Question
Our multi-specialty not-for-profit clinic in Washington state sometimes uses medical assistants to perform tympanometry and air conduction hearing screening at out-lying clinic locations where there is no sound booth or audiologist. I don't think these procedures are being billed. Are there any legal issues to medical assistants performing these procedures? Thank you.
Answer
Here is the section of the Washington State SLP/Aud licensure law defining the various practitioners covered, which does not include medical assistants.
apps.leg.wa.gov/RCW/default.aspx?cite=18.35.010
Medical assistants scope of practice is defined under the Healthcare Assistant Law (see the link below). Medical Assistants fall under the Healthcare Assistant definition. The law states "A health care assistant must be supervised by a "delegator". The delegator may be a physician (MD or DO), a podiatrist, or an Advanced Registered Nurse Practitioner (ARNP) with prescriptive ability. The delegator must be physically present and immediately available during the administration of injections, but need not be present during withdrawal of blood. Only those licensees that can order a procedure may delegate the responsibility to the health care assistant."
There are six categories, or performance levels, for Healthcare Assistants that are outlined in the rules. Individuals may be certified in one or several categories on a single certification so that their scope of practice may be broad or more narrow (see below).
Category A - Performs venous and capillary invasive procedures for blood withdrawal.
Category B - Performs arterial invasive procedures for blood withdrawal.
Category C - Performs intradermal (including skin tests), subcutaneous, and intramuscular injections for diagnostic agents.
Category D - Performs intravenous injections for diagnostic agents.
Category E - Performs intramuscular, intradermal (including skin tests), and subcutaneous, injections for therapeutic agents.
Category F - Performs intravenous injections for therapeutic agents.
Category G - Performs hemodialysis.
wssma.org/medical-assisting/hca-law/
I would recommend contacting your Board of Speech and Hearing to share your concerns.
www.doh.wa.gov/hsqa/professions/Hearing_Speech/boardinfo.htm
Hope this helps!
Eileen K. Crowe is the Director for State Association Relations at ASHA. She is responsible for providing assistance and support on legislative, regulatory, and administrative issues to the Western region of state speech-language-hearing associations. She also oversees the State Education Advocacy Leader's network and serves as the ex-officio to ASHA's Joint Committee on State-National Association Relationships. Eileen has presented in numerous venues nationwide on advocacy and has developed an extensive array of materials to assist the professions in this area. Prior to joining ASHA, she spent four years with the Maryland General Assembly as a legislative analyst for the House Commerce and Government Matters Committee and under the Department of Legislative Services, Research Division. Eileen received her BA in political science and her master's degree in public administration from Louisiana State University.
Dr. Steven C. White has been an audiologist for over 40 years and at ASHA for 30years where he is the director of Health Care Economics and Advocacy. He can be contacted at swhite@asha.org.
Janet Deppe is the Director of State Advocacy in the Government Relations at ASHA. She coordinates the state advocacy team, liaisons with Midwestern states and assists with legislation, regulation and management issues. Janet represents ASHA at federal and state meetings and is the ex officio for ASHA's School Finance Committee