assistants to have “passed a national certifying exam approved by the boards.” For twenty years the rules have required medical assistants to have “graduated from a medical assisting program approved by the boards.” Note the following excerpts from the South Dakota law: 

20:84:03:01. Qualifications of applicants. An applicant for registration shall provide:
(1) Proof of graduation from a medical assistant program approved by the boards;
(2) Proof of good moral character;
(3) Proof the applicant has graduated from high school or passed a standard equivalency test;
(4) Documentation showing the applicant is at least 18 years of age; and
(5) Proof of having passed a national certifying exam approved by the boards. [Emphasis added.]
20:84:04:01. Approved education programs. An applicant for registration shall have graduated from a medical assistant program that is approved by the boards or accredited by the Commission on Accreditation of Allied Health Education Programs (CAAHEP), or a similar accrediting institution approved by the United States Department of Education. Approved programs must provide classroom, laboratory, and clinical learning experiences that provide for student attainment of entry level competence as a registered medical assistant.

California—Kathy Megivern, JD, CAE, Executive Director of CAAHEP, informed Mr. Balasa of a California bill (Assembly Bill 387) that would require students participating in a practicum/externship to be paid the minimum wage for externship hours. Mr. Balasa informed the leaders of the California Society of Medical Assistants, drafted testimony, and submitted the testimony on behalf of the California Society and the AAMA. The following are excerpts: 

The AAMA and CSMA share the concern of Assembly Member Thurmond over the proportionately small number of low-income and minority students in California allied health education programs. Nevertheless, it is our position that the enactment of Assembly Bill 387 would not address this problem, and could exacerbate it.
…If practicum sites were required to pay medical assisting externs for the practicum hours, fewer outpatient delivery settings (e.g., medical offices and clinics) would be willing to serve as practicum sites. This could result in a reduction in the number of medical assisting programs in California, and fewer opportunities for low-income and minority students to receive medical assisting education and enter the allied health workforce.
Another possible scenario is that medical assisting programs would have to reimburse outpatient settings for wages paid to externs. This could result in higher tuition for medical assisting programs. Higher tuition would impose a hardship for all potential and current medical assisting students, and could result in fewer students from under-represented communities being able to afford medical assisting education. Consequently, the enactment of Assembly Bill 387 could heighten the barriers for low-income and minority students wanting to pursue allied health careers, and could reduce the number of medical assistants from under-represented communities.

California Assembly Bill 387 was not enacted.

Minnesota—Minnesota Senate Bill 318 would authorize medical assistants with formal medical assisting education and a medical assisting credential, and who have “completed 40 hours of training on the provision of home care services,” to provide such home care services. Mr. Balasa provided feedback to Danielle Perron, CMA (AAMA), Legislative Chair of the Minnesota Society of Medical Assistants, on this legislation. The bill was referred to committee for study.

Wisconsin—Mr. Balasa was alerted to an article in The LaCrosse Tribune about apprenticeship-type medical assisting training programs in the LaCrosse area. At the request of the Wisconsin Society of Medical Assistants, he drafted the following letter for submission to the newspaper:

The Wisconsin Society of Medical Assistants is concerned about on-the-job training programs for medical assistants discussed in your January 3, 2017, edition. The Centers for Medicare & Medicaid Services (CMS) oversees the Medicaid Electronic Health Record (EHR) Incentive Program established by the United States Congress. The federally-mandated CMS regulations state that only “credentialed medical assistants” (in addition to licensed health care professionals) are permitted to enter medication/prescription, laboratory, and diagnostic imaging orders into the EHR and have such entry count toward meeting the meaningful use requirements of the Medicaid Incentive Program.
The CMS regulations stipulate that credentialing for a medical assistant must come from a body other than the body employing the medical assistant. Thus, on-the-job training programs may not qualify medical assistants for order entry under the Medicaid Incentive Program. Employers of these on-the-job trained medical assistants, consequently, may not meet the order entry requirements and may be denied incentive payments.
The Wisconsin Society of Medical Assistants urges employers to hire formally educated medical assistants who have an accredited, national medical assisting credential such as the CMA (AAMA). Questions may be directed to the American Association of Medical Assistants and the Wisconsin Society of Medical Assistants at dbalasa@aama-ntl.org.

 

PRESENTATIONS

2016 AAMA House of Delegates

CEO Balasa presented “Educator Eligibility: Why the Certifying Board Continues to Require CAAHEP or ABHES Graduation for the CMA (AAMA) Certification Examination” at the 2016 AAMA House of Delegates morning session on Sunday, September 18, 2016, in Reston, Virginia. His article of the same title was published in the September-October 2016 CMA Today.

PAHCOM Annual Conference

Mr. Balasa presented “How Expanding Roles for NPs and PAs Are Impacting Reimbursement and Delegation in Medical Offices” on October 18, 2016, at the Annual Conference of the Professional Association for Health Care Office Management (PAHCOM). He also assisted President Flaatten and Vice President Lee in the staffing the exhibit booth at this meeting, and answered scope of practice questions from the attendees.

Macomb Community College

On October 25, 2016, Mr. Balasa presented “The New Merit-Based Incentive Payment System (MIPS): How Could the Proposed CMS Rule Impact Order Entry for Credentialed Medical Assistants?” after a dinner for alumnae/alumni of the medical assisting program of Macomb Community College in Michigan. AAMA CEUs were granted for this presentation.

Northwest Cook Chapter of the Illinois Society of Medical Assistants

On January 21, 2017, Legal Counsel Balasa gave a 90-minute CEU presentation entitled “Illinois Scope of Practice and How MACRA Impacts Order Entry for Credentialed Medical Assistants.” He spoke for another 30 minutes on the importance of AAMA membership and maintaining currency of the CMA (AAMA) credential.

Institute for Credentialing Excellence (ICE)

Mr. Balasa co-presented a webinar February 28, 2017, entitled “Common Pitfalls in Applying for NCCA Accreditation.” The webinar received good ratings from the participants.

Presence Medical Group (formerly Lutheran General Health System)

On March 23, 2017, Legal Counsel Balasa presented a session on the medical assisting scope of practice under Illinois and federal law to the Quality Department of Presence Medical Group in Park Ridge, Illinois.

MedStar Health

Mr. Balasa presented a CEU session for medical assistants, providers, and managers April 22, 2017, in Baltimore, Maryland, on the scope of practice for medical assistants under Maryland law, and the roles of medical assistants under the Medicare Access and CHIP Reauthorization Act (MACRA) of 2015, and the Medicare Chronic Care Management (CCM) and Transitional Care Management (TCM) programs.

California Association of Public Hospitals and Health Systems, California Health Care Safety Net Institute

On May 10, 2017, Mr. Balasa co-presented during a webinar entitled “Medical Assistants: CA Regulations and Opportunities for Innovation” for the above-captioned organization. The following is a description of the entity:

The California Association of Public Hospitals and Health Systems (CAPH) represents California’s 21 public health care systems, which include county-affiliated systems and the five University of California academic medical centers. The California Health Care Safety Net Institute (SNI) is the performance improvement affiliate of CAPH. Together, CAPH and SNI provide programmatic support, policy advocacy, and technical expertise for member systems to ensure that all Californians receive high value care, irrespective of insurance status, ability to pay, or other circumstances.

The webinar received good ratings from the participants.

Journal of Medical Practice Management

Mr. Balasa’s article “NPs and PAs: How Expanding Reimbursement and Scopes of Practice Can Facilitate High Quality, Efficient Health Care” was published in the March 2017 issue of the Journal of Medical Practice Management.

MEETINGS

MGMA Annual Conference

CEO Balasa attended the 2016 Medical Group Management Association (MGMA) Annual Conference October 30-November 1, 2016. He helped President Flaatten and Immediate Past President Purdy staff the exhibit booth, and he answered many questions on scope of practice and other legal issues.

ATP Annual Conference

Mr. Balasa attended the Association of Test Publishers (ATP) Annual Conference March 5-8, 2017, in Scottsdale, Arizona. He is serving on the ATP Health Care Sector Division, the Workforce Skills Credentialing Division, and the Certification/Licensure Division.

American Council on Exercise (ACE)

The CEO participated in the final meeting of the Prescription for Activity Task Force of the American Council on Exercise (ACE) held March 22-23, 2017, at the Hyatt Regency O’Hare. He has made valuable new contacts from the three meetings of this task force and has solidified previous contacts, one of whom has been helpful to Mr. Balasa with a current AAMA undertaking.

Credential Engine Certification and Licensure Advisory Group (CLAG)

Mr. Balasa participated in the inaugural meeting of the CLAG of Credential Engine April 12, 2017, in Washington, DC. He knew and had worked with over half the members of the CLAG, and met new colleagues, one of whom has already proven helpful with a current AAMA undertaking. The following is a description of the Certification and Licensure Advisory Group: 

Draft
Credential Engine
Certification and Licensure Advisory Group (CLAG)

 

Mission Statement - Credential Engine is a 501(c)(3) non-profit organization working to improve transparency in the credentialing marketplace.

As the number of certifications, licenses, badges, apprenticeships, microcredentials, certificates outside of higher education, higher education certificates, and degrees dramatically increases, there is a growing need to be able to understand the purposes, common uses, competencies, and strengths of the different type of credentials. Credential Engine aims to solve this problem by expanding and maintaining a new online system for creating, aggregating, and communicating information about credentials, more specifically by:

  1. Scaling a web-based Credential Registry that enables job seekers, students, workers, and employers to easily search for and compare credentials, just as travel apps are used to compare flights, rental cars, and hotels.
  2. Maintaining WorkitTM, a prototype open-source credential search application to demonstrate the power of the registry.
  3. Promoting an open applications marketplace to foster the development of additional apps that serve the needs of job seekers, students, workers, employers, and other stakeholders.
  4. Guiding the future development and use of the registry through stakeholder advisory groups and the technical advisory committee.
  5. Maintaining and improving the open-licensed Credential Transparency Description Language (CTDL), which provides and updates the common language for the metadata on the registry.

To ensure the relevance of its work and the registry, Credential Engine has created six advisory groups: 1) Higher Education; 2) Business; 3) Certification and Licensure; 4) Quality Assurance; 5) Technical; and 6) Philanthropic.

Charter - The charter of the Certification and Licensure Advisory Group (CLAG) is to provide support and guidance to Credential Engine as it seeks to bring more transparency and clarity to government and private sector certifications and licenses related to competencies, connections to other types of credentials, and market value in today’s complex marketplace. The CLAG will focus on industry certifications and state licenses, while also considering federal licenses. The primary purpose is to give stakeholders the appropriate and valid data needed to make choices about certifications and licenses related to individuals, educational and career counselors, corporations, private sector, and government.

Activities
The Certification and Licensure Advisory Group (CLAG) implements its Charter by supporting Credential Engine Board and staff in the following ways:

Provide expertise and advice on current certification and licensure policies, practices, and processes and its effect on the workforce. ...

Provide guidance on innovation in credentialing, including latest advances in technology to support credentialing (e.g., software, platforms, databases) and cutting-edge policies, practices and processes in the creation of quality and market-valued certification and licenses. ...

Recommend areas of research that should be undertaken by Credential Engine to further understand and validate trends and uses in the marketplace. ...

Serve as a resource for recruiting certification and licensure bodies to post on the registry and educating stakeholders regarding the certification and licensure industry. ...

Coordinate messaging with other advisory groups to Credential Engine.

Mr. Balasa also attended a meeting of the Certification and Licensure Advisory Group August 29, 2017, in Washington, DC.

CAAHEP Annual Meeting

On April 23-24, 2017, Mr. Balasa attended the Annual Meeting of the Commission on Accreditation of Allied Health Education Programs (CAAHEP) in Atlanta, Georgia. He is the AAMA Commissioner to CAAHEP and also serves on the CAAHEP Public Policy Committee. There was discussion about California Assembly Bill 387 (see above) that would have required externing students to be paid the minimum wage for externship/practicum hours.

Excelsior College

President Flaatten, Vice President Lee, and Mr. Balasa met with Laurie Carbo-Porter, PhD, RN, CNE, Acting Dean of the Excelsior College School of Health Sciences, at the 2016 PAHCOM Annual Conference.

As a follow-up to the discussion at the PAHCOM meeting, Mr. Balasa sent the following e-mail to Dr. Carbo-Porter:

We would appreciate your considering awarding credit to individuals who have passed the CMA (AAMA) Certification Examination and who hold the CMA (AAMA) credential. I have attached the current Content Outline of the examination. Please let me know what type of psychometric information you will need, and I will request permission from the Certifying Board of the AAMA and the National Board of Medical Examiners to provide this information to you.

 

Association of Surgical Technologists

Legal Counsel Balasa occasionally receives questions about whether CMAs (AAMA) are permitted to work in outpatient surgical centers and to assist physicians in the operating room. He contacted William Teutsch, CAE, Chief Executive Officer of the Association of Surgical Technologists (AST), and was given access to the page on the AST website that provides information about state surgical technology laws. This will enable Mr. Balasa to answer these scope of practice questions more quickly.

House Legal Counsel Responsibilities

Legal Counsel Balasa has continued to provide assistance to state societies and local chapters on questions involving bylaws, parliamentary procedure, suspected or actual misappropriation of funds, records retention, obtaining an Employer Identification Number/Taxpayer Identification Number (EIN/TIN), incorporation, responding to questions from the Internal Revenue Service, and the ineligibility of states and chapters for state sales tax exemption. He has provided standard letter templates and has reviewed and signed cease and desist letters to medical assistants who are using the CMA (AAMA) credential and are not CMAs (AAMA), and to former CMAs (AAMA) who are using the credential, even though their CMA (AAMA) is not current.

Assisting State Societies with Bylaws Questions

During state society annual conferences in March, April, and May of 2017, Mr. Balasa provided assistance to the leaders of three different state societies who wanted guidance on interpretation of their state and/or local bylaws, or wanted to make sure they had the most recent version of their state society bylaws.

ASSISTING STATE SOCIETY LEADERS WITH INCONSISTENT IRS, STATE CORPORATION AGENCY, AND BANK ACCOUNT INFORMATION

Legal Counsel Balasa helped officers from three state societies who were told that the Taxpayer Identification Number/Employer Identification Number (TIN/EIN) on file with the Internal Revenue Service did not match the TIN on the bank account, and/or did not match the TIN on file with the state agency that regulates non-profit corporations. He obtained a TIN online for one state society, spoke with a bank representative for another state society, and offered advice on how to address a problem with the state department of licensing and regulatory affairs (corporations bureau) for the third state society.

 

September 2016

ACCREDITATION OF THE CERTIFYING BOARD OF THE AAMA UNDER ISO 17024 

On March 31, 2016, the Certifying Board (CB) of the AAMA was awarded accreditation as a Body Operating Certification of Persons (AC474) by the International Accreditation Service (IAS). By virtue of this accreditation, the Certifying Board of the AAMA demonstrated compliance with ISO/IEC Standard 17024:2012 (ISO 17024 or 17024), the global benchmark for personnel certification bodies.

The magnitude of this accomplishment is difficult to overstate. The Certifying Board of the AAMA is one of only ten health care certifying bodies that has been accredited as having met the rigorous requirements of ISO 17024. The other accredited certifying bodies include the American Society of Clinical Pathologists, the American Registry for Diagnostic Medical Sonography, and the National Board of Certification in Occupational Therapy. The Certifying Board is the only credentialing body for medical assistants that has obtained this international recognition.

The CMA (AAMA) Certification Program remains accredited by the National Commission for Certifying Agencies (NCCA)—an accrediting arm of the Institute for Credentialing Excellence (ICE)—under its Standards for the Accreditation of Certification Programs. Consequently, the Certifying Board and its CMA (AAMA) Certification Program are the only medical assisting certifying body and certification program (respectively) that hold both accreditation under ISO 17024 and also NCCA accreditation.

The Certifying Board and Director of Certification and Associate Executive Director Anna L. Johnson, CAE, are to be commended for this monumental achievement.

 

CDC FETAL ALCOHOL SPECTRUM DISORDERS (FASDs) PREVENTION INITIATIVE 

Mr. Balasa continues to serve as the principal staff contact for the partnership between the AAMA and the Centers for the Application of Substance Abuse Technologies (CASAT) of the University of Nevada, Reno (UNR) in carrying out the grant from the Centers for Disease Control and Prevention (CDC) to combat Fetal Alcohol Spectrum Disorders (FASDs). The goals of the University of Nevada, Reno, and the AAMA are the following:

  • To introduce, improve, and sustain the knowledge and practice behaviors of medical assistants in preventing and intervening with risky and hazardous alcohol use which are supported by the adopting of evidence-based interventions in clinical practices; and
  •  To increase, improve, and sustain the engagement, knowledge, and practice behaviors of health care professionals related to FASDs prevention, intervention, and treatment through the availability of online workshops and resources.

Mr. Balasa attended the April 2016 FASDs Practice and Implementation Centers and National Partners Grantee Meeting in Decatur, Georgia. He submits periodic reports to the UNR CASAT about the progress the AAMA is making in ensuring fulfillment of the above goals. The UNR CASAT has written a continuing education article on FASDs for an upcoming issue of CMA Today. CEO Balasa will write the questions for this article.

 

GRANTING OF AAMA CEUs TO SMILES FOR LIFE CURRICULUM 

As was the case with the partnership with the University of Nevada, Reno, in regard to the CDC grant for FASDs prevention, Mr. Balasa received a cold-call e-mail about this opportunity and referred it to the appropriate AAMA Board—in this case, to the Continuing Education Board. (Please refer to the report of the Continuing Education Board for more information.)

 

PRESENTATION AT THE PAHCOM ANNUAL CONFERENCE 

Legal Counsel Balasa has been chosen to present at the 2016 Annual Meeting of the Professional Association of Health Care Office Management (PAHCOM) in October. His presentation is “How Expanding Roles for Nurse Practitioners and Physician Assistants Are Impacting Reimbursement and Delegation in Medical Offices.

 

CAAHEP COMMISSIONER 

Mr. Balasa continues to serve as the AAMA Commissioner to the Commission on Accreditation of Allied Health Education Programs (CAAHEP), and as a member of the CAAHEP Public Policy Committee. He attended the CAAHEP Annual Meeting April 10-11, 2016, in Memphis, Tennessee.

 

AMERICAN COUNCIL ON EXERCISE TASK FORCE 

CEO Balasa was invited to be a member of the Prescription for Activity Task Force (Task Force) of the American Council on Exercise (ACE).

The following is the Vision of the Task Force:

A future in which a significant number of health care consumers in the U.S. are prescribed or incentivized to pursue physical-activity-based behavior-change interventions for preventive care and self-maintenance—interventions that are readily accessible, delivered by trusted members of the patient-centered team, reimbursable by payers, and integrated into patient records.

The following is the Need for the Task Force:

There is broad agreement that increased physical activity counseling is a promising strategy to improve the quality of healthcare, create a better experience for the health care consumer, and lower costs. Thus, leading recommending authorities have called for physical activity counseling to be widespread, particularly for those with or at risk of chronic conditions. Yet to date, there has been no clear, broadly accepted road map for making that happen. The Prescription for Activity Task Force aims to change that.

The following is the Task for the Task Force:

The charge of the Prescription for Activity Task Force is to construct a long-term “change map” for clinical and community integration of physical-activity-based behavior-change interventions for the prevention and treatment of disease.

The following is information about the members of the Task Force:

[The] Prescription for Activity Task Force members [are a] group of 30+ national experts, thought leaders, and luminaries from healthcare, academia, business, philanthropy, and government. All share a belief that physical-activity-based behavior-change interventions should be more integral to health care; they have convened to find a way to make that happen.

Mr. Balasa attended the Task Force planning retreat May 11-12, 2016, in Dallas, Texas. He will be attending another Task Force meeting September 13-14, 2016, in Denver, Colorado.

 

ASSOCIATION OF TEST PUBLISHERS

Mr. Balasa attended the Association of Test Publishers (ATP) Annual Conference March 20-23, 2016, in Orlando, Florida. He is serving on the ATP Health Care Sector Division, the Workforce Skills Credentialing Division, and the Certification/Licensure Division.

 

FEDERAL HEALTH INFORMATION TECHNOLOGY

Mr. Balasa is perceiving new opportunities in the arena of health information technology. He attended the Annual Meeting of the Office of the National Coordinator for Health Information Technology (HIT) May 31-June 2, 2016, in Washington, D.C.

 

COMMENT TO CMS

On June 21, 2016, Mr. Balasa submitted a comment to the Centers for Medicare & Medicaid Services (CMS) about the proposed rule regarding the Merit-Based Incentive Payment System (MIPS) and Alternative Payment Model (APM). The following is an excerpt from this comment:

The American Association of Medical Assistants is in total agreement with the following excerpts from the “Medicare and Medicaid Programs; Electronic Health Record Incentive Programs—Stage 3 and Modifications to Meaningful Use in 2015 Through 2017; Final Rule” (80 FR 62762 through 62955), October 16, 2015:

(Page 62798, second column)
In the Stage 2 final rule (77 FR 53986) and in subsequent guidance in FAQ 9058, we explained for Stage 2 that a licensed health care provider or a medical staff person who is a credentialed medical assistant or is credentialed to and performs the duties equivalent to a credentialed medical assistant may enter orders. We maintain our position that medical staff must have at least a certain level of medical training in order to execute the related CDS [clinical decision support] for a CPOE order entry…

(Page 62839, second column)
…We believe CPOE and CDS duties should be considered clinical in nature, not clerical. Therefore, CPOE and CDS duties, as noted, should be viewed in the same category as any other clinical task, which may only be performed by a qualified medical or clinical staff person.

In keeping with the above excerpts, it is the position of the AAMA that only appropriately credentialed medical assistants (in addition to licensed health care professionals) should be permitted to enter medication, laboratory, and diagnostic imaging orders into the computerized provider order entry system for meaningful use calculation purposes under the Medicaid Electronic Health Record Incentive Program, and for advancing-care-information purposes under the Merit-Based Incentive Payment System (MIPS). Without this requirement, the welfare of patients would be jeopardized.

 

INSTITUTE FOR CREDENTIALING EXCELLENCE

Mr. Balasa continues to serve as chair of the Institute for Credentialing Excellence (ICE) Government Affairs Working Group. He also serves on the Lumina Project Subgroup.

 

HOUSE LEGAL COUNSEL RESPONSIBILITIES

House Legal Counsel Balasa has continued to provide assistance to state societies and local chapters on questions involving bylaws, parliamentary procedure, suspected or actual misappropriation of funds, records retention, obtaining an Employer Identification Number/Taxpayer Identification Number (EIN/TIN), incorporation, responding to questions from the Internal Revenue Service, and the ineligibility of states and chapters for state sales tax exemption. He has assisted in the answering of questions about the Certifying Board Disciplinary Standards and in the reviewing of complaints about CMAs (AAMA). Also, he has helped review petitions from felons seeking a waiver to take the CMA (AAMA) Certification Examination. He has provided standard letter templates and has reviewed and signed cease and desist letters to medical assistants who are using the CMA (AAMA) credential and are not CMAs (AAMA), and to former CMAs (AAMA) who are using the credential, even though their CMA (AAMA) is not current.

 

LEGAL EYE: ON MEDICAL ASSISTING AND PUBLIC AFFAIRS ARTICLES IN CMA TODAY

Mr. Balasa continues to write monthly (or more frequent) posts to his blog Legal Eye: On Medical Assisting. He also continues to write a Public Affairs article for each issue of CMA Today. His recent and upcoming Public Affairs articles are: “One Credential, Many Roles: Why CMAs (AAMA) Are Uniquely Qualified for Advanced Positions” (May-June 2016); “Why IAS Accreditation and ISO 17024 Compliance Are Monumental Achievements” (July-August 2016); “Why the Certifying Board Continues to Require CAAHEP or ABHES Graduation for Educator Eligibility for the CMA (AAMA) Certification Examination” (September-October 2016).

 

PROTECTING THE RIGHT TO PRACTICE OF CMAs (AAMA) AND MEDICAL ASSISTANTS

Ohio - At the request of the Ohio State Society of Medical Assistants (OSSMA), Mr. Balasa drafted comments on behalf of the OSSMA and the AAMA regarding proposed rules issued by the Ohio Board of Nursing for advanced practice registered nurse (APRN) delegation to medical assistants of certain types of medication administration. These were published as the Public Affairs article in the March-April 2016 CMA Today.

New York
Mr. Balasa attended the Annual Meeting of the New York State Society of Medical Assistants (NYSSMA) April 14-16, 2016, in Syracuse, New York. He addressed the attendees about important AAMA accomplishments and initiatives, and advised the NYSSMA leaders and members regarding what position to take on the medical assisting legislation pending in the New York legislature.

Florida
Mr. Balasa attended the Annual Meeting of the Florida Society of Medical Assistants (FSMA) April 29-30, 2016, in Cocoa Beach, Florida. He addressed the attendees about important AAMA accomplishments and initiatives, explained legislation that had been recently enacted by the Florida legislature, and explained and expressed his support for the resolution presented to the FSMA General Assembly about pursuing medical assisting legislation.

Michigan
Legal Counsel Balasa and two leaders of the Michigan Society of Medical Assistants attended a meeting with a state legislator and staff May 18, 2016, in Lansing, Michigan, about the need for medical assisting legislation in Michigan.

 

September 2015

ORDER ENTRY UNDER THE MEDICARE AND MEDICAID ELECTRONIC HEALTH RECORD (EHR) INCENTIVE PROGRAMS AND RELATED DEVELOPMENTS 

AAMA CEU for 2014 Annual Conference Presentation

Mr. Balasa presented “How Medical Assistants Can Meet the Centers for Medicare and Medicaid Services (CMS) Meaningful Use Requirements” at the 2014 AAMA Annual Conference in St. Louis, Missouri. A summary of this presentation was published in the November-December 2014 CMA Today, and a video of the presentation was posted to the AAMA website. At the request of the AAMA Continuing Education Board (CEB), he wrote twenty questions for his presentation so it could be awarded an AAMA Continuing Education Unit (CEU).

CMS NPRM for Stage 3 of the Incentive Programs

On March 20, 2015, the Centers for Medicare and Medicaid Services (CMS) issued a notice of proposed rulemaking (NPRM) for Stage 3 of the Medicare and Medicaid Electronic Health Record (EHR) Incentive Programs. This NPRM continues the CMS requirement that medical assistants be “credentialed” in order to enter medication, laboratory, and imaging orders into the CPOE system for purposes of meaningful use calculation.

On March 24 and 25, 2015, CEO Balasa posted comments about this CMS NPRM to his Legal Eye on Medical Assisting blog. His article “Proposed CMS Rule Is Favorable for CMAs (AAMA)” was published in the May-June 2015 CMA Today. On May 23, 2015, he submitted comments to CMS about this NPRM.

Audit Program of the Medicare EHR Incentive Program

Legal Counsel Balasa posted the following to his blog on April 21, 2015:

As part of its Work Plan for Fiscal Year 2015, the Office of Inspector General (OIG) of the Department of Health and Human Services is initiating an audit program of the Medicare Electronic Health Record (EHR) Incentive Program…

  Any eligible professionals (EPs) who received incentive payments from Jan. 1, 2011, to June 30, 2014, are eligible to be randomly selected for auditing. The OIG will review certain meaningful use measures to determine whether selected EPs incorrectly received any incentive payments, and whether those EPs have adequately protected patients’ health information created or maintained by the EHR. As part of the auditing process, the agency will request specific information and documentation of compliance with the meaningful use measures under review.

Presentation at the PAHCOM Annual Conference

Mr. Balasa presented “Who Can Enter Orders into the EHR? What Managers Need to Know” at the Annual Conference of the Professional Association of Health Care Office Management (PAHCOM) October 21-23, 2014, in Clearwater Beach, Florida. His talk was well received by the attendees, and generated many questions and great interest in the AAMA.

Presentation for the Michigan Osteopathic Association

On November 1, 2014, CEO Balasa presented on the CMS order entry rule to the Michigan Osteopathic Association’s 10th Annual Autumn Practice Manager Program in Grand Rapids, Michigan. This speaking engagement resulted from his CMS presentation to this organization in May of 2014.

Presentation to ABHES Annual National Conference and Article in CMA Today

CEO Balasa presented “The CMS Meaningful Use Order Entry Rule: What Educators Need to Know” at the 12th Annual National Conference on Allied Health Education February 27, 2015, in Las Vegas, Nevada. A summary of this presentation was published in the March-April 2015 CMA Today.

Presentation to ADAM Annual Meeting

Legal Counsel Balasa presented “Who Can Enter Orders into the EHR for Meaningful Use: What You Need to Know” at the 23rd Annual Meeting of the Association of Dermatology Administrators and Managers (ADAM) March 20, 2015, in San Francisco, California. He received favorable evaluations from the attendees, and discovered from comments by attendees that CMS meaningful use audits had begun in at least three states (i.e., Florida, Ohio, and California).

Article for the Journal of Medical Practice Management

Mr. Balasa’s article entitled “Who Can Enter Orders for Meaningful Use? An Evolving Challenge for Practice Managers” was accepted for publication in the Journal of Medical Practice Management. This journal is published by Greenbranch Publishing. This article incorporates the proposed changes to the Incentive Programs reflected in the March 20, 2015 CMS NPRM.

Presentation to Association of Surgical Assistants

As a result of his presentation to the ABHES National Conference and a subsequent conversation with an attendee, Mr. Balasa was invited to present on the CMS meaningful use order entry rule at the Fall Conference of the Association of Surgical Assistants October 3, 2015, in Nashville, Tennessee.

Presentation to the Virginia Medical Group Management Association

As a result of his presentation at the ADAM Annual Meeting, Mr. Balasa was asked to present on the CMS meaningful use order entry rule at the Fall Conference of the Virginia Medical Group Management Association (VMGMA) September 22, 2015, in Norfolk, Virginia.


HOUSE LEGAL COUNSEL RESPONSIBILITIES

House Legal Counsel Balasa has continued to provide assistance to state societies and local chapters on questions involving bylaws, parliamentary procedure, suspected or actual misappropriation of funds, record retention, obtaining an Employer Identification Number/Taxpayer Identification Number (EIN/TIN), incorporation, responding to questions from the Internal Revenue Service, and the ineligibility of states and chapters for state sales tax exemption. He has assisted in the answering of questions about the Certifying Board Disciplinary Standards and in the reviewing of complaints about CMAs (AAMA). Also, he has helped review petitions from felons seeking a waiver to take the CMA (AAMA) Certification Examination. He has provided standard letter templates and has reviewed and signed cease and desist letters to medical assistants who are using the CMA (AAMA) credential and are not CMAs (AAMA), and to former CMAs (AAMA) who are using the credential, even though their CMA (AAMA) is not current.


EAGEN V. HARRIS SCHOOL OF BUSINESS

Mr. Balasa was subpoenaed to produce documents in the above-captioned matter and to give a deposition in this New Jersey class action by 74 former medical assisting students against the school they attended. This cause of action is based on the alleged promises to students and graduates of the medical assisting program of Harris School of Business that they would be eligible for the CMA (AAMA) Certification Examination. The medical assisting program at this school was not CAAHEP or ABHES accredited. Legal Counsel Balasa will be giving a deposition in Atlantic City, New Jersey.

 

FINANCIAL MANAGEMENT

The AAMA continues to do well financially. The two AAMA funds (General Fund and Certification Fund) are projected to finish fiscal year 2015 (July 1, 2014 through June 30, 2015) with an excess of revenue over expense. 

 

REPRESENTATIVES BUREAU ASSIGNMENT

Mr. Balasa was pleased to represent the AAMA at the Montana Society of Medical Assistants annual meeting May 1-3, 2015, in Bozeman, Montana. He gave his CMS meaningful use presentation, and also addressed right to practice issues under Montana law. He spoke with the executive director of the Montana Board of Medical Examiners (BOME) and the executive director of the Montana Medical Society, and will monitor the May 14, 2015, meeting (and future meetings) of the Montana BOME via telephone. He presided over the installation ceremony for the incoming officers and trustees of the Montana Society. Mr. Balasa is grateful to the leaders and members of the Montana Society for their kindness and hospitality.

 

FEDERAL AND INTERNATIONAL MATTERS

Bureau of Labor Statistics Occupational Outlook Handbook

The United States Bureau of Labor Statistics (BLS) each year publishes an updated version of its Occupational Outlook Handbook, one of the most reliable and authoritative sources on professions and occupations. As has been the case for several years, BLS staff contacted Mr. Balasa and asked him questions about the medical assisting profession, the CMA (AAMA), the AAMA, and the CMS meaningful use order entry rule. He was able to suggest language changes in the entry about medical assistants that reflect more accurately the current realities of the profession of medical assisting.

Center for the Application of Substance Abuse Technologies (CASAT)

CEO Balasa will be representing the AAMA at a meeting of the Centers for Disease Control and Prevention (CDC) in Atlanta, Georgia, July 20-21, 2015. The invitation to this meeting was issued by the Center for the Application of Substance Abuse Technologies (CASAT).

 

PRESENTATIONS AND ARTICLES, LEADERSHIP ROLES, AND MEETING ATTENDANCE FOR NATIONAL HEALTH ORGANIZATIONS

Presentation at the Annual Meeting of the National Council of State Boards of Nursing (NCSBN)

CEO Balasa spoke to nurse regulators from throughout the United States at the Annual Meeting of the National Council of State Boards of Nursing August 14, 2014, in Chicago. He described the important role of CMAs (AAMA) in ambulatory care delivery settings, and stressed the fact that medical assistants must be graduates of CAAHEP or ABHES accredited medical assisting programs and hold a current CMA (AAMA) credential in order to best ensure high quality health care for patients. Mr. Balasa commended the NCSBN for its great assistance to the medical assisting profession in recent years, and offered suggestions on how the NCSBN and the AAMA can work together during this unprecedented time of change for the American health care system.

Institute for Credentialing Excellence (ICE) and the National Commission for Certifying Agencies (NCCA) 

In November of 2014 Mr. Balasa was appointed Chair of the Institute for Credentialing Excellence (ICE) Government Affairs Committee. He served on this committee from 2005 to 2009 and served as Chair from 2008 to 2009.

In May of 2013, the National Commission for Certifying Agencies (NCCA) started the process of revising its Standards for the Accreditation of Certification Programs (Standards). Because of his service on the NCCA from 2007 to 2013, Mr. Balasa was appointed Leader of one of the three task forces—the task force responsible for reviewing the administrative elements of the Standards. The new Standards were approved and will go into effect January 1, 2016. 

Legal Counsel Balasa wrote the “Governance” and “Legal Issues” modules for ICE’s “Credentialing Specialist” assessment-based certificate program.

At the annual ICE Exchange held in San Antonio, Texas, November 11-14, 2014, House Counsel Balasa was the co-presenter for two education sessions: “Key Legal Issues for Certification Entities: Perspectives of General and Staff Counsel,” and “Special Arrangements: Accommodations 101.” He co-authored an article with Jefferson C. Glassie, Esquire, FASAE, entitled “Key Legal Issues for Certification Bodies: An Ever-Changing Landscape” that was published in ICE Digest.

Presentation to 2015 HPN Spring Conference

Mr. Balasa presented “Competency Development Driven by DATA—Why an Occupational Analysis Is Important” at the Health Professions Network (HPN) Spring Conference April 10, 2015, in Grand Rapids, Michigan. An article adapted from this presentation will be published in the July/August 2015 issue of CMA Today.

Attendance at CAAHEP Annual Meeting


Mr. Balasa continues to serve as the AAMA Commissioner to the Commission on Accreditation of Allied Health Education Programs (CAAHEP). He attended the CAAHEP Annual Meeting in Kansas City, Missouri, April 19 and 20, 2015, and sat in on the open session led by Medical Assisting Education Board (MAERB) Chair Jenny Spegal, MAERB Executive Director Sarah Marino, and MAERB member and Commissioner to CAAHEP Tina Broderick.

Attendance at ATP Annual Conference

CEO Balasa attended the Annual Conference of the Association of Test Publishers (ATP) March 1-4, 2015, in Palm Springs, California. He continues to serve on the ATP Americans with Disabilities Act (ADA) Special Interest Group (SIG), and participated in a meeting of this SIG at the ATP Annual Conference. ATP formed a new SIG consisting of representatives from medicine, nursing, dentistry, and the allied health professions, and Mr. Balasa volunteered to be a part of this SIG.

PROTECTING THE RIGHT TO PRACTICE OF MEDICAL ASSISTANTS

State Net

The AAMA retained the services of State Net, a leading legislative tracking service. The following is a description of State Net’s capabilities:

To help find and identify key legislation in the 50 States, District of Columbia and Federal Government, store and classify the information within State Net’s secure online database, and provide flexible management and reporting tools for quick access and easy dissemination, including an automated e-mail alert system.

State Net has helped Staff Legal Counsel Balasa: (1) find newly introduced legislation that has the potential of impacting the medical assisting profession; (2) inform state societies and the Board of Trustees of favorable and unfavorable bills; and (3) develop a strategy about how to respond to each pertinent piece of legislation.

Michigan

Mr. Balasa was alerted by the weekly State Net report to House Bill No. 6078 introduced into the Michigan House of Representatives December 3, 2014. After informing and consulting with the appropriate leaders of the Michigan Society of Medical Assistants, a December 10, 2014, letter to the sponsor of the bill over the signatures of Christa Smith, CMA (AAMA), President of the Michigan Society, and Mr. Balasa, was sent. The letter read, in part, as follows:

The MSMA and the AAMA are concerned about the inclusion of the phrase “medical assistant” in the legisla­tion’s references to “search and rescue operation medical assistant” and “tactical operation medical assistant.” Medical assisting is a specific allied health profession, as demonstrated by the article in the Occupational Outlook Handbook of the United States Bureau of Labor Statistics (attached). Using “medical assistant” to refer to a set of licensed health professionals who are assisting a governmental agency or law enforcement officers could be confusing.

The MSMA and the AAMA suggest that the references in the bill be changed to “search and rescue operation assisting [or assistive] medical licensees” and “tactical operation assisting [or assistive] medical licensees.”

Connecticut

With the help of a lobbyist and the excellent leadership of Connecticut Society of Medical Assistants Public Policy Chair Holly Martin, a bill was introduced into the Connecticut legislature that would permit physicians, advanced practice registered nurses, and physician assistants to delegate to medical assistants who meet specified education and credentialing requirements and who work under a provider’s direct supervision in outpatient settings vaccines. The bill passed one house of the Connecticut legislature, which is an extraordinary accomplishment—especially in light of the strong opposition to the legislation. The Connecticut Society will work to get legislation passed in the 2016 session, and Mr. Balasa will continue to assist them with bill language and strategy.

Ohio
   

Language permitting advanced practice registered nurses to delegate to unlicensed allied health professionals such as medical assistants working under their direct supervision has been incorporated into an omnibus bill that is moving forward in the Ohio legislature. The Ohio Society of Medical Assistants has done an excellent job working with organized nursing and other stakeholders who have an interest in the enactment of this legislative language.

Massachusetts

A bill authorizing primary care providers to delegate to medical assistants who meet certain education requirements the administration of immunizations has been introduced in the Massachusetts legislature. It is likely that the progress of this bill will be slower than the progress of the bills in Connecticut and Ohio. Dawn Jordan and other leaders of the Massachusetts Society of Medical Assistants have done an excellent job monitoring the progress of this bill.

Illinois

A bill introduced into the Illinois House of Representatives provides for financial grants for students enrolled in, or accepted for, a “medical assistant program at a public community college in [Illinois] that will lead to certification to work as a medical assistant.” The following is the bill language:

HB3577 Engrossed

AN ACT concerning education.

Be it enacted by the People of the State of Illinois, represented in the General Assembly: 

Section 5. The Higher Education Student Assistance Act is amended by adding Section 65.90 as follows:

(110 ILCS 947/65.90 new)

Sec. 65.90. Medical assistant grants.

(a) Beginning with the 2016-2017 academic year through the 2020-2021 academic year, the Commission [Illinois Student Assistance Commission] shall, each year, receive and consider applications for grant assistance under this Section. An applicant is eligible for a grant under this Section if the Commission finds that the applicant meets all of the following qualifications:

(1) He or she is a resident of this State and a United States citizen or eligible noncitizen.

(2) He or she is enrolled or accepted for enrollment in a medical assistant program at a public community college in this State that will lead to certification to work as a medical assistant. 

(b) Recipients shall be selected from among applicants qualified pursuant to subsection (a) of this Section based on financial need, as determined by the Commission. Preference may be given to previous recipients of assistance under this Section, provided they continue to maintain eligibility and maintain satisfactory academic progress, as determined by the institution at which they enroll.

(c) Each grant awarded under this Section shall be in an amount sufficient to pay the tuition and fees of the institution at which the recipient is enrolled, except that no recipient may receive more than $5,000 in a single academic year. 

(d) The total amount of grant assistance awarded by the Commission under this Section to an individual in any given fiscal year, when added to other financial assistance awarded to that individual for that year, shall not exceed the cost of attendance at the institution at which the student is enrolled. 

(e) All applications for grant assistance to be awarded under this Section shall be made to the Commission in a form as set forth by the Commission. The form of application and the information required to be set forth in the application shall be determined by the Commission, and the Commission shall require eligible applicants to submit with their applications such supporting documents as the Commission deems necessary.

(f) Subject to a separate appropriation made for such purposes, payment of any grants awarded under this Section shall be determined by the Commission. All grant funds distributed in accordance with this Section shall be paid to the institution on behalf of the recipients. Grant funds are applicable toward 2 semesters of enrollment within an academic year. Up to 2% of the appropriation for this grant program may be used by the Commission for the costs of administering the grant program. 

(g) The Commission shall administer the grant program established by this Section and shall make all necessary and proper rules not inconsistent with this Section for its effective implementation.

 

October 2014

ORDER ENTRY UNDER THE MEDICARE AND MEDICAID ELECTRONIC HEALTH RECORD (EHR) INCENTIVE PROGRAMS AND RELATED DEVELOPMENTS

Joint Presentation at the 2013 AAMA Annual Conference

On September 29, 2013, Executive Director Balasa and Robert Anthony, Deputy Director of the Health Information Technology Initiatives Group of the Centers for Medicare and Medicaid Services (CMS), gave a joint presentation to the AAMA House of Delegates at the 57th Annual Conference of the American Association of Medical Assistants in Atlanta, Georgia. The video of the presentation and question and answer session were posted on the AAMA website. An article summarizing the key elements of the joint presentation was published in the November-December 2013 issue of CMA Today. The video and article have generated numerous scope of practice and legal questions for Mr. Balasa, and have increased the credibility and visibility of the AAMA in the federal and state policy arenas.

Post on Legal Eye: Audits and the Importance of Credentialing for Order Entry

On December 19, 2013, Mr. Balasa posted the following on his Legal Eye blog:

During the coverage of the Centers for Medicare and Medicaid Services (CMS) Stage 2 rule, there was some thought that CMS auditors would not have the authority to inquire about the credential status of medical assistants entering orders into the computerized provider order entry (CPOE) system.

This thinking is incorrect. To qualify for payments under the Electronic Health Record (EHR) Incentive Programs, providers will be required to present documentation of all entries, many of which are automatically kept by the EHR system. CMS auditors do have the authority to determine whether entry of medication, laboratory, and radiology orders has been made by licensed health care professionals or credentialed medical assistants. If it is discovered that order entry was done by individuals other than licensed professionals or credentialed medical assistants, the auditors could cite this violation, and it is possible that the order entry by these individuals would not be counted toward meeting the meaningful use thresholds. As a result, the eligible professional may not meet all the core objectives and consequently would not receive incentive payments.

The reality of these audits only serves to emphasize the importance of employing credentialed professionals in the health care setting. A description of the CMS EHR audit process can be found in the attached document [See May/June 2014 CMA Today]. In addition, I have provided a link to a question and answer session I took part in with Robert Anthony of CMS. 


CMS Article for Nebraska Physician Publication

The Executive Director’s article “CMS EHR Rule Benefits Physicians” was published in the Winter 2014 issue of Cornhusker Family Physician, a publication of the Nebraska Academy of Family Physicians.

Presentation at Michigan Osteopathic Association 14th Annual Practice Manager Program

On May 16, 2014, Executive Director Balasa presented a 90-minute session entitled “CMS Rule for Meaningful Use Order Entry” at the Michigan Osteopathic Association Annual Practice Manager Program in Detroit, Michigan. His talk included information about the scope of practice for medical assistants under Michigan law.

His presentation was well-received, and Mr. Balasa was asked to present at another conference of the Michigan Osteopathic Association November 1, 2014, in Grand Rapids, Michigan.

The American Osteopathic Association posted a link to his handouts and articles for his presentation of May 16, 2014.

Updated CMS PowerPoint for BOT Representatives Bureau Assignees

Executive Director Balasa updated his PowerPoint presentation “The CMS Rule for Meaningful Use Order Entry” that was originally presented at the 2013 AAMA Annual Conference in conjunction with the presentation of Robert Anthony of the Centers for Medicare and Medicaid Services. He forwarded the revised PowerPoint slides to the Board of Trustees as a resource for their Representatives Bureau assignments.

Presentation for WSMA 2014 Annual Conference

Mr. Balasa presented a PowerPoint presentation “CMAs (AAMA) in the Current Health Care Environment: Unprecedented Opportunities and New Challenges” at the Annual Conference of the Wisconsin Society of Medical Assistants (WSMA) April 24-26, 2014, in La Crosse, Wisconsin. He sent his slides to the members of the Board of Trustees, Certifying Board, and Continuing Education Board for their information.

Presentation at PAHCOM Annual Conference

Mr. Balasa will present “Who Can Enter Orders into the EHR? What Managers Need to Know” at the Annual Conference of the Professional Association of Health Care Office Management (PAHCOM) October 21-23, 2014, in Clearwater Beach, Florida.

Presentation for California Quality Collaborative

On May 13, 2014, Executive Director Balasa presented on the CMA (AAMA) credential, California medical assisting law, and the CMS rule for meaningful use electronic order entry for a webinar of the California Qualify Collaborative entitled “Achieve More through Managing Medical Assistants’ Scope.”

Joint Presentation with Robert Anthony of CMS

The Oregon Health Authority, an agency of the state of Oregon, posted on its webpage a link to the videos of the joint presentation of Mr. Balasa and Robert Anthony of CMS given at the 2013 AAMA Annual Conference.

ADVOCACY FOR FEDERAL AND NATIONAL INITIATIVES

Letter to Congress Urging Funding for the Medical Assistant Profession and Other Allied Health Professions under Title VII of the Public Health Services Act

Executive Director Balasa wrote a letter to leaders of both houses of the United States Congress advocating funding for the medical assistant profession and other allied health professions under Title VII of the Public Health Services Act. The following is an excerpt from this letter: 

As the nation adjusts to the ramifications of President Obama’s Patient Protection and Affordable Care Act, medical assistants holding the CMA (AAMA) credential awarded by the Certifying Board of the AAMA are assuming additional, vital roles in the health care delivery system, such as patient advocate and health coach. Only medical assistants who have graduated from a programmatically-accredited, postsecondary medical assistant program are eligible for the CMA (AAMA) Certification Examination.

The American Association of Medical Assistants urges your subcommittee to prioritize funding for the medical assistant profession and the other allied health professions subsumed under Title VII of the Public Health Services Act. Ensuring state-of-the-art, affordable education in all allied health fields will enable the American health care delivery system to respond quickly and seamlessly to the influx of patients resulting from the Affordable Care Act. Importantly, well-educated allied health professionals will enhance the cost-effectiveness as well as the capacity of the delivery system, and will assist our nation in reaching its goal of providing affordable and appropriate health care for all.
This letter was published in CMA Today, and readers were asked to write similar letters to their federal legislators. Associate Executive Director Johnson is also disseminating this letter to medical assisting communities of interest and requesting that they also contact Congress. Mr. Balasa commends Ms. Johnson for her excellent work and leadership on this issue. She became aware of this initiative by virtue of her service on the Board of Directors of the Health Professions Network (HPN). Letter in Support of a Grant Application from the Center for the Application of Substance Abuse Technologies

The Executive Director sent a letter to the Center for the Application of Substance Abuse Technologies (CASAT), University of Nevada, Reno, supporting its application for a Fetal Alcohol Spectrum Disorders (FASDs) Practice and Implementation Centers grant to develop, deliver, disseminate, and evaluate medical assisting-specific academic curricula for pre-service students and continuing education training for practitioners on the prevention, identification, and treatment of FASDs.

 

PRESENTATIONS AND ARTICLES, LEADERSHIP ROLES, AND MEETING ATTENDANCE FOR NATIONAL HEALTH ORGANIZATIONS

National Commission for Certifying Agencies (NCCA)

After serving six years on the National Commission for Certifying Agencies (NCCA), three of the six years as Chair, Executive Director Balasa completed his service in November of 2013. He received a special commendation for his service from the Board of Directors of the Institute for Credentialing Excellence (ICE), the parent association of the NCCA.

ATP ADA Special Interest Group

Because of his knowledge of how the Americans with Disabilities Act (ADA) and the regulations of the United States Department of Justice impact testing programs, the Executive Director continues to serve on the ADA Special Interest Group of the Association of Test Publishers (ATP).

Federation of Associations of Regulatory Boards (FARB)

Mr. Balasa spoke at the Annual Attorney Certification Seminar in Professional Regulatory Law sponsored by the Federation of Associations of Regulatory Boards (FARB) October 4-6, 2013, in Coeur d’Alene, Idaho. His presentation was entitled “Americans with Disabilities Act: Another Update.”

CDR Credentials Evaluation Task Force

In November of 2013 Executive Director Balasa was appointed to the Credentials Evaluation Task Force of the Commission on Dietetic Registration (CDR).

Service as AAMA CAAHEP Commissioner

Mr. Balasa began his service as the American Association of Medical Assistants’ Commissioner to the Commission on Accreditation of Allied Health Education Programs (CAAHEP) at CAAHEP’s annual conference April 27-28, 2014, in San Antonio, Texas. He looks forward to being of service to CAAHEP and the allied health community in this important role.

ABHES Annual Conference

The Executive Director staffed the exhibit booth of the Certifying Board of the AAMA at the Annual Conference of the Accrediting Bureau of Health Education Schools (ABHES) February 27-28, 2014, in Nashville, Tennessee. He met several ABHES program directors and educators, many of whom indicated that they had their students take the CMA (AAMA) Certification Examination.

Presentation for National Council of State Boards of Nursing

On April 23, 2014, Executive Director Balasa presented “NCCA Standards Revision Update” at a meeting in Chicago of the National Council of State Boards of Nursing (NCSBN) about the Consensus Model for Advanced Practice Registered Nurses (APRNs). Approximately 250 nursing leaders from throughout the United States were present, many of them serving in leadership positions on state boards of nursing. Although he was speaking as Immediate Past Chair of the National Commission for Certifying Agencies (NCCA), Mr. Balasa also mentioned that an increasing number of CMAs (AAMA) are working under the direct supervision of nurse practitioners, and that these NPs are finding CMAs (AAMA) to be ideal employees.

ADA Article for ICE Website

Legal Counsel Balasa’s article “Proposed ADA Regulations Would Impact Assessment Industry” was posted to the website of the Institute for Credentialing Excellent (ICE) February 25, 2014.

American Academy of Ambulatory Care Nurses Annual Conference

The Executive Director attended one day of the American Academy of Ambulatory Care Nurses (AAACN) Annual Conference in New Orleans, Louisiana, May 22, 2014. Of special interest was the session “Organization Medical Assistant Role Development and Utilization Strategies.”

ASSISTANCE TO THE AAMA BOARD OF TRUSTEES

Upon the request of Vice President Charlene Couch, CMA (AAMA), the Executive Director wrote questions and answers for the Board of Trustees to assist them during their Representatives Bureau assignments.

 

DEFENDING THE CMA (AAMA) CREDENTIAL AND REPORTING “DIPLOMA MILLS” AND “ACCREDITATION MILLS”

Trademark Registration of “CMA (AAMA),” “AAMA,” and “American Association of Medical Assistants”

Mr. Balasa is pleased to report that the initialisms “CMA (AAMA)” and “AAMA,” and the phrase “American Association of Medical Assistants,” have been registered with the United States Patent and Trademark Office (USPTO). He commends the Certifying Board of the AAMA, Director of Certification Anna L. Johnson, CAE, and General Counsel Nathan J. Breen, Esquire, for their invaluable assistance. Registration on the Principal Register of the USPTO enhances the AAMA’s common law, substantive intellectual property rights in these three marks, and offers procedural advantages in case of infringement.

Correcting Wrong Information about CMA (AAMA) Eligibility

Staff Counsel Balasa informed Florida State College at Jacksonville that its website statement that graduates of its medical assisting program (that is not CAAHEP or ABHES accredited) would be eligible for the CMA (AAMA) Certification Examination after one year of work experience had to be removed. The statement was promptly removed.

Correcting School’s Misuse of “Certified Medical Assistant”

The Executive Director informed Gogebic Community College in Michigan that its use of “certified medical assistant” to describe its academic program was a violation of the AAMA’s intellectual property rights. The college immediately agreed to remove all offending phrases.

Misleading Language by Medical Career Specialists

On December 30, 2013, Executive Director Balasa wrote to the Florida Attorney General to report misleading statements by Medical Career Specialists. Here is an excerpt from his letter:

Medical Career Specialists purports to be “the Nation’s premier choice for alternative healthcare education.” Specifically, MCS offers a “Certified Clinical Medical Assistant-CCMA” program whose duration is five (5) days.

MCS claims that it is accredited by the “National Healthcare Credentialing Institute (NHCI),” and that it is an Affiliated Partner of the “National Medical Licensing Association (NMLA).” The NHCI and the NMLA do not appear to be legitimate accrediting or certifying bodies.
The Florida Attorney General reported this to the Florida Department of Education (DOE), and suggested to Mr. Balasa that he contact the Florida DOE, which he did. He was informed by the Florida DOE that action is being taken against Medical Career Specialists. This matter also has been reported to the United States Federal Trade Commission (FTC) and the District of Columbia Health Regulation and Licensing Administration. “Certified Medical Assistant (AMT) (CMA) Test”

The website of ExamEdge, a provider of practice tests for several allied health examinations, contained several references to the “Certified Medical Assistant (AMT) (CMA) test.” Mr. Balasa sent a cease and desist letter, and references connecting American Medical Technologists (AMT) with “Certified Medical Assistant” and “CMA” were deleted from the website.

Revised Wording for ABR-OE Documents and Articles

The Executive Director and staff directors revised the wording for Assessment-Based Recognition in Order Entry (ABR-OE) documents, article, and web pages to read as follows:

CMAs (AAMA) do not need the ABR. The CMA (AAMA) credential meets the CMS “credentialed medical assistant” requirement because CMA (AAMA) education, training, and testing includes electronic order entry. Therefore, the ABR is not granted to CMAs (AAMA).
 

PROTECING THE RIGHT TO PRACTICE OF MEDICAL ASSISTANTS

Rhode Island

Executive Director Balasa was contacted by the Rhode Island Board of Medical Licensure and Discipline and was asked to offer comments on its draft Guideline for Supervision of Medical Assistants.

Connecticut

On March 19, 2014, the Public Health Committee of the Connecticut legislature held a public hearing on General Assembly Raised Bill No. 459, “An Act Concerning Medical Assistants.” This legislation was the result of a scope of practice request submitted by the American Association of Medical Assistants (AAMA) and the Connecticut Society of Medical Assistants (CSMA) July 16, 2012, to the Connecticut Department of Public Health (see the March-April 2013 issue of CMA Today).

Raised Bill No. 459 would have permitted physicians to delegate to medical assistants who had graduated from an accredited postsecondary medical assisting program and who are certified by the Certifying Board of the AAMA “the administration of medication orally, by inhalation, or by intramuscular, intradermal, or subcutaneous injections, including, but not limited to, the administration of a vaccine.” The bill also would have required that the medication be administered “under the direct supervision, control, and responsibility of a physician who is in the outpatient clinic or office when such medication is administered.”

The AAMA and the CSMA submitted joint written testimony drafted by Mr. Balasa in support of Raised Bill No. 459, and Holly Martin, CMA (AAMA), of the CSMA presented oral testimony at the March 19 hearing. American Medical Technologists (AMT) Executive Director Chris Damon also presented written and oral comments at the hearing.

At the March 19 committee hearing, a key legislator expressed concern about the bill because there was no requirement for a certain number of hours of pharmacology in the CAAHEP and ABHES medical assisting accreditation Standards. This legislator indicated that a minimum number of hours of pharmacology is required by Connecticut law for the registered nurse curriculum. The legislator felt that there would be no guarantee that the people of Connecticut would be protected from substandard injection practice by medical assistants without an assurance that graduates of accredited medical assisting programs have been taught an acceptable amount of pharmacology. The bill was not reported out of committee. Efforts are underway to reword the bill and have it introduced into the next session of the Connecticut legislature.

Utah

The Executive Director continued to represent the American Association of Medical Assistants and the Utah Society of Medical Assistants in reference to an initiative from the Utah Cluster Acceleration Partnership (UCAP) to regulate medical assistants. He drafted medical assisting scope of practice language for consideration by the UCAP and participated in conference calls.

Iowa

At the request of a member of the Iowa Society of Medical Assistants, Mr. Balasa wrote a letter pointing out the “distinct superiority” of the CMA (AAMA) credential. This letter and some of his articles were forwarded to human resource decision makers in northern Iowa. Following is an excerpt from the letter:

Of the four medical assisting credentials discussed in my attached article, the CMA (AAMA) is the only one that has an eligibility requirement for all candidates of graduation from a postsecondary, accredited medical assisting academic program. The other three credentialing bodies permit an individual to take their tests without having any formal medical assisting education. Because “hands-on,” psychomotor competencies cannot be measured by a paper-and-pencil or computer-based test, the mandatory education requirement distinguishes the CMA (AAMA) from all other medical assisting credentials, and provides employers, patients, malpractice insurance carriers, and third-party accrediting bodies such as The Joint Commission and the National Committee for Quality Assurance with tangible evidence that CMAs (AAMA) are not only knowledgeable about the multifaceted dimensions of the profession, but also competent in the clinical and administrative duties that are required in ambulatory care delivery settings.

Because of its distinct superiority, the CMA (AAMA) is being recognized as the foremost standard of medical assisting excellence, and the optimal credential for protecting patients from substandard medical assisting services. For example, note the following excerpt from the third attachment, which is a position statement from the West Virginia Board of Nursing. Only the CMA (AAMA) is recognized by the WV Board of Nursing:
Prior to delegating any medication administration, the APRN and/or CNM is
responsible for validating: the credentials of the medical assistant to assure completion of a nationally recognized accredited program of study with a curriculum that included pharmacology and medication administration; the medical assistant has a current national certification through the American Association of Medical Assistants; and related competencies have been validated within the past twelve months.
Ohio
 

The Executive Director assisted the Ohio State Society of Medical Assistants in working with the Ohio Board of Nursing and nursing organizations to have legislation introduced that would permit certain advanced practice nurses to delegate the administration of certain medications to a medical assistant who “has successfully completed education based on a recognized body of knowledge concerning drug administration and demonstrates to the person’s employer the knowledge, skills, and ability to administer the drug safely.”

Nebraska

Staff Counsel Balasa was informed by a leader of the Nebraska Society of Medical Assistants that a large health system in that state was using the initialism “CMA” when advertising for medication aides. In response to Mr. Balasa’s letter, the Director of Operations of the health system sent a letter stating that the health system would discontinue using “CMA” when advertising for medication aide positions.

Massachusetts

The Executive Director informed the Massachusetts Society of Medical Assistants of legislation that would clarify the right of medical assistants who have completed a qualified medical assisting program to be delegated the administration of certain kinds of injections—including vaccinations/immunizations. He also contacted the sponsor of the legislation and informed him of the importance of incorporating the CMA (AAMA) credential into the bill, or in rules promulgated pursuant to the bill.

Washington

Mr. Balasa and Director of Certification Johnson continue to answer questions about the medical assisting law in Washington State that went into effect July 1, 2013. They participated in a conference call involving Washington medical assisting educators and officials of the Washington Department of Health (DOH). The Executive Director discussed during the call the potential impact of the CMS rule for order entry under the Medicare and Medicaid Electronic Health Record Incentive Programs on the medical assisting regulations of the WA DOH.
 

HOUSE LEGAL COUNSEL RESPONSIBILITIES

House Legal Counsel Balasa has continued to provide assistance to state societies and local chapters on questions involving bylaws, parliamentary procedure, suspected or actual misappropriation of funds, record retention, obtaining an Employer Identification Number/Taxpayer Identification Number (EIN/TIN), and the ineligibility of states and chapters for state sales tax exemption. He has assisted in the answering of questions about the Certifying Board Disciplinary Standards and in the reviewing of complaints about CMAs (AAMA). Also, he has helped review petitions from felons seeking a waiver to take the CMA (AAMA) Certification Examination. He has provided standard letter templates and has reviewed and signed cease and desist letters to medical assistants who are using the CMA (AAMA) credential and are not CMAs (AAMA), and to CMAs (AAMA) who are using the credential, even though their CMA (AAMA) is not current.

DIRECTOR OF ACCREDITATION

After fourteen years of distinguished service, Director of Accreditation Judy Jondahl, MS, RN, retired at the end of 2013. With the invaluable assistance of the Executive Committee of the Medical Assisting Education Review Board and Associate Executive Director Anna Johnson, CAE, Mr. Balasa hired Sarah R. Marino, PhD, as Director of Accreditation. Dr. Marino has been doing an outstanding job as Director of Accreditation. She is well regarded by her colleagues in the academic accreditation community, and has earned the respect of the members of the Accreditation Department.

FINANCIAL MANAGEMENT 

The AAMA continues to do well financially. Although final figures are not ready, it appears that the two AAMA funds (General Fund and Certification Fund) will finish fiscal year 2014 (July 1, 2013 through June 30, 2014) with an excess of revenue over expense. The membership numbers for calendar year 2014 indicate an increase in total membership over calendar year 2013.

 

September 2013

THE MEDICARE AND MEDICAID ELECTRONIC HEALTH RECORDS (EHR) INCENTIVE PROGRAMS

Oral Presentation at the 2012 AAMA Annual Conference
Mr. Balasa addressed the 2012 AAMA House of Delegates on the decision of the Centers for Medicare and Medicaid Services (CMS) to permit "credentialed medical assistants" to enter medication, laboratory, and radiology orders into the computerized provider order entry (CPOE) system for purposes of calculating meaningful use under the Medicare and Medicaid Electronic Health Records (EHR) Incentive Programs. His presentation was videotaped and posted on the AAMA website.

CMA Today Article
The Executive Director's article "AAMA triumphs in CMS order entry rule" was published in the November-December 2012 issue of CMA Today. The following is the opening paragraph:

On August 23, 2012, the Centers for Medicare and Medicaid Services (CMS) issued a final rule on Stage 2 of the Medicare and Medicaid Electronic Health Records (EHR) Incentive Program. Due, in part, to the advocacy efforts of the American Association of Medical Assistants (AAMA), the CMS decided that credentialed medical assistants—including CMAs (AAMA)—would be permitted to enter medication [and laboratory and radiology] orders into the computerized provider order entry (CPOE) system. This is a major victory for the AAMA and the medical assisting profession.

Electronic Learning Center (e-LC) Course
At the request of the Continuing Education Board and Director David Knight, Mr. Balasa converted his written pieces on the CMS rule into a continuing education course for the e-LC by writing the required number of questions.

Contact with CMS Staff
Throughout the process of analyzing and submitting comments on the CMS rule, the Executive Director found CMS staffers to be very helpful and very prompt in responding to his e-mails and voicemail messages. In November of 2012 CMS staffer Travis Broome confirmed that Mr. Balasa's interpretations of some of the seeming inconsistencies in the CMS final rule were correct.

December 3, 2012, Legal Eye Post
An example of one of Mr. Balasa's interpretations that has been confirmed by CMS involves the question of whether the CMS decision applies to Stage 1 as well as Stage 2 of the EHR Incentive Program. Note his December 3, 2012, post on Legal Eye:

As the implications of the CMS Stage 2 final rule continue to unfold, more questions inevitably arise. One of these questions involves the status of "credentialed medical assistants" in the computerized provider order entry (CPOE) system with regard to Stages 1 and 2. The CMS website addresses this very question:

Q: Does the inclusion of [credentialed medical assistants] in the list of professionals who can enter orders into the EHR using CPOE and have them count in the numerator of the CPOE measure apply to Stage 1 as well as Stage 2?

A: We have revised the description of who can enter orders into the EHR and have it count as CPOE and have it count for purposes of the CPOE measure. This revision is available for EHR reporting periods in 2013 and beyond regardless of what stage of meaningful use the provider is attesting to.

I will continue to keep you updated as more questions are raised—and answered—in the wake of this important rule. (Source:
https://questions.cms.gov/faq.php?id=5005&faqId=7693)

Article in The Portland Physician Scribe
At the request of Speaker of the House Paula Purdy, CMA (AAMA), Executive Director Balasa wrote an article on the CMS final rule from a physician's perspective. This article, entitled "CMS Final Ruling Expands Physician Delegation of Electronic Order Entry, Includes Medical Assistants," was published in the December 2012 issue of this publication.

Article in Lane County Medical Society Publication
At the request of Trustee Joyce Garibay, CMA (AAMA), the Executive Director wrote an article on the CMS final rule for the January 2013 issue of Of Interest, a publication of the Lane County Medical Society. The article is entitled "CMS Broadens Delegation of EHR Order Entry."

Participation in CMS National Provider Call
Mr. Balasa participated in the October 24, 2012, CMS National Provider Call "In-depth Overview of Stage 2 Clinical Quality Measures for the Medicare and Medicaid EHR Incentive Programs for Eligible Professionals."

Increasing Number and Complexity of Questions about the CMS Order Entry Rule
Questions have increased about the decision by CMS to permit "credentialed medical assistants" to enter medication, laboratory, and radiology orders into the CPOE system for purposes of meeting the Stage 2 Core Objective "CPOE for Medication, Laboratory, and Radiology Orders." The CMS final rule has increased awareness of medical assistants, and especially CMAs (AAMA), throughout the United States. The AAMA's advocacy in persuading CMS to expand its order entry provisions has borne very positive and unexpected fruit. The CMS rule could be a turning point in recognition of the CMA (AAMA) credential.

"FAQs about the CMS Rule for Meaningful Use Order Entry"
On March 28, 2013, Executive Director Balasa sent the above-captioned piece to Board of Trustees members to help them prepare for questions during Representatives Bureau assignments. This article was published in the July/August 2013 CMA Today.

January 17, 2013, Electronic Health Records (EHR) Incentive Program News Update
Mr. Balasa sent to the BOT the January 17, 2013, EHR electronic news update. It reads, in part, as follows:

Several Changes to Stage 1 Meaningful Use Measures Begin This Year
The Stage 2 rule for the Electronic Health Records (EHR) Incentive Programs included changes to the Stage 1 meaningful use objectives, measures, and exclusions for eligible professionals (EPs), eligible hospitals, and critical access hospitals (CAHs). Some of these Stage 1 changes took effect on October 1, 2012, for eligible hospitals and CAHs, or January 1, 2013, for EPs...

Computerized Physician Order Entry (CPOE)

Change: Revised the description of who can enter orders into the EHR and have it count as CPOE
Timing: 2013 and onward (regardless of what stage of meaningful use the provider is attesting to)

(This is proof that credentialed medical assistants are permitted to enter medication, laboratory, and radiology orders for Stages 1 and 2 of the EHR Incentive Program as of January 1, 2013, not as of January 1, 2014.)

Joint Commission on Allied Health Personnel in Ophthalmology (JCAHPO)
The Executive Director's article "CMS Order Entry Rule Impacts Ophthalmic Personnel" was published in the April 2013 electronic newsletter of JCAHPO. On May 2, 2013, Mr. Balasa participated by speakerphone in a JCAHPO Board of Directors meeting. He answered questions about the CMS final rule.

Assistance to a CMA (AAMA)
Mr. Balasa assisted a CMA (AAMA) who was told by her supervisor that she could no longer use her credential. Here are excerpts from the e-mail dialogue:

CMA (AAMA): Today my supervisor told me I could no longer place CMA (AAMA) on the end of my name to anything I sign, fax, document, etc., because I was not hired to be a CMA (AAMA). I was hired for medical records/clerical.

Mr. Balasa: I would suggest that you share my attached article with your superiors. You can point out that only "credentialed medical assistants" (in addition to licensed professionals) are now allowed to enter medication, laboratory, and radiology orders in the electronic health record for purposes of calculating meaningful use under the Medicare and Medicaid Incentive Programs. Thus, in light of the CMS final rule, your employer and supervisors would be well advised to not move too quickly in having administrative medical assistants remove their credentials.

CMA (AAMA): Thank you for your insight and input. I will give this a try.
...
CMA (AAMA): Mr. Balasa, words cannot express how grateful I am for your article and advice. Not only did my employer apologize to me, I also get to continue using my CMA (AAMA) behind my name!

Progress in Iowa
Mr. Balasa received the following e-mail May 16, 2013:

You are hearing from one VERY EXCITED CERTIFIED Medical Assistant who cannot thank you enough for all you do for our profession. I was able to forward to our regional manager and clinic liaison the E-Blast article that reflected your success with CMS and allowing credentialed medical assistants to enter information into EHRs and WE HAVE WON THE BATTLE!!!

Please see below the initial correspondence (to an office manager) that they are now requiring medical assistants to be certified and/or registered to work in the clinical setting! Honestly, I never thought I would see this in my lifetime and I just want to express how thankful I am for our national organization going to bat for us. It has been a sequence of meetings, waiting, persisting, waiting, hoping and praying and waiting, but it has finally been accomplished! The North Iowa area and our North Iowa Chapter are extremely proud!

CMS National Provider Call
On May 30, 2013, Executive Director Balasa and Associate Executive Director Anna Johnson, CAE, participated in a National Provider Call sponsored by CMS. The program was entitled: "Stage 1 of the Medicare and Medicaid EHR Incentive Programs for Eligible Professionals: First in a Series."

Letter to Epic Systems Corporation about its Electronic Health Records Software
It was brought to the attention of Mr. Balasa that the Electronic Health Records software of Epic Systems Corporation did not provide a means for medical assistants to enter orders. He informed Epic by letter that the CMS rule permits credentialed medical assistants to enter orders into the EHR.

FINANCIAL MANAGEMENT

The AAMA continues to do well financially. Although final figures are not quite ready, it appears that the two AAMA funds (General Fund and Certification Fund) will finish fiscal year 2013 (July 1, 2012 through June 30, 2013) with an excess of revenue over expense. The membership numbers for calendar year 2013 indicate an increase in total membership over calendar year 2012.

PRESIDENT HOLLANDER AND EXECUTIVE DIRECTOR BALASA IN ASAE's "ASK THE CEO" FEATURE

The American Society of Association Executives (ASAE) asked President Christine Hollander, CMA (AAMA), and Executive Director Balasa to be the featured volunteer leader and association executive (respectively) for the "Ask the CEO" feature in the March 2013 issue of Associations Now. The following is the preliminary copy of this piece.

Donald Balasa, executive director, American Association of Medical Assistants (AAMA), answers questions from AAMA President Chris Hollander:

With several different credentials being awarded to medical assistants today, how will you distinguish and promote the CMA (AAMA) credential?

Many associations offer professional/occupational credentials, and there are competing credentials. An association should emphasize, especially in its marketing and government advocacy initiatives, how its credential is superior to others. It is best to focus on a few obvious points. For example, the Certified Medical Assistant (CMA) (AAMA) credential is the only one in our field that requires graduation from an accredited medical assisting program.

What is the difference between a mandatory credential and a voluntary one, and how does that apply to medical assistants?

A mandatory credential is a legal requirement for an individual to work in a particular occupation or a certain part of an occupation. Mandatory credentials are usually (although not always) licenses. A voluntary credential is not a legal requirement for work and is often (although not always) a certification. In most American jurisdictions, medical assistants are not required to have formal medical assisting education or a credential, such as the CMA (AAMA). An association with a voluntary credential must demonstrate how those who hold it provide superior service.

Do you think partial state licensing for medical assistants is becoming necessary?

Medical assistants are now being delegated duties that are within the scope of practice of licensed professionals. Partial licensing of medical assistants in performing these duties is becoming necessary to protect public health and safety.

DEFENDING THE CMA (AAMA) CREDENTIAL

Inaccurate Statements by the National Healthcareer Association (NHA)
A staff member of the National Healthcareer Association (NHA) made inaccurate statements about the CMA (AAMA) credential in e-mail dialogues with at least three program directors of medical assisting programs accredited by the Commission on Accreditation of Allied Health Education Programs (CAAHEP). These program directors brought these e-mails to the attention of Legal Counsel Balasa. Mr. Balasa asked AAMA General Counsel John M. Peterson of Howe & Hutton to write a cease and desist letter to NHA. The Deputy General Counsel of Ascend Learning, LLC, parent company of NHA, responded that the statements by the staff member were not authorized by NHA, are not the type of representation that NHA would permit its employees to make, and will not be made in the future.

(If any educator receives erroneous or derogatory statements from the National Healthcareer Association about the CMA (AAMA) or the AAMA, please immediately bring them to the attention of Mr. Balasa.)

Misstatement by a School in Washington State
A leader of the Yakima County Chapter of the Washington State Society of Medical Assistants informed the Executive Director about a school that had published articles and advertisements stating that graduates of its medical assisting program were eligible to take the CMA (AAMA) Certification Examination. The medical assisting program at this school is not accredited by either the Commission on Accreditation of Allied Health Education Programs (CAAHEP) or the Accrediting Bureau of Health Education Schools (ABHES). In response to a letter from Mr. Balasa, the president of the school acknowledged the serious error in its written materials and immediately removed such statements from its website and other written media, and promised that such statements would not be made in the future.

"Specialty Certified Medical Assistant-SCMA"
Counsel Balasa, with the assistance of Associate Executive Director Johnson and General Counsel Nathan J. Breen, negotiated an agreement with The Certification Commission, a North Carolina limited liability company, in regard to its "Specialty Certified Medical Assistant-SCMA" designation. The agreement states that The Certification Commission will only use the "SCMA" either in connection with the words "Specialty Certified Medical Assistant," or in a hyphenated form (e.g., SCMA-CD, SCMA-D, SCMA-END). The Certification Commission is prohibited from using the initialism "SCMA" standing alone. The Certification Commission also agreed to "conspicuously display the following disclaimer on the bottom of each page of its website in at least eleven point font: 'The Certification Commission, LLC, and its Specialty Certified Medical Assistant program are not affiliated with the American Association of Medical Assistants or its Certified Medical Assistant [CMA (AAMA)] certification.'"

"Certified Dermatology Medical Assistant (CDMA)"
Dermatology On Demand, Inc., d/b/a Association of Certified Dermatology Techs, located in Waynesville, North Carolina, has filed a petition with the United States Patent and Trademark Office (USPTO) for "Certified Dermatology Medical Assistant (CDMA)" in connection with "testing, analysis, and evaluation of the knowledge, skills and abilities of others for the purpose of certification and re-certification in the field of healthcare." This trademark application is in an early stage, and no publication date has been set by the USPTO. Mr. Balasa, Ms. Johnson, and Mr. Breen will determine whether the AAMA should oppose the petition for registration of this mark.

Eagen v. Harris School of Business
Executive Director Balasa and other AAMA staff continue to provide assistance to plaintiffs' attorney David Sinderbrand, Esquire, of New Jersey in a class action by 74 former medical assisting students against the school they attended. This cause of action is based on the alleged promises to students and graduates of the medical assisting program of Harris School of Business that they would be eligible for the CMA (AAMA) Certification Examination. The medical assisting program at this school was not CAAHEP or ABHES accredited.

NHA Misuse of "Certified Medical Assistant"
Linda Prince, CMA (AAMA), a leader of the New Hampshire Society of Medical Assistants, brought to the attention of Mr. Balasa and other AAMA staff the fact that a Google search indicated that the National Healthcareer Association was referring to its Certified Clinical Medical Assistants (CCMAs) as "Certified Medical Assistants." AAMA Trademark Counsel Nathan Breen wrote to NHA indicating that NHA was using the mark "Certified Medical Assistant" in connection with metatags for a portion of its website (see www.nhanow.com/clinical-medical-assistant.aspx). In response to Mr. Breen's letter, Deputy General Counsel of NHA's parent company indicated that NHA is not making use of "Certified Medical Assistant" in connection with metatags. Subsequent research by AAMA staff and Mr. Breen indicated that this is the case.

Misuse of "Certified Medical Assistant" by California School
A school in California that was not accredited by either CAAHEP or ABHES was referring to its program as "Certified Medical Assistant." A cease and desist letter was sent to the school, indicating that its use of "Certified Medical Assistant" in connection with its program could mislead potential students into thinking that they would be eligible for the CMA (AAMA) Certification Examination. The school agreed to remove all references to "CMA" and "Certified Medical Assistant" from its website.

HOUSE LEGAL COUNSEL RESPONSIBILITIES

House Legal Counsel Balasa has continued to provide assistance to state societies and local chapters on questions involving bylaws, parliamentary procedure, suspected or actual misappropriation of funds, record retention, obtaining an Employer Identification Number/Taxpayer Identification Number (EIN/TIN), and the ineligibility of states and chapters for state sales tax exemption. He has assisted in the answering of questions about the Certifying Board Disciplinary Standards and in the reviewing of complaints about CMAs (AAMA). Also, he has helped review petitions from felons seeking a waiver to take the CMA (AAMA) Certification Examination. He has provided standard letter templates and has reviewed and signed cease and desist letters to medical assistants who are using the CMA (AAMA) credential and are not CMAs (AAMA), and to CMAs (AAMA) who are using the credential, even though their CMA (AAMA) is not current.

In November of 2012 the president of a constituent society informed Mr. Balasa that an immediate past president of a component chapter was not responding to requests to turn over the chapter's current financial records and the remaining balances of any chapter bank accounts. Legal Counsel Balasa sent a letter to the immediate past president of the chapter. Shortly thereafter the financial records and account balance information were provided to the constituent society.

In addition, Mr. Balasa helped the Management Steering Committee with two state society issues that occurred during April and May of 2013.

CLEAR Webinar
The Executive Director participated in a webinar about ISO/IEC 17024 sponsored by the Council on Licensure, Enforcement and Regulation (CLEAR). The following is a description of this webinar:

ISO/IEC 17024 is a standard that defines the general requirements for bodies operating certification programs of persons (Personnel Certification Body). ISO/IEC 17024 defines how a certification body should develop, implement and maintain a certification program and provides a global benchmark for certification schemes to ensure that they operate in a consistent, comparable and reliable manner worldwide, thus establishing an environment for the mutual recognition of schemes and facilitating the global mobility of personnel. It was updated and republished in July of 2012.

OCCUPATIONAL OUTLOOK HANDBOOK

The United States Bureau of Labor Statistics (BLS) each year publishes an updated version of its Occupational Outlook Handbook, one of the most reliable and authoritative sources on professions and occupations. As has been the case for several years, BLS staff contacted the Executive Director and asked him questions about the medical assisting profession, the CMA (AAMA), and the AAMA. Mr. Balasa was able to suggest language changes in the entry about medical assistants that would reflect more accurately the current realities of the profession of medical assisting.

PARTICIPATION IN MILLER-MOTTE COLLEGE ADVISORY BOARD MEETING

Mr. Balasa and Secretary-Treasurer Charlene Couch, CMA (AAMA), participated by speakerphone in a meeting of the Miller-Motte College (Raleigh, North Carolina) Advisory Board. Ms. Couch and Mr. Balasa answered questions and provided updates about the medical assisting profession and the CMS order entry rule and how it is impacting credentialed medical assistants such as CMAs (AAMA).

PROTECTING THE RIGHT TO PRACTICE OF MEDICAL ASSISTANTS

Alaska
Robin Wahto, CMA (AAMA), program director of the medical assisting program at the University of Alaska Anchorage, informed the Executive Director that amendments to the rules of the Alaska State Medical Board were pending. These amendments would reduce the number of duties that physicians would be able to delegate to unlicensed allied health professionals such as medical assistants. These changes were most likely the result of liability concerns on the part of the malpractice insurance carriers in Alaska. Mr. Balasa proposed that the Alaska Medical Assistants Society contact malpractice insurance companies and educate them about how the employment of CMAs (AAMA) provides a higher level of protection from a malpractice standpoint. Ms. Wahto and Freda Miller, CMA (AAMA) (AAMA Trustee and a leader of the Alaska Society), agreed with Mr. Balasa's recommendation and will develop a plan for taking this message to the malpractice carriers.

Connecticut
On February 1, 2013, the Connecticut Department of Public Health issued a favorable report to the Connecticut General Assembly in regard to the scope of practice request submitted by the Connecticut Society of Medical Assistants and the AAMA. Holly Martin, CMA (AAMA), and Wendy Carros, CMA (AAMA) of the Connecticut Society are to be commended for their excellent leadership and hard work throughout the scope of practice request process. This is an important precedent that should have a positive impact on right to practice efforts in other states.

Unfortunately, legislation embodying the scope of practice request was not introduced into the Connecticut General Assembly. However, the Connecticut Society now will have the opportunity to work with all parties that were involved in the scope of practice request process to craft legislative language that is acceptable to all parties. A bill then can be raised during the next session of the state legislature.

Nebraska
At the request of the leadership of the Nebraska Society of Medical Assistants, Mr. Balasa drafted a letter to the incoming Chief Medical Officer of Nebraska emphasizing the growing importance of CMAs (AAMA) in the outpatient health care delivery environment.

Executive Director Balasa also wrote an article on the CMS rule and submitted it to Physician's Bulletin, a Nebraska publication. This also was done at the request of the leaders of the Nebraska Society.

Mr. Balasa and leaders of the Nebraska Society will meet with Nebraska government officials July 9, 2013, in Lincoln to present the case that Nebraska law does not require medical assistants to meet the requirements and register with the state as medication aides in order to be delegated the administration of medication by physicians.

New Hampshire
At the request of the leadership of the New Hampshire Society of Medical Assistants, Mr. Balasa wrote a cease and desist letter to a New Hampshire medical assistant who was using "CMA" after her name. She had never been granted the CMA (AAMA) designation. He also wrote a memorandum to be sent to New Hampshire medical assistants and their employers that included the following paragraphs:

It has been brought to my attention that some New Hampshire employers are putting the phrase "Certified Medical Assistant" and/or the initialism "CMA" on name tags of medical assistants who are not certified by the Certifying Board of the American Association of Medical Assistants (AAMA).

Any medical assistant who represents herself/himself as a "Certified Medical Assistant" or a "CMA," and any organization which represents its medical assistants as "Certified Medical Assistants" or "CMAs" when such individuals have not been certified by the Certifying Board of the AAMA, are doing so falsely and may be in jeopardy of legal sanction.

The American Association of Medical Assistants therefore urges all medical assistants and all employers of medical assistants who misuse the "Certified Medical Assistant" or "CMA" to immediately cease from these misleading and illegal practices that are infringing on the rights of the AAMA in these marks.

This memorandum was converted into a generic memorandum that was posted on the AAMA website. It can be used by CMAs (AAMA) throughout the United States.

Ohio
Ohio law does not permit nurse practitioners to delegate to medical assistants the administration of medication. Mr. Balasa has been helping the leaders of the Ohio State Society of Medical Assistants work with the Ohio State Board of Nursing and other organized nursing associations in an effort to have legislation introduced that would authorize medical assistants to administer medication as directed by a nurse practitioner. The Ohio Association of Advanced Practice Nurses is heading up this effort, and all key players appear to be supportive of such an amendment to the Nurse Practice Act.

Washington
On May 7, 2013, the Executive Director testified at a Washington Department of Health (DOH) hearing on the proposed rules implementing legislation enacted in 2012. He had submitted written comments prior to the hearing. Mr. Balasa, Pat Hightower, CMA (AAMA), and Tom Wolfe, CMA (AAMA), public affairs leaders of the Washington State Society of Medical Assistants, testified on the rules as a panel and spoke from their different perspectives. As a result of this testimony, the DOH made a major change in the regulations. The regulations went into effect July 1, 2013.

The Executive Director commends Ms. Hightower and Mr. Wolf for their excellent and hard work on the legislation and the regulations.

North Dakota
The North Dakota Board of Nursing thoroughly understands, and is very supportive of, the medical assisting profession and the CMA (AAMA) credential.

In October of 2012 a North Dakota CMA (AAMA) contacted Executive Director Balasa and expressed concern about an in-service program at her place of employment during which the medical assistants were told that North Dakota law prohibits them from working under physician supervision and requires that they work only under nurse supervision. The medical assistants also were given a handout. Since 2004 Mr. Balasa has worked collegially with Connie Kalanek, PhD, RN, Executive Director of the North Dakota Board of Nursing, in clarifying the practice rights of medical assistants in North Dakota. (For example, Dr. Kalanek had contacted Mr. Balasa in September of 2012 after she had read his comments in Legal Eye about the CMS final rule.) Mr. Balasa e-mailed the misleading handout to Executive Director Kalanek, who was able to correct the incorrect statements about the legal source of medical assistants' practice rights under North Dakota law.

Utah
In October of 2012 the Executive Director was alerted to an initiative from the Utah Cluster Acceleration Partnership (UCAP) to regulate medical assistants. After studying the UCAP proposal and considering the excellent points of AAMA Vice Speaker of the House Lisa Lee, CMA (AAMA), who is also a leader of the Utah Society of Medical Assistants, Mr. Balasa offered the following comments by e-mail to Vice Speaker Lee:

On page 6, I take umbrage with the reference to medical assistants filling "low-skilled" and "low-cost" positions. This is demeaning to the medical assisting profession and most unfortunate.

In a similar vein, I take issue with the emphasis on medical assistants being used to "drive down costs," and the reference to "lower cost MAs."

I commend the purpose of the strategy, which is "to create a higher degree of standardization of MAs, to ensure an optimally and consistently prepared workforce." This has to be accomplished in the right way, however, and should utilize the CMA (AAMA) credential. I also agree with the following statement on page 7: "Meanwhile, we are recommending that all public MA programs work to maintain accreditation or to become accredited, and we are also recommending that we endorse and foster the current trend toward more students sitting for certification exams."

To reiterate, this purpose is noble and good. However, this initiative could go in a bad direction if the already-existing accredited academic programs and the CMA (AAMA) credential are not incorporated into the end result.

Georgia
The Georgia State Society of Medical Assistants asked Executive Director Balasa to review the rules proposed by the Georgia Composite Medical Board because they mentioned medical assistants. He informed the leadership of the Georgia State Society that the proposed rules do not have any substantive impact on medical assistants' scope of practice.

Minnesota
It was brought to the attention of Mr. Balasa that 2012 amendments to the Minnesota Pharmacy Act were being interpreted by some employers as limiting the right of physicians to delegate to medical assistants certain types of injections. He contacted the Executive Director of the Minnesota Board of Pharmacy and was told that the 2012 statutory changes do not affect what types of medication administration physicians are permitted to delegate to medical assistants.

Montana
A rumor was circulating in Montana that physician assistants no longer would be allowed to delegate tasks to medical assistants. At the request of the leaders of the Montana Society of Medical Assistants, Executive Director Balasa reviewed the statutory and rule language and offered his opinion that this interpretation was not correct.

California
Legislation has been introduced into the California legislature that would permit nurse practitioners, nurse midwives, and physician assistants to supervise medical assistants even if a physician is not on the premises. Mr. Balasa reviewed the bill and offered his advice to the leaders of the California Society of Medical Assistants. At their request, he drafted a letter in support of this bill (Senate Bill 352) to be sent to the Chair of the Senate Committee on Business, Professions, and Economic Development.

Interestingly, the California Association of Nurse Practitioners, the California Academy of Physician Assistants, and the California Academy of Family Physicians support this legislation, but the California Nurses Association opposes this bill.

Iowa
A CMA (AAMA) contacted the Executive Director and informed him that her superiors were saying that the Iowa tuberculosis screening law did not permit physicians to delegate to medical assistants the placement of tuberculin skin tests. He reviewed the law and informed her that this was not the case.

PROFESSIONAL PRESENTATIONS

Commission on Dietetic Registration
The certification programs of the Commission on Dietetic Registration are accredited by the National Commission for Certifying Agencies (NCCA), of which Mr. Balasa is chair. Because of his expertise on the confidentiality provisions of the NCCA Standards, Mr. Balasa was asked to address an assembly of nutrition and dietetic educators in Philadelphia, Pennsylvania, on October 7, 2012. He provided to the attendees his position paper entitled "NCCA Requirements and Legal Issues Pertaining to Providing Names of Candidates and Their Scores to Academic Programs," explained its key points, and answered questions.

Institute for Credentialing Excellence (ICE)/National Commission for Certifying Agencies (NCCA) Annual Conference
The Executive Director was a presenter in two panel presentations at the ICE/NCCA Annual Conference in Palm Springs, California, in November of 2012.

Certification of Disability Management Specialists Commission
Executive Director Balasa provided an overview of the NCCA Standards to the Certification of Disability Management Specialists Commission in Glenview, Illinois, on November 10, 2012.

Health Managers Group in the Quad Cities Area
Mr. Balasa answered an Illinois scope of practice question from a nurse manager in Moline, Illinois. She found the information interesting and helpful and asked Mr. Balasa if he would be willing to speak to a health managers group in the Quad Cities area, which is on the Illinois and Iowa border. He accepted the invitation and spoke to this group January 24, 2013, in Davenport, Iowa.

Americans with Disabilities Act (ADA) Presentation at the Association of Test Publishers (ATP) Annual Conference
The Executive Director attended the Association of Test Publishers (ATP) Annual Conference in Fort Lauderdale, Florida, February 3 through 6, 2013. He co-presented "The Changing Landscape of High Stakes Test Accommodation; Disability-related Accommodations in 2012: What is reasonable and what is beyond reasonable; ADA Compliance and the NCCA Standards; Review of ADA Case law" with Dale Atkinson, JD, of the Federation of Associations of Regulatory Boards (FARB) and Kendra Johnson of the Graduate Management Admission Council.

Washington Health Care Educators Conference
Executive Director Balasa spoke at a June 7, 2013, conference of faculty, deans, and directors from allied health community colleges in Washington State. The purpose of the conference was: "(1) to allow Washington State community college educators to come together to hear from national leaders in health care reform regarding the Affordable Care Act's impact on workforce development and implications for the education pipeline; and (2) to promote best practices in incumbent worker-focus curriculum development and program design, drawing on five years of Washington State Hospital Employees Education and Training (HEET) grant successes in health care training programs." Mr. Balasa was one of three participants in a panel discussion entitled "Health Care Education and the Affordable Care Act."

LEADERSHIP OF AND INVOLVEMENT IN NATIONAL AND LOCAL ORGANIZATIONS

National Commission for Certifying Agencies (NCCA)
Mr. Balasa is serving his sixth year as an administrative reviewer on the National Commission for Certifying Agencies (NCCA) and his third year as Chair of the Commission. His position on the NCCA will end in November of 2013.

The NCCA Standards for the Accreditation of Certification Programs (Standards) are being revised. Mr. Balasa was appointed as Group Leader of the "Purpose, Governance, and Resources Task Group" that will make recommendations for revisions to the Standards.

Institute for Credentialing Excellence (ICE)
By virtue of his position as chair of the NCCA, Executive Director Balasa serves on the Board of Directors of the Institute for Credentialing Excellence. He was featured in a May 2, 2013, ICE blast e-mail, and was thanked for his service to the NCCA and ICE.

Health Professions Network (HPN)
Mr. Balasa and Associate Executive Director Johnson attended the Health Workforce Summit of the Health Professions Network (HPN) February 27 through March 1, 2013, in Las Vegas, Nevada. This proved to be a landmark event, and Associate Executive Director Anna Johnson's excellent leadership on the HPN Board was apparent throughout the conference.

ATP ADA Special Interest Group
Because of his knowledge of how the Americans with Disabilities Act and the regulations of the United States Department of Justice impact testing programs, the Executive Director was appointed to the ADA Special Interest Group of the Association of Test Publishers.

Annual Association Law Symposium Planning Committee
The Executive Director again served on the American Society of Association Executives' (ASAE) Annual Association Law Symposium Planning Committee. The event took place April 5, 2013.

CONTINUING EDUCATION

Council on Licensure, Enforcement and Regulation (CLEAR)
On December 14, 2012, Executive Director Balasa attended the CLEAR webinar "Setting Precedents: The Top Ten Cases You Need to Know About."

Center for the Health Professions
Mr. Balasa attended the January 11, 2013, webinar "Innovative Workforce Models in Health Care" presented by the Center for the Health Professions at the University of California, San Francisco (Center). Catherine Dower, JD, is one of the staff leaders of the Center. Ms. Dower served with Mr. Balasa on the NCCA. As a result, the Center for the Health Professions keeps the AAMA informed of significant developments.

September 2012

FEDERAL/NATIONAL MATTERS

CMS Regulations about Entering Medication Orders into Electronic Health Records (EHR)
The Executive Director has received an increasing number of questions about the regulations of the Centers for Medicare & Medicaid Services (CMS) in regard to the Electronic Health Record Incentive Program and whether the regulations prohibit medical assistants from entering medication orders by computerized physician/provider order entry (CPOE). On December 23, 2011, Mr. Balasa submitted a letter to CMS requesting that wording be changed in its next set of regulations.

CMS published a Notice of Proposed Rulemaking (NPRM) March 7, 2012, with a May 7, 2012, deadline to submit comments. The following is an excerpt from the comment submitted by AAMA.

One of the primary public policy objectives of the American Association of Medical Assistants is to promote patient safety and well-being by protecting the public from substandard allied health services. Therefore, the AAMA agrees with the position of the Centers for Medicare & Medicaid Services (CMS) that it would be unwise and potentially harmful to patients to allow any individual—regardless of education, credentialing, or experience—to enter orders into the Computerized Physician/Provider Order Entry (CPOE) system. However, there are a number of allied health professionals who are not licensed, but who are formally educated in their discipline, have a current accredited certification awarded by a national credentialing body, and have the competence and knowledge to be able to enter orders into the CPOE system as directed by an overseeing healthcare provider, such as a physician, nurse practitioner, or physician assistant. A good example of such allied health professionals are medical assistants who have graduated from a programmatically-accredited postsecondary medical assisting program, and who hold a current medical assisting credential that is accredited by the National Commission for Certifying Agencies (NCCA) and/or the American National Standards Institute (ANSI).

Given the reality that a significant number of allied health professionals are not licensed by state law, but are capable of entering orders into the CPOE as directed by the overseeing healthcare provider without endangering the health and safety of patients, the AAMA respectfully requests that CMS alter the wording in its existing and proposed regulations to read as follows:

Use computerized physician order entry (CPOE) for medication orders directly entered by any licensed or appropriately credentialed healthcare professional who can enter orders into the medical record per state, local, and professional guidelines.

Allowing appropriately credentialed, as well as licensed, healthcare professionals to enter orders into the CPOE system as directed by a healthcare provider would not increase the risk of inaccurate information being entered into the electronic healthcare record, but would allow for enhanced patient care resulting from increased attention to patient needs and greater communication among the healthcare team. It would also lessen disruption of the current division of labor within the healthcare system. Retaining the qualifying clause "who can enter orders into the medical record per state, local, and professional guidelines" provides another safeguard against unqualified personnel entering faulty data into the CPOE system.

The Executive Director shared his comments with Diane VanderPloeg, CMA (AAMA), MS, of Des Moines Area Community College, which also submitted comments to CMS. He also provided the AAMA's comments to a health system in Iowa that also responded to the NPRM.

Mr. Balasa is confident that the above AAMA comment on the NPRM and similar comments from other interested parties will result in CMS changing the current language and reinstating the rights of CMAs (AAMA) to enter medication orders into the EHR. Comments on this Notice of Proposed Rulemaking will be posted on a CMS website set aside for this purpose, and he will monitor the comments and keep the Board of Trustees informed.

Participation in CMS Call
The Executive Director participated in a March 12, 2012, 90-minute CMS national provider call on the proposed rule discussed immediately above.

Alliance for Quality Medical Imaging and Radiation Therapy (Alliance)
The Alliance for Quality Medical Imaging and Radiation Therapy (Alliance) continues to advocate for the enactment of the Consistency, Accuracy, Responsibility, and Excellence (CARE) bill in the United States Congress. The AAMA is a charter member of the Alliance. The CARE bill would establish mandatory federal standards that would, in part, require allied health personnel who practice limited scope radiography to meet educational and credentialing standards. The CARE bill is of interest to the AAMA and the medical assisting profession because, in some states, medical assistants are permitted to perform limited scope radiography duties under direct physician supervision. Enactment of the CARE bill, therefore, would ensure that medical assistants (in states that permit limited scope practice for medical assistants) have adequate education and training in limited scope radiography, and have demonstrated their knowledge and competency by passing an examination on limited scope radiography theory and technique.

Executive Director Balasa represented the AAMA at a meeting of the Alliance in Chicago on November 30, 2011. There is new hope that the CARE bill will be signed into law before the end of the current session of Congress. Mr. Balasa continues to make sure that the rights of medical assistants who are delegated limited scope x-rays are protected in the body of the CARE legislation.

Occupational Outlook Handbook of the Bureau of Labor Statistics
The Executive Director was asked by a staff member of the United States Bureau of Labor Statistics to review the draft of the two-page description of the medical assisting profession that will be included in the 2012 edition of the Occupational Outlook Handbook.

Autism Screening Toolkit
The Georgetown University Center for Child and Human Development approached Mr. Balasa and asked for a letter from the AAMA supporting its grant proposal to the Autism Speaks organization. Georgetown is proposing to create a toolkit that would help medical assistants screen toddlers—especially children of Hispanic nationality—for autism. The letter of support was approved and sent.

FINANCIAL MANAGEMENT

The AAMA continues to do well financially. Based on revenue and expense figures available as of the date of the writing of this report (June 15, 2012), it appears that the two AAMA funds (General Fund and Certification Fund) will finish fiscal year 2012 (July 1, 2011 through June 30, 2012) with an excess of revenue over expense. It is encouraging that the number of AAMA members to date did not decrease from comparable 2011 numbers to date as a result of the dues increase implemented for this membership year.

BOARD OF TRUSTEES PLANNING SESSION (October 2011)

Under the excellent leadership and guidance of President Ann E. Naegele, CMA (AAMA), the Executive Director prepared documents and presentations to assist the Board of Trustees in its important two-fold responsibility of "visioning" the long-term trajectory of the American Association of Medical Assistants and addressing immediate strategic opportunities and threats.

OCCUPATIONAL ANALYSIS TASK FORCE AND CORE CURRICULUM TASK FORCE

The Board of Trustees established an Occupational Analysis Task Force (OATF) and a Core Curriculum Task Force (CCTF). The charge of the OATF is to determine by survey research what duties CMAs (AAMA) are actually doing in the workforce at the present time. The end result will be the issuance of the 2012-2013 Occupational Analysis of the CMA (AAMA). The charge of the CCTF is to survey medical assisting practitioners and educators, and other appropriate parties, for the purposes of determining what medical assistants need to know, and what they need to be able to do, in order to protect the public and employers from medical assisting graduates of insufficient knowledge and competence.

Executive Director Balasa wrote a request for proposal that was sent to testing and measurement vendors with expertise in these types of projects. Applied Measurement Professionals (AMP) was chosen, and Mr. Balasa assisted AMP personnel in preparing for the June 7, 2012, meeting of the two task forces in Chicago. He also served as a liaison and resource for the leaders and members of the OATF and the CCTF.

LEADERSHIP AND INVOLVEMENT IN NATIONAL AND LOCAL ORGANIZATIONS

American Society of Association Executives (ASAE) Legal Section Council
Executive Director Balasa continued his service on the Legal Section Council (Council) of ASAE—the association of association executives. He attended a September 2011 meeting of the Council in Washington, DC, and participated via speakerphone in a subsequent meeting of the Council. Part of his role on the Council includes serving as Chair of the Annual Association Law Symposium in Chicago, May 16, 2012, and writing one "Ask the Legal" article for Associations Now, the monthly journal of ASAE. His article entitled "Keep Committees in Check to Curb Legal Exposure" was published in the September/October 2011 issue of Associations Now, and in the October 25, 2011, issue of the ASAE electronic newsletter Association Law & Policy. His article "Associations Should Heed Rulings on Exam Accommodations" will be published in upcoming ASAE publications.

National Commission for Certifying Agencies (NCCA)
Mr. Balasa is serving his fifth year as an administrative reviewer on the National Commission for Certifying Agencies (NCCA, Commission) and his second year as Chair of the Commission. From November of 2011 to November of 2012, Mr. Balasa will chair four in-person meetings of the Commission and seven conference call meetings. He was one of three presenters for an NCCA webinar entitled "NCCA Accreditation: Demystifying the Application Process and Standards." This webinar was recorded and will be available on the Institute for Credentialing Excellence website. Also, during the next two years the Commission will be revising its 2004 Standards for the Accreditation of Certification Programs. Mr. Balasa's position will enable him to exercise influence on this important document.

Institute for Credentialing Excellence (ICE) (formerly NOCA)
By virtue of his position as Chair of the NCCA, the Executive Director has served on the Board of Directors of ICE. Between November of 2011 and November of 2012, he will attend three in-person meetings of the Board of Directors, and participate in six conference call meetings. (Some of the in-person meetings of the NCCA and the ICE Board will be held at the same location, and on consecutive days.) Mr. Balasa has also been appointed to the ICE Advocacy Task Force.

Mr. Balasa attended the ICE Annual Educational Conference in New Orleans, Louisiana, November 8-11, 2011. At this conference he attended two excellent presentations: "New Job Analysis: Cosmetic Change or Extreme Makeover," and "Are Government Mandates for Accreditation on the Horizon? A Discussion of Military Efforts to Certify Service Members." The hypothesis of the presenter of the second program was the following: "This new wave of service members returning to civilian life may contribute to accreditation requirements for credentials, as the previous wave contributed to accreditation requirements for higher education."

Health Professions Network (HPN)
The Executive Director gave a PowerPoint presentation entitled "Medical Assistants: Helping Physicians Meet New and Shifting Patient and Staffing Demands," at a semi-annual meeting of the Health Professions Network, October 12-14, 2011, in Jacksonville, Florida.

Chicago Bar Association
Mr. Balasa gave an interactive presentation entitled "Overview of Certification Law" at a December 13, 2011, meeting of the Trade and Professional Association Committee of the Chicago Bar Association.

ABHES Annual National Conference on Allied Health Education
The Executive Director attended the February 22-24, 2012, Annual National Conference of the Accrediting Bureau of Health Education Schools (ABHES) in Las Vegas, Nevada. He re-established contacts with ABHES leaders and answered questions about the CMA (AAMA) Certification Examination, and the differences between the CMA (AAMA) and other medical assisting credentials. The presentation entitled "The Power of the Medical Assisting Credential: Don't Get Caught Without It" was of particular interest to him. He perceived that an increasing number of program directors and educators in ABHES accredited medical assisting programs are urging their students and graduates to sit for the CMA (AAMA) Certification Examination.

CAAHEP Annual Meeting
Mr. Balasa attended the Annual Meeting of the Commission on Accreditation of Allied Health Education Programs (CAAHEP) April 29 and 30, 2012, in San Diego, California. He attended the presentations "Certification, Accreditation, and Professional Interests: Creating a Collaborative Relationship While Remaining at 'Arms' Length'" and "The Importance of Autonomy in the Accreditation Process" by an attorney he had spoken with at the aforementioned ABHES National Conference. His sense was that CAAHEP continues to have a significant presence in the allied health educational community.

NCSBN Webinar and Article
Based on her reading of Mr. Balasa's articles on the AAMA website, Mary Pat Olson of the National Council of State Boards of Nursing (NCSBN) met with Executive Director Balasa and asked him to co-present an NCSBN webinar and co-author an NCSBN article on the difference between medical assistants and medication aides. Mr. Balasa agreed. The webinar will take place in June of 2012.

AHIMA
The Executive Director met with Mike Niederpruem, a staff director at the American Health Information Management Association (AHIMA), to discuss collaboration possibilities between AHIMA and the AAMA—especially in the continuing education domain. A report was made to the Continuing Education Board and the Board of Trustees, and these possibilities will continue to be pursued.

AMA Annual Meeting
Mr. Balasa will represent the AAMA at the American Medical Association Annual Meeting June 16-20, 2012, in Chicago.

LITIGATION

Eagen v. Harris School of Business
Plaintiffs' attorney David Sinderbrand of New Jersey asked Mr. Balasa to serve as an expert witness in Eagen v. Harris School of Business, a class action by 74 former medical assisting students against the school they attended. Mr. Sinderbrand asked for a DVD of Mr. Balasa's presentation before the 2011 AAMA House of Delegates on "How the CMA (AAMA) Stands Apart" to assist him in preparing and presenting his case, and the request was granted. The cause of action in this matter is based on the alleged promises to students and graduates of the medical assisting program of this school that they would be eligible for the CMA (AAMA) Certification Examination. This Harris School of Business was not CAAHEP or ABHES accredited, and the graduates were therefore not eligible for the CMA (AAMA) Certification Examination.

Attorney Jeffrey J. Antonelli
Mr. Antonelli has represented several students and graduates of medical assisting programs that were promised eligibility for the CMA (AAMA) Certification Examination by programs that were not CAAHEP or ABHES accredited. Mr. Balasa has assisted Mr. Antonelli in the past. Attorney Antonelli asked permission to post a link to Mr. Balasa's CMA Today article "How the CMA (AAMA) Standards Apart" on his firm's website, and this request was granted.

PROTECTING THE MEDICAL ASSISTANT'S RIGHT TO PRACTICE; PROVIDING PUBLIC AFFAIRS VISION AND LEADERSHIP

Public Affairs Articles in CMA Today
Mr. Balasa has continued to write Public Affairs features for CMA Today. These articles have been posted to the AAMA website. "Frequent Questions about Medical Assistants' Scope of Practice" was published in the March-April 2012 issue of CMA Today. "AAMA Comments on the Proposed CMS Rule" was published in the May-June 2012 CMA Today. "There Are Legal Differences between Working in Inpatient and Outpatient Settings" will appear in the July-August 2012 CMA Today.

Legal Eye on Medical Assisting Blog on the AAMA Website
The Executive Director continues to respond to legal questions that are submitted on his blog on the AAMA website. He wrote Legal Eye posts on the Supreme Court's review of President Obama's Patient Protection and Affordable Care Act and on diploma mills such as St. Augustine School of Medical Assistants. The second post generated a lot of interest and many impassioned posts from followers of Legal Eye. (Approximately three years ago the AAMA reported this school to the Federal Trade Commission (FTC). The FTC is continuing its investigation of St. Augustine School.)

Presentation at the 2011 Annual Conference
Mr. Balasa gave a presentation at the 2011 House of Delegates summarizing and amplifying his article "How the CMA (AAMA) Stands Apart: A Comparison of Four Medical Assisting Certifications." His talk has been posted to the AAMA website for convenient viewing.

Presentation at Gundersen Lutheran Health System
Executive Director Balasa gave a PowerPoint presentation entitled "Medical Assistants in the Current Health Care Environment: Unprecedented Opportunities and New Challenges" at the Gundersen Lutheran Medical Assistant Recognition Event in La Crosse, Wisconsin, October 19, 2011.

Washington State
A bill clarifying and protecting the practice rights of medical assistants was signed into law on March 29, 2012. Mr. Balasa commends the leaders of the Washington State Society of Medical Assistants for this outstanding accomplishment. Work on the drafting of rules to implement the legislation will begin shortly. As is the case with most health and allied health legislation, the writing of the administrative rules will be extremely important.

Florida Society of Medical Assistants
Immediately after the Health Professions Network meeting mentioned above, Executive Director Balasa addressed a meeting of the Florida Society of Medical Assistants in Jacksonville. His presentation summarized his "How the CMA (AAMA) Stands Apart" article, and offered suggestions on how this written piece could help protect the distinctiveness and superiority of the CMA (AAMA) credential.

West Virginia
On October 21, 2011, the West Virginia Board of Examiners for Registered Professional Nurses issued a position statement declaring that Advanced Practice Registered Nurses and Certified Nurse Midwives are permitted to delegate the administration of medication only to medical assistants who have completed "a nationally recognized accredited program of study with a curriculum that included pharmacology and medication administration," and who have a "current national certification through the American Association of Medical Assistants," and for whom "related competencies have been verified within the past twelve months." Although there is no state society affiliated with the AAMA in West Virginia, Mr. Balasa informed a prominent medical assisting educator in West Virginia about this position statement of the Board of Nursing.

New Hampshire
In September of 2011, the New Hampshire Board of Nursing issued a clinical advisory "relative to the role of the [nurse] licensee with regard to supervision and delegation to the medical assistant." Here are some relevant excerpts from the clinical advisory:

As an integral role in the office practice settings, the Medical Assistant (MA) presents a unique challenge to the licensed nurse. While many MAs have received structured formal education, the role is unregulated and therefore open to individuals with widely varying backgrounds and education.

The following parameters established by the NH Board of Nursing are intended to guide the licensed nurse in his/her supervision of and delegation to the MA.

Accountability and Responsibility: Prior to any act of delegation to an MA, the licensed nurse following the Administrative Rules of NUR 404, must determine the competency of the MA to perform the delegated task.
...
Formal structured education, with recognized certification, is a preferred element in the determination of competency of the MA. In the absence of documented competencies for tasks and screenings, sample competencies are attached.
...
Delegation of tasks and screenings appropriate for delegation to the MA may vary widely depending on the practice setting. Therefore this document addresses those tasks and screenings by exception as follows:

Medication Administration: Medication administration, with the exception of narcotics, may be delegated provided that:

  • The competency requirement of NUR 404 has been met and documented
  • Evidence of formal structured pharmacology education is preferred but not required
  • Any non-unit dose medication requiring calculation must be double checked with the licensee [i.e., the nurse] prior to administration

IV medication administration may not be delegated
Narcotic administration may not be delegated

The New Hampshire Society of Medical Assistants is very aware of right to practice issues, and has a very capable group of leaders. The New Hampshire Society wants to pursue licensing of medical assistants. With the permission of the New Hampshire Society leadership, Mr. Balasa has been in touch with Kathryn Bradley, Executive Director of the New Hampshire Board of Medicine. The Board of Medicine plans to contact the Board of Nursing about the above statement.

Guam
Executive Director Balasa analyzed a medical assisting bill in Guam and submitted a letter urging the enactment of the legislation. Unfortunately, this legislation did not move forward.

Iowa
There is controversy in an Iowa podiatric clinic in regard to what duties doctors of podiatric medicine are permitted to delegate to medical assistants and CMAs (AAMA). Mr. Balasa has assisted the practice manager—who is a CMA (AAMA) and a former leader at the Iowa Society of Medical Assistants and the AAMA levels—in framing strategy about how to approach the Iowa Board of Podiatry. He also has written a letter to a company that manufactures wound care equipment. This company refuses to allow CMAs (AAMA) to take the professional education it offers to allied health personnel, and will not permit CMAs (AAMA) to be certified in the use of its main product.

Connecticut
The Executive Director and Holly Martin, CMA (AAMA), of the Connecticut Society of Medical Assistants, participated in a June 4, 2012, conference call with volunteer and staff public policy leaders of the Connecticut State Medical Society (CSMS). CSMS is willing to support legislative efforts to regain the medical assistants' rights to be delegated intramuscular, intradermal, and subcutaneous injections. Mr. Balasa will be the primary drafter of a written scope of practice request that will be submitted to the Connecticut Department of Public Health for consideration during the 2013 legislative session. This written scope of practice request is similar to the document required to initiative sunrise review in other states.

New York
Executive Director Balasa submitted a cease and desist letter to a school in New York that is allegedly advising their students and graduates that they are permitted to use "CMA" after their name, even though the program is not CAAHEP or ABHES accredited, and its graduates are not eligible for the CMA (AAMA) Certification Examination.

Ohio
A large medical system in Ohio recently decided to only hire CMAs (AAMA). A medical assistant program director of a CAAHEP accredited program spoke to all of the practice managers of this system. At this meeting Mr. Balasa's presentation at the 2011 House of Delegates was presented to the practice managers via the AAMA website. He was on speakerphone and answered several questions about Ohio medical assisting law.

HOUSE LEGAL COUNSEL RESPONSIBILITIES

House Legal Counsel Balasa has continued to provide assistance to state societies and local chapters on questions involving bylaws, parliamentary procedure, suspected or actual misappropriation of funds, record retention, obtaining an Employer Identification Number/Taxpayer Identification Number (EIN/TIN), and the ineligibility of states and chapters for state sales tax exemption. He has assisted in the answering of questions about the Certifying Board Disciplinary Standards and in the reviewing of complaints about CMAs (AAMA). Also, he has helped review petitions from felons seeking a waiver to take the CMA (AAMA) Certification Examination. He has provided standard letter templates and has reviewed and signed cease and desist letters to medical assistants who are using the CMA (AAMA) credential and are not CMAs (AAMA), and to CMAs (AAMA) who are using the credential in connection with employment, even though their CMA (AAMA) is not current.

Letters to Protect the Intellectual Property Interests in "CMA" and "Certified Medical Assistant"
Legal Counsel Balasa assisted General Counsel Nathan J. Breen in drafting two letters to protect the trademark rights of the "Certified Medical Assistant" and "CMA" designations against possible infringements.

September 2011

FEDERAL ISSUES, LEGISLATION, HEARINGS, AND INVESTIGATIONS

CMS Regulations about Entering Medication Orders in Electronic Health Records
The Executive Director has received an increasing number of questions about the regulations of the Centers for Medicare and Medicaid Services (CMS) in regard to the Electronic Health Record Incentive Program and whether the regulations prohibit medical assistants from entering medication orders by computerized provider order entry (CPOE). Mr. Balasa has taken the position that the CMS regulations do not prohibit medical assistants from entering medication orders by CPOE if such entry is assigned to the medical assistant by the overseeing/delegating/supervising physician(s). The wording of the CMS final rule seems to indicate that only licensed healthcare professionals are permitted to enter medication orders by CPOE. However, the broader context of the final rule and the delegation rights of physicians according to state law argue in favor of the Executive Director's legal interpretation.

Executive Director Balasa has spoken with CMS staff. Another set of CMS proposed regulations on the Electronic Health Record Incentive Program will be published in the Federal Register, probably in early 2012. This will give the AAMA an opportunity to advocate for rule language that will protect the medical assistant's right to enter medication orders by computerized provider order entry.

Are Medical Assistants "Other Qualified Healthcare Personnel"?
Executive Director Balasa has continued to argue and advocate for the position that CPT codes 90460-90461 can be used when a medical assistant working under direct physician supervision educates and counsels patients by communicating information reviewed and approved by the overseeing/delegating/supervising physician(s). Mr. Balasa's article on this matter was published in the May/June 2011 issue of CMA Today.

Meeting with CDC Staff at the Annual Conference
President Springer and Mr. Balasa met with two representatives from the Centers for Disease Control and Prevention (CDC) at the 2010 AAMA Annual Conference. The purpose of the meeting was to discuss possible areas of collaboration between the AAMA and the CDC.

Alliance for Quality Medical Imaging and Radiation Therapy (Alliance)
The Consistency, Accuracy, Responsibility, and Excellence (CARE) bill was not enacted into law during the 111th Congress. A slightly revised version of the CARE bill was introduced into the United States House of Representatives of the 112th Congress on June 2, 2011. The Executive Director volunteered to serve on the Regulations Revisions Task Force of the Alliance. The task force will redraft regulations that will be submitted to the U.S. Department of Health and Human Services after the CARE bill is passed.

Senate HELP Committee
The United States Senate Health, Education, Labor, and Pensions (HELP) Committee has been conducting an investigation of for-profit education. The Executive Director has been reading the documents produced by the HELP Committee pertaining to this issue, and has watched some committee hearings on the Internet.

Request for Assistance from the Government Accountability Office (GAO)
Mr. Balasa received a December 15, 2010, e-mail from the Government Accountability Office (GAO), the research arm of the United States Congress. The GAO had been asked by the Senate HELP Committee, and the House Education and Labor Committee and its Subcommittee on Higher Education, Lifelong Learning, and Competitiveness, "to conduct a study on the student outcomes achieved by for-profit colleges and universities." Specifically, the GAO was hoping to compare pass rates for takers of the CMA (AAMA) Certification Examination from public, for-profit, non-profit, one-year, and two-year medical assisting programs. After asking permission from the Certifying Board of the AAMA and notifying the Management Steering Committee, Executive Director Balasa sent the GAO an e-mail including the following data from the 2009 CMA (AAMA) Certification Examination:

Candidate Group

Total N

% Failed

N Failed

Public

3793

20.2

765

Private

5119

40.0

2048

Private Non-Profit

336

19.9

67

Private For-Profit

4783

41.4

1981

One-Year Public

2756

20.3

559

One-Year Private

2902

42.8

1243

Two-Year Public

1037

19.9

206

Two-Year Private

2217

36.3

805

TEAM-BASED CARE/PATIENT-CENTERED MEDICAL HOME (PCMH)

Potential Collaborative Efforts with TransforMED
President Springer, Mr. Balasa, and AAMA member Deborah Novak, CMA (AAMA), of the Ohio State Society, participated in an October 6, 2010, conference call with Ana-Elena Jensen, PhD, a Practice Enhancement Facilitator with TransforMED. Dr. Jensen was the TransforMED consultant who assisted Ms. Novak's employer, TriHealth Physician Practices, transition to a Patient-Centered Medical Home and achieve accreditation as a PCMH by the National Committee for Quality Assurance (NCQA). After follow-up e-mails and another conference call, Dr. Jensen agreed to submit a written proposal for collaborative efforts between the AAMA and TransforMED. (TransforMEDis a subsidiary of the American Academy of Family Physicians.)

American Academy of Family Physicians (AAFP) Practice Improvement Conference
The Executive Director attended the American Academy of Family Physicians Practice Improvement Conference December 2-4, 2010, in San Antonio, Texas. He participated in a pre-conference workshop entitled "Staffing the Medical Home: Hiring, Directing, Supervising, and Evaluating." The attendees were assigned to tables, and each table worked on a job analysis for various allied health professionals in the Patient-Centered Medical Home (PCMH). Mr. Balasa was able to clarify the role of medical assistants and CMAs (AAMA).

Presentation of Telephone Seminar
On October 28, 2010, the Executive Director presented a telephone seminar on the scope of practice for medical assistants in Maryland and Delaware, and the advantages of employing CMAs (AAMA) in Patient-Centered Medical Homes. The following is an excerpt from the e-mail invitation from the coordinator of the telephone seminar:

As a refresher, I am the Director of Clinical Quality for the Mid-Atlantic Association of Community Health Centers (MACHC). We are a non-profit organization that is federally designated by the government to provide training and technical assistance to our federally qualified health centers (FQHCs) in the States of Maryland and Delaware. We provide technical assistance in a variety of areas, in particular, Clinical Quality and Improvement and Financial.

Our members, the Federally Qualified Health Centers, employ and rely heavily on the support and wonderful work of Medical Assistants. Our FQHCs provide care to the uninsured, underinsured, and impoverished. Most have low or no incomes and are socially and economically depressed. Our FQHCs provide care to a diverse population of patients with high rates of IV drug use, HIV, diabetes, hypertension, high cholesterol, asthma, and other chronic health conditions.

In my experience working in primary care, I have noticed that Medical Assistants perform routine tasks that do not accentuate the wealth of knowledge they possess and the extent of their competencies and duties. It is my belief that they can offer more in their role and can be a tremendous asset to our patients and healthcare providers in providing quality care delivery.

The State of Maryland is in the midst of the Patient Centered Medical Home (PCMH) movement which focuses on a medical team approach and maximizing clinical staff. In light of these findings, I am very motivated and eager to host a conference call that addresses:

  • Medical Assistant Scope of Practice in Primary Care
  • Medical Assistant Oversight and Management
  • Medical Assistant Certification: What Is It and Implications
  • Medical Assistant Skills and Competency Review, Education, and Training Recommendations
  • State Specific Requirements for Maryland and Delaware

The conference call will be 45 minutes with a 15 minute Q&A session with our community health center chief medical officers, medical directors, chief nursing officers, nurse managers, nurses, and medical assistants.

ACCESS
On March 26, 2011, President Springer and Mr. Balasa met with representatives of ACCESS, a community health network in Chicago that employs many medical assistants and CMAs (AAMA). ACCESS will propose collaborative efforts with the AAMA for consideration by the Board of Trustees.

FINANCIAL MANAGEMENT

Despite these times of continuing financial stringency, the AAMA continues to do well financially. The two AAMA funds (General Fund and Certification Fund) finished fiscal year 2010 (July 1, 2009 through June 30, 2010) with an excess of revenue over expense. Tentative figures indicate that the General Fund and the Certification Fund also will have an excess of revenue over expense for fiscal year 2011 (July 1, 2010 through June 30, 2011).

LEADERSHIP AND INVOLVEMENT IN NATIONAL ORGANIZATIONS

American Society of Association Executives (ASAE) Legal Section Council
Executive Director Balasa continued his service on the Legal Section Council (Council) of ASAE—the association of association executives. He attended a September 2010 meeting of the Council in Washington, DC, and participated via speakerphone in subsequent meetings of the Council. Part of his role on the Council included serving as Vice Chair of the Annual Association Law Symposium in Chicago May 18, 2011, and writing an "Ask the Legal" article for Associations Now, the journal of ASAE.

National Commission for Certifying Agencies (NCCA)
In November of 2010 Mr. Balasa assumed the position of Chair of the National Commission for Certifying Agencies (NCCA, Commission). This position has provided him the opportunity to influence the operations and policies of one of the two accrediting bodies of certification programs recognized in federal and state legislation and regulations. (The other accrediting body so recognized is the American National Standards Institute (ANSI).) Also, during the next two years the Commission will be revising its 2004 Standards for the Accreditation of Certification Programs. Mr. Balasa's position will enable him to exercise influence on this important document.

Institute for Credentialing Excellence (ICE) (formerly NOCA)
Executive Director Balasa was one of the Institute for Credentialing Excellence leaders who was chosen to be interviewed for a video clip that was shown at the Opening Session of the 2010 ICE Annual Educational Conference (November 15-19, 2010) in Atlanta, Georgia. He also co-presented the one-hour program "The New Haven Firefighters Decision: What Impact Will It Have?" at the Annual Educational Conference. By virtue of his position as Chair of the NCCA, he has served on the Board of Directors of ICE.

Presentation to National Association for Healthcare Quality
In his capacity as Chair of the NCCA, Mr. Balasa spoke to the Board of Directors of the National Association for Healthcare Quality February 19, 2011, in Glenview, Illinois, about the degree of autonomy of certifying boards required by the NCCA Standards.

Health Professions Network (HPN)
The Executive Director represented the AAMA at the April 15, 2011, meeting of the HPN in Milwaukee, Wisconsin. (Mr. Balasa was a frequent attendee of HPN meetings in the 1990s and early 2000s, but has not attended an HPN meeting in the last seven years.) He had prepared a presentation on the importance of CMAs (AAMA) in the Patient-Centered Medical Home, but was not able to give it because of time constraints. He has been asked to give this presentation at the October 12-14, 2011, HPN meeting in Jacksonville, Florida.

Institute of Medicine (IOM) Workshop on the Allied Health Workforce
Executive Director Balasa represented the AAMA at the May 9-10, 2011, IOM allied health workshop in Washington, DC.

American Medical Association (AMA) Annual Meeting
The Executive Director attended the AMA Annual Meeting in Chicago June 19-22, 2011. The AAMA is an Official Observer of the AMA House of Delegates.

HOUSE LEGAL COUNSEL RESPONSIBILITIES

House Legal Counsel Balasa has continued to provide assistance to state societies and local chapters on questions involving bylaws, parliamentary procedure, suspected or actual misappropriation of funds, record retention, obtaining an Employer Identification Number/Taxpayer Identification Number (EIN/TIN), and the ineligibility of states and chapters for state sales tax exemption. He has assisted in the answering of questions about the Certifying Board Disciplinary Standards and in the reviewing of complaints about CMAs (AAMA). Also, he has helped review petitions from felons seeking a waiver to take the CMA (AAMA) Certification Examination. He has provided standard letter templates and has reviewed and signed cease and desist letters to medical assistants who are using the CMA (AAMA) credential and are not CMAs (AAMA), and to CMAs (AAMA) who are using the credential in connection with employment, even though their CMA (AAMA) is not current.

Mr. Balasa sent a letter dated September 8, 2010, to officers of those AAMA state societies that were included on the Internal Revenue Service list of tax-exempt organizations in jeopardy of having their exempt status revoked for failing to file an annual informational return (Form 990). Some of these state society officers had questions, and Mr. Balasa was able to answer their questions by e-mail and telephone. In early 2011 he sent another letter to all state societies reminding them of the requirements for filing Form 990 (or simplified Form 990-N) for 2011 and future years.

As requested of him publicly at the Advisory Council of Presidents and Presidents-Elect at the 2010 Annual Conference, in early 2011 Mr. Balasa sent all state societies a letter containing legally permissible language they and their local chapters can use in soliciting corporations for corporate sponsorship funds for continuing education events and other society or chapter functions.

PROTECTING THE MEDICAL ASSISTANT'S RIGHT TO PRACTICE; PROVIDING PUBLIC AFFAIRS VISION AND LEADERSHIP

Public Affairs Articles in CMA Today
Mr. Balasa has continued to write Public Affairs features for CMA Today. These articles have been posted to the AAMA website.

Legal Eye on Medical Assisting Blog on the AAMA Website
The Executive Director continues to respond to legal questions that are submitted on his blog on the AAMA website. He has begun posting monthly summaries of his CMA Today articles and of other important legal issues in order to prompt even more interest, questions, and comments.

STATE LEGISLATION, REGULATIONS, AND OTHER MATTERS

Georgia
Nikal Redwine, CMA (AAMA), and other leaders of the Georgia State Society of Medical Assistants (GSSMA) contacted Mr. Balasa and asked for his assistance in regard to erroneous information about the CMA (AAMA) Certification Examination in Licensed and Certified Occupations in Georgia, published by the Georgia Department of Labor. He sent an October 15, 2010, letter to the Commissioner of the Department of Labor. The following is an excerpt from the letter:

The GSSMA and the AAMA would urge you to include specific information on page 204 under "Certifying Agency," "Fees," and "Examination" about the Certifying Board of the American Association of Medical Assistants and the Certified Medical Assistant (AAMA) [CMA (AAMA)] credential. In other words, under "Certifying Agency," the Certifying Board of the AAMA and its contact information should be listed in addition to American Medical Technologists. Under "Fees," the fees for the CMA (AAMA) Certification Examination should be listed in addition to the $90 fee of American Medical Technologists. Finally, under "Examination," the information regarding the CMA (AAMA) Certification Examination should also be listed on the lines "Repeats," "Type," "When," and "Where."

Nebraska
The Nebraska Department of Health and Human Services has taken a written position that physicians are not permitted to delegate the administration of medication to medical assistants working under their direct supervision in outpatient settings unless they become medication aides. Mr. Balasa addressed the Nebraska Society of Medical Assistants (NSMA) Board of Directors by speakerphone during the NSMA annual conference in April. He advised them to first approach the Nebraska Board of Medical Examiners in order to correct this grievous misinterpretation of the law. Mr. Balasa continues to work closely with Laura Blankenship, RN, CMA-C (AAMA), and the other public policy leaders of the NSMA.

Arizona
At the request of Director of Accreditation Judy Jondahl, Mr. Balasa wrote to the Arizona Board of Medical Examiners and pointed out that its medical assisting regulations still make reference to the 2003 Standards for the Accreditation of Educational Programs in Medical Assisting, rather than to the 2008 Standards.

At the request of Arizona Society of Medical Assistants leader Darcy Atwood, CMA (AAMA), the Executive Director called the head of the Phoenix Job Corps and explained the difference between postsecondary medical assisting education accredited by CAAHEP, and Job Corps training programs.

Arkansas
After more than a decade of intense disagreement between the Arkansas Board of Medical Examiners and the Arkansas Board of Nursing, legislation was passed in 2009 that codified the fact that medical assistants are permitted to administer medication under a physician's direct supervision. In 2010 the Board of Medical Examiners promulgated regulations pursuant to the legislation. Regaining the right to be delegated injections is a significant victory for the medical assisting profession in Arkansas.

California
At the request of Cori Burns, CMA (AAMA), a California educator and a leader of the California Society of Medical Assistants, the Executive Director contacted a school that was stating on its website that medical assisting graduates who pass the test given by the California Certifying Board for Medical Assistants (a private sector body, despite its name) become Certified Medical Assistants. In response to Mr. Balasa's e-mail, the school quickly agreed to rectify this error.

New York
Mr. Balasa has helped the New York State Society of Medical Assistants (NYSSMA) as it makes steady progress in its efforts to regain the medical assistant's right to be delegated injections. Mr. Balasa has worked closely with the NYSSMA President Paula Guidozzoli, CMA (AAMA), and has been asked to write articles about the education and credentialing of CMAs (AAMA) for the Medical Society of the State of New York and the New York State Nurses Association. Ms. Guidozzoli continues to provide excellent leadership, establish important contacts, and seek the best ways to effect positive change for medical assistants in this important state.

Washington
Public policy leaders of the Washington State Society of Medical Assistants (WSSMA), including AAMA Trustee Patricia Hightower, CMA (AAMA), have forged a strong alliance with the Washington State Medical Association (WSMA), and are participating in a broad-based coalition of health and allied health groups that are seeking legislative changes that would clarify and protect the medical assistant's right to practice. Well-crafted legislation would also give the medical assisting profession legal authority, existence, and identity in this state. Mr. Balasa met with two leaders of the coalition during the AAMA Board of Trustees meeting in Seattle in early June. This meeting proved to be most productive.

Connecticut
Under the excellent leadership of Holly Martin, CMA (AAMA), the Connecticut Society of Medical Assistants has continued to make steady progress in regaining the right of medical assistants to be delegated administration of medication (including by injection). The Connecticut State Medical Society (CSMS) and some primary care specialty societies are supportive of a legislative expansion of medical assistants' scope of duties. Mr. Balasa has participated in conference calls with the Vice President of Public Policy and Government Affairs of CSMS, and a physician who is chairing a public policy committee of CSMS, and legislative leaders of specialty societies. The Executive Director has sent documents and articles to these individuals, and has offered to assist with the drafting of legislation. There is good reason for optimism about the right to practice goals of the Connecticut Society.

Nevada
The Nevada Society of Medical Assistants, under the excellent leadership of Carol Cohen, CMA (AAMA), garnered significant support from key state legislators in its efforts to solidify medical assistants' right to practice in the wake of the influenza vaccine debacle in the fall of 2009. Ms. Cohen and Mr. Balasa testified at a hearing and workshop of the Nevada Legislative Committee on Health Care held in Las Vegas. Mr. Balasa explained the medical assisting laws in other states, and was asked several questions by the committee members. A bill establishing the right of physicians to delegate intramuscular, intradermal, and subcutaneous injections (including immunizations/vaccinations) to medical assistants has been passed by both houses of the Nevada legislature, and is expected to be signed by the governor. Mr. Balasa had monitored legislative committee hearings on this bill via Internet and assisted Ms. Cohen in devising strategy and delivering testimony.

Michigan
The Executive Director was contacted by Rusty Dowling, CMA (AAMA), on behalf of the Michigan State Society of Medical Assistants. Concern was expressed that the Michigan Department of Labor and Economic Growth (DLEG) in one of its publications had classified medical assisting as a "high-growth occupation requiring at least moderate on-the-job training." Mr. Balasa pointed out that the United States Department of Labor (DOL) also classifies medical assisting in this manner, and forwarded to Ms. Dowling letters that he had written to the Department of Labor objecting to the fact that medical assisting is so classified, and is considered an "apprenticeable occupation" by the DOL. He suggested that Ms. Dowling inform the Michigan DLEG of the formal opposition of the AAMA to these classifications of medical assisting by the United States DOL, and he further suggested that the Michigan State Society also express its disagreement with this classification to the Michigan DLEG.

Because the legislative landscapes in Michigan and Washington are similar, two public policy leaders of the Michigan State Society joined Mr. Balasa in meeting with representatives of the Washington State legislative coalition during the AAMA Board of Trustees meeting in Seattle in early June.

Iowa and Wisconsin
As discussed above, some analysts are taking the position that the CMS Electronic Health Record Incentive Program regulations prohibit medical assistants from entering medication orders by computerized provider order entry (CPOE). The Executive Director has been receiving a lot of e-mails about this issue from CMAs (AAMA) and other health professionals in Iowa and Wisconsin. Trustee Julie Flaatten, RN, EMT-B, CMA (AAMA), of Wisconsin has provided Mr. Balasa information about the policy of Marshfield Clinic in Wisconsin on medical assistants entering medication orders by CPOE. Certifying Board member Diane VanderPloeg, CMA (AAMA), MS, of Iowa, who first brought this issue to the Executive Director's attention, has provided him recent information about CPOE policies in Iowa.